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Introduction: The French day hospital program specialized in eating disorders (ED) opened in January 2018. Our study presents preliminary data on clinical profiles of patients with anorexia nervosa (AN). We describe more specifically clinical characteristics of patients with early onset AN and according to their therapeutics orientations. Then, we compare the weight gain of patients managed only in day-patient (DP) treatment with those managed initially inpatient (IP) treatment and relays in DP., Methods: Ninety-two patients with AN, aged between 8 and 18 years, were evaluated with several questionnaires (EDI-2, EDE-Q, BSQ, EDS-R, CDI, STAI-Y, VSP-A, EPN-13)., Results: Patients with early onset AN, n = 23 (25.3%), presented more restrictive behaviors, less marked dietary symptomatology, a lower degree of clinical perfectionism and a less marked feeling of ineffectiveness than adolescent patients with AN. Regarding the choice of hospitalization modality (DP alone or IP-DP), the only difference highlighted was the severity of patient undernutrition. Among the patients who were treated (IP-DP n = 27 vs DP alone n = 25), the weight evolution after one month and at discharge was favorable for both groups., Conclusion: These preliminary data suggest the effectiveness of DP in the care of AN in children and adolescents., (Copyright © 2022 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Aim: MPH is the more often prescribed stimulant for Attention Deficit Hyperactivity Disorder (ADHD), but it has been estimated that 30% of patients do not adequately respond or cannot tolerate it. Therefore, some other therapies are needed, such as cognitive behavioral therapy. Cognitive behavioral therapy is an intervention proposed over several sessions and aimed at modifying behavior by teaching different techniques that participants can re-use to control their symptoms. In our Institute, we used a program centered on attentional and metacognitive functions. It consists of a series of workshops performed in group at the rate of one workshop of 90minutes per week for 12 weeks. Positive effects on the behavior of adolescents with ADHD have been reported by parents and educators, but the effects of the program on specific cognitive processes have never been precisely investigated., Method: In the present study, we evaluated the impact of the program on impulsive control in adolescents with ADHD who are known to present impaired impulsive control. Impulsive control is required each time there is a conflict between an inappropriate prepotent action and a goal-directed action. At an experimental level, impulsive control can be studied with conflict tasks, such as the Simon reaction time task. Interpreted within the theoretical framework of the so-called « Dual-process activation suppression » (DPAS) model, this task is a powerful conceptual and experimental tool to separately investigate the activation and inhibition of impulsive actions, which is almost never done in studies about impulsive control. Twenty adolescents followed the program and were tested before and at the end of the program by using dynamic analyses of performance associated with DPAS model., Results: The results have shown an improvement of the impulsive control after three months of cognitive behavioral therapy, and this improvement was due to both a decrease of the propensity to trigger impulsive actions and an improvement of inhibitory processes efficiency., Conclusion: This program could be a relevant alternative to the stimulant medication, more particularly when parents are reluctant with medication or when the adolescent suffers from important side effects., (Copyright © 2021 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Virtual reality is a new technology that can be used to model an environment with which an individual can interact using all five senses. It is notably used in psychiatry for anxiety disorders and addictions, and its use in eating disorders has been growing in recent years. Indeed, virtual reality offers interesting advantages, such as its ability to personalize any environment, which is also more secure and controllable. Recent studies show promising results in the understanding, evaluation, and therapeutic management of eating disorders. The use of avatars in anorexia nervosa allows for a correct assessment of the perceptual (body image distortion) and cognitive-affective (body dissatisfaction) components of the body image disorder in a similar way to conventional methods, but also for a better understanding of them. Moreover, avatars allow the development of innovative therapeutic protocols and are thus used in the context of exposure therapy. The new body swapping protocol, based on a multisensory illusion, offers particularly promising results in the reduction of body image disorder. For bulimia nervosa and binge eating disorder, virtual reality has made it possible to better characterize the triggering mechanisms of binge eating episodes through studies that have observed different responses to food-related environments and stimuli. At the therapeutic level, virtual reality cue exposure therapy has the most empirical support. Its aim is to reduce or eliminate the anxiety and craving felt by a patient in response to exposure to food or other food-related cues by preventing the patient from consuming food, and results show clear reductions in anxiety, craving and binge eating episodes. While all these results seem to indicate a bright future for virtual reality in eating disorders, further studies are needed to validate the positive impact of its use, but also its limitations. Notably, cyber sickness could alter the smooth running of virtual reality therapy sessions by causing nausea and disorientation. Moreover, it is important to verify that a therapeutic protocol does not lose its effectiveness when it is transposed into virtual reality. However, virtual reality seems to be a therapeutic tool that is better accepted by patients, and even better by adolescents, which is very interesting for eating disorders since adolescents are the most affected. Virtual reality could therefore help motivate patients to pursue treatment and reduce the dropout rate while offering good therapeutic results. Thus, studies conducted in recent years have shown that virtual reality is a promising tool in the understanding, assessment and treatment of eating disorders, and future research should confirm this, particularly in the adolescent population., (Copyright © 2021 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: Adolescent sleep is characterized by a physiological delayed sleep phase disorder frequently exacerbated by the intensive use of information and communication technologies. The sleep restriction thus induced during schooling has consequences on the physical and psychological health of the adolescent. On the other hand, the sleep complaint may correspond to psychiatric disorders in the adolescent. Thus, when this complaint is associated with school absenteeism, the management of sleep alone is often insufficient. In order to understand the reason for this inefficiency, we wanted to better characterize the profile of these adolescents., Method: We have developed a somnological and psychiatric "screening kit" resulting in a management decision tree. This kit was tested in 2017 as part of joint consultations at the Lyon Sleep Center in adolescents who presented a complaint of sleepiness or insomnia associated with school absenteeism., Results: These preliminary results on 11 patients show the predominance of a delayed sleep phase syndrome or an absence of sleep diagnosis associated in more than 90 % of cases with anxiety-depressive difficulties ranging from the mood depressive disorder to the school refusal behavior and underlying anxiety disorders. Somatization is also common., Conclusion: These first data seem to confirm the need for a child and adolescent psychiatric assessment to deal with the psychological difficulties of these adolescents in parallel with their sleep complaint so as to offer them the best chances of improvement, re-schooling and social insertion., (Copyright © 2018 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Very early onset schizophrenia begins before the age of 13. This form of schizophrenia is particularly difficult to diagnose. The differential diagnosis is difficult because some psychotic signs can be passing or be representative of an anxious or depressive disorder. The differential diagnosis with the autistic spectrum disorder is also complex. Finally, other disorders are associated in the majority of the cases. It is a neurodevelopmental disorder with premature cerebral anomalies engendered by the interaction of genetic factors and environmental factors. There seems be a real continuity between the very early form and the adult form although very early onset schizophrenia is a severe form of the disorder which carries a relatively poor prognosis. Its outcome depends both on early screening, the quality of diagnosis and on the speed of multidisciplinary interventions offered., (© 2018 L’Encéphale, Paris.)

Pathology of adolescence and young adult, schizophrenia can begin in very rare cases during childhood. Two early clinical forms of the disorder have been identified by epidemiological studies: one beginning at the age of 15; the other around 9 years old; While many questions remain unsanswered about the neurobiological and environmental factors - common or distinct - of these two clinical phenotype, both are related to a profoun and lasting alteration of the neurocognitive development whose origin would clearly go back to infancy or to the antenal period. Here we will present a possible story back of schizophrenia in the light of the latest neuroscientific studies in imagery and genetics from adolescence to antenal period., (© 2018 L’Encéphale, Paris.)

Introduction: Insomnia is considered to be a serious public health issue affecting approximately 10% of adults. Chronic insomnia may increase the risk of health problem, psychological vulnerability and proneness to accidents. Cognitive behavioral therapy for insomnia (CBT-I) is recommended as the first line of treatment. Even though CBT-I is widely considered as an effective therapy, 20 to 30% of patients do not respond to this treatment. Mindfulness therapy, known to reduce rumination and stress, could be an interesting complement to enhance CBT-I. The aim of this study is to evaluate the efficacy of therapy combining mindfulness meditation and CBT-I for the treatment of chronic insomnia., Methods: Thirty-three patients, diagnosed with chronic insomnia, aged 18 to 75 years (51±15 years) were recruited between October 2015 and June 2016 at the Sleep Center of Marseille. The patients were then divided into two groups according to their psychotherapy method: group CBT-I alone (17 patients) or a group therapy combining CBT-I and Mindfulness (16 patients). All participants were given five sessions of standard CBT during eight weeks. The patient-reported outcome measures were sleep onset latency, wake after sleep onset (WASO), total wake time, total sleep time, time in bed, sleep efficiency and number of awakening from sleep diaries before treatment (T0) and six weeks later (T1). Assessments were done using Pittsburgh Sleep quality index (PSQI), Insomnia severity Index (ISI), the Epworth sleepiness scale, the hospital anxiety and depression scale (HAD), the dysfunctional beliefs and attitude about sleep (DBAS-16); further, the use of sleeping pills was also recorded at T0 and T1., Results: Out of the 33 participants who began the treatment, 29 completed all sessions and were included in the analyses (4 dropouts in the group CBT-I alone). The data shows that each treatment yielded significant improvements over time in sleep variables from the diary, PSQI, ISI, anxiety (P=0.004), DBAS 16, sleeping pill use and vitality measured by SF36 health survey (P=0.004). Comparing the results of the two therapy groups, the meditation associated to CBT-I shows significantly greater rates of reduction in WASO relative to CBT-I group (P=0.009)., Conclusions: This study confirms the beneficial effects of CBT for patients suffering from insomnia on sleep parameters, anxiety symptoms and quality of life. Furthermore, this study suggests, for the first time, that combining CBT and mindfulness is a superior approach compared to that of only conventional CBT-I in improving sleep., (Copyright © 2017 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Objectives: The aim of this review is to summarize the available data in the literature about the therapeutic applications of transcranial magnetic stimulation and transcranial direct current stimulation in attention-deficit hyperactivity disorder (ADHD)., Method: The scientific literature search of international articles was performed in February 2016 using the PubMed electronic database. The following MeSH terms were employed: "attention-deficit disorder with hyperactivity" AND "transcranial magnetic stimulation", "attention-deficit disorder with hyperactivity" AND "transcranial direct current stimulation"., Results: Five studies were retained by the literature search and were included in the review about rTMS and ADHD. Except for one study, they all showed significant positive effects of rTMS on ADHD. Four studies were retained by the literature search and were included in the review about tDCS and ADHD. Three of them showed significant positive effects of tDCS on ADHD. Two of them used tDCS during sleep at a frequency<1Hz. Only low-level evidences are available to support treatment with rTMS or tDCS in patients with ADHD. Indeed, randomized controlled trials are rare in this field of research., Conclusion: Additional studies are needed to confirm the efficacy of rTMS and tDCS in ADHD. rTMS could be used as an alternative therapy when methylphenidate is not well tolerated or shows an insufficient efficacy. Nevertheless, the optimal target, frequency and duration remain to be determined. tDCS can modulate attention in healthy subjects but data are insufficient in ADHD to conclude. It could be interesting to study its use in association with cognitive remediation to enhance its cognitive efficacy., (Copyright © 2016 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: The emotional process is characterized by a negative bias in depression, thus it was legitimate to establish if they same is true in very young at-risk children. Furthermore, sleep, also proposed as a marker of the depression risk, is closely linked in adults and adolescents with emotions. That is why we wanted first to better describe the characteristics of emotional recognition by 3-year-olds and their links with sleep. Secondly we observed, if found at this young age, an emotional recognition pattern indicating a vulnerability to depression., Material and Method: We studied, in 133 children aged 36 months from the AuBE cohort, the number of correct answers to the task of recognition of facial emotions (joy, anger and sadness). Cognitive functions were also assessed by the WPPSI III at 3 years old, and the different sleep parameters (time of light off and light on, sleep times, difficulty to go to sleep and number of parents' awakes per night) were described by questionnaires filled out by mothers at 6, 12, 18, 24 and 36 months after birth. Of these 133 children, 21 children whose mothers had at least one history of depression (13 boys) were the high-risk group and 19 children (8 boys) born to women with no history of depression were the low-risk group (or control group)., Results: Overall, 133 children by the age of 36 months recognize significantly better happiness than other emotions (P=0.000) with a better global recognition higher in girls (M=8.8) than boys (M=7.8) (P=0.013) and a positive correlation between global recognition ability and verbal IQ (P=0.000). Children who have less daytime sleep at 18 months and those who sleep less at 24 months show a better recognition of sadness (P=0.043 and P=0.042); those with difficulties at bedtime at 18 months recognize less happiness (P=0.043), and those who awaken earlier at 24 months have a better global recognition of emotions (P=0.015). Finally, the boys of the high-risk group recognize sadness better than boys in the control group (P=0.015)., Conclusion: This study confirms that the recognition of emotion is related to development with a female advantage and a link with the language skills at 36 months of life. More importantly, we found a relationship between sleep characteristics and emotional recognition ability and a negative bias in emotional recognition in young males at risk for depression., (Copyright © 2016 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

The phenomenology of dissociative disorders may be complex and sometimes confusing. We describe here two cases who were initially misdiagnosed. The first case concerned a 61 year-old woman, who was initially diagnosed as an isolated dissociative fugue and was actually suffering from severe major depressive episode. The second case concerned a 55 year-old man, who was suffering from type I bipolar disorder and polyvascular disease, and was initially diagnosed as dissociative fugue in a mooddestabilization context, while it was finally a stroke. Yet dissociative disorders as affective disorder comorbidity are relatively unknown. We made a review on this topic. Dissociative disorders are often studied through psycho-trauma issues. Litterature is rare on affective illness comorbid with dissociative disorders, but highlight the link between bipolar and dissociative disorders. The later comorbidity often refers to an early onset subtype with also comorbid panic and depersonalization-derealization disorder. Besides, unipolar patients suffering from dissociative symptoms have more often cyclothymic affective temperament. Despite the limits of such studies dissociative symptoms-BD association seems to correspond to a clinical reality and further works on this topic may be warranted., (Copyright © 2014 L’Encéphale. Published by Elsevier Masson SAS.. All rights reserved.)

The attention deficit disorder and the bipolar disorder maintain a complex relation. Indeed, these two syndromes share numerous symptoms that engender numerous diagnostic difficulties. According to several studies, it seems that these two disorders are really different with significant differences at the functional and anatomical level. However, there are common cognitive deficits as well as relatively frequent co-morbidity which is necessary to know in order to adjust the treatment., (Copyright © 2014 L’Encéphale. Published by Elsevier Masson SAS.. All rights reserved.)

Objective: This study investigated the cognitive skills in pervasive developmental disorders (PDD)., Methodology: Two groups of children participated in this study, 39 individuals with autism and 18 individuals with Asperger syndrome. Each participant was assessed by the Wechsler scales: WPPSI-III, WISC-III or WISC-IV., Results: Children with Asperger syndrome have VIQ more than PIQ and the children with autism have VIQ less than PIQ. The performances in "block design" task vary according to the cognitive level and not according to the PDD type. The high-functioning autistic children show high performance in "block design" task. Children with Asperger syndrome revealed impairments in the "understanding of social situations" task., Discussion: Individuals with autism have a verbal intelligence quotient lower than individuals with an Asperger syndrome. Several hypotheses have tried to explain verbal differences between children with autism and Asperger syndrome. A first hypothesis proposed a developmental convergence between these two groups. A second hypothesis suggested that communication and social interaction impairments could be implicated in verbal skills. A third hypothesis supported that individuals with Asperger syndrome could develop a specific cognitive style. Children with autism have spatial and perceptive capacities better than verbal capacities. These performances could be interpreted as the expression of a specific cognitive style based on the visual analysis of the detail., Conclusion: The low-functioning children with autism have a cognitive profile with PIQ more than VIQ and high skills in spatial organization. The high-level children with autism have a cognitive profile with PIQ more than VIQ and high skills in spatial abstraction. Children with Asperger syndrome have a profile VIQ more than PIQ profile, they are particularly good in verbal learning notably vocabulary., (Copyright © 2012 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Abnormalities involving the prefrontal cortex (PFC) have long been postulated to underpin the pathophysiology of schizophrenia. Investigations of PFC integrity have focused mainly on the dorsolateral PFC (DLPFC) and abnormalities in this region have been extensively documented. However, defects in schizophrenia may extend to other prefrontal regions, including the ventromedial PFC (VMPFC), and evidence of VMPFC abnormalities comes from neuropathological, structural and functional studies. Patients with acquired brain injury to the VMPFC display profound disruption of social behaviour and poor judgment in their personal lives. The Iowa Gambling Task (IGT) was developed to assess decision-making in these neurological cases : it presents a series of 100 choices from four card decks that differ in the distribution of rewarding and punishing outcomes. Whilst healthy volunteers gradually develop a preference for the two "safe" decks over the course of the task, patients with VMPFC lesions maintain a preference for the two "risky" decks which are associated with high reinforcement in the short term, but significant long-term debt. Interestingly, damage to VMPFC may cause both poor performance on the IGT and lack of insight concerning the acquired personality modification. Recently, our group reported a trait-related decisionmaking impairment in the three phases of bipolar disorder. In a PET study, VMPFC dysfunction was shown in bipolar manic patients impaired on a decision-making task and an association between decision-making cognition and lack of insight was described in mania. A quantitative association between grey matter volume of VMPFC and memory impairment was previously reported in schizophrenia. Research suggests that lack of insight is a prevalent feature in schizophrenia patients, like auditory hallucinations, paranoid or bizarre delusions, and disorganized speech and thinking. Because schizophrenia is associated with significant social or occupational dysfunction, previous research assessed decision-making function but indicates conflicting results. Thirteen studies have reported impaired IGT performance in patients with schizophrenia and, in seven reports, no significant differences in IGT performance between patient and healthy control groups were found. Those discrepancies may relate to multiple factors. First, most of the studies included small sample size and negative findings may be due to the large variance of net scores. Second, as suggested by Rodríguez-Sánchez et al., there is a wide disparity in performance by control subjects across studies. Third, intelligence quotient (IQ) score and level of education may be correlated with IGT performance, which may explain IGT performance differences in studies that did not control for educational or IQ score. Fourth, only two studies have systematically controlled for substance use disorder, a potential confounder. Fifth, only two studies assessed the impact of antipsychotic (AP) class on performance. Sixth, to our knowledge, no study assessed the impact of AP dosage on decision-making ability, while AP dose-reduction and dopamine increase, might lead to improvements, in cognitive functions in schizophrenia and in IGT performance in bipolar disorder, respectively. Finally, discrepancies between studies may be related to the heterogeneity of diagnostic groups. Two of the negative studies included schizophrenia and schizoaffective disorder while positive studies have generally included only patients with schizophrenia. Nevertheless, some studies that included only patients with schizophrenia failed to find differences between groups. Thus, further research should assess decision-making in schizophrenia by testing a large group of patients with homogeneity of diagnostic, in comparison with a large group of control subjects. Authors should control for IQ or level of education, substance use disorder and smoking status. While it is now accepted that DLPFC defects in schizophrenia may extend to VMPFC, future investigations should test for an association between memory, insight ability and IGT performance and assess the impact of antipsychotic dosage upon performance., (Copyright © 2011 L’Encéphale. Published by Elsevier Masson SAS.. All rights reserved.)

In social cognition, the notion of Theory of Mind (ToM) is widely studied among people with schizophrenia to give an account for intersubjective disturbances. ToM is classically defined as the ability to make inferences about other persons'mental states, as beliefs, thoughts or intentions. However, ToM is not understood or explored as a homogeneous notion. First, this review briefly describes main theoretical models, as well as experimental tasks of ToM. Second, clinical results strongly suggest that patients with schizophrenia present impaired ToM performances. However, the presence of a robust relationship between ToM and schizophrenic symptomatology, or clinical course, is still controversial. Third, we highlight main findings from functional brain imaging studies based on ToM. Finally and in a more critical perspective, we suggest a few theoretical and experimental limitations regarding impaired ToM as a core feature of schizophrenic disturbances in social interactions., (Copyright © 2011 L’Encéphale. Published by Elsevier Masson SAS.. All rights reserved.)

Accumulating evidence supports the hypothesis of abnormal neurodevelopment in schizophrenia. According to this hypothesis, schizophrenia is the consequence of prenatal abnormalities resulting from the interaction of genetic and environmental factors. In line with this hypothesis, several studies indicate that pregnancy and birth complications are risk factors for developing schizophrenia. At the clinical level, multiple cognitive deficits can be found in schizophrenic patients before illness onset. The neurodevelopmental hypothesis considers these cognitive deficits as the expression of early abnormalities on the central nervous system development. Consistently, brain imaging data show early structural abnormalities and abnormal progressive brain changes in schizophrenia. Finally, genetic and histological data indicate that genes associated with schizophrenia are involved in brain development., (Copyright © 2011 L’Encéphale. Published by Elsevier Masson SAS.. All rights reserved.)

Cognitive impairment among patients suffering from schizophrenia is closely linked to psychoeducation and therapeutic education. First, this cognitive impairment requires specific communication strategy and special cognitive and behavioral techniques, which make possible for the patients to improve their trainability. Some of these tools are detailed, such as solving problems, communication skills, role plays, repetition, rewarding, and motivational support. Second, functional and social impairment, and outcome, are partly consequences of these cognitive problems. Cognitive remediation targets elementary cognitive impairment, mostly with repetitive cognitive tasks, and studies show an improvement in these specific tasks, but without positive effect on functional and social aspects of the illness. Overall approaches, such as psychoeducation or therapeutic education, obtain real gains in quality of life for the patients, autonomy and clinical improvement. It's not yet possible to know if these positive results underlie improvement in elementary cognitive impairment. The combination between remediation and psychoeducation seems to be promising., (Copyright © 2011 L’Encéphale. Published by Elsevier Masson SAS.. All rights reserved.)

As it is the case in other psychiatric disorders, etiopathogenic hypotheses of depression have chiefly been shaped by the fortuitous discovery of antidepressive drugs. Reciprocally, these hypotheses have largely influenced later innovation in therapeutic drugs. In this paper, we aimed to study the development of pharmacological treatments through the different neurobiological and molecular models proposed in depressive illness through the last half-century. We first started by the monoaminergic hypothesis who postulates the existence of a deficit in monoamine transmission (norepinephrine and serotonine). We also discuss of drugs involving other neurotransmitters than the classic monoamines. If this monoaminergic hypothesis has long provided a first level of explanation for the action of antidepressant drugs, limitations have been pointed out. In the last 15 years, another model for the study of depression has clearly emanated: the stress model of depression. A possible reason for the success of this new hypothesis is its ability to provide a satisfying framework to experimental studies, in man and in animal. In this new background, numerous molecular and cellular events have been observed under the influence of stress, and these injuries appear to reverse with antidepressants. It thus seems that antidepressant agents have the ability to opposite the impact of stress through molecular actions, which directly or indirectly influence neuroplasticity., (Copyright © 2010 L'Encéphale. Published by Elsevier Masson SAS.. All rights reserved.)

Kindling and behavioural sensitization were probably the first among the animal models of affective disorders, to suggest that genes-environment interactions were likely to be involved in the pathophysiology of these disorders. Cross-sensitization among stressors, drugs of abuse and illness episodes was deemed to be supported by the induction of a series of transcription factors, such as the proto-oncogene c-fos that subsequently alter gene expression by binding at DNA sites and inducing mRNAs for substances that may exert effects over long time periods. This was an anticipation of epigenetics which is currently defined as a functional modification to the DNA that does not involve an alteration of sequence. Epigenetic modifications are most commonly regulated by DNA methylation and histone acetylation which are usually associated with the silencing and activation of gene transcription, respectively. In animal models, it was shown that parents can actively remodel epigenetic marks, and thus affect patterns of gene expression in the offspring, whereas environmental adversity decreases parental investment in the offspring and thus alters phenotypic development. In line with this, some laboratories have sought to identify changes in gene expression in post mortem brain samples of humans with affective disorders. Finally, gene-environment interactions have been directly studied, both in animals and humans, by testing how a functional polymorphism in candidate genes would moderate the influence of stressful life events on behavioural expression. Interesting results have been found and replicated for unipolar depression, however date are scarce for bipolar disorder. Findings from these studies allow the building of more sophisticated models for unipolar and bipolar genetics., (Copyright © 2010 L'Encéphale. Published by Elsevier Masson SAS.. All rights reserved.)

Management of bipolar disorder has undergone many revisions in recent years as new agents and treatments have been developed and studied with variable success. In conjunction with the advent of novel therapies and indications, there has been an increase in the understanding of the phenomenology and neurobiology of bipolar disorder that has made the classification and management of the illness necessarily more sophisticated. However, there remains a significant delay of 8 years in detecting and diagnosing bipolar disorder, and a further need to improve treatments. However, this paper has emphasized the need to be aware of recent advances and the emerging uses of new pharmacological treatments in the management of bipolar disorder. It has also highlighted the need for tailoring management to the individual. In particular, the successful treatment of bipolar disorder requires achieving prophylaxis and preventing relapse. In this regard, maintenance therapy is of paramount importance, and thus the tolerability of agents needs to be considered throughout treatment and should be factored into all management decisions. At the centre is the individual with bipolar disorder and the need to maintain a healthy therapeutic relationship. However, it is important to note that the evidence synthesized in this paper serves only as a guide to the management of bipolar disorder and that, in clinical practice, all treatment recommendations require contextual interpretation, the consideration of local factors and the consultation of additional resources., (Copyright © 2010 L'Encéphale. Published by Elsevier Masson SAS.. All rights reserved.)

In the history of the nosographies in psychiatry, the affective disorders were gradually distinguished from the other categories of mental disorders, until being considered as separate illness entities, such as what Kraepelin named manic-depressive insanity at the end of the 19th century. The latter will be subsequently divided in two main categories, the bipolar disorder on the one hand and recurrent depression on the other hand, this separation being still current, and extensively diffused by the mean of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM, whose revisions largely determine the evolution of the contemporary nosographic models, mainly relies on a categorical approach of the mental disorders. The next revision will probably continue to follow this kind of approach, even if the use of dimensional components could also be developed. In the future, true nosographic advances can be waited from clinical epidemiology studies, as those which recently made it possible to highlight various sub-types of affective disorders on the basis of clinical, biographical or temperamental characteristics. Etiological approaches, centered on the pathophysiology of the affective disorders, could also contribute to build nosographic models on the basis of an objective knowledge on these diseases., (Copyright © 2010 L'Encéphale. Published by Elsevier Masson SAS.. All rights reserved.)

Early onset (pediatric) bipolar disorders are still an issue of much controversy due to several clinical particularities of the thymic episodes at this age. To date, there is indeed no consensus regarding the prevalence of bipolar disorders before puberty. Diagnosis criteria in children and young adolescents remain thus elusive. The purpose of this review is to provide an overview of this issue. The idea of continuity, from childhood to adulthood, in bipolar disorders also raises important questions regarding predictive factors of bipolar disorders in adults. Studies on the childhood of bipolar adults, as well as studies on the children of bipolar parents will be reviewed, in an attempt to identify the psychopathological substrates of bipolar disorders., (Copyright © 2010 L'Encéphale. Published by Elsevier Masson SAS.. All rights reserved.)

The prodromal phase is generally described as a subsyndromal stage preceding the disease onset. The characterization of such phase found its main purpose in secondary prevention. Up to now, clinical research relating to this topic in mental health has primarily focus on schizophrenic disorders. Over the last years, some studies have applied similar methods in order to characterize a preclinical phase in bipolar disorders. In spite of the fact that this strategy appears less adequate in bipolar disorders, these studies have demonstrated the existence of prodromal signs in a majority of patients. However, these features appear for the moment neither sufficiently characteristic, nor sufficiently specific to allow the construction of suitable assessment instruments, or to suggest precise guidelines in the management of these subjects. Also, these prodromal features show considerable overlap with other psychiatric disorders, especially attention-deficit hyperactivity disorder (ADHD) and schizophrenia Interestingly, a limited number of studies have looked at the number of patients considered in a prodromal phase of schizophrenia which later developed a bipolar disorder and reported substantial proportions of subjects in this case, further highlighting the obvious bias in favor of schizophrenia in the actual prevention politics. In order to identify potential candidates at a prodromal phase of bipolar disorders that could benefit from early intervention, studies have relied on both high genetic risk and symptoms at the boundary of the actual classification. However, even within such approach, pharmacological treatments have not proven obvious advantage in terms of prevention. It is suggested that adopting a more longitudinal vision of the disease and, given the mean age of onset of bipolar disorder and a fortiori of its prodromal phase, a more developmental perspective of individuals, could help lowering the confusion in this field ; Also, given the considerable overlap in prodromal features between different psychiatric disorders, early detection programs could benefit from implementing approach open to multiple diseases assessment, rather than hyper-specialization in a specific disorder., (Copyright (c) 2010 L'Encéphale. Published by Elsevier Masson SAS.. All rights reserved.)

The study of the premorbid functioning in bipolar disorder allows us to identify several risk factors of the disease. First we will present retrospective studies of adults or teenagers presenting a bipolar disorder and second the studies concerning offspring of parents with bipolar disorder. Despite contradictory results and methodological weaknesses, these studies indicate that anxious disorders and childhood disruptive behaviour disorders may be useful markers of risk for adult bipolar disorder. All these results may open up several interesting perspectives for the prevention ant the treatment of bipolar disorder., (Copyright (c) 2010 L'Encéphale. Published by Elsevier Masson SAS.. All rights reserved.)

Very early onset schizophrenia is a form which begins before the age of 12. The criteria used are the same as in adults although there are specific features for children. This is a particularly difficult psychopathological disorder to diagnose and has considerable comorbidity. The differential diagnosis, particularly from invasive developmental disorders, is also difficult. There appears to be a true continuum between the very early form and the adult form although very early onset schizophrenia is a severe form of the disorder which carries a relatively poor prognosis. Its outcome depends both on early screening, the quality of diagnosis and on the speed of multidisciplinary interventions offered.

We are able to identify the different risk factors involved in the development of the disorder from a study of the childhood of a schizophrenic patient. More specifically, we will define the perinatal risk factors: season and place of birth, viral exposure during pregnancy and obstetric complications. Developmental factors will also be discussed. Socialisation, language, psychomotor and cognitive development disorders are all developmental difficulties seen during the childhood of the schizophrenic patient. Finally we will finish by discussing a few psychosocial risk factors.

Introduction: The aim of this study was to complete the identification of predictive factors of depression during adolescence. For some authors, depression is characterized by a style of attribution, which consists essentially in attributing most of the negative outcomes to internal, stable, and uncontrollable factors. It seems that these attributions depend essentially on the type of their beliefs and in particular, those concerning the nature of intelligence. These beliefs called "implicit theories of intelligence", are the entity theory of intelligence and the incremental theory of intelligence. The entity theory of intelligence corresponds to the belief according to which intelligence is the expression of a relatively stable, fixed, and noncontrollable feature, and which we cannot change. In contrast, the incremental theory corresponds to the belief according to which intelligence is a controllable quality, which we can develop through effort and work. Several studies have demonstrated that the adolescents who consider intelligence as a malleable quality explain their bad results by internal, unstable, and controllable factors. Conversely, students who consider intelligence as a fixed capacity tend to strongly attribute their failure to internal, stable, and uncontrollable factors. We have consequently formulated the hypothesis according to which the entity theory should be a predictive factor of depression. We have also tested the fact that anxiety should be a mediating factor within the relation between the entity theory and depression., Method: The sample was composed of 424 adolescents. Using different questionnaires, we measured implicit theories of the intelligence (TIDI), self-esteem (EES), anxiety (STAI-Form Y-B) and depression (CDI)., Results: Multiple regression analyses demonstrated that the entity theory of intelligence positively predicts depression. Self-esteem negatively predicts anxiety and depression. Moreover, anxiety is a mediator of the relation between self-esteem and depression, on one hand, and the relation between the entity theory of intelligence and depression, on the other. Finally, the effect of the entity theory of intelligence appears to be modulated by the level of self-esteem., Discussion: This study explains the mechanisms by which the implicit theories of intelligence engender anxiety and depression. Furthermore, this approach provides interesting perspectives in the prevention and management of adolescents presenting depression.

Introduction: Theory of mind deficit can be used to explain social and communication impairments that define the autism spectrum disorder. Theory of mind is the ability to attribute mental states to self and others in order to understand and predict behavior. It involves the distinction between the real world and mental representations of the world. Several studies established that high functioning autistic individuals and individuals with Asperger syndrome (ASP) tend to be as proficient as controls in understanding first order false belief tasks. In contrast, they still lag behind their typical peers in understanding second order false belief tasks or more advanced tasks of theory of mind (e.g., Baron-Cohen, 1993). Most of these studies focus on the adult population and it seems particularly interesting to investigate whether children with ASP would present the same pattern of strengths and deficits as adults. In our research, children with ASP were tested in an advanced task of theory of mind based on a visual presentation of comic strips and in a more traditional assessment of false belief understanding: the Smarties test., Method: Two experimental groups participated in this study: a group of 16 high functioning children and adolescents with autism or with Asperger syndrome (ASP) and a group of 16 typically developing children matched on gender and age (CONT). The task was designed to assess the ability of children with ASP to infer the mental state of others. Stimuli were 26 different comic strips depicting a short story. Each comic strip was composed of three pictures and was shown on the upper half of the screen. Then three pictures numbered 1 to 3 showing possible outcomes of the scenario were superimposed on the bottom half of the screen. Only one of these three pictures represented a plausible conclusion to the scenario. This experiment contained two conditions: A Character intention (CI) condition and a Physical causality (PC) condition. The comic strips in the CI condition involved one character whose intentions had to be inferred by the subject in order to choose the correct picture. Comic strips in PC condition only required to understand physical causalities. Subjects were asked to watch the comic strip attentively and then they were required to make a choice between the three story endings by pressing the corresponding keyboard button. Both answers and response times were recorded. Additionally, all participants were enrolled in the classical false belief (Smarties) task., Results: Comic strips: An ANOVA [2 groups (CONT/ASP) x 2 conditions (CI/PC)] was performed on the number of correct responses. Neither the Group nor the Condition factor was significant (p>0.05). In contrast, the interaction Group x Condition reached significance level [F(1-30)=4.3, p<0.05)]. Further analysis revealed that performance of the ASP group was significantly higher in the CP (M=10.8, SD=2.5) than in the CI (M=9.8, SD=2) condition [t (1-14)=2.9, p<0.001)], whereas there was no condition difference in the control group (p>0.05). False belief: all ASP participants succeeded in the task., Discussion: Our data clearly demonstrated that children and adolescents with Asperger syndrome or high functioning autism exhibited an impairment in understanding the intention of others. In the comic strip task, children with ASP have more difficulties in the character's intention condition than in the physical causality condition. This impairment is not imputable to a deficit in taking into account the context (Weack Central Coherence theory) since they performed as well as controls in the physical causality condition which also required the processing of the whole scene. In contrast, all children with ASP succeeded at the false belief task. These contradictory findings suggest that, although testing theory of mind, the two tasks do not tap similar mechanisms. It is possible that the use of verbal material in the false belief task improved performance of the ASP children who are known to present particular strengths in this domain. Another possible explanation that needs further testing would be that the level of complexity differs between the two tasks.

Background: According to several authors, it seems that beliefs about the nature of intelligence have a very powerful impact on behavior in learning situations. These implicit theories of intelligence create a meaning system or conceptual framework that influences the individuals interpretation of school situations. Thus, an entity theory of intelligence is the belief that intelligence is a fixed trait, a personal quality that cannot be changed. Students who subscribe to this theory believe that although people can learn new things, their underlying intelligence remains the same. In contrast, an incremental theory of intelligence is the belief that intelligence is a malleable quality that can increase through efforts. This paper presents the development and the validation of the Implicit Theories Of Intelligence scale (TIDI) for French teenagers. Most of the studies attest the validity of the scales measuring the implicit theories of the intelligence. The instrument used by the authors include 3 items assessing the entity theory. Recently, theoretical debates suggested to measure within a single questionnaire both theories at the same time. Moreover, there is no instrument in French language which measures the implicit theories of the intelligence. Two studies have been conducted. The purpose of the first study was to test the factorial validity and the internal consistency of the scale. The goal of the second study was to test the temporal stability of the instrument. STUDY 1: This study describes the procedures used to create the TIDI, the internal consistency and the factorial validity. This instrument was composed of two subscales of three items assessing incremental theory of the intelligence and entity theory of the intelligence. French teenagers (n=453) aged 11 to 16 years completed the questionnaire during a lecture. Cronbach's alpha was 0.81 for the scale assessing incremental theory and 0.78 for the scale assessing entity theory. Confirmatory factor analysis was conducted using Lisrel. The fit for this model was: chi2 (8)=24.23, p<0.01, GFI=0.98, CFI=0.98, RMSEA=0.067, AGFI=0.95. All indexes of fit improved. An examination of the output indicated that the range of factor loadings of items on their respective scales was 0.66 to 0.82. These statistical analyses reveal that the TIDI shows an excellent internal consistency and a very good validity. STUDY 2: This second study examines the temporal stability of the TIDI. The sample includes 209 French teenagers aged 11 to 16 years who completed the questionnaire and participated at the second administration of the questionnaire, three months later. The stability coefficient for entity theory was 0.74 and for incremental theory was 0.70. These results indicate that the TIDI is stable over time, thus supporting its temporal stability., Conclusion: The overall results presented in these studies confirm the excellent psychometric properties of the TIDI. These studies also attest that a teenager can subscribe in a simultaneous way to both implicit theories of intelligence. Although a theory is dominant, the opposite theory can be available according to the context. From a theoretical point of view, this questionnaire could be used within correlational studies in order to study the correlation between the implicit theories and the psychopathological variables such as anxiety and depression. From a pragmatic point of view, this questionnaire can be used for the treatment of children with learning disabilities.

Most studies have tried to explain the school difficulties by analysing the intellectual factors that lead to school failure. However in addition to the instrumental capacities, authors also recognize the role played by other factors such as motivation. More specifically, the theory of achievement motivation aims to determine motivational factors involved in achievement situations when the students have to demonstrate their competencies. This paradigm attributes a central place to beliefs in order to explain children's behavior in academic situations. According to Dweck, it seems that beliefs about the nature of intelligence have a very powerful impact on behavior. These implicit theories of intelligence create a meaning system or conceptual framework that influences the individual interpretation of school situations. Thus, an entity theory of intelligence is the belief that intelligence is a fixed trait, a personal quality that cannot be changed. Students who subscribe to this theory believe that although people can learn new things, their underlying intelligence remains the same. In contrast, an incremental theory of intelligence is the belief that intelligence is a malleable quality that can increase through efforts. The identification of these two theories allows us to understand the cognition and behavior of individuals in achievement situations. Many studies carried out in the academic area show that students who hold an entity theory of intelligence (ie they consider intelligence like a stable quality) have a strong tendency to attribute their failures to a fixed trait. They are more likely to blame their intelligence for ne-gative outcomes and to attribute failures to their bad intellectual ability. In contrast, students who hold an incremental theory of intelligence (ie they consider intelligence as a malleable quality) are more likely to understand the same ne-gative outcomes in terms of specific factors: they attribute them to a lack of effort. This differential emphasis on traits versus specific mediators in turn fosters different reactions to negative events. Several studies have shown that entity theorists of intelligence are more likely than incremental theorists to react helplessly in the face of failure. They are not only more likely to make negative judgments about their intelligence from the failures, but also more likely to show negative affect and behaviors. This helpless response pattern is cha-racterized by a lack of persistence, and performance decrements. In contrast, incremental theorists, who focus more on behavioral factors (eg effort, problem-solving strategies) as causes of negative achievement outcomes, tend to act on these mediators. They try harder and develop better strategies and continue to work. Some authors have tendency to consider implicit theories of intelligence as a disposition or a stable dimension. But in the last few years, several studies showed that people's theories are not fixed traits; they are beliefs that may be influenced. These studies also suggested that students use the two types of beliefs and that the context determines the choice between the two types of theories. According to these authors, the psychological state of the student depends on dispositional factors but also on situational factors. Thus, several studies have tried to demonstrate that it is possible to modify experimentally implicit theories of intelligence and subsequent cognitions and behaviors by modifying situational factors. Several studies have demonstrated that it was possible to induce students to adopt one of the two theories of intelligence by presenting them a scientific article that compelling argued for either an entity or an incremental view of intelligence. The results showed that participants who had received the entity theory induction exhibited more evidence of a helpless reaction to failure. These studies show that some of the judgments and reactions associated with implicit theories can be experimentally induced by manipulating participant theories. However in the context of school difficulties, only few works have been conducted. We think that the model of the motivation of achievement would allow us to better understand maladjusted behaviors that engender failure and scholastic exclusion. In one study, reseachers have demonstrated that children with mental disorders are less likely than other children to hold an incremental theory of their intellectual abilities. Other studies have demonstrated that entity theorists interpret their bad results according to their global intelligence level by negatively judging their global abilities ("I think I am stupid"). It is interesting to note that these students make the same attributions as depressive students. These results reveal the need to determine systems of beliefs within populations with anxiety or depressive symptoms in order to characterise their motivational profiles. Indeed, we think that these symptoms contribute to modify implicit theories of intelligence and the nature of the subsequent scholastic achievement. Finally, we think that it is inte-resting to demonstrate the positive motivational effects of the experimental induction of the incremental theory. A series of studies showed that children's theories of intelligence expe-rimentally induced will influence their tendency to persevere in the face of failure. Like normally developing children, children with mental disorders were more likely to prefer challenging activities and report high levels of interest-enjoyment when the task was presented as one which is improvable. It suggests that although children with difficulties are pessimistic about improving their intellectual capacities, if a new task is introduced in a way that highlights the possibility of self-improvement (incremental theory), then they will pursue the challenge in an adaptive manner (strong perseverance, enjoy, and important interest). These results are very inte-resting. Indeed, highlighting an incremental theory had a po-sitive motivational effect on behavior in achievement situations. In addition, all these results also may open up several interesting perspectives for the treatment of learning disabi-lities. The results should lead to plan programmes of cognitive therapy in order to modify beliefs that underlie maladjusted achievement behaviors of children and adolescents in scholastic failure.