D. Da Fonseca

Syndrome d’Asperger et théorie de l’esprit

Resume Introduction Selon de nombreux auteurs, l’alteration des interactions sociales chez les enfants presentant un trouble du spectre autistique serait liee a un deficit de la theorie de l’esprit. La theorie de l’esprit est decrite comme l’aptitude de chacun a predire ou expliquer le comportement de nos semblables en leur attribuant des croyances, des souhaits ou des intentions. De nombreuses etudes ont demontre que les enfants souffrant d’un syndrome d’Asperger ou d’un autisme de haut niveau reussissent les epreuves testant les fausses croyances de premier ordre aussi bien que les sujets controles. En revanche, pour les epreuves de fausses croyances du deuxieme ordre, les resultats sont plus controverses. Pour avancer dans la comprehension de cette competence, plusieurs auteurs ont elabore des epreuves de theorie de l’esprit plus complexes et ont montre que les sujets Asperger ou autistes de haut niveau ne parvenaient pas a realiser ces tâches. Mais la plupart de ces epreuves n’ont ete realisees que chez les adultes. L’objet de cette etude etait d’evaluer les capacites d’enfants et d’adolescents Asperger ou autistes de haut niveau a attribuer des intentions a autrui en utilisant une epreuve complexe basee sur la comprehension de bandes dessinees. Les memes enfants etaient egalement engages dans une epreuve de fausses croyances classiquement utilisee : la tâche des Smarties. Methode Deux groupes d’enfants ont participe a cette etude : un groupe de 16 enfants porteurs d’un syndrome Asperger ou autisme de haut niveau et un groupe de 16 enfants controles apparies sur l’âge et le sexe. L’epreuve proposee comportait 26 bandes dessinees racontant une histoire courte. Pour chaque histoire, le sujet devait choisir parmi 3 images celle qui representait la suite plausible de l’histoire. Dans la condition Attribution d’intention, l’histoire impliquait un personnage dont le sujet devait comprendre les intentions pour pouvoir donner la reponse correcte. Dans la condition Causalite physique, le sujet devait comprendre le deroulement physique d’un evenement. Resultats Tâche bande dessinee : une analyse de variance [2 groupes (CONT/ASD) × 2 conditions (AI/CP)] a ete conduite sur le nombre de reponses correctes. Cette analyse montre que l’interaction Groupe × Condition est significative [F(1-30) = 4,3, p Discussion Les resultats de cette etude montrent clairement que les enfants souffrant du syndrome d’Asperger ou d’autisme de haut niveau presentent un deficit selectif pour interpreter les intentions d’autrui. En effet, dans l’epreuve des bandes dessinees, ces patients ont des difficultes pour trouver la suite logique d’une histoire lorsque cette derniere implique des attributions d’intention. Notre etude demontre aussi que si les sujets Asperger echouent lors de l’epreuve testant la theorie de l’esprit a l’aide de bandes dessinees, ils reussissent l’epreuve de la theorie de l’esprit basee sur les fausses croyances (Smarties). Meme s’il s’agit de deux epreuves testant la theorie de l’esprit, il semble que ces deux tests sont bien distincts. Il est possible que ce soit la modalite verbale du test qui explique la meilleure reussite au test des Smarties par rapport au test des bandes dessinees ou les modalites de presentation sont uniquement visuelles.

Les profils cognitifs dans les troubles envahissants du développement

OBJECTIVEnThis study investigated the cognitive skills in pervasive developmental disorders (PDD).nnnMETHODOLOGYnTwo groups of children participated in this study, 39 individuals with autism and 18 individuals with Asperger syndrome. Each participant was assessed by the Wechsler scales: WPPSI-III, WISC-III or WISC-IV.nnnRESULTSnChildren with Asperger syndrome have VIQ more than PIQ and the children with autism have VIQ less than PIQ. The performances in block design task vary according to the cognitive level and not according to the PDD type. The high-functioning autistic children show high performance in block design task. Children with Asperger syndrome revealed impairments in the understanding of social situations task.nnnDISCUSSIONnIndividuals with autism have a verbal intelligence quotient lower than individuals with an Asperger syndrome. Several hypotheses have tried to explain verbal differences between children with autism and Asperger syndrome. A first hypothesis proposed a developmental convergence between these two groups. A second hypothesis suggested that communication and social interaction impairments could be implicated in verbal skills. A third hypothesis supported that individuals with Asperger syndrome could develop a specific cognitive style. Children with autism have spatial and perceptive capacities better than verbal capacities. These performances could be interpreted as the expression of a specific cognitive style based on the visual analysis of the detail.nnnCONCLUSIONnThe low-functioning children with autism have a cognitive profile with PIQ more than VIQ and high skills in spatial organization. The high-level children with autism have a cognitive profile with PIQ more than VIQ and high skills in spatial abstraction. Children with Asperger syndrome have a profile VIQ more than PIQ profile, they are particularly good in verbal learning notably vocabulary.

[Decision-making and schizophrenia].

Abnormalities involving the prefrontal cortex (PFC) have long been postulated to underpin the pathophysiology of schizophrenia. Investigations of PFC integrity have focused mainly on the dorsolateral PFC (DLPFC) and abnormalities in this region have been extensively documented. However, defects in schizophrenia may extend to other prefrontal regions, including the ventromedial PFC (VMPFC), and evidence of VMPFC abnormalities comes from neuropathological, structural and functional studies. Patients with acquired brain injury to the VMPFC display profound disruption of social behaviour and poor judgment in their personal lives. The Iowa Gambling Task (IGT) was developed to assess decision-making in these neurological cases : it presents a series of 100 choices from four card decks that differ in the distribution of rewarding and punishing outcomes. Whilst healthy volunteers gradually develop a preference for the two safe decks over the course of the task, patients with VMPFC lesions maintain a preference for the two risky decks which are associated with high reinforcement in the short term, but significant long-term debt. Interestingly, damage to VMPFC may cause both poor performance on the IGT and lack of insight concerning the acquired personality modification. Recently, our group reported a trait-related decision-making impairment in the three phases of bipolar disorder. In a PET study, VMPFC dysfunction was shown in bipolar manic patients impaired on a decision-making task and an association between decision-making cognition and lack of insight was described in mania. A quantitative association between grey matter volume of VMPFC and memory impairment was previously reported in schizophrenia. Research suggests that lack of insight is a prevalent feature in schizophrenia patients, like auditory hallucinations, paranoid or bizarre delusions, and disorganized speech and thinking. Because schizophrenia is associated with significant social or occupational dysfunction, previous research assessed decision-making function but indicates conflicting results. Thirteen studies have reported impaired IGT performance in patients with schizophrenia and, in seven reports, no significant differences in IGT performance between patient and healthy control groups were found. Those discrepancies may relate to multiple factors. First, most of the studies included small sample size and negative findings may be due to the large variance of net scores. Second, as suggested by Rodriguez-Sanchez et al., there is a wide disparity in performance by control subjects across studies. Third, intelligence quotient (IQ) score and level of education may be correlated with IGT performance, which may explain IGT performance differences in studies that did not control for educational or IQ score. Fourth, only two studies have systematically controlled for substance use disorder, a potential confounder. Fifth, only two studies assessed the impact of antipsychotic (AP) class on performance. Sixth, to our knowledge, no study assessed the impact of AP dosage on decision-making ability, while AP dose-reduction and dopamine increase, might lead to improvements, in cognitive functions in schizophrenia and in IGT performance in bipolar disorder, respectively. Finally, discrepancies between studies may be related to the heterogeneity of diagnostic groups. Two of the negative studies included schizophrenia and schizoaffective disorder while positive studies have generally included only patients with schizophrenia. Nevertheless, some studies that included only patients with schizophrenia failed to find differences between groups. Thus, further research should assess decision-making in schizophrenia by testing a large group of patients with homogeneity of diagnostic, in comparison with a large group of control subjects. Authors should control for IQ or level of education, substance use disorder and smoking status. While it is now accepted that DLPFC defects in schizophrenia may extend to VMPFC, future investigations should test for an association between memory, insight ability and IGT performance and assess the impact of antipsychotic dosage upon performance. Language: fr

Phase prodromale du trouble bipolaire

The prodromal phase is generally described as a subsyndromal stage preceding the disease onset. The characterization of such phase found its main purpose in secondary prevention. Up to now, clinical research relating to this topic in mental health has primarily focus on schizophrenic disorders. Over the last years, some studies have applied similar methods in order to characterize a preclinical phase in bipolar disorders. In spite of the fact that this strategy appears less adequate in bipolar disorders, these studies have demonstrated the existence of prodromal signs in a majority of patients. However, these features appear for the moment neither sufficiently characteristic, nor sufficiently specific to allow the construction of suitable assessment instruments, or to suggest precise guidelines in the management of these subjects. Also, these prodromal features show considerable overlap with other psychiatric disorders, especially attention-deficit hyperactivity disorder (ADHD) and schizophrenia Interestingly, a limited number of studies have looked at the number of patients considered in a prodromal phase of schizophrenia which later developed a bipolar disorder and reported substantial proportions of subjects in this case, further highlighting the obvious bias in favor of schizophrenia in the actual prevention politics. In order to identify potential candidates at a prodromal phase of bipolar disorders that could benefit from early intervention, studies have relied on both high genetic risk and symptoms at the boundary of the actual classification. However, even within such approach, pharmacological treatments have not proven obvious advantage in terms of prevention. It is suggested that adopting a more longitudinal vision of the disease and, given the mean age of onset of bipolar disorder and a fortiori of its prodromal phase, a more developmental perspective of individuals, could help lowering the confusion in this field ; Also, given the considerable overlap in prodromal features between different psychiatric disorders, early detection programs could benefit from implementing approach open to multiple diseases assessment, rather than hyper-specialization in a specific disorder.

Validité factorielle d’un questionnaire mesurant les théories implicites de l’intelligence (TIDI)

Resume Selon certains auteurs, il semble que les croyances qui concernent la nature de l’intelligence ont un impact tres puissant sur le comportement des eleves en situation d’apprentissage. Ces croyances ou theories implicites sont au nombre de deux : la theorie de l’entite de l’intelligence et la theorie incrementielle de l’intelligence. Cet article presente le developpement et la validation d’un questionnaire sur les theories implicites de l’intelligence en langue francaise (TIDI). Cet instrument est compose de deux sous-echelles de trois items mesurant la theorie incrementielle de l’intelligence et la theorie de l’entite de l’intelligence. Deux etudes ont ete realisees aupres de 662 eleves. La premiere etude avait pour but de tester la validite factorielle et la consistance interne du questionnaire. La deuxieme etude avait pour objectif de tester la fidelite temporelle de l’instrument. Les resultats obtenus sont satisfaisants et attestent de la validite de cette echelle. Ces etudes confirment egalement la coexistence chez les eleves des deux theories implicites. D’un point de vue pragmatique, ce questionnaire pourra etre utilise pour la mise en place de strategies de prevention ou de prise en charge des enfants en difficulte scolaire.

L'enfance du schizophrène

RESUME Pathologie de l’adolescence et du jeune adulte, la schizophrenie peut debuter dans de tres rares cas au cours de l’enfance. Deux formes cliniques precoces du trouble ont pu etre identifiees par les etudes epidemiologiques : l’une debutant vers l’âge de 15 ans ; l’autre aux alentours de 9 ans. Si nombre de questions restent en suspens quant aux determinants neurobiologiques et environnementaux – communs ou distincts – de ces deux formes cliniques, toutes deux traduisent une alteration profonde et durable du developpement neurocognitif dont l’origine remonterait manifestement a la prime enfance, voire a la periode antenatale. Nous presenterons, ici, une possible histoire a rebours de la schizophrenie a l’eclairage des derniers travaux neuroscientifiques en imagerie et en genetique de l’adolescence a l’antenatal.We are able to identify the different risk factors involved in the development of the disorder from a study of the childhood of a schizophrenic patient. More specifically, we will define the perinatal risk factors: season and place of birth, viral exposure during pregnancy and obstetric complications. Developmental factors will also be discussed. Socialisation, language, psychomotor and cognitive development disorders are all developmental difficulties seen during the childhood of the schizophrenic patient. Finally we will finish by discussing a few psychosocial risk factors.

Schizophrénie, cognition et psycho-éducation

Cognitive impairment among patients suffering from schizophrenia is closely linked to psychoeducation and therapeutic education. First, this cognitive impairment requires specific communication strategy and special cognitive and behavioral techniques, which make possible for the patients to improve their trainability. Some of these tools are detailed, such as solving problems, communication skills, role plays, repetition, rewarding, and motivational support. Second, functional and social impairment, and outcome, are partly consequences of these cognitive problems. Cognitive remediation targets elementary cognitive impairment, mostly with repetitive cognitive tasks, and studies show an improvement in these specific tasks, but without positive effect on functional and social aspects of the illness. Overall approaches, such as psychoeducation or therapeutic education, obtain real gains in quality of life for the patients, autonomy and clinical improvement. Its not yet possible to know if these positive results underlie improvement in elementary cognitive impairment. The combination between remediation and psychoeducation seems to be promising.

How to increase academic performance in children with oppositional defiant disorder? An implicit theory effect.

The aim of the present study was to determine whether the implicit theory effect extends to children with oppositional defiant disorder (ODD), with academic difficulties. Twenty-five male children, aged 8-11 years with ODD were randomly assigned to one of two experimental conditions (Incremental Theory highlighting the possibility of self-improvement vs. control). An increase of cognitive performance (IQ) was found for children with ODD in the incremental condition, but not in the control condition. This cognitive improvement could be viewed as a protective factor for children and adolescents with ODD on academic setting.

Phase prémorbide du trouble bipolaire

The study of the premorbid functioning in bipolar disorder allows us to identify several risk factors of the disease. First we will present retrospective studies of adults or teenagers presenting a bipolar disorder and second the studies concerning offspring of parents with bipolar disorder. Despite contradictory results and methodological weaknesses, these studies indicate that anxious disorders and childhood disruptive behaviour disorders may be useful markers of risk for adult bipolar disorder. All these results may open up several interesting perspectives for the prevention ant the treatment of bipolar disorder.The study of the premorbid functioning in bipolar disorder allows us to identify several risk factors of the disease. First we will present retrospective studies of adults or teenagers presenting a bipolar disorder and second the studies concerning offspring of parents with bipolar disorder. Despite contradictory results and methodological weaknesses, these studies indicate that anxious disorders and childhood disruptive behaviour disorders may be useful markers of risk for adult bipolar disorder. All these results may open up several interesting perspectives for the prevention ant the treatment of bipolar disorder.

Troubles affectifs et antidépresseurs : innovations thérapeutiques

Resume A l’instar d’autres troubles psychiatriques, les hypotheses etiopathologiques de la depression se sont largement fondees sur la decouverte fortuite de traitements pharmacologiques efficaces dans cette maladie. Reciproquement, l’innovation therapeutique s’est ensuite nourrie de ces hypotheses pour stimuler le developpement de nouvelles molecules. Nous proposons ici d’etudier le developpement des traitements pharmacologiques a travers les differents modeles neurobiologiques et moleculaires proposes dans la depression. Nous partirons ainsi de l’hypothese monoaminergique qui postule l’existence d’un deficit dans la transmission des monoamines (noradrenaline et serotonine). Si ce modele a longtemps pu fournir un premier niveau d’explication de l’action des molecules antidepressives, les limitations ont ete pointees. Ces insuffisances ont pu deboucher sur un cadre theorique se pretant particulierement bien aux exigences de l’experimentation pharmacologique : le modele de stress de la depression. Des lors, d’autres phenomenes moleculaires et cellulaires ont pu etre observes sous l’influence du stress, reversibles sous traitements antidepresseurs.