From love to pain: is oxytocin the key to grief complications?

While most adults confronted with the death of a loved one manage to grieve, about 10-20% of individuals develop complicated grief, characterized by persistent distress and impaired social skills, or pathological grief, defined by the onset or decompensation of a psychiatric disorder. Little is known about the biological causes of these grief complications. Recent work suggests that oxytocin, a major neuroendocrine hormone regulating many neurocognitive mechanisms, may be involved in this process. Oxytocin is widely studied and well known for its impact on the mother-child bond and hormonal and brain systems related to attachment and social interactions. In this article, we propose a neurocognitive model of grief complications based on existing data on the role of oxytocin in interpersonal attachment and its impact on brain activity. We suggest that complicated grief is associated with dysfunctional cerebral oxytocinergic signaling and persistent hyperactivation of the nucleus accumbens. This mechanism is involved in limiting the reduction of interpersonal attachment to the deceased during acute phases and in searching for new interpersonal relationships during the recovery phase. We show how the exploration of cerebral oxytocinergic signaling would improve the understanding of physiological grief mechanisms in the general population and could allow the development of new therapeutic perspectives against the complications of grief.

[Combination of ketamine and esketamine with Exposure and Response Prevention (ERP) therapy for Obsessive-Compulsive Disorder]. / Combinaison de la kétamine et de l'eskétamine avec la thérapie d'exposition avec prévention de la réponse (EPR) dans le trouble obsessionnel-compulsif.

Obsessive-Compulsive Disorder (OCD), characterized by the combination of obsession and compulsion, is a clinical and therapeutic challenge. Many patients with OCD do not respond to first-line treatments such as serotonin selective reuptake inhibitors (SSRIs) and exposure and response prevention psychotherapy (ERP). For these resistant patients, some preliminary studies have shown that ketamine, a non-selective glutamatergic NMDA receptors antagonist, could improve the obsessive symptoms. A number of these studies have also suggested that the combination of ketamine with ERP psychotherapy may jointly potentiate the effectiveness of ketamine and ERP. In this paper, we present the existing data on the combined use of ketamine with ERP psychotherapy for OCD. We suggest that modulation of NMDA receptor activity and glutamatergic signaling by ketamine may promote the therapeutic mechanisms involved in ERP such as fear extinction and brain plasticity mechanisms. Finally, we propose a ketamine-augmented ERP psychotherapy (KAP-ERP) protocol in OCD, and we present the limitations associated with its application in clinical practice.

[Mother brain: Bayesian theory of maternal interoception during pregnancy and postpartum]. / Cerveau maternel : Théorie bayésienne de l'intéroception maternelle pendant la grossesse et le postpartum.

The perinatal period, including pregnancy and postpartum, causes major morphological, endocrinal, and thermal transitions in women. As the fetus grows, abdominal muscle fibers stretch, internal organs such as the bladder or colon move, and the uterine anatomy changes. Many of these changes involve interoception, the perception of internal body signals such as muscle and visceral sensations. Despite the importance of these interoceptive signals, few studies have explored perinatal interoception. We propose an innovative theory of maternal interoception based on recent findings in neuroscience. We show that interoceptive signals processing during pregnancy is crucial for understanding perinatal phenomenology and psychopathology, such as maternal perception of fetal movements, maternal-infant bonding, denial of pregnancy, phantom fetal movements after childbirth, pseudocyesis or even puerperal delusion. Knowing the importance of these interoceptive mechanisms, clinicians in obstetrics, gynecology and mental health should be particularly vigilant to maternal interoception during the perinatal period.

[Denial of pregnancy: focus on clinical specificities]. / Déni de grossesse : mise au point sur les spécificités cliniques.

DENIAL OF PREGNANCY: FOCUS ON CLINICAL SPECIFICITIES Denial of pregnancy corresponds to an evolving pregnan¬cy without the woman being aware of being pregnant. It is generally associated with an absence of gravidic signs such as amenorrhea, abdominal swelling, breast tension, morning sickness, or maternal perception of fetal move¬ments. Although this phenomenon is not well known and is sometimes considered a myth by the medical world, it represents a significant public health problem. Indeed, the lack of obstetric monitoring and preparation for pa¬renthood are the cause of maternal, fetal and neonatal morbidity. The discovery of a denial of pregnancy should lead to the exploration of its clinical characteristics, its risk factors and the keys to its management. Although its causes are still unknown, recent discoveries in the neu¬roscience of maternal interoception could provide a better understanding of this phenomenon.

DÉNI DE GROSSESSE : MISE AU POINT SUR LES SPÉCIFICITÉS CLINIQUES Le déni de grossesse correspond à une grossesse évolu¬tive sans que la femme ne soit consciente d'être enceinte. Il est généralement associé à une absence de signes gravidiques comme l'aménorrhée, le gonflement abdomi¬nal, la tension mammaire, les nausées matinales, ou en¬core la perception maternelle des mouvements foetaux. Phénomène méconnu, parfois considéré comme un mythe par le monde médical, il représente pourtant un problème conséquent de santé publique. En effet, l'absence de suivi obstétrical et de préparation à la parentalité font le lit de morbidités maternelle, foetale et néonatale. La découverte d'un déni de grossesse doit amener à ex¬plorer ses caractéristiques cliniques, ses facteurs de risque et les clés de sa prise en charge. Bien que ses causes soient encore inconnues, les découvertes récentes en neurosciences sur l'intéroception maternelle pour¬raient permettre de mieux comprendre ce phénomène.

[Perinatal beliefs: Neurocognitive mechanisms and cultural specificities]. / Croyances périnatales : mécanismes neurocognitifs et spécificités culturelles.

Perinatal beliefs contribute to the experience of pregnancy and the process of parenthood. Many of these perinatal beliefs have been perpetuated and evolved over time and throughout the world, exerting their influence on the behavior of pregnant women in interaction with medical recommendations. These beliefs generally offer explanations for gravidic and puerperal phenomena, helping to reduce the uncertainty of parents faced with the biological, psychological and social transitions of pregnancy. But certain beliefs can also be harmful, and alter the maternal experience of pregnancy and postpartum. In this paper, we provide an overview of the beliefs associated with the perinatal period. We successively detail the beliefs concerning fertility, pregnancy, childbirth, and postpartum, specifying the cultural beliefs from other cultures interacting with medical recommendations. Finally, we propose a neurocognitive model of perinatal beliefs generation, and we show the need to know these beliefs to improve care in midwifery, obstetrics, and fetal medicine.

Becoming a Mother During COVID-19 Pandemic: How to Protect Maternal Mental Health Against Stress Factors.

During the COVID-19 pandemic, there were an increasing prevalence of perinatal psychiatric symptoms, such as perinatal anxiety, depression, and post-traumatic stress disorders. This growth could be caused by a range of direct and indirect stress factors related to the virus and changes in health, social and economic organization. In this review, we explore the impact of COVID-19 pandemic on perinatal mental health, and propose a range of hypothesis about their etiological mechanisms. We suggest first that the fear of being infected or infected others (intrauterine transmission, passage of the virus from mother to baby during childbirth, infection through breast milk), and the uncertainty about the effect of the virus on the fetuses and infants may have played a key-role to weakening the mental health of mothers. We also highlight that public health policies such as lockdown, limiting prenatal visits, social distancing measures, and their many associated socio-economic consequences (unemployment, loss of income, and domestic violence) may have been an additional challenge for perinatal mental health. Ground on these hypotheses, we finally purpose some recommendations to protect perinatal mental health during a pandemic, including a range of specific support based on digital technologies (video consultations, phone applications) during pregnancy and the postpartum period.