Year in review in Intensive Care Medicine 2009: II. Neurology, cardiovascular, experimental, pharmacology and sedation, communication and teaching

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Place of electroconvulsive therapy in the treatment of depression in France: A comparative study between clinical practice and international recommendations

ObjectivesTo study the place of electroconvulsive therapy (ECT) in the treatment of major depressive disorder in France and compare it with international recommendations and algorithms.MethodMulticenter, retrospective study in 12 French university hospitals. Diagnosis, delay between the onset of the episode and the first day of ECT, previous treatments have been identified. Only patients treated for major depressive disorder between 1 January 2009 and 1 January 2014 were included.ResultsA total of 754 patients were included (middle age 61.07 years, sex ratio 0.53). The diagnoses listed were: first major depressive episode (14.95%), bipolar depression (38.85%) and unipolar recurrent depression (46.19%). The delay before ECT, was 11.01 months (13,98), and was significantly longer for first episodes (16.45 months, P &lt; 0.001) and shorter in case of psychotic symptoms (8.76 months, P &lt; 0.03) and catatonic symptoms (6.70, P &lt; 0.01).ConclusionsThe delay before ECT appears on average, four times longer than recommended by treatment algorithms for the management of major depressive disorder. This long delay could be explained by a very heterogeneous access to this treatment in French territory.Disclosure of interestThe authors have not supplied their declaration of competing interest.</jats:sec

Alcohol use and bipolar disorder comorbidity: Synthesis and perspectives

ObjectiveAlcohol use disorders and bipolar disorder commonly co-occur and both are associated with more pejorative outcomes, thus constituting a major public health problem. We undertook this synthetic review to provide an update on this issue in order to clarify the nature of the relationship between the two disorders, improve clinical outcomes, prevent complications and therefore optimize management of patients.MethodsWe conducted an electronic search by keywords in databases MEDLINE, EMBASE, PsychINFO, published in English and French from January1985 to December 2015.ResultsThe AUD prevalence is important among BD patients in whom the effects of alcohol are more severe. However, in terms of screening, it appears that the comorbidity is not systematically sought. The concept of co-occurrence finds its clinical interest in the development of specific screening and therapeutic strategies. To date, there are only few recommendations about the management of dual diagnosis and the majority of them support “integrated” approaches.ConclusionsRecommendations should emphasize this strong co-occurrence and promote systematic screening and offered integrated cares.Disclosure of interestThe authors have not supplied their declaration of competing interest.</jats:sec

Alcohol use and bipolar disorder comorbidity: Synthesis and perspectives

International audienceObjective Alcohol use disorders and bipolar disorder commonly co-occur and both are associated with more pejorative outcomes, thus constituting a major public health problem. We undertook this synthetic review to provide an update on this issue in order to clarify the nature of the relationship between the two disorders, improve clinical outcomes, prevent complications and therefore optimize management of patients. Methods We conducted an electronic search by keywords in databases MEDLINE, EMBASE, PsychINFO, published in English and French from January1985 to December 2015. Results The AUD prevalence is important among BD patients in whom the effects of alcohol are more severe. However, in terms of screening, it appears that the comorbidity is not systematically sought. The concept of co-occurrence finds its clinical interest in the development of specific screening and therapeutic strategies. To date, there are only few recommendations about the management of dual diagnosis and the majority of them support “integrated” approaches. Conclusions Recommendations should emphasize this strong co-occurrence and promote systematic screening and offered integrated cares. Disclosure of interest The authors have not supplied their declaration of competing interest