[Autism spectrum disorder : ethiopathogenesis and benefits of early diagnosis]. / Trouble du spectre autistique : étiopathogénie et intérêt d'un diagnostic précoce.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that manifests in altered or reduced social behaviours, social communication disorders, and repetitive behaviours and/or restricted interests. The etiology of ASD is complex and multifactorial. The etiopathogenesis of the disorder is multiple, including brain abnormalities, visual contact and early interaction disorders. These signs are often the focus of parental concerns. In addition, since ASD is neurodevelopmental, all signs are not always present simultaneously. Indeed, they appear progressively, until the age of 3 years, at which the diagnosis can usually be made. Nevertheless, in more complex cases, this diagnosis may be considered later. The first signs of ASD (before 24 months) will be addressed because they are crucial for an early diagnosis. Their knowledge allows the establishment of a follow-up as well as its quick specific care. Indeed, by acting during a developmental period when brain plasticity is high, early intervention allows to modify the evolution of symptoms, and later on to limit secondary handicaps.

Le trouble du spectre de l'autisme (TSA) est un trouble neurodéveloppemental qui se manifeste par des comportements sociaux altérés ou réduits, des troubles de la communication sociale ainsi que des comportements répétitifs et/ou intérêts restreints. L'étiologie du TSA est complexe et multifactorielle. Les étiopathogénies du trouble mises en avant sont multiples. On y retrouve, entre autres, des anomalies cérébrales, des anomalies du contact visuel et des troubles des interactions précoces. Ces signes font souvent l'objet des préoccupations parentales. En outre, le TSA étant neurodéveloppemental, l'ensemble des signes ne sont pas toujours présents d'emblée. En effet, ils apparaissent progressivement, jusqu'à l'âge de 3 ans, moment à partir duquel le diagnostic peut généralement être posé. Néanmoins, dans des cas plus complexes, ce diagnostic peut être envisagé de manière plus tardive. Les premiers signes du TSA (avant 24 mois) seront abordés car ils sont au cœur de l'enjeu du diagnostic précoce. Leur connaissance permet la mise en place d'un suivi et d'une prise en charge rapide. En effet, en agissant au cours d'une période développementale où la plasticité cérébrale est élevée, l'intervention précoce permet de modifier l'évolution des symptômes et, a posteriori, de limiter les handicaps secondaires.

[Mental health of children refugees : a review]. / La santé mentale des enfants réfugiés : revue de la littérature

This review is devoted to all health professionals in order to raise awareness of the psychopathological consequences of forced migration on the mental health of children. First, we will talk about the psychological consequences of immigration in a global way, and then we will discuss about some specific situations. We will finish with prevention and care of these vulnerable children.

Cette revue de la littérature est destinée à tout professionnel de la santé et a pour objectif de sensibiliser aux conséquences psychopathologiques des migrations forcées sur la santé mentale des enfants réfugiés. Nous aborderons d'abord les conséquences psychologiques de la migration de manière globale puis nous évoquerons certaines situations spécifiques. Nous terminerons par des pistes liées à la prévention et à la prise en charge de ces enfants vulnérables.

[Merycism : when humain being starts ruminating]. / Le mérycisme : quand l'être humain se met à ruminer.

Merycism is a rare and little-known functional gastrointestinal disorder. Indeed, the diagnosis is made, on average, with a delay of 21 to 77 months. This delay can lead to dramatic consequences for the patient such as significant weight loss, ionic imbalance and social isolation. Through a clinical situation, we evoke the difficulties and the particularities of the diagnosis of merycism as well as its management, in a situation evoking a disorder of the eating habits. This pathology can be found in various specialties such as general medicine, pediatrics, gastroenterology, endocrinology, dentistry, child psychiatry, psychiatry, neonatology services or maternity.

Le mérycisme est un trouble gastro-intestinal fonctionnel rare et méconnu. En effet, le diagnostic est posé, en moyenne, avec un retard de 21 à 77 mois. Ce retard peut entraîner des conséquences dramatiques pour le patient, comme une importante perte de poids, un déséquilibre ionique et un isolement social. Au travers d'une situation clinique, nous évoquons les difficultés et les particularités du diagnostic de mérycisme ainsi que sa prise en charge, dans un tableau évoquant un trouble des conduites alimentaires. Cette pathologie peut se rencontrer dans diverses spécialités comme la médecine générale, la pédiatrie, la gastro-entérologie, l'endocrinologie, la dentisterie, la pédopsychiatrie, la psychiatrie, les services de néonatologie ou encore à la maternité.

[Alcohol consumption in teenagers : binge drinking]. / La consommation d'alcool chez les jeunes : le «binge drinking¼.

Binge drinking has become a common practice among teenagers, thus a banal behaviour in parties. It is part of a normal psychological evolution that pushes the young to confront limits, prohibitions, other peers, and even more to confront himself. The festive dimension further reinforces this attraction for group transgression. Yet neuroscientific studies are unanimous in showing the negative effects of binge drinking on a maturing brain, with significant neurocognitive and even neuroanatomical alterations. It is illustrated by research conducted on humans and on animal models. This article aims to show the difficult articulation between a clinical practice open to young people and a necessary concern about their behaviour, the danger of which they usually do not know.

Le «binge drinking¼ est devenu une pratique courante chez les adolescents, donc un comportement banal en soirée. Il s'inscrit dans une évolution psychologique normale qui pousse le jeune à se confronter aux limites, aux interdits, aux autres pairs, et plus encore à soi-même. La dimension festive renforce, encore, cet attrait pour la transgression en groupe. Pourtant, les études neuroscientifiques sont unanimes pour montrer les effets négatifs du «binge drinking¼ sur un cerveau en pleine maturation, avec d'importantes altérations neurocognitives, et même neuro-anatomiques. Cela est illustré par des recherches, tant sur les humains que via des modèles animaux. Cet article a pour but de montrer la difficile articulation entre une pratique clinique ouverte au jeune et une nécessaire inquiétude face à ses comportements, dont il ignore généralement le danger.

[Prescriptions in child psychiatry, on the use of antipsychotic drugs for children and Adolescents]. / La prescription en pédopsychiatrie. Exemple de l'usage des antipsychotiques chez l'enfant et l'adolescent.

In line with Evidence-based medicine and more recently with the emergence of Evidence-based practice in psychology, what are the current trends in medical prescriptions in child psychiatry? The use of psychotropic drugs for children and adolescents is constantly increasing, although most pharmacological prescriptions in child psychiatry result in off-label drug use. This article aims at understanding the legal and scientific framework that regulates the prescription of psychopharmacological treatments for children and adolescents. In the absence of clear therapeutic indications, which scientific data should be used to lead our prescribing practice? This topic is illustrated by a common case in child psychiatry: the prescription of medicines to treat psychotic disorders.

A l'heure de l'Evidence Based Medicine et de la réflexion sur l'Evidence Based Practice en psychologie, qu'en est-il de la prescription médicamenteuse en pédopsychiatrie? L'usage des psychotropes chez l'enfant et l'adolescent est en constante augmentation. Cependant, la grande majorité des prescriptions en pédopsychiatrie est réalisée «hors autorisation de mise sur le marché¼ ou «off label¼. Cet article a pour but de comprendre dans quel cadre légal et scientifique s'inscrit la prescription de traitements psychopharmacologiques chez l'enfant et l'adolescent. En l'absence d'indications officiellement reconnues, sur quelles données scientifiques baser sa pratique de prescription ? Il a été choisi d'illustrer ce propos par un exemple de pratique courante en pédopsychiatrie : la prescription d'antipsychotiques dans les troubles psychotiques.

[Self-injuring, a symptom retaining our attention]. / L'automutilation, ce symptôme qui retient notre attention.

Self-injuring is a process that usually occurs during adolescence; its prevalence has increased over recent years. Nowadays, nearly one out of six teenagers is concerned. The most frequent form is the «superficial¼ one and corresponds to the term NSSI (Non Suicidal Self Injury) recently mentioned in the third section of the DSM-5. More and more publicized, this practice may disturb. However, it reflects an underlying state of psychic suffering and should not be underestimated or dramatized. It has to be considered as a form of coping even if it is clearly damaging and, in some cases, may be connected to a higher suicidal risk. This article aims at raising the reader's attention to this expression of the patient's pain. A better approach of this symptom in its context enables to better understand its clinical significance and to adapt the therapeutical approach.

L'automutilation est un phénomène, habituellement rencontré durant l'adolescence, dont la prévalence a augmenté au cours des dernières années. Elle concerne aujourd'hui près d'un jeune sur six. La modalité dite «superficielle¼ est le plus fréquemment rencontrée et correspond au terme NSSI (Non Suicidal Self Injury) ou «lésions auto-infligées non suicidaires¼ récemment repris dans la section 3 du DSM-5. De plus en plus médiatisée, cette pratique interpelle. Elle reflète une souffrance psychique sous-jacente et ne doit être ni banalisée, ni dramatisée. Elle est à considérer comme un mode d'adaptation dommageable pouvant être associé à une augmentation du risque suicidaire. Le but de cet article est de sensibiliser le lecteur à cette forme d'expression de la souffrance chez un patient jeune. Mieux appréhender le geste dans son contexte permet d'en comprendre la valeur clinique et d'adapter la prise en charge.

[Early detection to prevent mental illness during adolescence: ethical and theoretical considerations]. / Détection prévenante en santé mentale chez l'adolescent: considérations éthiques et théoriques.

In the face of changes that characterise adolescence, a number of youth experience ill-being, as part of a normal developmental process. For some of them, however, this ill-being may represent early signs of a psychopathological process. Regarding depression and psychosis, such early signs are non-specific, which complicates and delays treatment. In addition, issues such as stigmatization and unfamiliarity with these psychopathologies represent major obstacles to treatment access. Attempts to early detection, which involves identifying risk factors in order to provide support and follow-up, making an effort to take these clinical signs seriously, while at the same time avoiding to mistake a normal developmental process for a pathological condition.

[Vulnerable children detected by the school health service: the forgotten?]. / Enfants en situation de vulnérabilité médico-psycho-sociale repérés par la médecine scolaire: les oubliés du réseau de soins?

The current health needs of children largely exceeds the biomedical model. The school doctor occupies a special position where he can take into account the social determinants of health and identify vulneirable children. After the detection by the school health service, the harmonious development of, the child requires that health professionals cooperate in a "preventive network".

[The specific problem of addiction in teenagers]. / La problématique spécifique des addictions chez les adolescents.

In his/her normal development, the teenager is naturally at risk for addiction. He/she finds therein what he/she believes to be a solution to his/her internal tensions, but risks finding himself/herself trapped by the poison of dependence. He/she rarely recognizes his/her difficulties and tends to consider his/her consumption trivial: this may render care particularly troublesome. The best treatment doubtless consists of prevention and pedagogy.

[Is my child normal, doctor? The specifics of child psychiatric examination]. / Mon enfant est-il normal, docteur? Les spécificités de l'examen pédopsychiatrique.

The psychiatric assessment of a child requires to integrate the symptoms presented, for example, the child's suffering, in an array of complex family interactions The consultation process is difficult for parents and child, but also for the physician. Many pitfalls exist for everyone, namely the stigma attached to a disease, the search for normality at any price, the seduction of a reductive explanatory theory, and especially the oversight of the child's evolutionary potential. Finally, the characteristics of examination vary at each age; the differences may be major and depend on the development of the child in the process of empowerment.

[Suicidal behavior in childhood]. / Le comportement suicidaire chez l'enfant.

The suicidal behaviour in the child is a complex problem, less rare than suggested by epidemiological data which only concern the completed suicide. Implicitly, this subject raises the question of the idea a child has of death. Some risk factors and clinical signs are mentioned in the literature but they remain insufficiently studied. It is based on their knowledge and detection however that a preventive action can be taken, but only on an individual basis.

[Adolescents who sexually abuse children]. / Les adolescents qui abusent sexuellement des enfants.

The adolescents responsible for sexual abuses on children confront the medico-psycho-social workers with many questions. In this article, thanks to a bibliographical approach, we first discuss the definitions concerning sexual abuses and paedophilia as well as family, psychodynamic and legal specificities of adolescents. We then mention a few epidemiological facts as well as the different behavioural cognitive, psychodynamic and family hypotheses related to that problem. We finally illustrate all this through two clinical cases encountered during our ambulatory exercise and submit some thinking to readers.

[Anaclitism, the abandonment syndrome and essential depression]. / Anaclitisme, syndrome d'abandon et dépression essentielle.

Following the recall of certain basic notions such as anaclitic depression, "abandonic syndrome" and "essential depression", the authors concentrate their interest on the clinical case of an adolescent girl both asthmatic and "abandonic"; the deprivation syndrome is discussed as a consequence of abandonment when the substitutive figure is deficient; the relationship between psychosomatic disorder and perturbations of the mother-child relationship is examined. A certain correlation between anaclitic depression in the infant and "essential depression" in adult life is suggested in the light of a re-enactment of the initial psychosomatic unit.

[The myth of gratuitousness and psychosocial reality]. / Mythe de la gratuité et réalité psychosociale.

The gratuitousness is a positive social measure, particularly specific of the psychosocial patients, but applied in a dissatisfying context because the financial aspect is the only considered and because the other therapeutic exigences, implicitly in such a measure contained, are in that way eluded.