La sante mentale est une composante essentielle de la sante humaine. Uneproportion non negligeable d’enfants et d’adolescents (environ 12 % enFrance) souffrent de troubles mentaux, c’est-a-dire de troubles de certaines deleurs activites mentales, qui interferent avec leur developpement, freinentleurs apprentissages scolaires et compromettent leur devenir par une repercussionsur la qualite de vie au quotidien.D’apres l’Organisation mondiale de la sante, les troubles mentaux devraientaugmenter de 50 % en 2020, devenant sur le plan international l’une des cinqprincipales causes de morbidite chez l’enfant. Cet accroissement est evoquecomme la crise du XXIe siecle.Les demandes de traitement en pedopsychiatrie sont frequemment tardives,alors qu’une prise en charge precoce semble essentielle pour le pronostic. Ilapparait donc necessaire d’apprendre a reconnaitre le plus tot possible lestroubles chez les enfants, dans les differents lieux qui les accueillent.La Canam (Caisse nationale d’assurance maladie des professions independantes)a souhaite interroger l’Inserm, a travers la procedure d’expertise collective,pour degager les elements permettant d’ameliorer le depistage et laprevention des troubles mentaux chez l’enfant et l’adolescent, a partir desdonnees validees au niveau international. Compte tenu de l’ampleur du sujet,l’Inserm a, en accord avec le demandeur, oriente l’expertise vers les troublessemblant les mieux deﬁnis dans la litterature : autisme, hyperactivite, troublesobsessionnels compulsifs, troubles anxieux, troubles de l’humeur, troubles ducomportement alimentaire, schizophrenie. Les troubles des conduites, quirepresentent une part importante des troubles mentaux, n’ont pas ete pris enconsideration car ils seront abordes dans d’autres travaux d’expertise collective.Ainsi, cette expertise ne pretend pas aborder la globalite de la pratiqueclinique en psychiatrie de l’enfant et de l’adolescent.Pour repondre aux objectifs deﬁnis, l’Inserm a mis en place un groupe d’expertsrassemblant un large eventail de competences medicales et scientiﬁquespour prendre en charge les differents aspects transversaux du sujet traite(epidemiologie descriptive et analytique, neurobiologie, imagerie, cognition,psychiatrie clinique, psychologie) ainsi que pour faire l’analyse critique destravaux realises sur le plan international dans le domaine du depistage et de laprevention des differents troubles mentaux retenus pour cette expertise.Le groupe a structure son analyse autour des questions suivantes :• Quelles sont les donnees de prevalence des differents troubles mentaux chezl’enfant et l’adolescent, en particulier en France ? • Quels sont les differents facteurs de risque ? Quel est l’impact des complicationsperinatales sur le developpement de troubles mentaux ? Quel est le rolede l’environnement familial et social dans le developpement normal et pathologiquede l’enfant ?• Quelles sont les donnees actuelles en epidemiologie genetique sur les facteursde risque hereditaires ? Quels sont les resultats des travaux en genetiquemoleculaire sur les genes susceptibles d’etre impliques ?• Quelles sont les donnees en neurobiologie sur le developpement du systemenerveux central et les interactions genes-environnement dans ce developpement?• Quels sont les donnees recentes en neurosciences cognitives et l’apport destechniques d’imagerie ?• Quels sont les signes d’appel des pathologies retenues dans cette expertise :autisme, hyperactivite, troubles obsessionnels compulsifs, troubles anxieux,troubles de l’humeur, troubles des conduites alimentaires, schizophrenie ?• Quels sont les outils disponibles pour un reperage des troubles en populationgenerale ? Quels sont les moyens de prevention actuellement evalues ?L’interrogation des bases de donnees (Medline, Pascal, PsycINFO, ExcerptaMedica) a conduit a selectionner pres de 3 000 articles.Au cours de treize seances de travail organisees entre les mois de mai 2000 etseptembre 2001, les experts ont presente une analyse critique et une synthesedes travaux publies au plan international sur les troubles mentaux de l’enfantet de l’adolescent. Les toutes dernieres seances ont ete consacrees a l’elaborationdes principales conclusions et des recommandations. En ﬁn d’ouvrage, lescommunications abordent differents aspects du suivi de la sante mentale del’enfant et de l’adolescent, en France comme a l’etranger.

https://hal-lara.archives-ouvertes.fr/hal-01570673/document

Troubles mentaux : dépistage et prévention chez l'enfant et l'adolescent

Superior temporal gyrus differences in childhood-onset schizophrenia

Categorical disease models of personality disorder currently dominate in the DSM-IV-TR and ICD-10 diagnostic systems. In preparation for DSM-V, these models have been questioned in light of evidence and widely held beliefs that disorders of personality are extreme variants of normal personality. Unfortunately, problems arise in trying to produce a dimensional model of abnormal and normal personality, such as how aspects of normal personality can be applied to personality disorders, and the all-important issue of precisely what aspect of normal personality is overextended in these disorders. In contrast to other approaches, a dimensional model based on defense mechanisms is easily applied to personality disorders, eliminates the need for complex scales, retains the notion of entities with which clinicians are familiar, provide useful therapeutic strategies, and clearly specify what aspect of normal personality is overextended. It also allows for the addition of new personality disorders.

Personality disorders: a dimensional defense mechanism approach.

A cognitive regulatory control model of schizophrenia.

The invention relates to polynucleotides of the PAPAP gene, polypeptides encoded by the PAPAP gene, and antibodies directed specifically against such polypeptides. The invention also concerns methods for the treatment or diagnosis of schizophrenia, bipolar disorder or related CNS disorder. The invention also concerns the interaction of PAPAP with schizophrenia candidate gene g34872.

Schizophrenia related protein

Schizophrenia has the quality of a 'top-down' disorder with perturbation of self, and malattuned appraisal of basic experience of the outside world, and of intentionality. There is dissonance between the faculties of consciousness. The neuronal cortical network displays distributed activation of the sensory cortices during perception, and retroactivation during recall. This multimodal organization is sensitive to aberrations of structure and informational content during the metabolically dynamic phases of expansion and pruning in childhood and adolescence. There is substantial evidence of deviant function of the cortical network in schizophrenia. This includes increased neuronal density, reduced prefrontal capacity for activation, impaired fronto-temporal interaction during language production, defect monitoring of inner speech, activation of secondary sensory cortices during hallucinations, reduced cortical and thalamic volume, reduced thalamic activation (filtering) and sensitization of dopaminergic modulation. As a hypothesis the cortical defects lead to secondary causation of abnormalities at the levels of neuroplasticity, symptomatology and social competence. Suggestions for empirical testing are presented for the hypothesis that neocortical defects are primary, thalamic defects secondary and dopaminergic aberrations tertiary in the schizophrenic process. This testing of hypotheses involves prospective studies of patient groups at various ages of onset, as well as comparison of neurobiological measures in remitting vs. treatment-resistant cases.

Cortical brain dysfunction in early schizophrenia: secondary pathogenetic hierarchy of neuroplasticity, psychopathology and social impairment

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Cortical brain dysfunction in early schizophrenia: secondary pathogenetic hierarchy of neuroplasticity, psychopathology and social impairment