AIDS-related stigma and mental health professionals.

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Le refus scolaire anxieux est un phénomène complexe et multiforme qui peut avoir des conséquences graves au niveau familial, professionnel et sur le fonctionnement psychique de l’adolescent. La reconnaissance précoce est importante car le pronostic dépend en partie de la rapidité de l’intervention. Cependant, le refus scolaire anxieux est un objet encore mal défini, ce qui entrave sa prise en charge et la reconnaissance du phénomène par l’ensemble des partenaires. A ce jour, il n’existe pas d’outil commun aux différents professionnels pour aider au repérage précoce. L’objectif général de cette recherche était de créer et de valider un auto-questionnaire de repérage du refus scolaire anxieux au collège. Trois études ont été menées successivement en utilisant une approche intégrative et une méthodologie mixte (qualitative pour l’étude 1 et quantitative pour les études 2 et 3). L’étude 1 a été l’occasion, à l’aide d’entretiens (N = 42), de recenser et d’organiser les différentes manifestations du refus scolaire anxieux au collège de façon à pouvoir créer ensuite les items du questionnaire. L’analyse de contenu a mis en évidence un modèle de description du refus scolaire en quatre grands thèmes. L’étude 2 (N = 22) a permis d’élaborer la version pilote du questionnaire (SChool REfusal EvaluatioN ; SCREEN). Cette étude portait sur les étapes de création et de sélection des items et sur la création de la structure du questionnaire. L’étude 3 (N = 584) a porté sur la validation de la SCREEN auprès de collégiens et de patients et la mise en évidence de scores seuils pour le repérage du refus scolaire anxieux. Les analyses factorielles indiquent que la SCREEN est composée de 18 items repartis en 4 facteurs. Une analyse en courbe ROC et une standardisation des résultats ont déterminé des scores seuils. Les résultats indiquent de bonnes qualités psychométriques de la SCREEN (sensibilité de .88 et spécificité de .89 ; alpha de Cronbach de .84). Le modèle issu de l’étude 1, ainsi que le questionnaire, peuvent être utilisés dans les établissements scolaires comme dans les services de soins, à des fins de recherche ou dans le cadre d’une pratique clinique. La SCREEN peut contribuer à l’orientation plus rapide des adolescents, aider au développement des études empiriques sur le refus scolaire anxieux et favoriser le travail de partenariat entre les différents acteurs. / Anxiety-based school refusal is a complex, ill-defined phenomenon related to several dimensions social, family, school, psychological…). This anxious absenteeism is a clinical reality with consequences on the adolescent’s family and professional perspectives and on his/her psychological functioning. As the prognosis depends to a large extent on early clinical care, early diagnosis is crucial. While a specific assessment is required, there is still no common tool that school professionals and health care professionals may use.The goal of this research was the creation and the validation of a self-reported screening tool for assessing school refusal.Three studies were carried out successively using an integrative approach and qualitative method (Study 1) or a quantitative method (Studies 2 and 3). The first study, with interviews (N = 42), aimed at a conceptual and operational definition of this construct. The content analysis revealed a descriptive model of school refusal comprising four different themes. The second study (N = 22) concerned the creation of the pilot version of the questionnaire (SChool REfusal EvaluatioN; SCREEN): generation of items, selection of items and creation of the questionnaire. The last study (n = 584) involved the validation of the SCREEN with a community sample of teenagers and a clinical sample. Analyses revealed a 4-factor model structure with 18 items. ROC analyses and standardization revealed a cut-off for screening school refusal. Results suggested that the tool has good psychometric properties (sensitivity .88; specificity .89; Cronbach’s alpha .84).The SCREEN and the descriptive model of school refusal can be helpful both at school and in health care services, for research and clinical practice. The SCREEN is useful for early clinical care, empirical studies, and for developing partnerships between school educators and health care professionals.

Die Spezifischen Phobien stellen die häufigste Gruppe der Angststörungen dar. Die Angst vor dem Verschlucken bzw. dem Ersticken wurde jedoch nur sehr selten beschrieben. Bei der Behandlung der Spezifischen Phobien wird fast immer eine Konfrontation in vivo eingesetzt. Die Angst vor dem Verschlucken scheint aber eine der Spezifischen Phobien zu sein, bei der eine Konfrontation schwierig ist. Die hier vorgestellte Fallgeschichte schildert eine mögliche Vorgehensweise, die Ängste vor dem Verschlucken mit einer Reizkonfrontation in vivo zu behandeln. Dabei werden die verschiedenen Schwierigkeiten, die aufgetreten sind, und ihre Lösungen geschildert. Die Therapie wurde erfolgreich abgeschlossen, und auch die Ergebnisse der Nachuntersuchungen zeigten eine stabile Verbesserung. / Specific phobias are the most common anxiety disorders. However, the fear of swallowing the wrong way and choking has rarely been described. Specific phobias are usually treated using exposure therapy. The excessive fear of swallowing the wrong way does not seem to be very well suited for an exposure in vivo. In this case study, a patient afflicted with the fear of swallowing and choking was treated with flooding. The various difficulties encountered during treatment and their remedies will be described. The therapy was successful. The patient showed stable and lasting improvements at posttreatment and at one-year follow-up. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Background. The paper describes prevalence, impairments, patterns of co-morbidity and other correlates of DSM-IV social phobia in adolescents and young adults, separating generalized and non-generalized social phobics. Methods. Data are derived from the baseline investigation of the Early Developmental Stages of Psychopathology Study (EDSP), a prospective longitudinal community study of 3021 subjects, aged 14–24. Diagnoses were based on the DSM-IV algorithms of an expanded version of the Composite International Diagnostic Interview. Results. Lifetime prevalence of DSM-IV/CIDI social phobia was 9·5% in females and 4·9% in males, with about one-third being classified as generalized social phobics. Twelve-month prevalence was only slightly lower, indicating considerable persistence. Respondents with generalized social phobia reported an earlier age of onset, higher symptom persistence, more co-morbidity, more severe impairments, higher treatment rates and indicated more frequently a parental history of mental disorders than respondents with non-generalized social phobia. Conclusions. History of DSM-IV social phobia was found to be quite prevalent in 14–24 year-olds. The generalized subtype of social phobia was found to have different correlates and to be considerably more persistent, impairing and co-morbid than non-generalized social phobia. Although generalized social phobics are more likely than non-generalized social phobics to receive mental health treatments, the treatment rate in this sample was low despite the fact that mental health services are free in Germany.

Background. General population data were used to study co-morbidities between lifetime social phobia and mood disorders. Methods. Data come from the US National Comorbidity Survey (NCS). Results. Strong associations exist between lifetime social phobia and major depressive disorder (odds ratio 2·9), dysthymia (2·7) and bipolar disorder (5·9). Odds ratios increase in magnitude with number of social fears. Reported age of onset is earlier for social phobia than mood disorders in the vast majority of co-morbid cases. Temporally-primary social phobia predicts subsequent onset of mood disorders, with population attributable risk proportions of 10–15%. Social phobia is also associated with severity and persistence of co-morbid mood disorders. Conclusions. Social phobia is a commonly occurring, chronic and seriously impairing disorder that is seldom treated unless it occurs in conjunction with another co-morbid condition. The adverse consequences of social phobia include increased risk of onset, severity and course of subsequent mood disorders. Early outreach and treatment of primary social phobia might not only reduce the prevalence of this disorder itself, but also the subsequent onset of mood disorders.

Social phobia is a common disorder associated with significant psychosocial impairment, representing a substantial public health problem largely determined by the high prevalence, and the lifelong chronicity. Social phobia starts in early childhood or adolescence and is often comorbid with depression, other anxiety disorders, alcohol and substance abuse or eating disorders. This cascade of comorbidity, usually secondary to social phobia, increases the disability associated with the condition. The possibility that social phobia may be a trigger for later developing comorbid disorders directs attention to the need for early effective treatment as a preventive measure. The most recent drug class to be investigated for the psychopharmacological treatment of social phobia is the SSRI group for which there is growing support. The other drug classes that have been evaluated are monoamine oxidase inhibitors (MAOIs), benzodiazepines, and beta-blockers. The SSRIs represent a new and attractive therapeutic choice for patients with generalized social phobia. Recently the first, large scale, placebo-controlled study to assess the efficacy of drug treatment in generalized social phobia has been completed with paroxetine. Paroxetine was more effective in reducing the symptoms than placebo and was well tolerated. Many now regard SSRIs as the drugs of choice in social phobia because of their effectiveness and because they avoid the problems of treatment with benzodiazepines or classical MAOIs.

Syfte: Syftet med litteraturöversikten var att utifrån svenska forskningsresultat kartlägga bakomliggande faktorer till tandvårdsrädsla och undersöka vilken effekt kognitiv beteendeterapi (KBT) har på tillståndet. Metod: Sökningen efter svenska vetenskapliga artiklar har gjorts genom Dentistry of Oral Sciences, MEDLINE och CINAHL. Artiklar skrivna under de senaste tio åren har valts. Både kvalitativa och kvantitativa artiklar har använts, samt har kvalitetsgranskats utefter två mallar. Resultat: Underliggande faktorer för utveckling av tandvårdsrädsla inkluderar tidigare negativa tandvårdssituationer, tandvårdsrädsla i familjen, kön, ålder, temperament, allmän ångest och depression, låg socioekonomisk ställning, låg inkomst, rökning, oral smärta, utbildningsnivå och Hyperaktivitetssyndrom (ADHD). KBT-behandling har visat sig vara mycket effektiv när det gäller att behandla tandvårdsrädsla. Slutsats: Det har visats att tandvårdsrädsla utvecklas tidigt i livet och kan vidmakthållas. Det finns flertalet faktorer som bör ses över och om behandling sätts in i sig kan man potentiellt förbättra hälsan hos individen med tandvårdsrädsla. KBT har visat sig vara en mycket framgångsrik behandling för tandvårdsrädsla, då det har en bevisad långvarig effekt. / Aim: The aim of the literature review was to map underlying factors of the development of dental anxiety and investigate the effect cognitive behavioral therapy (CBT)has on the condition, based on Swedish research results. Method: This was a literature review over Swedish studies. The search for scientific articles has been done through the databases Dentistry of Oral Sciences, MEDLINE and CINAHL. Articles written for the past ten years were chosen. Both qualitative and quantitative articles have been used and reviewed with quality templates. Results: Factors for developing dental fear include previous negative dental experiences, dental fear within the family, gender, age, temperament, general anxiety, depression, low socioeconomic standard, low income, smoking, oral pain, education level and for people with attention deficit hyperactivity disorder (ADHD). CBT treatment has shown to be very effective in treating dental anxiety. Conclusion: It has been shown that dental fear develops early in life and can be perpetuated. There are a number of factors that should be considered, and if treatment is initiated the health of the individual with dental fear can potentially be improved. CBT has been proven to be a very successful treatment for dental care, as it has a long-lasting effect.

Ce travail, inscrit dans une perspective psychanalytique propose, au travers de la clinique singulière de l'alcoolisme, une réflexion métapsychologique à propos de l'addiction, à l'appui d'un référentiel freudien et lacanien. Dans une attention particulière portée au triptyque sur lequel est fondée la métapsychologie, l'alcoolisme se voit alors abordé du point de vue économique augmenté des points de vue topique et dynamique, ouvrant ainsi autant de perspectives clinique que psychopathologique. Départi de toute conception déficitaire ou carentielle, c'est dans sa dimension conflictuelle qu'est appréhendé l'alcoolisme, hors du seul sillon narcissique. Au moyen d'une méthodologie croisée alliant cas cliniques issus de psychothérapie et cas cliniques de recherche enrichis des épreuves projectives, c'est au regard du sexuel que se trouve interrogé le symptôme alcoolique, privilégiant ainsi les problématiques œdipienne et de castration. A l'appui des concepts de répétition et de compulsion de répétition, il est dans un premier temps proposé de comprendre l'addiction en tant que conduite compulsive, aux fins de mettre en exergue la dynamique psychique sous-jacente au comportement et ce faisant, ses ressorts inconscient et fantasmatique. Figure d'un temps erratique, c'est dans ses incidences temporelles que l'addiction est mise en lumière, dans un différentiel entre cliniques de l'alcoolisme et de la toxicomanie. Si toutes deux procèdent à une subversion de la temporalité, que de la suspendre au seul profit de l'instant en vue de s'affranchir de toute causalité psychique, chacune relève d'une économie pulsionnelle propre. Si la conduite toxicomaniaque se montre massivement placée sous l'égide de Thanatos, l'alcoolisme n'en connaîtrait que de ponctuelles expressions, la dimension mortifère à l'œuvre dans la conduite alcoolique étant susceptible d'être imputée à Éros, de son excès d'intrication. Poursuivant, l'objet d'addiction, l'alcool, est questionné quant à sa fonction au sein de l'économie psychique du sujet. Envisagée comme tentative de solution de la part du sujet face à la castration et ses écueils, la conduite alcoolique se voit mise en lumière dans sa dimension de ratage, nommément phobique. L'objet d'addiction, alors entendu comme objet d'attraction, se fait le témoin du ratage de la constitution d'un objet phobique, répulsif par définition ; de cet échec, c'est alors la portée structurante de la phobie vis-à-vis de la castration qui disparaît, autant que le nouage de l'angoisse qu'elle offre - l'abstinence pouvant à ce titre être envisagée comme relance phobique. C'est à l'endroit de la figure paternelle et de ses défaillances que se poursuit la réflexion et, de la mise au jour de l'organisation œdipienne singulière qui en résulte, s'augure l'hypothèse d'un « complexe du père mort » chez ces hommes en proie à une conduite alcoolique. Enfin, le symptôme alcoolique se fait le lieu d'un débat psychopathologique entre névrose hystérique, fonctionnement limite et perversion. C'est l'hypothèse de l'hystérie masculine qui se verra défendue, la névrose se voyant ainsi abordée dans la gravité qu'elle peut recouvrir. C'est notamment des considérations quant au féminin, dans son opposition au phallique - et non au masculin - et à ce titre présent dans les deux sexes, que se soutiendra cette proposition. La question de la perte, très agissante dans les problématiques addictives, relue à la faveur du féminin, aboutit à un changement de paradigme, le narcissisme se trouvant relégué au second plan. / This work, part of a psychoanalytic perspective offers, through the singular clinical alcoholism, a metapsychological thinking about addiction, in support of a Freudian and Lacanian points of view. In a particular attention to the triptych on which is founded metapsychology, alcohol will be addressed through an economic point of view, increased with topographical and dynamic points of view, opening many as clinical and psychopathological perspectives. Divested of any deficit or carentiel design is in its conflictual dimension that will be apprehended alcoholism outside the narcissistic single way. Using a cross methodology combining cases from clinical psychotherapy and research, enriched projective tests is that in terms of psychosexuality is found interrogated alcoholic symptoms, and favoring Oedipal issues and castration. In support of the concepts of repetition and compulsion to repeat, it will be initially offered to understand addiction as compulsive behavior, in order to highlight the psychological dynamics underlying the behavior and thereby its unconscious and fantasmatic motivations. Figure of an erratic time, it is in its temporal effects that addiction will be found highlighted in a clinical difference between alcoholism and drugaddiction. If both proceed to a subversion of temporality in suspending it, in favour of instant, in order to overcome any psychical causality, each has is own instinctual economy. If drugaddiction shows heavily under the aegis of Thanatos, alcoholism would know only occasional expressions of the death instinct; mostly morbid dimension in alcoholaddiction may be attributed to Eros, because of its excessive fusion. Continuing, the object of addiction, alcohol, will be questioned as to its function within the psychic economy of the subject. Considered as attempted solution from the subject facing castration and its pitfalls, alcoholic behavior will be highlighted in its dimension of misfires, namely phobic. The object of addiction, then heard as an object of attraction, would witness misfires of the establishment of a phobic object, repulsive by definition. Through this failure, the structuring significance of phobia regarding castration disappears, as far as the knotting anxiety it offers - abstinence as such can be considered as phobic relaunch . This reflection will continue regarding the father figure and its failures and by means of the discovery of the singular oedipal organization that results, will herald the hypothesis of a "dead father complex" in these alcoholic's men. Finally, the alcoholic symptom will be the site of a psychopathological debate between hysterical neurosis, perversion and borderline. This is the hypothesis of male hysteria that will be defended, neurosis addressed in seeing the seriousness it can cover. This is particularly the considerations about the feminine, in its opposition to the phallic and not to masculine - and for that reason, present in both sexes, that will support this proposal, to authorize a re-reading of the issue of loss, very active in addictive problems, in a paradigm shift, narcissism being upstaged.

Objective. To examine the natural course of social anxiety disorder (SAD) in the community and to explore predictors for adverse long-term outcomes. Method. A community sample of N=3,021 subjects aged 14-24 was followed-up over 10 years using the DSM-IV/M-CIDI. Persistence of SAD is based on a composite score reflecting the proportion of years affected since onset. Diagnostic stability is the proportion of SAD subjects still affected at follow-up. Results. SAD reveals considerable persistence with more than half of the years observed since onset spent with symptoms. 56.7% of SAD cases revealed stability with at least symptomatic expressions at follow-up; 15.5% met SAD threshold criteria again. 15.1% were completely remitted (no SAD symptoms and no other mental disorders during follow-up). Several clinical features (early onset, generalized subtype, more anxiety cognitions, severe avoidance and impairment, co-occurring panic) and vulnerability characteristics (parental SAD and depression, behavioural inhibition, harm avoidance) predicted higher SAD persistence and -less impressively- diagnostic stability. Conclusion. A persistent course with a considerable degree of fluctuations in symptom severity is characteristic for SAD. Both, consistently meeting full threshold diagnostic criteria and complete remissions are rare. Vulnerability and clinical severity indicators predict poor prognosis and might be helpful markers for intervention needs.