[Ten-year psychosocial outcome of 29 adolescent suicide-attempters]. / Devenir psychosocial, dix ans après, de 29 adolescents suicidants.

OBJECTIVES: This study investigates the psychosocial outcome of adolescents admitted to the Nancy University Children's Hospital between the 1st January 1996 and 31st December 1996 following a suicide attempt, and the influence that the initial characteristics (personal, familial and social) of these patients can have on their long-term outcome. Defining prognostic factors for a long-term negative outcome in young suicide-attempters will enable us to focus our therapeutic approach on long-term prevention, as opposed to simple crisis management. METHODS: Longitudinal study conducted in 2006 on the basis of self-questionnaires distributed to former patients and their parents. The self-questionnaires consisted of 39 questions: 22 questions requiring yes/no answers and 12 open questions, 11 of which required a quantitative or objective answer (for example, level of education, number of cigarettes consumed, etc.), and one of which required a subjective answer (concerning perceived improvements in care received), and five satisfaction scales graded from 1 to 10 for the different parameters considered, on which responders were asked to make a cross. The questions were grouped into three main categories: family life, professional status and education, and finally physical and mental health. Patients were also asked to answer a second self-questionnaire, the Center for Epidemiologic Studies-Depression scale (CES-D), which provides an objective assessment of psychological well-being. Composed of 20 items (16 presented in negative form and four in positive form), this test measures the frequency of symptoms experienced in the past week. Symptom frequency is graded from 0 to 3; possible scores therefore range from 0 to 60. In France for adults, the depression threshold is considered to be 17 in men and 23 in women. The data collected from the different self-questionnaires was then cross-matched with the personal, familial and social characteristics recorded in the former patients' medical and social case notes, taken at the time of their suicide attempt in 1996. RESULTS: It was possible to trace 67.2% of the former patients and 67.4% of these answered the questionnaires, i.e. 45.3% of the initial population. The psychosocial outcome of the former patients in our study was quite encouraging, with over three quarters of former suicide-attempters stating they were happy in their personal lives, and more than half of the 65.5% actually working considering themselves to be satisfied or very satisfied with their professional lives. In addition, 66.7% of responders did not report any particular psychiatric problem. However, one patient completed suicide in the course of 1996. 17.2% of the former patients responding to the questionnaire reported a chronic psychiatric condition, sometimes accompanied by repeated suicide attempts, and 13.8% situated themselves somewhere in between. Learning difficulties and falling behind at school were evidenced as risk factors for recurrence, and personal psychiatric antecedents were evidenced as factors for poor psychosocial outcome. However, other factors, such as personal suicide attempt antecedents, were not evidenced as risk factors for poor psychosocial outcome. CONCLUSION: The psychosocial outcome of the former patients in our study was quite encouraging. Suicide-attempters who relapsed, those who had had more school difficulties, and those who experienced a less favourable ten-year psychosocial outcome, had more personal psychiatric antecedents.

Riboflavin and riboflavin-derived cofactors in adolescent girls with anorexia nervosa.

BACKGROUND: Thyroid hormones, riboflavin, riboflavin cofactors, and organic acids were assessed in girls with anorexia nervosa. OBJECTIVE: The objective was to examine the effect of malnutrition and low thyroid hormone concentrations on erythrocyte and plasma riboflavin metabolism and their relation with urinary organic acid excretion. DESIGN: Seventeen adolescent girls with anorexia nervosa [body mass index (BMI; in kg/m2): 14.8 +/- 2.2] and 17 age-matched, healthy girls (control subjects; BMI: 20.5 +/- 2.2) took part in the feeding study. Erythrocyte and plasma riboflavin as well as riboflavin cofactors (flavin mononucleotide and flavin adenine dinucleotide) were assessed by HPLC, whereas urinary organic acids were assessed by gas chromatography-mass spectrometry. RESULTS: Anorectic patients who began a feeding program had higher erythrocyte riboflavin (3.5 +/- 2.2 compared with <0.1 nmol/mol hemoglobin; P < 0.001), lower plasma flavin adenine dinucleotide (57.8 +/- 18.5 compared with 78.5 +/- 54.3 nmol/L; P < 0.05), and higher urinary ethylmalonic acid (7.12 +/- 4.39 compared with 1.3 +/- 2.8 micromol/mmol creatinine; P < 0.001) and isovalerylglycine (7.65 +/- 4.78 compared with 3.8 +/- 0.9 micromol/mmol creatinine; P < 0.05) concentrations than did control subjects. Triiodothyronine concentrations were low and negatively correlated with plasma riboflavin concentrations (r = -0.69, P < 0.01). Not all patients showed improvements in these biochemical indexes after 30 d of refeeding. CONCLUSIONS: The low triiodothyronine concentrations observed in anorexia nervosa could alter the extent of riboflavin conversion into cofactors, thus leading to high erythrocyte riboflavin concentrations, low plasma flavin adenine dinucleotide concentrations, and high rates of ethylmalonic acid and isovalerylglycine excretion.

[The acrodynic form of the Riley-Day syndrome]. / Forme acrodynique du syndrome de Riley-Day.

The authors report the case of a 10-year-old girl who died after suffering from severe erythromelalgia combined with digestive and general disorders associated with multiple vegetative disturbances (high blood pressure, hypothermia, colic and urinary disorders, raised catecholamine levels) for 2 years. Although the appearance of the tongue was normal and in spite of the absence of genetic criteria the diagnosis of Riley-Day dysautonomia was made and its association with neural crest disorders was indicated.