Nowadays, the rehabilitation of schizophrenic patients is a major issue for psychiatry. Regarding the role of conventional neuroleptics, the following points will be considered in this paper: the role of neuroleptics in the number, length and frequency of hospitalisations; the role of neuroleptics in the number, degree and length of relapses; the clinical effects of neuroleptics focusing particularly on their disinhibitory action, the most controversial and least studied of the clinical effects of these drugs; and the side effects, which have been intensively studied and particularly criticised during these last years, leading to the development of new drugs discussed in the next article. All the published data relating to the psychosocial profile of schizophrenic patients clearly demonstrate the need for further research in order to improve the familial, social and professional rehabilitation of these patients

Introduction: Despite the provision of evidence-based care, approximately 15% of patients discharged from the emergency department (ED) after being treated for asthma exacerbations will relapse within two weeks. This study summarizes the evidence regarding relapses and factors associated with increased relapse in patients discharged from EDs after being treated for asthma exacerbations. Methods: Comprehensive literature searches were conducted in seven electronic databases; manual and grey literature searches were performed. Studies tracking outcomes for adults after ED management and discharge were included. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS) and the Risk of Bias (RoB) tools. Studies were summarized using medians and interquartile ranges (IQR) or mean and standard deviation (±SD), as appropriate. Results: From 793 potentially relevant citations, 178 articles underwent full text review and 10 studies involving 32,923 patients were included. The majority of the studies were of high quality according to NOS and RoB tools. Relapse proportions were 8±3%, 12±4%, and 14±6% at one, two, and four weeks, respectively. Female sex was the most common statistically significant reported factor associated with an increased risk of relapse within 4 weeks of ED discharge for acute asthma. Other factors significantly associated with relapse were past healthcare utilization and symptom duration. Conclusion: After ED management and discharge of acute asthma, a considerable proportion of patients will relapse within the first four weeks. Factors such as female sex, past healthcare utilization, and symptom duration were commonly and significantly associated with relapse occurrence. Identifying patients with these features could provide guidance to clinicians during the ED-discharge decision-making.

Preliminary small studies have shown that transcranial direct current stimulation (tDCS) reduces craving in alcoholic subjects. It is unclear whether tDCS also leads to changes in clinically meaningful outcomes for alcohol dependence in a properly powered phase II randomized clinical trial. We aimed to investigate whether repetitive tDCS changes the risk of alcohol use relapse in severe alcoholics from outpatient services. Thirty-five subjects were randomized to receive active bilateral [left cathodal/right anodal over the dorsolateral prefrontal cortex (dlPFC)] repetitive (five consecutive days) tDCS (2 mA, 35 cm2, two times daily stimulation for 13 min with a 20-min interval) or sham-tDCS. There were two dropouts before treatment. From 33 alcoholic subjects, 17 (mean age 45.5 ± 8.9 s.d., 16 males) were randomized to sham and 16 (44 ± 7.8 s.d., 16 males) to real tDCS treatment. By the end of the six months of follow-up, two subjects treated with sham (11.8%) and eight treated with real tDCS (50%) were still alcohol-abstinent [p = 0.02, Long-rank (Mantel-Cox) Test, HR = 0.35 (95% CI, 0.14–0.85)]. No differences with regard to changes on scores of craving, frontal function, global mental status, depressive or anxiety symptoms were observed between groups. However, subjects from the tDCS group improved with regard to their overall perception of quality of life (p = 0.02), and increased their scores in the environment domain (p = 0.04) after treatment. Bilateral tDCS over dlPFC reduces relapse probability in severe alcoholic subjects and results in improved perception of quality of life.

Leishmania parasites can escape the immune response by invading cell types lacking leishmanicidal mechanisms. Silent persistence of Leishmania parasites in the host organism is responsible for asymptomatic carriage and relapses after cured leishmaniasis. Here, we studied the interaction between Hepatic Stellate Cells (HSC) and Leishmania. An original model of human HSC in primary culture infected with L. donovani was developed. The presence of intracellular parasites was studied and quantified using optical and confocal microscopy. HSC characteristics were studied using microscopy, methylene blue assay, long-term cultures and qPCR. We showed for the first time that human HSC are permissive to L. donovani infection, with no modification of HSC survival, growth rate and proinflammatory and fibrogenic characteristics. Intracellular parasites did not replicate but HSC had no effect on their survival. Indeed, after a 40-day culture, infected HSC cultures transferred on NNN medium yielded new promastigotes that were able to proliferate and efficiently infect new cells. HSC are permissive to L. donovani, with neither parasite killing nor apparent cell damage. Thus, HSC could act as potent sanctuary cells for Leishmania in the liver, which could partially explain parasite reactivation after an asymptomatic carriage or a cured visceral leishmaniasis.