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Resume Au sein de notre service, nous travaillons avec un programme de therapie cognitive comportementale centre sur les processus attentionnels. Les parents et educateurs rapportent les effets positifs de celui-ci sur le comportement des adolescents avec un trouble de l’attention avec hyperactivite (TDAH) mais ses effets sur des processus cognitifs precis n’ont encore jamais ete testes. Cette etude s’interesse a l’impact de ce programme sur le controle de l’impulsivite des adolescents avec un TDAH non traite. Nous avons utilise la tâche de Simon (connue pour generer un conflit entre une reponse automatique et une reponse dirigee vers un but) et interprete les resultats dans le cadre theorique du modele « Activation-suppression ». Ce cadre experimental et theorique nous fournit un outil puissant et precis pour etudier le controle de l’impulsivite en dissociant l’activation et la suppression des actions impulsives, ce qui n’est quasiment jamais realise dans les etudes sur le controle de l’impulsivite. Vingt adolescents avec un TDAH non traite ont suivi le programme pendant 12 semaines et nous avons compare leur performance avant et apres la realisation de ce programme. Les resultats montrent que l’amelioration du controle de l’impulsivite observee en fin de session vient a la fois d’une diminution de la propension a declencher des actions impulsives et d’une augmentation de l’efficacite des processus inhibiteurs. Ce programme pourrait donc se reveler une alternative pertinente a la medication stimulante, en particulier quand les parents sont reticents face a la medication ou quand leurs enfants presentent des effets secondaires trop importants.

Problematic physical activity (PPA) is a symptom commonly present in patients suffering from anorexia nervosa (AN). This study aims to refine the clinical description of children with early-onset AN and adolescents with standard-onset AN and associated PPA, in order to better understand their associated features, and to offer them adapted care and physical activity programs. 107 participants treated at the Salvator University Hospital Centre of Marseille for AN were retrospectively evaluated by the Exercise Dependence Scale Revised concerning PPA. Other self-report questionnaires were used to evaluate eating disorder, anxiety and depressive symptoms, quality of life, emotions, sleep, and attention deficit disorder with or without hyperactivity. In the entire sample, the presence of PPA was associated with significantly higher levels of eating disorder (EDI-2: p = 0.001) and body image concerns (p = 0.002), anxiety (STAI-Y-trait: p = 0.013) and depression (p = 0.006), as well as significantly lower psychological well-being (p

This retrospective study investigated, for the first time, sleep characteristics in anorexia nervosa (AN) subtypes and the clinical profile in adolescents, as well as the quality of life (QoL) and emotionality in these patients with poor sleep. The sample included 111 adolescents with AN. First, restrictive AN (ANR) and binge eating/purging AN (ANB/P) groups were compared in terms of self-reported sleep characteristics, sleepiness and chronotype. Second, the clinical profile, QoL, and emotionality of good sleepers (GS) and poor sleepers (PS) were compared. Compared to the ANR group, participants with ANB/P showed significantly greater sleep disturbances and sleepiness, and also a higher preference for an eveningness chronotype. Results also showed a clinical profile significantly more severe in PS than in GS. After adjustment, only the ANB/P subtype and the EDI-2 ineffectiveness subscale remained significantly linked to poor sleep. Moreover, the QoL was lower and emotionality more negative in PS with respect to GS. Findings suggest that subjective sleep disturbances may be used as a clinical marker for AN severity and for ANB/P subtype. Importantly, findings suggest that improving sleep quality in adolescents with AN may help managing their ED and their comorbidities, but also improve their QoL. Level V, descriptive study (evaluation data retrospectively studied).

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.

International audience; Humans are commonly motivated towards cooperation and prosociality. In this study, we examined this motivational predisposition in autistic individuals. Using an adaptation of the Cyberball paradigm, we investigated subsequent pro-social behaviour after witnessing social exclusion. Participants witnessed and played a series of Cyberball games, rated their affective state and valued emotional faces with respect to their approachability. Results showed that participants from both groups were aware of the social exclusion. However, while neurotypically developing participants engaged in pro-social behaviour in reaction to the exclusion, autistic participants showed less alterations, in terms of either behaviour or affective state. The current findings suggest a distinct motivational drive and processing of social reward stimuli in autism, which may result in behavioural responses divergent from typical development when engaging in the social world.

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.

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.

The deficit in "interference control" found in children with Attention Deficit Hyperactivity Disorder (ADHD) could be due to two distinct processes, which are not disentangled in most studies: a larger susceptibility to activating prepotent response impulses and a deficit in suppressing them. Here, we investigated the effect of 1/ADHD and 2/ methylphenidate (MPH), on these two components of interference control. We compared interference control between untreated children with ADHD, children with ADHD under MPH, and typically developing children performing a Simon task. The main findings were that 1/ children with ADHD were more susceptible to reacting impulsively and less efficient at suppressing impulsive actions, and 2/ MPH improved the selective inhibition of impulsive actions but did not modify the strength of response impulse. This work provides an example of how pharmacological interventions and selective responses to them can be used to investigate and further our understanding of cognitive processing.

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.

Background Humour is fundamentally a social phenomenon, occurring frequently in social and playful contexts. The positive affect resulting from an experience of enjoyed humour makes it socially rew ...

L'Encephale - Sous presse. Epreuves corrigees par l'auteur. Disponible en ligne depuis le lundi 11 fevrier 2019

Purpose: This pilot study describes the socio-professional development and quality of life of young adults with Asperger syndrome in France.Methods: Those young adults, between 18 and 30 years old,...

Assessment of the symptoms of body image disorder (BID) is crucial in anorexia nervosa (AN). Recent technological advancements such as virtual reality (VR) have improved the visual perception with 3D avatars and the feeling to be the avatar with the immersive conditions. This retrospective study examines the hypothesis that VR with standardized 3D avatars would improve body image perception and then body image evaluation by adolescents with AN, compared to the paper-based figure rating scales (FRS). Data of 31 female adolescents with AN were retrospectively studied. Paired data of perceived and desired body forms in addition to body perception index (BPI) (p = 0.2) and body dissatisfaction (p = 0.6), obtained by both VR and FRS were compared. Furthermore, correlation with validated psychometric questionnaires was also studied. Head-tracking technology allowed for the implicit measurement of explicit choices of patients. Participants with AN overestimated own body size regardless of the assessment tool used. BPI and body dissatisfaction did not differ significantly between FRS and VR. VR-based evaluation was correlated with the psychometric parameters BID and body dissatisfaction. Head tracking revealed significantly longer participant engagement with avatars representing malnutrition and underweight states, while those least engaged corresponded to obesity. Results of BID evaluation by VR standardized 3D avatars are comparable to those obtained by paper-based FRS. These findings suggest that comparable results obtained by both tools of evaluation reflect primarily the role of affective-cognitive perturbation in BID. The perceptive component could be better evaluated using biometric-enhanced assessment tools. Level V, cross-sectional descriptive study (evaluation data retrospectively studied).

Individuals with autism spectrum disorder (ASD) show a lack of motivation to engage in spontaneous social encounters with other human beings. However, the basis for these diminished approach-relate ...

High-functioning individuals with Autism Spectrum Disorder (ASD) and age- and verbal IQ-matched controls (CTL) were fMRI scanned when playing “stone paper scissors”. They believed they were playing against three different opponents: a Human, a Robot endowed with an artificial intelligence attempting to win the game, and a Computer running a random number generator. No differences between ASD and CTL reached significance in canonical mentalizing regions, in the medial prefrontal cortex and right temporoparietal junction. In contrast, activity in a cluster located in the left hypothalamus, attributed to the paraventricular hypothalamic nucleus (PHN), increased in the CTL, but not ASD, group when participants played against the human compared to the artificial agent. The left temporoparietal junction (lTPJ), that has been previously associated with anthropomorphization, influenced this PHN cluster activity differently between groups, with a significantly negative functional connectivity when CTL played against the robot and when ASD participants played against the human. Brain activity results are consistent with the hypothesis that hypothalamus-secreted neurohormones, including oxytocin, could support motivation for social interactions and be impaired in autism. Brain connectivity results suggest that cortical encoding of social context information, putatively related to anthropomorphism, has a reversed effect on hypothalamus activity in autism.

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.

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.

Objective This study investigated sleep architecture in newborn and six-month-old infants who were born to depressed mothers. Method Sixty-four healthy full-term infants (32 males and 32 females) participated in the study. Of these, 32 were high-risk infants who were born to mothers diagnosed with depression, and 32 were low-risk infants born to mothers without a personal history of depression. 24-hour polysomnography was recorded at zero and six months of age (M0 and M6). Sleep macro-structural parameters (total sleep time, TST; awake time; non-rapid eye movement, NREM sleep (%); rapid eye movement, REM sleep %; arousal index; and sleep efficiency) were analysed at M0 and M6. Micro-architectural sleep features (slow-wave activity, SWA; delta sleep ratio, DSR; spindle density; and rapid eye movement density) were calculated at M6. The data between high-risk and low-risk groups were compared using Student's t -tests. Results At M0 and M6, the high-risk infants showed more awake time and fewer arousals than the low-risk infants. However, the high-risk group had less NREM% at M0 and a shorter TST as well as less REM% at M6 than the low-risk group. At M6, the high-risk group showed higher SWA, higher DSR and lower spindle density in comparison with the low-risk group. Conclusions Altered sleep structure was observed during their first months of life in infants born from depressed mothers, thereby suggesting that the prenatal environment could enhance the depression vulnerability of the child and potentially decrease their neuroplasticity.

Autism has been considered as a deficit in prediction of the upcoming event or of the sensory consequences of our own movements. To test this hypothesis, we recorded eye movements from high-functioning autistic adolescents and from age-matched controls during a blanking paradigm. In this paradigm, adolescents were instructed to follow a moving target with their eyes even during its transient disappearance. Given the absence of visual information during the blanking period, eye movements during this period are solely controlled on the basis of the prediction of the ongoing target motion. Typical markers of predictive eye movements such as the number and accuracy of predictive saccades and the predictive reacceleration before target reappearance were identical in the two populations. In addition, the synergy of predictive saccades and smooth pursuit observed during the blanking periods, which is a marker for the quality of internal models about target/eye motions, was comparable between these two populations. These results suggest that, in our large population of high-functioning autistic adolescent, both predictive abilities and internal models are left intact in Autism, at least for low-level sensorimotor transformations. ispartof: Neuropsychologia vol:91 pages:335-345 ispartof: location:England status: published

Sleep deprivation is highly prevalent in the general population and related to lifestyle in industrialized countries. There has been an increase in this reduction of sleep for half a century and adolescents are particularly affected. Given the magnitude of this sleep restriction, it seems important to focus its mechanisms and its neurocognitive, endocrine, metabolic, weight, psychological and school consequences on adolescents. This sleep deprivation is described and the solutions that can be proposed to adolescents and their family or school environment to increase sleep duration and decrease the negative consequences of their current sleep deprivation are reviewed.

ObjectiveThe primary aim of this study was to compare the sleep macroarchitecture of children and adolescents whose mothers have a history of depression with children and adolescents whose mothers do not.MethodPolysomnography (PSG) and Holter electroencephalogram (EEG) were used to compare the sleep architecture of 35 children whose mothers had at least one previous depressive episode (19 boys, aged 4–18 years, “high-risk” group) and 25 controls (13 males, aged 4–18 years, “low-risk” group) whose mothers had never had a depressive episode. The total sleep time, wakefulness after sleep onset (WASO), sleep latency, sleep efficiency, number of awakenings per hour of sleep, percentages of time spent in each sleep stage, rapid eye movement (REM) latency and the depressive symptoms of participants were measured.ResultsIn children (4–12 years old), the high-risk group exhibited significantly more depressive symptoms than controls (P = 0.02). However, PSG parameters were not significantly different between high-risk children and controls. In adolescents (13–18 years old), the high-risk subjects presented with significantly more depressive symptoms (P = 0.003), a significant increase in WASO (P = 0.019) and a significant decrease in sleep efficiency compared to controls (P = 0.009).ConclusionThis study shows that children and adolescents born from mothers with a history of at least one depressive episode had significantly more depressive symptoms than controls. However, only high-risk adolescents presented with concurrent alterations of sleep macroarchitecture.

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.

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 Rodriguez-Sanchez 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.

The angry superiority effect refers to more efficient way individuals detect angry relative to happy faces in a crowd. Given their socio-emotional deficits, children with autism spectrum disorders (ASD) may be impervious to this effect. Thirty children with ASD and 30 matched-typically developing children were presented with a visual search task, in which they were to detect a happy or angry target face in a crowd. A significant angry superiority effect was found for children with and without ASD. Results are discussed in light of perceptual, cognitive and social mechanisms underlying this effect in children with ASD.

We report a case of schizophrenia with partial agenesis of the corpus callosum in a 14-year-old girl. Diagnosis of schizophrenia was confirmed in the longitudinal follow-up and partial agenesis of the corpus callosum was found on brain MRI at the prodromal stage of disease. The prodromal symptom was progressive deterioration of social and academic adjustment in a context of non-specified psychotic disorder in the father. We found no abnormality in the development but a history of seizures that did not require specific treatment. Follow-up at 8 months showed an increase in negative symptoms and the onset of delusional symptoms and disorganization leading to the prescription of antipsychotic treatment. A review of the literature shows that agenesis of corpus callosum is the most reliable brain morphology abnormality in schizophrenia and is related to the neurodevelopmental and abnormal brain connectivity hypothesis in schizophrenia. Although this abnormality may be a marker of disease severity, our case report highlights the lack of longitudinal follow-up to allow the characterization of a specific outcome pattern of schizophrenic adolescents with partial agenesis of the corpus callosum.

The “beauty is good” (BIG) stereotype is a robust and extensively documented social stereotype. While one may think that children with autism are impervious to the BIG stereotype, given their remarkable difficulties in the social sphere, this issue has not yet been addressed. We have asked 18 children with autism to judge how friendly and intelligent faces appeared. They were then asked to judge the same faces on beauty, and their responses were compared to that of 18-matched controls, as well as to 71 typically developing children. Results revealed similar beauty judgements across the groups. Importantly, children with autism also showed a BIG stereotype, considering friendly and intelligent the beautiful faces, and unfriendly and not intelligent the ugly faces, just like their matched controls and typical children. These findings raise critical questions on stereotype acquisition as well as on the characterization of autism as a global social disability.

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.

Resume A l’instar d’autres troubles psychiatriques, les hypotheses etiopathologiques de la depression se sont largement fondees sur la decouverte fortuite de traitements pharmacologiques efficaces dans cette maladie. Reciproquement, l’innovation therapeutique s’est ensuite nourrie de ces hypotheses pour stimuler le developpement de nouvelles molecules. Nous proposons ici d’etudier le developpement des traitements pharmacologiques a travers les differents modeles neurobiologiques et moleculaires proposes dans la depression. Nous partirons ainsi de l’hypothese monoaminergique qui postule l’existence d’un deficit dans la transmission des monoamines (noradrenaline et serotonine). Si ce modele a longtemps pu fournir un premier niveau d’explication de l’action des molecules antidepressives, les limitations ont ete pointees. Ces insuffisances ont pu deboucher sur un cadre theorique se pretant particulierement bien aux exigences de l’experimentation pharmacologique : le modele de stress de la depression. Des lors, d’autres phenomenes moleculaires et cellulaires ont pu etre observes sous l’influence du stress, reversibles sous traitements antidepresseurs.

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.

Resume Selon de nombreux auteurs, le trouble qualitatif des interactions sociales, caracteristique du syndrome d’Asperger, serait lie a une faible comprehension des informations emotionnelles. C’est dans ce cadre que nous avons realise trois etudes concernant la reconnaissance des emotions a partir des visages, des gestes et du contexte emotionnel. Dans une premiere etude, nous avons propose des stimuli hybrides (procedure de dissociation frequentielle des visages) a un groupe d’enfants Asperger (n = 17) et a un groupe d’enfants temoins. Les resultats revelent que contrairement au groupe temoin, le groupe Asperger utilise preferentiellement les hautes frequences qui vehiculent les informations sur les details, ce qui confirme leur perception atypique des emotions faciales. Dans une deuxieme etude, les sujets Asperger (n = 23) devaient identifier des gestes emotionnels decrits par des points lumineux en mouvement. Les donnees montrent que les sujets Asperger semblent ne pas traiter correctement l’information emotionnelle contenue dans la gestuelle corporelle. Enfin, dans une troisieme etude, nous avons teste la capacite des enfants Asperger (n = 19) a identifier des emotions a partir d’informations provenant du contexte (i.e., scene visuelle). Les resultats demontrent qu’ils ont plus de difficultes que les sujets temoins a inferer l’emotion d’un visage masque en s’appuyant sur le contexte environnemental, alors qu’ils parviennent tres bien a inferer l’identite d’un objet. Toutes nos etudes vont dans le sens d’un deficit specifique de la reconnaissance des emotions chez les sujets Asperger. Ce deficit concerne non seulement la reconnaissance des visages mais egalement l’utilisation des indices non faciaux, tels que les gestes et le contexte.

Eating disorders and school refusal behavior with delayed sleep phase are pathologies associated with very different or even inverse school problems. It is through these two prisms that we will develop the idea of school care, which is being set up in the innovative framework of the Mediterranean Area of the Adolescent, integrating a National Education Unit within the Child and Adolescent Psychiatry unit. This specific care seems to us interesting in the adolescent because it allows a work in «natural» environment of certain difficulties related to the different psychiatric disorders and seems to us as a help to the revival of the adolescent process.

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.

Points essentiels Les avantages de la pratique de l’activite physique sont maintenant reconnus tant du point de vue physiologique que du point de vue psychologique. Des etudes demontrent que l’activite physique est associee a une importante reduction des etats depressifs et anxieux, dans la population generale comme dans des sous-groupes ayant un diagnostic psychiatrique d’anxiete ou de depression. Ces benefices de l’exercice physique peuvent s’expliquer par des processus physiologiques, biochimiques et psychologiques. L’activite physique peut etre consideree comme une aide therapeutique aux approches psychotherapeutiques et pharmacologiques de la depression et de l’anxiete. Elle semble donc constituer un type de traitement non specifique avec un reel potentiel psychotherapeutique qui a ete jusqu’ici neglige.

Resume L’etude de l’enfance du schizophrene nous permet d’identifier les differents facteurs de risque qui participent au developpement de la maladie. Nous definirons plus specifiquement les facteurs de risques perinataux : la saison et le lieu de naissance, l’exposition virale pendant la grossesse et les complications obstetricales. Les facteurs developpementaux seront egalement evoques. Les troubles de la socialisation, du langage, du developpement psychomoteur et cognitif sont autant de difficultes developpementales retrouvees pendant l’enfance du schizophrene. Enfin, nous terminerons en mentionnant quelques facteurs de risques psychosociaux.

The aim of the present study was to determine whether children with autism spectrum disorders (ASD) are able to recognize facial expressions of emotion and objects missing on the basis of contextual cues. While most of these studies focused on facial emotion recognition, here we examined the ability to extract emotional information on the basis contextual cues. Nineteen children and adolescents with ASD were asked to recognize emotions and objects (control condition) masked within visual scenes and their performance was compared to that of 19 typically developing controls matched on chronological age and gender. Results revealed that children with ASD were able to use contextual cues to recognize objects but not emotions. Findings of this study are discussed within the framework of specific emotional processing deficits in ASD.

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.

Patients with Asperger syndrome are often diagnosed late or are wrongly considered to have schizophrenia. Misdiagnosing Asperger syndrome creates serious problems by preventing effective therapy. Several clinical signs described in Asperger syndrome could also be considered as clinical signs of schizophrenia, including impaired social interactions, disabilities in communication, restricted interests, and delusions of persecution. A number of clinical features may facilitate the differential diagnosis: younger age at onset, family history of pervasive developmental disorder, recurring conversations on the same topic, pragmatic aspects of language use, oddities of intonation and pitch, lack of imagination, and incomprehension of social rules are more characteristic of Asperger syndrome. Accurate distinction between Asperger syndrome and schizophrenia would make it possible to offer more treatment appropriate to the patient's functioning.

Background and purpose: Although participation of opioids in antinociception induced by cannabinoids has been documented, there is little information regarding the participation of cannabinoids in the antinociceptive mechanisms of opioids. The aim of the present study was to determine whether endocannabinoids could be involved in peripheral antinociception induced by activation of μ-, δ- and κ-opioid receptors. Experimental approach: Nociceptive thresholds to mechanical stimulation of rat paws treated with intraplantar prostaglandin E2 (PGE2, 2 μg) to induce hyperalgesia were measured 3 h after injection using an algesimetric apparatus. Opioid agonists morphine (200 μg), (+)-4-[(alphaR)-alpha-((2S,5R)-4-Allyl-2,5-dimethyl-1-piperazinyl)-3- methoxybenzyl]-N,N-diethylbenzamide (SNC80) (80 μg), bremazocine (50 μg); cannabinoid receptor antagonists N-(piperidin-1-yl)-5-(4- iodophenyl)-1-(2,4-dichlorophenyl)-4-methyl-1H-pyrazole-3-carboxamide (AM251) (20–80 μg), 6-iodo-2-methyl-1-[2-(4-morpholinyl) ethyl]-1H-indol-3-yl(4-methoxyphenyl) methanone (AM630) (12.5–100 μg); and an inhibitor of methyl arachidonyl fluorophosphonate (MAFP) (1–4 μg) were also injected in the paw. Key results: The CB1-selective cannabinoid receptor antagonist AM251 completely reversed the peripheral antinociception induced by morphine in a dose-dependent manner. In contrast, the CB2-selective cannabinoid receptor antagonist AM630 elicited partial antagonism of this effect. In addition, the administration of the fatty acid amide hydrolase inhibitor, MAFP, enhanced the antinociception induced by morphine. The cannabinoid receptor antagonists AM251 and AM630 did not modify the antinociceptive effect of SNC80 or bremazocine. The antagonists alone did not cause any hyperalgesic or antinociceptive effect. Conclusions and implications: Our results provide evidence for the involvement of endocannabinoids, in the peripheral antinociception induced by the μ-opioid receptor agonist morphine. The release of cannabinoids appears not to be involved in the peripheral antinociceptive effect induced by κ- and δ-opioid receptor agonists. British Journal of Pharmacology (2008) 154, 1143–1149; doi:10.1038/bjp.2008.175; published online 12 May 2008

Studies on emotional processing report that schizophrenic patients present a specific pattern of emotional responding that usually includes deficits in emotional expressiveness, increased feelings of unpleasant emotion but decreased feelings of pleasant emotion, and increased physiological reactivity. However, studies have rarely controlled the nature of antipsychotic medication. Yet, the influence of these drugs on emotional response is uncertain and could vary depending on their pharmacological profile.This prospective and randomized study aimed to compare the effects of an atypical antipsychotic, risperidone, to a typical one, haloperidol, on patients' emotional responding during an emotional induction task.Twenty-five schizophrenic patients underwent two emotional and clinical evaluations: one before treatment initiation and a second 4 weeks after. Emotional states of fear, sadness, anger, joy, and disgust were induced, as well as a neutral baseline state. Video recordings of patients during the induction task allowed for assessment of emotional expressiveness. Self-reports and measures of skin conductance and heart rate were performed to determine both subjective and physiological reactions to emotional experience.Compared to haloperidol, risperidone did not reduce patients' facial expressiveness, decreased physiological reactivity, and decreased experience of unpleasant emotion but maintained experience of pleasant emotion. Emotional expressiveness was negatively correlated to parkisonism.Our preliminary results suggest that atypical antipsychotics allow for better-adapted patterns of emotional responding than typical ones do. We suggest that this effect is due to reduced striatal D2 blockade, therefore, attenuating akinesia, coupled with increased 5HT and DA levels in prefrontal cortex, which improves emotional regulation.

It is widely accepted that autistic children experience difficulties in processing and recognizing emotions. Most relevant studies have explored the perception of faces. However, context and bodily gestures are also sources from which we derive emotional meanings. We tested 23 autistic children and 23 typically developing control children on their ability to recognize point-light displays of a person's actions, subjective states and emotions. In a control task, children had to recognize point-light displays of everyday objects. The children with autism only differed from the control children in their ability to name the emotional point-light displays. This suggests that children with autism can extract complex meanings from bodily movements but may be less sensitive to higher-order emotional information conveyed by human movement. The results are discussed in the context of a specific deficit in emotion perception in children with autism.

This study compared the influence of categorization on perceptual processing in adults with autistic spectrum disorders (ASD) and normal control participants. Participants were asked to categorize hybrid faces (composed of two overlapped faces of different spatial bandwidths) by gender and emotion. Control participants exhibited a bias for low-pass information during gender categorization and a bias for high-pass information during emotion categorization. By contrast, adults with ASD showed the same low-pass bias in both tasks. This absence of a shift in processing style in the ASD group is discussed in terms of diminished top-down modulation in autism.

This study evaluated whether atypical face processing in autism extends from human to cartoon faces for which they show a greater interest. Twenty children with autistic spectrum disorders (ASD) were compared to two groups of typically developing children, matched on chronological and mental age. They processed the emotional expressions of real faces, human cartoon and non-human cartoon faces. Children with ASD were as capable as controls in processing emotional expressions, but strategies differed according to the type of face. Controls relied on a configural strategy with all faces. By contrast, ASD children exploited this typical configural strategy with cartoons but used a local strategy with real faces. This atypical visual processing style is discussed in the context of face expertise.

In the embodied cognition framework, sensory, motor and emotional experiences are encoded along with sensorimotor cues from the context in which information was acquired. As such, representations retain an initial imprint of the manner in which information was acquired. The current study reports results indicating a lack of embodiment effects in ASD and, further, an association between embodiment differences and ASD symptomatology. The current results are consistent with an embodied account of ASD that goes beyond social experiences and could be driven by subtle deficits in sensorimotor coordination.

Background Recent neuroimaging studies suggest that autism spectrum disorder results from abnormalities in the cortical folding pattern. Usual morphometric measurements have failed to provide reliable neuroanatomic markers. Here, we propose that sulcal pits, which are the deepest points in each fold, are suitable candidates to uncover this atypical cortical folding. Methods Sulcal pits were extracted from a magnetic resonance imaging database of 102 children (1.5–10 years old) distributed in three groups: children with autistic disorder ( n = 59), typically developing children ( n = 22), and children with pervasive developmental disorder not otherwise specified ( n = 21). The geometrical properties of sulcal pits were compared between these three groups. Results Fold-level analyses revealed a reduced pit depth in the left ascending ramus of the Sylvian fissure in children with autistic disorder only. The depth of this central fold of Broca’s area was correlated with the social communication impairments that are characteristic of the pathology. Conclusions Our findings support an atypical gyrogenesis of this specific fold in autistic disorder that could be used for differential diagnosis. Sulcal pits constitute valuable markers of the cortical folding dynamics and could help for the early detection of atypical brain maturation.

The anthropomorphic bias describes the finding that the perceived naturalness of a biological motion decreases as the human-likeness of a computer-animated agent increases. To investigate the anthropomorphic bias in autistic children, human or cartoon characters were presented with biological and artificial motions side by side on a touchscreen. Children were required to touch one that would grow while the other would disappear, implicitly rewarding their choice. Only typically developing controls depicted the expected preference for biological motion when rendered with human, but not cartoon, characters. Despite performing the task to report a preference, children with autism depicted neither normal nor reversed anthropomorphic bias, suggesting that they are not sensitive to the congruence of form and motion information when observing computer-animated agents’ actions.

This study aimed to explore the perception of different components of biological movement in individuals with autism and Asperger syndrome. The ability to recognize a person's actions, subjective states, emotions, and objects conveyed by moving point-light displays was assessed in 19 participants with autism and 19 comparable typical control participants. Results showed that the participants with autism were as able as controls to name point-light displays of non-human objects and human actions. In contrast, they were significantly poorer at labeling emotional displays, suggesting that they are specifically impaired in attending to emotional states. Most studies have highlighted an emotional deficit in facial expression perception; our results extend this hypothesized deficit to the perception and interpretation of whole-body biological movements.