Mental healthcare utilization among head and neck cancer patients: A longitudinal cohort study.

OBJECTIVE: To investigate utilization of mental healthcare among head and neck cancer (HNC) patients from diagnosis to 2 years after treatment, in relation to psychological symptoms, mental disorders, need for mental healthcare, and sociodemographic, clinical and personal factors. METHODS: Netherlands Quality of life and Biomedical Cohort study data as measured before treatment, at 3 and 6 months, and at 1 and 2 years after treatment was used (n = 610). Data on mental healthcare utilization (iMCQ), psychological symptoms (Hospital Anxiety and Depression Scale, Cancer Worry Scale), mental disorders (CIDI interview), need for mental healthcare (Supportive Care Needs Survey Short-Form 34, either as continuous outcome indicating the level of need or dichotomized into unmet need (yes/no)) and several sociodemographic, clinical and personal factors were collected. Factors associated with mental healthcare utilization were investigated using generalized estimating equations (p < 0.05). RESULTS: Of all HNC patients, 5%-9% used mental healthcare per timepoint. This was 4%-14% in patients with mild-severe psychological symptoms, 4%-17% in patients with severe psychological symptoms, 15%-35% in patients with a mental disorder and 5%-16% in patients with an unmet need for mental healthcare. Among all patients, higher symptoms of anxiety, a higher need for mental healthcare, lower age, higher disease stage, lower self-efficacy and higher social support seeking were significantly associated with mental healthcare utilization. CONCLUSION: Mental health care utilization among HNC patients is limited, and is related to psychological symptoms, need for mental healthcare, and sociodemographic, clinical and personal factors.

Analyzing the application of dezocine combined with psychological care in the postoperative pain management of patients with hemifacial spasm.

OBJECTIVE: To analyze the application of Dezocine combined with psychological care in the postoperative pain management. METHODS: This is a retrospective study. A total of 186 HFS patients who underwent Microvascular Decompression (MVD) at First People's Hospital of Zunyi between January 2020 and January 2022 were selected as the study subjects. Patients were divided into two groups based on different treatment interventions. The control group (n = 93) received routine perioperative care without preemptive analgesia, while the observation group (n = 93) received preemptive analgesia and combined psychological care on the basis of the control group's intervention. RESULTS: At 30 min post-laryngeal mask removal (T3), no significant difference in Ramsay Sedation Scale scores existed between control and observation groups (p > 0.05). The observation group showed significantly lower RSS scores at immediate mask removal (T2) and VAS scores at T3 compared to controls (p < 0.05). Following intervention, the observation group had notably lower SAS and SDS scores than controls (p < 0.05). Baseline (T0) and 5 min pre-removal (T1) exhibited no significant differences in mean arterial pressure (MAP) and heart rate (HR) values between groups (p > 0.05). However, at T2 and T3, the observation group displayed significantly lower MAP and HR values than controls (p < 0.05). No significant differences in pulse oxygen saturation (SpO2) values existed between groups at any time point (p > 0.05). CONCLUSION: Compared to standard perioperative care alone, Dezocine combined with preemptive analgesia and psychological care effectively reduces postoperative pain during the awakening period, lowers the risk of immediate extubation-related agitation, and maintains stable hemodynamics in the postoperative period.

Developing a psychological care competences framework for nurses in China: a mixed methods study.

BACKGROUND: With social transformation, rapid economic development and deepening awareness of psychological health in China, people's demand for psychological health services is becoming increasingly urgent. A key challenge for Chinese medical organizations is to train enough qualified psychological care nurses. A greater understanding of psychological care competences (PCC) can help in clinical nurse selection, training, and assessment. OBJECTIVE: To develop a PCC framework for Chinese nurses and obtain a consensus on the framework among experts. METHODS: A descriptive mixed methods study was designed consisting of a literature review and semi-structured interviews followed by three Delphi rounds. The experts (n = 16) involved were nurses, nursing managers and educators from nine Chinese provinces with a specific interest in psychological care. Descriptive statistics assisted in data analysis. RESULTS: Using the Iceberg Model as a theoretical foundation, five main dimensions and associated subdomains were integrated from 39 chosen articles. The semi-structured interviews with 24 nursing managers and nurses confirmed all of the themes from the literature review while generating new themes, both of which were incorporated into the initial PCC framework. After three Delphi rounds, the experts reached consensus on the PCC framework, including five domains (knowledge, skills, professional ethics, personal traits, internal motivations) and 22 subdomains with connotations. The response rate (RR) values for the three rounds of consultation were 80.00%, 87.50% and 92.86%, the composite reliability (Cr) values were 0.89-0.90, and the Kendall coordination coefficients were 0.155-0.200 (P < 0.05). CONCLUSIONS: On the basis of the Iceberg Model, literature review and qualitative research methods along with Delphi technique were used to develop a scientific and systematic PCC framework. The research methods were feasible and the results were reliable, thereby providing a basis for adopting this framework into nursing education. A formal assessment tool should be developed to test the PCC of nurses in clinical practice.

Assessment of the spectrum of depression and bipolarity in patients with type 1 diabetes.

AIMS: The aim of the study was to check the prevalence of unipolarity (depression), bipolarity, as well as the quality of sleep and temperament traits in patients with type 1 diabetes (T1DM) who are provided with optimal conditions of diabetes care and to identify possible risk factors connected with affective traits. MATERIALS AND METHODS: Out of the 107 T1DM patients, 78 (54 females, 24 males) were included for the analysis (HbA1c [%] 7.11 ± 1.0, BMI [kg/m2 ] 25.3 ± 5.6; Years of disease duration [N] 13.7 ± 8.3). The patients filled in a set of questionnaires during their regular visit to the outpatient clinic. Three patients from the whole group were on intensive insulin therapy with Multiple Daily Injections (MDI) and Self-Monitoring of Blood Glucose (SMBG), all the rest were on various types of personal insulin pumps (years on insulin pump [N] 9.1 ± 4.5). All the patients were on regular diabetologist care, with regular visits in a Centre for Advanced Technologies in Diabetes (at least every 6 months). RESULTS: In QIDS-S (full explanation and abbreviation 26 patients (33.8%) were screened positive for depression, in PHQ (full explanation and ab 57.7% of the patients (45 patients) had symptoms of depression (age was negatively correlated with PHQ score [r = -0.26; p = 0.023]). In CES-D 16 (20%) of the patients assessed their present affect as depressed. None of the analysed clinical variables correlated with depression scores. In the Mood Disorder Questionnaire (MDQ), 16 patients reported having symptoms of bipolarity (20.5% vs. 79.5%). Hypomania Checklist (HCL) analysis indicated 10 patients with bipolar traits (>14) (14.9% vs. 85.1%). None of the analysed clinical variables correlated with HCL results. 11.5% of patients were indicated to be of morning type. Morningness was more often seen in younger patients (r = 0.39; p = 0.001). As many as 46.6% declared that they had poor sleep quality. The temperament traits analysis correlated with clinical parameters: Cyclothymic temperament trait was negatively correlated with age (r = -0.30; p = 0.007) and positively with HbA1c level (r = 0.30; p = 0.025). Hyperthymic temperament was positively correlated with (BMI r = 0.28; p = 0.016). Quality of sleep was highly correlated with depressive symptoms CESD (r = 0.61, p = 0.001), PHQ Score (r = 0.62; p = 0.001), QISD (r = 0.68; p = 0.001) and bipolarity MDQ (p = 0.50, p = 0.001) and HCL (r = 0.42, p = 0.001). In addition, QIDS was shown to be correlated with the following features of temperament: depressive factor (r = 0.41; p = 0.001), irritable factor (r = 0.53; p = 0.001), cyclothymic factor (r = 0.59; p = 0.001), anxious factor (r = 0.58, p = 0.001). CONCLUSIONS: The prevalence of affective disorders and poor sleep quality in the examined T1DM patients was much higher than in the general population. Even if the patients have in general good glycaemic control, their mental health condition should not be neglected. Well organised cooperation between patients, diabetologists, psychiatrists and psychotherapists is needed (Clinical Trials Identifier: NCT04616391).

Neurological Consequences, Mental Health, Physical Care, and Appropriate Nutrition in Long-COVID-19.

SARS-CoV-2 pandemic has caused a collapse of the world health systems. Now, vaccines and more effective therapies have reversed this crisis but the scenario is further aggravated by the appearance of a new pathology, occurring as SARS-CoV-2 infection consequence: the long-COVID-19. This term is commonly used to describe signs and symptoms that continue or develop after acute infection of COVID-19 up to several months. In this review, the consequences of the disease on mental health and the neurological implications due to the long-COVID are described. Furthermore, the appropriate nutritional approach and some recommendations to relieve the symptoms of the pathology are presented. Data collected indicated that in the next future the disease will affect an increasing number of individuals and that interdisciplinary action is needed to counteract it.

Application value of structured psychological nursing combined group health education in blood purification patients: Assisted by the purification of a nanofiber composite.

To explore the research value of structured psychological nursing combined with group health education in patients with blood purification. From May 2020 to March 2022, 96 pure-blood patients in the hospital were selected and divided into research group and control group according to simple random classification, with 48 patients in each group. The control group received routine nursing, and the study group conducted health education combined with structured psychological nursing on the basis of usual care. The disease cognitive ability, negative emotions, blood purification adequacy rate, nutritional status qualification rate and complication rate of the two groups before and after intervention were counted. (1) The number of disease points with unclear status in the study group after intervention was 10.39 ± 1.87, complications were 13.88 ± 2.27, lack of disease information was 12.36 ± 2.16, and unpredictability was 9.58 ± 1.38, which were lower than 13.12 ± 2.53, 17.56 ± 2.53, 15.83 ± 3.0411.67 ± 1.71; (2) After the intervention, the values of SDS of 40.77 ± 3.69 and SAS of 41.52 ± 4.06 were lower than those of 45.82 ± 5.01 and 46.35 ± 4.81 in the control group. (3) The blood adequacy rate of the study group was 91.67%, and the nutritional qualification rate was 93.75%, and the data of both groups were higher than that of 77.08% and 79.17% of the control group. (4) The incidence of complications in the study group was 4.17%, and the control group was 16.67%. Group health education and structured psychological care can effectively alleviate patients' negative emotions and deepen their awareness of diseases, thereby improving blood purification rate and nutrient absorption.

Health care providers' perspectives on providing end-of-life psychiatric care in cardiology and oncology hospitals: a cross-sectional questionnaire survey.

BACKGROUND: Psychological distress is a major concern for patients with end-stage heart failure (HF). However, psychiatric care for patients with HF is not as organized as that for patients with cancer. Therefore, the aim of this study was to elucidate and compare the barriers faced by health care providers of cardiology and oncology hospitals in providing end-of-life psychiatric care to patients with HF and cancer, respectively. METHODS: We conducted a cross-sectional questionnaire survey among the health care providers of Japan. Questionnaires were mailed to physicians and nurses of 427 cardiology and 347 oncology hospitals in March 2018 to assess health care providers' perspectives. First, we compared the scores of the Palliative Care Difficulties Scale and the original scale of end-of-life psychiatric care difficulties between health care providers of cardiology and oncology hospitals. Second, we asked the health care providers to describe the barriers to providing end-of-life psychiatric care with an open-ended question and then compared the freely-provided descriptions using content analysis. RESULTS: A total of 213 cardiology and 224 oncology health care providers responded to the questionnaire. No significant differences were found between health care providers of cardiology and oncology hospitals in the frequency of experiencing barriers to providing end-of-life psychiatric care (59.8% and 62.2%, respectively). A content analysis identified the following eight barriers: "patients' personal problems," "family members' problems," "professionals' personal problems," "communication problems between professionals and patients," "problems specific to end-of-life care," "problems specific to psychiatric care," "problems of institution or system," and "problems specific to non-cancer patients." The "problems specific to noncancer patients" was described more frequently by health care providers in cardiology hospitals than that in oncology hospitals. However, there were no significant differences in other items between the two. CONCLUSION: Although health care providers of both cardiology and oncology hospitals faced barriers to providing end-of-life psychiatric care, those of cardiology hospitals particularly faced challenges pertaining to non-cancer patients, such as unpredictability of prognosis or insufficiency of guideline development. A system of psychiatric care, specifically for patients with HF, should be established.

Evaluation of a Routine Psychosocial Screening for Patients Receiving Inpatient Specialist Palliative Care: Feasibility and Outcomes.

This prospective one-year cohort study aimed to assess the feasibility and outcomes of a routine psychosocial screening at patients' admittance to specialist inpatient palliative care. Patients admitted to an academic palliative care ward were routinely screened for self-reported distress and psychological morbidity, psychosocial stress factors, and subjective need for help from psychosocial professions. Cognitive impairments were the most common patient barrier to screening. Screenings were completed in 138 of 428 patients (32%). Based on established cutoffs, distress was indicated in 89%, depression in 51%, and anxiety in 50% of these patients. The burden on next-of-kin emerged as the most prevalent stress factor (73%). One-half of the patients disclosed a subjective need for help (53%). Possible depression (p = .023), anxiety (p < .001), and subjective need for help (p < .001) correlated positively with a higher amount of time spent by psychologists and creative arts-based therapists with small to moderate effects. Patients who completed the screening were attributed with a higher amount of time by social workers than patients who did not (p = .004), but there were no relationships between screening results and social work. Results suggest the potential of screenings for the allocation of specialist psychosocial care during specialist palliative care; however, barriers to screening do exist.

Compassion: Learning Needs and Training Opportunities-a Survey Among Palliative Healthcare Providers in Italy.

Compassion is a key quality in palliative care; however, there is a lack of evidence of the need to discuss the theme of compassion and professionals' training in the subject. The study aimed to investigate the knowledge of the construct of a sample of Italian healthcare professionals (HCPs) working in palliative care. In addition, their learning needs and training opportunities were explored. An online survey was completed by 330 HCPs. It was divided into five sections which examined knowledge of the construct of compassion and the perception of its utility in palliative care, the activities carried out in eventual training in compassion, and professionals' learning needs thereof. Professionals who had knowledge of the right definition of compassion considered it more useful and training more necessary. Most of the sample never received training about compassion. However, 97% of those who received training believed it to be necessary. Satisfaction with training was higher among those who received multidisciplinary team education. Training occasions are relatively rare in the Italian context, although they seem to increase knowledge and awareness about the construct utility and training necessity. Besides, multidisciplinary team training seems to be more satisfying. Offering team training on compassion can promote a deeper awareness of it and of its utility in clinical practice.

Coping with cancer and a history of health-related events.

Background: Cancer is a source of stress related to the resulting change in lifestyle. The processes which take place when a patient is coping with a disease may be explained in terms of the transactional concept of psychological stress (Lazarus, Folkman) and the critical life events model (Filipp). These two complementary theoretical approaches set the direction and aim of the study which was to determine the role played by earlier events responsible for health loss due to a chronic, serious disease in the course of a stress transaction in cancer patients. Materials and methods: The study involved 121 patients with either breast or colorectal cancer undergoing chemotherapy as part of their treatment. They were asked to complete a purpose-designed set of questionnaires which included Revised Illness Perception Questionnaire (IPQ-R), the Mini-Mental Adjustment to Cancer (Mini-MAC) questionnaire, the Hospital Anxiety and Depression Scale (HADS), Acceptance of Illness Scale (AIS). The interdependencies between variables were determined using difference significance tests (Mann-Whitney, Kruskal-Wallis) and the Dunn's correction test. The significance level (alpha) of 0.05 was assumed appropriate for the study. Results: Patients with previous health-related events were found to expect the struggle with cancer to be a greater and more serious challenge. Those patients had suffered loss of health prior to getting cancer and their emotional reactions were heightened. This finding allowed the identification of patients more prone to creating a negative view of their disease. Conclusions: When planning a psychological treatment of patients with cancer, an account must be taken of their past life events and earlier experiences of being ill, in order to implement appropriate psychological intervention aimed at reducing their emotional stress.

[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.

[Restore parenthood, and the feeling of security of the victim children]. / Restaurer la parentalité, et le sentiment de sécurité des enfants victimes.

The current state of knowledge leaves no doubt about the impact of domestic violence on children. Children are not simply passive witnesses, they are directly affected, and this can have serious consequences on their physical, psychological and emotional development. From the year 2000 to today, the reflection on their status has evolved, as well as the parental support offered in cases of domestic violence. How is the place of children thought of when they are taken in by associations such as Solidarité Femmes Besançon?

Understanding care needs of cancer patients with depressive symptoms: The importance of patients' recognition of depressive symptoms.

OBJECTIVE: The majority of cancer patients with depressive symptoms does not perceive a need for psychological care. Reasons for this are still unclear. We examined the mediating role of cancer patients' perceptions of depressive symptoms in the relationship between depressive symptoms and perceived need for psychological care. METHODS: For this cross-sectional study, we recruited 127 Dutch cancer patients with moderate to severe levels of depressive symptoms (Patient Health Questionnaire [PHQ]-9≥10) who did not receive professional psychological care. Depressive symptoms were measured with the PHQ-9 questionnaire, by using three different depression score operationalizations. We used mediation analyses to test the mediating role of patients' illness perceptions (measured with subscales of the Brief Illness Perception Questionnaire) in the relation between depressive symptoms and need for care. RESULTS: Whilst results did not show significant direct associations between depressive symptoms and perceived need for psychological care, we found positive indirect effects of severity (B = 0.07, SE = 0.04, p < 0.02), meeting the DSM-5 diagnosis (B = 0.45, SE = 0.26, p < 0.02) and having relatively more affective symptoms (B = 2.37, SE = 1.10, p < 0.02) on need for care through the identity perception. CONCLUSIONS: Including assessments of patients' recognition of depressive symptoms and their perceptions of depression treatment efficacy might improve depression screening in cancer patients by more accurately identifying those with a need for psychological care. Moreover, improving patients' knowledge and recognition of symptoms as being depressive symptoms might be a possible target point in increasing care needs and hereby optimizing the uptake of psychological care in cancer patients with depressive symptoms.

Critically ill patients' experience of agitation: A qualitative meta-synthesis.

BACKGROUND: Acute episodes of agitation are frequently experienced by patients during critical illness, yet what is not understood is the experience of agitation from the patient and family perspectives. AIMS AND OBJECTIVES: To search existing literature, appraise it and then provide a synthesized interpretation to broaden the understanding of patients' and their families' experience of agitation during an adult critical care admission. DESIGN: Qualitative meta-synthesis. METHODS: A qualitative meta-synthesis based on a systematic literature search registered with PROSPERO. The search conducted between July and September 2019 was applied to ProQuest, Cumulative Index to Nursing and Allied Health, British Nursing Index, Cochrane Library, Ovid Medline, Web of Science, and PsycINFO databases. We appraised the selected literature and presented a synthesized interpretation. Analysis was based on the approach of Gadamerian hermeneutics. Due to the lack of data identified; the family experiences of agitation could not be addressed within the review. RESULTS: In total, 8 studies were included capturing the experiences of 494 patients, aged between 18 and 92 years, with 225 (45%) women. The analysis generated three core themes: (a) What is real, what is not, (b) loss of communication and dependency, and (c) what helps, what does not. Fear of death, the emotion of anxiety, and feelings of pain alongside transient periods of fluctuating conscious levels provoked a feeling of intense vulnerability. The loss of effective communication and the feeling of dependence incite agitation and distress. CONCLUSIONS: The patient's recollection of their critical illness can be completely or partially absent and disjointed with uncertainty around what is real and what is not. Family members observe the full effect of the patient's critical care illness and could be a wealth of untapped information. RELEVANCE TO CLINICAL PRACTICE: Increasing awareness of the critically ill patients' experience of agitation highlights possible contributing factors to agitation development, such as staff interaction and communication skills, and the critical care environment.

Exploring the perceptions of former ICU patients and clinical staff on barriers and facilitators to the implementation of virtual reality exposure therapy: A qualitative study.

BACKGROUND: Virtual reality (VR) as a digital technology has developed rapidly, becoming more realistic, portable, sensory and easier to navigate. Although studies have found VR to be effective for many clinical applications, patients and clinicians have described several barriers to the successful implementation of this technology. To remove barriers for implementation of VR in health care, a greater understanding is needed of how VR can integrate into clinical environments, particularly complex settings such as an intensive care unit. AIM: This study aimed to explore the perceived barriers and facilitators for the implementation of VR exposure therapy for intensive care patients and clinical staff. STUDY DESIGN: A qualitative study using an Interpretative Description approach was undertaken. Semi-structured focus groups were conducted with 13 participants: nine patients and four health care professionals. Focus groups explored barriers and facilitators of using virtual reality (VR) exposure therapy in intensive care. Thematic analysis was employed to produce codes and themes. RESULTS: In total, eight themes describing the perceived barriers and facilitators to implementing VR exposure therapy were identified. Four themes related to the perceived barriers of implementing VR exposure therapy in intensive care were identified: psychological, sensory, environmental and staff competency and confidence. There were a further four themes related to the perceived facilitators to the implementation of VR exposure therapy: staff training, patient capacity, orientation to technology and support during the intervention. CONCLUSIONS: This study identified novel barriers and facilitators that could be expected when implementing VR exposure therapy for patients' post-intensive care unit stay. The findings suggest that psychological barriers of fear and apprehension were expected to provoke patient avoidance of exposure therapy. Perceived barriers for staff focused on preparedness to deliver the VR exposure therapy and a lack of technological competence. Both patients and staff stated that a comprehensive induction, orientation and training could facilitate VR exposure therapy, improving engagement. RELEVANCE TO CLINICAL PRACTICE: This study has identified that with appropriate staff training, resources, and integration into current patient care pathways, VR exposure therapy may be a valuable intervention to support patient recovery following critical illness. Prior to undertaking VR exposure therapy, patients often need reassurance that side-effects can be managed, and that they can easily control their virtual exposure experience.

HIV at 40: reflections on and development of interdisciplinary working in HIV care.

This article reflects on 40 years of HIV and the growing need to work collaboratively to improve outcomes for people living with HIV. It reflects on the history of interdisciplinary working in HIV care in the UK and discusses the development of links between the professions of nursing and clinical psychology. Both professions had contributed to the development of the Standards for Psychological Support for Adults Living with HIV. One of the authors, who was chair of the National HIV Nurses Association, initiated an audit of the use of the standards within UK HIV clinics and invited local British Psychological Society members to participate in the development of the audit process. The audit results identified gaps in the provision of care that led to further close working relationships. In an era of highly effective antiretrovirals that address the medical aspects of HIV care, the focus of care has shifted to the management of psychosocial factors that contribute to poor outcomes in of HIV. Interdisciplinary work and cooperation is the most effective way to address those complex issues.

Clinical condition, Resuscitation and Medical-Psychological Care of Severe COVID-19 patients (part 2).

Respiratory rehabilitation is the penultimate step in the medical management of patients with severe COPD-19. It is an essential step before patients' returning home, and is usually carried out in specialised Follow-up and Rehabilitation Clinics. When discharged from hospital, patients with post-severe COVID-19 usually progress in their medical condition. However, they may remain frail and have a constant fear of possible deterioration leading to (re)hospitalisation and a return to baseline. Psychological support in this phase can reduce patients' anxiety and increase their motivation to carry out daily rehabilitation activities. This support provides a stable and consistent basis for patients to focus on their progress, leaving the difficulties behind. Being aware of the improvements in their physical condition allows them to maintain their motivation to continue to be physically active. Psychological support during respiratory rehabilitation aims at preparing patients to return to the normal life they had before the disease. It is usually based on brief psychotherapies that focus on strengthening the patient's abilities through behavioural changes and through reducing risk behaviours. Only after this phase is it sometimes possible to deal with complex issues and to cope with personality mechanisms and maladaptive behaviour patterns.

La réadaptation respiratoire constitue l'avant-dernier étage dans la prise en charge des patients COVID-19 sévère, une étape essentielle avant de retrouver leur vie quotidienne. L'accompagnement psychologique occupe une place importante dans cette étape. Cette réadaptation s'effectue habituellement dans une clinique de Soins de Suite et de Réadaptation (SSR) spécialisée. On peut généralement affirmer que les patients post-COVID-19 sévère sortis de danger vont progresser. Cette progression peut se décrire à travers le modèle de la spirale ascendante. Ce sont, néanmoins, des patients fragiles, pour lesquels on craint perpétuellement une dégradation rapide des paramètres physiologiques qui risque de les ramener vers une (ré)hospitalisation d'urgence et un retour vers la case de départ. L'accompagnement psychologique empêche les sensations négatives d'occuper le devant de la scène et d'aspirer le patient vers le bas. Il permet de baisser les angoisses et d'augmenter les motivations pour effectuer des activités de réadaptation quotidiennes. De cette manière, cet accompagnement a des retentissements physiologiques importants, permettant aux patients de progresser en voie de guérison, malgré certaines séquelles occasionnées par la maladie. Cet accompagnement psychologique permet, également, de préparer les patients à leur retour à la vie d'avant et d'adoucir l'impact traumatisant des souvenirs douloureux. Le patient peut les regarder de nouveau et leur redonner un sens moins troublant. Le travail psychologique vise à rassurer ces personnes qui ont perdu confiance en leur corps. On tend à favoriser des thérapies brèves qui mettent l'accent sur les renforcements des capacités, sur les changements comportementaux et le sevrage des produits, avant d'agir sur les mécanismes de coping et sur les schémas inadaptés plus profonds.

Clinical condition, resuscitation and medical-psychological care of severe COVID-19 patients (part 1).

This interview covers the clinical and psychological condition of patients afflicted with severe COVID-19 and their pulmonary rehabilitation process. For these patients, symptoms are medically urgent and life-threatening. The sequelae of this viral attack and immune response to it are significant, and often persist for months after discharge from intensive care. To understand the medical and psychological state of these patients, a description is given of the organs affected, the oxygen cycle in the body and the medical care procedures that are used to help patients with dysfunctional respiratory systems. The link between physical and psychological progress is described. Physical weakness results from pulmonary sequelae and deconditioning, and is often experienced by patients as mental fatigue similar to psychological depression. This may draw the patient into a downward spiral, with multiple health aspects deteriorating, independently of the resolution of initial problems. Conversely, a positive physical or psychological evolution may lead to the evolution of the other. Thus, reversing the negative trend for just one system component can delay, completely arrest the spiralling down, or transform it into an upward spiral, improving the patient's condition. In addition, for people undergoing severe COVID-19, the return to normal life could be destabilizing and memories that arise from their crisis state may trigger Post-Traumatic Stress Disorder (PTSD). Health and psychosocial professionals hold an important role both in post-hospital care and in secondary prevention, i.e. prevention of relapse and re-hospitalization. Physical rehabilitation work must take these psychological factors into account, in the same way that any psychological follow-up is supposed to consider physiological factors.

Cet entretien porte sur l'état clinique médicopsychologique des patients atteints de COVID-19 sévère et sur leur réadaptation respiratoire. Pour ces patients, les séquelles de l'attaque virale et de la réaction immunitaire sont importantes et apparentes dans les tests fonctionnels et les imageries médicales. Elles persistent souvent quelques mois après la sortie des soins intensifs. Le virus SARS-CoV-2 provoque des atteintes des muqueuses bronchiques et alvéolaires. Le circuit de l'oxygène dans le corps peut être découpé en trois maillons imbriqués: l'ensemble de l'appareil respiratoire, le système cardiovasculaire, les muscles et le métabolisme énergétique. Ces systèmes fonctionnent en interdépendance. Lorsqu'il y a une défaillance de l'un des éléments, les autres sont touchés, pouvant amener l'ensemble à une décompensation. La décompensation respiratoire désigne la défaillance ou l'incapacité du système à fonctionner. Les patients sont hospitalisés en réanimation et bénéficient d'une supplémentation en oxygène, d'un support ventilatoire pour compenser la fatigue des muscles respiratoires et d'un traitement médicamenteux visant à réduire les symptômes et à lutter contre les infections acquises. À la sortie de l'hospitalisation, les patients post-COVID-19 sévère se trouvent dans un état physique et psychologique fébrile. La sensation vécue par ces personnes est celle d'une fatigue physique et mentale ; autrement dit, l'incapacité de trouver des ressources suffisantes pour effectuer des activités simples. Cette fatigue est vécue comme une dépression, une sensation qui elle seule risque d'aspirer le patient dans une spirale descendante : soit d'une fatigue en une absence de motivation, puis de sédentarité en déconditionnement musculaire. Ainsi, il y a un lien étroit qui existe entre progrès physique et renforcement psychologique, les deux sont interdépendants, un déclin dans l'un risque d'entraîner l'autre, mais, à l'inverse, une évolution positive dans l'un fait évoluer l'autre. Se rendre compte de l'amélioration de l'état physique permet de nourrir sa motivation et de trouver de l'énergie permettant de continuer à être physiquement actif. Le travail de réadaptation physique doit tenir compte de ces facteurs psychologiques, de la même manière que tout suivi psychologique doit tenir compte des facteurs physiologiques. Pour les personnes subissant un COVID-19 sévère, le retour à la vie normale peut être déstabilisant et les souvenirs de leur état de crise peuvent déclencher un syndrome de stress post-traumatique (SSPT). Les professionnels de la santé et les psychologues jouent un rôle important dans les soins post-hospitaliers et dans la prévention secondaire, c'est-à-dire la prévention des rechutes et des ré-hospitalisations.

[Trauma of intensive care workers in the face of a health crisis: a two-step psychological support]. / Traumatisme des soignants de réanimation face à la crise sanitaire.

The COVID-19 crisis has profoundly affected intensive care units. To protect themselves from the violence of the circumstances, the caregivers relied on their team membership, but it is in the aftermath that these situations seem to take their full traumatic dimension. A clinical case illustrates the two-step work of the psychologist with the caregivers and his role in the traumatic elaboration passing by an individual and collective reconquest of the caregiving function.

Effect of intensive care unit diary on incidence of posttraumatic stress disorder, anxiety, and depression of adult intensive care unit survivors: A systematic review and meta-analysis.

AIM: To systematically evaluate the effect of intensive care unit diary psychotherapy on the incidence of posttraumatic stress disorder, anxiety, and depression after discharge from intensive care unit. BACKGROUND: Many studies have reported the potential advantages and risks of intensive care unit diary psychotherapy in adult patients discharged from intensive care unit, but the results are divergent. DESIGN: Systematic review and meta-analysis of prospective randomized controlled or case-controlled studies. DATA SOURCE: Databases such as Cochran Library, Pubmed, Embase, CINAHL, and ProQuest databases, China national knowledge infrastructure (CNKI) were searched for literatures published from January 2000-March 2020. REVIEW METHODS: We use the Cochrane Risk of Bias Tool for quality assessment and audit manager 5.3 software for meta-analysis. The main result is the incidence of posttraumatic stress disorder, anxiety, and depression. RESULTS: Ten studies meeting the inclusion criteria were identified, including eight randomized controlled studies and two case-controlled studies, with a total of 1,210 patients. The pooled results of this meta-analysis indicated that the intensive care unit diary could reduce the incidence of posttraumatic stress disorder, anxiety, and depression. CONCLUSION: This study showed that an intensive care unit diary could improve the psychological symptoms of adult intensive care unit patients after discharge. However, due to limitations such as publication bias and case sample size, the results should be carefully considered. Researchers need to further clarify the multidisciplinary collaborative process of intensive care unit diary therapy, the real beneficiaries, and its impact on family members' psychological status by conducting large, robust studies in the future. IMPACT: This study's findings suggest that medical staff need to re-examine the role of intensive care unit diary therapy, its standardized implementation and provide effective intervention for reducing psychological stress-related symptoms of intensive care unit patients after discharge.