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[Ensuring mental health care during the SARS-CoV-2 epidemic in France: A narrative review].
Encephale. 2020 Jun; 46(3S):S3-S13.E

Abstract

OBJECTIVE

The lack of ressources and coordination to face the epidemic of coronavirus raises concerns for the health of patients with mental disorders in a country where we keep in memory the dramatic experience of famine in psychiatric hospitals during the Second World War. This article aims at proposing guidance to ensure mental health care during the SARS-CoV epidemy in France.

METHODS

Authors performed a narrative review identifying relevant results in the scientific and medical literature and local initiatives in France.

RESULTS

We identified four types of major vulnerabilities in patients suffering from mental disorders during this pandemic: (1) medical comorbidities that are more frequently found in patients suffering from mental disorders (cardiovascular and pulmonary pathologies, diabetes, obesity, etc.) which represent risk factors for severe infections with Covid-19; (2) age (the elderly constituting the population most vulnerable to coronavirus); (3) cognitive and behavioral troubles which can hamper compliance with confinement and hygiene measures and finally and (4) psychosocial vulnerability due to stigmatization and/or socio-economic difficulties. Furthermore, the mental health healthcare system is more vulnerable than other healthcare systems. Current government plans are poorly adapted to psychiatric establishments in a context of major shortage of organizational, material and human resources. In addition, a certain number of structural aspects make the psychiatric institution particularly vulnerable: many beds are closed, wards have a high density of patients, mental health community facilities are closed, medical teams are understaffed and poorly trained to face infectious diseases. We could also face major issues in referring patients with acute mental disorders to intensive care units. To maintain continuity of psychiatric care in this pandemic situation, several directions can be considered, in particular with the creation of Covid+ units. These units are under the dual supervision of a psychiatrist and of an internist/infectious disease specialist; all new entrants should be placed in quarantine for 14 days; the nurse staff should benefit from specific training, from daily medical check-ups and from close psychological support. Family visits would be prohibited and replaced by videoconference. At the end of hospitalization, in particular for the population of patients in compulsory ambulatory care situations, specific case-management should be organized with the possibility of home visits, in order to support them when they get back home and to help them to cope with the experience of confinement, which is at risk to induce recurrences of mental disorders. The total or partial closure of mental health community facilities is particularly disturbing for patients but a regular follow-up is possible with telemedicine and should include the monitoring of the suicide risk and psychoeducation strategies; developing support platforms could also be very helpful in this context. Private psychiatrists have also a crucial role of information with their patients on confinement and barrier measures, but also on measures to prevent the psychological risks inherent to confinement: maintenance of sleep regularity, physical exercise, social interactions, stress management and coping strategies, prevention of addictions, etc. They should also be trained to prevent, detect and treat early warning symptoms of post-traumatic stress disorder, because their prevalence was high in the regions of China most affected by the pandemic.

DISCUSSION

French mental healthcare is now in a great and urgent need for reorganization and must also prepare in the coming days and weeks to face an epidemic of emotional disorders due to the containment of the general population.

Authors+Show Affiliations

Université de Paris, CRESS, Inserm, INRA, 75004 Paris, France. Electronic address: astrid.chevance@gmail.com.HEC Paris (Jouy-en-Josas), Paris, France.Centre ressource régional de psychiatrie du sujet âgé (CRRPSA), service de psychiatrie et d'addictologie de l'adulte et du sujet âgé, DMU psychiatrie et addictologie, Inserm U1266, institut de psychiatrie et neurosciences de Paris, centre université de Paris, AP-HP, Paris, France.Université Clermont-Auvergne, CHU de Clermont-Ferrand, Clermont-Ferrand, France.Laboratoire de sciences cognitives et sciences affectives (SCALab-PsyCHIC), université de Lille, CNRS UMR 9193, CHU de Lille, Lille, France.CHU de Nantes, Nantes, France.Université de Paris, collège national des universitaires de psychiatrie (CNUP), Inserm, CESP, Paris, France.Pôle hospitalo-universitaire de psychiatrie d'adultes et d'addictologie du Grand-Nancy, centre psychothérapique de Nancy, Laxou, France; Faculté de médecine, université de Lorraine, Nancy, France.Département de psychiatrie et d'addictologie, hôpital Paul-Brousse, AP-HP, 94800 Villejuif, France; Unité psychiatrie-comorbidités-addictions-unité de recherche, PSYCOMADD université Paris Sud, université Paris Saclay, AP-HP, Paris, France.Service de psychiatrie adultes, Sorbonne université, groupe hospitalier Pitié-Salpêtrière, ICM, Inserm U1127, AP-HP, Paris, France.SHU, GHU psychiatrie et neurosciences, Nightingale Hospitals-Paris, clinique du Château-de-Garches, Paris, France.Centre hospitalier Le Vinatier, Bron, France; Université Lyon, Lyon, France.Université Paris Est Créteil, Inserm, Fondation FondaMental, AP-HP, Paris, France.Université de Paris, GHU psychiatrie et neurosciences, Paris, France.

Pub Type(s)

Journal Article
Review

Language

fre

PubMed ID

32312567

Citation

Chevance, A, et al. "[Ensuring Mental Health Care During the SARS-CoV-2 Epidemic in France: a Narrative Review]." L'Encephale, vol. 46, no. 3S, 2020, pp. S3-S13.
Chevance A, Gourion D, Hoertel N, et al. [Ensuring mental health care during the SARS-CoV-2 epidemic in France: A narrative review]. Encephale. 2020;46(3S):S3-S13.
Chevance, A., Gourion, D., Hoertel, N., Llorca, P. M., Thomas, P., Bocher, R., Moro, M. R., Laprévote, V., Benyamina, A., Fossati, P., Masson, M., Leaune, E., Leboyer, M., & Gaillard, R. (2020). [Ensuring mental health care during the SARS-CoV-2 epidemic in France: A narrative review]. L'Encephale, 46(3S), S3-S13. https://doi.org/10.1016/j.encep.2020.03.001
Chevance A, et al. [Ensuring Mental Health Care During the SARS-CoV-2 Epidemic in France: a Narrative Review]. Encephale. 2020;46(3S):S3-S13. PubMed PMID: 32312567.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Ensuring mental health care during the SARS-CoV-2 epidemic in France: A narrative review]. AU - Chevance,A, AU - Gourion,D, AU - Hoertel,N, AU - Llorca,P-M, AU - Thomas,P, AU - Bocher,R, AU - Moro,M-R, AU - Laprévote,V, AU - Benyamina,A, AU - Fossati,P, AU - Masson,M, AU - Leaune,E, AU - Leboyer,M, AU - Gaillard,R, Y1 - 2020/04/02/ PY - 2020/03/26/received PY - 2020/03/29/accepted PY - 2020/4/22/pubmed PY - 2020/7/14/medline PY - 2020/4/22/entrez KW - Coronavirus KW - Covid-19 KW - Epidemy KW - France KW - Pandemy KW - Pandémie KW - Psychiatrie KW - Psychiatry KW - SARS-CoV-2 KW - Santé mentale KW - Épidémie SP - S3 EP - S13 JF - L'Encephale JO - Encephale VL - 46 IS - 3S N2 - OBJECTIVE: The lack of ressources and coordination to face the epidemic of coronavirus raises concerns for the health of patients with mental disorders in a country where we keep in memory the dramatic experience of famine in psychiatric hospitals during the Second World War. This article aims at proposing guidance to ensure mental health care during the SARS-CoV epidemy in France. METHODS: Authors performed a narrative review identifying relevant results in the scientific and medical literature and local initiatives in France. RESULTS: We identified four types of major vulnerabilities in patients suffering from mental disorders during this pandemic: (1) medical comorbidities that are more frequently found in patients suffering from mental disorders (cardiovascular and pulmonary pathologies, diabetes, obesity, etc.) which represent risk factors for severe infections with Covid-19; (2) age (the elderly constituting the population most vulnerable to coronavirus); (3) cognitive and behavioral troubles which can hamper compliance with confinement and hygiene measures and finally and (4) psychosocial vulnerability due to stigmatization and/or socio-economic difficulties. Furthermore, the mental health healthcare system is more vulnerable than other healthcare systems. Current government plans are poorly adapted to psychiatric establishments in a context of major shortage of organizational, material and human resources. In addition, a certain number of structural aspects make the psychiatric institution particularly vulnerable: many beds are closed, wards have a high density of patients, mental health community facilities are closed, medical teams are understaffed and poorly trained to face infectious diseases. We could also face major issues in referring patients with acute mental disorders to intensive care units. To maintain continuity of psychiatric care in this pandemic situation, several directions can be considered, in particular with the creation of Covid+ units. These units are under the dual supervision of a psychiatrist and of an internist/infectious disease specialist; all new entrants should be placed in quarantine for 14 days; the nurse staff should benefit from specific training, from daily medical check-ups and from close psychological support. Family visits would be prohibited and replaced by videoconference. At the end of hospitalization, in particular for the population of patients in compulsory ambulatory care situations, specific case-management should be organized with the possibility of home visits, in order to support them when they get back home and to help them to cope with the experience of confinement, which is at risk to induce recurrences of mental disorders. The total or partial closure of mental health community facilities is particularly disturbing for patients but a regular follow-up is possible with telemedicine and should include the monitoring of the suicide risk and psychoeducation strategies; developing support platforms could also be very helpful in this context. Private psychiatrists have also a crucial role of information with their patients on confinement and barrier measures, but also on measures to prevent the psychological risks inherent to confinement: maintenance of sleep regularity, physical exercise, social interactions, stress management and coping strategies, prevention of addictions, etc. They should also be trained to prevent, detect and treat early warning symptoms of post-traumatic stress disorder, because their prevalence was high in the regions of China most affected by the pandemic. DISCUSSION: French mental healthcare is now in a great and urgent need for reorganization and must also prepare in the coming days and weeks to face an epidemic of emotional disorders due to the containment of the general population. SN - 0013-7006 UR - https://www.unboundmedicine.com/medline/citation/32312567/[Ensuring_mental_health_care_during_the_SARS_CoV_2_epidemic_in_France:_A_narrative_review]_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0013-7006(20)30064-6 DB - PRIME DP - Unbound Medicine ER -