[A mentalization-based perspective on childhood autism treatment]. / Perspective de prise en charge d'enfants atteints de troubles du spectre autistique par psychothérapie inspirée des thérapies basées sur la mentalisation.

Mentalization is a process by which a subject makes sense of both his own mental representations and of those around him. Disturbances in the mentalization process are found in several psychiatric disorders, notably borderline personality disorders for which mentalization-based treatments (MBT) have been developed and evaluated. Children with Autism Spectrum Disorder (ASD) display a theory of mind impairments, which corresponds to disturbances in the mentalization process. Although no MBT protocol for patients with ASD has been described in the literature, such treatment appears promising to improve theory of mind and functional outcome of these children. In this paper, we propose to discuss the theoretical ground of MBT therapeutic effect in children with ASD without intellectual disabilities and to describe a clinical protocol to test this perspective.

Polymorphisms in candidate genes for type 2 diabetes mellitus in a Mexican population with metabolic syndrome findings.

The metabolic or insulin resistance syndrome, characterized by hypertension, dyslipidemia, glucose intolerance and hyperinsulinemia, may have genetic determinants. The insulin gene (INS), insulin receptor gene (INSR) and insulin receptor substrate 1 gene (IRS1) have been proposed as candidate genes. We examined eight polymorphisms in these genes in 163 individuals from Yucatan, Mexico; this population has a high prevalence of obesity, type 2 diabetes mellitus and dyslipidemia. Subjects were evaluated for body mass index (BMI) and blood pressure. Blood samples were collected to determine glucose, insulin, triglycerides and cholesterol levels, as well as for DNA isolation. Restriction fragment length polymorphisms in INS, INSR and IRS1 were identified by polymerase chain reaction and digestion with selected restriction enzymes. Among the eight polymorphisms analyzed, the PstI polymorphism in INS was significantly associated with hypertriglyceridemia and with the presence of at least one abnormality related to the metabolic syndrome (P=0.007 and 0.004, respectively). The MaeIII polymorphism in INS was associated with fasting hyperinsulinemia (P=0.045). In multilocus analyses including both INS polymorphisms, significant associations were seen with hypertriglyceridemia (P=0.006), hypercholesterolemia (P=0.031) and with presence of at least one metabolic abnormality (P=0.009). None of the polymorphisms in INSR or IRS1 was associated with any of these traits. These findings suggest that the insulin gene may be an important determinant of metabolic syndrome, and particularly of dyslipidemia, in this population.

L-acetylcarnitine in depressed elderly subjects. A cross-over study vs placebo.

An open, cross-over study was performed on a population of 24 geriatric patients hospitalized because of depressive syndrome. They were subdivided, according to Hamilton's Scale as modified for the aged, into low- and high-score subgroups. The study period covered 2 months. Half the patients received acetylcarnitine for 1 month and placebo thereafter (Group A); the other half received placebo and acetyl-carnitine thereafter (Group B). Statistical evaluation was twofold: parametrical analysis of variance was carried out on 4 subgroups (A1, A2, B1 and B2) and analysis of the score percentage modifications before and after treatment was performed on Groups A and B. The experimental results showed that acetylcarnitine treatment was highly effective and statistically significant in subgroups A1/B1, A2/B2, A1, B1 and B2. In particular, it should be noted that depressive tendencies were significantly modified in most groups, whereas general somatic symptoms as well as anxiety, asthenia and sleep disturbances proved to be little affected. Clinical evaluation, carried out by calculation of modifications in pre- and post-treatment score percentages, provided clear evidence that acetylcarnitine was particularly effective in patients showing more serious clinical symptoms. The drug caused no side-effects at the doses and regimens used.

The psychodynamics of achondroplasia.

From the psychological-social point of view, achondroplasia is a complex disorder; in fact, one must take into consideration aspects of the body image, family-surroundings reaction and possible corrective therapy. The achondroplast has a physical image that coincides with his personality and from this standpoint it does not appear to be problematic in the sense that (if accepted right from the start as such) there is a natural acceptance of the disorder, complicated only by the practical difficulties in adapting to a world created for non-achondroplasts. The medieval court jester, who was generally a well-adapted achondroplast, is proof of what we have been saying. The problem of the achondroplast arises when his surroundings, right from the start, reject his disorder, connoting it with destructive anxiety: this seriously harms the subject's physical image, making him an outcast. Even though it is difficult to direct the reaction of the family-surroundings, it is the only way to prevent the achondroplast from suffering greatly and to guarantee the best results from a corrective operation, instead of a renewed rejection.

Behavioral versus pharmacological treatments for essential hypertension: a pilot study.

This is the only study so far in which a behavioral treatment is compared with standard pharmacological treatments for essential hypertension. Three groups of five subjects each were compared: 1. pharmacological treatment; 2. relaxation treatment (autogenic training); 3. the combination. The group given antihypertensive medication was significantly more improved (as determined by blood pressure decrease) by the fourth quarter of the treatment as compared with the relaxation treatment or with the combination. This advantage for routine amounts of antihypertensive medications vs. behavioral treatments is consistent with the only other data from a similar comparison that is available [1].