Encephale
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The aim of this article is to provide an overview of existing studies on gay and lesbian parenthood and child development. Although 200,000 to 300,000 children could be concerned in 2010 in France, there is a lack of research on this issue in our country. ⋯ Our practice must find new reference marks to understand the stakes and the difficulties of these configurations for a better empathy with the child and his/her family.
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Review Meta Analysis Comparative Study
[Clinical efficacy and achievement of a complete remission in depression: increasing interest in treatment with escitalopram].
Such a prevalent disease as Major Depressive Disorder (MDD), associated with prominent impairment in physical and social functioning, implies as well an increased morbidity and mortality. Long-term treatments are required due to the frequent occurrence of relapses. Patient compliance is a core factor in both acute and continuation treatment, closely related to tolerability issues. ⋯ And after 6 months, fewer patients discontinued treatment with escitalopram (15.9%) than with the pooled comparators (23.9%) (P<0.001). This fragmentary review of the literature shows that it is necessary to adopt a stringent definition of remission in depression, especially in clinical trials; a MADRS total score less or equal to 10 to define remission, a MADRS total score less or equal to 5 to define complete remission, and moreover no MADRS single item greater than 1 to define symptom-free remission. In all these meta-analyses, the superiority of escitalopram compared with other antidepressants was confirmed for both acute and long-term treatment of MDD, especially in harshly depressed patients.
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Review Comparative Study
[Psychomotor agitation, pharmaceutical sedation and psychiatric emergency in psychotic patients].
Psychomotor agitation, very common among psychiatric emergencies, raises the question of pharmaceutical sedation, its indications, and its issues, notably with regard to the observance in postemergency. A new approach to sedation places it within its therapeutic aim and also takes into account the sometimes harmful impact on the course of the patient's care. A pretherapeutical, analysis both clinical and environmental is crucial. ⋯ The use of atypical antipsychotics and injectable forms is argued. Early psychical sedation is preferable to the obsolete practice of vigilance sedation and to behavioural sedation with its limited indications. The use of excessive or prolonged sedation might have a detrimental effect on the care offered after psychiatric emergency treatment.
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Abnormalities involving the prefrontal cortex (PFC) have long been postulated to underpin the pathophysiology of schizophrenia. Investigations of PFC integrity have focused mainly on the dorsolateral PFC (DLPFC) and abnormalities in this region have been extensively documented. However, defects in schizophrenia may extend to other prefrontal regions, including the ventromedial PFC (VMPFC), and evidence of VMPFC abnormalities comes from neuropathological, structural and functional studies. ⋯ Thus, further research should assess decision-making in schizophrenia by testing a large group of patients with homogeneity of diagnostic, in comparison with a large group of control subjects. Authors should control for IQ or level of education, substance use disorder and smoking status. While it is now accepted that DLPFC defects in schizophrenia may extend to VMPFC, future investigations should test for an association between memory, insight ability and IGT performance and assess the impact of antipsychotic dosage upon performance.
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The co-occurrence between post-traumatic symptoms and psychotic symptoms is well described in the immediate suites of a trauma but can also be chronic. This symptomatic co-occurrence, rarely studied in the literature, is often approached under the sole angle of a primary post-traumatic stress disorder (PTSD) or of a primary psychosis, without federative will to unify the psychotic and post-traumatic symptoms within the same nosological framework. Individuals with schizophrenia or schizoaffective disorder report higher rates of trauma and assault than the general population. ⋯ The links between psychotic and psycho-traumatic symptoms are complex and multidirectional; this co-occurrence is a factor of seriousness. The clinician, while paying attention to these symptoms, has to distinguish the structure of the personality of the subject to articulate the psychotherapy and the pharmacological treatment. Further investigational studies may determine whether antipsychotics will enhance treatment response in PTSD patients with psychotic features.