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Major Depressive Disorder – A Clinical Perspective: Concept, Treatment and the Place of Neurostimulation
No full textMajor depression is one of the most devastating disorders as measured by years of lives lost and diminished quality of live. According to treatment guidelines, mild depression should mainly be treated by psychotherapy, but moderate and severe disorders need very often pharmacological treatment. Drug therapy has several limitations: delay in treatment response, lack of efficacy, pharmacokinetic interactions, unwanted effects and unsatisfactory compliancy, especially in the long term treatment. About 30%-40% of moderate to severely depressed patients do not achieve remission after 2 antidepressant trials. They subsequently undergo treatment trials which are mainly based on the clinical practice of their prescriber. This is frequently a scientifically uninformed ‘‘trial and error'' approach. Indeed, solid evidence concerning individual therapeutic approaches is lacking. Electroconvulsive therapy is widely considered as an efficient treatment of last resort. But it is associated with cognitive side effects and high relapse rates. Its use is limited by availability and sometimes a negative perception by the public. Therefore, there is a need to develop alternative treatment approaches. Despite tremendous advances in genetics, neuroimagery, basic neurosciences and other research areas, depression is still considered as a “heterogeneous disorder with a highly variable course, an inconsistent response to treatment, and no established mechanism” (2). In this thesis, we discuss the concept, the clinical course and unmet needs in the treatment of major depression based on selective reviews. A particularly troublesome aspect, emergent suicidality during antidepressant treatment, is illustrated by own work. Electroconvulsive therapy as the paradigmatic, controversial somatic treatment of depression is described, besides newer techniques such as repetitive transcranial magnetic stimulation. We present also our own contributions in the field of neurostimulation, especially magnetic seizure therapy, vagus nerve stimulation and deep brain stimulation and discuss their place in the treatment armamentarium of depression. We outline ongoing research activity to treat severe depression by modulation of glutamatergic neurotransmission using ketamine in a translational approach. We hope to contribute through our studies to better treat and understand depression, one of the major challenges in the field of mental disorders
Evaluation et systématisation des pratiques de prescription médicamenteuse chez les adultes avec déficience intellectuelle
No full textLa population d'individus atteints de déficience intellectuelle (DI) reste peu étudiée et peu de recherches sont faites dans le domaine de la prescription médicamenteuse. En effet, il n'y a pas de traitement pharmacologique du trouble de base. Cependant, les individus atteints de DI souffrent aussi souvent de nombreuses comorbidités somatiques et psychiatriques qui peuvent conduire à ou accentuer des troubles du comportement. Ces personnes sont donc aussi souvent polymédiquées, ce qui augmente le risque d'interactions médicamenteuses et d'effets indésirables. La présente thèse a pour but d'évaluer et d'améliorer les pratiques de prescription chez les adultes atteints de DI. Elle a été divisée en trois parties : une revue exhaustive de la littérature sur quatre situations cliniques fréquentes posant souvent des difficultés de prise en soins, une étude observationnelle visant à évaluer les pratiques de prescription dans une population d'adultes atteints de DI en milieu hospitalier, et le développement d'un outil d'aide à la prescription et à la déprescription
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Current status of brain imaging in anxiety disorders
No full textPURPOSE OF REVIEW: This study reviews the most recent literature about brain imaging research in anxiety disorders. There is a growing body of evidence that neuroimaging of anxiety disorders contributes to a better understanding of the neurobiology of these disorders, by identifying cerebral modifications occurring previously or subsequent to symptoms of anxiety. A systematic search of the literature (January 1978-July 2008) was performed in MEDLINE using the keywords brain imaging, anxiety disorders, posttraumatic stress disorder, obsessive-compulsive disorder, generalized anxiety disorder, specific phobia, social anxiety disorder, panic disorders and agoraphobia. References cited in all trials were searched iteratively to identify missing studies. Our review focused only on the last year's findings. RECENT FINDINGS: There is a consensus on the crucial role of the amygdala, anterior cingulate cortex and insula in the pathophysiology of anxiety disorders. SUMMARY: Brain imaging research in anxiety disorders has become increasingly important, especially in the last decade, because of the opportunity to validate neurobiological hypotheses for anxiety disorders. Thus, neuroimaging data raise the question of the neurobiological cause of anxiety disorders, opening up new reflections not only on pharmacological treatments but also on the nosology of the anxiety disorders
Antipsychotic medication for behaviors that challenge in individuals with intellectual disabilities: a clinically informed review
No full textIndividuals with intellectual disabilities (ID) frequently exhibit behaviors that challenge (BC), such as aggression and self-injury, which significantly impact their quality of life. Pharmacological interventions, particularly antipsychotics, are regularly employed to manage these behaviors. However, these medications are frequently prescribed off-label, increasing the risks of polypharmacy, drug-drug interactions, and potential adverse effects. We conducted a comprehensive literature search to identify studies on antipsychotic interventions for BC in individuals with ID. Eligible studies included observational (cross-sectional and longitudinal) studies and randomized controlled trials (RCTs). Findings from RCTs were mixed: while some trials reported reductions in aggression and irritability with antipsychotics such as risperidone and olanzapine, others showed no advantage over placebo or supported deprescription strategies. Observational studies generally supported the short-term effectiveness of risperidone, olanzapine, and zuclopenthixol in reducing aggressive behaviors, although evidence for their impact on self-injurious behaviors (SIBs) was inconsistent. Across both study types, the use of antipsychotics was consistently associated with adverse effects, including sedation, weight gain, and metabolic changes. Preliminary open-label evidence suggested that aripiprazole may reduce BC in individuals with Fragile X Syndrome (FXS), while causing fewer metabolic side effects. These findings highlight key limitations of the current literature, including the scarcity of studies focusing specifically on ID populations, small sample sizes, the limited number of RCTs, and often controversial or inconsistent results. Despite these limitations, the review indicates potential benefits from reducing dosages and discontinuing long-term antipsychotic use, particularly when guided by personalized treatment plans and regular reassessment. Overall, the results support cautious and individualized prescribing, with close monitoring of adverse effects and attention to deprescribing when appropriate. Further longitudinal and naturalistic studies are warranted, along with the development of structured tools to assist clinicians in optimizing pharmacological care for this vulnerable population.</p
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Dépression: analyse décisionnelle pour la prise en charge par le médecin de premier recours
No full textUnipolar depression is among the leading causes of invalidity and disability-adjusted life-years. General practitioners frequently encounter patients suffering from depressive syndromes and very often, it's they, who make the initial diagnosis, take care of these patients, eventually prescribe an antidepressant treatment, identify difficult cases and address them to the specialists of mental health. In this article, we present concepts of diagnosis and differential diagnoses of depression, its therapy and the collaboration between the general practitioner and the psychiatrist/psychotherapist
Handicap intellectuel : apport de la génétique pour le diagnostic étiologique
No full textThe multidiscipinary care of patients with intellectual disability requires a structured and systematic etiological process. Today, advances in technology make it possible to perform diagnostic genetic analyzes that are highly contributive in this process. The CGH-array (Comparative Genomic Hybridization array) makes it possible to search for chromosomal anomalies with a very high level of resolution; high throughput sequencing can detect gene abnormalities on the whole exome or on a panel of genes. For the patient the detection of genetic anomalies aims to improve the quality of care; for related parties, genetic counseling is systematically offered
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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