Showing papers by "David Cohen published in 2020"
TL;DR: In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to a conservative strategy.
Abstract: Background In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease a...
268 citations
119 citations
TL;DR: The Sensory Profile was found to discriminate best between the participants with DMDD and those in the clinical control group with regard to the category “Behavioral outcomes of sensory processing” and the factor “Fine motor/perceptual behavior.”
Abstract: Difficulty modulating sensory information has been described in children with developmental disorders. However, the relation of sensory processing difficulties (SPD) to emotional regulation problems remains poorly understood. The aim of this study is to determine the rate and patterns of SPD in youth with disruptive mood dysregulation disorder (DMDD). Participants were DMDD patients aged 6-16 years presenting at a university hospital in outpatient or inpatient facilities (n = 30). For each participant, the parent-reported Sensory Profile, the Affective Lability Scale, the Beck Depression Inventory-Second Edition, the Child Behavior Checklist/4-18, and the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version were completed. The scores of the Sensory Profile of the DMDD youths were compared to those obtained in a clinical control group and to the manual scores for same-age typically developing youths. SPD were reported in 53% of the subjects in the DMDD group compared to 33% in the clinical control group (p = 0.405). Youths with DMDD showed a significant difference on almost all items of the Sensory Profile compared to typically developing youth. The Sensory Profile was found to discriminate best between the participants with DMDD and those in the clinical control group with regard to the category "Behavioral outcomes of sensory processing" and the factor "Fine motor/perceptual behavior." All types of sensory processing patterns were reported in the DMDD youths: sensation avoiding (40%), low registration (27%), sensory sensitivity (20%), and sensation seeking (10%). As a group, youths with DMDD have significantly more SPD when compared to typical youths. Therefore, SPD could be an important factor to consider in youths with DMDD when providing comprehensive assessment and therapeutic interventions.
49 citations
TL;DR: The objective of this study was to demonstrate the importance of knowing the carrier and removal of canine coronavirus, as a source of infection for other animals, not necessarily belonging to the same breeds.
Abstract: Journal of Gynecology Obstetrics and Human Reproduction - Sous presse. Manuscrit accepte. Disponible en ligne depuis le lundi 11 mai 2020
45 citations
TL;DR: Two unrelated cases diagnosed with both COS and alternating hemiplegia of childhood are reported on, and for whom two distinct pathogenic de novo variants were identified in the ATP1A3 gene.
Abstract: Childhood-onset schizophrenia (COS) is a rare and severe form of schizophrenia defined as onset before age of 13. Here we report on two unrelated cases diagnosed with both COS and alternating hemiplegia of childhood (AHC), and for whom two distinct pathogenic de novo variants were identified in the ATP1A3 gene. ATP1A3 encodes the α-subunit of a neuron-specific ATP-dependent transmembrane sodium-potassium pump. Using whole exome sequencing data derived from a cohort of 17 unrelated COS cases, we also examined ATP1A3 and all of its interactors known to be expressed in the brain to establish if variants could be identified. This led to the identification of a third case with a possibly damaging missense mutation in ATP1A3 and three others cases with predicted pathogenic missense variants in the FXYD gene family (FXYD1, FXYD6, and FXYD6-FXYD2 readthrough). FXYD genes encode proteins that modulate the ATP-dependant pump function. This report is the first to identify variants in the same pathway for COS. Our COS study illustrates the interest of stratifying a complex condition according to the age of onset for the identification of deleterious variants. Whereas ATP1A3 is a replicated gene in rare neuropediatric diseases, this gene has previously been linked with COS in only one case report. The association with rare variants in FXYD gene family is novel and highlights the interest of exploring these genes in COS as well as in pediatric neurodevelopmental disorders.
36 citations
TL;DR: The Randomized Efficacy and Safety Trial of Oral GABAA α5 receptor antagonist S44819 after Recent ischemic Event (RESTORE BRAIN) aimed to evaluate the safety and efficacy of S 44819 for enhancing clinical recovery of patients with ischaemic stroke.
Abstract: Summary Background S44819, a selective GABAA α5 receptor antagonist, reduces tonic post-ischaemic inhibition of the peri-infarct cortex. S44819 improved stroke recovery in rodents and increased cortical excitability in a transcranial magnetic stimulation study in healthy volunteers. The Randomized Efficacy and Safety Trial of Oral GABAA α5 antagonist S44819 after Recent ischemic Event (RESTORE BRAIN) aimed to evaluate the safety and efficacy of S44819 for enhancing clinical recovery of patients with ischaemic stroke. Methods RESTORE BRAIN was an international, randomised, double-blind, parallel-group, placebo-controlled, multicentre phase 2 trial that evaluated the safety and efficacy of oral S44189 in patients with recent ischaemic stroke. The study was done in specialised stroke units in 92 actively recruiting centres in 14 countries: ten were European countries (Belgium, Czech Republic, France, Germany, Hungary, Italy, Netherlands, Poland, Spain, and the UK) and four were non-European countries (Australia, Brazil, Canada, and South Korea). Patients aged 18–85 years with acute ischaemic stroke involving cerebral cortex (National Institute of Health Stroke Scale [NIHSS] score 7–20) without previous disability were eligible for inclusion. Participants were randomly assigned to receive 150 mg S44819 twice a day, 300 mg S44819 twice a day, or placebo twice a day by a balanced, non-adaptive randomisation method with a 1:1:1 ratio. Treatment randomisation and allocation were centralised via the interactive web response system using computer-generated random sequences with a block size of 3. Blinding of treatment was achieved by identical appearance and taste of all sachets. Patients, investigators and individuals involved in the analysis of the trial were masked to group assignment. The primary endpoint was the modified Rankin Scale (mRS) score 90 days from onset of treatment, evaluated by shift analysis (predefined main analysis) or by dichotomised analyses using 0–1 versus 2–6 and 0–2 versus 3–6 cutoffs (predefined secondary analysis). Secondary endpoints were the effects of S44819 on the NIHSS and Montreal Cognitive Assessment (MoCA) scores, time needed to complete parts A and B of the Trail Making Test, and the Barthel index. Efficacy analyses were done on all patients who received at least one dose of treatment and had at least one mRS score taken after day 5 (specifically, on or after day 30). Safety was compared across treatment groups for all patients who received at least one dose of treatment. The study was registered at ClinicalTrials.gov , NCT02877615 . Findings Between Dec 19, 2016, and Nov 16, 2018, 585 patients were enrolled in the study. Of these, 197 (34%) were randomly assigned to receive 150 mg S44819 twice a day, 195 (33%) to receive 300 mg S44819 twice a day, and 193 (33%) to receive placebo twice a day. 189 (96%) of 197 patients in the 150 mg S44819 group, 188 (96%) of 195 patients in the 300 mg S44819 group, and 191 (99%) patients in the placebo group received at least one dose of treatment and had at least one mRS score taken after day 5, and were included in efficacy analyses. 195 (99%) of 197 patients in the 150 mg S44819 group, 194 (99%) of 195 patients in the 300 mg S44819 group, and 193 (100%) patients in the placebo group received at least one dose of treatment, and were included in safety analyses. The primary endpoint of mRS at day 90 did not differ between each of the two S44819 groups and the placebo group (OR 0·91 [95% CI 0·64–1·31]; p=0·80 for 150 mg S44819 compared with placebo and OR 1·17 [95% CI 0·81–1·67]; p=0·80 for 300 mg S44819 compared with placebo). Likewise, dichotomised mRS scores at day 90 (mRS 0–2 vs 3–6 or mRS 0–1 vs 2–6) did not differ between groups. Secondary endpoints did not reveal any significant group differences. The median NIHSS score at day 90 did not differ between groups (4 [IQR 2–8] in 150 mg S44819 group, 4 [2–7] in 300 mg S44819 group, and 4 [2–6] in placebo group), nor did the number of patients at day 90 with an NIHSS score of up to 5 (95 [61%] of 156 in 150 mg S44819 group, 106 [66%] of 161 in 300 mg S44819 group, and 104 [66%] of 157 in placebo group) versus more than 5 (61 [39%] in 150 mg S44819 group, 55 [34%] in 300 mg S44819 group, and 53 [34%] in placebo group). Likewise, the median MoCA score (22·0 [IQR 17·0–26·0] in 150 mg S44819 group, 23·0 [19·0–26·5] in 300 mg S44819 group, and 22·0 [17·0–26·0] in placebo group), time needed to complete parts A (50 s [IQR 42–68] in 150 mg S44819 group, 49 s [36–63] in 300 mg S44819 group, and 50 s [38–68] in placebo group) and B (107 s [81–144] in 150 mg S44819 group, 121 s [76–159] in 300 mg S44819 group, and 130 s [86–175] in placebo group) of the Trail Making Test, and the Barthel index (90 [IQR 60–100] in 150 mg S44819 group, 90 [70–100] in 300 mg S44819 group, and 90 [70–100] in placebo group) were similar in all groups. Number and type of adverse events were similar between the three groups. There were no drug-related adverse events and no drug-related deaths. Interpretation There was no evidence that S44819 improved clinical outcome in patients after ischaemic stroke, and thus S44819 cannot be recommended for stroke therapy. The concept of tonic inhibition after stroke should be re-evaluated in humans. Funding Servier.
27 citations
TL;DR: According to simulation models, the durability of TAVR valves must be 70% shorter than that of surgical valves to result in reduced life expectancy in patients with demographics similar to those of recent trials, but in younger low-risk patients, valve durability must be weighed against other patient factors such as life expectancy.
Abstract: Background: Recent clinical trial results showed that transcatheter aortic valve replacement (TAVR) is noninferior and may be superior to surgical aortic valve replacement (SAVR) for mortality, str...
22 citations
TL;DR: In this article, the authors describe how their hospital team has reorganized itself to meet the new demands and questions, in particular by opening a unit dedicated to people with autism and challenging behaviors affected by COVID-19.
Abstract: COVID-19 is a multi-organ disease due to an infection with the SARS-CoV2 virus. It has become a pandemic in early 2020. The disease appears less devastating in children and adolescents. However, stress, quarantine and eventually mourning have major impacts on development. It is difficult to describe what this pandemic implies for a child psychiatrist, other than by giving a first-hand account. I propose to go through the main ethical questions that have arisen; to describe how my hospital team has reorganized itself to meet the new demands and questions, in particular by opening a unit dedicated to people with autism and challenging behaviors affected by COVID-19; and to address, in a context of national discussion, how the discipline has sought to understand the conditions of a certain well-being during quarantine. Finally, I will try to conclude with more speculative reflections on re-opening.
16 citations
TL;DR: It is confirmed that a history of SA and seeking psychiatric care with medication are risk factors for SA relapse, however, productive coping strategies and cooperativeness are protective factors, and the improvement of such strategies as well as treatment of persisting depression should be a goal of psychotherapy treatment offered to suicidal adolescents.
Abstract: Suicide attempts (SAs) are a public health concern in adolescence. A brief hospitalization is recommended, but access to inpatient wards is often not available. In addition, numerous risk factors for SA recurrence have been identified, but few studies have explored protective factors. Here, we aimed to assess the role of both risk and protective factors on SA relapse in a context of free access to inpatient services. We performed a prospective follow-up study of 320 adolescents who were hospitalized for an SA between January 2011 and December 2014 in France. Assessments at baseline included socio-demographics, clinical characteristics, temperament, reasons for living, spirituality, and coping. Patients were re-evaluated at 6 months and 12 months for depression severity and SA relapse. A total of 135 and 91 patients (78 girls, 12 boys, aged 13–17) were followed up at 6 and 12 months, respectively. At the 12-month follow-up, 28 (30%) subjects had repeated an SA. Adolescents who either had a history of SA or were receiving psychotropic treatment at baseline were at higher risk of recurrence. Several variables had a protective effect: (1) productive coping skills, namely, working hard and achieving, physical recreation, and seeking relaxing diversions; (2) a particular temperament trait, namely, cooperativeness; and (3) having experienced more life events. We also found a significant interaction: the higher the depression score during follow-up, the lower the protective effect of productive coping. Our findings confirm that a history of SA and seeking psychiatric care with medication are risk factors for SA relapse. However, productive coping strategies and cooperativeness are protective factors, and the improvement of such strategies as well as treatment of persisting depression should be a goal of psychotherapy treatment offered to suicidal adolescents.
16 citations
TL;DR: Data indicate that behavioral and interaction imaging was able to predict ASD/ID in high-risk children with WS, and included a combination of infant vocalizations and HM features combined with synchrony vocalization features.
Abstract: Automated behavior analysis are promising tools to overcome current assessment limitations in psychiatry. At 9 months of age, we recorded 32 infants with West syndrome (WS) and 19 typically developing (TD) controls during a standardized mother-infant interaction. We computed infant hand movements (HM), speech turn taking of both partners (vocalization, pause, silences, overlap) and motherese. Then, we assessed whether multimodal social signals and interactional synchrony at 9 months could predict outcomes (autism spectrum disorder (ASD) and intellectual disability (ID)) of infants with WS at 4 years. At follow-up, 10 infants developed ASD/ID (WS+). The best machine learning reached 76.47% accuracy classifying WS vs. TD and 81.25% accuracy classifying WS+ vs. WS-. The 10 best features to distinguish WS+ and WS- included a combination of infant vocalizations and HM features combined with synchrony vocalization features. These data indicate that behavioral and interaction imaging was able to predict ASD/ID in high-risk children with WS.
12 citations
TL;DR: Youths with DMDD share several clinical features with youths with MDD and PDD, and further studies are required to determine the developmental trajectories and the benefits of expanding pharmacotherapy for DD to D MDD.
18 Aug 2020
TL;DR: This study’s results suggest that social adversity-related stress experienced in native countries, especially by paternal grandparents, is potentially a traumatic experience that may play a role in ASD development.
Abstract: Background Several studies suggest significant relationships between migration and autism spectrum disorder (ASD) but there are discrepant results Given that no studies to date have included a pathological control group, the specificity of the results in ASD can be questioned Aims To compare the migration experience (premigration, migratory trip, postmigration) in ASD and non-ASD pathological control groups, and study the relationships between migration and autism severity Method Parents' and grandparents' migrant status was compared in 30 prepubertal boys with ASD and 30 prepubertal boys without ASD but with language disorders, using a questionnaire including Human Development Index (HDI)/Inequality-adjusted Human Development Index (IHDI) of native countries Autism severity was assessed using the Child Autism Rating Scale, Autism Diagnostic Observation Schedule and Autism Diagnostic Interview-Revised scales Results The parents' and grandparents' migrant status frequency did not differ between ASD and control groups and was not associated with autism severity The HDI/IHDI values of native countries were significantly lower for parents and grandparents of children with ASD compared with the controls, especially for paternal grandparents Furthermore, HDI/IDHI levels from the paternal line (father and especially paternal grandparents) were significantly negatively correlated with autism severity, particularly for social interaction impairments Conclusions In this study, parents' and/or grandparents' migrant status did not discriminate ASD and pathological control groups and did not contribute either to autism severity However, the HDI/IHDI results suggest that social adversity-related stress experienced in native countries, especially by paternal grandparents, is potentially a traumatic experience that may play a role in ASD development A 'premigration theory of autism' is then proposed
TL;DR: In this paper, the authors investigated the predictifs de the duree d'hospitalisation en unite pour adolescents dans un service hospitalo-universitaire, i.e., the number of admissions to the hospital and the length of the hospitalisation.
Abstract: Resume But de l’etude Dans un contexte d’inflation du nombre de demandes de prises en charge en pedopsychiatrie, les unites d’hospitalisation pour adolescents sont de plus en plus sollicitees. Notre objectif est de determiner les facteurs predictifs de la duree d’hospitalisation en unite pour adolescents dans un service hospitalo-universitaire. Patients et methode Il s’agit d’une etude catamnestique, retrospective, sur deux ans. Tous les dossiers de patients (n = 191) ayant ete hospitalises dans deux unites d’hospitalisation pour adolescents d’un service hospitalo-universitaire de pedopsychiatrie ne disposant que d’unites fermees ont ete repris. Resultats La duree d’hospitalisation moyenne dans notre population etait de 96 jours (DS = 101, min = 1, max = 600, mediane 67). Dans les analyses multivariees, les variables statistiquement associees a une duree d’hospitalisation plus longue etaient un diagnostic de schizophrenie, de trouble du comportement alimentaire, la presence d’idees suicidaires, un score a l’echelle d’evaluation globale du fonctionnement (EGF) bas a l’admission, l’existence d’une mesure educative, et une orientation vers une structure de soins ambulatoire de type centre d’activite therapeutique a temps partiel (CATTP) ou hopital de jour (HDJ). Ce modele predisait pres de 40 % de la variance de la duree d’hospitalisation. Conclusion On retrouve des effets independants de facteurs pronostiques cliniques et fonctionnels sur la duree de prise en charge hospitaliere. Le poids des facteurs socio-educatifs et lies a l’orientation ulterieure dans le systeme de soins pose la question des fonctions eventuelles de l’hospitalisation (de crise, ou d’accompagnement vers un projet ambulatoire), voire des limites de notre discipline dans ses articulations avec les champs medico-social et sanitaire.
TL;DR: A cross-sectional comparative study to compare cognitive development, mental health, gender identity, quality of life, and family dynamics in children of transgender fathers and donor sperm insemination (DSI) and two control groups matched for age and gende typically developing (TD) children and children from cisgender parents and DSI.
Abstract: Background Today, individuals and couples with fertility issues can use advances in biomedical technologies to conceive. Transgender persons also benefit from these advances and can not only actualize their self-identified gender identities but also experience parenthood. These strategies for persons to self-actualize and to access parenthood have improved the condition of transgender persons. However, some may question the welfare of the offspring because such transfamily forms are often confusing to many. The sparse research on the psychological well-being of children of transgender people is reassuring. However, the limited empirical research justifies more studies to be conducted with an evidence-based methodology to assess whether these new methods of parenting have any adverse impact on children. Aims The current report details the protocol we built to compare cognitive development, mental health, gender identity, quality of life, and family dynamics in children of transgender fathers and donor sperm insemination (DSI) and two control groups matched for age and gende typically developing (TD) children and children from cisgender parents and DSI. Hypothesis To calculate sample sizes, we hypothesize no significant difference between groups. Subjects and Methods Since 2008, married couples that include a transgender father have been able to access DSI and have started conceiving children in France. They are always invited to participate in research to assess their children's well-being. To date, the cohort includes 53 children in 37 families. We propose to carry out a cross-sectional comparative study exploring cognitive development with the Brunet-Lezine Psychomotor Development Scale or Wechsler's Intelligence Scales according to age; mental health with the Child Behaviour Checklist; gender identity with the Gender Identity Interview for Children; quality of life with the KIDSCREEN and the Adolescent Coping Questionnaire; and family dynamics with the Parental Bonding Instrument, the Inventory of Parent and Peer Attachment, the Five-Minute Speech Sample, and Corman's Family Drawing Test. To assess possible subtle differences between children's family drawings, we will use a generalization of the "lady-tasting-tea" procedure to link qualitative and quantitative approaches in psychiatric research. Twenty raters [four child and family psychoanalysts (CHILDPSY), four adult psychiatrists (ADUPSY), four biologists working in assistive reproduction technology (BIOL), four endocrinologists working with transgender individuals (ENDOC), and four students (STUD)] will be randomly shown the drawings and asked to blindly classify them using a Likert scale according to whether the child has a transgender father. Statistical Analysis After testing normality, comparisons between the three groups will be performed with appropriate statistical tests (Kruskal-Wallis, ANOVA, Chi2 or Fisher's exact test). For the "lady-tasting-tea" procedure, we will use a permutation test. Ethics The study protocol has been approved by the CERES (Comite d'Ethique de Recherche en Sante) of Paris 5 University. Registration number is 2015/31.
TL;DR: The 4-year delay in diagnosis may represent a loss of opportunity for caregivers, and training health care professionals in the core symptoms of ADHD may help reduce disparities and improve patient trajectory.
Abstract: Objective: The objective of this study is to retrospectively describe the pathway toward ADHD diagnosis and treatment, and identify potential areas for improvement. Method: Parent-reported questionnaires were collected by a national sample of ADHD specialists. Results: In total, 473 complete questionnaires were analyzed. Initial onset of ADHD symptoms was reported at a mean age of 4.45 years. Mean age at diagnosis was 8.07 years, and half of the families had seen at least three health care professionals previously. Psychiatrists were most commonly consulted. A "combined" (89% boys) and inattentive (49% boys) profile was identified. Diagnosis was made 1 year later for the latter group. Two thirds of patients received pharmacological treatment. The delay in diagnosis was identified as the main source of concern for caregivers. Conclusion: The 4-year delay in diagnosis may represent a loss of opportunity. Training health care professionals in the core symptoms of ADHD may help reduce disparities and improve patient trajectory.
TL;DR: There is a trend of increasing complications and 30-day mortality following AF ablation from 2010 through 2015, and the authors hypothesize that these trends may be due to increasing age and comorbidity burden or perhaps to increasing performance.
TL;DR: Although observational studies have suggested that conscious sedation for transcatheter aortic valve replacement (TAVR) is associated with reduced mortality compared with general anesthesia (GA), these findings may reflect unmeasured confounding.
TL;DR: In this paper, les principales perspectives of reflexion avancees dans le contexte d'un seminaire de travail multidisciplinaire associant psychiatres d’enfant, psychologues du developpement et psychanalystes, biologistes de la reproduction, endocrinologistes, ethiciens, juristes and usagers transgenres.
Abstract: Resume Aujourd’hui, les techniques medicales permettent des avancees importantes, notamment dans le champ de la procreation pour les personnes ayant des problemes de fertilite. Les personnes transgenres beneficient de ces biotechnologies dans le cadre de leur parcours de transition, et aussi afin d’acceder au statut de parent. Nous proposons de presenter dans ce present article, les principales perspectives de reflexion avancees dans le contexte d’un seminaire de travail multidisciplinaire associant psychiatres d’enfant, psychologues du developpement et psychanalystes, biologistes de la reproduction, endocrinologistes, ethiciens, juristes et usagers transgenres. Nous en proposons une synthese a l’appui d’une revue de la litterature des enjeux ethiques, et de la dimension psychologique a l’œuvre pour les personnes transgenres et leurs enfants. Pour bien comprendre les differents enjeux, nous exposons d’abord l’etat actuel de la litterature concernant les parcours de transition, puis l’actualite des options d’aide medicale a la procreation (AMP), avant d’exposer les modifications que ces nouveautes introduisent dans notre schema de pensee de tradition monotheiste. Enfin, en parcourant les principes ethiques de Beauchamp et Childress, nous tentons de situer les implications de ces nouvelles possibilites de faire famille, et avec elles, les possibilites d’inventer des solutions utiles a la societe pour accepter, et accompagner ces nouvelles formes familiales.
TL;DR: The results found in the cross-over condition support the hypothesis that the emotional component of infant-directed speech shares similar acoustic characteristics across languages.
Abstract: Backgrounds Infant-directed speech (IDS) is part of an interactive loop that plays an important role in infants’ cognitive and social development. The use of IDS is universal and is composed of linguistic and emotional components. However, whether the emotional component has similar acoustics characteristics has not been studied automatically. Methods We performed a cross-cultural study using automatic social signal processing techniques (SSP) to compare IDS across languages. Our speech corpus consisted of audio-recorded vocalizations from parents during interactions with their infant between the ages of 4 and 18 months. It included 6 databases of five languages: English, French, Hebrew (two databases: mothers/fathers), Italian, and Brazilian Portuguese. We used an automatic classifier that exploits the acoustic characteristics of speech and machine learning methods (Support Vector Machines, SVM) to distinguish emotional IDS and non-emotional IDS. Results Automated classification of emotional IDS was possible for all languages and speakers (father and mother). The uni-language condition (classifier trained and tested in the same language) produced moderate to excellent classification results, all of which were significantly different from chance (P Conclusion The automated classification of emotional and non-emotional components of IDS is possible based on the acoustic characteristics regardless of the language. The results found in the cross-over condition support the hypothesis that the emotional component shares similar acoustic characteristics across languages.
TL;DR: In this article, the authors present an analysis of the difference between transgenre and mere cis-gene in a group of French enfants with respect to a procreation medicalement assistee (PMA).
Abstract: Resume Contexte Depuis plusieurs annees en France, des enfants dont le pere est transgenre (ne fille) sont issus par procreation medicalement assistee (PMA) avec don de sperme. Le developpement de ces enfants est mal connu. Bon nombre d’interrogations participent aux polemiques concernant ce type de parentalite dont l’identite meme de la famille constituee. Methode Afin d’apprecier s’il y avait une difference de representation reperable de l’identite sexuee chez ces enfants, nous avons demande a 47 enfants (74,5 % de garcons) âges de 3 a 14 ans de realiser « le dessin d’une famille » (Corman, 1964). Les 24 enfants nes de pere transgenre ont ete compares a 23 enfants nes de parents cisgenres et concus par rapports sexuels. La recherche a ete approuvee par le comite d’ethique de l’universite Paris V. Resultats L’analyse en aveugle des differents dessins ne nous a pas permis de distinguer de difference ou de particularite qualitatives qui indiqueraient le groupe d’appartenance de l’enfant. Nous avons pu, apres la levee de l’aveugle, realiser une analyse descriptive des dessins et observer que les marqueurs de genre au sein des dessins evoluent, en partie et comme attendu, en fonction de l’âge des enfants mais ne sont pas lies a un effet du groupe d’appartenance. Nous avons egalement pu apprecier comme attendu d’apres les precedentes recherches ayant utilisees le dessin de famille des differences a travers certains elements qualitatifs en lien avec la representation familiale, et ce, dans les deux groupes. Conclusion L’enfant ne de pere transgenre et mere cisgenre avec recours a la PMA projette dans le dessin d’une famille des etats internes en tous points proches de ceux d’enfants du meme âge et du meme sexe mais nes de parents cisgenres et rapport sexuel. Il serait pertinent de pouvoir evaluer a nouveau, la cohorte des plus jeunes au moment de l’adolescence ou l’identite sexuee est remaniee du fait de la puberte.
TL;DR: In the COAPT trial, transcatheter mitral valve repair with the MitraClip rapidly improved health status and reduced the long-term risk of death and heart failure hospitalization in patients with HF and severe functional mitral regurgitation.
TL;DR: Tout comme en psychiatrie adulte, les enfants et adolescents atteints de troubles mentaux semblent avoir une esperance de vie diminuee par rapport a la population generale.
Abstract: Resume Contexte Le deces est un evenement rare en pedopsychiatrie et il reste tres peu etudie. Methodes Nous rapportons ici une recension de la litterature sur la mortalite en pedopsychiatrie et une serie retrospective depuis 2007 la mise en place des revues de mortalite et de morbidite realisee dans un service hospitalo-universitaire disposant de plusieurs unites d’hospitalisation. Resultats La revue a collige 73 etudes. Toutes concourent a confirmer la surmortalite des enfants et adolescents suivis en pedopsychiatrie qu’elle soit en population generale ou non specifique (ex : patients hospitalises) ou en population specifique (ex : patients autistes). Les causes de surmortalite sont bien sur le suicide mais egalement nombre de causes naturelles (ex : complications d’addiction ou d’anorexie mentale). Notre etude retrospective collige 11 patients (âge moyen = 15,5 ans ; 9 filles pour 2 garcons) avec 5 deces et 14 situations engageant le pronostic vital (EPV). La encore les suicides completes et les tentatives de suicide graves sont tres presents (n = 8 dont 2 deces), mais nous decrivons egalement des causes somatiques complications de conduites pathologiques (n = 5 : denutrition dans un contexte d’anorexie, intoxication a l’eau) ou sous-tendues par une maladie somatique (n = 5, dont 2 deces lies a une maladie de Sanfilippo et un lymphome infiltrant du tronc cerebral). Conclusion Tout comme en psychiatrie adulte, les enfants et adolescents atteints de troubles mentaux semblent avoir une esperance de vie diminuee par rapport a la population generale. Neanmoins, le deces en pedopsychiatrie reste un phenomene rare et ce d’autant plus lorsqu’il s’agit d’une prise en charge hospitaliere. Notre etude met en evidence que les cas de deces ou d’EPV en pedopsychiatrie hospitaliere sont dus a des maladies somatiques plus ou moins intriquees a des troubles psychiatriques, d’une part, et a des suicides, d’autre part.
TL;DR: In this article, a nouvelle approche de la suicidologie offre des perspectives passionnantes tant en matiere de comprehension qu’en matiere of prise en charge.
Abstract: INTRODUCTION : Le suicide de l’adolescent constitue un probleme de sante publique majeur, tout particulierement chez ceux souffrant d’un Trouble de la Personnalite Limite (TPL). L’etude des facteurs de protections tels que les raisons de vivre est novatrice sur le sujet. Notre objectif etait d’analyser les specificites dans l’elaboration de raison de vivre chez des adolescents suicidant souffrant d’un TPL, par rapport a un echantillon sans trouble de personnalite.
MATERIEL ET METHODES : Notre etude constituait une analyse correlationnelle et comparative intermediaire des donnees d’une etude multicentrique, prospective en cours. Nos objectifs etaient de determiner s’il existait une difference significative sur les scores a l’echelle RFL-A total et aux 5 sous echelles entre les groupes TPL et non TPL. Pouvaient etre inclus tout adolescent admis apres une tentative de suicide. Le diagnostic de TPL etait definie par l’Ab-DIB.
RESULTATS : 223 adolescents ont ete inclus, avec un sex ratio (M/F) de 0,22 et un âge moyen de 14,8 ans. Le groupe TPL obtenait des scores significativement inferieurs au groupe non TPL pour le RFL-A total et pour chacune des sous echelles. Les deux groupes differaient le plus sur les echelles « Peur du Suicide » et « Confiance en Soi ».
DISCUSSION : Notre etude a mis en avant des difficultes globales a l’elaboration de raisons de vivre chez les patients TPL et cela surtout sur les dimensions « peur du suicide » et « confiance en soi ». Ces observations etayent les conceptions psychopathologiques actuelles du TPL.
CONCLUSION : Ces differences suggerent des particularites dans l’elaboration de raisons de vivre chez les patients borderline. Cette nouvelle approche de la suicidologie offre des perspectives passionnantes tant en matiere de comprehension qu’en matiere de prise en charge.
TL;DR: In hostile iliac vessels for which transfemoral transcatheter aortic valve replacement (TAVR) is not feasible, alternative access is required and the choice of access between peripheral and central access TAVR has not been chosen.
TL;DR: In this article, a revue de la litterature sur le syndrome ADNP, d'avril 2014-a juillet 2019, sur la base des donnees bibliographiques Medline, via le serveur PubMed, was realized.
Abstract: Resume Objectifs Le syndrome ADNP, pour proteine neuroprotectrice dependante de l’activite, decrit en 2014, est une cause de deficience intellectuelle et d’autisme syndromiques. Nous rapportons l’etat actuel des connaissances, 5 ans apres sa decouverte. Cette revue de la litterature reprend la description clinique, les outils diagnostiques et la prise en charge de ce syndrome. Methodes Nous avons realise une revue de la litterature sur le syndrome ADNP, d’avril 2014 a juillet 2019, sur la base des donnees bibliographiques Medline, via le serveur PubMed, et avons complete notre recherche par une recherche manuelle. Resultats Dix-huit articles restituaient des descriptions cliniques de patients porteurs d’un syndrome ADNP, 6 articles decrivant une serie de cas ou une etude de cohorte descriptive, 12 articles rapportant des cas cliniques isoles. L’analyse de la litterature souligne l’importance du sequencage de l’exome complet, afin d’etablir un diagnostic precoce du syndrome ADNP, dans les cas de syndrome polymalformatif associe a une deficience intellectuelle et/ou un autisme. Une eruption prematuree des dents de lait, un colobome et/ou un blepharophimosis sont evocateurs, sachant que de tres nombreux organes peuvent etre concernes (malformations cerebro-cranio-faciales, gastroenterologiques, cardiaques, urogenitales, musculosquelettiques notamment). La prise en charge requiert une collaboration etroite entre somaticiens et psychiatres. Des ameliorations sont decrites lorsque des soins multidimensionnels, integratifs et intensifs sont prodigues. Notons que des recherches cliniques sont en cours afin d’offrir aux jeunes avec ADNP une strategie therapeutique ciblee, en utilisant de nouveaux peptides de l’ADNP biologiquement actifs. Conclusion Le syndrome ADNP doit etre reconnu precocement pour ameliorer la prise en charge multidisciplinaire et la qualite de vie des patients atteints et de leurs familles. En cas de trouble du spectre autistique avec deficience intellectuelle et anomalies congenitales multiples, une analyse genetique avec sequencage de l’exome complet s’avere indispensable.