Determinants of Care Pathways for C-PTSD Patients in French Psychotrauma Centers: A Qualitative Study.

In 2018, the International Classification of Diseases (ICD-11) established a novel nosographic category within the stress-specific disorders known as complex post-traumatic stress disorder (C-PTSD). Characterized by distinctive clinical attributes and a limited response to conventional PTSD treatments, C-PTSD has prompted the reconsideration of care methods. Our study's purpose was to explore the intricate factors shaping the care pathways for individuals suffering from C-PTSD. We used a grounded theorization technique involving professionals across a range of specialized French psychotraumatology institutions. The resulting comprehensive theoretical model offers valuable insights into the constitution mechanisms of these pathways, helping elucidate the varying care options. Interestingly, we found that differences in clinical perspectives were determined by the care provider's viewpoint on clinical guidelines, screening tools, and treatment options, but also by structural and organizational factors. The distinctive dynamics and interrelationships identified in our research reveal potential areas of focus for incorporating C-PTSD care more effectively into specialized French trauma centers. This investigation offers a path toward improved understanding and management of C-PTSD, ultimately advancing patient outcomes.

[Contribution of equine therapy in the management of post-traumatic stress disorder]. / Apport de la thérapie équine dans la prise en charge du trouble de stress post-traumatique.

For several years, animal-mediated therapies have been used in the treatment of psychiatric patients. Post-traumatic stress disorder has the particularity of being generated by an external event in a person a priori free of mental pathology. In this disorder, various so-called targeted psychotherapies have proven to be effective, including equine therapy.

EMDR for symptoms of depression, stress and burnout in health care workers exposed to COVID-19 (HARD): A study protocol for a trial within a cohort study.

Background: Stressful events during a pandemic are a major cause of serious health problems, such as burnout, depression and posttraumatic stress disorder (PTSD) among health care workers (HCWs). During three years, HCWs, on the frontline to fight the COVID-19 pandemic, have been at an increased risk of high levels of stress, anxiety, depression, burnout and PTSD. Regarding potential psychological interventions, Eye Movement Desensitization & Reprocessing (EMDR) is a structured, strongly recommended therapy based on its well-known efficacy in reducing PTSD symptoms and anxiety.Objectives: This study, designed as a trial within a cohort (TwiC), aims to 1) estimate the prevalence of depression, burnout and PTSD in a sample of HCWs after experiencing the COVID-19 emergency (cohort part) and 2) assess the efficacy and acceptability of 'EMDR + usual care' for HCWs from the cohort who report significant psychological symptoms (trial part).Methods: The study, designed as a TwiC, consists of a prospective cohort study (n = 3000) with an embedded, pragmatic, randomized open-label superiority trial with two groups (n = 900). Participants included in the trial part are HCWs recruited for the cohort with significant symptoms on at least one psychological dimension (depression, burnout, PTSD) at baseline, 3 months or 6 months, determined by using the Patient Health Questionnaire (PHQ-9), Professional Quality of Life (ProQOL) scale, and PTSD Checklist for the DSM-5 (PCL-5). The intervention consists of 12 separate EMDR sessions with a certified therapist. The control group receives usual care. The trial has three primary outcomes: changes in depression, burnout and PTSD scores from randomization to 6 months. All participants are followed up for 12 months.Conclusions: This study provides empirical evidence about the impact of the COVID-19 pandemic and the mental health burden it places on HCWs and assesses the effectiveness of EMDR as a psychological intervention.Trial registration NCT04570202.

Health care workers are at increased risk of stress, anxiety, depression, burnout and PTSD following the COVID-19 pandemic.In this study, the effectiveness of EMDR in reducing depression, burnout and PTSD in health care workers exposed to COVID-19 is investigated.In this study, an original 'trial within a cohort' (TwiC) design that consists of a cohort study with an embedded pragmatic randomized trial is used.The study is fully web-based, including online screening, consent and assessments.

Relevance and Feasibility of Group Traumatic Episode Protocol Delivered to Migrants: A Pilot Field Study.

INTRODUCTION: Post-Traumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) are commonly observed in migrants. Although Eye Movement Desensitization and Reprocessing (EMDR) can be helpful to treat these diseases, it remains difficult to propose EMDR as an individual intervention in help-seeking migrants. Group EMDR, like Group Traumatic Episode Protocol (G-TEP), which was built around the 8 phases of the original EMDR protocol, could offer an effective treatment to a large number of people. It may also be more resource-efficient to provide psychiatric care to migrants. METHODS: In this open-label trial, the feasibility and the effectiveness of a 6-session G-TEP intervention was investigated in a group of 10 migrants. RESULTS: The intervention was well tolerated by participants. The final attrition rate was 10%. After the intervention, there was a 28.2% significant decrease in PTSD and complex PTSD symptoms, as measured by the International Trauma Questionnaires (total_ITQ) scores (p = 0.013) and a trend towards a significant decrease in MDD symptoms, as measured with the Patient Health Questionnaire (PHQ-9) (p = 0.057). CONCLUSIONS: G-TEP may be effective in decreasing PTSD symptoms in migrants. The accessibility, low-cost, and very structured features of G-TEP may make its implementation sustainable in the field of psychiatric care for migrants.

Experiences of Inter-Hospital Transfers (IHT) by Patients and Relatives during the COVID-19 Pandemic in France: A Qualitative Study.

BACKGROUND: The first wave of the COVID-19 epidemic led to a rapid and unexpected saturation of the French ICU, forcing the health care system to adapt. Among other emergency measures, inter-hospital transfers were carried out. OBJECTIVE: To assess the psychological experience of patients and their relatives regarding inter-hospital transfers. METHODS: Semi-structured interviews were conducted with transferred patients and their relatives. A phenomenological study design was used to examine subjective experiences and their meanings for the participants. RESULTS: The analysis found nine axes pertaining to the experiences of IHT (inter-hospital transfers), grouped in three super-ordinate themes: Information about inter-hospital transfers, differences in patients' and relatives' experiences, and host hospital experience. It appears that patients felt little impacted by the transfers, unlike relatives who experienced intense anxiety when the transfer was announced. Good communications between patients and their relatives resulted in a good level of satisfaction regarding their host hospitals. COVID-19 and its somatic consequences seem to have had more psychological impact on the participants than the transfers by themselves. CONCLUSION: Our results suggest that there are limited current psychological consequences of the IHT implemented during the first wave of COVID-19, although the involvement of patients and their relatives in the organization of the IHT at the time of transfer could further limit them.

Can a single session of noninvasive brain stimulation applied over the prefrontal cortex prevent stress-induced cortisol release?

INTRODUCTION: A better understanding of how the hypothalamic-pituitary-adrenal (HPA) axis can be externally regulated is of major importance, especially because hyperreactivity to stress has been proposed as a key factor in the onset and maintenance of many psychiatric conditions. Over the past decades, numerous studies have investigated whether non-invasive brain stimulation (NIBS) can regulate HPA axis reactivity in acute stress situation. As the current results did not allow us to draw clear conclusions, we decided to conduct a systematic review of the literature investigating the effect of a single NIBS session on stress-induced cortisol release. METHODS: We searched MEDLINE and Web Of Science for articles indexed through December 2021. Among the 246 articles identified, 15 fulfilled our inclusion criteria with a quality estimated between 52 and 93%. RESULTS: Of the different NIBS used and targeted brain regions, stimulating the left dorsolateral prefrontal cortex, with either high frequency repetitive transcranial magnetic stimulation or anodal transcranial direct current stimulation, seems to be the most appropriate for reducing cortisol release in acute stress situations. CONCLUSIONS: Despite the heterogeneity of the stimulation parameters, the characteristics of participants, the modalities of cortisol collection, the timing of the NIBS session in relation to the stressor exposure, and methodological considerations, stimulating the left dorsolateral prefrontal cortex can be efficient to modulate stress-induced cortisol release.

[Psychological impact of involvement of medical and psychological emergency unit professionals in the medical and psychological care system of the COVID-19 epidemic]. / Impact psychologique de l'implication des professionnels des CUMP dans le dispositif de soins médico-psychologique face à l'épidémie COVID-19.

Objectives: COVID-19 pandemic and its consequences have put into great difficulty health professionals, and the general population, fostering the emergence of various psychological and psychiatric disorders. Medical and psychological emergency units' mission is the medical and psychological emergency care of people impacted during a traumatic event. Given their expertise in crisis management, they set up an important medical and psychological support system adapted to the health crisis' characteristics. The unusual modalities of intervention, the specific clinic that these professionals faced in this context of great tension may have unsettled workers and generate a psychological impact. This study aims to assess the existence of such repercussions among medical and psychological emergency unit professionals involved in this new system. Method: In all, 313 medical and psychological emergency unit professionals agreed to participate at the online survey. They filled surveys and visual analog scales assessing the difficulties encountered in the system, as well as their level of satisfaction, post-traumatic stress, burnout, level of anxiety and depression and coping strategies put in place. Results: Results show few significant emotional difficulties. However higher scores are found among women, among professionals who felt a negative impact on their personal lives, as well as for those who thought they had been infected with COVID-19. The establishment of coping strategies such as active coping, planning, expressing feelings, positive reinterpretation and acceptance helped to decrease the level of emotional complexities and brought more compassionate satisfaction. We note that participants with more medical and psychological emergency unit experience tend to show less emotional hardship and more compassionate satisfaction. It appears that older as well as younger professionals have lower burnout scores, as do workers who conducted more interviews for the same person. Likewise, participants who were satisfied of the system organization and of the support - a majority in this study - report less emotional challenges and more compassionate satisfaction. Conclusion: Psychological impact in this new system among medical and psychological emergency unit professionals is overall low. It appears that some coping strategies, perceived usefulness, satisfaction with the organization and the received support are associated with a lower level of emotional difficulties. A supportive framework and an operative organization of the medical and psychological emergency unit system in times of crisis has a protective effect on the participants.

Short-Term Psychological Support for Civilians Exposed to the January 2015 Terrorist Attacks in France.

INTRODUCTION: Following a terrorist attack, responses to a psychosocial disaster range from low-intensity initiatives to high-intensity treatment. Some studies described post-disaster psychosocial services and planning across Europe. However, little is known about the psychosocial support (PS) actually delivered after terrorist attacks. STUDY OBJECTIVE: This study assesses prevalence and the factors associated with not receiving short-term PS among terror-exposed people with probable mental health disorders following the January 2015 terrorist attacks in France. METHODS: This study used data from the first wave of a longitudinal survey conducted six months after the attacks. Prevalence and factors associated with not receiving PS were described in the immediate period (48 hours), the early post-immediate period (48 hours-one week), and the medium-term (over one week) using a robust Poisson regression for each of the three periods. RESULTS: Nearly one-half of the participants (N = 189) did not receive PS in any period (46.6% in the immediate period, 45.5% in the early post-immediate period, and 54.5% in the medium-term). In each period, not receiving PS was associated with not being very close to the attack sites. Not receiving PS in the immediate period was also associated with being a direct witness (DW) rather than being directly threatened (DT) and not having support in daily life; in the early post-immediate period, not receiving PS was associated with not having a peri-traumatic dissociation experience and being followed for a psychological problem before the attacks; and in the medium-term period, it was associated with perceived social isolation. CONCLUSION: The characteristics of the terror exposure and social support seemed to influence presence or absence of PS after the terrorist attack and highlight the need for strategies to reach out to people regardless of the type of exposure.

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.

Are psychological debriefing groups after a potential traumatic event suitable to prevent the symptoms of PTSD?

Psychological debriefing is a psychotherapeutic approach developed for early intervention in civilians and professionals who have to cope with a potential traumatic event (PTE). Although initial works claimed that this approach may decrease symptoms of posttraumatic stress disorder (PTSD), some studies have concluded that the clinical benefits of psychological debriefing were limited. Several methodological variations could explain the discrepancies observed among studies. Among these variations, how the approach is administered to participants should have importance, and clinical evidence suggests that debriefing groups instead of individuals could have a beneficial clinical effect. We conducted a systematic search of the literature investigating the clinical effects of psychological debriefing groups on PTSD symptoms after a PTE according to the PRISMA guidelines. Among the 790 articles found, 11 met our inclusion criteria. Most of these articles did not support any beneficial effect of psychological debriefing groups on PTSD symptoms. A large number of methodological variations that may influence the outcomes of these studies were observed. Psychological debriefing groups did not seem efficient in alleviating PTSD symptoms. Further studies of high methodological quality are needed to elucidate the effect of psychological debriefing groups on specific PTSD symptoms and on nonspecific symptoms.

An appropriate and reactive response to the repeated waves of the COVID-19 pandemic by the national medico-psychological network (CUMP) in France.

INTRODUCTION: France has been impacted by the COVID-19 pandemic. Anxiety, depression, burn out and the high proportion of post-traumatic stress disorder proved to be the most expected troubles caused by this pandemic and the confinement. Medico-psychological emergency units (CUMP) have been solicited at the very early stage of the pandemic because CUMP units are very well known by the French government and systematically associated to emergency plans. METHODS: In this article we describe the process which has been developed to cope with the psychological needs in the general population. At a first level, platforms of volunteers specialised into listening were available. Then those platforms could directly mobilise the CUMP in case of psychiatric disorders. It ran over the whole first wave and it has been reactivated because of the second confinement in France. RESULTS: During the first wave, approximately 1% of all the calls made on the national Covid number required to be redirected to the listening platforms. Of this group, 4% were related to reactive pathology or a psychiatric decompensating that required adapted and specialised care. CONCLUSION: The high rates of psychological distress detected in the general population in recent scientific literature seem discrepant with our findings of relatively low reorientation towards the CUMP. Nevertheless, our study highlights that the response of the CUMP network in France during the first wave was supportive. The second wave displays its adaptability to the public health policies.

TRANSCOV cohort protocol: an epidemiological study assessing the impact of critically ill COVID-19 patients long distance transfers between intensive care units.

INTRODUCTION: During spring 2020, four regions of France faced a surge of severe COVID-19 patients which threatened to overflow local intensive care units (ICU) capacities. As an emergency response, between 13 March 2020 and 10 April 2020, an estimated 661 patients were transferred from overcrowded ICUs to eight other French regions and four neighbouring countries. The intensity, geographical spread and the diversity of vectors used are unprecedented. The study aims at assessing the impact of these inter-ICU transfers on the short-term and medium-term physical and psychological outcomes in this population of severe COVID-19 patients. METHODS AND ANALYSIS: The TRANSCOV cohort is a multicentre observational retrospective study. All transferred patients between ICUs outside the origin region will be invited to take part. For each transfer, up to four control patients will be selected among those admitted in the same ICU during the same period (±4 days of transfer date). Clinical data will be extracted from medical records and will include haemodynamic and respiratory parameters, as well as clinical severity scores before, during and after transfer. Data linkage with medicoadministrative data will enrich the clinical database and allow follow-up up to 1 year after initial admission. ETHICS AND DISSEMINATION: The study has been approved by the French Ethics and Scientific Committee on the 16 July 2020 (file no. 2046524). The results will be disseminated via publication of scientific articles and communications in national and international conferences. TRIAL REGISTRATION NUMBER: 20 CO 015 CZ.

Psychological impact of an acute intervention on medical-psychological emergency unit professionals: the example of hurricane Irma.

BACKGROUND: Medical-psychological emergency units (Cellules d'Urgence Médico-Psychologiques, CUMP) are deployed following major events where there is a risk of psychological trauma, in order to provide acute and proper psychological care for the victims. AIMS: To describe and evaluate the risk of a psychological impact on CUMP professionals after their participation in the aftermath of the hurricane Irma natural disaster. CUMP teams consist of medical and paramedical staff, who can have permanent or volunteer status. We reasoned that there might be a psychological and emotional impact on CUMP professionals, despite their own expertise in the field, after their intervention following hurricane Irma. METHOD: A cross-sectional survey was conducted during a feedback meeting. Participating professionals completed a sociodemographic questionnaire and the Professional Quality of Life (ProQOL) scale (5th French version), which is composed of three subscales: compassion satisfaction, burnout and secondary traumatic stress (STS). RESULTS: A total of 53 participants were included with 24 (45.3%) psychiatrists, 15 (28.3%) paramedical staff and 14 (26.4%) psychologists. The median age was 46 years (range 39-55.5) and 29 (54.7%) were women. We found that psychiatrists compared with other professions had higher secondary traumatic stress scores (P = 0.007) and that volunteer psychiatrists had higher burnout scores than permanent psychiatrists (P = 0.03). CONCLUSIONS: These preliminary results suggest a psychological impact attributable to leadership status, which was reserved for psychiatrists. The results also underline the need for a supportive accompaniment for such teams by promoting formation improvement, psychological support and team cohesion.

[Psychological impact of the COVID-19 pandemic on health care professionals]. / Impact psychique de la pandémie de Covid-19 sur les professionnels soignants.

Like other pandemics, those of COVID-19 had a significant psychological impact on the general population. Nevertheless, this impact was even more acute among healthcare staff, in connection with repeated exposure to the risk of infection, the reorganization of healthcare and their specific positioning. Dispensary pharmacists, who ensured continuity of healthcare in a climate of widespread teleworking, were not spared. Psychotraumatic, anxiety and depressive symptoms were observed.

Improving the mental health system for trauma victims in France.

France has a rich history of exposure to large-scale traumas such as wars, disasters and terrorist attacks, and psychiatric teams specialized in emergency interventions for mass trauma have been created across the territory. However, no public resources are dedicated for long-term interventions or for individual trauma cases. This letter describes how a government supported model of care has been created and implemented in 2019. A national centre for resources and resilience (CN2R) and 10 regional ambulatory services specializing in psychotraumatology were created with the aim of improving public mental health-care delivery while providing a comprehensive suite of services for trauma victims from the most immediate to longer-term considerations.

Race/Ethnicity, Obesity, and the Risk of Being Verbally Bullied: a National Multilevel Study.

OBJECTIVE: To examine the effects of obese/overweight status and race/ethnicity on the risk for being verbally bullied among second grade children, and to investigate if the relationship between weight status and verbal bullying varies based on race/ethnicity. DESIGN: Data on second graders from the Early Childhood Longitudinal Study, Kindergarten Class of 2010-11 (Children = 18,130; Schools = 2419) were analyzed. Hierarchical generalized logistic modeling was used to address the objectives. RESULTS: Independent of the child's sex, age, academic performance, family socioeconomic status, and school characteristics, obese/overweight children (relative to non-obese/overweight children) and Black children (relative to White children) were more likely to be verbally bullied. Hispanic and Asian children were less likely to be verbally bullied relative to White children. Hispanic obese/overweight children experienced less verbal bullying than White obese/overweight children. CONCLUSIONS: This study documented disproportionate risks of being verbally bullied for obese/overweight US second graders. The risk of being verbally bullied was significantly greater for obese/overweight White children vs. obese/overweight Hispanic children. IMPLICATIONS: Findings can inform the development of strategies to reduce verbal bullying of obese/overweight children in US elementary schools.

[Treatment of post-traumatic stress disorder]. / Prise en charge des troubles psychotraumatiques.

Treatment of post-traumatic stress disorder. Psychological traumas, whose cares are complex, need to be furthermore clarified since they recently became a major public health issue in the wake of the terrorists' attacks that struck France over the past three years. It is its temporality since the event which will determine the type of disorder which might appear thus its adequate processing treatment. In the short term, in the context of collective events or disasters, treatments of psychological suffering by the Medico-Psychological Units (CUMP) are very specific by combining sorting out and direct health care to the victims as well as indirect care such as crisis management. For the health practitioner, a precise knowledge of the disorders which might appear at the early stage, prior to the onset of PTSD, is mandatory. Likewise, approaching a patient with a high emotional load requires specific skills. This is about establishing a real therapeutic alliance with the patient, key factor to prevent a more embedded pathology. Medical treatments at this stage are yet sparsely codified. When pathology is confirmed, post-traumatic stress disorders together with the existence of potential comorbidity (depression, addiction, etc.) require specialized care. Targeted psychotherapies are the first-line treatments, often combined with medical treatments (SSRI antidepressants, for instance) depending on the symptom's seriousness. Sleep disorders, likely conditioning the pathology, will require heightened vigilance. In any case, medication should be adapted to the patient. Similarly, elements of relational approach, any advice, or other health lifestyle rules together with referral to more specific cares, should be individualised.

Prise en charge des troubles psychotraumatiques. Les traumatismes psychiques sont un enjeu de santé publique, leur prise en charge est complexe et mérite d'être précisée, particulièrement dans le contexte actuel des attentats survenus en France ces trois dernières années. La temporalité depuis l'événement conditionne le type de trouble et donc les modalités de traitement. Dans l'immédiat, dans le contexte de l'événement collectif, la prise en charge par les cellules d'urgence médico-psychologique (CUMP) est très spécialisée en associant au tri et soins directs aux victimes, des soins indirects sous forme de gestion de la crise. Pour le praticien, une connaissance précise des troubles dans la phase précoce, avant la survenue d'un trouble de stress post-traumatique, est impérative. De même, aborder un sujet ayant une charge émotionnelle forte nécessite un savoir-faire particulier. Il s'agit d'établir avec le sujet une véritable alliance thérapeutique, facteur essentiel de prévention d'une pathologie plus enkystée. Les traitements médicamenteux à cette phase sont encore peu codifiés. Lorsque la pathologie est avérée, le trouble de stress post-traumatique et l'existence d'une éventuelle comorbidité (dépression, addiction, etc.) nécessitent des soins spécialisés. Les psychothérapies ciblées sont le traitement de première intention, très souvent associées à un traitement médicamenteux (antidépresseur de type inhibiteur sélectif de la recapture de la sérotonine, par exemple), en fonction de la gravité des symptômes. Les troubles du sommeil, conditionnant probablement la pathologie, nécessitent une vigilance particulière. Quoi qu'il en soit, toute médication doit être adaptée au sujet. De même que doivent être individualisés les éléments d'approche relationnelle, tout conseil et autres règles d'hygiène de vie ainsi que l'orientation vers un soin spécialisé.

[What's the post-traumatic stress disorder (PTSD)?] / Qu'est-ce que le trouble de stress post-traumatique ?

What's the post-traumatic stress disorder? Post-traumatic stress disorder (PTSD) is a major public health problem by virtue of its frequency, chronicity and the disability it generates in daily life. PTSD has been known since Antiquity and explored by military psychiatrists and early psychoanalysts, but today more than ever it is a topical issue because of the large number of events such as terrorist attacks or meteorological disasters that occurred lately in France and outside the country. This disorder is characterized by four main dimensions: reexperiencing, avoidance, hyperarousal, and cognitive and mood disturbances. Sleep is very often disrupted and comorbidity is common. The suicidal risk is also frequent. PTSD can affect anybody even though a number of individual risk factors have been identified, such as gender, socio-economic status and psychiatric or traumatic history, with a special focus on peri-traumatic dissociation. As we know, this disorder is the result of exceptional events but is can also be the consequence of more "daily" events which general practitioners are often the first to be consulted for. Despite an apparent "popularization" of the symptoms by greater media coverage, this specific disorder is still poorly understood in its definition and in routine medical practice.

Qu'est-ce que le trouble de stress post-traumatique ? Le trouble de stress post-traumatique est un réel problème de santé publique en raison de sa fréquence, de sa chronicité et du handicap généré au quotidien. Connu depuis l'Antiquité, exploré par les psychiatres militaires et les premiers psychanalystes, il est aujourd'hui plus que jamais d'actualité du fait des événements de grande ampleur (terrorismes, catastrophes météorologiques…) survenus en France, et hors territoire, ces derniers temps. Ce trouble est caractérisé par quatre dimensions principales qui sont l'intrusion, l'évitement, l'hypervigilance, les perturbations cognitives et de l'humeur. Le sommeil est très souvent altéré et la comorbidité fréquente. Le risque suicidaire est également élevé. Le trouble de stress post-traumatique touche une population « tout-venant ¼ même si ont été identifiés un certain nombre de facteurs de risque, comme le sexe, le niveau socio-économique, les antécédents psychiatriques ou traumatiques, etc., avec une place particulière de la dissociation péritraumatique. Les événements à caractère exceptionnel ne doivent pas faire oublier que le quotidien reste aussi un grand pourvoyeur de cette pathologie et que les médecins généralistes sont souvent les premiers consultés. Malgré une apparente « vulgarisation ¼ des symptômes par une plus grande médiatisation, ce trouble spécifique reste encore mal connu dans sa définition et mal appréhendé en pratique médicale courante.

[The nurse within emergency medical-psychological units]. / L'infirmier au sein des cellules d'urgence médico-psychologique.

The growing recognition of post-traumatic stress disorders and the need to intervene early justifies the creation of emergency medical-psychological units. The nurse has a major role to play within these teams.