Guide de prescription psychiatrique pendant la grossesse, le postpartum et l’allaitement

Perinatal psychopharmacology is an emerging specialty that is gradually developing alongside perinatal psychiatry. The management of psychiatric disorders during the perinatal period is a challenge for perinatal practitioners due to the multiple changes occurring during this crucial period. This little-known specialty still suffers from inappropriate considerations on the impact of psychotropic treatments on the mother and the infant during pregnancy and postpartum, which can promote a deficiency in perinatal psychic care. However, the risks associated with insufficient management of mental health are major, impacting both the mental and physical health of the mother and the infant. In this paper, we propose a perinatal psychopharmacology prescription guide based on available scientific evidence and international and national recommendations. We thus propose a decision-making process formalized on simple heuristics in order to help the clinician to prescribe psychotropic drugs during the perinatal period.

Théories du complot et COVID-19 : comment naissent les croyances complotistes ?

La pandémie COVID-19 causée par le nouveau coronavirus SARS-CoV-2 a provoqué une crise mondiale sans précédent, associée à une prolifération de théories du complot. La prévalence de ces croyances complotistes a participé à affaiblir la crédibilité des mesures gouvernementales de santé publique, limiter l'accès des citoyens aux sources d’information fiables, et perturber la réponse des systèmes de santé face à la crise sanitaire. Plusieurs hypothèses ont été proposées en psychologie et en sciences sociales pour comprendre la genèse de ces croyances dans des contextes épidémiques, associant l’implication conjointe de facteurs psychologiques (comme la volonté de préserver sa sécurité, de maintenir une image de soi positive, ou encore de renforcer son rôle social) et sociodémographiques (comme les caractéristiques générationnelles, socioculturelles et politiques des individus). Toutefois, les découvertes récentes en sciences cognitives à propos des mécanismes élémentaires de traitement de l'information offrent un nouvel éclairage sur la génération des croyances conspirationnistes à travers les époques et les cultures. Dans cet article, nous proposons une définition de la théorie du complot et une classification des croyances complotistes pendant la pandémie de COVID-19. Nous montrons comment les mécanismes de génération et de mise à jour des croyances permettent d'expliquer la genèse des théories du complot, et nous proposons plusieurs hypothèses étayées par les recherches contemporaines en sciences cognitives et en sciences sociales à propos des théories du complot.

[The invisible pregnancy: Clinical characteristics and perspectives about denial of pregnancy]

Denial of pregnancy is a public health problem due to maternal, fetal, and neonatal morbidity, affecting both physical and mental health. It generally involves an absence of the physical signals associated with pregnancy such as abdominal swelling, amenorrhea, weight gain, or even perception of fetal movements. Despite the potential consequences for mother and child, there is still little data on its clinical features and the neurocognitive mechanisms involved. In this paper, we provide an update on the clinical, socio-demographic, and psychopathological characteristics of pregnancy denial based on contemporary scientific literature. We first define denial of pregnancy by referring to the history of the concept, previous definitions, and nosographic classifications. We then detail the clinic of denial by distinguishing the physical and psychological symptoms of this disorder, then the socio-demographic, gynecological, and psychiatric characteristics. We describe the consequences of denial on the mother, infant, and the dyad, referring to situations of cryptic neonaticide. Finally, we show the importance of perinatal neuroscience research on maternal interoception to understand the mechanisms involved in denial of pregnancy, and improve their medical management in clinical practice.

[Belief updating and mood congruence in depressive disorder]

Depressive disorder is characterized by a polymorphic symptomatology associating emotional, cognitive and behavioral disturbances. One of the most specific symptoms is negative beliefs, called congruent to mood. Despite the importance of these beliefs in the development, the maintenance, and the recurrence of depressive episodes, little is known about the processes underlying the generation of depressive beliefs. In this paper, we detail the link between belief updating mechanisms and the genesis of depressive beliefs. We show how depression alters information processing, generating cognitive immunization when processing positive information, affective updating bias related to the valence of belief and prediction error, and difficultie to disengage from negative information. We suggest that disruption of belief-updating mechanisms forms the basis of belief-mood congruence in depression.

[Psychiatry without mind?]

Philosophy of Mind is currently one of the most prolific fields of research in philosophy and has witnessed a progressive hybridization with cognitive science. It focuses on fundamental questions to neuroscience and psychiatry, such as the nature of mental states and cognitive processes, or the relationships between mental states and the world. Anticipating the accumulation of experimental data from neuroscience, it provides a framework for the generation of theories in cognitive science. Philosophy of mind has thus laid the foundations of the conceptual space within which cognitive sciences have spread: a large part of contemporary theories in cognitive science result from a hybridization of conceptions forged by philosophers of mind and data produced by neuroscientists. Yet contemporary psychiatry is still reluctant to feed on the philosophy of mind, other than through the fragments that emerge from neuroscience. In this paper, we describe the evolution of contemporary philosophy of mind, and we detail its contributions around three central themes for psychiatry: naturalization of mind, mental causality, and subjectivity of mental states. We show how philosophy of mind provide the conceptual framework to link different levels of explanation in psychiatry: from biological to functional, from neurophysiology to cognition, from matter to mind.

[Ketamine, psilocybin, and rapid acting antidepressant: new promise for psychiatry?]

The hypothesis of monoaminergic deficiency has long dominated the conceptual framework for the development of new antidepressant strategies, but the limits of conventional antidepressant treatments targeting monoaminergic signaling have motivated the search for new antidepressant pathways. The success of ketamine in the management of depressive disorders has provoked a renewed interest in hallucinogenic substances such as psilocybin targeting the serotonergic signaling 5HT^2A and neurosteroid allosteric modulator of γ-aminobutyric acid (GABAA) receptors such as brexanolone. Unlike conventional treatments, these modulators of glutamatergic, serotonergic and GABAergic systems exert a rapid antidepressant effect ranging from 24hours to a week. Apart from their clinical interest and the fantasized search for a "miracle" molecule that jointly meets the expectations of patients and clinicians, these new targets could lead to the identification of potential new biomarkers for the development of rapid-acting antidepressants and redefine therapeutic strategies in mood disorders.

[Bayesian brain: Can we model emotion?]

Computational modeling builds mathematical models of cognitive phenomena to simulate patterns of perception, decision-making, and belief updating. These models mathematically represent the information processing by combining an anterior probability distribution, a likelihood function and a set of parameters and hyperparameters. Their use popularized the conception of a nervous system functioning as a predictive machine, or "bayesian brain". Applied to psychiatry, these models seek to explain how psychiatric dysfunction may emerge mechanistically. Despite the significance of emotions for cognitive phenomena and for psychiatric disorders, few computational models offer mathematical representations of emotion or incorporate emotional factors into their modeling parameters. We present here some computational hypotheses for the modeling of affective parameters, and we suggest that computational psychiatry would benefit from these modeling parameters.

[Coronavirus: Predictive brain and terror management]

Emerging infectious diseases like Covid-19 cause a major threat to global health. When confronted with new pathogens, individuals generate several beliefs about the epidemic phenomenon. Many studies have shown that individual protective behaviors largely depend on these beliefs. Due to the absence of treatment and vaccine against these emerging pathogens, the relation between these beliefs and these behaviors represents a crucial issue for public health policies. In the premises of the Covid-19 pandemic, several preliminary studies have highlighted a delay in the perception of risk by individuals, which potentially holds back the implementing of the necessary precautionary measures: people underestimated the risks associated with the virus, and therefore also the importance of complying with sanitary guidelines. During the peak of the pandemic, the salience of the threat and of the risk of mortality could then have transformed the way people generate their beliefs. This potentially leads to upheavals in the way they understand the world. Here, we propose to explore the evolution of beliefs and behaviors during the Covid-19 crisis, using the theory of predictive coding and the theory of terror management, two influential frameworks in cognitive science and in social psychology.