An appropriate and reactive response to the repeated waves of the COVID-19 pandemic by the national medico-psychological network (CUMP) in France.

INTRODUCTION: France has been impacted by the COVID-19 pandemic. Anxiety, depression, burn out and the high proportion of post-traumatic stress disorder proved to be the most expected troubles caused by this pandemic and the confinement. Medico-psychological emergency units (CUMP) have been solicited at the very early stage of the pandemic because CUMP units are very well known by the French government and systematically associated to emergency plans. METHODS: In this article we describe the process which has been developed to cope with the psychological needs in the general population. At a first level, platforms of volunteers specialised into listening were available. Then those platforms could directly mobilise the CUMP in case of psychiatric disorders. It ran over the whole first wave and it has been reactivated because of the second confinement in France. RESULTS: During the first wave, approximately 1% of all the calls made on the national Covid number required to be redirected to the listening platforms. Of this group, 4% were related to reactive pathology or a psychiatric decompensating that required adapted and specialised care. CONCLUSION: The high rates of psychological distress detected in the general population in recent scientific literature seem discrepant with our findings of relatively low reorientation towards the CUMP. Nevertheless, our study highlights that the response of the CUMP network in France during the first wave was supportive. The second wave displays its adaptability to the public health policies.

[Treatment of post-traumatic stress disorder]. / Prise en charge des troubles psychotraumatiques.

Treatment of post-traumatic stress disorder. Psychological traumas, whose cares are complex, need to be furthermore clarified since they recently became a major public health issue in the wake of the terrorists' attacks that struck France over the past three years. It is its temporality since the event which will determine the type of disorder which might appear thus its adequate processing treatment. In the short term, in the context of collective events or disasters, treatments of psychological suffering by the Medico-Psychological Units (CUMP) are very specific by combining sorting out and direct health care to the victims as well as indirect care such as crisis management. For the health practitioner, a precise knowledge of the disorders which might appear at the early stage, prior to the onset of PTSD, is mandatory. Likewise, approaching a patient with a high emotional load requires specific skills. This is about establishing a real therapeutic alliance with the patient, key factor to prevent a more embedded pathology. Medical treatments at this stage are yet sparsely codified. When pathology is confirmed, post-traumatic stress disorders together with the existence of potential comorbidity (depression, addiction, etc.) require specialized care. Targeted psychotherapies are the first-line treatments, often combined with medical treatments (SSRI antidepressants, for instance) depending on the symptom's seriousness. Sleep disorders, likely conditioning the pathology, will require heightened vigilance. In any case, medication should be adapted to the patient. Similarly, elements of relational approach, any advice, or other health lifestyle rules together with referral to more specific cares, should be individualised.

Prise en charge des troubles psychotraumatiques. Les traumatismes psychiques sont un enjeu de santé publique, leur prise en charge est complexe et mérite d'être précisée, particulièrement dans le contexte actuel des attentats survenus en France ces trois dernières années. La temporalité depuis l'événement conditionne le type de trouble et donc les modalités de traitement. Dans l'immédiat, dans le contexte de l'événement collectif, la prise en charge par les cellules d'urgence médico-psychologique (CUMP) est très spécialisée en associant au tri et soins directs aux victimes, des soins indirects sous forme de gestion de la crise. Pour le praticien, une connaissance précise des troubles dans la phase précoce, avant la survenue d'un trouble de stress post-traumatique, est impérative. De même, aborder un sujet ayant une charge émotionnelle forte nécessite un savoir-faire particulier. Il s'agit d'établir avec le sujet une véritable alliance thérapeutique, facteur essentiel de prévention d'une pathologie plus enkystée. Les traitements médicamenteux à cette phase sont encore peu codifiés. Lorsque la pathologie est avérée, le trouble de stress post-traumatique et l'existence d'une éventuelle comorbidité (dépression, addiction, etc.) nécessitent des soins spécialisés. Les psychothérapies ciblées sont le traitement de première intention, très souvent associées à un traitement médicamenteux (antidépresseur de type inhibiteur sélectif de la recapture de la sérotonine, par exemple), en fonction de la gravité des symptômes. Les troubles du sommeil, conditionnant probablement la pathologie, nécessitent une vigilance particulière. Quoi qu'il en soit, toute médication doit être adaptée au sujet. De même que doivent être individualisés les éléments d'approche relationnelle, tout conseil et autres règles d'hygiène de vie ainsi que l'orientation vers un soin spécialisé.

[The nurse within emergency medical-psychological units]. / L'infirmier au sein des cellules d'urgence médico-psychologique.

The growing recognition of post-traumatic stress disorders and the need to intervene early justifies the creation of emergency medical-psychological units. The nurse has a major role to play within these teams.

[Psychological debriefing and post-immediate psychotherapeutic intervention]. / Débriefing psychologique et intervention psychothérapique post-immédiate.

Psychological debriefing is a controversial treatment technique. In principle, many such treatments exist based on apparently indisputable conclusions which only assess the personal traumatic effect and neglect the collective impact, which is the original reason for the creation of this technique. Therefore, it is essential to take a look at the way in which debriefings are conducted, its indications, its limits and the psychodynamic processes at play.