Self-representation in Kleine-Levin syndrome: a single case fMRI study.

Kleine-Levin syndrome (KLS) is characterized by recurrent episodes of hypersomnia, compulsive hyperphagia, disinhibition, hypersexuality and self modifications. To investigate the Self, we used afunctional magnetic resonance imaging paradigm evaluating Self-reference processing (SRP) and Self-reference effect (SRE) in a17-year-old male adolescent at the end of an episode. We observed enhanced activations in right hemisphere and posterior areas- associated with physical Self representations- during the SRP condition, while during the SRE condition, enhanced activations in bilateral but prevailing left frontal areas- associated with the conceptual Self. These results suggest amodified Self during aKLS episode being more physically grounded.

High-risk behaviours for the fœtus in pregnant women: The medicolegal and judicial aspects.

Pregnancy is a period of psychological change which may lead to difficulties of adaptation and psychological suffering and give rise to high-risk behaviours for the fœtus in pregnant women. These risk behaviours, which are defined by certain authors as a form of "maltreatment" of the fœtus, usually spring from the psychological distress of the pregnant woman but are not recognised as a specific medical disorder. We illustrate the difficulties encountered in the identification of, and the specific intervention in, these situations through the clinical case of a pregnant drugs-dependent patient subjected to several stress factors who, in addition to consuming substances, developed high-risk behaviours for herself and her pregnancy: self-endangerment under the influence of substances, falls or refusals of treatment. In our first part, we discuss the medicolegal possibilities afforded by French law to protect the fœtus in the event of the future mother's high-risk behaviours. In our second part, we discuss the successive evolutions of the legal status of the fœtus and pregnancy, and their consequences for medical practice and the clinical situations concerned. The lack of an answer concerning the designation of these behaviours, as either medical, legal or social acts, will prompt perinatal practitioners to a certain medicolegal prudence.

[Life-threatening sleepwalking (Elpenor's syndrome) in a 10-year-old child]. / Somnambulisme avec mise en danger vital (syndrome d'Elpénor) chez un enfant.

Though benign in the majority of cases, sleepwalking sometimes causes injuries due, among other causes, to falls. Such accidents can be life-threatening - a situation that has been termed Elpenor syndrome (in reference to an accident experienced by a character in Homer's epic The Odyssey) - in particular when entailing defenestration. This syndrome has been described in adults and adolescents; we report here a case in a child. OBSERVATION: This 10-year-old girl was admitted at night to our hospital after a 3-m fall at home. She was alert (Glasgow score, 15) at admission; a frontal wound and a deformation of the right wrist were noted. Brain CT scans showed a frontal skull fracture and frontal lobe contusion, wrist x-rays showed a displaced right fracture. The patient underwent urgent neurosurgery (wound excision and suture after reduction of skull fracture) and closed reduction and immobilization of the wrist fracture, both under general anesthesia. She underwent a psychiatric assessment in the intensive care unit 3 days after her fall. She was alert, well-oriented in time and space, and spoke fluently. She had no memory of her fall, only remembering going to bed in the evening before the accident and waking up in the ambulance on the way to the hospital. She displayed no sign of a concurrent mental illness and no suicidal ideas. Her parents reported that the evening of the accident she and her two brothers had all fallen asleep about 11:00 pm while watching TV, in the double bed of the guest room, placed just beside its window. At approximately 1:00 am, her father, who was going to bed and had just made noise in the hall, heard a cry from the guest room. He entered the room immediately and saw the opened window and his daughter lying on the outside ground; the brothers only awakened after the fall. The family had returned 2 days before from a 6-month stay in the United States, with jet-lag, sleep deprivation, and a disorganized sleep/wake rhythm in the patient. There was no medication before the accident, no substance use (including caffeine), and no concurrent medical problem. Over the 2 preceding years, the patient had undergone two witnessed episodes of early-nighttime arousal with altered consciousness and calm wandering (including going downstairs on one occasion), both strongly suggesting sleepwalking. There was a history of sleepwalking in her father and her older brother. Life-threatening sleepwalking (Elpenor syndrome) was diagnosed. The child and her parents were educated about sleepwalking; regularization of sleep schedules and sleep extension (avoidance of sleep deprivation, short napping when possible) were prescribed. We also recommended securing the home (bed, windows, and stairways). No pharmacological treatment was instituted. During the following 18 months, the child manifested only one noted sleepwalking episode, without risk-taking. She had no neurological or psychopathological sequela from her accident, of which she never had a memory. CONCLUSION: Elpenor syndrome can occur in a child; consequently, it is important to inform parents of children with sleepwalking about the necessity of always securing the night-time environment.

[A cross-sectional study of trait-anxiety in a group of 111 intellectually gifted children]. / Étude transversale de l'anxiété trait dans un groupe de 111 enfants intellectuellement surdoués.

INTRODUCTION: Intellectually gifted children are often thought to display a high risk for psychopathology. However, this assertion has received only few direct arguments to date, and there is in fact a lack of knowledge on this subject. The aim of this study was to compare trait-anxiety - which is considered as a sensitive and early indicator of psychoaffective difficulties in children - in intellectually gifted children to the norm. METHODS: One hundred and eleven children aged 8 to 12 and with an intellectual quotient (IQ) higher than 129 participated in the study. They were recruited in a hospital department of child and adolescent psychiatry and through psychologists' private practice, where they attended consultation because of academic underachievement and/or social maladjustment. All the children were examined by trained psychiatrists and psychologists: none had a present or past medical or psychiatric condition and, additionally, none had an elevated score on the French version of the Children's Depressive Rating Scale Revised (Moor & Mack, 1982). Parents filled in a questionnaire for the collection of socio-demographic data and children answered the French version of the Revised-Children's Manifest Anxiety Scale (R-CMAS; Reynolds, 1999), a 37-items self-assessment of trait-anxiety, the psychometric properties of which have been validated in children with high IQ. DATA ANALYSIS: Mean scores and subscores on the R-CMAS in the whole studied group and as a function of gender and age were compared to French normative data (Reynolds, 1999) by calculation of 95% confidence intervals; subgroups were compared using Student's t-tests. Proportions of children who's score and subscores exceeded anxiety cut-off norms were compared to normative data using chi-square tests. Statistical significance was considered at the P<0.05 level. RESULTS: The studied group comprised mainly boys, and members of a sibling. Parents mainly lived as man and wife, had high academic levels, and had a professional activity. The confidence intervals of the R-CMAS scores and subscores all comprised their normative value, which denotes that no difference was statistically significant. Comparisons for age and gender showed no significant difference. Proportions of results exceeding the cut-off scores and subscores did not significantly differ from the norms. DISCUSSION: General and dimensional trait-anxiety levels in the studied group were comparable to normative data. These results are in accordance with previous studies of trait-anxiety in children and adolescents with high IQ, which all showed normal or decreased levels. These findings do not corroborate the hypothesis that intellectual giftedness constitutes a risk factor for psychopathology. LIMITS: The studied group was a clinical one, which could limit the generalisation of the results. However, mental disorders were ruled out, and the psychometric and socio-demographic characteristics of the group were in keeping with those described for the general population of gifted children. Moreover, considering that participant children displayed academic underachievement and/or social maladjustment, it can be supposed that their anxiety levels were not lower than those in the general population of gifted children. Secondly, the potentially confusing effect of socio-demographic variables (underrepresentation of low socio-economic levels and single-parent families) could not be statistically taken into account, due to the absence of a specific control group. CONCLUSION: Intellectually gifted children seem not to display increased trait-anxiety. However, further studies are necessary to investigate psychological functioning in gifted children and their risk for psychopathology.

[Dreaming is a hypnic state of consciousness: getting rid of the Goblot hypothesis and its modern avatars]. / Le rêve est un état hypnique de la conscience : pour en finir avec l'hypothèse de Goblot et ses avatars contemporains.

SUMMARY: In the late nineteenth century, French logician Edmond Goblot first hypothesized that dreaming occurred at the moment of awakening only. Revisiting--more or less directly--Goblot's hypothesis, several contemporary authors have since renewed this unusual claim that oniric experience does not occur during sleep. So did some influential analytical philosophers (Wittgenstein, Malcolm, Dennett), with their typical formalism, and famous dream researcher Calvin Hall, who tried to provide experimental evidence for the Goblot's hypothesis. More recently, French neurobiologist Jean-Pol Tassin claimed, on the basis of controversial neurobiological and cognitive principles, that only awakening gives rise to a dream, by instantaneous shaping of information issuing of neural networks activated during preceding sleep. Actually, numerous and robust experimental data in sleep psychophysiology clearly rule out Goblot's hypothesis and its modern avatars. Thus, results of studies using nocturnal awakenings (with or without preceding hypnic stimulation), as well as observations of onirical behaviours (like rapid eye movement sleep behavior disorders, or voluntary movements of lucid dreamers) demonstrate that dreaming definitely occurs during sleep. Actually, cortical evoked potentials can be observed during sleep, which likely reflect controlled cognitive processes. Dreaming is a hypnic state of consciousness, and seems to represent a sleep thought which, although uneasily accessible, is nevertheless open to psychological investigation.