B Acad Nat Med Paris
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Borderline personality disorders are complex clinical states with highly polymorphic symptoms and signs, leading to delays in their diagnosis and treatment. All international classifications emphasize certain clinical criteria such as unstable identity and interpersonal relationships, feelings of emptiness or boredom, and pathological impulsiveness. The prevalence is about 2%, with a female-male sex ratio of 2 or 3 to 1. ⋯ The psychiatric bio-psycho-social model takes into account multiple pathogenic factors, such as trauma during early development, temperamental instability and other emotional disorders, as well as psychosocial, neurobiological (5HT etc.) and genetic vulnerabilities. Treatment requires optimal integration of psychotherapeutic and pharmacotherapeutic approaches. Emergency intervention must be available in case of delirious or suicidal behavior The clinical course is often lengthy and complex, but outcome may be favorable, provided the principal risk--suicide--is correctly managed,
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Rheumatoid arthritis (RA) is a chronic disabling disease that induces substantial costs in terms of healthcare resources (direct costs) and lost productivity (indirect costs). The main cost drivers used to be disability and hospitalization. ⋯ These effective treatments have lowered RA-related use of healthcare resources, especially totaljoint replacement, as well as sick leave. In contrast, they have not yet been shown to reduce the number of patients who become disabled, and their cost-effectiveness ratio thus tends to be unfavorable.