Pr Mohamed Saoud

Purpose: To assess the level of stress and anxiety in healthcare workers in the departments of obstetrics and gynecology in France during and after the first Covid-19 lockdown.

Methods: Two web-based cross-sectional surveys using several validated questionnaires (the HAD scale, the PSS-10 questionnaire and the Short Form 12 Questionnaire [SF-12]) were proposed to all staff of obstetrics and gynecologic departments in 18 French university hospitals.

Results: A total of 1565 respondents answered the first questionnaire and 1109 completed the second survey. Respondents reported greater levels of stress and impaired mental quality of life during the lockdown, followed by a significant improvement after the end of lockdown (respectively p < .0001 and p = .01). Anxiety was significantly higher among the older participants during the lockdown (p = .008). The potential putative factors related to impaired mental health status were personal protective equipment (PPE) deficit (<.0001), the fear of contracting the virus from the workplace and transmitting to their families (<.0001) and concerns about information given by media and hospitals (<.0001).

Conclusions: Understanding the heavy mental repercussions of the Covid-19 pandemic on healthcare workers could lead to the identification of high-risk in medical and non-medical staff and the implementation of targeted psychological monitoring program.

Psychiatric comorbidities are frequent in adolescents with internet gaming disorder (IGD). In contrast, the proportion of IGD among adolescents hospitalized for a psychiatric disorder has not been documented yet. In addition, parental ratings of IGD could be useful for diagnosis, but very few data exist on this issue. The objectives of this study were to: (1) assess the prevalence of IGD among adolescent psychiatric inpatients, using the Ten-Item Internet Gaming Disorder Test (IGDT-10), and (2) assess the parental version developed for this study (IGDT-10-P). A total of 102 patients, aged from 12 to 17 years old, were included from four psychiatric units of the French region Auvergne-Rhône-Alpes, during a 6-month inclusion period. Adolescents completed the IGDT-10 while one of their parents completed the IGDT-10-P. The inclusion rate among the eligible population was 57.95%. The prevalence of IGD in the sample, based on the IGDT-10 and IGDT-10-P, was 6.00% and 12.79%, respectively. Psychometric features of the IGDT-10-P indicated excellent internal consistency, a good model fit to the one factor model in confirmatory factor analysis, a strong correlation with gaming time, and a moderate correlation with the IGDT-10. Our results support the need for a systematic screening of IGD among adolescents hospitalized for a psychiatric disorder. Future studies should aim to confirm and explain the prevalence gap between self- and parent-reported criteria.

Objectives: The Beck Cognitive Insight Scale (BCIS) is composed of two subscales, self-reflectiveness and self-certainty, assessing reflectiveness and openness to feedback, and mental flexibility. Delusions have previously been associated with low cognitive insight. The aim of this study was to determine whether changes in BCIS scores predict changes in delusional beliefs.

Methods: The study is a secondary analysis of a previously published randomized controlled trial. All participants had a psychotic disorder diagnosis and received treatment as usual, with half of them also receiving the cognitive restructuring intervention ‘Michael’s game’. Participants were assessed at three different times: at baseline (T1), at 3 months (T2), and at 9 months (T3). Cognitive insight was measured with the BCIS, belief flexibility with the Maudsley assessment of delusions schedule (MADS), and psychotic symptoms with the Brief Psychiatric Rating Scale (BPRS).

Results: A total of 172 participants took part in the trial. After using generalized estimating equation (GEE) modelling, we observed (1) significant main effects of BCIS self-certainty and Time and (2) significant Time × BCIS self-certainty and Time × treatment group interaction effects on belief flexibility. Improvements in self-certainty (i.e., decrease in scores) were associated with more changes in conviction over time, more accommodation, improved ability in ignoring or rejecting a hypothetical contradiction and increased use of verification of facts. Medication and BPRS total scores were controlled for in the GEE analyses at their baseline values.

Conclusions: Overall improvement in BCIS self-certainty scores over time predicted better treatment outcomes as assessed with MADS items.

Practitioner points: Treatments for patients with psychosis should focus on improving cognitive insight as this seems to improve overall treatment outcomes and recovery. The Beck Cognitive Insight Scale can be used to measure changes during treatment and can predict treatment outcomes.

Background: Most individuals with schizophrenia (SZ) have little to no insight regarding the presence of their illness. Psychoeducational programs are state-of-the-art interventions that consist in delivering stabilized patients with accurate knowledge about their illness and its treatment. Evidence suggests a significant relationship between levels of illness-related knowledge and insight in SZ patients. However, the effect of psychoeducation on these related outcomes needs to be explored further.

Methods: In this open label study involving 30 French-speaking patients with SZ, we propose to compare levels of knowledge and insight before and after the French P.A.C.T.® psychoeducation program to investigate how this approach affects both outcomes. Knowledge levels were measured with the self-questionnaire « What do I know? ». Insight levels were measured using the Scale to Assess Unawareness of Mental Disorder (SUMD). Symptoms were assessed with the Positive And Negative Syndrome Scale (PANSS).

Results: A large significant improvement of knowledge was observed (p < 0.001; d = 0.77). By contrast, the analysis reported no significant effect of psychoeducation on insight (p = 0.86; d = 0.07). PANSS total scores were significantly decreased after treatment (p = 0.001; d = 0.66).

Conclusions: Although the P.A.C.T.® program is a promising tool for improving illness-related knowledge in SZ patients, its use is not sufficient to significantly improve insight levels.

Despite the advances in psychopharmacology and established psychotherapeutic interventions, more than 40% of patients with obsessive-compulsive disorder (OCD) do not respond to conventional treatment approaches. Transcranial direct current stimulation (tDCS) has been recently proposed as a therapeutic tool to alleviate treatment-resistant symptoms in patients with OCD. The aim of this review was to provide a comprehensive overview of the current state of the art and future clinical applications of tDCS in patients with OCD. A literature search conducted on the PubMed database following PRISMA guidelines and completed by a manual search yielded 12 results: eight case reports, three open-label studies (with 5, 8, and 42 participants), and one randomized trial with two active conditions (12 patients). There was no sham-controlled study. A total of 77 patients received active tDCS with a large diversity of electrode montages mainly targeting the dorsolateral prefrontal cortex, the orbitofrontal cortex or the (pre-) supplementary motor area. Despite methodological limitations and the heterogeneity of stimulation parameters, tDCS appears to be a promising tool to decrease obsessive-compulsive symptoms as well as comorbid depression and anxiety in patients with treatment-resistant OCD. Further sham-controlled studies are needed to confirm these preliminary results.

Allogeneic hematopoietic stem cell transplantation can efficiently treat patients with severe hematological diseases. A human leukocyte antigen-compatible donor is required for performing transplantation. The occurrence of unexpected acute severe diseases in a donor can compromise the feasibility of allogeneic hematopoietic stem cell transplantation. However, when a severe health problem occurs in a donor while the recipient has already received a conditioning regimen, hematologists have to find the best solutions for the recipient, while the team in charge of the donor has to find the best medical solutions for the donor. We describe here the occurrence of psychiatric acute complications in an unrelated donor while the myeloablative conditioning regimen had already been given to the recipient. We report the successive decisions that were made in an emergency based upon the expertise of physicians specialized in hematology, apheresis, cell therapy, and psychiatry to preserve the donor’s health and recipient’s life.