Telephone-delivered Interpersonal Psychotherapy: a systematic review.

BACKGROUND: The aim of this paper is to review evidence on Interpersonal Psychotherapy (IPT) administered via telephone (IPT-T). METHODS: We conducted a systematic review of studies published between January 1, 1990 and June 30, 2020, assessing the efficacy of IPT administered by phone, using PubMed. RESULTS: Originally, we found 60 papers; the final selection led to 13 papers. Six studies were performed using a randomized clinical trial methodology (6/13, 46.2%), three were prospective open-label not randomized studies (3/13, 15.7%), three were pilot studies (3/13, 23.1%), and one was a feasibility/acceptance study (1/13, 7.7%). The number of subjects included in the studies ranged between 14 and 442 (mean: 140.0 ± 124.9), for a total of 1850 patients. The mean age of the enrolled subjects was 47.8 ± 9.3 years (range: 27.4-70.4). Thirty-four different instruments were utilized. Qualitative synthesis was conducted only on randomized controlled trials (RCTs), namely on six studies. RCTs were almost all of good quality (mean score/standard deviation of the RCT-Psychotherapy Quality Rating Scale omnibus rating: 5.6 ± 1.2 points; range: 3-7). CONCLUSIONS: IPT-T showed response rates similar to IPT administered in the usual way. Results are limited by small samples sizes, selection bias of the less severe depressed patients, and the heterogeneity of rating scales.

The impact of COVID-19 on psychiatric and mental health services in Europe: suffering experienced by professionals.

BACKGROUND: The COVID-19 pandemic has not only impacted intensive care units, but all healthcare services generally. This PsyGipo2C project specifically investigates how psychiatry and mental health professionals have been affected by the reorganizations and constraints imposed, which have reshaped their often already difficult working conditions. METHODS: Our research combined quantitative and qualitative methods, surveying and interviewing health professionals of all occupations working in psychiatric and mental health services. A questionnaire was completed by 1241 professionals from 10 European countries, and 13 group interviews were conducted across 5 countries. In addition to this, 31 individual interviews were conducted in Belgium and France. RESULTS: Among the questionnaire respondents, 70.2% felt that their workload had increased, particularly due to their tasks being diversified and due to increased complexity in the provision of care. 48.9% felt that finding a work-life balance had become more difficult, and 59.5% felt their health had been affected by the crisis. The impact of the health crisis nevertheless varied across professions: our data provides insight into how the health measures have had a differential impact on professional tasks and roles across the various categories of occupations, obliging professionals to make various adaptations. The distress incurred has been linked not only to these new constraints in their work, but also to the combination of these with other pressures in their personal lives, which has consequently compromised their well-being and their ability to cope with multiple demands. DISCUSSION: The COVID-19 health crisis has had varying impacts depending on the profession and access to remote work, sometimes leading to conflicts within the teams. The suffering expressed by the professionals was tied to their values and patterns of investment in work. Our research also highlights how these professionals made little use of the psychological supports offered, probably due to a reluctance to acknowledge that their mental health was affected.

Oxytocin: An Old Hormone, a Novel Psychotropic Drug and its Possible Use in Treating Psychiatric Disorders.

BACKGROUND: Oxytocin is a nonapeptide synthesized in the paraventricular and supraoptic nuclei of the hypothalamus. Historically, this molecule has been involved as a key factor in the formation of infant attachment, maternal behavior and pair bonding and, more generally, in linking social signals with cognition, behaviors and reward. In the last decades, the whole oxytocin system has gained a growing interest as it was proposed to be implicated in etiopathogenesis of several neurodevelopmental and neuropsychiatric disorders. METHODS: With the main goal of an in-depth understanding of the oxytocin role in the regulation of different functions and complex behaviors as well as its intriguing implications in different neuropsychiatric disorders, we performed a critical review of the current state of the art. We carried out this work through the PubMed database up to June 2021 with the search terms: 1) "oxytocin and neuropsychiatric disorders"; 2) "oxytocin and neurodevelopmental disorders"; 3) "oxytocin and anorexia"; 4) "oxytocin and eating disorders"; 5) "oxytocin and obsessive- compulsive disorder"; 6) "oxytocin and schizophrenia"; 7) "oxytocin and depression"; 8) "oxytocin and bipolar disorder"; 9) "oxytocin and psychosis"; 10) "oxytocin and anxiety"; 11) "oxytocin and personality disorder"; 12) "oxytocin and PTSD". RESULTS: Biological, genetic, and epigenetic studies highlighted quality and quantity modifications in the expression of oxytocin peptide or in oxytocin receptor isoforms. These alterations would seem to be correlated with a higher risk of presenting several neuropsychiatric disorders belonging to different psychopathological spectra. Collaterally, the exogenous oxytocin administration has shown to ameliorate many neuropsychiatric clinical conditions. CONCLUSION: Finally, we briefly analyzed the potential pharmacological use of oxytocin in a patient with severe symptomatic SARS-CoV-2 infection due to its anti-inflammatory, antioxidative and immunoregulatory properties.

Back to the Future: The Role of Infections in Psychopathology. Focus on OCD.

Objective: Recently, there has been a resurgence of interest in the relationship between infections and psychopathology, given the increasing data on the neurotropism and neurological/psychiatric morbidity of the SARS-COV2 virus, responsible for the current worldwide pandemic. Although the majority of observations were those obtained in mood and schizophrenic disorders, a few data are also available on the presence of bacterial or viral infections in patients suffering from obsessive-compulsive disorder (OCD). Therefore, given the limited information, the present paper aimed at reviewing the most updated evidence of infections in neuropsychiatric disorders and their possible mechanisms of actions, with a narrow focus on microbes in OCD. Method: This paper is a narrative review. The databases of PubMed, Scopus, Embase, PsycINFO and Google Scholar were accessed to research and collect English language papers published between 1 January 1980 and 31 December 2021. The data on PANDAS/PANS and those observed during severe brain infections were excluded. Results: Several pathogens have been associated with an increased risk to develop a broad spectrum of neuropsychiatric conditions, such as schizophrenia, mood disorders, autism, attention-deficit/hyperactivity disorder, anorexia nervosa, and post-traumatic stress disorder. Some evidence supported a possible role of infections also in the pathophysiology of OCD. Infections from Herpes simplex virus 1, Borna disease virus, Group A-Beta Hemolytic Streptococcus, Borrelia spp., and Toxoplasma gondii were actually found in patients with OCD. Although different mechanisms have been hypothesized, all would converge to trigger functional/structural alterations of specific circuits or immune processes, with cascade dysfunctions of several other systems. Conclusions: Based on the current evidence, a possible contribution of different types of microbes has been proposed for different neuropsychiatric disorders including OCD. However, the currently available literature is meager and heterogeneous in terms of sample characteristics and methods used. Therefore, further studies are needed to better understand the impact of infectious agents in neuropsychiatric disorders. Our opinion is that deeper insights in this field might contribute to a better definition of biological underpinnings of specific clinical pictures, as well as to promote psychiatric precision medicine, with treatments based on altered pathological pathways of single patients. This might be particularly relevant in OCD, a disorder with a high proportion of patients who are resistant or do not respond to conventional therapeutic strategies.

Lessons Learned from the Covid-19 Crisis: Recommendations for Action to Optimize Occupational Health in Mental Health Professionals in Europe.

Objective: The Covid-19 health crisis has disrupted the organization and functioning of European mental health and psychiatric services, impacting the working conditions - already difficult before the epidemic - of professionals working therein. The Psy-GIPO2C project investigated the impact of the pandemic on these professionals. The Psy-GIPOC2C project has been co-funded by the Agence Nationale de la Recherche française (ANR, French National Research Agency) and the Centre-Val de Loire region (France). Method: This research took the form of a collaborative mixed methods study. The data collected through qualitative and quantitative research were analyzed during a working session held by the research consortium, which resulted in the formulation of recommendations for action to optimize the occupational health of European mental health professionals. Results: This research made it possible to identify and explain the extent to which, and the ways in which, the reorganization of European mental health services has impacted the mental health of the professionals working therein, and, in particular, to highlight the fact that the unprecedented use of digital devices has generated stress, and even tension, within these services. Conclusions: It is important to promote well-being at work among European mental health professionals, by involving them in the development of ad hoc measures (in addition to the existing psychological support measures available) to enable them to recharge their batteries. It is also important to support current and future professionals in their appropriation of digital tools for professional use.

COVID-19 and Physical Distancing Measures: Experience of Psychiatric Professionals in Europe.

A The COVID-19 pandemic has had a considerable impact on the organization of psychiatric care. The present study examines how care professionals experienced this period and faced these new constraints weighing on their professional practices. Based on a qualitative research methodology, 13 group interviews with healthcare professionals working in psychiatric wards were conducted in five countries in western Europe. To complement this, 31 individual interviews were carried out in Belgium and France. Public health measures hindered certain therapeutic activities, jeopardized communication, and obliged healthcare professionals to modify and adapt their practices. Confronted with a transformation of their usual roles, healthcare professionals feared a deterioration in the quality of care. Impossible to continue in-person care practices, they resorted to online videoconferencing which went against their idea of care in which the encounter holds an essential place. The lockdown contradicted efforts to co-build care pathways toward readaptation, social reintegration, and recovery, thus reviving the perception of psychiatric hospitalization based on isolation.

Opportunities and Challenges for Professionals in Psychiatry and Mental Health Care Using Digital Technologies During the COVID-19 Pandemic: Systematic Review.

BACKGROUND: The COVID-19 pandemic has required psychiatric and mental health professionals to change their practices to reduce the risk of transmission of SARS-CoV-2, in particular by favoring remote monitoring and assessment via digital technologies. OBJECTIVE: As part of a research project that was cofunded by the French National Research Agency (ARN) and the Centre-Val de Loire Region, the aim of this systematic literature review was to investigate how such uses of digital technologies have been developing. METHODS: This systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was carried out in the MEDLINE (ie, PubMed) and Cairn databases, as well as in a platform specializing in mental health, Ascodocpsy. The search yielded 558 results for the year 2020. After applying inclusion and exclusion criteria, first on titles and abstracts and then on full texts, 61 articles were included. RESULTS: The analysis of the literature revealed a heterogeneous integration of digital technologies, not only depending on countries, contexts, and local regulations, but also depending on the modalities of care. Notwithstanding these variations, the use of videoconferencing has developed significantly, affecting working conditions and therapeutic relationships. For many psychiatric and mental health professionals, the pandemic has been an opportunity to build up their experience of remote care and, thus, better identify the possibilities and limits of these digital technologies. CONCLUSIONS: New uses of such technologies essentially consist of a transition from the classic consultation model toward teleconsultation and make less use of the specific potential of artificial intelligence. As professionals were not prepared for these uses, they were confronted with practical difficulties and ethical questions, such as the place of digital technology in care, confidentiality and protection of personal data, and equity in access to care. The COVID-19 health crisis questions how the organization of health care integrates the possibilities offered by digital technology, in particular to promote the autonomy and empowerment of mental health service users.

International professional practices in mental health, organization of psychiatric care, and COVID-19: A survey protocol.

OBJECTIVE: Our project aims to provide: an overview of the impact of the COVID-19 pandemic on the field of mental health professionals in 23 countries;a model of recommendations for good practice and proposals for methods and digital tools to improve the well-being at work of mental health professionals and the quality of services offered during crisis and post-crisis periods;an in-depth ethics review of the assessment of the use of numerical tools for psychiatry professionals and patient support, including teleconsulting. METHODS: This is a large international survey conducted among 2,000 mental health professionals in 23 countries over a 12-month period. This survey will be based on 30 individual interviews and 20 focus group sessions, and a digital questionnaire will be sent online to 2,000 professionals based on the criteria of gender, age, professional experience, psychiatric specialty, context of work in psychiatry, and geographical location. Regarding the development of telepsychiatry during the COVID-19 pandemic, a pilot study on the use of digital tools will be carried out on 100 clients of psychiatry professionals in France and Belgium. DISCUSSION-CONCLUSION: This study will contribute to the co-construction of an international organization and monitoring system that takes into account psychiatric health professionals as major resources to fight against the COVID-19 pandemic and to develop efficient processes for preparing and anticipating crises by reducing psychosocial risks as much as possible. This project also aims to design tools for remote medicine and to develop the use of numerical tools for monitoring and supporting professionals and helping professionals to build the conditions for satisfactory operational work during crises and post-crisis situations, using adapted organizational methods. Our ongoing research should support professionals in the search for existing concrete solutions to cope with emergency work situations while maintaining an optimal quality of life.

W.A.R.A. (Wiring Affect with Reattach) Provided by Remote Training: First-Aid Psychological Intervention?

Wiring Affect with ReAttach (W.A.R.A) is an ultrafast affect-regulation technique that is commonly provided by ReAttach therapists in the proximity of the patient. The benefits of W.A.R.A. are that the intervention is light, brief, and simple in helping to process negative affect. Facing the COVID-19 pandemic and the devastating consequences for mental health, we propose W.A.R.A, amongst other self-regulation strategies, as a first-aid psychological intervention. We immediately started to give access to free online W.A.R.A. training, so professionals, worldwide, can offer W.A.R.A. by remote training and help patients suffering from elevated stress to regulate their negative affect.

Risk for Pathological Contamination Fears at Coronavirus Time: Proposal of Early Intervention and Prevention Strategies.

COVID-19 outbreak represents a stressful life event that might potentially trigger psychopathological symptoms in people with a pre-existing vulnerability. This is particularly relevant for the onset or exacerbation of pathological contamination fears in people with vulnerability to obsessive-compulsive disorder (OCD) or in those individuals with sub-threshold obsessive-compulsive symptoms, or who achieved recovery after a successful treatment. Strict movement restrictions and hygiene habits are essential to limit COVID-19 diffusion and delay its progression. However, the occurrence of dysfunctional, clinically relevant contamination fears may be the downside highlighting the importance of a more comprehensive knowledge on the vulnerability factors of OCD in order to inform policy making and risk communication on one hand, early identification and prevention on the other one. The importance of early identification and prevention of OCD during critical periods, such as the present one, is of paramount importance since this psychiatric condition is associated with a prolonged latency in the correct diagnosis and first professional contact which is in turn associated with worse prognosis and higher resistance to treatment.

Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review.

Background: Several data suggest that coronavirus disease 2019 (COVID-19) pandemic may exacerbate or trigger eating disorders (EDs). The aim of this paper was to summarize current literature studies on COVID pandemic and EDs. Methods: Literature search, study selection, methods, and quality evaluation were performed according to the preferred reporting items for systematic review and meta-analyses (PRISMA) guidelines. Results: A systematic search allowed the initial selection of 172 papers; 21 (12.2%) papers were eligible and included in the review. In selected studies, a total number of 29,108 subjects were enrolled (range: 10-11,391; mean/SD: 1,386 ± 2,800), 6,216 were men (21.4%), 22,703 were women (77.9%), and 189 (0.7%) were gender fluid or not declared. The mean age/SD of subjects was 30.2 ± 7.7. About 12 studies (57.1%) were online surveys, 4 (19.0%) were retrospective studies, 2 (9.5%) were qualitative studies, 2 (9.5%) were longitudinal cohort studies, and 1 was a social media survey (4.8%). Their analysis revealed five main findings: (1) changes in the routines of physical activities were related to the worsening of preoccupation on weight/body shape; (2) food access limitation during pandemic represented the risk factors for both triggering and exacerbating EDs; (3) restriction in healthcare facilities contributed to increase anxiety levels and to modify treatment compliance; (4) social isolation was related to the exacerbation of symptoms in patients with EDs who are home-confined with family members; and (5) conflicts and difficulties in relationships with "no way out" were the maintenance factors for ED symptoms, especially in adolescents and young adults. Conclusion: The COVID-19 pandemic had a negative impact on EDs that might be triggered by the exceptional conditions derived from COVID-19-related stress in predisposed subjects. Patients who were already affected by EDs experienced the worsening of their clinical conditions and related quality of life (QoL).

The Early Impacts of the COVID-19 Pandemic on Mental Health Facilities and Psychiatric Professionals.

(1) Background: While in many countries, the psychiatric and mental health sectors had been in crisis for years, the onset of a novel coronavirus pandemic impacted their structures, organizations, and professionals worldwide. (2) Methods: To document the early impacts of the COVID-19 health crisis on psychiatry and mental health sectors, a systematic review of the international literature published in 2020 was conducted in PubMed (MEDLINE), Cairn.info, and SantéPsy (Ascodocpsy) databases. (3) Results: After applying inclusion and exclusion criteria, 72 articles from scientific journals were selected, including papers documenting the early impact of the COVID-19 pandemic on the organization of psychiatric care delivery, work processes in psychiatry and mental health units, and personal experiences of mental health professionals. This review identified the contributions aimed at preventing the onset of mental disorders in the early stages of the health crisis. It lists the organizational changes that have been implemented in the first place to ensure continuity of psychiatric care while reducing the risk of SARS-CoV-2 transmission. It questions the evolution of the rights and duties of mental health professionals in the first months of the pandemic. (4) Discussion and conclusions: Although this literature review exclusively documented the early impacts of the COVID-19 health crisis, it is of significant interest, as it pictures the unprecedent situation in which psychiatry and mental health care professionals found themselves in the first stages of the pandemic. This work is a preliminary step of a study to be conducted with mental health professionals on an international scale-the Psy-GIPO2C project-based on more than 15 group interviews, 30 individual interviews, and 2000 questionnaires. The final aim of this study is to formulate concrete recommendations for decision-makers to improve work in psychiatry and mental health.

Compulsive Hoarding Symptoms and the Role of Mindfulness Skills During Social Distancing for the COVID-19 Pandemic: An Exploratory Survey.

People reporting compulsive hoarding symptoms (CHS) have lower mindfulness skills than those without such symptoms. Mindfulness skills can have the role of a protective buffer against stressful periods. The quarantine imposed to contain the COVID-19 spread had a negative impact on daily habits and healthy behaviors (including social interactions). An increased attachment to objects might be one of the under-recognized psychological consequences of these difficult times, yet no study focused on CHS. Through an online survey in men who were on quarantine during the pandemic, this exploratory survey examined the prevalence of men reporting CHS during this period and explored the role of mindfulness skills on CHS controlling for anxious-depressive/stress symptoms. Forty-three men from the general population completed the Obsessive Compulsive Inventory-Revised (OCI-R), Cognitive and Affective Mindfulness Scale-Revised (CAMS-R) and Depression Anxiety Stress Scales-21 (DASS-21). Twenty-eight percent reported CHS. No differences on the scores of the questionnaires emerged between men with and without CHS, except on CAMS-R Attention scores. In a logistic regression analysis lower CAMS-R Attention scores predicted CHS (ß = -0.34, p = 0.03). This is the first, yet preliminary investigation on CHS during quarantine. The prevalence of CHS appears higher than the rates (4%) reported in the last years before the COVID-19 outbreak. Perhaps people showed more intense hoarding tendencies during quarantine/social distancing, and this pattern should be monitored. Larger samples, longitudinal designs and clinician-rated instruments are needed to support or not our findings.

Impact and consequences of COVID-19 pandemic on complicated grief and persistent complex bereavement disorder.

Mourning is a coping-with-loss stage that prevents grief from becoming pathologic, i.e., complicated grief (CG) syndrome and persistent complex bereavement disorder (PCBD), recently included in international classification systems. During the COVID-19 pandemic, to contain virus spread, several countries adopted/adopt the prohibition of mourning rituals (funeral ceremonies/visiting to cemeteries), so that people were/are unable to give their hospitalized relatives the latest goodbye. Such measures can lead vulnerable individuals to develop CG and PCBD. We critically discuss literature-based risk factors for and protective resources against the onset of these conditions since the start of the pandemic and analyze prevention strategies to inform public health programs.

Letter to the editor

Comments on an article by Phuoc-Tan Diep et al. (see record 2020-96407-008). COVID-19 pandemic is a tragic event involving and scrambling everybody worldwide for its high morbidity and mortality provoking negative consequences at both societal and individual level. The present author discusses her view of the proposal and suggests that governmental medical agencies implement clinical trials with oxytocin in COVID-19 patients (PsycInfo Database Record (c) 2021 APA, all rights reserved)