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The concept of autism has led to the inclusion of increasingly heterogeneous and atypical individuals. Clinicians find it difficult to establish clear boundaries between autism, other psychiatric and/or neurodevelopmental disorders and atypical individuals, despite standardized instruments. What's more, these standardized instruments have been built around the male phenotype, and do not allow for an accurate assessment of autism in women. Whatever the gender, the diagnosis is based on multiple, variable, disabling and persistent deficits. Finally, we'll mention a few recommendations to help clinicians make a diagnosis or invoke the precautionary principle., Competing Interests: les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

This article explores the overlap of symptoms between autism and attachment difficulties in adulthood. Clinicians express difficulties in differentiating between these conditions contributing to misdiagnosis. Distinguishing autism spectrum behaviors from behaviors relating to disorganized attachment can be challenging. Urgency is added by the fact that the number of cases is increasing in the diagnosis of autism spectrum disorder (ASD). It is becoming increasingly recognized that ASD shares phenotypic similarities with other traditionally distinct developmental conditions. This article aims enhance the clinicians' critical reasoning regarding the patient's behavior to distinguish if its autism or attachment-related behavior disorders. For us, the clearest differentiation factor seemed to be the nature of the behavior., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder associating persistent communication and social interaction deficits with behaviors, interests or activities of a restricted and repetitive nature. The etiology of ASD is not yet fully understood but appears to be multifactorial, including both genetic and environmental factors. The concept of autism underwent a major evolution before arriving at the current definition in DSM-5. The diagnosis has two parts: a categorical from cut-off and differential diagnosis established from a specification of the category by dimensional variables (intelligence, language, associated diseases, adaptation). These two parts (categorical diagnosis and specifiers) are complementary but pose a certain number of practical problems in establishing the diagnosis in adulthood., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

A significant number of individuals with intellectual disability also display serious behavioral problems. We believe that improving the care and medical treatment for this population is essential because there is a great disparity in care between these individuals and the general population. This article elaborates a little guideline in the mental health., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Introduction: Anhedonia is defined as a diminished capacity to experience pleasant emotion and is commonly included among the negative symptoms of schizophrenia. However, if patients report experiencing a lower level of pleasure than controls, they report experiencing as much pleasure as controls with online measurements of emotion., Objective: The Temporal Experience of Pleasure Scale (TEPS) measures pleasure experienced in the moment and in anticipation of future activities. The TEPS is an 18-item self-report measurement of anticipatory (10 items) and consummatory (eight items) pleasure. The goal of this paper is to assess the psychometric characteristics of the French translation of this scale., Methods: A control sample was composed of 60 women and 22 men, with a mean age of 38.1 years (S.D.: 10.8). Thirty-six were without qualification and 46 with qualified professional diploma. A sample of 21 patients meeting DSM IV-TR criteria for schizophrenia was recruited among the community psychiatry service of the department of psychiatry in Lausanne. They were five women and 16 men; mean age was of 34.1 years (S.D.: 7.5). Ten obtained a professional qualification and 11 were without qualification. None worked in competitive employment. Their mean dose of chlorpromazine equivalent was 431 mg (S.D.: 259). All patients were on atypical antipsychotics. The control sample fulfilled the TEPS and the Physical Anhedonia Scale (PAS). The patient sample fulfilled the TEPS and was independently rated on the Calgary Depression Scale and the Scale for Assessment of Negative Symptoms. For comparison with controls, patients were matched on age, sex and professional qualification. This required the supplementary recruitment of two control subjects., Results: Results with the control sample indicate that the TEPS presents an acceptable internal validity with Crombach alphas of 0.84 for the total scale, 0.74 for the anticipatory pleasure scale and 0.79 for the consummatory pleasure scale. The confirmatory factor analysis indicated that the model is well adapted to our data (chi(2)/dl=1.333; df=134; p<0.0006; root mean square residual, RMSEA=0.064). External validity measured with the PAS showed R=-0.27 (p<0.05) for the consummatory scale and R=-0.26 for the total score. Comparisons between patients and matched controls indicated that patients were significantly lower than control on anticipatory pleasure (t=2.7, df(40), 2-tailed p=0.01; cohen's d=0.83) and on total score of the TEPS (t=2.8, df (40), 2-tailed p=0.01; cohen's d=0.87). The two samples did not differ on consummatory pleasure. The anticipatory pleasure factor and the total TEPS showed significant negative correlation with the SANS anhedonia, respectively R=-0.78 (p<0.01) for the anticipatory factor and R=-0.61 (p<0.01) for the total TEPS. There was also a negative correlation between the anticipatory factor and the SANS avolition of R=-0.50 (p<0.05). These correlations were maintained, with partial correlations controlling for depression and chlorpromazine equivalents., Conclusion: The results of this validation show that the French version of the TEPS has psychometric characteristics similar to the original version. These results highlight the discrepancy between results of direct or indirect report of experienced pleasure in patients with schizophrenia. Patients may have difficulties in anticipating the pleasure of future enjoyable activities, but not in experiencing pleasure once in an enjoyable activity. Medication and depression do not seems to modify our results, but this should be better controlled in a longitudinal study. The anticipatory versus consummatory pleasure distinction appears to be useful for the development of new psychosocial interventions, tailored to improve desire in patients suffering from schizophrenia. Major limitations of the study are the small size of patient sample and the under representation of men in the control sample.

In the canton de Vaud (Switzerland) the psychiatric units devoted to mental retardation have been suppressed during the deinstitutionalization process in the 1970/80s. However, the use of psychiatric hospitalizations has increased these last years. This increase is accompanied by an interdiction of seclusion and restraint outside of the specialized psychiatric unit. A unit of liaison psychiatry has been created as an alternative to psychiatric hospitalization and to assist directly the staff of specialized institutions for people with mental retardation or the family of the patient. The article describes the challenges of liaison psychiatry in this field and the potential benefits of research for the psychiatry of mental retardation.