[Hearing impairment and psychopathological disorders in children and adolescents. Review of the recent literature]

OBJECTIVE

Hearing impairment is a multifaceted condition with medical and social aspects. If the neuropsychiatric impact of deafness on children has been investigated by researchers from a variety of fields and backgrounds, their conclusion is that children with hearing impairment follow many different developmental pathways. The aim of this paper is to examine the relationships between hearing impairment and mental health and the effect of impaired communication on family development.

METHOD

From a review of the literature, the authors examine the relationships between hearing impairment and mental disorders in children and adolescents in terms of prevalence, clinical features and etiological factors. The fami-ly dynamics and the parents-child interactions were also explored.

RESULTS

The assessment of psychiatric disorders in hearing-impaired children sets some methodological pro-blems. Accurate evaluation is hampered by the immature language exhi-bited by many hearing-impaired children and by the difficulties that may be encountered in establishing rapport if the child does not understand the examiner's verbal exchanges. Several authors point out the lack of communication skills and experiences with hearing-impaired children on the part of many examiners. In addition, delays have been observed for the development of social maturity in hearing-impaired children and the parents' descriptions may reflect their own worries, rather than the emotional-behavioral functioning of the child. The measurement of psychiatric symptoms is then compromised insofar as many of the assessment procedures are highly verbal and were standardized for normal-hearing children. These difficulties may explain that the pre-valence rates of mental disorders in hearing-impaired children and adolescents found in the literature vary from 15% to 60%. If autism and deafness may both confound each others' dia-gnosis, several studies also point out the high comorbidity observed between these 2 conditions. The significance of this association remains unclear. Many of the authors conclude that hearing impairment is unlikely to be an etiological factor in autism. However, auditory impairment may be a marker for brain damage in autism. Although some studies showed high rates of depression and anxiety disorders, particularly social phobias, in deaf and hard-of-hearing children and adolescents, most of the studies conclude that the prevalence of affective disorders in hearing-impaired children and adolescents is comparable with estimates of prevalence for hearing young people. A number of studies have suggested that deaf children show greater degrees of impulsivity than hearing children. However, it seems that this background of greater impulsivity does not lead to higher rates of attention-deficit/hyperactivity disorder (ADHD) among deaf children. Using standardized instruments to estimate the prevalence of ADHD in this population, recent studies conclude that deaf children with hereditary deafness are not at greater risk of developing ADHD but that children with acquired deafness are, and that this difference is probably related to the medical conditions and family climates distinguishing these two groups. Psychotic disorders are no more common among hearing-impaired young people than among young people with normal hearing. However, some recent studies showed that the presentation of schizophrenia can differ in deaf people because of the high frequency of visual hallucinations observed in them. Lastly, if primitive personality has been described as being more prevalent among hearing-impaired children and adolescents, most of the studies found a normal range of emotional-behavioral functioning in them. In summary, if varying incidences of emotional disturbances and behavioral problems have been reported for hearing-impaired children and adolescents, except autism, it seems that children with hearing impairment experience the same range of mental health problems as hearing children. A variety of demographic, medical and educational factors were investigated as possible etiological factors for the psychiatric disorders observed in hearing-impaired children. Factors such as medical conditions, degree of deafness, communication ability and social deprivation may play a role. However, many studies also emphasize that a number of other variables, including educational methods, parental adaptation and parental support, may have an impact, positive or negative, on the development of the hearing-impaired child. By this way, numerous investigations have shown that deaf children of deaf parents attain better emotional and cognitive development than do deaf children of hearing parents.

CONCLUSION

A number of questions remain about the neuropsychiatric and psychosocial aspects of hearing-impairment in children. For instance, few studies have been conducted to examine the impact of the different methods of communication and education on the psychosocial adjustment of deaf children. However, this review clearly show that appropriate and effective management can occur only when the mental health professionals are know-ledgeable and sensitive to the unique characteristics and experiences of hearing-impaired children and adolescents.

[Hearing impairment and cognitive development]

The study of the cognitive abilities of hearing-impaired children is important for both practical (e.g. to determine appropriate teaching strategies) and theoretical reasons (e.g. to examine the role of language in thought processes). The aim of this paper is to examine the cognitive function of hearing-impaired children from a review of the literature. If most studies show that deaf children are similar to normal children in virtually all aspects of cognitive function, many studies also emphasize pronounced differences in their academic achievement. Besides the degree of hearing loss and the age at onset of deafness, environmental factors (such as parental support and educational methods) seem to play an important role in the cognitive development and academic success of these children. This underlines the importance of the measures adopted for the deaf children as they may have a positive or negative impact on their development.

Treatment of comorbid opiate addiction and attention-deficit hyperactivity disorder (residual type) with moclobemide: a case report

Moclobemide is a specific and reversible monoamine oxidase-A (MAO-A) inhibitor. Studies show that it is an effective and well-tolerated treatment for attention-deficit hyperactivity disorder (ADHD). A number of reports suggest that ADHD may have a causal influence on the development of substance use disorders. The authors describe the use of moclobemide in a 27-year-old patient with comorbid opiate addiction and ADHD (residual type). The positive clinical response shown suggests that moclobemide may have a particular interest in the treatment of drug-dependent patients with current ADHD.

[Obsessive-compulsive disorder in children induced by streptococcal infection]

FROM OBSESSIVE-COMPULSIVE DISORDER TO PANDAS: Obsessive-compulsive disorder (OCD) represents a potentially severe and handicapping disorder that affects several hundreds of thousands of children in France. OCD has, for many years, been considered as a neurosis resulting from mental conflicts. It is currently seen as a neurobiological disorder, the etiological substratum of which is more organic than mental. Recently a sub-type of OCD was isolated in children following infection by Group A b-hemolytic streptococci. This sub-type has been described as Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS). A NEW PHYSIOPATHOLOGICAL APPROACH: The putative dysimmune relationship between bacterial infection and neurotic disorder has led to the development of an original etiopathogenic model that may lead to new therapeutic strategies. The clinical case report of an adolescent presenting with trichotillomania associated with recurrent pharyngitis is a good illustration of this. PUBLISHED DATA: Data published in medical literature over the last 10 years indicates a 10% prevalence in the young suffering from OCD, i.e. 0.1 to 0.3% of the young population.

[Alpha-interferon and mental disorders]

The interferon alpha stands as a reference both in oncology and virology. But its efficiency is limited by frequent somatic as well as neuropsychic side effects. As a matter of fact, the reduction or the ending of a chemotherapy treatment come chiefly from the psychiatric complications caused by the use of interferon. For about 30% of patients, various psychic disorders are noticed: personality disorders, mood disorders, anxiety states, suicidal tendencies, manic and psychotic symptoms. We thus propose a review which shall be completed by a discussion on wether the interferon is responsible or not of the appearance of the described mental disorders. We shall conclude with a synthesis of the proposed practical management when confronted with such disorders. Psychiatric complications under interferon-Alpha. The appearance of psychiatric complications caused by interferon has been the subject of many publications. They have also raised the question of the toxicity mechanism which is still misunderstood today. This toxicity appears to be dose-dependent with variations depending on the daily dose given, the mode of administration, the combination with other chemotherapy treatments, the concomitance with a cerebral radiotherapy or a medical history of psychiatric disorders. Most of these effects occur after three weeks of treatment but non specific neuropsychic symptoms can be observed earlier. Non specific symptoms. They appear early but are difficult to detect, though they bring together a whole lot of clinical signs: asthenia, irritability, psychomotor slowdown, depressive mood or even a real "subsyndromic" depressive syndrome, anorexia, decline of the libido, concentration and attention problems, dizzy spells and headaches. Some authors have described intense and fluctuating of personality, mixing anxiety, irritability and disorder of drive control. Depression. Depression is the most frequently found psychiatric pathology in studies but the real frequency of clear cases of depressive problems is difficult to determine through lack of serious studies. So the incidence of depressive disorders usually varies from 5 to 15%. The depressive syndrome can settle as soon as the first week treatment, with a peak in the frequency during the first and third months. The seriousness and the incidence of this syndrome seem to be dose-dependent. The gravity of this complication lies in the suicidal risk, a risk all the more dreadful since there is not any identified risk factor. Suicides and suicidal behaviours. Serious complications, because they act directly on the vital prognosis. However fortunately, suicidal behaviours only represent a minority within all the side effects attributed to the interferon-alpha. These actions fit into three main clinical dimensions: complication of a severe depressive syndrome, confusional context and disorder of the impulses control. In practical terms, prevention proves to be difficult without identified predictive factors. Nevertheless, some authors point out the importance of aggravating comorbid disorders like alcoholism or the coinfection by the HIV. Manic syndrome. The appearance of a manic state under a chemotherapy treatment seems to be rare, given that there have been only a dozen cases published around the world. But these observations are interesting as far as both the study of imputability and the understanding of the toxicity mechanisms are concerned. Most of the cases deal with patients without a family or personal history of psychiatric disorders, and whose symptomatology disappears with the end of the treatment, which is an argument in favour of the imputation of the interferon in the appearance of manic disorders. In addition, some authors introduce the notion of tertiary mania: the appearance of an autoimmune hypothyroidism in relation with interferon and leading to athymic elation. Eventually, the appearance of manic problems at the end of the treatment makes it possible to speculate about the physiopathological mechanisms that are at issue. Anxiety disorders. These disorders are not much described: they generally are already existing disorders (like phobic or obsessive compulsive disorders), reactivated or aggravated by the interferon-alpha molecule. Adaptation disorders. It deals with adaptation disorders along with anxious temper coming at the beginning of the treatment. These problems are more concerned with the announcement of the diagnosis and its seriousness than with the toxicity of the interferon-alpha molecule. Psychotic states. There are less papers on the prevalence of psychotic disorders during the treatment, or at the end of it. But they can be found in both viral and malignant pathologies. A large retrospective study has shown ten cases of psychotic disorders and that in the absence of history of psychiatry or of a HIV co-infection. In every case the psychiatric aspect is stopped by the ending of the treatment or by an appropriated treatment. Usually, the few cases of paranoïd delusion described in papers seem to appear between one and three months of treatment, with patients having a history of psychiatric disorders. Aggravation of pre-existing mental disorders. Numerous authors have reported the recurrence of addictive behaviours (alcohol or other psychoactive matter) by weaned patients. Imputability to interferon-alpha in psychiatric disorders. It is difficult to draw the relationship between the chemotherapy with the interferon-alpha treatment and neuropsychiatric complications because there is a lack in specific studies. Nevertheless, it seems to be causal relations between the prescription of interferon and the appearance of psychic disorders. As a matter of fact, even if there is neither predictive criterion nor diagnosis of clinical type (set apart a dose effect), it is clear that there are diagnostic criteria of chronological kind: delay of appearance and disappearance of side effects compatible with the kinetics of the molecule and test of positive reintroduction. The imputability is thus most likely towards, given the reported clinical observations and signs of direct cerebral toxicity described for interferon: induction of neurophysiological changes among healthy volunteers, reversible EEG impairments the second week of treatment, direct vascular and neurological toxicity. Eventually, authors have shown that the psychiatric morbidity could be more important among patients under treatment than in a control group. In conclusion, the imputability of interferon appears to be very likely, more particularly in the appearance of mood disorders, mainly depressive ones, of manic syndromes and of certain psychotic episodes.

MANAGEMENT

The most numerous therapeutic propositions naturally concern the depressive syndromes, because of their high frequency. In a recent article, the authors have detailed the pharmacological criteria of the ideal molecule: limited hepatic metabolism, low rate of proteinic fixation, long half-life and absence of active metabolite. So they advise not to prescribe imipraminic molecules and recommend the use of some SRI in first intention: citalopram and sertraline mainly, paroxetine to avoid given its pharmacological features that do not seem adapted. Only the minalcipram seems to show all the theoretical advantages described above. If there is an indication in the introduction of an anxiolytic medication, we shall prefer a benzodiazepine with short half-life like loxazepam and alprazolam. Besides, all the publications point out the importance of a specific clinical observation during the treatment as well as in the six months following its end. The agreement must bear full medical costs, above all including psychotherapic and social aspects. The proposed treatments for the other disorders are conventional: haloperidol and lithium for bipolar disorders, fluvoxamine for obsessive compulsive disorders and neuroleptics for psychotic disorders.

CONCLUSION

The appearance of neuropsychiatric side effects during a chemotherapy using the interferon-alpha molecule is a frequent complication, the consequences of which can prove tragic: involvement of the vital prognosis, family and professional relation disturbances, compliance problems, risks of psychiatric morbidity at short and middle terms.... In spite of the absence of rigorous controlled studies, the imputability to the interferon of the appearance of psychological disorders appears very likely. So the role of the psychiatrist seems to be determining in the follow-up care of these patients who must be considered at high risk to develop a psychiatric pathology. The agreement to bear medical costs has to be made in narrow collaboration with clinical practitioners and must be part of a clinical continuity, from the pre-therapeutical evaluation to the remote follow-up care. Finally, it seems important to implement controlled studies, resting on a great diagnostic and methodological rigour, in order to clarify the toxicity mechanisms of interferon and to optimise the agreement to bear medical cost for the patients.

[Obesity, alexithymia, psychopathology and binge eating: a comparative study of 40 obese patients and 32 controls]

Alexithymia may be considered as a personality feature characterized by poorness of imaginary life, speech focused on actual facts and physical sensations, general inaccuracy in or paucity of the words used to express emotions, and recourse to acting out to avoid intrapsychic conflicts. The possible link between alexithymia and psychosomatic or psychopathological disorders is now well documented. In particular, studies suggested that alexithymia may be frequently observed in obese or bulimic patients. This study was designed to investigate the link between obesity and alexithymia according to the presence or not of binge eating problems; 40 obese female patients (BMI > or = 27.3) seeking obesity treatment and 32 normal weight women used as controls were included in the study. In the obese group, 11 patients (27.5%) exhibited binge-eating disorder according to the DSM IV criteria. Alexithymia was assessed using the Toronto Alexithymia Scale (TAS), and past and current mental disorders were assessed by means of the Structured Clinical Interview for DSM III-R (SCID). In addition, current depression was assessed using the Beck Depression Inventory (BDI). The mean TAS score was found significantly higher in obese patients than in controls (72.6 +/- 11.8 vs 65.2 +/- 9.3, respectively; p < 0.005). In the same way, alexithymia (defined by TAS score > or = 74) was found significantly more frequent in obese patients than in controls (52.5% vs 21.8%, respectively; p < 0.03). However, among obese patients no significant difference was found between patients with and without binge-eating disorder. Current major depression was also found significantly more frequent in obese patients than in controls (15% vs 0%, respectively; p < 0.03), and the mean BDI score was very significantly higher in obese patients (12.2 +/- 8.7 vs 4.6 +/- 4.6, respectively; p < 0.0001). Comparisons between obese patients with and without binge-eating disorder showed that only past major depression was found significantly more frequent in those with binge-eating disorder (81.8% vs 10.3%, respectively; p < 0.0001), although the mean BDI score was significantly higher in patients with binge-eating disorder (18.5 +/- 11.7 vs 9.8 +/- 5.9, respectively; p < 0.02). Group by group comparisons suggested that two factors may play a role in the correlation found between obesity and alexithymia. First, the mean TAS score was found significantly higher in subjects with low educational level (p < 0.05), obese patients exhibiting significantly lower educational level when compared to controls (p < 0.002). Then, a significant positive correlation was found between TAS scores and BDI scores (Spearman's test: p < 0.01), obese patients showing significantly higher BDI scores than controls (p < 0.0001). In order to confirm these results, a logistic regression procedure was performed in the total sample (obese patients + controls). Three factors were found significantly increasing the risk to get a TAS score > or = 74: low educational level (odds ratio: 3.56), past and/or current major depression (odds ratio: 2.77), and BDI score > or = 8 (odds ratio: 2.18). Obesity in itself had no significant effect on TAS scores. Our results confirm that alexithymia is a psychological feature frequently observed in obese patients. In our study, the correlation found between obesity and alexithymia appears to be irrespective of binge-eating disorder, and seems to be mediated by the educational level and the frequency of associated depression. However, further investigations need to be done in order to specify the relationships between obesity, alexithymia, low educational level, and depression.

[A case of acute psychotic episode after a single dose of ecstasy]

Over the last 10 years or so in Europe, there has been a development of the "ecstasy" phenomenon, which is the symbol of "recreational" drugs in general. Users, either alone or in private parties, are on the increase. The phenomenon is most frequent in England and in the Netherlands, with an estimated incidence of 13-18% amongst the 18-25 years old, which may reach 52% in "exposed populations", such as individuals who go to "techno" night clubs. In France, the prevalence is uncertain, but estimated at least 5% of males between 18 and 23 years old. Several substance, with more or less the same effects, are grouped together by the term "ecstasy", the best-known one being 3,4-methylenedioxymethamphetamine (MDMA), but there are also an N-demethylated derivative (MDA), methylenedioxyethylamphetamine (MDEA), N-methyl-benzodioxazolylbutanamine (MBDB) and 4-bromo-2,5-dimethoxyphenylethylamine (2-CB or Nexus). The psychopathological consequences of MDMA in man are relatively poorly understood. On the basis of series of cases reported in the literature, acute psychosis, chronic psychosis similar to paranoid delusions, flash-back phenomena similar to with LSD, anxiety/panic states and depressive mood disorders may occur. The case which we report is therefore that of an acute psychotic episode, with residual symptomatology 6 months later, which occurred suddenly following absorption of toxic substances (alcohol and ecstasy), at least 12 hours after taking the ecstasy tablet without his knowing it, in an individual without any previous psychopathology, other than moderate social phobia. Twelve cases of acute psychotic episodes after ecstasy have been reported in the literature. Two of them occurred after a single dose and one after 2 doses. No author was able to examined the previous history of the individuals accurately, nor any possible psychopathological history. Our patient did not have any previous history of psychosis, using a standardized validated interview, which his peers and family confirmed. He did however fulfil the criteria of "social phobia". Retrospectively, we noted the extent of his psychomotor disinhibition with ecstasy, which seemed to be proportional to the intensity of his previous social inhibition. This point does not explain the psychotic episode. From a neurobiologic point of view, acute psychotic disorders are often related to dysfunction of the mesolimbic dopaminergic system. During the first 3 hours, the effect of absorption of MDMA is a massive release of the serotonin, dopamine and noradrenaline stocks. Later, an acute hyposerotoninergic state is present. In our observation, the psychotic disorder appeared at least 12 hours after taking ecstasy, during the reduction phase of the intoxication. Toxicological analysis of the blood was negative (this detection is only positive for 24 hours). Like other authors, our hypothesis is that serotoninergic dysregulation affects the dopaminergic system. Sudden disappearance of serotoninergic feedback on the dopaminergic pathways, may contribute to an increase in the mesolimbic hyperdopaminergic state. In animals, it has been shown that serotonin depletion induced by MDMA, unmasks the effects of a hyperdopaminergic state. In addition, although it has not been mentioned much in the literature, MDMA disturbs dopaminergic function either directly, or through the peptidergic systems (neurotensin, substance P, dynorphines). A consistent series of arguments therefore suggest that there is a sudden central hyperdopaminergic state, which may be related to the appearance, sometimes de novo, of an acute psychotic disorder. From the published cases, psychotic disorders following absorption of ecstasy, appear to become chronic. Most of the cases occurred in individuals, who either abused multiple substances or were chronic ecstasy users. In a case like the one we report, in an individual with good general health, who is not a drug user and who has an acute episode following a single dose, the prognosis should be good. Similarly, a team from Milan has described the experience of 3 friends who had a brief psychotic episode, following ingestion of substances containing ecstasy. These episodes resolved completely, after rehydration and anxiolytic treatment. However, after 6 months' follow-up, our patient still has psychotic symptoms, albeit mild, but which were not present before the intoxication. The patient and his psychiatrist do not envisage changing or stopping his antipsychotic treatment. Other authors have described a lesion in the serotoninergic neurons, by making a parallel with toxic effects described in animals, in particular in primates, with MDMA. Degradation of the serotoninergic cell bodies and nerve endings has been suggested to occur with high doses and/or repeated doses of MDMA. Other authors show the large variations in MDMA and MDA metabolism. (ABSTRACT TRUNCATED)

[Post-traumatic stress, post-traumatic depression and major depressive episode: literature]

Although they are likely to add their effects, physical and psychic traumata (or traumas) can provoke in different ways the appearance of depressive symptoms sometimes common. Post-traumatic depression, reactional depression, major depressive disorder and post-traumatic stress disorder represent different clinical and nosographic disorders in despite of their occasionally common symptomatic core. Historically, it is interesting to note during the XXth century the true semantic change of the terms of trauma from the somatic field to the psychic sphere. Physical traumatism is often represented by a material shock for the subject and by its organic consequences. It is defined as an event that leaves its mark which itself inflicts and handicaps the vital trajectory of the subject. It primarily comprises brain and rachis injuries, whose evolution is frequently characterized by the occurrence/appearance of a depressive disorder, whose genesis rests on psychological but also neurobiologic and physical arguments. Thus major depressive disorders are often present in the course of various physical traumatisms mainly related to nervous system. In accordance with several studies, the prevalence of major depressive disorders ranges from 25% to 50%. These mood disorders occur in the year which follows the accidental event. Their average time of revelation is estimated at four months and their average duration lies between three and six months. Lastly, although these depressive illnesses present clinical symptoms comparable with those observed in other contexts, some nuances can be raised. Nonetheless, they confine sometimes with true clinical forms depending on the intensity, the form, the circumstances or the consequences of the trauma. Psychic traumatism doesn't have the same profile and rests for much dedicated with the reexperiencing. Thus for some authors, depression illness represents a disorder that occurs after a traumatic event whereas others see a differential diagnosis which exludes or which represents a comorbidity with post-traumatic stress disorder. The review of the literature allows us to emphasize the complexity of the links as well as the clinical and epidemiologic differences between stress disorder and major depressive disorder. From the clinical point of view, the major features of PTSD are articulated around a triad of symptoms. They include the reexperiencing symptoms of the traumatic event such as intrusive memories and recurrent nightmares, the protective reactions such as avoidance of the stimuli associated with the trauma and emotional numbing, and the arousal symptoms such as the startled response and hypervigilance. The complexity of this syndrom is due to the frequent combination of these symptoms with other nonspecific ones. As far as the mood is concerned (the mood symptoms are concerned), the regrouping of some of these symptoms allows the clinician to sometimes releave a depressive symptomatology without being able to assess the DSM diagnosis of major depressive disorder. Epidemiologic studies dealing with the risk of installation of a PTSD after a traumatic event reveal differences in the prevalence depending on the nature of the traumatic events: ranging from 1% in general population to 80% following some situations of extreme and durable psychic suffering. Between both poles, one finds a prevalence ranging between 20 and 50% following other events such as serious accidents, natural disasters or criminal assaults. The clinical features of depressive episodes comorbid or associated with PTSD have some characteristics making it possible to individualize various clinical forms as a function of traumatic event type: asthenic, characterial or with somatic symptoms. According to the majority of authors, the co-occurrence of post-traumatic stress disorder and major depressive disorder is high although differential diagnosis is sometimes difficult. However, conceptual differences remain and two conceptions are distinguished. For some authors, like Bleich and Shalev, there would not be true chronological evolution from PTSD to MDD. Moreover the presence of symptoms considered as pertaining to the mood register within the criteria of PTSD would be clearly predictive of the occurrence and the severity of the diagnosis but not of the chronicity. For others, there would be a continuity between post-traumatic stress disorder and major depressive disorder. It is the case in many studies of veterans but also for civilian traumatic events. It is also the case for the American national study of comorbidity in which Kessler concludes that for 78% of the subjects who present a comorbidity PTSD/MDD (comorbidity raised for 48% of the 5,877 subjects included), the mood disorder is secondary to PTSD. (ABSTRACT TRUNCATED)

An "accidental" acute psychosis with ecstasy use

Over the last 10 years, Europe has witnessed the development of the ecstasy phenomenon; this term is used to describe several products sharing more or less the same effects. The most widely used and hence the most well known is 3,4 MDMA, but MDA, MDEA, MBDB and even 2CB or nexus are available. The psychopathological consequences of MDMA use in man are relatively poorly understood. The case reported here involves an acute psychotic episode with residual symptoms after six months, with a sudden onset at least 12 hours after taking alcohol and ecstasy without realising it, in an individual with no previous psychopathology other than a moderate anxiety disorder. Twelve cases of acute psychotic episodes after taking ecstasy have been reported in the literature; two after taking the drug on two occasions and one after a single use. No authors have examined the previous mental state or possible previous psychopathology with any precision. The present subject had not displayed any previous psychotic behavior when tested with a proven standardized interview technique; this was confirmed by his peers and his family. He did, however, show signs of social phobia. Although the personality of an individual is a factor in taking a drug, and probably in the quality of the psychotropic effects experienced, a host of arguments favor the appearance of psychotic symptoms de novo, which were probably related to direct toxicity by MDMA and/or its metabolites on the serotoninergic neurons.

Hydrodynamic theory of density relaxation in near-critical fluids

This paper gives a complete hydrodynamic theory of density relaxation after a temperature step at the boundary of a cell filled with a nearly supercritical pure fluid in microgravity conditions. It uses the matched asymptotic expansion technique to solve the one-dimensional Navier-Stokes equations written for a viscous, low-heat-diffusing, near-critical van der Waals gas. The continuous description obtained for density relaxation in space and time confirms that it is governed by two fundamental mechanisms, the piston effect and heat diffusion. It gives a space-resolved description of density inside the cell during the divergently long heat diffusion time, which is shown to be the ultimate one to achieve complete thermodynamic equilibrium. On that very long time scale, the still measurable density inhomogeneities are shown to follow the diffusion of the vanishingly small temperature perturbations left by the piston effect. Temperature, which relaxes first to nonmeasurable values, and density, which relaxes on a much longer time scale, may thus appear to be uncoupled. The relaxation of density on the diffusion time scale is shown to be driven by a bulk expansion-compression process slowly moving at the heat diffusion speed, which is generated by heat diffusion coupled with the large compressibility of the near-critical fluid. The process is shown to be the signature of the thermoacoustic events that occur during the very short piston effect time period. The generalization of the theory to real critical behavior opens the present results to future experimental investigation.

13C(16)O(2): Global Treatment of Vibrational-Rotational Spectra and First Observation of the 2nu(1) + 5nu(3) and nu(1) + 2nu(2) + 5nu(3) Absorption Bands

The effective operator approach is applied to the calculation of both line positions and line intensities of the (13)C(16)O(2) molecule. About 11 000 observed line positions of (13)C(16)O(2) selected from the literature have been used to derive 84 parameters of a reduced effective Hamiltonian globally describing all known vibrational-rotational energy levels in the ground electronic state. The standard deviation of the fit is 0.0015 cm(-1). The eigenfunctions of this effective Hamiltonian have then been used in fittings of parameters of an effective dipole-moment operator to more than 600 observed line intensities of the cold and hot bands covering the nu(2) and 3nu(2) regions. The standard deviations of the fits are 3.2 and 12.0% for these regions, respectively. The quality of the fittings and the extrapolation properties of the fitted parameters are discussed. A comparison of calculated line parameters with those provided by the HITRAN database is given. Finally, the first observations of the 2nu(1) + 5nu(3) and nu(1) + 2nu(2) + 5nu(3) absorption bands by means of photoacoustic spectroscopy (PAS) is presented. The deviations of predicted line positions from observed ones is found to be less than 0.1 cm(-1), and most of them lie within the experimental accuracy (0.007 cm(-1)) once the observed line positions are included in the global fit. Copyright 2000 Academic Press.

[Neuropsychiatric disorders induced by MDMA ("Ecstasy")]

If neurotoxicity of MDMA (ecstasy) is now well documented in animals, it is not the same in humans. MDMA intoxication puts the problem of its possible link with the serotonin syndrome and the neuroleptic malignant syndrome. Neuropathological consequences following MDMA intake have been reported, including hemorrhaging and cerebral infarction, cerebral venous sinus thrombosis, and acute inflammatory CNS disease. However, the physiopathology of these complications remains unclear. In the same way, there have been various reports that have attributed MDMA to precipitating the onset of a wide range of psychiatric disorders including sleep disorders, cognitive disorders, panic attacks, depression, flashbacks, psychosis and severe paranoia. Findings suggest that these psychiatric manifestations might be consequences of MDMA induced brain serotonin neurotoxic lesions. All these data are examined from a critical review of the literature.

[Separation anxiety disorder and eating disorders]

Separation anxiety disorder (SAD) is probably the most common anxiety disorder observed in childhood. If some studies suggest that SAD may increase the risk of anxiety and mood disorders in adolescents and young people, the outcome of childhood SAD remains unclear. Because of the high mental-eating disorders comorbidity, we performed a follow-back study in 81 young patients showing anorexia nervosa (AN) or bulimia nervosa (BN) according to DSM III-R criteria. The current and lifetime psychiatric histories were assessed using structured interviews (SADS-LA and SCID) and the psychopathological profile with the SCL-90. The results showed that about 20% of young patients with AN and BN had a past history of childhood SAD. This subgroup of patients significantly differed from the other (without childhood SAD) with respect to associated anxiety and depressive disorders. These data suggest a specific association between eating disorders and childhood SAD and show that epidemiologic investigations can be helpful for planning the prevention and treatment of eating disorders.

The nu1 + 5nu3 Dyad of 12CO2 and 13CO2

The (1 0(0) 5)1,2 --> (1 0(0) 4)1,2 and (1 0(0) 6)1,2 --> (1 0(0) 5)1,2 emission bands of 12C16O2 have been recorded near 4.5 µm by Fourier transform spectroscopy of a CO2 + N2 mixture excited by dc discharge. The spectroscopic parameters of the (1 0(0) v3)1,2 vibrational states with v3 = 0-6 have been obtained from a global rotational analysis of the six (1 0(0) v3)1,2 --> (1 0(0) (v3-1))1,2 emission bands (v3 = 1-6). The (1 0(0) 5)1,2 vibrational states of both 12C16O2 and 13C16O2 have been observed by direct absorption from the vibrational ground state by Intracavity Laser Absorption Spectroscopy near 12 700 and 12 400 cm-1, respectively. The rovibrational energy levels obtained by the two experimental techniques are discussed and compared with those calculated in the framework of the effective operator approach. Copyright 1999 Academic Press.

12C16O2 in Emission in the 4.5-µm Region: Transitions v1vl2v3 --> v1vl2(v3-1) with (2v1 + v2) = 6 Occurring between Highly Excited Vibrational States

Eight emission spectra of CO2 + N2 mixtures excited by dc discharge were recorded using a Fourier Transform Spectrometer (Bruker Spectrometer 120HR) with a resolution of 0.003 cm-1 in the 4.5-µm region. Results (wavenumbers, band centers, spectroscopic constants) concerning 13 new vibrational transitions which have not been observed earlier and which occur between highly excited levels (hence their very small population) are reported. The derived spectroscopic parameters allow the reproduction of the experimental wavenumbers with a RMS < 3 x 10(-4) cm-1. Copyright 1998 Academic Press.

CO2 Emission in the 4-µm Region

From spectra recorded at a resolution of 0.020 cm-1 of the flame CH4 + O2 at low pressure, six new vibrational transitions in Deltav3 = 1 with 2v1 + v2 = 5 had been recently identified [D. Bailly et al., J. Mol. Spectrosc. 182, 10-17 (1996)] based on the HITRAN 92 predictions. New calculations have shown good consistency with our assignments except for one transition, namely, (21(1)1)3e --> (21(1)0)3e for which discrepancies (reaching 0.2 cm-1) were found. It has been possible to resolve this issue using new emission spectra of CO2, vibrationally excited by active nitrogen and recorded with a Fourier transform spectrometer at a resolution of 6.3 x 10(-3) cm-1 in the 4-5 µm spectral region. Copyright 1998 Academic Press.

Epidemiologic study of sleep quality and troubles in French secondary school adolescents

BACKGROUND

The purpose of the study was to assess the prevalence and correlates of sleep problems in adolescents.

METHODS

A total of 763 students chosen at random among the 15 secondary schools of a French département were given a self-report questionnaire.

RESULTS

As much as 40.8% reported at least one of the five sleep disturbances we studied including difficulties falling asleep and staying asleep, a need for more sleep, early awakenings, and chronic sleeping pill intake. These sleep problems were highly related to various personal and family disorders. Discriminant analysis for categorical data pointed to a consistent but not significant descriptive profile accounting for sleep problems in these students. Suicide, weight concerns, and stimulant abuse were the most informative personal correlates as parts of this profile.

CONCLUSION

These findings suggest that the complaint of poor sleep should be regarded with special care in adolescents as a possibly meaningful and sensitive sign of severe family or personal disruption.