Philippe de Timary

In this longitudinal study, 37 patients with severe alcohol use disorder (SAUD) were tested at the beginning (T1) and end (T2) of supervised detoxification to explore the evolution of and relationship between systemic inflammation, volumetric changes for brain grey matter (GM) and choroid plexus (ChP), and clinical symptoms. At T1, patients exhibited high levels of anxiety, depression, and craving, and had elevated plasmatic pro-inflammatory cytokines, indicating low-grade systemic inflammation. Monocyte chemoattractant protein-1 (CCL2) (MCP-1) levels correlated positively with ChP volume and severity of withdrawal symptoms, while macrophage inflammatory protein-1 beta (CCL4) (MIP-1β) also correlated with ChP volume, together suggesting an acute immune response at T1, and underscoring the ChP as a potential neuroimmune biomarker to be further evaluated in future studies. During three weeks' abstinence, Interleukin-8 (IL-8), MIP-1β, and MCP-1 levels decreased, although MIP-1β did not return to control levels, and tumor necrosis factor-alpha (TNF-α) showed no significant reduction. Volumetric MRI analyses suggested two concurrent trajectories during detoxification. First, an overall "recovery-driven" pattern of rapidly increasing GM volume in widespread forebrain regions with parallel declines in ventricle size and craving. Second, GM in limbic cortical areas, temporal and inferior frontal cortex showed no significant volumetric gain. However, these regional volumes correlated significantly with declining MCP-1, indicative of a "deflation", potentially related to declining microglial activation. These findings highlight the role of inflammatory processes in shaping early neuroplastic changes during detoxification and point to a central role of MCP-1 in inflammation-driven morphometric changes.

Background: Posttraumatic stress disorder (PTSD) is highly prevalent in conflict-affected regions like eastern Democratic Republic of Congo; yet, cultural stigma and lack of psychoeducation limit public understanding and help-seeking behaviors. Objective: This study evaluates the effect of a short, culturally adapted animated video on mental health perception, knowledge, and attitudes toward trauma. Methods: A community-based quasi-experimental pre-post design was implemented among 239 participants from South Kivu. The intervention involved viewing a 3-minute animated psychoeducational video portraying locally relevant PTSD symptoms and resilience strategies. Perception, knowledge, and attitude scores were measured before and after the intervention, alongside PTSD prevalence and video appreciation. Results: Out of 239, 40% (n=96) of the participants screened positively for PTSD. Post intervention, significant improvements were observed in perception (P=.01), knowledge (P<.001), and attitudes (P=.001) toward trauma. Appreciation was high; 82% (n= 195) expressed empathy for the characters, and 74% (n= 176) were likely to share the video. Linear regression showed that having PTSD symptoms (β coefficient=3.29, SE=1.09; P=.003), years of education (β coefficient=0.54, SE=0.08; P<.001), empathy toward the portrayed situations (β coefficient=5.07, SE=0.56; P<.001), perceived acquisition of new knowledge (β coefficient=2.58, SE=0.59; P<.001) and willingness to share the video (β coefficient=1.75, SE=0.50; P=.001) predicted stronger positive effect. A multiple linear regression including all predictors revealed that PTSD symptoms (β coefficient=1.93, SE=0.90; P=.03), years of education (β coefficient=0.47, SE=0.07; P<.001), empathy toward the portrayed situations (β coefficient=3.50, SE=0.55; P<.001), and willingness to share the video (β coefficient=1.75, SE=0.50; P=.001) remained significant predictors of video impact. Age and perceived acquisition of new knowledge were not significant in the multivariate model. This model accounted for 44.6% of the variance in video impact scores (R2=0.446, F6,231=30.99, P<.001). Conclusions: This study highlights the effectiveness of culturally grounded, low-cost digital media for improving mental health literacy in postconflict settings. Video-based tools may serve as scalable components of trauma-informed care and public health communication in low-resource, high-need areas.

BACKGROUND Posttraumatic stress disorder (PTSD) is highly prevalent in conflict-affected regions like eastern Democratic Republic of Congo; yet, cultural stigma and lack of psychoeducation limit public understanding and help-seeking behaviors. OBJECTIVE This study evaluates the effect of a short, culturally adapted animated video on mental health perception, knowledge, and attitudes toward trauma. METHODS A community-based quasi-experimental pre-post design was implemented among 239 participants from South Kivu. The intervention involved viewing a 3-minute animated psychoeducational video portraying locally relevant PTSD symptoms and resilience strategies. Perception, knowledge, and attitude scores were measured before and after the intervention, alongside PTSD prevalence and video appreciation. RESULTS Out of 239, 40% (n=96) of the participants screened positively for PTSD. Post intervention, significant improvements were observed in perception (P=.01), knowledge (P<.001), and attitudes (P=.001) toward trauma. Appreciation was high; 82% (n= 195) expressed empathy for the characters, and 74% (n= 176) were likely to share the video. Linear regression showed that having PTSD symptoms (β coefficient=3.29, SE=1.09; P=.003), years of education (β coefficient=0.54, SE=0.08; P<.001), empathy toward the portrayed situations (β coefficient=5.07, SE=0.56; P<.001), perceived acquisition of new knowledge (β coefficient=2.58, SE=0.59; P<.001) and willingness to share the video (β coefficient=1.75, SE=0.50; P=.001) predicted stronger positive effect. A multiple linear regression including all predictors revealed that PTSD symptoms (β coefficient=1.93, SE=0.90; P=.03), years of education (β coefficient=0.47, SE=0.07; P<.001), empathy toward the portrayed situations (β coefficient=3.50, SE=0.55; P<.001), and willingness to share the video (β coefficient=1.75, SE=0.50; P=.001) remained significant predictors of video impact. Age and perceived acquisition of new knowledge were not significant in the multivariate model. This model accounted for 44.6% of the variance in video impact scores (R2=0.446, F6,231=30.99, P<.001). CONCLUSIONS This study highlights the effectiveness of culturally grounded, low-cost digital media for improving mental health literacy in postconflict settings. Video-based tools may serve as scalable components of trauma-informed care and public health communication in low-resource, high-need areas. CLINICALTRIAL

Background: Although the link between trauma, posttraumatic stress disorder (PTSD), and hypertension is established, its underlying mechanisms remain underexplored. Objective: This study tested a theoretical model exploring the moderating influence of psychological (emotion regulation) and interpersonal (social support) factors on the mediation between trauma and hypertension, through PTSD. Methods: We measured these variables through self-reported questionnaire on 212 patients, recruited from internal medicine in a general hospital of Bukavu, a region affected by more than 25 years of armed conflicts. We first evaluated the PTSD mediation in the absence of moderators, before testing each moderator using moderated path analysis. Results: Results showed that PTSD partially mediates the relationship between human-made trauma and hypertension, whereas social support and maladaptive emotion regulation moderate the relationship between human-made trauma and PTSD. Conclusions: The relationship between human-made trauma, PTSD, and hypertension might be modulated by psychological and interpersonal factors, which paves the way for new interventions targeting emotion regulation and social support to reduce PTSD and hypertension in populations exposed to human-made violence.

The Multidimensional Assessment of COVID-19-Related Fears (MAC-RF) is an 8-item self-report measure, which is based on the theoretical premise that fear responses to COVID-19 involve different yet intertwined domains (i.e., bodily, relational, cognitive, and behavioural). In this multi-step study, we tested the psychometric properties of the French version of the MAC-RF and examined the reciprocal relationships among COVID-19-related fears. Data were collected in two French-speaking samples (N = 521 individuals from the community and N = 328 healthcare professionals). Internal reliability, convergent validity, construct validity, and internal structure of the MAC-RF were tested. The French version of the MAC-RF demonstrated good psychometric properties and a two-factor structure, with bodily and relational fears tapping into the first factor, and cognitive and behavioural fears tapping into the second factor. Healthcare professionals reported greater COVID-19-related fears than community participants. Correlation network analysis showed that fear for one’s own body and fear of taking action might increase the risk of experiencing other COVID-19-related fears. Limitations comprised the cross-sectional design of the study, risk of bias associated with self-report instruments, and use of online surveys. A careful assessment of different types of fear related to COVID-19 may have implications for prevention and clinical practice during the current coronavirus pandemic. The French version of the MAC-RF is valid and reliable and can thus be used for this purpose.

BackgroundAnxiety and depression are psychopathological states frequently co-occurring with severe alcohol use disorder (SAUD). These symptoms generally disappear with abstinence but may persist in some patients, increasing the relapse risk.MethodsThe cerebral cortex thickness of 94 male patients with SAUD was correlated with symptoms of depression and anxiety, both measured at the end (2-3 weeks) of the detoxification treatment. Cortical measures were obtained using surface-based morphometry implemented with Freesurfer.ResultsDepressive symptoms were associated with reduced cortical thickness in the superior temporal gyrus of the right hemisphere. Anxiety level was correlated with lower cortical thickness in the rostral middle frontal region, inferior temporal region, and supramarginal, postcentral, superior temporal, and transverse temporal regions of the left hemisphere, as well as with a large cluster in the middle temporal region of the right hemisphere.ConclusionsAt the end of the detoxification stage, the intensity of depressive and anxiety symptoms is inversely associated with the cortical thickness of regions involved in emotions-related processes, and the persistence of the symptoms could be explained by these brain deficits.

Objective: Altered psychological profiles are associated with drug adherence and drug resistance in patients with resistant hypertension (RHTN). However, treatment resistance may also result from increased arterial stiffness and target organ damage. The aim of this study was to assess the association of psychological factors with both drug adherence and drug resistance in two subtypes of patients with RHTN: younger patients without cardiovascular complications versus older or vascular patients. Design and method: Ninety-seven patients with RHTN were enrolled and split in two groups: patients 60y or older or with previous cardiovascular diseases (VRHTN), and younger patients without cardiovascular complications (NVRHTN). Drug adherence was assessed by urinary Liquid Chromatography coupled with tandem Mass Spectrometry. Drug resistance was evaluated by 24-hour ambulatory blood pressure adjusted for the number of antihypertensive drugs and drug adherence. Psychological profile was assessed using five validated questionnaires: the Brief Symptom Inventory (BSI), the Toronto Alexithymia Scale (TAS-20), the Emotion Regulation Questionnaire (ERQ), the Cognitive Emotion Regulation Questionnaire (CERQ) and the Post Traumatic Diagnostic Scale (PDS). Results: The proportion of fully adherent, partly adherent, and totally non-adherent patients was significantly different between NVRHTN (37, 39 and 24%) and VRHTN (67, 26 and 7 %) respectively (p-value = 0.010). After multiple regression analysis, independent predictors of poor drug adherence in NVRHTN were “adaptive strategies’’, male gender and family history of hypertension, accounting for 39.2% of the variability. Independent predictors of drug resistance were difficulties in planification and somatization, accounting for 39.0% of the variability. In the VRHTN group, predictors of drug adherence were yearly number of visits at the emergency department for hypertension and family history of cardiovascular events, accounting for 28.1% of the variability in drug adherence. Predictors of drug resistance were the number of visits at the emergency department and the total number of drugs prescribed per day, accounting for 35.0% of the variability in drug resistance. Conclusions: Poor drug adherence and altered psychological profiles appear to play a major role in younger patients with RHTN without cardiovascular complications. This subset of patients should be prioritized for assessment of drug adherence and psychological evaluation.

Visuo-perceptive deficits in severe alcohol use disorder (SAUD) remain little understood, notably regarding the respective involvement of the two main huma