关于法国精神卫生系统与刑事司法制度的描述性回顾

各国刑事司法体系和精神病学都具有悠久历史,故而,对精神病患者的治疗情况在世界各国都有很大的差别。因此,要想掌握每个体系的具体情况是十分困难的。本文的主旨是对精神健康与法国司法体系之间的相互作用进行叙述性回顾。随后,我们将讨论司法精神病学这一概念在法国是如何从不存在到应用的过程。

Useful or Not? How Schizophrenic Patients Process the Relevance of a Visual Stimulus

Introduction: The impairment of relevant information selection results in clinical symptoms of schizophrenia. Previous studies assessing visual modality, have reported an impairment of automatic sensory information processing related to abnormal irrelevant stimuli processing. In healthy subjects, neurophysiologic studies have distinguished two early posterior components which the second could be considered as a deviant processing marker. We propose to explore early selective properties of attention in acute patients using event related potential (ERP) methods. We hypothesize an impairment of the detection of deviant stimuli processing, supported by sensory integration neural region. Materiel and method: Ten patients suffering from an acute episode of schizophrenia and ten controls were assessed with a simple three stimuli oddball paradigm analysed by principal components analysis (PCA) method which allows to separate overlapping components and to evaluate their modifications. Result: PCA distinguished two posterior negative components between 100 and 230 msec. The early one was not different between controls and patients. The later one was significantly decreased in the patients group. Discussion: two different physiological components involved in stimuli detection were clearly isolated. The earliest, reflecting elementary perceptive process seems to be preserved in patients with acute schizophrenia whereas the later component, reflecting integrative processing involved in detection of deviance was impaired. These results could be a clue to understand clinical distractibility.

丙戊酸用于育龄女性双相障碍患者治疗管理的专家意见(欧洲)

背景在未治疗的双相障碍(BD)中,围产期患者的复发率高达三分之二,伴随着BD临床转归、胎儿和儿童发育等方面的严重问题。丙戊酸(VPA)是最有效的BD治疗药物之一,但暴露于该药的儿童出现严重神经发育障碍的风险最高。因此,监管机构和临床指南对VPA的使用有着严格限制。方法BD药物治疗专家组对截至2019年3月的科学文献和临床指南进行了非系统性回顾,为VPA在育龄女性BD患者中的换药/停药提供了基于循证和经验的临床建议。结果专家组认为,在制定VPA停药和换药决策时,需要考虑到几个临床标准。优先选择平台交叉-减停换药方法,突然换药可能增加复发风险。结论对于接受VPA治疗的育龄女性BD患者,必须根据临床情况进行个体化管理。在妊娠期必须停用VPA,停药/换药过程的持续时间取决于不同的临床指标。锂盐、拉莫三嗪、喹硫平、奥氮平或阿立哌唑是病情稳定的BD患者在计划/意外妊娠期换药的良好选择。对于计划妊娠但病情不稳定的BD患者,稳定病情至关重要。对于使用VPA治疗的患者,在分娩前/分娩后需恢复有效治疗以预防产后发作。在产后及其后阶段,VPA仍然是一种治疗选择。