Circadian copeptin and oxytocin profiles in anorexia nervosa: Exploring the interplay with neurohypophysis opioid tone.

CONTEXT: Neurohypophysis (NH) function in eating disorders (ED) remains poorly elucidated. Studies on vasopressin and oxytocin display inconclusive findings regarding their levels and associations with psychological complications in ED. The profile of opioid tone, a crucial NH activity regulator, is also unknown. OBJECTIVE: To characterise the circadian profile of NH hormones and NH opioid tone using positron emission tomography/MRI (PET/MRI) imaging in patients with ED compared to healthy controls. METHODS: Twelve-point plasma circadian profiles of copeptin and oxytocin, alongside nutritional and psychological scores, were assessed in age-matched female participants: 13 patients with anorexia nervosa restrictive-type (ANR), 12 patients recovered from AN (ANrec), 14 patients with bulimia nervosa and 12 controls. Neurohypophysis PET/MRI [11C] diprenorphin binding potential (BPND) was evaluated in AN, ANrec and controls. RESULTS: Results revealed lower copeptin circadian levels in both ANR and ANrec compared to controls, with no oxytocin differences. Bulimia nervosa exhibited elevated copeptin and low oxytocin levels. [11C] diprenorphin pituitary binding was fully localised in NH. Anorexia nervosa restrictive-type displayed lower NH [11C] diprenorphin BPND (indicating higher opioid tone) and volume than controls. In ANR, copeptin inversely correlated with osmolarity. Neurohypophysis [11C] diprenorphin BPND did not correlated with copeptin or oxytocin. CONCLUSION: Copeptin demonstrated significant group differences, highlighting its potential diagnostic and prognostic value. Oxytocin levels exhibited conflicting results, questioning the reliability of peripheral blood assessment. Increased NH opioid tone in anorexia nervosa may influence the vasopressin or oxytocin release, suggesting potential therapeutic applications.

Older adult women with chronic anorexia nervosa: heterogeneous adaptation to undernutrition over time.

INTRODUCTION: Anorexia nervosa (AN) in older adult women is primarily described through reviews or case reports focusing on psychiatric traits, with no comprehensive studies evaluating their complete nutritional and hormonal profiles. This study aimed to describe a group of women with anorexia nervosa aged above 35 years old (AN35), and compare them with young women with anorexia nervosa (ANY) and normal-weight control participants. METHOD: Anthropometric, metabolic, nutritional, and psychiatric parameters were collected and compared among three groups of women: 50 AN35, 37 ANY, and 38 controls. RESULTS: AN35 exhibited a mean disease duration of 271 ± 19 months, with 94% chronic forms and 58% restrictive types. Despite having similar BMI as ANY, AN35 displayed more altered parameters, including higher liver enzymes (p = 0.007), free T3 (p = 0.0046) and leptin (p < 0.0001); and lower albumin (p = 0.0029), and white cells (p < 0.0001). AN35 showed significant heterogeneity in hormonal adaptation, such as free T3. Half of the patients aged above 51 years revealed high gonadotropin levels despite being undernourished. Additionally, AN35 groups presented with 50% of bones fractures, decreased T-scores under -2.5 (p < 0.0001 for femoral), and altered micro architectural HRPQT parameters compared to ANY. CONCLUSION: Anorexia nervosa in older adult women is predominantly chronic. Nutritional parameters changes with age suggests a significant heterogeneity and possible adaptation of energy balance and bodyweight set point for others. Complications may be severe, altering the quality of life, and sometimes potentially lethal. These findings highlight the potential adaptation of energy balance with age, and should assist clinicians in clinical practice.

Impact of horticultural therapy on patients admitted to psychiatric wards, a randomised, controlled and open trial.

Psychiatric inpatients often endure anxiety. This randomized trial assessed the impact of horticultural therapy on anxiety in adult psychiatric inpatients over four weeks, compared to standard care. Recruiting 211 inpatients from six units were randomized into control (n = 105) and experimental (n = 106) groups. Control received usual care; the experimental group had horticultural therapy alongside usual care. Anxiety, measured using HADS-A scale at four weeks, aimed to establish horticultural therapy's superiority. After four weeks, horticultural therapy significantly reduced anxiety compared to standard care (P < 0.001). These results argue in favor of integrating horticultural therapy into psychiatric nursing practices.Trial registration: No Clinical Trail: NCT02666339 (1st registration: 28/01/2016).

A systematic review of midwives' training needs in perinatal mental health and related interventions.

Background: Midwives may be key stakeholders to improve perinatal mental healthcare (PMHC). Three systematic reviews considered midwives' educational needs in perinatal mental health (PMH) or related interventions with a focus on depression or anxiety. This systematic review aims to review: 1) midwives' educational/training needs in PMH; 2) the training programs in PMH and their effectiveness in improving PMHC. Methods: We searched six electronic databases using a search strategy designed by a biomedical information specialist. Inclusion criteria were: (1) focus on midwives; (2) reporting on training needs in PMH, perinatal mental health problems or related conditions or training programs; (3) using quantitative, qualitative or mixed-methods design. We used the Mixed Methods Appraisal Tool for study quality. Results: Of 4969 articles screened, 66 papers met eligibility criteria (47 on knowledge, skills or attitudes and 19 on training programs). Study quality was low to moderate in most studies. We found that midwives' understanding of their role in PMHC (e.g. finding meaning in opening discussions about PMH; perception that screening, referral and support is part of their routine clinical duties) is determinant. Training programs had positive effects on proximal outcomes (e.g. knowledge) and contrasted effects on distal outcomes (e.g. number of referrals). Conclusions: This review generated novel insights to inform initial and continuous education curriculums on PMH (e.g. focus on midwives' understanding on their role in PMHC or content on person-centered care). Registration details: The protocol is registered on PROSPERO (CRD42021285926).

Differential associations between insight and quality-of-life dimensions among individuals with schizophrenia.

PURPOSE/OBJECTIVE: In schizophrenia, insight, the recognition that one has a medical illness that requires treatment, has long been related to deteriorated quality of life. Yet, insight and quality of life are broad constructs that encompass several dimensions. Here, we investigated differential associations between insight and quality-of-life dimensions using a psychological network approach. RESEARCH METHOD/DESIGN: We extracted data from the French network of rehabilitation centers REHABase (January 2016 to December 2022, N = 1,056). Our psychological network analysis modeled insight and quality of life as a network of interacting dimensions: three insight dimensions (awareness of illness, reattribution of symptoms to the disease, and recognition of treatment need) and eight quality-of-life dimensions (autonomy, physical and psychosocial well-being, relationships with family, friends and romantic partners, resilience, and self-esteem). RESULTS: Insight was negatively associated with quality of life. Our psychological network analysis revealed a strong negative association between awareness of disease and self-esteem. Both dimensions were the strongest nodes in the overall network. Our network analysis also revealed a significant but positive connection between recognition of treatment needs and resilience. CONCLUSION/IMPLICATIONS: While insight and quality of life are overall negatively associated, we found both negative and positive connections between insight and quality-of-life dimensions. The negative relationship between insight and quality of life may reflect the deleterious effects of diagnostic labeling on a patient's self-esteem. Yet, acknowledgment of treatment needs may have positive effects on quality of life and may promote recovery, perhaps because it emphasizes the need for support rather than labels and abnormalities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Contribution of socio-demographic and clinical characteristics to predict initial referrals to psychosocial interventions in patients with serious mental illness.

AIMS: Psychosocial rehabilitation (PSR) is at the core of psychiatric recovery. There is a paucity of evidence regarding how the needs and characteristics of patients guide clinical decisions to refer to PSR interventions. Here, we used explainable machine learning methods to determine how socio-demographic and clinical characteristics contribute to initial referrals to PSR interventions in patients with serious mental illness. METHODS: Data were extracted from the French network of rehabilitation centres, REHABase, collected between years 2016 and 2022 and analysed between February and September 2022. Participants presented with serious mental illnesses, including schizophrenia spectrum disorders, bipolar disorders, autism spectrum disorders, depressive disorders, anxiety disorders and personality disorders. Information from 37 socio-demographic and clinical variables was extracted at baseline and used as potential predictors. Several machine learning models were tested to predict initial referrals to four PSR interventions: cognitive behavioural therapy (CBT), cognitive remediation (CR), psychoeducation (PE) and vocational training (VT). Explanatory power of predictors was determined using the artificial intelligence-based SHAP (SHapley Additive exPlanations) method from the best performing algorithm. RESULTS: Data from a total of 1146 patients were included (mean age, 33.2 years [range, 16-72 years]; 366 [39.2%] women). A random forest algorithm demonstrated the best predictive performance, with a moderate or average predictive accuracy [micro-averaged area under the receiver operating curve from 'external' cross-validation: 0.672]. SHAP dependence plots demonstrated insightful associations between socio-demographic and clinical predictors and referrals to PSR programmes. For instance, patients with psychotic disorders were more likely to be referred to PE and CR, while those with non-psychotic disorders were more likely to be referred to CBT and VT. Likewise, patients with social dysfunctions and lack of educational attainment were more likely to be referred to CR and VT, while those with better functioning and education were more likely to be referred to CBT and PE. CONCLUSIONS: A combination of socio-demographic and clinical features was not sufficient to accurately predict initial referrals to four PSR programmes among a French network of rehabilitation centres. Referrals to PSR interventions may also involve service- and clinician-level factors. Considering socio-demographic and clinical predictors revealed disparities in referrals with respect to diagnoses, current clinical and psychological issues, functioning and education.

The value of a multidisciplinary consensus meeting in achieving agreement on eating disorders diagnosis at a specialized referral center.

OBJECTIVE: This study aimed to evaluate the concordance of eating disorders (EDs) diagnoses within a multidisciplinary team in a specialized hospital unit dedicated to the medical care of ED. METHODS: The study analyzed data from 608 female patients who sought consultation at the Eating Disorders Referral Center between 2017 and 2021. The diagnoses were established according to the DSM-5 criteria by endocrinologists, psychiatrists, and finally confirmed or discussed within a monthly multidisciplinary consensus meeting (MCM). Fleiss' Kappa tests were conducted to assess inter-raters' agreement. RESULTS: Overall, substantial agreement was observed between endocrinologists and psychiatrists and the MCM. A more detailed analysis revealed variations in agreement across different disorders. Certain EDs demonstrated substantial agreement (e.g., anorexia nervosa restrictive subtype), while others approached near-perfect agreement (e.g., binge-eating disorder). In contrast, agreement was fair to poor for anorexia nervosa binge-purge subtype (ANBP) and slight for other specified feeding and ED. A period of temporary disagreement was noted for ANBP, partially attributed to practitioner turnover. An improvement in interdisciplinary agreement was observed for all ED diagnoses by the end of the study period. DISCUSSION: Variations or lower levels of inter-rater agreement may stem from atypical cases that fall on the border between two diagnoses or complex cases, as well as fluctuating symptoms. The progress observed throughout the study can be attributed in part to interdisciplinary learning, particularly facilitated by the MCM. The findings underscore the significance of striving for optimal concordance among different medical specialties to enhance patient care in ED treatment. PUBLIC SIGNIFICANCE: This study scrutinizes the agreement levels of ED diagnoses among endocrinologists and psychiatrists within a multidisciplinary team at an Eating Disorders Referral Center. While substantial overall agreement was achieved, disparities or lower agreement levels were evident for certain diagnoses such as anorexia nervosa binge-purge subtype. However, collaborative meetings led to a progressive enhancement in agreement over time. This research underscores the crucial role of a multidisciplinary team working collectively to ensure precise diagnoses and improved care for patients with EDs.

Functioning, clinical severity, education and sex moderate the inverse relationship between insight and quality of life in patients with schizophrenia.

BACKGROUND: In schizophrenia, insight, the recognition that one has a medical illness that requires treatment, has long been related to deteriorated quality of life, a phenomenon that has been described as the "insight paradox". Here, we aimed to determine whether certain socio-demographic and clinical characteristics strengthen or weaken this negative relationship. METHODS: We used data from the French network of rehabilitation centers REHABase (N = 769). We explored mean differences in quality-of-life scores between patients with good insight vs. poor insight. We also explored modifying effects of socio-demographic and clinical characteristics (sex, education, age, functioning, clinical severity, duration of illness). RESULTS: Patients with good insight had a decreased quality-of-life total score. Similar effects were found for the following sub-dimensions of quality of life: autonomy, physical and psychological well-being, and self-esteem. The negative effect of insight on quality of life was attenuated for people who had >12 years of education and for people with a higher level of functioning. By contrast, the negative effect of insight on quality of life was accentuated in people with greater clinical severity. Functioning and clinical severity showed similar modifying effects for other quality-of-life dimensions: autonomy, physical and psychological well-being, and self-esteem. Finally, males demonstrated an increased negative association between insight and self-esteem. CONCLUSIONS: The relationship between insight and quality of life is moderated by socio-demographic and clinical circumstances. Future inquiries may utilize our findings by integrating socio-demographic and clinical factors in treatment programs designs to conjointly improve insight and quality of life.

Survey on the Mental Health of Dispensing Pharmacists in the Auvergne-Rhône-Alpes Region (France).

BACKGROUND: The COVID-19 pandemic intensely involved pharmacists in France, with new responsibilities on a large scale, introducing to dispensary practice the performance of vaccination and nasopharyngeal swabs. This study aimed to assess the prevalence of burnout, anxiety, and depression in pharmacists after the COVID-19 health crisis and to identify factors associated with psychological distress. METHODS: A cross-sectional observational study involved 1700 pharmacies in an entire French region. Sociodemographic, geographical, and medical information (burnout tested with the MBI and anxiety/depression measured on the HAD scale) were collected via an online anonymous self-administered questionnaire. The characteristics of the pharmacy and the practice of antigen testing and vaccination were requested. Quantitative and qualitative variables associated with psychological distress were investigated with a factor analysis. RESULTS: In total, 360 responses were collected (20.5%). Of the responses, 41.9% showed definite anxiety symptoms and 18.3% showed proven depressive symptoms. Three clusters were described according to the intensity of burnout experience, depersonalization, and loss of personal accomplishment. The analysis identified that one cluster was at high risk of burnout (high burnout and depersonalization scores). Of these stressed, exhausted pharmacists, 69.3% showed definite anxiety, 37.9% showed proven depression, and in smaller pharmacies. The carrying out of antigenic testing and anti-COVID vaccination, as well as the geographical location of the pharmacy, were not discriminating factors in these three groups. CONCLUSION: Mental health care and suicide prevention should be provided to at-risk pharmacists. It seems essential to publicize the range of resources available to support pharmacists.

Toward recovery-oriented perinatal healthcare: A participatory qualitative exploration of persons with lived experience and health providers' views and experiences.

BACKGROUND: Perinatal mental health disorders (PMHD) remain often undetected, undiagnosed, and untreated with variable access to perinatal mental health care (PMHC). To guide the design of optimal PMHC (i.e., coproduced with persons with lived experience [PLEs]), this qualitative participatory study explored the experiences, views, and expectations of PLEs, obstetric providers (OP), childcare health providers (CHPs), and mental health providers (MHPs) on PMHC and the care of perinatal depression. METHODS: We conducted nine focus groups and 24 individual interviews between December 2020 and May 2022 for a total number of 84 participants (24 PLEs; 30 OPs; 11 CHPs; and 19 MHPs). The PLEs group included women with serious mental illness (SMI) or autistic women who had contact with perinatal health services. We recruited PLEs through social media and a center for psychiatric rehabilitation, and health providers (HPs) through perinatal health networks. We used the inductive six-step process by Braun and Clarke for the thematic analysis. RESULTS: We found some degree of difference in the identified priorities between PLEs (e.g., personal recovery, person-centered care) and HPs (e.g., common culture, communication between providers, and risk management). Personal recovery in PMHD corresponded to the CHIME framework, that is, connectedness, hope, identity, meaning, and empowerment. Recovery-supporting relations and peer support contributed to personal recovery. Other factors included changes in the socio-cultural conception of the peripartum, challenging stigma (e.g., integrating PMH into standard perinatal healthcare), and service integration. DISCUSSION: This analysis generated novel insights into how to improve PMHC for all users including those with SMI or autism.

Systematic review of prospective studies assessing risk factors to predict anorexia nervosa onset.

BACKGROUND: According to case‒control studies, a multitude of factors contribute to the emergence of anorexia nervosa (AN). The present systematic review examines prospective studies specifically designed to evaluate the prediction of AN onset. METHODS: According to the ARMSTAR 2 and PRISMA 2020 checklists, the PubMed, PsycINFO and Cochrane databases were searched. The methodological quality of the studies was assessed with the Downs and Black checklist. RESULTS: Three articles concerning prospective studies of the general population were ultimately included in the review. The methodological quality of these studies was not optimal. Bidirectional amplification effects were observed between risk factors, some of which could have a relative predictive force as low bodyweight or body dissatisfaction. Even if not included according to specified criteria for this systematic review 11 longitudinal studies, with retrospective analysis of AN onset' prediction, were also discussed. None of these studies asserted the predictive value of particular risk factors as low body weight, anxiety disorders or childhood aggression. CONCLUSIONS: To date there are insufficient established data to propose predictive markers of AN onset for predictive actions in pre-adolescent or adolescent populations. Future work should further evaluate potential risk factors previously identified in case‒control/retrospective studies within larger prospective investigations in preadolescent populations. It is important to clearly distinguish predisposing factors from precipitating factors in subjects at risk of developing AN.

Currently health care guidelines for eating disorders do not include proposal of markers to predict the onset of anorexia nervosa. The current work provides a systematic review of the scientific literature concerning this subject. To date only three published studies were designed in a prospective longitudinal way to evaluate potential predictors of anorexia nervosa onset. When taking into account these studies only low bodyweight and body dissatisfaction in early puberty were proposed as predicting elements for further anorexia nervosa development. Meanwhile the prediction precision was calculated for none of them. No other psychological elements were retained or studied. The age range of the population entering the follow up in these studies was too large covering the peak age of anorexia nervosa itself (13­16 years of age). Larger prospective studies including prepubescent individual and evaluating more psychological markers (perfectionism, negative affectivity or negative self-evaluation) or environmental ones are needed.

Mechanisms and predictors of menses resumption once normal weight is reached in anorexia nervosa.

BACKGROUND: In cases of Anorexia Nervosa (AN), achieving weight gain recovery beyond the lower limits set by the World Health Organization and normalizing classical nutritional markers appears to be essential for most patients. However, this is not always adequate to restore menstrual cycles. This discrepancy can cause concern for both patients and healthcare providers, and can impact the medical management of these individuals. Thus, the purpose of this study was to assess the ability of anthropometric and hormonal factors to predict the resumption of menstrual cycles in individuals with anorexia nervosa upon reaching a normal body weight. METHOD: Patients with AN who had achieved a normal Body Mass Index but had not yet resumed their menstrual cycles (referred to as ANRec) were evaluated on two occasions: first at visit 1 and then again 6 months later, provided their body weight remained stable over this period (visit 2). Among the 46 ANRec patients who reached visit 2, they were categorized into two groups: 20 with persistent amenorrhea (PA-ANRec) and 26 who had regained their menstrual cycles (RM-ANRec). Anthropometric measurements, several hormone levels, Luteinizing Hormone (LH) pulsatility over a 4-h period, and LH response to gonadotropin-releasing hormone injection (LH/GnRH) were then compared between the two groups at visit 1. RESULTS: Patients in the RM-ANRec group exhibited higher levels of follicular stimulating hormone, estradiol, inhibin B, LH/GnRH, and lower levels of ghrelin compared to those in the PA-ANRec group. Analysis of Receiver Operating Characteristic curves indicated that having ≥ 2 LH pulses over a 4-h period, LH/GnRH levels ≥ 33 IU/l, and inhibin B levels > 63 pg/ml predicted the resumption of menstrual cycles with a high degree of specificity (87%, 100%, and 100%, respectively) and sensitivity (82%, 80%, and 79%, respectively). CONCLUSIONS: These three hormonal tests, of which two are straightforward to perform, demonstrated a high predictive accuracy for the resumption of menstrual cycles. They could offer valuable support for the management of individuals with AN upon achieving normalized weight. Negative results from these tests could assist clinicians and patients in maintaining their efforts to attain individualized metabolic targets. TRIAL REGISTRATION: IORG0004981.

Once a minimally normal weight has been reached during eating disorder recovery for female patients with anorexia nervosa (AN), the persistence of amenorrhea can be a cause for concern both patient and practitioner. In our study, we have discovered that positive results in biological blood tests, which can be conveniently conducted in an ambulatory setting, offer valuable predictive insights. Specifically, parameters such as LH pulse numbers exceeding 2, LH response to GnRH injection surpassing 33 UI/L, or Inhibin B levels in the blood exceeding 63 pg/mL, can accurately predict the resumption of menstrual cycles in the upcoming months, provided that the patient does not experience weight loss or engage in intense exercise. Conversely, negative results from these tests at this critical juncture in the recovery process can serve as valuable tools to encourage and motivate both the healthcare provider and the patient. By maintaining their efforts and continuing to increase their weight, patients can work towards a more comprehensive restoration of their menstrual cycles.

Association of gut-specific non-inflammatory T lymphocytes with chronic anorexia nervosa and constitutional thinness.

OBJECTIVE: Previous studies of AN showed low-grade inflammation. Are low-grade inflammation and circulating lymphocytes associated with chronic conditions? METHOD: Peripheric blood cytokines were measured using Luminex™ technology in a chronic AN cohort (mean = 67.42 months), compared to Constitutional Thinness (CT), Constitutional Obesity (CO), and Healthy Controls (HC). Secondarily a prospective cohort of chronic AN (mean = 54.11 months) was recruited to compare the functional lymphocyte profile in blood by flow cytometry to CT and HC. RESULTS: In the AN group, most cytokine concentrations were lower than in CT and HC groups. The IL-23 (98.02 pg/ml) was elevated related to HC and CO, and the IL-10 (4.178 pg/ml) was elevated versus CO. In the CT group, IL-9 (0.06216 pg/ml) was elevated compared to AN. The AN group had high Treg (9.259% of CD4+ ) and CD8+ Integrinß7+ (9.552% of CD3+ ) versus HC for lymphocyte populations. In CT group, elevated Treg (9.7% of CD4+ ) elevated percentage of CD4+ CCR9+ (5.867% of CD3+ ) and CD8+ Integrinß7+ (10.21% of CD3+ ) were found versus HC. CONCLUSIONS: The chronic state of AN and CT is surprisingly non-inflammatory with elevated Treg cells. These results suggest that maintaining a dysregulated response to intestinal antigens may contribute to maintaining AN.

Continuous glucose monitoring assessment in patients suffering from anorexia nervosa reveals chronic prolonged mild hypoglycemia all over the nycthemeron.

OBJECTIVE: Anorexia nervosa (AN) is an eating disorder characterised by voluntary dietary restriction leading to severe undernutrition. Hypoglycaemia is mostly described through severe case reports and is always evaluated by fasting or post-meal blood glucose, showing nothing about hypoglycaemia's length or duration. The interest of continuous interstitial glucose monitoring (CGM), largely used in diabetes mellitus, has never been evaluated in AN patients. METHOD: Glycaemia cycles in AN patients were assessed using CGM over 5 days and then analysed according to food intake. RESULTS: Mean glycaemia was within normal range. 91% of the patients presented with at least one episode with glycaemia under 70 mg/dl. Within the 24 h, the percentage of time spent with a glycaemia under 70 mg/dl was of 20.82 ± 3.90% with a maximum of 52%. We found 2.52 ± 0.33 hypoglycaemia events per 24 h, including 21.11 ± 3.76% at night. CGM parameters correlated with cortisol and IGF1 plasma levels. Comparison with estimated carbohydrate intakes discriminated concordant and non-concordant estimations depending on patient. CONCLUSIONS: AN patients display chronic prolonged mild hypoglycaemia all over the nycthemeron despite normal fasting glycaemia. Associated adaptive increased counter-regulatory hormones might protect AN patients from deeper hypoglycaemia. CGM allowed testing food intake self-estimation reliability of AN patients and could be a very useful biofeedback tool.

Clinical features and outcomes of COVID-19 patients hospitalized for psychiatric disorders: a French multi-centered prospective observational study.

BACKGROUND: Patients with psychiatric disorders are exposed to high risk of COVID-19 and increased mortality. In this study, we set out to assess the clinical features and outcomes of patients with current psychiatric disorders exposed to COVID-19. METHODS: This multi-center prospective study was conducted in 22 psychiatric wards dedicated to COVID-19 inpatients between 28 February and 30 May 2020. The main outcomes were the number of patients transferred to somatic care units, the number of deaths, and the number of patients developing a confusional state. The risk factors of confusional state and transfer to somatic care units were assessed by a multivariate logistic model. The risk of death was analyzed by a univariate analysis. RESULTS: In total, 350 patients were included in the study. Overall, 24 (7%) were transferred to medicine units, 7 (2%) died, and 51 (15%) patients presented a confusional state. Severe respiratory symptoms predicted the transfer to a medicine unit [odds ratio (OR) 17.1; confidence interval (CI) 4.9-59.3]. Older age, an organic mental disorder, a confusional state, and severe respiratory symptoms predicted mortality in univariate analysis. Age >55 (OR 4.9; CI 2.1-11.4), an affective disorder (OR 4.1; CI 1.6-10.9), and severe respiratory symptoms (OR 4.6; CI 2.2-9.7) predicted a higher risk, whereas smoking (OR 0.3; CI 0.1-0.9) predicted a lower risk of a confusional state. CONCLUSION: COVID-19 patients with severe psychiatric disorders have multiple somatic comorbidities and have a risk of developing a confusional state. These data underline the need for extreme caution given the risks of COVID-19 in patients hospitalized for psychiatric disorders.

Mental Health Mobile Apps in the French App Store: Assessment Study of Functionality and Quality.

BACKGROUND: Approximately 800 million people, representing 11% of the world's population, are affected by mental health problems. The COVID-19 pandemic exacerbated problems and triggered a decline in well-being, with drastic increase in the incidence of conditions such as anxiety, depression, and stress. Approximately 20,000 mental health apps are listed in mobile app stores. However, no significant evaluation of mental health apps in French, spoken by approximately 300 million people, has been identified in the literature yet. OBJECTIVE: This study aims to review the mental health mobile apps currently available on the French Apple App Store and Google Play Store and to evaluate their quality using Mobile App Rating Scale-French (MARS-F). METHODS: Screening of mental health apps was conducted from June 10, 2022, to June 17, 2022, on the French Apple App Store and Google Play Store. A shortlist of 12 apps was identified using the criteria of selection and assessed using MARS-F by 9 mental health professionals. Intraclass correlation was used to evaluate interrater agreement. Mean (SD) scores and their distributions for each section and item were calculated. RESULTS: The highest scores for MARS-F quality were obtained by Soutien psy avec Mon Sherpa (mean 3.85, SD 0.48), Evoluno (mean 3.54, SD 0.72), and Teale (mean 3.53, SD 0.87). Mean engagement scores (section A) ranged from 2.33 (SD 0.69) for Reflexe reussite to 3.80 (SD 0.61) for Soutien psy avec Mon Sherpa. Mean aesthetics scores (section C) ranged from 2.52 (SD 0.62) for Mental Booster to 3.89 (SD 0.69) for Soutien psy avec Mon Sherpa. Mean information scores (section D) ranged from 2.00 (SD 0.75) for Mental Booster to 3.46 (SD 0.77) for Soutien psy avec Mon Sherpa. Mean Mobile App Rating Scale subjective quality (section E) score varied from 1.22 (SD 0.26) for VOS - journal de l'humeur to 2.69 (SD 0.84) for Soutien psy avec Mon Sherpa. Mean app specificity (section F) score varied from 1.56 (SD 0.97) for Mental Booster to 3.31 (SD 1.22) for Evoluno. For all the mental health apps studied, except Soutien psy avec Mon Sherpa (11/12, 92%), the subjective quality score was always lower than the app specificity score, which was always lower than the MARS-F quality score, and that was lower than the rating score from the iPhone Operating System or Android app stores. CONCLUSIONS: Mental health professionals assessed that, despite the lack of scientific evidence, the mental health mobile apps available on the French Apple App Store and Google Play Store were of good quality. However, they are reluctant to use them in their professional practice. Additional investigations are needed to assess their compliance with recommendations and their long-term impact on users.

Actionable Predictive Factors of Homelessness in a Psychiatric Population: Results from the REHABase Cohort Using a Machine Learning Approach.

BACKGROUND: There is a lack of knowledge regarding the actionable key predictive factors of homelessness in psychiatric populations. Therefore, we used a machine learning model to explore the REHABase database (for rehabilitation database-n = 3416), which is a cohort of users referred to French psychosocial rehabilitation centers in France. METHODS: First, we analyzed whether the different risk factors previously associated with homelessness in mental health were also significant risk factors in the REHABase. In the second step, we used unbiased classification and regression trees to determine the key predictors of homelessness. Post hoc analyses were performed to examine the importance of the predictors and to explore the impact of cognitive factors among the participants. RESULTS:  First, risk factors that were previously found to be associated with homelessness were also significant risk factors in the REHABase. Among all the variables studied with a machine learning approach, the most robust variable in terms of predictive value was the nature of the psychotropic medication (sex/sex relative mean predictor importance: 22.8, σ = 3.4). Post hoc analyses revealed that first-generation antipsychotics (15.61%; p < 0.05 FDR corrected), loxapine (16.57%; p < 0.05 FWER corrected) and hypnotics (17.56%; p < 0.05 FWER corrected) were significantly associated with homelessness. Antidepressant medication was associated with a protective effect against housing deprivation (9.21%; p < 0.05 FWER corrected). CONCLUSIONS: Psychotropic medication was found to be an important predictor of homelessness in our REHABase cohort, particularly loxapine and hypnotics. On the other hand, the putative protective effect of antidepressants confirms the need for systematic screening of depression and anxiety in the homeless population.

The central role of self-esteem in the quality of life of patients with mental disorders.

In psychiatry, recent years have seen a change of focus from a clinician- to a patient-centered perspective that emphasizes quality of life as a treatment target. As a complex construct, quality of life is composed of multiple dimensions that interact with one-another (e.g. physical and psychological well-being, relationships, autonomy, self-esteem). Here, we used data from the REHABase cohort, which includes N = 2180 patients from 15 psychosocial rehabilitation centers in France, to explore networks of quality-of-life dimensions among six psychiatric disorders: schizophrenia, neurodevelopmental, bipolar, depressive, anxiety, and personality disorders. Stronger connections (edges) involved the Self-Esteem dimension, such as Self-Esteem-Physical Well-Being, Self-Esteem-Autonomy, Self-Esteem-Psychological Well-Being, and Self-Esteem-Resilience. Self-esteem was also consistently retrieved as the most central node (the dimension with the most connections within each network). Between-group tests did not reveal any differences regarding network structure, overall connectivity, edge-weights, and nodes' centrality. Despite presenting with different symptom profiles, various psychiatric disorders may demonstrate similar inter-relationships among quality-of-life dimensions. In particular, self-esteem may have a crucial inter-connecting role in patients' quality of life. Our findings could support treatment programmes that specifically target self-esteem to improve patients' quality of life in a cost-effective way.

Long-Term Clinical and Psychiatric Complications of Young Adults Cured of a Pediatric Bone Tumor Diagnosed Between 1987 and 1999 in Rhône: Alpes Region (France).

Purpose: The 5-year survival for children diagnosed with cancer is ∼85%. The constant increase in survival curves is evidence of therapeutic optimization. Clinical and psychological complications are rarely analyzed simultaneously in the literature for pediatric malignant bone tumors. We aimed to describe different clinical and psychiatric sequelae and to evaluate the quality of life (QoL) of adults followed for a pediatric bone tumor. Methods: The Association of the Childhood Cancer Registry in Rhône-Alpes Region has coordinated two long-term follow-up studies designed to evaluate complications of childhood cancer. Only bone tumors are analyzed. Patients were given a self-questionnaire, followed by a clinical consultation then a psychological interview. Results: Twenty-five patients were studied. The mean age at diagnosis was 11.3 years. The median follow-up time was 20.7 years. Of the patients, 66.7% had at least one psychiatric disorder versus 31.9% in the general population (p = 0.0006). Comparing with the general population, 47.6% have at least one mood disorder (p < 0.001), 52.4% have at least one anxiety disorder (p = 0.0035), and 28.6% have an addiction (p < 0.0001). The mean number of clinical sequelae per patient was 3.12. Ninety-six percent of the patients studied had at least one clinical sequela. The overall QoL score was 59.7 with a physical score of 60.5 and a mental score of 52.9. All domains considered were lower for these patients. Conclusion: It is essential to offer psychological support from the time of diagnosis to limit the risk of developing an addiction. Clinical Trial numbers: NCT01531478 and NCT02675166.

Factors Associated with Psychological Distress in French Medical Students during the COVID-19 Health Crisis: A Cross-Sectional Study.

BACKGROUND: The purpose of this study was to assess the prevalence of psychological distress in medical students during the COVID-19 health crisis and to identify factors associated with psychological distress. METHODS: A cross-sectional observational study was presented to 1814 medical students (from first to sixth year) in a French university hospital center. Sociodemographic, occupational and medical information (psychological distress measured on the French GHQ12 scale) were collected via an online anonymous self-administered questionnaire. Variables associated with psychological distress were investigated using univariate analysis and multivariate analysis (modified Poisson regression). RESULTS: In total, 832 medical students responded (46%) and 699 completed the questionnaire in full (39%); 625 (75%) showed signs of psychological distress and 109 (15%) reported suicidal ideation. Female gender, psychological trauma during the COVID-19 health crisis, change in alcohol consumption, and difficulties with online learning emerged as risk factors for psychological distress, whereas a paid activity, a feeling of mutual aid and cooperation within the studies framework, and recognition of work appeared to be protective factors. CONCLUSIONS: Mental health care or suicide prevention should be provided to students at risk in the aftermath of the pandemic. Knowing the educational and medical factors associated with psychological distress enables areas for prevention to be identified.