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Résumé But de l’étude À partir de huit situations cliniques de troubles du comportement alimentaire en Chine, pays vivant de nombreuses mutations, nous interrogeons l’impact des changements sociétaux rapides sur ces troubles. Méthode et population Nous présentons toutes les patientes hospitalisées pour un trouble du comportement alimentaire lors du stage d’un médecin français au centre de santé mentale de Shanghai, de décembre 2015 à janvier 2016. Une analyse thématique qualitative a été réalisée et les résultats ont été interprétés avec la méthode complémentariste, c’est-à-dire en utilisant une lecture psychiatrique et anthropologique. Résultats Six thèmes et deux mécanismes principaux ont été identifiés et semblent en lien avec le développement des troubles du comportement alimentaire en Chine : l’impact des changements socioculturels et le conflit identitaire culturel. Discussion Les changements sociétaux rapides auraient pour conséquences une acculturation avec l’adoption de l’idéal de minceur occidental, un changement du rôle des femmes, une pression scolaire, des difficultés relationnelles, ce qui pourrait vulnérabiliser au développement des troubles du comportement alimentaire en Chine. Les différences intergénérationnelles entre les parents et les enfants en Chine ont pour conséquence un conflit identitaire culturel qui pourrait fragiliser la construction identitaire, induirait des difficultés d’autonomisation et des difficultés familiales qui sont des facteurs de risques de développer un trouble du comportement alimentaire. La thérapie familiale adaptée aux Chinois semble pertinente ainsi qu’un soutien à la parentalité. Conclusion La connaissance des troubles du comportement alimentaire dans divers contextes culturels et l’approche transculturelle permettent de mieux comprendre ces troubles, d’améliorer l’approche thérapeutique et l’alliance. Background Eating disorders were long considered as a culture-bound syndrome specific to western countries. However, studies reported results for anorexia in other cultural areas such as China, where its prevalence and incidence is rising. This suggests that anorexia is rather a culture-change syndrome arising during fast sociocultural changes. Adaptation to those changes may contribute to the increasing prevalence of eating disorders. Furthermore, transcultural psychiatrists consider that acculturation and culture clash (conflict between different cultural models) are risk factors for developing eating disorders; but they are less transcultural studies about bulimia. Clinical cases of eating disorders studied around the world showed a great variability in symptoms and psychopathology. Therefore, the role of cultural played and transcultural factors in the increase in eating disorders needs to be defined. Method and population Based on a qualitative study of eight clinical cases of eating disorders in China, a country and a society undergoing and experiencing a lot of fast sociocultural changes, our work aims to show the impact of cultural and transcultural factors on eating disorders, and takes into account the psychopathology and the symptomatology. Patients were hospitalized in Shanghai Mental Health Center and observed during the internship of a French resident in psychiatry. Results Cultural factors accounted for the symptomatology differences identified with the Western country eating disorders such as: the variability of fat phobia, weight concern, and the absence of denial of thinness. The one child policy bears responsibility for eating disorders in China by improving the academic stress, changing the socialization context, impacting the affiliation process and the family context. Acculturation to western values such as the adoption of an ideal of thinness, growing autonomy claims, and desire for success favors the development of eating disorders. A cultural clash emerges as a consequence of contradictory expectations, of Chinese women's moving roles and of intergenerational gaps between parents and children; all these factors contribute to weaken the identity building, inducing individuation difficulties and parenthood difficulties. Eating disorders in China are also a means to protest against the family. Therefore, family therapy adapted to the Chinese setting seems relevant, together with a specific support for parenthood. Conclusion Knowledge about eating disorders from around the world and the transcultural approach enable a better understanding of these disorders, an enrichment of the diagnostic and therapeutic approach for eating disorders and an improvement of the therapeutic alliance. [ABSTRACT FROM AUTHOR]

Résumé L’anorexie mentale a été la cible de nombreux efforts en recherche. Ces derniers se sont cependant principalement concentrés sur l’étude de femmes. Les écrits portant sur les garçons atteints d’anorexie mentale étant actuellement émergents, la présente recension des écrits propose une mise en commun des connaissances concernant cette population pouvant être dégagées des recherches publiées sur une période de 15 ans. Les variables spécifiquement ciblées sont la présentation clinique, les conditions préalables au trouble, les caractéristiques de la personnalité, l’orientation et l’activité sexuelles, l’identité de genre et les troubles comorbides. La mise en commun et les comparaisons des résultats des 24 études constituant la recension permettent d’appuyer des constats émis par des recherches antérieures et de dégager certaines tendances, dont celle qu’il semble exister des similarités entre la symptomatologie comportementale des garçons et des filles. La recension résume les connaissances actuelles sur les différents thèmes à l’étude concernant l’anorexie masculine et souligne la pluralité et l’hétérogénéité des méthodes de recherche tout en dégageant des aspects spécifiques où des recherches supplémentaires sont nécessaires. Anorexia nervosa has been the target of many research efforts. However, the latest studies, are mainly focused on female subjects. The literature on males with anorexia nervosa is currently emerging. This review of literature suggests pooling knowledge about male anorexia nervosa that can be extracted from the literature over a period of 15 years. The variables that are specifically targeted are clinical presentation, premorbid conditions, personality characteristics, sexual orientation and activity, gender identity and comorbid troubles. The comparison and the pooling of the results of 24 studies forming the review allow us, in some cases, to support observations made by previous research and to identify certain trends. Among other things, there appears to be similarities between the behavioral symptoms of boys and girls. The review gives a summary of the current knowledge on the various themes of the study concerning male anorexia and emphasizes the plurality and heterogeneity of research methods identifying some areas where further research is needed. [ABSTRACT FROM AUTHOR]

Résumé But de l’étude L’anorexie altère la qualité de vie familiale et amplifie les dysfonctionnements familiaux. Il apparaît primordial de prendre en charge la famille des anorexiques pour limiter l’impact de l’anorexie sur la famille. Cette étude exploratoire s’intéresse au vécu de la prise en charge de l’anorexie des parents et de la fratrie de jeunes filles anorexiques en France. L’objectif est d’explorer le vécu des traitements afin d’acquérir une meilleure connaissance de l’impact de cette maladie sur les parents et sur la fratrie. L’objectif second est de proposer différentes pistes de réflexion pour améliorer le processus de soin du patient et de sa famille. Participants et méthode Douze proches (6 mères, 3 pères et 3 fratries) de jeunes filles anorexiques ont participé à des entretiens semi-directifs. Résultats Une analyse thématique a permis d’extraire des unités signifiantes sous le thème du vécu de la prise en charge, eux-mêmes regroupés dans 5 catégories : longueur et inefficacité des traitements, prise en charge de la famille, implication de la fratrie, besoin de guidance et bénéfices des groupes de paroles. Conclusion L’analyse du vécu de la maladie par les proches offre de nouvelles perspectives concernant les besoins des familles pour améliorer la prise en charge. Background Anorexia nervosa (AN) is a serious psychiatric disorder, which affects 0.3% of young people, with a high mortality rate. The impacts of AN on both the patient and their family are severe, as AN decreases the quality of life of the whole family, and increases dysfunctional family interactions. Providing families affected by AN with support to limit the impact of the disorder on the family is therefore critical. Importantly, the lack of consensus regarding treatments for AN is particularly painful for the patients and their relatives. This exploratory study focuses on the impact of treatments for AN on families in France. The main aim is to explore the experience of parents and siblings of individuals suffering from AN to gain a better understanding of the impact of the disorder and its treatment on the whole family. The second purpose is to identify directions for improving the support provided to patient and their relatives. Method Twelve relatives of girls suffering from anorexia (6 mothers, 3 fathers and 3 siblings) were recruited within an association dedicated to the support of parents of individuals suffering from AN. Semi-structured interviews were conducted and thematic analysis was used to extract the meaningful themes. Results The results highlight five distinct categories: long and ineffective treatments, family support (of lack thereof), involvement of the siblings, the need of guidance and the benefits of support groups. Treatments are stressful for family members who are negatively impacted by both the length of treatment and the slow rates of improvement. Relatives of individuals suffering from AN, particularly siblings, require greater support as they are generally excluded from the treatment process. Parents clearly express a need of guidance concerning the appropriate behavior to adopt with their daughters. Plus they highlight the benefits of talking with other parents. Conclusion Our exploration of the experience of the families of individuals suffering from AN provides targets for the improvement of the support provided to families. Findings highlight the need for information, guidance and sharing with other families. Relatives need to be provided with more information throughout the treatment process, from diagnosis to recovery. In addition, families were particularly interested in obtaining practical advice on the appropriate behaviors to adopt with their anorexic daughter or/and sister. Finally, our results stress the helpfulness of sharing the experience of caring for someone with AN with other families facing eating disorders, in order to decrease isolation and social stigma. This study contributes to the evidence of how AN deeply affects the entire family, with major consequences for parents and siblings. This study emphasizes the need to improve the support for relatives and their involvement in the care process, in order to limit the impact of AN on other family members and to promote recovery. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to describe psychological, sociodemographic and somatic characteristics of all children aged 8-12 years who received treatments for eating disorders on a pediatric unit of a University Health Centre during a period of 15 years. Methods: We reviewed the medical records of 215 children with a detailed grid. Descriptive statistics (t-test, Chi2) were performed. Results: The overall sample was comprised largely (92%) of girls (n = 197); 4% of whom were twins. Out of the 215 children, 52% were hospitalized at least one time and 48% were seen and treated as outpatients. In the sample, 82% expressed concerns towards food/weight, 69.4% were afraid of gaining weight, 57.5% still want to lose weight and 46.6% had body image preoccupations. Most of the children, e.g. 95%, had restrictive eating behaviors and 13.5% had bulimia symptoms. Eating problems during infancy were present in 15.9% of the sample. More than half of the children (55.8%) had at least one comorbid condition and family history of psychiatric problems was observed for 36.3% of the children. Boys and girls obtained very similar results on all variables of the study. Only one significant difference had been observed between them: boys were more socially withdrawn. Some significant differences were found between younger children (8-10 years old) and the older one (10-12 years old) of the sample. Conclusion: These results bring out questioning on the etiology of ED in children and on their outcome. Follow-up studies of children presenting ED are essential to better understand these problems and their evolution in order to adapt our strategies for treating them. [ABSTRACT FROM AUTHOR]

Abstract: The presence of eating disorders in adults and adolescents has long been recognized; their identification in children aged between 8 and 13 years is more recent. The emergence of eating problems among this age group is noted by clinicians and researchers [3,5,12–14]. Some authors have deepened their research with those clients to better document the clinical presentation. They have come to formulate a specific classification for this age group, which differs on some points from those proposed for infants and toddlers, and for adolescents and adults. The aim of this paper is to present a review of the literature on eating disorders in children aged between 8 and 13 and to expose the proposed classification of Bryant-Waugh and Lask [4] for this age group. Each of the categories suggested will be illustrated by a brief clinical vignette. In the last part of the article, a critical point of view is expressed regarding the proposed categories and also suggestions for future research. [Copyright &y& Elsevier]

Summary: The model of comprehension in anorexia improves with this of a particular perceptive organisation. Neuroscience carries out an explanation to the mechanisms, which integrate the perceptive system. In another hand, psychodynamic theories propose an attempt of comprehension. These models could be helpful for clinician to use a new form of clinic. This paper is a first step carrying clinical observations realised with anorectic adolescents with a specific associative listening. Then become possible to describe a new clinic, which seems specific to anorexia: clinic of physiologic functions, clinic of perceptive functions, more particularly olfactive and gustative. Then we observe different forms going from disordered state, to distortion until disappearance. It creates a new comprehension of anorectic mechanisms. [ABSTRACT FROM AUTHOR]

Summary: Gayet-Wernicke''s encephalopathy is a neurological condition caused by a deficit in vitamin B1, occurring most frequently in alcoholic patients. Although rare, its description is also known in the pediatric population where it is often associated with cancers, gastrointestinal chronic malabsorption disorders, and has also been reported with teenagers suffering from malnutrition exhibiting particular psychiatric diseases. The diagnosis of Gayet-Wernicke''s encephalopathy is mainly clinical and is characterized by the triad of mental confusion, occulomotor disorders and ataxia. Treatment consists of vitamin B1 infusion and is generally associated with a good prognosis if the diagnosis is made on time. We report the original observation of a 14-year-old male patient. He was admitted in the child psychiatry unit in the context of anorexia nervosa associated with anxiety disorders. He had been presenting important weight loss and malnutrition for the last eight months. This patient''s clinical symptoms consisted of acute anxiety, mental slowness and a progressive confusion that were initially attributed to a psychiatric condition. After the administration of a glucose infusion, the patient developed severe ataxia and a multidirectional nystagmus making the diagnosis of Gayet-Werncike encephalopathy highly probable. Gayet-Wernicke was indeed confirmed by typical ophtalmological and brain MRI findings together with a low blood cell transketolase activity. Symptoms drastically improved after high doses of vitamin B1 infusion. Our case illustrates the importance of timely identification of Gayet-Wernicke encephalopathy in young psychiatric patients particularly when associated with eating disorders. Early vitamin B1 supplementation should be initiated quite early in the diagnosis process to avoid long-term sequels in this young age population. [ABSTRACT FROM AUTHOR]

Abstract: Therapeutic approaches to prepubertal anorexia nervosa are strongly based on family therapy, nutritional guidance and the child''s development of eating, social and family skills which contribute to prevent the maintenance or the aggravation of the symptoms. Cognitive and behavioral approaches adapted to young children are useful for the development of a therapeutic alliance which needs to be maintained over a long period of time before considering a positive outcome. Concrete “play” approaches are helpful for the child who is in the denial phase or is very underweight, motivation and change are two main therapeutic objectives, as it is in the treatment of addictions. [Copyright &y& Elsevier]

Summary: The paper about institutional treatment of severe anorectic adolescents follows another report published in 2007. In this study, we first described new psychodynamic hypothesis facing the concept of negativity in his clinical and psychodynamic double significance. We hypothesized negativity of death representation in anorexia nervosa. Secondly, we described new therapeutical modalities for inpatients. Three axes are developed: 1) limits of the therapeutical program band 2) a new experience of life with familial separation with regular mediate meeting; 3) the therapeutical workshop focused on the capacity to listen non verbal signs; and the work with the families to elaborate hatred and death. This work needs to be pursued and thought regularly to take in life the psyche of these patients. [Copyright &y& Elsevier]

Some adolescents who have food disorders are sent to us for psychotherapies with psychoanalytical inspiration. This is often after a period of absence from the family circle (admission to hospital, center for post-treatment...). During these periods of remission from somatic disorders the intellectual over investissments (cultural and academics) are re-evaluated downwards. This leads to transference on new and idealised objects, among which being in a loving state can be a resolutive step. The psychotherapy shown illustrates the developpement of the mother inference and the return to the puberty scene in the transference. [Copyright &y& Elsevier]