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Abstract: Global Management of autistic people primarily requires behavioral and educational therapy. There is actually no psychopharmacological agent that is efficient on the core symptoms of autism, especially the social and communicative impairments. However psychotropic medications are widely prescribed in this population and as mush as one out two people with autism receives at least one medication. In this population, medications are mainly directed at the frequently associated behavioral symptoms such as aggression toward self or others, tantrums, hyperactivity, severe repetitive behaviors. The goal of this article is to provide a review of the existing controlled studies in this area. The presented studies aim the following therapeutic classes: atypical antipsychotics, selective serotonin reuptake inhibitors (SSRI), psychostimulants and antiepileptics. The studies and their main results in terms of efficiency and safety are presented in tables. Atypical antipsychotics, especially risperidone and aripiprazole have been shown to be useful in the treatment of behavioral symptoms. SSRI seem to have limited interest for the management of repetitive behaviors. Stimulants can help in case of hyperactivity and attention deficit associated with Autism spectrum disorders. Antiepileptics show promising results, but the best indications for this class are not clear. For sleep disturbances, melatonin can be a safe and efficient option. Challenging behaviors requires careful investigation to understand their origin in order to provide the specific management. The first answer should be environmental and educational. Somatic or mental diseases should be carefully assessed. Medication use in this vulnerable population should carefully evaluate the benefit/risk balance. Medications should be prescribed at the minimum dose for the minimum duration. [Copyright &y& Elsevier]

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

Abstract: Because of the close relationship between child and adolescents with their environment, Psychiatric emergencies in this population are very specific. Situations seen and their management are different from psychiatric adult emergencies. Beside real psychiatric emergencies, we often see situations characterised by psychological distress with an important social component. Our retrospective study compares two populations of youth people seen in the outpatient psychiatric emergency unit of the Pitié-Salpêtrière hospital in Paris. We analyse 196 cases seen during 1992 and 314 seen during 2002. The purpose is to evaluate the evolution of demographic and clinical characteristics of these two populations. The results are completed by a previous study conducted in 1981. Main demographic results are: 1) a dramatic increase of the number of patients seen; 2) a significant decrease of the mean age of consultation (13.6 yo in 1992 vs 12.3 yo in 2002); 3) sex-ratio stay the same, with more girls among old ages and more boys among young ages; 4) families themselves ask for consultation more and more often (58% in 2002). Clinical results are: 1) main reason of consultation stays acting-out disorders, especially in boys (50% in 1992 and 2002); 2) a greater proportion of patients has a psychiatric follow-up at the time of the consultation (38.2% in 1992; 55.4% in 2002); 3) major depression is the first diagnosis in 1992 (24.2%) and 2002 (35.8%); 4) psychiatric hospitalisation occurs in 34.2% in 1992 vs 19.8% in 2002, but absolute numbers remains stable. These results might be useful for the public health system in order to improve our answers for these requests more and more numerous for patients younger and younger. [Copyright &y& Elsevier]

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

Abstract: Hypersexuality is a frequent symptom in bipolar episode in teenagers. It can (1) favour at risk behaviours and put the adolescent in a dangerous situation, a rape being the first clinical manifestation of a manic episode; (2) induce sexual delusional ideas and/or false allegations of sexual abuse as psychotic features are frequent in this age range. In the present paper, we briefly report four recent cases seen a tour institution, and discuss the clinical, therapeutic and forensic implications of such situations. [Copyright &y& Elsevier]

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

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