Trust in sources of information on COVID-19 at the beginning of the pandemic first wave and incident persistent symptoms: A prospective population-based cohort study

Background: Many patients affected by COVID-19 suffer from persistent symptoms after infection. Compared to biomedical mechanisms, psychosocial mechanisms have been less investigated. This study examined the association between trust in sources of information on COVID-19 and the burden of incident persistent symptoms. Method(s): A prospective study using data from the SAPRIS and SAPRIS-Serologie surveys nested in the French CONSTANCES cohort. Trust in medical doctors, government, scientists, journalists, and social media was measured between April 2020 and May 2020. The number of incident persistent symptoms lasting for at least two months was recorded. Psychological burden was measured with the somatic symptom disorder B criteria scale. Associations between trust in information sources and outcomes were examined with zero-inflated negative binomial regression and general linear models, adjusting for gender, age, education, income, self-rated health, SARS-CoV-2 serology tests, and self-reported COVID-19 Results: Among 20,985 participants, those with higher trust in government/journalists at baseline had fewer incident persistent symptoms at follow-up (estimate (SE): -0.21 (0.03), p < 0.001). Among 3372 participants (16.07%) who reported at least one symptom, those with higher trust in government/journalists and medical doctors/scientists had lower SSD-12 scores (-0.39 (0.17), p = 0.0219 and - 0.85 (0.24), p < 0.001, respectively), whereas higher trust in social media sources predicted higher SSD-12 scores in those with lower trust in government/journalists (0.90 (0.34), p = 0.008). These associations did not depend upon surrogate markers of past infection with SARS-CoV-2 Conclusion(s): Trust in information sources on COVID-19 should be tested as a target in the prevention of incident persistent symptoms.Copyright © 2023

Psychiatry training goes virtual: the experience of the first online edition of the EPA Research Summer School

Introduction: The European Psychiatric Association (EPA) Summer School allows psychiatric trainees and early career psychiatrists (ECPs) from all over Europe to meet, network, and learn together. After the 2020 edition being cancelled due to COVID-19, the 10th edition in 2021 focused for the first time on research and was conducted remotely. Objective(s): To provide an overview and feedback about the first Virtual EPA Research Summer School as a new way to encourage international networking during COVID-19. Method(s): The School was organized by the EPA Secretary for Education, and 4 Faculty members. It started with a breaking the ice session one week before and then a two-days meeting on 23-24 September 2021 using an online video-platform. This was preceded by all the 21 participants (from 18 different countries) recording a short 4-minute video presentation, which was uploaded and shared with other participants and Faculty. Result(s): Participants were divided on a voluntary basis into three working groups: 1) Drug repurposing: overcoming challenges in pharmacoepidemiology 2) Psychopathological research in psychiatry;3) How to conduct a cross-sectional survey?. The Summer School program was composed of plenary sessions with lectures by the Faculty members, discussion sessions, and working groups time. At the end, each group presented a summary of the work done to the rest of the participants. Conclusion(s): Although the remote format limits social interactions during the Summer School, overall participants' high satisfaction and productivity indicate that not only online formats, but also the topic of research might be covered in future editions.

10th EPA Summer School on Research 2021: sharing experience of the first online edition

The European Psychiatric Association (EPA) Summer School is an intensive program which has been organised for 10 years now by the EPA Committee on Education and allows selected psychiatric trainees and early career psychiatrists (ECPs) from all over Europe to meet, network, and learn together. After the 2020 edition being cancelled due to COVID-19 pandemic, the 2021 edition was held online and continued the EPA educational mission in an innovative and up-to-date approach. Twenty one participants from 16 different countries were selected to attend by the EPA Committee on Education. During the two full days of training, participants were engaged in fundamental educational activities by renowned faculty members such as Dr. Cécile Hanon, Dr. Nicolas Hoertel, Dr. Mariana Pinto da Costa, Prof. Andrea Raballo, Prof. Norman Sartorius and Prof. Peter Falkai. This was the first time EPA Summer School centered its topic on Research in Psychiatry, giving a unique opportunity for ECPs and psychiatric trainees to enrich their knowledge and skills and to find inspiration for their future research. In this paper, we intend to share our experience and provide a perspective on what we have learned during the EPA Summer School sessions. Copyright © 2022 John Libbey Eurotext. L’université d’été de l’Association européenne de psychiatrie (EPA) est un programme intensif organisé depuis 10 ans par le Comité de l’éducation de l’EPA et permet à des stagiaires en psychiatrie et à des psychiatres en début de carrière (ECP) sélectionnés dans toute l’Europe de se rencontrer, de créer des réseaux et d’apprendre ensemble. Après l’annulation de l’édition 2020 en raison de la pandémie de Covid-19, l’édition 2021 s’est tenue en ligne et a poursuivi la mission éducative de l’EPA dans une approche innovante et actualisée. Vingt-et-un participants de 16 pays différents ont été sélectionnés par le comité d’éducation de l’EPA. Pendant les deux jours de formation, les participants ont participé à des activités éducatives fondamentales dispensées par des professeurs renommés tels que le Dr Cécile Hanon, le Dr Nicolas Hoertel, le Dr Mariana Pinto da Costa, le Pr Andrea Raballo, le Pr Norman Sartorius et le Pr Peter Falkai. C’était la première fois que l’école d’été de l’EPA centrait son sujet sur la recherche en psychiatrie, donnant ainsi une occasion unique aux ECP et aux stagiaires en psychiatrie d’enrichir leurs connaissances et leurs compétences et de trouver une inspiration pour leurs futures recherches. Dans cet article, nous avons l’intention de partager notre expérience et de fournir une perspective sur ce que nous avons appris pendant les sessions de l’école d’été de l’EPA. © 2022 John Libbey Eurotext. All rights reserved.

Association between benzodiazepine receptor agonist use and mortality in patients hospitalised for COVID-19: a multicentre observational study.

AIMS: To examine the association between benzodiazepine receptor agonist (BZRA) use and mortality in patients hospitalised for coronavirus disease 2019 (COVID-19). METHODS: A multicentre observational study was performed at Greater Paris University hospitals. The sample involved 14 381 patients hospitalised for COVID-19. A total of 686 (4.8%) inpatients received a BZRA at hospital admission at a mean daily diazepam-equivalent dose of 19.7 mg (standard deviation (s.d.) = 25.4). The study baseline was the date of admission, and the primary endpoint was death. We compared this endpoint between patients who received BZRAs and those who did not in time-to-event analyses adjusted for sociodemographic characteristics, medical comorbidities and other medications. The primary analysis was a Cox regression model with inverse probability weighting (IPW). RESULTS: Over a mean follow-up of 14.5 days (s.d. = 18.1), the primary endpoint occurred in 186 patients (27.1%) who received BZRAs and in 1134 patients (8.3%) who did not. There was a significant association between BZRA use and increased mortality both in the crude analysis (hazard ratio (HR) = 3.20; 95% confidence interval (CI) = 2.74-3.74; p < 0.01) and in the IPW analysis (HR = 1.61; 95% CI = 1.31-1.98, p < 0.01), with a significant dose-dependent relationship (HR = 1.55; 95% CI = 1.08-2.22; p = 0.02). This association remained significant in sensitivity analyses. Exploratory analyses indicate that most BZRAs may be associated with an increased mortality among patients hospitalised for COVID-19, except for diazepam, which may be associated with a reduced mortality compared with any other BZRA treatment. CONCLUSIONS: BZRA use may be associated with an increased mortality among patients hospitalised for COVID-19, suggesting the potential benefit of decreasing dose or tapering off gradually these medications when possible.

[Ensuring mental health care during the SARS-CoV-2 epidemic in France: A narrative review]. / Assurer les soins aux patients souffrant de troubles psychiques en France pendant l'épidémie à SARS-CoV-2.

OBJECTIVE: The lack of ressources and coordination to face the epidemic of coronavirus raises concerns for the health of patients with mental disorders in a country where we keep in memory the dramatic experience of famine in psychiatric hospitals during the Second World War. This article aims at proposing guidance to ensure mental health care during the SARS-CoV epidemy in France. METHODS: Authors performed a narrative review identifying relevant results in the scientific and medical literature and local initiatives in France. RESULTS: We identified four types of major vulnerabilities in patients suffering from mental disorders during this pandemic: (1) medical comorbidities that are more frequently found in patients suffering from mental disorders (cardiovascular and pulmonary pathologies, diabetes, obesity, etc.) which represent risk factors for severe infections with Covid-19; (2) age (the elderly constituting the population most vulnerable to coronavirus); (3) cognitive and behavioral troubles which can hamper compliance with confinement and hygiene measures and finally and (4) psychosocial vulnerability due to stigmatization and/or socio-economic difficulties. Furthermore, the mental health healthcare system is more vulnerable than other healthcare systems. Current government plans are poorly adapted to psychiatric establishments in a context of major shortage of organizational, material and human resources. In addition, a certain number of structural aspects make the psychiatric institution particularly vulnerable: many beds are closed, wards have a high density of patients, mental health community facilities are closed, medical teams are understaffed and poorly trained to face infectious diseases. We could also face major issues in referring patients with acute mental disorders to intensive care units. To maintain continuity of psychiatric care in this pandemic situation, several directions can be considered, in particular with the creation of Covid+ units. These units are under the dual supervision of a psychiatrist and of an internist/infectious disease specialist; all new entrants should be placed in quarantine for 14 days; the nurse staff should benefit from specific training, from daily medical check-ups and from close psychological support. Family visits would be prohibited and replaced by videoconference. At the end of hospitalization, in particular for the population of patients in compulsory ambulatory care situations, specific case-management should be organized with the possibility of home visits, in order to support them when they get back home and to help them to cope with the experience of confinement, which is at risk to induce recurrences of mental disorders. The total or partial closure of mental health community facilities is particularly disturbing for patients but a regular follow-up is possible with telemedicine and should include the monitoring of the suicide risk and psychoeducation strategies; developing support platforms could also be very helpful in this context. Private psychiatrists have also a crucial role of information with their patients on confinement and barrier measures, but also on measures to prevent the psychological risks inherent to confinement: maintenance of sleep regularity, physical exercise, social interactions, stress management and coping strategies, prevention of addictions, etc. They should also be trained to prevent, detect and treat early warning symptoms of post-traumatic stress disorder, because their prevalence was high in the regions of China most affected by the pandemic. DISCUSSION: French mental healthcare is now in a great and urgent need for reorganization and must also prepare in the coming days and weeks to face an epidemic of emotional disorders due to the containment of the general population.

Ensuring mental health care during the SARS-CoV-2 epidemic in France: A narrative review.

OBJECTIVE: The lack of resources and coordination to face the coronavirus epidemic raises concerns for the health of patients with mental disorders in a country where we still have memories of the dramatic experience of famine in psychiatric hospitals during the Second World War. This article aims to propose guidance to ensure mental health care during the SARS-CoV epidemic in France. METHODS: The authors performed a narrative review identifying relevant results in the scientific and medical literature and in local initiatives in France. RESULTS: We identified four types of major vulnerabilities among patients with mental disorders during this pandemic: (1) medical comorbidities that are more frequently found among patients with mental disorders (cardiovascular and pulmonary pathologies, diabetes, obesity, etc.) which are risk factors for severe covid-19 infection; (2) age (the elderly form the population most vulnerable to the coronavirus); (3) cognitive and behavioural disorders, which can hamper compliance with confinement and hygiene measures and finally and (4) psychosocial vulnerability as a result of stigmatization and/or socio-economic difficulties. Furthermore, the mental health healthcare system is more vulnerable than other healthcare systems. Current government plans are poorly suited to psychiatric establishments in a context of major shortages of organizational, material and human resources. In addition, a certain number of structural aspects make the psychiatric institution particularly vulnerable: many beds have been closed, wards have high densities of patients, mental health community facilities are closed, and medical teams are understaffed and poorly trained to face infectious diseases. There are also major issues when referring patients with acute mental disorders to intensive care units. To maintain the continuity of psychiatric care in this pandemic situation, several directions can be considered, in particular with the creation of "COVID+ units". These units are under the dual supervision of a psychiatrist and an internist/infectious disease specialist; all new entrants are placed in quarantine for 14 days; the nursing staff receives specific training, daily medical check-ups and close psychological support. Family visits are prohibited and replaced by videoconference. At the end of hospitalization, in particular for the population of patients in compulsory ambulatory care situations, specific case-management are organized with the possibility of home visits, in order to support patients when they get back home and to help them cope with the experience of confinement, which is liable to induce recurrences of mental disorders. The total or partial closure of community mental health facilities is particularly disturbing for patients, but a regular follow-up is possible with telemedicine and should include the monitoring of suicide risk and psycho-education strategies; developing support platforms could also be very helpful in this context. Private practice psychiatrists also have a crucial role of information towards their patients on confinement and barrier measures, and also on measures to prevent the psychological risks inherent in confinement: maintenance of regular sleep r, physical exercise, social interactions, stress management and coping strategies, prevention of addictions, etc. They should also be trained to prevent, detect and treat early warning symptoms of post-traumatic stress disorder, because their prevalence was high in the regions of China most affected by the pandemic. DISCUSSION: French mental healthcare is now facing a great and urgent need for reorganization and must also prepare in the coming days and weeks to face an epidemic of emotional disorders due to the confinement of the general population.