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Mentally disordered offenders may be convicted to court-ordered psychiatric-psychotherapeutic inpatient care. Based on the concept of a forensic therapeutic community, the treatments of 204 inmates of a medium-security hospital, who presented with psychosis, personality disorders or substance-use disorders, have been assessed. After a median stay of 2.5 years, 56% of the offenders had been transferred to a sheltered educational housing or to an open low-security psychiatric ward. Length of stay was independent of psychiatric diagnosis, yet dependent on the nature of the offense. Having a cluster B personality disorder or a conviction for a sexual offense increased the risk of return to prison. Younger age and offenses without interpersonal violence increased the chances to enter sheltered educational housing., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

To improve the clinical detection of Alzheimer's disease (AD) new diagnostic criteria have been proposed, based on biomarkers of synaptic dysfunction, AD-related neurodegeneration, and Aβ cerebral amyloidosis. Magnetic resonance imaging (MRI) and position emission tomography (PET) neuroimaging can be configured as powerful means for the detection of medial-temporal atrophy, reduced uptake of 18F-FDG PET or and increased retention of Aβ amyloid protein by amyloïd-PET. In this review, we will discuss these promising techniques that allow assessing in vivo AD pathology and help clinicians to better diagnose and follow-up patients, particularly in clinical trials using disease-modifying treatments.

Psychosocial rehabilitation is a theoretical tools used in psychiatry to fight against the marginalization of chronic patients. In Geneva, the "Tilleuls", a rehabilitation unit located in the psychiatric hospital, provides a range of group and individual interventionsfocusing on recovery for patients with criminal or civil constraints but also patient with severe and debilitating forms of psychotic illness. This article addresses the various types of constraints (medical, civil or criminal) and their impact on for the recovery process. In agreement with other studies, subjective perception of constraints in our clinical setting does not correspond to the legal status of admission. Similarly, the outcome of care is only marginally related to the presence of criminal or civil constraints.

Asylum seekers constitute a vulnerable population insofar as they are submitted to numerous stress factors which facilitate the emergence of mental disorders, such as low socio-economic status, forced separation from loved ones and exposure to violence. Asylum seekers who consult at our community psychiatry facility usually have short-term residence permits, live in collective housing and do not speak the local language. The most frequent diagnoses are depressive disorder (64.7%) and post-traumatic stress disorder (34.5%). Due to their specific clinical and social situation and to the involvement of several professionals in these situations, a specialized psychiatric intervention coordinated with the rest of the network seems necessary.

The aim of this article is a critical review of the main pathogenetic issues debated in Alzheimer disease, with a focus on the clinical perspectives that could derive from. The pertinence of the amyloid cascade hypothesis as a unique and causal explanation of cognitive deterioration is challenged in the light of recent therapeutic failures of clinical trials and increasing role of tau protein in clinical expression. The detection of very early and possibly preclinical stages of the disease emerges as a necessary condition for the efficacy of future amyloid or tau-oriented curative strategies. In this respect, the possibility of finding individual vulnerability markers--in the group of patients with "mild cognitive impairment" or even in cognitively intact subjects--represents a major challenge of the clinical research in this field.

Delirium is a common condition in both inpatient and outpatient settings usually caused by a physical illness. Its one-year prevalence increases with age ranging from 22 to 31%. Numerous studies have shown that early diagnosis leads to rapid improvement, decreased hospital stays and long-term complications. In order to explore the agreement between the reasons of liaison consultation and final diagnosis of delirium, we performed a retrospective analysis of 1106 records corresponding to all elderly inpatients referred to the psychogeriatric liaison consultation of the University Hospitals of Geneva during one year. Among the 44 patients with suspected delirium, the diagnosis was confirmed by the liaison psychiatrist only in 41% of cases. Conversely, a final diagnosis of delirium matched to the reason of consultation only in 24.3% of cases. These observations show that the identification of delirium remains a difficult task.

idemiological studies reveal that aging has significant consequences in community mental health. The mobile Team of the old age psychiatry (EMPAA) in Lausanne has the mission to respond to the increasing demands of psychiatric care, in a flexible, rapid and economic way, combining a high level of conceptual specificity with the logic of proximity. This article describes the development of this mobile team and reports data on the demographic pattern of patients and degree of satisfaction in the caregiver network. The question that arises in this context is that of the extension of this model in the other geographical areas of the district (Vaud country).

In the context of demographic evolution, psychiatric care needs increase steadily in most western countries. Given the financial limitations, it is mandatory to establish appropriate care priorities in order to avoid psychiatric hospitalisations by assisting care providers, general practionners and nurses, at home or in the nursing homes. A crisis team has been established 18 months ago within the Division of old age psychiatry in Lausanne. The care program included immediate assistance in the community, assessement, crisis counseling, medication consultation and referral for psychiatric services providing an alternative to hospitalization. The first results indicate that this intervention is well accepted by the users and correspond to a real need.

Effect of religious culture on obsessive Cultural factors may influence the nature of obsessions and compulsions associated with the obsessive compulsive disorder (OCD). The aim of this review is to evaluate the effect of religious upbringing on OCD symptoms. In fact, a variety of symptoms related to religious thoughts are more prevalent in clinical populations from countries in which religion is at the central core of the society, particularly in Muslim and Jewish Middle Eastern cultures, as compared with clinical populations from the West. These findings suggest that clinicians should be sensitive to the fact that religious obsessions may be more prevalent in certain cultures with which they may not be well acquainted.

Senile plaques, neurofibrillary tangles and neuronal loss are the major histopathologic hallmarks of Alzheimer's disease. A prominent component of the senile plaques is a polypeptide (beta A4) of about 40 amino acids derived via proteolytic cleavage from a set of larger protein isoforms collectively referred to as the amyloid precursor protein (APP). The protein APP is a widely distributed transmembrane glycoprotein structurally related to a cell surface receptor. APP is encoded by a single gene on chromosome 21 in which missense mutations have been demonstrated in several cases of familial Alzheimer's disease. It is thought that various factors fostering the APP-processing pathway by which the polypeptide beta A4 is generated might be pathogenic. Thus the mechanisms that govern the rate of transcription of the APP gene, the differential splicing of the precursor messenger and the proteolytic processing of APP are current subjects of intensive investigation. Theoretically, each of these events represents a potential target for a therapeutic intervention. However, the relationships between amyloidogenesis and the formation of the neurofibrillary tangles associated to the neuronal loss remain to be elucidated.