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Prevalence, symptoms, and treatment of depression suggest that major depressive disorders (MDD) present sex differences. Social stress-induced neurovascular pathology is associated with depressive symptoms in male mice; however, this association is unclear in females. Here, we report that chronic social and subchronic variable stress promotes blood-brain barrier (BBB) alterations in mood-related brain regions of female mice. Targeted disruption of the BBB in the female prefrontal cortex (PFC) induces anxiety- and depression-like behaviours. By comparing the endothelium cell-specific transcriptomic profiling of the mouse male and female PFC, we identify several pathways and genes involved in maladaptive stress responses and resilience to stress. Furthermore, we confirm that the BBB in the PFC of stressed female mice is leaky. Then, we identify circulating vascular biomarkers of chronic stress, such as soluble E-selectin. Similar changes in circulating soluble E-selectin, BBB gene expression and morphology can be found in blood serum and postmortem brain samples from women diagnosed with MDD. Altogether, we propose that BBB dysfunction plays an important role in modulating stress responses in female mice and possibly MDD., The vascular, cellular and molecular changes underlying sex differences in mood disorders are unclear. Here, the authors show that blood-brain barrier dysfunction modulates anxiety- and depressive-like behaviors in female mice and endothelium-specific changes associated with maladaptive responses compared to resilience to stress.

To examine the clinical characteristics of adolescent girls consulting in a mood disorder clinic with a history of physical or sexual abuse.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.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.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.Examiner les caractéristiques cliniques des adolescentes consultant à une clinique des troubles de l’humeur et ayant été victime d’abus physique ou sexuel dans le passé.Une étude rétrospective de 55 dossiers d’adolescentes a été réalisée. Une grille d’analyse fut utilisée pour recueillir les données sociodémographiques, les antécédents personnels, les symptômes et les diagnostics. Les adolescentes ayant été victime d’abus physique ou sexuel dans le passé ont été comparées à d’autres adolescentes sans histoire d’abus. Une analyse univariée et une analyse de régression logistique ont été effectuées.Les adolescentes ayant été victimes d’abus physiqueou sexuel ne différaient pas statistiquement de celles sans histoire d’abus, en ce qui a trait aux symptômes dépressifs, ou au type et au nombre de diagnostics. Toutefois, elles présentaient une proportion plus élevée d’automutilation et de problèmes relationnels avec leurs parents et leurs pairs.Un passé de victimisation physique ou sexuel et des comportements autodestructeurs traduisent des problèmes relationnels. Les résultats montrent que ces variables sont reliées l’une à l’autre chez ces adolescentes ayant été victimes d’abus physique ou sexuel. Ce résultat suggère l’importance pour le clinicien d’explorer en profondeur les comportements autodestructeurs ainsi que les relations avec la famille et les pairs lors de l’évaluation des adolescentes dépressives.

To examine whether protective factors in the Protection for Adolescent Depression Study (PADS) moderate the impact of stressful events on depression and suicidal behaviour in the community and a clinical setting; and to study the influence of sex.Participants were 283 adolescents from the community and 119 from a mood disorder clinic in Montreal. The participants were evaluated on 6 instruments measuring individual risk and protective factors. Descriptive analyses and univariate and multiple logistic regression models were carried out.Risk factors predicted higher levels of depression and presence of suicidal behaviour, and protective factors predicted lower levels of depression and absence of suicidal behaviour, as expected under the vulnerability-resilience stress model. Several sex differences were observed in terms of the predictive power of risk factors (for example, hopelessness among girls and keep to themselves among boys) and protective factors (for example, focusing on the positive among girls and self-discovery among boys).Findings from the PADS suggest that protective factors moderate the impact of stress on depression and suicidal behaviour. Developing protection appears important in the presence of chronic conditions, such as depressive disorders, to reduce the likelihood of further episodes. The influence of sex makes it all the more relevant to target different factors for boys and girls to increase protection and decrease risk in prevention and intervention programs.

To compare the coping strategies of adolescents with borderline personality disorder (BPD) to the coping strategies of adolescents without BPD, and to explore the association of coping with suicidal ideation and attempts among adolescents with BPD.Adolescent inpatients (n = 167) aged 13 to 17 years were admitted after suicide attempts and evaluated within 10 days, using the abbreviated version of the Diagnostic Interview for Borderlines-Revised, the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version supported by a team consensus best estimate method for the primary diagnosis, the Adolescent Coping Scale, and the Columbia-Suicide Severity Rating Scale.Firstly, compared with adolescents without BPD, adolescents with BPD relied more on nonproductive coping strategies, mostly avoidant strategies, and less on productive coping strategies. Secondly, coping appeared as a factor associated with suicidal ideation in adolescents with BPD. While while controlling for age, sex, and depression, multivariate analyses showed a significant positive association between the coping strategy to focusing on solving the problem and suicidal ideation.The use of avoidant strategies by adolescents with BPD could be viewed as attempts to increase emotional regulation. Problem-solving strategies in the immediate aftermath of a suicide attempt may prevent adolescents with BPD from overcoming a crisis and may increase suicidal ideation.

A multisite study was undertaken to advance our understanding of how coping skills, depression, and suicidal ideation are related among adolescents who attempt suicide. Two hypotheses were postulated: productive coping and nonproductive coping would be associated, respectively, with lower and higher depression scores when age, sex, and stressful life events (SLEs) were controlled; and productive coping and nonproductive coping would be associated, respectively, with the presence and absence of suicidal ideation when age, sex, and SLEs were controlled.Participants were 167 adolescents (13 to 17 years of age) hospitalized for attempting suicide in 5 pediatric departments across France. Four instruments were administered: the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version, the Adolescent Coping Scale, the Life Events Questionnaire, and the Columbia-Suicide Severity Rating Scale. Descriptive analyses and univariate and multiple regression models were completed.Both hypotheses were confirmed. Focus on the positive emerged as a significant variable in both models; depression emerged as a significant variable in the suicidal ideation model. The only sex difference observed was that girls made greater use of wishful thinking and seek social support.These findings suggest that coping skills are important mechanisms through which depression and suicidal ideation are maintained after attempting suicide. In intervening with adolescents who have attempted suicide, it may be useful to emphasize cognitive work geared to looking on the bright side, positive thinking, and fighting depression.

DSM-5 has added a new developmentally appropriate child and adolescent mood disorder subtype called disruptive mood dysregulation disorder (DMDD). The core features of DMDD are temper outbursts (manifested by either verbal rages and/or physical aggression) and unrelenting irritability or anger. Currently, the literature is lacking a thorough review of the possible treatment options for the cardinal symptoms constituting DMDD. The objective of this article is to provide a thorough review of peer-reviewed studies on the subject of pharmacological treatment options for children and adolescents with the cardinal symptoms of DMDD.Relevant articles for this study were obtained through Pubmed, Medline, PsychINFO and PsychINDEXplus using the key words: "adolescents," "children," "paediatric," "youth," "irritability," "temper outbursts," "aggression," "rage," "disruptive behaviour," "treatment," "dysphoria," "autism," "mental retardation/intellectual disability," "impulsivity," "ADHD," "oppositional defiant disorder," and "conduct disorder." A total of 823 studies were generated; only English studies focusing on pharmacological treatment were retained.Currently there are no established guidelines or thorough reviews summarizing the treatment of DMDD. Pharmacotherapeutic treatment options of both aggression and chronic irritability include: antidepressants/selective norepinephrine reuptake inhibitors, mood stabilizers, psychostimulants, antipsychotics, and alpha-2 agonists.Treatment options of severe, persistent irritability in youth are numerous, and a consensual treatment algorithm has not yet emerged from the literature. Further studies and clinical trials are warranted to determine efficacious and safe treatment modalities.Le DSM-5 a ajouté un nouveau sous-type de trouble de l’humeur adapté au développement des enfants et des adolescents qui porte le nom de trouble disruptif avec dysrégulation de l’humeur (TDDH). Les principales caractéristiques du TDHE sont des accès de colère (manifestés soit par des rages verbales et/ou une agression physique) et une irritabilité ou une colère persistante. À l’heure actuelle, la littérature ne présente pas de revue approfondie des options de traitement possibles des symptômes cardinaux constituant le TDHE. L’objectif de cet article est d’offrir une revue approfondie des études révisées par des pairs sur le sujet des options de traitement pharmacologique pour les enfants et les adolescents présentant les symptômes cardinaux du TDHE.Les articles pertinents pour cette étude ont été obtenus dans Pubmed, Medline, PsychINFO et PsychINDEXplus à l’aide des mots clés: « adolescents », « enfants », « pédiatrie », « jeunesse », « irritabilité », « accès de colère », « agressivité », « rage », « comportement perturbateur », « traitement », « dysphorie », « autisme », « retard mental/déficience intellectuelle », « impulsivité », « TDAH », « trouble oppositionnel avec provocation », et « trouble des conduites ». Au total, 823 études ont été relevées; seulement les études en anglais portant sur le traitement pharmacologique ont été retenues.À l’heure actuelle, il n’y a pas de lignes directrices établies ou de revues approfondies qui résument le traitement du TDHE. Les options de traitement pharmacologique de l’agressivité et de l’irritabilité chronique sont notamment: les antidépresseurs/inhibiteurs spécifiques du recaptage de la noradrénaline, les stabilisateurs de l’humeur, les psychostimulants, les antipsychotiques, et les agonistes alpha-2.Les options de traitement de l’irritabilité grave et persistante chez les adolescents sont nombreuses, et un algorithme de traitement consensuel n’a pas encore été dégagé de la littérature. D’autres études et essais cliniques sont nécessaires pour déterminer des modes de traitement efficaces et sûrs.

to study the reliability of a self-questionnaire on adolescent affective instability, within a francophone clinical population.After reviewing the literature and consulting experts, the Affective Lability Scale (ALS), developed by Harvey and collaborators (1989), was selected. An anglophone and francophone version, adapted for the adolescent population, was developed. The final version includes 54 questions, divided into six sections, which examine the affective variations between euthymia, on the one hand, and depression, elation, and anxiety, on the other, and also examine the affective variations between anxiety and depression, and between depression and elation. The francophone version was the subject of a reliability study. A total of 43 francophone adolescents (48.8% male, 51.2% female; median age=14.86 years) took part in the comprehension and reliability study.All questions were assigned a comprehension rate per item (CRI)0.60 as evaluated by inter-rater agreement (median kappa=0.85). The median CRI is very satisfactory (0.88, SD=0.14). The internal consistency, determined by Cronbach coefficients, is elevated for each section and for the entire instrument (0.87 to 0.95). The temporal stability at three weeks is satisfactory, with an intraclass correlation coefficient (ICC) for the entire scale of 0.89 (confidence interval of 95%=0.75 to 0.95) and section's ICCs ranging between 0.72 and 0.89.This initial reliability data supports interest in the ALS as a means to evaluate a global level of affective lability, during the euthymic phase, among francophone adolescents in an in-patient psychiatric unit. A future study with a larger sample will make it possible to confirm these initial results and examine the factorial structure of the instrument.