[Suicidal behavior prevention for children under age 13: A systematic review]. / Prévention des conduites suicidaires de l'enfant de moins de 13ans : une revue de la littérature.

OBJECTIVE: Our objective was to review international literature on suicidal behavior prevention for children under age 13. METHODS: We gathered all relevant articles on suicide prevention for children under 13. We researched all publications in the French and English languages in PubMed (MEDLINE), PsychINFO and SUDOC databases published until February 2014, with the keywords "child", "child preschool", "prevention and control", "suicide", and "suicide attempted". Publications were included if they described suicidal behavior prevention programs (suicide prevention programs, attempted-suicide prevention programs, suicidal ideation screening programs), and if the studies concerned children under age 13. We also included references cited in the articles if they were not already present in our searches but met inclusion criteria. Studies were excluded if they analyzed populations of children and adolescents without sub-analysis for children under age 13. RESULTS: A total of 350 potentially relevant articles were identified, 33 of which met the inclusion criteria, including 4 retrieved from articles' bibliography. Preventive measures against suicidal behavior for children under 13 exist and include: social programs, maltreatment prevention, curriculum-based suicide prevention programs, suicide screening in schools, gatekeepers, reduction of access of lethal means of suicide, suicide screening by primary care, and post-suicide intervention programs. Overall, the evidence was limited by methodological concerns, particularly a lack of RCTs. However, positive effects were found: school-based suicide prevention programs and gatekeepers increased knowledge about suicide and how to seek help, post-suicide programs helped to reduce psychological distress in the short term. One study showed a decreased risk of attempted-suicide after entry into the child welfare system. CONCLUSION: There are promising interventions but there is not enough scientific evidence to support any efficient preventive measure against suicidal behavior for children under 13, whether primary, secondary, tertiary or post-intervention. More research is needed.

Defective relationship between subjective experience and behavior in schizophrenia.

OBJECTIVE: The relationship between subjective experience and behavior abnormalities in schizophrenia was investigated. METHOD: Eighteen patients with schizophrenia and 18 normal comparison subjects completed a general knowledge task with two incentive conditions to measure monitoring effectiveness, control sensitivity, and response criterion setting. RESULTS: The patients' levels of monitoring effectiveness and control sensitivity were lower than those of the comparison subjects. The effect of incentives on response criterion values was similar in the two groups. CONCLUSIONS: Patients were impaired in subjectively assessing the correctness of their knowledge, and their behavior was less determined by subjective experience than that of normal subjects. The patients' intact sensitivity to incentives has implications for cognitive remediation.

Evaluation of the supervisory system in elderly subjects with and without disinhibition.

UNLABELLED: Disinhibition and irritability, defined as loss of behavioral and emotional control, are frequent in the elderly. The working hypothesis for this study was that these disorders are associated with a cognitive alteration of control processes that manifests as non-routine behavior because of the dysfunction of a general executive component known as the supervisory attentional system (SAS). METHODS: A total of 28 elderly subjects with mild cognitive impairment were recruited and divided into two groups using the Neuropsychiatric Inventory. Fourteen subjects were allocated to the disinhibited group and 14 subjects matched for age, sex and educational level formed a disinhibition-free control group. The neuropsychological battery included the following tests: Mini Mental Score Evaluation, Boston Naming test, Token test, Trail Making and Verbal Fluency. Two tasks were specifically designed to stress the SAS: 1) A specific verbal sentence arrangement task in which subjects had to use sequential reasoning with verbal material. Each test sequence consisted of a series of words shown in jumbled order. The construction of some sequences had to be done by using familiar routine associations (valid conditions). In contrast, other sequences required the overriding selection of familiar routine associations, which were inappropriate within the general context of the task (invalid conditions). 2) Using the Continuous Performance Test, four aspects were evaluated: sustained, selective, preparation and suppressive attention. RESULTS: The only group differences in neuropsychological test results were the following: 1) the sentence arrangement task. In comparison with the control group, the disinhibited group was impaired in invalid conditions and the calculated difference between the number of correct responses in invalid conditions minus that in valid conditions was significantly higher; and 2) the CPT. Disinhibited subjects had a significantly lower number of hits, exclusively in the 'suppressive attention' paradigm. These results suggest that subjects with disinhibition have impaired supervisory system function.

[Cholinergic hypothesis and Alzheimer's disease: the place of donepezil (Aricept)]. / Hypothèse cholinergique et maladie d'Alzheimer: place du donepezil (Aricept).

This presentation has two objectives: 1) presenting the relationships between the clinical symptoms of Alzheimer's disease and cholinergic deficiency, 2) presenting the results obtained with Aricept (proprietary name of donepezil hydrochloride), one of the most recent drugs developed in the context of the cholinergic hypothesis. One of the earliest pathological events in Alzheimer's disease consists in the degeneration of cholinergic neurons in the subcortical regions and, more particularly, in Meynert's nucleus basalis which projects, in a topographically organized manner, to the cortical regions and hippocampus. Some of those regions less affected by the degenerative process nonetheless retain active post-junctional receptors. The disappearance of cholinergic neurons from the nucleus basalis induces disactivation of the cortical and limbic cells and is responsible for the clinical symptoms, such as attention, memory and behavioral disorders. The marketing authorization application for Aricept is based on various studies designed to enable preliminary dose determination and assess efficacy and safety. The first large-scale study designed to evaluate the efficacy of Aricept administered at a daily dosage of 5 to 10 mg was conducted over 14 weeks. The results show a significant improvement in cognitive function in the treatment groups, compared to the placebo groups. The difference emerged after 3 weeks of treatment, lasted throughout the 12 weeks of the study and was still very marked 3 weeks post-treatment discontinuation. The results of a second study conducted over 30 weeks were similar to the foregoing results. Compared to placebo, Aricept at a daily dosage of 5 to 10 mg induces a significant improvement in cognitive function and overall function. At week 24, the patients still showed performances that were superior to their baseline performances. In parallel with its cognitive effects, Aricept was also shown to improve the activities of everyday life and alleviate the distress of caregivers directly confronted with the behavioral disorders of patients suffering from Alzheimer's disease.