[Psychiatry: what's new in 2023]. / Psychiatrie : ce qui a changé en 2023.

Resistance to treatment in psychiatry can arise from a variety of causes, and here we look at two strategies that can improve this problem. First, we discuss the role of patients' relatives; in addition to family therapy interventions, setting up groups of relatives makes it possible to increase their skills in helping their sick relative and to help each other in this process. And finally, we look at the option of interventional psychiatry. These methods, which have been greatly enriched in recent years, are now available in the interventional psychiatry unit recently opened in the new Cery psychiatric hospital in Lausanne.

La résistance au traitement en psychiatrie peut découler de multiples causes ; deux stratégies pouvant améliorer ce problème sont abordées dans cet article. En premier lieu, le rôle des proches des patients ; au-delà d'interventions de thérapie de famille, la mise en place de groupes de proches permet d'augmenter leurs compétences à aider leur proche malade et de s'entraider dans cette démarche. Et enfin, l'option que peuvent constituer les approches de psychiatrie interventionnelle. Ces méthodes se sont grandement enrichies au cours des dernières années et sont maintenant accessibles dans l'Unité de psychiatrie interventionnelle récemment ouverte dans le nouvel hôpital psychiatrique de Cery, récemment inauguré à Lausanne.

Therapies for obsessive-compulsive disorder: Current state of the art and perspectives for approaching treatment-resistant patients.

Even though obsessive compulsive disorder (OCD) is one of the ten most disabling diseases according to the WHO, only 30-40% of patients suffering from OCD seek specialized treatment. The currently available psychotherapeutic and pharmacological approaches, when properly applied, prove ineffective in about 10% of cases. The use of neuromodulation techniques, especially Deep Brain Stimulation, is highly promising for these clinical pictures and knowledge in this domain is constantly evolving. The aim of this paper is to provide a summary of the current knowledge about OCD treatment, while also discussing the more recent proposals for defining resistance.

[Use of ketamine in psychiatry: an update]. / Utilisation de la kétamine en psychiatrie†: mise à jour.

Ketamine has demonstrated at a lower dose a robust and rapid antidepressant effect due to a mechanism of action different from conventional treatments. It is now included in several international recommendations on treatment-resistant depression. Ketamine may be used in both out- or in-patient settings, generally by way of intravenous or intranasal formulations provided the fulfillment of safety requirements. There is a growing interest in the use of ketamine for other resistant psychiatric disorders such as anxiety and substance use disorders. Ketamine proves an innovating and promising treatment that extends the range of therapeutic possibilities in psychiatry. We propose here to review its current clinical use.

À faible dose, la kétamine a démontré un effet antidépresseur robuste et rapide grâce à un mécanisme d'action différent des traitements usuels. Elle figure désormais dans plusieurs recommandations internationales portant sur le traitement de la dépression résistante. Elle peut être administrée dans un cadre ambulatoire ou hospitalier, généralement par voie intraveineuse ou intranasale, moyennant le respect de consignes de sécurité. L'intérêt grandissant qu'elle suscite s'étend à d'autres troubles psychiatriques résistants, en particulier les troubles anxieux et l'abus de substances. La kétamine est un traitement innovant et prometteur qui enrichit l'éventail des possibilités thérapeutiques en psychiatrie. Nous proposons ici de faire le point sur son utilisation actuelle en clinique.

Atypical association of semantic dementia, corticobasal syndrome, and 4R tauopathy.

A 57-year-old male with no family history was diagnosed with semantic dementia. He also showed some unusual cognitive features such as episodic memory and executive dysfunctions, spatial disorientation, and dyscalculia. Rapidly progressive cognitive and physical decline occurred. About 1.5 years later, he developed clinical features of a corticobasal syndrome. He died at the age of 60. Brain autopsy revealed numerous 4R-tau-positive lesions in the frontal, parietal and temporal lobes, basal ganglia, and brainstem. Neuronal loss was severe in the temporal cortex. Such association of semantic dementia with tauopathy and corticobasal syndrome is highly unusual. These findings are discussed in the light of current knowledge about frontotemporal lobar degeneration.