General sanitary containment during the Coronavirus epidemic: Medico-psychological consequences in general population, caregivers, and subjects suffering previously from mental disorders (Retrospective on the repercussions of lethal mass risks, scientific models of collective confinement, first clinical observations, implementation of countermeasures and innovative therapeutic strategies)
General sanitary containment during the Coronavirus epidemic: Medico-psychological consequences in general population, caregivers, and subjects suffering previously from mental disorders (Retrospective on the repercussions of lethal mass risks, scientific models of collective confinement, first clinical observations, implementation of countermeasures and innovative therapeutic strategies)
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DOI：
10.1016/j.amp.2020.06.001
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发表时间：
2020-09-01
影响因子：
0.6
通讯作者：
Tarquinio, Cyril
中科院分区：
文献类型：
--
作者：
Auxemery, Yann;Tarquinio, Cyril
背景。-我们目前所经历的情况是前所未有的。为了遏制一种可怕的流行病，当局宣布进入卫生紧急状态，并下令对我国大多数人口实行居家隔离数周。在几天内，无数的问题出现在非常不同的空间：流行病学，免疫学，社会学，信息科学家，医学，行政，政治等。-我们提出一项反思，旨在描述心理风险，澄清所发现的疾病，并讨论在此期间照顾这些疾病的方法。材料和方法。-我们的想法基于对当前临床经验的文献回顾，包括关于非物质化医学-心理监测的可能性。-在根据战区军事行动、极地越冬任务和航天征服来探讨集体禁闭的现有科学模式之前，我们回顾新出现的大规模致命风险，特别是病毒传染因子的集体影响。在以前的大流行病期间，对全球遏制的研究似乎有所研究，压力反应和心理动力适应的概念证明是相关的。我们根据三种人群类型详细介绍了禁闭对个人心理健康的心理影响及其对策：一般人群、在疫情一线的护理人员人群和已经患有精神疾病或再次出现疾病的人群。我们还参考了社会认知心理学的研究成果，解释了在引发焦虑的情况下，推理是如何有偏见的，并导致最终被证明不是很理性的选择，在做出选择的人看来。在这方面，卫生部门的现状是有利的，媒体和社交网络上广泛报道的“关于氯喹的辩论”证明了这一点，相反的结论往往是基于与循证医学相反的信念。-监禁的心理影响似乎取决于其可能采取的多种形式：自愿或遭受，或多或少延长，在家中或其他地方度过，单独生活或在小社区生活，相关的其他压力和/或创伤因素等。从未对一个国家的人口居家隔离情况进行过评估。在我们看来，这种经历似乎使我们的整个社会面临着死亡的禁忌，这种禁忌是强加的，随着“西方人”试图远离他的陆地起源，死亡越来越被逃避。从这个意义上说，心理创伤型的影响是要防止的。为了面对多重挑战，医疗保健系统特别适应了互联网的发展，以提供旨在更好地体验禁闭的信息，甚至是电子心理治疗的推广，提出了与提供答案一样多的问题。在心理治疗领域，这些错综复杂的计算机技术，这些我们曾经质疑过的技术，像病毒一样迅速确立起来：临床医生和研究人员的任务是衡量问题和后果。-公共卫生方案可以在现有方案的基础上出现，以管理众所周知的慢性地方病：防止与久坐不动的生活方式有关的不平衡饮食的影响，反对吸烟和酗酒，防止自我攻击行为等。我们还需要支持一直在第一线的护理人员，他们将在这次大流行中受到考验：这取决于我们的医疗保健系统的行动能力的可持续性，以恢复其名义状态，也可能是为了应对其他危机，特别是社会危机造成的后果。(C) 2020 Elsevier Masson SAS。版权所有。
Background. - The situation we are currently experiencing is unprecedented. Declaring a state of health emergency in order to curb a frightening epidemic, the authorities have decreed the home confinement of the majority of the population of our country for several weeks. In a few days, innumerable questions arise for very diverse spaces: epidemiological, immunological, sociological, information scientists, medical, administrative, political, etc.Objective. - We propose a reflection intended to describe the psychological risks, to clarify the disorders found, and to discuss the means to take care of them in the duration.Material and methods. - We base our thinking on a review of the literature confronted with our current clinical experience, including concerning the possibilities of dematerialised medico-psychological monitoring.Results. - We recall the collective repercussions of emerging lethal mass risks, and in particular viral infectious agents, before approaching the existing scientific models of collective confinement according to military operations in war zones, polar wintering missions and aerospace conquest. It appears that for the study of a global containment, somewhat studied during previous pandemics, the conceptions of stress reaction and psychodynamic adaptation prove to be relevant. We detail the psychological consequences of confinement on individual mental health and their countermeasures according to three population typologies: general population, population of caregivers on the front line against the epidemic, and population of subjects already suffering from mental illness or seeing their disorders reappear. We also refer to works in social cognitive psychology explaining how, in an anxiety-provoking situation, reasoning can be biased and lead to choices that ultimately prove to be not very rational, in the opinion of those who made them. The current situation in the health sector is favourable in this, as evidenced by the "debate on chloroquine'' widely reported in the media and on social networks, opposing conclusions most often decided on the basis of beliefs on contrary to evidence based medicine.Discussion. - The psychological repercussions of confinement appear conditioned by the multiple forms that it can take: voluntary or suffered, more or less prolonged, spent at home or in another place, lived in individual isolation or in a small community, associated other stressors and/or traumatic factors, etc. The home confinement of a population across a country has never been assessed. This experience seems to us to confront our society as a whole with the taboo of death, which is imposed, death more and more evaded as the "Western man'' tries to move away from his terrestrial origins. In this sense, psychotraumatic type repercussions are to be prevented. In order to face multiple challenges, the healthcare system has adapted with, in particular, the development of the use of the Internet for the provision of information intended to better experience confinement, or even the generalisation of e-psychotherapy asking as many questions as it provides answers. These intricacies of computer techniques in the area of psychotherapy, techniques with which we had some questioning, became established as quickly as the virus: the task of clinicians and researchers to measure the issues and the consequences.Conclusion. - Public health programs could emerge on the model of those already existing in order to manage well-known chronic endemic disorders: protection against the effects of an unbalanced diet associated with a sedentary lifestyle, fight against smoking and alcoholism, prevention of self-aggressive behaviour, etc. We will also need to support the caregivers who have been on the front line and who will emerge tested from this pandemic: depending on the sustainability of the action capacities of our healthcare system to return to its nominal state and also perhaps, so that it can face consequences resulting from other crises, especially social ones. (C) 2020 Elsevier Masson SAS. All rights reserved.