[Responsiveness and sustainability of psychiatric care in France during COVID-19 epidemic]

COVID-19 crisis and the incidence of hospital admissions for psychosis in France

OBJECTIVES

We aimed to assess the impact of the COVID-19 crisis on the occurrence of new hospital admissions for cases of psychosis in France.

METHOD

We conducted a retrospective observational study from the French national PMSI database. We included patients hospitalized between 2018 and 2020 with a principal diagnosis of schizophrenia or delusional disorder with no history of psychosis in the previous 10 years. In total, we included 77,172 inpatients at crisis centers and/or in full-time hospitalization at 465 French hospitals. We assessed the number of inpatients during the year of the Covid crisis (2020) and the two years prior (2018, 2019).

RESULTS

The number of inpatients in full-time hospitalization decreased gradually from 2018 to 2020 by 10.6%. This downward trend was observed in all age groups. In contrast, in crisis centers the number of inpatients increased by 13.4% between 2019 and 2020, while a 7.6% decrease was seen between 2018 and 2019. The greatest increase was observed in the 31-60-year age category, and particularly amongst 46-60-year-olds, i.e. 38.0%.

CONCLUSION

The COVID-19 crisis was associated with an increase in the number of inpatients with a new episode of psychosis in crisis centers but not in full-time hospitalization. The profile of patients in crisis centers was different from that seen in preceding years and included more middle-to-late age adults. Particular attention should be given to this category of patients in the crisis environment to prevent the occurrence of new cases of psychosis in France.

Evolution of the profiles of new psychotropic drug users before and during the COVID-19 crisis: an original longitudinal approach through multichannel sequence analysis using the French health-care database

The COVID-19 pandemic has had a substantial impact on mental health. An increase in the use of anxiolytic, hypnotic, and antidepressant drugs has been highlighted in France, but with no information at the individual level (trajectories) or concerning patient characteristics. The objective of this study was to describe the profile of new psychotropic drug users since the beginning of the pandemic. We formed two historical cohorts using the Pays-de-la-Loire regional component of the National Health Data System (SNDS): a "COVID-19 crisis cohort" (2020-2021) and a "control cohort" (2018-2019). We analyzed reimbursements for psychotropic medications (anxiolytics, antidepressants, hypnotics, mood stabilizers, and antipsychotics) using a multichannel sequence analysis and performed clustering analysis of sequences. The proportion of new consumers of psychotropic drugs was higher in the COVID-19 crisis cohort (18.0%) than that in the control cohort (16.0%). In the COVID-19 cohort, three clusters of psychotropic drug users were identified, whereas four clusters were identified in the control cohort. A time lag in treatment initiation was observed in the COVID-19 crisis cohort (September) compared with the control cohort (July). This study is one of the first to analyze the profile of psychotropic treatment users during the COVID-19 crisis. Our analysis sheds light on changes in patterns of psychotropic drug use during the COVID-19 pandemic, possibly associated with changes in prescribing conditions and mental health conditions during the crisis. This study also provides an example of the application of an innovative longitudinal analysis methodology in the field of pharmacoepidemiology.

Prevalence of COVID-19 and Psychotropic Drug Treatment in Psychiatric In-patients in Germany in 2020: Results from a Nationwide Pilot Survey

INTRODUCTION

In patients with a pre-existing mental disorder, an increased risk for a first manifestation of a psychiatric disorder in COVID-19 patients, a more severe course of COVID-19 and an increased mortality have been described. Conversely, observations of lower COVID-19 incidences in psychiatric in-patients suggested protective effects of psychiatric treatment and/or psychotropic drugs against COVID-19.

METHODS

A retrospective multi-center study was conducted in 24 German psychiatric university hospitals. Between April and December 2020 (the first and partly second wave of COVID-19), the effects of COVID-19 were assessed on psychiatric in-patient care, the incidence and course of a SARS-CoV-2 infection, and treatment with psychotropic drugs.

RESULTS

Patients (n=36,322) were admitted to the hospitals. Mandatory SARS-CoV-2 tests before/during admission were reported by 23 hospitals (95.8%), while 18 (75%) conducted regular testing during the hospital stay. Two hundred thirty-two (0.6%) patients were tested SARS-CoV-2-positive. Thirty-seven (16%) patients were receiving medical treatment for COVID-19 at the psychiatric hospital, ten (4.3%) were transferred to an intermediate/intensive care unit, and three (1.3%) died. The most common prescription for SARS-CoV-2-positive patients was for second-generation antipsychotics (n=79, 28.2%) and antidepressants (SSRIs (n=38, 13.5%), mirtazapine (n=36, 12.9%) and SNRIs (n=29, 10.4%)).

DISCUSSION

Contrary to previous studies, our results showed a low number of infections and mortality in SARS-CoV-2-positive psychiatric patients. Several preventive measures seem effective to protect this vulnerable group. Our observations are compatible with the hypothesis of a protective effect of psychotropic drugs against COVID-19 as the overall mortality and need for specific medical treatment was low.

Lessons from the coronavirus disease 2019 pandemic in schizophrenia: a review

PURPOSE OF REVIEW

Multiple countries have reported increased COVID-19 mortality in patients with schizophrenia. The purpose of this review was to synthetize the consequences of the pandemic on patients with schizophrenia including vaccination data.

RECENT FINDINGS

We have synthetized data on the increased risk of infection and increased mortality, the impact of the pandemic and lockdowns on psychiatric care, vaccination policies, unwillingness to vaccine in patients and the rates of vaccination.

SUMMARY

Schizophrenia has been confirmed at increased risk of both COVID-19 infection and developing a severe/lethal form of the infection. Patients with schizophrenia should, therefore, be prioritized for vaccination whenever possible and should be prioritized for psychiatric and somatic care access. Psychotic symptomatology may be a barrier to vaccination in some patients, and heterogenous vaccination rates were identified in national databases. The COVID-19 pandemic has been also a unique opportunity to develop telehealth. A mixed face-to-face and distance model should be encouraged, whenever possible, to improve the experience of patients, relatives and healthcare professionals. No major change of long-acting antipsychotics has been reported in most countries, and there was no consistent evidence for clozapine prescription to increase the risk of COVID-19 infection or severe outcomes.

Profile changes in admissions to a psychiatric hospitalisation unit over 15 years (2006-2021), considering the impact of the pandemic caused by SARS-CoV-2

The objective of this current work was to explore whether modification of the diagnostic criteria upon the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the impact of the COVID-19 pandemic had influenced the diagnostic and sociodemographic profiles of mental health admissions. For that purpose, we designed an observational, longitudinal, and retrospective study of the data recorded in the discharge reports of the Brief Hospitalization Unit at Castellon (Spain), between January 2006 and December 2021. The sample consisted of 7,037 participants, with a mean age of 42.1 years. The mean age of admissions, number of women, and presentation of affective disorders, addictions, and dementias all increased significantly during the DSM-5 period. Beyond diagnoses, the reduction in readmissions before the pandemic could be attributed to the use of long-acting injectable antipsychotics. In contrast, the pandemic did not change the percentage of readmissions or the volume of admissions. Also, during the pandemic period, the significant results obtained indicate that the average stay was reduced, affective disorders decreased, and addictions increased. Therefore, clinicians should consider these diagnostic and sociodemographic fluctuations when adapting clinical care, taking into account gender perspective, ageing of patients and increasing of dual and affective disorders.

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.

[Pulmonary rehabilitation, return home: the issues of psychic care for severe Covid-19 patients]

Upon discharge from the ICU, most severe post-Covid-19 patients are considered out of danger and on the mend. A large proportion of these patients are able to go home, but some continue to be frail and suffer from the side effects of the disease and the past heavy hospitalization. Others do not have the necessary support at home. Pulmonary rehabilitation is becoming a critical step in prognosis and a comfortable return home. It allows many patients to regain confidence in their body and its potential, to bridge the gap between a medically safe passive position and daily life, which should become as independent as possible, and to optimally reduce the risks of regression or relapse.

Une équipe mobile de psychiatrie du sujet âgé au temps de la pandémie : situations cliniques et ressenti des soignantes

Notre équipe mobile de psychiatrie du sujet âgé est restée mobilisée pendant le premier confinement lié à la propagation du SARS-CoV-2. Des adaptations et des modifications des pratiques soignantes ont été nécessaires face aux nouvelles contraintes et à l’absence de différents partenaires sur le terrain. À travers cet article, nous souhaitons partager deux situations cliniques : l’une concerne un duo mère-fille vivant dans un lieu inadapté à la vie à deux, et l’autre, la situation d’une patiente de 93 ans atteinte de troubles cognitifs et ayant contracté le virus. À partir de ces deux situations, l’article aborde le vécu, les émotions et le ressenti des soignantes durant cette période inédite.

COVID-19 and Physical Distancing Measures: Experience of Psychiatric Professionals in Europe

A The COVID-19 pandemic has had a considerable impact on the organization of psychiatric care. The present study examines how care professionals experienced this period and faced these new constraints weighing on their professional practices. Based on a qualitative research methodology, 13 group interviews with healthcare professionals working in psychiatric wards were conducted in five countries in western Europe. To complement this, 31 individual interviews were carried out in Belgium and France. Public health measures hindered certain therapeutic activities, jeopardized communication, and obliged healthcare professionals to modify and adapt their practices. Confronted with a transformation of their usual roles, healthcare professionals feared a deterioration in the quality of care. Impossible to continue in-person care practices, they resorted to online videoconferencing which went against their idea of care in which the encounter holds an essential place. The lockdown contradicted efforts to co-build care pathways toward readaptation, social reintegration, and recovery, thus reviving the perception of psychiatric hospitalization based on isolation.

Effect of the COVID-19 pandemic on the psychotropic drug consumption

IMPORTANCE

Although the COVID-19 pandemic has had a negative impact on mental health, there is no comprehensive longitudinal study of the entire population of a country without selection bias.

OBJECTIVE

The objective of this study was to evaluate the prescription of psychotropic drugs during the COVID-19 pandemic, using data from the French national health data system (SNDS).

DESIGN SETTINGS AND PARTICIPANTS

Prescriptions for psychotropic drugs (antidepressants, anxiolytics, hypnotics, and antipsychotics) from 1 January 2015 to 30 September 2021 were collected from administrative data provided by the SNDS. This database includes more than 99% of the French population, i.e., 67 million people. The data were analyzed using an interrupted time series analysis (ITSA) model.

MAIN OUTCOMES AND MEASURES

Consumption of psychotropic drugs was aggregated in months and expressed in number of boxes per thousand inhabitants.

RESULTS

During the study period, more than 1.3 billion boxes of psychotropic medications were dispensed. Comparison of psychotropic drug dispensing before and after the pandemic showed a relative increase of 0.76 (95 CI 0.57 to 0.95, p<0.001) boxes per month per thousand inhabitants, all classes of psychotropic drugs combined. Three classes saw their consumption increase in an almost similar proportion, respectively, by 0.23 (0.15 to 0.32, p<0.001) boxes for antidepressants, 0.27 (0.20 to 0.34, p<0.001) boxes for anxiolytics and 0.23 (0.17 to 0.30, p<0.001) boxes for hypnotics. The change in antipsychotic consumption was very small, with an increase of 0.04 boxes (0.02 to 0.06, p = 0.001) per month per thousand population.

CONCLUSION AND RELEVANCE

The COVID-19 pandemic had led to an increase in the consumption of psychotropic drugs, confirming the significant impact of the pandemic on the mental health of the general population.

[Psychiatric emergencies in teleconsultation: legal and practical aspects]

In the context of the Covid-19 pandemic, teleconsultation is an obvious solution in psychiatry to ensure continuity of care and facilitate access. However, the digitisation of ambulatory practices raises a certain number of reservations, in particular concerning the remote management of psychiatric emergencies. These situations, because of the specific aspects they cover, are in fact upsetting texts and recommendations of good practice in terms of teleconsultation. Thus, the questions of eligibility of people suffering from psychiatric disorders, the identification of an immediate self- or hetero-aggressive risk during teleconsultation and the establishment of a measure of psychiatric care without consent at the end of a teleconsultation require specific reflection in order to allow the practitioner to anticipate and manage the situation in the best possible way.

Telemental Health Use in the COVID-19 Pandemic: A Scoping Review and Evidence Gap Mapping

Background: The COVID-19 pandemic has highlighted telemedicine use for mental illness (telemental health). Objective: In the scoping review, we describe the scope and domains of telemental health during the COVID-19 pandemic from the published literature and discuss associated challenges. Methods: PubMed, EMBASE, and the World Health Organization's Global COVID-19 Database were searched up to August 23, 2020 with no restrictions on study design, language, or geographical, following an a priori protocol (https://osf.io/4dxms/). Data were synthesized using descriptive statistics from the peer-reviewed literature and the National Quality Forum's (NQF) framework for telemental health. Sentiment analysis was also used to gauge patient and healthcare provider opinion toward telemental health. Results: After screening, we identified 196 articles, predominantly from high-income countries (36.22%). Most articles were classified as commentaries (51.53%) and discussed telemental health from a management standpoint (86.22%). Conditions commonly treated with telemental health were depression, anxiety, and eating disorders. Where data were available, most articles described telemental health in a home-based setting (use of telemental health at home by patients). Overall sentiment was neutral-to-positive for the individual domains of the NQF framework. Conclusions: Our findings suggest that there was a marked growth in the uptake of telemental health during the pandemic and that telemental health is effective, safe, and will remain in use for the foreseeable future. However, more needs to be done to better understand these findings. Greater investment into human and financial resources, and research should be made by governments, global funding agencies, academia, and other stakeholders, especially in low- and middle- income countries. Uniform guidelines for licensing and credentialing, payment and insurance, and standards of care need to be developed to ensure safe and optimal telemental health delivery. Telemental health education should be incorporated into health professions curricula globally. With rapidly advancing technology and increasing acceptance of interactive online platforms amongst patients and healthcare providers, telemental health can provide sustainable mental healthcare across patient populations. Systematic Review Registration: https://osf.io/4dxms/.

Covid-19 and organisational development: important signs of a new pillar for sustainability

Purpose

The global pandemic has had a considerable effect on organisations’ performance and development and on the daily lives of the general population. This study aims to analyse the recent literature on the topics of Covid-19 and sustainability and proposes to rethink and redefine sustainability with the intersection of human health as a fourth sustainable pillar.

Design/methodology/approach

Using the Scopus and ISI Web of Science databases, 119 articles were analysed in detail and classified according to concepts and principles for achieving sustainable development, based on the Brundtland Report, 1987.

Findings

The results indicate a high number of publications in the social dimension, with a relevant proportion of studies in the health sector. This study allows us to conclude that all sectors of society are being affected by the pandemic. However, the enormous tension and the immediate impact felt by the health sector during the pandemic reflect directly on the population, and there are clear signs that in the medium and long term, instability and uncertainty in the environmental, economic and social dimensions will remain. In national health systems, monitoring, innovating in human resource management and investing in information technology can ensure organizations’ reliability and sustainability. The conclusion involves the suggestion of introducing health as a new pillar for sustainability to consolidate the basis and structure of the United Nations’ Sustainable Development Objectives. The use of fundamental concepts is necessary and must be aligned to reassess the results obtained in studies, in comparison with observational data.

Practical implications

The implications arising from the inclusion of health as a fourth pillar of sustainability are diverse. The need to build a new theoretical and conceptual framework for sustainability derives from the fact that health reflects the concern of many postulants in this field of practices. The determining or conditioning conditions of the observed effects of the pandemic by COVID-19, whether situated simply as factors and/or economic, environmental or social reflexes that precede them, requires a conceptual development that allows its approach, as a complex object, whose determinations are subject to variable degrees of uncertainty and diversity.

Originality/value

This study aims to redefine the concept of sustainability, considering that health has become a public health emergency of international interest. Health affects the supply chain, cash flow, interferes with the educational format and interrupts the workforce’s routine, among other aspects, showing the true nature of its importance and its impact in all spheres (economic, environmental and social).

Uses of digital technologies in the time of Covid-19: opportunities and challenges for professionals in psychiatry and mental health care

BACKGROUND

The Covid-19 pandemic has required psychiatric and mental health professionals to change their practices to reduce the risk of transmission of SARS-CoV-2, in particular by favoring remote monitoring and assessment via digital technologies.

OBJECTIVE

As part of a research project that was co-funded by the French National Research Agency (ARN) and the Centre-Val de Loire Region, we carried out a systematic literature review to investigate how such uses of digital technologies have been developing.

METHODS

The present systematic review was conducted following the PRISMA guidelines. The search was carried out in MEDLINE (PubMed) and Cairn databases, as well as in a platform specializing in mental health, Ascodocpsy. The search yielded 558 results for the year 2020. After applying inclusion and exclusion criteria, first on titles and abstracts, and then on full texts, 61 articles were included.

RESULTS

The analysis of the literature revealed a heterogeneous integration of digital technologies, not only depending on countries, contexts, and local regulations, but also depending on the modalities of care. Notwithstanding these variations, the use of videoconferencing has developed significantly, affecting working conditions and therapeutic relationships. For many psychiatric and mental health professionals, the pandemic has been an opportunity to build up an experience of remote care, and thus better identify the possibilities and limits of these digital technologies.

CONCLUSIONS

The new uses of such technologies essentially consist in a transition from the classic consultation model towards teleconsultation and makes less use of the specific potential of artificial intelligence. As professionals were not prepared for these uses, they were confronted with practical difficulties and ethical questions, such as the place of digital technology in care, confidentiality and protection of personal data, and equity in access to care. The health crisis questions how the organization of health care integrates the possibilities offered by digital technology, in particular so as to promote the autonomy and empowerment of mental health service users.

CLINICALTRIAL

The impact of the COVID-19 epidemic on primary care in South-eastern France: implementation of a real-time monitoring system based on regional health insurance system data

BACKGROUND

The spring 2020 COVID-19 epidemic severely impacted France's healthcare system. The associated lockdown (17 March- 11 May 2020) and the risk of exposure to SARS-CoV-2 led patients to change their use of healthcare. This article presents the development and implementation of a real-time system to monitor i) private doctors' activity in South-eastern France, and ii) changes in prescription of drugs for people with diabetes, mental health disorders and for certain vaccines from Mars 2020 to October 2020.

METHODS

Data extracted from the regional healthcare insurance databases for 2019 and 2020 were used to construct indicators of healthcare use. They were calculated on a weekly basis, starting from week 2 2020 and compared for the same period between 2019 and 2020.

RESULTS

Private doctors' activity decreased during the spring 2020 lockdown (by 23 % for general practitioners and 46 % for specialists), followed by an almost complete return to normal after it ended until week 41. Over the same period, a huge increase in teleconsultations was observed, accounting for 30 % of private doctors' consultations at the height of the crisis. The start of the lockdown was marked by a peak in drug prescriptions, while vaccinations declined sharply (by 39 % for the measles, mumps and rubella (MMR) vaccine in children under 5 years old, and by 54 % for human papillomavirus vaccine in girls aged 10-14 years old).

CONCLUSION

The ongoing COVID-19 epidemic may lead to health consequences other than those directly attributable to the disease itself. Specifically, lockdowns and foregoing healthcare could be very harmful at the individual and population levels. The latter issue is a concern for French public authorities, which have implemented actions aimed at encouraging patients to immediately seek treatment. However, the COVID-19 crisis has also created opportunities, such as the roll-out of teleconsultation and tele-expertise. The indicators described here as part of the monitoring system can help public decision-makers to become more responsive and to implement tailored actions to better meet the general population's healthcare needs.

The Early Impacts of the COVID-19 Pandemic on Mental Health Facilities and Psychiatric Professionals

(1) Background: While in many countries, the psychiatric and mental health sectors had been in crisis for years, the onset of a novel coronavirus pandemic impacted their structures, organizations, and professionals worldwide. (2) Methods: To document the early impacts of the COVID-19 health crisis on psychiatry and mental health sectors, a systematic review of the international literature published in 2020 was conducted in PubMed (MEDLINE), Cairn.info, and SantéPsy (Ascodocpsy) databases. (3) Results: After applying inclusion and exclusion criteria, 72 articles from scientific journals were selected, including papers documenting the early impact of the COVID-19 pandemic on the organization of psychiatric care delivery, work processes in psychiatry and mental health units, and personal experiences of mental health professionals. This review identified the contributions aimed at preventing the onset of mental disorders in the early stages of the health crisis. It lists the organizational changes that have been implemented in the first place to ensure continuity of psychiatric care while reducing the risk of SARS-CoV-2 transmission. It questions the evolution of the rights and duties of mental health professionals in the first months of the pandemic. (4) Discussion and conclusions: Although this literature review exclusively documented the early impacts of the COVID-19 health crisis, it is of significant interest, as it pictures the unprecedent situation in which psychiatry and mental health care professionals found themselves in the first stages of the pandemic. This work is a preliminary step of a study to be conducted with mental health professionals on an international scale—the Psy-GIPO2C project—based on more than 15 group interviews, 30 individual interviews, and 2000 questionnaires. The final aim of this study is to formulate concrete recommendations for decision-makers to improve work in psychiatry and mental health.

Occupational Therapy in Mental Health via Telehealth during the COVID-19 Pandemic

The COVID-19 pandemic has brought about changes in mental health occupational therapy. Research into these changes and the associated risks of relapse is insufficient. To explore the changes that have taken place in forms of occupational intervention (face-to-face and online) during the pandemic, and to analyze their association with subsequent relapses, a multicenter retrospective cohort study was carried out of 270 patients with mental disorder diagnoses under follow-up in day hospitals during 2020. Our results show that the frequency of face-to-face occupational therapy interventions decreased during lockdown and subsequently recovered. Interventions via telehealth increased during lockdown and have since been continued to a greater extent than before lockdown. Patients who received occupational intervention via telehealth relapsed less in the following six months (10.7% vs. 26.3%; χ2 = 10.372; p = 0.001), especially those who received intervention via videoconferencing (4.2% vs. 22%; χ2 = 5.718; p = 0.017). In conclusion, lockdown subsequent to the COVID-19 outbreak led to a reduction in face-to-face occupational therapy interventions, putting people with prior mental disorders at risk, while the implementation of telehealth tools helped reduce relapses.

[The impact of the COVID-19 pandemic on first-line primary care in southeastern France: Feedback on the implementation of a real-time monitoring system based on regional health insurance data]

Position du problème

L’épidémie de COVID-19 du printemps 2020 a fortement affecté le système de soins. Le confinement et les risques d’exposition au coronavirus ont incité les patients à modifier leur recours aux soins. L’objectif était de partager un retour d’expérience sur la mise en place d’un dispositif de surveillance en temps réel de l’activité des médecins libéraux de la région Provence-Alpes-Côte d’Azur, et de l’évolution des remboursements de médicaments prescrits aux assurés du régime général pour le diabète, pour des troubles de la santé mentale et pour certains vaccins.

Méthodes

Les données ont été extraites à partir des bases régionales de l’Assurance maladie pour les années 2019 et 2020. Elles ont permis de construire des indicateurs en date de soins pour le régime général stricto sensu, calculés de façon hebdomadaire, à partir de la semaine 2.

Résultats

On constate une chute d’activité des médecins libéraux lors du confinement (−23 % pour les médecins généralistes ; −46 % pour les spécialistes), suivie d’un quasi retour à la normale par la suite. Dans le même temps, les téléconsultations ont connu un véritable essor : elles ont constitué 30 % des actes des médecins libéraux au plus fort de la crise. Le début du confinement a été marqué par un pic d’approvisionnement en médicaments, tandis que la vaccination a fortement diminué (−39 % concernant le vaccin contre la rougeole, les oreillons et la rubéole chez les enfants âgés de moins de 5 ans ; −54 % pour le vaccin contre les papillomavirus humains chez les filles âgées de 10–14 ans).

Conclusion

L’épidémie de COVID-19 risque d’entraîner d’autres conséquences sanitaires que celles directement imputables à la COVID-19 elle-même. Le renoncement aux soins pourrait causer des retards de soins fortement préjudiciables aux individus et à la collectivité. Ces questions inquiètent les autorités publiques, qui mettent en place des actions visant à inciter les patients à se soigner sans tarder. Mais la crise liée à la COVID-19 a aussi créé des opportunités, telles que le déploiement de la téléconsultation et de la télé-expertise. Bien que partiels, les indicateurs mis en œuvre peuvent permettre aux décideurs publics d’être réactifs et de mettre en place certaines actions afin de répondre aux besoins de santé des populations.

[Mortality in schizophrenia: Towards a new health scandal? COVID-19 and schizophrenia]

Patients with schizophrenia represent a vulnerable population who have been understudied in COVID-19 research. We aimed to establish whether health outcomes and care differed between patients with schizophrenia and patients without a diagnosis of severe mental illness. We conducted a population-based cohort study of all patients with identified COVID-19 and respiratory symptoms who were hospitalized in France between February and June 2020. Cases were patients who had a diagnosis of schizophrenia. Controls were patients who did not have a diagnosis of severe mental illness. The outcomes were in-hospital mortality and intensive care unit (ICU) admission. A total of 50,750 patients were included, of whom 823 were schizophrenia patients (1.6%). The schizophrenia patients had an increased in-hospital mortality (25.6% vs. 21.7%; adjusted odds ratio (aOR) 1.30 [95% CI 1.08-1.56], p = 0.0093) and a decreased ICU admission rate (23.7% vs. 28.4%; aOR 0.75 [95% CI 0.62-0.91], p = 0.0062) compared to controls. Significant interactions between schizophrenia and age for mortality and ICU admission were observed (p = 0.0006 and p < 0.0001). Schizophrenia patients between 65 and 80 years had a significantly higher risk of death than controls of the same age (+7.89%). schizophrenia patients younger than 55 years had more ICU admissions (+13.93%) and schizophrenia patients between 65 and 80 years and older than 80 years had less ICU admissions than controls of the same age (-15.44% and -5.93%, respectively). Our findings report the existence of disparities in health and health care between schizophrenia patients and patients without a diagnosis of severe mental illness. These disparities differed according to the age and clinical profile of schizophrenia patients, suggesting the importance of personalized COVID-19 clinical management and health care strategies before, during and after hospitalization for reducing health disparities in this vulnerable population.

Disparities in Intensive Care Unit Admission and Mortality Among Patients With Schizophrenia and COVID-19: A National Cohort Study

Patients with schizophrenia (SCZ) represent a vulnerable population who have been understudied in COVID-19 research. We aimed to establish whether health outcomes and care differed between patients with SCZ and patients without a diagnosis of severe mental illness. We conducted a population-based cohort study of all patients with identified COVID-19 and respiratory symptoms who were hospitalized in France between February and June 2020. Cases were patients who had a diagnosis of SCZ. Controls were patients who did not have a diagnosis of severe mental illness. The outcomes were in-hospital mortality and intensive care unit (ICU) admission. A total of 50 750 patients were included, of whom 823 were SCZ patients (1.6%). The SCZ patients had an increased in-hospital mortality (25.6% vs 21.7%; adjusted OR 1.30 [95% CI, 1.08-1.56], P = .0093) and a decreased ICU admission rate (23.7% vs 28.4%; adjusted OR, 0.75 [95% CI, 0.62-0.91], P = .0062) compared with controls. Significant interactions between SCZ and age for mortality and ICU admission were observed (P = .0006 and P < .0001). SCZ patients between 65 and 80 years had a significantly higher risk of death than controls of the same age (+7.89%). SCZ patients younger than 55 years had more ICU admissions (+13.93%) and SCZ patients between 65 and 80 years and older than 80 years had less ICU admissions than controls of the same age (-15.44% and -5.93%, respectively). Our findings report the existence of disparities in health and health care between SCZ patients and patients without a diagnosis of severe mental illness. These disparities differed according to the age and clinical profile of SCZ patients, suggesting the importance of personalized COVID-19 clinical management and health care strategies before, during, and after hospitalization for reducing health disparities in this vulnerable population.

[Organisation of psychiatric care in Gabon during the COVID-19 epidemic]

Objectifs

L’épidémie du COVID-19 est survenue au Gabon à une période où l’hôpital psychiatrique vit une crise sans précédent du fait d’une baisse des moyens matériels et humains. À partir de l’expérience clinique des soignants, nous présentons les difficultés que rencontrent ces acteurs du soin pour maintenir l’alliance thérapeutique.

Méthode

L’article expose une synthèse de travaux sur le confinement, le COVID-19 et les troubles psychiques.

Résultats

Globalement, on observe une baisse des consultations en ambulatoire. En zone rurale, la crise sanitaire a occasionné une suppression des suivis au domicile des patients ainsi qu’une difficulté d’accès aux médicaments psychotropes onéreux, favorisant l’inobservance du traitement avec comme conséquence des décompensations psychiatriques.

[Adaptations of an outpatient Dialectical Behavioral Therapy during the COVID-19 pandemic and consequences of the confinement on patients with borderline personality disorder]

Objectif

La pandémie due à la COVID-19 a impacté l’accessibilité à la psychothérapie pour des patients particulièrement vulnérables pendant la période de confinement. Nous présentons les adaptations d’un programme de thérapie comportementale dialectique et les conséquences du confinement sur le vécu de patients souffrant d’un trouble de personnalité borderline.

Méthode

Nous avons, pour sept patients, comparé deux périodes de huit semaines, avant et pendant le confinement. Nous avons analysé leurs cartes journalières (n = 426) et le recensement hebdomadaire de la fréquence de leurs comportements problèmes (n = 69).

Résultats

L’analyse des cartes journalières indique que la période de confinement prédit une diminution significative des sentiments de peur, de honte ou culpabilité et de tension mais une augmentation de la détresse. Le suivi hebdomadaire montre une diminution significative des comportements hyperphagiques.

Discussion

Malgré le petit nombre de patients inclus, cette étude se base sur des échantillonnages d’expérience au quotidien et des mesures hebdomadaires. Ces deux types de mesures répétées indiquent certaines améliorations pendant le confinement, attestant des capacités d’adaptation de ces patients, soutenus par un cadre thérapeutique intensif qui a été maintenu.