[The adolescent abstainers: A risk group?] / Les adolescents abstinents : un groupe à risque ?

OBJECTIVE: If abstinence from substance in adolescents may nowadays be regarded statistically as a deviant behavior, what is its significance from a developmental point of view? The aim of this article is to examine the mental health characteristics and the social integration of adolescent abstainers. METHODS: A comprehensive literature review of epidemiological studies including data on adolescent abstainers was conducted. RESULTS: Compared to the abundant literature devoted to adolescent substance abusers, few studies report data on adolescent abstainers. In addition, many methodological problems limit their interpretability and their comparison. However that may be, this body of work suggests that if abstinence may be due to something intrinsic about the individual (such as psychosocial adjustment difficulties, personality traits or gender), many other environmental factors (such as family background of temperance, cultural practices, upbringing or religion) may determine abstaining behavior. By this way, from a psychopathological angle, adolescent abstainers certainly constitute a more heterogeneous group than the adolescent substance abusers. Some of them are quite psychologically healthy, whereas others are more socially withdrawn and may suffer from emotional disorders. CONCLUSION: In terms of prevention, these data highlight the need for longitudinal prospective studies examining the psychosocial status of adolescent abstainers, their antecedents, their outcome and their motivations.

[Pharmacological treatment of bipolar disorder in children and adolescents]. / Traitement pharmacologique du trouble bipolaire chez l'enfant et l'adolescent.

OBJECTIVE: To review the options for acute and maintenance pharmacological treatment of bipolar disorder in children and adolescents. METHODS: A comprehensive literature review of randomized clinical trials and open-label studies was conducted. RESULTS: Published data from randomized controlled trials show that antipsychotics are significantly more effective than mood stabilizers in the treatment of manic or mixed episodes. Few data are available related to the treatment of depressive episodes. No trials of selective serotonin reuptake inhibitors have been conducted. Only open trials suggest that lithium and lamotrigine may be effective, whereas quetiapine did not demonstrate efficacy relative to placebo in two studies. Studies regarding the effectiveness of antipsychotics and mood stabilizers for the comorbid disorders are also few and inconclusive. Although long-term treatment is a core aspect of the management of children and adolescents with bipolar disorder, there is a lack of consistent efficacy data. If non-controlled trials suggest that lithium, lamotrigine, quetiapine, ziprazidone, and the combination of risperidone and divalproex or lithium may be useful in some conditions, only aripiprazole has shown efficacy relative to placebo for long-term symptom reduction and relapse prevention. Safety data show that the most frequently reported adverse events in children and adolescents treated with mood stabilizers are gastrointestinal and neurological, whereas use of antipsychotics is mainly related to weight gain and sedation. Lastly, while results from studies having evaluated the impact of pharmacological treatment on neuropsychological functioning are inconsistent, some of them nevertheless suggest that treatment with mood stabilizers may be associated with specific impairments. CONCLUSION: Despite recent developments in identifying effective pharmacological interventions, numerous critical gaps remain.

[Psychotherapic interventions for bipolar disorder in children and adolescents]. / Interventions psychothérapiques dans le trouble bipolaire chez l'enfant et l'adolescent.

OBJECTIVE: To review the options for psychosocial interventions in pediatric bipolar disorders. METHODS: A comprehensive literature review of randomized clinical trials and open-label studies was conducted. RESULTS: Randomized controlled trials show that psychosocial interventions involving families (i.e. family-focused treatment) or individual and family therapy (i.e. multi- or individual-family psychoeducational psychotherapy, child- and family-focused cognitive-behavioral therapy, dialectical behavior therapy) may be effective through added benefit to pharmacotherapy. All these interventions share numerous common therapeutic elements such as psychoeducation and skills training. Individual interventions (i.e. interpersonal and social rhythm therapy and cognitive-behavioral therapy) are to date less well documented. However that may be, outcome studies remain few, and numerous methodological limitations (small sample sizes, designs not very rigorous) restrict the interpretability and generalisability of their results. In addition, most studies were conducted in specialty centers with highly trained therapists, and the feasibility and acceptability of these interventions in practice settings remain to be shown. CONCLUSION: Despite recent developments in identifying effective psychosocial interventions, numerous critical gaps remain, and more longitudinal studies are needed to clarify how these interventions work.

[Adolescence and schizophrenia]. / Adolescence et schizophrénie.

Whilst early onset schizophrenias are rare all studies show a clear increase in the incidence and prevalence of the disorder from the age of 15 onwards. The clinical picture in adolescence is similar to that described in adults although the diagnosis of schizophrenia at this age is still difficult, as the disorder shares many common symptoms with the affective psychoses (particularly with bipolar disorder). Some clinical features, the premorbid history and past family history can help with the differential diagnosis in this situation. Studies on the fate of schizophrenic adolescents show that the disorder has particularly harmful consequences on the individuals' development and psychosocial adaptation. The risk of suicide or accidental death are highlighted. This may be partly explained by the progressive deterioration of cognitive function seen, with the progression and the prevalence of co-morbid disorders (conduct disorders, substance abuse). Paradoxically there are few objective data available as yet about the efficacy of the different treatment strategies offered ; medical and psychotherapeutic, behavioural or psychosocial. Whilst early intervention programmes for adolescents at high risk of schizophrenia have been introduced, their utility and efficacy remain to be shown.

[Theory of mind in Asperger syndrome]. / Syndrome d'Asperger et théorie de l'esprit.

INTRODUCTION: Theory of mind deficit can be used to explain social and communication impairments that define the autism spectrum disorder. Theory of mind is the ability to attribute mental states to self and others in order to understand and predict behavior. It involves the distinction between the real world and mental representations of the world. Several studies established that high functioning autistic individuals and individuals with Asperger syndrome (ASP) tend to be as proficient as controls in understanding first order false belief tasks. In contrast, they still lag behind their typical peers in understanding second order false belief tasks or more advanced tasks of theory of mind (e.g., Baron-Cohen, 1993). Most of these studies focus on the adult population and it seems particularly interesting to investigate whether children with ASP would present the same pattern of strengths and deficits as adults. In our research, children with ASP were tested in an advanced task of theory of mind based on a visual presentation of comic strips and in a more traditional assessment of false belief understanding: the Smarties test. METHOD: Two experimental groups participated in this study: a group of 16 high functioning children and adolescents with autism or with Asperger syndrome (ASP) and a group of 16 typically developing children matched on gender and age (CONT). The task was designed to assess the ability of children with ASP to infer the mental state of others. Stimuli were 26 different comic strips depicting a short story. Each comic strip was composed of three pictures and was shown on the upper half of the screen. Then three pictures numbered 1 to 3 showing possible outcomes of the scenario were superimposed on the bottom half of the screen. Only one of these three pictures represented a plausible conclusion to the scenario. This experiment contained two conditions: A Character intention (CI) condition and a Physical causality (PC) condition. The comic strips in the CI condition involved one character whose intentions had to be inferred by the subject in order to choose the correct picture. Comic strips in PC condition only required to understand physical causalities. Subjects were asked to watch the comic strip attentively and then they were required to make a choice between the three story endings by pressing the corresponding keyboard button. Both answers and response times were recorded. Additionally, all participants were enrolled in the classical false belief (Smarties) task. RESULTS: Comic strips: An ANOVA [2 groups (CONT/ASP) x 2 conditions (CI/PC)] was performed on the number of correct responses. Neither the Group nor the Condition factor was significant (p>0.05). In contrast, the interaction Group x Condition reached significance level [F(1-30)=4.3, p<0.05)]. Further analysis revealed that performance of the ASP group was significantly higher in the CP (M=10.8, SD=2.5) than in the CI (M=9.8, SD=2) condition [t (1-14)=2.9, p<0.001)], whereas there was no condition difference in the control group (p>0.05). False belief: all ASP participants succeeded in the task. DISCUSSION: Our data clearly demonstrated that children and adolescents with Asperger syndrome or high functioning autism exhibited an impairment in understanding the intention of others. In the comic strip task, children with ASP have more difficulties in the character's intention condition than in the physical causality condition. This impairment is not imputable to a deficit in taking into account the context (Weack Central Coherence theory) since they performed as well as controls in the physical causality condition which also required the processing of the whole scene. In contrast, all children with ASP succeeded at the false belief task. These contradictory findings suggest that, although testing theory of mind, the two tasks do not tap similar mechanisms. It is possible that the use of verbal material in the false belief task improved performance of the ASP children who are known to present particular strengths in this domain. Another possible explanation that needs further testing would be that the level of complexity differs between the two tasks.

[Alcohol use in children: An unrecognized fact]. / La consommation d'alcool chez les enfants : une réalité méconnue.

Although drinking problems are now well documented in adolescents and young people, few data are available on alcohol use in children younger than 12. In France, studies have shown that 60-70% of 11-year-olds reported having tasted alcohol drinks, 4-7% having experienced drunkenness at least once, and that 5-8% might be regarded as "regular" alcohol users. By comparison, the prevalence of child drinking in the United States seems to be lower. All studies show that parental alcohol-specific attitudes and parental educational practices have a strong influence on the initiation of alcohol use in children. Some of them also indicate that early-onset drinking in children may be related to psychosocial functioning in other life areas, such as problem behaviors, low school engagement, and poor relationships with parents, in association with temperamental and environmental risk factors similar to those described in substance use disorders. Since epidemiological studies showed that early initiation of alcohol use is linked to later alcohol-related problems, these data call for further attention to children's perceptions and attitudes with respect to alcohol in research to prevent alcohol misuse.

[Alcohol use in young adolescents. A survey in French secondary schools]. / Consommation d'alcool chez les jeunes adolescents : enquête en milieu scolaire.

Among young adolescents, early use of alcohol has been shown to be related to later alcohol use disorders and alcohol-related problems in numerous epidemiologic studies. However, if drinking problems are now well documented in young people, few data are available on alcohol use in children and young adolescents. The purpose of this study was to examine the perceptions and attitudes with respect to alcohol use among young adolescents entering their first year of secondary school (mean age, 11.5 years). Data were collected from the ESPACE program, a preventive program conducted in the educational district of Limoges, France. Of the 2268 respondents with complete data, 73.4% (77.1% in males vs. 69.9% in females; P<0.001) reported having tasted alcohol drinks and 3.7% (4.9% in males vs. 2.6% in females; P=0.004) having experienced drunkenness at least once. Of these adolescents, 5.4% (8.5% in males vs. 2.4% in females, P<0.001) reported consuming alcohol at least once per month, which may be considered as a sort of regular drinking pattern. Taking age, sex, and level of alcohol consumption into account, experience of drunkenness (21.9% in regular users vs. 3.7% in occasional users), tobacco use (25.8% in regular users vs. 12.6% in occasional users and 1.5% in nonusers) and cannabis use (6.0% in regular users vs. 0.9% in occasional users and 0.2% in nonusers) were found to be significantly more frequent in regular alcohol users than in other students (P<0.001). Data analysis also showed that regular alcohol users felt significantly more frequently depressed, lacking self-assurance, dissatisfied with their physical appearance and their way of life, and they felt that they exhibited significantly more impairments in their interactions with parents, peers, and the school environment. Similarly, they were found to have significantly more frequently an inclination for risk behaviors and a significantly more positive view of drinking than other students. These results look almost like those reported in adolescents and young people, and show that the alcohol abuse pattern is drawn early in childhood. They also highlight the value of epidemiologic investigations for planning preventive interventions.

Estrogen modulation of angiotensin-stimulated phosphoinositide hydrolysis in slices of rat anterior pituitary.

In this study, slices of rat anterior pituitary were prelabeled with [(3)H]myo-inositol and the ability of angiotensins II and III to stimulate [(3)H]phosphoinositide hydrolysis was characterized. When using tissue derived from ovariectomized rats, dose-response experiments revealed that angiotensin II significantly increases [(3)H]inositol monophosphate formation (in the presence of 10 mM LiCI) at concentrations of 10 nM and above. Maximal stimulation by angiotensin II was observed at 1 ?M (228% of basal) and 50% maximal stimulation was at 10.8 +/- 2.7 nM. Angiotensin III was less potent when compared to angiotensin II (maximal stimulation at 10 ?M; 220% of basal: 50% maximal stimulation, 475 +/- 159 nM). When using normal female rats, significant stimulation by angiotensin II was not observed until 1 ?M angiotensin II. When ovariectomized rats were treated for 7 days with 17?-estradiol, increases in [(3)H]inositol monophosphate induced by 1 ?M angiotensin II were significantly reduced when compared to sesame oil vehicle controls. This study shows that estrogen down-regulates angiotensin receptor coupling in the anterior pituitary. Moreover, it illustrates the influence of the hormonal state of the animal on the regulation of the effects of angiotensins in this tissue.

Endothelium-dependent modulation of angiotensin II-induced contraction in blood vessels.

The influence of endothelium on angiotensin II-induced contraction was investigated in rings of rat aorta, bovine coronary artery, bovine intrapulmonary artery and bovine intrapulmonary vein. Destruction of endothelium significantly enhanced angiotensin II-induced contraction in rat aorta and bovine coronary artery, but not in bovine intrapulmonary artery and bovine intrapulmonary vein. Indomethacin (10(-5) M) did not alter angiotensin II-induced contraction in rat aorta or bovine coronary artery. However, hemoglobin (10(-5) M) or methylene blue (10(-5) M) significantly enhanced angiotensin II-induced contraction in rat aorta and bovine coronary artery with, but not without, endothelium. Intimal rubbing did not affect stimulation of phosphoinositide hydrolysis by angiotensin II in rat aorta. The findings demonstrate that angiotensin II-induced contraction in vascular rings can be modulated by endothelium. However, the effect of endothelium apparently depends upon the species and vascular bed from which the vessel is isolated. Results obtained using inhibitors suggest that in rat aorta and bovine coronary artery release of endothelium-derived relaxant factor (EDRF), rather than cyclooxygenase products, is involved in mediating the inhibitory influence of endothelium. Further, similar stimulation of phosphoinositide hydrolysis in intimally rubbed and unrubbed rat aorta suggests that EDRF does not modulate angiotensin II-induced contraction in this vessel by inhibiting angiotensin II stimulation of phosphoinositide hydrolysis.

Major depression in panic disorder: role of recent life events.

The authors assessed life events during the year before the onset of panic disorder in 57 panic patients with a lifetime history of major depression. Compared with a group of 43 panic patients without major depression, the group with depression had experienced more severe events. The clinical and theoretical implications of these results are discussed in the context of current concepts regarding the role of recent life events in comorbidity of panic disorder and major depression.

Effects of beta-blocking drugs in alcohol withdrawal: a double-blind comparative study with propranolol and diazepam.

Alcohol withdrawal is associated with a decrease in gamma-aminobutyric acid neurotransmission. This explains the efficacy of benzodiazepines. However, an increase in adrenergic activity may also play a part in alcohol withdrawal symptoms, suggesting a potential efficacy of beta-blocking drugs. A double-blind comparative study of propranolol and diazepam was carried out in 28 patients suffering from moderate uncomplicated alcohol withdrawal. Patients were treated for 15 days with either 75 mg of propranolol or 30 mg of diazepam. The results show that both drugs at the dosages used are equipotent in reducing physical withdrawal symptoms and anxiety symptoms. This suggests that most likely the central as well as the peripheral effects determine the clinical usefulness of propranolol in the management of alcohol withdrawal. However, propranolol is ineffective in preventing major motor seizures, suggesting that different neurobiological mechanisms underlie the alcohol withdrawal symptoms.

Prevalence of hepatitis B virus, delta agent and human immunodeficiency virus infections in drug addicts.

Infections with the hepatitis B (HBV) and delta (HDV) viruses and with the human immunodeficiency virus (HIV) are very common among intravenous drug addicts. The serum of 80 percent of drug addicts contains one of the HBV markers, and 15 percent of them carry an anti-D antibody. Infections with the hepatitis A and non A-non B viruses are also very common among drug abusers. Some of them may harbour several of these pathogens. This can explain the frequency of liver disease (biological anomalies and histological lesions) observed in drug addicts, as does alcohol consumption associated with drug abuse. Fifty to 60 per cent of intravenous drug addicts are seropositive for HIV. This prevalence varies across studies and countries. The high prevalence of infection by HIV in drug addicts may be explained by the use of a shared syringe. This prevalence exposes drug addicts to an increase in AIDS cases in the near future. The high prevalence of infections by HBV, HDV and HIV in drug addicts represents a risk factor for the spread of HBV, HDV and HIV infections among the general population. Preventing the rapid spread of these viruses among drug addicts is of utmost importance for the future.

Platelet serotonin levels in alcoholic patients: changes related to physiological and pathological factors.

This study investigated platelet serotonin (5-hydroxytryptamine; 5-HT) levels and the effects of different physiological and pathological factors in 108 alcoholic patients (alcohol abuse, n = 49; alcohol dependence, n = 59) and 32 healthy control subjects. Platelet 5-HT levels were determined by a fluorescent-ortho-phthalaldehyde assay. In patients, platelet 5-HT levels during withdrawal from alcohol and after 2 weeks of abstinence were significantly lower than in control subjects. Among patients, this decrease was enhanced both in alcohol-dependent patients and in patients who were depressed during the withdrawal phase, whereas lifetime impulse control disorders (mostly found in alcohol abusers) were associated with comparatively high platelet 5-HT levels (i.e., close to control subjects' values). These results, which reflect the likely biphasic effect of alcohol ingestion upon 5-HT functioning, are consistent with the dimensional 5-HT hypothesis in psychiatric disorders.

Epidemiologic study of sleep quality and troubles in French secondary school adolescents.

BACKGROUND: The purpose of the study was to assess the prevalence and correlates of sleep problems in adolescents. METHODS: A total of 763 students chosen at random among the 15 secondary schools of a French département were given a self-report questionnaire. RESULTS: As much as 40.8% reported at least one of the five sleep disturbances we studied including difficulties falling asleep and staying asleep, a need for more sleep, early awakenings, and chronic sleeping pill intake. These sleep problems were highly related to various personal and family disorders. Discriminant analysis for categorical data pointed to a consistent but not significant descriptive profile accounting for sleep problems in these students. Suicide, weight concerns, and stimulant abuse were the most informative personal correlates as parts of this profile. CONCLUSION: These findings suggest that the complaint of poor sleep should be regarded with special care in adolescents as a possibly meaningful and sensitive sign of severe family or personal disruption.

Refractory cardiogenic shock and complete heart block after unsuspected verapamil-SR and atenolol overdose.

A 57-year-old female presented with complete heart block and then developed refractory hypotension despite temporary pacing. Moderate left ventricular dysfunction with focal wall motion abnormalities, as well as severe hypoxemia, were demonstrated. However, neither significant coronary disease nor evidence for pulmonary embolus or other lung disease could be determined. Hemodynamic stabilization was achieved with the use of an intra-aortic balloon pump and multiple high-dose pressor agents. A retrospective diagnosis of toxic verapamil-SR and atenolol ingestion was confirmed, and the patient gradually recovered. The relevant literature is reviewed and various treatment approaches are discussed.

Sex differences in the manifestations of depression in young people. A study of French high school students part I: Prevalence and clinical data.

The first part of this study investigates the prevalence and clinical manifestations of major depressive episodes in young people. The sample for this investigation consisted of 744 high school students (439 males and 305 females), aged 14 to 23 years, and attending 15 high schools in the North of France. Assessment of major depressive episodes according to DSM-III-R criteria was performed by medical doctors using a semi-structured interview and by means of the French version of the Center for Epidemiologic Studies-Depression Scale (CES-D). Thirty-two students (18 males and 14 females) were found to have a major depressive episode with a prevalence of 4.1% in males and 4.7% in females. However, the results also showed that the significant manifestations of major depression differed according to sex and suggested that manifestations of major depression in female young people might differ from those observed in adults more markedly than in males. This may explain that the diagnostic performance of the CES-D was found to be higher in males than in females and that the female prevalence of major depression was found to be lower than those usually obtained with adolescent-specific diagnostic criteria.

Sex differences in the manifestations of depression in young people. A study of French high school students. Part II: Correlates and background factors.

The second part of this study investigates the correlates and background factors of major depression in young people. The study sample consisted of 744 high school students, (439 males and 305 females), aged 14 to 23 years, and attending 15 high schools in the North of France. Among them, 32 (18 males and 14 females) had a major depressive episode according to DSM-III-R criteria. Data were collected by means of a questionnaire devised for the study in order to investigate sociodemographic, behavioral, medical and environmental factors associated with depression. Antisocial behavior, more frequently found in males, was the only factor significantly differentiating male from female depressed students. On the other hand, school difficulties, health problems, impairments in interpersonal relationships and family history disorders were most often found significantly associated with major depression in males but not in females. According to these findings, the authors examine the concept of "masked depression" and advance some hypotheses about the reasons why major depression in young people is so often underdiagnosed.

[Prevalence of hepatitis C, B and D markers and histopathological aspects in a group of intravenous drug addicts]. / Prévalence des marqueurs des hépatites C, B et D et aspects histopathologiques dans un groupe de toxicomanes intraveineux.

OBJECTIVES: The aim of this study was to assess the prevalence of infection by HCV, HBV, HDV and HIV and their biological and histopathological patterns in 104 intravenous drug users. METHODS AND RESULTS: Seventy-five patients (72%) had anti-HCV antibodies. Transmission was rapid because 33% of those who had been drug users for 6 months or less had anti-HCV antibodies. The contamination rate was very high because 90% of those who had been drug users for 2 years or less had anti-HCV antibodies. Thirty-four (33%) had an HBV marker, and 6 were HBs Ag carriers. None of the patients had anti-HDV antibodies. Only one patient had anti-HIV antibodies. Twenty-five anti-HCV antibody positive drug users underwent liver biopsy. Seven (28%) had normal ALAT levels and 18 (72%) had permanently or intermittently elevated ALAT levels. The mean histological activity on the Knodell index was 4.1 (range: 1-8). CONCLUSIONS: This study indicates that contamination by HCV is almost inevitable after 2 years of intravenous drug use. The low prevalence of HBV, HDV, and HIV infection might be explained by a low endemic state of these viruses in our area.

[Diagnostic criteria in bulimia: reassessment and proposals based on a series of 539 cases]. / Critères diagnostiques de la boulimie: réévaluation et propositions à partir d'une population de 539 cas.

Bulimia nervosa is a recently identified psychiatric disorder. Several clinical definitions have been successively proposed, some of which contradictory. In a multicenter study (INSERM clinical research network), 539 consecutive outpatients with bulimic behaviors were evaluated in 18 treatment centers and classified according to several diagnostic reference systems. We tested the validity of diagnostic criteria proposed by the American Psychiatric Association for DSM-IV classification. Our data support inclusion of both purging and nonpurging subtypes for the diagnosis of bulimia nervosa. The newly defined syndrome "Binge Eating Disorder" should be retained, but its diagnostic criteria modified.

An "accidental" acute psychosis with ecstasy use.

Over the last 10 years, Europe has witnessed the development of the ecstasy phenomenon; this term is used to describe several products sharing more or less the same effects. The most widely used and hence the most well known is 3,4 MDMA, but MDA, MDEA, MBDB and even 2CB or nexus are available. The psychopathological consequences of MDMA use in man are relatively poorly understood. The case reported here involves an acute psychotic episode with residual symptoms after six months, with a sudden onset at least 12 hours after taking alcohol and ecstasy without realising it, in an individual with no previous psychopathology other than a moderate anxiety disorder. Twelve cases of acute psychotic episodes after taking ecstasy have been reported in the literature; two after taking the drug on two occasions and one after a single use. No authors have examined the previous mental state or possible previous psychopathology with any precision. The present subject had not displayed any previous psychotic behavior when tested with a proven standardized interview technique; this was confirmed by his peers and his family. He did, however, show signs of social phobia. Although the personality of an individual is a factor in taking a drug, and probably in the quality of the psychotropic effects experienced, a host of arguments favor the appearance of psychotic symptoms de novo, which were probably related to direct toxicity by MDMA and/or its metabolites on the serotoninergic neurons.