France has been severely impacted by the pandemic. The first wave imposed a major lockdown, never seen before. The second and third wave lockdown responses were somewhat less dramatic. People were allowed to travel to work. Nursery and elementary schools were left open while high schools had part-time attendance. Spring 2021, still presented with a terrible death toll of 300/day, for a 67million population country. For many months the spotlights were focused on the high levels of mortality and morbidity of the elderly. This somehow obliterated the younger generation’s mental health issues. It now appears that children and adolescents have had to pay a steep price to Covid 19. In France, during the first lockdown, child and adolescent morbidity and mortality due to abuse heightened considerably compared to 2019 during the same period. And during the second and mostly the third lockdown, pediatric emergency wards have been underwater with youth mental health issues ranging form suicidal ideation to acute dissociation. Different hypotheses have emerged on how the pandemic has so dramatically impacted the mental health of children and adolescents, specifically the most vulnerable ones. The consequences this might have for child development and mental health during the years to come will be debated.

We assessed hemisphere function in right-handed male chronic schizophrenic patients using dichotic listening tests. We evaluated digit, tonic and transitional tests in patients with paranoid schizophrenia (n = 8), patients with disorganized schizophrenia (n = 8) and in control subjects (n = 8). The dichotic listening analysis discriminated between paranoid and disorganized schizophrenia. In disorganized schizophrenia, functional impairment of both hemispheres was demonstrated, while in paranoid schizophrenia dysfunction was more prominent in the right hemisphere. These results indicate the possible involvement of right hemisphere dysfunction in the pathophysiology of chronic paranoid schizophrenia, in contrast to dysfunction of both hemispheres in chronic disorganized schizophrenia.

Family environment has a clear role in suicidal behavior of adolescents. We assessed the relationship between parental bonding and suicidal behavior in suicidal (n = 53) and non-suicidal (n = 47) adolescent inpatients. Two dimensions of parental bonding: care and overprotection, were assessed with the Parental Bonding Instrument. Results showed that adolescents with severe suicidal behavior tended to perceive their mothers as less caring and more overprotective compared to those with mild or no suicidal behavior. A discriminant analysis distinguished significantly between adolescents with high suicidality and those with low suicidality [χ2(5) = 15.54; p = 0.01] in 71% of the cases. The perception of the quality of maternal bonding may be an important correlate of suicidal behavior in adolescence and may guide therapeutic strategies and prevention.

Le trouble de personnalité borderline (TPB) se caractérise notamment par des troubles de régulation des émotions en lien avec des troubles de l’attachement. Ces troubles entravent en eux-mêmes l’établissement de relations nouvelles et entretiennent les difficultés de régulation et d’attachement perpétuant ainsi le développement psychopathologique. Lors de l’avènement de la parentalité, la relation contrainte et le bouleversement inhérent à la venue d’un enfant sont susceptibles d’entraîner des distorsions interactives initiées par les parents atteints de psychopathologie borderline, contraignant ainsi le développement émotionnel du tout-petit. La micro-analyse des interactions lors d’une épreuve dite du Still-Face montre que les mères atteintes de TPB et leur bébé de 3 mois sont engagés dans des comportements qui combinent paradoxalement, une pauvreté de variation dans les interactions ainsi qu’un excès de comportements stimulants et intrusifs. L’effort de régulation et la dysrégulation du bébé sont visibles au travers de comportements de dyscoordination des regards, à la modification négative et dysrythmique des vocalisations et de la prosodie et à l’absence de modulation des temps dits de « réparation » lorsque qu’il existe des moments de rupture de la communication. Les résultats d’une étude longitudinale (n = 60) montrent que les déterminants micro-analytiques à l’âge de trois mois des prémices de l’attachement désorganisé concernent avant tout la dynamique interactive plus que la quantité d’un comportement spécifique. Ce serait la mise en place d’un accordage à « sens unique » qui malgré la motivation maternelle d’interagir avec le bébé induirait des exigences au-delà des capacités développementales de celui-ci. L’attachement désorganisé constaté à l’âge de la marche traduirait la non-mise en place du développement des capacités de régulation du bébé. Reste à évaluer si les potentialités de réorganisation demeurent encore ouvertes à cette période précoce de la vie, invitant à découvrir des potentialités thérapeutiques encore balbutiantes à ce jour.

Adolescent suicide is a worldwide troubling phenomenon that has high comorbidity, including impulsivity, depression, and personality disorders. Attention Deficit Hyperactivity Disorder (ADHD) includes attention, impulsivity and hyperactivity. Comorbidity includes depression and substance abuse, and has a higher rate in adolescents and adults. Studies considering the association between these phenomena are surprisingly rare. This pilot study estimated the percentage of ADHD in a population of adolescents who attempted suicide. Population included all adolescents (12-18 yrs.) who were brought to local ER after attempting suicide. Assessment included an interview according to the DSM-IV criteria, the Strengths and Difficulties Questionnaire parents (SDQ-P) the Conners' Rating Scale parents (CRS-P), and Kiddie-SADS. Test Of Variables of Attention (TOVA) with methylphenidate (MPH) challenge was done after the clinical evaluation to those diagnosed as ADHD.

Marked gender differences have been identified in cigarette smoking. In this study, we aimed to identify the gender-specific emotional and behavioral disorders among adolescent smokers and their consequent utilization of mental health services. We performed a nationwide survey study of an Israeli representative sample of 906 adolescents and their mothers. Mental disorders were assessed using the Development and Well-Being Assessment (DAWBA) Inventory. Levels of emotional and behavioral difficulties were evaluated using the Strengths and Difficulties Questionnaire (SDQ). Mental health services use and smoking habits were also assessed. Among non-smoker adolescents there were significant gender differences in almost all SDQ scales: emotional problems, pro-social, hyperactivity/inattention and conduct problems, whereas in the smoker group there was a difference only in the SDQ emotional problems scale (both self- and maternal-rated, P < 0.001 and P = 0.002, respectively). Only marginal difference was noted between males and females in help-seeking for emotional or behavioral problems. Over 50% of both male and female smokers in the study had untreated mental disorders (non-significant gender difference). The well-established gender differences in psychiatric symptomatology narrowed markedly in adolescent smokers; the typical gender difference in disruptive behaviors was lost in the adolescent smoking population. The implications of these findings are particularly relevant to developing more effective gender-specific programs to prevent youth smoking, to facilitate quitting and prepare primary care practitioners to identify mental disorders and behavioral problems in adolescents with a smoking history.

In this study, we aimed to evaluate the utilization of mental health services by adolescent smokers, the presence of untreated mental disorders in this young population and the associated emotional and behavioral difficulties. We performed a nationwide survey study of an Israeli representative sample of 906 adolescents and their mothers. Mental disorders were assessed using the Development and Well-Being Assessment (DAWBA) Inventory. Emotional and behavioral difficulties were evaluated using the Strengths and Difficulties Questionnaire (SDQ). Mental health services use and smoking habits were evaluated by relevant questionnaires. Adolescent smokers were using significantly more mental health services than non-smokers (79% vs. 63%, respectively, P < 0.001), independently of their mental health status or ethnic group. Adolescent smokers also reported more emotional and behavioral difficulties in most areas (P < 0.001), which are consistent with their mothers’ reports, except in the area of peer relationships. The treatment gap for the smoking adolescents was 53% compared to 69% in the non-smokers (P < 0.001). This is the first study characterizing the use of mental health services and the related emotional and behavioral difficulties in a nationally-representative sample of adolescents. The findings of a wide treatment gap and the rates of the associated emotional and behavioral difficulties are highly relevant to the psychiatric assessment and national treatment plans of adolescent smokers.

Les résultats d’une étude constituant un suivi longitudinal prospectif d’une cohorte de dyades de mères présentant une pathologie borderline/limite avec leur enfant, dans une approche comparative avec une population témoin de dyades avec des mères sans trouble psychique apporte des pistes de réflexion sur les mécanismes d’une possible transmission de ces pathologies. Les interactions précoces à 3 mois au Still-face permettent d’appréhender comment les bébés peuvent précocement présenter des difficultés en lien avec des particularités du fonctionnement intrapsychique et interpersonnel maternel impactant la régulation émotionnelle dyadique. La grossesse, crise identitaire et narcissique, ébranle l’identité de ces mères aux pathologies limites déjà fragilisée par un narcissisme défaillant. Le bébé, par la relation de dépendance qu’il lui impose, réactive les particularités du fonctionnement interpersonnel de cette dernière et propre à cette pathologie. Les interactions précoces reflèteraient l’incapacité maternelle à s’accorder aux rythmes propres et aux mouvements affectifs et émotionnels de leur enfant. La notion de partage intersubjectif troublé éclaire la façon dont nous pouvons envisager les difficultés maternelles à aider le bébé à réguler ses émotions. Cette étude, par l’utilisation du protocole de la situation étrange, donne également un éclairage sur la manière dont les comportements d’attachement de ces enfants, à 13 mois, s’ancrent dans la particularité de ces dysfonctionnements interactifs. L’évaluation des représentations d’attachement et de la narrativité des enfants, entre 4 et 8 ans, met en lumière différentes évolutions dans la qualité de leur attachement. Ces différents résultats soulèvent, d’une part, la question de la transmission intergénérationnelle des modalités d’attachement – avec l’importance de sa qualité et des capacités de fonction réflexive maternelles – et d’autre part, celle de la désorganisation de l’attachement dans les pathologies limites. Enfin, une approche psychodynamique des narratifs des enfants au test des histoires à compléter éclaire les particularités de leur fonctionnement psychique.

If Postpartum mood disorders are now considered a major issue both in public health and in psychiatry, the study of maternal Borderline personality disorder (BPD), most often or not associated with peripartum depressive disorder has attracted much less attention. We now know that BPD is common and highly associated with postpartum depression (Apter et al, 2012). This constitutes a high risk group where both mothers and infants are at relational and psychiatric risk; mothers do not acknowledge their mental health issues and therefore do not seek and receive care, whereas their emotional dysregulation negatively impacts interactions. Distorted interactive configurations organize as early as three months postpartum. Mothers show major difficulty in responding to infants and in turn, infants react with dysregulated and/or dismissive behaviors thus reinforcing the risk for an increase of intrusive and inappropriate response from the caregiver. Rapidly mothers and infants seem off beat. At one year, the infants are at high risk of presenting insecure attachment thus heightening their risk of developing future psychopathology. How to recognize, and intervene with these populations will be presented using videos as illustration and tailored management in a perinatal and infant/toddler unit.

There is relatively little research addressing parent-adolescent agreement as regards to reporting on adolescent suicidal behavior in general and their behavioral and emotional difficulties in particular. The objective of this study was to compare maternal and adolescents’ reports on behavioral and emotional difficulties among adolescents with and without suicidal behavior. This nationally-representative sample included 906 adolescents and their mothers. The mothers and adolescents were interviewed and evaluated separately using the Development and Well-Being Assessment Inventory (DAWBA) and the Strengths and Difficulties Questionnaire (SDQ). Self-rated SDQ scores of the suicidal adolescents were significantly higher in all SDQ problem scales compared to the non-suicidal participants. In contrast, maternal-rated SDQ assessments failed to discriminate between these groups, except the Hyperactivity scale. We demonstrated that mothers of suicidal adolescents in the community hardly recognize the emotional and behavioral difficulties of their offsprings.