[Management of anorexia nervosa in a Tunisian case]

Anorexia nervosa is a complex psychiatric illness that can lead to severe physical complications. This work aimed to study the approach taken by the child psychiatry service of Razi hospital in the management of anorexia nervosa and to compare it with international recommendation. We propose to illustrate by a case report the management of anorexia nervosa in its typical form and review international recommendations on this topic while undertaking a review of the literature based on a Medline search using the following keywords: anorexia nervosa, adolescence, management, guidelines. Case report: AS, 16 years old, addressed to us by the school doctor for management of anorexia nervosa evolving for two years without improvement through outpatient care. His condition was considered precarious requiring urgent care in a medical hospital. She was then hospitalized at the Institute of Nutrition with a weight contract to achieve. She received a gradual refeeding strongly denied. We have provided a psychological support by moving on site three times a week to help establish a good therapeutic alliance. After three weeks, the teenager has reached an acceptable weight for its output to the hospital and additional support at the outpatient child psychiatry with supportive psychotherapy. Two months later, she developed depression because of the weight gain. The appointment at the dietician was continued three months after hospitalization. At 10 months of the hospitalization, the girl At 10 months of the hospitalization, the girl had good grades and was not amenorrheic. However, on the psychological level she kept the same traits and intrafamilial relationships were marked by the seal of the manipulation. Subsequently, the teenager has spaced the consultations then lost sight. Currently, at 15 months of the hospitalization, parents describe a

relapse, with a dietary restriction without amenorrhea and a refusal to take weight. [asterisk] In management of this patient, we followed the recommendations of the literature namely those of the High Authority of Health and NICE

[National Institute for Clinical Excellence] which recommend a target tracking of anorexia nervosa, the establishment of a multidisciplinary team care, a long hospitalization with a weight contract, support and cognitive therapy of the body image when the initial outpatient care is not effective. Similarly, for children and adolescents, family therapy is recommended as an outpatient after hospitalization. In our country, the prevalence of anorexia nervosa is gradually increasing although we have not an idea concerning the frequency or prevalence of this disease which has serious and unpredictable complications. For what, It requires a multidisciplinary and prolonged surveillance to prevent recurrence

[ diagnosis of temporal epilepsy in child psychiatry: a report of 7 cases]

This paper attempts to describe the features of temporal epilepsy in patients firstly considered as having psychiatric disorders. The cases of seven patients followed between 2005 arc 2008 at the Child and Adolescent Psychiatry Department of Ran Hospital, aged II to 15 years are treated. All the patients showed complex partial seizures, and some of them showed secondarily generalized tonic-clonic seizures. Seizures were predominantly made of psychic symptoms [delusion fear, aggressiveness] hot also associated sensory, motor and vegetative features, In 5 cases, epilepsy was idiopathic, and symptomatic of brain anomaly in 2 cases, Careful attention must be paid to paroxystic symptoma in children

[Adaption of a soft signs scale to children with autism spectrum disorders]

Neurological soft signs [NSS] are endophenotypic markers of schizophrenia, and their high prevalence in pervasive developmental disorders [PDD] support the existence of the spectrum of psychoses. These NSS were evaluated by standardized scales which were not adapted to children with PDD. This study aimed to propose an adaptation for children of a scale of NSS already used in adults. 21 children with PDD [II with autistic disorder, 10 with PDD not otherwise specified] aged 6-12 years and 21 controls matched on age. sex, and cognitive level were included. Evaluating tools were NSS scale of Krebs et al. adapted after a pilot-study with the accordance of its author; the Progressive Matrices of Raven for intellectual level, and ADI-R to confirm diagnosis. Patients were significantly more impaired on total score [p=0, 001], motor coordination [p=0, 08]. motor integration [p=0, 000]. and sensory integration [p=0, 001]. There were no difference between patients and controls on abnormal movements and quality of lateralization. This adaptation of Krebs et al. scale seems to be a good tool for evaluating NSS in children, especially in those with PDD.A further validation study. including a larger sample is necessary

[Memory impairments during child and adolescent depression]

This study aimed to evaluate basic performances on verbal memory in treatment-naive children and adolescents with depression and in healthy control subjects. 34 children and adolescents aged 6-16 years, suffering from a first major depressive disorder [DSM IV] and 34 controls matched on sex, age and cognitive ability were evaluated. Psychiatric diagnosis was assessed with the K-SADS-PL. The Child Depression Rating Scale [CDRS] was used to assess the severity of depression. Progressive matrices of Raven were used to evaluate intelligence. Tow different cognitive tasks were administered to assess semantic and working memory: digit span test, and semantic and phonemic verbal fluency. A significant effect of diagnosis was found for digit span: patients showed lower performance on forward [p=0, 015] and backward [p=0, 002] digits. No difference was found between patients and controls on verbal fluency. The young age of the sample and the first depressive episode criteria may explain the absence of severe impairment of this type of semantic and working memory. These results support the hypothesis that memory deficits in depressive disorders are partly the result of poor encoding caused by a deficit in attention