[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

[ Tunisian revolution in the eyes of children]

The child uses drawing as a language. By reflecting faithfully all that is involved in the psychic life of the child, the drawing participates in the diagnosis and plays a role in the therapeutic management of young people suffering from psychological difficulties. To analyze the drawings of children and adolescents followed at the department of Child and Adolescent Psychiatry, further to the events of the Tunisian Revolution. It is about a cross sectional study conducted among outpatients consulting the department of Child and Adolescent Psychiatry at Razi hospital in Manouba during the period from January 25 to February 28, 2011. These patients were divided into two groups with a specific instruction for each, to represent the events experienced by the patient and his family for the first group and to do a free drawing for the second. Both groups consisted of 16 patients each with successively average age of 10, 5 and 10.33 years and sex ratio of 2.20 and 1.25. Patients in both groups were exposed to different stressors. The first group of children used in their drawings few colors, mostly black and red. The instruments of war such as bullets, guns, tanks and military helicopters were well represented. The characters were mostly male who were angry and looking for leakage. The drawings depicted scenes of war and conflict with people in distress or dead. The drawings of the second group were essentially about nature. We find that the instruction has significantly changed the behavior of children from the sheet. The instruction in this context seems to be a necessary to help these children overcome their concerns and express their pain

[Clinical characteristics of Rett syndrome]

Rett Syndrome is a neurodevelopmental disorder, one of the least commonly occurring autism spectrum disorders [ASD], affecting mainly females. To describe features and molecular specificities of Rett syndrome. To identify articles for this review, a Pubmed search was conducted using the following keywords: Rett syndrome, regression,mutation, stereotypes. This syndrome is characterized by cognitive impairment,communication dysfunction, stereotypic movement disorder, and growth failure. It is generally caused by mutations in the MECP2 gene. Rett Syndrome has a prevalence ranging from 10-20 000 females. Specific treatement is not available, but patients need a careful planning for long-term care, with multidisciplinary approaches

[ mobile: a new addiction upon adolescents]

This survey was conducted to investigate mobile phone used and dependence in Tunisian high school students. Questionnaires were anonymously distributed to 120 adolescents looking for the modalities of use of mobiles. SMS dependency was assessed with the French version of the Igarashi scale. The two most used means for communication were SMS and missing calls. 83.2% of the sample sent more than 6 missing perception of excessive use in 31. Seven percent of cases, emotional reaction in 33.4% of cases and exclusive relationship maintenance thanks to mobile in 18% of cases. This study demonstrated a new addiction to mobile phone among Tunisian high school students

[Profile of a population of consultants in child psychiatry and access to care by Gender]

Access to care in mental health is a fundamental element in the monitoring and care of children and adolescents. The objective of this work was to draw up the demographic and clinical characteristics of a population of consultants in child psychiatry and to investigate possible gender inequalities in access to care. This is a descriptive cross-sectional study concerning a sample of 730 children and adolescents having consulted child psychiatry department in Tunis and Monastir during a period of 4 months [April- July on 2006]. Data were collected through a questionnaire administered to the relatives of patients consulting these various structures. 66% of consulting were boys. In 55% of cases, the mother, alone, accompanied the child to the consultation. The request of care emanated in the majority of the cases from parents and doctors. On average ran out 18 months before the first medical visit and 26 months before the first psychiatric consultation. Multiple medical consultations precede the meeting with the child psychiatrist. We have not found difference in the care of children and adolescents according to gender. Only the period preceding the first medical consultation for psychiatric symptoms was longer in girls compared to boys. Access to care structures was easy and even in cases of geographical remoteness parents did not seem to privilege boys over girls

[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

[ 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