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Introduction: Compared to specialized care, primary care is considered to be more accessible, less stigmatizing, and more comprehensive since it manages physical ailments along with mental disorders (MD). Thus, MD are mainly treated by general practitioners (GP), even though their ability to diagnose and treat these diseases is often considered unsatisfactory. Objectives: This study aimed to analyze perceptions of GP capacity to manage MD, and to assess the difficulties encountered during this management. Methods: A cross-sectional web-based survey design was adopted between August 22 and September 23, 2020, so that 47 responses of GP were included. Results: The mean age of respondents was 37.3 years. Among them, only 17% attended a post-university psychiatric training. On average, 6.3% of GP visits were MD-related. Anxious disorders and depression were perceived as very frequent respectively in 82.9% and 40.4% of cases. Among GP, 17% considered bipolar disorder as a difficult pathology to diagnose, followed by schizophrenia (12.7%), while the pathologies perceived to be most difficult to treat were dementia (17%), acute agitations (14.9%) and schizophrenia (10.6%). Anxiolytics and antidepressants use was very frequent (40.4% and 27.7% respectively), and 34% needed training in antipsychotics prescription. Difficulties encountered duringMD management were related to lack of psychiatric continuing education (19.4%) and lack of collaboration with mental health professionals (12.5%). Among participants, 93.6% requested a psychiatric training: theoretical 29.3%, practice exchange 24.7%. Conclusions: Our study confirmed that MD related visits are common in primary care and highlighted several obstacles in their management. Further continuous education, training, and collaboration between practitioners is required. [ABSTRACT FROM AUTHOR]

Previous publications suggest that prolonged inhalation of frusemide (F) does not cause a fall in the nasal transepithelial potential difference (PD) whereas locally deposited F does. In an attempt to reconcile these observations, we have measured the effect of inhalation through the nose and local deposition of F, amiloride (A), bumetanide (B) and salbutamol (S) on nasal PD in 7 healthy male volunteers in a randomised, double blind study. Solutions of drugs ranging from 10 M to 10 M (3.10 M to 3.10 M for B) in phosphate buffered saline 0.5 ml (PBS) were sequentially deposited in both nostrils, and nasal PD was measured 5 min after each dose. In 10 further volunteers, 10 M solutions of A, F and S (3.10 M for B) 5 ml were nebulised through the nose for 15 min, when nasal PD was measured. Resting PD was similar in the left and right nostrils averaging −17.1 mV (lumen negative). Placebo, inhaled of deposited B and S, and inhaled F did not change nasal PD. Topically deposited F significantly lowered PD in a dose-dependent manner [10 M, −12% from baseline; 10 M, −24%] as did the more potent A [10 M, −19%; 10 M, −31%; 10 M, −47%]. Nebulised A (10 M) had the same effect on nasal PD as deposited A (10 M). The effects of locally deposited F and A (10 M) on nasal PD were additive. Our results suggest first that, aerosol administration is less effective than local application in assessing the effect of a drug on nasal PD. And second, F cannot act primarily at the cotransporter level to reduce nasal PD, as B and F share the same inhibitory effect of the basolateral Na/K/Cl cotransporter and B does not reduce nasal PD. [ABSTRACT FROM AUTHOR]

Introduction: People suffering from chronic diseases, especially epilepsy, are more likely to suffer from neurobehavioral disorders, like psychotic states. Postictal psychosis (PIP) is one of these potentially serious complications, that classically follows exacerbations of seizures. Objectives: The present paper aimed to study the clinical and therapeutic aspects of PIP. Methods: We report a case of PIP, which involved a patient hospitalized in psychiatry department, and discuss it in light of the relevant literature. Results: We report the case of a 27-year-old man, with medical history of generalized epilepsy which was well stabilized under treatment (carbamazepine 600 mg/day). The patient was hospitalized for dangerous behaviors after having experienced 2 episodes of seizure activity in context of poor therapeutic adherence. Psychiatric assessment revealed a psychomotor instability, a pressured speech and hallucinatory behavior. There were no delirium symptoms. Neurological examination showed no localization signs, and cerebral imaging was normal. The patient was treated with benzodiazepines (Diazepam), associated to antipsychotics (Haloperidol). His antiepileptic drug was quickly reintroduced. After 48 hours of treatment, psychiatric symptoms improved. The patient returned to its baseline condition after 7 days. Conclusions: The short-term prognosis of PPI is often favorable, compared to other psychotic disorders. However, more severe psychiatric disorders can potentially develop in the long-term, raising diagnostic and therapeutic difficulties. Thus, a good collaboration between psychiatrists and neurologists is highly desirable in order to better adapt the treatment. [ABSTRACT FROM AUTHOR]

Introduction: Over half of patients with mental disorders are seen by primary care physicians. However, as for patients with somatic problems, referral to psychiatrists seems to be sometimes necessary. Objectives: The present study aimed to identify reasons and difficulties perceived by general practitioners (GP) in mental health referrals. Methods: A cross-sectional web-based survey was conducted between August 22 and September 23, 2020, so that 47 responses of GP were included. Results: The mean age of respondents was 37.3 years. Their seniority as doctors was 8 years on average. Among them, only 17% attended a post-university psychiatric training. The participants reported that they refer on average 32.5% of patients with mental disorders to psychiatrist: 85.1% to psychiatric hospital, 40.4% to liberal psychiatrists and 21.3% to clinical psychologists. Regarding the reasons for referral to mental healthcare structures, 70.2% of doctors justified their doing so by their insufficient training in mental healthcare; 66% by a need for hospitalization, 57.4% by the presence of delusions, while in 27.7 % of cases, the transfer was carried out at the request of the patient or his family. The difficulties mentioned by GP were patient refusal to consult a psychiatrist (70.2%) and difficulties related to the management delay (44.7%). Conclusions: Patient and health system factors, as well as physicians experience seem to have important influences on mental health referral. Open communication and ease of consultation with psychiatrists can make the care of patients with mental health problems even more rewarding to the primary care physician. [ABSTRACT FROM AUTHOR]