Encephale
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Depressive disorders have a major impact on public health. They are prevalent and disabling, with high economic burden for society. Antidepressants have a delayed action and at least one third of patients do not achieve adequate response. The recent discovery of ketamine's unique antidepressant properties, with rapid onset of response and high rate of responders opens new perspectives for treatment-resistant depression (TRD). ⋯ Our review highlights the increasing interest in the use of ketamine in the treatment of treatment-resistant depression. Although a widespread use of ketamine as an antidepressant in routine clinical settings seems limited by psychotomimetic effects and the lack of strategy to maintain initial benefits, ketamine or related drugs might be used to target specific conditions, such as bipolar depression or high suicide risk.
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Major depressive disorder remains one of the leading causes of disability in developed countries despite pharmacological and psychological treatments. Patients with major depression have poorer health-related quality of life than persons of the general population, or patients with chronic somatic illness. Improvement of health-related quality of life in depression is thus a pertinent treatment objective. Both high-frequency repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex and low-frequency rTMS over the right dorsolateral prefrontal cortex have shown their effectiveness in medication-resistant depression. However, the Health-related Quality of Life questionnaire remains under-utilized to assess the effectiveness of rTMS in research or in a routine clinical setting. Our study aims to investigate in an open label trial the efficacy of low-frequency rTMS over the right dorsolateral prefrontal cortex on health-related quality of life and clinical outcomes in medication-resistant depression. ⋯ Low-frequency rTMS over the right dorsolateral prefrontal cortex improves Health-related Quality of Life in unipolar and bipolar patients with medication-resistant depression. Improvement in mental health-related quality of life is significantly correlated with improvement in depressive symptoms. However, further studies with larger samples and controlled designs are needed to clarify our findings.
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Depression is one of the most frequent mental disorders in older people, known to increase rates of disability and mortality. Depression in late life, commonly accompanied by multiple medical illnesses, reduces quality of life and is a strong risk factor for suicide. Despite its clinical significance, depression remains underdiagnosed and inadequately treated in older patients. Cognitive-behavioural psychotherapies have the most empirical support in treating late-life depression, and are recommended by numerous guidelines in this indication. Group interventions are also recommended for older adults because they offer peer support, mitigate social isolation, encourage shared empathy and provide a context for peer feedback help from the group. Previous studies have shown that maladaptive schemas have an important role in the development or maintenance of depression and anxiety in older people, either as risk factors or as vulnerability markers, but there are no studies that have examined the effectiveness of schema-focused therapy to improve depression in late life. ⋯ This study confirms the results of previous research and shows that specific maladaptive schemas are related to depression and anxiety severity in clinically depressed aged patients. Contrary to other previous studies, we find that the activation of maladaptive schemas can decrease during a group psychotherapeutic program that includes schema-focused therapy. These findings support the feasibility of individual and group schema-focused therapy to assist older people suffering from depression effectively.
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New challenges arise in medicine, particularly in psychiatry. In the near future, psychiatrists' role may evolve into management of mental health care teams (GPs, nurses, psychologists…) thus creating the need for charisma and leadership. Charisma is defined as « a quality that allows it's possessor to exercise influence, authority over a group »; leadership as « the function, the position of chief, and by extension, a dominant position ». ⋯ Charisma seems to be an essential dimension for effective leadership and team management. Beyond psychiatry, we believe these reflections to be useful for all branches of medicine.