[Asthma: a respiratory pathology with a high risk for mental health]. / Asthme: pathologie respiratoire à haut risque pour la santé mentale.

The subjective experience of asthma can be accompanied by significant emotional suffering. The presence of psychiatric comorbidities in asthma is common and worsens the prognosis of asthma. Bidirectional relationships between psychiatric disorders and asthma via inflammatory mechanisms are highlighted. Systematic screening for the most common psychiatric comorbidities such as depression, anxiety disorders and post-traumatic stress disorder is recommended. A multidisciplinary collaboration with a mental health specialist in the presence of psychiatric comorbidity has proven necessary to improve the quality of life and both the somatic and psychiatric prognosis of patients suffering from asthma.

Le vécu subjectif de l'asthme peut s'accompagner d'une importante souffrance émotionnelle. La présence de comorbidités psychiatriques dans l'asthme est fréquente et péjore le pronostic de l'asthme. On note des relations bidirectionnelles entre troubles psychiatriques et asthme via des mécanismes inflammatoires. Un dépistage systématique des comorbidités psychiatriques les plus fréquentes comme la dépression, les troubles anxieux et le trouble de stress post-traumatique est recommandé. Une collaboration multidisciplinaire avec un-e spécialiste de santé mentale en présence de comorbidité psychiatrique avérée est nécessaire pour améliorer la qualité de vie et le pronostic tant somatique que psychiatrique des patients souffrant d'asthme.

[Diabetes and pancreas or islet transplantation: psychological issues]. / Diabète et transplantation du pancréas ou d'îlots de Langerhans : enjeux psychologiques.

Diabetes is a chronic and progressive disease that affects an increasing number of patients. The prevalence of associated psychological comorbidities is high and often requires the implementation of targeted psychological interventions. Pancreas or islet transplantation remains a therapeutic option to consider, for a part of patients with type 1 diabetes unstable disease or established complications. From the clinical indication to the waiting period for a transplantation, then to the postoperative and long-term care, the diabetic patient is found to experience perpetual changes that may test his adaptability. In this article, the psychological aspects of the pancreas or islet transplantation, as well as the role of a liaison psychiatrist in a transplantation unit will be discussed.

Le diabète est une maladie chronique et évolutive atteignant un nombre croissant de patients. La prévalence des comorbidités psychiques associées est élevée et nécessite souvent l'implémentation d'interventions psychologiques ciblées. La transplantation du pancréas ou d'îlots de Langerhans est une option thérapeutique à considérer pour certains patients avec un diabète de type 1 instable ou des complications installées. De l'indication clinique à la période d'attente pour une greffe, puis des suites postopératoires jusqu'à la vie d'après la greffe, le patient diabétique vit des transitions multiples le mettant à l'épreuve. Dans cet article, nous discutons les aspects psychologiques de ces transplantations ainsi que les interventions du psychiatre de liaison au sein d'un service de transplantation.

Exercise ventilatory response after COVID-19: comparison between ambulatory and hospitalized patients.

Inefficient ventilatory response during cardiopulmonary exercise testing (CPET) has been suggested as a cause of post-COVID-19 dyspnea. It has been described in hospitalized patients (HOSP) with lung parenchymal sequelae but also after mild infection in ambulatory patients (AMBU). We hypothesize that AMBU and HOSP have different ventilatory responses to exercise, due to different etiologies. We analyzed CPET realized between July 2020 and May 2022 of patients with persisting respiratory symptoms 3 mo after COVID-19. Chest computed tomography (CT) scan, pulmonary function tests, quality of life, and respiratory questionnaires were collected. CPET data were specifically explored as a function of ventilation (V̇e) and time. Seventy-nine consecutive patients were included (42 AMBU and 37 HOSP, median: 54 [44-60] yr old, 57% female). Patients were hospitalized for a median of 20 [8-34] days, with pneumonia (41%) or acute respiratory distress syndrome (ARDS; 30%). Among HOSP, 12(32%) patients had abnormal values for spirometry and 18(51%) for carbon monoxide diffusing capacity (P < 0.001). CPET showed no differences between AMBU and HOSP in peak absolute O2 uptake (V̇o2) (1.59 [1.22-2.11] mL·min-1; P = 0.65). Tidal volume (VT) as a function of V̇e, was lower in AMBU than in HOSP (P < 0.01) toward the end of exercise. The slope of the V̇e-CO2 production was higher than normal in both groups (30.9 [26.1-34.3]; P = 0.96). In conclusion, the severity of COVID-19 did not influence the exercise capacity, but AMBU demonstrated a less efficient ventilatory response to exercise as compared with HOSP. CPET with exploration of data as a function of V̇e and throughout the exercise better unveil ventilatory inefficiency.NEW & NOTEWORTHY We evaluated the exercise ventilatory response in patients with persisting dyspnea after severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. We found that despite similar peak power and peak absolute O2 uptake, tidal volume as a function of ventilation was lower in ambulatory than in hospitalized patients toward the end of exercise, reflecting ventilatory inefficiency. We call for evaluation of minute ventilation with the exploration of data throughout the exercise and not only peak data to better unveil ventilatory inefficiency.

Brain functional connectivity alterations associated with neuropsychological performance 6-9 months following SARS-CoV-2 infection.

Neuropsychological deficits and brain damage following SARS-CoV-2 infection are not well understood. Then, 116 patients, with either severe, moderate, or mild disease in the acute phase underwent neuropsychological and olfactory tests, as well as completed psychiatric and respiratory questionnaires at 223 ± 42 days postinfection. Additionally, a subgroup of 50 patients underwent functional magnetic resonance imaging. Patients in the severe group displayed poorer verbal episodic memory performances, and moderate patients had reduced mental flexibility. Neuroimaging revealed patterns of hypofunctional and hyperfunctional connectivities in severe patients, while only hyperconnectivity patterns were observed for moderate. The default mode, somatosensory, dorsal attention, subcortical, and cerebellar networks were implicated. Partial least squares correlations analysis confirmed specific association between memory, executive functions performances and brain functional connectivity. The severity of the infection in the acute phase is a predictor of neuropsychological performance 6-9 months following SARS-CoV-2 infection. SARS-CoV-2 infection causes long-term memory and executive dysfunctions, related to large-scale functional brain connectivity alterations.

[Maternal suicide, a little-known reality that can be prevented]. / Suicide maternel, une réalité méconnue que l'on peut prévenir.

While maternal suicide is an important cause of perinatal mortality, the assessment of this risk can be more difficult in the context of perinatality. Pregnancy acceptance problems and perinatal psychiatric disorders are major risk factors for maternal suicide. The -clinical evaluation focuses on the mental health of the mother on the one hand, but also on the quality of her interactions with the baby and the signs of psychological suffering of the latter during postpartum period. Coordinated and multidisciplinary management is recommended to prevent these fatal outcomes and the indication for hospitalization should always be discussed.

Alors que le suicide maternel est une cause importante de ­mortalité périnatale, l'évaluation de ce risque peut être plus ­ardue en contexte de périnatalité. Les problèmes d'acceptation de la grossesse et les troubles psychiatriques périnataux sont des facteurs de risque majeurs de suicide maternel. L'évaluation ­clinique porte sur la santé psychique de la mère d'une part mais également sur la qualité de ses interactions avec le bébé et les signes de souffrance psychique de ce dernier pendant la période de postpartum. Une prise en charge coordonnée et multidisci­plinaire est recommandée pour prévenir cette issue fatale, et l'indication d'une hospitalisation doit toujours être discutée.

One-year persistent symptoms and functional impairment in SARS-CoV-2 positive and negative individuals.

BACKGROUND: Persistent symptoms of SARS-CoV-2 are prevalent weeks to months following the infection. To date, it is difficult to disentangle the direct from the indirect effects of SARS-CoV-2, including lockdown, social, and economic factors. OBJECTIVE: The study aims to characterize the prevalence of symptoms, functional capacity, and quality of life at 12 months in outpatient symptomatic individuals tested positive for SARS-CoV-2 compared to individuals tested negative. METHODS: From 23 April to 27 July 2021, outpatient symptomatic individuals tested for SARS-CoV-2 at the Geneva University Hospitals were followed up 12 months after their test date. RESULTS: At 12 months, out of the 1447 participants (mean age 45.2 years, 61.2% women), 33.4% reported residual mild to moderate symptoms following SARS-CoV-2 infection compared to 6.5% in the control group. Symptoms included fatigue (16% vs. 3.1%), dyspnea (8.9% vs. 1.1%), headache (9.8% vs. 1.7%), insomnia (8.9% vs. 2.7%), and difficulty concentrating (7.4% vs. 2.5%). When compared to the control group, 30.5% of SARS-CoV-2 positive individuals reported functional impairment at 12 months versus 6.6%. SARS-CoV-2 infection was associated with the persistence of symptoms (adjusted odds ratio [aOR] 4.1; 2.60-6.83) and functional impairment (aOR 3.54; 2.16-5.80) overall, and in subgroups of women, men, individuals younger than 40 years, those between 40-59 years, and in individuals with no past medical or psychiatric history. CONCLUSION: SARS-CoV-2 infection leads to persistent symptoms over several months, including in young healthy individuals, in addition to the pandemic effects, and potentially more than other common respiratory infections. Symptoms impact functional capacity up to 12 months post infection.

[The ordeal of perinatal bereavement : what roles for the liaison psychiatrist ?] / À l'épreuve du deuil périnatal : quels rôles pour la psychiatrie de liaison ?

Perinatal grief should be given special attention for bereaved parents. In the hospital, multidisciplinary support is provided at different times of care. The loss of a pregnancy or a baby can permanently destabilize the couple's relationship and give rise to psychiatric complications in the presence of risk factors, such as pathological bereavement, a major depressive disorder, an anxiety disorder or a post-traumatic stress disorder. For subsequent pregnancies, there are risks of developing antenatal anxiety, attachment disorder, or parenting disorder. Multidisciplinary support and personalized psychotherapeutic and psychiatric care provided by liaison psychiatry when indicated, aim to reduce these risks.

Le deuil périnatal doit faire l'objet d'une attention particulière pour les parents endeuillés. À l'hôpital, un accompagnement multidisciplinaire est assuré aux différents temps de la prise en charge. La perte d'une grossesse ou d'un bébé peut déstabiliser durablement la relation de couple et donner lieu à des complications psychiatriques en présence de facteurs de risque, comme un deuil pathologique, un épisode dépressif, un trouble anxieux ou un trouble de stress post-traumatique. Pour les grossesses suivantes, il existe des risques de développer une anxiété anté natale, un trouble de l'attachement ou de la parentalité. Un accompagnement multidisciplinaire et des prises en charge psychothérapeutique et psychiatrique personnalisées assurées par la psychiatrie de liaison quand elles sont indiquées visent à réduire ces risques.

[Contain psychomotor agitation in somatic units : implementation of a protocol at the HUG]. / Contenir l'agitation psychomotrice dans les unités somatiques : mise en place d'un protocole aux HUG.

Psychomotor agitation in somatic units is a medical and psychiatric emergency requiring rapid intervention by the team in charge of the patient and the liaison psychiatrist. Verbal de-escalation is attempted throughout the treatment. Securing the surroundings is needed to protect both the patient and the team. The etiology of the agitation, somatic and/or psychiatric, should be investigated to allow the administration of an adequate treatment. Antipsychotics and benzodiazepines are often recommended. Physical restraint measures can be applied as a last resort if necessary. The continuation of care is decided jointly between the team in charge and the liaison psychiatrist. An intervention protocol has been drawn up by the HUG liaison psychiatry team.

L'agitation psychomotrice dans les unités somatiques est une urgence médicale et psychiatrique qui nécessite une intervention rapide de l'équipe en charge et du psychiatre de liaison auprès du patient. Une désescalade verbale est tentée tout au long de la prise en charge. La sécurisation de l'environnement pour protéger le patient et l'équipe est primordiale. L'étiologie de l'agitation, somatique et/ou psychiatrique, doit être recherchée, ce qui permet l'administration d'un traitement adéquat. Les antipsychotiques et les benzodiazépines sont souvent préconisés. Des mesures de contention physique peuvent être appliquées en dernière intention si besoin. La poursuite des soins se décide en commun entre l'équipe en charge et le psychiatre de liaison. Un protocole d'intervention a été élaboré par l'équipe de la psychiatrie de liaison des HUG.

[Latest developments in the non-pharmacological treatment of depression - A more integrative approach]. / Nouveautés dans les traitements non pharmacologiques de la dépression - Place à une approche plus intégrative.

Non-pharmacological treatments of depression have become more widespread recently, especially for mild to moderate forms of depression. These complementary approaches are particularly interesting for patients who are reluctant to start an antidepressant. Novel approaches are found in psychotherapy, alternative treatments, plant-based treatments as well as the prevention of relapse through the use of digital tools. Some are even reimbursed by health insurance. However, these approaches are currently only applicable in combination with usual treatment, pharmacological or psychotherapy, as studies have shown that their efficiency in monotherapy is still limited.

L'intérêt pour les approches non pharmacologiques a augmenté ces dernières années dans la prise en charge des dépressions légères à modérées. Ces nouvelles approches sont intéressantes, notamment pour les patients qui peuvent être réticents à la prise d'un antidépresseur seul. Les nouveautés se trouvent dans les méthodes de psychothérapie, les traitements alternatifs, la phytothérapie ainsi que dans la prévention des rechutes par des outils digitaux. Certaines de ces approches sont remboursées par l'assurance-maladie obligatoire ou complémentaire. Néanmoins, elles restent des traitements complémentaires aux thérapies usuelles, soit pharmacologique et psychothérapeutique, car les preuves de leur efficacité en monothérapie sont encore limitées dans les études.

[Neuropsychological long-COVID : neurologic or psychiatric origin?] / Covid long neuropsychologique : origine neurologique ou psychiatrique ?

Among the long-COVID symptoms, neuropsychological sequelae are frequent after an infection by SARS-CoV-2, whatever the severity of the respiratory disease in the acute phase. These deficits seem to result from a neurological disorder, but also from psychiatric symptoms. Not only inflammatory components, which can play a major role in the genesis of the neuropsychological sequelae, but also the hypotheses of vascular systemic lesions, the neurotropism of SARS-CoV-2, or the effect of the stress and the hypothalamic-pituitary-adrenal axis (HPA) are suggested. Psychiatric complications due to SSARS-CoV-2 infection would partly explain these neuropsychological sequelae.

Parmi les symptômes de Covid long, les séquelles neuropsychologiques sont fréquentes dans les suites d'une infection par le SARS-CoV-2, et ce quel que soit le degré de sévérité de l'atteinte respiratoire en phase aiguë. Ces déficits semblent résulter d'une atteinte neurologique, mais aussi de l'installation de troubles psychiatriques. En plus de l'inflammation, qui joue un rôle majeur dans la genèse des séquelles neuropsychologiques, les hypothèses de lésions endothéliales systémiques, de l'existence d'un neurotropisme du SARS-CoV-2, de même que de celles de l'effet du stress et de la mise en jeu de l'axe hypothalamo-hypophysaire-surrénalien, sont proposées. Les complications psychiatriques de l'infection par le SARS-CoV-2 semblent, quant à elles, n'expliquer qu'une partie des séquelles neuropsychologiques.

The effect of mind-body interventions on psychological and pregnancy outcomes in infertile women: a systematic review.

Preliminary evidence suggests that mind-body interventions, including mindfulness-based interventions and yoga, may be effective in reducing mental health difficulties and psychological distress in infertile patients undergoing fertility treatments. We systematically reviewed and synthesized current medical literature of the effectiveness of mind-body interventions in reducing the severity of psychological distress and improving marital function and pregnancy outcomes in infertile women/couple. Databases including PsychINFO, PubMed, EMBASE, and the Cochrane Library were searched for relevant studies. Manual searches were conducted in relevant articles. We included 12 studies that met the inclusion criteria. Four studies were randomized controlled trials (RCT), 4 non-randomized controlled trial (NRCT), and 4 uncontrolled studies (UCT). Participation in a mind-body intervention was associated with reduced anxiety trait and depression scores. The reduction was of low or moderate amplitude in most studies. Our review offers evidence for the effectiveness of mind-body interventions in reducing anxiety state and depression in infertile women and a possible improvement in pregnancy rate. Further RCTs with a precise timing of intervention are needed.

[Psychotrauma in the context of liaison psychiatry]. / Psychotraumatisme en contexte de psychiatrie de liaison.

In the context of liaison psychiatry, potentially traumatic somatic situations at the psychic level are frequent. They can be grouped into three broad categories: 1) psychotrauma in connection with a medical event ; 2) traumatic event at the origin of somatic management ; 3) traumatic event prior to somatic management. It is important to know the possible clinical reactions after a traumatic event. In the immediate aftermath of trauma, a clinical assessment is recommended to allow early identification of subjects at risk of developing post-traumatic stress disorder (PTSD). Pharmacological and non-pharmacological interventions should be considered to prevent or to treat the installation of PTSD with the aim of also improving the somatic prognosis.

Dans le contexte de la psychiatrie de liaison, les situations somatiques potentiellement traumatiques sont fréquentes. Elles peuvent être regroupées en trois grandes catégories : 1) psychotraumatismes en lien avec un événement médical ; 2) événement traumatique à l'origine de la prise en charge somatique et 3) événement traumatique antérieur à la prise en charge somatique. Il est important de connaître les réactions cliniques possibles après un événement traumatique. Dans les suites immédiates d'un traumatisme, une évaluation clinique est recommandée pour permettre un repérage précoce des sujets à risque de développer un trouble de stress post-traumatique (TSPT). Des interventions pharmacologiques comme non pharmacologiques sont à envisager, en prévention ou en traitement du TSPT dans le but d'améliorer aussi le pronostic somatique.

[State of knowledge of post-natal post-traumatic stress disorder]. / Etat des connaissances sur le trouble de stress post-traumatique du postpartum.

In this article, a synthesis of data from the literature on postpartum post-traumatic stress disorder (PTSD) related to childbirth is presented, knowing that the psychological suffering in this period of life is frequently associated with a certain taboo. The criteria to diagnose psychotraumatism, as well as postpartum PTSD just after the birth are here recalled as well as the importance of evaluating the subjective experience of the mother wich is a central issue. The clinical specificity and key symptoms of postpartum PTSD are described along with the risk and protective factors. In the light of scientific knowledge in the field of psychotraumatology, we present the prevention strategies of this disorder that can be applied, but which remain to be evaluated and tailored to this specific context.

Dans cet article, nous proposons une synthèse des données de la littérature sur le trouble de stress post-traumatique (TSPT) du postpartum en lien avec l'accouchement, en sachant que ce trouble continue d'être entouré d'un certain tabou. Les critères diagnostiques du psychotraumatisme, ainsi que du TSPT du postpartum (TSPTPP) en lien avec l'accouchement sont présentés. L'importance de l'évaluation du vécu subjectif de la mère est centrale. Les spécificités cliniques du TSPTPP en lien avec l'accouchement, à l'instar de la dépression du postpartum, sont présentées, de même que les facteurs de risque et de protection. A la lumière des connaissances scientifiques dans le champ de la psychotraumatologie, nous présentons les stratégies de prévention de ce trouble envisageables, mais qui restent à évaluer dans ce contexte spécifique.

[Evolution in Geneva of institutional psychiatric services for asylum seekers persons]. / Evolution à Genève des soins psychiatriques institutionnels pour les personnes requérantes d'asile.

Recent conflicts in the Middle East and Africa generated the displacement of millions of refugees seeking a safe haven. It led to a transformation in the population of asylum seekers attending our community psychiatry clinic serving refugees and asylum seekers in Geneva. That patient population doubled in a couple of years, comprising a higher number of young men, migrating alone, mostly from the Middle East and Afghanistan. Higher demand on our system and specific mental health needs brought us to transform our setting. We have set up a new evaluation step, we developed outreach interventions, we work more closely with people in the patients' networks and we have dedicated meetings to discuss cases within the team and with supervisors with expertise in working in transcultural settings.

Les récents conflits internationaux survenus au Proche-Orient et en Afrique ont conduit à l'exode massif de millions de réfugiés en quête d'abri. Cela a conduit à une profonde transformation de la population des requérants d'asile soignés au CAPPI Servette. Cette population a doublé en l'espace de quelques années. Les jeunes hommes migrants seuls, provenant majoritairement du Moyen-Orient et d'Afghanistan sont ainsi bien plus fortement représentés. L'augmentation et la modification des besoins en termes de santé mentale de cette population nous ont amené à transformer notre dispositif d'accueil et d'évaluation, à développer des interventions mobiles tout en intensifiant le travail de réseau et en déployant des espaces de supervisions plus spécifiques aux interventions transculturelles.

The Maternal Psychic Impact of Infection by SARS-CoV-2 during Pregnancy: Results from a Preliminary Prospective Study.

Due to a higher risk of maternal complications during pregnancy, as well as pregnancy complications such as stillbirth, SARS-CoV-2 contamination during pregnancy is a putative stress factor that could increase the risk of perinatal maternal mental health issues. We included women older than 18 years, who delivered a living baby at the Geneva University Hospitals' maternity wards after 29 weeks of amenorrhea (w.a.) and excluded women who did not read or speak fluent French. We compared women who declared having had COVID-19, confirmed by a positive PCR test for SARS-CoV-2, during pregnancy with women who did not, both at delivery and at one month postpartum. We collected clinical data by auto-questionnaires between time of childbirth and the third day postpartum regarding the occurrence of perinatal depression, peritraumatic dissociation, and peritraumatic distress during childbirth, measured, respectively, by the EPDS (depression is score > 11), PDI (peritraumatic distress is score > 15), and PDEQ (scales). At one month postpartum, we compared the proportion of women with a diagnosis of postpartum depression (PPD) and birth-related posttraumatic stress disorder (CB-PTSD), using PCL-5 for CB-PTSD and using diagnosis criteria according DSM-5 for both PPD and CB-PTSD, in the context of a semi-structured interview, conducted by a clinician psychologist. Off the 257 women included, who delivered at the University Hospitals of Geneva between 25 January 2021 and 10 March 2022, 41 (16.1%) declared they had a positive PCR test for SARS-CoV-2 during their pregnancy. Regarding mental outcomes, except birth-related PTSD, all scores provided higher mean values in the group of women who declared having been infected by SARS-CoV-2, at delivery and at one month postpartum, without reaching any statistical significance: respectively, 7.8 (±5.2, 8:4-10.5) versus 6.5 (±4.7, 6:3-9), p = 0.139 ***, for continuous EPDS scores; 10 (25.0) versus 45 (21.1), p = 0.586 *, for dichotomous EPDS scores (≥11); 118 (55.7) versus 26 (63.4), p = 0.359 *, for continuous PDI scores; 18.3 (±6.8, 16:14-21) versus 21.1 (±10.7, 17:15-22), 0.231 ***, for dichotomous PDI scores (≥15); 14.7 (±5.9, 13:10-16) versus 15.7 (±7.1, 14:10-18), p = 0.636 ***, for continuous PDEQ scores; 64 (30.0) versus 17 (41.5), p = 0.151 *, for dichotomous PDEQ scores (≥15); and 2 (8.0) versus 5 (3.6), p = 0.289 *, for postpartum depression diagnosis, according DSM-5. We performed Chi-squared or Fisher's exact tests, depending on applicability for the comparison of categorical variables and Mann-Whitney nonparametric tests for continuous variables; p < 0.05 was considered as statistically significant. Surprisingly, we did not find more birth-related PTSD as noted by the PCL-5 score at one month postpartum in women who declared a positive PCR test for SARS-CoV-2:15 (10.6) versus no case of birth related PTSD in women who were infected during pregnancy (p = 0.131 *). Our study showed that mental outcomes were differently distributed between women who declared having been infected by SARS-CoV-2 compared to women who were not infected. However, our study was underpowered to explore all the factors associated with psychiatric issues during pregnancy, postpartum, depending on the exposure to SARS-CoV-2 infection during pregnancy. Future longitudinal studies on bigger samples and more diverse populations over a longer period are needed to explore the long-term psychic impact on women who had COVID-19 during pregnancy.

Persistence and emergence of new neuropsychological deficits following SARS-CoV-2 infection: A follow-up assessment of the Geneva COVID-COG cohort.

Background: Despite numerous observations of neuropsychological deficits immediately following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, little is known about what happens to these deficits over time and whether they are affected by changes in fatigue and any psychiatric symptoms. We aimed to assess the prevalence of neuropsychological deficits at 6-9 months and again at 12-15 months after coronavirus disease 2019 (COVID-19) and to explore whether it was associated with changes in fatigue and psychiatric symptoms. Methods: We administered a series of neuropsychological tests and psychiatric questionnaires to 95 patients (mean age = 57.12 years, standard deviation (SD) = 10.68; 35.79% women) 222 (time point 1 (T1)) and 441 (time point 2 (T2)) days on average after infection. Patients were categorised according to the severity of their respiratory COVID-19 symptoms in the acute phase: mild (no hospitalisation), moderate (conventional hospitalisation), and severe (hospitalisation in intensive care unit (ICU) plus mechanical ventilation). We ran Monte-Carlo simulation methods at each time point to generate a simulated population and then compared the cumulative percentages of cognitive disorders displayed by the three patient subgroups with the estimated normative data. We calculated generalised estimating equations for the whole sample to assess the longitudinal associations between cumulative neuropsychological deficits, fatigue, and psychiatric data (anxiety, depressive symptoms, posttraumatic stress disorder, and apathy). Results: Most participants (>50%) exhibited a decrease in their neuropsychological impairments, while approximately 25% showed an escalation in these cognitive deficits. At T2, patients in the mild subgroup remained free of accumulated neuropsychological impairments. Patients with moderate severity of symptoms displayed a decrease in the magnitude of cumulative deficits in perceptual and attentional functions, a persistence of executive, memory and logical reasoning deficits, and the emergence of language deficits. In patients with severe symptoms, perceptual deficits emerged and executive deficits increased, while attentional and memory deficits remained unchanged. Changes in executive functions were significantly associated with changes in depressive symptoms, but the generalised estimating equations failed to reveal any other significant effect. Conclusion: While most cumulative neuropsychological deficits observed at T1 persisted and even worsened over time in the subgroups of patients with moderate and severe symptoms, a significant proportion of patients, mainly in the mild subgroup, exhibited improved performances. However, we identified heterogeneous neuropsychological profiles both cross-sectionally and over time, suggesting that there may be distinct patient phenotypes. Predictors of these detrimental dynamics have yet to be identified.

Markers of limbic system damage following SARS-CoV-2 infection.

Alterations of the limbic system may be present in the chronic phase of SARS-CoV-2 infection. Our aim was to study the long-term impact of this disease on limbic system-related behaviour and its associated brain functional connectivity, according to the severity of respiratory symptoms in the acute phase. To this end, we investigated the multimodal emotion recognition abilities of 105 patients from the Geneva COVID-COG Cohort 223 days on average after SARS-CoV-2 infection (diagnosed between March 2020 and May 2021), dividing them into three groups (severe, moderate or mild) according to respiratory symptom severity in the acute phase. We used multiple regressions and partial least squares correlation analyses to investigate the relationships between emotion recognition, olfaction, cognition, neuropsychiatric symptoms and functional brain networks. Six to 9 months following SARS-CoV-2 infection, moderate patients exhibited poorer recognition abilities than mild patients for expressions of fear (P = 0.03 corrected), as did severe patients for disgust (P = 0.04 corrected) and irritation (P < 0.01 corrected). In the whole cohort, these performances were associated with decreased episodic memory and anosmia, but not with depressive symptoms, anxiety or post-traumatic stress disorder. Neuroimaging revealed a positive contribution of functional connectivity, notably between the cerebellum and the default mode, somatosensory motor and salience/ventral attention networks. These results highlight the long-term consequences of SARS-Cov-2 infection on the limbic system at both the behavioural and neuroimaging levels.

Psychiatric reaction of an intensive care unit survivor in the context of coronavirus disease 2019: a case report.

BACKGROUND: The coronavirus disease 2019 pandemic has had a serious impact on global mental health, particularly in intensive care unit survivors. Given the lethal potential and unpredictability of coronavirus disease 2019, a high risk of posttraumatic stress disorder was identified in the beginning of the crisis. There are insufficient details in current literature and no official guidelines available for the treatment and follow-up of acute stress disorder and the prevention of posttraumatic stress disorder for intensive care unit survivors in the context of coronavirus disease 2019. CASE PRESENTATION: We hereby describe a 67-year-old Swiss patient presenting a psychiatric reaction in the context of coronavirus disease 2019. He was admitted to the intensive care unit due to severe acute respiratory distress syndrome from severe acute respiratory syndrome coronavirus 2 and intubated for 13 days. Afterwards, there was a severe worsening of acute renal failure prompting hemodialysis, and he developed delirium. Psychiatric liaison was requested 4 days post-intubation because the patient presented residual symptoms of delirium, false memories about the real context of his medical care, and ideas of persecution toward medical caregivers. He suffered from a very strong peritraumatic reaction, then developed an acute stress disorder linked with his care on the intensive care unit. We looked for strategies to prevent progression from acute stress disorder to posttraumatic stress disorder. We proceeded to the following therapeutic interventions: intensive psychiatric follow-up, intensive care unit diary, and low-dose antipsychotic treatment. The aim of our psychotherapeutic approach was to allow him to increase his feeling of security and to cope with the reality of his traumatic experience. He showed clinical improvement in his mental state after 3 months, despite several predictive factors of evolution to post-intensive care unit posttraumatic stress disorder. CONCLUSION: This case report illustrates how a delusional clinical presentation after intensive care in the context of coronavirus disease 2019 can hide psychotraumatic symptoms. It is important to highlight that the intensive care unit diary completed by the intensive care team and the follow-up by the psychiatric liaison team helped the patient reconstruct an appropriate and coherent account. Further studies are needed to determine the psychiatric effects of coronavirus disease 2019 and to assess early and appropriate psychiatric intervention for patients hospitalized for coronavirus disease 2019 to prevent posttraumatic stress disorder.

Implementation of a Psychiatric Consultation for Healthcare Workers during First Wave of COVID-19 Outbreak.

BACKGROUND: Prevention and management strategies of mental suffering in healthcare workers appeared as important challenges during the COVID-19 pandemic. This article aims to: (1) show how potential psychiatric disorders for healthcare workers (HCW) during the first wave of the COVID-19 outbreak were identified; (2) present an activity report of this consultation; and (3) analyze and learn from this experience for the future. METHODS: We performed a retrospective quantitative analysis of socio-demographic and clinical data, in addition to psychiatric scales scores for the main potential psychiatric risks (PDI, PDEQ, PCL-5, HADS, MBI-HSS) and post-hoc qualitative analysis of written interviews. RESULTS: Twenty-five healthcare workers consulted between 19 March 2020 and 12 June 2020. We found 78.57% presented high peritraumatic dissociation and peritraumatic distress, 68.75% had severe anxiety symptoms, and 31.25% had severe depression symptoms. Concerning burnout, we found that 23.53% had a high level of emotional exhaustion. In the qualitative analysis of the written interview, we found a direct link between stress and the COVID-19 pandemic, primarily concerning traumatic stressors, and secondarily with work-related stress. CONCLUSIONS: Early detection of traumatic reactions, valorization of individual effort, and limitations on work overload appear like potential key preventive measures to prevent psychiatric complications for healthcare workers in the context of the COVID-19 pandemic.

Traumatic Childbirth and Birth-Related Post-Traumatic Stress Disorder in the Time of the COVID-19 Pandemic: A Prospective Cohort Study.

BACKGROUND: Birth-related post-traumatic stress disorder occurs in 4.7% of mothers. No previous study focusing precisely on the stress factors related to the COVID-19 pandemic regarding this important public mental health issue has been conducted. However, the stress load brought about by the COVID-19 pandemic could have influenced this risk. METHODS: We aimed to estimate the prevalence of traumatic childbirth and birth-related PTSD and to analyze the risk and protective factors involved, including the risk factors related to the COVID-19 pandemic. We conducted a prospective cohort study of women who delivered at the University Hospitals of Geneva between 25 January 2021 and 10 March 2022 with an assessment within 3 days of delivery and a clinical interview at one month post-partum. RESULTS: Among the 254 participants included, 35 (21.1%, 95% CI: 15.1-28.1%) experienced a traumatic childbirth and 15 (9.1%, 95% CI: 5.2-14.6%) developed a birth-related PTSD at one month post-partum according to DSM-5. Known risk factors of birth-related PTSD such as antenatal depression, previous traumatic events, neonatal complications, peritraumatic distress and peritraumatic dissociation were confirmed. Among the factors related to COVID-19, only limited access to prenatal care increased the risk of birth-related PTSD. CONCLUSIONS: This study highlights the challenges of early mental health screening during the maternity stay when seeking to provide an early intervention and reduce the risk of developing birth-related PTSD. We found a modest influence of stress factors directly related to the COVID-19 pandemic on this risk.