Neurodevelopmental Disorders: From Pathophysiology to Novel Therapeutic Approaches

This special issue of Biomedicines on Neurodevelopmental Disorders (NDD): “From Pathophysiology to Novel Therapeutic Approaches”, is a precursor of what we hope will develop into a thriving and inspiring transdisciplinary field, including genetics, psychiatry, neurology, as well as basic and applied neurosciences and molecular biology in the research area [...

Major Depressive Disorder – A Clinical Perspective: Concept, Treatment and the Place of Neurostimulation

Major depression is one of the most devastating disorders as measured by years of lives lost and diminished quality of live. According to treatment guidelines, mild depression should mainly be treated by psychotherapy, but moderate and severe disorders need very often pharmacological treatment. Drug therapy has several limitations: delay in treatment response, lack of efficacy, pharmacokinetic interactions, unwanted effects and unsatisfactory compliancy, especially in the long term treatment. About 30%-40% of moderate to severely depressed patients do not achieve remission after 2 antidepressant trials. They subsequently undergo treatment trials which are mainly based on the clinical practice of their prescriber. This is frequently a scientifically uninformed ‘‘trial and error’’ approach. Indeed, solid evidence concerning individual therapeutic approaches is lacking. Electroconvulsive therapy is widely considered as an efficient treatment of last resort. But it is associated with cognitive side effects and high relapse rates. Its use is limited by availability and sometimes a negative perception by the public. Therefore, there is a need to develop alternative treatment approaches. Despite tremendous advances in genetics, neuroimagery, basic neurosciences and other research areas, depression is still considered as a “heterogeneous disorder with a highly variable course, an inconsistent response to treatment, and no established mechanism” (2). In this thesis, we discuss the concept, the clinical course and unmet needs in the treatment of major depression based on selective reviews. A particularly troublesome aspect, emergent suicidality during antidepressant treatment, is illustrated by own work. Electroconvulsive therapy as the paradigmatic, controversial somatic treatment of depression is described, besides newer techniques such as repetitive transcranial magnetic stimulation. We present also our own contributions in the field of neurostimulation, especially magnetic seizure therapy, vagus nerve stimulation and deep brain stimulation and discuss their place in the treatment armamentarium of depression. We outline ongoing research activity to treat severe depression by modulation of glutamatergic neurotransmission using ketamine in a translational approach. We hope to contribute through our studies to better treat and understand depression, one of the major challenges in the field of mental disorders

Neurodevelopmental Disorders: From Pathophysiology to Novel Therapeutic Approaches

This special issue of Biomedicines on Neurodevelopmental Disorders (NDD): “From Pathophysiology to Novel Therapeutic Approaches”, is a precursor of what we hope will develop into a thriving and inspiring transdisciplinary field, including genetics, psychiatry, neurology, as well as basic and applied neurosciences and molecular biology in the research area [...

Le handicap intellectuel chez l’adulte : concepts actuels et défis dans l’approche clinique

The condition of the adult with intellectual disability (AWID) includes the largely autonomous, integrated person but also the one in need of constant support, with grossly altered communication abilities, frequently affected by somatic and mental comorbidities and non-adapted behaviors. Their prevalence is about 1 % of the adult population. They should benefit from particular attention of health care professionals, including in mental health. However, their access to health care is often limited and their quality of life and life expectancy are diminished. Recent advances in the field of ID include modified diagnostic criteria, as well as individualized care in a multidisciplinary approach in partnership with relatives and professionals from the community/service providers. These approaches allow to better address special needs of AWID

Current status of brain imaging in anxiety disorders

PURPOSE OF REVIEW: This study reviews the most recent literature about brain imaging research in anxiety disorders. There is a growing body of evidence that neuroimaging of anxiety disorders contributes to a better understanding of the neurobiology of these disorders, by identifying cerebral modifications occurring previously or subsequent to symptoms of anxiety. A systematic search of the literature (January 1978-July 2008) was performed in MEDLINE using the keywords brain imaging, anxiety disorders, posttraumatic stress disorder, obsessive-compulsive disorder, generalized anxiety disorder, specific phobia, social anxiety disorder, panic disorders and agoraphobia. References cited in all trials were searched iteratively to identify missing studies. Our review focused only on the last year's findings. RECENT FINDINGS: There is a consensus on the crucial role of the amygdala, anterior cingulate cortex and insula in the pathophysiology of anxiety disorders. SUMMARY: Brain imaging research in anxiety disorders has become increasingly important, especially in the last decade, because of the opportunity to validate neurobiological hypotheses for anxiety disorders. Thus, neuroimaging data raise the question of the neurobiological cause of anxiety disorders, opening up new reflections not only on pharmacological treatments but also on the nosology of the anxiety disorders

Dépression: analyse décisionnelle pour la prise en charge par le médecin de premier recours

Unipolar depression is among the leading causes of invalidity and disability-adjusted life-years. General practitioners frequently encounter patients suffering from depressive syndromes and very often, it's they, who make the initial diagnosis, take care of these patients, eventually prescribe an antidepressant treatment, identify difficult cases and address them to the specialists of mental health. In this article, we present concepts of diagnosis and differential diagnoses of depression, its therapy and the collaboration between the general practitioner and the psychiatrist/psychotherapist

Psychiatrie

Methods of brain stimulation such as transcranial magnetic stimulation, deep brain stimulation and vagus nerve stimulation may have a place in the treatment of depression or severe anxiety disorders resistant to conventional treatments. Several advances in chronotherapy as well as developments in treatment protocols have helped to prolong the antidepressant effect of sleep deprivation. The clinical applications of these methods in depressive episodes and especially in bipolar depression are discussed. The complete remission of a depressive episode and the maintenance of therapeutic benefit beyond the mere reduction of symptoms, have become important issues. The persistence of residual depressive symptoms is associated with increased risk of relapse: their recognition and treatment are illustrated in this article