RESUMEN
In France, there is no across-the-board formal connection between psychiatric and somatic treatment and the somatic care of patients undergoing psychiatric treatment remains very heterogeneous and inadequate. Despite some attempts at providing structure, it is the place of the physician which must be examined and optimised.
Asunto(s)
Conducta Cooperativa , Accesibilidad a los Servicios de Salud , Comunicación Interdisciplinaria , Trastornos Mentales/enfermería , Grupo de Atención al Paciente , Trastornos Psicofisiológicos/enfermería , Atención Ambulatoria , Diagnóstico Diferencial , Francia , Infecciones por VIH/enfermería , Infecciones por VIH/prevención & control , Infecciones por VIH/psicología , Necesidades y Demandas de Servicios de Salud , Hospitales Psiquiátricos , Humanos , Trastornos Mentales/psicología , Trastornos Psicofisiológicos/prevención & control , Trastornos Psicofisiológicos/psicología , Derivación y Consulta , Enfermedades de Transmisión Sexual/enfermería , Enfermedades de Transmisión Sexual/prevención & control , Enfermedades de Transmisión Sexual/psicologíaRESUMEN
BACKGROUND: Transcranial magnetic stimulation (TMS) has become a therapeutic tool in psychiatric diseases. METHODOLOGY: The objective was to evaluate the efficacy of TMS in unipolar depression: the percentage of responders (>50% HDRS reduction) and remission (HDRS score < or =8, after four weeks of active TMS treatment in depressed patients free of any antidepressive agent versus placebo-TMS. RESULTS: 27 patients were randomized in two groups: rTMS (N=11) versus sham TMS (N=16). Statistical differences were detected between sham and TMS treated groups on remission (0/16 versus 4/11 p=0.032, 1/16 versus 6/11 0.028 and 1/16 versus 7/11 p=0.011 at day 14, day 21 and day 28, respectively) and on response (2/16 versus 5/11 at day 14 (NS), 2/16 versus 7/11 p=0.0115 at day 21 and 1/16 versus 7/11 (p=0.025) day 28, respectively, using the exact Fisher test). Significant differences were observed between day 1 versus day 8 (p<0.01), day 15, day 21 and day 28 (p<0.001) in TMS group and only versus day 21 (p<0.01) and day 28 (p<0.05) for the sham group. ANOVA comparison between TMS and sham groups was significant at day 14 and day 28 (p<0.05). LIMITATIONS: The few number of patients. CONCLUSION: Our study has shown an efficacy of right rTMS in free medication unipolar depression over a month. Nevertheless, number of patients included is limited and multicentric studies will be necessary to specify the antidepressive action of TMS.
Asunto(s)
Cognición/efectos de la radiación , Trastorno Depresivo/terapia , Corteza Prefrontal/efectos de la radiación , Estimulación Magnética Transcraneal/métodos , Adolescente , Adulto , Anciano , Análisis de Varianza , Método Doble Ciego , Femenino , Lateralidad Funcional , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas/estadística & datos numéricos , Cooperación del Paciente , Corteza Prefrontal/fisiopatología , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Atención Integral de Salud/organización & administración , Servicios de Salud Mental/organización & administración , Atención Primaria de Salud/organización & administración , Psiquiatría/organización & administración , Conducta Cooperativa , Francia , Salud Holística , Humanos , Relaciones Interinstitucionales , Desarrollo de ProgramaRESUMEN
Atypical antipsychotics represent a new class of medication for the treatment of schizophrenia and their use is associated with a reduction of neurological side effects. This article reports the result of the systematic clinical and biological supervision of hepatic enzymes on 23 schizophrenic inpatients treated by atypical antipsychotic during 2 weeks at Days 1 (D1), 7 (D7), and 14 (D14) in a naturalistic study during 6 months. The drug administrated was limited to four medications--risperidone, amisulpride, olanzapine, and clozapine--but other psychotropic agents were prescribed. Six cases of biological cytolytic hepatitis were observed. Due to the numerous risk factors and the frequency of "routine" conditions, careful supervision of the hepatic function is needed to prevent this kind of side effect.