[The concept of paedophilia. Part 2: Etiologies, forensic aspects and therapeutic options]. / Le concept de pédophilie. Partie 2 : Hypothèses étiologiques, aspects médico-légaux et stratégies thérapeutiques.

Paedophilia is a paraphilia characterised by behaviour, drives or sexual fantasies that are intense and recurring and that generally involve children. This sexual deviation is often linked to personal distress, to a significant alteration of personal, family, professional and social life, in a general sense. In our modern Western societies, paedophilia and the perversions associated with it are punishable by law. Paedophilia is a concept that is very ancient, complex and particularly diverse in its many clinical presentations. Its societal impact is very important and contrasts with the real knowledge of this issue among non-specialists, or even among specialists. In this second part of the article, the authors will develop the aetiologies of paedophilia, the therapeutic options and the forensic aspects.

La pédophilie est une paraphilie caractérisée par des comportements, des pulsions ou des fantasmes sexuels intenses et récurrents qui impliquent, de manière générale, les enfants. Cette déviance sexuelle s'accompagne souvent d'une souffrance personnelle, d'une altération significative du fonctionnement personnel, familial, professionnel et, au sens large, social. Dans nos sociétés occidentales modernes, la pédophilie et les perversions s'y rapportant sont condamnées par la loi. La pédophilie est un concept très ancien, complexe et surtout hétérogène. Son impact sociétal est très important et contraste avec le degré de connaissance réel de cette déviance parmi les non spécialistes et même parmi les spécialistes. Dans la seconde partie de cet article, les auteurs vont développer les hypothèses étiologiques, les principales options thérapeutiques et quelques aspects médico-légaux.

[The concept of paedophilia. Part 1 : Historical background and nosology]. / Le concept de pédophilie. Partie 1: Historique et nosologie.

Paedophilia is a paraphilia characterised by behaviour, drives or sexual fantasies that are intense and recurring and that involve children, in a general sense. This sexual deviation is often linked to personal distress, to a significant alteration of personal, family, professional and social life, in a general sense. In our modern Western societies, paedophilia and the perversions associated with it are punishable by law. Paedophilia is a concept that is very ancient, complex and particularly diverse in its many clinical presentations. Its societal impact is very important and contrasts with the real knowledge of this issue among non-specialists, or even among specialists. Based on expert clinical experience gathered at the courts and on an exhaustive review of current literature on the subject, the authors propose an update of the concept of paedophilia. In the first part of this work, the authors will discuss several aspects such as the historical background and the clinical aspects and nosography of paedophilia. This literature review will be accompanied by short clinical vignettes, based on the authors' clinical experience.

La pédophilie est une paraphilie caractérisée par des comportements, des pulsions ou des fantasmes sexuels intenses et récurrents qui impliquent, de manière générale, les enfants. Cette déviance sexuelle s'accompagne souvent d'une souffrance personnelle, d'une altération significative du fonctionnement personnel, familial, professionnel et, de manière générale, social. Dans nos sociétés occidentales modernes, la pédophilie et les perversions s'y rapportant sont condamnées par la loi. La pédophilie est un concept très ancien, complexe et surtout hétérogène. Son impact sociétal est très important et contraste avec le degré de connaissance réel de cette déviance parmi les non-spécialistes et même parmi les spécialistes. En se basant sur une expérience clinique d'expert auprès des tribunaux et sur une revue exhaustive de la littérature actuelle, les auteurs proposent une actualisation du concept de pédophilie. Cette revue de littérature sera accompagnée de courtes vignettes cliniques issues de l'expérience clinique des auteurs.

[Forensic Psychiatry in Belgium in 2020]. / La psychiatrie légale en Belgique en 2020.

Forensic psychiatry is a medical (sub-) speciality covering a variety of different fields, such as general psychiatry, criminology, law, anthropology and sociology. Experts in forensic psychiatry are required to have a base of specific training, eclectic knowledge and correct ethical and professional practice. The cross-disciplinary nature of forensic psychiatry means that it demands flexibility, procedural rigour and a continuous dialogue between the medical field and the legal profession. The aim of this article is to provide an overview of the evolution in this field, which is very specific and also essential to today's democracy. Indeed, forensic psychiatry can be traced all the way back to Antiquity, but it has undergone profound changes in the last few years, with the field gaining recognition and its practices becoming increasingly professionalised. This is indeed excellent news.

La psychiatrie légale est une spécialité médicale s'inscrivant au carrefour de différentes disciplines, telles la psychiatrie générale, la criminologie, le droit, l'anthropologie et la sociologie. La psychiatrie légale exige de ses experts une formation de base spécifique, des connaissances éclectiques ainsi que de bonnes pratiques éthiques et déontologiques. Par son caractère transdisciplinaire, elle exige de ses praticiens une flexibilité d'esprit, une rigueur procédurale et un dialogue constant entre médecine et droit. L'objectif de cet article est de faire le point sur l'évolution de cette discipline si particulière et essentielle à notre démocratie actuelle. En effet, la psychiatrie légale trouve son origine dans l'Antiquité, mais elle a connu, ces dernières années, de profondes transformations comme la reconnaissance de la discipline et la professionnalisation de sa pratique. Et c'est une excellente nouvelle.

[Terrorism and human behavior]. / Terrorisme et comportement humain.

OBJECTIVES: Theories of religion are essential for understanding current trends in terrorist activities. The aim of this work is to clarify religion's role in facilitating terror and outline in parallel with recent theoretical developments on terrorism and human behaviour. METHODS: Several databases were used such as PubCentral, Scopus, Medline and Science Direct. The search terms "terrorism", "social psychology", "religion", "evolution", and "cognition" were used to identify relevant studies in the databases. RESULTS: This work examines, in a multidimensional way, how terrorists employ these features of religion to achieve their goals. In the same way, it describes how terrorists use rituals to conditionally associate emotions with sanctified symbols that are emotionally evocative and motivationally powerful, fostering group solidarity, trust, and cooperation. Religious beliefs, including promised rewards in the afterlife, further serve to facilitate cooperation by altering the perceived payoffs of costly actions, including suicide bombing. The adolescent pattern of brain development is unique, and young adulthood presents an ideal developmental stage to attract recruits and enlist them in high-risk behaviors. CONCLUSIONS: This work offers insights, based on this translational analysis, concerning the links between religion, terrorism and human behavior.

[Childhood in sex offenders; A retrospective study]. / L'enfance chez les auteurs de crimes sexuels; une étude rétrospective.

BACKGROUND: This retrospective and observational study is based on the hypothesis that sex offenders have experienced trauma and/or educational dysfunction which have a responsibility in theirs crimes of sexual type. The purpose of this study is to highlight these disturbances, develop a typology of sex offenders and offer a reflection on elements which allowed their acting out. METHODS: Two groups were selected. A group of 31 patients having committed criminal offences or murders and having been determined as mentally irresponsibles of their act (" Défense Sociale " in Belgium). This group was compared to a group of 31 patients consulting a general practitioner. A survey and a personal interview were used. Most of this questions came from Thomas Achenbach's Child Behavior Checklist (this questionnaire highlight psychiatric disorders or pathological behaviors in childhood). The inclusion criteria were: male patients major in social defense; single or series rape(s) (accompanied or not by murder); incest; pedophilia; intelligence quotient greater than or equal to 80 (determined by the scale WAIS). RESULTS: The anova test results showed a statistically significant difference between the two groups (p ⟨ 0,00063). Several different profiles of rapists were established. CONCLUSION: Indeed, patient group shows more trauma such as sexual abuse (9.8 times more) and physical abuse (3.1 times more) than the control group. Three factors were identified as a condition to an achieved rape: a pathological family dynamic, impaired impulse control and an empathic deficit.

INTRODUCTION: Cette étude rétrospective et observationnelle se base sur une hypothèse de travail postulant que les délinquants sexuels auraient évolué dans une dynamique familiale pathologique comprenant des dysfonctions éducatives et/ou des éléments traumatiques. Les buts de cette étude sont de mettre en évidence les perturbations familiales qu'ils auraient subies durant l'enfance, d'élaborer une typologie actuelle de ces délinquants en défense sociale et de proposer une réflexion sur les éléments qui ont permis leur passage à l'acte. METHODES: Deux groupes ont été sélectionnés. Le groupe de patients est représenté par 31 AICS (Auteurs d'Infractions à Caractère Sexuel) choisis aléatoirement en Défense Sociale belge en 2013 et ayant répondu à un questionnaire. Ce groupe a été comparé à un autre groupe de 31 patients ayant répondu au même questionnaire anonyme dans la salle d'attente d'un médecin généraliste. Ce questionnaire a été inspiré de la Child Behavior Checklist qui est utilisée pour mettre en évidence des comportements pathologiques de l'enfant et de l'adolescent. Les questions étaient donc ciblées dans leur passé, lorsqu'ils étaient enfants et adolescents. RESULTATS: Le test anova (p ⟨ 0,00063) montre une différence significative des scores entre les deux groupes pour les questions fermées. En effet, le groupe d'AICS présente un score plus élevé dans les paramètres scorés des réponses fermées (plus d'abus sexuels, plus de toxicomanies, etc.). Pour les pédophiles, l'étude a permis de mettre en évidence plusieurs facteurs qui orientent la pulsion sexuelle préférentiellement vers l'enfant plutôt que vers l'adulte. Les violeurs de femmes adultes semblent présenter davantage de traits sadiques. Différents profils d'AICS ont pu être établis. CONCLUSION: Le passage à l'acte du viol met en évidence sur les patients de l'étude trois facteurs nécessaires à son déroulement : une dynamique familiale pathologique, des troubles du contrôle des impulsions et un déficit empathique. Les résultats de cette recherche pourraient permettre d'apporter des informations concernant les différentes étiologies motivant leur passage à l'acte afin de mieux cibler le traitement pour diminuer le risque de récidive.

[The setting in observation and involuntary treatments: a conversation between the law and medicine]. / La mise en observation et les soins sous contrainte: une conversation entre le droit et la médecine.

The law of June 26, 1990 (protection measure of the mental patients) has replaced the old law of collocation of 1850 (review in 1873). Conceived in the line of the principles of the European Convention of the Humans right, it constitutes an important reform of the involuntary treatment of the mental patients and recalls, without any doubt, that the patient is prone of right. The article describes the scope of application of the law of June 26, 1990, and the methods of initiation of a protection measure. Then, the measure in a hospital environment (ordinary procedure and urgent procedure), as well as the measure in a family environment are approached in their waning. Furthermore, the author discusses the networks between physicians and lawyers and the difficulty to communicate between these two worlds, such as Justice and Medicine.

[Anorexia nervosa: bioelectrical impedance analysis in body composition measurement during hospitalization]. / Anorexie mentale: etude de la composition corporelle mesurée par impédancemétrie en cours d'hospitalisation.

Monitoring parameters for anorexia nervosa include clinical, biological and psychological factors. Many research groups are currently trying to identify parameters more likely to predict the severity or the evolution of the illness. Body composition has been proposed as one of those parameters. The aim of the present study is to demonstrate that measures of body composition are more accurate and efficient than the use of body composition index (BMI). We also aim to show that body composition could be used as a prognostic factor in the long-term evolution of patients with anorexia nervosa. It's a retrospective study investigating body composition and BMI in 44 patients treated in a specialized unit for eating disorder. Measures of body composition and BMI were gathered at the time of admission and again 3 months after refeeding onset. Data was correlated to the EDI-2 questionnaire scores. BMI and %FM where found to be increased (P < 0.05) between admission and after 3 months refeeding. The double objective of reaching a BMI value > or = 20 kg/m2 and a %FM value > or = 2% was achieved by 22% of patients. No significant correlation was found between EDI-2 scores and measures of BMI and %FM either on admission or after the 3 months refeeding period. In conclusion, results of our study don't allow concluding for a prognostic superiority of %FM. Nonetheless, BMI currently used as a reference for the monitoring of eating disorders patients seems to lack sensitivity where measures of body composition seem more informative regarding nutritional status. Furthermore, fat mass plays an important role in other clinical manifestations. In addition, measures of body composition should allow more individualised therapeutic support.

[Psychotropics, pregnancy, lactation and neurodevelopmental issues: a review]. / Psychotropes, grossesse, allaitement et conséquences neurodéveloppementales: une revue de la littérature.

Young women are at risk of mental problem during pregnancy and postpartum. It is particularly important that the mental health of childbearing women is stable. However, all psychotropic medications diffuse across the placenta and are excreted into breast milk. The fetus is thus at risk of teratogenicity and postnatal behavioural sequelae. Which are today the psychotropics that can take up the challenge of minimizing the risk for the foetus and at the same time limiting the impact of morbidity on the mother ? Medical literature of last ten years is reviewed. The safety issue of psychotropic's use during pregnancy and lactation is still unresolved. Little information is available concerning developmental outcome of children exposed to medication, especially about newer molecules even though recent case reports are encouraging. Larger standardized studies are still needed.

[The serial murder: a few theoretical perspectives]. / Le meurtre en série: quelques perspectives théoriques.

Despite numbers of publications and effort to try to establish the definition, the classification, the epidemiology, the clinical aspects and the psychopathology of serial killers, a universal consensus seems to say the least. Crime, though reduced in some countries, appears to impact more and more consistent worldwide, generating controversial ideas and a multitude of possible explanations. The serial killer usually presents as a caucasian man, aged between 20 and 40 years, often embedded socially and in his family, but with serious psychiatric, personal and especially family history. Usually acting alone, the serial killer plans a crime well in advance, but sometimes within the scope of impulsivity for a minority, the victim not being previously selected. In the latter case, an actual mental illness like psychosis is found. It is clear from numerous psychopathological studies conducted so far that most serial killers are defined as psychopathic sexual sadists, whose childhood was difficult, if not flouted, punctuated by physical and psychological violence situations. In addition, pervasive fantasies combined with thoughts of death, sex and violence are as much in common with the original acts of which they are the instigators. Beyond a relentless media that is constantly watering the public with stories and pictures depicting them as such, serial killers remain an enigma. We can therefore attempt to answer the various questions raised by this phenomenon, the way these people operate and how we can curb the rise, thanks to the neurobiological and neurophysiological approaches that science offers us.

[The female psychopath: a review]. / La psychopathie féminine: une revue de la littérature.

Psychopathy related research has traditionally focused on males. Today, numerous evidences testify to the existence of the disorder in women. Nevertheless the possibility to transpose this concept unchanged to women is debated, as it was initially developed in male populations. Current researches didn't notice major gender differences in the structure of the disorder. Nevertheless, one note differences in the prevalence measurement and in the mean score of psychopathy according to usual diagnostic scales. The prevalence rates are generally lower among women, and men seem to have higher mean scores on psychopathy measures. Furthermore, man and woman share most of interpersonal and affective traits as well as psychopathic behaviours, but they may rely on different tactics to achieve the same goals. Considering these differences, the increase of the female criminality speaks to the need for understanding more the construct of the disorder in women, for validating results already obtained with larger samples and for developing objective and adapted evaluating instruments to predict reliably reoffends, institutional structures and treatment response. Secondly it would be interesting to enlighten early factors that may affect, predict or moderate the expression of the disorder, in a preventive goal.

Decreased neuroautonomic complexity in men during an acute major depressive episode: analysis of heart rate dynamics.

Major depression affects multiple physiologic systems. Therefore, analysis of signals that reflect integrated function may be useful in probing dynamical changes in this syndrome. Increasing evidence supports the conceptual framework that complex variability is a marker of healthy, adaptive control mechanisms and that dynamical complexity decreases with aging and disease. We tested the hypothesis that heart rate (HR) dynamics in non-medicated, young to middle-aged males during an acute major depressive episode would exhibit lower complexity compared with healthy counterparts. We analyzed HR time series, a neuroautonomically regulated signal, during sleep, using the multiscale entropy method. Our results show that the complexity of the HR dynamics is significantly lower for depressed than for non-depressed subjects for the entire night (P<0.02) and combined sleep stages 1 and 2 (P<0.02). These findings raise the possibility of using the complexity of physiologic signals as the basis of novel dynamical biomarkers of depression.

The impact of chronic primary insomnia on the heart rate--EEG variability link.

OBJECTIVE: To determine if chronic insomnia alters the relationship between heart rate variability and delta sleep determined at the EEG. METHODS: After one night of accommodation, polysomnography was performed in 14 male patients with chronic primary insomnia matched with 14 healthy men. ECG and EEG recordings allowed the determination of High Frequency (HF) power of RR-interval and delta sleep EEG power across the first three Non Rapid Eye Movement (NREM)-REM cycles. Interaction between normalized HF RR-interval variability and normalized delta sleep EEG power was studied by coherency analysis. RESULTS: Patients showed increased total number of awakenings, longer sleep latency and wake durations and shorter sleep efficiency and REM duration than controls (p<.01). Heart rate variability across first three NREM-REM cycles and sleep stages (NREM, REM and awake) were similar between both groups. In each group, normalized HF variability of RR-interval decreased from NREM to both REM and awake. Patients showed decreased linear relationship between normalized HF RR-interval variability and delta EEG power, expressed by decreased coherence, in comparison to controls (p<.05). Gain and phase shift between these signals were similar between both groups. CONCLUSIONS: Interaction between changes in cardiac autonomic activity and delta power is altered in chronic primary insomniac patients, even in the absence of modifications in heart rate variability and cardiovascular diseases. SIGNIFICANCE: This altered interaction could reflect the first step to cardiovascular disorders.

[Psychopathy: from "The Mask of Sanity" to social neurosciences]. / La psychopathie: depuis "The Mask of Sanity" aux neurosciences sociales.

Although psychopathy has traditionally been cited as a disorder of personality, confusion arises as the term is used interchangeably with the terms antisocial personality disorder of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV TR) or dissocial personality disorder, both of which are largely behaviorally based. This paper aims to provide a clinical and scientific overview of the literature on the topic of psychopathy, which examines this conundrum. This article begins with a wee bit of history about Hervey Cleckley's work, The Mask of Sanity, and then presents the definitions and nosography of psychopathy, focusing on the distinction between the antisocial psychopath and the successful psychopath. The discussion will then lead on the epidemiological aspects and diagnosis, especially psychometric and measurement tools used to assess psychopathy in the individual: Hare's Psychopathy Checklist-Revised (PCL-R), as this is the most frequently used and validated measure of psychopathy. The second section of the article reviews several studies dealing with structural and functional neuroimaging in psychopaths. The final part of this overview considers the treatment and interventions that are available to psychopathic offenders and the implications for future research, especially in terms of prevention. This review demonstrates that studies and further research are still required in psychopathy, particularly using functional neuroimaging techniques, as fMRI and magnetoencephalography, that can describe the functional neuroanatomy of human emotion. Today, cognitive and social neurosciences constitute one of the most promising way to study psychopathy.

The modifications of the long-range temporal correlations of the sleep EEG due to major depressive episode disappear with the status of remission.

OBJECTIVE: The aim of the present study is to investigate the scaling properties of the sleep electroencephalogram (EEG) in remitted depressed men, and to evaluate if a past history of major depressive disorder (MDD) could modify significantly and definitively, as a "scar marker," the dynamics of the sleep EEG time series. METHODOLOGY: Whole night sleep electroencephalogram signals were recorded in 24 men: 10 untreated depressed men in full to partial remission (42.43+/-5.62 years) and 14 healthy subjects (42.8+/-8.55 years). Scaling properties in these time series were investigated with detrended fluctuation analysis (DFA) (time range: 0.16-2.00 s). The scaling exponent alpha was determined in stage 2, in slow wave sleep (stages 3 and 4), and during rapid eye movement (REM) sleep. Forty-five epochs of 20 s were chosen randomly in each of these stages for each subject in both groups. RESULTS: We did not observe a significant difference and deviation of the scaling exponents between the two groups during the three sleep stages of interest. CONCLUSION: In this study, we do not observe any functional sequelae of a past history of one or more unipolar major depressive episode on the fluctuation properties of the sleep EEG. This finding is a sign of similar underlying neuronal dynamics in healthy controls and patients with a lifetime history of MDD. This study gives an additional argument to the theory that depression does not modify definitively the dynamics of the neuronal networks and is therefore against the "depressive scar hypothesis," in which permanent residual deficit is created by the acute state of the depressive disease.

[Neurophysiological and clinical aspects of psychophysiological insomnia]. / Aspects cliniques et neurophysiologiques de i'insomnie psychophysiologique.

Nowadays, a high percentage of the population in modern societies suffers from various kinds of sleep disturbances, in part due to the impact of increased socio-cultural stress factors. The most common sleep complaint is insomnia. Psychophysiological insomnia is one of the most frequent forms of sleep disturbances. It is a type of conditioned or learned insomnia that is presumably derived from two sources. The first involves the conditioning of sleep-preventing habits in which repeated pairing of sleeplessness and situational, temporal, or behavioural stimuli normally associated with sleep leads to conditional arousal that impairs sleep. The second involves somatised tension believed to result from the internalisation of psychological conflicts and excessive worrying about sleep, which are incompatible with sleep. Quantitative EEG approach, particularly with spectral analysis, has recently refined the analysis of the EEG in sleep. These EEG quantification techniques are now very useful to understand the neurophysiological basis of a lot of sleep disorders, particularly in the case of psychophysiological insomnia.

Characterization of the sleep EEG in acutely depressed men using detrended fluctuation analysis.

OBJECTIVE: The aim of the present paper is to study the fluctuations of the sleep EEG over various time scales during a specific pathological condition: major depressive episode. Focus is made on scaling behaviour, which is the signature of the absence of characteristic time scale, and the presence of long-range correlations associated to physiological constancy preservation, variability reduction and mostly adaptability. METHODS: Whole night sleep electroencephalogram signals were recorded in 24 men: 10 untreated patients with a major depressive episode (41.70+/-8.11 years) and 14 healthy subjects (42.43+/-5.67 years). Scaling in these time series was investigated with detrended fluctuation analysis (time range: 0.16-2.00s). Scaling exponents (alpha) were determined in stage 2, slow wave sleep (stages 3 and 4) and during REM sleep. Forty-five epochs of 20s were chosen randomly in each of these stages. RESULTS: The median values of alpha were lower in patients during stage 2 and SWS. CONCLUSIONS: Major depressive episodes are characterized by a modification in the correlation structure of the sleep EEG time series. The finding which shows decreasing rate of the temporal correlations being different within the two groups in stage 2 and SWS provides an electrophysiologic argument that the underlying neuronal dynamics are modified during acute depression. SIGNIFICANCE: The observed modifications in scaling behaviour in acutely depressed patients could be an explanation of the sleep fragmentation and instability found during major depressive episode.