Identité et spécificité du « pédantisme » dans le syndrome d’Asperger

The purpose of this work is to better understand pedantic speech in Asperger syndrome as a pervasive developmental disorder. Often mentioned, unlike echolalia in studies on typical autism, this symptom questions the possible specificity of Asperger syndrome. From a review of literature and clinical examples, we propose an interpretation of this speech style as unified and coherent as possible. This clinical feature includes an overly precise vocabulary or overly favourite topic (which can be explained by a more general sameness) in the context of a one-side interaction (which can be explained by a more general impairment of influence). We suggest that the tendency to speak in a pedantic manner may be specific despite a generic disorder shared with typical autism.     

Activités à médiation : de l’occupationnel au thérapeutique

This reports deals with reflections by the medical staff of the Child and Teenager Care Centre about the therapeutic interest of mediator-supervised activities. This Care Centre, which is set within the university department of Child and Adolescent Psychiatry of Brest Hospital, receives mainly difficult teenagers. This study is in line with a redevelopment, at constant means, of our care offer because of the gradual changes observed in the issues and requests we have to cope with. This clinical evolution marked by deep societal motions has imposed us to modify our analysis of psychic suffering expression. The difficult teenager shows us to which extent our therapeutic and institutional tools may sometimes prove to be inadequate: indeed, his/her difficult behaviour means that we have failed. This finding drove us led us to take an interest in mediator-supervised activities that we needed to rediscover prior to appropriating them. As they proved to be better suited to difficult teenagers than “classical” approaches, we will try to highlight the ins and outs while underlining how an efficient therapy can emerge from a thorough organisation of occupations. The experience we have acquired through sailing activities will be used as illustration of our reflection.     

Autisme du nourrisson : quoi de neuf dans le diagnostic et l'accompagnement ?

The field of knowledge on autism has deeply changed within a decade. We know more about the different kinds of pervasive developmental disorders, on their incidence, on the clinical aspects of onset of autism, on the possibility of early detection, as soon as 18 months of age, on the frequency of neurological and genetic disorders which may be associated with autism, and on the necessity of an early intervention. New media, as video, are useful to enhance assessment and therapeutic follow-up. Research allow for a therapeutic follow-up that goes further than the splitting between educative and psychodynamic trends of thoughts. However, prognosis in autism is still a difficult issue, and therapeutic efficiency is still globally low. This paper is not a literature review on pervasive disorders in general or particularly in autism, but aims at highlighting some new aspects which may be of interest for both clinicians and researchers on these several issues, about children up to 3 years of age.     

Psychopathologie du syndrome d’Asperger et « aspérigisation » de la société contemporaine

The author has attempted here to point out, just for a start, the characteristics of Asperger syndrome from the point of view of psychopathology through a rereading of Hans Asperger's original paper (1944). This thesis merits reevaluation, if for no other reason than to fill the gaps in operational diagnostics based on the DSM. It is found by rereading that Asperger's view of the principal disturbances of autistic psychopathy include a “disturbance of natural evidence” or a “crisis of common sense”. This question of natural evidence that he evokes with regard to autistic psychopathy corresponds to W. Blankenburg's natural evidence, which constitutes a key concept for comprehending schizophrenia in the form poor-symptom (“symptomarme Schizophrenie”) that he observes in the speech of his patient Anne Rau. One can deduce from this that in terms of fundamental disturbances, Asperger syndrome and this “symptom-poor” schizophrenia overlap at the level of loss of natural evidence. It is moreover possible to classify Asperger syndrome among the disturbances of spacing in the sense meant by the evolutionary psychiatry of A. Stevens and J. Price. The author then develops our comprehension of Asperger syndrome from the point of view of the perspective proposed by the notion of resilience in people with Asperger syndrome and of the possibility for them, through these mechanisms of adaptation, to find in the organization of the personality of the “as if” type a position of relative equilibrium. They concur or overlap in the creation of crutches, of borrowed personalities secondarily legitimated by the reaction of the socius. This will end up in the production of inventions and œuvres (works). Clearly, one rarely encounters several cases that one could consider pertinently to be “successful” Asperger syndrome. Finally, the author notes that one can find a sort of isomorphism between Asperger syndrome and contemporary society when he proposes the term “asperigisation” to characterize our society, given that the equilibrium between emotion and logic is strongly disturbed in these patients, in whom logic undergoes hypertrophy while emotion is impoverished. From this perspective, the author hopes to suggest reasons for the increase in the number of cases of Asperger syndrome in the clinical setting and in society in general in our contemporary era.     

Suicide des jeunes et crise de la famille : la question de l'anomie

Suicide in young people, new phenomenon in Occident, coincides with the actual family crisis. Based on the anomy concept, the author shows that youth symbolically ended in the family institution, conducting “domestic society” to play an anti-anomic role, identified by Durkheim, and proved by a series of interviews with relatives of young who has committed suicide. It is depicted that in plenty of adolescents, lost in the darkness of their adolescence, grows an aversion to themselves which leads them to death.     

Le syndrome de Prader-Willi : à propos d'un cas au Burkina Faso

A male infant was born at term after a normal pregnancy, without any evidence of prenatal asphyxia. On neonatal examination hypotonia was noticed, as well as on excessive weight at one month of age. The diagnosis of Prader-Willi syndrome was given and reinforced by the clinical evolution of the child's condition with time: persistant hypotonia, cryptorchidism, small penis and retardation of bone growth. A cranio-encephalic scan and transfontanel echography were normal at three months of age. The diagnosis was confirmed by analysis of the chromosomes, which showed a male karyotype with a microdélétion on chromosome 15 (q11.2q11.2).     

Les « maisons d’adolescents » : le défi de l’accueil et de l’écoute

Insidiously, the label “adolescent halfway house” evokes a lot of phantasms. Nevertheless, these new structures appear as an opportunity to reinforce the provision of accommodation and care for a population which, to all evidence, presents health requirements that have not always been satisfactorily met in the past. However, in order to be fully efficient and without substituting the existing proper health structures, these “halfway houses” must prove their methodological rigour, essential when replying to the obvious particularities of the relational contract that is characteristic of this age group. This article provides various thoughts on the requirements of training and supervision by professionals assigned to accommodate and listen to adolescents.     

Thrombose néonatale des veines rénales : l’expérience récente de l’hôpital Robert-Debré

Neonatal renal venous thrombosis (NRVT) is a rare disease, with variable consequences on kidney function. We report a retrospective study of 9 newborns with NRVT admitted to our hospital from 1996 to 2005. The median age at diagnosis was 2 days (range, 1–10 days). In 7 patients, diagnosis was suspected based on one classical clinical or biological sign and was confirmed by ultrasound. Seven newborns had at least one known obstetrical or neonatal risk factor. NRVT was unilateral in three cases, was bilateral in 6 cases, and was associated with inferior vena cava thrombosis in 5 patients, with surrenal hemorrhage in 3 patients. Three patients did not receive specific treatment. The median delay between diagnosis and specific treatment was 20 h (range, 3–36 h). Three patients were treated by fibrinolysis, including 2 with bilateral NRVT, 2 newborns received heparins, and 1 patient was treated with a vitamin K antagonist. With a median evaluation time of 5 years and 2 months for 6 patients, 5 patients recovered their kidney function completely and the 6th child has moderate renal failure. It seems illusory to wait for randomized control studies to appreciate the potential long-term benefit of treatments on kidney function after a NRVT, whose bilateral forms appear to be more severe. A case-by-case approach appears better adapted. These results reinforce recommendations that suggest an early pediatric nephrologic follow-up for all newborns with a NRVT.