Natural language processing of multi-hospital electronic health records for public health surveillance of suicidality.

There is an urgent need to monitor the mental health of large populations, especially during crises such as the COVID-19 pandemic, to timely identify the most at-risk subgroups and to design targeted prevention campaigns. We therefore developed and validated surveillance indicators related to suicidality: the monthly number of hospitalisations caused by suicide attempts and the prevalence among them of five known risks factors. They were automatically computed analysing the electronic health records of fifteen university hospitals of the Paris area, France, using natural language processing algorithms based on artificial intelligence. We evaluated the relevance of these indicators conducting a retrospective cohort study. Considering 2,911,920 records contained in a common data warehouse, we tested for changes after the pandemic outbreak in the slope of the monthly number of suicide attempts by conducting an interrupted time-series analysis. We segmented the assessment time in two sub-periods: before (August 1, 2017, to February 29, 2020) and during (March 1, 2020, to June 31, 2022) the COVID-19 pandemic. We detected 14,023 hospitalisations caused by suicide attempts. Their monthly number accelerated after the COVID-19 outbreak with an estimated trend variation reaching 3.7 (95%CI 2.1-5.3), mainly driven by an increase among girls aged 8-17 (trend variation 1.8, 95%CI 1.2-2.5). After the pandemic outbreak, acts of domestic, physical and sexual violence were more often reported (prevalence ratios: 1.3, 95%CI 1.16-1.48; 1.3, 95%CI 1.10-1.64 and 1.7, 95%CI 1.48-1.98), fewer patients died (p = 0.007) and stays were shorter (p < 0.001). Our study demonstrates that textual clinical data collected in multiple hospitals can be jointly analysed to compute timely indicators describing mental health conditions of populations. Our findings also highlight the need to better take into account the violence imposed on women, especially at early ages and in the aftermath of the COVID-19 pandemic.

Psychotropic Medication Prescribing for Children and Adolescents After the Onset of the COVID-19 Pandemic.

Importance: Numerous studies have provided evidence for the negative associations of the COVID-19 pandemic with mental health, but data on the use of psychotropic medication in children and adolescents after the onset of the COVID-19 pandemic are lacking. Objective: To assess the rates and trends of psychotropic medication prescribing before and over the 2 years after the onset of the COVID-19 pandemic in children and adolescents in France. Design, Setting, and Participants: This cross-sectional study used nationwide interrupted time-series analysis of outpatient drug dispensing data from the IQVIA X-ponent database. All 8 839 143 psychotropic medication prescriptions dispensed to children (6 to 11 years of age) and adolescents (12 to 17 years of age) between January 2016 and May 2022 in France were retrieved and analyzed. Exposure: Onset of COVID-19 pandemic. Main outcomes and Measures: Monthly rates of psychotropic medication prescriptions per 1000 children and adolescents were analyzed using a quasi-Poisson regression before and after the pandemic onset (March 2020), and percentage changes in rates and trends were assessed. After the pandemic onset, rate ratios (RRs) were calculated between estimated and expected monthly prescription rates. Analyses were stratified by psychotropic medication class (antipsychotic, anxiolytic, hypnotic and sedative, antidepressant, and psychostimulant) and age group (children, adolescents). Results: In total, 8 839 143 psychotropic medication prescriptions were analyzed, 5 884 819 [66.6%] for adolescents and 2 954 324 [33.4%] for children. In January 2016, the estimated rate of monthly psychotropic medication prescriptions was 9.9 per 1000 children and adolescents, with the prepandemic rate increasing by 0.4% per month (95% CI, 0.3%-0.4%). In March 2020, the monthly prescription rate dropped by 11.5% (95% CI, -17.7% to -4.9%). During the 2 years following the pandemic onset, the trend changed significantly, and the prescription rate increased by 1.3% per month (95% CI, 1.2%-1.5%), reaching 16.1 per 1000 children and adolescents in May 2022. Monthly rates of psychotropic medication prescriptions exceeded the expected rates by 11% (RR, 1.11 [95% CI, 1.08-1.14]). Increases in prescribing trends were observed for all psychotropic medication classes after the pandemic onset but were substantial for anxiolytics, hypnotics and sedatives, and antidepressants. Prescription rates rose above those expected for all psychotropic medication classes except psychostimulants (RR, 1.12 [95% CI, 1.09-1.15] in adolescents and 1.06 [95% CI, 1.05-1.07] in children for antipsychotics; RR, 1.30 [95% CI, 1.25-1.35] in adolescents and 1.11 [95% CI, 1.09-1.12] in children for anxiolytics; RR, 2.50 [95% CI, 2.23-2.77] in adolescents and 1.40 [95% CI, 1.30-1.50] in children for hypnotics and sedatives; RR, 1.38 [95% CI, 1.29-1.47] in adolescents and 1.23 [95% CI, 1.20-1.25] in children for antidepressants; and RR, 0.97 [95% CI, 0.95-0.98] in adolescents and 1.02 [95% CI, 1.00-1.04] in children for psychostimulants). Changes were more pronounced among adolescents than children. Conclusions and Relevance: These findings suggest that prescribing of psychotropic medications for children and adolescents in France significantly and persistently increased after the COVID-19 pandemic onset. Future research should identify underlying determinants to improve psychological trajectories in young people.

Juvenile neuropsychiatric systemic lupus erythematosus: A specific clinical phenotype and proposal of a probability score.

OBJECTIVE: Juvenile systemic lupus erythematosus (j-SLE) is a rare chronic auto-immune disease involving several organs. Neuropsychiatric (NP) SLE (NPSLE) is frequent in j-SLE and associated with increased morbidity/mortality. Although NPSLE classification criteria exist, attributing NP features to j-SLE remains a major challenge. The study objective is to thoroughly describe j-NPSLE patients and assist in their diagnosis. METHODS: This is a 4-year retrospective monocentric study of j-SLE patients. NP events were attributed to j-SLE using standardised diagnostic criteria and multidisciplinary paediatric clinical expertise. Clinical features, brain magnetic resonance imaging (MRI)s and samples analysis including cerebrospinal fluid were assessed. A risk of j-NPSLE score was developed based on multivariable logistic regression analysis. RESULTS: Of 39 patients included, 44% were identified as having j-NPSLE. J-NPSLE diagnosis was established at the onset of j-SLE in 59% of patients. In addition to frequent kidney involvement (76%) and chilblains (65%), all j-NPSLE patients displayed psychiatric features: cognitive symptoms (82%), hallucinations (76%), depressed mood (35%), acute confused state (18%) and catatonia (12%). Neurological involvement was often mild and nonspecific, with headache (53%) in about half of the patients. The main features reported on brain MRI were nonspecific T2/FLAIR white matter hyperintensities (65%), and cerebral atrophy (88%). Upon immunosuppressive treatment, clinical improvement of NP features was observed in all j-NPSLE patients. The score developed to attribute j-NPSLE probability, guide further investigations and appropriate treatments is based on hallucinations, memory, sleep and renal involvement (Sensitivity: 0.95 Specificity: 0.85). Cerebrospinal fluid (CSF) neopterin assessment increases the score sensitivity and specificity. CONCLUSION: Physicians should carefully and systematically assess the presence of NP features at diagnosis and early stages of j-SLE. For j-NPSLE patients with predominant psychiatric features, a multidisciplinary collaboration, including psychiatrists, is essential for the diagnosis, management and follow-up.

Early-onset restrictive food intake disorders in children: a latent class analysis.

The two most frequent early-onset restrictive food intake disorders are early-onset anorexia nervosa (EOAN) and avoidant/restrictive food intake disorders (ARFID). Although the core symptoms of EOAN (i.e., fear of gaining weight and disturbed body image) are not present in ARFID, these symptoms are difficult to assess during the initial phase of hospitalisation. Our aim was  to identify restrictive food intake disorder subtypes in children using latent class analysis (LCA) based on the information available at admission to hospital, and to determine the agreement between the subtypes identified using LCA and the final diagnosis: EOAN or ARFID. We retrospectively included 97 children under 13 years old with severe eating disorders (DSM-5) at their first hospitalisation in a specialised French paediatric unit. LCA was based on clinical information, growth chart analyses and socio-demographic parameters available at admission. We then compared the probabilities of latent class membership with the diagnosis (EOAN or ARFID) made at the end of the hospitalisation. The most parsimonious LCA model was a 2-class solution. Children diagnosed with EOAN at the end of hospitalisation had a 100% probability of belonging to class 1 while children diagnosed with ARFID had an 8% probability of belonging to class 1 based on parameters available at admission. Our results indicate that clinical and socio-demographic characteristics other than the core symptoms of EOAN may be discriminating for a differential diagnosis.

Emotional and behavioral changes in French children during the COVID-19 pandemic: a retrospective study.

COVID-19 outbreak caused severe disruptions in daily life, partly due to limitations implemented to prevent the spreading. In France, it included school closures during a national lockdown, then a reopening of schools, with access depending on viral status of students and teachers. Those changes had an impact on children's mental health. We conducted an online cross-sectional study using a parental self-administered survey in December 2021 to explore the emotional and behavioral changes (EBC) during this 5th wave (W5) and retrospectively since the first one (W1) in their children and their multidimensionality with principal factor analysis (PCA) and stability analysis. Out of 4552 parent responders, 62.4% (n = 2839) noticed negative EBC during W1 and 54.1% (n = 2462) during W5 of the pandemic. Only 10.0% of the responders noticed negative EBC at W1 but not during the W5. In younger children (3-6 years old) with significant EBC, PCA revealed three main dimensions at W1 and W5: restlessness, depression and anxiety. In older children (7-13 years old), PCA showed partially similar dimensions: depression-suicidality, anxiety and withdrawal. Almost all correlations between dimensions at W1 and W5 were significantly positive. Every EBC was stable across waves, except for one. Recall bias concerning the EBC during W1 and lack of data concerning parental mental health should be taken into account. Our stability analysis found a strong correlation between dimensions at W1 and W5. Our results highlighted the impact of the COVID-19 outbreak on children's mental health and the predictive aspect of its early deterioration.

Juvenile Neuropsychiatric Systemic Lupus Erythematosus: Identification of Novel Central Neuroinflammation Biomarkers.

INTRODUCTION: Juvenile systemic lupus erythematosus (j-SLE) is a rare chronic autoimmune disease affecting multiple organs. Ranging from minor features, such as headache or mild cognitive impairment, to serious and life-threatening presentations, j-neuropsychiatric SLE (j-NPSLE) is a therapeutic challenge. Thus, the diagnosis of NPSLE remains difficult, especially in pediatrics, with no specific biomarker of the disease yet validated. OBJECTIVES: To identify central nervous system (CNS) disease biomarkers of j-NPSLE. METHODS: A 5-year retrospective tertiary reference monocentric j-SLE study. A combination of standardized diagnostic criteria and multidisciplinary pediatric clinical expertise was combined to attribute NP involvement in the context of j-SLE. Neopterin and interferon-alpha (IFN-α) protein levels in cerebrospinal fluid (CSF) were assessed, together with routine biological and radiological investigations. RESULTS: Among 51 patients with j-SLE included, 39% presented with j-NPSLE. J-NPSLE was diagnosed at onset of j-SLE in 65% of patients. No specific routine biological or radiological marker of j-NPSLE was identified. However, CSF neopterin levels were significantly higher in active j-NPSLE with CNS involvement than in j-SLE alone (p = 0.0008). Neopterin and IFN-α protein levels in CSF were significantly higher at diagnosis of j-NPSLE with CNS involvement than after resolution of NP features (respectively p = 0.0015 and p = 0.0010) upon immunosuppressive treatment in all patients tested (n = 10). Both biomarkers correlated strongly with each other (Rs = 0.832, p < 0.0001, n = 23 paired samples). CONCLUSION: CSF IFN-α and neopterin constitute promising biomarkers useful in the diagnosis and monitoring of activity in j-NPSLE.

Is SARS-CoV-2 seroconversion a risk factor for severe and acute psychiatric symptoms in children?

AIMS: Since the beginning of the COVID pandemic, studies reported an increase in children's mental health issues and questioned the impact of SARS-CoV-2 on psychiatric symptoms. METHODS: We compared COVID seroconversion in children hospitalized with acute, severe psychiatric symptoms (n = 52) with the sex- and age-matched control group (n = 52) living in the same low-income geographic area and sampled during the same time period. RESULTS: Contrary to our hypothesis, we observed less seroconverted children with psychiatric conditions 9.61% (95% CI, 3.59-21.80) vs 34.61% (95% CI, 22.33-49.16; χ2  = 14.7, P = 1.24E-4; OR = 0.20; 95% CI, 0.05-0.64). CONCLUSION: This suggests a lower direct impact of SARS-CoV-2 compared with the impact of mitigation strategies on psychiatric symptom deterioration in children reported since early stages of the pandemic.

[Impacts of the covid-19 pandemic on children and adolescents]. / Impacts de la pandémie de Covid-19 sur les enfants et adolescents.

IMPACTS OF THE COVID-19 PANDEMIC ON CHILDREN AND ADOLESCENTS. The Covid-19 pandemic and the lockdown measures taken to limit the spread of the virus have caused significant changes in the daily lives of the whole population including children and adolescents. School closure and physical distancing significantly interfere with their learning and social life deeply impacting their health and education. The most vulnerable children (personal history of mental health or neurodevelopmental disorders, chronic physical illness) were also those the most significantly affected by the Sars-CoV-2 pandemic. However, data remains scarce today, and it remains a major challenge to conduct longitudinal studies that will enable the development of primary prevention programs in the general population and secondary prevention programs in already affected children.

RÉSUMÉ IMPACTS DE LA PANDÉMIE DE COVID-19 SUR LES ENFANTS ET ADOLESCENTS. L'épidémie de Covid-19 et les mesures prises pour limiter la propagation du virus ont provoqué des modifications importantes dans la vie quotidienne des enfants et adolescents ainsi que de leur famille. Ces changements, avec notamment les fermetures itératives des écoles et la distanciation physique, ont eu un impact sur la santé mentale des enfants et des adolescents ainsi que sur leur scolarité et leurs apprentissages. Des conséquences plus importantes ont été mises en évidence chez les enfants les plus vulnérables, notamment ceux porteurs d'un trouble du neurodéveloppement ou d'un trouble psychiatrique. Les données restent cependant aujourd'hui peu nombreuses, et il est donc important de conduire des études longitudinales permettant d'établir des programmes de prévention primaire en population générale et secondaire au sein des populations les plus vulnérables.

Regulatory T lymphocytes/Th17 lymphocytes imbalance in autism spectrum disorders: evidence from a meta-analysis.

BACKGROUND: Immune system dysfunction has been proposed to play a critical role in the pathophysiology of autism spectrum disorders (ASD). Conflicting reports of lymphocyte subpopulation abnormalities have been described in numerous studies of patients with ASD. To better define lymphocytes abnormalities in ASD, we performed a meta-analysis of the lymphocyte profiles from subjects with ASD. METHODS: We used the PRISMA recommendations to query PubMed, Embase, PsychoINFO, BIOSIS, Science Direct, Cochrane CENTRAL, and Clinicaltrials.gov for terms related to clinical diagnosis of ASD and to lymphocytes' populations. We selected studies exploring lymphocyte subpopulations in children with ASD. The search protocol has been registered in the international Prospective Register of Systematic Reviews (CRD42019121473). RESULTS: We selected 13 studies gathering 388 ASD patients and 326 healthy controls. A significant decrease in the CD4+ lymphocyte was found in ASD patients compared to controls [- 1.51 (95% CI - 2.99; - 0.04) p = 0.04] (I2 = 96% [95% CI 94.6, 97.7], p < 0.01). No significant difference was found for the CD8+ T, B and natural killer lymphocytes. Considering the CD4+ subpopulation, there was a significant decrease in regulatory T lymphocytes (Tregs) in ASD patients (n = 114) compared to controls (n = 107) [- 3.09 (95% CI - 4.41; - 1.76) p = 0.0001]; (I2 = 90.9%, [95% CI 76.2, 96.5], p < 0.0001) associated with an increase oin the Th17 lymphocytes (ASD; n = 147 controls; n = 128) [2.23 (95% CI 0.79; 3.66) p = 0,002] (I2 = 95.1% [95% CI 90.4, 97.5], p < 0.0001). LIMITATIONS: Several factors inducing heterogeneity should be considered. First, differences in the staining method may be responsible for a part in the heterogeneity of results. Second, ASD population is also by itself heterogeneous, underlying the need of studying sub-groups that are more homogeneous. CONCLUSION: Our meta-analysis indicates defects in CD4+ lymphocytes, specifically decrease oin Tregs and increase in Th17 in ASD patients and supports the development of targeted immunotherapies in the field of ASD.

[Child disruptive behaviors at school]. / Comportements perturbateurs de l'enfant à l'école.

Child disruptive behaviors at school. Disruptive behaviors at school are a common reason of medical consultation. Being able to cope with it constitute a major challenge for teachers and parents. We summarize the key steps of the clinical examination of children with disruptive behaviors at school. These behaviors may indicate a psychiatric disorder. We also describe the treatments for disruptive behavior disorders in children, particularly interventions based on positive reinforcement of desired behaviors. Other specific pharmacological or nonpharmacological treatments are relevant in the context of psychiatric disorders, particularly psychoeducation.

Comportements perturbateurs de l'enfant à l'école. Les comportements perturbateurs de l'enfant à l'école constituent un motif fréquent de consultation en médecine. Savoir les gérer est un enjeu éducatif et pédagogique majeur pour les parents comme pour les professeurs. Nous proposons ici une conduite à tenir pour l'exploration clinique des comportements perturbateurs en milieu scolaire. En effet, ces comportements peuvent s'inscrire dans le cadre d'un trouble psychiatrique de l'enfant. Nous décrivons aussi la prise en charge des comportements perturbateurs. Celle-ci est principalement fondée sur les interventions comportementales qui visent à augmenter des comportements favorables en milieu scolaire par la mise en place de système de récompenses de l'enfant. D'autres interventions plus spécifiques, pharmacologiques ou non pharmacologiques, sont indiquées si un trouble psychiatrique a été diagnostiqué, notamment les interventions de psychoéducation.

Immune Activation and Deficit in Neurotransmitters Synthesis in Treatment Resistant Depression: About a Case of Hashimoto Encephalopathy.

We report a case of Hashimoto encephalopathy initially presented as a drug-resistant depression with predominant apathy and asthenia, successfully treated with cyclophosphamide. We suspected that the psychiatric symptoms were due to a deficit in neurotransmitter synthesis related to immune activation. We hypothesized that the immunomodulatory treatment helped to restore the neurotransmitter synthesis and thus decreased the patient's depressive symptoms. In this case report we propose an innovative model in which immunity might disturbs neurotransmitters synthesis leading to depressive symptoms.