La clinique d’un adolescent en grande souffrance du point de vue de la négociation du choix d’objet sexuel offre l’opportunité de revisiter la notion de fantasme de fustigation (Freud, 1919) et d’en ...discuter la pertinence. L’actualisation de cette notion dans le champ clinique et social permettra d’éclairer les points de butée du processus adolescent, dans un contexte où l’« assignation à la pédophilie » vient semble-t-il oblitérer une possible élaboration du collapsus traumatique ouvert par le pubertaire. Le processus adolescent mobilise des mouvements qui contribuent à une déstabilisation des repères de l’adolescent, mais aussi des repères du psychothérapeute confronté à des configurations cliniques qui dérangent : ainsi en est-il de l’envahissement de la vie psychique par des fantasmes pédophiles, dont la fonction paradoxalement maturative mérite d’être relevée. L’enjeu du repérage de ces problématiques singulières est central du point de vue de l’accompagnement psychothérapeutique des adolescents, dont les potentiels de réaménagements psychiques au temps de l’adolescence se trouvent tout particulièrement mis à mal. En effet, les modalités de déploiement du transfert se trouvent particulièrement affectées par la fantasmatique de séduction qui sous-tend le lien thérapeutique.
The uncinate fasciculus is a major white matter tract that provides a crucial link between areas of the human brain that underlie emotion processing and regulation. Specifically, the uncinate ...fasciculus is the major direct fiber tract that connects the prefrontal cortex and the amygdala. The aim of the present study was to use a multi-modal imaging approach in order to simultaneously examine the relation between structural connectivity of the uncinate fasciculus and functional activation of the amygdala in a youth sample (children and adolescents). Participants were 9 to 19 years old and underwent diffusion tensor imaging (DTI) and functional magnetic resonance imaging (fMRI). Results indicate that greater structural connectivity of the uncinate fasciculus predicts reduced amygdala activation to sad and happy faces. This effect is moderated by age, with younger participants exhibiting a stronger relation. Further, decreased amygdala activation to sad faces predicts lower internalizing symptoms. These results provide important insights into brain structureafunction relationships during adolescence, and suggest that greater structural connectivity of the uncinate fasciculus may facilitate regulation of the amygdala, particularly during early adolescence. These findings also have implications for understanding the relation between brain structure, function, and the development of emotion regulation difficulties, such as internalizing symptoms.
Background: This study examined functioning of the Hypothalamic Pituitary Adrenal (HPA) axis, a neurobiological stress system centrally implicated in depression, as a predictor of treatment response ...to Interpersonal Psychotherapy for Depressed Adolescents (IPT-A; Mufson et al., 2004. Interpersonal psychotherapy for depressed adolescents. (second ed.). New York, Guilford Press).
Objective: Globally, recommendations differ on the ideal angle of needle insertion to ensure vaccinate deposition in muscle for optimal safety and immunogenicity. This study aimed to compare the ...level of vaccinate deposition during vaccination, using two different needle angles (60 degree and 90 degree ), in young children, adolescents and adults. Methods: In this randomized cross-over study, two doses of a licensed hepatitis vaccine, were administered to study participants, at a 60 degree or 90 degree angle using a fixed template. Ultrasonography was performed with a Philips iu22 ultrasound system. Real time clips and hard copies of images were recorded showing the injection and level of deposition of the vaccinate. Reactogenicity at the site of administration was assessed by participants/parents. Results: Nineteen participants were enrolled including children, adolescents and adults. Of the total 38 injections performed, 29 (76%) were confirmed by ultrasound as intramuscular (IM), 3 (8%) as not IM, and 6 (16%) unknown. For vaccinations visualised and administered at 60 degree , 87% (13/15) were intramuscular vs 94.1% (16/17) for those administered at 90 degree . A body mass index (BMI) less than or equal to 25 was associated with a higher likelihood of IM injection compared to BMI>25 (p = 0.038). There were no differences in reactogenicity for either 60 degree or 90 degree angle of administration. Conclusion: For the majority of vaccinees, a 60-90 degree angle of vaccine administration is appropriate for IM deposition of vaccinate. The likelihood of intramuscular deposition is reduced for individuals with a BMI>25. The increasing rates of obesity globally highlight the importance of tailoring vaccination procedures accordingly.
It is not known how 5-HTTLPR genotype A childhood adversity (CA) interactions that are associated with an increased risk for affective disorders in population studies operate at the neural systems ...level. We hypothesized that healthy adolescents at increased genetic and environmental risk for developing mood disorders (depression and anxiety) would demonstrate increased amygdala reactivity to emotional stimuli compared to those with only one such risk factor or those with none. Participants (n = 67) were classified into one of 4 groups dependent on being homozygous for the long or short alleles within the serotonin-transporter-linked polymorphic region (5-HTTLPR) of the SLC6A4 gene and exposure to CA in the first 11 years of life (present or absent). A functional magnetic resonance imaging investigation was undertaken which involved viewing emotionally-salient face stimuli. In addition, we assessed the role of other variables hypothesized to influence amygdala reactivity, namely recent negative life-events (RNLE) assessed at ages 14 and 17, current anxiety symptoms and psychiatric history. We replicated prior findings demonstrating moderation by gene variants in 5-HTTLPR, but found no support for an effect of CA on amygdala reactivity. We also found a significant effect of RNLE aged 17 with amygdala reactivity demonstrating additive, but not interactive effects with 5-HTTLPR. A whole-brain analysis found a 5-HTTLPR A CA interaction in the lingual gyrus whereby CA appears to differentially modify neural reactivity depending on genotype. These results demonstrate that two different forms of environmental adversities interplay with 5-HTTLPR and thereby differentially impact amygdala and cortical reactivity.
Developmental studies have demonstrated that cognitive processes such as attention, suppression of interference and memory develop throughout childhood and adolescence. However, little is currently ...known about the development of top-down control mechanisms and their influence on cognitive performance. In the present study, we used functional magnetic resonance imaging to investigate modulation of activity in the ventral visual cortex in healthy 7a11-year-old children and young adults. The participants performed tasks that required attention to either face (Fs task) or scene (Sf task) images while trying to ignore distracting scene or face images, respectively. A face-selective area in the fusiform gyrus (fusiform face area, FFA) and an area responding preferentially to scene images in the parahippocampal gyrus (parahippocampal place area, PPA) were defined using functional localizers. Children responded slower and less accurately in the tasks than adults. In children, the right FFA was less selective to face images and regulation of activity between the Fs and Sf tasks was weaker compared to adults. In the PPA, selectivity to scenes and regulation of activity, there according to the task demands were comparable between children and adults. During the tasks, children activated prefrontal cortical areas including the middle (MFG) and superior (SFG) frontal gyrus more than adults. Functional connectivity between the right FFA and left MFG was stronger in adults than children in the Fs task. Children, on the other hand, had stronger functional connectivity than adults in the Sf task between the right FFA and right PPA and between right MFG and medial SFG. There were no group differences in the functional connectivity between the PPA and the prefrontal cortex (PFC). Together the results suggest that, in 7a11-year-old children, the FFA is still immature, whereas the selectivity to scenes and regulation of activity in the PPA is comparable to adults. The results also indicated functional immaturity of the PFC in children compared to adults and weaker connectivity between the PFC and the rFFA, explaining the weaker regulation of activity in the rFFA between the Fs and Sf tasks.
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