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AIM: During adolescence, some individuals with autism engage in severe disruptive behaviors, such as violence, agitation, tantrums, or self-injurious behaviors. We aimed to assess risk factors associated with very acute states and regression in adolescents with autism in an inpatient population. METHOD: Between 2001 and 2005, we reviewed the charts of all adolescents with autism (N=29, mean age=14.8 years, 79% male) hospitalized for severe disruptive behaviors in a psychiatric intensive care unit. We systematically collected data describing socio-demographic characteristics, clinical variables (severity, presence of language, cognitive level), associated organic conditions, etiologic diagnosis of the episode, and treatments. RESULTS: All patients exhibited severe autistic symptoms and intellectual disability, and two-thirds had no functional verbal language. Fifteen subjects exhibited epilepsy, including three cases in which epilepsy was unknown before the acute episode. For six (21%) of the subjects, uncontrolled seizures were considered the main cause of the disruptive behaviors. Other suspected risk factors associated with disruptive behavior disorders included adjustment disorder (N=7), lack of adequate therapeutic or educational management (N=6), depression (N=2), catatonia (N=2), and painful comorbid organic conditions (N=3). CONCLUSION: Disruptive behaviors among adolescents with autism may stem from diverse risk factors, including environmental problems, comorbid acute psychiatric conditions, or somatic diseases such as epilepsy. The management of these behavioral changes requires a multidisciplinary functional approach. [ABSTRACT FROM AUTHOR]

BACKGROUND: The existence of bipolar disorder type I (BD-I) during adolescence is now clearly established whereas there are still some controversies on BD-II and BD-NOS diagnosis, mainly in Europe (O'Dowd in Br Med J 29, 2006). Little is known on the phenomenology and potential short-term prognosis factors of bipolar episodes in this age population. In particular, very few studies examine this issue on inpatients in the European context of free access to care. OBJECTIVE: To describe the phenomenology of acute manic and mixed episodes in hospitalized adolescents and to analyse potential predictive factors associated with clinical improvement at discharge and length of hospitalization. METHODS: A total of 80 subjects, aged 12-20 years, consecutively hospitalized for a manic or mixed episode. Socio-demographic and clinical data were extracted by reviewing patients' charts. We used a multivariate analysis to evaluate short-term outcome predictors. RESULTS: The sample was characterized by severe impairment, high rates of psychotic features (N = 50, 62.5%), a long duration of stay (mean 80.4 days), and an overall good improvement (86% very much or much improved). Thirty-three (41.3%) patients had a history of depressive episodes, 13 (16.3%) had manic or brief psychotic episodes but only 3 (3.7%) had a history of attention deficit/hyperactivity disorders. More manic episodes than mixed episodes were identified in subjects with mental retardation (MR) and in subjects from migrant and/or low socio-economic families. Overall severity and female gender predicted better improvement in GAF scores. Poor insight and the existence of psychotic features predicted longer duration of stay. CONCLUSION: These results suggest that severe manic and mixed episodes in adolescents with BD-I need prolonged inpatient care to improve and that socio-cultural factors and MR should be examined more closely in youth with BD. [ABSTRACT FROM AUTHOR]

Abstract: Sensory-motor integration approach of severe pervasive developmental disorders has become more popular during the recent years thank to André Bullinger''s research in the field of infant development. In this second paper, we aim to report a clinical illustration starting at the sensory-motor assessment as a key for therapeutic proposal in psychomotor therapy. The treatment included two sessions per week in classical room and in pool, alternatively. Technical interventions during sessions are presented and articulated with the sensory-motor assessment. Course of general functioning during the two years of treatment as well as comparison of yearly sensory-motor assessment are summarized. [Copyright &y& Elsevier]

OBJECTIVE: In the absence of recommendations from drug regulatory agencies for most medications to treat severe manic or mixed episode in adolescence, this study aims to (i) describe the pharmacological treatment prescribed in an inpatient setting for acute manic or mixed episodes in adolescents; (ii) determine whether type of episode, duration of stay, improvement, and psychotic features were associated with the nature of the given treatment; (iii) compare the results with evidence-based data. METHOD: From 1993 to 2003, we received 80 subjects, aged 12 to 20 years, consecutively hospitalized for a manic or mixed episode. Socio-demographic, clinical and treatment data were extracted by reviewing patients' charts. Treatment data were available for 75 subjects. RESULTS: Most patients received a combination treatment including mood stabilizer (82.6%), classical antipsychotic (AP) (86.6%) and atypical AP (24%). Despite prolonged hospitalisation (minimum stay = 17 days), 69 (86.2%) patients were scored very much or much improved at discharge. Secondary therapeutic options occurred in 15 subjects because of poor therapeutic response (N=13), severe adverse effects (N=5) or both. Two patients had electroconvulsive therapy as third therapeutic option. Adolescents with psychotic symptoms were significantly more frequently treated by lithium (Fisher exact test: p=0,0052). No other variable was associated with treatment. CONCLUSIONS: This study reported on patterns of medication use that mainly followed treatment recommendations and evidence-based data existing in adults. However, the presence of psychotic features appeared to favour the use of lithium in this French sample. [ABSTRACT FROM AUTHOR]