Are psychiatric residents still interested in psychoanalysis? A brief report.

In spite of the efficacy of the psychodynamic psychotherapies, the number of young psychiatric residents interested in psychodynamic therapies is decreasing. Our psychoanalytical group, Genden (Genève-Denver), explored the possible reasons for psychiatric residents' hesitation to get psychoanalytic training. Five psychoanalytical psychotherapists met weekly for a year in order to debate that question, focusing on personal feedbacks from all of our 100 residents in psychiatry working with us for at least 4 years.

[Couples and families emergency/crisis consultation: emergency patterns and treatment assessment].

Since the opening in 2003 of the Couple & Family Consultation Unit (UCCF) at Prangins Hospital, we have met urgent demands and observed that the suffering systems (i.e., couples and families) couldn't face any waiting period.

[Psychiatry].

In 2008 there is no major breakthrough in the field of psychopharmacology. Paliperidone, (Invega), or 9-hydroxyrisperidone, the main hydroxylated metabolite of risperidone, is now available in Switzerland. It has the same pharmacodynamic profile and a different pharmacokinetic profile, linked to an extended release preparation.

[Acute confusional episode--delirium in elderly patients. Definition, etiology and treatment].

Delirium, (acute confusional episode in European nomenclature) frequently occurs to elderly patients. This confusional condition is characterized by a sudden beginning and fluctuating clinical manifestations. It can bring out or showup a large number of illnesses.

[Bipolar paediatric disorder early diagnosis].

The Bipolar Disorder in infants and youngsters is not very known and under-diagnosed in the concerned population. We hereby describe its clinical features, its comorbidity along with other frequent psychopathologies, such as ADHD, which enable us to describe the symptoms and the indicators of risk. According to how these indicators appear, we can establish various degrees of clinical risk.

[Somatic disorders, factitious disorders and simulation: the subtle art of differential diagnosis].

In every day practice, it is difficult, sometimes impossible, and always ethically delicate to determine the differential diagnosis between: disorders of a somatic nature, simulation and factitious disorders, as much for the psychiatrist as for the general practitioner in the front line. Our aim is to lead a reflection on this controversial theme on the basis of a clinical illustration.

[Psychiatry].

Introduced this year on the Swiss market, duloxetine (Cymbalta) is a new antidepressant which inhibits the reuptake of noradrenaline and serotonin. Clinical studies have shown its efficacy in depression as well as in neuropathic pains (60-120 mg/day) with a good tolerability. In this paper are also included short reviews about the two large American studies developed by the National Institute of Mental Health in the fields of the treatment for depression (STAR-D) and of the antipsychotic treatments for schizophrenia (CATIE study).

[Somatoform disorders: diagnosis and treatment].

Somatoform disorders include several diagnoses, the treatment of which concerns somaticians as well as psychiatrists. This paper defines those diagnosis features, differential diagnosis, epidemiological aspects and etiology hypothesis. Regarding treatments, emphasis is stressed upon, the high level of collaboration between somaticians and psychiatrists, regarding those long term follow-up, well known for potential high-costs in terms of individual suffering and financial terms.

[Treatment of agitation in the emergency room].

The treatment of agitation in the emergency room is a subject regularly treated in different studies and conferences because of the diagnosis difficulties and the psychological impact on medical teams. Differential diagnosis includes organic, toxic and psychiatric causes. Non-pharmacological means (emergency rooms' organisation, communication skills, first care teams' formation) allow resolution of some of these situations.

[Psychiatry].

The main innovation of the year 2004 was the introduction of a new, second-generation antipsychotic drug with a new mechanism of action (partial dopamine agonist), encouraging first clinical results, and an advantageous clinical tolerance profile. Additionally, three new galenic forms are presented: an oral, extended-release form of methylphenidate that could be useful in the treatment of attention-deficit/hyperactivity disorders; an intramuscular depot form of a second-generation antipsychotic drug (risperidone) with the advantage of improving adherence; and an intramuscular form of a second generation antipsychotic (olanzapine) that is valuable in emergency situations. Finally, we will briefly give an update on the advantages of lamotrigine in bipolar depression.

[Psychotropics and weight gain].

Weight overload and obesity became these last years a major health problem. However gain weight is a frequent side effect of a large number of psychotropics. This article proposes to discuss this potential while reviewing various molecules.

Major depressive disorder in the general hospital: adaptation of clinical practice guidelines.

Major Depressive Disorder is particularly frequent among physically ill inpatients. Despite the considerable human burden and financial costs, Major Depressive Disorder remains under-detected and under-treated. To improve this situation, clinical practice guidelines for the management of Major Depressive Disorder were developed for patients in the general hospital.

[Schizophrenia, diabetes and new neuroleptics].

Diabetes mellitus occurs more frequently in schizophrenic patients. The use of a novel antipsychotic drug seems to be concomitant to a further increase in imbalance of blood glucose homeostasis. Such cases have already been reported in the literature indicating that diabetes mellitus might be a real side effect of this novel class of neuroleptics.

Pharmacokinetic drug interaction potential of risperidone with cytochrome p450 isozymes as assessed by the dextromethorphan, the caffeine, and the mephenytoin test.

Two published case reports showed that addition of risperidone (1 and 2 mg/d) to a clozapine treatment resulted in a strong increase of clozapine plasma levels. As clozapine is metabolized by cytochrome P450 isozymes, a study was initiated to assess the in vivo interaction potential of risperidone on various cytochrome P450 isozymes. Eight patients were phenotyped with dextromethorphan (CYP2D6), mephenytoin (CYP2C19), and caffeine (CYP1A2) before and after the introduction of risperidone.

[Antidepressants and somatic disease].

Depression is the most frequent psychiatric disease associated with chronic somatic disorders. Diagnosis, however, is frequently difficult to make, due on one hand to the presence of symptoms that depression and chronic somatic disorders have in common, and on the other hand to the assumption shared by the physician and its patient that depression is a normal reaction to a somatic illness. Accurate diagnosis is nevertheless necessary in order to initiate the appropriate treatment.

Pharmacokinetic consequences of a citalopram treatment discontinuation.

In this pilot study, the pharmacokinetics of citalopram (CIT) were examined in five hospitalized depressed patients after an abrupt discontinuation of a treatment with 40 mg/d of this selective serotonin reuptake inhibitor (SSRI). During the 8-day study period, clinical ratings were regularly carried out. Between days 5 and 8, the patients were treated with clomipramine (75 mg/d).

[Withdrawal syndrome caused by selective serotonin reuptake inhibitors: apropos of a case].

During the past 4 years, several case reports have been published on the withdrawal syndrome which may be observed after acute interruption of a treatment with selective serotonin reuptake inhibiting antidepressants (SSRI). Paroxetine is the most frequently cited antidepressant in the literature, whereas fluoxetine is the less frequently cited of this type of drugs. The withdrawal symptoms appear a few days after stopping treatment or after a decrease of the dose.

The association carbamazepine-mianserin in opiate withdrawal: a double blind pilot study versus clonidine.

Our clinic has fortuitously developed the therapeutic use of the association of mianserin (maximum daily dose 90 mg) and carbamazepine (maximum daily dose 400 mg) in opiate withdrawal management. If animal studies have suggested efficacy of mianserin in such indication, no human studies have been performed. To test the efficacy of such an association, a comparison was made to clonidine (maximum daily dose 0.