Effectiveness of an emotion focused cognitive-behavioral therapy (ECBT) program for externalizing disorders in children and adolescents : clinical profile

Introduction

Externalizing disorders involve undercontrolled, impulsive, or aggressive behavior. Included in this category are Conduct Disorder, Oppositional Defiant Disorder, and Attention deficit hyperactivity. Difficulties with emotion regulation are a core feature of externalizing disorders in children and adolescents. Yet, no studies to date have compared the relative efficacy of an ECBT program in this population.

Objectives

to investigate the effectiveness of an ECBT inspired program in children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD), Conduct Disorder (CD) and Oppositional Defiant Disorder (ODD)

Methods

We conducted an experimental study with a pretest posttest design and a control group. 50 subjects with either ADHD, ODD or CD were selected and assigned to the experimental and control group. 25 patients ages 9–18 (13 boys, 12 girls) were enrolled in the ECBT-inspired program with 19 completing treatment. Comparison of pre- and post-test results for each sub-group was performed using the Wilcoxon test.

Results

showed that youths in the ADHD and ODD groups demonstrated a significant reduction in externalizing behavior problems measured by the Child Behavior Checklist (CBCL). In terms of emotional regulation, only the group of patients with ODD showed a significant improvement in the cognitive reappraisal subscale of the emotional regulation questionnaire(ERQ- CA ). Only in the ODD group, significant improvement was found in the identification and external oriented thniking subscale scores of the alexithymia questionnaire for children (AQC).

Conclusions

Such comparisons are necessary to determine the clinical profile of patients who might most benefit from such an intervention.

Disclosure

No significant relationships.

Emotion-focused Cognitive-Behavioral Therapy for externalizing disorders in children and adolescents : an attempt to resolve emotion regulation difficulties

Introduction

Deficient emotion regulation is a common and impairing area of difficulty among children and adolescents with externalizing disorders. Emotion focused cognitive behavioral therapy ECBT is a form of CBT that is suggested to be employed to improve dysregulation of anxiety and other kind of emotions in anxious youth.

Objectives

Examine the efficacy of an Emotion-focused Cognitive-Behavioral Therapy (ECBT) inspired program on emotional regulation difficulties and behavioral problems in children and adolescents with externalizing disorders

Methods

We conducted a cross-sectional comparative experimental study. Subjects were 50 patients exhibiting behavioral disorders aged 9 to 18 years , with a diagnosis of attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD).Participants were assigned to ECBT and control groups. ECBT group contributed in 12-h weekly sessions within ECBT-inspired program. The control group received standard care. To assess emotion-related competencies, children were administered the emotion regulation questionnaire (ERQ-CA) and the alexithymia questionnaire for children(AQC). Parents completed the Child Behavior Checklist(CBCL) to measure youth externalizing problems. Tests were administered in pre- and post-test to all subjects. Both groups were matched for age, sex and educationnal level. Comparison of pre- and post-test results was performed using the Student’s t-test.

Results

ECBT demonstrated a significant difference in the reduction of behavioral problems. ECBT effectively increased adaptive emotion regulation strategies (cognitive reappraisal) in the post-test. ECBT also reduced alexithymia scores, particularly difficulty identifying feelings, and externally oriented thinking.

Conclusions

ECBT demonstrated promising initial effectiveness in addressing emotion regulation deficits of children with externalizing behaviors

Disclosure

No significant relationships.

Clinical features of bipolar disorder in adolescents with intellectual disability

Introduction

Bipolar disorder in children and adolescents is distinguished by a variable and complex clinical expression. Mood is difficult to assess, mood symptoms are often masked and signs of disorganization may be in the limelight. This can be more difficult when adolescents have intellectual disability (ID).

Objectives

This work aims to describe diagnostical and therapeutical features of bipolar disorder in adolescents with ID.

Methods

Case reports about five patients who have been diagnosed with bipolar disorder associated to ID, all seen and treated in child and adolescent psychiatry department of Razi Hospital, in Tunis.

Results

The study focused on three girls and two boys, all with mild to moderate ID. Four patients had psychiatric family history of bipolar disorder and ID. Only one patient was followed since childhood for mixed ADHD. The average age of onset of bipolar disorder was 14 years. Four cases were inaugurated by manic access; the fifth was a depressive disorder followed by a manic shift under sertraline. Only one case was rapidly favorable, under 10mg of Olanzapine, without any recurrence or relapse during 18 months of follow-up. Another case was slower but also favorable, under 10mg of Olanzapine. We found resistance to usual treatments for 2 patients; these did not evolve well under conventional thymoregulators, or different antipsychotic molecules, nor with combinations of two thymoregulators + an antipsychotic. One of them benefited from a combination of clozapine and lithium with excellent response.

Conclusions

Bipolar disorder comorbid with ID in adolescents is a difficult diagnostic entity and particularly hard to manage.

Disclosure

No significant relationships.

[Anxiety disorders in type 1 neurofibromatosis: A case report]

BACKGROUND

Neurofibromatosis type 1 (NF1), also known as Von Recklinghausen disease, is one of the most frequent human genetic diseases, with a prevalence of one case in 3000 births, an autosomal dominant mode of inheritance, and a high rate of new mutations. NF1 has markedly variable clinical expression, with manifestations ranging from mild lesions to several complications and functional impairment. The complications are age-specific. Psychiatric disorders are more frequent in NF1 than in the general population, especially in children. They include dysthymia, depressive mood, anxiety, and personality disorders. Bipolar mood disorders or schizophrenia are rather rare. The majority of studies have focused on physical health and neurocognitive function in NF1, whereas psychiatric disorders associated with this disease remain unclear and poorly documented. This report is based on a clinical case and discusses the relationship between neurofibromatosis type 1 and psychiatric disorders, particularly anxiety disorders.

PRESENTATION OF CASE

This case concerns a 13-year-old girl, the first child of healthy and non-consanguineous parents. The patient's history showed normal psychomotor and psychoaffective development. Her father and paternal grandmother had isolated café-au-lait spots. In June 2013, a subcutaneous mass appeared in her right thigh. She consulted a neurologist and was explored. The physical examination revealed signs of NF1. She had café-au-lait spots on the trunk and extremities, and a neurofibroma in the right thigh. Bilateral ophthalmic examination revealed multiple Lish nodules. After 1 month, a psychiatric consultation was requested for sad mood and night terrors. Obsessive compulsive disorder and generalized anxiety disorder were diagnosed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition.

CONCLUSIONS

The current psychiatric literature does not provide full explanations of anxiety symptoms associated with NF1. Some authors have tried to explain the link between NF1 and psychiatric disorders, and several etiopathogenic hypotheses have been discussed. In our case, a concomitant diagnosis of NF1 and anxiety disorders was made at the age of 13. However, anxiety symptoms started to appear before age 4; they increased gradually and occupied the foreground. This would strengthen the hypothesis of genetic determinism in NF1 patients. The question that arises is: is it a fortuitous association of psychiatric disorders and NF1 or are they psychiatric manifestations induced by a multisystem disease? More detailed investigations are necessary to clarify the etiopathogenic and psychopathological mechanisms that would cause psychiatric comorbidity associated with NF1.

Effects of exogenous salicylic acid pre-treatment on cadmium toxicity and leaf lipid content in Linum usitatissimum L

The effects of salicylic acid (SA) on cadmium (Cd) toxicity in flax plants were studied by investigating plant growth, lipid peroxidation and fatty acid composition. Cadmium inhibited biomass production as well as the absorption of K, Ca, Mg and Fe. Furthermore, it dramatically increased Cd accumulation in both roots and shoots. The pre-soaking of dry flax grains in SA-containing solutions partially protected seedlings from Cd toxicity during the following growth period. SA treatment decreased the uptake and the transport of Cd, alleviated the Cd-induced inhibition of Ca, Mg and Fe absorption and promoted plant growth. At leaf level, Cd significantly decreased both total lipid (TL) and chlorophyll (Chl) content and enhanced electrolyte leakage and lipid peroxidation as indicated by malondialdehyde (MDA) accumulation. Concomitantly, Cd caused a shift in fatty acid composition, resulting in a lower degree of their unsaturation. SA pre-soaking ameliorated the increased electrolyte leakage as well as Chl, MDA and TL content. SA particularly increased the percentage of linolenic acid and lowered that of palmitic acid by the same proportion. These results suggest that SA could be used as a potential growth regulator and a stabilizer of membrane integrity to improve plant resistance to Cd stress.