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BackgroundTerrorist attacks occurred in Paris in January 2015.AimsTo assess the mental health impact and the access to psychomedical care of people exposed to the attacks.MethodWe implemented an open-cohort design 6 and 18 months after the attacks. Exposed civilians and rescue workers were included according to the exposure criteria A for post-traumatic stress disorder (PTSD) in DSM-5. A face-to-face questionnaire conducted by trained psychologists was used to collect sociodemographic characteristics, exposure level, scores on psychometric scales, an international neuropsychiatric interview and access to care.ResultsSix months after the attacks, 18% of civilians reported symptoms of PTSD, 31% had anxiety disorders and 11% depression. Among rescue workers, 3% reported symptoms of PTSD and 14% anxiety disorders. During the 48 h following the attacks, 53.2% of civilian had access to psychomedical carev. 35% of rescue and police staff.ConclusionsWe found severe psychological consequences, even in people who were less exposed.Declaration of interestNone.

International medical graduates (IMGs) account for more than 30% of the first-year positions filled in US psychiatric residencies (Nation Residency Match Program, 2007). At the time of writing, the first author was 4 months away from finishing his residency at the University of Connecticut (UCONN) when the opportunity arose to turn the tables and use his fluency in French to complete a month-long elective in France. During this period, he spent time as an observer in the psychiatric service of a Parisian hospital, l'Hôtel-Dieu. The realisation of this elective was helped by the fourth author, who knew various members of World Psychiatric Association. This paper presents some comparative observations of the clinical milieus at UCONN and the Hôtel-Dieu.

Victims of terrorist attacks: forensic issues. France has recently suffered multiple terrorist attacks. A lot of physicians had to face massive incoming victims. The first priority was somatic and psychological care. However, lack of juridical counseling led to delay in victim status recognition. Legal procedures are essentials in patients' recovery. We propose guidelines for medical certificate writing and first response legal orientation of terrorism victims.Victimes d’attentats : aspects médico-légaux. La France a récemment été le terrain de multiples attaques terroristes confrontant de nombreux médecins, parfois non spécialisés, à prendre en charge un afflux soudain et massif de personnes exposées. Dans ce cadre, l’urgence médicale initiale se complète d’un accompagnement dans les démarches médico-judiciaires. Celles-ci, souvent peu connues des non-spécialistes, sont nécessaires à la reconnaissance du statut de victime. Elles comportent plusieurs étapes bien définies. Nous proposons des recommandations afin de guider le praticien dans la rédaction du certificat médical initial, et dans l’accompagnement aux démarches de plainte pénale et d’indemnisation.

Total incapacity to work (TIW) is a legal concept that allows magistrates to assess the severity of violence against persons. The TIW is the duration of the victims' inability to fulfil their usual activities and is determined by physicians. Professional guidelines from the French National Authority for Health indicate that TIW applies both to physical and psychological problems. The law of 9 July 2010 makes explicit reference to TIW in cases of psychological violence and intimate partner harassment. Prosecutors base criminal penalties on the duration of TIW in cases of assault and battery. Whatever the physician, they should describe the mental state of the victim and identify the signs that may indicate the mental impact of reported assaults. Identifying combinations of symptoms can be useful in deciding whether the duration of TIW should be increased because of the psychic state. In case of stalking, assessment of TIW can allow prosecutors to link the reported facts to a criminal offence. In complex situations, the physician may be unable to assess a duration of TIW and can suggest expert assessment. In all cases, the duration of TIW needs to be based on functional criteria. The extent of harm to the life of relationships results from suffered violence, from the victim's reaction, and from the perception of their family and friends. In this area, we suggest to limit the first assessment of TIW to a few days and to reassess it later, according to real information reported by the victims, to careful observation of their behaviour, and to results of a questioning that should be as little suggestive as possible. At either end of the age scale and in case of preexisting functional impairment, assessment of TIW should take into account the actual and global capacity of the person before the assault.

Summary Introduction Coming from literature and medicine and medical humanities north American seminars, narrative medicine has applied narratology for analyzing patients’ discourse and has been taught during a decade. Methods At Paris Descartes School of Medicine a twenty-hour narrative medicine elective program including whole class lectures and writing and reading small group exercises for second year medical students has been assessed using satisfaction questionnaires. Results Although several students were uncomfortable with the first writing and reading exercises, the whole satisfaction scores demonstrate that this new program is very well appreciated even when students did not choose this program because they were interested with the patient physician relationship. These results have been confirmed when all students state this program should be continued and when half of them state this program should be offered to more students or made mandatory. Discussion The primary focus on literary characteristics of patients’ and physicians’ discourses, without ignoring psychoanalysis theory, has shown to be safe for young students. Writing exercises are encouraged but not mandatory, and reading is optional if ever they feel embarrassed after producing their own texts. Narrative medicine impact on students’ attitudes and behaviors has now to be assessed before implementing new educational programs.

In patients with clinical signs that may indicate a colorectal cancer, physicians may interpret the presence of a comorbid depressive mood as either increasing or decreasing the likelihood of cancer diagnosis. This study examined the association between depressive mood in candidates for a colonoscopy and subsequent diagnosis of cancer.Ninety-four outpatients [35 men, mean age ± standard deviation (SD) = 56.2 ± 9.8 years, 59 women, mean age ± SD = 54.2 ± 12.9 years] were given the 13-item Beck depression inventory to assess depressive mood before undergoing a colonoscopy. Additional psychological, demographic, and clinical data were collected prior to the colonoscopy.The colonoscopy found a cancer in 18 patients (19.1%). Cancer patients were older (P = 0.015) and more likely to present with anemia (P0.001) and unexplained weight loss (P = 0.046). Depressive mood was associated with a subsequent diagnosis of cancer in women (P = 0.007), but not in men (P = 0.985). This association remained significant after adjustment for potential confounders in women (i.e., anemia and unexplained weight loss) (P = 0.014).In women with clinical signs that warrant a colonoscopy, comorbid depressive mood may be associated with an increased likelihood of colorectal cancer and should not delay the receipt of a guideline-based diagnosis procedure.

Friday, Nov 13, 2015. It's 2130 h when the Assistance Publique-Hopitaux de Paris (APHP) is alerted to the explosions that have just occurred at the Stade de France, a stadium in Saint-Denis just outside Paris. Within 20 min, there are shootings at four sites and three bloody explosions in the capital. At 2140 h, a massacre takes place and hundreds of people are held hostage for 3 h in Bataclan concert hall. The emergency medical services (service d'aide medicale d'urgence, SAMU) are immediately mobilised and the crisis cell at the APHP is opened. The APHP crisis unit is able to coordinate 40 hospitals, the biggest entity in Europe with a total of 100 000 health professionals, a capacity of 22 000 beds, and 200 operating rooms. It is very quickly confirmed that the attacks are multiple and that the situation is highly scalable and progressing dangerously. These facts led to a first decision: the activation of the “White Plan” (by the APHP Director General) at 2234 h—mobilising all hospitals, recalling staff, and releasing beds to cope with a large influx of wounded people. The concept of the White Plan was developed 20 years ago, but this is the first time that the plan has been activated. It is a big decision, and timing is key: it would lose its effectiveness if taken too late. On the night of Friday Nov 13 to Saturday Nov 14, the activation of the White Plan had a critical effect. At no time during the emergency was there a shortage of personnel. During these hours, as the number of victims increased, with a sharp increase after the assault was launched inside the Bataclan, we were able to reassure the public and government that our abilities matched the demand. And when we felt that it might be necessary to deal with an influx of severely injured people, two further “reservoir” capacities were prepared: other hospitals in the area were put on alert, together with some university hospitals, more distant from Paris, but with the ability to mobilise ten helicopters to organise the transport of the wounded... Language: en

Consultation-liaison (C-L) and emergency psychiatry are two aspects of public psychiatry that experienced considerable development during the last decade in France. Major disparities still persist as regards endowment in professional resources and organization of C-L activity from one general hospital to another. Several emergent practices are described that underlie the role attributed to the C-L psychiatrist or psychologist as an expert in some systematic screening or assessment requests, as well as address the issue of combining, for some clinical situations, psychiatric and medical consultations. Substantial efforts have also been made for implementing C-L psychiatry outside the general hospital wards, notably in prisons. Psychiatric emergencies are, henceforth, integrated within emergency facilities of general hospitals. Several sociological changes or health policy decisions in France, such as the deinstitutionalization movement of the mentally ill, led to an increased numbers of patients at psychia...

The so called "psychological impact examination" (PIE) evaluates the potential psychological impact of an attack. It is conducted by highly specialized psychiatrists in medical and legal area. One of the PIE objectives is for the victim to be recognized by the legal system, the recognition includes not only the physical trauma but also and as importantly the psychological trauma. The exact evaluation of the psychological trauma is however challenging mainly because of the difficulty in predicting the long term psychological sequelae. The other objective of the PIE is to inform the victim of the mental health care and legal assistance available.

The 24-hour motor activity pattern was evaluated in 26 inpatients with major depression at treatment onset and after 4 weeks of antidepressant therapy. Clinical state, depression, and psychomotor retardation, as well as motor activity level and circadian rhythm, were simultaneously assessed. Treatment responders and nonresponders were also considered. Diurnal hypoactivity and reduced 24-hour rhythm amplitude were found at treatment onset. Activity level increased significantly on discharge. The rest-activity cycle for each depressed patient fit a cosine function of 24-hour periodicity. Data tended to show no phase shift but a large intragroup phase variability. Preliminary findings of a negative correlation between basic activity level and clinical improvement, and a trend toward responders having a lower activity level than nonresponders, suggest that activity could be used to predict therapeutic response.