Clinical features and outcomes of COVID-19 patients hospitalized for psychiatric disorders: a French multi-centered prospective observational study.

BACKGROUND: Patients with psychiatric disorders are exposed to high risk of COVID-19 and increased mortality. In this study, we set out to assess the clinical features and outcomes of patients with current psychiatric disorders exposed to COVID-19. METHODS: This multi-center prospective study was conducted in 22 psychiatric wards dedicated to COVID-19 inpatients between 28 February and 30 May 2020. The main outcomes were the number of patients transferred to somatic care units, the number of deaths, and the number of patients developing a confusional state. The risk factors of confusional state and transfer to somatic care units were assessed by a multivariate logistic model. The risk of death was analyzed by a univariate analysis. RESULTS: In total, 350 patients were included in the study. Overall, 24 (7%) were transferred to medicine units, 7 (2%) died, and 51 (15%) patients presented a confusional state. Severe respiratory symptoms predicted the transfer to a medicine unit [odds ratio (OR) 17.1; confidence interval (CI) 4.9-59.3]. Older age, an organic mental disorder, a confusional state, and severe respiratory symptoms predicted mortality in univariate analysis. Age >55 (OR 4.9; CI 2.1-11.4), an affective disorder (OR 4.1; CI 1.6-10.9), and severe respiratory symptoms (OR 4.6; CI 2.2-9.7) predicted a higher risk, whereas smoking (OR 0.3; CI 0.1-0.9) predicted a lower risk of a confusional state. CONCLUSION: COVID-19 patients with severe psychiatric disorders have multiple somatic comorbidities and have a risk of developing a confusional state. These data underline the need for extreme caution given the risks of COVID-19 in patients hospitalized for psychiatric disorders.

PREVALENCE OF RETICULAR PSEUDODRUSEN IN AGE-RELATED MACULAR DEGENERATION USING MULTIMODAL IMAGING.

PURPOSE: To determine the rate of reticular pseudodrusen (RPD) in age-related macular degeneration using multimodal imaging, including color fundus photography, the blue channel image of fundus photography, infrared reflectance, fundus autofluorescence, multicolor imaging, and spectral domain optical coherence tomography, as well as to compare the sensitivities and specificities of these modalities for detecting RPD. METHODS: This prospective study included 243 eyes from 125 consecutive patients with age-related macular degeneration. They underwent fundus examination including color fundus photography, blue channel, infrared reflectance, fundus autofluorescence, multicolor imaging, and spectral domain optical coherence tomography in both eyes. To be considered as having RPD, eyes had to have reticular patterns on spectral domain optical coherence tomography in a large studied cube of 30° × 25° or on infrared reflectance with at least one other examination. RESULTS: The mean age of the 125 patients was 81.1 years (± 8.1). Eighty-six patients (68.8%) were diagnosed with RPD. Spectral domain optical coherence tomography, infrared reflectance, and multicolor imaging had the highest sensitivity (99.3, 84.6, and 87.1%, respectively) and specificity (100%). The color fundus photography, blue channel, and fundus autofluorescence had lower sensitivity to detect RPD. CONCLUSION: Reticular pseudodrusen is frequently associated with soft drusen in patients with age-related macular degeneration. As RPD may be rarely located only in the perifoveal area, spectral domain optical coherence tomography with a larger cube (30 × 25°) than that usually used (20 × 20°) had the highest sensitivity and specificity to detect RPD and is recommended to optimize the rate of detection.

[Compulsory admissions in psychiatry: comparative analysis between sensitive urban zones and other areas]. / Hospitalisations sans consentement en psychiatrie : analyse comparative chez les personnes résidant ou non en zones urbaines sensibles.

OBJECTIVES: To compare compulsory and non-compulsory psychiatric hospitalization rates between Sensitive Urban Zones (SUZ) and other areas. An association between Compulsory Admission at the Request of a State Representative (CARSR) and SUZ was then investigated among compulsory admission patients. METHODS: This retrospective observational study identified hospitalized patients in a French psychiatric hospital territory from 2012 to 2013. Legal methods of admission, medical and demographic data, as well as place of residence (SUZ or not) were extracted from the hospital information system. Hospitalization rate analysis was based on 2010 INSEE census data. Multivariate analysis among compulsory admission patients was performed by logistic regression. RESULTS: 2,677 patients were hospitalized from 2012 to 2013. The hospitalization rate during the two years of the study was about 6.25 patients per 1,000 inhabitants in SUZ and about 3.93 in other areas (p < 0.0001). Although a statistically significant association was observed between CARSR and SUZ among compulsory admission patients (p = 0.003), multivariate analysis did not confirm this result (OR = 1.29, 95% CI [0.90 ; 1.85], p = 0.16). Characteristics related to CARSR were male gender (OR = 3.72, 95% CI [2.56 ; 5.51], p < 0.0001), schizophrenia (OR = 1.84, 95% CI [1.28 ; 2.66], p=0.001) and personality and behavioral disorders (OR = 1.83, 95% CI [1.30 ; 2.56], p = 0.0005). CONCLUSION: Psychiatric hospitalization rates and the proportion of patients admitted at the request of a state representative were higher in SUZ than in other areas, but this association was not confirmed by multivariate analysis.

Impact of exposure to severe suicidal behaviours in patients during psychiatric training: An online French survey.

AIM: Patient suicide (PS) has been identified as a frequent and stressful "occupational hazard" for mental health professionals. Studies are needed to assess the impact on psychiatric trainees of the exposure to severe patient suicidal behaviours. METHODS: Our cross-sectional study aimed to measure the prevalence of exposure to PS and severe patient suicide attempts (SPSA) in French psychiatric trainees. We also assessed the emotional, traumatic and professional impacts and perceived support in the aftermath through a 62-item online questionnaire that included the French version of the IES-R, a composite emotional score and questions about professional practice and perceived support. All French psychiatric trainees were contacted regarding participation in the study through email and social networks between November 2017 and March 2018. RESULTS: A total of 409 trainees participated in the survey (response rate = 16.4%). 253 trainees fully completed the questionnaire. Of the 253 trainees, 43.2% were exposed to PS and 13.8% to SPSA. The exposure mostly occurred in the early stage of the training period. Ten to 15% of exposed trainees showed a high level of traumatic and emotional impact and 8.1% exhibited clinically relevant symptoms of post-traumatic stress disorder (PTSD). We found that 21.6% received no support in the aftermath, especially after PS. CONCLUSION: A large proportion of psychiatric trainees encounter severe suicidal behaviours of patients, and a substantial part of them is highly impacted. Our results thus stress the need for programmes dedicated to the prevention of the deleterious effects of the exposure to PS or SPSA in psychiatric trainees.