[Telepsychiatry at the service of autism].

Introduction: The authors report on the set-up of a telehealth system developed to facilitate exchanges between the Autism Resource Centre of Brittany (centre de ressources pour l'autisme [CRA]) located in Brest and an adult psychiatry structure of Vannes' Hospital in the Morbihan region, these sites are about 200 kilometres distant.

Objectives: This coordinated work using computer networks aims at sustaining the action of a unit specialised in autistic patients. The goal is to both render a precise diagnostic (teleexpertise) and favour assistance and support to residents and their families while instituting a medical education tool for the health professionals of this unit.

Acute and chronic anxiogenic-like response to fluoxetine in rats in the elevated plus-maze: modulation by stressful handling.

While antidepressants are widely prescribed to humans for the treatment of anxiety, the results achieved with animal anxiety models are conflicting. The experimental procedure and the prior test history of the animals are critical parameters that are largely susceptible to influence the results and their interpretation. We compared the effect of 5mg fluoxetine administered to six groups of rats subjected to the psychopharmacological test of the elevated plus-maze, under experimental conditions designed to demonstrate the effect of handling and one daily injection on the response to fluoxetine.

[Bipolar disorders in children and adolescents].

While difficult, early detection of bipolar disorders in children and adolescents is crucial. Depending on age, diagnosis may be more or less difficult. Family history and the environment must also be taken into account.

[French translation and validation of the Scale to assess Unawareness of Mental Disorder (SUMD) in patients with schizophrenics].

Background: The Scale to assess Unawareness of Mental Disorder (SUMD) is a semi-structured interview based on a dimensional and quantitative approach of insight. Different forms of insight are assessed: global insight into mental illness, insight into symptoms and insight into symptom aetiology (i.e.

[Adherence to treatment in chronic skin disorders].

Numerous studies report poor therapeutic adherence in chronic disorders, including chronic skin disorders. This article reviews compliance issues in a psychological perspective (mainly through the patient-physician relationship). Potential factors that could influence adherence to treatment related to the disease itself, the treatment, the patient, the physician and the patient-physician relationship are discussed.

[Early diagnosis in schizophrenia: a mission for the general practitioners?].

Schizophrenia represents a relatively frequent disease within the population with a prevalence of 1 %. Despite a consistent therapeutic equipment at doctors' disposal, the evolution of this disease remains globally rather unfavourable. For a long time, the classic concept from Magnan "bouffée délirante aiguë" was considered as the main mode of entrance of the schizophrenia.

[Sleep and depression in elderly people].

Mood disorders and sleep disturbances are closely related. In elderly people, the prevalence of insomnia and depressive symptoms is increased. Moreover, somatic co-morbidities associated with aging are known to be risk factors for both insomnia and depression.

[Issues related to consent to healthcare decisions in children and adolescents].

The process of consent to healthcare decisions in children and adolescents often set physicians difficult problems. From what age is a child able to understand the information given to him or her about illness and treatment? Is an ill child indeed in the capacity to give his or her voluntary consent to treatment? How to define and to assess the capacity of an ill child to take part in treatment decisions? More than the age of the child, it is his or her level of cognitive, emotional and social development and its interactions with illness that will determine his or her degree of involvement in the decision-making process. There is a moral and ethical need to respect the rights and autonomy of every individual, regardless of age.

[Kleine-Levin syndrome: a case report].

The purpose of this article is to report an original clinical case whose symptoms suggest a very peculiar pathology, because of its rarity, symptomatic expression and unclear etiopathogenesis: the Kleine-Levin Syndrome (KLS). During the regression of tonsillitis concomitant with an emotional shock, the 15-year-old patient exhibited a dramatic change in behaviour, at odds with his previous state, and accompanied by hypersomnia and confusion, megaphagia, irritability, hypersexuality and mood disorders. We observed a spontaneous and total regression of the symptoms after 12 days, except for the incomplete amnesia that proved to be persistent.

[Evolution and description of a complete hospitalisation unity in child and teenager psychiatry].

The university department of child and adolescent psychiatry of Brest Hospital (a medium size town of 200,000 inhabitants) has at disposal a 14 in-patient emergency care unit, where young people under 16, mostly in crisis (individual and/or family and/or institutional crisis) are admitted. This unit opens 24h a day throughout the year, and patients with any type of pathology are admitted for a short stay, mainly with no demand for care. After a description of this unit with its modalities of functioning, the authors will report on its activity assessed from sets of data pertinent to the last 8 years.

[Persons suffering from schizophrenia and relapses].

Introduction: In schizophrenia, relapse is a common event that affects more than half the patients within 2 years after a first episode. It is a real setback for them and their relatives. Surprisingly, we do not have much information on how patients and their relatives experience the relapse.

[Pathomimesis and Münchhausen syndrome].

Factitious disorders, as pathomimesis and Münchhausen syndrome, have to be diagnosed early to avoid numerous exams and inadequate treatments, which intensify symptoms. Lesions are self-inflicted in a fully conscious manner. The patient does not search for direct benefits, hides his/her responsibility in the induction of lesions.

The role of coagulation marker fibrin D-dimer in early diagnosis of catatonia.

Catatonia is a common but under-diagnosed neuropsychiatric syndrome characterized by the occurrence in a single patient of concomitant affective, motor and behavioral symptoms with a hazardous outcome (called lethal catatonia: LC). Deaths by thromboembolic disease have been previously reported in LC. A 2-year prospective study was carried out to examine D-dimer levels, an early and sensitive coagulation marker, in patients with catatonic disorders.

[How to differentiate schizophrenia from bipolar disorder using cognitive assessment?].

Background: Historical aspects of the dichotomy between manic-depressive disorders and schizophrenia raise the question of a continuum between the two entities. Griesinger (1817-1868) proposed a unitary concept of psychosis: "Einheitspsychose", adaptations of which have survived until the present day. Although Kraepelin's traditional dichotomy is still a common base for clinicians every day: diagnosis, prognosis and treatment of psychotic disorders, recent epidemiological and neurobiological data are congruent with a dimensional aspect of psychosis.

[Insight in schizophrenia: assessment of 31 patients with different scales].

Introduction: Insight is more than frequently altered in schizophrenia, rupture of treatment being one the most known consequences of this impairment. Two different types of scales can be used to assess consciousness: self-questionnaires directly filled-in by the patient or questionnaires assessed by a psychiatrist after an interview. AIM OF THE STUDIES: The goal of this study was first to assess insight in schizophrenic patients with these two different types of scales and then try to find a link between insight impairment and schizophrenic symptoms.

[Psychiatric assessment].

Psychiatric disorders and behavioral disturbances may complicate the postsurgical outcome in patients and de novo psychiatric symptoms have been reported. In numerous, but not all epilepsy surgical centers, a psychiatric assessment is included as part of the presurgical evaluation of potential candidates for surgery. Affective disorders and psychosis are the most frequently reported postsurgical psychiatric disorders.

Benefits and risks of using antidepressants in children and adolescents.

The present controversy about the use of selective serotonin re-uptake inhibitors in paediatric patients has been the subject of many publications. This article summarises the available data on the efficacy and safety of selective serotonin re-uptake inhibitors and other non-tricyclic antidepressants in children and adolescents with mental disorders. These data are compared with those related to the efficacy and safety of tricyclic antidepressants.

[Clinical impact of aripiprazole in patients suffering from schizophrenia].

Introduction: In this study, we present seven case reports concerning patients suffering from schizophrenia or schizo-affective disorders, treated by aripiprazole.

Study Design: Through these patient case reports, we have attempted to highlight the specificities of aripiprazole's action on schizophrenic symptoms, especially in the cognitive dimension. In acting as a regulator more than as a brake on the translation messages between neurons, aripiprazole does not increase cognitive disorders, but may have a procognitive affect.

[Treatment of obsessive-compulsive disorder].

Treatment of obsessive compulsive disorder has not changed a lot since 2000. Following a cautious assessment of the patient, using adequate scales, OCD patients require a step by step hierarchical treatment. A syndrome of low intensity (Yale-Brown Obsessive Compulsive Score [Y-BOCS] around 15) will be mainly treated by behavioural and cognitive therapy (BCT) especially exposition with prevention of response technique; for a more severe disorder, a drug treatment is required.

[From a categorical diagnostic approach to a dimensional approach for mental disorders: interest of sex differences].

A strong prevalence of females or males is often found in mental disorders. Based on examples of anorexia (90% females) and autistic disorder (80 to 90% males), arguments that allow a better understanding of these different sex ratios are presented. The role of certain sociocultural factors in the onset of anorexia is developed.