Décrire un tableau d’autisme associé au syndrome de Rubinstein–Taybi à travers le cas d’un enfant suivi à la consultation du service de pédopsychiatrie, hôpital Razi.

Il s’agit d’un garçon de 6 ans, qui a été adressé par son médecin généticien en mai 2014 pour prise en charge d’une irritabilité et troubles de comportement. L’enfant avait des antécédents de persistance de canal artériel opéré à l’âge de 8 mois. Le développement était marqué par un retard des acquisitions psychomotrices. L’inquiétude de la mère a commencé vers l’âge de 18 mois où elle avait constaté des anomalies phénotypiques chez son fils avec apparition des stéréotypies gestuelles, angoisse inexpliquée, troubles des interactions sociales et troubles de la communication non verbale devenus manifestes à l’âge de 4 ans. Il a été adressé en neuropédiatrie pour explorations (EEG de veille/sommeil, IRM cérébrale : normaux) puis a été adressé à la consultation de génétique ou le diagnostic de syndrome de de Rubinstein–Taybi a été suspecté puis confirmé. L’examen a trouvé un enfant avec un retard staturo-pondéral important (–4 à–3 DS), des dysmorphies qui seront comparées aux données de la littérature. Le contact était très difficile, voire absent, il était très agité et refusait tout contact. L’interrogatoire de la mère et l’utilisation de la CARS nous ont permis de poser le diagnostic de trouble de spectre de l’autisme. L’indication de le mettre sous neuroleptiques était discutable vus ses antécédents cardiaques. L’évolution était marquée par une amélioration des interactions sociales, des troubles de la communication non verbale et des troubles de comportement associé.

Nous discuterons les caractéristiques sémiologiques autistiques de cet enfant en comparaison aux données de la littérature de même que les facteurs génétiques et développementaux et environnementaux dans leurs rôles étiopathogéniques.

Depressive/dysphoric personality (DP) is common in clinical settings, particularly among individuals with clinical depression.

The purpose of this research was to examine DP in two treatment settings (Study 1 and Study 2, respectively), and to determine whether those with comorbid DP would respond differentially to antidepressant medication, psychotherapy, or their combination as compared to those without DP.

The specific aim of the study was to evaluate pre- to post-treatment changes in depression severity levels between those with and without DP.

Study 1: Six hundred eighty (N=680) psychiatric outpatients with chronic depression were randomized to receive antidepressant medication, cognitive behavioral psychotherapy, or their combination for 12 weeks. Patients with and without DP were statistically compared on changes in levels of depression severity from pre- to post-treatment. Study 2: One hundred fifty-nine (N=159) psychotherapy clients were naturalistically followed from pre-to post treatment (average 6.5 months). Clients with and without DP were statistically compared on changes in levels of depression severity from pre- to post-treatment.

Thirty six percent (36%) of psychiatric outpatients and 44% of psychotherapy clients presented with DP at pre-treatment. There were no signficiant differences between those with and without DP on levels of depression severity in any treatment modality. In fact, among psychotherapy clients, those with DP made greater treatment gains than those without DP.

These findings suggest that in routine clinical situations, comorbid DP at pre-treatment should not be seen as an obstacle to successful treatment outcomes.

L’objectif de notre travail est d’étudier le retentissement psychologique de diabète type 1 chez un échantillon d’enfants suivis par l’unité de diabétologie pédiatrique du service PUC de l’hôpital Béchir Hamza de Tunis.

Notre étude est une enquête épidémiologique transversale de type descriptif des enfants vus en consultation externe ou au cours de l’hospitalisation pendant une période de 6 mois (juillet 2014–décembre 2014). Les informations sont recueillies sur le dossier médical et auprès des parents et/ou des enfants (quand l’âge est supérieur ou égal à 6 ans).

Trente-quatre enfants présentant un diabète de type 1 ont été colligés. L’âge moyen est de 9 ans (2–18 ans), 73,5 % ont une histoire familiale de diabète avec un lien de parenté du 1er degré dans 32 % des cas. Soixante-quatre pour cent avaient un diabète de type 2, la notion de diabète compliqué était présente dans 28 % des cas. La durée d’évolution de la maladie dans notre série est de 33 mois. 16,7 % des malades ont un fléchissement scolaire après le début du diabète, cause directe de redoublement dans 14,7 % des cas. 40 % des enfants cachent leur maladie à l’école et en société. Au total, 22,6 % des enfants ont présenté une dépression masquée sous forme de plaintes somatiques, 54,8 % ont présenté des troubles de comportement après l’annonce de diagnostic dont 82,4 % sous forme d’agressivité. De plus, 6,9 % des malades ont présenté des équivalents suicidaires (auto-injection de doses élevées d’insuline, consommation excessive de sucreries, mise en danger…) 18,8 % ont verbalisé un besoin de consulter en pédopsychiatrie.

Il est fondamental de bien comprendre la réaction de l’enfant face à sa maladie chronique, qui peut parfois produire ou renforcer des modes relationnels pathogènes restructurant les défenses de l’enfant sur un mode pathologique. Un dépistage précoce avec une prise en charge multidisciplinaire est nécessaire.

La prévalence des troubles anxieux est élevée autant pour les adultes que les enfants . Young et al. (2005) élaborent une théorie des schémas précoces utile à la compréhension des troubles anxieux. Les schémas comprennent des cognitions, des émotions, des images mentales et des sensations corporelles. Depuis, une corrélation entre ces schémas et les troubles anxieux a été établie chez l’adulte et l’adolescent . Toutefois, ce thème demeure rarement exploré auprès de participants âgés de 10 à 15 ans. Cette étude examine la présence de corrélations entre les schémas précoces et les troubles anxieux.

Cent cinquante-neuf élèves de collège (10–15 ans) ont complété l’échelle des peurs pour enfants ; l’Inventaire des schémas précoces pour enfants et l’outil de dépistage de l’anxiété de l’enfant et des troubles émotionnels associés (SCARED).

Des corrélations significatives sont visibles entre :

– l’échelle Trouble Anxiété Généralisée et les schémas Incompétence (r = 0,48 ; p < 0,05) et Carence émotionnelle (r = 0,41 ; p < 0,05) ;

– l’échelle Trouble Anxiété de Séparation et les schémas Abandon, (r = 0,41 ; p < 0,05), Vulnérabilité (r = 0,40 ; p < 0,05) et Dépendance ; (r = 0,42 ; p < 0,05) ;

– l’échelle Phobie Scolaire et le schéma Incompétence, soit la croyance en des capacités inférieures à celles des autres(r = 0,52 ; p < 0,05).

Enfin, la corrélation entre le schéma Perte de Contrôle et l’âge indique qu’en grandissant, l’intensité de ce schéma diminue, alors que le schéma Abandon aurait tendance à s’intensifier avec l’âge.

Les schémas activés diffèrent selon le type de symptômes anxieux présentés. Une intervention ciblant les pensées dysfonctionnelles liées aux schémas inadaptés et aux symptômes anxieux pourrait être proposée pour cette tranche d’âge.

It has been assumed that a key difference between burnout and depression is that burnout is job-related and situation-specific whereas depression is context-free and pervasive. This view has recently been challenged at a theoretical level and additional empirical investigation has been called for.

The aim of this study was to examine whether chronic occupational stress—the putative cause of burnout—discriminated burnout from depression. Following a scope-based approach to the burnout-depression distinction, chronic occupational stress should be primarily related to burnout and only to a lesser degree to depression. This hypothesis was tested.

A total of 2124 French teachers took part in this study (mean age: 41.36; 73% female) during the last trimester of the 2013-2014 school year. Burnout was assessed with the Maslach Burnout Inventory and depression with the 9-item depression module of the Patient Health Questionnaire. The Effort-Reward Imbalance Questionnaire short form (ERIQ) was used for assessing chronic occupational stress.

Burnout and depression were almost identically correlated to effort-reward imbalance at work. Interestingly, the job over-commitment component of the ERIQ was slightly more correlated to depression than to burnout. Multiple regression analyses showed that effort-reward imbalance at work and job over-commitment predicted depression as much as burnout, controlling for gender, age, and length of employment.

Chronic occupational stress was not found to discriminate burnout from depression. These results further question the relevance of a scope-based distinction between burnout and depression and supports the idea that burnout overlaps with depression.

Only four of the fourteen-predictor variables on univariate analysis made unique statistically significant contributions to a logistic regression model. The odds ratios suggest that crisis nurses were twice as likely to refer patients who were not in any relationship or those who were known to psychiatric services compared to those who were in a relationship or not known to psychiatric services respectively; nineteen and six times respectively more likely to refer patients presenting with psychotic symptoms or a drug or alcohol problem compared to someone presenting with a medical problem and twenty and seven times respectively less likely to refer patients who were given a probable primary diagnosis of ‘drug/alcohol use disorder’ or ‘personality disorders’ compared to patients who were given the probable primary diagnosis of a ‘Depressive disorder’, controlling for other factors in the model.

In a task-shifting model of care, protocols need to be developed with clear guidelines around patients who need to be referred to a psychiatrist for further management.

Excessive use of emergency departments (EDs) for the treatment of mental health complaints (MHCs) suggests alternate interventions are required.

To understand attributes of patients who are high frequent users (HFUs) of EDs for the treatment for MHCs.

Suggest realistic changes that would make the health care system more effectively respond to HFUs needs.

Administrative data were used to analyze the use of all three emergency departments in Saskatoon Health Region by patients presenting with primary MHCs in 2012. A chart review of HFUs for the years 2011 to 2013 was also undertaken.

In 2012 approximately 1.2% (3,824) of the Region’s population made the 6,235 visits for a primary MHC. ED visits exhibit a Pareto distribution with most patients (72.8%) making a single visit however < 0.1 % (34) made 10+ visits. HFUs (10+ visits) used EDs in multiple years, over 3 years making an average of 59 ED visits (R=19 to 194). They were generally, young, male, unemployed, transient or homeless with many unmet social and economic needs. They could be categorized into: 1) suffering from severe alcohol abuse/withdrawal or illicit drug use; 2) chronic mood and anxiety disorders; 3) significant personal and social stressors; and 4) a complex combination of psychiatric disease(s) and cognitive impairment.

Action should be taken to identify ‘High Frequency Users’ early in their patient career and develop appropriate interventions taking into account their unique and diverse needs.

To examine incidence ofand factors associated with metabolic syndrome in patients with majordepressive disorder within a year.

All majordepressive disorder (MDD)patients who visited our psychiatric clinic were screened. All subjects were screenedby the metabolic syndrome criteria proposed by the American Heart Association/National Heart, Lung, and BloodInstitute (updated ATPIII). Subjects who did not meet the criteria of metabolicsyndrome would come after one year to screen for it again. Age and history ofused atypical antipsychotic use, duration of illness, severity of illness andfamily history of metabolic syndrome were assessed as factors associated withthe metabolic syndrome. Data was analyzed by using percentage, mean, standarddeviations, student t-test, chi-square test and Fisher's exact test.

There were 140 subjectsrecruited. 53 were excluded because they had metabolic syndrome. After one year77 of 87 came to the follow up visit for screening metabolic syndrome. The1-year incidence of metabolic is 16.9%(13 subjects) and 11.7%(9 subjects) dueto ATP III and IDF criteria respectively. Triglyceride and HDL at baseline wassignificantly associated with metabolic syndrome in patients with majordepressive disorder (p≤0.001). Age andhistory of used atypical antipsychotic use, duration of illness, severity ofillness and family history of metabolic were not associated with metabolicsyndrome.

Thai MDD patients are likely to have and developmetabolic syndrome. These findings support the importance of assessing andmonitoring metabolic syndrome in MDD patients especially in patients who havehigh triglyceride and HDL.

To evaluate the relative efficacy of Cognitive Behavioral Therapy (CBT) and Specialist Supportive Clinical Management (SSCM) for adults with severe and enduring anorexia nervosa.

Randomised controlled trial.

Sixty-three participants aged 18 and over (range 20-62) with a DSM-IV diagnosis of anorexia nervosa with at least a seven year illness history.

Thirty outpatient visits over 8 months. Participants were assessed at baseline, end of treatment (EOT), and 6-month and 12-month post-treatment follow-up. At EOP and follow-up, both groups improved significantly on the majority of outcome measures. However, there were no differences between treatment groups at EOT. At 6- and 12-month follow-up, analyses indicate greater improvement for those in CBT compared to SSCM. At 6-month follow-up, CBT participants had higher scores on the social adjustment scale (p = .038), and at 12-month they reported lower eating disorder examination global score (p = .004), and higher readiness for recovery (p = .013) compared to SSCM.

Patients with severe and enduring anorexia nervosa can make significant and meaningful improvements with therapy. CBT shows significant advantage over SSCM in terms of social adjustment, core eating pathology, and readiness for change over time.

Le dysfonctionnement émotionnel est présent dans de nombreuses pathologies mentales des enfants et des adolescents. On observe ce dérèglement aussi bien dans des troubles de type anorexie nerveuse (AN), mérycisme, évitement-restriction, que dans des troubles, tels que la boulimie nerveuse (BN), le syndrome d’hyperphagie incontrôlée (binge-eating), et les troubles du comportement alimentaire (TCA), que ceux-ci soient spécifiés ou pas. Le dysfonctionnement émotionnel peut également être observé dans le spectre bipolaire. Ainsi, il est démontré qu’il existe des ressemblances entre un spectre bipolaire mineur (sous des formes au-dessous du seuil) et des syndromes ou « sous-syndromes » de troubles de la conduite alimentaire chez les adolescents. C’est de ces prémisses que naît la recherche qu’on présente [aujourd’hui] et qui a pour but d’évaluer le dysfonctionnement émotionnel (mesuré à travers le CLH-32) et les habitudes alimentaires (mesurées à travers la BEDS) dans une population touchée par les TCA.

Il s’agit d’une étude transversale basée sur l’observation d’un corpus de patients âgés de 12 à 19 ans et ayant été touchés de TCA avant l’âge de 18 ans et suivant un traitement intrahospitalier (n = 40). L’échantillon a été divisé en deux sous-ensembles : I-AN (n = 17) et II-BN (n = 23) et on a procédé à établir des corrélations et des régressions linéaires afin de pouvoir déterminer quelles variables étaient associées au dysfonctionnement émotionnel dans chacun des deux groupes.

Le groupe I-AN a présenté des scores élevés sur la CLH-32, qui ne gardaient pas de corrélation positive avec les trouvailles sur l’échelle BEDS. Le groupe II-BN a présenté des scores élevés sur la CLH-32, qui montrent une corrélation positive avec les trouvailles sur l’échelle BEDS, notamment dans la sous-échelle Symptômes de l’Hypomanie associés à la désinhibition, le contrôle de soi et la capacité d’attention (CLH-32-Facteur 2).

Le dysfonctionnement émotionnel est un facteur à prendre en considération dans le dépistage et l’abord clinique des patients souffrant de TCA, que ce soit en anorexie nerveuse, en boulimie nerveuse ou autres TCA, puisqu’ils peuvent présenter d’autres pathologies comorbides. Par ailleurs, la boulimie nerveuse, notamment celle qui se développe avec dysfonctionnement émotionnel, peut être mise en rapport avec l’hypomanie ou un spectre bipolaire.

Binge drinking and mental health problems in the depression/anxiety spectrum often begin in adolescence as co-occurring phenomena.

To evaluate the mediating role of socioeconomic status in the association between binge drinking and adolescent depression/anxiety.

A prospective cohort study of adolescents (n=3008), with 4 follow-up assessments between July 2006 and July 2010.

Family Panel, Institut d’Infància i Mon Urbà, Catalonia.

Adolescents and their parents.

The presence or absence of a diagnosis of depression/anxiety was determined at T1 and at T4 in interviews with parents. Binge drinking, defined as 2 monthly binges or more, was assessed at T1, T2 and T3 through interviews with the adolescent study participants, and the responses recorded as variables (yes or no). Age, sex, income, parents’ level of education, number of friends, peer pressure, parental pressure, and risk-prone friends were included as variables in data analysis. Descriptive and inferential statistics and simple and multivariate logistics models were applied to study the long-term effect of alcohol consumption on depression/anxiety.

Binge drinking is a risk factor for depression/anxiety in the last year of follow-up T3 (OR:1.7, IC 95%: 1.1-2.5). After adjusting for age and sex, the risk remains. The risk of depression decreases as household income increases (OR: 1.47, IC 95%: 0.9-2.4].

Binge drinking increases the risk of depression and anxiety disorders mainly in adolescents from low-income families. Mental health interventions and treatment for addiction should be sensitive to the effect of socioeconomic inequalities in this age group.

Disordered eating has a strong genetic component which is not fully understood.

Possible associations between certain genetic markers and disordered eating at adolescence were tested in the Nord-Trøndelag Health Study (HUNT).

Logistic regression was employed to test for association with the gene variants rs6277 (DRD2), rs569356 (OPRD1), rs10195252 (GRB14), rs35683 (GHRL), rs4074134 (BDNF), rs10838738 (MTCH2), rs1121980 (FTO), rs17782313 (MC4R) and rs11084753 (KCTD15) in participants aged 13 to19. EAT-7, a shortened version of EAT-12 was used to identify cases as those scoring above cutoff on EAT-7(456 cases) and its anorexia (EAT-A, 259 cases) and bulimia subscale (EAT-B, 433 cases), compared against 5405 controls. A haplotype analysis was performed for markers within FTO, MC4R and BDNF genes. Associations were adjusted for gender, age and BMI.

In males, rs6277 showed significant association with EAT-B (OR: 1.32, p = 0.03) after adjustments for age and BMI.

The A-allele of rs11084753 showed positive associations with EAT-A (OR: 1.25, p = 0.01) in the combined sample. In females, after adjusting for age and BMI, the C-allele of rs10195252 was positively associated with EAT-A (OR: 1.30, p = 0.01).

After adjustments for age and BMI in females, rs10195252 showed significant association with EAT-7(OR: 1.18, p: 0.02).

Haplotype analysis on FTO gene revealed a 'collective reinforced effect' of the GCT alleles from rs1121980, rs8050136 and rs9939609, respectively, compared to rs1121980 variant alone.

We found evidence in support of associations between DRD2, FTO, GRB14 and KCTD15 with disordered eating. Associations seem to vary based on gender.

To evaluate the prevalence and associated variables of intentional self-poisoning in individuals from 8 to 17 years.

This study includes 4658 cases. Analyzed variables were gender, age, agent and time (month, week day and hour).

In total, 3759 (80.70%) were girls. The rate in 100,000 children and adolescents residents grown from 25.12 in 2005 to 35.24 to 2012. The biggest incidence was in the 15 to 17 age group (63.35%). The leading agent was medications (84.6%): 1093 (23.47%) antidepressant, 967 (20.76%) benzodiazepines, 708 (15.20%) antipyretics, 606 (13.01%) anticonvulsants, 460 (9.88%) neuroleptics and 382 (8.2%) anti-inflammatory non-steroids. The antidepressant more used was amitriptyline (7.26%), followed by fluoxetine (6.57%). Growing cases involving selective serotonin reuptake inhibitors have been seen, as a fall of self-poisoning tricyclic antidepressants cases. The majority of cases was in October (10.1%), on Tuesday (15.1%), and at 18:00 to 21:00 (29.46%).

The elevated rate of self-poisoning in children and adolescents in southern Brazil, growing each year, shows the relevance of this subject. It is important to considerate how easily these children and adolescents have access to psychotropics.

- to assess the severity of depression

- to Identify depression structure

The study involved 50 patients with a diagnosis of recurrent depressive disorder. All patients were diagnosed with non-insulin-dependent diabetes mellitus. Assessment of patients was carried out twice: on admission to a psychiatric hospital and at 1 year. Used psychometric method – HDRS-21 scale.

<a name="_GoBack"></a>Results: we found an association between the severity of depressive symptoms and an increased risk of complications of type 2 diabetes mellitus. New complications developed in 30% of patients after a year of observation. These patients had a comparatively high level of depression on a first visit (mean score on a scale of HDRS 19.2 (SD = 7.5) vs. 16.3 (SD = 6.2) with the rest of patients). The difference of the average score was conditioned by differences in the level of mental anxiety (1.33 points, 95% CI = 0.8-1.87, p <0.0001), somatic anxiety (0.64 points, 95% CI = 0.05-1.23, p <0.05), and hypochondriasis (1.03 points, 95% CI = 0.65-1.41, p <0.0001).

The increase of depressive symptoms level in patients with diabetes mellitus type 2 can indicate decompensation in endocrine disease.