Greater Nancy | Mental health: put words on the evil ones

Bipolar disorders can now affect 10% of the French population. Photo DR

The mental health of the French is deteriorating and how could it be otherwise? Sanitary, geopolitical or even climatic crises follow one another. The Covid-19 crisis has put mental health in the spotlight. In Nancy, an entire scientific community welcomes, treats, researches and innovates. Such as the Psychotherapeutic Center and its division on bipolar disorders.

Even if bipolar disorders cannot be cured, they are being treated better and better thanks to increasingly personalized care and knowledge-enriching research. Since September 2019, the Expertise Center for Bipolar Disorders has been part of the University Hospital Center for Adult Psychiatry and Addiction Care of Great Nancy of the Psychotherapeutic Center of Nancy. Its mission: to provide comprehensive and standardized assessments to patients diagnosed with or suspected of having bipolar disorder. Under the responsibility of Dr. Thomas Schwitzer, a team of university hospital psychiatrists, neuropsychologists and a medical administrator cares for approximately 400 patients per year.

Bipolar disorder today affects 1 to 4% of the general population in France. By expanding to the entire spectrum of bipolar disorder, the percentage of individuals involved would be 10%. The clinical diagnosis is made in the context of an interview with the patient, which is the result of numerous parallel evaluations: blood tests, psychological evaluations and symptoms evoked or observed in the patient. “The signs usually appear quite early, between the ages of 15 and 25. Today there is a nearly ten-year delay in diagnosis. Often because these are episodes or symptoms that seem quite classic: Seizures in a teen or young adult do not immediately indicate bipolar disorder. They are often downplayed. The diagnosis is usually made during periods of decompensation that are more pronounced due to the presence of more pronounced signs,” explains Thomas Schwitzer.

So what can be done to detect and treat patients earlier? “Strengthen detection and screening by more carefully observing symptoms that may seem atypical but are revealing. We need to monitor these young adults not to act in the first place, but rather to conduct accurate assessments and more oversight. We also need raising awareness of the onset of symptoms in this age group,” continues Thomas Schwitzer.

Therapeutic Education: Sharing and Solutions

After the diagnosis, the patients seen in the Center of Expertise are followed up over three years. At one or two annual meetings with specialists, their condition is regularly reassessed, their medication use and care monitored, and they can be offered new specialized treatment. All patients referred to the Center of Expertise are with their consent. “They are sent to us by hospital doctors or their attending physicians or even psychiatrists for a suspected diagnosis of bipolar disorder, which we invalidate or confirm thanks to an initial expert visit. We then propose that, in the case of diagnostic confirmation, patients integrate the follow-up course into our structure,” explains the health professional.

The first phase of any treatment involves stabilizing the patient’s mood through a pharmacological treatment known as a “mood regulator” adapted to their clinical features. Specific and specialized psychotherapeutic care is then deployed, including the therapeutic training offered in Nancy. “These are therapeutic groups that bring together patients, family members and specialists to explain what the disease is, its symptoms, the signs that can warn of the onset of a new episode, the treatments and their effects,” confides Thomas Schwitzer. “It’s very interesting because healthcare providers are sharing their knowledge, patients and loved ones about their experiences with bipolar disorder and this has quite a strong therapeutic effect. That the patient knows his conditions as well as the doctor and that he becomes an actor in his care by listening to himself to detect the hallmark signs of bipolar disorder, that is the whole point of therapeutic education,” says the psychiatrist.

The Nancy Expert Center also develops individual or group psychotherapy called “cognitive remediation.” After an assessment of the patient’s higher cognitive functions (memory, attention, task performance, etc.), any anomalies can be corrected to limit their impact on daily life. Healing to calm down and get on with his life, almost easy.

Retinal markers: a way forward

Nancy’s doctors work a lot to look for electrophysiological markers, especially retinal markers. With three objectives: to find diagnostic markers, improve the effectiveness of treatments and try to screen patients at risk to prevent them from developing bipolar disorder years later. This early detection is important to avoid the path of entry into pathology by quickly providing customized and personalized care. That is why Expertise Center Nancy participates in a project in close collaboration with the FondaMental Foundation with 500 patients who suffer from, among other things, bipolar disorder.

Another protocol in progress is the one called Bimar, which studies electrophysiological markers in patients suffering from bipolar disorder in Nancy. “To record these retinal markers, we perform an electrophysiological study of the retina to record the electrical response of retinal neurons,” explains Dr. Schwitter out. “Classically, this device is used by ophthalmologists, but in Nancy, with the help of BioSerenity, a French company based in Paris, we adapted it and incorporated it into a virtual reality headset”.

Covid-19 and Mental Health: Consulting Students

More and more students are concerned about their mental health. Photo DR

The Covid-19 epidemic has caused a lot of stress, uncertainty and turmoil in everyone’s lives. Fear, sadness, or concern for the future are common feelings. What are the effects on the side of professionals with, among other things, the free consultations provided by the government? Answers with Doctor Thomas Hubert, psychiatrist at the Nancy Psychotherapeutic Center.

One thing is certain: for an entire generation of patients, and for the entire population itself, the Covid will leave its mark. Some have endured this period alone, others have had help or still need help. Healthcare professionals are busy. Even though the pandemic seems to be less present on a daily basis, other problems are emerging. “We are in a post-Covid phase, but the climate remains tinged with fear and stress. The crises follow each other. For patients who already have vulnerability factors (anxiety disorders, withdrawal behavior, etc.), the Covid has only amplified them. On the one hand, the impact of incarceration, but also the disruption of daily structures. Work that becomes telecommuting and then becomes optional depending on the company. These discrepancies have led to additional limitations,” explains Dr. Thomas Hubert, psychiatrist at the Center psychothérapique de Nancy.

Certain protective factors such as the entourage played a very important role during this Covid period and its release. Still, mental health professionals are finding that many more young people are pushing their doors. “Students who often worry about their disrupted study, about their future and the loss of bearings, suffer even today,” continues Thomas Hubert.

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