Multimodal treatment for attention deficit hyperactivity disorder?
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Biomedical subjects
Publications and source records attributed to H Chabrol.
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Comparative studies of psychoanalytical and cognitive approaches to psychotherapy for borderline personalities reveal not only convergences of opinion, particularly concerning the importance of the relationship with the therapist, but also noteworthy differences. Different types of cognitive therapy are to be distinguished by their highly structural nature and by the learning of cognitive capacity with a view to reducing the severity of emotional and behavioral disorders. The different types of analytical therapy attempt a reorganisation of the personality by referring to a complex psychopathological model, allowing an overview of mental functions and of transferral interaction, and attempt to modify them.
The diagnosis of personality disorders is particularly difficult in childhood and requires prolonged psychiatric evaluation. Authors focus discussion upon the diagnosis of borderline and narcissistic personality disorders in children. Although Misès recently favours the term child borderline pathologies covering all personality disorders other than psychosis or neurosis, the american school of psychiatry tends to separate different personality disorders according to DSM-IV diagnosis propositions. The results of rare prospective studies suggest a pathological continuum which remains within the sphere of personality disorders. Further research is in fact necessary to determine the specific evolutive profiles of each personality disorder.
Cognitive behavioral approaches of adolescent drug abuse participate in the understanding of their complex determinisms. Some of their therapeutic methods may be an useful component of a multimodal therapy which is often necessary because of the multiplicity of pathogenic factors and dysfunctions. The preferential use of cognitive behavioral therapies seems to be group therapies or an auxiliary therapy which carried the supportive work. The systemic approach may help to minimize resistances, to mobilize the family, to induce positive changes which strengthen the therapeutic alliance which may be used secondarily for a psychoanalytical approach of family conflicts.
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DSM-IV and ICD-10 show the convergence of international nomenclatures of psychotic disorders. Their emphasis on antheorism and the definition of operational diagnostic criteria converge with one major trend in traditional French psychiatry which has been illustrated by Chaslin. The principal discrepancy which concerns chronic hallucinatory psychosis has been reduced by the restrictive conception of schizophrenic disorders in DSM-IV and ICD-10. Despite the attempt to define French empirical criteria, chronic hallucinatory psychosis has not been accepted by international classifications and is in pronounced decline in French scientific works. On the other had, the "bouffées délirantes aiguës", taken up by ICD-10, are acknowledged internationally.
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Nowadays the diagnosis of depression can be made through two neuroendocrine tests, which tend to become common: the TRH test and the Dexamethasone Suppression Test which have a wide diagnostic accuracy. Any abnormal finding could implicate a dysfunction of neurotransmitter systems. They are of diagnostic assistance in endogenous depressions supposed to be responsive to antidepressants. They might also be a practical monitor of treatment response since the test results reverting to normal seems to indicate recovery whereas persisting abnormal results are a possible predictor of relapse.
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