Physicians' and medical students' beliefs and attitudes toward psychotic disorders: A systematic review.

OBJECTIVE: The aim of this study was to analyze physicians' and medical students' (MS) beliefs and attitudes toward people with psychotic disorders. METHODS: This systematic review follows the PRISMA guidelines. It was conducted on 5 databases (Pubmed, PsycINFO, Pascal & Francis, Scopus and EMBASE) with a keyword string combining words for physicians' and students' professional status, attitudes toward people, and psychotic disorders. No limitations on publication dates were imposed. RESULTS: This review includes 39 articles, among which quantitative studies are in the majority, and general practioners are mainly represented. Schizophrenia is the main condition used to illustrate psychotic disorders and measure stigmatizing attitudes. Physicians' and MS' beliefs toward people with psychotic disorders are mainly represented by dangerousness and unpredictability. They can be reinforced with socio-demographic criteria (age and female gender) or physicians' beliefs about the disease's etiology. The desire for social distance is higher toward patients with schizophrenia compared to other psychiatric disorders, and medical care could be impacted with a tendency to refer them at psychiatric specific care or to anticipate their difficulties and to modify their treatment plan. Stigma scores remain globally high during medical training. Even if specific anti-stigma trainings have a positive impact on beliefs and attitudes, these effects do not last in time. CONCLUSION: This review highlights the importance to explore physicians' and medical students' representations about patient with psychosis to understand better their difficulties in the management of these patients.

[Linguistic markers in improving the predictive model of the transition to schizophrenia]. / Les marqueurs linguistiques dans l'amélioration du modèle prédictif de la transition vers la schizophrénie.

Over the past twenty years, research in psychiatry has focused primarily on the early detection of schizophrenia. The objective has been to engage the patient with prodromal symptoms in a trajectory of care. It has also been a question of being able to offer treatment as soon as the patient "at risk" of schizophrenia triggered a possible first psychotic episode. Standardized clinical tools were developed and now allow identification of subjects at risk of developing psychotic disorders. However, the reliability of predictions of the psychotic transition, which is between 15 and 25%, remains insufficient. In order to improve care, it is now necessary to highlight markers to refine the prediction of the risk of developing schizophrenia. Some teams are trying to identify linguistic anomalies in UHR subjects (disorganized speech, illogical thoughts, poor speech, altered semantic verbal fluencies…). Some of these abnormalities could be specific to the transition to psychosis. The severity of these markers could be proportional to the progressive stage of the disorder, consistent with the hypothesis of a continuum from normal to pathological in schizophrenia. In addition, automated speech analysis techniques in UHR subjects allow identification of subtle semantic and syntactic anomalies (a decrease in semantic coherence, but also the use of possessive pronouns and a poverty of speech) predictive in 79% of cases of psychotic transition. Some authors demonstrate the value of using linguistic markers and automated speech analysis methods to improve the predictive model of the transition to schizophrenia. However, from reification of language to desubjectification of the individual, this transformation in clinical practice raises ethical and epistemological challenges.

[Suicidal behavior in light of COVID-19 outbreak: Clinical challenges and treatment perspectives]. / Épidémie de COVID-19 et prise en charge des conduites suicidaires : challenge et perspectives.

OBJECTIVE: The COVID-19 pandemic affected today more than 3,000,000 worldwide, and more than half of humanity has been placed in quarantine. The scientific community and the political authorities fear an epidemic of suicide secondary to this crisis. The aim of this review is to analyze the impact of the COVID-19 pandemic on the dimensions of the suicidal process and its interaction with the various risk factors. We also propose innovative strategies to manage suicidal behavior in the context of pandemic. METHODS: We carried out a narrative review of international publications dealing with major pandemics (COVID-19, SARS) and their influence on suicidal vulnerability. RESULTS: Many factors are likely to increase the emergence of suicidal ideation and suicide attempts during this crisis. Social distancing and quarantine could increase the feeling of disconnection and the perception of social pain in vulnerable individuals. Some populations at high suicidal risk could be further impacted by the current pandemic: the elderly, medical staff and individuals exposed to economic insecurity. Several innovative tools adapted to the constraints of social distancing and quarantine may prevent suicide risk: e-health, VigilanS, buddhist-derived practices and art engagement. CONCLUSIONS: This unprecedented crisis may interact with certain dimensions of the suicidal process. However, it is time to innovate. Several suicide prevention tools all have their place in new modes of care and should be tested on a large scale.

Distress, Suicidality, and Affective Disorders at the Time of Social Networks.

PURPOSE OF REVIEW: We reviewed how scholars recently addressed the complex relationship that binds distress, affective disorders, and suicidal behaviors on the one hand and social networking on the other. We considered the latest machine learning performances in detecting affective-related outcomes from social media data, and reviewed understandings of how, why, and with what consequences distressed individuals use social network sites. Finally, we examined how these insights may concretely instantiate on the individual level with a qualitative case series. RECENT FINDINGS: Machine learning classifiers are progressively stabilizing with moderate to high performances in detecting affective-related diagnosis, symptoms, and risks from social media linguistic markers. Qualitatively, such markers appear to translate ambivalent and socially constrained motivations such as self-disclosure, passive support seeking, and connectedness reinforcement. Binding data science and psychosocial research appears as the unique condition to ground a translational web-clinic for treating and preventing affective-related issues on social media.

[The philosophical roots of "connectedness": The care clinic]. / Les racines philosophiques du « rester en lien ¼ : la clinique du souci.

If suicide remains "the only really serious philosophical problem" (A. Camus), historically a certain number of philosophers have legitimized it while others have condemned it. Among the philosophers who admitted that suicide could be a possibility, some showed understanding and others remained more modest. Kierkegaard's philosophical stance, demonstrating that one can never decide for the other where existential problems are concerned, opens a third way. Following him, Michel Cornu coined the expression "ethics of concern". That restlessness, etymologically, can be understood at the same time at the epistemological level (lack of a single constituted knowledge, hence the need to resort to a fully interdisciplinary approach of the "suicide" object), but as a relational attitude as well, namely a restlessness vis-à-vis the other, in other words concern for the other. This concept of concern does not exist in philosophical literature as such, but it has been addressed by philosophers. Therefore, it is essential to begin with a differential reflection on the notions of concern, care and solicitude. Then three "philosophies of solicitude" will be developed, those of Heidegger (concern in itself), Ricœur (concern as reciprocity) and Levinas (concern as responsibility). The monitoring devices, which will be widely discussed in other articles of this special issue, are based on philosophical notions borrowed from Heidegger (thoughtful solicitude), or Ricœur (solicitude) and Levinas (responsibility) or Cornu (ethics of concern). In addition, throughout our text we have mentioned a certain number of tensions inherent to these notions themselves, such as that intrinsic to the term solicitude (both care and concern), or peculiar to the authors' work (substitutive solicitude - thoughtful solicitude for Heidegger), or related to the debate of ideas (solicitude for Ricœur - responsibility for Levinas). Implementing these monitoring devices in clinical practice as well as in the territories will raise other problems, in particular, between benevolence and monitoring, but also between justice and equity, which will be our conclusion.

How far is clinical assessment from the bullseye? Using MEmind to compare clinical assessment with self-assessment in patients with depression and anxiety diagnosis

Background and objectives: Technology based assessments are being used for screening and monitoring in a wide scope of medical specialties, including mental health field. Depression and anxiety are common disorders in which e-health tools can be useful. We aimed to compare clinician assessment of illness severity in patients with depression and anxiety diagnosis with computer-based self-assessment within 24h of clinician evaluation via MEmind (www.memind.net), a novel web-tool. Methods: From May 2014, adult patients attended in outpatient settings in Fundación Jiménez Diaz Psychiatry Department were registered in MEmind, a web tool designed for psychiatric assessment. During the recruitment, clinicians use CGI-S for patient assessment via MEmind and provide patients a code and password to use the web-tool. We selected those patients diagnosed with depression and/or anxiety who connected within 24h of the clinical visit and complete in the web page GHQ and WHO-5 scales. We calculated a bivariate correlation for CGI-S, WHO-5 and GHQ-12. Results: Of the 231 participants, 157 (68%) were diagnosed with anxiety disorders and 74 (32%) with depression. Using the Spearman Rho test for correlation, we found a low correlation between CGI-S and total WHO-5 (r=−0.192; p=0.006) and between CGI-S and total GHQ-12 (r=0.211; p=0.002) and a good correlation between total WHO-5 and total GQH-12 (r=−0.606; p=0.000). Conclusions: We found a low correlation between clinician assessment and patients’ self-reports within 24h of clinician evaluation. Factors that potentially influenced the degree of correlation related with patients, clinicians, measurements and technology are discussed

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