[Fragile X syndrome and very early onset schizophrenia: a female case study]. / Syndrome de l'X fragile et schizophrénie à début très précoce : à propos d'un cas féminin.

Genotype-phenotype relationship studies for psychiatric disorders in females carrying fragile X syndrome full mutation and premutation underline association with schizo-affective disorders. In female children with X fragile full mutation, only behavioural symptoms and no standardised psychiatric disorders have been systematically explored. Therefore, we report the case of a nine-year-old girl carrying the fragile X syndrome full mutation with a comorbid childhood onset schizophrenia (COS), and of her mother carrying the fragile X syndrome premutation and a comorbid schizotypal personality disorder. The impact of these associations is discussed regarding the recent literature in chromosome anomalies in COS.

[Attention deficit-hyperactivity disorder or juvenile mania]. / Trouble déficit de l'attention/hyperactivité ou manie de l'enfant.

In recent years, the relationship between juvenile mania and attention deficit hyperactivity disorder has been the focus of renewed clinical research and controversial debates. We have reviewed the recent literature about bipolar disorder and juvenile mania in children in order to clarify the knowledge in assessment, phenomenology and diagnosis of prepubertal bipolar disorder. Despite the fact that prepubertal mania has been recognized, there is no consensus on the diagnostic criteria. The symptomatic overlap and comorbidity of juvenile mania with attention deficit hyperactivity disorder has produced confusion. As prospective studies are not yet contributive because of the heterogeneity of samples and criteria, one cannot consider these manic children as truly cases of bipolar disorder.

A French study of the Dominic Interactive.

INTRODUCTION: The Dominic Interactive was developed in North America to assess a child's perception of her/his own symptoms, which is critical to balance parents' and school professionals' perception. It is a computerized, DSM-IV-based pictorial questionnaire akin to a video game, for children aged 6-11. A strengths and competencies scale displays positive situations. Most children complete the Dominic Interactive 90 situations within 10-15 min. OBJECTIVE: Because of the cultural differences between North American and French children, a study of the appropriateness of the instrument to assess French children was required. METHODS: The CD-ROM-based Dominic Interactive was completed by 253 community children, and by 150 children from outpatient clinics in four French cities. The latter also received clinical diagnoses. Prevalence estimates yielded by the Dominic Interactive in the general population and referred children, relationships between prevalence estimates based on the Dominic Interactive and clinical judgments, and differences between Dominic Interactive scores in sub-samples of children with and without a clinical diagnosis were studied. RESULTS: Significant differences between clinically referred and non-referred children were found for every diagnosis, and between Dominic Interactive scores of referred children with and without a clinical diagnosis with the exception of oppositional disorder. Parental acceptability of the instrument was never a problem, children like it, and clinicians' comments were positive. DISCUSSION: Reference and clinical judgment both indicate that the Dominic Interactive is appropriate to assess child mental health in France. Clinical judgment discrepancies between sites and small numbers are the limitations of this study. CONCLUSION: The instrument performed well in the French context. The potential advantages of using the Dominic Interactive (children enjoy the activity, parents approve of it, it is relatively cost-effective, etc.) suggest its applicability in other settings.

Central pre- and postsynaptic 5-HT1A receptors in rats treated chronically with a novel antidepressant, cericlamine.

Biochemical and electrophysiological approaches were used to assess the possible changes in 5-hydroxytryptamine (serotonin) 5-HT1A receptors in the rat brain after a long-term treatment with cericlamine [2-(3,4-dichlorobenzyl)-2-dimethylamino-1-propanol], a novel serotonin reuptake inhibitor with antidepressant properties. Possible changes in other serotonin receptor binding sites (5-HT2A, 5-HT2C and 5-HT3) were also investigated after this treatment. Cericlamine was injected for 2 weeks at a dose (16 mg/kg i.p., twice daily) that ensured complete prevention of 4-methyl-alpha-ethyl-meta-tyramine-induced depletion of brain serotonin. In vitro binding and quantitative autoradiographic studies showed that neither 5-HT1A, 5-HT2A, 5-HT2C nor 5-HT3 receptor binding sites in various brain areas were affected by the 14-day treatment with cericlamine. Although forskolin-stimulated adenylate cyclase activity was significantly increased in hippocampal homogenates from cericlamine-treated rats, the reduction in this enzymatic activity due to 5-HT1A receptor stimulation by 8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT) was unchanged in these animals as compared with controls. In contrast, in vitro and in vivo electrophysiological recordings of serotoninergic neurons in the dorsal raphe nucleus revealed a clearcut functional desensitization of somatodendritic 5-HT1A autoreceptors. Thus the potency of 8-OH-DPAT and ipsapirone to depress the firing rate of these neurons in brain stem slices was significantly reduced after the 2-week treatment with cericlamine. In vivo, the potency of an injection of cericlamine to inhibit the discharge of serotoninergic neurons was also markedly less in rats that had been pretreated for 2 weeks with this drug as compared with controls. However, the inhibitory effects of systemically injected 8-OH-DPAT and ipsapirone on the electrical activity of serotoninergic neurons were as pronounced in cericlamine-treated rats as in controls. In addition, the reduction in serotonin synthesis due to an acute treatment with 8-OH-DPAT (0.1 or 0.3 mg/kg s.c.) was not significantly different in both groups of rats. These data support the idea that postsynaptic (in the hippocampus) and somatodendritic (in the dorsal raphe nucleus) 5-HT1A receptors are differently regulated in the rat brain, because only the latter receptors desensitized after a long-term blockade of serotonin reuptake by cericlamine. They also suggest that the inhibitory influence of systemically administered direct 5-HT1A agonists such as 8-OH-DPAT and ipsapirone on the electrical and metabolic activity of serotoninergic neurons does not result solely from the stimulation of somatodendritic 5-HT1A autoreceptors.

Possible involvement of K(ATP) channels in the control of 5-HT neurons.

The possible involvement of ATP-sensitive potassium channels in the control of the electrical activity of central serotoninergic neurons was investigated by recording their firing rate in the dorsal raphe nucleus of rat brain stem slices exposed to various blockers and openers of these channels. Whereas the channel openers lemakalim and aprikalim produced no change in the firing rate of these neurons, the channel blockers glibenclamide and gliquidone were strongly inhibitory. As expected from an effect through ATP-sensitive potassium channels, the inhibition by glibenclamide could be prevented in a competitive manner by lemakalim and aprikalim. In contrast, the inactive isomer of the latter drug, RP 61499, did not alter the glibenclamide effect. In addition to the channel openers, the GABA receptor antagonists, bicuculline and phaclofen, but not the antagonist of somato-dendritic 5-HT1A autoreceptors, (-)tertatolol, prevented the negative influence of glibenclamide on the firing rate of serotoninergic neurons. This suggests that GABA acting at both GABAA and GABAB receptors (but not serotonin through the possible stimulation of autoreceptors) was responsible for the effect of glibenclamide. Accordingly, the blockade by the latter drug of ATP-sensitive potassium channels on GABAergic interneurons probably triggered the release of GABA, which in turn, inhibited serotoninergic neurons. In agreement with this hypothetical mechanism, autoradiographic studies demonstrated that ATP-sensitive potassium channels are not located on serotoninergic neurons (but probably on GABAergic interneurons) as the extensive lesion of these neurons by 5,7-dihydroxytryptamine did not reduce the specific labelling of the dorsal raphe nucleus by [3H]glibenclamide.

[Current thoughts apropos of delusional disorders]. / Réflexions actuelles a propos des bouffées délirantes.

In the 1890's Valentin Magnan established the concept of acute "bouffée délirante". Ten years ago, a majority of french psychiatrists still wished to distinguish it from schizophrenia. A recent clinical case gave us the opportunity to reactualize what we know about the historical evolution of the concept, the contradictions regarding the prognostic, the psychopathological hypothesis and the changes in our therapeutic means.