Difficulties in Combining Somatic and Psychiatric Care in Psychogeriatry.

BACKGROUND: This article attempts to understand the difficulties encountered in the articulation of health care, particularly between the organic and psychiatric aspects. It also aims to provide solutions to these collaboration issues. METHODS: We realized a literature review based on articles dated from 2002 to 2021 and selected from following databases: Pubmed, Cochrane, Scopus, Cairn, Psychinfo and Google. Used key words are "aging, multidisciplinarity, psychiatric stigma, impotence, efficiency". RESULTS: Medical staff may encounter different problems in terms of care, faced to psychogeriatricpatients.These are both related to the medical aspect, including the difficulty of establishing a clear diagnosis in the face of a complex medical situation,clinical unknownledge, multiplication of intervenants with loss of centralisation in terms of care, etc. Added to this, is the organization of health care, which is increasingly specialized and restrictive in terms of hospitalization criteria. Finally to this, is the relational experience of the caregiver, both in relation to the patient and his disorders, and to their colleagues. CONCLUSION: In the era of the advent of medicinal progress and the advance of diagnostic and therapeutic techniques, it seems mandatory to place the human being at the center of our care. Interhuman interactions constituting the basis of medical care especially in terms of transdisciplinary collaboration. This last point could lead to cost reduction, a more efficient diagnostic and therapeutic management. It seems to be mandatory to reinforce our health care politics in order to time and importance to these various essential and fundamental relational issues.

The therapeutic alliance - its impact on antidepressant therapies in major depressive conditions and on the overall health.

BACKGROUND: Based on our 2012 study and a review of the literature on the therapeutic alliance we asked ourselves different questions: does the alliance exert a real influence on the evolution of depressive affects, the rate of remission and the physical and global health? SUBJECTS AND METHODS: In a two-year study, forty people with major depressive disorder are randomly assigned to groups that receive a SSRI (escitalopram) or a SNRI (duloxetine), each group receive concomitant ASA (100 mg) or a placebo. Sociodemographic data are recorded and patients under went regular assessments with the Hamilton depression scale (HDS) and Clinical Global Impression (CGI) scale, the Helping Alliance Questionnaire (HAQ) and the Short Form Health Survey (SF-12). RESULTS: There is no significant difference in efficacy between the two antidepressants or between antidepressant treatment with and without ASA. However, subgroup comparisons reveal that the duloxetine + ASA (DASA) subgroup showed a more rapid improvement in HDS score as early as 2 months (t=-3.114, p=0.01), in CGI score at 5 months (t=-2.119, p 0.05) than the escitalopram + placebo (EP) subgroup. Regardless of the treatment arm, the remission rate at 2 years is 50%. Among patients in remission a majority, 65%, have a high level of alliance in opposition to nonresponders who have found mostly a low level of alliance (χ2=6.296, p 0.012). HAQ scores are not correlated with HAD scores, but a correlation is found with remission rates (r=0.316*). At all times, HAQ scores are correlated with physical health. CONCLUSION: Our findings suggest that a noradrenergic agent combined with ASA is more effective in treating depression than a serotonergic agent alone. A good alliance improves effectiveness of anti-depressant treatment of 1.85 and leads to an improvement of the physical health rather than directly on the depressive feelings.