[Pedophilia: contribution of neurology and neuroimaging techniques]. / Corrélats cérébraux de la pédophilie: apports de la neurologie et de la neuro-imagerie.

INTRODUCTION: Pedophilia is characterized by a persistent sexual interest of an adult for prepubescent children. The development of neuroimaging techniques such as functional Magnetic Resonance Imaging (fMRI) is starting to clarify the cerebral basis of disorders of sexual behavior such as pedophilia, which had been previously suggested by case studies. OBJECTIVE: To review structural and functional neuroimaging studies of pedophilia. METHOD: An exhaustive consultation of PubMed and Ovid databases was conducted. We obtained 19 articles presented in the present review of the literature. RESULTS: Case studies have demonstrated various changes of sexual behavior in relation to brain lesions, including the late appearance in adults of a sexual attraction to prepubescent children. In most cases of pedophilia associated with brain lesions, these lesions were located in frontal or in temporal regions. Structural neuroimaging studies have compared pedophiles with healthy subjects and tried to relate pedophilia to anatomical differences between these two groups. The location of structural changes is inconsistent across studies. Recent functional neuroimaging studies have also attempted to investigate the cerebral correlates of pedophilia. Results suggest that the activation pattern found in pedophiles in response to pictures of prepubescent nude girls or boys is similar to the pattern observed in healthy subjects in response to pictures of adult nude women or men. However, regions that become more activated in patients than in healthy controls in response to the presentation of pictures of children vary across studies. CONCLUSION: Studies that have begun to investigate the cerebral correlates of pedophilia demonstrate that it is possible to explore them through neuroimaging techniques. These initial results have to be confirmed by new studies backed with objective measurements of sexual arousal such as phallometry.

Evaluating major depressive episodes through the algorithmically structured systematic exploration of subject's state of mind.

BACKGROUND/AIMS: Whereas instruments are available to diagnose depression and to rate its severity, there is a lack of instruments to assess the phenomenology of depression, i.e. a set of mental phenomena that constitute subjective experience. The Algorithmically Structured Systematic Exploration of Subject's State of Mind (Assess_Mind) is based on open questions asked via a structured algorithm. Here, we evaluated its reliability and its validity to assess the phenomenology of major depressive episodes. METHODS: Scales were constructed to evaluate various aspects of major depressive episodes, and an Assess_Mind score was derived from these scales. Thirty-five patients presenting a major depressive episode were assessed with the Hamilton Depression Rating Scale, Clinical Global Impressions (CGI) scale, Beck Depression Inventory and Symptom Checklist-90R. Two series of assessments were conducted, separated by 3 weeks. RESULTS: Interrater reliability was good to excellent and test-retest reliability was acceptable. Whereas construct validity was poor at the first time point (first day of the patient's inclusion), it was adequate for the second day and 3 weeks later. The change in the Assess_Mind score predicted the change in the CGI rating as well as the other instruments did. These results should be confirmed in larger samples. CONCLUSION: The Assess_Mind provided a useful assessment of the phenomenology of depression and of the course of major depressive episodes.

Activation of mirror-neuron system by erotic video clips predicts degree of induced erection: an fMRI study.

Although visually-induced erection is a common occurrence in human male behaviour, the cerebral underpinnings of this response are not well-known. We hypothesized that the magnitude of induced erection would be linearly correlated with the activation of the mirror-neuron system in response to sexually explicit films. When presented with sexual video clips, eight out of ten healthy subjects had an erectile response demonstrated through volumetric penile plethysmography. The level of activation of the left frontal operculum and of the inferior parietal lobules, areas which contain mirror neurons, predicted the magnitude of the erectile response. These results suggest that the response of the mirror-neuron system may not only code for the motor correlates of observed actions, but also for autonomic correlates of these actions.

Neuroanatomical correlates of penile erection evoked by photographic stimuli in human males.

The objective of this study was to identify the cerebral correlates of the early phase, and of low to moderate levels, of penile tumescence using for the first time a volumetric measure of the penile response. We hypothesized that (i) regions whose response had been found correlated with circumferential penile responses in previous studies would be identified with volumetric plethysmography and (ii) that other brain regions, including the amygdalae, would be found using the more sensitive volumetric measurement. In ten healthy males, functional magnetic resonance imaging (fMRI) was used to study brain responses to sexually stimulating photographs and to various categories of control photographs. Both ratings of perceived erection and penile plethysmography demonstrated an erectile response to the presentation of sexually stimulating photographs. Regions where the BOLD signal was correlated with penile volumetric responses included the right medial prefrontal cortex, the right and left orbitofrontal cortices, the insulae, the paracentral lobules, the right ventral lateral thalamic nucleus, the right anterior cingulate cortex and regions involved in motor imagery and motor preparation (supplementary motor areas, left ventral premotor area). This study suggests that the development of low levels of penile tumescence in response to static sexual stimuli is controlled by a network of frontal, parietal, insular and cingulate cortical areas and that penile tumescence reciprocally induces activation in somatosensory regions of the brain.

Brain processing of visual sexual stimuli in human males.

Despite its critical sociobiological importance, the brain processing of visual sexual stimuli has not been characterized precisely in human beings. We used Positron Emission Tomography (PET) to investigate responses of regional cerebral blood flow (rCBF) in nine healthy males presented with visual sexual stimuli of graded intensity. Statistical Parametric Mapping was used to locate brain regions whose activation was associated with the presentation of the sexual stimuli and was correlated with markers of sexual arousal. The claustrum, a region whose function had been unclear, displayed one of the highest activations. Additionally, activations were recorded in paralimbic areas (anterior cingulate gyrus, orbito-frontal cortex), in the striatum (head of caudate nucleus, putamen), and in the posterior hypothalamus. By contrast, decreased rCBF was observed in several temporal areas. Based on these results, we propose a model of the brain processes mediating the cognitive, emotional, motivational, and autonomic components of human male sexual arousal.

Neuroanatomical correlates of visually evoked sexual arousal in human males.

Brain areas activated in human male sexual behavior have not been characterized precisely. For the first time, positron emission tomography (PET) was used to identify the brain areas activated in healthy males experiencing visually evoked sexual arousal. Eight male subjects underwent six measurements of regional brain activity following the administration of [15O]H2O as they viewed three categories of film clips: sexually explicit clips, emotionally neutral control clips, and humorous control clips inducing positive but nonsexual emotions. Statistical Parametric Mapping was used to identify brain regions demonstrating an increased activity associated with the sexual response to the visual stimulus. Visually evoked sexual arousal was characterized by a threefold pattern of activation: the bilateral activation of the inferior temporal cortex, a visual association area; the activation of the right insula and right inferior frontal cortex, which are two paralimbic areas relating highly processed sensory information with motivational states; and the activation of the left anterior cingulate cortex, another paralimbic area known to control autonomic and neuroendocrine functions. Activation of some of these areas was positively correlated with plasma testosterone levels. Although this study should be considered preliminary, it identified brain regions whose activation was correlated with visually evoked sexual arousal in males.

Sleep problems in children of affectively ill mothers.

The objective of the study was to determine whether the frequency and severity of sleep problems were greater in children of affectively ill mothers than in children of control mothers. Sleep problems were studied in children of mothers with a diagnosis of unipolar (N = 38) and bipolar (N = 23) affective illness and children of mothers with no current or past psychiatric diagnosis (N = 24). Mothers' reports on the Child Behavior Checklist (CBCL) were obtained three times, 4 years apart, on sibling pairs (ages 1.5-3.5 and 5-8 years, respectively, at first assessment). In addition, on the third assessment, the Diagnostic Interview for Children and Adolescents was filled out by mothers and children. In both siblings, sleep problems, as assessed through the CBCL, were more frequent and severe in children of affectively ill mothers. In younger siblings, the persistence of sleep problems was more frequent in children of affectively ill mothers. Co-occurrence of sleep problems among siblings was more frequent in children of affectively ill mothers than in those of control mothers.

The influence of psychological factors on the outcome of the fertilization step of in vitro fertilization.

Our objective was to determine whether psychological factors have an influence on the outcome of the fertilization step of in vitro fertilization (IVF) trials. The design was a prospective cohort study. We studied 48 women and 32 of their spouses. Each subject was assessed psychologically on the day before oocyte retrieval (OR) with the Child Project Questionnaire (CPQ) and the Ways of Coping Checklist. In addition, the State-Trait Anxiety Inventory was filled in by subjects 2 days before OR, and the State form was completed again for 6 additional days. The outcome measure was the success of the fertilization step. Logistic regression analysis was used to test the influence of psychological factors while taking into account the effect of medical and sociodemographic variables. The following variables were found to be statistically significant predictors of fertilization: normal sperm; tubal lesions or occlusion; women's factor II of the CPQ, i.e. Perception of Marital Harmony in the Project to Conceive a Child. We conclude that, even when the influence of biomedical variables is taken into account, the women's Perception of Marital Harmony in the Project to Conceive a Child, is a statistically significant predictor of the success of the fertilization step of IVF.

Psychological characteristics of infertile patients: discriminating etiological factors from reactive changes.

Our objective was to discriminate psychological factors playing an etiological role in infertility and psychological problems as consequences of infertility. The design was a prospective study of couples with initially Undetermined Fertility (UF couples) and couples with initially Known Infertility (KI couples). After a 13-month follow-up, three groups could be defined: fertile UF couples; infertile UF couples; and KI couples. Hypotheses were the following. If a psychological factor played an etiological role, measures in fertile UF couples should be different from measures in infertile UF couples and in KI couples. If a psychological measure reflected a reactive change, KI couples should differ from both groups of UF couples. Finally, if a psychological variable played both roles, the three pairwise comparisons between groups should reveal differences, with the largest difference between fertile UF couples and KI couples. The questionnaires used were the Child Project Questionnaire (CPQ), with three factor scores (different for men and women) and a Sexual Problems Score (SPS); the Dyadic Adjustment Scale; the State-Trait Anxiety Inventory; the Neonatal Perception Inventory. In women, on CPQ factor II, i.e. Frequency of Thoughts and Concerns related to the Project to Conceive a Child and on the SPS, KI women had scores significantly higher than both groups of UF women. In men, on CPQ factor II, i.e. Quality of Integration between Wish for a Child and Sexuality, men from fertile UF couples had significantly higher scores than men from both infertile groups; the two latter groups did not differ significantly. On the SPS, scores of men from infertile UF couples and scores of men from KI couples were significantly higher than scores of men from fertile UF couples; scores were similar in both groups of men from infertile couples. We conclude that in women, CPQ factor II and sexual problems reflected reactive changes to infertility and that in men CPQ factor II and sexual problems represented etiological factors.

[Psychotherapy with mothers and infants in problem families]. / Psychotherapie mit Müttern und Säuglingen in Problemfamilien.

This article reports on a project in which mothers living in conditions describable as suproletarian are given psychotherapeutic treatment alongside practical care. The special feature of this system of comprehensive care for mothers from so-called "hard-to-reach-families" is that it begins during pregnancy, is instituted via the agency of midwives and that the therapeutic sessions are designed on a long-term basis and take place in the mothers' own homes. In two detailed case reports the authors describe their methods and define the objectives pursued by this project - the stabilization of the mothers in their family life situation and the prevention, from birth, of disturbances and disabilities otherwise to be anticipated in the children themselves.

Psychological factors in the aetiology of infertility: a prospective cohort study.

The objectives were to identify and measure psychological factors characterizing the period following the cessation of contraception and to assess these psychological factors as predictors of the couples' fertility. A cohort of 63 couples with initially undetermined fertility status was prospectively studied, first shortly after the cessation of contraception, then 13 months later. The Child Project Questionnaire was constructed to assess psychological variations following the cessation of contraception. An Interspouse Difference Score was constructed to measure the difference between the spouses' responses. Three male and three female factors were derived from the questionnaire. The Interspouse Difference Score was significantly greater in infertile than in fertile couples. Two psychological factor scores were significantly higher in fertile subjects: the wives' level of positive expectations related to motherhood, and the husbands' quality of integration between the wish for a child and sexual relationships. Within the group of fertile couples, time to pregnancy was predicted by the husbands' above-cited factor and by the wives' frequency of thoughts and concerns related to the desired child. The results support the conclusion that in both women and men, psychological factors specifically related to the project of conceiving a child are significant predictors of the couple's fertility status.

LH pulsatile secretion and testosterone blood levels are influenced by sexual arousal in human males.

To determine whether changes in LH and testosterone (T) blood levels and pulse signals were induced by sexual arousal, nine healthy young males were presented on two different days with a sexually arousing (S) and a sexually neutral control (C) film. On both sessions, blood was sampled every 10 min for 12 hr. The Cluster and the Detect pulse identification algorithms were used to characterize the peaks in LH and T series. The second plasma LH peak following the beginning of the film was higher in the S than in the C condition (percent increases above preceding nadir: 322.1 +/- 183.9% vs. 202.6 +/- 108.7%). The area of the second pituitary peak of LH instantaneous secretion rate, which corresponded to the second plasma LH peak, was also greater in the S condition (6.2 +/- 3.3 vs. 3.4 +/- 2.3 UI/l). Compared with the C condition, T blood levels were increased within the first 10 min of sexual arousal (25.2 +/- 6.3 vs. 22.2 +/- 5.6 nmol/l). These results, consistent with the findings of animal studies, indicate that LH pulsatile secretion and T blood levels are influenced by changes in the state of sexual arousal in human males.

Serious complications of topical mitomycin-C after pterygium surgery.

BACKGROUND: The use of topical mitomycin (mitomycin-C) as a medical adjunct to pterygium and glaucoma surgery is increasing. METHODS: The authors report on a series of 10 patients who experienced serious, vision-threatening complications associated with the use of this drug after pterygium surgery. RESULTS: Complications included severe secondary glaucoma (4 patients), corneal edema (3 patients), corneal perforation (1 patient), corectopia (2 patients), iritis (8 patients), sudden onset mature cataract (2 patients), scleral calcification (1 patient) and incapacitating photophobia and pain (8 patients). Two patients required penetrating keratoplasties and a third required three lamellar keratoplasties. Another patient underwent four additional surgeries including a conjunctival Z-plasty, scleral patch grafting, and conjunctival autografting before his intractable pain and photophobia resolved 15 months after the original surgery. Because of these complications, 6 patients required a total of 20 return visits to the operating room after their original pterygium surgery. In 5 eyes, visual acuity remained at 20/200 or less. Three of the six patients with the most severe complications had concomitant chronic external diseases (rosacea [3 patients], ichthyosis [1 patient], keratitis sicca [1 patient]). CONCLUSION: The authors urge extreme caution in the use of mitomycin. If mitomycin is used, the lowest possible concentration should be applied for the shortest time period in an effort to avoid these complications. A prospective multicenter study of the ophthalmic use of this medication is needed.

The feasibility of an ambulatory surgery service for military personnel.

In the past, ambulatory surgery has been considered unsuitable for military personnel. In this pilot study, 69 members of the Israel Defense Forces underwent a variety of surgical procedures on an ambulatory basis in a central, university-affiliated general hospital. The waiting time for surgery was considerably reduced. The patients, the army, and the hospital staff were satisfied with the service. Although further study is needed, ambulatory surgery appears to be a suitable and advantageous modality for military personnel.

[Visual selectivity in infants. Study of visual preference for new images in normal infants]. / La sélectivité visuelle chez le nourrisson. Etude de la préférence visuelle pour les images niuvelles chez des nourrissons normaux.

The authors report and assess a method for the study of the development of visual selectivity in 9 infants aged 11 to 41 weeks. This study confirms previous results and shows that from 11 weeks, infants who are offered a choice between a new or a familiar picture look preferentially at the new one. The authors propose to apply this method to the early evaluation of cognitive development in infants.