HOW SHOULD PSYCHIATRISTS AND GENERAL PHYSICIAN COMMUNICATE TO INCREASE PATIENTS’ PERCEPTION OF CONTINUITY OF CARE AFTER THEIR HOSPITALIZATION FOR ALCOHOL WITHDRAWAL?

Background: There are medico-psycho-social indications to apprehend the alcohol use disorder (AUD) as a chronic problem for which a continuous care is necessary. The perception of continuity of care is also associated with positive outcomes on the patient’s health. Communication between caregivers is essential to maintain a good continual care. In order to put patients back into the center of care, we asked them the question: “why should the psychiatric department (PD) and general physicians (GP) should communicate about AUD patients”? Subjects and methods: After a week of hospitalization for alcoholic withdrawal, we used a qualitative approach with 4 open questions to explore AUD patients’ point of view (N=17) about the best way of communication between psychiatrists and GP to improve care continuity. The data collection was carried out in the psychiatric department of the University Hospital of Mont- Godinne, Belgium. Results: AUD patients consider that the GP is the first line actor that will be consulted after hospitalization and have a privileged relationship with him. These arguments justify him being informed. Concerning these patients, communication is useful to have a continuous treatment and project care, for purposes of symptoms’ evolution follow-up and so as to help the GP to understand them better to follow the evolution of symptoms and to help the GP to understand them better. Conclusion: From AUD patients’ point of view, communication between psychiatric department and the GP is useful for a perspective of continuity of care at discharge from the hospital. This communication seems to be at the service of the GP and his patient rather than for the psychiatrist himself. Mainly because of the GP’s role as a privileged first-line care, but also thanks to the specific relationship relating him to his patient

ALCOHOL USE DISORDER IN PRIMARY CARES: HOW TO INTEGRATE BRIEF INTERVENTIONS AND CONTINUOUS CARE?

Background: In Belgium, 82% of the population consumes alcohol occasionally while 10% consume in a way that can be seen as problematic. On a European level, only 8% of the people who can be characterized as having Alcohol Use Disorder (AUD) would have consulted professional assistance in the past year. In this context, the KCE (Belgian Health Care Knowledge Centre) has addressed multiple recommendations to health professionals to reduce the “treatment gap” concerning the patients’ care: (1) encourage screening and preventative interventions, (2) promote the acquirement of communicational and relational competences (3) develop collaborations between professionals. The objective of this article is to better understand their functioning. Method: We format a non-systematic literature review concerning these recommendations. Results: The implementation of these Brief Interventions programs in primary care is relevant due to the moderately positive impact on the frequency and quantity of alcohol consumption but both the quality of the therapeutic relationship and collaboration with the care network would optimize Brief Interventions. The quality of the therapeutic relationship alone appears to have an impact on therapeutic outcome. Conclusion: Training concerning patient-professional relationship is necessary to maximize the effectiveness of BIs

IMPROVING TRANSITION FROM CHILD AND ADOLESCENT MENTAL HEALTH SERVICES TO ADULT MENTAL HEALTH SERVICES FOR ADOLESCENTS IN TRANSITION TO YOUNG ADULTHOOD: A LITERATURE REVIEW

Background: These last years adolescents in transition to young adulthood (ATYA) have become a new matter of research. This population encounter specific issues and challenges regarding their mental health particularly when they have attained age boundaries and deal with the issue of transition from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS). Many key questions regarding how to sustain continuity of mental health care for ATYA during transition remain. The aim of this paper is to review recent literature in the domain to identify dimensions that should be considered to improve ATYA transition from CAMHS to AMHS. Subjects and methods: A qualitative literature review was performed in Scopus-Elsevier database using the PRISMA method as reporting guidelines. Only papers discussing dimensions involved in the transition process from CAMHS to AMHS were considered. We restricted the review to researches published between 2010 and 2020. Results: We identified 85 potential researches, after filtering; only 10 articles were finally included in the qualitative synthesis of the literature. Five main dimensions were identified: patient, professional, organization, policy, and ethic related. Those dimensions should be considered in order to improve ATYA transition process out of CAMHS to AMHS. Conclusion: This work contributes to identify principal dimensions that should be considered by mental health professionals and organizations in order to improve ATYA transition from CAMHS to AMHS

TOWARDS A VULNERABILITY MODEL FOR MAJOR DEPRESSIVE EPISODES

Background: While many studies have investigated depression risk factors, few attempts have been made to weight, and compare them. Therefore, we conducted a prospective comparison of a sample of subjects suffering from major depressive disorder and a group of healthy subjects. We compared classic risk factors with internal elements such as personality, family dynamics and hea lth locus of control. We also looked for prognostic factors. Methods: Forty people with major depressive disorder (the MDD group) were randomly assigned to different treatment groups and followed for two years. In parallel, we followed a group of 21 healthy subjects (healthy group). At the beginning of the st udy, sociodemographic data were recorded and all subjects were asked to complete the Multidimensional Health Locus of Control (MHLC) scale, the NEO Five-Factor Inventory (NEO-FFI), and the Family Adaptation and Cohesion Scale (FACES III). During the study, subjects were regularly assessed using the Hamilton Depression Scale (HDS) and the Short Form Health Survey (SF-12). Results: Of the 23 explanatory variables, 13 were statistically different (p .05): age, gender, number of people living together, income, extravert personality and neuroticism, Internal HLC, Powerful others HLC, Adaptability of the current couple and the family of origin, and Cohesion of the ideal and nuclear family and family of origin. The accumulation of risk factors doubles the chan ces of suffering from MDD (odds ratio 1.905**). Independent of treatment, among the 13 variables, the first nine explain 34.1% of chan ge in depression measured on the HDS scale (p<0.001). Conclusion: While the size of our sample limits the robustness of our results, our study suggests that some risk factors are also prognostic. The respective weights of these factors vary as a function of age group. Finally, some, such as health locus of control, family dynamics or extraversion, can be modified as an adjunct to pharmacological treatmen

SELECTIVE SEROTONERGIC (SSRI) VERSUS NORADRENERGIC (SNRI) REUPTAKE INHIBITORS WITH AND WITHOUT ACETYLSALICYLIC ACID IN MAJOR DEPRESSIVE DISORDER

Background: Antidepressant medication efficacy remains a major research challenge. Here, we explored four questions: whether noradrenergic antidepressants are more effective than serotonergic antidepressants; whether the addition of 100 mg acetylsalicylic acid (ASA) changes antidepressant efficacy; whether the long-term efficacy differs depending on the antidepressant and the addition of ASA; and whether serum levels of brain-derived neurotrophic factor (BDNF) are clinically informative. Subjects and methods: In a two-year study, forty people with major depressive disorder were randomly assigned to groups that received an SSRI (escitalopram) or an SNRI (duloxetine), each group received concomitant ASA (100 mg) or a placebo. Sociodemographic data were recorded and patients under went regular assessments with the Hamilton depression scale (HDS) and clinical global impression (CGI) scale. Serum levels of BDNF were measured four times per year. Results: There was no significant difference in efficacy between the two antidepressants or between antidepressant treatment with and without ASA. However, subgroup comparisons revealed that the duloxetine + ASA (DASA) subgroup showed a more rapid improvement in HDS score as early as 2 months (t=-3.114, p=0.01), in CGI score at 5 months (t=-2.119, p 0.05), and a better remission rate (2=6.296, p 0.012) than the escitalopram + placebo (EP) subgroup. Serum BDNF before treatment was also higher in the DASA subgroup than in the EP subgroup (t=3.713; p 0.002). Conclusion: This suggest two hypotheses: either a noradrenergic agent combined with ASA is more effective in treating depression than a serotonergic agent alone, or the level of serum BDNF before treatment is a precursor marker of the response to antidepressants. Further research is needed to test these hypotheses

FROM FAMILY SURROUNDINGS TO INTESTINAL FLORA, A LITERATURE REVIEW CONCERNING EPIGENETIC PROCESSES IN PSYCHIATRIC DISORDERS

Background: Some behaviors or psychiatric conditions seem to be inherited from parents or explain by family environment. We hypothesized interactions between epigenetic processes, inflammatory response and gut microbiota with family surroundings or environmental characteristics. Subjects and methods: We searched in literature interactions between epigenetic processes and psychiatric disorders with a special interest for environmental factors such as traumatic or stress events, family relationships and also gut microbiota. We searched on Pubmed, PsycINFO, PsycARTICLES and Sciencedirect articles with the keywords psychiatric disorders, epigenome, microbiome and family relationships. Results: Some gene polymorphisms interact with negative environment and lead to psychiatric disorders. Negative environment is correlated with different epigenetic modifications in genes implicated in mental health. Gut microbiota diversity affect host epigenetic. Animal studies showed evidences for a transgenerational transmission of epigenetic characteristics. Conclusions: Our findings support the hypothesis that epigenetic mediate gene-environment interactions and psychiatric disorders. Several environmental characteristics such as traumatic life events, family adversity, psychological stress or internal environment such as gut microbiota diversity and diet showed an impact on epigenetic. These epigenetic modifications are also correlated with neurophysiological, inflammatory or hypothalamic-pituitary-adrenal axis dysregulations

PARTIAL DENIAL OF PREGNANCY AT 32 WEEKS IN A DIABETIC AND SUICIDAL PATIENT: A CASE REPORT. What Are the Treatment Recommendations?

Background: Denial of pregnancy is an issue that is often discovered a posteriori with sometimes dramatic complications. Denial of pregnancy is considered partial when the woman becomes aware of the pregnancy after the fifth month before delivery. The populations studied were heterogeneous, which made it impossible to establish a standard algorithm of the treatment and support of a discovery of partial denial of pregnancy. Subjects and methods: Based on a literature review and a discussion of partial denial of pregnancy case and the consequential treatment with a five-year follow-up, the global management recommendations need consideration in the case of partial denial of pregnancy. Results: The reported case confirmed the significance of the trauma caused by the discovery of pregnancy in a patient in denial, but also showed that this trauma can extend to caregivers concerned by the treatment. Conclusion: Continuous training of all caregivers for denial of pregnancy is essential even if the issue may be considered infrequent. Contraception, prevention of sexually transmitted diseases and the importance of gynecological follow-up must be systematically addressed in a medical consultation. A standard algorithm for the treatment of partial denial is difficult to establish, but the rapid mobilization of a multidisciplinary team or hospitalization is recommended for the announcement of the diagnosis as well as personalized support during ultrasounds. The establishment of a relationship of trust remains the major issue

ROLE OF GUT MICROBIOTA IN THE INTERACTION BETWEEN IMMUNITY AND PSYCHIATRY: A LITERATURE REVIEW

Background: Psychiatric disorders may be correlated with a low-grade systemic inflammation but the origin of this inflammatory response remains unclear and both genetics and environmental factors seems to be concerned. Recent researches observed that gut microbiota seems to have an impact on the brain and immune processes. Method: We review recent literature to a better understanding of how microbiota interacts with brain, immunity and psychiatric disorders. We search on Pubmed, PsycINFO, PsycARTICLES and Sciencedirect articles with the keywords ”gastrointestinal microbiota” and “mental disorders” or “psychological stress”. Results: We showed links between gut microbiota and brain-gut axis regulation, immune and endocrine system activity, neurophysiological changes, behavior variations and neuropsychiatric disorders. Communications between brain and gut are bidirectional via neural, endocrine and immune pathway. Microbiota dysbiosis and increase gut permeability with subsequent immune challenges seems to be the source of the chronic mild inflammation associated with neuropsychiatric disorders. Repeated immune or stress events early in life may lead to neurodevelopmental disorders or sickness behavior later in life. Conclusions: psychological stress impact gut microbiota with subsequent immune activation leading to neurodevelopmental disorders or sickness behavior and altering neurophysiology and reactivity to stress or lifestyle

IMMUNITY AND PSYCHIATRIC DISORDERS: VARIABILITIES OF IMMUNITY BIOMARKERS ARE THEY SPECIFIC?

Background: In previous studies we showed the interaction between depression and immunity. We observed that psychological stress seems to be important in this association. In this review we try to understand if psychological stress and immunity have similar or specific impact on the other psychiatric disorders. More generally we review literature to understand if specific immune alterations exist between the main psychiatric diagnoses. Method: We studied the literature in search of variabilities between the different psychiatric disorders in terms of immunity especially inflammation. We search on Pubmed, PsycINFO, PsycARTICLES and Sciencedirect articles with the keywords immunity or inflammation and depression, anxious disorders and schizophrenia. Results: Prevalence of inflammation in psychiatric disorders seems to be between 21 to 42%. Psychiatric disorders are correlated with elevated levels of CRP, pro-inflammatory cytokines (IL-6, IL-1 and TNF) and anti-inflammatory factors (TGF , IL-10, sIL-2, IL-1RA). IL-6 in childhood were associated with subsequent risk of depression or psychotic disorders in early adulthood and in a dose dependent manner. Discussions: We found similar immune processes through the different disorders. Variations in cytokines levels seem paralleling various stages of the illness and treatment. Inflammatory markers are linked with severity and resistance to treatment and with subsequent risk of disorders. Conclusions: Some inflammatory parameters could be considered as risk factor, severity, resistance, trait or state markers of a psychiatric disorder. Other studies are necessary to a better understanding of clinical implications of this heterogeneity