Neuropsychiatrie de l''Enfance et de l''Adolescence最新文献

英文中文

Régulation émotionnelle, alexithymie et dissociation chez les adolescents hospitalisés : un modèle de médiation par équation structurelle 住院青少年的情绪调节、失眠和离解：结构方程调解模型

Q4 Medicine

Neuropsychiatrie de l''Enfance et de l''Adolescence

Pub Date : 2025-01-01 DOI: 10.1016/j.neurenf.2024.11.002

S. Chergui , P. Fourneret , P. Espi , C. Gauld

Objectives

Dissociation is a major phenomenon in child and adolescent psychiatry. It involves an involuntary disruption in the adequate integration of psychological functions, related to various neuropsychological mechanisms. This study aims to examine the relationships between dissociation, emotion regulation, and alexithymia in adolescents.

Patients and methods

. Forty-eight hospitalized adolescents (aged 12–16) were recruited from February 2022 to October 2023. They completed the Dissociative Experience Scale (DES), the Difficulties in Emotion Regulation Scale (DERS), and the Toronto Alexithymia Scale (TAS-20). A series of multiple regressions and Structural Equation Modeling (SEM) were conducted to analyze the relationships among these variables.

Results

The findings revealed a significant association between dissociation (DES) and alexithymia (TAS) (β = 1.45, P = 0.002), as well as between dissociation and difficulties in emotion regulation (DERS) (β = 0.98, P = 0.018). The SEM indicated that while the total effect of alexithymia on dissociation was significant (P < 0.001), the specific mediating effect of emotion regulation was not statistically significant (P = 0.29).

Discussion

These results highlight the importance of alexithymia in the dissociative experience of adolescents, independent of emotion regulation difficulties. The absence of a mediating effect of DERS suggests that dissociation and alexithymia may be directly related without the involvement of emotion regulation.

Conclusions

This study opens avenues for therapeutic interventions targeting alexithymia to alleviate dissociative symptoms.

目的分离是儿童和青少年精神病学的一个重要现象。它涉及与各种神经心理机制有关的心理功能的充分整合的不自主中断。本研究旨在探讨青少年解离、情绪调节与述情障碍之间的关系。患者和方法。从2022年2月至2023年10月招募了48名住院青少年（12-16岁）。他们分别完成了解离体验量表（DES）、情绪调节困难量表（DERS）和多伦多述情障碍量表（TAS-20）。通过一系列多元回归和结构方程模型（SEM）分析了这些变量之间的关系。结果分离与述情障碍（TAS）（β = 1.45, P = 0.002）、情绪调节困难（DERS）（β = 0.98, P = 0.018）存在显著相关性。扫描电镜显示，虽然述情障碍对解离的总体影响显著(P <；0.001)，情绪调节的特定中介作用无统计学意义（P = 0.29）。这些结果强调述情障碍在青少年分离体验中的重要性，独立于情绪调节困难。无DERS的中介作用提示解离和述情障碍可能在没有情绪调节参与的情况下直接相关。结论本研究为缓解述情障碍解离症状的治疗干预开辟了途径。

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引用次数: 0

Quand des manifestations psychiatriques dévoilent l’épilepsie temporale chez l’enfant 当精神病学表现揭示儿童暂时性癫痫

Q4 Medicine

Neuropsychiatrie de l''Enfance et de l''Adolescence

Pub Date : 2024-12-18 DOI: 10.1016/j.neurenf.2024.11.007

A. Ben Hamouda , M.C. Gharbi , S. Bourgou , M. Daoud , K. Bouzghaïa Bagbag , M. Hamza , F. Charfi , A. Belhadj

Aim

This paper attempts to illustrate the semiology of temporal epilepsy in patients initially considered to be suffering from psychiatric disorders.

Methods

We report five clinical vignettes of patients referred to the Child and Adolescent Psychiatry Department of Mongi Slim Hospital (Tunisia) between 2017 and 2021 for psychiatric disorders, in whom the diagnosis of temporal epilepsy was retained.

Results

Four boys and one girl, aged three to eleven, were referred for paroxysmal neuropsychiatric features. Family history of epilepsy was noted in three patients. Two children had psychomotor and language delay. Symptomatology was dominated by cognitive and behavioral disorders. Electroencephalogram confirmed the diagnosis of temporal epilepsy by showing local paroxysmal abnormalities. Brain imaging had shown predominantly temporal abnormalities in two cases. The evolution, under antiepileptic treatment, was favorable in four patients.

Conclusion

The reported clinical vignettes underline the importance of discussing temporal lobe epilepsy when faced with paroxysmal and/or atypical psychiatric manifestations in children.

目的探讨初步认为患有精神疾病的颞叶癫痫的符号学特征。方法：我们报告了2017年至2021年在突尼斯Mongi Slim医院儿童和青少年精神科转诊的5例精神障碍患者的临床资料，其中颞叶癫痫的诊断保留。结果4名男孩和1名女孩，年龄3至11岁，因阵发性神经精神特征被转诊。3例患者有癫痫家族史。两名儿童有精神运动和语言迟缓。症状以认知和行为障碍为主。脑电图显示局部阵发性异常，证实了颞叶癫痫的诊断。脑成像显示两例主要是颞叶异常。在抗癫痫治疗下，4例患者的进化是有利的。结论报告的临床小片段强调了在面对儿童发作性和/或非典型精神表现时讨论颞叶癫痫的重要性。

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引用次数: 0

Les parents au cœur des interventions dans le TSA en France : focus sur la thérapie d’échange et de développement 家长在法国TSA干预的中心：关注交流与发展疗法

Q4 Medicine

Neuropsychiatrie de l''Enfance et de l''Adolescence

Pub Date : 2024-11-20 DOI: 10.1016/j.neurenf.2024.11.003

R. Blanc , A. Rambault , P. Dansart , H. Zoppé , F. Bonnet-Brilhault , J. Malvy

Concepts of care for children with ASD have evolved significantly over the past two decades. These evolutions have been possible thanks not only to an earlier identification of the developmental particularities of children, but also by the development of earlier intervention programs and a better consideration of family needs. This present work aims to present the evolution of these care practices for children with ASD and their families in France, illustrating it with the example of exchange and development therapy and EDT through parent involvement.

在过去的二十年里，照顾自闭症儿童的概念发生了显著的变化。这些进步之所以成为可能，不仅要归功于早期对儿童发展特点的识别，还要归功于早期干预计划的制定和对家庭需求的更好考虑。本研究旨在介绍法国自闭症儿童及其家庭护理实践的演变，并以家长参与的交流与发展疗法和EDT为例进行说明。

引用次数: 0

Agenda 议程

Q4 Medicine

Neuropsychiatrie de l''Enfance et de l''Adolescence

Pub Date : 2024-11-16 DOI: 10.1016/j.neurenf.2024.11.001

引用次数: 0

Une symptomatologie autistique ? À la croisée de trois lectures diagnostiques 自闭症症状？三种诊断读法的交叉点

Q4 Medicine

Neuropsychiatrie de l''Enfance et de l''Adolescence

Pub Date : 2024-11-01 DOI: 10.1016/j.neurenf.2024.07.008

Valentine d’Aspremont Lynden , Cécile Vander Vorst , Anne Wintgens

We herein present the case of a child treated in our outpatient clinic, by a resident physician in child psychiatry. His symptoms of autism were seemingly evident at first glance. However, his medical history, psychosocial background and neurodevelopment led us to question this diagnosis with nuance and caution. In this situation, we observed the intertwining of neurological, developmental and psychological factors, all of which seem to have played a role in the evolution of symptoms presented by the patient. We felt it was essential to allow space for each of these three potential diagnostic readings. Our investment in this situation was particularly marked by the obstacles we encountered in setting up appropriate treatment. These difficulties arose as a result of network overload, administrative difficulties encountered by the parents, cultural and language barriers, as well as familial limitations and resistance to assistance. Despite this, the psychological mobilisation of the parents seemed to play an important role in this child's evolution. Finally, this case led us to consider the importance of prevention, particularly in perinatal care. Identification by a team of child psychiatrists in the immediate postpartum period would probably have prevented, at least in part, this child's deterioration and limited the family's suffering.

我们在此介绍一名儿童精神科住院医生在门诊治疗的一名儿童的病例。他的自闭症症状乍一看似乎很明显。然而，他的病史、社会心理背景和神经发育情况让我们对这一诊断产生了微妙而谨慎的质疑。在这种情况下，我们观察到神经、发育和心理因素交织在一起，所有这些因素似乎都在患者症状的演变过程中发挥了作用。我们认为，必须为这三种潜在的诊断解读留出空间。我们在这种情况下的投入，尤其体现在我们在建立适当治疗时遇到的障碍上。这些困难是由于网络负荷过重、家长在行政管理方面遇到困难、文化和语言障碍以及家庭限制和对援助的抵制造成的。尽管如此，父母的心理动员似乎在这名儿童的成长过程中发挥了重要作用。最后，这个病例让我们想到了预防的重要性，尤其是在围产期护理方面。如果能在产后第一时间由儿童精神科医生团队对该患儿进行识别，很可能至少能部分防止其病情恶化，并减轻该家庭的痛苦。

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引用次数: 0

Quels soins pédopsychiatriques proposer aux enfants de parents présentant une pathologie psychiatrique ? Réflexions à partir d’une situation clinique 应该为父母患有精神疾病的子女提供哪些儿童精神科护理？基于临床情况的思考

Q4 Medicine

Neuropsychiatrie de l''Enfance et de l''Adolescence

Pub Date : 2024-11-01 DOI: 10.1016/j.neurenf.2024.04.004

This paper initiates a theoretical-clinical reflection on the specificity of child psychiatric support for children of psychotic parents or those suffering from severe personality disorders, at the time of the psychotherapeutic follow-up of a five-year-old child presenting psychomotor agitation. Over and above the multiple biopsychosocial risk factors, these complex situations require child psychiatrists to clarify their support and public health role in order to guarantee coherent care and expertise. Indeed, the various players involved (child welfare, justice, education, adult psychiatry, neuropediatric, etc.) may ignore one another or take on a role that exceeds their field of competence : the result is sometimes a certain confusion of roles, or even confusing measures and contradictory positions. When a child's symptomatology and that of his or her family preclude the use of classic, standardized interviews, it seems to us that narrative work is best carried out as close as possible to the subject's spontaneous enunciation (spoken or acted). We can then attempt to identify the operative stages of care and postulate that it is only when the child names his own impulsivity (his “crazy” part) that he will be able to recognize it in his parent. This opens the possibility of a certain representation of parental psychopathology and of putting it into narrative form. First postulated as a subject, this child is invited to name his psychomotor excitement, then that of his parent: “volcano”. The loss of a concrete object, a “blue pebble”, between two sessions, opens the space for representation and graphic expression. This object of reality becomes an object of mediation between him and his therapist and is presented as the support for a signifier, “blue”: in this way, a process of encryption and symbolization begins, an attempt to put the world in order. The signifier “blue” (which cools and extinguishes fire) is articulated with the signifier “red” (which burns and excites) in complex constructions, but not without effect on the patient's body and symptoms. These clinical elements could be passed on to the various partners and could support their care, educational, rehabilitative and expert missions.

在对一名出现精神运动性躁动的五岁儿童进行心理治疗随访时，本文从理论和临床角度出发，探讨了为父母患有精神病或严重人格障碍的儿童提供儿童精神科支持的特殊性。除了多种生物心理社会风险因素之外，这些复杂的情况还要求儿童精神科医生明确其支持和公共卫生角色，以确保协调一致的护理和专业知识。事实上，不同的参与方（儿童福利、司法、教育、成人精神病学、神经儿科等）可能会相互忽视，或承担超出其职权范围的角色：结果有时会造成角色混乱，甚至措施混乱和立场矛盾。当儿童及其家庭的症状不允许使用传统的标准化访谈时，在我们看来，叙事工作的最佳方式是尽可能接近受试者的自发表述（口语或表演）。这样，我们就可以尝试确定照顾的操作阶段，并推测只有当孩子说出自己的冲动（他的 "疯狂 "部分）时，他才能从父母身上认识到这一点。这就为父母的精神病态提供了某种表征的可能性，并将其转化为叙事形式。首先，孩子被假定为一个主体，他被邀请说出自己的精神运动兴奋点，然后说出父母的兴奋点："火山"。在两节课之间失去了一个具体的物体--"蓝色鹅卵石"，这为再现和图形表达开辟了空间。这个现实中的物体成为他和治疗师之间的调解对象，并作为 "蓝色 "这个符号的支撑物：这样，一个加密和符号化的过程就开始了，这是他试图把世界整理得井井有条。符号 "蓝色"（冷却和熄灭火焰）与符号 "红色"（燃烧和兴奋）在复杂的结构中相互衔接，但对患者的身体和症状并非没有影响。这些临床元素可以传递给不同的合作伙伴，并支持他们的护理、教育、康复和专家任务。

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引用次数: 0

Impact des attentats du 13 novembre 2015 sur les enfants des civils exposés et sur les relations parents–enfants 2015 年 11 月 13 日的袭击对受影响平民的子女和亲子关系的影响

Q4 Medicine

Neuropsychiatrie de l''Enfance et de l''Adolescence

Pub Date : 2024-11-01 DOI: 10.1016/j.neurenf.2024.06.002

S. Fierdepied , Y. Motreff , P. Pirard , T. Baubet

Introduction

Santé publique France carried out a web-based epidemiological survey (ESPA 13 Novembre) between 8 and 12 months after the terrorist attacks of the 13 November 2015. This was done in order to explore the post-traumatic psychological impact of the attacks on the directly exposed civilians and responders as well as their use of healthcare services. The survey took the form of a series of closed-ended questions as well as several open-ended questions. We present here an analysis of the responses of civilians to the following specific question: “If you have children, can you tell us whether you think the experience you went through had an effect on them, or on your relationship with them? Can you explain?”.

Objective

To find out about the impact of the attacks on the children of exposed civilians and on parent–child relationships, something that has never been studied in the context of mass attacks.

Method

We carried out a thematic analysis of civilians’ responses to this specific question, building up general themes by data reduction.

Results

The analyses revealed four main themes which relate to the impact of the exposure to terrorist attacks on parent-child relationships, the changes experienced in their role as parents, their children's reactions and, finally, the ways in which they tried to protect their children.

Discussion

The parents highlighted the psychological changes that operated in them, their unease, their fear of the outside world, and their concern for their children's safety. They discussed the consequences of the attacks on their children in terms of stress, insecurity, psychological disturbances, and even of the emergence of real disorders. The parents have tried to fulfil their protective role in a variety of ways, sometimes with a feeling of powerlessness reinforced for some by the difficulty of finding suitable care spaces. Attachment bonds have, for the most part, tightened in these families demonstrating their reassuring function within the group. It seems essential to care for children, and the family as a whole, alongside their parents, in order to re-establish secure attachment bonds which are a factor in resilience.

导言：2015 年 11 月 13 日恐怖袭击发生后 8 至 12 个月期间，法国卫生部开展了一项基于网络的流行病学调查（ESPA 13 Novembre）。这样做的目的是为了探究袭击对直接受影响的平民和救灾人员造成的创伤后心理影响，以及他们对医疗服务的使用情况。调查采用了一系列封闭式问题和若干开放式问题的形式。我们在此对平民对以下具体问题的回答进行分析："如果您有孩子，您能否告诉我们您认为您的经历是否对他们或您与他们的关系产生了影响？我们对平民对这一具体问题的回答进行了专题分析，并通过数据还原建立了一般主题。结果分析揭示了四大主题，分别涉及遭受恐怖袭击对亲子关系的影响、父母角色的变化、子女的反应，以及他们试图保护子女的方式。讨论父母们强调了他们的心理变化、不安、对外界的恐惧以及对子女安全的担忧。他们从压力、不安全感、心理障碍，甚至出现真正的心理失调等方面讨论了孩子受到攻击的后果。父母们试图通过各种方式来履行他们的保护职责，但有时由于难以找到合适的看护场所，一些父母会感到无能为力。在大多数情况下，这些家庭中的依恋纽带更加紧密，这表明它们在群体中起着安抚作用。看来有必要与父母一起照顾儿童和整个家庭，以重建安全的依恋关系，这是恢复能力的一个因素。

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引用次数: 0

Profil sociodémographique et clinique des enfants examinés en pédopsychiatrie dans un cadre médico-légal 在法医背景下接受儿童精神病学检查的儿童的社会人口学和临床概况

Q4 Medicine

Neuropsychiatrie de l''Enfance et de l''Adolescence

Pub Date : 2024-11-01 DOI: 10.1016/j.neurenf.2024.07.002

Marwa Boussaid , Asma Guedria , Roua Manaa , Rakia Soiniya , Abir Aissaoui

Background

Child and adolescent psychiatrists are increasingly being requested by judicial authorities to examine children and adolescents. This increase is in part attributable to progress in Tunisian legislation on the protection of women and children. Nevertheless, clinicians have encountered several difficulties in conducting these examinations. This study aims to analyse the epidemiological and clinical profiles of children examined in a medico-legal context and to discuss the difficulties in managing these examinations.

Methods

This is a cross-sectional descriptive and analytical study that examined the records of all patients referred to the Child Psychiatry Department in Monastir as part of medico-legal examinations during the years 2021–2022. We therefore filled in a form to investigate the child's socio-demographic data, background and the specifics of the medical-legal examination.

Results

Our study included 454 children and adolescents with a M/F sex ratio equal to 103 and an average age of 11 years. The majority of the population was of low socioeconomic status and lived in a disrupted environment. Child abuse (60.1%), particularly of the sexual type (53.5%), was the most frequent reason for requesting a medico-legal examination, and the diagnoses retained were dominated by acute and post-traumatic stress disorders and adjustment disorders. We also observed a high rate of interruption in medical follow-up and limited availability of information regarding legal outcomes for children in need of psychiatric care.

Conclusion

The current study delves into a significant matter by delineating the socio-demographic and clinical profiles of children undergoing examination in child psychiatry within a medico-legal framework. Collaboration among all stakeholders is thus imperative to ensure improved management and, most importantly, the continuity of care for this specific population.

背景司法当局越来越多地要求儿童和青少年精神科医生对儿童和青少年进行检查。这种增长的部分原因是突尼斯在保护妇女和儿童方面的立法取得了进展。然而，临床医生在进行这些检查时也遇到了一些困难。本研究旨在分析在医学法律背景下接受检查的儿童的流行病学和临床概况，并讨论在管理这些检查时遇到的困难。本研究是一项横断面描述性和分析性研究，对 2021-2022 年期间作为医学法律检查的一部分被转介到莫纳斯提尔儿童精神科的所有患者的记录进行了检查。因此，我们填写了一份表格，以调查儿童的社会人口数据、背景和医学法律检查的具体情况。结果我们的研究包括 454 名儿童和青少年，男女性别比为 103，平均年龄为 11 岁。大多数人社会经济地位低下，生活环境混乱。儿童遭受虐待（60.1%），尤其是性虐待（53.5%），是要求进行医学法律检查的最常见原因，保留的诊断主要是急性和创伤后应激障碍以及适应障碍。我们还观察到，需要接受精神病治疗的儿童的医疗随访中断率很高，有关其法律结果的信息也很有限。结论：本研究通过在医学-法律框架内描述接受儿童精神病学检查的儿童的社会人口学和临床概况，探讨了一个重要问题。因此，所有利益相关者之间的合作势在必行，以确保改善对这一特殊群体的管理，最重要的是确保护理的连续性。

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引用次数: 0

Q4 Medicine

Neuropsychiatrie de l''Enfance et de l''Adolescence

Pub Date : 2024-11-01 DOI: 10.1016/j.neurenf.2024.09.004

J.-M. Coq

引用次数: 0

Hommage à Jean Pierre Visier (1933–2024) 向让-皮埃尔-维西埃（1933-2024 年）致敬

Q4 Medicine

Neuropsychiatrie de l''Enfance et de l''Adolescence

Pub Date : 2024-11-01 DOI: 10.1016/j.neurenf.2024.10.001

M. Maury

引用次数: 0

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