Tentative de suicide chez l’enfant et l’adolescent et bipolarité - 14/06/18
Suicidal attempts in child and adolescent and bipolar disorders
pages | 9 |
Iconographies | 0 |
Vidéos | 0 |
Autres | 0 |
Résumé |
Introduction |
Le diagnostic de trouble bipolaire (TB) de l’enfant et l’adolescent augmente le risque de tentative de suicide (TS).
Objectifs |
L’objectif principal est d’identifier le nombre de diagnostic de TB (DSM-5) dans une population d’enfants et adolescents ayant fait une TS.
Méthodes |
Étude de soins courants portant sur des suicidants de 6 à 18 ans, inclus consécutivement pendant 4 mois et suivis pendant 12 mois. À l’inclusion : évaluation diagnostique standardisée DSM-5 du TB et répartition des patients en deux groupes : TB+ trouble bipolaire ; TB− : non bipolaire. Lors du suivi : évaluation du nombre de récidive de TS à 3 et 12 mois et nouvelle évaluation diagnostique DSM-5 effectué à 12 mois dans les 2 groupes.
Résultats |
Au total, 26 (22F/4M) patients sont inclus, d’âge moyen 14,5 ans et 20/26 d’entre eux sont suivis à 12 mois. Selon les critères DSM-5 : 5 diagnostics (19,2 %) de bipolarité sont posés à l’inclusion. À 12 mois : aucune récidive de TS n’est observée dans le groupe TB+, mais (45 %) dans le groupe TB, 75 % patients présentent une persistance du diagnostic de bipolarité à 12 mois.
Conclusion |
Le diagnostic de bipolarité paraît stable à 12 mois. L’évaluation standardisée DSM-5 du diagnostic de bipolarité chez l’enfant et l’adolescent est indispensable pour la prise en charge et le suivi à moyen et long terme.
Le texte complet de cet article est disponible en PDF.Abstract |
Background |
Child and adolescent psychiatrists are frequently confronted with suicide attempts and comorbid mood disorders. Diagnoses of juvenile bipolar disorders (BD) are rare and controversial and standardized assessment is helpful for a reliable diagnosis. The main objective of this study was to identify the number of juvenile bipolar disorder diagnoses according to DSM-5 criteria in a population of children and adolescents hospitalized for suicide attempts. Secondary objectives were the assessment of a patient's characteristics and the comparison of suicide attempt recurrence during 12 months of follow-up.
Methods |
This current practice study consecutively included children and adolescents aged 6 to 18 years and hospitalized for a suicide attempt in a French University Pediatric Hospital over a 4-month period. Patients were assessed at baseline, at 3 months and at 12 months. The standardized assessment was realized by the investigator using semi-structured interview K-SADS-PL (2013) to diagnose juvenile bipolar disorders based on DSM-5 criteria. Clinical diagnoses based on medical charts and according to ICD-10 criteria were also collected at 12-month follow-up. Standardized assessment was completed by the French validated K-SADS-PL (2004) for comorbidities (DSM-IV), dimensional assessment by MADRS–YMRS–ARI–C-SSR, and C-GAS at inclusion. Patients were divided into two groups: (1) those presenting juvenile bipolar disorder according to DSM 5 (BD+) and (2) those without criteria for bipolar disorder (BD−). Suicide risk factors and suicide attempt relapse were assessed at 3 and 12 months of follow-up.
Results |
Twenty-six inpatients (22 female and 4 male) aged 14.5 years (SD 1,5) were consecutively included. Twenty patients were followed up during the 12-month period. At baseline, 5 patients (19.2 %) presented a diagnosis of BD (DSM-5): 1 BD type 2, 2 non specified BD, 2 cyclothymic disorders. According to the medical charts (ICD-10), none of the patients had been diagnosed with BD but had diagnoses of dysthymia, of borderline personality disorder and of conduct disorder corresponding to DMDD in 3, 2 and 1 patient respectively. During the 12-month follow-up, 9 patients of the BD− group and none of the BD+ presented recurrence of suicide attempt with 67 % during the first 3 months and 3 patients with multi-relapses. These 3 patients were female adolescents out of care and carrying at least three suicide risk factors. Six patients have been lost to follow-up (1 BD+, 5 BD−). In the BD+ group, 3 patients out of 4 had a persistent diagnosis (DSM-5) of BD at 12 months.
Conclusion |
In our adolescent population hospitalized for suicidal attempt, 19,2 % present BD using DSM-5 criteria. Diagnoses are stable during 12 months of follow-up, but under diagnosed in current clinical practice. DSM-5 standardized assessment appears to be very important to diagnose juvenile BD, mandatory for medium and long-term psychiatric follow-up, especially for suicide prevention and psychopharmacologic therapeutics. Nevertheless, no recurrence of suicide attempts has been observed in our BP+ group, contrary to BP−, possibly due the absence of BP 1 disorder.
Le texte complet de cet article est disponible en PDF.Mots clés : Trouble bipolaire, Enfant et adolescent, Tentative de suicide, Récidive, DSM-5
Keywords : Juvenile bipolar disorder, Suicide attempt, Relapse, DSM-5, Child and adolescent psychiatry
Plan
Vol 44 - N° 3
P. 215-223 - juin 2018 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’achat d’article à l’unité est indisponible à l’heure actuelle.
Déjà abonné à cette revue ?