RESUMO
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.
Assuntos
Comportamento Cooperativo , Acessibilidade aos Serviços de Saúde , Comunicação Interdisciplinar , Transtornos Mentais/enfermagem , Equipe de Assistência ao Paciente , Transtornos Psicofisiológicos/enfermagem , Assistência Ambulatorial , Diagnóstico Diferencial , França , Infecções por HIV/enfermagem , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Necessidades e Demandas de Serviços de Saúde , Hospitais Psiquiátricos , Humanos , Transtornos Mentais/psicologia , Transtornos Psicofisiológicos/prevenção & controle , Transtornos Psicofisiológicos/psicologia , Encaminhamento e Consulta , Infecções Sexualmente Transmissíveis/enfermagem , Infecções Sexualmente Transmissíveis/prevenção & controle , Infecções Sexualmente Transmissíveis/psicologiaRESUMO
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.
Assuntos
Cognição/efeitos da radiação , Transtorno Depressivo/terapia , Córtex Pré-Frontal/efeitos da radiação , Estimulação Magnética Transcraniana/métodos , Adolescente , Adulto , Idoso , Análise de Variância , Método Duplo-Cego , Feminino , Lateralidade Funcional , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos/estatística & dados numéricos , Cooperação do Paciente , Córtex Pré-Frontal/fisiopatologia , Fatores de Tempo , Resultado do TratamentoAssuntos
Assistência Integral à Saúde/organização & administração , Serviços de Saúde Mental/organização & administração , Atenção Primária à Saúde/organização & administração , Psiquiatria/organização & administração , Comportamento Cooperativo , França , Saúde Holística , Humanos , Relações Interinstitucionais , Desenvolvimento de ProgramasRESUMO
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.
