Les thymoregulateurs chez l’enfant et l’adolescent

Background

In child and adolescent psychiatry, mood stabilizers are mainly prescribed for bipolar disorders (BD). Recognition of BD in adolescent is now clearly established. However, whether bipolarity exists in children is more controversial. To distinguish different clinical presentation in youth, it is recommended to use severe mood dysregulation (SMD) or temper dysregulation disorder (TDD) regarding previously called BD not otherwise specified. This point is currently in discussion for DSM 5. This distinction is very important as recent studies showed that treatment efficacy depends on diagnosis.

Methods

We reviewed pharmacological treatment approaches for BD in children and adolescents focusing both on short-term efficacy, prevention of relapse and adverse effects.

Results

We found 16 double blind randomized controlled trials (DBRCT) with rigorous methodological criteria assessing short-term efficacy of medications in BD in children and/or adolescents. Four used mood stabilizers (lithium, n = 2; valproate, n = 1; divalproate, n = 1; oxcarbamazepine, n = 1); eight second-generation antipsychotics (SGA); two compared divalproate with an SGA; one compared lithium, valproate and risperidone; and one combined divalproate plus quetiapine. We found at least one DBRCT showing superiority to placebo for lithium, valproate, as compared to SGA (aripiprazole, risperidone, quetiapine, olanzapine and ziprasidone). Finally, we found only one relapse prevention DBRCT comparing lithium and divalproate. In sum, most studies refer to SGA short-term efficacy and trials remain too rare regarding mood stabilizers. However, anti-epileptics’ secondary effects are more evaluated compared with SGA or lithium because of their use in treating epilepsy.

Conclusion

Current state of data and recent studies bring us to stay very careful regarding use of mood stabilizers in pre-pubertal child with BD. In contrast, these treatments are indicated for adolescent BD in addition to psychotherapeutic treatment and educational care although the number of studies is still limited.     

Spécificités du psychotraumatisme chez l’enfant et l’adolescent

Some accounts of psychotraumatic reactions date from 2000 before JC and a lot of observations of posttraumatic troubles have been reported in the course of history. Nevertheless, interest for those troubles is more recent. This concept has been created to describe adults’ troubles. It includes only a part of the aspects of child posttraumatic disorders. There have been a lot of scientific publications on this theme during the last years but few studies on young subjects until recently. Before explaining the different notions of trauma, life events, stress or risk, we are going to describe the historic specificities in child psycho trauma, its late recognition and the effective advances. We will take an interest in the specificities of the nature and the symptomatology of the trauma affecting children. The consequences of a trauma and the adaptative possibilities of the subject are different on a constantly evolving person.     

SociaBillyQuizz,un jeu pour l’entraînement aux habiletés sociales chez l’enfant et l’adolescent : étude exploratoire

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.     

L’évaluation du contexte familial dans l’examen psychologique de l’enfant

Family assessment is an essential component of the psychological evaluation of the child. The aim of this assessment is to determine risk and resiliency factor in the proximal relational environment of the child. Results of researches have indeed shown on the one hand that family-level variables explain a specific part of the variance in child development and psychopathology, and on the other hand that family intervention is efficient to treat several pathological conditions in child and adolescent such as conduct disorders, substance abuse, or eating disorders. In this paper, we present the specific dimensions of family functioning (e.g. cohesion and flexibility) and the different methods and instruments that can be used to assess them, with their respective benefits (e.g. direct observation with the Lausanne Trilogue Play, questionnaires such as the Family Adaptability and Cohesion Evaluation Scales). We present then different possible uses of family assessment: for therapeutic indication (to evaluate the relevance of a family intervention in a given situation), or to determine therapeutic goals (to specify which relational dimension may be targeted by the intervention), or as an intervention in itself (like in the joint assessment procedures developed by the family-centred approaches).     

Approche psychopharmacologique des troubles du comportement chez l’enfant et l’adolescent

The aim of this article is to present the state of the art of the psychopharmacological approach to behavioral disorders in children and adolescents. First, we will specify the phenomenology of behavioral disorders with a particular attention to the notion of aggressiveness. Then we will present a review of the psychopharmacology of behavioral disorders according to the various syndroms in which, these behaviors are observed and we will end with some recommendations concerning the pharmacological approach to this type of disorders.     

Le devenir du trouble déficit de l’attention/hyperactivité chez l’adulte

Attention deficit hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood. Although some symptoms of ADHD may diminish this does not mean that functioning is unimpaired in adults. Follow-up studies of children with ADHD show that it persists into adulthood in the majority of cases. Due to genetic factors high rates of ADHD exist among the parents of children with ADHD. More females are identified and become diagnosed in adulthood. There is a greater persistence of inattentive than of hyperactive/impulsive childhood symptoms of ADHD in adulthood. Some experts conceptualise ADHD as primarily a deficit of executive functions impairing planification, time perception and emotional regulation. ADHD often presents as a lifelong condition in adults associated with a range of clinical and psychosocial impairments. Young adults with comorbid antisocial or substance use disorder in adolescence are at significantly increased risk for criminal behaviors. Some predictors of the outcome have been identified such as childhood symptom profile and severity, comorbidity and childhood family adversities.     

L’impact du cannabis à l’adolescence sur la transition psychotique de l’adulte

It is now well known that cannabis can precipitate the onset of psychosis. The epidemiological studies have shown that the increased risk is significant from ‘recreational’ consumptions (ten times exposure at the age of 18), but the effect is more important with higher doses (dose-dependent effect) and more marked in adolescent (with a two-fold increase of exposure at the age of 15 compared to 18). The effect is also dependent on the composition in cannabinoids: delta-9-tetrahydrocannabinol have psychotomimetic effects while cannabidiol has anxiolytic and possibly antipsychotic. This question is timely since some production of cannabis includes genetic modifications that tend to decrease the level of cannabidiol. Cannabis interferes with endogeneous cannabinoides systems, involved in the maturation processes at adolescence, and adolescence seems a critical period of sensitivity to the deleterious effects of cannabis. The recent literature in human and animal have demonstrated that exposure to cannabis at adolescence can result in chronic deleterious effect on cognition in adulthood. While the reliable data are compelling, we now need to disseminate these informations in an appropriate way, without militant excess but without complaisance. It is also needed to identify the markers that shall alert the environment of the adolescent or young adults and identify subjects at risk of complications when exposed to cannabis. It is already established that exposure at adolescence should not be minimized since adolescence per se appears as a risk factor for chronic cognitive deleterious effect and sometimes psychotic complications, even after relatively minor exposure.