Entourage des patients âgés avec une pathologie mentale [Carers of elderly patients suffering from mental disorders]

Mental disorders in the elderly lead their families to stand in and adopt a variety of roles before institutional care takes over. These pathologies carry a high risk of suffering for families and distress for professional caregivers. Thus, the psychological burden endured by the proxies of an elderly depressed patient, or of one who has committed suicide, or of patient suffering from dementia needs special attention and, in some cases, professional care. The discussion of these paradigmatic situations in this manuscript will be extended by a paragraph on specific stakes raised by alcoholic patients living in nursing homes. It will stress the complexity and requirements of professionalism when approaching the familial and professional circle of the elderly psychiatric patient.

The role of potassium in inflammasome activation by bacteria.

Many Gram-negative bacteria possess a type III secretion system (TTSS( paragraph sign)) that can activate the NLRC4 inflammasome, process caspase-1 and lead to secretion of mature IL-1beta. This is dependent on the presence of intracellular flagellin. Previous reports have suggested that this activation is independent of extracellular K(+) and not accompanied by leakage of K(+) from the cell, in contrast to activation of the NLRP3 inflammasome. However, non-flagellated strains of Pseudomonas aeruginosa are able to activate NLRC4, suggesting that formation of a pore in the cell membrane by the TTSS apparatus may be sufficient for inflammasome activation. Thus, we set out to determine if extracellular K(+) influenced P. aeruginosa inflammasome activation. We found that raising extracellular K(+) prevented TTSS NLRC4 activation by the non-flagellated P. aeruginosa strain PA103DeltaUDeltaT at concentrations above 90 mm, higher than those reported to inhibit NLRP3 activation. Infection was accompanied by efflux of K(+) from a minority of cells as determined using the K(+)-sensitive fluorophore PBFI, but no formation of a leaky pore. We obtained exactly the same results following infection with Salmonella typhimurium, previously described as independent of extracellular K(+). The inhibitory effect of raised extracellular K(+) on NLRC4 activation thus reflects a requirement for a decrease in intracellular K(+) for this inflammasome component as well as that described for NLRP3.