[Münchhausen syndrome by proxy]

Munchausen syndrome is a rare and little known disturbance, which corresponds to the current definition of "factitious disorder". In its "proxy" type, there is a child maltreatment by a person who is in charge. Its complexity is that it is part of a triangular relationship [parent-child-doctor]. We report the case of a 3 years old girl, who was subject of maltreatment by her mother, with repeated injections of salt spirit, which caused deep wounds with important mutilations. The unexplained injuries and their recurrence has raised the questions of the medical staff. The separation between mother and her child confirmed the diagnosis and has protected the patient. The clinical presentations of this syndrome are diverse, but with some common characteristics. The mother is often blamed and suffers rarely from psychiatric disorders. The observed improvement after her removal away from the child remains the most important element to confirm this diagnosis. This disorder must be suspected in presence of symptoms with clinically discordant evolution. When Munchausen syndrome by proxy is suspected, a specific course of action is needed, and child protection is required in the shortest possible time

Psychotropic drugs: [2nd part] for a better prescription of antidepressants and antipsychotics

The general practitioner needs often, in the daily practice, to prescribe antidepressants for their efficacy in the treatment of depression. Antidepressants target essentially the depressed mood. We currently dispose of many groups of antidepressants based on their mechanism of action. Antidepressants have types of clinical effects. Even though depression remains the specific indication of antidepressants, they are also active in treating other psychiatric and non psychiatric conditions. Antidepressants may show different side effects although new generation components are well tolerated and easily used. Antipsychotics are psycholeptic substances. Their main action is to alleviate psychotic symptoms. There are four main classes of antipsychotics: phenothiazines, butyrophenones, benzamids and the atypical antipsychotics. The clinical effects of antipsychotics, are of three type: sedative, antipychotic and desinhibitory. The indications of antipsychotics are essentially psychiatric conditions, and they are mainaly meant for psychotic states Antipsychotics side effects are numerous, and of varois frequnce and severity