[Psychiatric dimensions of post-COVID-19 condition : an overview]. / Dimensions psychiatriques de l'affection post-Covid-19 : état des lieux.

In the aftermath of the SARS-CoV-2 pandemic, many patients developed a set of persistent and disabling symptoms, commonly referred to as "long COVID" and defined as "post-COVID-19 condition" by the World Health Organization. The multi-systemic impairments caused by this condition include neuropsychiatric symptoms characterized by the presence of fatigue, cognitive and sleep disturbances, and increased rates of mood and anxiety disorders. Despite their high incidence and a significant risk of chronicity, they remain poorly understood. This article provides an overview of the psychiatric aspects of post-COVID-19 condition and their treatment.

Au décours de la pandémie de SARS-CoV-2 sont apparus chez de nombreux patients un ensemble de symptômes persistants et invalidants, communément appelé « Covid long ¼ et défini comme « affection post-Covid-19 ¼ par l'OMS. Les atteintes multisystémiques provoquées par cette affection comprennent des symptômes neuropsychiatriques caractérisés, notamment une fatigue, des troubles cognitifs et des taux élevés de troubles de l'humeur et anxieux. Malgré leur incidence élevée et un risque important de chronicité, ils restent mal connus. Cet article propose une synthèse et une mise à jour des connaissances au sujet des dimensions psychiatriques de l'affection post-Covid-19 et de leurs prises en charge.

Depersonalization- and derealization-like phenomena of epileptic origin.

OBJECTIVE: Depersonalization refers to the sensation of being detached from one's body, often associated with feelings of loss of control over one's own body, actions, or thoughts. Derealization refers to the altered perception of one's surroundings that is experienced as unreal. Although usually reported by psychiatric patients suffering from depression or anxiety, single case reports and small case series have described depersonalization- and derealization-like symptoms in the context of epilepsy. METHODS: We investigated the brain mechanisms of ictal depersonalization- and derealization like symptoms by analyzing clinical and neuropsychological data as well as the epileptogenic zone based on a multimodal approach in a group of patients reporting depersonalization- (n = 9) and derealization-like symptoms (n = 7), from a single presurgical epilepsy center with focal epilepsy. We compared them with a group of control patients with experiential phenomena due to temporal lobe epilepsy (n = 28). RESULTS: We show that all patients with ictal depersonalization-like symptoms report altered self-identification with their body and mostly suffer from frontal lobe epilepsy with the epileptogenic zone in the dorsal premotor cortex, while patients with derealization-like symptoms suffer from temporal lobe epilepsy. This finding is supported by post-ictal neuropsychological deficits, showing that depersonalization-like symptoms were significantly more often associated with frontal lobe dysfunction as compared to the control patients and patients with derealization-like symptoms. CONCLUSION: We argue that depersonalization of epileptic origin constitutes a distinct disorder due to frontal lobe epilepsy. We discuss these findings with respect to earlier accounts of depersonalization and the recent concept of bodily self-consciousness.

Are French orthopedic and trauma surgeons affected by burnout? Results of a nationwide survey.

INTRODUCTION: Burnout is a pathology that can affect care-giving professionals. It associates emotional exhaustion (EE), depersonalization (DP) and impaired personal accomplishment (PA). Surgery entails great responsibility and frequently heavy workloads, incurring risk of burnout. Data, however, are not available for French orthopedic and trauma surgeons. We therefore conducted a prospective survey to 1) assess burnout prevalence in French orthopedic surgeons, and 2) investigate risk factors and protective factors. HYPOTHESIS: Burnout prevalence is at least as high in French orthopedic surgeons as in other medical and surgical specialties. MATERIALS AND METHODS: A nationwide survey was conducted in France between February and April 2017, using a digitized questionnaire sent out by e-mail. Burnout was assessed on the MBI (Maslach Burnout Inventory), and depressive symptoms on the GHQ-12 (General Health Questionnaire-12). Demographic and occupational data were also collected. RESULTS: Out of 1,900 surgeons contacted, 441 (23%) responded. Mean age was 50.2±10.1 years; 413 (93.7%) were male. Sixty one (14%) reported elevated EE, 100 (23%) elevated DP, and 82 (19%) impaired AP. One hundred and seventy two (39%) showed burnout symptomatology (e.g., pathologic score on one MBI scale), while 47 (10%) had pathologic scores on 2 or 3 scales, indicating severe burnout. One hundred and ninety three (43%) would not advise their children to take up orthopedic surgery. Thirty eight (8%) expressed suicidal ideation. Statistical analysis identified public-sector practice (OR=4.6; 95% CI: 2.1-10.7; p=0.0002) and pathologic GHQ-12 score (OR=6.3; 95% CI: 2.2-17.8; p=0.0006) as risk factors for burnout. Outside activity (OR=0.39; 95% CI: 0.1-0.9; p=0.0406) and male gender (OR=0.2; 95% CI: 0.05-0.7; p=0.0160) emerged as protective factors. DISCUSSION: Despite a response rate of only 23% (n=441/1,900), the present study sheds light on burnout rates in French orthopedic surgeons, with 39% burnout symptoms and 10% severe burnout. Burnout impacts personal and occupational life, with increased suicidal ideation and impaired quality of life. The present results confirm the importance of screening and treatment in care-providers. TYPE OF STUDY: Level IV, prospective descriptive transverse study without control group.

Cardio-visual full body illusion alters bodily self-consciousness and tactile processing in somatosensory cortex.

Prominent theories highlight the importance of bodily perception for self-consciousness, but it is currently not known whether this is based on interoceptive or exteroceptive signals or on integrated signals from these anatomically distinct systems, nor where in the brain such integration might occur. To investigate this, we measured brain activity during the recently described 'cardio-visual full body illusion' which combines interoceptive and exteroceptive signals, by providing participants with visual exteroceptive information about their heartbeat in the form of a periodically illuminated silhouette outlining a video image of the participant's body and flashing in synchrony with their heartbeat. We found, as also reported previously, that synchronous cardio-visual signals increased self-identification with the virtual body. Here we further investigated whether experimental changes in self-consciousness during this illusion are accompanied by activity changes in somatosensory cortex by recording somatosensory evoked potentials (SEPs). We show that a late somatosensory evoked potential component (P45) reflects the illusory self-identification with a virtual body. These data demonstrate that interoceptive and exteroceptive signals can be combined to modulate activity in parietal somatosensory cortex.

Lateralising value of experiential hallucinations in temporal lobe epilepsy.

OBJECTIVES: Ever since John Hughlings Jackson first described the so-called 'dreamy state' during temporal lobe epilepsy, that is, the sense of an abnormal familiarity (déjà vu) or vivid memory-like hallucinations from the past (experiential hallucinations), these phenomena have been studied and repeatedly linked to mesial temporal lobe structures. However, little is known about the lateralising value of either déjà vu or experiential hallucinations. METHODS: We analysed a sample of 28 patients with intractable focal epilepsy suffering from either déjà vu or experiential hallucinations. All the patients underwent thorough presurgical examination, including MRI, positron emission tomography, single-photon emission CT, EEG and neuropsychological examination. RESULTS: While déjà vu was due to right or left mesial temporal lobe epilepsy, experiential hallucinations were strongly lateralised to the left mesial temporal lobe. Moreover, there was a significant effect for interictal language deficits being more frequent in patients suffering from experiential hallucinations. CONCLUSIONS: These results suggest a lateralising value for experiential hallucinations to the left temporal lobe.

Turning body and self inside out: visualized heartbeats alter bodily self-consciousness and tactile perception.

Prominent theories highlight the importance of bodily perception for self-consciousness, but it is currently not known whether bodily perception is based on interoceptive or exteroceptive signals or on integrated signals from these anatomically distinct systems. In the research reported here, we combined both types of signals by surreptitiously providing participants with visual exteroceptive information about their heartbeat: A real-time video image of a periodically illuminated silhouette outlined participants' (projected, "virtual") bodies and flashed in synchrony with their heartbeats. We investigated whether these "cardio-visual" signals could modulate bodily self-consciousness and tactile perception. We report two main findings. First, synchronous cardio-visual signals increased self-identification with and self-location toward the virtual body, and second, they altered the perception of tactile stimuli applied to participants' backs so that touch was mislocalized toward the virtual body. We argue that the integration of signals from the inside and the outside of the human body is a fundamental neurobiological process underlying self-consciousness.