Women's Mental Health and Lessons Learnt from the COVID-19 Pandemic.

Women are at the highest risk of pandemic adversities as they represent the majority of health and frontline workers in addition to their essential roles at home. We review gender differences during the COVID-19 pandemic by demonstrating risk-exposure during specific situations such as pregnancy, women's mental health fallouts, COVID-19 disease itself and exposure to different forms of violence. We discuss the particularities that women face in developing countries with depicted examples from some countries in Africa and the Middle East. Women mental health care service stands out as an essential component of the national response to pandemics. Women's integration and leadership in the national pandemic response planning is crucial.

Perinatal Psychoactive Substances Use: A Rising Perinatal Mental Health Concern.

INTRODUCTION: A significant increase in psychoactive drugs use was observed in women of childbearing age and during the perinatal period worldwide. Yet, the use of illicit drugs, alcohol and tobacco during pregnancy is a serious health risk for the mother, developing fetus and newborn. METHODS: This review of current trends and consequences of psychoactive substance use in the general population and in pregnant women was conducted using the English and French literature published during the years 2000 to 2022, supplemented by guidelines, meta-analyses and reviews. RESULTS: According to current rates of prenatal substances use, it was calculated that 380,000 offspring were exposed to illicit substances, more than 500,000 to alcohol and over one million to tobacco during uterine life. Alarmingly, drug-related pregnancy-associated mortality has shown a staggering 190% rise between 2010 and 2019 in the USA. Different drugs of abuse, when used during pregnancy, increase the risk of stillbirth, neonatal abstinence syndrome and sudden infant death. Adverse effects on pregnancy include premature rupture of membranes, placental abruption, preterm birth, low birth space? weight and small-for-gestational-age infants. There is also an increased risk of morbidity and mortality for the pregnant women. Long-term negative adverse effects of perinatal exposure to substances also include a number of neurocognitive, behavioral and emotional dysfunctions in infants. Each type of substance has its own specificities, which will be briefly summarized. CONCLUSION: All childbearing age women must be informed about the potential harm of the prenatal use of psychoactive substances and should be encouraged to stop their use when pregnancy is planned and, at least, when pregnancy is known. Questioning women about their alcohol consumption should be systematic at the first prenatal visit and then at every prenatal visit until delivery. Multidisciplinary prevention approaches as well as intervention measures targeted to each type of psychoactive substance can save mothers' lives and mitigate serious adversities to the offspring.

Educational Initiative about the COVID-19 Pandemic-Related Neuropsychiatry for Early Career Professionals in EU: The Impact of the Novel Virus on Brain, Mind, and Society.

BACKGROUND: The COVID-19 pandemic brought challenges to governments, healthcare systems (including, mental healthcare services), clinicians and researchers in the EU and worldwide. A range of neurological (e.g., brain fog, encephalitis, myalgia) and psychiatric (e.g., affective disorders, delirium, cognitive disturbances) complications of a novel nature have been observed in patients during the acute phase of illness, which often persist as a Long-COVID state for months after the primary recovery. The pandemic has progressed to a psychodemic and syndemic, affecting communities with social distress, panic, fears, increased home violence, and protest movements that derive from conspiracy theories and hostile attitudes towards vaccination and lockdown measures. In response to this complex scenario of major social changes, universities must face the need to equip the new generation of doctors with novel special skills. SUBJECTS AND METHODS: The study course (50 hours duration; 20 lectures, three webinars, three e-discussion forums, five local seminars, two social events, three intermediate assessments and a final test for certification; bilingual Russian/English hybrid format, information materials, video-content, interactive web-page and social media) was developed by the team of the International Centre for Education and Research in Neuropsychiatry (ICERN), and is unique for the EU. The course integrates the most relevant data on SARS-Cov-2-related neuropsychiatry, and COVID-19' pandemic impact on mental health and society, including assignment of the vulnerable groups of students and healthcare professionals. The major topics covered during the course are (i) Novel virus, (ii) Brain, (iii) Society. The project takes place originally in Samara State Medical University. The ICERN Faculty includes academic staff from France, Hungary, Italy, Russia, Switzerland, invited speakers from the WHO Regional Office for Europe and World Psychiatric Association (EU Zones) members, some of them employed at ICERN by remote work contracts. The format of the educational process for students is hybrid suggesting both remote and face-to-face events. Distant learning participants and EU lecturers are to attend on-line via zoom platform, whereas local participants and staff work face-to-face in the ICERN video-conference room. The course is addressed to a broad audience of doctors, undergraduate and postgraduate students, and researchers from EU wishing to upgrade their knowledge in the pandemic-associated neuropsychiatry. RESULTS: The evaluation process supposes three intermediate assessments and a final test for certification. On-line assessment is to be performed at the project web-page - 10 randomly selected questions with scoring from 1 to 10 each. The Pass Score is 70-100. At the end of the course all the participants receive certificates of Samara State Medical University according to the ERASMUS policy book, as planned in 2021. CONCLUSIONS: We formatted this course as essential for the target audience to improve their resources of professional adaptability in the field of neuropsychiatry and mental healthcare management during challenging times. The ICERN course in pandemic-related neuropsychiatry is essential for early career health professionals and targets the principles of "academia without borders" in the context of international medical knowledge exchange. In the conditions of the changing social situation this educational content is necessary for the young doctors to acquire the add-on skills on flexibility to switch toward new professional approaches in the times of need. The long-term outcomes in pandemic-related neuropsychiatry are still to be seen, though the first feedback on the course content is already promising for the academic community.

Psychoactive substance use, internet use and mental health changes during the COVID-19 lockdown in a French population: A study of gender effect.

Introduction: COVID-19 has enormous impacts on each individual. The goals of our study were (1) to assess the rate of internet and psychoactive substance use, clinical depression and anxiety in a French population during the lockdown (2) to study the role of clinical and socio-demographic variables (especially, gender). Materials and methods: During lockdown, an online anonymous questionnaire was used to assess socio-demographic and health data, previous psychiatric history, anterior and current internet and psychoactive substance use, current anxiety, depression and suicidal ideation. The associations of socio-demographic, clinical variables with anxiety, depression, internet or psychoactive substance use were examined. Results: The study included 263 participants (aged 38.1 ± 15.3-197 males and 64 females). During the lockdown, internet use increased in 14.4% of cases, alcohol use in 20.2%, and tobacco use in 6.8%. In contrast, more participants reported a decrease in alcohol, tobacco or illicit drug use (25.9, 24, and 27.8% respectively). Anxiety was reported in 62.4% and depression in 20.2% of cases; 29.7% of participants reported an increase in anxiety and 25.5% an increase in depression. Depression was associated with an increase in internet and tobacco use. Tobacco and alcohol use were positively associated and an increase in use was more frequent in previous users of both substances. Maintaining a daily routine and relationships with family, being self-employed were associated to lower risks of depression and anxiety. Conclusion: Higher rates of internet use, as well as depression and anxiety, were observed during the lockdown. Gender was not a significant associated factor.

Criminal responsibility evaluations: Benchmarking in different countries.

Forensic mental health experts play a crucial role in criminal responsibility evaluations. However, the quality of these assessments has at time come under scrutiny and has been heavily criticized. A literature review revealed significant differences between countries concerning legal frameworks and procedures for conducting these assessments. The findings suggest that although some countries can be seen as a "role model", there still is room for improvement.

The World Federation of Societies of Biological Psychiatry guidelines on the assessment and pharmacological treatment of compulsive sexual behaviour disorder.

OBJECTIVES: The current guidelines aim to evaluate the role of pharmacological agents in the treatment of patients with compulsive sexual behaviour disorder (CSBD). They are intended for use in clinical practice by clinicians who treat patients with CSBD. METHODS: An extensive literature search was conducted using the English-language-literature indexed on PubMed and Google Scholar without time limit, supplemented by other sources, including published reviews. RESULTS: Each treatment recommendation was evaluated with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. Psychoeducation and psychotherapy are first-choice treatments and should always be conducted. The type of medication recommended depended mainly on the intensity of CSBD and comorbid sexual and psychiatric disorders. There are few randomised controlled trials. Although no medications carry formal indications for CSBD, selective-serotonin-reuptake-inhibitors and naltrexone currently constitute the most relevant pharmacological treatments for the treatment of CSBD. In cases of CSBD with comorbid paraphilic disorders, hormonal agents may be indicated, and one should refer to previously published guidelines on the treatment of adults with paraphilic disorders. Specific recommendations are also proposed in case of chemsex behaviour associated with CSBD. CONCLUSIONS: An algorithm is proposed with different levels of treatment for different categories of patients with CSBD.

Caffeine use during pregnancy: prevalence of use and newborn consequences in a cohort of French pregnant women.

Many pregnant women, in the world, drink caffeine-containing beverages. Maternal caffeine consumption during pregnancy may have adverse effects on foetus but results are conflicting. Our goals were to estimate the prevalence of caffeine use in a cohort of French pregnant women using maternal self-reports and to evaluate the association between caffeine consumption during pregnancy and delivery and newborn characteristics. All pregnant women who gave birth in a large French urban area during a limited period of time were included (in total 724 mothers were included). Coffee, tea or cola consumption as well as pregnancy and neonate characteristics were analysed. The mean consumption of caffeine per day slightly decreased from the first to the third trimester of pregnancy: 587 caffeine users, with a consumption of caffeine of 59.2 ± 61.5 mg/day during the first trimester as compared to 577 consumers (54.3 ± 55.4 mg/day) during the third trimester, respectively. A significant decrease of neonates' birth length was observed when mothers were using at least 100 mg/day (or two cups) of caffeine during the second and third trimesters but this difference was no longer significant after adjustment on potential confounding factors such as tobacco use. The potential existence of other confounders (e.g. poorer dietary habits or other lifestyle variables) that might also be associated with reduced birth length, may not be excluded. Caffeine use during pregnancy was associated with reduced birth length but this effect was no longer significant after adjustment on potential confounding variables.

Cannabinoids: for better and for worse
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The use of cannabis as a drug has undergone a remarkable change of direction: considered as a symbol of countercultures in past decades, it is presently being hailed as a cure for any number of diseases and conditions. Thus, despite concerns about the safety of cannabis and cannabinoids, quite a few drugs that contain cannabinoids have recently been approved by several drug agencies, and the medicinal and recreational use of cannabis has been legalized in various countries and states. The promise of cannabinoids for therapeutic use, as well as potentially detrimental health risks and regulatory issues, will need to be carefully weighed.
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El consumo de cannabis como droga ha experimentado un notable cambio de dirección: considerado como un símbolo de las contraculturas en las últimas décadas, actualmente está siendo aclamado como cura para una serie de enfermedades y afecciones. Por lo tanto, a pesar de las preocupaciones sobre la seguridad del cannabis y de los cannabinoides, bastantes medicamentos que contienen cannabinoides han sido recientemente aprobados por varias agencias de edicamentos, y el uso medicinal y recreativo del cannabis se ha legalizado en varios países y estados. La promesa de los cannabinoides para uso terapéutico, así como los riesgos potencialmente perjudiciales para la salud y cuestiones reglamentarias, deberán ser cuidadosamente evaluados.

L'usage du cannabis en tant que drogue a subi un changement d'orientation remarquable: considéré comme un symbole des contre-cultures au cours des dernières décennies, il est actuellement salué comme remède pour un certain nombre de maladies et pathologies. Ainsi, malgré les inquiétudes concernant la sécurité du cannabis et des cannabinoïdes, de nombreux médicaments contenant des cannabinoïdes ont récemment été approuvés par plusieurs agences de médicaments, et l'usage médicinal et récréatif du cannabis a été légalisé dans divers pays et états. La promesse des cannabinoïdes à usage thérapeutique, ainsi que des risques sanitaires potentiellement néfastes et les questions réglementaires devront être soigneusement pesées.

First case report of tDCS efficacy in severe chemsex addiction
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Chemsex is an escalating public health issue among men who have sex with men, with potentially severe somatic and psychiatric consequences. Given the limited knowledge and lack of treatment recommendations available in this area, we proposed the use of noninvasive brain stimulation in order to reduce problematic chemsex behavior. This is the first open-label case report of a positive effect of transcranial direct current stimulation (tDCS) in a patient who was complaining of severe chemsex addiction. Total disappearance of chemsex behavior occurred after 5 days of daily sessions of right prefrontal cortex stimulation and did not return after 8 months of follow-up. The strengthening of dorsolateral prefrontal cortex activity may have modulated limbic pathways and reduced incentive salience and craving of both sexual addiction and concomitant illicit drug use.
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El Chemsex es un problema de salud pública creciente entre los hombres homosexuales, con consecuencias somáticas y psiquiátricas potencialmente graves. Dados el conocimiento limitado y la falta de recomendaciones de tratamiento disponibles en esta área, propusimos el uso de estimulación cerebral no invasiva para reducir los comportamientos problemáticos relacionados con el chemsex. Este es el primer informe de caso clínico abierto que muestra un efecto positivo de la estimulación transcraneal de corriente directa (tDCS) en un paciente que se quejaba de una adicción grave al chemsex. La desaparición total de los comportamientos relacionados con el chemsex se produjo después de 5 días de sesiones diarias de estimulación de la corteza prefrontal derecha y no regresó después de 8 meses de seguimiento. El aumento de la actividad de la corteza prefrontal dorsolateral puede haber modulado las vías límbicas y reducido la prominencia del incentivo y los antojos asociados tanto con la adicción sexual como con el uso concurrente de drogas ilícitas.

Le chemsex est un problème de santé publique croissant chez les hommes ayant des relations homosexuelles, aux conséquences somatiques et psychiatriques potentiellement graves. Compte tenu des connaissances limitées et du manque de recommandations de traitement disponibles dans ce domaine, nous avons proposé l'utilisation de stimulation cérébrale non invasive afin de réduire les comportements problématiques liés au chemsex. C'est le premier rapport de cas clinique ouvert montrant un effet positif du courant continu transcrânien stimulation (tDCS) chez un patient qui se plaignait d'une grave dépendance au chemsex. La disparition totale des comportements liés au chemsex est survenue après 5 jours de séances quotidiennes de stimulation du cortex préfrontal droit et n'est pas revenue après 8 mois de suivi. Le renforcement de l'activité du cortex préfrontal dorsolatéral peut avoir modulé les voies limbiques et réduit la saillance incitative et les état de manque liés tant à la dépendance sexuelle qu'à l'usage concomitant de drogues illicites.

Do we need to rethink our current classifications of mental disorders?
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The traditional categorical classification system and new diagnostic systems will be discussed in this issue.
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Mettre la traduction FR.

Going digital: how technology use may influence human brains and behavior
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The digital revolution has changed, and continues to change, our world and our lives. Currently, major aspects of our lives have moved online due to the coronavirus pandemic, and social distancing has necessitated virtual togetherness. In a synopsis of 10 articles we present ample evidence that the use of digital technology may influence human brains and behavior in both negative and positive ways. For instance, brain imaging techniques show concrete morphological alterations in early childhood and during adolescence that are associated with intensive digital media use. Technology use apparently affects brain functions, for example visual perception, language, and cognition. Extensive studies could not confirm common concerns that excessive screen time is linked to mental health problems, or the deterioration of well-being. Nevertheless, it is important to use digital technology consciously, creatively, and sensibly to improve personal and professional relationships. Digital technology has great potential for mental health assessment and treatment, and the improvement of personal mental performance.
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La revolución digital ha cambiado y continúa cambiando nuestro mundo y nuestras vidas. Actualmente, los principales aspectos de nuestras vidas han migrado hacia el funcionamiento "online" debido a la pandemia del coronavirus, y el distanciamiento social ha requerido de cercanías virtuales. En una sinopsis de 10 artículos, se presenta una amplia evidencia de que el empleo de la tecnología digital puede influir en el cerebro y en el comportamiento humano de manera negativa y positiva. Por ejemplo, las técnicas de imágenes cerebrales muestran alteraciones morfológicas concretas en la primera infancia y durante la adolescencia, las cuales están asociadas con el empleo intenso de medios digitales. En apariencia, la utilización de la tecnología afecta las funciones cerebrales, como la percepción visual, el lenguaje y la cognición. Numerosos estudios no pudieron confirmar las preocupaciones comunes en cuanto a que el tiempo excesivo de pantalla esté relacionado con problemas de salud mental o el deterioro del bienestar. Sin embargo, es importante emplear la tecnología digital de manera consciente, creativa y sensata para mejorar las relaciones personales y profesionales. La tecnología digital tiene un gran potencial para la evaluación y el tratamiento de la salud mental, y el aumento del rendimiento mental personal.

La révolution numérique a modifié et continue à modifier notre monde et nos vies. La pandémie actuelle due au coronavirus a fait basculer en ligne de nombreux pans de notre existence et la distanciation sociale a imposé la virtualité des rassemblements. Les données des dix articles présentés ici attestent de l'influence de la technologie numérique sur les cerveaux et les comportements, de manière positive et négative. Par exemple,l'imagerie cérébrale montre des altérations morphologiques concrètes apparaissant tôt dans l'enfance et pendant l'adolescence lors d'une pratique intensive des media numériques. Cela concernerait certaines fonctions cérébrales comme la perception visuelle, le langage et la cognition. Des études approfondies n'ont pas confirmé les inquiétudes courantes quant aux répercussions d'un temps excessif passé devant un écran en termes de santé mentale ou de qualité de vie. Il est néanmoins important de privilégier une utilisation consciente, créative et raisonnable des technologies numériques afin d'améliorer les relations personnelles et professionnelles. Ces technologies ont un grand potentiel dans l'évaluation et le traitement de la santé mentale ainsi que dans l'amélioration des performances mentales personnelles.

Pharmacotherapy of Sexual Addiction.

PURPOSE OF REVIEW: We reviewed recent data on sexual addiction and its treatment. We examined the different definitions of this disorder, related to the pathophysiological mechanisms. We addressed the pharmacological treatment of sexual addiction. RECENT FINDINGS: Hypersexual behavior can be considered an addictive disorder. Sexual addiction is accompanied by significant psychiatric and addictive comorbidities and is responsible for life impairment. A comprehensive and efficient treatment must be proposed. Selective serotonin reuptake inhibitors seem the first-line pharmacological treatment for sexual addiction. Naltrexone could be another therapeutic option. Psychotherapy and preferentially cognitive-behavioral therapy should be used in association with pharmacotherapy and treatments of comorbidities.

The World Federation of Societies of Biological Psychiatry (WFSBP) 2020 guidelines for the pharmacological treatment of paraphilic disorders.

Objectives: The primary aim of these guidelines is to evaluate the role of pharmacological agents in the treatment and management of patients with paraphilic disorders, with a focus on the treatment of adult males. Because such treatments are not delivered in isolation, the role of specific psychotherapeutic interventions is also briefly covered. These guidelines are intended for use in clinical practice by clinicians who diagnose and treat patients, including sexual offenders, with paraphilic disorders. The aim of these guidelines is to bring together different views on the appropriate treatment of paraphilic disorders from experts representing different countries in order to aid physicians in clinical decisions and to improve the quality of care.Methods: An extensive literature search was conducted using the English-language-literature indexed on MEDLINE/PubMed (1990-2018 for SSRIs) (1969-2018 for hormonal treatments), supplemented by other sources, including published reviews.Results: Each treatment recommendation was evaluated and discussed with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. The type of medication used depends on the severity of the paraphilic disorder and the respective risk of behaviour endangering others. GnRH analogue treatment constitutes the most relevant treatment for patients with severe paraphilic disorders.Conclusions: An algorithm is proposed with different levels of treatment for different categories of paraphilic disorders accompanied by different risk levels.

A positive association between a polymorphism in the HTR2B gene and cocaine-crack in a French Afro-Caribbean population.

OBJECTIVES: Cocaine dependence has a strong heritability component. The aim of this study was to investigate the putative association between the serotonin 2B receptor gene (HTR2B), crack use disorders and impulsivity. METHODS: A French Afro-Caribbean male population of patients with crack use disorders (n = 80) was compared to healthy Afro-Caribbean male controls (n = 60). Comorbid ADHD and impulsivity were assessed. Five single nucleotide polymorphisms (SNPs) in the HTR2B gene were selected: rs643700, rs6736017, rs1549339, rs17586428 and rs3806545. These SNPs were chosen to include most of the linkage disequilibrium blocks in the HTR2B gene. The French translation of the Barratt Impulsivity Scale BIS-11 was used to evaluate impulsivity. Comorbid ADHD was diagnosed using the Wender Utah Rating Scale-25 item for Attention Deficit-Hyperactivity Disorder. RESULTS: We have observed a positive association between the rs6736017 polymorphism and crack use disorders in a French Afro-Caribbean male population. CONCLUSIONS: In our population, the risk effect of HTR2B rs6736017 appeared to be specific to individuals with crack use disorders rather than being driven by impulsivity or ADHD alone.

Women's Mental Health in the Time of Covid-19 Pandemic.

Even if the fatality rate has been twice higher for men than for women, the Covid-19 pandemic has affected women more than men, both as frontline workers and at home. The aim of our article was to analyze the differences observed in mental health and violence between men and women in the COVID outbreak. For this purpose, we have used all papers available in PubMed between January and July 2020 as well as data from non-governmental associations. We have thus successively analyzed the situation of pregnancy during the pandemic; the specific psychological and psychiatric risks faced by women both as patients and as workers in the health sector, the increased risk of violence against women at home and at workplace and, finally the risk run by children within their families. In conclusion, research on the subject of mental health issues during the Covid-19 pandemic is still scarce, especially in women. We hope that this pandemic will help to recognize the major role of women at home and at the workplace.

Mental health and the criminal justice system in France: A narrative review.

The treatment of people diagnosed with mental disorders who committed crimes differ greatly in countries around the world because of the long histories of criminal justice and psychiatry specific to each country. As a result, it is often difficult to grasp the specificities of each system. The main objective of this paper is to provide a narrative review of the interactions between the French mental health and judicial systems. Subsequently, we will discuss how the concept of forensic psychiatry does not yet exist in France and how it can be applied.

French forensic mental health system during the COVID-19 pandemic.

Many facilities involved in caring people diagnosed with mental health disorders who committed crime had to adapt to COVID-19 pandemic in France. Particularly, the impact of the COVID-19 pandemic on incarcerated people was the subject of many concerns. The COVID-19 pandemic also posed major challenges in secure psychiatric hospitals and for psychiatrist experts. Rapid changes in working practices occurred. Finally, the lockdown period was associated with an increase in domestic violence, especially gender-based violence and child abuse and neglect. Overall, the COVID-19 pandemic emphasized the well-known limitations of the French mental health system to manage people diagnosed with mental health disorders who committed crime and the urgent need for better recognition of forensic psychiatry in France.

Cognition in psychiatry
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Cognition has attracted a growing interest in psychiatry. Since the 1990s, cognition as a whole has become an important determinant in the outcome of psychosis. Despite recent progress in the genetics of cognition, the development of new pharmacological compounds in order to improve cognition has not progressed as quickly. This issue will review and discuss the main areas of clinical and basic research in this domain.
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