[COVID-19: risks of psychological trauma for patients in intensive care or for their families]

[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.

[Psychological impact of the COVID-19 pandemic on children and adolescents and treatments]

Les enfants et les adolescents ont été particulièrement touchés par les conséquences psychologiques de la crise sanitaire liée à la pandémie de COVID-19. Les confinements successifs, le port du masque, la perte de leurs repères et de leur environnement social habituel à la suite des fermetures des écoles et à l’arrêt des activités extra-scolaires ont été autant d’adversités auxquelles ils ont été confrontés et qui ont fragilisé leurs stratégies de coping et leurs ressources. Dans cet entretien avec Jean-Pierre Bouchard, Olivier Sorel, Juliane Tortes Saint-Jammes et Sandie Meillerais discutent des modifications mises en place dans leur clinique de l’enfant dans le cadre de cette pandémie. Dans un deuxième temps, ils mettent en évidence les modalités de prise en charge spécifiques afin de développer, renforcer ou relancer les ressources des enfants et des adolescents pendant la thérapie au moyen de vignettes cliniques. Enfin, ils abordent la notion même de l’accompagnement clinique, en laissant une grande place à la thérapie EMDR et à une approche centrée sur la famille.

[Psychological state of Covid-19 patients after resuscitation]

The epidemic of Covid-19 was characterized, from its beginning, by "emergency". A state of emergency enacted by the state authorities to fight, on one hand, against the pandemic as such and, on the other hand, to manage the influx of patients admitted in intensive care. In this unprecedented context, the suffering of the people goes beyond the emergency situation and persists in forms ranging from a pseudo-banality to the complexity of an insidious evolution.

Clinical condition, Resuscitation and Medical-Psychological Care of Severe COVID-19 patients (part 2)

Respiratory rehabilitation is the penultimate step in the medical management of patients with severe COPD-19. It is an essential step before patients’ returning home, and is usually carried out in specialised Follow-up and Rehabilitation Clinics. When discharged from hospital, patients with post-severe COVID-19 usually progress in their medical condition. However, they may remain frail and have a constant fear of possible deterioration leading to (re)hospitalisation and a return to baseline. Psychological support in this phase can reduce patients’ anxiety and increase their motivation to carry out daily rehabilitation activities. This support provides a stable and consistent basis for patients to focus on their progress, leaving the difficulties behind. Being aware of the improvements in their physical condition allows them to maintain their motivation to continue to be physically active. Psychological support during respiratory rehabilitation aims at preparing patients to return to the normal life they had before the disease. It is usually based on brief psychotherapies that focus on strengthening the patient's abilities through behavioural changes and through reducing risk behaviours. Only after this phase is it sometimes possible to deal with complex issues and to cope with personality mechanisms and maladaptive behaviour patterns.

Clinical condition, Resuscitation and Medical-Psychological Care of Severe COVID-19 patients (part 1)

This interview covers the clinical and psychological condition of patients afflicted with severe COVID-19 and their pulmonary rehabilitation process. For these patients, symptoms are medically urgent and life-threatening. The sequelae of this viral attack and immune response to it are significant, and often persist for months after discharge from intensive care. To understand the medical and psychological state of these patients, a description is given of the organs affected, the oxygen cycle in the body and the medical care procedures that are used to help patients with dysfunctional respiratory systems. The link between physical and psychological progress is described. Physical weakness results from pulmonary sequelae and deconditioning, and is often experienced by patients as mental fatigue similar to psychological depression. This may draw the patient into a downward spiral, with multiple health aspects deteriorating, independently of the resolution of initial problems. Conversely, a positive physical or psychological evolution may lead to the evolution of the other. Thus, reversing the negative trend for just one system component can delay, completely arrest the spiralling down, or transform it into an upward spiral, improving the patient's condition. In addition, for people undergoing severe COVID-19, the return to normal life could be destabilizing and memories that arise from their crisis state may trigger Post-Traumatic Stress Disorder (PTSD). Health and psychosocial professionals hold an important role both in post-hospital care and in secondary prevention, i.e. prevention of relapse and re-hospitalization. Physical rehabilitation work must take these psychological factors into account, in the same way that any psychological follow-up is supposed to consider physiological factors.

[Screening for Alzheimer's disease by assessing memory impairment]

The feeling of memory failure is the most frequently expressed discomfort with age. The difficulty is to distinguish between a memory complaint and a memory pathology. Alzheimer's disease is diagnosed at the stage of dementia. Early detection and the prospect of treatments likely to act lead to an interest in its pre-dementia phase, which is known to precede the appearance of the dementia syndrome by several years.