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To explain irradiation creep, several mechanisms have been proposed. Some are based on the effect of stress on either nucleation or growth of dislocation loops. To investigate these mechanisms in aluminum we combine in-situ transmission electron microscope irradiation under stress and two simulation approaches (object kinetic Monte-Carlo, molecular dynamics Frenkel pair accumulation). We observe the selectivity of Frank loop variants under electron irradiation and applied stress. When the stress is turned on after loop formation, there is no loop variant selectivity, suggesting the absence of preferential absorption on already formed loops. Object kinetic Monte-Carlo simulations, including the effect of stress on the diffusion of point defects, show no growth rate difference between loop variants. Frenkel pair accumulation simulations exhibit variant selectivity of nucleated loops. This shows that loop selectivity is due to preferential nucleation of well oriented loops under stress and not to differential growth of loops. [ABSTRACT FROM AUTHOR]

[Display omitted] We investigate the influence of elastic properties of point defects on dislocation climb under stress and irradiation. For this purpose, elastic dipole tensors and diaelastic polarizabilities are evaluated in aluminum for vacancies and self-interstitial atoms in their stable and saddle configurations, using density functional theory calculations. These parameters are introduced in an object kinetic Monte-Carlo code and a continuous diffusion model to estimate the stress dependence of dislocation climb, using a dipole of straight dislocations. We show that both parameters have an influence on absorption of point defects under stress, in agreement with previous analytical models. However, the effect of dipole tensor is found only 5 times larger than polarizability, whereas models predict a factor up to 30. In addition, including polarizability reverses the stress angular dependence when a uniaxial stress is applied orthogonal to the dislocation line, so in general polarizability cannot be ignored for simulations under applied stress. Further comparison with analytical models shows that they give a good description of angular dependence, provided saddle point configuration of point defects is not too anisotropic. For vacancies, which are strongly anisotropic in their saddle configuration, models fail to reproduce quantitatively lattice effects on stress angular dependence observed in simulations. Calculations show that dislocation climb velocity under irradiation is expected to be the highest if the stress is approximately orthogonal to the dislocation line, especially along the Burgers vector, and the lowest if the stress is applied close to the 〈 100 〉 direction with the largest projection on the dislocation line. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The 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. Method: Polysomnography (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 4–18years, “high-risk” group) and 25 controls (13 males, aged 4–18years, “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. Results: In children (4–12years 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 (13–18years 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). Conclusion: This 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. [Copyright &y& Elsevier]

Summary: 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. [Copyright &y& Elsevier]

Abstract: The aim of the present study was to determine whether the implicit theory effect extends to children with oppositional defiant disorder (ODD), with academic difficulties. Twenty-five male children, aged 8–11 years with ODD were randomly assigned to one of two experimental conditions (Incremental Theory highlighting the possibility of self-improvement vs. control). An increase of cognitive performance (IQ) was found for children with ODD in the incremental condition, but not in the control condition. This cognitive improvement could be viewed as a protective factor for children and adolescents with ODD on academic setting. [Copyright &y& Elsevier]

Abstract: According to several authors, social disabilities in Asperger syndrome would be correlated to a weak understanding of emotional information. In this context, we conducted three studies on the recognition of emotions from faces, gestures and emotional context. In a first study, we proposed a face-matching task, including hybrid faces (composed of two overlapping faces of different spatial bandwidths) to a group of children with Asperger syndrome (n =17) and to a control group. Results reveal that, unlike the control group, Asperger subjects preferentially use the high spatial frequencies (i.e.: local information) to recognize emotion, thus confirming their atypical perception of facial emotions. In a second study, subjects with Asperger syndrome (n =23) had to recognize emotions and actions from point-light displays. Our findings show difficulties in identifying emotion information (but not action) conveyed by human movement in this population. Finally, in a third study, we assessed the capacity of children with Asperger syndrome (n =19) to identify facial expression or objects on the basis of contextual cues (i.e., visual scenes). Results show that they performed poorer than control subjects in emotions but not in objects recognition. Taken together, our studies reveal a specific deficit in emotion recognition in children with Asperger syndrome. This deficit concerns not only the recognition of faces but extends to the use of cues, such as gestures and visual context. [Copyright &y& Elsevier]

Abstract: During the past decade, several studies have reported positive effects of cognitive-behavioral therapy (CBT) in the treatment of children and adolescents with mental disorders. One of the most important CBT interventions is to teach children and adolescents to challenge negative thoughts that lead to maladjusted behaviors. Based on the implicit theories of intelligence framework, the main purpose of this study was to test whether an incremental theory manipulation could be used to affect IQ test performance in adolescents with Generalized Anxiety Disorder (GAD). Results showed that patients demonstrated enhanced IQ performance and experienced less state anxiety when they were exposed to an incremental theory of intelligence manipulation. Our findings suggest that incremental theory manipulation provides a useful cognitive strategy for addressing school-related anxiety in adolescents with mental disorders such as GAD. [Copyright &y& Elsevier]

Abstract: The Attention-Deficit and Hyperactivity Disorder is frequent and well known in childhood and in child psychiatry. However, this disorder is widely under-diagnosed in adults. There has been a greater interest in this disorder for several decades: Several studies have indicated a persistence of symptoms beyond childhood and adolescence in up to 66% of cases, which leads to a prevalence of 5% in the general population of adults. This disorder is diagnosed on clinical presentation. The diagnostic criteria in adults are facilitated if the first symptoms of this disorder are detected before the age of seven. The symptoms are similar to those observed in children, even thought attention deficits are more frequent than impulsiveness or psychomotor hyperactivity in this population. Very often, patients diagnose their disorder on their own via journals or Internet, and then they try to find a specialist. The DSM-IV and ICD-10 criteria for adults include several items typically found in children suffering from this disorder, and differentiate several subtypes. This paper tries to clarify the functioning of this disorder, with the objective of a better knowledge and treatment for patients who are seriously handicapped by their trouble. Whereas there is a gender ratio of 4:1 (males: females) in children, women are as much concerned as men in the adult forms. The daily life of patients suffering from hyperactivity is disturbed in nearly all fields, including work, relationships and leisure. The disorder can lead to severe consequences for patients and their environment, including loss of work, separations, accidents and chaotic lifestyles. Hyperactivity can be difficult to distinguish from some of the other psychiatric disorders - mostly borderline or dissocial behaviour -, such as bipolar or conduct disorders. However, it can also occur in co-morbidity of any one of these disorders, and this in up to 60% of the cases. Nevertheless, it is important to mention that this disorder is usually present before the onset of the other co-morbid disorders. Multiple etiological factors seem to be implicated in this disorder. Several studies have highlighted the possible contribution of perinatal, neurobiological, neuroanatomical, neuropsychological and genetic factors. The abnormality most explored is the imbalance between noradrenergic and dopaminergic systems. Similarly, genetic studies underline the aberrations found in the dopamine transporter gene and in the D2 and D4 receptor genes. For general practitioners, social workers, forensic institutions or courts, it is important to realise that these patients can beneficiate from an adequate and effective treatment. Pharmacological treatments are the same as the ones for children, they include méthylphénidate and atomoxetine but also antidepressants and antihypertonics. Beside pharmacotherapy, psycho-education can significantly improve symptoms and results in improving self-management of daily life difficulties. [Copyright &y& Elsevier]

Abstract: Objective: To determine developmental communication profiles in young autistic children with mental retardation. Methods: A group of 19 autistic children (mean age=43 months) were matched with a group of 11 mentally retarded children (mean age=39 months) on mental age (17,6 months). All of these children were without speech (less than 5 words of vocabulary). Communication skills were assessed with the Guidetti-Tourrette scales (ECSP), French adaptation of the Seibert-Hogan scales. Results: Autistic children displayed a much lower score than mentally retarded children in the 3 functions of early social communication (behavior regulation, social interaction and joint attention). The developmental communication profiles was the same in the 2 groups. Discussion: The results showed evidence of distortion in autistic children development: they displayed important deficits in communication skills, in comparison with cognitive skills. Autistic children mainly displayed requesting gestures: they used adults to help them to reach a goal, instead of regarding them as social partners. However, young children who have mental age less than 18 months mainly use the same functions of communication, with or without autistic trouble. Conclusions: There is a same developmental sequence in communication skills in young children, with or without autistic trouble. [Copyright &y& Elsevier]

Abstract: Patients with anorexia nervosa are usually presented as studious pupils, proposing their school performances to avoid the hospitalisation. Their real intellectual level is discussed in the literature, by taking into account of their state of denutrition, of the possibly associated depression and the psychopathological aspects of the cognitive investment. Population and methodology: This study includes a population of 21 teenagers and adults with anorexia nervosa hospitalized in an endocrinology unit. They were evaluated using the IQ scales of Weschler and the scales of logical thought. Results: These patients with anorexia nervosa have a normal IQ (average QIG=102). On the other hand, 19 patients out of 21, present either a delay (50%), or a normal cognitive disharmony (45%). Conclusions: The intellectual performances measured by the psychometric tests do not differentiate this group of patients from the general population. But these patients have a form of concrete thought, revealed by the tests of logical thought, which show their difficulties of accession to the abstract or formal thought of adolescence. We make the hypothesis of a link between the refusal of the sexual body and the immaturity of the new cognitive processes of the adolescence as the formal thought. [Copyright &y& Elsevier]

Abstract: Over the past 25 years, the achievement goals have become an important concept to address achievement motivation in school settings. Achievement goals are defined as the purpose or cognitive-dynamic focus of competence-relevant activity and the goal adopted is posited to influence how individuals interpret and experience achievement settings. According to the trichotomous model, three independent achievement goals are supposed to account for competence-based strivings (a) Mastery goals that focus on the development of competence and task mastery, (b) Performance-approach goals that focus on the attainment of favourable judgements of normative competence, and (c) Performance-avoidance goals that focus on avoiding unfavourable judgements of normative competence. In the past few years, most research conducted using the trichotomous achievement-goal framework has focused on the consequences of pursuing different achievement goals. To date, empirical work conducted in academic settings on modeling possible antecedents of the three types of goals has focused on achievement motives, perceptions of competence. The purpose of the current study was to extend the research in academic settings based on the trichotomous framework by focusing on the antecedents of the three goals such as implicit theories about intelligence. An entity theory of intelligence is the belief that intelligence is a fixed trait, a personal quality that cannot be changed. In contrast, an incremental theory of intelligence is the belief that intelligence is a malleable quality that can increase through efforts. In the present research, we assessed among 695 boys attending five French schools perception of Competence, implicit theories about intelligence in addition to the three achievement goals to identify the profiles underlying each goal type in academic situations. Regression analyses modeling possible predictors of each goal showed that (1) Performance-approach goals were ... [Copyright &y& Elsevier]

Since the 50s, the role of implicit theories in the organization and interpretation of information has gained increasing acceptance among both cognitive and social psychologists. These implicit theories refer to the two different assumptions people may make about the malleability of personal attributes. They may believe that a highly valued personal attribute, such as intelligence or morality, is fixed, i.e. a nonmalleable trait-like entity (entity theory), or that the attribute is a malleable quality that can be changed and developed (incremental theory). The identification of these two theories allows us to understand the cognition, emotion and behavior of individuals in achievement situations. Many studies carried out in the primary school show that children who hold an entity theory of personal attribute (i.e. they consider badness like a stable quality) have a strong tendency to attribute their failures to a fixed trait. They are more likely to attribute failures to their bad abilities. In contrast, children who hold an incremental theory of personal attribute (i.e. they consider badness as a malleable quality) are more likely to understand the same negative outcomes in terms of specific factors: they attribute them to a lack of effort. In addition, several studies have shown that entity theorists are more likely than incremental theorists to react helplessly in the face of failure. They are more likely to show negative affect and behaviors. This helpless response pattern is characterized by a lack of persistence. In contrast, incremental theorists try harder and develop better strategies and continue to work. Finally, several studies demonstrate that environmental factors play an important role in the implicit theories elaboration. [Copyright &y& Elsevier]

Notre objectif principal était de décrire les caractéristiques des actes auto-agressifs avec substance des sujets de moins de 18 ans pris en charge dans le cadre de la régulation téléphonique d'urgence du centre antipoison et de toxicovigilance de Marseille. Cette étude est descriptive, prospective et quantitative. Elle est monocentrique et a été réalisée au sein du centre antipoison et de toxicovigilance de Marseille. Elle a inclus l'ensemble des sujets de moins de 18 ans pour lesquels un avis au centre antipoison et de toxicovigilance de Marseille a été sollicité au décours d'un acte auto-agressif avec une substance toxique (dont des médicaments) entre le 1er octobre 2021 et le 31 janvier 2022. Les 308 sujets inclus étaient âgés de 11 à 17 ans avec un âge moyen de 14,9 ans (±1,5) pour les filles et 14,6 (±1,7) pour les garçons (p = 0,234). Le sex-ratio était de 0,14. Deux cent quarante patients (77,9 %) avaient déjà un suivi antérieur psychologique ou psychiatrique. Il s'agissait d'une récidive de tentative de suicide dans 43,8 % des cas (n = 135). Le recours aux services des urgences était quasiment systématique (n = 277, 89,9 %). Il s'agissait en majorité de mono-intoxications (n = 193, 62,7 %). Les intoxications étaient dans la plupart des cas médicamenteuses (n = 281, 91,2 %). Les antalgiques-antipyrétiques étaient la classe médicamenteuse la plus utilisée (n = 147 patients, 47,7 %), suivis par les anxiolytiques (n = 62, 20,1 %). Le paracétamol s'est avéré la substance la plus ingérée (n = 108, 35,1 %). Cent six patients sont restés asymptomatiques (34,4 %). Sur les 308 sujets inclus, 78,6 % étaient hospitalisés pour une durée moyenne de 4 ans jours. Deux cent quarante-neuf jeunes (80,8 %) avaient eu au moins un avis psychiatrique et 200 (64,9 %) avaient un rendez-vous pour une consultation psychiatrique à la sortie. Les caractéristiques démographiques des jeunes suicidants et celles de l'intoxication étaient globalement similaires à celles retrouvées dans la littérature. Le taux de récidive est plus élevé que dans la littérature. Plus de deux ans après le début de la pandémie de SARS-CoV-2, le mal-être de la jeunesse est toujours là alors que l'offre de soin est déjà saturée. Pour inverser la tendance d'ici 2027, le ministère de la Santé et de la Prévention a actualisé sa stratégie nationale de prévention par différents moyens. Une étude au décours pourrait être intéressante pour voir l'impact de ces mesures. Cette étude, même limitée dans le temps et l'espace, complète d'autres indicateurs peu nombreux et partiels, et montre que la crise de santé mentale pédiatrique s'aggrave, en particulier chez les plus jeunes adolescents, avec un taux de récidive qui augmente. Il faut rester vigilant et continuer à mettre en place des actions de dépistage et des moyens de prévention notamment des récidives. To describe poison exposures in case of self-poisoning subjects younger than 18 years old reported to the Marseille Poison Control Center. This is a descriptive, monocentric and prospective review of self-poisoning patients aged < 18 years who reported to the Marseille Poison Control Center from 1st October 2021 to 31st January 2022. The 308 subjects included were aged 11 to 17 years with an average age of 14.9 years (±1.5) for girls and 14.6 (±1.7) for boys (P = 0.234). The sex ratio was 0.14. Two hundred and forty patients (77.9%) already had prior psychological or psychiatric follow-up. It was a recurrence of suicide attempts in 43.8% of cases (n = 135). The use of an emergency department was almost systematic (n = 277, 89.9%). Most of these were mono-intoxications (n = 193, 62.7%). The poisonings were in most cases drug-induced (n = 281, 91.2%). Analgesics-antipyretics were the most used drug class (n = 147 patients, 47.7%), followed by anxiolytics (n = 62, 20.1%). Paracetamol proved to be the most ingested substance (n = 108, 35.1%). One hundred and six patients remained asymptomatic (34.4%). Of the 308 cases included, 78.6% were hospitalized for an average of four days. Two hundred forty-nine cases (80.8%) had one psychiatric evaluation in an emergency department and 200 (64.9%) will have an appointment for a psychiatric consultation on discharge. The demographic characteristics of young suicides and those of intoxication were globally like those found in the literature although our recurrence rate was higher than those in the literature. More than two years after the start of the SARS-CoV-2 pandemic, the malaise of young people remains while the care offer is already saturated. To reverse the trend by 2027 the French Ministry of Health and Prevention has updated its national prevention strategy by various means. A subsequent study could be interesting to see the impact of these measures. This study is limited but seems to complement some indicators, which shows that the pediatric mental health crisis is worsening, especially among the youngest adolescents who have an increased recurrence rate. We must remain vigilant and continue to implement screening actions and means of prevention, particularly of recurrences. [ABSTRACT FROM AUTHOR]

Le trouble déficit de l’attention/hyperactivité est actuellement un trouble relativement bien connu chez l’enfant et l’adolescent. Mais depuis quelques années, de nombreuses études ont démontré une persistance partielle ou complète de ce syndrome à l’âge adulte. En effet, beaucoup d’adultes présentent des symptômes similaires à ceux retrouvés chez les enfants mais avec une symptomatologie plus souvent marquée par le déficit de l’attention que par l’hyperactivité psychomotrice et l’impulsivité. Le diagnostic différentiel reste difficile en particulier avec les troubles anxieux, les troubles de l’humeur ou les troubles de la personnalité. En effet, le TDAH partage de nombreux symptômes avec ces troubles psychopathologiques ce qui engendre de nombreuses difficultés diagnostiques. L’objectif de cette présentation est de montrer en quoi le TDAH est une entité distincte sur le plan clinique et neuropsychologique ainsi qu’au niveau fonctionnel et anatomique. Nous évoquerons également la question des comorbidités relativement fréquentes qui participent à la confusion et à la méconnaissance du trouble. À l’instar des enfants, le TDAH de l’adulte engendre malheureusement de nombreux dysfonctionnements tant au niveau social et professionnel qu’au niveau affectif. En revanche, il semble que ce trouble soit particulièrement sensible aux différents traitements (psychothérapies et/ou médicaments) qui permettent aux patients une meilleure qualité de vie. Une meilleure connaissance de ce trouble paraît donc incontournable afin de mieux comprendre les difficultés quotidiennes qu’il engendre mais aussi de proposer la prise en charge la mieux adaptée. [ABSTRACT FROM AUTHOR]

Attention-deficit/hyperactivity disorder (ADHD) was initially considered as a childhood psychiatric disorder. However, longitudinal observations have revealed that ADHD symptoms may persist in adulthood among approximately 50% of the patients [1] . Adult ADHD is associated with impaired social outcome and frequent comorbidities such as mood disorders, personality disorders, and substance use disorders [2,3] . Correctly identifying and treating ADHD can significantly improve the global functioning and cognition of adult subjects, and reduce the intensity and frequency of the comorbid states [2,3] . Nonetheless, the clinical features of adult ADHD are clearly different from the youth form [1,2] , and ADHD symptoms are easily mixed up in adults with symptoms of the comorbid conditions [2,3] . These clinical intricacies can make the diagnosis of ADHD difficult in adults. Moreover, the management of methylphenidate in adult subjects is also associated with specific risks and pitfalls, such as abuse and tampering behaviors, and additional safety risks [4] . Put together, it appears crucial to identify and treat ADHD in adults, but the clinical and therapeutic complexities of adult ADHD require improved expertise and caution from adult psychiatrists and addiction specialists. In this thematic session of the 2015 French Psychiatry Congress, three French leading experts of adult ADHD will address the aforementioned clinical and therapeutic issues of the adulthood form of this disorder. David Da Fonseca, professor of child psychiatry in Marseille, will disentangle the clinical features of adult ADHD from the typical symptoms observed in the youth form. Mélina FATSEAS, associate professor of psychiatry and addiction medicine in Bordeaux, will specifically focus on the many and complex relationships observed between adult ADHD and substance use disorders. Last, Nicolas Simon, professor of addiction medicine and psychopharmacology in Marseille, will synthesize what are the very risks and issues with prescribing methylphenidate in adults. [ABSTRACT FROM AUTHOR]

Résumé Introduction Le refus scolaire anxieux est apparu avec les lois de Jules Ferry instituant l’obligation scolaire en 1882. Dans les classifications psychiatriques internationales, le refus scolaire anxieux n’apparaît pas comme un diagnostic en soi. L’objectif principal de cette étude était de décrire les troubles psychopathologiques d’adolescents en refus scolaire suivis en hôpital de jour. L’objectif secondaire était de comparer le niveau d’anxiété, d’affects dépressifs, d’estime de soi, de solitude, d’attachement aux parents et aux pairs et de qualité de vie de ces adolescents, à celui d’adolescents scolarisés. Matériel et méthode Le groupe refus scolaire était composé de 22 patients suivis en l’hôpital de jour. Le groupe témoin comprenait 21 adolescents scolarisés. Les troubles psychopathologiques ont été définis grâce au questionnaire semi-dirigé d’évaluation diagnostique kiddie-schedule for affective disorders and schizophrenia (KIDDIE-SADS). L’intensité des troubles a été évaluée par des échelles d’auto-évaluation. Résultats Les principaux diagnostics observés chez les adolescents en refus scolaire étaient la phobie sociale (59 %), l’anxiété de séparation (50 %), l’épisode dépressif caractérisé (32 %) et le trouble anxieux généralisé (18 %). Par rapport aux adolescents scolarisés, les adolescents en refus scolaire présentaient un niveau d’anxiété, d’affects dépressifs, un sentiment de solitude significativement plus élevés, une estime de soi et une qualité de vie plus faible. La perception de l’attachement de ces adolescents à leurs mères et à leurs pairs était plus faible. Conclusion Les adolescents en refus scolaire ont des troubles sévères, dominés par des profils psychopathologiques variés. Ces difficultés ont un impact sur le sentiment de solitude et la qualité de vie. L’attachement semble jouer un rôle dans ce trouble. Summary Introduction School refusal appeared when formal education became compulsory in 1882, with the Jules Ferry laws. In international psychiatric classifications, school refusal does not appear as a diagnosis by itself, but it co-exists and is inherent to the symptoms of other psychiatric conditions, in particular of anxiety and depressive disorders. The main goal of this study was to describe psychopathological disorders in teenagers presenting school refusal followed in a day hospital setting. The second goal was to measure the level of anxiety, depressive emotion, self-esteem, loneliness, attachment to parents and peers, as well as quality of life, and to compare these with teenagers in school. Material and methods Two groups of individuals participated in this study. The first group consisted of 22 adolescents presenting school refusal followed in the Espace Arthur day hospital in Marseille. The control group included 23 teenagers in school. The psychopathological profile of teenagers with school refusal was defined using the semi-directed KIDDIE-SADS questionnaire. The level of psychopathology was assessed in the two groups through self-evaluation scales. Results The results showed that among teenagers with school refusal, four main diagnoses were found: social phobia (59%), separation anxiety disorder (50%), depression (32%), and generalized anxiety disorder (18%). Compared to teenagers in school, those with school refusal had significantly higher levels of anxiety, depression, and loneliness. In addition, they had low self-esteem, and the perception of attachment to their mother and to peers was also less secure. In line with this, they also showed poor quality of life. Conclusion Adolescents with school refusal show a wide variety of psychopathological symptoms, mainly inherent to anxiety and depressive disorders. These difficulties have an impact on the quality of life, loneliness, and self-esteem. Moreover, attachment to parents and peers seems to play an important role in this condition. [ABSTRACT FROM AUTHOR]

Résumé Introduction Il existe peu d’études concernant les problèmes médicaux rencontrés chez les enfants placés à l’Aide sociale à l’enfance (ASE). L’objectif de notre étude était de décrire la population des mineurs placés à l’ASE et ayant fait l’objet d’une notification à la MDPH (Maison départementale des personnes handicapées) des Bouches-du-Rhône au 1 er janvier 2014. Patients et méthodes Le registre informatique de l’ASE et celui de la MDPH ont été croisés afin d’en extraire les données administratives. Après une analyse des dossiers médicaux MDPH, les informations sur les enfants placés (âge gestationnel, déficiences, pathologies) ont été codées. Résultats Parmi les 2965 mineurs placés (0,7 % des mineurs de notre région), 506 (17 %) avaient une notification à la MDPH, contre 2,5 % en population générale. Parmi eux, 80,2 % avaient été confiés suite à une mesure de placement et 50 % des notifications MDPH concernaient les orientations vers un établissement scolaire et médico-social. On a noté 2,1 déficiences par enfant, dont 35,9 % étaient des déficiences du psychisme, 26,4 % des déficiences du langage et de la parole et 21,6 % des déficiences intellectuelles cognitives. Les pathologies rencontrées étaient pour 71 % des troubles mentaux et du comportement. Les enfants les plus jeunes et placés en famille d’accueil présentaient plus de pathologies et de déficiences d’organe et peu d’atteintes du psychisme. Les enfants présentant des troubles du comportement étaient en général plus âgés et placés en foyer. Discussion Le taux de notification MDPH est 7 fois plus élevé parmi les enfants placés qu’en population générale. Ce lien entre enfance en danger et handicap est difficile à expliquer, et la psychopathologie des enfants placés complexe. Ces résultats illustrent la nécessité d’un suivi adapté aux besoins spécifiques de ces enfants. Summary Introduction By the end of 2011, 275,000 children in France were included in the Aide sociale à l’enfance (ASE, Child Welfare System). Half of these children were entrusted to public care. There is limited data on these children. The MDPH (Maison départementale des personnes handicapées) is an administrative body assisting in the care of disabled children, through material, financial, and human means. Analyzing MDPH medical records can provide medical information about these children. The aim of this study was to describe the characteristics of children left to the ASE with a record at MDPH in Bouches-du-Rhône. Methods We extracted administrative data from two registers, the ASE register and the MDPH register. The MDPH medical files of each patient were analyzed and their medical information was coded: gestational age, deficiencies, and pathologies. Results In Bouches-du-Rhône, 2965 children were entrusted, 506 (17%) of whom were known by the MDPH: 30.6% of the entrusted children known by MDPH were taken into foster care and 48% were in residential group homes. Half of the MDPH notifications concerned a referral to a school or medico-social institution. By analyzing the medical data, we observed an average of 2.1 deficiencies per child. The types of deficiencies were distributed as follows: 35.9% were psychological deficiencies, 26.4% were speech deficiencies, and 21.6% were intellectual cognitive deficiencies. The most common pathology was mental and behavioral disorder (71% of diagnoses). Discussion The MDPH notification rate in children entrusted to public care was seven times higher than in the general population. Overall, explaining the relation between child abuse and neglect and disability is difficult. The psychopathology of these children is complex. These results show the importance of specific medical monitoring for these children. [ABSTRACT FROM AUTHOR]

Purpose: The service configuration with distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) may be a barrier to continuity of care. Because of a lack of transition policy, CAMHS clinicians have to decide whether and when a young person should transition to AMHS. This study describes which characteristics are associated with the clinicians' advice to continue treatment at AMHS. Methods: Demographic, family, clinical, treatment, and service-use characteristics of the MILESTONE cohort of 763 young people from 39 CAMHS in Europe were assessed using multi-informant and standardized assessment tools. Logistic mixed models were fitted to assess the relationship between these characteristics and clinicians' transition recommendations. Results: Young people with higher clinician-rated severity of psychopathology scores, with self- and parent-reported need for ongoing treatment, with lower everyday functional skills and without self-reported psychotic experiences were more likely to be recommended to continue treatment. Among those who had been recommended to continue treatment, young people who used psychotropic medication, who had been in CAMHS for more than a year, and for whom appropriate AMHS were available were more likely to be recommended to continue treatment at AMHS. Young people whose parents indicated a need for ongoing treatment were more likely to be recommended to stay in CAMHS. Conclusion: Although the decision regarding continuity of treatment was mostly determined by a small set of clinical characteristics, the recommendation to continue treatment at AMHS was mostly affected by service-use related characteristics, such as the availability of appropriate services. [ABSTRACT FROM AUTHOR]

Summary: 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. [ABSTRACT FROM AUTHOR]

Résumé Le neurofeedback par la création d’une boucle psychophysiologique rétroactive présente des avantages, en comparaison des autres techniques de remédiation cognitive utilisées dans la prise en charge des enfants souffrant de trouble déficit de l’attention/hyperactivité (TDA/H). Pourtant, bien que cette technique soit utilisée depuis près de 20 ans dans le TDA/H, son niveau de preuve d’efficacité reste débattu. L’évolution du nombre de publications recensées par la base de données électroniques PubMed par les termes medical subject headings (Mesh) « Neurofeedback » et « Attention-Deficit Disorder with Hyperactivity » permet de proposer une analyse de l’évolution de la littérature sur le neurofeedback et le TDA/H suivant deux périodes : avant 2011 et après 2011. Les premières études avant 2011, sur neurofeedback et TDA/H, ont mis essentiellement l’accent sur la qualité du protocole de neurofeedback et de l’effet d’apprentissage au cours des séances, aux dépens de la construction méthodologique du protocole en lui-même (absence de randomisation et de groupe témoin). Cette attention semble avoir diminué dans les études plus récentes, qui se concentrent sur la construction de protocoles plus rigoureux (avec groupes témoins de meilleure qualité et évaluations en aveugle). Cependant, les conditions de bonne pratique du neurofeedback lui-même sont le pendant indispensable aux études de preuve d’efficacité bien conduites. Ainsi les futures études d’efficacité du neurofeedback dans le TDA/H devront allier la qualité méthodologique des études randomisées contrôlées en aveugle à la qualité de la conduite des séances de neurofeedback. Background Neurofeedback, based on the concept of creating a retroactive psychophysiological loop, has advantages compared with other cognitive therapeutic techniques in the treatment of children with attention-deficit/hyperactivity disorder (ADHD). However, although this technique has been used for almost 20 years in ADHD, the level of evidence for its efficacy remains debated. This debate has recently been brought into focus in the literature following a published meta-analysis. Aims This article aims to review and classify existing literature on the efficacy of neurofeedback in ADHD. Methods Publications were identified through a literature search of the electronic database PubMed using the Medical Subject Headings (Mesh) terms “Neurofeedback” and “Attention-Deficit/Hyperactivity Disorder”. All relevant papers published in English or French were reviewed by the authors. These were separated into 2 groups: published before and after 2011. Results Prior to 2011, studies are characterized by low sample size and are often non-randomized and uncontrolled. In addition these are most often performed by practitioners who participated in the development of the first neurofeedback equipment and who have electrophysiological expertise, essential for effective training during sessions. In 2009 Arns et al. published the first meta-analysis on the efficacy of neurofeedback in ADHD. They found a large effect size, 1.02 (0.84 to 1.21) and 0.94 (0.76 to 1.12) respectively for the inattention and impulsivity dimensions, and a moderate effect size of 0.71 (0.54 to 0.87) on the hyperactivity dimension. Improved inattention dimension was proportional to the number of sessions and maintained in randomized trials, which was not the case for the hyperactivity dimension. After 2011, studies are characterized by larger samples, and methodology including randomized, controlled trials and blinded assessments. In 2013, Sonuga-Barke et al. published the second meta-analysis on the efficacy of neurofeedback in ADHD ( Am J Psych ). They found a smaller effect size of 0.59 (0.31 to 0.87) compared to the first meta-analysis of 2009. The effectiveness of neurofeedback was not confirmed in studies with blinded assessment. The effect size was 0.29 (−0.02 to 0.61) ( P = 0.07; NS). However the effectiveness of the training during neurofeedback sessions in some of the included studies has been called into question. Conclusion Methodological issues are likely to have a large impact on results obtained in studies of neurofeedback. Thus, it is critical that future trials implement adequately randomized, controlled, blinded designs that do not compromise the quality of neurofeedback session itself. [ABSTRACT FROM AUTHOR]

Summary: The treatment of children with pervasive developmental disorders (PDD) has not been systematically assessed in French day-care units. In this prospective study, 11 children with a diagnosis of PDD were followed up for 2years in a day-care unit in the Marseille university hospital. The treatment they received is based on an initial assessment by the “Centre Ressources Autisme” (CRA PACA) and further included a continued observation of the child and an assessment of the child''s abilities and needs. This treatment used various therapeutic approaches 10h weekly and also included parental counseling and coordinated work with schools. Treatment in our day-care unit can be categorized as eclectic, non-intensive therapy. It is based on methods such as TEACCH (Treatment and Education of Autistic and related Communication handicapped Children), Floor Time Play, speech and language therapy, developmental therapy, and psychotherapy. International studies on intensive behavioral therapies suggest that this treatment is superior to non-behavioral and/or non-intensive treatment. They suggest its efficiency is due both to the nature of the treatment (behavioral) and to its intensity (more than 25h a week). In this study, the CRA diagnosed children using the ADI and ADOS. The 11 children (mean age, 3years 5months) were tested twice, with the Vineland and CARS scales. The first assessment was on admission to the day hospital and the second was 2years later. The results showed developmental progress with a mean increase of 13.5 months at the Vineland Scale, and a decrease of the autism severity score on the CARS. The treatment presented here proves to be efficient; if compared to similar results in international studies, we obtained better results than their eclectic intensive or non-intensive treatment comparison group. [Copyright &y& Elsevier]

A new tuberculosis vaccine is urgently needed. Prime-boost strategies are considered very promising and the inclusion of BCG is highly desirable. In this investigation, we tested the protective efficacy of BCG delivered in the neonatal period followed by boosters in the adult phase with a DNA vaccine containing the hsp65 gene from Mycobacterium leprae (pVAXhsp65). Immune responses were characterized by serum anti-hsp65 antibody levels and IFN-γ and IL-5 production by the spleen. Amounts of these cytokines were also determined in lung homogenates. Protective efficacy was established by the number of colony-forming units (CFU) and histopathological analysis of the lungs after challenge with Mycobacterium tuberculosis. Immunization with BCG alone triggered a significant reduction of CFU in the lungs and also clearly preserved the pulmonary parenchyma. BCG priming also increased the immunogenicity of pVAXhsp65. However, boosters with pVAXhsp65 or the empty vector abolished the protective efficacy of BCG. Also, higher IL-5 levels were produced by spleen and lungs after DNA boosters. These results demonstrated that neonatal BCG immunization followed by DNAhsp65 boosters is highly immunogenic but is not protective against tuberculosis. [ABSTRACT FROM AUTHOR]

Investigates the influence of the trichotomous achievement goal model on intrinsic motivation. Use of the achievement goal approach in achievement motivation; Definition of achievement goals; Comparison between performance-approach and performance-avoidance.