Therapeutic body wraps (TBW) for treatment of severe injurious behaviour in children with autism spectrum disorder (ASD): A 3-month randomized controlled feasibility study.

INTRODUCTION: The use of therapeutic body wraps (TBW) has been reported in small series or case reports, but has become controversial. OBJECTIVES: This is a feasibility, multicentre, randomized, controlled, open-label trial with blinded outcome assessment (PROBE design). SETTING: Children with autism and severe-injurious behaviours (SIB) were enrolled from 13 specialized clinics. INTERVENTIONS: Dry-sheet TBW (DRY group) vs. wet-sheet TBW (WET group). PRIMARY OUTCOME MEASURES: 3-month change in the Aberrant Behaviour Checklist irritability score (ABC-irritability) within per-protocol (PP) sample. RESULTS: From January 2008 to January 2015, we recruited 48 children (age range: 5.9 to 9.9 years, 78.1% male). Seven patients (4 in the DRY group, 3 in the WET group) were dropped from the study early and were excluded from PP analysis. At endpoint, ABC-irritability significantly improved in both groups (means (standard deviation) = -11.15 (8.05) in the DRY group and -10.57 (9.29) in the WET group), as did the other ABC scores and the Children Autism Rating scale score. However, there was no significant difference between groups. All but 5 patients were rated as much or very much improved. A repeated-measures analysis confirmed the significant improvement in ABC-irritability scores according to time (p < .0001), with no significant difference between the two groups (group effect: p = .55; interaction time x group: p = .27). Pooling both groups together, the mean 3-month change from baseline in ABC-irritability score was -10.90 (effect size = 1.59, p < .0001). CONCLUSIONS: We found that feasibility was overall satisfactory with a slow recruitment rate and a rather good attrition rate. TBW was a safe complementary therapy in this population. There was no difference between wet and dry TBW at 3 months, and ABC-irritability significantly decreased with both wet and dry sheet TBW. To assess whether TBW may constitute an alternative to medication or behavioural intervention for treating SIB in ASD patients, a larger randomized comparative trial (e.g. TBW vs. antipsychotics) is warranted. TRIAL REGISTRATION: ClinicalTrials.gov NCT03164746.

[Hallucinations in children and adolescents: diagnostic and treatment strategies]. / Stratégies diagnostiques et thérapeutiques face aux hallucinations de l'enfant et de l'adolescent.

Hallucinations are a common symptom in pediatric populations. Because spontaneous rapid recovery often occurs, routine medication with antipsychotic drugs should be avoided. An adequate initial etiological assessment requires a medical examination, a psychiatric interview, and a meeting with key adult informants. Laboratory testing and imaging may also be useful. The risk of self-injury or harming others must be systematically assessed and should determine the choice between prescribing a nonspecific anxiolytic medication or hospitalizing the child. Treatment should combine psychotherapy and psychoeducation, and antipsychotics should be given in case of prodromal psychotic presentation. In the years to come, randomized controlled trials should define the exact role that repetitive transcranial magnetic stimulation might play as a treatment of hallucinations in children and adolescents.

Clinical practice of rTMS reveals a functional dissociation between agency and hallucinations in schizophrenia.

We report here the case of a hospitalized 11 year-old boy (YP) with a positive diagnosis of 'Childhood Onset Schizophrenia'. YP experienced verbal-auditory hallucinations, a delusion of alien control and hetero-aggressive behaviour. Antipsychotic drugs were unsuccessful and furthermore provoked severe acute dystonia. fMRI-guided rTMS applied over several cortical regions provided the means to reveal for the first time a functional dissociation between auditory-verbal hallucinations and agency. These results demonstrate the efficacy of rTMS for young patients suffering from drug-resistant hallucinations but they furthermore question the physiopathology of the hallucinatory process by suggesting that agency and hallucinations may be sub-served by different neural networks.

Depressive disorder with psychotic symptoms as psychiatric presentation of sporadic Creutzfeldt-Jakob disease: a case report.

Creutzfeldt-Jakob disease (CJD) is a rare neurodegenerative disease and shows a wide range of early clinical manifestation. We report the case of Ms. A, a 50-year-old woman, who exhibited an atypical psychiatric presentation of CJD at the beginning of the disease, as a depressive disorder with psychotic features. We discuss this case, the clinical attitudes that can lead to misdiagnose such presentation of CJD with other psychiatric diseases, and propose to repeat complementary investigations when the diagnostic is evocated, even if these tests are often negative or nonspecific in the early stages of CJD.

Hepatitis C, alpha interferon, anxiety and depression disorders: a prospective study of 71 patients.

This article presents a prospective study of 71 patients infected with chronic viral hepatitis C and treated with interferon alpha during one year. The objective was to assess the incidence and predictive factors of anxiety and depression symptoms during and after the therapy. Each patient received psychiatric assessment before, during and after treatment, with evaluations using Hamilton-anxiety and MADRS scales. Results confirm the great incidence of depression and anxiety not only during interferon alpha therapy but also after treatment is discontinued. Sleep disorders and MADRS ratings of M4 seem to be predictive of the therapy's side effects. Thus, there seem to be easily discernable parameters allowing depression and suicidal behaviour to be anticipated. This paper emphasises their possible occurrence after the treatment and, therefore, the need for routine assessments after treatment is discontinued. Teams comprising both hepatologists and psychiatrists should complete these assessments. This shows the necessity of interdisciplinary collaboration treatment of this kind.