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1.
目的了解左乙拉西坦(LEV)添加治疗大田原综合征(OS)的疗效。方法采用开放性自身对照研究,对确诊OS且当抗癫药物治疗无效的患儿给予添加LEV口服治疗。共入组11例。男7例,女4例;年龄29~87 d。治疗剂量从10 mg·kg-1·d-1开始,每1~2周日剂量增加10 mg·kg-1,至维持剂量40~50 mg·kg-1·d-1,分2次口服。治疗前1周和治疗后1个月及每3个月分别评价临床发作及视频脑电图。治疗期间检测肝肾功能及血常规,密切随访不良反应。结果 1例(9.1%)因出现明显的烦躁症状,在服药2周停药,停药2 d后烦躁症状完全缓解;其余10例患儿平均随访时间16.3个月(7~28个月)。1例(9.1%)发作完全控制,7例(63.6%)发作减少>50%,2例(18.1%)无效,总有效率为72.7%。6例患儿(54.5%)精神运动发育滞后有不同程度减轻。坚持服药的10例患儿均未出现明显不良反应,治疗期间未见肝、肾功能及血常规有异常改变。结论 LEV添加治疗OS具有良好疗效及安全性,可以在临床中进一步推广,但尚需多中心随机双盲安慰剂对照试验进一步支持。  相似文献   

2.
目的 评价左乙拉西坦(LEV)治疗小儿癫痫的疗效和安全性.方法 2007年8月 2008年8月武汉市儿童医院神经内科病房和门诊收治的56例癫痫患儿口服LEV片.其中32例单药治疗;24例添加治疗,即在原有抗癫痫药物剂量及用法不变的基础上添加LEV口服.起始剂量为5.2~20.8 mg/(kg·d),2次/d;目标剂量为14.4~41.6 mg/(kg·d),2次/d.随访时间为3~12个月.结果 LEV单药治疗有效率为68.8%,无发作率为40.6%.添加治疗有效率为41.7%,无发作率为8.3%.两组比较差异有统计学意义(P<0.05).LEV副反应较少,主要为胃肠不适、头晕、嗜睡、易激惹等.结论 LEV治疗儿童癫痫有效,单药治疗疗效高于添加治疗,患儿对其有较好的耐受性.  相似文献   

3.
奥卡西平治疗儿童良性癫(癎)伴中央颞区棘波的临床观察   总被引:3,自引:1,他引:2  
目的观察奥卡西平(OXC)治疗儿童良性癫癎伴中央颞区棘波(BECT)的疗效和安全性。方法用OXC治疗17例BECT患儿,分析单药治疗后1、2、4、6个月的疗效和不良反应。OXC起始剂量为5~10mg/(kg·d),每隔1周增加1次剂量5~10mg/(kg·d),维持剂量20~30mg/(kg·d)。结果本组总有效率为88.24%,服药6个月时累积控制率为70.59%,留存率为94.12%,均呈现较高比率。结论OXC治疗BECT的疗效明显,不良反应轻,安全性高。  相似文献   

4.
普罗帕酮和美托洛尔治疗病毒性心肌炎致期前收缩的比较   总被引:1,自引:0,他引:1  
目的 比较普罗帕酮和美托洛尔治疗病毒性心肌炎(VM)所致室上性和室性期前收缩的疗效和不良反应.方法 将108例VM致频发室上性(11例)或室性(97例)期前收缩且需要抗心律失常药物治疗的患儿随机分为二组,分别予普罗帕酮(56例)5~7 mg/(kg·次),每6 h一次,减少或控制后改为每8 h一次,症状消失1个月,改为2次/d再持续用药3个月停药,总疗程5~6个月.和美托洛尔(52例)2~3 ms/(kg·d),分2次服用,连续服用2周,无效停药,有效持续用药3个月,总疗程4~6个月,比较二组的起效时间、疗效和不良反应.结果 普罗帕酮组的显效率71.34%(40/56例)、总有效率91.07%(51/56例),均较美托洛尔组高(分别为40.38%、69.23%)(X2=10.572,8.211 P.<0.005),但二组的有效率比较无显著性差异(X2=1.249 P0.05).普罗帕酮起效时间(8.48±6.02)h较美托洛尔短(96.21±31.24)h(P<0.05).但普罗帕酮组不良反应发生率达25.0%、心血管不良反应发生率达14.29%,较美托洛尔组高(分别为5.77%、1.92%)(Pa<0.05).结论 普罗帕酮与美托洛尔治疗VM所致的期前收缩,疗效均肯定,但前者更有效、起效更快.但均需注意其致心律失常作用,及时调整药物剂量或种类.  相似文献   

5.
奥卡西平治疗儿童局限性癫(间)464例   总被引:1,自引:0,他引:1  
目的 观察奥卡西平(OXC)治疗儿童局限性癫(间)的疗效和不良反应,并作出评价.方法 局限性癫(间)患儿64例,41例新诊断或未经正规抗癫(间)治疗需用OXC单药治疗的患儿进入OXC单药治疗组;23例曾使用一种或多种抗癫(间)药物治疗,目前仍需联合应用OXC进行抗癫(间)治疗的患儿进入OXC添加治疗组.OXC治疗的起始剂量为4~8 mg/(kg·d),每隔1周增加1次剂量,每次增加不超过10 mg/(kg·d),维持剂量28~40 mg/(kg·d),分2次服用.进行自身对比开放性观察,分析二组6个月内的疗效及不良反应.结果 本组中单药治疗组、添加治疗组、全组的总有效率分别为85.4%、69.6%、79.7%,其完全控制率分别为53.7%、17.4%、40.6%.单药治疗与添加治疗组6个月后总有效率比较有显著性差异(P<0.05);单药治疗组2、4、6个月总有效率比较无显著性差异(Pa>0.05).最常见的不良反应:皮疹7例,嗜睡、头晕各3例,乏力2例,低钠血症、恶心纳差各1例. 因皮疹退出6例(9.4%),停药及对症处理后,均恢复正常.结论 OXC治疗儿童局限性癫(间)疗效确切、耐受性好、不良反应轻.  相似文献   

6.
目的 探讨左乙拉西坦(LEV)治疗儿童失神癫(癎)(CAE)的疗效.方法 选择2008年1月-2010年12月于本院诊治的CAE患儿65例.男35例,女30例;就诊年龄5~14(7.8±3.5)岁.发病年龄3~12(7.1±3.0)岁.病程为1个月~4.3 a[(12.2±9.8)个月].随机分为LEV组(33例)和丙戊酸钠(VPA)组(32例).分别接受LEV及VPA治疗,LEV开始剂量为10 mg·kg-1·d-1,每周加量1次,逐渐加量至20~30 mg· kg-1·d-1,最大剂量40mg·kg-1·d-1.VPA治疗剂量为15 ~40 mg·kg-1·d-1,血药质量浓度控制在50~100mg· L-1.治疗期均为24周,观察2组发作控制的效果和药物不良反应.结果 LEV组9例(27.2%)完全控制,15例(45.5%)部分控制,总有效率72.7%;VPA组11例(34.4%)完全控制,15例(46.9%)部分控制,总有效率81.3%.2组总有效率比较差异无统计学意义(P>0.05).2组均未出现不能耐受而中断治疗的病例,LEV组不良反应轻微,3例诉头晕,2例出现困倦、乏力;VPA组不良反应较多,5例患儿体质量明显增加,4例学习成绩明显下降.结论 LEV对大部分CAE疗效满意,且不良反应小.  相似文献   

7.
目的观察霉酚酸酯(MMF)联合中小剂量肾上腺皮质激素隔日治疗在儿童狼疮性肾炎(LN)的疗效,以探讨儿童LN的最佳治疗方案。 方法回顾性分析1999—2004年在复旦大学附属儿科医院住院的LN患儿30例,男6例,女24例,处于病情的活动期,给予MMF联合中小剂量肾上腺皮质激素隔日治疗。MMF初始剂量为20~30mg/(kg·d)(总量<1.5g/d),病情好转后每3~6个月减量1次,至0.25g/d维持。甲基泼尼松龙冲击治疗15~30mg/(kg·d)(总量≤1.0g/d),初始剂量1.0~1.5mg/(kg·d)(总量≤60mg/d)。 结果(1)30例患儿MMF治疗时间不少于6个月,为(28.6±15.1)个月,在治疗过程中未见明显副反应;(2)在肾活检的24例中,狼疮性肾炎Ⅱ型者8例在加用MMF治疗的3~6个月获得缓解;狼疮性肾炎Ⅳ型者16例,12例在治疗的3~12(6.0±1.3)个月获得缓解,1例患儿部分缓解,3例患儿经过至少6个月的足量MMF治疗无效。(3)在治疗过程中有7例患儿在减量或停药后出现疾病的复发或部分复发。(4)随访终点获得缓解的27例患儿,治疗前后身高增长无明显抑制。 结论MMF联合中小剂量的泼尼松龙能有效地治疗儿童系统性红斑狼疮,较长时间应用无明显副反应。患儿可保持相对正常的生长发育。  相似文献   

8.
目的分析左乙拉西坦(LEV)单药或联合用药治疗婴儿癫的长程保留率。方法回顾性分析2006年7月至2007年6月应用LEV治疗的婴儿癫患儿的临床资料。结果 60例服用LEV的癫患儿,部分性发作20例,全面性发作19例,癫综合征21例,其中难治性癫21例。23例LEV单药治疗,37例以LEV作为添加药物联合治疗。LEV首剂量10 mg/kg·d,每日2次口服,每周加量10 mg/kg,加量调整直至取得最佳疗效和耐受性。LEV治疗6个月、1年、2年、3年及4年的保留率分别为95.0%、75.0%、60.0%、51.7%和38.3%。最主要停药原因为缺乏疗效(43.2%)。COX回归模型提示,病程1个月(RR=2.91,95%CI:1.16~7.30)及难治性癫(RR=2.30,95%CI:1.22~4.32)是患儿停药的危险因素(P均0.05)。患儿服药后发作频率较基线水平明显减少(P0.01)。至随访结束,23例未停药患儿中,有效率100%,完全缓解率69.57%。主要不良反应为倦怠乏力(56.0%),其余为睡眠增多、烦躁不安等。结论 LEV单药或联合用药治疗婴儿癫具有较好的长程保留率、良好的疗效及耐受性。  相似文献   

9.
目的探讨托吡酯(TPM)治疗Tourette综合征的临床效果及合适剂量。方法Tourette综合征患儿79例予TPM口服,剂量从0.5mg/(kg.d)开始,渐增加至3mg/(kg.d),2次/d,于治疗前及治疗后3个月应用耶鲁抽动症整体严重程度量表(YGTSS)评估疗效,观察药物不良反应。结果除1例出现药物不良反应和2例剂量增加至3mg/(kg.d)无效果而退出观察外,余76例于治疗后2~4周症状均获显著改善,治疗前后YGTSS分值:运动性抽动分数19.63±3.09和5.05±1.74,发声性抽动分数18.95±2.56和4.82±1.94,综合损害分数24.21±5.89和10.42±3.69,严重度总分62.21±5.81和22.26±4.81。治疗前后YGTSS各分值比较均有显著差异(Pa<0.001)。76例中3例出现疲乏,1例嗜睡,2例注意力不集中,继续用药后症状消失,均不影响治疗。结论TPM治疗Tourette综合征疗效好,所需剂量小,不良反应轻,可作为治疗该病的首选药物之一。  相似文献   

10.
极低出生体重儿早期静脉营养的临床研究   总被引:2,自引:0,他引:2  
目的 研究极低出生体重儿对早期静脉营养的耐受情况和疗效.方法 32例极低出生体重儿随机分为2组:经典静脉营养组(CPN)和实验静脉营养组(EPN).CPN组生后24~48 h内仅给予5%~10%葡萄糖,之后加6%小儿氨基酸和20%脂肪乳,氨基酸从1.0 g/(kg·d)开始每口递增0.5 g/(kg·d),直至3.0 g/(kg·d);脂肪乳选用含中长链脂肪酸,从0.5 g/(kg·d)开始每日递增0.5 g/(kg·d),直至3.0 g/(kg·d).EPN组生后24 h内起即予6%小儿氨基酸2.4 g/(kg·d)和脂肪乳2.4 g/(kg·d),72 h内均增至3.0 g/(kg·d),即达到足量静脉营养.1周内每天计算总热卡包括胃肠内和胃肠外热卡,检测入院72 h内和1周后监测血脂、胆红素、肾功能、血碳酸氢盐、血糖等生化指标.并记录体质量最大丢失,计算1周后可以部分胃肠营养的患儿百分比、恢复出生体质量时间和达到完全胃肠营养时间等指标.结果 与CPN组相比,EPN组的总能量摄入以及胃肠外提供热卡在生后前5 d明显增高,1周内体质量丢失较少,恢复出生体重时间和恢复完全胃肠营养时间缩短,且末增加代谢性酸中毒、脂质代谢紊乱、高胆红素血症以及肾功能损伤等并发症.结论 极低出生体重儿早期可以耐受较大剂量的静脉营养,且有一定的临床效应.  相似文献   

11.
Solid-organ transplantation is the optimal long-term treatment for most patients with end-stage organ failure. After solid-organ transplantation, short-term graft survival significantly improved (1). However, due to chronic allograft nephropathy and death with functioning graft, long-term survival has not prolonged remarkably (2). Posttransplant immunosuppressive medications consist of one of the calcineurin inhibitors in combination with mycophenolate mofetil (MMF) or azathioprine (Aza) and steroids. All of them have different adverse effects, among which posttransplant diabetes mellitus (PTDM) is an independent risk factor for cardiovascular (CV) events and infections causing the death of many transplant patients and it may directly contribute to graft failure (3). According to the criteria of the American Diabetes Association (4), diabetes mellitus (DM) is defined by symptoms of diabetes (polyuria and polydipsia and weight loss) plus casual plasma glucose concentration ≥ 11.1 mmol/L or fasting plasma glucose (FPG) ≥ 7.0 mmol/L or 2-h plasma glucose level ≥ 11.1 mmol/L following oral glucose tolerance test (OGTT). This metabolic disorder occurring as a complication of organ transplantation has been recognized for many years. PTDM, which is a combination of decreased insulin secretion and increased insulin resistance, develops in 4.9/15.9% of liver transplant patients, in 4.7/11.5% of kidney recipients, and in 15/17.5% of heart and lung transplants [cyclosporine A (CyA)/tacrolimus (Tac)-based regimen, respectively] (5). Risk factors of PTDM can be divided into non-modifiable and modifiable ones (6), among which the most prominent is the immunosuppressive therapy being responsible for 74% of PTDM development (7). Emphasizing the importance of the PTDM, numerous studies have determined the long-term outcome. On the basis of these studies, graft and patient survival is tendentiously (8) or significantly (9, 10) decreased for those developing PTDM.  相似文献   

12.
Carney complex is a multiple endocrine neoplasia (MEN) syndrome that affects the adrenal cortex, the pituitary and thyroid glands, and the gonads. The complex is also associated with skin and mucosa pigmentation abnormalities and myxoid and other neoplasms of mesenchymal and neural crest origin. Thus, this syndrome also belongs to another group of genetic disorders, the lentiginoses (or lentigenoses), which include the Peutz-Jeghers, LEOPARD, arterial dissections and lentiginosis, and Laugier-Hunziker syndromes, Cowden disease and Ruvalcaba-Myhre-Smith (Bannayan-Zonana) syndrome and the centrofacial, benign patterned and segmental lentiginoses, all of which can be associated with a variety of developmental defects. The inheritance of Carney complex, just like that of the other MENs and the lentiginoses, is autosomal dominant. Genetic loci or genes have been identified for Carney complex, Peutz-Jeghers and Ruvalcaba-Myhre-Smith syndromes, but not for other lentiginoses. Elucidation of the molecular defects responsible for these disorders is expected to shed light on aspects of early neural crest differentiation, the regulation of pigmentation, the development of autonomous endocrine function, and endocrine and nonendocrine tumorigenesis.  相似文献   

13.
Bibliometric data published by the Institute of Scientific Information in Philadelphia (ISI), and which was previously discussed in Acta Paediatrica , has increasingly been used despite all the relevant and severe criticism that has been raised against this method of evaluating individual research results and grading scientific journals. It is obvious that the present trend regarding the use of bibliometric data as a basis for priorities and funding of research and for the promotion of individual scientists favours American-oriented research projects at the expense of those that are based on concepts of predominantly European relevance.

Conclusion: For the future of non-American research, it is important that no single super-power, i.e. the USA, should dominate scientific priorities. The condition for efficient European competition is that European Centres with high levels of competence for creative research and training of scientists from all over the world are established. In addition, it is important that the results of European research are published in prestigious European journals, as was the situation before World War II.  相似文献   

14.
The World Health organisation recommends breast feeding infants for the first six months of life. When this breast feeding does not occur either through parental choice or medical need, infant formulas will be required. There is a bewildering array of formulas on the UK market for many different requirements. When faced with an unsettled infant many parents (and health care professionals) will experiment with the infant formula available and often attend the paediatric clinic looking for help and advice. It is therefore essential that paediatricians understand what milks are available and what the key differences between different products are. This review attempts to provide a simple guide through many of the formulations currently available in the UK; and offers advice for the dietary management of the child with extra calorie requirements, infants with cow's milk protein allergy, gastro oesophageal reflux disease, apparent unresolved hunger and infantile colic. Whatever the underlying condition, there is likely to be an infant formula that is suitable in this generation of ever expanding formulations.  相似文献   

15.
In recent years, measurement of serum osteocalcin has been introduced for assessment of bone turnover in patients treated with exogeneous glucocorticoids. Studies in children with asthma on inhaled glucocorticoids, however, have shown inconsistent results. The aim of the present study is to assess bone turnover in prepubertal children and in adolescents with asthma treated with inhaled budesonide using three different osteocalcin assays: the Pharmacia Osteocalcin CAP FEIA, the CIS OSTK-PR and CIS IRMA ELSA-OSTEO assays. Two studies were conducted: 1) a randomised double blind two-period crossover study of 22 prepubertal children aged 5-12 years. In one period 800 μg budesonide was given once in the morning, in the other 400 μg was given twice daily; 2) a randomised double blind placebo controlled two period crossover study of inhaled budesonide 400 μg twice daily in fourteen 13-16 year old adolescents with pubertal stages II-V. In both studies, treatment periods were of four weeks duration, and blood samples were collected at the last day of each period. In the prepubertal children none of the osteocalcin assays detected any statistically significant differences between any of the periods. In the adolescent group reduced levels of osteocalcin were seen during budesonide treatment. The suppression reached statistical significance with the CAP FEIA (P = 0.03) and the OSTK-PR (P =0.01) assays, but not with the ELSA-OSTEO assay (P = 0.06). Correlation analyses showed statistically significant correlation coefficients varying between 0.58 and 0.91 (P=0.03 and P < 0.0001, respectively). The effect of inhaled glucocorticoids on serum osteocalcin may depend on the assay applied, and inhaled glucocorticoids have differential effects in children and adolescents.  相似文献   

16.
We investigated the intra-acinar pulmonary vascular muscularization in the developing human fetal lung between the 17th and 24th gestational weeks, that is, during the canalicular phase of lung development. Fifteen hypoplastic and 25 normal developed lungs were included in this study using monoclonal alpha -smooth muscle (sm) actin antibodies for smooth muscle detection. Computer-aided image analysis was performed for morphometrical measurements and statistical evaluation. Alphasm-actin-immunoreactive intra-acinar vessels down to a luminal diameter of less than 10 mu m were detected in hypoplastic as well as in normally developed lungs. Crucial differences presented as follows: significantly higher density of intra-acinar vessels, especially due to alpha -sm-actin-negative vessels less than 30 mu m in luminal diameter, in the control group; significantly higher alpha -sm-actin immunoreactivity per section unit as well as per vessel in the hypoplastic lung group. As suggested by others, alpha-sm-actin-positive cells of the intra-acinar vessel wall in the developing human lung were demonstrated to be smooth muscle cells, their immediate precursors, and pericytes. We conclude that the increased alpha -sm-actin immunoreactivity represents muscularization of the vessel wall in functional terms and may be regarded as one structural cause among others for the establishment of persistent fetal circulation in hypoplastic lungs.  相似文献   

17.

Background

The emotional and psychological impact of chronical disease among children is considerable. The aim of this study was to explore the emotional representations of sickle cell children followed up at Bordeaux University Hospital in both qualitative and quantitative ways.

Methods

Prospective observational study, conducted from February to May 2010 among 22 sickle cell children (SS, SC and Sβ) followed at Bordeaux University Hospital and among their parents. A questionnaire evaluating depressive symptoms and emotional representations was proposed to children and to their parents separately, measuring their child's emotions. Children were asked to draw themselves during sickle cell crisis and without any painful episode, in order to illustrate their perception of their disease.

Results

Emotional and psychological impact on sickle cell children was important in this study. Eighty-six percent of children have commonly had negative feelings such as sadness, anger or fear. Thirty-six percent of them had depressive symptoms. Parents largely underestimated this impact. Drawings and answers to the questionnaire emphasized an important lack of disease understanding, social consequences, and depressive affects.

Conclusion

Psychological and emotional difficulties in sickle cell children should be identified and supported. Resources for psychological and educational support are necessary to improve the quality of life of sickle cell patients in France.  相似文献   

18.
Parenteral lipids are susceptible to light-induced peroxidation, particularly under phototherapy. Ascorbic acid is protective. The aim of this study was to investigate whether dark delivery tubing and/or coadministration of multivitamin preparations could prevent peroxidation of Intralipid without undue vitamin loss. In experiments carried out on the benchtop, lipid peroxidation occurred in ambient light and was more extensive under phototherapy. Dark tubing decreased peroxide formation, but only by about 65%. In simulated clinical conditions in which solutions were pumped through standard clear or dark minibore plastic tubing, Intralipid accumulated lipid peroxides as measured by the FOX assay (280 µM) or as triglyceride hydroperoxides (52 µM). Multivitamin preparations (MVIP or completely, and were fully protective when used with dark tubing. There was loss of riboflavin (65% from Soluvit and 35% from MVIP) in clear tubing but this was decreased to 18% and 11%, respectively, in dark tubing. Ascorbate loss was 20% (MVIP) and 50% (Soluvit) and only slightly less in dark tubing. Ascorbate loss was also seen in the absence of Intralipid and is due to riboflavin-induced photo-oxidation.Conclusion: Multivitamin preparations protect Intralipid against light-induced formation of lipid hydroperoxides, and administering multivitamins with Intralipid via dark delivery tubing provides a practical way of preventing peroxidation of the lipid while limiting vitamin loss. This procedure should be considered for routine use as well as with phototherapy. Soluvit/Vitlipid) inhibited peroxide formation almost  相似文献   

19.

Background

The SociaBillyQuizz is a therapeutic game designed for social skills training groups with children and adolescents. Using an entertaining method, this media requests several dimensions: exposure, cognition, communication skills, imagination, emotional expression and sign decoding. In this preliminary study, the setting includes two groups of six adolescents, one with social anxiety disorder and the other with Asperger syndrome.

Objective

To evaluate, in an exploratory study, the effects of a therapeutic device involving this game for these two clinically different groups of adolescents.

Methods

During 26 of 1 hour weekly sessions, two adolescents groups participate to a program including the SociaBillyQuizz and cognitive behavioral therapies. The groups are moderated by two therapists. The SociaBillyQuizz is a board game for two to six players; its goal is to collect points by answering instructions from the different thematic cards. There are four thematic cards: action cards (players have to do something), brainstorming cards (players have to use their imagination and demonstrate cognitive flexibility), interview cards (players have to express themselves about what they think or feel) and mystery cards (unexpected instructions). According to the groups’ clinical characteristics, some aims are specifically highlighted. In the anxiety disorder group, the cognitive dimension is privileged and in the Asperger syndrome group, we emphasise the pretend, cognitive flexibility and theory of mind. The effects are measured by the Rathus Assertiveness Schedule and the Fear Avoidance Hierarchy (FAH) for the social anxiety disorder group and by the Faux Pas Recognition Test and the Social Responsiveness Scale (parent version) for the Asperger group.

Results

These assessment tools indicate, for both groups, a significant increase of the scores corroborating the observed clinical effects. For eleven of the twelve adolescents, a clinical interview 6 months after the retest shows a continuity of therapeutic benefit.

Discussion

These early results suggest that a social skills training device featuring the SociaBillyQuizz produces clinical improvements in these two groups of adolescents. In future researches, with control group and more complete follow-up, nature and effectiveness of its contribution should be specified.

Conclusion

In this preliminary study, the SociaBillyQuizz appears to be an interesting therapeutic tool that can increase implication, motivation, participation and cohesiveness of the group. It also makes easier the cognitive-behavioural-strategies learning.  相似文献   

20.

Aim of this study

In this article we wish to question the effects of incarceration on minors. The history of prison reveals that it is the work of a humanist and philanthropic discourse that ensued from the effects of revolutionary ideas. However, from the moment of its reform – that transformed it from a place of confinement to a penal institution – it has only demonstrated its dysfunctional aspect. Our objective is to initiate a reflection on the effects of incarceration, whether it be collective or individual and in particular when it involves adolescents.

Patients and methods

Applying a clinical method, we are analyzing four specific cases: either within a psychiatric department for people under criminal justice control, or in an adult detention center.

Results

The starting point for the “antisocial” behavior is situated, according to our study, at the time of adolescence. Indeed the presence of violence, aggressiveness, and impulsiveness, in other words the “behavioral disorders”, is a constant in each case that is presented. The heart of this, the unifying theme between the psychopathology and the delinquency/criminality, is a feeling of exclusion: an exclusion already present in childhood/adolescence and that is reactivated, in a second instance, by imprisonment. Similarly, identity and identification – already clearly involved in acting out, crime or criminal offences – undergo a further weakening.

Discussion

Through a historical reminder of the questions surrounding criminality and criminals, we will demonstrate that it is not solely a case of finding the causes, undoubtedly important though they be, but of inventing solutions for and with these subjects who have committed a crime or criminal offence. As is indicated in the results, juvenile detention centers appear to further muddle questions of identity and identification, leading to an unleashing of violence and aggressiveness. Thus an experience of abandonment and of exclusion re-enforces that of belonging. The challenge, as much for psychiatry as for psychoanalysis, is to find solutions that enable these youngsters to overcome their violence rather than actualize it.

Conclusion

The incarceration of minors increases and inscribes an aggressiveness and violence that, at the start, was only a need to belong: to the social being, to society, to the social tie. It is not so much the question of the structure or the type of underlying disorder – behavioral, of the personality or psychiatric – that is in question, but rather the effects of a deprivation of freedom that could lead to decompensation, acting out, repeat offending, and to the crystallizing of violence as a mode of discourse.  相似文献   

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