Perinatal psychopharmacology is an emerging specialty that is gradually developing alongside perinatal psychiatry. The management of psychiatric disorders during the perinatal period is a challenge for perinatal practitioners due to the multiple changes occurring during this crucial period. This little-known specialty still suffers from inappropriate considerations on the impact of psychotropic treatments on the mother and the infant during pregnancy and postpartum, which can promote a deficiency in perinatal psychic care. However, the risks associated with insufficient management of mental health are major, impacting both the mental and physical health of the mother and the infant. In this paper, we propose a perinatal psychopharmacology prescription guide based on available scientific evidence and international and national recommendations. We thus propose a decision-making process formalized on simple heuristics in order to help the clinician to prescribe psychotropic drugs during the perinatal period.
Breast Feeding , Mental Disorders , Pregnancy , Infant , Female , Humans , Postpartum Period , Mental Disorders/drug therapy , Mental Disorders/psychology , Psychotropic Drugs/adverse effects , Mental Health
The COVID-19 pandemic caused by the novel coronavirus SARS-CoV-2 has caused an unprecedented global crisis, and a proliferation of conspiracy theories. These conspiratorial beliefs has contributed to weakening the credibility of government public health measures, limiting citizens' access to reliable sources of information, and disrupting the response of health systems to the crisis. Several hypotheses have been proposed in psychology and social science to understand the genesis of these beliefs during a pandemic, including generational, socio-cultural and political characteristics of individuals, and psychological factors such as the desire to preserve one's safety, to maintain a positive self-image, or even to strengthen its social role. However, recent discoveries in cognitive science about belief updating mechanisms offer new insights into the generation of conspiratorial beliefs across time and culture. In this paper, we offer a definition of conspiracy theory and a classification of conspiracy beliefs during the COVID-19 pandemic. We show how the mechanisms of belief updating may explain the genesis of conspiracy theories, and we propose several hypotheses supported by contemporary research in cognitive and social science.
COVID-19 , Humans , Pandemics , Public Health , SARS-CoV-2
Denial of pregnancy is a public health problem due to maternal, fetal, and neonatal morbidity, affecting both physical and mental health. It generally involves an absence of the physical signals associated with pregnancy such as abdominal swelling, amenorrhea, weight gain, or even perception of fetal movements. Despite the potential consequences for mother and child, there is still little data on its clinical features and the neurocognitive mechanisms involved. In this paper, we provide an update on the clinical, socio-demographic, and psychopathological characteristics of pregnancy denial based on contemporary scientific literature. We first define denial of pregnancy by referring to the history of the concept, previous definitions, and nosographic classifications. We then detail the clinic of denial by distinguishing the physical and psychological symptoms of this disorder, then the socio-demographic, gynecological, and psychiatric characteristics. We describe the consequences of denial on the mother, infant, and the dyad, referring to situations of cryptic neonaticide. Finally, we show the importance of perinatal neuroscience research on maternal interoception to understand the mechanisms involved in denial of pregnancy, and improve their medical management in clinical practice.
Denial, Psychological , Infanticide , Child , Female , Humans , Infant , Infant, Newborn , Infanticide/psychology , Mothers/psychology , Parturition , Pregnancy
The question of how the mind works is at the heart of cognitive science. It aims to understand and explain the complex processes underlying perception, decision-making and learning, three fundamental areas of cognition. Bayesian Brain Theory, a computational approach derived from the principles of Predictive Processing (PP), offers a mechanistic and mathematical formulation of these cognitive processes. This theory assumes that the brain encodes beliefs (probabilistic states) to generate predictions about sensory input, then uses prediction errors to update its beliefs. In this paper, we present an introduction to the fundamentals of Bayesian Brain Theory. We show how this innovative theory hybridizes concepts inherited from the philosophy of mind and experimental data from neuroscience, and how it translates complex cognitive processes such as perception, action, emotion, or belief, or even the psychiatric symptomatology.
Brain , Neurosciences , Bayes Theorem , Cognition , Emotions , Humans
BACKGROUND: We report the observation of a 47-year-old woman with functional neurological disorder (tetraparesis, mixed tremors and non-epileptic seizures) treated with a protocol of augmented psychotherapy in combination with repeated transcranial magnetic stimulation (rTMS). INTERVENTION: We carried out a biofeedback psychotherapy protocol with rTMS (twenty sessions, two sessions per day for ten days; 1Hz, 150% of the motor threshold, twenty minute sessions, 300 pulses per session) in which the patient visualized the motor activity of her upper limbs during stimulation of the primary motor area (PMA). The evolution of neurological symptoms was assessed using the Medical Research Council Scale for Muscle Strength (MRC). RESULTS: Symptoms were improved between the 4th and 6th days of treatment (8th and 12th sessions) with first a relief of paresis, then a secondary cascade improvement of other functional symptoms. At two months the patient no longer presented any functional neurological symptoms. DISCUSSION & CONCLUSION: We propose several hypotheses concerning the effectiveness of this type of biofeedback protocol using rTMS. We also suggest that this type of protocol should be systematically associated with psychotherapeutic support on biographical elements for holistic management. This observation underlines the interest of potentiating cognitive-behavioral therapies using the principle of operant conditioning with the aid of brain stimulation in functional neurological disorders, and motivates the realization of future studies.
Conversion Disorder , Transcranial Magnetic Stimulation , Conversion Disorder/therapy , Female , Humans , Middle Aged , Paresis , Psychotherapy , Treatment Outcome
Depressive disorder is characterized by a polymorphic symptomatology associating emotional, cognitive and behavioral disturbances. One of the most specific symptoms is negative beliefs, called congruent to mood. Despite the importance of these beliefs in the development, the maintenance, and the recurrence of depressive episodes, little is known about the processes underlying the generation of depressive beliefs. In this paper, we detail the link between belief updating mechanisms and the genesis of depressive beliefs. We show how depression alters information processing, generating cognitive immunization when processing positive information, affective updating bias related to the valence of belief and prediction error, and difficultie to disengage from negative information. We suggest that disruption of belief-updating mechanisms forms the basis of belief-mood congruence in depression.
Affect , Depressive Disorder , Cognition , Emotions , Humans
Ketamine, a non-competitive NMDA receptor antagonist, is used as a fast-acting antidepressant therapy in depressive disorders. This treatment provokes dissociative effects associating derealization and depersonalization, and a synaptogenic signaling cascade promoting brain plasticity. Despite several preliminary studies suggesting the usefulness of its combination with psychotherapy, administration of ketamine isn't generally combined with per- and post-infusion psychotherapy protocols in its clinical antidepressant use. However, the phenomenology of psychodysleptic experiences and the synaptogenic effect could potentiate cognitive and behavioral therapies (CBT). In this article, we purpose a practical protocol to Ketamine Augmented Psychotherapy (KAP) synthesizing contemporary data from the literature and our clinical experience. We detail proposals for clinical practice, and propose four important steps for the use of a psychodysleptic molecule for antidepressant purposes: preparation, administration, integration, and prolongation. Finally, we discuss the limits and prospects of this combination in the management of mood disorders.
Ketamine , Antidepressive Agents/therapeutic use , Dissociative Disorders , Humans , Ketamine/therapeutic use , Mood Disorders/drug therapy , Psychotherapy/methods
Philosophy of Mind is currently one of the most prolific fields of research in philosophy and has witnessed a progressive hybridization with cognitive science. It focuses on fundamental questions to neuroscience and psychiatry, such as the nature of mental states and cognitive processes, or the relationships between mental states and the world. Anticipating the accumulation of experimental data from neuroscience, it provides a framework for the generation of theories in cognitive science. Philosophy of mind has thus laid the foundations of the conceptual space within which cognitive sciences have spread: a large part of contemporary theories in cognitive science result from a hybridization of conceptions forged by philosophers of mind and data produced by neuroscientists. Yet contemporary psychiatry is still reluctant to feed on the philosophy of mind, other than through the fragments that emerge from neuroscience. In this paper, we describe the evolution of contemporary philosophy of mind, and we detail its contributions around three central themes for psychiatry: naturalization of mind, mental causality, and subjectivity of mental states. We show how philosophy of mind provide the conceptual framework to link different levels of explanation in psychiatry: from biological to functional, from neurophysiology to cognition, from matter to mind.
Neurosciences , Psychiatry , Citizenship , Cognition , Humans , Philosophy
Computational modeling builds mathematical models of cognitive phenomena to simulate patterns of perception, decision-making, and belief updating. These models mathematically represent the information processing by combining an anterior probability distribution, a likelihood function and a set of parameters and hyperparameters. Their use popularized the conception of a nervous system functioning as a predictive machine, or "bayesian brain". Applied to psychiatry, these models seek to explain how psychiatric dysfunction may emerge mechanistically. Despite the significance of emotions for cognitive phenomena and for psychiatric disorders, few computational models offer mathematical representations of emotion or incorporate emotional factors into their modeling parameters. We present here some computational hypotheses for the modeling of affective parameters, and we suggest that computational psychiatry would benefit from these modeling parameters.
Brain , Emotions , Bayes Theorem , Cognition , Humans , Models, Theoretical
The hypothesis of monoaminergic deficiency has long dominated the conceptual framework for the development of new antidepressant strategies, but the limits of conventional antidepressant treatments targeting monoaminergic signaling have motivated the search for new antidepressant pathways. The success of ketamine in the management of depressive disorders has provoked a renewed interest in hallucinogenic substances such as psilocybin targeting the serotonergic signaling 5HT2A and neurosteroid allosteric modulator of γ-aminobutyric acid (GABAA) receptors such as brexanolone. Unlike conventional treatments, these modulators of glutamatergic, serotonergic and GABAergic systems exert a rapid antidepressant effect ranging from 24hours to a week. Apart from their clinical interest and the fantasized search for a "miracle" molecule that jointly meets the expectations of patients and clinicians, these new targets could lead to the identification of potential new biomarkers for the development of rapid-acting antidepressants and redefine therapeutic strategies in mood disorders.
Ketamine , Psychiatry , Antidepressive Agents/therapeutic use , Humans , Ketamine/pharmacology , Ketamine/therapeutic use , Psilocybin/pharmacology , Psilocybin/therapeutic use
Emerging infectious diseases like Covid-19 cause a major threat to global health. When confronted with new pathogens, individuals generate several beliefs about the epidemic phenomenon. Many studies have shown that individual protective behaviors largely depend on these beliefs. Due to the absence of treatment and vaccine against these emerging pathogens, the relation between these beliefs and these behaviors represents a crucial issue for public health policies. In the premises of the Covid-19 pandemic, several preliminary studies have highlighted a delay in the perception of risk by individuals, which potentially holds back the implementing of the necessary precautionary measures: people underestimated the risks associated with the virus, and therefore also the importance of complying with sanitary guidelines. During the peak of the pandemic, the salience of the threat and of the risk of mortality could then have transformed the way people generate their beliefs. This potentially leads to upheavals in the way they understand the world. Here, we propose to explore the evolution of beliefs and behaviors during the Covid-19 crisis, using the theory of predictive coding and the theory of terror management, two influential frameworks in cognitive science and in social psychology.
Betacoronavirus , Brain/physiology , Coronavirus Infections/psychology , Culture , Fear/psychology , Health Behavior , Pandemics , Pneumonia, Viral/psychology , Adaptation, Psychological , Attitude to Health , COVID-19 , Communicable Disease Control , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Denial, Psychological , Guideline Adherence , Guidelines as Topic , Health Risk Behaviors , Humans , Hygiene , Models, Psychological , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Protective Devices , Risk Management , Risk Reduction Behavior , SARS-CoV-2 , Universal Precautions
