[Psychological traumas in adults (2/2)]

[Psychological care for combatants psychotraumatized by armed conflict]

The treatment of psychotrauma is based on two main aspects, pharmacological and psychotherapeutic, in accordance with national and international recommendations on psychotherapy, which recommend the use of different techniques, depending on the time frame of the psychotraumatic event or events. The principles of psychological support are based on three phases: immediate, post-medical and long-term. Therapeutic patient education brings added value to the psychological care of psychotraumatized people.

[Risks and Opportunities of Reproducing with HIV]

The war in Ukraine is a major and long-lasting polytraumatic event which has deleterious psychological consequences on a very large number of people in the country (combatants, civilians of all ages), or outside the country. These psychological disorders can have a lasting effect on the lives of children, adolescents and adults who are direct or indirect victims.

[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 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.

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

For serious cases of COVID-19, with severe respiratory failure due to damage to the lungs by SARS-CoV-2, hospitalisation in intensive care with intubation is often essential. What psychotraumatic risks does this episode present for these patients? Are these sudden, complex treatments, sometimes with fatal outcomes and frequently reported in the media, also a factor in the appearance of psychological trauma for families? These questions are the subject of this clinical reflection.

[COVID-19, the psychopathological effects of the pandemic]

The psychopathological effects of the spread of the SARS-Cov-2 and the COVID-19 pandemic are mainly related to the preventive measures imposing a lockdown on the general population: anxiety disorders, sleep disorders, depression, addictions, post-traumatic stress disorder, symptoms of psychosis, etc. More specific categories of the population have been particularly exposed to the harmful psychological impact of this epidemic: caregivers, patients receiving mental health care, patients hospitalised for COVID-19 and their families. These psychopathological effects can be observed in France, and also abroad, notably in Spain.

[PSYCOVID-19, psychological support device in the fields of mental health, somatic and medico-social]

In December 2019 the World Health Organization (WHO) recorded the first cases of an infectious disease that appeared in China in November of the same year. Generated by the new coronavirus SARS-CoV2, it is quickly named COVID-19 for COronaVirus Infectious Disease 2019. The spread of this unknown disease will soon have worldwide consequences: the contagiousness of the virus is extremely high and potentially lethal. In France, the population initially reacted with disbelief until the disease reached Europe and the first cases appeared on French territory, at the end of January. A few weeks later, on 16 March 2020, President Macron declared the country "at war" against COVID-19. The next day the population was placed in lockdown. At the present time, the country's activity is at a standstill. Schools, businesses and shops are closed. The French citizens are astounded. They suddenly have to face fear: fear of falling ill or that a close relative may fall ill, fear of being locked up and experiencing restrictions of liberties, fear of economic precariousness. And, above all, fear of uncertainty. In order to prevent the mental consequences of this crisis, psychological support units have been created with urgency at national scale. These units are intended to support the healthcare professionals as well as the patients and more broadly, the general population. The unit responsible for the department of Gironde has been set up quickly, over the weekend of March 21, 2020. The COVIDPSY33 listening unit has thus been created in Bordeaux by the Charles Perrens Hospital with support from the Agence Régionale de Santé Nouvelle-Aquitaine (ARS). Simultaneously, the PSYCOVID-19 unit was created. This additional unit works in collaboration with the COVIDPSY33 platform and offers psychological assistance to the general population and caregivers in the sectors of Bordeaux Rive Droite, Bordeaux Gare, Rives de Garonne, Rives d'Arcins and Sud Gironde. It thus covers an area equivalent to approximately half of Gironde, the largest department in metropolitan France. In the present interview, Samantha Al Joboory and Florence Monello, psychiatrist and psychologist coordinating PSYCOD-19, present this psychological support unit.