Presse Med
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A certain number of historical elements including the progressive loss of religious values and the fact that suicide is considered to be an integral part of medical knowledge must be taken into consideration when assessing the risk of suicide. The sociological and psychoanalytical approaches attempt to help draw the suicidal subject out of the his/her personal implication by affecting the social and subconscious aspects of the problem respectively. Other elements such as psychiatric, sociocultural, biological and psychopathological factors are also involved in evaluating the risk of suicide. ⋯ There are no known clinical means, notably psychometric, which can successfully predict the imminence of suicide. Recent studies on brain monoamine levels have shown that a lower 5-HIAA level does play some role in suicidal behavior, particularly violent suicide, although there is no predictive power for normality. It is important to recall that certain advances in the field of psychopathic illnesses offer new insight into concepts such as the death instinct and the suicidal act itself.
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SCHIZOPHRENIA: The long-standing dopaminergic hypothesis is based on well-established findings, mainly related to a dysfunction of the mesolimbic C2 and D3 receptors, negative signs of prefrontal hypodopaminergia concerning the D2 and D4 receptors. Immune disorders are also involved as well as a possible neurodevelopmental component. Finally genetic factors play an important role.
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A COMMON SITUATION: Primary care physicians often provide care for schizophrenic patients. The main approaches include drug regimens, psychotherapy and psychosocial support.
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A WIDE SELECTION: New drugs have recently been added to the list of antidepressor agents which includes more than 20 compounds in 1998. The mechanisms of action are quite different. ⋯ Therapeutic decisions must also take into account the clinical and functional features expressed by the patient, focusing on the importance of the patient-physician relationship in treating patients with states of depression.
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OPTIMAL CHEMOTHERAPY DOSE: The goal of cancer chemotherapy is to eradicate the malignant disease while minimizing severe toxic effects. There is an optimal chemotherapy dose intensity above which palliation is adversely affected by toxicity; below this level the effect is also adverse because of a low rate of tumor response. ⋯ CHEMOPROTECTORS: Chemoprotectors achieve selective protection of normal tissues. These include mercaptoethanesulfonate (Mesna) for oxazophosphorouros, the cardioprotectant iron chelator, cardioxane, the nucleophilic tripeptide glutathione, and perhaps aminothiolaminofostine.