Psychoeducation and emotional regulation in times of confinement: Feasibility and interest of YouTube videos of dialectical behavioral therapy

Introduction: Dialectical Behavior Therapy (DBT) aims to decrease emotional dysregulation, particularly through psychoeducation groups targeting skills learning. In March 2020, the confinement due to COVID-19 abruptly interrupted these groups. We continued skills training through YouTube videos. Our objective is to evaluate the feasibility of this format during the confinement. Method(s): All the participants in the DBT skills group carried out in Strasbourg were included (n = 37). The psychoeducational videos were published biweekly during the confinement on the YouTube channel "GREMO HUS". Participants were encouraged to view these videos by calls/messages. One month after the end of the confinement, an online questionnaire assessed satisfaction. Result(s): In total, 92% of patients responded. Of the 34 respondents, 28 (82%) had watched at least one video, and 32% had watched more than 6 videos. A very large majority of users were satisfied with the videos. Seventy-nine percent said they were very helpful in understanding the skills, and 77% thought they had used the DBT skills more frequently. All but one said that the skills helped them to overcome difficulties in times of confinement. Discussion(s): Our study is the first to interview patients directly regarding DBT YouTube videos. These videos were considered relevant by participants during the confinement period. Their use could compliment DBT skills training groups, and serve as a training support for therapists.Copyright © 2021 Elsevier Masson SAS

A case of severe rhabdomyolysis and acute myocarditis in an adolescent female

INTRODUCTION: Rhabdomyolysis describes a condition where muscle tissue destruction occurs. Mortality and morbidity can be significant especially when multi-organ injury ensues. In very few instances, myocarditis has been described in association with this condition. DESCRIPTION: An 11-year-old previously healthy female presents with vomiting, diarrhea, tactile fever, worsening severe bilateral leg pain and gross hematuria for four days. At the Emergency Department, her ECG showed ST depression in lateral leads and abnormal Q waves. Laboratory studies were notable for significantly elevated CK >330,000 U/L. Elevated Troponin T and Troponin I at 3.60 ng/ml and 0.54 ng/mL, respectively. Elevation of CRP 23.5 mg/dl, ALT 1,966 U/L, AST 5,956 U/L, and Ferritin 712.1 ng/ml. Patient had dark brown urine, which was positive for blood, and urine myoglobin peaked at 2690 ng/mL. Her renal function was normal with blood urea nitrogen 8 mg/dl and creatinine 0.4 mg/dl. C3 and C4 levels were decreased, 45 mg/dl and 5 mg/dl, respectively. Anti-dsDNA negative, ANCA negative, and ANA negative. Nasopharyngeal PCR was negative for Mycoplasma pneumoniae, influenza A and B. Blood enterovirus PCR negative. COVID PCR and antibodies negative. Neuromuscular genetic testing was non-diagnostic. Her echocardiography showed thin rim of pericardial effusion and normal ejection fraction. Cardiac MRI demonstrated myocardial edema and regional sub-epicardial delayed enhancement consistent with acute myocarditis. Patient was started on hyperhydration therapy, Solumedrol and intravenous immunoglobulin. The rhabdomyolysis resulted in severe extremity weakness requiring prolonged rehabilitation. Her condition and biomarkers normalized and was subsequently discharged home. Follow up cardiac MRI 6 months later showed increased extracellular volume (ECV) of 38% suggestive of focal and diffuse areas of fibrosis. Patient remains under physical activity restrictions and is being followed by cardiology service. DISCUSSION: Our case highlights severe rhabdomyolysis in association with acute myocarditis and subsequent cardiac structural abnormalities. Although it remains unclear whether myocarditis evolved as a complication of rhabdomyolysis or was triggered by same inciting agent, an infectious etiology overall remains the most likely culprit.

Psychoeducation and emotional regulation in times of confinement: Feasibility and interest of YouTube videos of dialectical behavioral therapy

Introduction: Dialectical Behavior Therapy (DBT) aims to decrease emotional dysregulation, particularly through psychoeducation groups targeting skills learning. In March 2020, the confinement due to COVID-19 abruptly interrupted these groups. We continued skills training through YouTube videos. Our objective is to evaluate the feasibility of this format during the confinement. Method: All the participants in the DBT skills group carried out in Strasbourg were included (n = 37). The psychoeducational videos were published biweekly during the confinement on the YouTube channel “GREMO HUS”. Participants were encouraged to view these videos by calls/messages. One month after the end of the confinement, an online questionnaire assessed satisfaction. Results: In total, 92% of patients responded. Of the 34 respondents, 28 (82%) had watched at least one video, and 32% had watched more than 6 videos. A very large majority of users were satisfied with the videos. Seventy-nine percent said they were very helpful in understanding the skills, and 77% thought they had used the DBT skills more frequently. All but one said that the skills helped them to overcome difficulties in times of confinement. Discussion: Our study is the first to interview patients directly regarding DBT YouTube videos. These videos were considered relevant by participants during the confinement period. Their use could compliment DBT skills training groups, and serve as a training support for therapists.

Psychotropics and COVID-19: An analysis of safety and prophylaxis.

The use of psychotropics during the COVID-19 pandemic has raised two questions, in order of importance: first, what changes should be made to pharmacological treatments prescribed to mental health patients? Secondly, are there any positive side effects of these substances against SARS-CoV-2? Our aim was to analyze usage safety of psychotropics during COVID-19; therefore, herein, we have studied: (i) the risk of symptomatic complications of COVID-19 associated with the use of these drugs, notably central nervous system activity depression, QTc interval enlargement and infectious and thromboembolic complications; (ii) the risk of mistaking the iatrogenic impact of psychotropics with COVID-19 symptoms, causing diagnostic error. Moreover, we provided a summary of the different information available today for these risks, categorized by mental health disorder, for the following: schizophrenia, bipolar disorder, anxiety disorder, ADHD, sleep disorders and suicidal risk. The matter of psychoactive substance use during the pandemic is also analyzed in this paper, and guideline websites and publications for psychotropic treatments in the context of COVID-19 are referenced during the text, so that changes on those guidelines and eventual interaction between psychotropics and COVID-19 treatment medication can be reported and studied. Finally, we also provide a literature review of the latest known antiviral properties of psychotropics against SARS-CoV-2 as complementary information.

[Panic and pandemic: Review of the literature on the links between panic disorder and the SARS-CoV-2 epidemic]. / Panique et pandémie : revue de la littérature sur les liens entre le trouble panique et l'épidémie à SARS-CoV-2.

Although the "panic" word has been abundantly linked to the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic in the press, in the scientific literature very few studies have considered whether the current epidemic could predispose to the onset or the aggravation of panic attacks or panic disorder. Indeed, most studies thus far have focused on the risk of increase and aggravation of other psychiatric disorders as a consequence of the SARS-CoV-2 epidemic, such as obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). Yet, risk of onset or aggravation of panic disorder, especially the subtype with prominent respiratory symptoms, which is characterized by a fear response conditioning to interoceptive sensations (e.g., respiratory), and hypervigilance to these interoceptive signals, could be expected in the current situation. Indeed, respiratory symptoms, such as coughs and dyspnea, are among the most commonly associated with the SARS-CoV-2 (59-82% and 31-55%, respectively), and respiratory symptoms are associated with a poor illness prognosis. Hence given that some etiological and maintenance factors associated with panic disorder - i.e., fear conditioning to abnormal breathing patterns attributable or not to the COVID-19 (coronavirus disease 2019), as well as hypervigilance towards breathing abnormalities - are supposedly more prevalent, one could expect an increased risk of panic disorder onset or aggravation following the COVID-19 epidemic in people who were affected by the virus, but also those who were not. In people with the comorbidity (i.e., panic disorder or panic attacks and the COVID-19), it is particularly important to be aware of the risk of hypokalemia in specific at-risk situations or prescriptions. For instance, in the case of salbutamol prescription, which might be overly used in patients with anxiety disorders and COVID-19, or in patients presenting with diarrhea and vomiting. Hypokalemia is associated with an increased risk of torsade de pointe, thus caution is required when prescribing specific psychotropic drugs, such as the antidepressants citalopram and escitalopram, which are first-line treatments for panic disorder, but also hydroxyzine, aiming at anxiety reduction. The results reviewed here highlight the importance of considering and further investigating the impact of the current pandemic on the diagnosis and treatment of panic disorder (alone or comorbid with the COVID-19).

[Psychopharmacotherapeutic guidelines : a challenge during health crisis]

The construction of pharmacological guidelines is a complex endeavor, and this is all the truer amidst a health crisis such as the current SARS-CoV-2 pandemic. In psychiatric settings, guidelines have to consider the handling of other drugs (i.e., psychotropic medications), that have been suggested as potentially prophylactic for COVID-19. These dialectics are discussed here, and the methodological foundations used for the elaboration of guidelines are put forward.

Panic and pandemic: Narrative review of the literature on the links and risks of panic disorder as a consequence of the SARS-CoV-2 pandemic.

Although the "panic" word has been abundantly linked to the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic in the press, in the scientific literature very few studies have considered whether the current epidemic could predispose to the onset or the aggravation of panic attacks or panic disorder. Indeed, most studies thus far have focused on the risk of increase and aggravation of other psychiatric disorders as a consequence of the SARS-CoV-2 epidemic, such as obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). Yet, risk of onset or aggravation of panic disorder, especially the subtype with prominent respiratory symptoms, which is characterized by a fear response conditioning to interoceptive sensations (e.g., respiratory), and hypervigilance to these interoceptive signals, could be expected in the current situation. Indeed, respiratory symptoms, such as coughs and dyspnea, are among the most commonly associated with the SARS-CoV-2 (59-82% and 31-55%, respectively), and respiratory symptoms are associated with a poor illness prognosis. Hence, given that some etiological and maintenance factors associated with panic disorder - i.e., fear conditioning to abnormal breathing patterns attributable or not to the COVID-19 (coronavirus disease 2019), as well as hypervigilance towards breathing abnormalities - are supposedly more prevalent, one could expect an increased risk of panic disorder onset or aggravation following the COVID-19 pandemic in people who were affected by the virus, but also those who were not. In people with the comorbidity (i.e., panic disorder or panic attacks and the COVID-19), it is particularly important to be aware of the risk of hypokalemia in specific at-risk situations or prescriptions. For instance, in the case of salbutamol prescription, which might be overly used in patients with anxiety disorders and COVID-19, or in patients presenting with diarrhea and vomiting. Hypokalemia is associated with an increased risk of torsade de pointe; thus, caution is required when prescribing specific psychotropic drugs, such as the antidepressants citalopram and escitalopram, which are first-line treatments for panic disorder, but also hydroxyzine, aiming at anxiety relief. The results reviewed here highlight the importance of considering and further investigating the impact of the current pandemic on the diagnosis and treatment of panic disorder (alone or comorbid with the COVID-19).