L’adolescent aux diagnostics multiples ou le trouble dissociatif de l’identité à l’adolescence

ObjectiveTo evoke the notion of dissociative identity disorder in adolescence requires a nuance so many questions arise among others on the relevance of the juxtaposition of a complex disorder fluctuating at an age group marked by transition. In other words, is it appropriate to speak of dissociation of identity or multiple personality at this specific time of existence? It should also be noted that this diagnosis is controversial both because there is no consensus on definitions such as personality or identity and because some cultures take into account the possibility of possession to explain these tables without reference to pathology.MethodsTo illustrate our point, we will draw on the situation of a young person admitted to our institutional therapy centre located in a general hospital. The structure accommodates young people aged between fourteen and twenty for six to nine months. As we have also developed, these are usually directed in the course of ambulatory and/or residential therapeutic follow-ups, after experiencing moments of crisis or decompensation. The evaluation then carried out consolidates the prospect of a medium-term stay in a psychotherapeutic centre before considering a possible reintegration into daily life and activities. This clinical case illustrating the path of a teenager in prey to the tumults of wobbling of his identity causing confusion and uncertainty in the chief of the professionals encountered. The difficult situation experienced by this young person and his family questions on the one hand the relevance, the very basis of the diagnosis at this time of existence and on the other the notion of dissociative identity disorder in adolescence.ResultsThe dissociative identity disorder meets a number of criteria, the first of which is identity disturbance characterized by several distinct personality states. Clinically, we first observe a discontinuity in the integration of consciousness, of self-meaning. Registers of affects and sensory-motor functioning (perception, representation of the body) are also concerned. There are then disturbances of the agentivity (motor control, behaviors). In some cases, non-epileptogenic seizures and other conversive manifestations may be at the forefront of these complex clinical tables. The dissociative disorder of identity is also noticed by memory failures (dissociative amnesia) concerning the recall of daily events, personal information, which do not correspond to ordinary forgetfulness. This then leads to signs of impairment of social, professional or other relational functioning. Being an interruption in the tranquility of growth, adolescence is characterized by extreme conflicting positions, changing, fluctuating that give this period of life its appearance of tumult and crisis without being able to speak of frank psychic disturbances. Differential diagnosis between teen upheaval and true pathology is a difficult task.ConclusionsConsequently, we think it is important to pay attention to the diachronic and synchronic litters of what the young person in question is deploying. In order to do so, we advocate repeated clinical interviews with the patient and his or her entourage beside rigorous anamnesis. Time is an important element, the time of observation and encounter. Let us avoid precipitation without adopting an attitude of fatalism or even laxity, recalling that, for Winnicott, there is only one remedy for adolescence and only one; it is the passing time and gradual maturation processes that ultimately lead to the appearance of the adult person. Accompany a dissociative identity disorder, proven or suspected, includes the mobilization of a partnership envelope involving experienced institutional structures ready for the necessary clinical flexibility allowing continuous therapeutic adjustment.     

Structural brain correlates of serum and epigenetic markers of inflammation in major depressive disorder

Inflammatory processes are implicated in the aetiology of Major Depressive Disorder (MDD); however, the relationship between peripheral inflammation, brain structure and depression remains unclear, partly due to complexities around the use of acute/phasic inflammatory biomarkers.Here, we report the first large-scale study of both serological and methylomic signatures of CRP (considered to represent acute and chronic measures of inflammation respectively) and their associations with depression status/symptoms, and structural neuroimaging phenotypes (T1 and diffusion MRI) in a large community-based sample (Generation Scotland; N_{MDD cases} = 271, N_controls = 609).Serum CRP was associated with overall MDD severity, and specifically with current somatic symptoms- general interest (β = 0.145, P_FDR = 6 × 10⁻⁴) and energy levels (β = 0.101, P_FDR = 0.027), along with reduced entorhinal cortex thickness (β = −0.095, P_FDR = 0.037). DNAm CRP was significantly associated with reduced global grey matter/cortical volume and widespread reductions in integrity of 16/24 white matter tracts (with greatest regional effects in the external and internal capsules, β_FA= −0.12 to −0.14). In general, the methylation-based measures showed stronger associations with imaging metrics than serum-based CRP measures (βaverage = −0.15 versus βaverage = 0.01 respectively).These findings provide evidence for central effects of peripheral inflammation from both serological and epigenetic markers of inflammation, including in brain regions previously implicated in depression. This suggests that these imaging measures may be involved in the relationship between peripheral inflammation and somatic/depressive symptoms. Notably, greater effects on brain morphology were seen for methylation-based rather than serum-based measures of inflammation, indicating the importance of such measures for future studies.     

全科医师人文素质教育现状的探讨及反思

全科医师立足于基层医疗，旨在提高、满足基层居民卫生服务的全面需求。正是由于全科医师的定位及服务人群的特殊性，相对于专科医师来说，人文素质教育在全科医师培养中占据着更为重要的地位。如今，国内外越来越重视全科医师的人文素质培养，但我国相对于发达国家仍有不足。本文进一步强调了全科医师培养中人文素质教育的重要性，同时通过对比国内外全科医师人文素质教育的现状，进一步反思我国人文素质教育的改进方法。     

Plasma trimethylamine N-oxide,a gut microbe–generated phosphatidylcholine metabolite,is associated with autism spectrum disorders

ObjectiveThe compositions of the gut microbiota and its metabolites were altered in individuals with Autism Spectrum Disorder (ASD). The aim of this study was to assess whether plasma levels of gut-derived metabolite trimethylamine N-oxide (TMAO) were associated with ASD and the degree of symptom severity.MethodsFrom September 2017 to January 2019, a total of three hundred and twenty-eight Chinese children (164 with ASD and 164 their age-sex matched control subjects) aged 3–8 years were included. TMAO levels in plasma were determined using high-performance liquid chromatography tandem mass spectrometry (LC/MS/MS). Logistic regression analysis was used to examine the TMAO-ASD association.ResultsIn the study, the median age of the ASD group was 5 years (interquartile range [IQR], 4–6 years) and 129 (78.7%) were boys. The median plasma levels of TMAO in children with ASD and typically-developing (TD) children at admission were 4.2 (IQR, 3.0–5.6) μmol/l and 3.0 (2.0–4.4) μmol/l, respectively (P < 0.001). For each 1 μmol/l increase of plasma TMAO, the unadjusted and adjusted risk of ASD would be increased by 54% (with the odds ratios [OR] of 1.54; 95% confidence intervals [CI]: 1.32–1.78; P < 0.001) and 27% (1.27 [1.10–1.45], P < 0.001), respectively. Symptom severity was classified as mild-to-moderate (CARS < 37) for 66 children with ASD (40.2%). In these children, the plasma levels of TMAO were lower than in the 98 children with ASD (59.8%) whose symptoms were classified as severe (CARS > 36) (3.5[2.5–4.9] μmol/l vs. 4.5(3.7–6.0) μmol/l; P < 0.001). For each 1 μmol/l increase of plasma TMAO, the unadjusted and adjusted risk of severe autism would be increased by 61% (with the OR of 1.61 [95% CI 1.28–2.01], P < 0.001) and 31% (1.31 [1.08–1.49], P < 0.001), respectively.ConclusionsElevated plasma levels of TMAO were associated with ASD and symptom severity.     

Paclitaxel-related dermatological problems: Not only alopecia occurs

ObjectiveDermatological problems after chemotherapy are often neglected with gynecological oncologists. Since paclitaxel is one of most popular agents for gynecology organ-related cancers, dermatologic change after paclitaxel treatment is seldom reported before.Case reportTwo patients with gynecological organ malignancy who underwent the postoperative dose-dense weekly schedule of paclitaxel 80 mg/m² plus carboplatin (area of curve 5) every three weeks had repeat dermatological problems (skull, facial and upper trunk areas) during the treatment. They included dermatitis, eczema, and folliculitis. Topical use of anti-fungal cream and oral anti-histamine agents stopped the disease progression and all had completed their chemotherapy without interruption.ConclusionClinicians should be aware of paclitaxel-induced skin toxicities, especially on the skull, face and upper trunk areas to minimize the occurrence of severe morbidity and to provide the better quality of life when cure is our primary priority in the management of gynecological organs-related malignancies.