[Affective disorders and neurological comorbidities]. / Troubles affectifs et comorbidités neurologiques.

Mood disorders occupy a vast area in the field of psychiatry. Advances in the study of the brain, but also epidemiology and genetics allow us to make more solid connections between these disorders and neurological disorders, resuming a process of reconciliation between both specialties. The purpose of this short review is to draw the attention of the psychiatrist to these links, especially with a brief presentation of the psychiatric manifestations of a number of neurodegenerative diseases and more particularly frontotemporal dementia.

[Decision-making in termination of pregnancy: a French perspective]. / Décision d'interruption médicale de grossesse : le point de vue des soignants français.

OBJECTIVE: To evaluate the caregivers' opinions regarding decision-making in termination of pregnancy (TOP) for fetal anomaly. MATERIAL AND METHODS: Questionnaire survey using a semi-structured survey based on visual analogue scales, sent to all multidisciplinary centres for prenatal diagnosis in France. Answers were received from 26 centres nation-wide. RESULTS: Response rate was 39% (213 responses received over 550 questionnaires sent). Fifty-five percent of respondents were women, 90% physicians, 7,5% midwives. A vast majority (69.8%) believes that their own convictions play a bigger role in decision in real practice than in their ideal. The major decisional factors in decision-making for TOP are: the long-term prognosis of the anomaly, a specialized opinion on its curability, the quality of the information given to the future parents, their expressed opinion, the existence of a multidisciplinary decision, the ability of the future parents to understand the medical data, the obtention of a medical consensus, the proof level of the medical information. For only 55% of the respondents, the current legal framework is adequate to manage the situations that result from prenatal diagnostic practices today. The question of late third-trimester TOP raises ethical debate: over a third (37%) see no ethical difference between TOP and withdrawal of care during the neonatal period; the majority (48% versus 43%) feel that ethically speaking a neonate and a foetus at 39 weeks gestational age (GA) should not be treated differently; 37% of the respondents feel that current practice is likely to lead to eugenism. DISCUSSION AND CONCLUSION: As far as TOP is concerned, the huge discrepancies in responses from the professionals highlight the ongoing ethical debate, especially concerning the concept of informed choice in TOP, which we believe should be entirely revisited.

[Interpersonal sensorimotor coordination dynamics in schizophrenic patients: introducing a new experimental paradigm]. / Dynamique des coordinations sensorimotrices interpersonnelles chez les patients schizophrènes: introduction d'un nouveau paradigme.

Compared to healthy individuals, schizophrenic patients suffer from sensorimotor disorders including problems when tracking moving targets and perceiving biological motion. Recent advances in embodied cognition and social coordination dynamics have emphasized the important role played by bodily information exchange (e.g. facial expressions, posture, and movements) in the way people interact with and mutually influence each other. These experimental studies on healthy participants provide data on sensorimotor performances of a patient that are recorded at high temporal and spatial resolutions. They should therefore be considered in studies on schizophrenic patients. These functional, quantitive and dynamic aspects of sensorimotor coordination abilities, may offer promising perspectives and could lead to a better understanding of sensorimotor disorders in schizophrenia. The purpose of this article is to introduce a new experimental paradigm in schizophrenia inspired by the field of coordination dynamics, a theoretical and experimental approach born more than 30 years ago that has recently expanded to interpersonal interactions, the so-called social coordination dynamics. In our study, we hypothesize that the sensorimotor deficits associated with schizophrenia in social interaction may be, at least partially, due to a failure to properly pick up information about the movements of other people. We therefore designed a study where healthy individuals and schizophrenic patients were asked to intentionally track the oscillations of visual targets of various social relevance using hand movements. Four different rhythmic visual stimuli varying in degree of biological relevance (form and motion) are used: [1] an oscillating dot; [2] a computer generated hand moving up and down continuously driven by a sine function; [3] pre-recorded oscillatory movements of a real hand; and [4] the hand of a real individual (behind a curtain that occluded vision of the rest of the body). Two distinct dependent variables are computed to quantify the coordination between the movements of the participants and the visual stimuli: the relative phase and the power spectrum overlap between their own movements. In this preliminary study, analyses of kinematic data revealed that schizophrenic patients had trouble synchronizing to (the more) "biological" target unlike control healthy individuals. These results suggest that patients with schizophrenia may suffer from sensorimotor coordination disabilities with socially relevant visual stimuli. The novel paradigm we introduce in research on schizophrenia should allow for a better understanding of the troubles these patients encounter when interacting with other people thanks to an approach rooted and building on social coordination dynamics as well as motor and social cognition.

[Adverse drug events in hospitalized elderly patients in a geriatric medicine unit: study of prevalence and risk factors]. / Accidents iatrogènes médicamenteux chez le sujet âgé hospitalisé en court séjour gériatrique : étude de prévalence et des facteurs de risques.

INTRODUCTION: In the elderly, both the presence of a multiple pathology and multiple medication have been shown to be frequent risk factors for adverse drug events. However, a few studies only have included parameters of standardized geriatric assessment for the purpose of identifying other risk factors. Our study compared the parameters of standard geriatric assessment, in the presence or absence of adverse drug events and evaluated the prevalence of adverse drug events in elderly inpatients, the symptoms, and the drugs involved. METHODS: A total of 823 patients were studied during a two-year period. Two groups of patients were identified, according to the presence or absence of an adverse drug event. Eight fields of geriatric assessment were compared: comorbidities, number of drugs, functional status, nutritional status, mobility, mood, neurosensory disorders, and cognition. For patients who experienced an adverse drug event, we also analyzed the drugs involved and the symptoms of the adverse drug events. RESULTS: One hundred and twelve patients (13.6%) aged 82 years+/-7.5 experienced 144 adverse drug events. Significant differences between the two groups were observed in the following: symptoms of depression, problems of mobility, risk of malnutrition (respectively p=0.001, p=0.002, p=0.007), the female sex, number of drugs, number of comorbidities, and the administration of diuretics. Cardiovascular (23.2%), psychotropic (17.9%) and anti-infectious (17%) medicines were the most frequently involved. The symptoms that occurred most frequently were orthostatic hypotension (14.6%), gastrointestinal disorders (12.5%), and neuropsychological (10.4%) disorders. CONCLUSION: Elderly patients with multiple pathology and multiple medication are at high risk for adverse drug events. Other lesser known factors, such as depression, problems of mobility, and malnutrition must be researched, as they are evidence of the underlying the frailty of the elderly population.

Current knowledge in moral cognition can improve medical ethics.

Physicians frequently face ethical dilemmas when caring for patients. To help them to cope with these, biomedical ethics aims to implement moral norms for particular problems and contexts. As a means of studying the cognitive and neurobiological features underlying the respect for these norms, moral cognitive neuroscience could help us to understand and improve ethical questioning. The article reviews recent developments in the field and presents neurobiological arguments to highlight why some moral rules are universally shared and why some ethical responses are very dependent on context.

[Nephrogenic diabetes insipidus during lithium acute intoxication]. / Diabète insipide néphrogénique au cours d'une intoxication aiguë au lithium.

Acute lithium intoxication may occur in circumstances causing kidney failure, when using lithium chronically. This situation may lead to neurological symptoms with coma, gastrointestinal disorders with diarrhea, cardiovascular symptoms with hypotension and metabolic symptoms with hypercalcemia. Nephrogenic diabetes insipidus may also develop. We report the case of a 69-year-old woman suffering from unipolar manic-depressive psychosis and treated by lithium for 10 years. This case highlights the need to monitor serum lithium levels in patients on long-term lithium regimens, especially in circumstances involving dehydration.