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Objective Several studies have reported poor long-term neuropsychological performances in patients following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but none has yet considered the effect of administering multiple intercorrelated neuropsychological tests and assessed the frequency of cognitive deficits in a normative population. Our aim was therefore to assess the presence of cumulative neuropsychological deficits in an actual post-coronavirus disease of 2019 (COVID-19) comparison group versus one simulated using Monte-Carlo methods. Method Validated neuropsychological Monte-Carlo simulation methods were applied to scores from a battery of neuropsychological tests (memory, executive, attentional, perceptual, logical reasoning, language, and ideomotor praxis) administered to 121 patients who had had mild, moderate, or severe COVID-19 (mean age: 56.70 years; 32% women), 222 ± 43 days post-infection. The cumulative percentages of the three severity subgroups were compared with the results of a false discovery rate-corrected probability analysis based on normative data. Results The cumulative percentages of deficits in memory and executive functions among the severe and moderate patients were significantly higher than those estimated for the normative population. Moderate patients also had significantly more deficits in perception and logical reasoning. In contrast, the mild group did not have significantly more cumulative deficits. Conclusions Moderate and severe forms of COVID-19 cause greater long-term neuropsychological deficits than those that would be found in a normative population, reinforcing the hypothesis of long-term effects of SARS-CoV-2 on cognitive function, independent of the severity of the initial infection. [ABSTRACT FROM AUTHOR]

Due to a higher risk of maternal complications during pregnancy, as well as pregnancy complications such as stillbirth, SARS-CoV-2 contamination during pregnancy is a putative stress factor that could increase the risk of perinatal maternal mental health issues. We included women older than 18 years, who delivered a living baby at the Geneva University Hospitals' maternity wards after 29 weeks of amenorrhea (w.a.) and excluded women who did not read or speak fluent French. We compared women who declared having had COVID-19, confirmed by a positive PCR test for SARS-CoV-2, during pregnancy with women who did not, both at delivery and at one month postpartum. We collected clinical data by auto-questionnaires between time of childbirth and the third day postpartum regarding the occurrence of perinatal depression, peritraumatic dissociation, and peritraumatic distress during childbirth, measured, respectively, by the EPDS (depression is score > 11), PDI (peritraumatic distress is score > 15), and PDEQ (scales). At one month postpartum, we compared the proportion of women with a diagnosis of postpartum depression (PPD) and birth-related posttraumatic stress disorder (CB-PTSD), using PCL-5 for CB-PTSD and using diagnosis criteria according DSM-5 for both PPD and CB-PTSD, in the context of a semi-structured interview, conducted by a clinician psychologist. Off the 257 women included, who delivered at the University Hospitals of Geneva between 25 January 2021 and 10 March 2022, 41 (16.1%) declared they had a positive PCR test for SARS-CoV-2 during their pregnancy. Regarding mental outcomes, except birth-related PTSD, all scores provided higher mean values in the group of women who declared having been infected by SARS-CoV-2, at delivery and at one month postpartum, without reaching any statistical significance: respectively, 7.8 (±5.2, 8:4-10.5) versus 6.5 (±4.7, 6:3-9), p = 0.139 ***, for continuous EPDS scores; 10 (25.0) versus 45 (21.1), p = 0.586 *, for dichotomous EPDS scores (≥11); 118 (55.7) versus 26 (63.4), p = 0.359 *, for continuous PDI scores; 18.3 (±6.8, 16:14-21) versus 21.1 (±10.7, 17:15-22), 0.231 ***, for dichotomous PDI scores (≥15); 14.7 (±5.9, 13:10-16) versus 15.7 (±7.1, 14:10-18), p = 0.636 ***, for continuous PDEQ scores; 64 (30.0) versus 17 (41.5), p = 0.151 *, for dichotomous PDEQ scores (≥15); and 2 (8.0) versus 5 (3.6), p = 0.289 *, for postpartum depression diagnosis, according DSM-5. We performed Chi-squared or Fisher's exact tests, depending on applicability for the comparison of categorical variables and Mann-Whitney nonparametric tests for continuous variables; p < 0.05 was considered as statistically significant. Surprisingly, we did not find more birth-related PTSD as noted by the PCL-5 score at one month postpartum in women who declared a positive PCR test for SARS-CoV-2:15 (10.6) versus no case of birth related PTSD in women who were infected during pregnancy ( p = 0.131 *). Our study showed that mental outcomes were differently distributed between women who declared having been infected by SARS-CoV-2 compared to women who were not infected. However, our study was underpowered to explore all the factors associated with psychiatric issues during pregnancy, postpartum, depending on the exposure to SARS-CoV-2 infection during pregnancy. Future longitudinal studies on bigger samples and more diverse populations over a longer period are needed to explore the long-term psychic impact on women who had COVID-19 during pregnancy.

Background: Despite numerous observations of neuropsychological deficits immediately following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, little is known about what happens to these deficits over time and whether they are affected by changes in fatigue and any psychiatric symptoms. We aimed to assess the prevalence of neuropsychological deficits at 6-9 months and again at 12-15 months after coronavirus disease 2019 (COVID-19) and to explore whether it was associated with changes in fatigue and psychiatric symptoms., Methods: We administered a series of neuropsychological tests and psychiatric questionnaires to 95 patients (mean age = 57.12 years, standard deviation (SD) = 10.68; 35.79% women) 222 (time point 1 (T1)) and 441 (time point 2 (T2)) days on average after infection. Patients were categorised according to the severity of their respiratory COVID-19 symptoms in the acute phase: mild (no hospitalisation), moderate (conventional hospitalisation), and severe (hospitalisation in intensive care unit (ICU) plus mechanical ventilation). We ran Monte-Carlo simulation methods at each time point to generate a simulated population and then compared the cumulative percentages of cognitive disorders displayed by the three patient subgroups with the estimated normative data. We calculated generalised estimating equations for the whole sample to assess the longitudinal associations between cumulative neuropsychological deficits, fatigue, and psychiatric data (anxiety, depressive symptoms, posttraumatic stress disorder, and apathy)., Results: Most participants (>50%) exhibited a decrease in their neuropsychological impairments, while approximately 25% showed an escalation in these cognitive deficits. At T2, patients in the mild subgroup remained free of accumulated neuropsychological impairments. Patients with moderate severity of symptoms displayed a decrease in the magnitude of cumulative deficits in perceptual and attentional functions, a persistence of executive, memory and logical reasoning deficits, and the emergence of language deficits. In patients with severe symptoms, perceptual deficits emerged and executive deficits increased, while attentional and memory deficits remained unchanged. Changes in executive functions were significantly associated with changes in depressive symptoms, but the generalised estimating equations failed to reveal any other significant effect., Conclusion: While most cumulative neuropsychological deficits observed at T1 persisted and even worsened over time in the subgroups of patients with moderate and severe symptoms, a significant proportion of patients, mainly in the mild subgroup, exhibited improved performances. However, we identified heterogeneous neuropsychological profiles both cross-sectionally and over time, suggesting that there may be distinct patient phenotypes. Predictors of these detrimental dynamics have yet to be identified., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2024 by the Journal of Global Health. All rights reserved.)

The subjective experience of asthma can be accompanied by significant emotional suffering. The presence of psychiatric comorbidities in asthma is common and worsens the prognosis of asthma. Bidirectional relationships between psychiatric disorders and asthma via inflammatory mechanisms are highlighted. Systematic screening for the most common psychiatric comorbidities such as depression, anxiety disorders and post-traumatic stress disorder is recommended. A multidisciplinary collaboration with a mental health specialist in the presence of psychiatric comorbidity has proven necessary to improve the quality of life and both the somatic and psychiatric prognosis of patients suffering from asthma., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Diabetes is a chronic and progressive disease that affects an increasing number of patients. The prevalence of associated psychological comorbidities is high and often requires the implementation of targeted psychological interventions. Pancreas or islet transplantation remains a therapeutic option to consider, for a part of patients with type 1 diabetes unstable disease or established complications. From the clinical indication to the waiting period for a transplantation, then to the postoperative and long-term care, the diabetic patient is found to experience perpetual changes that may test his adaptability. In this article, the psychological aspects of the pancreas or islet transplantation, as well as the role of a liaison psychiatrist in a transplantation unit will be discussed., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Inefficient ventilatory response during cardiopulmonary exercise testing (CPET) has been suggested as a cause of post-COVID-19 dyspnea. It has been described in hospitalized patients (HOSP) with lung parenchymal sequelae but also after mild infection in ambulatory patients (AMBU). We hypothesize that AMBU and HOSP have different ventilatory responses to exercise, due to different etiologies. We analyzed CPET realized between July 2020 and May 2022 of patients with persisting respiratory symptoms 3 mo after COVID-19. Chest computed tomography (CT) scan, pulmonary function tests, quality of life, and respiratory questionnaires were collected. CPET data were specifically explored as a function of ventilation (V̇e) and time. Seventy-nine consecutive patients were included (42 AMBU and 37 HOSP, median: 54 [44-60] yr old, 57% female). Patients were hospitalized for a median of 20 [8-34] days, with pneumonia (41%) or acute respiratory distress syndrome (ARDS; 30%). Among HOSP, 12(32%) patients had abnormal values for spirometry and 18(51%) for carbon monoxide diffusing capacity ( P < 0.001). CPET showed no differences between AMBU and HOSP in peak absolute O 2 uptake (V̇o 2 ) (1.59 [1.22-2.11] mL·min -1 ; P = 0.65). Tidal volume (VT) as a function of V̇e, was lower in AMBU than in HOSP ( P < 0.01) toward the end of exercise. The slope of the V̇e-CO 2 production was higher than normal in both groups (30.9 [26.1-34.3]; P = 0.96). In conclusion, the severity of COVID-19 did not influence the exercise capacity, but AMBU demonstrated a less efficient ventilatory response to exercise as compared with HOSP. CPET with exploration of data as a function of V̇e and throughout the exercise better unveil ventilatory inefficiency. NEW & NOTEWORTHY We evaluated the exercise ventilatory response in patients with persisting dyspnea after severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. We found that despite similar peak power and peak absolute O 2 uptake, tidal volume as a function of ventilation was lower in ambulatory than in hospitalized patients toward the end of exercise, reflecting ventilatory inefficiency. We call for evaluation of minute ventilation with the exploration of data throughout the exercise and not only peak data to better unveil ventilatory inefficiency.

Alterations of the limbic system may be present in the chronic phase of SARS-CoV-2 infection. Our aim was to study the long-term impact of this disease on limbic system-related behaviour and its associated brain functional connectivity, according to the severity of respiratory symptoms in the acute phase. To this end, we investigated the multimodal emotion recognition abilities of 105 patients from the Geneva COVID-COG Cohort 223 days on average after SARS-CoV-2 infection (diagnosed between March 2020 and May 2021), dividing them into three groups (severe, moderate or mild) according to respiratory symptom severity in the acute phase. We used multiple regressions and partial least squares correlation analyses to investigate the relationships between emotion recognition, olfaction, cognition, neuropsychiatric symptoms and functional brain networks. Six to 9 months following SARS-CoV-2 infection, moderate patients exhibited poorer recognition abilities than mild patients for expressions of fear ( P = 0.03 corrected), as did severe patients for disgust ( P = 0.04 corrected) and irritation ( P < 0.01 corrected). In the whole cohort, these performances were associated with decreased episodic memory and anosmia, but not with depressive symptoms, anxiety or post-traumatic stress disorder. Neuroimaging revealed a positive contribution of functional connectivity, notably between the cerebellum and the default mode, somatosensory motor and salience/ventral attention networks. These results highlight the long-term consequences of SARS-Cov-2 infection on the limbic system at both the behavioural and neuroimaging levels., Competing Interests: The authors report no competing interests., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Guarantors of Brain.)

Neuropsychological deficits and brain damage following SARS-CoV-2 infection are not well understood. Then, 116 patients, with either severe, moderate, or mild disease in the acute phase underwent neuropsychological and olfactory tests, as well as completed psychiatric and respiratory questionnaires at 223 ± 42 days postinfection. Additionally, a subgroup of 50 patients underwent functional magnetic resonance imaging. Patients in the severe group displayed poorer verbal episodic memory performances, and moderate patients had reduced mental flexibility. Neuroimaging revealed patterns of hypofunctional and hyperfunctional connectivities in severe patients, while only hyperconnectivity patterns were observed for moderate. The default mode, somatosensory, dorsal attention, subcortical, and cerebellar networks were implicated. Partial least squares correlations analysis confirmed specific association between memory, executive functions performances and brain functional connectivity. The severity of the infection in the acute phase is a predictor of neuropsychological performance 6-9 months following SARS-CoV-2 infection. SARS-CoV-2 infection causes long-term memory and executive dysfunctions, related to large-scale functional brain connectivity alterations., (© 2022 The Authors. Human Brain Mapping published by Wiley Periodicals LLC.)

While maternal suicide is an important cause of perinatal mortality, the assessment of this risk can be more difficult in the context of perinatality. Pregnancy acceptance problems and perinatal psychiatric disorders are major risk factors for maternal suicide. The -clinical evaluation focuses on the mental health of the mother on the one hand, but also on the quality of her interactions with the baby and the signs of psychological suffering of the latter during postpartum period. Coordinated and multidisciplinary management is recommended to prevent these fatal outcomes and the indication for hospitalization should always be discussed., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

COVID-19 had a huge impact on healthcare systems globally. Institutions, care teams and individuals made considerable efforts to adapt their practices. The present longitudinal, mixed-methods study examined a large sample of healthcare institution employees in Switzerland. Organisational resilience processes were assessed by identifying problematic real-world situations and evaluating how they were managed during three phases of the pandemic's first year. Results highlighted differences between resilience processes across the different types of problematic situations encountered by healthcare workers. Four configurations of organisational resilience were identified depending on teams' performance and ability to adapt over time: "learning from mistakes", "effective development", "new standards" and "hindered resilience". Resilience trajectories differed depending on professional categories, hierarchical status and the problematic situation's perceived severity. Factors promoting or impairing organisational resilience are discussed. Findings highlighted the importance of individuals', teams' and institutions' meso - and micro-level adaptations and macro-level actors' structural actions., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)

Background: Birth-related post-traumatic stress disorder occurs in 4.7% of mothers. No previous study focusing precisely on the stress factors related to the COVID-19 pandemic regarding this important public mental health issue has been conducted. However, the stress load brought about by the COVID-19 pandemic could have influenced this risk., Methods: We aimed to estimate the prevalence of traumatic childbirth and birth-related PTSD and to analyze the risk and protective factors involved, including the risk factors related to the COVID-19 pandemic. We conducted a prospective cohort study of women who delivered at the University Hospitals of Geneva between 25 January 2021 and 10 March 2022 with an assessment within 3 days of delivery and a clinical interview at one month post-partum., Results: Among the 254 participants included, 35 (21.1%, 95% CI: 15.1-28.1%) experienced a traumatic childbirth and 15 (9.1%, 95% CI: 5.2-14.6%) developed a birth-related PTSD at one month post-partum according to DSM-5. Known risk factors of birth-related PTSD such as antenatal depression, previous traumatic events, neonatal complications, peritraumatic distress and peritraumatic dissociation were confirmed. Among the factors related to COVID-19, only limited access to prenatal care increased the risk of birth-related PTSD., Conclusions: This study highlights the challenges of early mental health screening during the maternity stay when seeking to provide an early intervention and reduce the risk of developing birth-related PTSD. We found a modest influence of stress factors directly related to the COVID-19 pandemic on this risk.

Healthcare workers have potentially been among the most exposed to SARS-CoV-2 infection as well as the deleterious toll of the pandemic. This study has the objective to differentiate the pandemic toll from post-acute sequelae of SARS-CoV-2 infection in healthcare workers compared to the general population. The study was conducted between April and July 2021 at the Geneva University Hospitals, Switzerland. Eligible participants were all tested staff, and outpatient individuals tested for SARS-CoV-2 at the same hospital. The primary outcome was the prevalence of symptoms in healthcare workers compared to the general population, with measures of COVID-related symptoms and functional impairment, using prevalence estimates and multivariable logistic regression models. Healthcare workers (n = 3083) suffered mostly from fatigue (25.5 %), headache (10.0 %), difficulty concentrating (7.9 %), exhaustion/burnout (7.1 %), insomnia (6.2 %), myalgia (6.7 %) and arthralgia (6.3 %). Regardless of SARS-CoV-2 infection, all symptoms were significantly higher in healthcare workers than the general population (n = 3556). SARS-CoV-2 infection in healthcare workers was associated with loss or change in smell, loss or change in taste, palpitations, dyspnea, difficulty concentrating, fatigue, and headache. Functional impairment was more significant in healthcare workers compared to the general population (aOR 2.28; 1.76-2.96), with a positive association with SARS-CoV-2 infection (aOR 3.81; 2.59-5.60). Symptoms and functional impairment in healthcare workers were increased compared to the general population, and potentially related to the pandemic toll as well as post-acute sequelae of SARS-CoV-2 infection. These findings are of concern, considering the essential role of healthcare workers in caring for all patients including and beyond COVID-19., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Author(s).)

Non-pharmacological treatments of depression have become more widespread recently, especially for mild to moderate forms of depression. These complementary approaches are particularly interesting for patients who are reluctant to start an antidepressant. Novel approaches are found in psychotherapy, alternative treatments, plant-based treatments as well as the prevention of relapse through the use of digital tools. Some are even reimbursed by health insurance. However, these approaches are currently only applicable in combination with usual treatment, pharmacological or psychotherapy, as studies have shown that their efficiency in monotherapy is still limited., Competing Interests: Les auteur-e-s n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Background: Persistent symptoms of SARS-CoV-2 are prevalent weeks to months following the infection. To date, it is difficult to disentangle the direct from the indirect effects of SARS-CoV-2, including lockdown, social, and economic factors., Objective: The study aims to characterize the prevalence of symptoms, functional capacity, and quality of life at 12 months in outpatient symptomatic individuals tested positive for SARS-CoV-2 compared to individuals tested negative., Methods: From 23 April to 27 July 2021, outpatient symptomatic individuals tested for SARS-CoV-2 at the Geneva University Hospitals were followed up 12 months after their test date., Results: At 12 months, out of the 1447 participants (mean age 45.2 years, 61.2% women), 33.4% reported residual mild to moderate symptoms following SARS-CoV-2 infection compared to 6.5% in the control group. Symptoms included fatigue (16% vs. 3.1%), dyspnea (8.9% vs. 1.1%), headache (9.8% vs. 1.7%), insomnia (8.9% vs. 2.7%), and difficulty concentrating (7.4% vs. 2.5%). When compared to the control group, 30.5% of SARS-CoV-2 positive individuals reported functional impairment at 12 months versus 6.6%. SARS-CoV-2 infection was associated with the persistence of symptoms (adjusted odds ratio [aOR] 4.1; 2.60-6.83) and functional impairment (aOR 3.54; 2.16-5.80) overall, and in subgroups of women, men, individuals younger than 40 years, those between 40-59 years, and in individuals with no past medical or psychiatric history., Conclusion: SARS-CoV-2 infection leads to persistent symptoms over several months, including in young healthy individuals, in addition to the pandemic effects, and potentially more than other common respiratory infections. Symptoms impact functional capacity up to 12 months post infection., (© 2022 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.)

Background: The coronavirus disease 2019 pandemic has had a serious impact on global mental health, particularly in intensive care unit survivors. Given the lethal potential and unpredictability of coronavirus disease 2019, a high risk of posttraumatic stress disorder was identified in the beginning of the crisis. There are insufficient details in current literature and no official guidelines available for the treatment and follow-up of acute stress disorder and the prevention of posttraumatic stress disorder for intensive care unit survivors in the context of coronavirus disease 2019., Case Presentation: We hereby describe a 67-year-old Swiss patient presenting a psychiatric reaction in the context of coronavirus disease 2019. He was admitted to the intensive care unit due to severe acute respiratory distress syndrome from severe acute respiratory syndrome coronavirus 2 and intubated for 13 days. Afterwards, there was a severe worsening of acute renal failure prompting hemodialysis, and he developed delirium. Psychiatric liaison was requested 4 days post-intubation because the patient presented residual symptoms of delirium, false memories about the real context of his medical care, and ideas of persecution toward medical caregivers. He suffered from a very strong peritraumatic reaction, then developed an acute stress disorder linked with his care on the intensive care unit. We looked for strategies to prevent progression from acute stress disorder to posttraumatic stress disorder. We proceeded to the following therapeutic interventions: intensive psychiatric follow-up, intensive care unit diary, and low-dose antipsychotic treatment. The aim of our psychotherapeutic approach was to allow him to increase his feeling of security and to cope with the reality of his traumatic experience. He showed clinical improvement in his mental state after 3 months, despite several predictive factors of evolution to post-intensive care unit posttraumatic stress disorder., Conclusion: This case report illustrates how a delusional clinical presentation after intensive care in the context of coronavirus disease 2019 can hide psychotraumatic symptoms. It is important to highlight that the intensive care unit diary completed by the intensive care team and the follow-up by the psychiatric liaison team helped the patient reconstruct an appropriate and coherent account. Further studies are needed to determine the psychiatric effects of coronavirus disease 2019 and to assess early and appropriate psychiatric intervention for patients hospitalized for coronavirus disease 2019 to prevent posttraumatic stress disorder., (© 2022. The Author(s).)

Healthcare workers (HCWs) have significantly suffered during the COVID-19 pandemic, reporting a high prevalence of anxiety, depression and post-traumatic stress disorder (PTSD). We investigated with this survey whether HCWs benefitted from supportive measures put in place by hospitals and how these measures were perceived. This cross-sectional survey, which was conducted during the first wave of COVID-19 at the Geneva University Hospitals, Switzerland, between May and July 2021, collected information on the use and perception of practical and mental health support measures provided by the hospital. In total, 3461 HCWs participated in the study. Regarding the practical support measures, 2896 (84%) participants found them useful, and 2650 (76%) used them. Regarding the mental health support measures, 3149 (90%) participants found useful to have the possibility of attending hypnosis sessions, 3163 (91%) to have a psychologist within hospital units, 3202 (93%) to have a medical nursing psychiatric permanence available seven days a week, and 3171 (92%) to have a hotline available seven days a week. In total, 436 (13%) HCWs used at least one of the available mental health support measures. During the COVID-19 pandemic, the support measures were valued by HCWs. Given the high prevalence of psychiatric issues among HCWs, these measures seem necessary and are likely to have alleviated the suffering of HCWs.

Background: Prevention and management strategies of mental suffering in healthcare workers appeared as important challenges during the COVID-19 pandemic. This article aims to: (1) show how potential psychiatric disorders for healthcare workers (HCW) during the first wave of the COVID-19 outbreak were identified; (2) present an activity report of this consultation; and (3) analyze and learn from this experience for the future., Methods: We performed a retrospective quantitative analysis of socio-demographic and clinical data, in addition to psychiatric scales scores for the main potential psychiatric risks (PDI, PDEQ, PCL-5, HADS, MBI-HSS) and post-hoc qualitative analysis of written interviews., Results: Twenty-five healthcare workers consulted between 19 March 2020 and 12 June 2020. We found 78.57% presented high peritraumatic dissociation and peritraumatic distress, 68.75% had severe anxiety symptoms, and 31.25% had severe depression symptoms. Concerning burnout, we found that 23.53% had a high level of emotional exhaustion. In the qualitative analysis of the written interview, we found a direct link between stress and the COVID-19 pandemic, primarily concerning traumatic stressors, and secondarily with work-related stress., Conclusions: Early detection of traumatic reactions, valorization of individual effort, and limitations on work overload appear like potential key preventive measures to prevent psychiatric complications for healthcare workers in the context of the COVID-19 pandemic.

Lack of awareness of cognitive impairment (i.e. anosognosia) could be a key factor for distinguishing between neuropsychological post-COVID-19 condition phenotypes. In this context, the 2-fold aim of the present study was to (i) establish the prevalence of anosognosia for memory impairment, according to the severity of the infection in the acute phase and (ii) determine whether anosognosic patients with post-COVID syndrome have a different cognitive and psychiatric profile from nosognosic patients, with associated differences in brain functional connectivity. A battery of neuropsychological, psychiatric, olfactory, dyspnoea, fatigue and quality-of-life tests was administered 227.07 ± 42.69 days post-SARS-CoV-2 infection to 102 patients (mean age: 56.35 years, 65 men, no history of neurological, psychiatric, neuro-oncological or neurodevelopmental disorder prior to infection) who had experienced either a mild (not hospitalized; n  = 45), moderate (conventional hospitalization; n  = 34) or severe (hospitalization with intensive care unit stay and mechanical ventilation; n  = 23) presentation in the acute phase. Patients were first divided into two groups according to the presence or absence of anosognosia for memory deficits (26 anosognosic patients and 76 nosognosic patients). Of these, 49 patients underwent an MRI. Structural images were visually analysed, and statistical intergroup analyses were then performed on behavioural and functional connectivity measures. Only 15.6% of patients who presented mild disease displayed anosognosia for memory dysfunction, compared with 32.4% of patients with moderate presentation and 34.8% of patients with severe disease. Compared with nosognosic patients, those with anosognosia for memory dysfunction performed significantly more poorly on objective cognitive and olfactory measures. By contrast, they gave significantly more positive subjective assessments of their quality of life, psychiatric status and fatigue. Interestingly, the proportion of patients exhibiting a lack of consciousness of olfactory deficits was significantly higher in the anosognosic group. Functional connectivity analyses revealed a significant decrease in connectivity, in the anosognosic group as compared with the nosognosic group, within and between the following networks: the left default mode, the bilateral somatosensory motor, the right executive control, the right salient ventral attention and the bilateral dorsal attention networks, as well as the right Lobules IV and V of the cerebellum. Lack of awareness of cognitive disorders and, to a broader extent, impairment of the self-monitoring brain system, may be a key factor for distinguishing between the clinical phenotypes of post-COVID syndrome with neuropsychological deficits., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Guarantors of Brain.)

Perinatal grief should be given special attention for bereaved parents. In the hospital, multidisciplinary support is provided at different times of care. The loss of a pregnancy or a baby can permanently destabilize the couple's relationship and give rise to psychiatric complications in the presence of risk factors, such as pathological bereavement, a major depressive disorder, an anxiety disorder or a post-traumatic stress disorder. For subsequent pregnancies, there are risks of developing antenatal anxiety, attachment disorder, or parenting disorder. Multidisciplinary support and personalized psychotherapeutic and psychiatric care provided by liaison psychiatry when indicated, aim to reduce these risks., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Psychomotor agitation in somatic units is a medical and psychiatric emergency requiring rapid intervention by the team in charge of the patient and the liaison psychiatrist. Verbal de-escalation is attempted throughout the treatment. Securing the surroundings is needed to protect both the patient and the team. The etiology of the agitation, somatic and/or psychiatric, should be investigated to allow the administration of an adequate treatment. Antipsychotics and benzodiazepines are often recommended. Physical restraint measures can be applied as a last resort if necessary. The continuation of care is decided jointly between the team in charge and the liaison psychiatrist. An intervention protocol has been drawn up by the HUG liaison psychiatry team., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Objective: Psychiatric impact of COVID-19 is still explored and previous data suggest potential risks of anxiety, depression and PTSD related to COVID-19. We aimed to explore the predictive value of risk factors during hospitalization (T0) for COVID-19 for anxiety, depression and PTSD and at three months (T1) because they could differ over these two time points., Methods: We performed a screening of mental suffering in hospitalized patients for COVID-19, as well as specialized care and three months longitudinal follow-up. We evaluated at T0 and at T1 the prevalence of anxiety, depression and PTSD in survivors who benefited from early detection and treatment, and assessed possible risk factors in adults surviving COVID-19 between the 30th March and the 1 st of July 2020., Results: 109 patients were screened at T0 and 61 of these were reassessed at T1. At T0, we found 44.9% pathological score on peritraumatic dissociation experiences questionnaire (PDEQ), 85.4% of post-traumatic stress disorder symptoms (PTSS), 14.6% of pathological rate of post-traumatic stress disorder scale 5 (PCL5) and at T1, 86.9% of PTSS, 10.6% of pathological rate of PCL5. Finally, PDEQ score at T0 during hospitalization was positively correlated to PCL-5 score at T1 (β = 0.26, p = 0.01) and that was confirmed in multivariate analysis (β = 0.04, p = 0.02 for the log of PCL-5 per point on the PDEQ)., Conclusion: Screening of psychiatric symptoms during hospitalization for COVID-19 should be systematic, especially peritraumatic dissociation to offer an early treatment and prevent PTSD, which seemed frequent for hospitalized patients for COVID-19 at three months., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Intensive care workers are known for their stressful work environment and for a high prevalence of mental health outcomes. The aim of this study was to evaluate the mental health, well-being and changes in lifestyle among intensive care unit (ICU) healthcare workers (HCW) during the first wave of the COVID-19 pandemic and to compare these results with those of HCW in other hospital units. Another objective was to understand which associated factors aggravate their mental health during the COVID-19 outbreak., Methods: This cross-sectional survey collected socio-demographic data, lifestyle changes and mental health evaluations as assessed by the Generalized Anxiety Disorder 7 items (GAD-7), the Patient Health Questionnaire 9 items (PHQ-9), the Peritraumatic Distress Inventory (PDI) and the World Health Organization Well-Being Index (WHO-5) from the 28th May to 7th July 2020. The study was carried out at Geneva University Hospitals, a group of eight public hospitals in Switzerland. ICU HCW were analyzed for mental health outcomes and lifestyles changes and then compared to non-ICU HCW. A series of linear regression analyses were performed to assess factors associated with mental health scores., Results: A total of 3461 HCW were included in the study, with 352 ICU HCW. Among ICU HCW, 145 (41%) showed low well-being, 162 (46%) symptoms of anxiety, 163 (46%) symptoms of depression and 76 (22%) had peritraumatic distress. The mean scores of GAD-7, PHQ-9 and WHO-5 were worse in ICU HCW than in non-ICU HCW (p < 0.01). Working in the ICU rather than in other departments resulted in a change of eating habits, sleeping patterns and alcohol consumption (p < 0.01). Being a woman, the fear of catching and transmitting COVID-19, anxiety of working with COVID-19 patients, work overload, eating and sleeping disorders as well as increased alcohol consumption were associated with worse mental health outcomes., Conclusion: This study confirms the suspicion of a high prevalence of anxiety, depression, peritraumatic distress and low well-being during the first COVID-19 wave among HCW, especially among ICU HCW. This allows for the identification of associated risk factors. Long-term psychological follow-up should be considered for HCW., (© 2021. The Author(s).)

The COVID-19 pandemic's first wave required considerable adaptation efforts on the part of healthcare workers. The literature on resilient healthcare describes how the collective regulation strategies implemented by frontline employees make essential contributions to institutions' abilities to cope with major crises. The present mixed-methodology study was thus conducted among a large sample of employees in a variety of Swiss healthcare institutions and focused on problematic real-world situations experienced by them and their managers during the pandemic's first wave. It highlighted the anticipatory and adaptive strategies implemented by institutions, teams and individuals. The most frequently cited problematic situations involved organisational changes, interpersonal conflicts and workloads. In addition to the numerous top-down measures implemented by institutions, respondents also identified personal or team regulation strategies such as increasing staff flexibility, prioritising tasks, interprofessional collaboration, peer support or creating new communication channels to families. The present findings underlined the importance of taking greater account of healthcare support staff and strengthening managerial capacity to support interprofessional teams including those support staff., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Authors.)

Aim: To assess the impact of the first wave of the COVID-19 pandemic on acute coronary syndromes and on the delay from symptom onset to first medical contact among patients presenting with ST-segment elevation myocardial infarction (STEMI), as well as to investigate whether there were patient-related reasons related to COVID-19 for delaying first medical contact., Methods and Results: All patients undergoing percutaneous coronary intervention (PCI) at the Geneva University Hospitals for acute coronary syndromes (ACS) during the first COVID-19 wave were compared with a control group consisting of all ACS patients who underwent PCI during the same period in 2019 and those treated in the period immediately preceding the pandemic. The primary outcome measure was the difference in the delay from symptom onset to first medical contact in the setting of STEMI between the COVID-19 period and the control period. Secondary outcome measures were the difference in ACS incidence and the impact of the COVID-19 pandemic on patients&rsquo; decisions to call the emergency services, assessed using a questionnaire. Delay from symptom onset to first medical contact was longer among patients suffering from STEMI in the COVID-19 period compared with the control period (112 min vs 60 min, p = 0.049). The incidence rate of ACS was lower during the COVID-19 period (incidence rate ratio 0.6, 95% confidence interval [CI] 0.449&ndash;0.905). ACS patients delayed their call to the emergency services mainly because of fear of contracting or spreading COVID-19 following hospital admission, as well as of adding burden to the healthcare system., Conclusion: We observed prolonged delays from symptom onset to first medical contact and a decline in overall ACS incidence during the first wave of the COVID-19 pandemic, with a higher threshold to call for help among ACS patients.

Preliminary evidence suggests that mind-body interventions, including mindfulness-based interventions and yoga, may be effective in reducing mental health difficulties and psychological distress in infertile patients undergoing fertility treatments. We systematically reviewed and synthesized current medical literature of the effectiveness of mind-body interventions in reducing the severity of psychological distress and improving marital function and pregnancy outcomes in infertile women/couple. Databases including PsychINFO, PubMed, EMBASE, and the Cochrane Library were searched for relevant studies. Manual searches were conducted in relevant articles. We included 12 studies that met the inclusion criteria. Four studies were randomized controlled trials (RCT), 4 non-randomized controlled trial (NRCT), and 4 uncontrolled studies (UCT). Participation in a mind-body intervention was associated with reduced anxiety trait and depression scores. The reduction was of low or moderate amplitude in most studies. Our review offers evidence for the effectiveness of mind-body interventions in reducing anxiety state and depression in infertile women and a possible improvement in pregnancy rate. Further RCTs with a precise timing of intervention are needed.

In the context of liaison psychiatry, potentially traumatic somatic situations at the psychic level are frequent. They can be grouped into three broad categories: 1) psychotrauma in connection with a medical event ; 2) traumatic event at the origin of somatic management ; 3) traumatic event prior to somatic management. It is important to know the possible clinical reactions after a traumatic event. In the immediate aftermath of trauma, a clinical assessment is recommended to allow early identification of subjects at risk of developing post-traumatic stress disorder (PTSD). Pharmacological and non-pharmacological interventions should be considered to prevent or to treat the installation of PTSD with the aim of also improving the somatic prognosis., Competing Interests: L’auteur n’a déclaré aucun conflit d’intérêts en relation avec cet article.

In this article, a synthesis of data from the literature on postpartum post-traumatic stress disorder (PTSD) related to childbirth is presented, knowing that the psychological suffering in this period of life is frequently associated with a certain taboo. The criteria to diagnose psychotraumatism, as well as postpartum PTSD just after the birth are here recalled as well as the importance of evaluating the subjective experience of the mother wich is a central issue. The clinical specificity and key symptoms of postpartum PTSD are described along with the risk and protective factors. In the light of scientific knowledge in the field of psychotraumatology, we present the prevention strategies of this disorder that can be applied, but which remain to be evaluated and tailored to this specific context., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Recent conflicts in the Middle East and Africa generated the displacement of millions of refugees seeking a safe haven. It led to a transformation in the population of asylum seekers attending our community psychiatry clinic serving refugees and asylum seekers in Geneva. That patient population doubled in a couple of years, comprising a higher number of young men, migrating alone, mostly from the Middle East and Afghanistan. Higher demand on our system and specific mental health needs brought us to transform our setting. We have set up a new evaluation step, we developed outreach interventions, we work more closely with people in the patients' networks and we have dedicated meetings to discuss cases within the team and with supervisors with expertise in working in transcultural settings., Competing Interests: Les auteurs ne déclarent aucun conflit d’intérêts en relation avec cet article.