[ELECTRONIC LOGBOOK: LEARNING TOOL AND TEACHING AID FOR THE EVALUATION OF LEARNING ACTIVITIES]. / LogBook numérique: un carnet de bord réflexif comme outil d'apprentissage en contexte de stage.

A LogBook is a learning tool and teaching aid I where clinical settings lived during training courses are provided. A LogBook is basically a journal which evidences learning and skills. LogBook provides a means for monitoring student learning, both for the student and for the instructor. It provides a feedback loop for the evaluation of learning activities. This LogBook has been developed for the student's training in psychiatry but it may be extended to all medical disciplines. The authors have developed an electronic logbook to support learning and assessment. In the context of Europe, it has become necessary to set up a LogBook of uniform learning outcomes to assist medical students.

[50 Hz electric and magnetic fields and health: which message to the public?]. / Champs électriques et magnétiques 50 Hz et santé: quel message au grand public?

Scientific data of effects of 50 Hz electric and magnetic fields on health are inconclusive. This uncertainty raises numerous questions. In this paper, significant key concepts are described to better understand the potential effects of electric and magnetic fields on health. Everyday life exposure values are included, as well as courses of action to be taken in front of a patient asking questions on health effects of 50 Hz electric and magnetic fields.

[Depression as a common complication of systemic lupus erythematosus]. / La vignette diagnostique de l'etudiant. La dépression est une complication fréquente du lupus érythémateux disséminé: considérations épidémiologiques, pathogéniques et thérapeutiques.

Systemic lupus erythematosus (SLE) is an inflammatory disease with multiple and disabling consequences, including the psychological status. The prevalence of major depressive episodes among patients suffering from SLE is significantly higher than in healthy people, or people suffering from other inflammatory diseases. While it is obvious that its chronic disease status with a frequently pejorative ending, as well as the number of treatments it requires, are contributing factors, it is likely that due to its pathogenic mechanisms, SLE causes direct injury to the brain, leading to a depressive symptomatology. Numerous hypotheses are under consideration. We shall review them all, recall a few epidemiologic features, add histology and medical imaging contributions and discuss the importance of setting up a fitting therapy for such patients.

Folinic acid treatment for schizophrenia associated with folate receptor autoantibodies.

BACKGROUND: Auto-antibodies against folate receptor alpha (FRα) at the choroid plexus that block N(5)-methyltetrahydrofolate (MTHF) transfer to the brain were identified in catatonic schizophrenia. Acoustic hallucinations disappeared following folinic acid treatment. Folate transport to the CNS prevents homocysteine accumulation and delivers one-carbon units for methyl-transfer reactions and synthesis of purines. The guanosine derivative tetrahydrobiopterin acts as common co-factor for the enzymes producing dopamine, serotonin and nitric oxide. METHODS: Our study selected patients with schizophrenia unresponsive to conventional treatment. Serum from these patients with normal plasma homocysteine, folate and vitamin B12 was tested for FR autoantibodies of the blocking type on serial samples each week. Spinal fluid was analyzed for MTHF and the metabolites of pterins, dopamine and serotonin. The clinical response to folinic acid treatment was evaluated. RESULTS: Fifteen of 18 patients (83.3%) had positive serum FR auto-antibodies compared to only 1 in 30 controls (3.3%) (χ(2)=21.6; p<0.0001). FRα antibody titers in patients fluctuated over time varying between negative and high titers, modulating folate flux to the CNS, which explained low CSF folate values in 6 and normal values in 7 patients. The mean±SD for CSF MTHF was diminished compared to previously established controls (t-test: 3.90; p=0.0002). A positive linear correlation existed between CSF MTHF and biopterin levels. CSF dopamine and serotonin metabolites were low or in the lower normal range. Administration of folinic acid (0.3-1mg/kg/day) to 7 participating patients during at least six months resulted in clinical improvement. CONCLUSION: Assessment of FR auto-antibodies in serum is recommended for schizophrenic patients. Clinical negative or positive symptoms are speculated to be influenced by the level and evolution of FRα antibody titers which determine folate flux to the brain with up- or down-regulation of brain folate intermediates linked to metabolic processes affecting homocysteine levels, synthesis of tetrahydrobiopterin and neurotransmitters. Folinic acid intervention appears to stabilize the disease process.

[Clinical study of the month: depressive pseudo-dementia]. / Le cas clinique du mois. Pseudo-démence dépressive.

We report the case of a man aged 62 suffering from a known type I bipolar disorder and referred by his attending psychiatrist because of a state of spatiotemporal disorientation, confusion and prostration evoking significant neurologic impairment. The interest of this case report is in the use of the 18-FDG PET-Scanner, which is increasingly widespread in clinical psychiatry, to support the differential diagnosis between a psycho-organic pathology like dementia or a functional psychiatric pathology like depressive pseudo-dementia (also named melancholic dementia), in which some patterns of dysfunction can now be identified by functional imaging.

[Depression and type 2 diabetes: etiopathogenic analysis of a frequent comorbidity]. / Dépression et diabète de type 2. Analyse étiopathogénique d'une comorbidité fréquente.

Recent advances in the neurobiology of depression have underlined the importance of markers of inflammation, neurotrophins, and hypothalamo-pituitary adrenal (HPA) axis dysfunction in the development of this pathology. These disorders could have some impact on other systems such as the glucose metabolism regulation with an increased risk of insulin resistance and type 2 diabetes. Type 2 diabetes is also frequently associated with a pro-inflammatory state that could favour the development of a depressive episode. Inflammatory phenomena and HPA axis dysfunction could be biological links between depression and type 2 diabetes and account not only for the frequent association between those two disorders, but also for the treatment-resistance to classical antidepressants.

[Psychiatric complications and addictions]. / Complications psychiatriques et addictions.

Psychiatric complications are clearly associated with substance abuse. Psychopathological symptoms appear during intoxication or in patients suffering from substance-induced psychiatric disorders. However, the assessment of the psychiatric symptomatology is particularly challenging in patients who express clear difficulties to accept that the disorder is favoured by substance abuse. Psychotic reactions, major depression and anxiety disorders are the main psychiatric issues observed in addict patients.

[Heroin]. / L'héroïne.

Heroin (or diacetylmorphine), a depressant nervous central system, is a semi-synthetic opiate. Its main adverse effect, respiratory depression, can lead to death, especially after an intravenous injection. By loss of tolerance, an overdose can be lethal following heroin use after a period of abstinence (voluntary or not). Mortality rate among heroin users is between 1 and 3%. Addiction, following a regular and continuous use, occurs in less than a quarter of persons who ever tried heroine. Heroin addicts often present with different problems (for instance, a criminal behaviour), without any obvious link with addiction. For a fraction of the addicts, addiction becomes a chronic relapsing disease, requiring a long term maintenance substitution therapy. However, relapses and sometimes continuous heroin use are frequent, For treatment resistant and severe heroin addicts, heroin-assisted treatment can be a solution. Despite the numerous available therapies, heroin is considered to be the drug with the most negative effects on the user.

[Affective dependency]. / La dépendance affective.

Affective dependency is characterized by emotional distress (insecure attachment) and dependency to another person with a low self-esteem and reassurance need. The paper proposes a reflection on the definition of emotional dependency and the confusion caused by various denominations. Overprotective and authoritarian parenting, cultural and socio-environmental factors may contribute to the development of dependent personality. Psychological epigenetic factors, such as early socio-emotional trauma could > on neuronal circuits in prefronto-limbic regions that are essential for emotional behaviour.We also focus on the interrelations between dependent personality, domestic violence and addictions. The objective for the clinician is to propose a restoration of self-esteem and therapeutic strategies focused on autonomy.

[Rapid opiate detoxification under anesthesia (RODA)]. / Sevrage rapide aux opiacés sous anesthésie (RODA).

Rapid Opiate Detoxification under Anesthesia (RODA) involves the use of opiate antagonists combined with anesthesia and pharmacotherapy to reduce withdrawal symptoms. The aim of our study was to measure the plasma concentrations of heroin metabolites and methadone during anesthesia and patient stay at the hospital in order to assess the amount of active substances at each protocol step. Plasma concentrations of antagonists were also quantified and compared to the recommended target values. Blood samples were drawn in 10 patients undergoing RODA at different times of the procedure (during anesthesia, in post-anesthesia care unit and in psychiatry unit). The plasma concentrations of heroin metabolites, methadone and antagonists were measured using a previously described method. Heroin active metabolites were no longer detected in the patient blood when helshe left the hospital; by contrast, methadone was still present at significant concentrations 3 days after the beginning of the detoxification procedure. Naltrexone analysis allowed us to adjust doses to insure opiate receptor blockade during acute withdrawal, which is a critical period.

[The acute management of agitation]. / Comment je traite ...la prise en charge de l'agitation en urgence.

Agitation in psychiatry is defined as "a request to which an answer cannot be deferred". If some types of controllable agitation can be solved by human means or psychotropic drugs, others may require the intervention of intensivists who will contribute to the onset of crisis resolution. In addition, an organic aetiology must be carefully excluded a before considering a psychiatric origin of agitation, especially in patients with no psychiatric history and in the elderly. Indeed, acute agitation can hide serious somatic traps and be life threatening.

[Clinical and therapeutical approach of depression in old age]. / Approche clinique et thérapeutique de la dépression chez la personne agée.

Despite recent clinical and scientific developments in the psychogeriatric field, depression in old age remains an underdiagnosed and undertreated disorder. However, depressive symptoms are frequent in older people and the impact on patients, their family and the society is very important. Depression is also frequently associated with somatic illnesses, with alcoholism, anxiety and a significant risk of suicide. In this context, a systematic screening of depression and an adequate treatment are a priority.

[Post-traumatic stress disorder and psychological debriefing: a controversial topic]. / Etat de stress post-traumatique et débriefing psychologique: un sujet controversé.

The last decades have demonstrated the value of early interventions after a traumatic event. The purpose of these interventions is to prevent the development of psychological consequences such as post-traumatic stress disorder. Psychological debriefing is clearly the most popular intervention. However, in the literature, it is subject to a real controversy. The objective of the present paper is to define the interest of psychological debriefing, but also alternative therapeutical strategies for people exposed to traumatic events.

[Bipolar disorder: a multifactorial disease]. / Le trouble bipolaire: une affection bien complexe.

Bipolar disorder is a multifactorial disease with a strong genetic component. However, environmental factors also play a role in the onset of the disease and in manic and depressive recurrence. The onset of the disorder is the consequence of a complex interaction between genetic and environmental factors. This gene-environment interaction is well illustrated by the influence of childhood trauma on the clinical expression of the disease in terms of age of onset, comorbidity and suicide. The complexity and heterogeneity of bipolar disorder require the identification of homogenous sub-groups with the use of biomarkers that could help reduce the etiological heterogeneity and better target the therapeutical options.

[Sexual dysfunction induced by antidepressants and antipsychotics].

The interest in sexual dysfunction induced by psychotropic drugs has increased considerably in recent years because of the new-generation antidepressants (AD) and antipsychotics (AP) being put into medical practice. These drugs are widely used to treat not only depression and schizophrenia, but also anxiety and affective disorders. Other, additional indications for the use of antidepressants are appetite disorders, premenstrual syndrome, chronic pain, etc. Neuroleptics are administered to treat resistant depressions, aggressiveness, impulsivity, and alcoholism. Impaired sexual functioning due to AD and AP lowers quality of life in patients and increases the risk of their refusing treatment, the result of which is a phenomenon associated with the occurrence of recurrent mental illnesses. There are few scientific data on the nature and prevalence of sexual dysfunctions induced by these medications. This topic is universally underestimated as it is rarely touched upon by specialists during their consultations. The aim of the review is to show the side effects of AP and AD on the sexual sphere, to compare different classes of the drugs, and to propose possible management strategies to correct these undesirable effects.

[Antidepressants of the future: role of the glutamatergic system]. / Les antidépresseurs du futur: rôle du système glutamatergique.

Despite the availability of several antidepressants, the treatment of major depression is far from being satisfactory. With conventional antidepressants, more than 30 to 45% of the patient will not respond or present only partial remission. In the prospect of a better treatment of depression, research tends to develop original molecules, more effective, with a faster onset of action and a better tolerability. The new targets of antidepressive pharmacotherapy are beyond the membrane receptor. The future in the treatment of depression requires a better understanding of cellular and molecular mechanisms involved in the pathophysiology of depression and biochemical mechanisms explaining the antidepressive effect. In this context, the glutamatergic system plays a role in the pathophysiology of depression. Agents modulating glutamatergic activity could act as antidepressants.

[Sexual dysfunction and antidepressants]. / Dysfonctions sexuelles et antidépresseurs.

Over the last two decades, several antidepressants (AD) were marketed. These drugs are not only used for the treatment of depression, but also for many other indications like anxiety disorders, eating disorders, premenstrual syndrome and neuropathic pain of diabetic origin... During several years, sexual side-effects of AD have been ignored. These side-effects have a great impact on the quality of life of patients and increase the risk of non-compliance to treatment. Presently, few reliable scientific data are available concerning the frequency and the nature of sexual disorders induced by AD. Overall, these effects are grossly underestimated because the problem is rarely addressed directly. In this review, the sexual side-effects of AD and the possible strategies to limit their consequences will be discussed.

[Tricyclic antidepressants and monoamine oxidase inhibitors - do they still have a role in the treatment of depression?]. / Les antidépresseurs tricycliques et les IMAO ont-ils encore une place dans le traitement de la dépression?

Today, tricyclic antidepressants and MonoAmine Oxidase Inhibitors are prescribed less frequently compared to Selective Serotonin Reuptake Inhibitors (SSRIs) or selective serotonin and noradrenalin reuptake inhibitors. These new medications are associated with a better safety profile. The new generation of psychiatrists is not really comfortable with these old medications. However, their use is still justified in some cases of treatment resistance, in the treatment of some anxious disorders, and in the management of chronic pain. But, their prescription requires a good knowledge of the potential complications.

[Inappropriate antidiuretic hormone secretion induced by sodium valproate]. / Le cas clinique du mois. Syndrome de sécrétion inappropriée d'hormone antidiurétique (SIADH) induit par le valproate de sodium.

The occurrence of a syndrome of inappropriate antidiuretic hormone secretion (SIADH) with sodium valproate has been rarely described in the literature. We present a 46-year-old patient, admitted to the Emergency Room for confusion and acute agitation. The exploration showed a severe hyponatraemia induced by sodium valproate, prescribed for a type I bipolar disorder. This article addresses both somatic and psychiatric issues in the differential diagnosis of confusion and agitation.

[Efficacy diacetylmorphine (pharmaceutical heroin) for heroin treatment ]. / L'efficacité du traitement assisté par diacétylmorphine (héroïne pharmaceutique) à l'étranger.

Before implementing the TADAM project in Belgium (a heroin-assisted treatment trial), our research team studied the trials in other countries. Since 1994, six randomised controlled trials have been developed using the same treatment model of heroin-assisted treatment (HAT). Each trial concluded that HAT had more efficacy than methadone treatment. We analysed those trials in order to find on which levels patients in a HAT treatment are expected to improve. Improvements appeared after at least six months on the level of street heroin use, (physical and mental) health and criminal behaviour. In the longer term, the continuation of treatment had positive but limited effects on the social level. Due to his higher cost, this treatment should remain a second-line treatment for this special target group: severe heroin addicts, using continuously street heroin in spite of a methadone treatment.