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Objective: To examine the clinical characteristics of adolescent girls consulting in a mood disorder clinic with a history of physical or sexual abuse. Method: A retrospective review was conducted of the charts of 55 adolescent girls consulting in a mood disorder clinic. An analysis grid was used to gather data on demographics, personal antecedents, symptoms and diagnoses. Girls with a history of physical or sexual abuse were compared with girls without such a history. Univariate analyses and a logistic regression analysis were performed. Results: Adolescent girls with a history of physical or sexual abuse did not differ statistically from those without such a history in terms of depressive symptoms or type and number of diagnoses. However, proportionally more girls with a history of physical or sexual abuse presented self-harm and relational problems with their parents and peers. Conclusion: Both history of physical or sexual abuse and self-destructive behaviors are rooted in relational problems. The results show that these are related to one another among those adolescent girls. Clinically, these findings suggest that it is important for clinicians do a thorough exploration of self-destructive behaviors and family and peer relations when assessing depressed adolescent girls. [ABSTRACT FROM AUTHOR]

Résumé Le TDAH est le trouble comportemental le plus fréquent chez les enfants et les adolescents. Il est souvent associé à d’autres atteintes psychiatriques et physiques, ce qui complique et aggrave la symptomatologie. Parmi les troubles psychiatriques comorbides, les troubles de l’humeur, les troubles du comportement et l’anxiété sont les plus fréquemment retrouvés. De même, il existe un chevauchement entre le TDAH et les addictions, les TOC, les troubles du sommeil et les troubles de l’apprentissage. Les TCA et les TSA sont aussi de plus en plus reconnus comme des entités comorbides au TDAH. Enfin, des liens avec l’ESPT et les troubles de l’attachement ont été notés. Les affections médicales doivent également être considérées lors de l’évaluation du TDAH – les traumatismes crâniens, l’épilepsie et l’obésité entre autres. Les enfants TDAH avec des pathologies concomitantes sont plus sévèrement atteints et leur traitement est plus complexe. Une meilleure compréhension de la fréquence élevée de ces comorbidités est nécessaire pour optimiser le traitement et permettre d’améliorer le mauvais pronostic lié à l’association du TDAH avec d’autres pathologies. ADHD is a common disorder for children and is highly comorbid with a number of psychiatric and somatic disorders, which leads to important social consequences. Therefore, it is important to screen for the presence of other disorders when a diagnosis of ADHD is considered. Because of the associated pathologies, the clinical picture of the ADHD is more complex and represents a diagnostic challenge. Furthermore, the prognostic and the future of children with a comorbid ADHD is much more unfavorable than that of children with ADHD only. It is thus necessary to recognize the presentation of ADHD associated with various and frequently comorbid pathologies knowing that those will change according to age and the developmental stage. The objective of this article is to describe these comorbidities. We are going to discuss pathologies most often associated with ADHD and the impact of its symptomatology on psychiatric disorders, medical affections and other disorders such as learning disorder and developmental coordination disorder. Along these lines, we carried out a mini review of ADHD and comorbidities. Results showed that comorbid psychiatric disorders such as conduct disorders, mood disorders and anxiety are among the most frequently associated with ADHD in clinical practice. Disruptive disorders are the most common comorbidities found with ADHD. Among these disorders, oppositional defiant disorder must be distinguished from conduct disorders. Conduct disorders are highly comorbid with ADHD (in more than a third of the cases) and increase the severity of the clinical picture. When children show at the same time ADHD and a conduct disorder, they are at risk to have an antisocial personality disorder as well as addictive disorders in adulthood. Depressive disorders can be triggered by ADHD since these young patients have to face numerous failures and difficulties in their family, social and school lives. With respect to bipolar disorders, links exist with ADHD. Bipolar disorder and ADHD treatment is complex: both thymoregulators and medication of ADHD are necessary. Finally, anxiety disorders are concomitant in 33 % of ADHD children, an association which deteriorates the symptoms of inattention and distractibility. Furthermore, there is also some overlap between ADHD and addictive behavior, obsessive-compulsive disorder, tics, sleeping disorder and specific learning disorder. There is a high prevalence of the association between ADHD and addictive behaviors in connection with impulsiveness, lack of control, automedication and similarity in the neurobiological circuits. Children with an obsessive-compulsive disorder have ADHD in 33 % of the cases. Although treatments of ADHD and obsessive-compulsive disorder differ, they must be taken simultaneously. It seems that sleeping disorders are not co-occurring with ADHD but intrinsic. Besides, sleeping disorders during childhood can mime an ADHD and complicate the diagnosis to be established, in particular when restless legs syndrome or sleep apnea is present. The comorbidity of ADHD and specific learning disorders is high. Children with specific learning disorders have difficulties staying attentive and their academic performance is often below their full potential, just like the ADHD children. Therefore, clinicians who assess patients for ADHD have to systematically screen for the presence of specific learning disorders and vice versa. Likewise, autistic spectrum disorder and eating disorder are more and more recognized as comorbid entities. The DSM-IV made impossible the concomitance between autism spectrum disorders and ADHD. However, the DSM-5 did recognize the existence of this comorbidity. The association of those two pathologies results in more severe dysfunction for the children, but the treatment of ADHD is going to facilitate the medical care of autism spectrum disorders. ADHD is described as a risk factor for eating disorders. Besides, the co-occurrence of obesity with ADHD is connected to impulsiveness and the tendency to addictive behaviors. Relationships of ADHD with posttraumatic stress disorder and attachment disorder have also been noted. Similarities between ADHD and posttraumatic stress disorder can cause diagnostic errors. Indeed, for both disorders we find the following: agitation, irritability, hypervigilance, sleeping disorders, attention disorders and disorders in the executive functions. Therefore, during the assessment of a child with a clinical picture of ADHD, anamnesis must be completed with the search of traumatic events. On the other hand, attachment disorder can also be confused with ADHD. Difficult temperament can disrupt the process of attachment and is associated with a bigger risk of ADHD. Finally, other medical issues should be considered in the assessment of ADHD: brain injury, epilepsy and obesity for example. ADHD children with a co-occurring condition may be severely impaired and treatment is more complex. ADHD is strongly comorbid with a large number of psychiatric and physical pathologies. It is probably more a set of affections than a homogeneous clinical entity. The longitudinal studies of children with one or several comorbidities showed that the outcome of these children was unfavorable, the association of pathologies causing an important dysfunction. The explanations proposed for this strong tendency of comorbidity with ADHD are that comorbidities have the same risk factors (genetic and environmental) and/or that one of the disorder is a subcategory of another. This leads us to conclude that a better comprehension of the high rates of comorbidities with ADHD is essential to optimize treatment of this condition and prevent some of the negative outcomes associated with comorbid ADHD. [ABSTRACT FROM AUTHOR]

Résumé Le trouble disruptif avec dysrégulation de l’humeur (TDDH) est la seule nouvelle entité diagnostique du DSM-5 concernant spécifiquement l’enfant et l’adolescent. Elle appartient aux troubles de l’humeur et a été créée pour rendre compte de troubles mixtes du comportement et des émotions affectant des enfants et adolescents qui auraient par le passé fait l’objet d’un diagnostic de trouble bipolaire ou d’un trouble du comportement perturbateur. Cette nouvelle entité diagnostique est la résultante d’un certain nombre de travaux et de débats dont nous retracerons les principales étapes et les enjeux en termes de diagnostic et de caractéristiques neuropsychologiques. Disruptive mood dysregulation disorder (DMDD) is a new DSM 5 diagnosis specifically addressing children and adolescents. DMDD belongs to the category of mood disorders and has been created to improve recognition of a condition characterized by both mood and behavioral symptoms and to avoid a diagnosis of bipolar disorder in children and adolescents with severe chronic irritability and temper tantrums. Its validity and possible overlap with disruptive behavior disorders such as oppositional defiant disorder or conduct disorder and neurodevelopmental disorder such as attention deficit hyperactivity disorder – especially in children with severe emotional liability or comorbidities – are still subject to debate. This review addresses the background of DMDD, diagnosis and neuropsychological correlates. [ABSTRACT FROM AUTHOR]

Résumé: Cette revue de la littérature est consacrée aux symptômes émotionnels associés au trouble déficit d’attention/hyperactivité (TDA/H). Elle retrace notamment l’évolution récente de la recherche clinique et des critères diagnostiques qui ont fait une place plus importante aux symptômes émotionnels survenant au cours des troubles du comportement. La labilité émotionnelle est une caractéristique associée au TDA/H mais n’en est pas spécifique puisqu’elle existe également dans les troubles internalisés, dans plusieurs troubles de la personnalité et dans les troubles du comportement comme le trouble oppositionnel avec provocation (TOP) et le trouble des conduites. Nous décrirons les caractéristiques de la labilité émotionnelle sévère qui caractérise certains sujets ayant un TDAH et proposerons une conduite à tenir diagnostique à partir des nouvelles catégories identifiées par le DSM-5. Malgré certaines limites liées à sa validité insuffisante, la nouvelle entité clinique « trouble disruptif avec dysrégulation émotionnelle » permet d’attirer l’attention des cliniciens et des chercheurs sur la part émotionnelle des troubles à expression comportementale, qui nécessitent probablement des démarches diagnostiques et thérapeutiques spécifiques. [Copyright &y& Elsevier]

Introduction: Contraception-induced mood changes have been identified since the 1960s. To our knowledge, there has been no reported case about self-mutilation associated to any form of contraception. We report the case of a 17-year-old adolescent girl who presented with de novo self-mutilation and depressive symptoms three and a half weeks after the administration of 150 mg of Depot-Medroxyprogesterone Acetate (DMPA). Method: Clinical case report and literature review. Possible confounding factors are reviewed. Results: The patient had no personal psychiatric history and no significant family psychiatric history. A DSM-IV diagnosis of "mood disorder due to DMPA with depressive features" was formulated. There was no evidence of abnormal personality functioning. The mental status exam and collateral information validated the severity of her condition. Discussion: DMPA is a birth control method especially useful for adolescent girls and possible secondary mood symptoms should not limit its access. However, since depressive symptoms substantially interfere with daily functioning and may have unfortunate consequences like self-mutilation and suicidal ideation, it is important to remain vigilant regarding the onset of mood symptoms following contraceptive use in adolescent girls. This vigilance should be more specific regarding adolescent girls with a history of mood disorders, anxiety disorders, selfmutilation or family diathesis of these conditions. [ABSTRACT FROM AUTHOR]