Post-traumatic stress among COVID-19 survivors: A descriptive study of hospitalized first-wave survivors

Introduction: The coronavirus Severe Acute Respiratory Syndrome Coronavirus Type 1 induces a severe respiratory disease, coronavirus disease 2019 (COVID-19). After Severe Acute Respiratory Syndrome Coronavirus Type 1 and Middle East Respiratory Syndrome infection, increased post-traumatic stress disorder (PTSD) rates were described. Methods: This single-centred, prospective study aimed to evaluate the rates of PTSD in patients who were hospitalized for COVID-19. Inclusion criteria were COVID-19 patients hospitalized in the intensive care unit (ICU) or in a standard unit with at least 2 L/min oxygen. Six months post-hospitalization, subjects were assessed for PTSD using a validated screening tool, the Post-Traumatic Stress Checklist-5 (PCL-5). Results: A total of 40 patients were included. No demographic differences between the ICU and non-ICU groups were found. The mean PCL-5 score for the population was 8.85±10. The mean PCL-5 score was 6.7±8 in the ICU group and 10.5±11 in the non-ICU group (P=0.27). We screened one patient with a positive PCL-5 score and one with a possible PCL-5 cluster score. Nine patients had a PCL-5 score of up to 15. Seven patients reported no symptoms.Seven patients accepted a psychological follow-up: one for PTSD, three for possible PTSD and three for other psychological problems. Discussion: The PCL-5 tool can be used by lung physicians during consultations to identify patients for whom follow-up mental health assessment and treatment for PTSD are warranted. Conclusion: Lung physicians should be aware of the risk of PTSD in patients hospitalized for COVID-19 and ensure appropriate screening and follow-up care

Anorexie mentale, grossesse et maternité : le corps enfantant

Tout au long de la vie, le corps de la femme est amené à grandir, vieillir, se modifier, se transformer. Ces moments de modifications corporelles, comme le représentent l’avènement pubertaire ou encore la grossesse, peuvent être pour les femmes des phases de grands bouleversements, à la fois somatique et psychique. La question des liens étroits entre corps et psyché prend un sens particulier lorsque l’on étudie la psychopathologie des patientes souffrant d’anorexie mentale, et notamment lorsque celles-ci sont enceintes et viennent enfanter. Nous proposons dans cet article de décrire la place du corps dans l’anorexie mentale, à la fois dans sa réalité effective et également dans les représentations dont il fait l’objet. Nous choisissons ensuite de détailler l’expérience de la maternité chez les femmes enceintes souffrant d’anorexie mentale avec un investissement narcissique marqué. Puis, nous nous interrogerons sur le vécu, les éprouvés, les fantasmes de ces patientes face à la métamorphose corporelle de la grossesse

Penser, représenter, la problématique de la féminité et du maternel dans l’anorexie mentale

L’épidémiologie des Troubles des conduites alimentaires (TCA) permet d’envisager que la problématique dans ces affections soit liée en grande partie à la problématique plus générale de la féminité et à celle de la constitution de l’identité de genre psychique et corporelle à l’adolescence. Nous allons particulièrement aborder ici la problématique des affects, de l’attachement insécure, le rôle des conflits émotionnels, de la psychopathologie parentale, la dynamique familiale dans cette population de patient(e)s. Notre regard psychopathologique se focalisera également sur les aspects transgénérationnels de l’identification avec la quête imaginaire d’une identité, d’une filiation du corps à corps, et sur le rôle particulier de l’éprouvé corporel dans la construction de la conscience de sa féminité et du maternel. Nous en conclurons que cette prison, que le sujet entretient jusqu’à en être -avec son corps-le co-geôlier, n’est pas qu’une simple prison mentale

Quels facteurs expliquent la durée d'hospitalisation pour anorexie mentale: revue systématique de la littérature

International audienceObjectives: The cost of hospital treatment for anorexia nervosa (AN) is very high given its duration. Identifying factors related to length of hospital stay (LOS) would make it possible to consider targeted therapeutic strategies that, by optimizing care, would reduce their duration and costs. The objective of this work is to identify the factors related (predictive and associated) to LOS for AN. Methods: Systematic review of existing literature up to October 2020, based on Pubmed, according to PRISMA recommendations (Preferred Reported Items for Systematic reviews and Meta-Analysis). Factors related to LOS have been described in two categories: factors related to clinical aspects; and factors related to therapeutic aspects and management modalities. We distinguished predictive factors (identified as pre-hospitalization or contemporaneous with hospital admission) and associated factors (observed during hospitalization) for each category. Results: Thirteen articles were selected. Samples from the selected studies ranged from 35 to 381 subjects, mostly women with restrictive type AN (R-AN), but some samples included all types of AN, or focused on purging-type forms. The mean age at admission ranged from 13.6 years (Standard Deviation–SD: ± 1.6) to 30.3 years (SD: ± 13.9), corresponding to adolescent, adult or mixed samples. Mean body mass indices at admission ranged from 12.3 (SD ± 1.4) to 16.6 (SD: ± 2.1). The duration of disease progression ranged from 11.7 months ± 2.2 to 9.7 years. Mean LOS are short for studies conducted in pediatrics or in medical services (ranging from 13.0 days [SD ± 7.3] to 22.1 days [SD ± 9.4]); they are more variable for studies conducted in psychiatry: from 15.6 days (SD ± 1.0) to 150.2 days (SD ± 80.8). Among the factors related to an increase in LOS, clinical predictors included: older age at onset or admission; longer duration of the disorder; low minimum body weight during AN; low BMI at admission; purgative form of anorexia nervosa; and high levels of dietary symptoms (asceticism and ineffectiveness dimensions on Eating Disorder Inventory-2). Therapeutic and management modality predictive factors were: a higher number of hospitalizations for AN; the use of enteral nutrition (nasogastric or percutaneous gastric tube) on admission or during hospitalization; the use of intravenous renutrition coupled with oral renutrition; hospitalization far from the patient's home; absence of hospital care in psychiatry after medical stabilization in a somatic unit; compulsory hospitalization. Associated factors were: the presence of psychiatric comorbidities; greater weight gain during hospitalization. Among the factors related to a decrease in LOS, the clinical predictive factor were: greater self-confidence at admission (measured by the Eating Disorder Recovery Self-Efficacy Questionnaire). Therapeutic and management modality predictors included: increased caloric intake of oral renutrition on admission; intake of oral nutritional supplements on admission; and hospitalization in urban areas. The associated factor was: compliance with the weight contract in the adolescent population. Discussion: Factors related to an increase in LOS are explained by: higher resistance to treatment, higher severity of the disease, the time required for weight gain in services using cognitive-behavioural therapy, complications associated with renutrition modalities such as parenteral renutrition, difficulties in organising outpatient follow-up which require better consolidation of inpatient treatment and the lack of multidisciplinary care in medical services. Factors related to a decrease in LOS are due to: faster weight gain, the presence of a greater number of outpatient follow-up structures close to the hospital and better adherence to treatment to complete the weight contract. Conclusions: Taking these factors into account during hospitalization for AN would help optimize care, duration and costs. This situation therefore requires the development of therapeutic trials targeting the identified factors in order to reduce LOS in the treatment of AN.ObjectifIdentifier les facteurs liés à la durée de séjour hospitalier pour anorexie mentale.MéthodeRevue systématique de la littérature.RésultatsLes facteurs prédictifs d’une durée de séjour hospitalier plus longue sont : un âge plus avancé au début du trouble ou à l’admission ; une plus longue durée d’évolution du trouble ; un poids minimum faible ; un IMC ou un poids plus faibles à l’admission ; le sous-type purgatif ; des niveaux de symptômes alimentaires élevés ; un nombre plus important d’hospitalisations pour anorexie mentale ; une nutrition entérale à l’admission ou durant l’hospitalisation ; devoir coupler une renutrition parentérale à la renutrition orale ; être hospitalisé loin du domicile ; l’absence d’hospitalisation en psychiatrie après stabilisation en unité somatique ; une hospitalisation sous contrainte. Les facteurs associés à une durée de séjour hospitalier plus longue sont : des comorbidités psychiatriques ; un gain pondéral plus important durant l’hospitalisation. Les facteurs prédictifs d’une diminution de la durée de séjour hospitalier sont : une meilleure confiance en soi, une renutrition orale plus intense, des compléments nutritionnels oraux à l’admission ; être hospitalisé en région urbaine. Le facteur associé à une diminution de la durée de séjour hospitalier est le respect du contrat de poids chez des adolescents.ConclusionLa durée de séjour hospitalier dépend des caractéristiques cliniques de l’anorexie mentale et des facteurs liés aux modalités de prise en charge. Optimiser les modalités de renutrition, traiter les comorbidités ou développer les hospitalisations de jour permettrait d’améliorer les soins, de diminuer les durées de séjour hospitalier et leurs coûts

Eating disorder or oesophageal achalasia during adolescence: diagnostic difficulties

International audienceMarine was a fourteen and a half-year-old adolescent female hospitalized for an eating disorder (ED) of the anorexic type with purging behaviors. She has had a complicated life course, made up of disruptions and discontinuities, both family and school. Since the age of five, Marine had been intermittently treated in psychiatry for a diagnosis of oppositional defiant disorder. The current illness started with spontaneous and induced vomiting associated with major weight loss (body mass index, 15.27 kg m−2). The diagnosis of anorexia nervosa was established after several opinions from professionals in five Parisian university pediatric departments, where additional investigations were carried out without any somatic cause being identified. In this context, Marine was transferred to a child psychiatry unit. There, she had acute dyspnea during the insertion of a nasogastric tube. As a result, a new specialized opinion was sought from a pediatric gastroenterologist and further explorations were performed (oeso-gastroduodenal transit and manometry), leading to the conclusion to an oesophageal achalasia requiring surgical treatment. This case report highlights that the exclusion of any organic disorder should be a priority in the diagnostic assessment of an ED. Oesophageal achalasia is a rare differential diagnosis and should be considered in case of swallowing difficulties or dysphagia. Health care professionals should take care to provide appropriate somatic follow-up for patients with psychiatric disorders

Music, vibrotactile mediation and bodily sensations in anorexia nervosa : "It's like I can really feel my heart beating"

This article presents the theoretical, scientific, and methodological foundations for the design and implementation of an innovative technological and clinical platform that combined sound, music, and vibrotactile mediation used in a therapeutic setting by adolescents suffering from anorexia nervosa. In 2019, we carried out a pilot experiment with a group of 8 adolescent patients hospitalized in the Eating Disorders Unit of the Department of Adolescent and Young Adult Psychiatry of the Institut Mutualiste Montsouris in Paris. Within this clinical framework, we aimed to create conditions suitable for patients to reinvest in their “disaffected” bodily zones and internal experiences through reflecting on the sensations, emotions, and ideas generated by the sensory experiences created when sound and musical stimuli are transmitted through vibrations. The findings demonstrate the ways in which adolescent patients made use of the platform’s audiovibrotactile mediating objects to express a personal associative process through speech during their exchanges with clinical psychologists.peerReviewe