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Results of recent studies in pharmacotherapy in autism are presented. Haloperidol, fenfluramine and naltrexone have been the most extensively studied drugs in systematic research. Haloperidol appeared to decrease levels of hyperactivity, stereotypies, emotional lability but also abnormal object relations and social withdrawal. However, the therapeutic effect was generally modest and long term administration was associated with dyskinesias in autistic children. The frequent hyperserotonemia in autism has suggested the use of fenfluramine, an antiserotoninergic agent. Although the initial reports were optimistic, more recent carefully designed studies often failed to show that fenfluramine was superior to placebo. Naltrexone, a potent opiate antagonist, was explored following the opioid hypothesis based on the similarity between autistic symptomatology and abnormal behaviors observed in opiate addicts and in laboratory animals administered opiates and on the abnormalities of endogenous opioids that exit in a subgroup of autistic children. However, the current studies do not concur and no definite conclusions can be made of the efficacy of naltrexone at present time. Low doses of amisulpride which have been shown to improve negative symptoms in schizophrenia and serotoninergic antidepressants, which have proven effective in repetitive and ritualized behaviors, have recently began to be evaluated in controlled studies. At present time, no medication has shown to alter the course or the symptoms of autism, but some seem to be effective in reducing severe aberrant behaviors.

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.

The author report a case of Capgras' syndrome in a 12-years-old girl, who had been hospitalized for attacks of abdominal pain. These symptoms had gone on for two years and led twice to surgical interventions which did not find any organic etiology. Interviews with the girl showed that the abdominal pains were related to symptoms of typical panic attacks which lasted about 20 minutes. In some on them, she experienced multiple autoscopy and the "illusion des sosies", described by Capgras. Long-term evolution showed that Capgras' syndrome disappeared with improvement of the panic attacks, but ten years later the patient is still suffering from generalized anxiety. To our knowledge, no case, even in adult patients, was previously described in the context of panic attacks. Furthermore, Capgras' syndrome is particularly rare at adolescence. Our review of literature exhibits only 19 cases under 18. Diagnosis was available in 16 cases, and consisted of schizophrenia or schizophreniform psychosis in 62.5% of the cases. The others involved acute psychosis (2 cases), post-partum psychosis (1 case), drug-induced-psychosis (1 case), psychotic major depression (1 case), and post-varicella encephalitis (1 case). The doubles (out of the 15 cases where relevant detail is available) included at least a parent in 92.9% of patients, a brother or sister in 35.7%, a member of the medical team in 21.4% and a grand-parent in 14.3%.

Severe forms of separation anxiety disorder with school refusal can be difficult to treat: on the one hand the resistance to outpatient treatment is usual, on the other hand, fear of separation is so overwhelming that hospitalization can be seen as too dramatic. We suggest hospitalizing the child with his or her father as fear of separation with the mother is usually the main problem. We report a case study of a 13 year old child with separation anxiety disorder who refused to go to school and to be separated from his mother. Treatment consisted of hospitalizing the child with his father and to gradually restore his autonomy. The father was given the role of a co-therapist: the main therapeutic decisions about graduated exposure to separation were taken after discussion with the father who passed them on to the child. These structuring interventions re-established the father's control which helped to sedate the child's anxiety.

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.

Psychological and physical signs traditionally considered as indicators of conversion disorder had never been confirmed through empirical data. Nineteen of these signs were sought in 40 patients with proved neurological disorder and in 15 patients with conversion disorder. All neurological patients but one showed at least one of these signs and most presented several signs. All the signs but one were as frequent in neurological patients as in patients with conversion disorder. These signs are lacking specificity. Even when several signs are present, this finding has no diagnostic specificity.

Regional cerebral blood flow (r CBF) was compared in ten adolescents with hebephrenia who were never treated with neuroleptics and ten normal controls using the Xenon 133 inhalation method. There were no differences in mean hemispheric blood flow. The main difference was the loss of the "hyperfrontal pattern" in the schizophrenics: the prefrontal values were only 0.7% greater than the blood flow in the rest of the hemisphere, compared with 14.6% in the controls.

Regional cerebral blood flow was compared in twenty depressed adolescents and ten normal controls using the Xenon 133 inhalation method. There were no differences in mean hemispheric blood flow. The main difference was the loss of the "hyperfrontal distribution" in the depressed adolescents: the prefrontal values were only 5.4% greater than the blood flow in the rest of the hemisphere, compared with 13.5% in the controls.

Thyroid-stimulating hormone (TSH) and triiodothyronine (T3) responses to thyrotropin-releasing hormone (TRH) were compared in sixty depressed adolescents and sixty normal controls. A significant difference was found for baseline and peak values of T3 and TSH levels. There was no correlation between TSH blunting and DSM III categories of depression.

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.