[What's today's view of manic-depressive disease in children?].
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Biomedical subjects
Publications and source records attributed to O Halfon.
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A new type of anxiety state has recently been identified: the panic attack. This condition is qualitatively distinct from other anxiety disturbances and its treatment is different. Sodium lactate seems to play an essential role in the triggering of panic attacks through the intermediary of catabolic, physicochemical mechanisms or by alteration of adrenergic neurotransmission. Anxiety may be autonomised into two sub-groups, based on the effects of psychotropic drugs: phobic and anxiety states. The presence or absence of panic attacks is essential as it has diagnostic and therapeutic implications: M.A.D.I. or tricyclic antidepressors have a specific action on panic attacks but are ineffective on anticipatory, chronic, phobic or other forms of anxiety. Which are improved by benzodiazepines which; themselves, have very little effect on panic attacks.
Anxiety has been the object of many therapeutic attempts, often in the absence of well-founded indications and often yielding inconclusive results. We obtained good results in two adolescents for whom we used a new classification system based upon the differential action of psychotropic drugs on anxiety. More specifically, this approach singled out the panic disorder by demonstrating that patients with this disorder react specifically to antidepressant drugs. More extensive studies are clearly needed to confirm that these results, well established for adult patients, also apply to an adolescent population.
The efficacy of mianserin in treating adult depression is now well established. Since there are no publications concerning the use of mianserin in children, the authors set up an open pilot study of 110 depressed children and adolescents aged 8-19 years. The average dose of mianserin was 1 mg/kg/day. Efficacy of treatment was noticeable by the end of the first week and was maintained throughout the 60 day study period. Evaluation was based on both clinical observations and changes in scores obtained from 80 subjects. Side-effects were minimal leading to temporary withdrawal of treatment in only seven cases. The profile of mianserin in children and adolescents is similar to that of adults. It is an antidepressant with an anxiolytic component, and has a regulating effect on sleep. In view of its efficacy, compliance, and the very low incidence of side-effects, mianserin appears to be a useful treatment for depression in children and adolescents. The results of this open study justify the development of further controlled studies.
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The present prospective study, with a five-year follow-up, presents an extensive psychiatric and educational assessment of an adolescent population (N = 30) in the age range 14-20, suffering from several psychiatric disorders, though apt to follow a normal academic program. The residential settings where the study took place provide both psychiatric and schooling facilities. In this environment, what is the effectiveness of long-term hospitalization? Are there any criteria for predicting results? After discharge, could social adjustments difficulties be prevented? Assessment instruments are described and the results of one preliminary study are presented. The actual data seems to confirm the impact of the special treatment facilities combining schooling and psychiatric settings on the long term outcome of adolescents.
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