De l'aliénation mentale de l'enfant et de l'adolescent à la pédopsychiatrie dans les communications à la Société Médico-Psychologique de 1852 à 1937

Fondée en 1848, la Société Médico-Psychologique s'est donné pour but l'étude de la pathologie mentale et le perfectionnement de son traitement. François Arnaud (1858–1927), Claude-Étienne Bourdin (1815–1886), Michel Catsaras (1860–1939), Louis Delasiauve (1804–1893), Eugène Dally (1833–1887), Jules Fournet (1812–1888), Paul Garnier (1848–1905), Valentin Magnan (1835–1916), Jacques-Joseph Moreau de Tours (1805–1884), Emmanuel Régis (1855–1918), Paul Sollier (1861–1933), Édouard Toulouse (1865–1947), Auguste Voisin (1829–1898) et Jules Voisin (1844–1920), pour la plupart aliénistes, se sont succédé au cours du XIXe siècle à la tribune de la Société afin d'y présenter des observations d'enfants ou d'adolescents. D'autres aliénistes, neuropsychiatres puis pédopsychiatres, nourriront les séances des XXe et XXIe siècles par leurs communications portant sur la pathologie mentale du bébé à l'adolescent. Ces communications et leurs auteurs appartiennent à leur époque, mais aussi au lieu où elles ont émergé. Ainsi, au-delà de l'inventaire des thèmes abordés (la déficience, la démence précoce, l'encéphalite épidémique, l'autisme...) est esquissé ici un travail de contextualisation de 170 ans de communications de pédopsychiatrie à la Société Médico-Psychologique. In 1848, the Société Médico-Psychologique was founded. Its aims is to promote the study and improvement of mental pathology. During the 19th century, François Arnaud (1858–1927), Claude-Etienne Bourdin (1815–1886), Michel Catsaras (1860–1939), Louis Delasiauve (1804–1893), Eugène Dally (1833–1887), Jules Fournet (1812–1888), Paul Garnier (1848–1905), Valentin Magnan (1835–1916), Jacques-Joseph Moreau De Tours (1805–1884), Emmanuel Régis (1855–1918), Paul Sollier (1861–1933), Edouard Toulouse (1865–1947), Auguste Voisin (1829–1898) and Jules Voisin (1844–1920) were the alienists or not, French or foreigners who succeeded at the chair of the Société Médico-Psychologique. This later presented observations of children or teenagers. The communications and discussions but also the issues raised by the alienists, neuro-psychiatrists then child psychiatrists will contribute to the reflections of members of the Société Médico-Psychologique over the course of the last century. But, they also forced us to take a more perceptive look at the child's mental health. Its communications and their authors belong to their time and to a time or even a place where they emerged. Apart from to looking into the topics pursued (deficiency, dementia praecox, epidemic encephalitis, autism, etc.) concerning the infantojuvenile psychiatry, we will carry out a work of communications contextualization focused on the child's mental health at the Société Médico-Psychologique during 170 years. [ FROM AUTHOR]

Comment les Annales Médico-Psychologiques parlaient-elles de l'encéphalite léthargique voici cent ans ?

Voici un siècle, alors que se répandait l'épidémie de grippe dite espagnole, René Cruchet, en France, et Constantin von Economo, en Autriche, attiraient l'attention des médecins militaires et civils sur l'apparition d'une autre pandémie, l'encéphalite léthargique. Après une phase de somnolence irrépressible plus ou moins prolongée, ceux qui survivaient développaient, progressivement, des séquelles permanentes de type syndrome parkinsonien ou paroxystiques à type de dystonies variées. Les patients étaient souvent des enfants et de jeunes adultes. De 1920 à 1946, la Société Médico-Psychologique consacre vingt séances à l'étude des séquelles neuropsychiatriques de ces encéphalites. À côté des mouvements anormaux, les psychiatres prennent en charge des délires hallucinatoires, des comportements violents et agressifs avec désinhibition sexuelle, des épilepsies myocloniques, etc. Il ressort des présentations cliniques résumées ici que cette pandémie permet aux psychiatres de rapporter à des lésions diencéphaliques et mésencéphaliques des détériorations psychiatriques comme jamais ils ne l'avaient fait auparavant. L'hypothèse étiologique actuelle conclut cette présentation. A century ago, when the so-called Spanish flu epidemic was spreading, René Cruchet in France and Constantin von Economo in Austria drew the attention of military and civilian physicians to the existence of another pandemic, encephalitis lethargica. After a more or less prolonged phase of irrepressible drowsiness, those who survived progressively developed permanent sequelae, i.e. parkinson' syndrome, or various types of paroxysmal dystonia. The patients were often children and young adults. From 1920 to 1946, the Société Médico-Psychologique devoted twenty sessions to the study of the neuropsychiatric sequelae of these encephalitides. In addition to abnormal movements, psychiatrists treated hallucinatory delusions, violent and aggressive behaviors with sexual disinhibition, myoclonic epilepsy, etc. The clinical presentations summarized here seem to demonstrate that this pandemic allowed psychiatrists to relate psychiatric deterioration to diencephalic and mesencephalic lesions in a way that they had never done before. The current etiological hypothesis concludes this presentation. [ FROM AUTHOR]

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.

La télémédecine en psychiatrie

z La télémédecine a pris un essor important depuis la crise sanitaire de la Covid-19 z Sa pratique répond à des critères définis, tels que la sécurité des réseaux et le respect de la confidentialité z Dans le champ de la psychiatrie, la relation entre le patient et le professionnel de santé est modifiée z La personne peut se montrer plus à l'aise ou, au contraire, plus inhibée. © 2022 Elsevier Masson SAS

A mobile psychiatric team for the elderly during the pandemic: Clinical cases and caregivers’ feelings

Our mobile psychiatry team for elderly remained active during the first lockdown related to the spread of the SARS-CoV-2. Adjustments and changes in care practices were needed, new constraints had to be coped with, and several partners in the field were absent. In this article, we set out to share two clinical situations;one concerns a mother-daughter dyad living in accommodation that was unsuitable for two people, the other concerns a 93-year-old woman with cognitive disorders who contracted the virus at this time. From these two situations, the article discusses the experiences, emotions and feelings of the caregivers during this unprecedented period. © 2022 Elsevier Masson SAS Notre équipe mobile de psychiatrie du sujet âgé est restée mobilisée pendant le premier confinement lié à la propagation du SARS-CoV-2. Des adaptations et des modifications des pratiques soignantes ont été nécessaires face aux nouvelles contraintes et à l'absence de différents partenaires sur le terrain. À travers cet article, nous souhaitons partager deux situations cliniques: l'une concerne un duo mère-fille vivant dans un lieu inadapté à la vie à deux, et l'autre, la situation d'une patiente de 93 ans atteinte de troubles cognitifs et ayant contracté le virus. À partir de ces deux situations, l'article aborde le vécu, les émotions et le ressenti des soignantes durant cette période inédite. © 2022 Elsevier Masson SAS

Une équipe mobile de psychiatrie du sujet âgé au temps de la pandémie : situations cliniques et ressenti des soignantes

Résumé Notre équipe mobile de psychiatrie du sujet âgé est restée mobilisée pendant le premier confinement lié à la propagation du SARS-CoV-2. Des adaptations et des modifications des pratiques soignantes ont été nécessaires face aux nouvelles contraintes et à l’absence de différents partenaires sur le terrain. À travers cet article, nous souhaitons partager deux situations cliniques : l’une concerne un duo mère-fille vivant dans un lieu inadapté à la vie à deux, et l’autre, la situation d’une patiente de 93 ans atteinte de troubles cognitifs et ayant contracté le virus. À partir de ces deux situations, l’article aborde le vécu, les émotions et le ressenti des soignantes durant cette période inédite. Summary Our mobile psychiatry team for elderly remained active during the first lockdown related to the spread of the SARS-CoV-2. Adjustments and changes in care practices were needed, new constraints had to be coped with, and several partners in the field were absent. In this article, we set out to share two clinical situations;one concerns a mother-daughter dyad living in accommodation that was unsuitable for two people, the other concerns a 93-year-old woman with cognitive disorders who contracted the virus at this time. From these two situations, the article discusses the experiences, emotions and feelings of the caregivers during this unprecedented period.

De la connaissance à la croyance ou l’égarement de Jules Luys, un cheminement intellectuel toujours d’actualité

Résumé Contemporain de Jean-Martin Charcot, Jules Bernard Luys, neurologue et psychiatre, reste célèbre pour avoir décrit le Corpus Luysii, formation grise sous-thalamique devenue le nucleus subthalamicus. Deux livres novateurs nous gardent son travail d’anatomiste, l’un tentant, grâce au dessin, de donner une vue en trois dimensions du système nerveux en 1865, l’autre inaugurant l’illustration anatomique grâce à la photographie et initiant la micro-photographie en 1873. Partageant son temps entre La Salpêtrière et la Maison de santé d’Ivry, il propose une exposition de la physiologie cérébrale, dans son livre Le cerveau et ses fonctions, afin d’éclairer ses désordres, en introduction à son volumineux Traité clinique et pratique des maladies mentales où déjà transparaît une imagination fertile tentant de rapporter les maladies mentales à des constatations anatomiques interprétées à dessein. Sa nomination en 1886 à l’Hôpital de La Charité est pour lui l’occasion de tenter d’imiter les Leçons de Charcot, alors qu’il se plonge dans l’étude de l’hystérie. Secondé par un fervent de l’occultisme, Gérard Encausse, qui manipule, à son insu, les jeunes femmes sur lesquelles il expérimente, Luys produit les plus extravagantes constatations avec une foi naïve, sans autocritique. Ce parcours d’un grand scientifique, sombrant dans l’irrationnel en abandonnant la prudence du doute, est l’occasion d’explorer les mécanismes conduisant à cette déroute qui n’est pas sans analogie avec quelques-unes, plus récentes, lors des pandémies de sida et de Covid-19. A contemporary of Jean-Martin Charcot, Jules Bernard Luys was a neurologist and psychiatrist who remains known for having described the corpus Luysii, a grey subthalmic formation which became the subthalmic nucleus. His work as an anatomist is preserved in two innovative books, the first designed to give a three-dimensional view of the nervous system in 1865, and the second ushering in anatomical illustration using photography and introducing micro-photography in 1873. Splitting his time between La Salpêtrière Hospital and the Ivry asylum, Luys presented brain physiology in his book Le cerveau et ses fonctions (the brain and its functions) to shine light on its disorders, as an introduction to his voluminous Traité clinique et pratique des maladies mentales (clinical and practical treatise on mental illnesses), which already showed the work of a fertile imagination attempting to connect mental illnesses with anatomical observations expressly interpreted. His 1886 appointment at La Charité Hospital provided him with an opportunity to imitate Charcot's Lessons, so he immersed himself in the study of hysteria. With the help of a fervent believer in occultism, Gérard Encausse, who, unbeknownst to him, manipulated the young women he ran his experiments on, Luys made the most extravagant observations, believing naively in his findings and proceeding without critical analysis. This story of a great scientist, slipping into irrational thinking by abandoning the benefits of doubt, is an opportunity to explore the mechanisms leading to this deviation, which is not without parallels with more recent deviations during the AIDS and Covid-19 pandemics.

Pratique clinique et pluralismes en psychiatrie

En psychiatrie, de nombreuses tentatives se sont réclamées pluralistes, depuis les approches kraepelinienne et meyérienne jusqu'au modèle biopsychosocial, en passant par l'approche jasperienne ou le modèle psychanalytique freudien. Jean Garrabé lui-même a cherché à s'inscrire dans cette dynamique, en considérant l'existence de différentes perspectives dans le paysage psychiatrique. L'objectif de cet article est de retracer d'éventuelles continuités entre la pensée de Jean Garrabé et les enjeux nosologiques contemporains axés autour du pluralisme. Nous partirons pour cela d'un des leitmotivs de l'auteur, selon lequel l'histoire peut renseigner la construction des classifications psychiatriques. Dans la première partie, nous rappellerons la diversité des perspectives en philosophie de la psychiatrie et en philosophie des sciences. Dans la seconde partie, nous verrons comment Jean Garrabé a su discuter, plus ou moins explicitement, trois axes actuellement développés dans les propositions de modélisations contemporaines de la psychiatrie. La première partie détaille les relations que Jean Garrabé a entretenues avec la philosophie des sciences. Nous analysons trois exemples nosographiques témoignant de la diversité de ces échanges. La seconde partie étudie trois axes conceptuels développés au sein des modélisations et des classifications contemporaines – à savoir la dynamique, la hiérarchie et la dimensionnalité des troubles psychiatriques. La pensée de Jean Garrabé est marquée par l'empreinte du pluralisme et des trois axes que nous avons identifiés. Le premier axe concerne son intérêt pour la dynamique temporelle des phénomènes psychopathologiques, évoluant dans le temps de manière synchronique et diachronique. Le deuxième concerne son intérêt pour la hiérarchisation des troubles et des éléments sémiologiques, que ce soit via une intuition de validité comme chez Kraepelin, ou via des études statistiques comme dans les taxonomies contemporaines. Le troisième axe correspond à l'intérêt de Jean Garrabé pour la dimensionnalité, qui prend en compte l'étude des fonctionnements sous-jacents aux troubles psychiatriques, qu'ils soient phénoménologiques ou physiopathologiques. The consideration of a plurality of perspectives is highlighted in a various number of medical and scientific disciplines. For example, in psychiatry, many attempts claiming to be pluralism have been carried out over the course of the discipline, e.g. Kraepelinian and Meyerian approaches, biopsychosocial model, Jasperian approach or Freudian psychoanalytic model. At the same time, the starting point for Jean Garrabé's views on psychiatric nosology refers to his consideration for the existence of different perspectives in the psychiatric landscape. The objective of this article is to highlight possible continuities between the Jean Garrabé's developments and contemporary nosological issues. We will start from one of his leitmotifs, i.e. "History can inform the construction of psychiatric classifications". In the first part, we present the diversity of perspectives in Philosophy of Psychiatry and in Philosophy of Science. In the second part, we will see how Jean Garrabé was able to discuss, in a more or less structured and explicit manner, three axes currently and widely studied in the proposals for contemporary models of psychiatry. In a first part, we analyze the integration of Jean Garrabé into the general debates of the philosophy of science and modelisation. We will thus develop three examples of modelisation, based on contemporary psychiatric classifications, to testify this integration. The first example corresponds to staging models, which consider that psychiatric disorders could be better understood as subgroups of evolving elements – rather than as fixed categories in time. Indeed, staging models allow a sub-classification of psychiatric disorders according to their dynamical progression. The second example concerns the Hierarchical Taxonomy of Psychopathology project, which d scribes psychiatric disorders according to a continuum of quantitative variations, hierarchized in several dimensions. The third example concerns the Research Domain Criteria initiative, which targets some dimensions of mental functioning, i.e. areas of research from contemporary cognitive neurosciences allowing to organize psychiatric research on specific neuroscientific constructs. In a second part of this article, we analyze three axes developed both within the proposals of contemporary models and classifications and the Jean Garrabé's views, namely dynamics, hierarchy and dimensionality of psychiatric disorders. Jean Garrabé's conceptions seem marked by the footprint of pluralism and the three identified axes. The first axe concerns his interest for the temporal dynamics of psychopathological phenomena, evolving in time in a synchronic and diachronic manner. The second concerns his interest in the hierarchy of disorders and semiological elements, e.g. through validity or statistical analyzes. The third axe corresponds to the Jean Garrabé's interest for the dimensionality, which considers elements underlying psychiatric disorders, whether they are phenomenological or physiopathological. [ FROM AUTHOR] Copyright of Annales Medico Psychologiques is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Vers une psychiatrie énactive et computationnelle

Résumé Introduction La psychiatrie est confrontée au défi d’une pluralité d’approches complémentaires issue des multiples niveaux de compréhension du vivant, que ce soit en termes de systèmes de représentations, d’outils, de méthodologies et d’objectifs. Dans le paysage clinique et scientifique actuel, les approches computationnelles et la multiplicité des nosographies émergentes telles que l’approches des Research Domain Criteria du NIMH ou les modèles de staging participent à cette pluralité théorique. En nous appuyant sur les limites du pluralisme scientifique, nous proposons une approche unifiant ces cadres théoriques fondée sur les principes de l’énactivisme, une théorie des sciences du vivant innovante en cela qu’elle s’applique à la psychiatrie. Méthodes Nous détaillons dans un premier temps le pluralisme théorique en psychiatrie, et ses liens avec la pratique clinique. Nous montrons quelles sont ses limites, et les raisons de la nécessité de théorie unificatrice pour la psychiatrie. À partir de ces limites, nous analysons les apports de l’approche énactiviste pour la pratique clinique et la génération de théories en psychiatrie. Nous montrons comment ce cadre pourrait améliorer la compréhension des symptômes en psychiatrie clinique, et unifier la diversité des approches complémentaires issues de la psychologie et des neurosciences. Résultats Le pluralisme comporte de nombreuses limites, inhérentes à la diversité des approches théoriques qu’il implique et la difficulté de modélisation computationnelle de ces différentes variables. Le cadre de travail énactiviste s’inscrit dans les avancées récentes en psychologie et en neurosciences, notamment en permettant la modélisation computationnelle. Il est ancré à la fois dans les sciences cognitives, la théorie des systèmes dynamiques, la biologie des systèmes et la phénoménologie, et peut ainsi être proposé comme réponse à cette question du défi intégratif en psychiatrie. Discussion et conclusion Un nombre conséquent de professionnels de la santé mentale travaillent déjà en acceptant une telle pluralité d’approches cliniques et scientifiques, mais cette diversité participe également au manque de structure théorique commune partagée par ces professionnels. Nous montrons que les formulations issues de l’approche énactiviste permettent à la psychiatrie : (1) de prendre en compte la subjectivité et l’expérience du patient ;(2) d’articuler différents niveaux de complexité au sein de la consultation clinique ;(3) d’expliquer les bénéfices de la création de sens pour le patient ;(4) de fournir des modélisations computationnelles concrètes ;(5) de soutenir la pédagogie en psychiatrie. Introduction Psychiatry is challenged by a plurality of complementary approaches. These challenges stem from the existence of multiple levels of understanding, i.e. systems of representations, tools, methodologies and objectives in psychiatry–ranging from computational approaches and systems dynamics to the multiplicity of emerging nosographies, such as the NIMH Research Domain Criteria project or staging models. In this plurality, a significant number of clinicians have adopted the biopsychosocial model. However, such a model has been widely criticized for more than twenty years. In parallel, science has declined a set of different pluralistic frameworks. Thus, through the challenges of computational modeling in psychiatry, we will see how the enactive approach of psychiatry could respond to this multiplicity. Indeed, such an enactive approach considers that perception is a (predictive) activity, which gives sense to the environment (i.e., sense making). Perception and, by extension, cognitive processes are not internal representations of the outside world, but they are deployed according to the 5E approach, i.e., an embodied, embedded, enacted, emotive and extended approach. Methods In this article, we first study the pluralist framework in psychiatry, in order to show its contributions in the clinical practice. Secondly, we analyze the contributions of the enactive approach for clinical practice in psychiatry. Results Two forms of pluralisms can be described: a non-integrative pluralism and an integrative pluralism. The first examines the coexistence of different potentially incompatible or untranslatable systems in the scientific or clinical landscape. The second proposes the development of a general framework, bringing together the different levels of understanding and systems of representations. However, pluralism has many pitfalls and limitations. Especially by allowing computational modeling, the enactive framework, anchored both in cognitive sciences, theory of dynamic systems, systems biology and phenomenology, has recently been proposed as an answer to the challenge of integrative psychiatry. Conclusions A significant number of mental health professionals are already working accepting such a variety of clinical and scientific approaches. We show that the enactive approach allows psychiatry: (1) to consider the subjectivity and the patient's experience, (2) to articulate different “granularities” within the clinical consultation, (3) to explain the benefits the creation of meaning for the patient, (4) to provide concrete models, (5) to support pedagogy in psychiatry. The enactive approach provides a conception for understanding psychiatric disorders as embodied, embedded, enacted, emotional and extended. In that way, the manifestations experienced by the patients are sense making experiences and can be conceived according to various levels of granularity.

[Influence of the work environment on burn-out and depression in nurses]. / Influence de l'environnement de travail sur le burn-out et la dépression des infirmiers.

Burn out is defined as a state of psychological exhaustion in the face of an unfavourable work environment. In the health sector, this includes, among other things, an excessive care burden, the lack of autonomy or control over work, the vicious circle of absenteeism, the lack of support, moral and sexual harassment, discrimination or the Covid-19 health crisis. Burn-out also increases the risk of depression among care workers.

Risk factors for burnout and depression in healthcare workers: The national AMADEUS study protocol.

CONTEXT: Burnout is an international phenomenon defined as a state of professional exhaustion. It can lead to depression and have major economic and organizational impacts. Previous studies of healthcare professionals in France have focused on physicians, but none to date have explored other healthcare professions. OBJECTIVES: The main objective of our study is to determine the prevalence of burnout among healthcare workers. The secondary objectives are to explore the associations of burnout with professional and psycho-social factors and the risk of depression, professional harassment, sexual harassment, sexual-orientation based discrimination, consumption of antidepressants, anxiolytics and also the lifestyle of the individual: smoking, alcohol consumption, coffee consumption, physical activity and sleep quality. MATERIALS AND METHODS: The survey will take the form of a voluntary and anonymous online questionnaire carried out on the FramaForm1® platform and will be disseminated via social networks, professional networks and mailings. STUDY POPULATION: Senior doctors, interns, directors of care, nurses, head nurses and senior head nurses, physiotherapists and occupational therapists, dieticians, radiology technicians, laboratory technicians, psychologists, nurses' aides, auxiliary nurses and midwives will be included. COLLECTED DATA: Burnout will be measured with the Maslach Inventory burnout (MBI) questionnaire, work environment with the Karasek questionnaire and anxiety, depression risk with the Center for Epidemiologic Studies- Depression (CES-D), physical activity with the Global Physical Activity Questionnaire (GPAQ) and sleep quality with the Pittsburgh Sleep Quality Index (PSQI). ETHICS: This protocol has been accepted by the ethical committee (IRB n°C08/21.01.06.93911, CNIL). EXPECTED RESULTS: Based on international studies, we expect a high rate of burnout with disparities according to profession, socio-demographic data, seniority and type of service. We also expect a significant rate of untreated depression. This study will provide evidence for policy makers to implement collective strategies to reduce burnout and depression in the different populations studied.

[Psychiatry to support the Covid-19 vaccination campaign]. / La psychiatrie en renfort de la campagne de vaccination anti-Covid-19.

Health professionals have been mobilised to contribute to the emergency vaccination campaign deployed since the end of 2020 to combat the Covid-19 pandemic. In a mental health institution of the Grand-Est region, a vaccination centre has been implemented in emergency to contribute to the collective public health effort. Feedback from a hospital health executive.

[Covid-19 infectious disease is also a psychogeriatric disease]. / L'infection à Covid-19 est aussi une maladie psychogériatrique.

Severe forms of Covid-19 infectious disease often affect the frail elderly. They can induce inaugural psychiatric manifestations or aggravate the underlying psychiatric pathologies. Some of these pathologies persist after the acute episode and require specific management. Doctors and caregivers involved in the care of infected patients are themselves exposed to psychological and even psychiatric difficulties and are looking for collaborative help complementing actions in the somatic care sectors.

The Covid-19 infection: An opportunity to develop systematic vitamin D supplementation in psychiatry.

Psychiatric patients are at risk of hypovitaminosis D and Covid-19-related mortality. In addition to the mental health benefits, vitamin D supplementation may be potentially effective in preventing severe forms of Covid-19 infections. Vitamin D supplementation is not necessary and is not reimbursed in France for this indication. A monthly supplementation of 50,000 IU may be sufficient in most cases. Double the dose is recommended for obese patients. The risk of renal lithiasis is not increased at these doses, even when supplemented in a patient without vitamin D deficiency. The Covid-19 crisis is an opportunity to disseminate vitamin D supplementation in psychiatric patients, as it has been shown to be effective in other respiratory diseases such as mild upper respiratory tract infections and influenza.

[Responsiveness and sustainability of psychiatric care in France during COVID-19 epidemic]. / Réactivité et pérennité des soins psychiatriques en France à l'épreuve du COVID-19.

OBJECTIVES: The sudden changes of healthcare system due to COVID-19 particularly affect the organization of psychiatry. The objective of this review is to examine the adaptations of psychiatric care in France during this pandemic. METHOD: This narrative review is based on the observation of changes made in French psychiatric hospitals and on an analysis of the literature. RESULTS: Regarding psychiatric hospitalization, the COVID-19 epidemic required rapid measures that profoundly modified the conditions of patients' reception, forcing the medical staffs to adapt their methods of care. The authors noted the creation of at least 89 wards specifically dedicated to patients with COVID-19 needing psychiatric hospitalization, allowing dual care of general medicine and psychiatry. Regarding ambulatory care, maintaining patients with long-term follow-up was a priority. Patients recalling and teleconsultation have been precious resources but cannot entirely replace face-to-face consultations. DISCUSSION: COVID-19 epidemic created unprecedented situation of large-scale upheavals in the healthcare system and in society. Despite the absence of previous recommendations on the subject, French psychiatry has shown great adaptability. Some changes could inspire post-COVID-19 care.

[Mental health care in French correctional facilities during the Covid-19 pandemic]. / Prisons confinées : quelles conséquences pour les soins psychiatriques et la santé mentale des personnes détenues en France ?

OBJECTIVE: The impact of the Covid-19 pandemic on the 11 million people currently incarcerated worldwide is the subject of many concerns. Prisons and jails are filled with people suffering from many preexisting medical conditions increasing the risk of complications. Detainees' access to medical services is already limited and overcrowding poses a threat of massive contagion. Beyond the health impact of the crisis, the tightening of prison conditions worries. On March 16, 2020, in France, the lockdown measures have been accompanied by specific provisions for prisons: all facilities have suspended visitations, group activities and external interventions. Over 10,000 prisoners have been released to reduce the prison population and the risk of virus propagation. These adjustments had major consequences on the healthcare system in French prisons. The objectives of this article are to describe the reorganization of the three levels of psychiatric care for inmates in France in the context of Covid-19 pandemic and to have a look at the impact of lockdown measures and early releases on mental health of prisoners. METHODS: This work is based on a survey conducted in April 2020 in France among psychiatric healthcare providers working in 42 ambulatory units for inmates and in the 9 full-time inpatient psychiatric wards exclusively for inmates called "UHSAs" (which stands for "unités hospitalières spécialement aménagées", and can be translated as "specially equipped hospital units"). A review of the international literature on mental healthcare system for inmates during the Covid-19 epidemic has also been performed. RESULTS: The Covid-19 epidemic has been rather contained during the period of confinement in French prisons but the impact of confinement measures on the prison population is significant. The three levels of psychiatric care for inmates have implemented specific measures to ensure continuity of care, to support detainees during Coronavirus lockdown and to prevent an infection's spread. Among the most important are: limitation of medical consultations to serious and urgent cases, creation of "Covid units", cancellation of voluntary psychiatric hospitalizations, reinforcement of preventive hygiene measures and reshuffling of medical staff. Prolonged confinement has consequences on mental health of detainees. Currently, mental health workers are facing multiple clinical situations such as forced drug and substance withdrawal (linked to difficulties in supplying psychoactive substances), symptoms of anxiety (due to concerns for their own and their relatives' well-being) and decompensation among patients with severe psychiatric conditions. Early releases from prison may also raise some issues. People recently released from prison are identified as at high risk of death by suicide and drug overdose. The lack of time to provide the necessary link between health services within prisons and health structures outside could have serious consequences, emphasizing the well-known "revolving prison doors" effect. DISCUSSION: The current lockdown measures applied in French jails and prisons point out the disparities between psychiatric care for inmates and psychiatric care for general population. Giving the high vulnerability of prison population, public health authorities should pay more attention to health care in prisons.

[Real-life data and Covid-19: The third avenue of reseach]. / Données de vie réelle et Covid-19 : la troisième voie.

The analysis of real-life data from hospital information systems could make possible to decide on the efficacy and safety of Covid-19 treatments by avoiding the pitfalls of preliminary studies and randomized clinical trials. The different drugs tested in current clinical trials are already widely prescribed to patients by doctors in hospitals, and can therefore be immediately analysed according to validated methodological standards.

[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.

Increased in-hospital mortality from COVID-19 in patients with schizophrenia.

BACKGROUND: There is limited information describing the presenting characteristics and outcomes of patients with schizophrenia (SCZ) requiring hospitalization for coronavirus disease 2019 (COVID-19). AIMS: We aimed to compare the clinical characteristics and outcomes of COVID-19 SCZ patients with those of non-SCZ patients. METHOD: This was a case-control study of COVID-19 patients admitted to 4 AP-HM/AMU acute care hospitals in Marseille, southern France. COVID-19 infection was confirmed by a positive result on polymerase chain reaction testing of a nasopharyngeal sample and/or on chest computed scan among patients requiring hospital admission. The primary outcome was in-hospital mortality. The secondary outcome was intensive care unit (ICU) admission. RESULTS: A total of 1092 patients were included. The overall in-hospital mortality rate was 9.0%. The SCZ patients had an increased mortality compared to the non-SCZ patients (26.7% vs. 8.7%, P=0.039), which was confirmed by the multivariable analysis after adjustment for age, sex, smoking status, obesity and comorbidity (adjusted odds ratio 4.36 [95% CI: 1.09-17.44]; P=0.038). In contrast, the SCZ patients were not more frequently admitted to the ICU than the non-SCZ patients. Importantly, the SCZ patients were mostly institutionalized (63.6%, 100% of those who died), and they were more likely to have cancers and respiratory comorbidities. CONCLUSIONS: This study suggests that SCZ is not overrepresented among COVID-19 hospitalized patients, but SCZ is associated with excess COVID-19 mortality, confirming the existence of health disparities described in other somatic diseases.