[The use of antidepressants to treat depression in children and adolescents].
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Adolescent↗
Biomedical subjects
O Revol
Publications and source records attributed to O Revol.
[Attention deficit and hyperactivity disorder or multiplex developmental disorders in child? Let us be sure...].
Personality disorders in child can be easily confused -- initially at least -- with Attention Deficit and Hyperactivity Disorder (ADHD). Because of the therapeutic and prognostic stake related to the early psychiatric care of Child Developmental Personality Disorders it is important to sensitize pédiatric and general practitioner with the clinical screening of these disorders. Indeed any premature prescription of psychostimulant treatment in these children can have regrettable consequences on their psychic functioning already precarious.
Attention Deficit Disorder with Hyperactivity↗
[Psychophysiological factors in high intellectual potential: comparative study in children aged from 8 to 11 years old].
UNLABELLED: Factors of intellectual talent as well as physiological and psychological characteristics are little known. However, giftedness is now a social problem and the knowledge of precocity hallmarks should permit the diagnosis in order to undertake the adequate educational orientation of these children. From questionnaires given anonymously to parents, this work showed comparative results between a population of gifted children and a control one. OBJECTIVES: The aim of this study was to present precocity hallmarks in the gifted population, following factorial analysis of socio-economic and familial parameters, as well as medical and psycho-physiological variables linked with the children's post-natal life. POPULATION: Four hundred and twelve children aged eight to 11 years, from Lyon, have been used in the survey: 217 children (control group) were included after a random selection in schools, and 195 children (gifted group, IQ >130, Wechsler test) were enrolled after clinician's diagnoses in four medical departments. RESULTS: Regression analysis allowed to draw relation between several factors and giftedness: abnormal pregnancy (CR =3.205, P =0.009), perinatal stress (CR =2.166, P =0.003), and presence of migraine (CR =3.169, P =0.001). Parents living together (married or not) (CR =2.100, P =0.080) with a good and superior level of learning (CR =5.464, P =0.0002) were also linked with giftedness. CONCLUSION: Our results indicate that precocity hallmarks are multifactorial. These data confirm some socio-economic and medical physiological features correlated with giftedness, and suggest that psychological factors may bear on the etiology of intellectual talent. We focus on the hypothesis than early stress may play a role on central nervous system maturation in these children.
Child↗
[Diagnosis and therapeutic current approach of obsessive compulsive disorder in children].
In the past years, obsessive-compulsive disorder has mainly been described in adults. However, recent epidemiological data has shown that 2 to 3% of the school-age population has OCD symptoms in the clinical range of severity. Despite these findings, this disorder remains still unknown and under recognized by child's clinicians--general practitioners, paediatricians or child and adolescent psychiatrists. This may contribute to the particularly damaging delay occurring in diagnosis and specific treatment of childhood onset OCD. Therefore, this article intends to review the main clinical signs likely to allow an early detection of OCD in child as well as the principal therapeutic methods currently in progress.
Child↗
[From tics to obsessive-compulsive disorders in children: a subsequent risk now recognized].
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Adolescent↗
Attention shifts and anticipatory mechanisms in hyperactive children: an ERP study using the Posner paradigm.
BACKGROUND: The aim of this study was to assess attentional, decisional, and motor processing stages during the performance of an attention shifting paradigm, both in normal children and children with attention-deficit/hyperactivity disorder (ADHD). METHODS: We recorded event-related potentials (ERPs) and performance measures during a variant of the Posner paradigm in 13 control subjects and 24 ADHD children. Subjects responded with a spatially concordant motor response to left or right visual targets, which could be either preceded by a spatial cue ("valid" = same side; "invalid" = opposite side) or presented uncued. RESULTS: Patients made significantly more errors than control subjects, with predominance of the anticipatory type. As compared to control subjects, ADHD children had faster reaction times, as well as a shortened interval between the N2 and P3 ERPs and the motor response. Patients also showed a decreased attentional priming effect on early sensory responses (P1). Finally, the slow negativity (contingent negative variation/readiness potential) that preceded the target in the "no cue" condition was absent in ADHD patients. CONCLUSIONS: The combined analysis of electrophysiological and behavioral data suggest a characteristic mode of response of ADHD in attention shifting tasks, characterized by "motor impulsivity" with release of motor responses before stimulus processing is adequately completed, as well as a lack of strategic planning/anticipatory mechanisms in the absence of warning stimulus. These deficits may be partly attributed to dysmaturation of executive frontal functions. In addition, a minor deficit in early attentional priming was also observed in ERPs, with no apparent behavioral counterparts.
Attention Deficit Disorder with Hyperactivity↗
[Cognitive-behavioral management of sleep disorders in young children].
Sleep disorders are prevalent in young children, the most frequent being disturbances in initiating and maintaining sleep. Behavioral and cognitive approaches are interesting techniques for their management. They can be used either for solving sleep problems at home, or in severe forms as part of a 'deconditioning' during a short hospitalization.
Behavior Therapy↗
[Decisional procedure in school-age children with hyperkinetic syndrome].
Hyperkinetic syndrome may be either secondary to an organic disease or a psycho-effective disorder (mood and/or anxiety disorder), or primary as part of an attention deficit hyperactivity disorder. Precise diagnosis is essential before any therapeutic decision; this requires a complete anamnestic, behavioural, psychological, sensorial, and neurological evaluation. It is only when a reliable diagnosis has been made that a relevant therapeutic project can be proposed. An evaluation procedure and a decisional tree are presented.
Adolescent↗
[School refusal anxiety].
School refusal mainly affects 11-13-year-old children but may be observed at any age from 5 to 15 years. It has two main clinical varieties: 1) school phobia in which the refusal attitude is directed toward school itself or an aspect of school environment; 2) separation anxiety in which the refusal of going to school is related to the separation with attached relatives, frequently the mother. Early recognition and intervention are determining factors for the prognosis. Hospital management and/or medication (imipramine) may be necessary in severe forms.
Adolescent↗
[Depression in children. Etiological, clinical and therapeutical aspects].
Although the concept of child depression is today well admitted, the diagnosis of childhood depression remains difficult due to the variety of its symptoms, many of them being non specific, and the frequency of masked depression. For each period of child development, ie: infancy, early childhood, late childhood and adolescence, depression has particular clinical characteristics which are important to be known for its early recognition. Depression in a child frequently appears to result from the conjunction of a constitutional predisposing ground, one or several losses, and an inappropriate parental response. One must be concerned about the major risk of deleterious effects on psychoaffective, intellectual and somatic development of neglected depression, so that its prevention, early recognition, and treatment are mandatory. According to the cases, treatment requires individual or familial psychotherapy and chemiotherapy, and in particular cases care in a medico-educative establishment.
Child↗
[Psychotropic drugs in child and adolescent psychiatry].
Although there has been concern about the use of psychoactive drugs in children, evidence is accumulating that these drugs are beneficial. The various groups of currently available drugs are reviewed with their pharmacological characteristics, adverse effects, dosages, and uses in children. Benzodiazepines, both widely used and severely criticized, are effective when used correctly, in particular for the shortest possible length of time. Antidepressants are indicated in many conditions including depression, obsessive-compulsive disorders, and anxiety; some of their indications are specific to children, such as separation anxiety, enuresis, and school phobia. Neuroleptics have a less well defined role and are usually given as symptomatic treatment, although their use is limited by their side effects. This is also true of lithium, despite fairly good tolerability in children. Carbamazepine was introduced in psychiatry too recently to allow valid evaluation. Psychostimulants are viewed with fear in France despite their documented efficacy in hyperkinetic children. A few other drugs used in other fields of medicine are currently being investigated in psychiatry (beta-blockers, clonidine, naloxone). A debate on drugs used in child psychiatry is much needed in particular to overcome the methodological and ethical problems raised by controlled trials of which few have been conducted to date. Drug therapy should be combined with psychotherapy to place the target symptoms in perspective with regard to the child's overall make-up.
Adolescent↗
[Platelet serotonin concentration in children under 5 years of age].
High platelet serotonin concentrations have been reported in children with early infantile autism. However, as yet there are no reference values regarding platelet serotonin in normal infants and young children so that it remains difficult to define the exact significance of this finding. We report here with the platelet serotonin concentration found in 57 infants and children (20 girls, 37 boys) ranging in age from 10 days to 5 years old. Our results show that mean platelet serotonin concentrations in infants and young children are significantly greater than mean values obtained in older children (+11%) and neonates in the umbilical cord (+64%). No significant variations were found relating to sex, leucocyte count and platelet count. There therefore appears to be a physiological elevation of platelet serotonin concentration in infants and young children, and this has to be taken into consideration in the interpretation of the elevated values found in cases of infantile autism.
Aging↗
[Nocturnus terrors--somnambulism].
Among disorders of sleep in children, pavor nocturnus ("night terrors") is common and considered harmless. Yet the clinical picture, the child's personality and the polygraphic electroencephalographic recordings suggest that it should be treated sooner and more often than is usually done. Somnambulism ("sleep walking") also is very frequent. It has no consequences in most cases, but it may be the cause of serious events such as falling out of a window which is rare but may result in death or disablement. Some children have repeated attack of somnambulism, and these constitute a true pathology of sleep requiring a specific treatment that will cure or improve. All this must be known to the practitioner who will inform the parents.
Adolescent↗
[Sleep disorders in infants and children].
Sleep disorders are common in childhood, and almost always benign. Simple explanations and parental reassurance are generally sufficient for the alleviation or tolerance of the disorder. However, severe forms exist for which a therapeutic support is necessary and often very efficient.
Bruxism↗
[Evaluation of the treatment with fenfluramine of autism in children].
The effects of fenfluramine were studied in a group of 44 children with the autistic syndrome and in 26 non autistic children with behavior abnormalities, mostly hyperkinetic children, as a control group. The mean daily dosage was 0.65 mg/kg/day. There were 75% positive results in the autistic children and 77% in the control group. The clinical improvement appears to be mainly related to the control of the hyperactive behavior in the autistic children. Platelet serotonin levels were studied in both groups, showing a clear cut decrease during fenfluramine therapy with no significant differences between the 2 groups and no correlation between the clinical effects and the magnitude of the decrease.
Ambulatory Care↗
[Interest of propranolol in the treatment of school refusal anxiety: about three clinical observations].
School refusal anxiety is a pathopsychological disorder which touches the young child, between 8 and 13 years. Even if the school refusal is studied for a long time, there is not still consensus as for the specific definition of this disorder or on the best way of treating it. Nevertheless, accountable of long-lasting difficulties in school integration, its short and medium term consequences are serious and well known: school desertion, mood disorder and behavioral problems. Speed and quality of the medico-psychological and educational interventions represent a important factor for evolution and prognosis. Although, psychological interventions remain essential, sometimes the interest of an associated psychotropic medication should be discussed. This one can indeed either improve their results or supporting their installations. Despite more than twenty controlled trials in the pediatric population, no definitive psychopharmacological treatment data exist for anxiety disorder in childhood and especially for school refusal disorder. The majority of the studies stress as well the interest of benzodiazepines as tricyclic antidepressants but without being able to specify the possible superiority of a chemical on the other. On the other hand, the side effects of each one are well-documented, in particular for the benzodiazepines (potential abuse, sedation, potential desinhibition, mnemonic disorder), limiting thus their uses in child. In this work, we would like to emphasize the interest of propranolol in the treatment of somatic symptoms usually met in school refusal anxiety. Although beta-blockers have been used in the treatment of neurovegetative symptoms associated with situational anxiety disorders, there is no controlled data and only some open data to guide pediatric use for anxiety disorders in children. Nevertheless, prescribed with low posology and in substitution of benzodiazepine, this medication enabled us in three severe clinical cases to shorter notably the time of school rehabilitation. Well tolerated on the clinical level, with a greater efficiency on the somatic signs related to anxiety than benzodiazepines and with not having their side effects, this therapeutic can constitute a significant support in the psychological treatment of these children. However, these present results require to be confirm by other observations, which will be lead perhaps to a controlled study.
Adrenergic beta-Antagonists↗