[Evaluation of an outpatient multidisciplinary Neuro-HIV clinic by the patients and referring doctors]. / Evaluation de la plateforme Neuro-VIH d'un hôpital universitaire par les patients et les médecins traitants.

The neurocognitive complaints among HIV infected patients remain frequent, and to establish their etiology can be challenging. We created in 2011 an outpatient Neuro-HIV clinical platform that takes advantage of a multidisciplinary approach with 5 specialists (neuropsychologist, neurologist, psychiatrist, infectiologist and neuroradiologist). In order to estimate its utility, we conducted two questionnaire-based interviews by phone calls with the patients and their referring physicians. Three quarters of both the patients and the physicians interviewed consider the platform useful or essential. Even though there is often no immediate treatment for cognitive disorders, the patients receive from this multidisciplinary approach a better understanding of their disease, which may help them to better cope with their anxieties in daily life.

Les plaintes neurocognitives chez les patients infectés par le VIH sont fréquentes, et diagnostiquer leur étiologie est complexe. En 2011, nous avons créé une plateforme ambulatoire Neuro-VIH permettant une évaluation multidisciplinaire (neuropsychologues, neurologues, psychiatres, infectiologues, neuroradiologues) de ces patients. Afin d'évaluer l'utilité de cette plateforme, une enquête téléphonique auprès des patients ainsi que de leurs médecins traitants a été effectuée. Trois quarts des patients et médecins interrogés la considèrent utile, voire indispensable. Malgré l'absence de traitement immédiat des troubles cognitifs, les patients disent que bénéficier de cette approche multidisciplinaire leur a permis de clarifier la nature de leurs troubles et de mieux faire face à leurs angoisses sur les plans privé et professionnel.

Fractal temporal organisation of motricity is altered in major depression.

OBJECTIVE: Motor changes in major depression (MD) may represent potential markers of treatment response. Physiological rhythms (heart rate/gait cycle/hand movements) have been recently shown to be neither random nor regular but to display a fractal temporal organisation, possibly reflecting a unique central "internal clock" control. Sleep and mood circadian rhythm modifications observed in MD also suggest a role for this "internal clock". We set out to examine the fractal pattern of motor activity in MD. METHODS: Ten depressed patients (46±20 years) and ten age- and gender-matched healthy controls (48±21 years) underwent a 6-h ambulatory monitoring of spontaneous hand activity with a validated wireless device. Fractal scaling exponent (α) was analysed. An α value close to 1 means the pattern is fractal. RESULTS: Healthy controls displayed a fractal pattern of spontaneous motor hand activity (α: 1.0±0.1), whereas depressed patients showed an alteration of that pattern (α:1.2±0.15, p<0.01), towards a smoother organisation. CONCLUSION: The alteration of fractal pattern of hand activity by depression further supports the role of a central internal clock in the temporal organisation of movements. This novel way of studying motor changes in depression might have an important role in the detection of endophenotypes and potential predictors of treatment response.