Impact des symptômes de stress post-traumatique lié à l’attaque terroriste de Nice du 14 juillet 2016 chez les enfants à la période infra-verbale : trois cas cliniques

IntroductionThe attack of July 14th, 2016 in Nice, France, is one of the first terrorist attacks in France to directly involve a population of numerous children and adolescents of all ages as well as their families. Children are highly affected by traumatic events and are at greater risk of developing Post-Traumatic Stress Disorder (PTSD) after a traumatic event that can result in complications and long-term changes in personality. It is important to take into consideration the child as a whole with his/her environment and in particular the quality of the relationship with his/her parents. To date, there is limited literature concerning the clinical course of PTSD and the medium and long-term consequences for children in the infra-verbal period (0–3 years).Clinical observationsIn this article, we will present three clinical cases aged respectively six months, one year and three years at the time of the Nice attack. Children present psycho-traumatic symptoms specific for young children with observable behaviors, neurodevelopmental symptoms, and psychosomatic disorders. Complications are frequently observed, particularly sleep and anxiety disorders. In addition, the parent-child relationship is likely to be impacted with altered attachment patterns.ConclusionFurther studies are necessary to understand more about PTSD in the infra-verbal period and to specify post-traumatic stress reactions according to developmental differences in childhood and the quality of interaction with the child's environment, particularly with attachment figures.     

Rôle de la génétique et de l’épigénétique dans l’obésité de l’enfant et de l’adolescent

Obesity is a complex, multifactorial disease due to a dysfunction of the hypothalamic control of weight and food intake. The contribution of genetics is constant, but its impact is variable depending on the situations ranging from rare genetic obesities (around 5% of cases) to more frequently polygenic obesity (or common obesity) (95% of cases). Other factors as pre- and post-natal, societal or psychological determinants always interact closely with these genetic factors explaining the high variability of the phenotype and the complex pathophysiology. A true continuum exists between all these situations through the involvement of more or less rare genetic variants located in genes encoding key proteins in the central regulation of food intake. Rare forms of obesity are characterized by their common phenotype including a very early-onset severe obesity (BMI Z score greater than + 3 SD early before the age of 3 years) with resistance to medical treatment, and major eating disorders characterized by difficulties in voluntary control of food intake. Central endocrine abnormalities such as hypogonadotropic hypogonadism or GH deficiency for example, and metabolic abnormalities due to abnormal adipose tissue distribution are also associated with variable degrees (Alström syndrome for example). Neuropsychological abnormalities are also present such as neurodevelopmental disorders (intellectual disability with variable intensity and/or adaptive development disorders which are part of many syndromes such as in Prader-Wili Syndrome; autism spectrum disorders (in SH2B1 or MYT1L deficiency for example), cognitive disorders with difficulties in emotional regulation (eg: Bardet-Biedl Syndrome or specific rare variants located on genes of the melanocortin pathway), behavioral or psychiatric disorders, sleep disorders and major hypothalamic dysfunctions (eg: Prader-Willi Syndrome, Smith Magenis syndrome). This better understanding of the mechanisms has made it possible to better precise the associated phenotypes and, recently, to lead to therapeutic innovations targeting these key genes. This evolution helps to quickly envisage the development of a real personalized medicine in early onset obesity using the combination of drug treatments targeted according to the identified genetic anomaly and/or a multidisciplinary global approach targeting the patient's phenotype or even the bariatric surgery in specific situations.     

Transformer les pratiques entre la psychiatrie de l’enfant et de l’adolescent et la psychiatrie de l’adulte pour une réelle prévention

It is estimated that around 20% of children in the general population have a parent affected by a major psychiatric disease such as schizophrenia, bipolar disorder or recurrent major depressive disorder. Nevertheless, we face the “medical paradox” in which these children most at risk, born to an affected parent, are overlooked by our health systems. These children are indeed 15 to 20 times more likely to develop a psychiatric disorder as young adults, and 50% of them present childhood developmental or behavioural problems deserving treatment. Several indicators of brain dysfunctions, or risk endophenotypes, carried by adult patients can be detected early in the life of these children, thus making it possible to differentiate the child at highest risk among the siblings in the same family. These discoveries support the neurodevelopmental hypothesis of schizophrenia, bipolar disorder and recurrent major depression and the partially shared origin of these three disorders. In this selective scientific review, we will discuss data suggesting that, among children at risk, those who progress towards the illness cumulate risk indicators during their early trajectory. This aggregation phenomenon can serve as an empirical ground for the definition of preclinical stages in the risk trajectory and the development of clinical practice guidelines regarding surveillance or prevention in these children. Governmental legislations have already been promulgated in several countries with mitigated success to change the situation for these high-risk children and families. Based on existing scientific data, we thus propose that clinical practice guidelines be delivered by national medical academies so as to bring about the needed changes, improve communication between primary care, and specialized care and foster functional connections between child and adult psychiatry.     

L’enfant et la violence. Un modèle de la violence fondamentale : l’interaction biologique : fœtus,placenta, mère

Violence lies inside all of us and the model of biological interactions between fetus, placenta and mother represents a new direction for research and reflexion. These interactions between the bodies of the mother and fetus are tripartite, as the placenta takes part in these exchanges and acts as a regulator. The characteristics of this regulation and its imperfections are undoubtedly the biological cause of postnatal psychosomatic disorders. We have more experience of psychological expressions of the relationship but this is a biological support. The violence and drama of this biological interaction is a striking illustration of the underlying violence.     

Intérêt de l’imagerie 3D dans le diagnostic et la surveillance des scolioses de l’enfant et de l’adolescent

Scoliosis is an abnormal curvature of the spine. One or several curves of more than 10 degrees in the frontal plane can be seen with the rotation of vertebrae in the axial plane, which modifies sagittal curves. In addition to esthetic harm, the morbidity of a scoliosis depends on the extent of the deformation. Treatment, whether it be orthopedic or surgical, is aggressive and never completely cures the condition. At best the deformation will be stabilized at the end of growth. Therefore, it is essential to detect any slight curve and quickly identify any potential progressive form in order to treat it. Visualization of scoliosis in 3D through spine modeling has several advantages at each stage of care. First, with slight curvatures, 3D modeling allows the medical staff to confirm the scoliosis by showing the modification in the three different planes. All curvatures will not progress. Orthopedic treatment is constraining and expensive; only progressive forms will receive it. When the curvature is slight and does not need immediate treatment, 3D modeling at each successive check-up will help detect any sign of likely progression quickly and reliably. Moreover, the medical observation of corset treatment and the preoperative work-up are improved because all 3D parameters of the deformation are accessible. The need for 3D modeling for scoliosis has been known for a long time, but no tool allowing a vertical study with a low level of radiation was available. The EOS imagery system meets these criteria through an optimal analysis of deformations caused by scoliosis.     

Conséquences psychiatriques de la pandémie de la Covid 19 chez l’enfant et l’adolescent

The objective of this article is to present a literature review concerning the psychiatric consequences associated with the Covid 19 pandemic, in the pediatric population. This review is realized with Pubmed Database, using Covid 19, Coronavirus, child, children, adolescent, mental health, psychiatric or psychological consequences as keywords. We propose to present an inventory of current research based on three factors: fear linked to the pandemic, the consequences of the stay-at-home confinement, and the risks of cumulative trauma. We will present three clinical vignettes of children who were followed during the health crisis following the development of symptoms related to the health situation. We will end with some perspectives on the management of the health crisis by child and adolescent psychiatry services.     

Évaluation de la formation théorique et pratique des internes en Île-de-France sur les connaissances et l’accompagnement de la transidentité chez l’enfant et l’adolescent

IntroductionGender dysphoria, non-binarity, trans-identity, neutrality, gender fluid. faced with the emergence of a redefinition and reaffirmation of gender, what place and training are there for the doctors of tomorrow? A public health issue is coming to the fore as the suicide rate among these adolescents is seven times higher than among so-called “cisgender” adolescents. So how do you take care of these patients and their families, for whom access to care is so difficult? Several doctors have found themselves confronted with this real tidal wave of requests for gender consultations without any training or clear recommendations.MethodThis survey, carried out among resident doctors in the Île-de-France region, aims to assess the current practical and theoretical training concerning the care of children and adolescents with a trans-identity status. This survey was carried out during the month of June 2020, using an anonymous online questionnaire consisting of 16 questions including multiple choices as well as open-ended ones. The questions concerned a self-assessment of practical and theoretical knowledge according to the year and specialty of the residency. It also addressed the issue of training programs implemented by medical faculties and university hospitals as well as the confrontation to trans-identity in clinical practice and the reflections emerging from it.ResultsThe findings, collected from the answers of 143 resident doctors, show an overall lack of knowledge, theoretical and practical, without medical specialization distinction. It includes pediatric and child psychiatric specialties that are all the more directly concerned. This gap is mostly attributed to the lack of training and teaching in medical universities and hospitals, as well as to a subject still considered taboo within the medical profession itself. The overwhelming majority of doctors are thus in demand for more comprehensive education on the issue as part of their general medical training curriculum.ConclusionIt appears more than important to consider trans-identity status a real public health issue. This matter is taking on an increasingly crucial role in child and adolescent medical counselling. In the coming years, this will enable better patient support and better access to care within a population weakened by years of discrimination and inequality in relation to the fundamental right to health.