[Rescue workers: at the heart and head of the traumatic event]

With the traumatic event, the victim has suffered and fallen into a world of horror, violence and chaos. Emergency first aid is intended to give him a sign, to reach out to him so that the victim can return to the shore of the living world. The duality of technical and psychological first aid is necessary for the immediate and post-medical management of these highly traumatic interventions. These are important points of reference for the future of the subject as well as for the carer in the management of his individual or team stress.

[Plea for a collegial practice of emergency psychiatric care]

The care of patients, especially in the field of agitation or psychiatry, requires close coordination between different actors. Interdisciplinarity makes it possible to analyse and harmonise the links between various disciplines with the common aim of solving complex problems. This interdisciplinarity must now become a fundamental in the teaching of health sciences and a prerequisite for the functioning of hospital services, in particular in the formalisation of acute care pathways.

[Managing mass psychiatric chaos]

During an event with a high traumatic potential, the patient, as well as the first intervener in the care process, will resonate with his or her own intimate life experience and that of the other person. This happens in the reality of experiences, but also in the constructed projections. These stress-related phenomena must be widely known and taught, in order to increase the capacity to respond and adjust to these individual and collective crisis situations. This guarantees the physical and psychological health of the people involved.

[Hygiene as a weapon in the fight against SARS-Cov-2. All experts in taking care!]

To combat SARS-Cov-2, hygiene is essential for the safety of caregivers and saves lives. In hospital as well as in everyday social and professional environments, everyone is concerned by hygiene and distancing rules. It is an opportunity for us to reinvent ourselves, protect ourselves and protect the most vulnerable. In hospital, at the heart of the crisis, the action of the infection control team, which includes the infection control nurse, is one of the cornerstones of the fight against COVID-19.

Post-Traumatic Stress Disorder among French Armed Forces Members in Afghanistan: A New Approach

During the 20th century, the management of war-related psychological trauma shifted from neurology to psychiatry. After September 11, 2001, the French forces participated in a multinational force deployed in Afghanistan to fight against terrorism. Post-traumatic stress disorder (PTSD) became a priority. We report the daily work of the psychiatrists involved in this mission and the organization developed to psychologically support wounded military personnel. The doctrine of early intervention psychiatrization and the technique of collective debriefing are the key points of this procedure. The psychiatrist is also responsible for the healthcare community, particularly vulnerable when confronted with severe ballistic injuries. One aim of this organization is also to screen PTSD in soldiers returning from Afghanistan. The military general practitioner is a pivotal point of this procedure built to detect PTSD, anxiety, depressive reaction and behavioral problems. The French health service has developed a genuine care strategy aimed at identifying patients, accompanying them in the formalities for recognition and compensation, and offering them treatment locally by arranging clinical psychology consultations near their home.

[Operational fatigue: debriefing from Kapisa, Afghanistan]

The concept of operational fatigue, a term first used during the Second World War, was subsequently extended to encompass a vague series of psychological disorders. This article looks back at an overseas operation in Afghanistan, during the summer of 2011, where the tense background situation, casualties and fatalities resulted in some members of the commando parachute units suffering from such conditions.

[Reception and involvement of soldiers' families]

Faced with a mental health crisis, the intervention of nurses, psychologists and psychiatrists is rarely limited to an individual approach. Our team has chosen to structure and systematise the involvement of the families of hospitalised soldiers.A family psychotherapy consultation has also been reinforced in orderto favourthe inclusion of the families of soldiers in crisis. These two tools are complementary and have enabled us to enrich the multidisciplinary work within the unit, as well as the relationship with the patients and families confronted with a crisis.

[The announcement of the need to amputate]

The announcement of a diagnosis is a difficult art. All the more so when it affects the patient's integrity, as is the case with a post-traumatic amputation. As part of the multidisciplinary support provided both prior to as well as after the procedure, the psychologist or psychiatrist has a specific role to play in ensuring the patient's future psychological rehabilitation.

Conditionnement et extinction à la peur dans l’état de stress post-traumatique, étude des mécanismes centraux en IRM fonctionnelle

Introduction

La réponse normale ou pathologique à la peur peut être étudiée par un protocole de conditionnement à la peur et à son extinction. Nous avons étudié les mécanismes cérébraux centraux de réponses à la peur à l’aide du modèle pathologique que constitue l’État de Stress Post-Traumatique (ESPT), par un protocole de conditionnement à la peur et à son extinction en IRM fonctionnelle (IRMf). Notre hypothèse est que si ce mécanisme de conditionnement/extinction est central dans l’ESPT, alors après disparition des symptômes, les anomalies fonctionnelles des structures impliquées dans ce mécanisme (amygdale et cortex préfrontal médian) disparaîtront.

Méthodes

Cinquante-deux sujets, 22 témoins sains et 30 patients atteints d’ESPT sont inclus. Les patients effectuaient le protocole de conditionnement à la peur et à son extinction avant puis après traitement et disparition des symptômes. Le contraste d’intérêt était la différence de signal BOLD après moins avant traitement chez les sujets ESPT.

Résultats

Les patients présentent un retard dans l’extinction d’une peur conditionnée (p < 0,001). Une augmentation du signal BOLD après disparition des symptômes chez les patients ESPT est retrouvée dans des clusters centrés sur le noyau médiodorsal du thalamus, les gyrus frontaux inférieurs et supérieurs gauche (p < 0,005 et k > 5).

Discussion et conclusion

Témoignant d’une dérégulation des réponses à la peur, l’ESPT se caractérise par un déficit dans l’extinction d’une peur conditionnée. Le traitement de l’ESPT restaure la fonction du thalamus et du cortex préfrontal dorsolatéral gauche. Le circuit neuronal sous-jacent aux mécanismes de stress ferait donc intervenir le noyau médiodorsal du thalamus gauche, inhibé chez les malades, qui ne jouerait plus son rôle dans l’encodage et le rappel des informations en lien avec le cortex préfrontal dorsolatéral gauche. Ces structures seraient donc essentielles pour permettre une « extinction » des événements traumatisants, c’est-à-dire une intégration de nos émotions négatives.

Post-traumatic stress disorder after a submarine accident

INTRODUCTION

Although submarine accidents occur rarely, they sometimes result in many casualties. Although there are numerous reports on behavioral health consequences following surface vessel accidents, few studies have focused on these issues in the unique context of submarines. This paper reviews the history of significant acknowledged submarine accidents and reports the results of a behavioral health assessment following one recent accident.

METHODS

In 2007, a French nuclear-powered submarine (SNA Rubis) suffered a collision during a diving exercise off Toulon, France. All of the crew were individually assessed by a psychiatric team following the event for defusing. A follow-up assessment by auto-questionnaire was only conducted 8 mo after the accident using an anonymous subjective survey tool, the French version of the post-traumatic checklist scale (PCLS).

RESULTS

Of the 50 male crew, 48 (average age 28.8 +/- 4.3 yr) completed the questionnaire. Most of the crew (95.8%) had talked about the accident with close relations or work colleagues, but only three discussed it with a doctor. Median PCLS score was 19 (range 17-45); 83.3% of the crew had scores < or = 29; one subject met the criteria for PTSD.

DISCUSSION

Whether or not PTSD is an occupational hazard in submariners, this report highlights the difficulties in conducting behavioral health follow-up after serious accidents.

History of the discovery and clinical introduction of chlorpromazine

BACKGROUND

The historical process of discovery and clinical introduction of chlorpromazine, one of the greatest advances of 20th century medicine and history of psychiatry, is analyzed.

METHODS

In this review, we have studied the original works of pioneers in the discovery and clinical use of chlorpromazine, as well as the contributions of prestigious researchers (historians, pharmacologists, psychiatrists, etc.) about this topic.

RESULTS

The discovery of phenothiazines, the first family of antipsychotic agents has its origin in the development of German dye industry, at the end of the 19th century (Graebe, Liebermann, Bernthsen). Up to 1940 they were employed as antiseptics, antihelminthics and antimalarials (Ehrlich, Schulemann, Gilman). Finally, in the context of research on antihistaminic substances in France after World War II (Bovet, Halpern, Ducrot) the chlorpromazine was synthesized at Rhône-Poulenc Laboratories (Charpentier, Courvoisier, Koetschet) in December 1950. Its introduction in anaesthesiology, in the antishock area (lytic cocktails) and "artificial hibernation" techniques, is reviewed (Laborit), and its further psychiatric clinical introduction in 1952, with initial discrepancies between the Parisian Val-de-Grâce (Laborit, Hamon, Paraire) and Sainte-Anne (Delay, Deniker) hospital groups. The first North-American publications on chlorpromazine took place in 1954 (Lehmann, Winkelman, Bower). The introduction of chlorpromazine in the USA (SKF) was more difficult due to their strong psychoanalytic tradition. The consolidation of the neuroleptic therapy took place in 1955, thanks to a series of scientific events, which confirmed the antipsychotic efficacy of the chlorpromazine.

CONCLUSIONS

The discovery of the antipsychotic properties of chlorpromazine in the 1950s was a fundamental event for the practice of psychiatry and for the genesis of the so-called "psychopharmacological revolution."

[The long-term course of psychological trauma: a multiplicity of outcomes]

The evolving severity of psychical trauma is measured on a scale of many years. It is assessed in relation to the upheaval that the traumatic event introduces in the life of a subject: in terms of the prior organization of his psychical life as in the relationships that he maintains with his social circle.

[Event, stress and psychological trauma]

The study on stress and trauma leads us to distinguish between two categories of events: those that involve constraint as opposed to those that involve intrusion. This distinction is more than just a philosophical speculation since it allows us to infer clinical manifestations of wide ranging acute disturbances while in the field, as well as the manifestations of highly characteristic delayed disturbances that can sometimes arise month after exposure to trauma. The epidemiology of delayed manifestations related to psychological trauma indicates that these are common disturbances marked by their persistence and chronicity. These manifestations present a variety of public health problem: the need to anticipate and prepare acute rescue efforts to be introduce in case of disasters, the need for specific and extended individual follow-up, and also, from a medico-legal perspective, the question of compensation that may arise later on.

[Traumatic repetition syndrome]

Central point of posttraumatic psychic troubles, the traumatic repetition syndrome is present either directly, or after a variable time. Clinic is based on nightmares and flash backs, but also contains lots of non-specific disorders, according to patient personality. One characteristic of this clinic is its eclipse evolution, with recurring symptoms which appear suddenly and sometimes vanish.

[Psychological and neuropsychological problems in multiple sclerosis]

Neuropsychological investigations have demonstrated that cognitive disorders are common (about 60%) in patients with multiple sclerosis. 22 patients and 22 controls participated in the study with a review of literature. The cognitive dysfunction may be termed a subcortical white matter dementia. The hallmarks are: forgetfulness, reduced speed of information processing, impaired attention and slowness of thought processes, impaired ability to manipulate acquired knowledge. Psychiatric disturbance have also high prevalence: emotional or personality changes, depression. Pathological laughing and crying are classical but not well understood. This intellectual and emotional changes in multiple sclerosis are studied by adapted psychometric psychiatric examination. Correlation of magnetic resonance imaging with neuropsychological testing is now demonstrated. Total lesion score is the best predictor of cognitive deficits, cerebral atrophy and lesions of the corpus collosium also. Neuropsychological rehabilitation techniques and symptomatic treatments must be applied to patients with multiple sclerosis.

[Epidemiology and natural history of schizophrenia]

The concept of schizophrenia is that of a group of illnesses with differing clinical pictures and evolution. The "modes of entry" into the illness can be dramatic, with the unveiling of an acute psychotic episode, just as they can be insidious, with a progressive withdrawal accompanied or not by prolonged disturbances of mood and possible drug experimentation that act to mask the symptoms. Psychological, pharmacological, genetic and neuro-developmental studies have led to different hypotheses of pathogenesis, none of which alone is sufficient to explain the observed troubles, nor can be formally excluded. Schizophrenia is a multi-factorial illness and the current tendency is to describe a "vulnerability" to schizophrenia with a clinical picture and evolution that is simultaneously dependant on the environmental conditions and the therapeutic modalities put in place during the management of these patients.

[Presentations and diagnostic criteria of schizophrenia]

Childhood onset schizophrenia is very rare, but it's existence evokes a neuro-developmental hypothesis of a morbid process (genetic vulnerability and perinatal factors), affecting early cerebral development and evolving quietly until post-adolescence when the first psychotic symptoms manifest. The prodromic phase of schizophrenia consists of a constellation of non-specific symptoms, that which renders the institution of early treatment so difficult. The presence of psychotic symptoms in adolescence, even more so than in the adult, is not synonymous with schizophrenia. The appearance of an acute psychotic episode does not automatically prejudge an evolution to schizophrenia. It is the clinical investigation over several weeks that gives a diagnostic and therapeutic orientation. The existence of proven positive symptoms and the evolution of negative symptoms, despite a supportive environment and treatment, provide the best diagnostic arguments.

[Pregnancy and drug abuse: current situation and therapeutic strategies]

Drug abuse, a general public health problem, concerns a growing number of the pregnant women. Pregnancy in a drug addict is a high risk condition. The prevention of neonatal and pediatric complications involving both organic and psychological conditions, requires early individual medical, psychological and social support adapted to each pregnant addict. The risk for the mother and the fetus warrant prescription of substitution therapy during pregnancy. Published results concerning pregnancies in women on substitution therapy have been encouraging and clearly show a decrease in maternal and fetal complications. These studies are however difficult to conduct and carry a certain number of biases related to the social and economical context of the patients and also to the type of drug abuse (multiple drugs, drug combinations, psychostimulants, smoking, alcohol).

[Manic-depressive disorders in adolescence. Lithium treatment]

FIRST INTENTION PREVENTION: Lithium is the first intention preventive treatment for bipolar disorders. It the most effective choice in this indication and provides the most benefit for the patient, particularly the young patient still in the process of maturation.

SURVEILLANCE

Serum lithium must be monitored regularly. It is important for the clinician to be aware of different factors which can modify serum levels, including disease states or iatrogenic effects related to co-prescriptions. PATIENT INFORMATION: Long-term compliance and surveillance, and thus treatment efficacy, depend greatly on the quality of the information provided to the patient and his/her family.

[Eating disorders. Anorexia nervosa in adolescents]

EPIDEMIOLOGICAL DATA

Anorexia nevrosa is mainly observed in young women in the 15-24 year age range. The incidence is 1 to 2% in the general population of female adolescents. The sex ratio is 9 girls for 1 boy.

SYMPTOM TRIAD

Three symptoms predominate in anorexia nevrosa: weight loss, anorexia, amenorrhea. Weight loss results from restrictive eating behavior and not from a loss of appetite.

CLINICAL DIAGNOSIS

Diagnosis is clinical and confirmed by an analysis of the underlying psychological conflicts which involve difficulty in accepting the female identity and in assuming self-sufficiency outside the family. The clinician should evaluate the quality of the familial environment, particularly the mother-daughter and father-daughter relationship as well as the social environment (school, friends) which is also needed to apprehend the global situation. Physical examination and laboratory tests are aimed at rapidly eliminating any differential diagnosis and to quantify the weight loss and its rate, and identify any nutritional disorders.

ETIOLOGY

Anorexia nevrosa is not a truly structured psychopathological disorder but rather a loss of a stable organization of Self, with a highly vulnerable narcissistic element and precarious neurotic defences.

CLINICAL COURSE

The risk of poor outcome is very real, sometimes life threatening. The treatment of choice is to implement analytical management as soon as possible, but outside acute episodes.

[Antiphospholipid syndrome and psychosis]

The authors studies literature on both psychiatrics manifestations in several auto-immune diseases like systemic lupus erythematosus and the antiphospholipid syndrome, and the impairment of immune functions in psychiatrics diseases. They try to expose the relevance of collaboration between Medical practitioners and psychiatrists to study the immunogenetic hypothesis of psychotic diseases.

[Delusion and sleep deprivation]

In this article, the authors report two observations of short delusion that occurred after taking Guronsan--a psychostimulant commercialized in France--for a few days, with the intention of maintaining a total deprivation of sleep for three days in both cases. The ensuing clinical picture included a state of depersonalization, a loss of the sense of reality, illusions and even visual hallucinations as well as a delirious feeling of persecution. These disorders altered with the state of vigilance and the patients remembered them clearly. The authors discussed the etiopathogenic role of this psychotrope, as its components--acid ascorbic, glucuronamide and caffein--are not mentioned in literature as causing factors of a psychotic state. Then they compared this psychotrope with other molecules: amphetamines in particular may start a delirium of persecution, but normally they just reveal an underlying psychotic structure, which doesn't seem to be the case here, where the two young adults were only found a little immature. Chloroquine has sometimes been incriminated for disorders similar to those mentioned above, with a difference lying in a greater stability in the duration of these disorders that would persist several days after the end of the treatment. The clinical picture of the two cases was more labile and sedation was complete as soon as the absorption of the psychotrope was interrupted and sleep was restored at the same time. That is why the authors emphasize the importance of the deprivation of sleep as a causing factor of those delusion disorders which have particularly been observed in the case of solitary navigators. The psychiatrist dealing with emergencies shouldn't overlook this clinical and etiological possibility, all the less so as the treatment is simple and the resort to neuroleptics unnecessary.

[Fault, sacrifice and traumatic neurosis. Apropos of a case]

The present case is one of a patient suffering from traumatic neurosis, on whom psychotherapeutic work has been possible. The traumatic experience, which dates back to the Franco-Algerian War, could have gradually started making sense in the context of its onset and of the state in which the relationship between the patient and his father remained at the time. Something along the lines of an irrevocable mistake, irrevocable since logically referred to as a serious moral mistake on the part of the father towards his son, renders humanely comprehensible his upkeep of his atrocity as represented by the repetition of the revival symptoms.