There have been over 900,000 deaths from COVID-19, with more than 3 million people bereaved. These deaths are associated with factors leading to poor bereavement outcomes, and distress in frontline-staff

to (i)present the rapid implementation of an intervention for bereavement support; (ii)characterize first calls and follow-up.

We recruited a multidisciplinary team and prepared a structure called “SIB” (Support and Intervention for Bereavement) in a matter of days. There were three steps for the support (Screening, First-line intervention, Second-line intervention (short follow-up). We collected data screening risk factors for complicated grief (CG).

Between March 24th-May 14th (lockdown, March 16th-May 13th), the hotline received nineteen calls for an intervention. The hospital contacts were various, including mortuary. Fifteen relatives were followed, among them thirteen bereaved for ten deaths (on 52 deaths=19.23%). Dead persons were young (m=59.68 years-old, SD=15.25). All contacts reported several risk factors for a CG (no “goodbye” (100%), no funeral rituals (82.35%)). Six relatives were addressed for short follow-up.

The actual pandemic is at high risk for complicated grief and may until 2021. We hope that all hospitals would implement basic bereavement outreach programs to prepare families for the death and to support them afterwards, as well as provide basic support to frontline staff.

No significant relationships.

During the Covid Outbreak, the deployment of psychiatric phone-based consultations (PbC) became a large necessity.

The main objective of our study was to assess, 4 months after the end of the lockdown, the degree of satisfaction of the PbCs compared to that of usual face-to-face consultations (FC) in young adults presenting a first episode of psychosis (FEP) or entering schizophrenia (SCZ).

All patients beneficiated from PbCs conducted by hospital care staff during lockdown. A 15-items questionnaire evaluating satisfaction was carried out remotely (score ranging from 1 to 10). Primary outcome was satisfaction with consultation allowing the comparison of a group preferring FC (FC+) against a group in favor or equivalent of PbC (PbC +).

30 patients were recruited (mean age 26.93 years old (4.9 SD), Male 56%. Diagnoses were SCZ 60% and FEP 40%. 20/30 participants belonged to (FC+) group. Total scores of satisfaction for the PbC differed between the (PbC+) group (mean 9 (1.69 SD)) and (FC+) group (mean 6.80, (1.32 SD)) p < 0.05. The (FC+) group tends to have PbC more frequently (40%) than the (PbC+) group (10%) and to find the phone interface more stressfull (40%) than the PbC+ group (10%). The (FC+) group tends to less wish (40%) PbC follow up in future than the (PbC+) group (90%).

This study shows that the PbCs were favorably evaluated by a third of the patients. The anxiety-inducing experience of the PbC in the (FC+) group could be explained by the severity of their pathology.

Selon le modèle multifactoriel, la schizophrénie résulte de l’interaction de plusieurs gènes avec différents facteurs environnementaux, dont le cannabis qui peut jouer un rôle chez des sujets vulnérables [1]. Certains résultats issus de l’hypothèse neurodéveloppementale suggèrent une perturbation précoce du neuro-développement moins importante chez les consommateurs de cannabis et une sensibilité aux effets pharmacologiques du cannabis [3]. Les signes neurologiques mineurs (SNM) sont le reflet d’anomalies neuro-développementales précoces, ils sont fréquents dans les pathologies développementales à début précoce et remplissent les critères d’un marqueur endophénotypique [2]. Nous avons fait l’hypothèse que les patients consommateurs réguliers de cannabis avant le début des troubles constituent une entité phénotypique homogène avec une atteinte neuro-développementale précoce moins marquée.

Nous avons évalué prospectivement la symptomatologie négative, les déficits cognitifs et les SNM chez 61 patients schizophrènes suivis à l’hôpital Louis-Mourier (Colombes). L’évaluation était clinique avec la Positive And Negative Symptoms Scale, cognitive (fonctions exécutives, attentionnelles et mnésiques) et neurologique à l’aide de la Neurological Evaluation Scale. Les patients ayant consommé du cannabis avant le début des troubles étaient comparés aux autres patients (test t de Student pour les données quantitatives, test du Δ-2 ou test de Fischer pour les données qualitatives).

Les résultats principaux sont présentés dans le Tableau 1. On constate une perturbation plus importante des fonctions exécutives, attentionnelles et mnésiques dans le groupe des non-consommateurs de cannabis. Les SNM sont plus fréquents dans le sous-groupe non-consommateur de cannabis.

Tableau 1

Comparaison des caractéristiques cliniques, cognitives et neurologiques entre les patients ayant fumé régulièrement du cannabis avant le début des troubles et les autres patients.

Les patients consommateurs réguliers de cannabis avant le début des troubles représenteraient une entité phénotypique homogène. Le cannabis est un facteur environnemental pouvant intervenir tardivement sur le neurodéveloppement et pouvant jouer un rôle causal chez certains patients.

Erotomania is a rare delusional disorder. De Clerambault, a French psychiatrist, was the first who advanced the concept of pure erotomania, one of the ‘passionate psychosis', as a distinct disorder. However, some authors tend to consider this syndrome as related to other psychiatric disorders.

To describe the case of a female patient with erotomanic delusion with no remission under an antipsychotic and to review the links between erotomania and other psychiatric disorders.

Literature review and a case report

We report the case of a 32 year-old epileptic woman, hospitalized for a delusional erotomanic disorder. Initially, the patient was treated with an antipsychotic, with partial effectiveness. In fact, it appeared that the conviction of being loved began while she was depressed. After one month of combined antipsychotic and antidepressive medication, she became euthymic and her erotomanic delusions disappeared. Major depressive disorder with psychotic symptoms was diagnosed.

After reviewing the literature, we found that erotomanic symptoms frequently appear secondarily in other psychiatric disorders. Several publications indicate a frequent association between erotomania and mood disorder, especially major depression and bipolar affective disorder, and describe the efficacy of antidepressant and mood stabilizers. Numerous theories may explain the link between erotomania and mood disorder : from narcissistic needs, to the capacity of empathy and emotional processing. Further studies are needed to clarify the nature of this link.

In clinical practice, a mood disorder must systematically be searched for and treated in a patient with erotomanic delusions.

Repetitive checking in obsessive-compulsive disorder (OCD) would serve to relieve obsession-related anxiety and/or to compensate memory deficit, but experimental literature on this subject is inconsistent. The main objective is to test the influence of obsession-related anxiety and memory on repetitive checking in OCD.

Twenty-three OCD checkers, 17 OCD non-checkers and 41 controls performed a delayed-matching-to-sample task with an unrestricted checking option. Some stimuli were obsession-related in order to measure the influence of anxiety on checking. A version of the task without checking possibility was used to assess memory abilities.

OCD checkers had similar memory performances but checked more than the other groups when presented with non-anxiogenic stimuli. Level of anxiety associated to the stimulus did not influence the number of checks.

Increased checking in OCD checkers, being independent of memory abilities and primary obsession-related anxiety, would, therefore, be closer to an automated behaviour than a coping strategy.

Identifying schizophrenia vulnerability factors requires testing specific hypotheses concerning etiopathogenic models, candidate genes, and environmental factors involved. We hypothesized that patients developing schizophrenia after using regularly cannabis represent an homogenous phenotypic entity which could result from a specific interaction between genetic polymorphisms (SNPs) of CNR1, CNR2 and COMT genes and cannabis use (an environmental factor intervening lately in the neurodevelopment).

The main objective was to confirm that patients using cannabis before the onset of schizophrenia had fewer markers of early-neurodevelopmental impairment. The secondary objective was to identify a gene environment interaction in this subset of patients.

Patients were prospectively included and underwent a standardized interview and an evaluation of cognitive functions and neurological soft signs. Blood and saliva samples were collected. For the case-case genetic study, those patients were pooled with patients included in a cannabisdependent schizophrenic-patients cohort. Eight CNR1, CNR2 and COMT SNPs were analyzed.

We included 61 patients in the clinical part. Regular cannabis users before the onset of the disorder had fewer neurological soft signs, less cognitive impairment and a different clinical symptomatology. For the genetic part 26 patients were added to the 57 patients from the clinical part (4 non Caucasian patients excluded). Results were in favor of a gene environment interaction for rs1049353 of CNR1.

We found that regular cannabis users before the onset of schizophrenia had less neurodevelopmental impairment. In this subset of patients, cannabis could play a causal role in a gene environment interaction leading to schizophrenia.

Patients with post-traumatic stress disorder (PTSD) have shown disturbances in visual information treatment. However, most of studies demonstrated attentional bias towards emotional stimuli by using non-ecological paradigm. The paradigm of change blindness offers the possibility of studying sensitivity to the sudden irruption of visual information with ecological stimuli.

To compare the explicit detection with the implicit detection by using respectively motor response and eye tracking in patients with PSTD and controls.

Fifteen patients with PTSD and fifteen healthy controls had to detect changes in 96 scenes with (1) no change, (2) one neutral change or (3) one emotional pleasant or unpleasant change. We measured the participant's speed and accuracy in explicitly reporting the changes via motor responses, and their capacity to implicitly detect changes via eye movements.

The patients showed a trend towards slower explicit detection for the emotional change (P = 0.06) and more specifically for unpleasant change (P = 0.054). The two groups did not differ for implicit detection.

Patients tend to explicitly detect more slowly emotional change (but not neutral), especially for unpleasant change. This could be the result of a lack of access to consciousness of the emotional information. The emotional visual information treatment in PSTD could require more attentional processes than the non-emotional visual information and then lead to a decrease of the available attentional resources for the explicit task.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Eating disorders are pathologies with potentially serious psychic and somatic consequences, and high mortality. Lifetime prevalence in adults is about 0.6% for anorexia nervosa, 1% for bulimia, and 3% for binge eating disorder. However, the prognosis is improved if a suitable care is quickly established. Caregivers are often highly involved and helpless in facing such diseases. They often express a significant psychological distress. We must contribute to provide them answers, to strengthen their key role as a resource and support for the patient. It is found that carers themselves are poorly trained in screening, diagnosing and supporting eating disorders. There are effective therapeutic approaches, such as psychoeducation, to improve therapeutic alliance.

This work aims to realize a French psychoeducational audio-visual tool for patients with eating disorders, their caregivers, and professional carers.

We made an extensive review of literature (focus on the international practice guidelines, existing psychoeducational tools), and several consensus meetings. We decided of original directions to drive the psychoeducational approach of the movies, taking into account previous findings.

This tool includes three movies approaching the symptoms and the choice of treatment setting, based on the disease course and the care's goals. They may be broadcasted on a national level through professional networks and associations involved in the treatment of eating disorders.

This work improves the knowledge of eating disorders in carers, patients and their families. The relevance and effectiveness of this tool on the course of the disease has to be further evaluated.

The authors have not supplied their declaration of competing interest.

Tobacco smoking is common in schizophrenia. Some characteristics are usually associated to tobacco smoking in schizophrenia, such as younger age, earlier onset of the disease, number of hospitalizations or higher treatment doses. However, little is known about positive symptoms or aggressiveness, as well as trauma history.

to study the relationship between smoking status and clinical characteristics in patients with schizophrenia.

A total of 474 patients with were consecutively included in the network of FondaMental Expert Center (FACE) for schizophrenia and assessed with the structural clinical interview for DSM-IV axis 1 disorders (SCID), validated scales for psychotic symptomatology and childhood trauma questionnaire. Tobacco abuse or dependence was defined according to the SCID. Ongoing antipsychotic treatment was recorded. Aggressiveness was measured with Buss-Perry Aggression Questionnaire (BPAQ).

A sample of 474 patients with schizophrenia was included in this study (non-smokers, n = 215; non-smokers, n = 259). Mean age at tobacco onset was 17.19 years old (SD = 3.93). In multivariate analysis, smoking was associated with SGA use (P = 0.028), with higher scores of physical aggressiveness (P = 0.042), with current alcohol-dependence (P = 0.002). However, no association was observed with sex, age of onset, trauma history, global functioning, observance or psychotic symptomatology.

Tobacco smoking was associated with physical aggressiveness, but not with earlier onset of the disease nor traumas or psychotic symptomatology. Besides, the results of the present study are in favor of a superior efficacy of second-generation antipsychotics in the treatment of comorbid tobacco use. These results need further investigation in longitudinal studies.

The authors have not supplied their declaration of competing interest.

Erotomania is a rare delusional disorder. De Clerambault, a French psychiatrist, was the first who advanced the concept of pure erotomania, one of the “passionate psychosis”, as a distinct disorder. However, some authors tend to consider this syndrome as related to other psychiatric disorders.

To describe the case of a female patient with erotomanic delusion with no remission under an antipsychotic and to review the links between erotomania and other psychiatric disorders.

Literature review and a case report.

We report the case of a 32 year-old epileptic woman, hospitalized for a delusional erotomanic disorder. Initially, the patient was treated with an antipsychotic, with partial effectiveness. In fact, it appeared that the conviction of being loved began while she was depressed. After one month of combined antipsychotic and antidepressive medication, she became euthymic and her erotomanic delusions disappeared. Major depressive disorder with psychotic symptoms was diagnosed. After reviewing the literature we found that erotomanic symptoms frequently appear secondarily in other psychiatric disorders. Several publications indicate a frequent association between erotomania and mood disorder, especially bipolar affective disorder and major depression, and describe the efficacy of antidepressant and mood stabilizers. Numerous theories may explain the link between erotomania and mood disorder: from narcissistic needs, to the capacity of empathy and emotional processing. Further studies are needed to clarify the nature of this link.

In clinical practice, a mood disorder must systematically be searched for and treated in a patient with erotomanic delusions.

The authors have not supplied their declaration of competing interest.

Down syndrome was clinically described the first time in France by Esquirol (1838) followed by Down (England, 1866), to the identification of a chromosomal abnormality in 1959 (trisomy 21), which is the most common abnormality in neurodevelopmental disorders. Life expectancy increased from 9 years in 1929 to 55 currently. This is a common cause of mental retardation, and few tools are suitable for the care of these patients, including patients with Alzheimer's disease (prevalence of 55% between 50 and 59) or depression (prevalence 30%). No study evaluates the effectiveness of cognitive and behavioral therapy (CBT) in patients with Down syndrome but it is known to be effective in Alzheimer's patients. Some cases have been reported on the efficacy of CBT on phobias in patients with intellectual disability.

To evaluate the efficacy of CBT in the treatment of a specific phobia in a patient with Down syndrome and early Alzheimer's disease.

Literature review and clinical case of a 51-year-old patient, hospitalized under constraints for behavioral disorders (agitation, body treatments refusals).

By adapting CBT techniques to the problem of intellectual disability, treatment against the phobia was effective with clinical improvement, which allowed a return home.

The tools provided by CBT are suitable for the treatment of anxiety disorders in patients with intellectual disability, especially in patients with Down syndrome. Psychiatric disorders are under-diagnosed in these patients and under-treated. CBT is an aid to the treatment. It may allow the dismantling of symptoms and reduce behavioral problems.

The authors have not supplied their declaration of competing interest.

We previously developed the Functional Remission Of General Schizophrenia (FROGS) scale demonstrating first, reliable assessment in a cross-sectional study and second, good time-stability. The purpose of the present analysis was to propose a shorter version (mini-FROGS), more compatible with the limited time available in a psychiatric visit, focusing on the functional domains that have higher likelihood of being improved with higher and/or longer symptomatic remission in different cultural backgrounds.

We used multiple regressions to find the most informative items explaining increased length of symptomatic remission, using prospective data from a national observational multicenter survey. Then, the mini-FROGS was used in different European countries to test its between-center reliability, compared to other scales.

Four domains were retained as capturing the maximum of symptomatic remission, namely (1) travel and communication, (2) management of illness and treatment, (3) self-esteem and sense of independence and (4) respect of biological rhythms. First, the mini-FROG was evaluated in 443 French patients with clinical remission and 22 without, and 12/18 months later in 140 patients still in clinical remission and 23 in relapse. In Europe, 295 schizophrenia patients were assessed with the mini-FROGS and other scales devoted to functional remission, allowing comparisons. The mini-FROGS showed good correlations with other scales in different countries and demonstrated good psychometric properties.

These results give evidence that a 4 items-only version of the FROGS scale may be useful to assess important aspects of functional remission, tightly linked to the length of clinical remission.