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The early intervention in psychiatric disorders to improving the clinical and functional prognosis has been studied for several years. Patient compliance must be paid attention, from the first months after a first episode. The use of freedom-restraining measures during the first psychiatric admission can reduce patient compliance. We conducted a literature review for the early management of psychiatric disorders, the specificities of the first psychiatric episode treatment, and the different measures and care that can be provided during a first hospitalization. A study with patients during a first psychiatric admission was carried out to evaluate the influence of freedom-restraining measures on the continuity of care after un first psychiatric admision. In our study, isolation is associated with non-compliance at one year in patients hospitalized for delusional disorder. The other freedom-restraining measures (physical restraint, involuntary commitment, hospital pyjamas, removing the telephone) are not associated with a non-compliance. A more cautious use appears essential in order to ensure a prescription adapted to each situation. In addition, better information to the patient seems to be a potential mean of reducing the feeling of injustice or inadequacy leading to non-compliance.; La prise en charge précoce des troubles psychiatriques dans l’amélioration du pronostic clinique et fonctionnel est étudiée depuis plusieurs années. La compliance aux soins doit faire l’objet d’une attention particulière, dès les premiers mois après un premier épisode. Les mesures de restriction des libertés lors d’une première hospitalisation en psychiatrie peuvent freiner la compliance. Nous avons mené une revue de la littérature sur la prise en charge précoce des troubles psychiatriques, le traitement spécifique au premier épisode psychotique ou dysthymique, puis les diverses mesures et soins pouvant être apportés lors d’une première hospitalisation. Une étude sur les patients hospitalisés pour la première fois en psychiatrie a été réalisée pour évaluer l’impact des mesures de privation des libertés sur le suivi ambulatoire après une première hospitalisation. Dans notre étude, la mise en chambre d’isolement est associée à une rupture de suivi à un an chez les patients hospitalisés pour trouble délirant. Les autres mesures de restriction des libertés (contention physique, mode d’hospitalisation sous contrainte, mise en pyjama, retrait du téléphone) ne sont pas associées à une rupture du suivi. Une utilisation plus précautionneuse apparait essentielle afin de s’assurer d’une pratique adaptée à chaque situation. De plus, une meilleure information au patient semble un moyen potentiel de diminuer le sentiment d’injustice ou d’inadéquation participant à la rupture de soins.

Early consultation after acute decompensated heart failure supplements and reinforces the hospital care of patients with severe heart failure. Its aim is to prevent a new episode occurring during the period of increased vulnerability. It requires the active partnership of the patient and the complementary expertise of different professionals, specialised in heart failure and in therapeutic education : cardiologist, nurse and dietician.

Many types of genodermatosis exist, with numerous modes of transmission. The development of molecular genetic methods, in particular the most recent sequencing techniques, can be used to identify an increasing number of genes involved in these forms of genodermatosis while providing confirmation or more details regarding clinical diagnosis. Thanks to this approach, it is possible to determine risk of recurrence and to formulate an antenatal strategy. These technologies have led to improved molecular definition and to a better understanding of the physiopathological mechanisms involved in different genodermatoses such as bullous epidermolysis, keratinisation disorders, pigmentation disorders, potentially tumoral conditions, and epidermal and pilar dysplasia. The large amount of information provided by high-throughput sequencing makes it possible to study modifying genes as well as genotype-phenotype correlations. However, this genetic information in its turn poses problems of interpretation and of control of the resulting data. The use of genetics in dermatology for the purposes of diagnosis or research requires a consultation to provide patients with information regarding the genetic tests involved and the potential consequences thereof for them and their families. Furthermore, with pangenomic approaches there is a higher probability of fortuitous discovery of abnormalities such as variants associated with risks predisposing to cancer or neurodegenerative disease. Collaboration between dermatologists and geneticists enables optimisation of patient management in terms of diagnosis and genetic counselling in the event of such rare diseases. Therapeutic applications are beginning to be developed. The scope of therapeutic application includes gene therapy, replacement therapy (enzyme therapy) and targeted therapy.

Early detection and early intervention programs in early adolescent and young adult psychosis have developed in many countries and have shown their effectiveness. The main lesson of these programs is to have demonstrated that the progression of at-risk mental state into to a full-blown psychosis or of a psychotic episode to a chronic schizophrenic disorder is evitable. They have also shown that the earlier appropriate care is set up the better the functional remission and that the period of "early psychosis" encompassing the period preceding the emergence of psychosis and the first months after the first psychotic episode, is a period of opportunity for a preventive or curative intervention. Specialized therapeutic strategies shall include patient's centered integrative care. According to international recommendations, early intervention provides an extensive multidisciplinary assessment in search of possible organic etiologies and in instrumental to adapt care strategies to the person's need. It helps to identify levers for a psychosocial approach (psychoeducation, cognitive and behavioral therapies, cognitive remediation, case management) and for adressing aggravating factors (substance use, family interventions, educational support, etc.). A second-generation antipsychotic should be introduced, at lower doses than for a chronic disorder. The young patient must be accompanied until recovery by a specialized multidisciplinary team, usually for a period of 2 to 3 years. Deployment of such programs is a societal challenge and represents a paradigm shift: it questions the practices and organization of the healthcare system, but also the way healthcare professionals and the general public look at these diseases. In France, the Transition Network, a founding member of the French-speaking branch of IEPA, aims to facilitate the dissemination of these practices on a National scale, and to help to harmonize emerging initiatives.

International audience; Suicide is the most common cause of early mortality during the course of schizophrenia. The most recent data in the literature show that the risk of suicide is greater at the beginning of the course of schizophrenia. The risk of suicide during the first year is 12 times higher than that of the general population. Specifically, 2-5 % of people with first-episode psychosis will die by suicide in long-term follow-up studies. Regarding the presence of suicidal ideation that are a major factor of suicide in subjects suffering from psychotic disorders, their prevalence remains extremely worrying, since they are substantial and persistent. Consequently, suicide prevention should be a major and immediate objective in the management of the disease, as soon as the diagnosis has been made. Suicidal ideas are a potential precursor to the evolution towards acting out. Their evolution must be specifically assessed in each individual. Indeed, in the influential Danish OPUS study the authors reported heterogeneity in suicidal ideations in young patients with first episode of psychosis and identified three prototypical trajectories of suicidal ideations over the first 2 years in treatment. Particularly, nearly 40 % of patients with first-episode psychosis have persisting suicidal thoughts over the initial treatment period. Consequently, the authors recommend routine screening for suicidality when providing treatment for first-episode psychosis. The main risk factors for suicidal behavior in patients with a first episode are classical ones. Previous research has suggested that, in addition to young age and early course of illness, other important clinical predictors of suicide in individuals with schizophrenia include presence of depressive symptoms and misuse of substances, which are very common conditions in these patients. Lack of social support, loss, rejection, stigma, insight, fear of future losses, are all negative experiences experienced by patients starting a psychotic disorder. Negative connotations of the diagnosis of psychotic disorders, feelings of being trapped that can be directly related to feeling a burden can lead to suicidal crisis in these individuals. Then, the painful experience of the disease and its consequences associated with self-stigmatization and social rejection may induce hopelessness and suicidal thoughts in these young subjects. The quality of the insight and its evolution may worsen the depressive experience and suicidal risk and they therefore also require to be measured regularly. Thus, the clinical evaluation of patients entering psychosis should focus on those dimensions that are not directly related to the psychotic symptoms. At the precise evaluation of each patient must be associated personalized measures of prevention. It is now proposed that prevention strategies targeting suicidal behaviour in first-episode psychosis should not be universal. On a more general level, evidence-based data to support specific care programs are still lacking, and only few data are in favor of integrated care in patients presenting with first episode. It should also be kept in mind that the risk of suicide is extraordinarily high for all psychiatric patients during the first few months after discharge from hospital. This should encourage caregivers to offer intensive follow-up programs to their patients and to embrace recontact and follow-up initiatives using the tools of e-health. Last, programs for the early detection of schizophrenia seem to be beneficial for the prevention of suicide in these subjects.

Surgical Treatment for Lipedema Abstract. Lipedema is a progressive disease that occurs in adolescence and affects one in nine women. The signs are limited to the lower limbs. Early signs are nonspecific, which is why the diagnosis is often ignored. Later, pain and heaviness of lower limbs become predominant. Finally, at an advanced stage, tissue fibrosis is associated with significant edema. At this stage, patients become severely disabled and bedridden. At the early stage, the treatment is conservative. Liposuction is indicated at the onset of pain. Its effectiveness pain and long-term control has been demonstrated on. Finally, late stages require heavy and complex surgeries combining dermolipectomy and liposuction.Zusammenfassung. Das Lipödem ist eine sich langsam entwickelnde Krankheit, die sich während der Adoleszenz bemerkbar macht und auf die unteren Extremitäten beschränkt. Eine von neun Frauen sind betroffen. Frühe Anzeichen sind unspezifisch, weshalb die Krankheit oft nicht diagnostiziert wird. Im späteren Verlauf sind Schmerzen und schwere Gliedmassen die vorherrschenden Symptome. Im fortgeschrittenen Stadium sind Gewebefibrose und Ödem kennzeichnend. In diesem Stadium sind die Patienten schwerbehindert und bettlägerig. In einem frühen Stadium ist die Behandlung konservativ. Beim schmerzhaften Lipödem wurde die Wirksamkeit von Liposuktion in Langzeitkontrolle gezeigt. Im fortgeschrittenen Stadium helfen nur noch komplexe Operationen in Verbindung mit Dermolipektomie und eine Liposuktion.

Physical Activity and Cancer Abstract. This article aims to summarize the literature on the role of physical activity in cancer patients and to propose exercise programs based on studies and recommendations. Medical advances with improved early diagnosis and treatment have increased the number of cancer survivors. At the same time, the quality of life of these patients must also be improved. In the different stages of the disease physical activity has an important role to play with its beneficial effects on fatigue, physical condition, mood etc. Collaboration between health system actors and patient education are the key to success in this multi-disciplinary care.Zusammenfassung. Dieser Artikel zielt darauf ab, die Literatur über die Rolle der körperlichen Aktivität bei Krebspatienten zusammenzufassen und Trainingsprogramme vorzuschlagen, die auf Studien und Empfehlungen basieren. Medizinische Fortschritte mit verbesserter Früherkennung und Behandlung haben die Zahl der Krebsüberlebenden erhöht. Gleichzeitig muss auch die Lebensqualität dieser Patienten verbessert werden. In den verschiedenen Stadien der Erkrankung spielt die körperliche Aktivität, mit ihren positiven Auswirkungen auf Müdigkeit, körperliche Verfassung, Stimmung usw., eine wichtige Rolle. Die Zusammenarbeit zwischen den verschiedenen Akteuren des Gesundheitswesens, die Patienteninformation und die Aufklärung sind der Schlüssel zum Erfolg dieser multidisziplinären Versorgung.

When people experiencing a manic episode arrive in hospital, restrictive measures are often put in place. The priority is to avoid all sources of stimulation, especially anything likely to activate the patient. The prescribing of occupational therapy sessions in a well-defined framework may however be appropriate at an early stage in the care. Aside from its effect on the therapeutic alliance, occupational therapy can help on the cognitive and temporal level, increasing awareness of the condition and engagement in the care.

Recent data has shown that lung inflammation and infection subvene very early in very young infants with Cystic Fibrosis (CF). This leads to impaired lung function and structural damage, even in asymptomatic children. In the CF-pig model constitutional airway narrowing is present at birth, and is associated with defective mucus migration, and impaired bacterial clearance. At the age of 3 months, 25% of screened CF infants show decreased lung function. Air trapping is also present in 68% and bronchiectasis in 28% of patients. At the same age, the presence of neutrophil elastase in the bronchoalveolar lavage is an ominous sign since it triples the risk of bronchiectasis at the age of 3 years. Since only very few drug therapies have been validated in the preschool children, adapted clinical trials are warranted in this age group. Early interventions may have a huge impact on the natural history of CF, on the condition of not interfering with normal lung growth.

In cystic fibrosis (CF), approximately 5-8% of the patients develop multilobular cirrhosis during the first decade of life. Annual screening (clinical examination, liver biochemistry, ultrasonography) is recommended in order to identify early signs of liver involvement, initiate ursodeoxycholic acid therapy and detect complications (portal hypertension and liver failure). Management should focus on nutrition and prevention of variceal bleeding. The gut may also be involved in children with CF. Gastroesophageal reflux is frequent, although often neglected and should be investigated by pH monitoring and impedancemetry, if available. Acute pancreatitis occurs in patients with persistent exocrine pancreatic activity. Intussusception, appendicular mucocele, distal intestinal occlusion syndrome, small bowel bacterial overgrowth and Clostridium difficile colitis should be considered in case of abdominal pain. Preventive nutritional support should be started as soon as possible after diagnosis of CF. Attainment of normal growth is one of the main goals and can be achieved with hypercaloric and salt supplemented food. Pancreatic enzyme replacement therapy should be started as soon as exocrine pancreatic insufficiency is confirmed and ingested immediately prior to meals with intake of fat-soluble vitamins. Curative nutritional interventions are more likely to be effective in the early stages of pulmonary disease. Feeding disorders, related to the physiopathology and the psychologic aspects of the disease are frequent. Repeated corporeal aggressions, associated with inappropriate medical and parental pressure, may increase the child's refusal of food. The multidisciplinary team should guide parents in order to avoid all intrusive feeding practices and promote pleasant mealtimes.

This review focused on the news in CF airways infection. International guidelines were provided for the care of non tuberculous mycobacteria, and recent studies stressed on the benefit effect of azithromycin or combined antibiotics. The identification of multiresistant environmental bacteria in airways made to account for little-known consequences. Early diagnosis and eradication of Pseudomonas aeruginosa and Staphylococcus aureus methi-R were still a concern, and reports were proposed. However, the studies on staphylococcus methi-R should be interpreted as regards the European or American continent. Thus, levofloxacine has demonstrated its efficacy without enhancing the efficiency. This drug will increase the choice for treating the patient, but no study were provided on the expected modification of the patient microbiota and the known risk of emergent resistance to antibiotics. Lastly, this review underlined that the CF practitioner was encouraged to search and not underestimate the presence of fungus, of which the not so well studied Aspergillus fumigatus.

In children and adolescents, psychotic disorders already represent one of the leading causes of disability-adjusted life years. During the past two decades, early detection of risk for psychosis has been intensively investigated, and in particular, predictive power for early signs of risk has been initiated and translated into clinical practice. In particular, the attenuated and transient positive symptoms of the ultra-high risk criteria, and the basic symptom criterion "cognitive disturbances", open promising routes to an indicated prevention and have recently been considered by the European Psychiatric Association (EPA) as diagnostic criteria of a psychosis-risk syndrome. The EPA recently provided evidence-based recommendations on the early detection of clinical high risk (CHR) for psychosis in patients with mental distress. In 2015, experts in the field of early detection conducted a meta-analysis reporting on studies examining conversion rates to psychosis in non-overlapping samples meeting at least one of the main CHR criteria: ultra-high risk (UHR) and/or basic symptoms criteria, examining the effects of potential moderators (different UHR criteria definitions, single UHR criteria and age) on conversion rates. In the 42 identified samples, comprising more than 4000 CHR patients who had been mainly identified by means of UHR criteria and/or the basic symptom criterion 'cognitive disturbances' (COGDIS), conversion rates showed considerable heterogeneity. While UHR and COGDIS criteria were related to comparable conversion rates until a 2-year follow-up, rates for COGDIS were significantly higher for follow-up periods beyond 2 years. Differences in onset and frequency requirements of symptomatic UHR criteria, or in their different consideration of functional decline, substance use and co-morbidity, did not seem to have an impact on conversion rates. The 'genetic risk and functional decline' UHR criterion was rarely met and only showed an insignificant pooled sample effect. However, age significantly affected UHR conversion rates with lower rates in children and adolescents. Although more research into potential sources of heterogeneity in conversion rates is needed to facilitate improvement of CHR criteria, six evidence-based recommendations for the early detection of psychosis were developed as a basis for the EPA guidance on early intervention in CHR states. The EPA guidance on early intervention aimed to provide evidence-based recommendations on early intervention in CHR states of psychosis, assessed according to the EPA guidance on early detection. The recommendations were also made by experts in the field of early intervention in psychoses and derived from a meta-analysis of current empirical evidence on the efficacy of psychological and pharmacological interventions in CHR samples. Eligible studies had to investigate conversion rate and/or functioning as a treatment outcome in CHR patients defined by the ultra-high risk and/or basic symptom criteria. In addition to analyses of treatment effects on conversion rate and functional outcome, age and type of intervention were examined as potential moderators. Based on data from 15 studies (n=1394), early intervention generally produced significantly reduced conversion rates at 6- to 48-month follow-up compared to control conditions. However, early intervention failed to achieve significantly greater functional improvements because both early intervention and control conditions produced similar positive effects. With regard to the type of intervention, both psychological and pharmacological interventions produced significant effects on conversion rates but not on functional outcome relative to the control conditions. Early intervention in youth samples was generally less effective than in predominantly adult samples. Seven evidence-based recommendations for early intervention in CHR samples have been formulated, although more studies are needed to investigate the specificity of treatment effects and potential age effects in order to tailor interventions to the individual treatment needs and risk status. Overall, age-related specificities and developmental transitions in the early detection and intervention in psychoses should be better accounted for in future research.

Vaudois university hospital in Lausanne, Switzerland, has an acute neurological rehabilitation unit. An interdisciplinary team cares for patients with brain injuries after their transfer from intensive care. In this context, nurses base their practice on different concepts and techniques for introducing early neurological rehabilitation into each care procedure.

The recent missions of military psychiatrists in the theatres of operation underline the reactivity of the French healthcare system, focused on the expertise of the combat unit doctor. Operation Serval in Mali illustrates in particular the methods of medical-psychological support in exceptional situations, across a vast geographical area and in very difficult climatic conditions. The concept of "forward psychiatry" has a particularly important role to play in the early screening and treatment of psychological disorders in order to preserve the operational capacity of the deployed personnel.

Operational conditions expose soldiers to situations which are potentially traumatic on a psychological level. The specific and non specific psychological disorders which can result require relatively flexible treatment tools which can be adapted to the circumstances.As the first "link in the chain", the intervention of a psychiatrist in a theatre of operations enables the psychological care to begin at an early stage to be followed by long-term treatment when necessary. This article focuses on a mission in Afghanistan.

The practice of the military psychiatrist comprises different perspectives, including a characteristic operational dimension. The unexpected is frequent in overseas missions, as illustrated by the crash of the Air Algeria flight in July 2014 in Mali and the deployment of French forces in the management of this disaster.This article reports on the medical-psychological intervention carried out in this context.

Infantile hemangioma is the consequence of both postnatal vasculogenesis and angiogenesis. Hypoxia appears to play an important role as a contributory factor. Infantile hemangiomas have variable clinical features: superficial, deep or mixed. They can be localized or segmental involving a large skin area. Localized infantile hemangiomas are usually benign, unless they are located near a noble structure (airway orbit...), while segmental infantile hemangioma may be associated with complex underlying birth defects (PHACES and SACRAL syndromes). Clinical follow-up of infants with infantile hemangioma must be particularly careful in the first weeks of life since 80% of all infantile hemangiomas have reached their final size at age 5 months. A majority of infantile hemangiomas are mild and do not required any treatment. Main indications for treatment are: vital risk (heart failure, respiratory distress), functional risk (amblyopia, swallowing disorders...), painful ulceration and disfigurement (face involvement of nose, lips...). Propranolol, has been quickly adopted as the first line medical treatment for complicated infantile hemangioma; and it is the only treatment to have a marketing authorization in this indication. It is recommended to begin the treatment as early as possible before three months of age to minimize the risk of complications and sequelae.

21 p. ill., Près de 10% des adultes en Belgique consomment l’alcool d’une manière que l’on qualifie de problématique. Mais parmi eux, seulement un sur douze cherche ou reçoit de l’aide, et encore, souvent après plusieurs années. À la demande du SPF Santé publique, le Centre fédéral d’Expertise des Soins de Santé (KCE) a analysé les raisons de cet écart et recommande plusieurs mesures pour faciliter la demande d’aide. Des raisons à la difficulté à trouver de l’aide ont été identifiées à différents niveaux : la société dans son ensemble, l’organisation/les prestataires de soins, et la personne concernée elle-même. Comme ces facteurs interagissent les uns avec les autres, il serait plus efficace d’agir sur ces trois niveaux en même temps. Les mesures préconisées comprennent entre autres un « Plan alcool » extensif, une meilleure formation des prestataires de soins, et davantage d’information du public au sujet de la consommation (problématique) d’alcool. PRÉFACE 1 -- MESSAGES CLÉS 2 -- RÉSUMÉ 3 -- 1. CONSOMMATION PROBLÉMATIQUE D’ALCOOL : RARES SONT CEUX QUI CHERCHENT DE L’AIDE 4 -- 1.1. LA CONSOMMATION D’ALCOOL EST TRÈS FRÉQUENTE 4 -- 1.2. LA CONSOMMATION PROBLÉMATIQUE D’ALCOOL : RAREMENT TRAITÉE 5 -- 2. UN PROBLÈME À COMPOSANTES MULTIPLES 6 -- 2.1. QU’EST-CE QUI EMPÊCHE DE CHERCHER DE L’AIDE ? 6 -- 2.2. QUELS RÔLES LES PRESTATAIRES DE SOINS ET L’ORGANISATION DES SOINS JOUENT-ILS DANS LA PROBLÉMATIQUE DU TREATMENT GAP ? 8 -- 2.3. COMMENT LE CONTEXTE SOCIAL CONTRIBUE-T-IL AU TREATMENT GAP ? 9 -- 3. SEULE UNE APPROCHE À DIFFÉRENTS NIVEAUX EST UTILE 11 -- 3.1. ÉLABORER UN PLAN « ALCOOL » AFIN DE MODIFIER LA PERCEPTION PAR LA SOCIÉTÉ 11 -- 3.2. ADAPTER L’ORGANISATION ET LE FINANCEMENT DES SOINS 11 -- 3.3. AU NIVEAU DES PRESTATAIRES DE SOINS : AMÉLIORER LA FORMATION, LES COMPÉTENCES ET L’ATTITUDE 12 -- 3.4. AU NIVEAU DE LA PERSONNE PRÉSENTANT UNE CPA : PRENDRE SON PROBLÈME EN CHARGE PERSONNELLEMENT ET ACTIVEMENT 14 -- 3.5. AU NIVEAU DE L’’ENTOURAGE IMMÉDIAT DU PATIENT : INFORMER ET SOUTENIR 14 -- 4. LA SYNERGIE EST ESSENTIELLE 15 -- RECOMMANDATIONS 16 -- RÉFÉRENCES 19

This study was designed to evaluate and compare the efficacy of early treatment of CRVO with either hemodilution by erythrocytopheresis or intravitreal (IVT) ranibizumab, or both.A multicentric prospective randomized study including patients with CRVO for less than 1 month was designed. Patients were randomized into 3 treatment groups: hemodilution (HD group), 3 monthly intravitreal injections of ranibizumab followed by PRN treatment (IVT group), or combined treatment (IVT+HD group). A monthly evaluation during a 6-month follow-up included best-corrected visual acuity (BCVA) and macular thickness measurements with OCT. Fluorescein angiography was performed at baseline, month 2 and month 6. Local and systemic tolerability of the different treatments were also compared.Forty-four CRVO patients were included between February 2010 and June 2013: 20 in the IVT group, 13 in the HD group and 11 in the HD+IVT group. The mean duration of CRVO at baseline was 10 days and 16 days at the time of treatment without any significant difference between groups. Retinal ischemia was present at baseline in 40% of eyes in each group. After a 6-month follow-up, no difference between the 3 groups was observed in BCVA (10.5 ETDRS letters, 14.6 and 14.1 in the IVT group, HD group and IVT+HD group respectively, P=0.726) or in macular thickness (398 μ, 440 μ and 379 μ respectively, P=0.465). The time until treatment from CRVO onset, ranging from 1 to 35 days, was not correlated to final outcomes. No significant difference in the mean number of IVT (3.2 in the IVT+HD group vs 3.7 in the IVT group) was observed at 6 months.No difference in BCVA nor in macular thickness was seen at M6 between the study groups. The duration of CRVO at the time of the initiation of the treatment was not correlated to better visual outcomes. Therefore, etiologic treatment with HD can still be proposed as a first-line treatment in young patients, which allows delaying or avoiding the IVT treatment and its potential side effects. Anti-VEGF IVT still remains an effective option in every case and can be started one month after the beginning of the CRVO.

This article attempts to identify and put into perspective the different approaches that could globally prevent the suffering induced by schizophrenia, from the detection of early psychosis to the impact on individual and family functioning and emotional health. Schizophrenia causes, at the community level, a number of difficult consequences and associated costs, which likely could be reduced if specific strategies, already known and documented internationally, were applied. Two areas not explored in this article: the role of medication and the issue of suicide prevention. In the scope of screening and early treatment, genetic risk, as well as the predictive ability of the clinical criteria for individuals at "ultra-high risk" of developing schizophrenia justify an increased vigilance for the detection of symptoms in order for treatment to begin earlier and to be more effective. These risk factors should not be neglected as the benefits of early management impact the course of illness and functional outcome. At this stage of the emergence of the disorder, it is difficult to systematize a therapeutic protocol. Two options are open to the clinician: "wait and watch" given the lack of a conclusive diagnosis and a more pro-active intervention, focused on the therapeutic alliance and enhancing insight and awareness. The second approach seems more productive but requires transparency with the patient and family regarding the uncertainty of the clinical situation, and an attitude that favors sharing information, along the lines of early psych education. Once a pathological stage is reached, early and accurate clinical care is fundamental. They depend heavily on access to care, proximity and availability to clinics or out-reach teams, capable of a thorough diagnostic work-up. Yet conversely, the availability for early and accurate clinical care faces obstacles which are closely related to the pejorative view of psychiatry held by the general public, health care professionals, and public officials. This poor image of psychiatry is partly due to cases of clinical decompensation, dangerous in some instances, underscoring why it is be important to understand and anticipate the contributory factors to these outcomes in the first place so as to avoid them. In this sense, defending a complacent and conciliatory approach can be counter-productive. Following developments of recent decades in other chronic diseases (diabetes, cancer, AIDS, severe heart disease…), the implementation of systematic clinical programs, treatment protocols, psycho-education to reinforce adherence to therapeutic measures, their simplification, the support and appreciation of the role of caregivers, destigmatizing due to proximity of contact, and therefore an increase in the use of care. Similarly, the systematic search for side-effects of medication and pro-actively managing to minimize their occurrence strengthen compliance, a recognized factor of relapse prevention. Preventable comorbidities, addictions, and common physical illnesses are not systematically screened (neoplastic diseases, diabetes, hypertension, dental health, gynecology…) in this population and thus also represent significant potential for a better life expectancy. The tools of psychosocial rehabilitation, unfortunately, are too infrequently used in France. Their goal is to improve the functional outcome of patients, a determinant of social integration and to lessen the burden shouldered by family and other carers, and ultimately to reduce exacerbations of the illness due to situations of interpersonal stress. Work has also proven its worth as a protective factor, as well as strengthening a sense of self-efficiency, of self-esteem, of empowerment, of quality of life, helping attain recovery. It is clear that not all social and health care systems are primarily geared towards these objectives, although they have at their disposal, by the means described above, strong preventive measures for relapses. Beyond the issue of the implementation of clinical programs, the existing culture would benefit from being infused with a prioritization of resource deployment, with debates of these issues regarding parity for mental health services, advocated by users, and forging a place, for example, for the intervention of "peer supports", sociologists, social workers, interested beyond the disease, in community environment, employment opportunities, and housing. Overall, this work argues for updating our conceptions of clinical care, supporting the systematic implementation of modern models of care, and expanding the scope of our concerns regarding patients' lives.

Children noses have special anatomical and functional characteristics. Early interventions performed before the end of the child's growth have been a main topic as they may cause adverse effects on the subsequent development and the function. This chapter describes the characteristics of the nasal pyramid and the septum at different stages of growth. Should one's approach be very cautious in children surgical indications, one should not hesitate opting for the treatment of congenital malposition or acquired when they jeopardize the nasal function. Considering possible procedures and specific conditions within pediatric field are discussed in this chapter.

Cancers of uppers aero-digestives tracts represent, infrequency, the 5th cancer in the French population. Most of them (about 70%) are diagnosed at an advanced stage (stage III or IV) while they are associated with a poor prognosis (only 40% five year survival). The objective of our study was to analyze the care pathway of patients with cancers of uppers aero-digestives tracts in order to target efforts to improve the survival of these patients.It was a descriptive and retrospective study, on medical files, on the health care pathway of patients with cancers of uppers aero-digestives tracts cared in the Head and Neck surgery department of Val de Grâce in Paris and Percy in Clamart between January 2004 and December 2006. The patients were adults with squamous cell carcinoma of uppers aero-digestives tracts.One hundred thirty-eight files of patients were analyzed. Fifty-five percent of patients were diagnosed at an advanced stage. On average patients have waited two months and twenty-one days before consulting a doctor for the first time. The time interval between the specialist consultation and the start of treatment was on average 7 weeks. The overall 5-year survival rate was 61%.Squamous cell carcinoma of uppers aero-digestives tracts remains serious and has a poor diagnosis, even in a population with a high social-cultural level. The long time interval before the first consultation may be reduced by improving health education among the general practitioner (primary and secondary prevention), and by establishing health care public campaigns. This would allow earlier diagnosis, more conservative therapeutic opportunities and therefore a better prognosis.

International audience; L-2-hydroxyglutaric aciduria is a rare genetic neurometabolic disease. It occurs in childhood with mental retardation, cerebellar ataxia, and epilepsy. Macrocephaly is present in half of the cases. Diagnosis is based on clinical symptoms, biological and radiological findings, and molecular testing. Specific treatments can improve the spontaneous progression of the disease. We examined two independent patients who presented with L-2-hydroxyglutaric aciduria. Clinical presentation led to cerebral MRI and urinary organic acid chromatography. The genetic analysis confirmed the diagnosis. Under specific treatment, the progression of the disease was subsequently stopped. L-2-hydroxyglutaric aciduria shares common symptoms with other genetic and metabolic diseases. However, the association of a distinct phenotype and typical MRI abnormalities (such as a high signal in the subcortical white matter, pallidum, and dentate nuclei) should draw the clinician's attention to this diagnosis. It can easily be suspected with a simple urinary analysis and can then be confirmed by genetic testing. With this case report, we show the importance of genetic identification to begin treatment with riboflavin. Early detection of L-2-hydroxyglutaric aciduria based on MRI abnormalities can enable rapid initiation of treatment and prevent disease progression.

The most frequent cause of Cushing's syndrome is iatrogenic, as Cushing's syndrome is the unavoidable consequence of long-term glucocorticoid treatment using more than 7.5 mg prednisone per day. The most frequent cause of endogenous Cushing's syndrome is Cushing's disease (CD), which is an ACTH dependent hypercortisolism linked to a pituitary corticotroph adenoma. This adenoma is often very small, its diagnosis may require bilateral inferior petrosal sinus sampling and the first line treatment of CD is transsphenoidal surgery by an expert neurosurgeon. The second line treatments include drugs that can act either on the pituitary adenoma or on adrenal steroidogenesis, pituitary radiotherapy or bilateral adrenalectomy. Ectopic ACTH dependent Cushing's syndrome is linked either to poorly differentiated endocrine tumors with a very poor prognosis, such as small cell lung cancer, or to well differentiated endocrine tumors, such as bronchial carcinoid tumors, which have a good prognosis when treated by surgery, but may be very difficult to localize. Adrenal Cushing's syndromes, which are independent of pituitary ACTH secretion, include adrenal cortex carcinoma, which requires abdominal surgery with extended adrenalectomy by an expert surgeon, adrenal adenoma which is treated by laparoscopic unilateral adrenalectomy and bilateral macronodular hyperplasia, whose surgical treatment may require unilateral or bilateral adrenalectomy. Treatment of Cushing's syndrome generally leads to spectacular clinical results, which must not hide the fact that the reversibility of some signs is actually incomplete. This underlines the need for a timely multidisciplinary management of the patients by an expert team.

Cushing's syndrome includes all the clinical manifestations induced by chronic glucocorticoid excess. The endogenous Cushing's syndrome is rare, but its prevalence, although difficult to define, is much higher in populations at risk. Data suggest that early and effective management would reduce morbidity and mortality after correction of hypercortisolism. It is not recommended to widespread test for Cushing's syndrome but targeted screening is indicated especially in the following indications: facio-troncular obesity, hypercatabolism signs, pituitary and adrenal tumor. In case of potential but less specific manifestation of Cushing's syndrome (diabetes, hypertension, osteoporosis, hypogonadism…), but unusual for age, familial background, or severity, particular attention will be paid to the clinical examination to search for signs of modest hypercortisolism which may justify screening. The positive diagnosis of Cushing's syndrome is based on two stages approach with the first tests simple and sensitive, and the second tests more specific, with investigations to determine the cause following a positive diagnosis.

Acute adrenal insufficiency is a rare, unknown, and life-threatening emergency. It seems therefore essential to help patients gain or maintain the skills they need to prevent or treat early acute adrenal insufficiency, which is the goal of therapeutic education. A program has been implemented within the service focused on patient empowerment.

In the context of the development of early intervention for first-episode psychosis, this manuscript reviews new data with respect to its incidence, risk factors and evolution. Annual incidence of non-affective psychosis appeared to be between 14 and 30/100,000 in people aged 18-64. Incidence decreases with age and is twice higher in men than in women. There is an interaction between age and gender; the risk of psychosis decreases with age faster in men than in women. Thus, for schizophrenia, incidence rate is twice higher in men under 45 year-old and similar in both genders after. There is evidence that genetic and environmental factors may cause enduring liability to psychotic disorder, and, in addition, that genes and environment may interact synergistically. Some environmental factors have been identified; they concern foetal life, childhood or adolescence and may be conceptualized at the individual or the contextual level. The definition of recent onset psychosis may be based on duration of psychosis, between two and five years. Its development is identified through the occurrence of major psychotic symptoms, such as positive, negative symptomatology or disorganization, and impairment of social functioning. The types and patterns of occurrence and of evolution of psychotic symptoms have a prognostic impact. A long duration of untreated psychosis impacts symptomatology. It is associated with less severe positive symptoms at baseline and more severe after three years, insidious onset, male gender, early onset, and diagnosis of schizophrenia. Recent onset psychosis is often associated with comorbidities, such as depression, anxiety disorders, suicidal behaviours, and addiction. Symptomatic remission rates are found between 25 and 60%. Symptomatic and functional remissions favour each other. A third to half of patients is active, employed or students. Symptoms and evolution are various in studies, probably corresponding to various patho-physiological mechanisms.

L-2-hydroxyglutaric aciduria is a rare genetic neurometabolic disease. It occurs in childhood with mental retardation, cerebellar ataxia, and epilepsy. Macrocephaly is present in half of the cases. Diagnosis is based on clinical symptoms, biological and radiological findings, and molecular testing. Specific treatments can improve the spontaneous progression of the disease. We examined two independent patients who presented with L-2-hydroxyglutaric aciduria. Clinical presentation led to cerebral MRI and urinary organic acid chromatography. The genetic analysis confirmed the diagnosis. Under specific treatment, the progression of the disease was subsequently stopped. L-2-hydroxyglutaric aciduria shares common symptoms with other genetic and metabolic diseases. However, the association of a distinct phenotype and typical MRI abnormalities (such as a high signal in the subcortical white matter, pallidum, and dentate nuclei) should draw the clinician's attention to this diagnosis. It can easily be suspected with a simple urinary analysis and can then be confirmed by genetic testing. With this case report, we show the importance of genetic identification to begin treatment with riboflavin. Early detection of L-2-hydroxyglutaric aciduria based on MRI abnormalities can enable rapid initiation of treatment and prevent disease progression.

Hurler syndrome, the most severe form of mucopolysaccharidosis type I (MPS I), is a rare lysosomal storage disease. The overall incidence of MPS I is 0.99-1.99/100,000 live births. Accumulation of glycosaminoglycans causes the progressive dysfunction of multiple organs. We report the case of a 3-week-old newborn who was hospitalized in the Neonatal Intensive Care Unit for feeding problems. Coarse facial features and gingival hypertrophy, associated with axial hypotonia, upper airway obstruction, and moderate hepatomegaly, led to the early diagnosis of MPS I at 3 weeks of age and was confirmed by an abnormally elevated amount of dermatan and heparan sulphate in the urine and complete deficiency of alpha-L-iduronidase lysosomal enzyme activity. The child was homozygous for the p.W402X mutation, located on chromosome 4p16.3 of the alpha-L-iduronidase (IDUA) gene. The clinical condition gradually deteriorated until the age of 4 months, with thoracic and lumbar dysostoses, glaucoma, cerebral ventricular dilatation and cervical spinal stenosis, dilated cardiomyopathy, and umbilical hernia. Early diagnosis allowed enzyme replacement therapy (iaronidase, Aldurazyme(®), Genzyme) started at the age of 5 months, which provided stabilization of the heart disease, significant regression of rhinologic symptoms, and regression of hepatomegaly. Cord blood hematopoietic stem cell transplantation was performed at 11 months of age, allowing optimal preservation of cognitive development.

Cryptorchidism is one of the commonest congenital anomalies in the male genitalia, affecting 3 to 5% of male full-term neonates. It is a known cause of infertility associated with a greater risk of development of germ cell tumor. The benefits of early orchidopexy include psychological affects, prevention of testicular degeneration and decrease in the risk of testicular cancer. Laparoscopy is the best way to diagnose and manage intra-abdominal testes.

The onset of schizophrenic disorders generally occurs in late adolescence/early adulthood. However, in 75% of the cases, the onset is preceded by a prodromal stage. Subjects concerned by these prodromal symptoms are defined at "high risk" for psychosis (30% of conversion to psychosis in the next year). Early detection programs aim at improving the recognition of the prodromal symptoms in order to develop appropriate early interventions that will delay or prevent conversion to psychosis or reduce the duration of untreated psychosis (DUP). Atypical antipsychotics are not recommended when psychotic symptoms are only attenuated, while they must be rapidly prescribed when a franc psychotic episode is present. Early identification of patients with schizophrenia is a general practitioners' task provided that they can rely on a supportive specialized psychiatric team. Early intervention should be based on a comprehensive assessment of the subject, in order to propose personalized care that include cognitive therapy, psycho-education, and treatment of associated disorders (depression, substance abuse). The reduction of duration of untreated psychosis will also require sensibilization campaigns in the community with the hope to improve access to care and service delivery.

The clinical aspects of neonatal cerebral venous thrombosis are polymorphic in their mode of onset, making diagnosis difficult. Transfontanellar ultrasound allows for the morphological and vascular exploration of intracranial contents. We report three cases of neonatal cerebral venous thrombosis diagnosed early by transfontanellar ultrasound. The patients were treated with low-molecular-weight heparin, and the outcome was favorable in all three newborns. Transfontanellar ultrasound has a variable sensitivity for the detection of thrombus, but it remains the first-line examination before any additional secondary exploration. The early diagnosis of neonatal cerebral venous thrombosis with transfontanellar ultrasound requires the implementation of emergency treatment.

Schizophrenia is a serious, chronic illness which, when treated early, can result in a better prognosis. The putting in place of treatment is often delayed because it is difficult to identify early schizophrenic disorders. At this stage of the illness, the doctor participates as much as the family and the patients themselves in the delay of the diagnosis. In order to encourage early diagnosis of people with schizophrenia, Brest regional university hospital has created a specialised consultation.