Phenomenological contribution to understanding of vocally disruptive behaviour: A clinical case study in a patient with dementia.

Background: Behavioural and psychological symptoms of dementia (BPSD) cause great suffering in patients and their families. Phenomenology can help clarify the diagnosis and propose some new therapeutic responses using Daseinsanalyse. Separation issues understood using the phenomenological description of the melancholic type (MT) by Tellenbach may further shed light on our understanding of depression in dementia.

Best practice in the management of behavioural and psychological symptoms of dementia.

Behavioural and psychological symptoms of dementia (BPSD) occur in most patients with dementia. They cause great suffering in patients and caregivers, sometimes more so than the cognitive and functional decline inherent to dementia. The clinical features of BPSD include a wide variety of affective, psychotic and behavioural symptoms and signs.

[Affective disorders: News in chronobiological models].

Good news on chronobiological models of affective disorders are coming from a therapeutic innovation in the field of antidepressive action. Coming back to fundamentals by reconsidering the importance of the role of biological rhythms impairment in dysthymic pathology, a new interest bored on studies exploring short periodicities, so-called "ultradian" ones, on the basis of pharmacodynamics in the concept of therapeutic "window" of administration. The priority of circadian rhythms due to the major external biological desynchronization in depression, as well as the importance of sleep and alertness pathology, the spectacular relief of the depressive mood upon sleep deprivation, and the strong reduction of sleep need in mania, delayed exploration of ultradian exaltation of harmonic circadian components, marking a "buzz" of rhythmic structure and calling a "chronobiotic compound" which would be able to apply a "reset" to the temporal organisation.

Diagnostic criteria for apathy in clinical practice.

Background: Apathy is an important and distressing behavioural symptom in Alzheimer's disease and in various neuropsychiatric disorders. Recently, diagnostic criteria for apathy have been proposed.

Objectives: In groups of patients suffering from different neuropsychiatric diseases, (i) to estimate the prevalence of patients meeting the proposed diagnostic criteria; (ii) to estimate the concurrent validity of the criteria with the neuropsychiatric inventory (NPI) apathy item; (iii) to identify the most frequently met criteria or sub-criteria in each specific neuropsychiatric disease and (iv) to estimate the inter-observer reliability of the diagnostic criteria for apathy.

[Treatment of a first depressive episode in bipolar disorder].

The first episode of bipolar depression needs a combined psychopharmacological, psychobehavioural and social treatment strategy but because of the pathological severity of the mood episode itself, it specifically requires to achieve total symptomatic remission and therefore appropriate treatment of the index episode. International recommendations which derive primarily from Anglo-Saxon regulations formally restrict the use of antidepressants in view of the risk of mania, suggesting that serotoninergic agents be used in preference and recommending the prescription of mood regulators or even antipsychotic agents and various stepwise associations based on the relative potencies of the pharmacological tools available and treatment stages deployed optimally to obtain complete remission. Finally, treatment of the episode includes prophylaxis as its initial episode is the first presentation of a chronic disease.

[Ontogenesis of circadian rhythm in the human].

Ontogenesis of circadian rhythms in human beings, the history of the development of synchronisation of the daily rhythm describes the deployment of an adaptive capacity providing vital biological linkage to the environment. Methods for dating the stages in this temporal organisation have advanced and the genetics approach to the circadian cycle is dominated by studies of the maturation of the awake-asleep cycle. Disease involves the functional regression to one of the different stages of genesis or alternatively will involve a pathological lesion.

The apathy inventory: assessment of apathy and awareness in Alzheimer's disease, Parkinson's disease and mild cognitive impairment.

Objective: This study was designed to establish the validity and reliability of the apathy inventory (IA), a rating scale for global assessment of apathy and separate assessment of emotional blunting, lack of initiative, and lack of interest.

Method: Information for the IA can be obtained from the patient or from a caregiver. We evaluated 115 subjects using the IA, consisting of 19 healthy elderly subjects, 24 patients with Mild Cognitive Impairment (MCI), 12 subjects with Parkinson's disease (PD) and 60 subjects with Alzheimer's disease (AD).