Papers by arnaud fernandez
Indian Journal of Pediatrics
nor in subgroup analyses according to age, sex, and reason for admission (χ² = 13.270; p = 0.348)... more nor in subgroup analyses according to age, sex, and reason for admission (χ² = 13.270; p = 0.348). The current trend in the management of psychiatric disorders in the emergency setting is to recognize the irrelevance of routine biological testing, increasing both the length of stay in the emergency department or hospital and the financial burden of unnecessary biological testing [3]. Moreover, Leo et al., followed the evolution of biological dysthyroidism in their adolescent inpatient population and emphasized that without treatment, most of the tests returned to normal, and none required drug treatment, given the absence of specific physical signs [4]. If our results are confirmed, the clinical approach will no longer be based on routine TSH testing but rather on a target test based on clinical signs.
L'Encéphale, 2022
Several studies have shown that in young children, behavioural and/or emotional disorders are mor... more Several studies have shown that in young children, behavioural and/or emotional disorders are more difficult to manage than regulatory disorders. Moreover, data are lacking on outcome predictive factors. This article presents a short synthesis of previous research about outcome predictive factors in child psychiatry. It also describes the protocol of a longitudinal observational European multicentre study the main objective of which was to identify predictive factors of behavioural and emotional disorder outcome in toddlers after parent-child psychotherapy. The secondary objectives were to study predictive factors of the outcome in parents (anxiety/depression symptoms) and parent-child relationship. In order to highlight medium-effect size, 255 toddlers (age: 18 to 48 months) needed to be included. Outcomes will be assessed by comparing the pre- and post-therapy scores of a battery of questionnaires that assess the child's symptoms, the parents' anxiety/depression, and the parent-child relationship. Multivariate linear regression analysis will be used to identify predictive factors of the outcome among the studied variables (child age and sex, socio-economic status, life events, disorder type, intensity and duration, social support, parents' psychopathology, parents' attachment, parent-child relationships, therapy length and frequency, father's involvement in the therapy, and therapeutic alliance). This study should allow identifying some of the factors that contribute to the outcome of externalizing and internalizing disorders, and distinguishing between pre-existing and treatment-related variables. It should also help to identify children at higher risk of poor outcome who require special vigilance on the part of the therapist. It should confirm the importance of therapeutic alliance. ID-RCB 2008-A01088-47.
Indian Journal of Pediatrics
In agreement with Aamir et al., and taking into account that the child's anxiety is modulated by ... more In agreement with Aamir et al., and taking into account that the child's anxiety is modulated by the parents' anxiety [1], it seems necessary to consider involving parents in specific care programs in order to reduce their stress during their children's care, especially in case of child's intubation [2]. Such a goal required from us to structure psychological and psychiatric interventions in the PICU of Nice to establish an appropriate care pathway (from PICU to child/parents' home), with child psychiatrist/psychologist devoted to this activity.
Frontiers in Genetics
Early-Onset Schizophrenia (EOS) is a very rare mental disorder that is a form of schizophrenia oc... more Early-Onset Schizophrenia (EOS) is a very rare mental disorder that is a form of schizophrenia occurring before the age of 18. EOS is a brain disease marked by an early onset of positive and negative symptoms of psychosis that impact development and cognitive functioning. Clinical manifestations commonly include premorbid features of Autism Spectrum Disorder (ASD), attention deficits, Intellectual Disability (ID), neurodevelopmental delay, and behavioral disturbances. After the onset of psychotic symptoms, other neuropsychiatric comorbidities are also common, including obsessive-compulsive disorder, major depressive disorder, expressive and receptive language disorders, auditory processing, and executive functioning deficits. With the purpose to better gain insight into the genetic bases of this disorder, we developed a pilot project performing whole exome sequencing of nine trios affected by EOS, ASD, and mild ID. We carried out gene prioritization by combining multiple bioinformat...
The Canadian Journal of Psychiatry
Introduction: La schizophrénie très précoce (STP) est une forme rare (1/40000), grave et neurodév... more Introduction: La schizophrénie très précoce (STP) est une forme rare (1/40000), grave et neurodéveloppementale de schizophrénie débutant avant 13 ans. Les comorbidités et atteintes associées spécifiques des STP étant peu étudiées, l’objectif de notre étude a été de les évaluer sur le plan psychiatrique, neurodéveloppemental et somatique. Méthode: Il s’agit d’une étude ancillaire du protocole GenAuDiss. Un entretien psychiatrique standardisé (K-SADS-PL DSM5) et un bilan neuropsychologique (WISC-V/WAIS-IV) ont été effectués chez les patients atteints de STP ainsi qu’une anamnèse concernant la grossesse, la périnatalité, le développement, la biographie et les antécédents médicaux et psychiatriques, personnels et familiaux. Résultats: 20 sujets ont été inclus. L’âge moyen de début du trouble était de 8,90 ans (+/−2,30). Les comorbidités psychiatriques (DSM5) étaient le Trouble Déficitaire de l’Attention avec Hyperactivité (15/20 patients), les troubles anxieux (14/20) et le Trouble du S...
Frontiers in Psychiatry
The acute response after a terror attack may have a crucial impact on the physical and psychologi... more The acute response after a terror attack may have a crucial impact on the physical and psychological wellbeing of the victims. Preparedness of the professionals involved in the acute response is a key element to ensure effective interventions, and can be improved through trainings. Today in Europe there is a recognized lack of inter-professional and international trainings, which are important, among others, to respond to the needs and the rights of victims affected by a terrorist attack in another country than their home country. In this paper we report the perspectives of an expert panel composed by different categories of professionals on the possible role of interprofessional trainings provided remotely. The experts discussed the pertinence of remote trainings for professionals involved in the acute response of a terror attack, and highlighted their Strengths, Weaknesses, Opportunities and Threats (SWOT analysis). We concluded that, while remote trainings cannot replace in-perso...
Children
Background: The results of 12 h nighttime Cheneau–Toulouse–Munster (CTM) brace wear on adolescent... more Background: The results of 12 h nighttime Cheneau–Toulouse–Munster (CTM) brace wear on adolescent idiopathic scoliosis are poorly described. Objective: The main objective was to analyze the efficiency of 12 h nighttime CTM brace wear on adolescent idiopathic scoliosis. The secondary objective was to identify the factors influencing good results. Methods: One hundred and fifty consecutive patients treated between 2006 and 2017 were retrospectively analyzed with subgroup analysis for the main curve pattern (main thoracic or main lumbar). The inclusion criteria were evolutive scoliosis, 12 h nighttime CTM brace wear, Risser stages 0-1-2 at the time of the prescription, and Cobb angle below 45 degrees. Success was defined as no surgery, and the main curve Cobb angle (CA) progression ≤5°. The overcurve was defined as the proximal thoracic curve above the main thoracic and mid-thoracic above the main lumbar curves. A logistic regression model was built to assess the predictors of success....
Pharmaceuticals
Children and youth treated with antipsychotic drugs (APs) are particularly vulnerable to adverse ... more Children and youth treated with antipsychotic drugs (APs) are particularly vulnerable to adverse drug reactions (ADRs) and prone to poor treatment response. In particular, interindividual variations in drug exposure can result from differential metabolism of APs by cytochromes, subject to genetic polymorphism. CYP1A2 is pivotal in the metabolism of the APs olanzapine, clozapine, and loxapine, whose safety profile warrants caution. We aimed to shed some light on the pharmacogenetic profiles possibly associated with these drugs’ ADRs and loss of efficacy in children and youth. We conducted a systematic review relying on four databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 recommendations and checklist, with a quality assessment. Our research yielded 32 publications. The most frequent ADRs were weight gain and metabolic syndrome (18; 56.3%), followed by lack of therapeutic effect (8; 25%) and neurological ADRs (7; 21.8%). The ov...
European Journal of Psychotraumatology
Background The mass terrorist attack in Nice, France in July 2016 caused deaths and injuries in a... more Background The mass terrorist attack in Nice, France in July 2016 caused deaths and injuries in a local population, including children and adolescents. Within six months, the Nice Pediatric Psychotrauma Center was opened to provide mental health care to the pediatric population (0–18 years) who experienced traumatic events. Objectives To report clinical findings and provide considerations focusing on 1) Traumatic events; 2) Psychiatric diagnoses; 3) Needed care of pediatric population; 4) Recommendations based on the experience of Nice Pediatric Psychotrauma Center (NPPC). Methods In this retrospective study, we conducted quantitative and qualitative data collection and analysis of new and follow-up consultations, main and comorbid diagnoses, and the type of trauma (terrorist attack versus other potentially traumatic events). Ethics approval was obtained from the local Ethics committee. Results 866 children and adolescents were followed in the NPPC. A high number of children and ado...
Frontiers in Psychiatry, 2022
IntroductionCatatonia is a severe syndrome associated with a high proportion of underlying organi... more IntroductionCatatonia is a severe syndrome associated with a high proportion of underlying organic conditions including autoimmune encephalitis. The link between catatonia and psychiatric conditions such as mood disorders and schizophrenia spectrum disorders is well established while the causative effect of Post-Traumatic Stress Disorders and stress related disorders remains speculative.Case ReportHere we describe the clinical case of a 14-year-old female patient presenting to the Emergency Department of a Pediatric University Hospital with acute changes in behavior five days after a sexual abuse. Acute stress reaction was suspected. Afterwards she developed catatonic symptoms alternating from stupor to excitement, resistant to the usual treatment with benzodiazepines. The first line examinations (PE, MRI, EEG) were inconclusive. The final diagnosis of anti-NMDARE was made 22 days after her admission in a University Department of Child and Adolescent Psychiatry. Her state improved a...
Neuropsychiatrie de l'Enfance et de l'Adolescence, 2021
L’objectif de cet article est de présenter une revue de la littérature concernant les risques psy... more L’objectif de cet article est de présenter une revue de la littérature concernant les risques psychiatriques liées à la pandémie de la Covid 19, en population pédiatrique. Une revue de littérature a été réalisée sur la base de données Pubmed avec les mots clés : Covid 19, coronavirus, enfant, adolescent, santé mentale, conséquences psychiatriques et/ou psychologiques (Covid 19, Coronavirus, child, children, adolescent, mental health, psychiatric or psychological consequences). Nous présentons un état des lieux des recherches actuelles en fonction de trois facteurs : la crainte liée à la pandémie, les séquelles psychiques du confinement et les risques de traumatismes cumulatifs. Nous présenterons trois vignettes cliniques d’enfants ayant été suivi pendant la crise sanitaire suite au développement de symptômes liés à cette situation exceptionnelle. Nous terminerons par des perspectives sur la gestion de la crise sanitaire par les services de psychiatrie de l’enfant et de l’adolescent. The objective of this article is to present a literature review concerning the psychiatric consequences associated with the Covid 19 pandemic, in the pediatric population. This review is realized with Pubmed Database, using Covid 19, Coronavirus, child, children, adolescent, mental health, psychiatric or psychological consequences as keywords. We propose to present an inventory of current research based on three factors: fear linked to the pandemic, the consequences of the stay-at-home confinement, and the risks of cumulative trauma. We will present three clinical vignettes of children who were followed during the health crisis following the development of symptoms related to the health situation. We will end with some perspectives on the management of the health crisis by child and adolescent psychiatry services.
L'Encephale, 2021
OBJECTIVES Some patients in child and adolescent psychiatry present resistance to psychotropic dr... more OBJECTIVES Some patients in child and adolescent psychiatry present resistance to psychotropic drugs, often resulting in polytherapy, an increased risk of adverse events, and more frequent and longer hospitalisation. Psychotropic drugs are mainly metabolised in the liver, in particular by the CYP2D6 subunit of cytochrome P450. Anomalies such as a duplication of the CYP2D6 gene related to an ultra-rapid metaboliser phenotype has been described to be linked to clinical efficacy. However, little research has been done in child and adolescent psychiatry. METHODS A multi-centric cross-sectional study in the southeast of France explored the relation between pharmaco-resistance to psychotropic drugs and the prevalence of duplications or polymorphisms of CYP2D6 associated with an ultra-rapid phenotype in children and adolescents with severe mental health disease. RESULTS Twenty-two patients have been included. The presence of an ultra-rapid phenotype concerns one patient in our study. A sec...
International Journal of Emergency Medicine, 2021
We aimed to describe the epidemiology of all pediatric emergency department visits (focusing on m... more We aimed to describe the epidemiology of all pediatric emergency department visits (focusing on mental health-related visits versus total visits) at the University Children’s Hospital of Nice (France) from 1 January to 31 December 2020 (year of the COVID-19 pandemic) and to compare it with the earlier 3-year period. The increase in mental health-related visits (44.2%) that we observed, while total visits decreased (30.0%), suggests an impact of the pandemic on children’s and adolescents’ mental health.
American Journal of Medical Genetics Part A, 2021
Childhood‐Onset Schizophrenia (COS) is a very rare and severe psychiatric disorder defined by adu... more Childhood‐Onset Schizophrenia (COS) is a very rare and severe psychiatric disorder defined by adult schizophrenia symptoms occurring before the age of 13. We report a microduplication in the 10q26.3 region including part of the Inositol Polyphosphate‐5‐Phosphatase A (INPP5A) gene that segregates with Schizophrenia Spectrum Disorders (SSDs) in the family of a female patient affected by both COS and Autism Spectrum Disorder (ASD). Phenotyping and genotyping (including CGH‐array) were performed for mother, healthy sister, and affected child according to the GenAuDiss protocol (NCT02565524). The duplication size is 324 kb and is present in a patient with COS and in her mother with SSD, but not in the patient's healthy sister. INPP5A encodes a membrane‐associated 43 kDa type I inositol 1,4,5‐trisphosphate (InsP3) 5‐phosphatase. This protein is found both in mouse and human brains and we found that its Drosophila homologue 5PtaseI is specifically expressed in the central nervous syste...
European Child & Adolescent Psychiatry, 2021
In April 2020, the European Society for Child and Adolescent Psychiatry (ESCAP) Research Academy ... more In April 2020, the European Society for Child and Adolescent Psychiatry (ESCAP) Research Academy and the ESCAP Board launched the first questionnaire of the CovCAP longitudinal survey to estimate the impact of COVID-19 on child and adolescent psychiatry (CAP) services in Europe. In this brief report, we present the main findings from the second questionnaire of the survey, one year after the COVID-19 pandemic began to hit Europe (i.e., February/March 2021). While service delivery to patients and their families was affected in a major way (reported by 68%) at the beginning of the pandemic, the majority of respondents (59%) in this second survey only reported a minor impact on care delivery. The use of telemedicine remained widespread (91%) but the proportion of CAP services partially closed or transformed to accommodate COVID-19 patients (59% in 2020) dropped to 20%. On the other hand, the perceived impact on the mental health and psychopathology of children and adolescents dramatically increased from "medium" (> 50%) in 2020 to "strong" or "extreme" (80%) in 2021. Four nosographic entities were particularly impacted: suicidal crises, anxiety disorders, eating disorders and major depressive episodes. Accordingly, this was associated with a substantial increase in the number of referrals or requests for assessments (91% reported an increase in 2021 while 61% reported a decrease in 2020). Finally, heads of the CAP departments expressed strong concerns regarding the management of the long-term consequences of this crisis, especially regarding the provision of care in light of the perceived increase in referrals. Keywords COVID-19 • Child and adolescent psychiatry • Europe • Mental health • Children • Adolescents The COVID-19 pandemic and the measures taken to control its spread have wreaked havoc worldwide, resulting in more than 3 million deaths and forcing billions of people into isolation, profoundly affecting all aspects of daily life. Numerous studies have reported on the consequences of the COVID-19 crisis on mental health [1], but few have focused on children and adolescents [2, 3]. The members of the COVID-19 Child and Adolescent Psychiatry Consortium are mentioned in the Acknowledgments section.
PLOS ONE, 2020
Background Early-Onset Schizophrenia (EOS) is rare but severe mental health disorder in children ... more Background Early-Onset Schizophrenia (EOS) is rare but severe mental health disorder in children and adolescents. Diagnosis of schizophrenia before the age of 18 years remains complex and challenging, especially in young children. In France, there are no recent reliable epidemiological data about the prevalence of EOS. The present study evaluates the EOS rate in a target clinical population of children and adolescents in psychiatric and medico-social care centres in the SouthEast of France. Methods Psychiatric and medico-social centres for children and adolescent in the geographical area have been contacted, and after receiving their agreement to participate in the study, eligible patients corresponding to inclusion criteria were selected based on patients' medical records. Main inclusion criteria were age 7 to 17 years and intelligence quotient > 35. EOS categorical diagnosis was assessed by Kiddie-SADS Present and Lifetime psychosis section. Results 37 centres participated and 302 subjects have been included in the study. The main result was the categorical diagnosis of EOS in 27 subjects, corresponding to a rate of 8.9% in the study population. Half of the patients presented mild to moderate intellectual deficiency. Interestingly, only 2.3% had a diagnosis of schizophrenia spectrum disorder noted in their medical records before standardized assessment.
French Journal of Psychiatry, 2019
Introduction La prescription de psychotropes en psychiatrie de l’enfant et de l’adolescent (PEA) ... more Introduction La prescription de psychotropes en psychiatrie de l’enfant et de l’adolescent (PEA) en France est en constante augmentation. Neanmoins, certains patients presentent une pharmacoresistance aux psychotropes impliquant souvent une polytherapie, un risque accru d’effets indesirables (EI) et des prises en charges hospitalieres plus longues. Les psychotropes sont majoritairement metabolises au niveau hepatique, et pour un grand nombre, par la sous-unite CYP2D6 du cytochrome P450. Une anomalie de cette sous-unite impliquera donc un trouble de la metabolisation de ces traitements. Une duplication du gene CYP2D6, est liee a un phenotype metaboliseur ultrarapide (MUR), et donc a une inefficacite clinique du traitement metabolise par cette voie. En PEA peu de travaux de recherche ont ete effectues dans ce sens. Une etude preliminaire sur une cohorte restreinte de patients presentant une pathologie psychiatrique pharmacoresistante, a montre que 56 % de cette population presentait une anomalie du metabolisme du CYP2D6. Methode M4P est une etude multicentrique transversale dont l’objectif principal est d’etudier la prevalence de duplications ou polymorphismes du CYP2D6 associes a un phenotype MUR chez l’enfant et l’adolescent pharmacoresistants aux psychotropes. Les objectifs secondaires sont entre autres d’etudier l’association de ces anomalies avec les caracteristiques liees au patient et a sa pathologie. Vingt-deux patients ont ete inclus. Resultats La presence de phenotype MUR concerne un patient dans notre etude. Un autre patient presente un phenotype metaboliseur lent. L’analyse des resultats sur les objectifs secondaires caracterise notre population de patients dont la severite et le retentissement des pathologies sont majeurs, les prises en charges longues et associees a des hospitalisations repetees, les prescriptions multiples et les EI nombreux. Conclusion M4P n’a pu confirmer un lien entre pharmacoresistance aux psychotropes et anomalies du CYP2D6 de type MUR. Cependant, l’exploration pharmacogenetique n’impliquait que les anomalies du CYP2D6 les plus frequentes. Dans un second temps, l’analyse d’un plus large panel de genes impliques dans le metabolisme des psychotropes sera realisee. Ce travail interroge sur l’apport d’une medecine personnalisee en PEA et ouvre la voie a d’autres projets de recherche afin de mieux comprendre la pharmacoresistance de nos patients, de questionner notre maniere d’y repondre et eventuellement de la prevenir.
Psychosomatics, 2020
HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific re... more HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.
L'Encéphale, 2020
HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific re... more HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés. Distributed under a Creative Commons Attribution-NonCommercial| 4.0 International License
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Papers by arnaud fernandez