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.

How to Improve Collaboration Between General Practitioners and Clinical Psychologists for Their Patients' Common Mental Health Problems in Primary Care Context?

BACKGROUND: Mental health problems have become a major topic of public health these last years, particularly since the pandemic of COVID-19. Primary care givers are confronted with high rates of common mental health problems (CMHPs) in population. This questions healthcare organization and specifically collaboration between general practitioners (GPs) and clinical psychologists (CPs). In this paper we aim to review recent literature to identify factors that facilitate or hinder collaboration between GPs and CPs when caring for their patients' CMHPs. METHODS: A non-systematic qualitative literature review was performed, using the PRISMA method. We restricted the review to papers published between 2010 and 2023. RESULTS: We identified 52 papers and after filtering, only 6 were included in the synthesis. Six main themes were identified: barriers to interprofessional collaboration, lack of mutual trust, mutual dissatisfaction with information exchanged, the paradox of professional secrecy, the necessity of a paradigm shift, and conceptual frameworks of collaboration. These themes were discussed to improve collaboration between GPs and CPs. CONCLUSION: This work provides some recommendations to support the development of interprofessional collaboration between GPs and CPs in primary care.

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.

How should psychiatrists and general physician communicate to increase patients' perception of continuity of care after their hospitalization for alcohol withdrawal?

BACKGROUND: There are medico-psycho-social indications to apprehend the alcohol use disorder (AUD) as a chronic problem for which a continuous care is necessary. The perception of continuity of care is also associated with positive outcomes on the patient's health. Communication between caregivers is essential to maintain a good continual care. In order to put patients back into the center of care, we asked them the question: "why should the psychiatric department (PD) and general physicians (GP) should communicate about AUD patients"? SUBJECTS AND METHODS: After a week of hospitalization for alcoholic withdrawal, we used a qualitative approach with 4 open questions to explore AUD patients' point of view (N=17) about the best way of communication between psychiatrists and GP to improve care continuity. The data collection was carried out in the psychiatric department of the University Hospital of Mont-Godinne, Belgium. RESULTS: AUD patients consider that the GP is the first line actor that will be consulted after hospitalization and have a privileged relationship with him. These arguments justify him being informed. Concerning these patients, communication is useful to have a continuous treatment and project care, for purposes of symptoms' evolution follow-up and so as to help the GP to understand them better to follow the evolution of symptoms and to help the GP to understand them better. CONCLUSION: From AUD patients' point of view, communication between psychiatric department and the GP is useful for a perspective of continuity of care at discharge from the hospital. This communication seems to be at the service of the GP and his patient rather than for the psychiatrist himself. Mainly because of the GP's role as a privileged first-line care, but also thanks to the specific relationship relating him to his patient.

Immunity and psychiatric disorders: variabilities of immunity biomarkers are they specific?

BACKGROUND: In previous studies we showed the interaction between depression and immunity. We observed that psychological stress seems to be important in this association. In this review we try to understand if psychological stress and immunity have similar or specific impact on the other psychiatric disorders. More generally we review literature to understand if specific immune alterations exist between the main psychiatric diagnoses. METHOD: We studied the literature in search of variabilities between the different psychiatric disorders in terms of immunity especially inflammation. We search on Pubmed, PsycINFO, PsycARTICLES and Sciencedirect articles with the keywords immunity or inflammation and depression, anxious disorders and schizophrenia. RESULTS: Prevalence of inflammation in psychiatric disorders seems to be between 21 to 42%. Psychiatric disorders are correlated with elevated levels of CRP, pro-inflammatory cytokines (IL-6, IL-1ß and TNFα) and anti-inflammatory factors (TGF ß, IL-10, sIL-2, IL-1RA). IL-6 in childhood were associated with subsequent risk of depression or psychotic disorders in early adulthood and in a dose dependent manner. DISCUSSIONS: We found similar immune processes through the different disorders. Variations in cytokines levels seem paralleling various stages of the illness and treatment. Inflammatory markers are linked with severity and resistance to treatment and with subsequent risk of disorders. CONCLUSIONS: Some inflammatory parameters could be considered as risk factor, severity, resistance, trait or state markers of a psychiatric disorder. Other studies are necessary to a better understanding of clinical implications of this heterogeneity.