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.

Autismo e parentalidade / Autism and parenting / El autismo y la parentalidad

As patologias autísticas são complexas e requerem uma atenção especifica para cada criança. Na organização que preside os tratamentos, a Psicoterapia Institucional tem uma grande importância devido à sua larga experiência com as psicopatologias graves como o autismo e a psicose. No projeto terapêutico da criança, a implicação e o papel dos pais são determinantes para sua orientação e indispensáveis para dar-lhe sentido. Contudo, por razões distintas, alguns pais podem desenvolver sentimentos negativos frente aos profissionais, que devem ser considerados.(AU)

Autistic disorders are complex and require a specific treatment for each child. For the organization that presides over the care, Institutional Psychotherapy movement is important because of its vast experience with severe psychopathology, such as autism and psychosis. In the treatments proposed to the child, the place of parents is crucial in terms of guidance and essential to reassign sense. However, for various reasons, some parents may develop negative feelings in the presence of professionals that should be considered.(AU)

Las patologías del autismo son complejas y se necesitan de una atención específica para cada niño. En la organización que ofrece atención, es importante el movimiento de la Psicoterapía Institucional debido a su larga experiencia con las psicopatologías graves, tales como el autismo y las psicosis. En los tratamientos propuestos al niño, el lugar de los padres resulta crucial en términos de orientación y es indispensable por reasignarles sentido. Sin embargo, por muchas razones, algunos padres pueden desarrollar, en los profesionales, sentimientos negativos que deben considerarse.(AU)

Autismo e parentalidade / Autism and parenting / El autismo y la parentalidad

As patologias autísticas são complexas e requerem uma atenção especifica para cada criança. Na organização que preside os tratamentos, a Psicoterapia Institucional tem uma grande importância devido à sua larga experiência com as psicopatologias graves como o autismo e a psicose. No projeto terapêutico da criança, a implicação e o papel dos pais são determinantes para sua orientação e indispensáveis para dar-lhe sentido. Contudo, por razões distintas, alguns pais podem desenvolver sentimentos negativos frente aos profissionais, que devem ser considerados.

Autistic disorders are complex and require a specific treatment for each child. For the organization that presides over the care, Institutional Psychotherapy movement is important because of its vast experience with severe psychopathology, such as autism and psychosis. In the treatments proposed to the child, the place of parents is crucial in terms of guidance and essential to reassign sense. However, for various reasons, some parents may develop negative feelings in the presence of professionals that should be considered.

Las patologías del autismo son complejas y se necesitan de una atención específica para cada niño. En la organización que ofrece atención, es importante el movimiento de la Psicoterapía Institucional debido a su larga experiencia con las psicopatologías graves, tales como el autismo y las psicosis. En los tratamientos propuestos al niño, el lugar de los padres resulta crucial en términos de orientación y es indispensable por reasignarles sentido. Sin embargo, por muchas razones, algunos padres pueden desarrollar, en los profesionales, sentimientos negativos que deben considerarse.

The neurodynamic organization of modality-dependent hallucinations.

The pathophysiology of hallucinations remains mysterious. This research aims to specifically explore the interaction between hallucinations and spontaneous resting-state activity. We used multimodal magnetic resonance imaging during hallucinations occurrence in 20 drug-free adolescents with a "brief psychotic disorder." They were furthermore compared with 20 matched controls at rest or during exteroceptive stimuli. Anatomical and functional symptom-mapping demonstrated reduced cortical thickness and increased blood oxygen level-dependent signal in modality-dependent association sensory cortices during auditory, visual, and multisensory hallucinations. On the contrary, primary-sensory-cortex recruitment was not systematic and was shown to be associated with increased vividness of the hallucinatory experiences. Spatiotemporal activity patterns in the default-mode network (DMN) during hallucinations and symptom-free periods in patients were compared with patterns measured in healthy individuals. A disengagement of the DMN was concomitant to hallucinations, as for exogenous stimulations in healthy participants. Specifically, spatial and temporal instabilities of the DMN correlated with the severity of hallucinations but persisted during symptom-free periods. These results suggest that hallucinatory experiences emerge from a spontaneous DMN withdrawal, providing a convincing model for hallucinations beyond the auditory modality.

Assessing fetal response to maternal speech using a noninvasive functional brain imaging technique.

Evidence for cortical sensory activation in the human fetus at the beginning of the third trimester of pregnancy was provided in a recent imaging study. Although hearing is functional before birth, it is not clear whether recognition of the mother's voice is learned in utero or rapidly following delivery. We developed an original fMRI procedure that allows for the specific exploration of fetal brain response to auditory stimuli. This procedure provides the first in vivo evidence for the development of maternal voice recognition in utero between 33 and 34 weeks of gestation. This methodology could have crucial implications in the study of fetal cognition.

Towards a dialogue between psychoanalysis and neuroscience: connections that are both possible and necessary.

The author, a child psychiatrist, calls for a dialogue between psychoanalysis and neuroscience (both from his clinical joint practices with neuropediatricians and on a theoretical level) to found a new approach to the questions of neurodevelopmental and psychopathological disorders. He briefly discusses two examples. The first example is developmental and concerns the links between the archaic grasping reflex and adhesive identification. He shows how the phenomena observed in the two fields can find a logical sequence. The second example concerns a therapeutic technique (wrapping) that is used to soothe self-injurious behaviours in children with autism. Here, again, both approaches are used to better understand the phenomenon in question. Bridges must be built to open new theoretico-clinical and therapeutic collaborations. One could imagine data integration from these two heterogeneous subdomains to form a new complex subdomain, from which productivity is guaranteed.

Pain as a confounding factor in postnatal depression screening.

BACKGROUND: Postnatal depression (PND) is one of the most serious complications following delivery in developed countries today. Thus, early screening strategies by first-line healthcare workers are of primary importance. Pain following childbirth has been proposed as a possible risk-marker for later depressive disorder. We tested this assumption and explored the possible link between pain and overestimation of PND risk in routine clinical screenings. METHODS: We assessed 320 women between the third and fifth day after delivery as well as at 8 weeks post-partum (PP). Midwives were asked to evaluate the risk of later PND upon discharge from the maternity unit; additionally, pain measurements were obtained using the Visual Analogic Scale (VAS) over the same time period. A stepwise logistic regression analysis was performed to identify the risk markers linked to a positive depressive disorder diagnosis (according to the MINI-DSM-IV) at 8 weeks PP. RESULTS AND DISCUSSION: Multivariate risk analysis showed no statistical link between physical pain shortly after childbirth and subsequent PND diagnosis at 8 weeks PP. However, VAS measurements for pain were significantly higher for women that the midwives estimated to be at risk for PND (|Z| = 2.78, p = 0.005), suggesting the routine clinical screening for PND is susceptible for false-positives. Psychiatrists should encourage midwives to have an empathetic approach, to increase the detection as well as treatment of mental and physical suffering in early postpartum. At the same time, adequate education programmes for early PND screening should be proposed to non-psychiatric staffs to demonstrate that women at risk of PND often show minimal physical symptoms.

[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.

Impact of midwives' training on postnatal depression screening in the first week post delivery: a quality improvement report.

BACKGROUND: postnatal depression (PND) is a major public health problem. The objective of this study was to improve early PND screening by midwives in a maternity unit. Professional screening techniques were evaluated and compared with reference screening techniques [Edinburgh Postnatal Depression Scale (EPDS), Mini International Neuropsychiatric Interview (MINI-DSM-IV)]. METHODS: the evaluation took place before and after the midwife training in order to determine the effectiveness of specific clinical recommendations for two successive 10-week inclusion periods (from November 2004 to September 2005). A short training course and posters were used to convey the recommendations, agreed by obstetricians, paediatricians and psychiatrists. RESULTS: a total of 463 postpartum women were included in the two phases of the study. Quantitative and qualitative PND screening by midwives improved significantly following training (Z=2.07, p=0.04; Z=2.62, p=0.008, respectively). Early detection of major depressive episodes increased by 37.7% (95% confidence interval 25.7-49.7) following training. A combination of midwives' perception of poor emotional well-being and the EPDS led to a significant improvement in early detection of PND (Q=8.00, p=0.04). DISCUSSION: targeted recommendations given to the midwives led to an improvement in the early detection of PND. Suitable programmes need to be offered to reduce the number of cases of PND. Perinatal psychiatrists should be seen to be meticulous and available for such prevention action.

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.

Fetal cortical activation to sound at 33 weeks of gestation: a functional MRI study.

Hearing already functions before birth, but little is known about the neural basis of fetal life experiences. Recent imaging studies have validated the use of functional magnetic resonance imaging (fMRI) in pregnant women at 38-weeks of gestation. The aim of the present study was to examine fetal brain activation to sound, using fMRI at the beginning of the third trimester of pregnancy. 6 pregnant women between 28- and 34-weeks of gestation were scanned using a magnetic strength of 1.5 T, with an auditory stimulus applied to their abdomen. 3 fetuses with a gestational age of 33 weeks, showed significant activation to sound in the left temporal lobe, measured using a new data-driven approach (Independent Component Analysis for fMRI time series). Only 2 of these fetuses showed left temporal activation, when the standard voxel-wise analysis method was used (p=0.007; p=0.001). Moreover, motion parameters added as predictors of the General Linear Model confirmed that motion cannot account for the signal variance in the fetal temporal cortex (p=0.01). Comparison between the statistical maps obtained from MRI scans of the fetuses with those obtained from adults, made it possible to confirm our hypothesis, that there is brain activation in the primary auditory cortex in response to sound. Measurement of the fetal hemodynamic response revealed an average fMRI signal change of +3.5%. This study shows that it is possible to use fMRI to detect early fetal brain function, but also confirms that sound processing occurs beyond the reflexive sub-cortical level, at the beginning of the third trimester of pregnancy.

Predictive validation study of the Edinburgh Postnatal Depression Scale in the first week after delivery and risk analysis for postnatal depression.

BACKGROUND: Postnatal depression is a major public health problem. The aim of this study is to validate the use of the Edinburgh Postnatal Depression Scale (EPDS) in the early postpartum, and to identify the markers for risk of postnatal depression. METHODS: 815 women filled out an EPDS and general information questionnaire between the third and the fifth day postpartum. The women with an EPDS score of >8 and a randomized control group from those with scores of <8 were contacted 8 weeks postpartum. 363 women therefore had a structured diagnostic interview by telephone at 8 weeks postpartum (MINI-DSM-IV), without knowledge of their EPDS scores, to screen for a major or minor depressive episode. RESULTS: The sensitivity of EPDS was measured as 0.82 [0.78-0.86], with a positivity threshold of 9.5/30. For an estimated prevalence for all depressive episodes of 16.1%, the positive predictive value of EPDS was measured as 42.8% [39.1-46.5%]. Multivariate risk analysis using logistical regression identified the following as risk markers for postnatal depression: previous history of depression (postnatal or other), unemployment, premature delivery or stopping breast-feeding in the first month for non-medical reasons. CONCLUSION: The use of EPDS between the third and fifth day postpartum is valid. An EPDS score of >10 should be completed by a clinical assessment and suitable management. The risk markers identified here are clinical indices that can be used for first-line early screening by non-psychiatric health workers.