Biomedical subjects
Publications and source records attributed to R de Villard.
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.
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.
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.
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.
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.
Explore the source record for details and available documents.
Post-puberty anorexia nervosa requires a thorough clinical study to facilitate its diagnosis and its early treatment. Longitudinal studies have demonstrated that good results usually depend on the speed of medical intervention (preferably with admission to hospital) and to the duration of treatment. The fact that certain cases result in death is too often due to excessive intensive care. Infusions must be avoided at all costs and should be replaced by forcible feeding if absolutely necessary. Finally, a better approach to, and a better understanding of adolescents should contribute to the prevention of anorexia nervosa.
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.
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.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
We have presented the case of a 7 year old retarded child with psychotic like behavioral troubles. Biological studies are compatible with typical phenylketonuria. Two times, a low phenylalanine diet was followed by an improvement of the behavioral troubles, and the interruption of the diet by a relapse of these troubles. Biologically, an hyposerotoninergy was recorded by the lowering of the 5 HIAA renewal in CSF after probenecid, partially corrected by the low phenylalanine diet. From this personal case and a review of the literature, the authors discuss the biochemical interpretation of the behavioral troubles in the light of the serotoninergic deficit.
Explore the source record for details and available documents.
According with experiments, it appears that hormonal environment plays a major role on anatomical, neuroendocrinological and behavioral sexual differentiation in animals. This environment occurs at a critical period, which is specific for each specie, either during fetal life or soon after birth. Sexually dimorphic behavior appears to be influenced by androgens who act either directly or after chemical modification on specific central receptors. In the absence of androgens during the critical specific period, these central structures and consequent behavior differentiate in a feminine pattern. In the presence of androgens during this period, structures and behavior differentiate in a masculine pattern. But this influence of androgens require a double component, defeminization and masculinization, variable among species, as it is observed in rats and mice when defeminization can not be obtained in primates. In human beings, "nature experiments" such as congenital adrenal hyperplasia in feminine foetuses and abnormalities in testosterone metabolism in masculine foetuses are more difficult to study. Fetal hyperandrogenization is responsible of an anatomical and perhaps behavioral masculinization. Neuroendocrine and behavioral defeminization seems not to occur as ovulatory menstrual cycles are possible with a regular treatment, and as sexual identity is feminine when sex of rearing is feminine even if some aspects of sexual roles are unusual. Moreover, these peculiar behavioral traits and changes in sexual orientation in a masculine way at puberty are difficult to explain : fetal hyperandrogenization seems to play a role, as it is observed in animals and as seem to demonstrate Dr J. Imperato-Mc Ginley's observations, but other factors seem to predominate, such as parental attitude in regard with sexual ambiguity and psychological consequences of the acknowledgment of ambiguous genitalia.
Explore the source record for details and available documents.
Transient hyperkinesia was observed in a 16-year-old epileptic and mentally retarded patient after a single intravenous perfusion of diphenylhydantoin (DPH). No clinical signs of DPH intoxication were associated with the movement disorder. Repeated plasma anticonvulsant level determinations never showed toxic concentrations of DPH. Since a few spontaneous episodes of hyperkinesia had been observed before, the DPH intravenous perfusion could have unmasked a preexisting latent movement disorder in our patient. However, neuroradiological investigations failed to demonstrate the existence of any anatomical damage of the basal ganglia, and HVA as well as 5-HIAA levels measured in the CSF with the probenecid technique were within the normal range 2 months after cessation of hyperkinesia. HVA and 5-HIAA levels have also been measured in the CSF during the period with hyperkinesia; the results are discussed with reference to previously published data concerning cerebral monoamine metabolism in drug-treated epileptic patients.
Explore the source record for details and available documents.
Explore the source record for details and available documents.