Julie Brunelle

Bio: Julie Brunelle is an academic researcher from Centre national de la recherche scientifique. The author has contributed to research in topics: Transgender & Population. The author has an hindex of 4, co-authored 7 publications receiving 74 citations.

Ecological momentary assessment and smartphone application intervention in adolescents with substance use and comorbid severe psychiatric disorders: study protocol

Abstract: Context: Substance Use Disorders (SUDs) are highly prevalent among inpatient adolescents with psychiatric disorders. In this population, substance use and other psychiatric outcomes can reinforce one another. Despite the need for integrated interventions in youths with dual diagnoses, few specific instruments are available. App-based technologies have shown promising results to help reduce substance use in adolescents, but their applicability in youths with associated severe psychiatric disorders is poorly documented. We aim to evaluate the feasibility of an ecological momentary assessment (EMA) intervention for all substance users, and of a smart-phone application for cannabis users (Stop-Cannabis), for outpatient treatment after hospital discharge. Methods and analysis: All inpatient adolescents with psychiatric disorders hospitalized between 2016 and 2018 in a university hospital will be systematically screened for SUD and, if positive, will be assessed by an independent specialist addiction team. Participants with confirmed SUDs will be invited and helped to download an EMA app and, if required, the Stop-Cannabis app the week preceding hospital discharge. Information about the acceptability and use of both apps and the validity of EMA data in comparison to clinical assessments will be assessed after 6 months and one year. Discussion: This research has been designed to raise specific issues for consideration regarding the sequence between substance use, contextual factors, and other psychiatric symptoms among adolescents with comorbid severe psychiatric disorders. A better understanding of the mechanisms involved will inform the development of integrated treatment for dual disorders at that age. Ethics and dissemination: The study has already been approved and granted. Dissemination will include presentations at international congresses as well as publications in peer-reviewed journals. Trial registration: European Clinical Trials Database: Number 2016-001999-30.

Phenomenology, socio-demographic factors and outcome upon discharge of manic and mixed episodes in hospitalized adolescents

Abstract: The existence of bipolar disorder type I (BD-I) during adolescence is now clearly established whereas there are still some controversies on BD-II and BD-NOS diagnosis, mainly in Europe (O’Dowd in Br Med J 29, 2006). Little is known on the phenomenology and potential short-term prognosis factors of bipolar episodes in this age population. In particular, very few studies examine this issue on inpatients in the European context of free access to care. To describe the phenomenology of acute manic and mixed episodes in hospitalized adolescents and to analyse potential predictive factors associated with clinical improvement at discharge and length of hospitalization. A total of 80 subjects, aged 12–20 years, consecutively hospitalized for a manic or mixed episode. Socio-demographic and clinical data were extracted by reviewing patients’ charts. We used a multivariate analysis to evaluate short-term outcome predictors. The sample was characterized by severe impairment, high rates of psychotic features (N = 50, 62.5%), a long duration of stay (mean 80.4 days), and an overall good improvement (86% very much or much improved). Thirty-three (41.3 %) patients had a history of depressive episodes, 13 (16.3%) had manic or brief psychotic episodes but only 3 (3.7%) had a history of attention deficit/hyperactivity disorders. More manic episodes than mixed episodes were identified in subjects with mental retardation (MR) and in subjects from migrant and/or low socio-economic families. Overall severity and female gender predicted better improvement in GAF scores. Poor insight and the existence of psychotic features predicted longer duration of stay. These results suggest that severe manic and mixed episodes in adolescents with BD-I need prolonged inpatient care to improve and that socio-cultural factors and MR should be examined more closely in youth with BD.

Medication use in Adolescents Treated in a French Psychiatric Setting for Acute Manic or Mixed Episode

Abstract: Objective: In the context of absence of recommendations from drug regulatory agencies for most medications to treat severemanic or mixed episode in adolescence, this study aims to (i) describe the pharmacological treatment prescribed in an inpa-tient setting for acute manic or mixed episodes in adolescents; (ii) determine whether type of episode, duration of stay,improvement, and psychotic features were associated with the nature of the given treatment; (iii) compare the results withevidence-based data. Method: From 1993 to 2003, we received 80 subjects, aged 12 to 20 years, consecutively hospital-ized for a manic or mixed episode. Socio-demographic, clinical and treatment data were extracted by reviewing patients’charts. Treatment data were available for 75 subjects. Results: Most patients received a combination treatment includingmood stabilizer (82.6%), classical antipsychotic (AP) (86.6%) and atypical AP (24%). Despite prolonged hospitalisation(minimum stay = 17 days), 69 (86.2%) patients were scored very much or much improved at discharge. Secondary therapeu-tic options occurred in 15 subjects because of poor therapeutic response (N=13), severe adverse effects (N=5) or both. Twopatients had electroconvulsive therapy as third therapeutic option. Adolescents with psychotic symptoms were significantlymore frequently treated by lithium (Fisher exact test: p=0,0052). No other variable was associated with treatment.Conclusions: This study reported on patterns of medication use that mainly followed treatment recommendations and evi-dence-based data existing in adults. However, the presence of psychotic features appeared to favour the use of lithium in thisFrench sample.Key words: bipolar disorder, adolescence, pharmacological treatmentRESUMEObjectif: Dans un contexte de prescriptions hors AMM (Autorisation de mise sur le marche) dans le traitement des episodesmaniaques ou mixtes aigus a l’adolescence, cette etude se propose 1) de decrire le traitement pharmacologique prescrit chezdes adolescents hospitalises pour un episode maniaque ou mixte 2) de determiner si le type d’episode, la duree de l’hospital-isation, l’amelioration clinique et la presence de signes psychotiques sont associes au type de traitement prescrit 3) de com-parer les resultats aux donnees issues d’ «evidence-based medecine». Methodologie: De 1993 a 2003, nous avons hospital-ise 80 sujets, âges de 12 a 20 ans, pour un episode maniaque ou mixte. Les donnees socio-demographiques, cliniques etpharmacologiques ont ete extraites des dossiers des patients. Les donnees sur le traitement etaient disponibles pour 75patients. Resultats: La majorite des patients a recu une combinaison de traitements associant un stabilisateur de l’humeur(82,6%), un antipsychotique classique (86,6%) et un antipsychotique atypique (24%). Malgre la duree prolongee de l’hospita-lisation (17 jours minimum), l’evaluation clinique de 69 patients (86,2%) montre une forte voire tres forte amelioration cliniquea la sortie. Une deuxieme option therapeutique a concerne 15 sujets en raison d’une mauvaise reponse therapeutique (n=13),d’effets secondaires severes (n=5) ou de ces deux raisons. 2 patients ont recu un traitement par electroconvulsivotherapie entroisieme option therapeutique. Les adolescents presentant des symptomes psychotiques ont ete significativement plusfrequemment traites par lithium (fisher exact test: p = 0,0052). Aucune autre variable n’est associee au type de traitement.Conclusions: Cette etude rapporte des schemas de traitement principalement en accord avec des recommandations et desdonnees issues d’ «evidence-based medecine» existant chez l’adulte. La presence de symptomes psychotiques semble toute-fois favoriser la prescription de lithium dans cet echantillon francais.Mots-cles: trouble bipolaire, adolescence, traitement pharmacologique

Transgender fathering: Children's psychological and family outcomes

Abstract: Medical advances in assisted reproductive technology have created new ways for transgender persons to become parents outside the context of adoption. The limited empirical data does not support the idea that trans-parenthood negatively impacts children's development. However, the question has led to lively societal debates making the need for evidence-based studies urgent. We aimed to compare cognitive development, mental health, gender identity, quality of life and family dynamics using standardized instruments and experimental protocols in 32 children who were conceived by donor sperm insemination (DSI) in French couples with a cisgender woman and a transgender man, the transition occurring before conception. We constituted two control groups matched for age, gender and family status. We found no significant difference between groups regarding cognitive development, mental health, and gender identity, meaning that neither the transgender fatherhood nor the use of DSI had any impact on these characteristics. The results of the descriptive analysis showed positive psycho-emotional development. Additionally, when we asked raters to differentiate the family drawings of the group of children of trans-fathers from those who were naturally conceived, no rater was able to differentiate the groups above chance levels, meaning that what children expressed through family drawing did not indicate cues related to trans-fatherhood. However, when we assessed mothers and fathers with the Five-Minute Speech Sample, we found that the emotions expressed by transgender fathers were higher than those of cisgender fathers who conceived by sex or by DSI. We conclude that the first empirical data regarding child development in the context of trans-parenthood are reassuring. We believe that this research will also improve transgender couple care and that of their children in a society where access to care remains difficult in this population. However, further research is needed with adolescents and young adults.

Quelle place pour une école dans un hôpital dans le cadre de soins associés au décrochage scolaire

Abstract: Resume Contexte Bien que le decrochage scolaire ne soit pas un diagnostic psychiatrique, il est une preoccupation frequente pour le pedopsychiatre, et recouvre des situations psychopathologiques variees En outre, les psychopathologies severes de l’adolescence sont aussi a risque de decrochage scolaire, grevant par la-meme le pronostic Integrer le soin dans la problematique du decrochage scolaire parait etre une piste interessante Nous avons depuis 2008 reorganise le partenariat entre le dispositif de soins specialise hospitalier, et le groupe scolaire detache dans notre hopital pour repondre a ces demandes en augmentation Nous proposons ici de reprendre les 50 premiers patients qui ont beneficies de ce dispositif, d’evaluer leur situation clinique a leur sortie (t1) et a 30 mois (t2) et d’explorer les facteurs potentiellement associes a leur reinsertion Methodes Les variables sociodemographiques et cliniques ont ete recueillies retrospectivement a t0 et t1 Concernant le devenir a t2, les donnees ont ete obtenues par appel telephonique Les criteres de reinsertion retenus a 30 mois sont : la reprise d’une scolarite (classique, adaptee, ou de type medico-sociale) ou l’existence d’une activite professionnelle Resultats Entre 2008 et 2012, nous avons accueilli 52 sujets (dont 36 garcons, 69 %) dans le dispositif scolaire de l’hopital en association avec des soins de consultation ( n = 20) ou en hospitalisation de jour ( n = 32) Ils presentent des profils psychopathologiques varies Au total, 37 sont des collegiens (71 %) et la duree de descolarisation moyenne est de 6,7 mois La duree moyenne de prise en charge dans le dispositif fut de 4 mois Au devenir a 30 mois, 34 sujets (65 %) ont une reinsertion scolaire avec une amelioration clinique globale significative (30 % d’augmentation du score EGF) Seule l’existence d’une mesure educative a t0 et la severite clinique (CGI-S et EGF) a t1 sont associees de maniere significative a une moins bonne reinsertion a t2 Conclusion Les adolescents a risque de decrochage scolaire ont beneficie du dispositif sur le plan de leur adaptation psychosociale et de leur reinsertion scolaire Bien que les profils psychopathologiques soient varies, le seul facteur pronostique retrouve est l’existence d’une mesure de protection aide sociale a l’enfance

Research report Complex and rapid-cycling in bipolar children and adolescents: a preliminary study

Abstract: subjects aged 7-18 years were studied. Diagnoses of bipolar disorders were established using the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present Episode Version-1986 modified for DSM-III-R criteria and for rating the number and duration of manic and hypomanic episodes, Complex cycling patterns were observed. These included numerous brief episodes suggesting continuous rapid-cycling in 80.8% of cases. Mean age of onset was early (8.5 k 4.4 years). Psychotic phenomena, suicidality, hyperactivity and 'mixed mania' were highly prevalent. Data in this report provide support for complex and rapid-cycling patterns in childhood onset bipolar disorder.

Research Review: What have we learned about adolescent substance use?

Abstract: Background Adolescence is a critical biological, psychological, and social developmental stage involving heightened risk for substance use and associated adverse consequences. This review, synthesizing emerging findings on this complex topic, is intended to inform research and clinical care focused on adolescents. Methods Literature searches were conducted using PubMed, yielding a cross-section of observational and interventional studies focused on adolescent substance use. Findings were organized and categorized to cover key areas of epidemiology, neurobiology, prevention, and treatment. Findings Adolescent substance-related attitudes and use patterns have evolved over time, informed by adult and peer behaviors, public policy, media messaging, substance availability, and other variables. A number of risk and resiliency factors contribute to individual differences in substance use and related consequences. Advances in observational techniques have provided enhanced understanding of adolescent brain development and its implications for substance use. Prevention efforts have yielded mixed results, and while a number of adolescent-targeted evidence-based treatments for substance use disorders have been developed, effect sizes are generally modest, indicating the need for further research to enhance prevention and treatment outcomes. Conclusions Substance use in adolescence is heterogeneous, ranging from normative to pathological, and can lead to significant acute and long-term morbidity and mortality. Understanding risk and resiliency factors, underlying neurobiology, and optimal developmentally sensitive interventions is critical in addressing substance-associated problems in adolescence.

Anxiety Disorders in Children and Adolescents

Abstract: The first section covers historical and conceptual issues, including cognitive and developmental processes, clinical and theoretical models, phenomenology and classification, and evidence-based assessment. Subsequent sections cover the biology of child and adolescent anxiety, and environmental influences including traumatic events, parenting and the impact of the peer group. The final section addresses prevention and treatment of anxiety. All chapters incorporate new advances in the field, explicitly differentiate between children and adolescents, and incorporate a developmental perspective. Written and edited by an international team of leading experts in the field, this is a key text for researchers, practitioners, students and clinical trainees with interests in child and adolescent anxiety.