Early psychological care of the French victims of the Costa Concordia shipwreck.

Most of the French passengers who survived the shipwreck of the cruise ship Costa Concordia were repatriatedfrom Italy to Marseille, one of the stopovers of the cruise. The shipwreck happened during the nightof 13th-14th January 2012 and entailed the forced evacuation of 4195 passengers and crewmembers.Thirty-two persons died and 2 others are still reported missing. The massive and unexpected inflow of402 French citizens in the port of Marseille required the quick setting up of welcome facilities, not only tosolve logistical problems, but also to address psychological and sometimes even medical problems. ThePrehospital Psychological Emergency Service (CUMP) and the Prehospital Emergency Medical Service(SAMU) of Marseille examined 196 persons in total, and were able to avoid a great number of emergencyadmissions deemed necessary because of difficult psychological situations (death, missing or lost persons,acute stress). The objective of this report is to rapidly present the emergency committee as a whole andto describe in more detail the work that the CUMP accomplished during the 36 hours necessary to takecharge of the majority of the French passengers of the Costa Concordia.

[Family's and/or relatives expectations concerning a patient emergently hospitalized into an intensive care unit after out-of-hospital medical care of by a samu team]. / Enquête sur les attentes de la famille et/ou des proches d'un patient hospitalisé en réanimation après prise en charge extrahospitalière par une équipe du samu.

INTRODUCTION: Emergency admission of a patient into an intensive care unit (ICU) is a source of stress for family and/or relatives. Expectations of family and/or relatives are important endpoints for the medical and paramedical team in charge of the patient, to better answer to their questions. OBJECTIVE: The aim of this study was to determine family's and/or relatives expectations concerning a patient emergently hospitalized into an ICU after out-of-hospital medical care of by a samu team. MATERIALS AND METHOD: We performed a survey using a questionnaire sent by email to 500 randomly chosen individuals from the French population. RESULTS: We received 220 responses (44 %). Family and/or relatives expectations are different about short, medium and long terms. Elements perceived as the most important in the short term are severity, diagnosis and prognosis, whereas in the medium and long terms they are hospital-stay and potential sequels. Medical language used is considered as too much complex for more than half of respondents. In case of foreseeable unfavourable outcome, 90 % of respondents would like to receive immediate information using a simple and brief language. At last, nearly two thirds of respondents had been really exposed to such a situation before, and assessed the quality of information received as moderate, with a score of 5/10. CONCLUSION: Information of families and/or relatives of a patient hospitalized in ICU is essential. Their expectations concern short, medium and long terms. At last, most of them prefers that information would be delivered by a physician, and using a simple and brief language.

Predictors of short-term deterioration and compliance in psychiatric emergency patients: a prospective study of 457 patients referred to the emergency room of a general hospital.

The aim of this study was to identify predictors of (1) short-term outcome and (2) short-term compliance with treatment (for non-hospitalized patients) in psychiatric emergency patients. Subjects comprised 457 patients referred to the emergency ward of a French general hospital and requiring examination by a psychiatrist. Clinical and therapeutic assessments were carried out at baseline, using DSM-IV diagnoses and overall psychopathological scoring scales [Brief Psychiatric Rating Scale (BPRS) and Symptom Checklist-90 Revised]. Clinical outcome and compliance were assessed 3 weeks after entry. For each of the two issues assessed, stepwise logistic regression analysis was performed following univariate comparisons. The three best predictors of deterioration at 3 weeks were lack of compliance to treatment, presence of a previous psychiatric history, and a low BPRS hebephrenic factor score. The best predictors of compliance in non-hospitalized patients were a previous psychiatric history, marital status, a low BPRS hostility factor score, and older age. The main predictor of deterioration was non-compliance. Thus, we emphasize the importance of improving compliance, especially among young patients with no previous psychiatric history.

Differential abnormalities in plasma 5-HIAA and platelet serotonin concentrations in violent suicide attempters: relationships with impulsivity and depression.

Brain serotonergic systems may participate in the regulation of mood, impulsivity and aggressive behavior. Because some monoaminergic mechanisms seem to be similar in the central nervous system and peripheral tissues, we tested whether serotonergic or dopaminergic biochemical parameters in peripheral venous blood are related or not to violent suicide behavior.We simultaneously studied plasma serotonin (5-HT), 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA) and platelet 5-HT content in patients within 3 days following a violent suicide attempt and in matched healthy controls. We examined their relationship with depression and impulsivity. Twenty seven drug-free suicide attempters and controls were included. Plasma 5-HIAA and platelet 5-HT concentrations were lower in suicide attempters than in controls. Fifteen patients were classified as impulsive (I), including all patients suffering from personality disorder and alcohol abuse, and 12 as non impulsive (NI), mostly melancholics. MADRS scores were similar in both I and NI suicide attempters. When controlling for age, plasma 5-HIAA was lower in I than in NI suicide attempters or controls; these findings are similar to those we observed recently with CSF 5-HIAA in I and NI violent suicide attempters. Contrarily, platelet 5-HT levels were lower in NI than in I patients or controls. Plasma HVA was not associated with suicide behavior. Plasma 5-HIAA concentration was inversely associated with the degree of impulsivity and platelet 5-HT with the intensity of depression. This study indicates that each peripheral serotonergic index is specifically related to a distinct clinical feature and shows differential alteration according to the impulsivity group. In I and NI drug-free violent suicide attempters an inverse figure between plasma 5-HIAA and platelet 5-HT data was observed indicating a non parallelism between these two peripheral variables. Further prospective studies are needed to investigate whether these peripheral serotonergic parameters may be used as helpful early predictors of violent suicide behavior.

Low serum cholesterol in violent but not in non-violent suicide attempters.

Many previous studies have suggested that low or lowered serum cholesterol levels may increase the risk of mortality not due to somatic disease: principally, suicide and violent death. Because violent death is rare, some studies have investigated afterwards the relation between cholesterol levels and either suicide attempts in psychiatric populations or violence in criminally violent populations. However, none of these studies have compared cholesterol levels in violent and non-violent suicide attempters. The blood of 25 consecutive drug-free patients following a violent suicide attempt and of 27 patients following a non-violent suicide attempt by drug overdose was drawn in the 24 h following admission. Patients with a diagnosis of alcohol abuse and with cholesterol-lowering therapy were excluded. Age, sex, body mass index, psychiatric diagnosis and the physical conditions of the suicide attempt were investigated. Thirty-two healthy subjects were used as a control group. There were no differences between the groups in age, frequency of psychiatric diagnoses or body mass index. There was more women in the group of non-violent suicide attempters than in that of violent suicide attempters (P<0.001). In analyses controlling for sex and age, the serum cholesterol concentration was 30% lower (F(2,82)=15.8; P<0.0001) in the group of violent suicide attempters (147+/-54 mg/dl) than in the group of non-violent suicide attempters (209+/-38 mg/dl) or control subjects (213+/-46 mg/dl). Our results showed that low serum cholesterol level is associated with the violence of the suicide attempt and not with the suicide attempt itself. Further investigations are necessary to determine the usefulness of this easily accessible parameter as a potential risk indicator for violent acts such as violent suicidal behavior in susceptible individuals.

Low blood cholesterol and low platelet serotonin levels in violent suicide attempters.

AIM OF THE STUDY: This study investigated the possible connection between serum cholesterol levels and platelet serotonin (5-HT) content in violent suicide attempters and matched controls. METHODS: Blood samples for cholesterol and platelet 5-HT levels were obtained from 17 drug-free patients within 3 days after the suicide attempt. RESULTS: Serum cholesterol and platelet 5-HT levels in the suicide attempters were significantly lower than in the controls; however, we did not find any significant correlation between these two variables. Indeed, three clinical dimensions are present in this patient group: suicidality, violence, and impulsiveness. Because we did not find a difference in cholesterol and platelet 5-HT levels between impulsive and nonimpulsive patients, these two indexes may more reflect the dimension of suicidality and/or violence. CONCLUSIONS: Further investigation is necessary to study the dependence of these two peripheral abnormalities within the context of violent suicidal behavior.

CSF 5-HIAA levels are lower in impulsive as compared to nonimpulsive violent suicide attempters and control subjects.

BACKGROUND: We studied CSF 5-HIAA and HVA concentrations in violent suicide attempters and examined their relationship with depression, anxiety, and impulsivity. METHODS: CSF 5-HIAA and HVA concentrations were determined very shortly after hospital admission and compared to those of a matched control population. Clinical evaluation was performed concomitantly; the level impulsivity was evaluated by the Impulsivity Rating Scale (IRS). RESULTS: Twenty-three patients and 23 control subjects were included. According to the IRS, 14 patients were classified as impulsive, including all patients suffering from personality disorders, and 9 as nonimpulsive, with a main DSM-IIIR diagnosis of melancholia. CSF 5-HIAA concentrations in the suicide group were significantly lower than in control subjects. This difference was entirely due to the impulsive suicide attempters. There was an inverse correlation between the IRS score and CSF 5-HIAA (r = -.47, p = .02) and only a trend for HVA (r = -.41, p = .078) levels in the suicide group. CONCLUSIONS: This study of a group of violent suicide attempters distinguished a subgroup of patients diagnosed with personality disorder with high impulsivity scores and a subgroup of patients with the main diagnosis of severe depression. CSF 5-HIAA was significantly lower in impulsive violent attempters than in nonimpulsive violent attempters, therefore desintangling violence from impulsivity and linking this biologic abnormality to impulsivity.

[The risk of suicide]. / Le risque suicidaire.

HISTORICAL PERSPECTIVE: A certain number of historical elements including the progressive loss of religious values and the fact that suicide is considered to be an integral part of medical knowledge must be taken into consideration when assessing the risk of suicide. The sociological and psychoanalytical approaches attempt to help draw the suicidal subject out of the his/her personal implication by affecting the social and subconscious aspects of the problem respectively. Other elements such as psychiatric, sociocultural, biological and psychopathological factors are also involved in evaluating the risk of suicide. RISK FACTORS: Durkheim's analysis of the social, familial and occupational factors observed in suicide remains pertinent for assessing risk. Psychiatric disorders are also highly significant risk factors since some type of disorder is found in approximately 90% of all suicide victims. Affective disorders including rapidly alternating bipolar behavior, psychoses, particularly schizophrenia, and borderline personality are the most frequently observed, especially when associated with certain types of behavior such as drug or alcohol abuse. The risk related to other factors such as suicidal behavior (attempts or ideation) is independent of the psychiatric illness. For example, the risk of successful suicide is 30 greater the year after an attempted suicide than in the normal population. ASSESSING RISK: There are no known clinical means, notably psychometric, which can successfully predict the imminence of suicide. Recent studies on brain monoamine levels have shown that a lower 5-HIAA level does play some role in suicidal behavior, particularly violent suicide, although there is no predictive power for normality. It is important to recall that certain advances in the field of psychopathic illnesses offer new insight into concepts such as the death instinct and the suicidal act itself.

Achalasia and megaesophagus misdiagnosed as anorexia nervosa.

A 40-year-old woman initially considered as suffering from anorexia nervosa was later diagnosed as having achalasia and megaesophagus.

Postdisaster psychosocial intervention: a field study of the impact of debriefing on psychological distress.

OBJECTIVE: Following a catastrophic natural disaster, the authors evaluated whether brief psychological intervention (debriefing 6 months later) reduced disaster-related psychological distress as measured by the Impact of Event Scale. METHOD: Two groups of subjects who had been exposed to Hurricane Iniki in Hawaii were assessed before and after participating in a multihour debriefing group. The intervention aimed to provide ventilation of feelings, normalization of responses, and education about normal psychological reactions to the disaster in a context of group support. To provide a partial control for the passage of time, the pretreatment assessment of the second group was concurrent with the posttreatment assessment of the first group. RESULTS: A repeated measures analysis of variance indicated that Impact of Event Scale scores were reduced in both groups after the treatment. CONCLUSIONS: There is preliminary empirical support for the effectiveness of postdisaster psychological intervention and for the feasibility of treatment research in postdisaster environments.

Analysis of the terms used by general practitioners to characterize patients considered by them as depressed. A prospective study on 682 patients.

The aim of the study was to investigate the terms used by general practitioners (GPs) to describe the patients considered by them to be depressed. 682 patients were diagnosed as depressed by 79 GPs selected at random in four regions of France. The frequency of the diagnosis of depression made by GPs in the total patient population was 3.6-5%. The GPs were asked to describe the main symptoms of these patients on a plain chart. The percentage of use of each term was calculated in each region. In all the regions, the most frequent symptoms were insomnia (31.8%), fatigue (29.9%) and anxiety (24.6%). The results suggest that the three main terms used by GPs to describe depression differ from those used by psychiatrists.

Serotonine and suicide: a preliminary study concerning a sample of violent suicidal patients.

1. A sample of patients having attempted to commit suicide by using violent methods (hanging, jumping) was investigated according to the following procedure: for each patient, some evaluative tests (the MADRS, the SCL 90 and an agressivity scale) were administered and DSM III diagnosis was provided as well as the therapeutical orientation. 2. The 5 HIAA' level was measured in the CSF soon after the suicide attempt except for patients with rachis fracture or exposed to a cerebral oedeme. 3. Results were compared to those of a control group composed with patients having operated with rachi-anesthesia for orthopedic surgery. 4. The preliminary results show that 5 HIAA' levels were lower for suicide patients except for one schizophrenic patient. 5. This study suggests the possible link between a low 5 HIAA' level in CSF and the clinical aspects of severe suicidal behaviour.

[Münchhausen syndrome]. / Le syndrome de Münchhausen.

Münchhausen's syndrome is characterized by fictitious illnesses associated with hospital peregrination, pseudologia fantastica with a mythomanic discourse that includes strongly structured medical elements, passivity and dependance at examinations, and aggressiveness. The whole picture is so typical that the syndrome can easily be recognized. Cases of Münchhausen's syndrome by proxy (Meadow's syndrome) have been reported during the last few years; the condition concerns children suffering from diseases which are entirely due to their parents and can be compared with the battered child syndrome. In terms of nosology, among pathomimias Münchhausen's syndrome figures as a borderline state. Since it is impossible to establish positive relations with these patients, treatment fails in almost every case.