[Cognitive-behavioral management of sleep disorders in young children]. / Prise en charge cognitivo-comportementale des troubles du sommeil du jeune enfant.

Sleep disorders are prevalent in young children, the most frequent being disturbances in initiating and maintaining sleep. Behavioral and cognitive approaches are interesting techniques for their management. They can be used either for solving sleep problems at home, or in severe forms as part of a 'deconditioning' during a short hospitalization.

[Interest of propranolol in the treatment of school refusal anxiety: about three clinical observations]. / Intérêt du propranolol dans la prise en charge du refus anxieux de l'école: à propos de trois observations.

School refusal anxiety is a pathopsychological disorder which touches the young child, between 8 and 13 years. Even if the school refusal is studied for a long time, there is not still consensus as for the specific definition of this disorder or on the best way of treating it. Nevertheless, accountable of long-lasting difficulties in school integration, its short and medium term consequences are serious and well known: school desertion, mood disorder and behavioral problems. Speed and quality of the medico-psychological and educational interventions represent a important factor for evolution and prognosis. Although, psychological interventions remain essential, sometimes the interest of an associated psychotropic medication should be discussed. This one can indeed either improve their results or supporting their installations. Despite more than twenty controlled trials in the pediatric population, no definitive psychopharmacological treatment data exist for anxiety disorder in childhood and especially for school refusal disorder. The majority of the studies stress as well the interest of benzodiazepines as tricyclic antidepressants but without being able to specify the possible superiority of a chemical on the other. On the other hand, the side effects of each one are well-documented, in particular for the benzodiazepines (potential abuse, sedation, potential desinhibition, mnemonic disorder), limiting thus their uses in child. In this work, we would like to emphasize the interest of propranolol in the treatment of somatic symptoms usually met in school refusal anxiety. Although beta-blockers have been used in the treatment of neurovegetative symptoms associated with situational anxiety disorders, there is no controlled data and only some open data to guide pediatric use for anxiety disorders in children. Nevertheless, prescribed with low posology and in substitution of benzodiazepine, this medication enabled us in three severe clinical cases to shorter notably the time of school rehabilitation. Well tolerated on the clinical level, with a greater efficiency on the somatic signs related to anxiety than benzodiazepines and with not having their side effects, this therapeutic can constitute a significant support in the psychological treatment of these children. However, these present results require to be confirm by other observations, which will be lead perhaps to a controlled study.

[Decisional procedure in school-age children with hyperkinetic syndrome]. / Procédure décisionnelle devant un tableau d'instabilité psychomotrice chez l'enfant d'âge scolaire.

Hyperkinetic syndrome may be either secondary to an organic disease or a psycho-effective disorder (mood and/or anxiety disorder), or primary as part of an attention deficit hyperactivity disorder. Precise diagnosis is essential before any therapeutic decision; this requires a complete anamnestic, behavioural, psychological, sensorial, and neurological evaluation. It is only when a reliable diagnosis has been made that a relevant therapeutic project can be proposed. An evaluation procedure and a decisional tree are presented.

[School refusal anxiety]. / Le refus anxieux de l'école.

School refusal mainly affects 11-13-year-old children but may be observed at any age from 5 to 15 years. It has two main clinical varieties: 1) school phobia in which the refusal attitude is directed toward school itself or an aspect of school environment; 2) separation anxiety in which the refusal of going to school is related to the separation with attached relatives, frequently the mother. Early recognition and intervention are determining factors for the prognosis. Hospital management and/or medication (imipramine) may be necessary in severe forms.

[Depression in children. Etiological, clinical and therapeutical aspects]. / La dépression de l'enfant. Aspects étiologiques, cliniques et thérapeutiques.

Although the concept of child depression is today well admitted, the diagnosis of childhood depression remains difficult due to the variety of its symptoms, many of them being non specific, and the frequency of masked depression. For each period of child development, ie: infancy, early childhood, late childhood and adolescence, depression has particular clinical characteristics which are important to be known for its early recognition. Depression in a child frequently appears to result from the conjunction of a constitutional predisposing ground, one or several losses, and an inappropriate parental response. One must be concerned about the major risk of deleterious effects on psychoaffective, intellectual and somatic development of neglected depression, so that its prevention, early recognition, and treatment are mandatory. According to the cases, treatment requires individual or familial psychotherapy and chemiotherapy, and in particular cases care in a medico-educative establishment.

[Psychotropic drugs in child and adolescent psychiatry]. / Les psychotropes en psychiatrie de l'enfant et de l'adolescent.

Although there has been concern about the use of psychoactive drugs in children, evidence is accumulating that these drugs are beneficial. The various groups of currently available drugs are reviewed with their pharmacological characteristics, adverse effects, dosages, and uses in children. Benzodiazepines, both widely used and severely criticized, are effective when used correctly, in particular for the shortest possible length of time. Antidepressants are indicated in many conditions including depression, obsessive-compulsive disorders, and anxiety; some of their indications are specific to children, such as separation anxiety, enuresis, and school phobia. Neuroleptics have a less well defined role and are usually given as symptomatic treatment, although their use is limited by their side effects. This is also true of lithium, despite fairly good tolerability in children. Carbamazepine was introduced in psychiatry too recently to allow valid evaluation. Psychostimulants are viewed with fear in France despite their documented efficacy in hyperkinetic children. A few other drugs used in other fields of medicine are currently being investigated in psychiatry (beta-blockers, clonidine, naloxone). A debate on drugs used in child psychiatry is much needed in particular to overcome the methodological and ethical problems raised by controlled trials of which few have been conducted to date. Drug therapy should be combined with psychotherapy to place the target symptoms in perspective with regard to the child's overall make-up.

[Platelet serotonin concentration in children under 5 years of age]. / Etude de la concentration en sérotonine plaquettaire chez les enfants de moins de 5 ans.

High platelet serotonin concentrations have been reported in children with early infantile autism. However, as yet there are no reference values regarding platelet serotonin in normal infants and young children so that it remains difficult to define the exact significance of this finding. We report here with the platelet serotonin concentration found in 57 infants and children (20 girls, 37 boys) ranging in age from 10 days to 5 years old. Our results show that mean platelet serotonin concentrations in infants and young children are significantly greater than mean values obtained in older children (+11%) and neonates in the umbilical cord (+64%). No significant variations were found relating to sex, leucocyte count and platelet count. There therefore appears to be a physiological elevation of platelet serotonin concentration in infants and young children, and this has to be taken into consideration in the interpretation of the elevated values found in cases of infantile autism.

[Post-puberty anorexia nervosa]. / L'anorexie mentale postpubertaire.

Post-puberty anorexia nervosa requires a thorough clinical study to facilitate its diagnosis and its early treatment. Longitudinal studies have demonstrated that good results usually depend on the speed of medical intervention (preferably with admission to hospital) and to the duration of treatment. The fact that certain cases result in death is too often due to excessive intensive care. Infusions must be avoided at all costs and should be replaced by forcible feeding if absolutely necessary. Finally, a better approach to, and a better understanding of adolescents should contribute to the prevention of anorexia nervosa.

[Nocturnus terrors--somnambulism]. / Les terreurs nocturnes--le somnambulisme.

Among disorders of sleep in children, pavor nocturnus ("night terrors") is common and considered harmless. Yet the clinical picture, the child's personality and the polygraphic electroencephalographic recordings suggest that it should be treated sooner and more often than is usually done. Somnambulism ("sleep walking") also is very frequent. It has no consequences in most cases, but it may be the cause of serious events such as falling out of a window which is rare but may result in death or disablement. Some children have repeated attack of somnambulism, and these constitute a true pathology of sleep requiring a specific treatment that will cure or improve. All this must be known to the practitioner who will inform the parents.

[Sleep disorders in infants and children]. / Les troubles du sommeil du nourrisson et de l'enfant.

Sleep disorders are common in childhood, and almost always benign. Simple explanations and parental reassurance are generally sufficient for the alleviation or tolerance of the disorder. However, severe forms exist for which a therapeutic support is necessary and often very efficient.

[Evaluation of the treatment with fenfluramine of autism in children]. / Evaluation du traitement par la fenfluramine dans l'autisme infantile.

The effects of fenfluramine were studied in a group of 44 children with the autistic syndrome and in 26 non autistic children with behavior abnormalities, mostly hyperkinetic children, as a control group. The mean daily dosage was 0.65 mg/kg/day. There were 75% positive results in the autistic children and 77% in the control group. The clinical improvement appears to be mainly related to the control of the hyperactive behavior in the autistic children. Platelet serotonin levels were studied in both groups, showing a clear cut decrease during fenfluramine therapy with no significant differences between the 2 groups and no correlation between the clinical effects and the magnitude of the decrease.

[Platelet serotonin concentrations in autistic children and members of their families]. / Etude de la concentration en sérotonine plaquettaire chez des enfants autistes et parmi les membres de leurs familles.

Children with early infantile autism have often high platelet serotonin (5 HT) levels. According to this fact, we wondered if a genetic abnormality of 5 HT metabolism could be detected in family members of autistic children. We has thus determined platelet 5 HT levels in these children's mothers, fathers and siblings. It is noteworthy to find out that: autistic children have a mean platelet 5 HT level significantly higher than their siblings' (p less than 0.01); fathers' levels are significantly lower (-29%; p less than 0.001) than those of other family members' and of control group. Furthermore, for future purposes, we studied platelet 5 HT levels at different times during pregnancy in controls and in a woman already mother of an autistic child. We observed a raise (+31%; p less than 0.01) in platelet 5 HT during the first trimester of the pregnancy with a lowering towards normal levels during the eight month, in the woman with an autistic child as well as in the controls.

[Daily profiles of melatonin, cortisol and gonadotropins in 8 adolescents with anorexia nervosa]. / Profils journaliers de la mélatonine, du cortisol et des gonadotrophines chez 8 adolescentes porteuses d'une anorexie mentale.

From a biological study of 8 patients with anorexia nervosa and an analysis of the daily profiles of gonadotropins, cortisol and melatonin, the authors discuss the possible relationship between anorexia nervosa and affective disorders. At the initial phase of the illness, plasmatic levels of FSH, LH and oestradiol were very low. 24-hour plasma cortisol values were comparable with those of a depressive population; when weight loss was equal to or higher than 25% of the initial weight, there was no suppression by dexamethasone. The daily profile of melatonin was maintained, with melatonin plasma levels significatively higher than in a control group of depressed patients.

[Behavior problems in phenylketonuria. Attempt at a biochemical interpretation based on a personal case and a review of the literature]. / Les troubles du comportement au cours de la phénylcétonurie. Essai d'interprétation biochimique à partir d'une observation personnelle et d'une revue de la littérature.

We have presented the case of a 7 year old retarded child with psychotic like behavioral troubles. Biological studies are compatible with typical phenylketonuria. Two times, a low phenylalanine diet was followed by an improvement of the behavioral troubles, and the interruption of the diet by a relapse of these troubles. Biologically, an hyposerotoninergy was recorded by the lowering of the 5 HIAA renewal in CSF after probenecid, partially corrected by the low phenylalanine diet. From this personal case and a review of the literature, the authors discuss the biochemical interpretation of the behavioral troubles in the light of the serotoninergic deficit.