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ObjectivesAdults with an intellectual disability (AWID) are often polymedicated because of somatic and psychiatric health problems. Besides, they may display challenging behaviours, leading to off-label prescription of psychotropic drugs, without efficacy and with numerous adverse effects. In this context, a prescription/deprescription tool (Tool for Optimising Prescription in Intellectual Disability/TOP-ID) was developed to improve the care of AWID. This paper describes how TOP-ID was designed.DesignFour-step consensus-based process involving a review of the literature, eight semistructured interviews and a two-round Delphi process.SettingSeventeen general practices and university and general hospitals from Belgium, France and Switzerland.ParticipantsEighteen French-speaking physicians from different domains of expertise participated in the Delphi process.Primary and secondary outcome measuresFor the Delphi iteration process, consensus was defined as at least a 65% agreement between the experts.ResultsTwo rounds were needed for the Delphi process. Eighty-one items of the tool were submitted to 18 out of 35 recruited French-speaking experts during the first round. Sixty-nine per cent of the items reached a rate of agreement of 65% or more in that round. Thirteen questions were reformulated and resubmitted for the second Delphi iteration round. All of the statements reached a rate of agreement of 65% or more in the second round.ConclusionTOP-ID is the first prescription–deprescription tool developed specifically for AWIDs in French. It is intended to help prescribers document patient care in order to reduce prescription errors and to improve safety. The next steps of the project include the development of an electronic version of TOP-ID and a utility study.

Afin d'améliorer la prise en charge somatique des patients avec troubles sévères du développement intellectuel et du spectre de l'autisme, un dispositif d'accueil a été mis en place aux Hôpitaux universitaires de Genève (HUG). Dans ce dispositif, l'Unité de psychiatrie hospitalière adulte (UPHA), une unité d'intervention complexe (UIC), collabore avec le Programme Handicap des HUG. De mai 2018 à mai 2019, 29 demandes d'hospitalisation pour soins ou bilans somatiques, évaluées en amont, ont été acceptées. Ces demandes venaient prioritairement des médecins de ville (42 %). Un accueil rapide a été organisé en urgence ou avec un délai moyen de 13 jours. Les séjours étaient adaptés : le plus souvent courts (48 %), 6 séjours ont été prolongés, avec une durée moyenne de séjour de 103 jours. Un cas clinique illustre le type de prise en charge.

Les troubles du comportement chez la personne en situation de handicap mental sont fréquents, mais leur prise en charge est peu enseignée aux médecins de premier recours. Cet article a pour objectif d'aider à la prescription d'un traitement médicamenteux. Nous discutons des éléments clés des deux classes de médicaments les plus utilisés, en tenant compte des comorbidités du patient, des contre-indications et des principaux effets secondaires.

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.

This paper reviews what we know about prediction in relation to mood disorders from the perspective of clinical, biological, and physiological markers. It then also presents how information and communication technologies have developed in the field of mood disorders, from the first steps, for example, the transition from paper and pencil to more sophisticated methods, to the development of ecological momentary assessment methods and, more recently, wearable systems. These recent developments have paved the way for the use of integrative approaches capable of assessing multiple variables. The PSYCHE project stands for Personalised monitoring SYstems for Care in mental HEalth.

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.

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.

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.

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.