Remote training as a common tool for the different professionals involved in the acute phase after terror attacks across Europe:Perspectives from an expert panel

The acute response after a terror attack may have a crucial impact on the physical and psychological wellbeing of the victims. Preparedness of the professionals involved in the acute response is a key element to ensure effective interventions, and can be improved through trainings. Today in Europe there is a recognized lack of inter-professional and international trainings, which are important, among others, to respond to the needs and the rights of victims affected by a terrorist attack in another country than their home country. In this paper we report the perspectives of an expert panel composed by different categories of professionals on the possible role of interprofessional trainings provided remotely. The experts discussed the pertinence of remote trainings for professionals involved in the acute response of a terror attack, and highlighted their Strengths, Weaknesses, Opportunities and Threats (SWOT analysis). We concluded that, while remote trainings cannot replace in-person trainings, they may be useful to share knowledge about the role and the organization of the different categories of professionals, thus potentially improving response coordination, and to easily share good practices across professionals and countries

Étude translationnelle de la "rechute" dans l'état de stress post-traumatique : prévention et prédiction du déficit de rappel de l'extinction de la peur conditionnée, chez le rongeur et chez l'humain

Consequences of a potentially traumatic event may be different depending on the person affected. While most of the people will recover after the event, others will develop a post-traumatic stress disorder (PTSD). Exposure therapy is one of the best treatments of this disorder and is based on fear extinction training. However, both conditioned fear response and psychotraumatic symptoms may appear again some time after the end of the therapy. Combining fundamental and clinical research, this thesis is aimed at investigating how activity of the ventromedial prefrontal cortex may be related to indicators of prediction and prevention of the return of fear. A consequent objective is to highlight some new possibilities to prevent relapse.Our rat experiments showed that high frequency stimulation of the ventromedial prefrontal cortex reduces the likelihood of return of fear responses. Our experiments with human, with or without post-traumatic stress disorder symptoms, revealed several physiological, cognitive, clinical and socio-demographic predictors.Moreover, we found interpersonal differences that allowed us to characterize qualitative profiles.To sum up, our work demonstrates that the ventromedial prefrontal cortex is involved in multiple ways in the recall of fear extinction. From a clinical perspective, our findings provide suggestions for an innovative development of tools capable to detect individual tendencies to have some deficit in fear extinction recall. This study has, thus, important implications in improving prevention of relapse in post-traumatic stress disorder.Après un évènement potentiellement traumatique, si pour la plupart des individus les symptômes associés disparaissent rapidement, pour d’autres ils persistent. On parle alors d’état de stress post-traumatique. L’une des prises en charge les plus efficaces, basée sur le modèle de l’extinction de la peur conditionnée, est l’exposition répétée au souvenir traumatique. Cependant, tout comme pour la peur conditionnée qui peut réapparaître après son extinction, les symptômes psychotraumatiques peuvent également resurgir quelques temps après leur réduction ou leur élimination. L’objectif de cette thèse, à l’interface entre recherche fondamentale et clinique, est d’établir des liens entre le fonctionnement du cortex préfrontal ventromédian et la prédiction et la prévention du retour de la peur éteinte.Nos études chez le rat ont ainsi montré un rôle protecteur de la stimulation à haute fréquence du cortex préfrontal ventromédian sur le retour de la peur. Nos travaux chez l’humain, avec ou sans symptôme, ont permis d’identifier un certain nombre de prédicteurs physiologiques, cognitifs, cliniques et sociodémographiques de ce retour de la peur.Nous avons également pu déterminer des différences interindividuelles et ainsi caractériser des profils psychologiques plus qualitatifs. Sur le plan fondamental, nous avons pu mettre en évidence différentes conditions d’implication du cortex préfrontal ventromédian dans le rappel de la mémoire de l’extinction de la peur. Du point de vue clinique, nous proposons une base pour le développement d’outils visant à détecter les individus prédisposés à un déficit de rappel de cette mémoire, autrement dit, à la rechute psychotraumatique

Transpersonal study of "relapse" in post-traumatic stress disorder : prevention and prediction of the deficit of recall of the extinction of the conditioned fear, in the rodent and in the human

Après un évènement potentiellement traumatique, si pour la plupart des individus les symptômes associés disparaissent rapidement, pour d’autres ils persistent. On parle alors d’état de stress post-traumatique. L’une des prises en charge les plus efficaces, basée sur le modèle de l’extinction de la peur conditionnée, est l’exposition répétée au souvenir traumatique. Cependant, tout comme pour la peur conditionnée qui peut réapparaître après son extinction, les symptômes psychotraumatiques peuvent également resurgir quelques temps après leur réduction ou leur élimination. L’objectif de cette thèse, à l’interface entre recherche fondamentale et clinique, est d’établir des liens entre le fonctionnement du cortex préfrontal ventromédian et la prédiction et la prévention du retour de la peur éteinte.Nos études chez le rat ont ainsi montré un rôle protecteur de la stimulation à haute fréquence du cortex préfrontal ventromédian sur le retour de la peur. Nos travaux chez l’humain, avec ou sans symptôme, ont permis d’identifier un certain nombre de prédicteurs physiologiques, cognitifs, cliniques et sociodémographiques de ce retour de la peur.Nous avons également pu déterminer des différences interindividuelles et ainsi caractériser des profils psychologiques plus qualitatifs. Sur le plan fondamental, nous avons pu mettre en évidence différentes conditions d’implication du cortex préfrontal ventromédian dans le rappel de la mémoire de l’extinction de la peur. Du point de vue clinique, nous proposons une base pour le développement d’outils visant à détecter les individus prédisposés à un déficit de rappel de cette mémoire, autrement dit, à la rechute psychotraumatique.Consequences of a potentially traumatic event may be different depending on the person affected. While most of the people will recover after the event, others will develop a post-traumatic stress disorder (PTSD). Exposure therapy is one of the best treatments of this disorder and is based on fear extinction training. However, both conditioned fear response and psychotraumatic symptoms may appear again some time after the end of the therapy. Combining fundamental and clinical research, this thesis is aimed at investigating how activity of the ventromedial prefrontal cortex may be related to indicators of prediction and prevention of the return of fear. A consequent objective is to highlight some new possibilities to prevent relapse.Our rat experiments showed that high frequency stimulation of the ventromedial prefrontal cortex reduces the likelihood of return of fear responses. Our experiments with human, with or without post-traumatic stress disorder symptoms, revealed several physiological, cognitive, clinical and socio-demographic predictors.Moreover, we found interpersonal differences that allowed us to characterize qualitative profiles.To sum up, our work demonstrates that the ventromedial prefrontal cortex is involved in multiple ways in the recall of fear extinction. From a clinical perspective, our findings provide suggestions for an innovative development of tools capable to detect individual tendencies to have some deficit in fear extinction recall. This study has, thus, important implications in improving prevention of relapse in post-traumatic stress disorder

Etude translationnelle de la "rechute" dans l'état de stress post-traumatique (prévention et prédiction du déficit de rappel de l'extinction de la peur conditionnée, chez le rongeur et chez l'humain)

Après un évènement potentiellement traumatique, si pour la plupart des individus les symptômes associés disparaissent rapidement, pour d autres ils persistent. On parle alors d état de stress post-traumatique. L une des prises en charge les plus efficaces, basée sur le modèle de l extinction de la peur conditionnée, est l exposition répétée au souvenir traumatique. Cependant, tout comme pour la peur conditionnée qui peut réapparaître après son extinction, les symptômes psychotraumatiques peuvent également resurgir quelques temps après leur réduction ou leur élimination. L objectif de cette thèse, à l interface entre recherche fondamentale et clinique, est d établir des liens entre le fonctionnement du cortex préfrontal ventromédian et la prédiction et la prévention du retour de la peur éteinte.Nos études chez le rat ont ainsi montré un rôle protecteur de la stimulation à haute fréquence du cortex préfrontal ventromédian sur le retour de la peur. Nos travaux chez l humain, avec ou sans symptôme, ont permis d identifier un certain nombre de prédicteurs physiologiques, cognitifs, cliniques et sociodémographiques de ce retour de la peur.Nous avons également pu déterminer des différences interindividuelles et ainsi caractériser des profils psychologiques plus qualitatifs. Sur le plan fondamental, nous avons pu mettre en évidence différentes conditions d implication du cortex préfrontal ventromédian dans le rappel de la mémoire de l extinction de la peur. Du point de vue clinique, nous proposons une base pour le développement d outils visant à détecter les individus prédisposés à un déficit de rappel de cette mémoire, autrement dit, à la rechute psychotraumatique.Consequences of a potentially traumatic event may be different depending on the person affected. While most of the people will recover after the event, others will develop a post-traumatic stress disorder (PTSD). Exposure therapy is one of the best treatments of this disorder and is based on fear extinction training. However, both conditioned fear response and psychotraumatic symptoms may appear again some time after the end of the therapy. Combining fundamental and clinical research, this thesis is aimed at investigating how activity of the ventromedial prefrontal cortex may be related to indicators of prediction and prevention of the return of fear. A consequent objective is to highlight some new possibilities to prevent relapse.Our rat experiments showed that high frequency stimulation of the ventromedial prefrontal cortex reduces the likelihood of return of fear responses. Our experiments with human, with or without post-traumatic stress disorder symptoms, revealed several physiological, cognitive, clinical and socio-demographic predictors.Moreover, we found interpersonal differences that allowed us to characterize qualitative profiles.To sum up, our work demonstrates that the ventromedial prefrontal cortex is involved in multiple ways in the recall of fear extinction. From a clinical perspective, our findings provide suggestions for an innovative development of tools capable to detect individual tendencies to have some deficit in fear extinction recall. This study has, thus, important implications in improving prevention of relapse in post-traumatic stress disorder.NICE-Bibliotheque electronique (060889901) / SudocSudocFranceF

Look to the left, look to the right, to the left, to the right… A review on the effect of horizontal saccades on cognitive performance

Look to the left, now look to the right, then to the left, to the right… This is essentially what is asked to the participants in the studies examining the effects of horizontal saccadic eye movements on cognitive performance, mainly on memory. It has been suggested that short (about 30 seconds) series of horizontal saccades preceding an episodic memory task appear to improve memory performance, especially in highly right-handed individuals. However, studies have not yielded conclusive evidence, sometimes showing a positive effect on episodic retrieval, sometimes failing to report this effect. As the question of whether and how bilateral saccades may modulate cognitive efficiency seems to be of undeniable interest, both on a theoretical and a clinical perspective, we aim at reviewing the existing work. The paper presents basic information about the cerebral substrates of saccade generation, a classical experimental paradigm used in the field, the main results and the different hypotheses about the cerebral and cognitive mechanisms underlying the effects. We emphasise that studies are still scarce and carried out by a limited number of teams, and attempts of explanations are still very preliminary. We also describe a research approach of “adversarial collaboration”, which we consider particularly appropriate in this context. Finally, as it seems necessary to take into account the links between this scientific study of the effects of eye movements on cognitive and cerebral functioning and the numerous publications on the effectiveness of the psychotherapies using eye movements, we propose some considerations on the treatments based on the Eye movement desensitisation and reprocessing (EMDR) approach

Low-frequency stimulation of the ventral hippocampus facilitates extinction of contextual fear

International audienceDifficulties to treat fear-associated disorders, including posttraumatic stress disorder, are thought to result from dysfunction in fear extinction learning and/or memory. Animal studies on extinction modulation are therefore promising for the development of new treatments. Recent rat studies, including ones using low-frequency stimulation (LFS), have demonstrated that the ventral hippocampus (VH) modulates extinction memory. The present study explores whether the VH also modulates extinction learning. For this, rats were implanted with stimulating electrodes in the VH and experienced contextual fear conditioning, followed 6 or 24 h later by VH LFS and three sessions of extinction training. We found that, whatever the delay used (6 or 24 h), animals that received VH LFS displayed persistent low levels of freezing from the second extinction session, whereas control rats showed low levels of freezing only during the third session. In animals submitted to a stress condition (provoked by a single inescapable foot-shock followed by three sessions of situational reminders) prior to fear conditioning, VH LFS also reduced freezing levels, which, in contrast, remained high in control rats during the course of extinction training. These data suggest that LFS, targeting the VH, may be useful in reducing fear responses during extinction learning

A New Class of Bi- and Trifunctional Sugar Oximes as Antidotes against Organophosphorus Poisoning

International audienceRecent events demonstrated that organophosphorus nerve agents are a serious threat for civilian and military populations. The current therapy includes a pyridinium aldoxime reactivator to restore the enzymatic activity of acetylcholinesterase located in the central nervous system and neuro-muscular junctions. One major drawback of these charged acetylcholinesterase reactivators is their poor ability to cross the blood–brain barrier. In this study, we propose to evaluate glucoconjugated oximes devoid of permanent charge as potential central nervous system reactivators. We determined their in vitro reactivation efficacy on inhibited human acetylcholinesterase, the crystal structure of two compounds in complex with the enzyme, their protective index on intoxicated mice, and their pharmacokinetics. We then evaluated their endothelial permeability coefficients with a human in vitro model. This study shed light on the structural restrains of new sugar oximes designed to reach the central nervous system through the glucose transporter located at the blood–brain barrier