Postpartum post-traumatic stress disorder (PTSD) symptoms are a significant mental health concern. Although obstetric complications are often considered central, growing evidence suggests that women’s emotional and subjective responses to childbirth may play a more decisive role in the development of trauma-related symptoms. To estimate the prevalence of postpartum PTSD symptoms one month after childbirth and to identify the most relevant obstetric, psychological, and psychosocial risk factors, with a particular focus on emotional and dissociative responses. A prospective observational study was conducted in a high risk maternity hospital between 2021 and 2024. Women completed validated self-report questionnaires one month postpartum, including the PTSD Checklist for DSM-IV (PCL-S), the Peritraumatic Dissociative Experiences Questionnaire (PDEQ), the Peritraumatic Distress Inventory (PDI), and the Edinburgh Postnatal Depression Scale (EPDS). Clinically significant PTSD symptoms were defined by a PCL-S score ≥ 26. Multivariate logistic regression analyses were performed to identify independent predictors. Among 1,451 women included, 11.8

Evaluating skills requires developing relevant grading tools that could potentially be used for self-assessments. The goal of our study was to assess the relevance of a self-assessment (SA) grid used for a skin suture exercise as compared to an evaluation carried out at the same time by an expert, while also identifying any factors likely to influence it. Between 2018 and 2022, an assessment grid for a skin suture exercise was used during skills assessment sessions with first-year trainee surgeons. The students were given a self-assessment grid to fill out at the same time. The results of the SA and the expert evaluation (EE) in this grid were analyzed and compared, then set against the anxiety scores of the trainees based on the STAI Y-A. A comparative analysis of trainees with a tendency to over- or underestimate themselves was carried out to identify the factors that could contribute to them misjudging their skills. The data for 70 trainee doctors was analyzed. The mean of the difference in score between the SA and the EE was 2 points lower for SA than EE (p < 0.001). The mean score for the STAI Y-A was 36.2 (± 8.9) and the learner’s anxiety had no effect on the EE but did affect the SA. When learners showed low self-confidence, they underestimated themselves, but examiners also had a tendency to give them lower grades. In multivariate analysis, the less experience a learner had, the more they tended to overestimate their abilities. Anxiety and self-confidence affect self-assessment, but external assessment does not seem to be affected by the learner’s stress levels. Formative self-reflection based on the use of SA grids should be introduced during medical studies so as to adjust the level of technical skill perceived by trainees and to make simulation-based training more effective.

Les troubles du comportement alimentaires sont des troubles psychiatriques invalidants, apparaissant le plus souvent à l’adolescence et impactant directement le développement de l’adolescent ainsi que son état de santé ultérieur. Ces troubles sont intriqués dans des facteurs étiologiques multifactoriels, à la fois génétiques, psychologiques et socioculturels, qu’il faut prendre en compte dans leur globalité. Ces troubles fréquents sont responsables de nombreuses complications médicales nécessitant une prise en charge pluridisciplinaire sur les plans pédiatrique, pédopsychiatrique et psychothérapeutique. Le soin doit être parfaitement coordonné entre ces différentes spécialités afin d’être le plus adapté et individualisé possible. Il doit prendre en compte l’aspect pondéral selon les caractéristiques individuelles du patient et les ressources familiales. La prise en charge des troubles du comportement alimentaire est souvent durable, car ces troubles se chronicisent volontiers. Ce chapitre permet d’identifier les diagnostics principaux intégrés dans les troubles du comportement alimentaire, à savoir l’anorexie mentale, la boulimie et l’hyperphagie boulimique, ou binge eating disorder, tels que décrits par le Diagnostic and Statistical Manual of Mental Disorder 5 (DSM-5). Ensuite sont détaillées les comorbidités médicales, dont psychiatriques, liées à ces troubles, leur épidémiologie, leur trajectoire évolutive, leurs facteurs étiopathogéniques et enfin leur prise en charge pluridisciplinaire.

Background: In recent years, there has been a wide array of research studies published on parental mental health and stress following very preterm birth. This review aims at reviewing the prevalence and risk factors of longterm parental depression, anxiety, post-traumatic stress symptoms and parenting stress following very preterm birth. Methods: We searched PubMed, PsychINFO and Web of Science for descriptive, cross-sectional and longitudinal studies published between January 2013 and August 2022. Results: 45 studies met our inclusion criteria. In the first two years, depression, anxiety, post-traumatic stress symptoms and parenting stress were present in similar to 20 % of mothers of extreme and very low birth weight (E/ VLBW) infants. Long-term psychological distress symptoms could be observed, although few studies have focused on symptoms into school age and longer. Fathers of VLBW infants might experience more psychological distress as well, however, they were only included in ten studies. We found that parental distress is more common when the co-parent is struggling with mental health symptoms. Many risk factors were identified such as social risk, history of mental illness, interpersonal factors (i.e. social support) and child-related factors (i.e. intraventricular hemorrhage, disability, use of medical equipment at home). Limitations: Several studies have methodological issues, such as a lack of control of known confounders and there is a large variety of measures employed. Conclusion: Important risk factors for stress and mental health symptoms were identified. More evidence is needed to determine if long-term symptoms persist into school age. Research should focus on taking a familybased approach in order to identify preventive strategies and resilience factors in parents of VLBW infants.

Background Previous studies have shown a negative impact of the COVID-19 pandemic and its associated sanitary measures on mental health, especially among adolescents and young adults. Such a context may raise many concerns about the COVID-19 pandemic long-term psychological effects. An analysis of administrative databases could be an alternative and complementary approach to medical interview-based epidemiological surveys to monitor the mental health of the population. We conducted a nationwide study to describe the consumption of anxiolytics, antidepressants and hypnotics during the first year of the COVID-19 pandemic, compared to the five previous years. Methods A historic cohort study was conducted by extracting and analysing data from the French health insurance database between 1 January 2015 and 28 February 2021. Individuals were classified into five age-based classes. Linear regression models were performed to assess the impact of the COVID-19 pandemic period on the number of drug consumers, in introducing an interaction term between time and COVID-19 period. Results Since March 2020, in all five age groups and all three drug categories studied, the number of patients reimbursed weekly has increased compared to the period from January 2015 to February 2020. The youngest the patients, the more pronounced the magnitude. Conclusions Monitoring the consumption of psychiatric medications could be of great interest as reliable indicators are essential for planning public health strategies. A post-crisis policy including reliable monitoring of mental health must be anticipated.

Los trastornos de la conducta alimentaria son trastornos psiquiátricos incapacitantes, que aparecen con mayor frecuencia durante la adolescencia y tienen un impacto directo en el desarrollo del adolescente y en su posterior estado de salud. Estos trastornos se entrelazan con factores etiológicos multifactoriales, tanto genéticos como psicológicos y socioculturales, que deben tenerse en cuenta en su totalidad. Estos trastornos frecuentes son responsables de numerosas complicaciones médicas que requieren una atención multidisciplinaria pediátrica, psiquiátrica infantojuvenil y psicoterapéutica. La atención debe estar perfectamente coordinada entre estas distintas especialidades para que sea lo más adecuada y personalizada posible. Debe tener en cuenta el aspecto ponderal según las características personales del paciente y los recursos familiares. Los trastornos de la conducta alimentaria suelen requerir tratamiento a largo plazo, ya que tienden a cronificarse. En este artículo se identifican los principales diagnósticos incluidos en los trastornos de la conducta alimentaria, a saber, la anorexia nerviosa, la bulimia y la hiperfagia bulímica, tal como se describen en la quinta edición del Manual diagnóstico y estadístico de los trastornos mentales (DSM-5). Después se detallan las comorbilidades médicas, incluidas las psiquiátricas, asociadas a estos trastornos, su epidemiología, su trayectoria evolutiva, sus factores etiopatogénicos y, por último, su tratamiento multidisciplinario.

AbstarctPurposeAnorexia Nervosa (AN) is a severe chronic disorder and parents' experience of caregiving is usually marked by emotional distress and burden. Severe chronic psychiatric disorders are known to be linked with the concept of grief. Grief has not been investigated in AN. The aim of this study was to explore parents' and adolescents' characteristics that may be related to parental burden and grief in AN, and the link between these two dimensions.MethodsEighty mothers, 55 fathers and their adolescents (N = 84) hospitalized for AN participated in this study. Evaluations of clinical characteristics of the adolescent's illness were completed, as well as self-evaluations of adolescent and parental emotional distress (anxiety, depression, alexithymia). Levels of parental burden were evaluated with the Experience of Caregiving Inventory and levels of parental grief with the Mental Illness Version of the Texas Revised Inventory of Grief.ResultsMain findings indicated that the burden was higher in parents of adolescents with a more severe AN; fathers' burden was also significantly and positively related to their own level of anxiety. Parental grief was higher when adolescents' clinical state was more severe. Paternal grief was related to higher anxiety and depression, while maternal grief was correlated to higher alexithymia and depression. Paternal burden was explained by the father's anxiety and grief, maternal burden by the mother's grief and her child's clinical state.ConclusionParents of adolescents suffering from AN showed high levels of burden, emotional distress and grief. These inter-related experiences should be specific targets for intervention aimed at supporting parents. Our results support the extensive literature on the need to assist fathers and mothers in their caregiving role. This in turn may improve both their mental health and their abilities as caregivers of their suffering child.

The number of studies on post-traumatic stress disorder after hospitalization in a pediatric intensive care unit raised since 2004. The objective of this systematic review was to summarize and critically examine the literature about risk factors for these children to develop post-traumatic stress disorder following admission to an intensive care unit. The data sources were PubMed, Cochrane, Web of Science, PsycInfo, SUDOC, Scopus, and ScienceDirect. Studies were selected if they were in English or French and published between 01/01/2004 and 31/01/2022. Studies were excluded if patients were less than 1 month old and if no post-traumatic stress disorder was found. The internal validity and risk of bias were assessed using the National Institutes of Health Study Quality Assessment Tools for observational studies and the Ottawa Scale was used for the interventional study. The search yielded 523 results and 22 articles met inclusion criteria. Three common risk factors were identified from the data: parental post-traumatic stress disorder (especially in mothers), severity of illness and delusional memories. Internalizing behavior in children, acute parent and child stress, emergency admission and sepsis are also potential risk factors that require further investigation. The prevalence of this pathology is substantial (between 14 and 36%) and increasing awareness among pediatricians and psychologists seems necessary. Prevention programs are being studied to reduce the incidence of post-traumatic stress disorder in this population. Child and adolescent psychiatry liaison should collaborate with pediatric teams to support this objective.

Background: Childhood obesity is associated with many comorbidities. Bariatric surgery is known to be efficient for reducing weight in adolescents. Objectives: The primary outcome was to identify somatic or psychosocial factors associated with success at 24 months after a laparoscopic adjustable gastric banding (LAGB) procedure in our cohort of adolescents with severe obesity. Secondary endpoints were to describe weight loss outcomes, comorbidity resolution, and complications. Methods: We have retrospectively reviewed medical records of patients who had LAGB placed between 2007 and 2017. Factors associated with success at 24 months after LAGB were researched, with success being defined as positive percentage of excess weight loss (%EWL) at 24 months. Results: Forty-two adolescents underwent a LAGB procedure, the mean %EWL was 34.1% at 24 months, with improvement in most comorbidities and without major complications. Having lost weight before surgery was associated with success, whereas a high body mass index at surgery was associated with a higher risk of failure. No other factor was found to be associated with success. Conclusion: Comorbidities mostly improved 24 months after LAGB and no major complication occurred. Having lost weight before surgery was associated with a successful surgery, whereas a high body mass index at surgery increases the risk of failure.

La doxycycline est un antibiotique régulièrement utilisé par les dermatologues pour ses propriétés anti-inflammatoires. Dans l'acné, il s'agit d'un traitement de seconde intention en cas d'échec des traitements topiques ou de première intention en cas d'acné inflammatoire étendue. L'hypertension intracrânienne est un effet secondaire connu et décrit notamment en cas d'association aux rétinoïdes per os. En revanche, sur le plan neuropsychiatrique, le résumé des caractéristiques du produit ne fait pas mention d'autres effets indésirables. Nous rapportons le cas d'une patiente ayant fait une tentative de suicide après l'introduction de la doxycycline prescrite dans le cadre d'une acné. Une fille de 16 ans sans antécédents personnels et n'ayant comme seul traitement la doxycycline depuis 1 mois pour une acné, était amenée aux urgences pour tentative de suicide après ingestion d'alcool et de 32 grammes de paracétamol. Elle a eu un protocole N-acétylcystéine et une surveillance en soins intensifs. Le bilan somatique, la biologie de routine et l'imagerie cérébrale étaient normaux. Un transfert était organisé en unité de psychiatrique d'accueil et d'orientation. L'anamnèse trouvait des hallucinations acoustico-verbales depuis un an avec des « voix de clown », puis visuelles de manière plus récente. Des idées suicidaires scénarisées étaient présentes depuis quelques mois, en lien avec les voix entendues tenant des propos dévalorisants. Il existait une vulnérabilité familiale avec une mère suivie pour un trouble bipolaire et un frère présentant un abus de substance. Le diagnostic de décompensation psychotique imputable à la doxycycline était retenu. Un traitement par loxapine et rispéridone était introduit permettant une disparition des idées suicidaires et un bon contrôle des hallucinations ; le traitement anti-acnéique était arrêté. La patiente regagnait son domicile après 4 jours d'hospitalisation avec un suivi externe. Nous avons émis l'hypothèse d'une décompensation psychotique imputable à la doxycycline. Les troubles psychotiques et bipolaires sont des affections psychiatriques chroniques dont la prévalence en population générale est comprise entre 0,5 et 2 % pour les troubles psychotiques et entre 1 et 5 % pour le trouble bipolaire. Elles se caractérisent, pour les troubles psychotiques, par des hallucinations, des idées délirantes et, pour la bipolarité, par l'alternance de phases maniaques ou hypomaniaques et de phases dépressives. Des facteurs de risque intrinsèques et extrinsèques contribuent au développement de ces affections. Parmi eux, la microglie, population de cellules du système nerveux central et participant au système immunitaire, semble jouer un rôle important. Une étude suédoise sur une large cohorte montre une majoration du risque de trouble bipolaire, notamment lorsque la dose cumulée de doxycycline dépasse 3000 mg. Cependant, plusieurs études rapportent un effet protecteur du traitement, par action suppressive sur la microglie, surtout s'il est administré durant l'adolescence. Le dermatologue doit garder en tête l'impact de la doxycycline sur le système nerveux central et la santé mentale en général, rester vigilant lors de sa prescription comme pour l'isotrétinoïne, repérer les signes annonciateurs d'une décompensation psychotique et savoir alerter la pharmacovigilance.

BACKGROUND:In child and adolescent psychiatry, many patients are placed in welfare institutions or foster care.OBJECTIVE:It is important to study their progress in the long term and to examine the psychological and social care arrangements as well as their impacts.POPULATION AND METHODS:This qualitative study designed to identify potential prognostic factors relating to the outcome of children placed in a welfare center or foster care before the age of 4 years was based on the analysis of 34 case histories of children placed in a welfare center or foster care in Angers. These records involved 129 cases collected for the "Saint Ex" study, a quantitative case study conducted from 1994 to 2001 designed to assess the outcome of children placed in a welfare center or foster care in Angers before the age of 4. The population sampling was purposive and was based on eight subgroups defined by three clinical criteria: Parent-Infant Relationship Global Scale assessment (PIR-GAS) at T1 (admission into welfare center or foster care), the status of a "infant at risk" at T1, and GAF (Global Assessment of Functioning) at T2 (exit from the welfare center or foster care).RESULTS:The study population included 11 girls and 23 boys. Factors contributing to adverse progression included problems with interactions at a very early age, failure to listen or respond to a child's request regarding his or her placement, long delays between establishing facts and implementing social measures, discontinuity and/or inconsistency regarding the placement arrangements, and sexual abuse. On the other hand, factors contributing to positive progress included the diagnosis and adapted treatment of a mental disorder in the case of one or both parents, early placement in a foster family, considering the child's requests regarding the placement, responsiveness of social services, and psychological or psychiatric follow-up.CONCLUSION:The analysis of these 34 cases sheds light on several prognostic elements, with the combination of all these factors as the background. Care based on prevention seems essential to protect early interactions and shorten the time that children are exposed to danger.

Background:Mitochondrial disorders (MD) are metabolic diseases related to genetic mutations in mitochondrial DNA and nuclear DNA that cause dysfunction of the mitochondrial respiratory chain. Cognitive impairment and psychiatric symptoms are frequently associated with MD in the adult population. The aim of this study is to describe the neuropsychological profile in children and adolescents with MD.Methods:We prospectively recruited a sample of 12 children and adolescents between February 2019 and February 2020 in the Reference Center for Mitochondrial Disorders of Angers (France). Participants and their parents completed an anamnestic form describing socio-demographic data and completed the WISC-V (Wechsler Intelligence Scale for Children, 5th edition) and the Parent and Teacher forms of the BRIEF (Behavior Rating Inventory of Executive Function).Results:In our sample, the mean IQ (Intellectual Quotient) score was 87.3 ± 25.3. The score ranged from 52 to 120. Concerning executive functions, a significant global clinical complaint was found for parents (six times more than normal) and to a lesser extent, for teachers (among 3 to 4 times more). Levels of intelligence and executive functioning were globally linked in our cohort but dissociation remains a possibility.Conclusion:The results of this study show that MD can be associated to neuropsychological disorders in children and adolescents, especially regarding the intelligence quotient and the executive function. Our study also highlights the need for regular neuropsychological assessments in individuals with MD and developing brains, such as children and adolescents.

Suicide is the leading cause of maternal mortality in high-resource countries. The onset of suicidal ideation is a major risk factor for suicide attempts. Suicidality has a major impact on the mother-baby relationship and on child development. The main objective of the study was to identify factors associated with the occurrence of perinatal suicidal ideation in women requiring hospitalization. The secondary objectives of the study were to describe the socio-demographic and clinical characteristics of this specific population, to specify the follow-up procedures at hospital discharge and to develop a semi-directed interview framework for psychiatric evaluation of perinatal patients admitted to a psychiatric hospital in order to better identify those at risk of suicide and improve overall management, particularly in terms of referral to existing perinatal care services.Descriptive and retrospective study carried out at the Specialized Hospital Center of women hospitalized in the perinatal period between 2014 and 2019. The inclusion criteria were: inpatient pregnant or postpartum within one year of delivery, 16 to 43 years. A keyword search was performed to retrieve the computerized records. All records matching the inclusion criteria were included. We studied the occurrence of suicidal ideation according to the main known clinical and socio-demographic risk factors.The sample included 25 pregnant patients and 57 post-partum patients. The presence of a psychiatric history increased the risk of suicidal ideation by 4.38 (P<0.03). The association between the occurrence of a stressful life event and the risk of suicidal ideation onset was close to significant (P<0.10). One third of the patients had been admitted for a reason related to suicidality. Less than one-third of the patients had been referred to existing perinatal services.Suicidality in the perinatal period has a major impact on the dyad as well as on the whole family. The search for suicidal ideas must be systematic during psychiatric interviews, a fortiori when a psychiatric history has been authenticated. Every patient hospitalized in adult psychiatry should be referred to specialized outpatient perinatal psychiatry services. Prevention involves raising awareness and training of all health professionals, networking, but also informing the general public.

Context and purpose Prematurity is a situation that can disrupt parent-child interactions. We hypothesize that establishing relationships with parents in a context of extreme prematurity can alter the development of secure attachment representations in the child. Furthermore, we hypothesize that secure maternal representations and their possible interactions with prematurity factors prevent the development of insecure or disorganized attachment in the child. In addition, maternal representations and their possible interactions with factors related to prematurity may prevent or accentuate the development of an insecure or disorganized attachment in the child. Methods and analysis This is a longitudinal, prospective, exploratory, and bi-centric study. Children born in the neonatal intensive care units of Angers or Nantes University Hospitals with a gestational age of up to 28 weeks will be included in the study. The main objective is to describe the attachment representations at 3 and 5 years through the Attachment Story Completion Task scales and to analyze them in regard to the children’s neurocognitive and behavioral outcomes as well as maternal attachment and mental health. Ethics The study file received a favorable opinion for the implementation of this research on February 18, 2020 - ID-RCB no. 2019-A03352-55 (File 2-20-007 id6699) 2°HPS. This study has received authorization from the French Data Protection Authority (CNIL) under no. 920229. Discussion A better understanding of attachment representations in extreme prematurity and their possible associations with children’s neurocognitive and behavioral outcomes as well as maternal attachment and mental health could pave the way for individualized care at an early stage, or even interventions during the neonatal period to improve the outcome of these vulnerable newborns. Trial registration [ClinicalTrials.gov], identifier [NCT04304846].

Late-term fetal demise including fetal death in utero, late miscarriage and late termination of pregnancy are relatively frequent occurrences. Post-traumatic stress disorder (PTSD) is a pathology that finds its roots in exposure to a life-threatening event or an event related to death. Exposure to fetal death during a late-term fetal demise is, therefore, a situation at risk of trauma. The objective of this study was to assess the prevalence of PTSD symptoms in the short term among patients faced with late fetal demise, and to identify potential risk factors. All women were assessed at 15 days, one month, and three months after late fetal demise using the Impact of Event Scale-Revised (IES-R) and the Peritraumatic Dissociative Experiences Questionnaire (PDEQ). At 15 days, 44.2% of patients presented a pathological score on the IES-R (≥ 33). At one month and three months, this figure was 34.1% and 9.1% respectively. Factor associated with PTSD symptoms were: peritraumatic dissociation (p = 0.014), seeing the fetus during hospitalization (p = 0.035), holding the fetus in one’s arms (p = 0.046), and the organization of a funeral service (p = 0.025). Patients experiencing late fetal demise are at significant risk of trauma. Care providers should remain vigilant to identify high-risk situations to offer appropriate care. Clinical trials registration number: NCT03433989.

Objectives. - In France, the family and friends of a patient with a psychiatric disorder can legally be involved in the decision to involuntary admission to psychiatry through care at the request of a third party. This involvement has been questioned in recent years, notably to protect this third party. The main objective of this work was to assess whether providing the third party with information on care without consent when providing care at the request of a third party (SDT) had an impact on the third party's experience. The secondary objectives were to identify other factors that might impact the third party's experience of the SDT, and to assess the impact of the SDT on the relationship between the third party and his or her hospitalized relative, as well as the factors that might influence it. Methods. - The study was based on a questionnaire, constructed after meeting several members of an association of relatives of patients with psychiatric disorders : UNAFAM. This questionnaire questioned the context of hospitalization, the information provided concerning care without consent, the experience of the third party at the time of hospitalization and at a distance, and the impact of hospitalization on the relationship between the third party and his or her hospitalized relative, both at the time of hospitalization and at a distance. This questionnaire was then sent to UNAFAM members in three randomly selected regions. It was specified that it was only intended for people who had already been a third party during SDT. The results were received anonymously.Results. - Among the 166 respondents, 85 (51.2 %) had received information about involuntary admission, and there was more frequent relief at the time of hospitalization (P < 0.01) and at a distance (P < 0.01), and less frequent feelings of violence towards their loved one at a distance from hospitalization (P = 0.02) compared to those who had not received information. The negative impact of hospitalization on the relationship between the third party and their hospitalized relative was lower (P = 0.04) among third parties who received information. The fact that the doctor was perceived as being mainly responsible for the decision to hospitalize also preserved the third party's experience and relationship with his or her relative. However, third parties who understood their involvement as an administrative necessity reported less frequent relief (P = 0.01), and the negative impact of hospitalization on their relationship with their relative was higher (P = 0.01). Conversely, the fact that they felt integrated into the care and listened to by the health care team was correlated with a better experience of the situation by the third party, and a lesser negative impact of hospitalization on the relationship between the third party and their relative.Conclusions. - Providing information to the third party about involuntary admission at the time of an SDT could improve his or her experience of the situation and limit the negative impact of hospitalization on his or her relationship with his or her loved one. Although it seems important for the third party to feel that the majority of the decision to hospitalize is made by the physician, including him/her in this decision could improve his/her experience of the situation and limit the negative impact of hospitalization on the relationship between the third party and his/her family member.(c) 2021 L'Encephale, Paris.

Objectives:To evaluate the impact of a bootcamp for new residents in surgery, in terms of both knowledge and skills improvement and psychological support. Design:Prospective inclusion of all the 59 new residents in surgery from 2018 to 2020. Analysis of their perception of the training and comparison of the bootcamp and control groups (n = 9, including the residents who could not attend the bootcamp) with respect to the results of their skills evaluations and surgical knowledge. Setting:A two-day bootcamp is organized every year in October since 2013 at the All'Sims simulation center (University Hospital, Angers, France) just before the beginning of the internship. A subsequent skills evaluation takes place partly in the operating room and partly as an objective structured clinical examination (OSCE). Participants:New residents from the different surgical specialties and gynecology, after having given their written consent. Results:Among the 50 residents who attended the bootcamp, knowledge in surgical skills improved by 10% (p<0.001). The median skills score on each OSCE station was at least one point higher in the bootcamp group than in the control group, predominantly in the suturing task (13.9+/-3.0 vs 11.5 +/- 1.6, p = 0.03). The reported usefulness level of the different surgical skills training when evaluated in consideration of daily practice varied from 50% to 95%. Feelings of ease and competency were quite well correlated with the reported usefulness of a given skill, especially since the task was a more generic one. Conclusion:Preparatory courses are of great interest for all surgical specialties as they improve procedural skills and knowledge as well as self-confidence during the first weeks of a resident's internship. As medical training continues to vary significantly between the different universities, such surgical curricula should be developed at a national level to standardize the surgical level of all new residents.

Objectives. - Suicide is the leading cause of maternal mortality in high-resource countries. The onset of suicidal ideation is a major risk factor for suicide attempts. Suicidality has a major impact on the mother-baby relationship and on child development. The main objective of the study was to identify factors associated with the occurrence of perinatal suicidal ideation in women requiring hospitalization. The secondary objectives of the study were to describe the socio-demographic and clinical characteristics of this specific population, to specify the follow-up procedures at hospital discharge and to develop a semi-directed interview framework for psychiatric evaluation of perinatal patients admitted to a psychiatric hospital in order to better identify those at risk of suicide and improve overall management, particularly in terms of referral to existing perinatal care services. Methods. - Descriptive and retrospective study carried out at the Specialized Hospital Center of women hospitalized in the perinatal period between 2014 and 2019. The inclusion criteria were: inpatient pregnant or postpartum within one year of delivery, 16 to 43 years. A keyword search was performed to retrieve the computerized records. All records matching the inclusion criteria were included. We studied the occurrence of suicidal ideation according to the main known clinical and socio-demographic risk factors. Results. - The sample included 25 pregnant patients and 57 post-partum patients. The presence of a psychiatric history increased the risk of suicidal ideation by 4.38 (P< 0.03). The association between the occurrence of a stressful life event and the risk of suicidal ideation onset was close to significant (P< 0.10). One third of the patients had been admitted for a reason related to suicidality. Less than one-third of the patients had been referred to existing perinatal services. Conclusions. - Suicidality in the perinatal period has a major impact on the dyad as well as on the whole family. The search for suicidal ideas must be systematic during psychiatric interviews, a fortiori when a psychiatric history has been authenticated. Every patient hospitalized in adult psychiatry should be referred to specialized outpatient perinatal psychiatry services. Prevention involves raising awareness and training of all health professionals, networking, but also informing the general public. (C) 2021 L'Encephale, Paris.

Fetal medicine practices, enable screening in utero fetal anomalies. These diagnoses involve a real break through maternal psyche and maternal emotions are therefore intense. The discovery of a fetal abnormality sets off a process in which the woman will be taken care of within the Multidisciplinary Center of Prenatal Diagnosis (MCPD) and the woman will be able, if she wishes so, to consider a Termination of Pregnancy (TOP), depending on the particular seriousness of the fetal pathology, upon approval of MCPD. However, how can she properly make such an important decision in such an emotional turmoil, caused by the fetal anomaly discovery? How can she mobilize her emotions, especially the negative ones, within the transgressive process of having recourse to TOP? First of all, it is highly necessary to build a context for our study with theoretical inputs on fetal medicine, psychological singularity of pregnancy and on the emotions triggered when announcing a fetal malformation. Second of all, a study compiling maternal testimonies have been driven in order to have a better understanding of the emotional process. The purpose of this study is to analyze the role of emotions in the TOP decision-making process. To finish with, a discussion regarding the results of this study will focus on how emotions are necessary in the decision-making process and need to be enhanced by the MCPD teams in order to make them more rational and thus help women. (C) 2021 Elsevier Masson SAS. All rights reserved.