Is Anorexia Truly a Contemporary Disease?

BACKGROUND: Anorexia nervosa (AN) is reported to be on the rise. However, instances of fasting have been noted since antiquity. Can modern diagnoses be applied to circumstances very different from our own? Is there a continuum of symptoms whose meanings have evolved over centuries, or is AN a recent development? SUBJECTS AND METHODS: A literature review was conducted. Twelve articles were found to be pertinent to the study, including several by Jacques Maître, who also published a book on the subject that was utilized. RESULTS: Few instances of fasting and no deaths from AN are reported in Western antiquity. With the advent of Christianity, prolonged fasting appears in the West. From the 12thcentury onwards, food deprivation becomes significant in women's spiritual lives, reaching a peak in inedia until the Renaissance. In 1873, Lasègue and Gull published a medical description of AN. Thereafter, AN fluctuated between being a distinct pathology and a symptom of another syndrome. Long considered a hysterical symptom, Freud initiated a shift toward sexual causality. In 1914, hypophyseal atrophy was considered a cause but was later forgotten. World War II did not produce instances of AN; food refusal has meaning only when food is abundant. During times of imposed famine, women's roles in food management and corpulence are valorized. In the 1960s, attention shifted to body image and an inability to cope with pubertal changes. Today, Russell describes a change in patient profiles with increased fear of weight gain and reduced fear of sexualization. CONCLUSION: Two opposing theses emerge. On one hand, it is argued that mystical fasts and AN cannot be linked and that AN is a recent disorder. Modern society subjects us to greater social pressures, forcing women to deny their biological roles in pursuit of thinness. On the other hand, AN is considered the heir to mystical fasting, as part of women's attempts to escape societal roles. Hagiographic descriptions and psychoanalytic studies that highlight the unconscious dynamics between mother-daughter relationships and pubertal difficulties support this view.

Microbiota Diversity and Inflammation as a New Target to Improve Mood: Probiotic Use in Depressive Disorder.

BACKGROUND: There is a lot of evidence for a bidirectional communication between the gut and brain. Dysbiosis and increase intestinal permeability may lead to a systemic low-grade inflammatory response or various neuroactive bacterial metabolite may cross gut barrier. Pro-inflammatory cytokines or bacterial metabolites such as short-chain fatty acid (SCFA) are known to pass through blood brain barrier and altered neurotransmitter metabolism or increase production of neurotoxic pathways. In this review we hypothesized that restoring the gut microbiota ecosystem could improve mental disorders. We reviewed literature for human evidence proving clinical relevance of probiotics intake in mental disorders. SUBJECTS AND METHODS: We searched literature with keywords "depression" or "major depressive disorder" and "probiotic". We selected randomized control trial and we considered having both outcomes concerning impact on depressive symptoms but also on inflammation biomarkers, microbiota composition, cerebral nervous system or cognition. RESULTS: Seven out of fourteen randomized control trial reported significant improvement on depressive symptoms in patients taking probiotics. Besides improvement in depressive symptoms, we found decrease in inflammatory markers such as IL-6, decrease in serum kynurenine level, changes in microbiota diversity and abundance of species correlated to depressive disorder and higher cognitive performance. CONCLUSIONS: Probiotic seems to be secure and more effective on depression when used in supplement to usual antidepressant and in mild to moderate depression. We highlighted positive impact on vulnerability factors prevent further worsening. Probiotics could have anti-inflammatory effect acting on inflammatory markers well known to have a role on pathogenesis of depression. A strong correlation between neuroactive metabolites and a relative abundance of microbiota bacterial species underlined importance to consider the gut-brain axis in mental disorders.

Difficulties in Combining Somatic and Psychiatric Care in Psychogeriatry.

BACKGROUND: This article attempts to understand the difficulties encountered in the articulation of health care, particularly between the organic and psychiatric aspects. It also aims to provide solutions to these collaboration issues. METHODS: We realized a literature review based on articles dated from 2002 to 2021 and selected from following databases: Pubmed, Cochrane, Scopus, Cairn, Psychinfo and Google. Used key words are "aging, multidisciplinarity, psychiatric stigma, impotence, efficiency". RESULTS: Medical staff may encounter different problems in terms of care, faced to psychogeriatricpatients.These are both related to the medical aspect, including the difficulty of establishing a clear diagnosis in the face of a complex medical situation,clinical unknownledge, multiplication of intervenants with loss of centralisation in terms of care, etc. Added to this, is the organization of health care, which is increasingly specialized and restrictive in terms of hospitalization criteria. Finally to this, is the relational experience of the caregiver, both in relation to the patient and his disorders, and to their colleagues. CONCLUSION: In the era of the advent of medicinal progress and the advance of diagnostic and therapeutic techniques, it seems mandatory to place the human being at the center of our care. Interhuman interactions constituting the basis of medical care especially in terms of transdisciplinary collaboration. This last point could lead to cost reduction, a more efficient diagnostic and therapeutic management. It seems to be mandatory to reinforce our health care politics in order to time and importance to these various essential and fundamental relational issues.

How Psychiatrists' Beliefs on Free Will Influence Their Clinical Practice.

BACKROUND: Literature suggests that most people believe in free will and that this belief is associated with more prosocial behavior. However, with the advent of neuroscience, free will seems to have been progressively excluded from psychiatry. This paper is a narrative literature review of the ways in which mental health professionals' premises and beliefs in free will influence their clinical practice. METHODS: The Scopus database was searched for papers concerning free will and psychiatric practice, 24 papers were included. This review looks at explicit links made by authors between free will and clinical practice as well as logical threads linking a premise of free will to clinical implications. RESULTS: The results suggest that belief in free will leads to trying to strengthen free will in patients. It also appears to be associated with using meaning in psychotherapy, with self-blame in patients, and with ethical questions such as involuntary psychiatric care and assisted suicide requests. Some authors believe the concept of free will should be discarded to make place for concepts such as autonomy, agency, decision-making capacity and self-control. CONCLUSION: While definitional ambiguity and paucity of data are limiting, the results indicate that mental health professionals' beliefs concerning free will can influence their clinical practice. Concepts such as autonomy and agency can sometimes hide psychiatrists' underlying beliefs. Increasing mental health professionals' awareness of their beliefs could be beneficial for psychiatric care.

COVID, the Main Cause of Mysery of Teenager? Retrospective Study of Hospitalizations of 15-25 in Psychosomatics (2018-2022).

BACKGROUND: Since the outbreak of COVID-19, there has been an apparent increase in the utilization of mental health services and psychiatric disorders among youth. However, there is little data on youth mental health prior to the pandemic. Some authors suggest that the increase in the use of psychiatric care started before. Are we facing a recent phenomenon initiated by the pandemic that will disappear with it, or did it highlight an older issue? Have the profiles of the young people and the care provided changed since the pandemic? SUBJECTS AND METHODS: Retrospective study of the hospitalization records of patients aged 15 to 25. The inclusion period extends from January 1, 2018, to December 31, 2022. RESULTS: There was an increase in the number of young people hospitalized from September 2020 to February 2021, suggesting a delayed effect of Covid's impact. 44% of young people were hospitalized through emergency services, number that has increased. There has been an increase in prior psychiatric care and hospitalizations among patients hospitalized since the beginning of the pandemic. 49% attribute their condition to family issues. Upon discharge, many patients were on medication, but there has been no significant change in prescriptions since the pandemic began. The majority of patients were referred to their primary care physician, psychologist, and psychiatrist, which has not changed since the pandemic began. CONCLUSIONS: Apart from the increase in hospitalizations, the rest of the practices within the institution has remained unchanged, suggesting that there are few differences in issues brought by patients since the start of the pandemic. Difficulties related to the family environment remain the primary reason for hospitalization requests. We do not have clear evidence of a worsening situation, which tends to support the hypothesis that COVID-19 has been a catalyst for a pre-existing state.

Alcohol Use Disorder in a University General Hospital: a Four-Year Observational Study of Liaison Psychiatry.

BACKGROUND: Alcohol use disorder is insufficiently treated because it is poorly detected. Improved screening in general hospitals is a major issue in treatment organisation. SUBJECT AND METHOD: Through a retrospective exploratory study based on a review of medical records over four years (2016-19) before the COVID pandemic, we recorded the number of liaison psychiatric referrals for alcohol use disorder and identified two indicators: follow-up care implemented and survival at three years. RESULTS: Subject to the limitations of a retrospective review of medical records, we observed that 136 of 859 referrals concerned an alcohol use disorder. At three years, 25% (34 patients) had died. The causes of death were analysed, which revealed that 65% were directly attributable to alcohol consumption. Ongoing follow-up care was documented for only 17% (15 patients) of the 136 referred patients. Twelve patients who were followed up (80%) were in remission at one year. CONCLUSION: Although the results showed the efficacy of psychiatric follow-up care, the low recruitment of patients receiving regular follow-up care confirmed the problem of access to treatment. Our results support the need for screening and earlier intervention in general hospitals by raising awareness and training all doctors, but also by reflecting on new methods of liaison psychiatry treatment.

Patient's Expectations Regarding Alcohol Misuse Prevention in General Hospitals.

BACKGROUND: The general hospital can be regarded as a suitable place to provide secondary prevention for patients with alcohol misuse. It appears that screening and/or brief interventions on alcohol are acceptable for patients in hospital wards. The aim of this exploration study is to assess patients' expectations regarding the prevention of alcohol misuse carried out in general hospitals. METHOD: This study is based on the results of an online survey conducted in February 2023. The survey was in free access on the CHU UCL Namur hospital's website. RESULTS: Only the alcohol consumption of 18.9% of our sample is usually assessed by hospital caregivers; however, we observe a high level of satisfaction with receiving information on the prevention of alcohol misuse. Among the proposed prevention interventions, screening feedback seems to be the most popular approach. CONCLUSION: This study confirms the recommendations on the role of the general hospital in the prevention of alcohol misuse. The big challenge remains to understand why the level of screening for alcohol misuse in general hospitals is so low. Future studies should assess the determinants of alcohol abuse screening behaviors among caregivers to understand why the screening rate is so low.

Towards a Vulnerability Model for Major Depressive Episodes.

BACKGROUND: While many studies have investigated depression risk factors, few attempts have been made to weight, and compare them. Therefore, we conducted a prospective comparison of a sample of subjects suffering from major depressive disorder and a group of healthy subjects. We compared classic risk factors with internal elements such as personality, family dynamics and health locus of control. We also looked for prognostic factors. METHODS: Forty people with major depressive disorder (the MDD group) were randomly assigned to different treatment groups and followed for two years. In parallel, we followed a group of 21 healthy subjects (healthy group). At the beginning of the study, sociodemographic data were recorded and all subjects were asked to complete the Multidimensional Health Locus of Control (MHLC) scale, the NEO Five-Factor Inventory (NEO-FFI), and the Family Adaptation and Cohesion Scale (FACES III). During the study, subjects were regularly assessed using the Hamilton Depression Scale (HDS) and the Short Form Health Survey (SF-12). RESULTS: Of the 23 explanatory variables, 13 were statistically different (p≤0.05): age, gender, number of people living together, income, extravert personality and neuroticism, Internal HLC, Powerful others HLC, Adaptability of the current couple and the family of origin, and Cohesion of the ideal and nuclear family and family of origin. The accumulation of risk factors doubles the chances of suffering from MDD (odds ratio 1.905**). Independent of treatment, among the 13 variables, the first nine explain 34.1% of change in depression measured on the HDS scale (p<0.001). CONCLUSION: While the size of our sample limits the robustness of our results, our study suggests that some risk factors are also prognostic. The respective weights of these factors vary as a function of age group. Finally, some, such as health locus of control, family dynamics or extraversion, can be modified as an adjunct to pharmacological treatment.

Multidisciplinary Management of Chronic Tinnitus in Audiophonology Centre: Survey of Psychiatric Comorbidities and Psychotropic Medications Use Over 10 Years of Activity.

BACKGROUND: The multidisciplinary management of disabling chronic tinnitus in the audiophonology centre demonstrates its relevance. The detection and treatment of overlapping psychiatric pathologies is a crucial issue in the work of liaison psychiatry. SUBJECTS AND METHODS: A 10-year retrospective review of the activities of a university audiophonology centre with 166 patients who consulted for disabling chronic tinnitus and who underwent a Mini International Neuropsychiatric Interview. The diagnostic criteria used were those of the DSM IV. RESULTS: Our sample shows that major depressive disorders, somatoform disorders and sleep disorders were the most frequently encountered. Alcohol misuse was also seen as the most common substance-related disorder. Thirty (30%) had prior psychiatric or psychological monitoring, and 60% were previously treated with at least one psychotropic drug. CONCLUSION: The systematic approach of liaison psychiatry appears to be essential in the treatment of disabling chronic tinnitus, given the associated psychiatric comorbidity. Beyond the detection of unrecognized or untreated disorders, patient education to attentional mechanisms and hypervigilance, which reinforce an unpleasant perception of tinnitus, as well as the management of stress and somatizations and sleep hygiene, is recommended.

Screen Time and (Belgian) Teenagers.

BACKGROUND: Parental anxiety about young people's use of media has increased with the advent of Generation Alpha. Excessive consumption is assumed to lead to a sedentary lifestyle, psychiatric disorders, overconsumption of sexual content and suicidal behaviour. But are these assumptions valid? METHODS: We supplemented data from the 2014 Health Behaviour in School-aged Children Study for Belgium with a bibliographical search of online databases (Medline, Scopus, PsycArticles, PsycInfo, PubMed) with the keywords 'adolescent' - 'internet' and 'sedentarity' or 'suicide' or 'family' or 'sex*' or 'porno*' for articles published between 2014 and 2019. We selected 27 original research articles and/ or quantitative or qualitative meta-analyses. RESULTS: Total consumption of different media (television, video games, internet) remained stable until 2010, and significantly increased in 2014. No parallel increase in sedentarity was reported. Controversy continues to surround the quantification of overconsumption, and the definition of 'problematic use'. Nevertheless, it appears that 5% of young people have unusual internet use, and 97.5% of these meet the criteria for a mental disorder. The risk of overconsumption is related to four factors: familial, personality, peer influence and supply. These general factors are supplemented by specific factors related to the abuse of sexual content and suicidal behaviour. For the latter, specific risk factors are the same as for suicidal young people who are not influenced by social media. CONCLUSION: Even if screen time is higher for Generation Alpha, these young people are no more at risk unless they accumulate risk factors. They are also exposed to challenges that researchers have not yet studied in any depth. One question relates to how they can manage their privacy if their parents published, without their consent, photographs of them as children? Another issue is their relationship to knowledge, given that everything they need to know can easily be found online.

Alcohol Use Disorder in Primary Cares: How to Integrate Brief Interventions and Continuous Care?

BACKGROUND: In Belgium, 82% of the population consumes alcohol occasionally while 10% consume in a way that can be seen as problematic. On a European level, only 8% of the people who can be characterized as having Alcohol Use Disorder (AUD) would have consulted professional assistance in the past year. In this context, the KCE (Belgian Health Care Knowledge Centre) has addressed multiple recommendations to health professionals to reduce the "treatment gap" concerning the patients' care: (1) encourage screening and preventative interventions, (2) promote the acquirement of communicational and relational competences (3) develop collaborations between professionals. The objective of this article is to better understand their functioning. METHOD: We format a non-systematic literature review concerning these recommendations. RESULTS: The implementation of these Brief Interventions programs in primary care is relevant due to the moderately positive impact on the frequency and quantity of alcohol consumption but both the quality of the therapeutic relationship and collaboration with the care network would optimize Brief Interventions. The quality of the therapeutic relationship alone appears to have an impact on therapeutic outcome. CONCLUSION: Training concerning patient-professional relationship is necessary to maximize the effectiveness of BIs.

Improving Transition from Child and Adolescent Mental Health Services to Adult Mental Health Services for Adolescents in Transition to Young Adulthood: A Literature Review.

BACKGROUND: These last years adolescents in transition to young adulthood (ATYA) have become a new matter of research. This population encounter specific issues and challenges regarding their mental health particularly when they have attained age boundaries and deal with the issue of transition from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS). Many key questions regarding how to sustain continuity of mental health care for ATYA during transition remain. The aim of this paper is to review recent literature in the domain to identify dimensions that should be considered to improve ATYA transition from CAMHS to AMHS. SUBJECTS AND METHODS: A qualitative literature review was performed in Scopus-Elsevier database using the PRISMA method as reporting guidelines. Only papers discussing dimensions involved in the transition process from CAMHS to AMHS were considered. We restricted the review to researches published between 2010 and 2020. RESULTS: We identified 85 potential researches, after filtering; only 10 articles were finally included in the qualitative synthesis of the literature. Five main dimensions were identified: patient, professional, organization, policy, and ethic related. Those dimensions should be considered in order to improve ATYA transition process out of CAMHS to AMHS. CONCLUSION: This work contributes to identify principal dimensions that should be considered by mental health professionals and organizations in order to improve ATYA transition from CAMHS to AMHS.

From Family Surroundings to Intestinal Flora, A Literature Review Concerning Epigenetic Processes in Psychiatric Disorders.

BACKGROUND: Some behaviors or psychiatric conditions seem to be inherited from parents or explain by family environment. We hypothesized interactions between epigenetic processes, inflammatory response and gut microbiota with family surroundings or environmental characteristics. SUBJECTS AND METHODS: We searched in literature interactions between epigenetic processes and psychiatric disorders with a special interest for environmental factors such as traumatic or stress events, family relationships and also gut microbiota. We searched on Pubmed, PsycINFO, PsycARTICLES and Sciencedirect articles with the keywords psychiatric disorders, epigenome, microbiome and family relationships. RESULTS: Some gene polymorphisms interact with negative environment and lead to psychiatric disorders. Negative environment is correlated with different epigenetic modifications in genes implicated in mental health. Gut microbiota diversity affect host epigenetic. Animal studies showed evidences for a transgenerational transmission of epigenetic characteristics. CONCLUSIONS: Our findings support the hypothesis that epigenetic mediate gene-environment interactions and psychiatric disorders. Several environmental characteristics such as traumatic life events, family adversity, psychological stress or internal environment such as gut microbiota diversity and diet showed an impact on epigenetic. These epigenetic modifications are also correlated with neurophysiological, inflammatory or hypothalamic-pituitary-adrenal axis dysregulations.

Role of gut microbiota in the interaction between immunity and psychiatry: a literature review.

BACKGROUND: Psychiatric disorders may be correlated with a low-grade systemic inflammation but the origin of this inflammatory response remains unclear and both genetics and environmental factors seems to be concerned. Recent researches observed that gut microbiota seems to have an impact on the brain and immune processes. METHOD: We review recent literature to a better understanding of how microbiota interacts with brain, immunity and psychiatric disorders. We search on Pubmed, PsycINFO, PsycARTICLES and Sciencedirect articles with the keywords "gastrointestinal microbiota" and "mental disorders" or "psychological stress". RESULTS: We showed links between gut microbiota and brain-gut axis regulation, immune and endocrine system activity, neurophysiological changes, behavior variations and neuropsychiatric disorders. Communications between brain and gut are bidirectional via neural, endocrine and immune pathway. Microbiota dysbiosis and increase gut permeability with subsequent immune challenges seems to be the source of the chronic mild inflammation associated with neuropsychiatric disorders. Repeated immune or stress events early in life may lead to neurodevelopmental disorders or sickness behavior later in life. CONCLUSIONS: Psychological stress impact gut microbiota with subsequent immune activation leading to neurodevelopmental disorders or sickness behavior and altering neurophysiology and reactivity to stress or lifestyle.

Cannabinoid hyperemesis syndrome: a review of the literature.

BACKGROUND: Cannabinoid Hyperemesis Syndrome (CHS) is characterized by cyclic vomiting and compulsive need to take hot showers in the context of chronic cannabis use. Physicians' lack of knowledge of CHS often results in a diagnostic delay of several years. The purpose of this article is to describe CHS in order to enable physicians, and more particularly psychiatrists, to diagnose it as quickly as possible and thus avoid unnecessary additional invasive examinations. SUBJECTS AND METHODS: Bibliographic search for scientific articles published between 2004 and 2019 in the Cochrane, Medline, PubMed, and Psycinfo databases. Key words used were "hyperemesis", "cannabis", "cannabinoid". RESULTS: CHS is associated with chronic cannabis use and typically manifests as incoercible cyclical vomiting, diffuse abdominal pain, and relief of symptoms by taking hot showers. Patients suffering from CHS generally visit emergency departments very regularly and undergo numerous additional examinations, both invasive and unnecessary. Since no organic cause can explain these symptoms, these patients are referred to the psychiatry department. The only curative treatment is the complete cessation of cannabis use. CONCLUSION: CHS is an under-diagnosed pathology because it is little known to physicians. This syndrome has unique clinical characteristics. Early recognition of CHS avoids repeated visits to the emergency room and unnecessary follow-up examinations.

Depression and physical health, the therapeutic alliance and antidepressants.

BACKGROUND: In a two-year study we compared the efficacy of noradrenergic (duloxetine D) and serotonergic (escitalopram E) antidepressants with and without the addition of 100 mg acetylsalicylic acid (ASA) in subjects suffering from a major depressive episode (MDE). The results showed that the D + ASA (DASA) group improved more rapidly than the E + placebo (EP) subgroup. In particular, Hamilton Depression Scale (HDS) scores improved as early as two months, Clinical Global Impression (CGI) scores improved at five months, and remission rates were better. In the course of this study, we also investigated the role of the therapeutic relationship (alliance) on both the progress of the MDE, and patients' mental and physical health. SUBJECTS AND METHODS: 40 people suffering from an MDE were randomly assigned to treatment groups. At the beginning of the study sociodemographic data were collected, and the Helping Alliance Questionnaire (HAQ) was completed. During the study, patients were regularly assessed using the HDS, CGI and the Short Form Health Survey (SF-12). RESULTS: Subgroup comparisons revealed that HAQ scores are not correlated with HAD scores, but a correlation was found with remission rates (r=0.316*). Similarly, at all times, HAQ scores were correlated with physical health (p<0.05), which is in turn correlated with HDS and CGI scores. CONCLUSION: Physical health is linked to the level of depression. While the alliance with the patient is not directly correlated with the intensity of depression, is it correlated with their physical condition and its improvement. For patients, improving their physical health appears to be more important than improving their mental health. These observations must be confirmed.