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2.
Arch Pediatr ; 20(4): 442-5, 2013 Apr.
Article in French | MEDLINE | ID: mdl-23414660

ABSTRACT

In child psychiatry, behaviour disorders in preschool children motivate frequently consultations. Indeed, from the nursery, young children, between 18months and 3years, present behaviours that alert the adults and disarm usually their parents. Unfortunately, this category of "catch-all" does not allow the childhood professionals to understand well the meaning of the disorder and to propose therapeutic strategies and/or educational properly adapted. This article offers an analysis of this psychopathological disorder, especially taking into account the nature of parent-child interaction during the different stages of development of this period.


Subject(s)
Mental Disorders , Child, Preschool , Humans , Infant , Mental Disorders/complications , Mental Disorders/etiology , Mental Disorders/psychology
3.
Encephale ; 37(3): 180-90, 2011 Jun.
Article in French | MEDLINE | ID: mdl-21703433

ABSTRACT

INTRODUCTION: In France, attention deficit disorder (ADHD) has traditionally met with two opposing approaches (biological and psychoanalytic). This conflict led us to conduct a multidisciplinary observational study, on a group of 36 children over a period of 1 year. METHODS: Thirty-six children with ADHD diagnostic (DSM IV), not treated by MPH were included. Initial "multi-field" evaluation (T0) consisted of: neuro-paediatric consultation (Conners questionnaire, Child Behaviour Checklist, reading and writing scores by French tests); semi-structured child psychiatric interview (DSM-IV axis I), structural hypothesis (CFTMEA), existence of narcissistic fragility, parents/child interactions; neuropsychological standardized evaluation (attention and executive functions); psychodynamic interview and projective tests (Rorscharch, CAT or TAT). A therapeutic project is proposed combining MPH and psychotherapy according to the results. A new evaluation 1 year later (T1) included a consultation and a neuropsychological evaluation. RESULTS T0: All parental questionnaires appreciating attention deficit and hyperactivity/impulsivity were significantly pathological. The neuropsychological evaluation showed usual characteristics of ADHD with individual differences. The psychiatric evaluation revealed the frequency of comorbidity in axis I (23% of children with more than two diagnoses, 57% with anxiety disorder, 23 and 3% with oppositional and conduct disorder). FOLLOW UP (T1): Thirty-one children were re-examined (20 treated by MPH and 11 not treated because of parental refusal or particular psychopathological situations). Psychoanalytical psychotherapy, proposed to 28 children, was undertaken with only 19. An improvement in scores for attention and executive tests was registered only in the treated group. DISCUSSION: The tests confirm deficits of attention and executive functions without correlation with the scores of questionnaires, underlining the need for a neuropsychological evaluation to objectify attention disorders. Projective tests refine and enrich psychiatric evaluation and showed that half of the children had borderline organization. However, structural hypotheses were heterogeneous, suggesting the need for specific therapeutic projects to be devised according to each child. The treated children were the only ones to improve attention deficit. On the other hand, the scores of anxiety are not improved by MPH, emphasizing the indications of psychotherapy if comorbidity is present. Psychotherapeutic care was carried out only among part of the population, because of parental reservations, exacerbated by differences of opinion among professionals and lack of access. CONCLUSION: This study is innovative, providing precise data on ADHD from a multidisciplinary perspective. Psychopathological comorbidity is high in this population, so the concept of ADHD cannot be limited to a cognitive point of view. These elements and doubts regarding the efficacy of behavioural therapies suggest the need for a rigorous evaluation of analytical psychotherapies independent of MPH to treat attention deficit.


Subject(s)
Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/therapy , Central Nervous System Stimulants/therapeutic use , Cooperative Behavior , Interdisciplinary Communication , Methylphenidate/therapeutic use , Psychoanalytic Therapy , Anxiety Disorders/diagnosis , Anxiety Disorders/psychology , Anxiety Disorders/therapy , Attention Deficit Disorder with Hyperactivity/psychology , Child , Combined Modality Therapy , Comorbidity , Executive Function , Female , Follow-Up Studies , France , Humans , Individuality , Male , Neuropsychological Tests , Patient Care Team , Patient-Centered Care , Personality Assessment , Referral and Consultation
5.
Ann Phys Rehabil Med ; 52(9): 623-37, 2009 Nov.
Article in English, French | MEDLINE | ID: mdl-19854122

ABSTRACT

AIMS: To study how physicians caring for adult patients presenting a chronic mental disturbance take account of the difficulties of their patients' children under 18. METHOD: Exploratory and qualitative study based on an in-depth study of interviews. STUDY POPULATION: Thirteen physiatrists or neurologists following brain-damaged patients and 12 psychiatrists following patients with chronic psychiatric disorders. RESULTS: In the two groups of physicians, diversified practices in catering for the issues of the patient's parenthood, child-parent relationships, and difficulties experienced by the child. The child's difficulties are not approached as such. For many of the physicians, representations of the parenting function, and of the child's needs and difficulties are not often used in work with the patient. Patient-centred care appears at odds with catering for the patient's children and their specific difficulties. The seriousness of the mental pathologies, their chronic nature, and the fact that they can affect the patient in his/her parental functioning and concerns, appear as factors in the reluctance of physicians. Other reasons are lack of familiarity with issues relating to childhood, and the feeling of encroaching on a private and intimate sphere. The representations of physicians with regard to parenthood, parent-child relations, and the needs and difficulties of children, are often not integrated into the corpus of knowledge. These issues are more often aspects of physicians' own experience. CONCLUSION: The conflict of values and the uneasiness of the physicians suggest the need for ethical reflection groups or Balint groups.


Subject(s)
Brain Injuries/psychology , Mental Disorders/psychology , Professional-Family Relations , Adult , Aged , Female , Humans , Male , Middle Aged , Parent-Child Relations , Pilot Projects , Practice Patterns, Physicians'
6.
Ann Readapt Med Phys ; 48(9): 650-61, 2005 Dec.
Article in French | MEDLINE | ID: mdl-15975682

ABSTRACT

OBJECTIVE: To explore the impact of brain injury of a parent on adolescent behavioural and emotional symptoms and personal experience. PATIENTS AND SETTING: Eleven adolescents from 13 to 18 years old with a brain-injured parent with cognitive impairment. MAIN OUTCOME MEASURES: Multiple case report. Assessment of anxiety and depression on the R-CMAS scale and the BDI. Qualitative analysis of a semi-structured interview and of the family drawing. RESULTS: Pathological scores on the R-CMAS scale involved 36% of the cases and the BDI, 45%. Impulsivity involved 36% of cases, difficulties in learning at school 73%, and somatic symptoms 45%. Feeling of loneliness involved 64% of cases and difficulty for the adolescent to speak about feelings in the family 82%. The symbolic position of the brain-injured parent was maintained in all cases. In 45% of cases, the parent was unable to recognize the adolescent, and in 55%, some characteristics of the adolescent were linked to the illness of the parent. A feeling of insecurity pervaded all cases. The family drawing revealed abnormalities in the bodily representation of the family members, especially a lack of hands or a representation of amputated hands in 91% of the cases and unsteadiness of the family members, also represented as ghosts in 82% of cases. CONCLUSION: Living with a brain-injured parent increases depression disorders, a feeling of loneliness and insecurity in adolescents. The inability for the adolescent to recognize parent's personality and the identification with caracteristics of the parent due to the illness is worrying. Abnormalities in the bodily representation of the family members and their unsteadiness are characteristic signs.


Subject(s)
Brain Injuries , Cognition Disorders , Family Health , Parents , Psychology, Adolescent , Adolescent , Affective Symptoms/etiology , Behavior , Brain Injuries/complications , Cognition Disorders/etiology , Emotions , Female , Humans , Male , Mental Disorders/etiology , Surveys and Questionnaires
7.
Psychoneuroendocrinology ; 28(3): 229-49, 2003 Apr.
Article in English | MEDLINE | ID: mdl-12573293

ABSTRACT

A number of findings from clinical and animal studies indicate that pro-inflammatory cytokines may play roles in eating disorders. The measurement of pro-inflammatory cytokines (IL-1, IL-6, TNFalpha), which are known to decrease food intake, provides highly variable data from which firm conclusions cannot be drawn. In most of the longitudinal studies where pro-inflammatory cytokines have been shown to be impaired in anorexia or bulimia nervosa, a return to normal values was observed after renutrition. However these findings do not exclude the possibility that pro-inflammatory cytokines might be overproduced in specific brain areas and act locally without concomitantly increased serum or immune production. It was also pointed out that the production of the major type-1 cytokines (especially IL-2) was depressed in anorexia nervosa. It remains unclear whether this is due to undernutrition or to a specific underlying cause common to eating disorders. The impaired cytokine profile observed in eating disorders could be related to several factors including impaired nutrition, psychopathological and neuroendocrine factors. More particular attention should be devoted to the deregulation of the anti/pro-inflammatory balance. Deregulation of the cytokine network may be responsible for medical complications in eating disorder patients who are afflicted with chronic underweight.


Subject(s)
Cytokines/physiology , Feeding and Eating Disorders/physiopathology , Cytokines/blood , Cytokines/cerebrospinal fluid , Feeding and Eating Disorders/blood , Feeding and Eating Disorders/cerebrospinal fluid , Humans , Neuroimmunomodulation/physiology , Neurosecretory Systems/physiology , Nutritional Status/physiology
8.
Biomed Pharmacother ; 56(2): 105-10, 2002 Mar.
Article in English | MEDLINE | ID: mdl-12000135

ABSTRACT

A growing body of evidence suggests that major depressive disorders may be accompanied by immune dysfunction and more particularly by an enhanced production of pro-inflammatory cytokines. The possible involvement of cytokines in depressive illness are based upon an analogic model. Pro-inflammatory cytokines are known to induce behavioral effects, and neuro-endocrine and immune activation similar to those observed in depression; these can be alleviated by antidepressant treatment. In this paper, we review research literature on the links between depressive illness and cytokine production and address further questions on this cytokine pathway. Further research is needed to see whether cytokines sustain specific depressive syndromes or whether cytokines induce depressive-like symptoms.


Subject(s)
Cytokines/metabolism , Depression/immunology , Depression/physiopathology , Acute-Phase Reaction , Antidepressive Agents/pharmacology , Brain/metabolism , Brain/physiopathology , Humans , Serotonin/biosynthesis
9.
Psychosom Med ; 63(3): 502-4, 2001.
Article in English | MEDLINE | ID: mdl-11382279

ABSTRACT

OBJECTIVE: Recent studies have indicated that the inflammatory cytokines could be implicated in anorexia nervosa and in its complications. To determinate the potential role of interleukins (IL-1, IL-2, IL-4, IL-6, IL-10), interferon (IFN gamma), tumor necrosis factor (TNF-alpha), and transforming growth factor (TGF-beta2) in anorexia nervosa, serum concentrations of these cytokines were measured in patients suffering from anorexia nervosa in comparison to healthy subjects. METHOD: Twenty-nine anorexic women according to DSM-IV criteria participated in the study. The control group consisted of 20 healthy women without eating disorders, mood disorders, and immunological disorders. RESULTS: We find that serum IL-2 and TGF-beta2 concentrations were both significantly decreased in anorexic patients, although the other cytokines did not differ significantly between the two groups. CONCLUSION: Our results show that in patients with anorexia nervosa, there are lower levels of specific cytokines (especially IL-2 and TGF-beta2). These levels may reflect the combination of impaired nutrition and weight loss, therefore, the dysregulation of these cytokines may contribute in anorexia's complications. Follow-up studies should examine the effects of parameters such as starvation, psychopathologic factors, and psychoneuroendocrinological perturbation which could affect interplay between cytokines, neuropeptides, and neurotransmitters.


Subject(s)
Anorexia Nervosa/metabolism , Cytokines/metabolism , Adolescent , Adult , Female , Humans , Interleukin-2/blood , Lymphotoxin-alpha/blood
10.
Encephale ; 26(5): 1-6, 2000.
Article in French | MEDLINE | ID: mdl-11192799

ABSTRACT

Patients suffering from eating disorder show elevated rates of alexithymia and depression. We compared alexithymia and depression ratings for non-hospitalized women meeting DSM IV criteria for anorexia nervosa (n = 32) and bulimia nervosa (n = 32) to healthy women (n = 74). Alexithymia was evaluated by the Toronto Alexithymia Scale (TAS-20) and depression by the Hospital Anxiety and Depression Scale (HAD). We found that TAS and HAD scores were significantly higher in anorexic compared to bulimic patients, although alexithymia and depression, as evaluated, were significantly and positively correlated with each other (r = 0.53, p = 0.001). Finally, a logistic regression with alexithymia and depression as independent variables showed a strong correlations between the HAD ratings and anorexia, but no correlations between TAS score and the eating disorder subgroups. In eating disorder patients, alexithymia, as evaluated by the Toronto Alexithymia Scale, seems to exhibit a thymo-dependent component which could be secondary to concurrent depression. Through recent studies and results of our research, we analyze and give several interpretations which may explain this correlation between alexithymia and depression.


Subject(s)
Affective Symptoms/psychology , Anorexia Nervosa/psychology , Bulimia/psychology , Depressive Disorder/psychology , Adolescent , Adult , Affective Symptoms/diagnosis , Anorexia Nervosa/diagnosis , Bulimia/diagnosis , Depressive Disorder/diagnosis , Female , Humans , Personality Inventory
12.
Eur J Pharmacol ; 128(1-2): 93-8, 1986 Aug 22.
Article in English | MEDLINE | ID: mdl-2875894

ABSTRACT

The effects of chlorpromazine, pipotiazine, haloperidol, domperidone, sulpiride and SCH 23390 on the potassium-evoked release of [3H]acetylcholine [( 3H]ACh) were studied in rat striatal slices. All 5 dopamine (DA) antagonists with D-2 blockade efficacy induced an increase of [3H]ACh release whereas the specific D-1 antagonist SCH 23390 was devoid of significant effects. The maximal effect (about 100% increase) was obtained with haloperidol, pipotiazine and sulpiride but not with domperidone and chlorpromazine. Interestingly, sulpiride was found to exert an unexpected marked potency. The comparison of the activities of the 6 compounds on evoked ACh release to their affinities for D-2 receptors [( 3H]N-propylnorapomorphine binding sites) indicates that the pharmacological profile of the dopamine receptor implicated in the regulation of ACh release cannot be superimposed on that of the classical D-2 receptor. Participation of DA presynaptic receptors could however explain the differences in efficacy observed with the compounds studied.


Subject(s)
Acetylcholine/metabolism , Corpus Striatum/drug effects , Dopamine Antagonists , Receptors, Dopamine/drug effects , Animals , Benzazepines/pharmacology , Chlorpromazine/pharmacology , Domperidone/pharmacology , Haloperidol/pharmacology , In Vitro Techniques , Male , Phenothiazines/pharmacology , Rats , Rats, Inbred Strains , Receptors, Dopamine D2 , Sulpiride/pharmacology
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