Le 13 octobre 2023, un attentat terroriste survient dans la cité scolaire Gambetta à Arras, exposant environ 2 000 personnes, majoritairement des adolescents, à une effraction traumatique majeure. Dès les premières heures, la cellule d’urgence médico-psychologique (CUMP) met en place un poste d’urgence médico-psychologique (PUMP). Cependant, une proportion importante des impliqués ne bénéficie pas d’évaluation ni d’orientation initiale, soulevant la nécessité d’un dispositif complémentaire. Un Guichet Unique Santé (GUS) est créé en novembre 2023, financé par l’Agence régionale de santé (ARS) Hauts-de-France, afin d’assurer la prise en soin médico-psychologique des élèves et personnels. Initialement centré sur des consultations, le dispositif évolue rapidement vers une organisation multimodale et multiniveau combinant : consultations spécialisées, interventions mobiles médico-psychologiques, actions de psychoéducation, dépistages systématiques à cinq et quatorze mois, formation graduée des professionnels en trois niveaux (sentinelles, évaluateurs, soignants spécialisés) et accompagnement institutionnel (commémorations, communication). Ce modèle global s’inspire de la stratégie nationale de prévention du suicide, transposée au champ du psychotraumatisme, et repose sur cinq axes : accessibilité universelle, repérage et suivi proactif, soutien institutionnel, maillage des ressources et communication. Le GUS a permis de prévenir la désorganisation des services de soins de droit commun, de structurer une réponse coordonnée et de réduire le risque de chronicisation des troubles psychotraumatiques. Cette expérience constitue un modèle de prise en soin post-immédiate dans un contexte d’attentat scolaire, susceptible d’être répliqué dans d’autres situations de psychotraumatisme institutionnel.

We report on the feasibility, effectiveness, and cost-utility of implementing evidence-based PTSD treatment to quickly enhance the capacities of a French public hospital network, in the weeks after the November 15 Paris attacks. A 2-arm, multicentric preference clinical trial and economic-evaluation compared the use of Reconsolidation Therapy (RT) to treatment-as-usual (TAU) for 332 adults, mostly with post-traumatic stress disorder (PTSD). RT involves recalling trauma under propranolol during a weekly 25-minute session for six consecutive weeks. Feasibility endpoints included the number of trained hospital personnel over two days and the number of participants choosing RT as their preferred treatment modality. The primary effectiveness endpoint was the delta scores in PTSD symptoms from baseline to Week 52. Cost-utility was evaluated by comparing RT to TAU. A large number of therapists (n = 160) were trained at various hospital sites over two days, and more participants opted for RT (n = 262) than TAU (n = 70), supporting feasibility endpoints. After 1 year, the mean PTSD symptom score decreased by 38.14 points (SD = 0.10) in the RT group and by 35.02 (SD = 1.68) for TAU (p = .297), indexing significant improvement in both groups. A significant difference of 5.11 points (SD = 2.50) in favor of RT (p = .041) emerged at Week 7, suggesting a faster initial recovery with RT vs. TAU. RT had a 55.4% probability of being the more effective and cheaper treatment compared to only 8.4% for TAU, outperforming TAU with a point-estimate saving of 27 150 euros per quality-adjusted life year (QALY). Annual sick leave costs were 4 147 euros (95%CI: 3 394 - 5 012) for RT versus 7 386 euros (95%CI: 5 416 - 10 340) for TAU (p = 0.01). Following massive trauma exposure, it is achievable to train mental health staff over 2 days in providing efficient evidence-based and cost-effective PTSD treatment. Findings await replication. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial NCT02789982 ### Clinical Protocols ### Funding Statement This study was funded by Assistance Publique - Hôpitaux de Paris, Fondation Assistance Publique - Hopitaux de Paris and MSD Avenir ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committees in France Comité de protection des personnes for Ile de France VI gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The datasets used and/or analyzed during the current study belong to the AP-HP (Assistance Publique-Hopitaux de Paris) research directorate and will be available by reasonable request to the corresponding author.

On 13 October 2023, a terrorist broke into the grounds of the Gambetta school complex in Arras, killing a teacher and injuring three other people. Around 2000 people were present at the school, directly or indirectly exposed. The nature of the attack within the school, the rapid dissemination of videos, and the length of the uncertainty as to the persistence of the threat in a context of confinement resulted in a major traumatic event. The intervention of the medical-psychological emergency unit as soon as the first few hours of the event and until D + 7, it was necessary to take into account and adjust to the limited nature of the event within the specific characteristics of the adolescent population affected. This feedback is to present and question the system put in place to draw the lessons learned from this mobilisation. (c) 2025 Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

In response to the Bataclan terrorist attacks, the deadliest on French soil since World War II, the Paris Mémoire Vive (PARIS MEM) project was launched to expand the public hospital network’s capacity to treat trauma-related disorders. Reconsolidation Therapy (RT), a brief evidence-based intervention for post-traumatic stress disorder (PTSD), was selected for rapid implementation across hospital sites. To evaluate the feasibility, effectiveness, and cost-utility of implementing RT to enhance public hospital treatment capacity after mass trauma exposure. A two-arm, multicentric, preference-based clinical trial and economic evaluation compared RT to treatment-as-usual (TAU) in 332 adults, mostly with PTSD. RT involves recalling trauma under propranolol during six weekly 25-minute sessions. Feasibility endpoints included the number of hospital staff trained and the proportion of participants choosing RT. The primary effectiveness endpoint was the delta scores in PTSD symptoms from baseline to Week 52. Cost-utility was evaluated using incremental cost-effectiveness ratios and quality-adjusted life years (QALYs). Across hospital sites, 160 therapists were trained in two days, and more participants opted for RT (n = 262) over TAU (n = 70), supporting feasibility endpoints. After one year, mean PTSD symptom scores decreased by 38.14 points (SD = 0.10) in RT and 35.02 (SD = 1.68) in TAU (p = .297), indexing significant improvement in both groups. At Week 7, RT showed faster initial recovery (difference = −5.11; p = .041). RT had a 55.4% probability of being cheaper and more effective than TAU (8.4%), with estimated savings of 27150€ per QALY. Annual sick-leave costs were lower for RT (4147€; 95% CI = 3 394–5 012) than TAU (7 386€; 95% CI = 5 416–10 340; p = .01). Following massive trauma exposure, training mental health staff over two days in providing efficient, evidence-based, cost-effective PTSD treatment is achievable. Findings await replication. NCT02789982. It is feasible to train a large cohort of therapists in the aftermath of mass trauma and enhance the treatment capacities of institutions. Reconsolidation Therapy worked faster than treatment as usual in the alleviation of traumatic stress symptoms. Reconsolidation Therapy emerges as a cost-effective treatment, being both cheaper and more effective in 55% of cases.

Le 13 octobre 2023, un terroriste s’introduit dans l’enceinte de la cité scolaire Gambetta à Arras, tuant un professeur et blessant trois autres personnes. Environ 2 000 personnes sont présentes au sein de l’établissement, exposées de manière directe ou indirecte. La nature de l’attentat au sein de l’établissement scolaire, la diffusion rapide de vidéos et la durée de l’incertitude quant à la persistance de la menace dans un contexte de confinement déclenché par l’équipe de direction, sont à l’origine d’une effraction traumatique majeure. L’intervention de la cellule d’urgence médicopsychologique dès les premières heures de l’évènement et jusqu’à j+7 a nécessité de prendre en compte et de s’ajuster au caractère circonscrit de l’événement au sein de l’institution et aux spécificités de la population adolescente touchée. Ce retour d’expérience a pour objectif de présenter et questionner le dispositif mis en place pour tirer les enseignements de cette mobilisation.

L’aide à distance constitue l’un des piliers les plus anciens des stratégies de prévention du suicide.

Helpline services have been identified as an important component of suicide prevention strategies. While the Covid-19 pandemic has raised major concerns about severe and longstanding mental health consequences, the French Ministry of Health and Prevention has recently decided to implement a national professional helpline dedicated to suicide prevention. The 3114 has been launched on October 1, 2021. Accessible 24/7 from any point of the national territory, it offers remote assistance to individuals in distress or worried about a close one, professionals, and bereaved persons. Spread in regional call centers, medically supervised nurses and psychologists provide callers with listening, evaluation, intervention (including the possible dispatch of a rescue team), and whenever needed, referral to adapted services. At the same time, the "3114 centers" contribute to the implementation of the regional suicide prevention strategies by stimulating the development of actions, promoting resources, monitoring at-risk events, and collaborating with professional and associative stakeholders. From a public health perspective, the inception of the 3114 has settled the conditions for a new paradigm in the French suicide prevention strategy. By dedicating specific resources to promote and organize interactions between stakeholders, it supports a major shift from the juxtaposition of efficient but segregated actions to the creation of an integrated prevention system. Embedded to the project, multidisciplinary and multilevel research will be carried out to evaluate the implementation, impact, and transferability of the 3114 model, conceived both as a helpline and territorial prevention strategy.

Objectives:COVID-19 pandemic and its consequences have put into great difficulty health professionals, and the general population, fostering the emergence of various psychological and psychiatric disorders. Medical and psychological emergency units' mission is the medical and psychological emergency care of people impacted during a traumatic event. Given their expertise in crisis management, they set up an important medical and psychological support system adapted to the health crisis' characteristics. The unusual modalities of intervention, the specific clinic that these professionals faced in this context of great tension may have unsettled workers and generate a psychological impact. This study aims to assess the existence of such repercussions among medical and psychological emergency unit professionals involved in this new system. Method:In all, 313 medical and psychological emergency unit professionals agreed to participate at the online survey. They filled surveys and visual analog scales assessing the difficulties encountered in the system, as well as their level of satisfaction, post-traumatic stress, burnout, level of anxiety and depression and coping strategies put in place. Results:Results show few significant emotional difficulties. However higher scores are found among women, among professionals who felt a negative impact on their personal lives, as well as for those who thought they had been infected with COVID-19. The establishment of coping strategies such as active coping, planning, expressing feelings, positive reinterpretation and acceptance helped to decrease the level of emotional complexities and brought more compassionate satisfaction. We note that participants with more medical and psychological emergency unit experience tend to show less emotional hardship and more compassionate satisfaction. It appears that older as well as younger professionals have lower burnout scores, as do workers who conducted more interviews for the same person. Likewise, participants who were satisfied of the system organization and of the support - a majority in this study - report less emotional challenges and more compassionate satisfaction. Conclusion:Psychological impact in this new system among medical and psychological emergency unit professionals is overall low. It appears that some coping strategies, perceived usefulness, satisfaction with the organization and the received support are associated with a lower level of emotional difficulties. A supportive framework and an operative organization of the medical and psychological emergency unit system in times of crisis has a protective effect on the participants.

Synthesis of 1D TiO2nanorods is promising nowadays owing to their broad applications in photocatalytic devices. A groundbreaking synthesis procedure of one-step producing large-scale, free-standing and heterogeneous phase (anatase and rutile) 1D TiO2 nanorod array which efficiently enhances the photocatalytic activity has been previously proposed. However, the detailed growth mechanism of this catalyst remains unclear, mainly because the synthesis takes place in a closed autoclave. This study presents a complementary approach to understand the growth mechanism using computer modeling based on density functional theory (DFT). The interaction of the precursor (titanium butoxide in hydrochloric acid media, modelled by TiCl4) and solvent (water) with preexisting rutile titania is computed to derive the thermodynamic trends to grow additional TiO2 layers. Five different termination models of the rutile surfaces were built: (001), (100), (101), (110) and (111), and their interaction with precursor and water was computed. Molecular and dissociative adsorption are considered as well as coadsorption. Our results point to a preferential growth of the (001) termination of rutile TiO2 through intermediates involving TiCl3+, Cl− and hydroxyl groups. The results obtained show how computational chemistry can be used to resolve experimental growth information. The protocol used i.e. computing different terminations and their explicit interaction with both the precursor and the solvent, can be extended to other materials in which the growth takes place following well-defined preferential directions.

Background The Paris and Nice terrorist attacks affected a thousand of trauma victims and first-line responders. Because there were concerns that this might represent the first of several attacks, there was a need to quickly enhance the local capacities to treat a large number of individuals suffering from trauma-related disorders. Since Reconsolidation Therapy (RT) is brief, relatively easy to learn, well tolerated and effective, it appeared as the ideal first-line treatment to teach to clinicians in this context. Methods This study protocol is a two-arm non-randomized, multicenter controlled trial, comparing RT to treatment as usual for the treatment of trauma-related disorders. RT consists of actively recalling one’s traumatic event under the influence of the ß-blocker propranolol, once a week, for 10–25 min with a therapist, over 6 consecutive weeks. This protocol evaluates the feasibility, effectiveness, and cost-utility of implementing RT as part of a large multi-center ( N = 400) pragmatic trial with a one-year follow-up. Discussion Paris MEM is the largest trial to date assessing the efficiency of RT in the aftermath of a large-scale man-made disaster. RT could possibly reinforce the therapeutic arsenal for the treatment of patients suffering from trauma-related disorders, not only for communities in western countries but also worldwide for terror- or disaster-stricken communities. Trial registration Clinical Trials ( ClinicalTrials.gov ). June 3, 2016. NCT02789982.

Les tentatives de suicide constituent un facteur de risque majeur de récidives et de décès. Les comportements suicidaires sont polyfactoriels et rendent inefficace une stratégie unique de prévention. L’adhésion aux soins est mauvaise dans un contexte où les liens sociaux sont souvent en souffrance. Deux catégories de programmes ont montré leur efficacité : les dispositifs d’intervention intensive et les dispositifs de veille. Ces derniers peuvent recouvrir différentes modalités : envois de courriers, remise de carte de crise comportant un numéro d’urgence, rappels téléphoniques. Un essai contrôlé randomisé, ALGOS, a combiné ces différentes stratégies dans l’algorithme suivant : délivrance d’une carte de crise pour les primosuicidants ; rappel téléphonique des non-primosuicidants 15jours après leur sortie des urgences ; envoi de cartes postales personnalisées mensuellement pendant 6 mois en cas d’échec de l’appel ; information du médecin traitant. Cette étude a été adaptée en soins courants en 2015 dans les départements du Nord et du Pas-de-Calais sous le nom de VigilanS. L’algorithme a été légèrement modifié par la remise de la carte de crise à tous. L’équipe de recontact, formée à la gestion de crise, gère tous les appels sortants et entrants vers les patients, leurs proches et leurs soignants. Un jeu de 4 cartes postales peut être envoyé en cas d’appel téléphonique non concluant. S’appuyant sur une philosophie de veille, VigilanS a développé un véritable savoir-faire de gestion de crise, nécessitant une supervision médicale constante et de solides capacités de mise en réseau.

BACKGROUND:Brief contact interventions (BCIs) might be reliable suicide prevention strategies. BCI efficacy trials, however, gave equivocal results. AlgoS trial is a composite BCI that yielded inconclusive results when analyzed with Intention-To-Treat strategy. In order to elicit intervention strengths and weaknesses, post-hoc analyses of AlgoS data were performed. METHODS:AlgoS was a randomized controlled trial conducted in 23 French hospitals. Suicide attempters were randomly assigned to either the intervention group (AlgoS) or the control group (Treatment as usual TAU). In the AlgoS arm, first-time suicide attempters received crisis cards; non first-time suicide attempters received a phone call, and post-cards if the call could not be completed, or if the participant was in crisis and/or non-compliant with the post-discharge treatment. An As Treated strategy, accounting for the actual intervention received, was combined with subgroup analyses. RESULTS:1,040 patients were recruited and randomized into two groups of N = 520, from which 53 withdrew participation; 15 were excluded after inclusion/exclusion criteria reassessment. AlgoS first attempters were less likely to reiterate suicide attempt (SA) than their TAU counterparts at 6 and 13-14 months (RR [95% CI]: 0.46 [0.25-0.85] and 0.50 [0.31-0.81] respectively). AlgoS non-first attempters had similar SA rates as their TAU counterparts at 6 and 13-14 months (RR [95% CI]: 0.84 [0.57-1.25] and 1.00 [0.73-1.37] respectively). SA rates were dissimilar within the AlgoS non-first attempter group. CONCLUSIONS:This new set of analysis suggests that crisis cards could be efficacious to prevent new SA attempts among first-time attempters, while phone calls were probably not significantly efficacious among multi-attempters. Importantly, phone calls were informative of new SA risk, thus a key component of future interventions.

Dopamine (DA) is a critical neurotransmitter involved in motivational processes. Tetrahydrobiopterin (BH4) is an essential cofactor for tyrosine hydroxylase, the rate-limiting enzyme in DA synthesis. Decreases in BH4 levels are observed in several DA-related neuropsychiatric diseases involving impairment in motivation. Yet, whether BH4 could be used to treat motivational deficits has not been comprehensively investigated. To investigate the effects of exogenous BH4 administration on the dopaminergic system and related behaviors, we acutely injected mice with BH4 (50 mg/kg). Passage of BH4 through the blood brain barrier and accumulation in brain was measured using the in situ brain perfusion technique. DA release was then recorded using in-vivo micro-dialysis and motivation was evaluated through operant conditioning paradigms in basal condition and after an amphetamine (AMPH) injection. First, we showed that BH4 crosses the blood-brain barrier and that an acute peripheral injection of BH4 is sufficient to increase the concentrations of biopterins in the brain, without affecting BH4- and DA-related protein expression. Second, we report that this increase in BH4 enhanced AMPH-stimulated DA release in the nucleus accumbens. Finally, we found that BH4-induced DA release led to improved performance of a motivational task. Altogether, these findings suggest that BH4, through its action on the dopaminergic tone, could be used as a motivational enhancer.

Progressive regression of cerebral arteriovenous malformations (AVMs) is a rare phenomenon that may occur spontaneously or after previous surgical or endovascular incomplete obliteration. We present two cases of AVMs occluded partially with Onyx followed by the unexpected cure of the lesions with the angiographic evidences as well as multiannual follow-up.

L’enquête ESPA 13-Novembre montre que, plus de 8 mois après les attentats de Paris, 54 % des victimes directes et 27 % des témoins pouvaient souffrir d’un stress post-traumatique. 54 % des endeuillés souffraient d’un TSPT, et, parmi ceux-ci, 81 % étaient potentiellement engagés dans un deuil compliqué. 46 % des sujets souffrant d’un TSPT n’avaient pourtant pas bénéficié d’un traitement médicopsychologique.

Background. - Attempted suicide is a major risk factor of further re-attempts and death. Self-harm behaviors are related to multiple causes explaining why it is ineffective to have a single and simple strategy to offer after the clinical assessment in reducing morbidity and mortality. Furthermore, treatment adherence is known to be especially poor in a context where social connection seems compromised and a source of pain. Effective interventions can be divided into two categories: intensive intervention programs (care at home, supported by a series of brief psychotherapy interventions) and case management programs that rely on a "stay in contact" dimension. These programs, initiated by Jerome Motto and its short letters may consist of: (1) sending letters or postcards after discharge of the ER; (2) giving a crisis card that offers a crisis telephone line and a crisis unit for hospitalization if needed, and; (3) placing a phone call at some time distance after the discharge. The aim is to enhance a "connectedness feeling" with the patient. These different strategies have proven to be even more effective in some specific subgroups, highlighting the heterogeneity of this population. Each modality of contact was well accepted and generated a positive involvement of the patients. Method. - It led to the idea of combining these different strategies in an algorithm built on the specificity of identified subgroups. A randomized controlled trial, named ALGOS was carried out in France to test this algorithm in 2011. The algorithm consisted of: (1) delivering a crisis card for first attempters; (2) giving a phone call for re-attempters to re-assess their situation between the 10th and 21st day after their discharge, and to propose a new intervention if needed, and; (3) in case of an unsuccessful call or a refusal of proposed care, sending personalized postcards for 6 months. All of this was supported with shared information to the general practitioner of the patient. This study was further adapted to routine care in 2015 in the northern departments of France, Nord and Pas-de-Calais (4.3 million people), taking the name of VigilanS. The inclusion consists of sending a form for every patient assessed after a suicide attempt in the two departments to the medical staff of VigilanS in order to provide information about the patient and the context of his suicide attempt. The algorithm has been modified in giving the crisis card to all the patients whether it is a first attempt or not. An information letter, explaining the aim of the monitoring is also given to the patient, and to his general practitioner. The calling staff is composed of 4 nurses and 4 psychologists, all trained in suicidal crisis management. They use a phone platform located in the Emergency Medical Assistance Service (SAMU) of the Nord department on a halftime basis and manage the incoming calls from the patients as well as the outgoing calls towards the patients, their relatives and their medical contacts. A set of 4 postcards (1 per month) can be sent if needed in case of an inconclusive or a failed phone call. Conclusion. - Built on a monitoring philosophy, VigilanS has further developed a real crisis case management dimension requiring enough time to insure an effective medical supervision and strong networking abilities. A specific time is also needed to take care of all the technical aspects of the organization. This program expertise, designed by Northern departments to prevent suicide, can be shared with other French or even foreign territories. (C) 2018

Objective: Survival rate of cardiac arrest due to hanging (H-CA) victims is low. Hence, this leads to the question of the utility of resuscitation in these patients. The objective was to investigate whether there are predictive criteria for survival with a good neurological outcome or predictive criteria for non-survival or survival with a poor neurological outcome enabling us to define the termination of resuscitation rules in these patients. Methods: Between July 1, 2011 and January 1, 2016, we included 1,689 out-of-hospital cardiac arrests due to hanging. We compared the characteristics of survivors with a good neurological outcome at day 30 with the others. Results: The study population was mainly composed of males with a median age of 48 [37-60]. The overall survival was 2.1%, among which 48.6% had a good neurological outcome. Survivors benefited more often from immediate basic life support than the rest of the subjects, which was corroborated by the shorter no-flow durations. We did not record any difference in terms of advanced cardiac life support initiation frequency and technique between survivors with a good neurological outcome and the rest. Nevertheless, ACLS duration was longer in survivors with a good neurological outcome than in others. Conclusions: Basic life support (BLS) was the decisive criterion for 15/17 survivors. However, a detailed analysis showed 2 survivors presenting no BLS before the arrival of mobile medical teams and non-shockable rhythms who survived at day 30 with a good neurological outcome. These results lead us to consider that mobile medical team intervention and ACLS attempt are not futile, and the benefit justifies the cost. Thus, we cannot define any rule for the termination of resuscitation.

Background: There is growing evidence in the literature that brief contact interventions (BCIs) might be reliable suicide prevention strategies. Objective: To assess the effectiveness of a decision-making algorithm for suicide prevention (ALGOS) combining existing BCIs in reducing suicide reattempts in patients discharged after a suicide attempt. Methods: A randomized, multicenter, controlled, parallel trial was conducted in 23 hospitals. The study was conducted from January 26, 2010, to February 28, 2013. People who had made a suicide attempt were randomly assigned to either the intervention group (ALGOS) or the control group. The primary outcome was the rate of participants who reattempted suicide (fatal or not) within the 6-month study period. Results: 1,040 patients were recruited. After 6 months, 58 participants in the intervention group (12.8%) reattempted suicide compared with 77 (17.2%) in the control group. The difference between groups (4.4%; 95% CI, -0.7% to 9.0%) was not significant (complete-case analysis, P=.059). Conclusions: These results may help researchers better integrate BCIs into routine health care and provide new insights concerning personalized suicide prevention strategies.