Mathieu Bernard

Substance use and depression. Comparative course in adolescents.

ObjectiveTo examine the relation between depression and substance use in adolescents and the concomitant courses of both disorders.MethodsFour individual interviews were administered to 85 adolescent substance users aged 14–19 years (mean 17.1 years, SD 1.4) over a 3.5 year period using the Adolescent Drug Abuse Interview (ADAD) and the Beck Depression Inventory (BDI-13).ResultsNo predictive effect was observed on one dimension over the other, but each dimension was predictive of its own course. A decrease in substance-use severity paralleled a decrease in depressive state. Similarly, stable substance-use rates, either at a low or a high level, tended to be associated with low or high levels of depression, respectively. However, an increase in substance use was not accompanied by an increase in depressive states. Moreover, depression varied greatly between adolescents, and according to gender and age.ConclusionsDepressive states and substance use in adolescents can vary considerably overtime, and are closely but rather synchronically related. Since most of the adolescents do not seek help for substance-related problems, substance use should be systematically assessed in adolescents presenting with a depressive state.

Psychodynamic aspects of communication skills training: a pilot study

Goals of work:Communication between patients and oncology clinicians is a key element of cancer care. Emotionally charged consultations may trigger clinicians’ defense mechanisms, protecting them from painful emotions. Defense mechanisms, however, may also hamper the recognition of patients’ suffering. This pilot study aims to explore clinicians’ defense mechanisms observed in communication skills training (CST).Patients and methods:A verbatim transcription of videotaped interviews with simulated patients were evaluated before (N = 10) and after CST (N = 10) with the defense mechanism rating scales (DMRS).Main results:A wide variety of defense mechanisms were observed such as obsessional (e.g. intellectualisation) or disavowal (e.g. denial or projection). Immature defense mechanisms decreased after CST.Conclusions:A wide variety of defense mechanisms are operant in oncology clinicians facing challenging interviews with simulated patients. Defense mechanisms may be modified by CST.

Adolescent drug use escalation and de-escalation: A 3-year follow-up study

This study aims to assess adolescents drug use with a longitudinal perspective in order to identify factors interacting with drug use onset and course. Supported by the Swiss Federal Office of Public Health, the study was initiated in 1999 with a follow-up in 2001 and 2002. The first objective was to measure risk factors for substance use initiation. The second objective was to analyse the co-variation of substance use with environmental, social, relational, medical and psychological factors. A total of 102 adolescents, aged 14–19 years, were recruited for the study in the French-speaking part of Switzerland. Results clearly show that substance use is not a disorder per se in adolescence, but that it is part of a multidimensional complex of problems that some adolescents may encounter: increase and decrease in substance use is paralleled with an increase or decrease in the other areas. This implies that prevention of substance use should not be focused mainly on substances but should consider the adolescent’s environment and significant life areas.

Attitudes Regarding Palliative Sedation and Death Hastening Among Swiss Physicians: A Contextually Sensitive Approach.

In Switzerland, where assisted suicide but not euthanasia is permitted, the authors sought to understand how physicians integrate palliative sedation in their practice and how they reflect on existential suffering and death hastening. They interviewed 31 physicians from different care settings. Five major attitudes emerged. Among specialized palliative care physicians, convinced, cautious and doubtful attitudes were evident. Within unspecialized settings, palliative sedation was more likely to be considered as death hastening: clinicians either avoid it with an inexperienced attitude or practice it with an ambiguous attitude, raising the issue of unskilled and abusive uses of sedatives at the end of life.

Measure development and assessing outcomes in palliative care: Always look on the bright side of life….

In recent years, there has been considerable output in the literature concerning the development of scales that are meant to capture, assess, and quantify subjective outcomes in palliative care and at the end of life. Several papers in the current special issue of Palliative & Supportive Care on “Measurement Development in Palliative and Supportive Care” are examples of such. The importance of these endeavors for palliative care is crucial, as the main outcome of palliative care as defined by the WHO—quality of life—is among the most subjective outcomes imaginable. Indeed, there has been a longstanding controversy about whether such a construct might be measurable by any means. The main arguments against assessing quality of life concern: