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Ketamine and its S-enantiomer, esketamine, have shown to be promising molecules for use in psychiatry. Widely investigated for the treatment of drug-resistant depression, they could be used in emergency conditions, due to their rapid onset of action, in two main conditions : 1) psychomotor agitation, and 2) acute suicidal ideation and behavior (suicidal crisis). In particular, intranasal administration offers a non-invasive, safe and very easy to administer option. An effect begins a few hours to a day after intake and lasts for about a week. These molecules present an innovative option for the future and their specific use in psychiatric emergencies., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Behavioral disorders in people with developmental and intellectual disability are frequent but their management is rarely taught. This article is to help primary physicians prescribe drug treatment. We will also discuss the key elements of two of the most commonly used classes of drugs, taking into account the patient's co-morbidities, contraindications and the main side effects., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

For the purpose of improving the management of somatic disorders among patients suffering from severe intellectual development and autism spectrum disorders, a specific admissions mechanism has been implemented at Geneva University Hospitals (HUG). The Adult Psychiatric Hospital Unit (UPHA), a complex intervention unit, collaborates with HUG's Disability Program. From May 2018 to May 2019, 29 requests for hospitalizations were accepted. These requests primarily originated from private practice physicians (42 %). In some cases, immediate admissions were urgently organized, and in others a 13-day waiting period was imposed. Hospitalizations were adapted to the patient: more often than not, these were short (48 %), with 6 hospitalizations extended for an average 103-day period. A clinical case illustrates the healthcare management provided., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

The multidiscipinary care of patients with intellectual disability requires a structured and systematic etiological process. Today, advances in technology make it possible to perform diagnostic genetic analyzes that are highly contributive in this process. The CGH-array (Comparative Genomic Hybridization array) makes it possible to search for chromosomal anomalies with a very high level of resolution; high throughput sequencing can detect gene abnormalities on the whole exome or on a panel of genes. For the patient the detection of genetic anomalies aims to improve the quality of care; for related parties, genetic counseling is systematically offered., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

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., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

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.

Unipolar depression is among the leading cause of invalidity and disability-adjusted life-years. Many depressed patients do not respond to several antidepressant treatments. Several treatments have been investigated in resistant depression using electrical or magnetic stimulation of the brain. In this field, electroconvulsivotherapy remains to date the only treatment validated for efficacy and security. Novel neuromodulatory treatments used in neurological conditions are currently under investigation. Vagus nerve stimulation and deep brain stimulation may offer long-term efficacy and therefore justify expensive and highly specialized treatment programs.

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.

For antidepressants as well as for other drugs, personalized prescription has become a major challenge, provided the large interindividual variability encountered both at the pharmacokinetic and the efficacy and tolerance levels. Better identification of the numerous relevant factors and quantification of their effects are prerequisites to progress in that direction. On the basis of recent literature, genetic factors are first reviewed, including polymorphisms of genes coding for drug-metabolizing enzymes, transporters and pharmacodynamic target molecules. Current recommendations with respect to therapeutic drug monitoring of antidepressants and use of pharmacogenetic testing are then summarized.