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Abstract: This paper aims to analyze the “adolescent detachment” which is a kind of autonomy where the emotional separation is dysfunctional. The detachment concept is described following a developmental view; attachment, separation–individuation and successful emotional separation are described. Several kinds of detachment are defined depending of the attachment type and of the biopsychosocial context from which the adolescent is. So, we hypothesize that the detachment in an adolescent population with delinquent behaviours is a “detached detachment”. The subject avoids any emotional feeling. The detachment for young people who are hospitalised in child and adolescent psychiatry follows a depressive way. These adolescents cannot handle emotional rush. Finally, the detachment for the general young population can evolve according to a more anxious way. Then, we can talk about an “attached detachment”. Thanks to a best knowledge of the separation kind that the adolescents play, we will be able to help them more with the symptoms they show. The “detachment clinic” is born! [Copyright &y& Elsevier]

BACKGROUND: Endoscopic transmural drainage is obtained by creating a communication between the intestinal tract and the pancreatic-fluid collection, and then inserting 1 or more stents. Collection recurrence after therapy is noted in 10% to 30% of cases. It is not known whether leaving the stents in position reduces recurrence rates. OBJECTIVE: To test the hypothesis that patients who have undergone previous successful pancreatic-collection drainage and whose stents are retrieved have higher recurrence rates. DESIGN: Randomized controlled trial. SETTING: Tertiary referral center. PATIENTS: During a period of 27 months, 46 of 77 patients who had undergone endoscopic transmural drainage for pancreatic collections met inclusion or exclusion criteria, and 28 of these patients were randomized. INTERVENTIONS: Fifteen patients were assigned to group A, whose stents were left in place, and 13 were assigned to group B, whose stents were removed after collection resolution. The remaining 18 patients, who were not randomized, also had their stents left in place. All 46 patients were similarly followed. MAIN OUTCOME MEASUREMENT: Recurrence of the same pancreatic collection that required therapy. RESULTS: All patients were followed for a median period of 14 months (interquartile range, 8.2-22 months) after treatment. The primary end point was reached in 5 patients in group B (stent retrieval), as opposed to none in group A (P = .013). Moreover, no recurrence was observed in the remaining 18 nonrandomized patients. LIMITATIONS: Small sample size. CONCLUSIONS: In patients who underwent successful transmural drainage of pancreatic collections, stent retrieval was associated with higher recurrence rates. [ABSTRACT FROM AUTHOR]

BACKGROUND: Pancreatic-fluid collections are frequent sequelae of acute and chronic pancreatitis, and endoscopic drainage of these collections has gained acceptance as an alternative to surgical drainage. METHODS: Patient data, collection characteristics, drainage technique, and outcomes were obtained through chart review and prospective follow-up for 116 patients with attempted endoscopic drainage of symptomatic pancreatic-fluid collections. RESULTS: A total of 116 patients presented with fluid collections classified as acute fluid collection (n = 5), necrosis (n = 8), acute pseudocyst (n = 30), chronic pseudocyst (n = 64), and pancreatic abscess (n = 9). The median diameter of the collection drained was 60 mm (15-275 mm). Median follow-up after drainage was 21 months. The drainage technique was transpapillary in 15 patients, transmural in 60, and both in 41. Successful resolution of symptoms and collection occurred in 87.9% of cases. No difference in success rates was observed between patients with acute pancreatitis and those with chronic pancreatitis. However, drainage of organized necrosis was associated with a significantly higher failure rate than other collections. No significant differences were observed regarding success when disease, drainage technique, or site of drainage was considered. Complications occurred in 13 patients (11%), and there were 6 deaths in the 30 days after drainage, including one that was procedure related. CONCLUSIONS: Endoscopic drainage of pancreatic-fluid collections is successful in the majority of patients and is accompanied by an acceptable complication rate. [ABSTRACT FROM AUTHOR]

Objectives – To review studies on eating disorders (ED) in insulin–dependant diabetes mellitus (IDDM), published after our first review in 1990 and meta-analysis by Nielsen et Mølbak (1998).Results – Prevalence of ED in IDDM does not seem significantly higher than in the general population. Very large IDDM populations would be necessary to give a definitive answer to this question. The last studies on the topic do not give further information. There are no studies to explain the biological and psychopathological association between ED and IDDM. All the studies agree with the fact that ED in IDDM are a risk factor for higher glycosylated hemoglobin (HBA1c) and retinopathy. A new way of work seems to be the relationships between overweight, ED and IDDM. Self-induced glycosuria seems particularly interesting to explain the bad metabolic control. Chronic high levels of HBA1c lead to microvascular complications.Conclusion – We propose a profile of typical IDDM patient with ED. We need studies to assess validity of therapeutic procedures for this special and severe comorbidity. [ABSTRACT FROM AUTHOR]

Résumé Le recours aux médiations dans les soins psychiques proposés aux enfants, d’abord considéré comme un moyen de suppléer ou soutenir une expression verbale trop balbutiante pour répondre aux exigences de la talking cure , tend à s’imposer comme une alternative dont on découvre des effets psychothérapiques inattendus, voire inespérés. Des pratiques diverses se sont ainsi multipliées, souvent sur des bases empiriques, à l’initiative de soignants s’appuyant sur une compétence, un goût, une passion mis au service de leurs jeunes patients. Force est alors de reconnaître qu’une certaine « alchimie » s’opère autour du « matériau » utilisé et que la créativité ainsi partagée facilite une rencontre intersubjective, voire une relance des processus de pensée. Le constat a posteriori d’un relâchement des symptômes, d’un mieux-être, ou d’une ouverture relationnelle encourage naturellement les équipes soignantes à innover, à oser mettre en place des ateliers suffisamment diversifiés pour répondre aux aspirations latentes des enfants et mieux s’ajuster à leurs contraintes de fonctionnement. Or quel que soit le souci de bien décrire le cadre et le contenu de ces ateliers, de les inscrire dans le dispositif institutionnel, de réfléchir soigneusement aux bonnes indications, quels que soient les essais de codification voire de protocolisation, l’essentiel semble se jouer ailleurs, dans l’accueil de l’imprévu, le hasard des rencontres, la tonalité des échanges, la circulation des émotions, les ressorts de l’humour, la valorisation des trouvailles… Il est bien difficile, même dans l’après-coup, de rendre compte de ces « petits riens qui changent tout ». Les tentatives d’articulation théoriques se sont pourtant multipliées ces dernières années et de nombreuses publications récentes tentent de mieux cerner le concept de médiation pour avancer quelques hypothèses sur ce « thérapeutique par surcroît », qui peut ainsi se manifester dans un cadre bien différent de celui de la « cure type ». Le bénéfice tiré de l’usage de médiations groupales en psychiatrie de l’enfant et de l’adolescent incite pareillement à qualifier les spécificités de cette dynamique de groupe qui s’installe et qui contribue aux progrès de chacun, sans pourtant faire l’objet d’un travail d’élucidation ou d’interprétation des fantasmes sous-jacents, comme c’est la règle dans les groupes thérapeutiques. Malgré toutes ces zones d’ombre, les indications sont indéniablement de plus en plus larges et pourraient témoigner d’un recul des psychothérapies d’inspiration analytique lié, à la raréfaction des organisations névrotiques au profit d’une inflation des pathologies limites et narcissiques, se prêtant mal, surtout à l’adolescence, à un dispositif thérapeutique en face à face. Dans un tel contexte, « poser l’indication » d’un soin avec médiations pourrait ne plus se faire par défaut, faute d’un abord possible de la conflictualité interne, mais dans la perspective winnicottienne de créer une aire de jeu partagée, un espace intersubjectif propre à soutenir le processus de subjectivation. La malléabilité et la solidité qui sont quelques unes des qualités « maternelles » requises pour les soignants engagés dans une telle entreprise ne peuvent se prescrire doctement, mais ne sauraient se déployer sans la référence à des instances de régulation, de réflexion et de soutien institués. First seen as a way to sustain an insufficient verbal expression to meet the requirements of talking therapies, mediated therapies are tending to become an unexpected effective psychotherapeutic alternative. Various practices have increased. They are often developed on empirical basis by caregivers, who commit themselves at the service of their young patients. They do it with passion, according to their taste and field of competence. This kind of alchemy operates through the material used in the therapy. Thus, this shared creativity seems to ease an intersubjective meeting or even a revival of thought processes. A relaxation of the symptoms, a well-being and a relational openness are often assessed afterwards. This, obviously, encourages caregivers to innovate and to dare to set up tailored action. These must be diverse enough to meet children's latent expectations and to better adjust to their operating constraints. In the last years, many publications tried to understand the concept of mediated therapies and to hypothesize about what is “therapeutic in addition,” despite not in the typical cure framework. Group mediated therapies in child and adolescent psychiatry show a benefit. It invites to interest to group dynamics that contribute to everybody's progress. But whatever the will to describe precisely the framework and content of workshops, to settle them in the institutional set-up and to establish precisely the indications for them, whatever the attempts to formalisation, the essential role is played by all these “little nothings that change everything”: openness to the unattended, chance encounters, atmosphere of the talks, humour, the way emotion spreads and circulates, and the way achievement is taken into account. In spite of all these shadows, indications keep growing. This could testify fewer neurotic organizations and an increase of limit and narcissistic pathologies, which can’t stand especially in adolescence in face-to-face therapy. In such a context, mediated therapies could be indicated to create a Winnicott inspired shared play field, an intersubjective space able to sustain the subjectification process. Maternal qualities such as malleability and solidity cannot be eruditely prescribed but must be found among those involved caregivers and need to refer to the regulatory institutional supporting and thinking bodies. [ABSTRACT FROM AUTHOR]