Presse Med
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Approximately 80% of the patients who have a first episode of major depression will have at least one more. The lifetime average is 4 episodes. Nevertheless, despite this high risk of relapse, often severe and disabling, only half the patients with recurrent major depression receive prophylactic treatment. ⋯ Lithium and carbamazepine may be prescribed as second-line preventive treatment. Although we lack controlled studies of the prophylactic efficacy of psychotherapies in recurrent depression, interpersonal, cognitive and behavioral psychotherapies have been shown to be effective in reducing the relapse rate, especially when associated with antidepressants. Treatment duration should be determined individually, taking into account the patient's risk profile and international and national guidelines.
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Comparative Study
[Mortality-morbidity conferences: evaluation of an intervention to expand their practice in a university hospital].
Mortality-morbidity conferences (M&MC) are a recognized technique for evaluating and improving medical practices as well as improving patient safety. ⋯ Our survey of department heads allowed us both to collect information about the methods they used for managing and evaluating adverse events and to provide information to them. This intervention may have contributed to increasing and improving the use of M&MC.
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Frontotemporal dementia usually begins before the age of 65 years. It is manifested by behavioral and language disorders. ⋯ The genetic component is important: 30-50% of patients have a family history of this disease. Cholinergic effects are not associated with frontotemporal dementia and therefore anticholinesterase treatment is not indicated.
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Hereditary iron overload is mainly due to mutations of the HFE gene, implicated in most cases of hereditary hemochromatosis. Non-HFE-related hereditary iron overload is rare. It includes hereditary hemochromatosis related to mutations of other genes, ferroportin disease (also known as hemochromatosis type 4), and entities associated with specific clinical manifestations. ⋯ Ferroportin disease is a special dominantly inherited clinical form of iron overload due to mutations of the SLC40A1 gene. Its expression differs significantly from that of hereditary hemochromatosis, and its mechanism is related to impairment of iron release from reticuloendothelial cells. Other causes of non-HFE-related hereditary iron overload are usually associated with recognizable clinical manifestations, such as anemia or neurological disorders.