[Detecting the alarm signs of the suicidal crisis]. / Entretien d'alerte de la crise suicidaire.

Suicidal crisis is an escaping moment during which the subject shows a state of vulnerability and a lack of his/her defense abilities, putting him/her in a pain which is not always visible and that does not express itself through a plain nosographic context. Because of that, the practitioner's intervention is made more complicated. In this article, we offer a way to conduct the interview to detect the alarm signs of the suicidal crisis, insisting on the clinical, biographical and environmental elements that are to be looked for. Therefore, the analysis of the suicidal discourse (suicidal ideas expressed or hidden suicidal complaints), the search for risk and protective factors clearly identified, and the interest shown to the personal experiment of the crisis state, will make the evaluation and the determination of suicidal potentialities easier. This is based on the tripod Risk-Emergency-Dangerousness (RED), which will give a direction to the most efficient 24-48 hours care at the conclusion of the interview, whether it were ambulatory (low suicidal potentiality) or requiring an hospitalization (medium or high suicidal potentiality).

[Early stages of schizophrenia, challenges and prospects]. / Schizophrénie débutante, enjeux et perspectives.

Despite a relatively extensive treatment armamentarium, the evolution of schizophrenic patients overall remains unfavourable. Early treatment is essential and influences the prognosis. Facilitating access to care through the creation of specialised assessment centres to complement the current system of care is one of the possible avenues for improvement.

[Early diagnosis in schizophrenia: a mission for the general practitioners?]. / Diagnostic précoce dans la schizophrénie: une mission pour les médecins généralistes?

Schizophrenia represents a relatively frequent disease within the population with a prevalence of 1 %. Despite a consistent therapeutic equipment at doctors' disposal, the evolution of this disease remains globally rather unfavourable. For a long time, the classic concept from Magnan "bouffée délirante aiguë" was considered as the main mode of entrance of the schizophrenia. Now, in most cases, the beginning of the disease is progressive and insidious. Two phases in the evolution of the disease before appearance of true psychotic symptoms are described: a premorbid phase and a prodromic phase. The early care of this disease has a major impact for the prognosis. The Duration of Untreated Psychosis (DUP) is correlated to an unfavourable evolution of the disease. It is advisable to reduce the delay of first care by locating prematurely the patients developing a psychosis. Because of their central place in our health care system, the general practitioners have a major role in this screening. The clinical symptoms of the prodromic phase are rather heterogeneous and little specific. The general practitioners must be made sensitive to search the symptoms suggesting an entrance to the psychosis and to allow a care adapted to these patients. But they are relatively little exposed to the psychotic disorders and must be supported in their mission by specialized centers.