 And now I will give the floor to Jean-Pierre La Blanchie, who is a very well-known psychiatrist in Paris and who has another virtue, which is that he has educated me a little bit on these complex matters. And thanks to him, my mental health is not as bad as it could have been if I had not met him. Well, so Jean-Pierre, the floor is yours. Thank you. Thank you, Céry. First of all, this question, are we facing a global international problem? My answer is yes, because this is called human condition. At first, I would like to thank Alexandre Apereu, because she said what he thinks about medical education and this very poor field called psychology. I fully agree with that. And I agree with Jean-Claude Hamard's when he said behavior is a key point. Trust is very important. I follow Roberto for the same reasons and I would add that we are facing people in a regression because of the fear they are dealing with. And these people are weaker than usual. And in this kind of progression, you can be like brainwashed by some dogma or whatever it is. And we know that for years now. Thanks to his excellency Théros, because he said something so important. We have to invest. And thanks to Michael too. Especially when he said that mental health is a somatic disease too. And I will try to point that in this little speech, because to speak about psychiatry in 10 minutes is quite a challenge. So the question is to protect some at-risk people. And this morning, we understood all that Eldorai and co-morbidities affections are very important. And the main risk should be to old people. On this point, I would disagree. Because what we see as a consequence of this COVID-19 huge wave is this mental health problem. Remember, suicide is the second cause of death in young people. 16% of deaths between 15 and 24 is caused by suicide. 20% of deaths in the 25 up to 34 in age. So depression kills. It's not only the virus. So I will argue about three major tests. One is very famous and expensive. And two of them are more recent. And I would like to make you understand that we could invest in that field. These tests are producing data. So what is the link between this COVID-19 wave, depression and addiction? 39% of people have experienced a relapse of their addictive behavior since lockdown. On the national scale, this may mean that more than 1 million people have experienced some four of relapse during the lockdown. It's a complex interplay with financial difficulties, social isolation, uncertainty about the future and the redistribution of the health workforce and the disruption to clinical services. This leads to an increased alcohol intake and relapse under lockdown. I have to explain this link with addictions. Addictions to psychoactive substances is expressed in the dependence syndrome. No single ideological factor for why some people use drugs and others do not. Why part of them becomes dependent? We don't really entirely know. This must be a combination of psychological, biochemical, genetic and environment factors which play a role. Studies describe this function in the central nervous system of substance dependence that may also negatively influence the functions of their ability to process sensory information adaptively. There are four problematic personalities, hopelessness, anxiety, impulsivity and sensation seeking. We call that sensory processing disorder or SPD which is frequently related to these personality traits. SPD is characterized by over or under responsiveness to environmental stimuli. People found in these patterns of over responsiveness to due to their low neurological are frequently described as irritable, moody, express poor socialization. SPD is frequent comorbidity of attention deficit hyperactivity disorder, ADHD and emotional disturbance. This explains why SPD is among substance dependence. This includes decreased dopamine uptake, altered dopamine synthesis and deficits in serotonin uptake sites. Some people seek for addictive substance as a compensatory mechanism for their unmodulated arousal level or for relief of a particular affective state. Individuals with sensory hyper sensitivity showed hyper arousal mechanism, enhanced sympathetic nervous system reactivity and elevated activity of brain areas associated with hyper-emotionality. This is very important. We will see that on the brain skies. This hyper-emotionality provided an explanation for the anxiety, depression, irritability and so forth and they are seeking for drugs. I will introduce a friend of mine, Rachel Yuda. She is the psychiatrist for Fireman in New York, so remember 9-11. She made some very interesting research showing that this kind of specific depression is a somatic disease. She proved first that a huge stress producing a PTSD post somatic stress disorder affects the cortisol receptors. So you cannot behave like before. She said from someone who was under a ketaspismic event are saying they are not the same as they were before and the explanation for that is that this shock can destroy the some genes activities. This is called epigenetic. If you go to internet and you type epigenetic and psychiatric, you will see thousands of publications in this field. So first we have genes. We come back to that and second these genes can be hampered by a huge huge stress. What she said too is that this kind of aggressions can be transmitted to the next generation and maybe the next two or three generations. It happens. These patients are comorbid with substance abuse, self-destructive behavior and medical illness. As a somatic disease, there is a test we can do. First is to check cortisol in the urine. Second is to make a blood test cause dexamethasone surge suppression test. It means that a very low amount of dexamethasone kills your production of cortisol. This means you are under PTSD. This is a very technical but very precise somatic point. What is PTSD? First it lasts more than one month and people would re-experience the symptoms of the bad feelings. You have nightmares, flashbacks, repetitive and distressing images or sensations, physical sensations such as pain, sweating, feeling sick, trembling. Some people have constant negative thoughts about their experience. They try to avoid this emotional learning. They try to avoid being reminded of the traumatic event. Usually they go and turn to be isolated and withdrawn. The main treatment for psychological and post-traumatic stress is psychological therapies. I just mentioned cognitive behavior therapy or CBT. I mentioned eye movement desensitization and reprocessing or E-I-D-R which is a very good technique we use in case of being stressed. We use that for years and it works very well. You can use medications. First beta blockers. You use beta blockers to make the debriefing because people otherwise would re-express the trauma and the pain. This trauma is a somatic pain. It's very painful. So you use beta blockers to help people do the debriefing which is a technique to take care of post-traumatic stress disorders. You can use antidepressants. Parc-setting sertraline are agreed for treatment for PTSD but you can use some other treatments. Something very specific to this coronavirus way. This is what said Professor Marion Le Boyer. Some US publications did exactly the same observations. It seems that there is a protective effect against directly the coronavirus of certain drugs widely used in psychiatry especially antidepressants and zoolytics and even antistaminates. This was done in Henri Mondeur hospital. What was the consumption of psychotropic drugs during the COVID period? It increased. For the first wave, we've seen an increase of 18.6% of the zoolytic use. So same for antidepressants. Now I will try to explain what we can do on a large scale. As I said, psychiatry is not a very well known discipline in the medical field and psychology less. So this test called the Minnesotan Multifasic Personality Inventory is the interest of the psychological test. It began in the 40s. It's the most published psychological test. It's very accurate and we can use it especially to deal with psychological stability for instance for workers at high risk. But there everyone was at high risk. This test is very easy to do. You have 330 questions dealing with hypochondria, depression, hysteria, psychopathic, deviate, masculinity and femininity which with paranoia, psychostomias, schizophrenia, hypomania and so forth. It shows like a sheen where you can see easily that when you are all in the blue situation everything is okay. So you just point out the points which are out of this sheen. You have many of them and it's very accurate. So after this explaining very briefly what is this psychological test. The second point is to go to brain spec imaging. This is more expensive but this is very accurate and I want you to see some pictures. For you to understand this is a somatic disease. It's not a state of mind. It's not an impression. It's not an emotion. So we have now these kind of tools mixing at the same time a PET scan and an MRI. And when you do the integration of the pictures you can see the metabolism mostly the metabolism of the neurological cells. So you can see functionally how the brain works. So here on the left you have a normal scan. On the right you have a scan for people taking drugs. This is an edited brain scan. At the top you see what how is this kind of scan for marijuana are users. Then you have the effect of long-term use of heroin. As you can see the pictures are not the same. Then you can see what's what's doing metamphetamine and then alcohol use. So as you can see we can now figure out what is the result of the use of drugs in terms of functional and it's a somatic disease then. It's not an impression. So alcohol with drugs at the top and then effect of heavy nicotine and caffeine abuse. The third point is that now we can use genetics as a preventive test for emotional instability. These tests are now used for something like 10 years and what you can see is how you were born with some genes which were not functional. Who do you test? Moved disorders, anxiety and impulsiveness, sleep disorders, fatigue, suspicion of depression, impaired concentration and impaired activity. Just remember you that it deals mostly with two main hormones called serotonin and dopamine. Serotonin is like a break and dopamine is like an accelerator. So these are examples of mutations. We should have nine lines in black which means nine functional genes. The first one you have three genes mutated. The second one you have four of them. The third one you have eight of them. And the last one nine and nine. Frankly I did not know this would exist. This was the first time I met this kind of results. This makes catastrophic life. This is important for many reasons to do this kind of test because it helps the psychiatrists to explain the patient should take a treatment because this last person with nine on nine mutated genes refused absolutely to take any kind of drug. And I had to explain with this kind of situation I cannot do anything with just using psychotherapy. This guy accepted at the end to take this treatment and then is very, very very in a better condition. Other interesting point is that when you can explain that to patients it means they were born like that. They have to deal with it all their life long and try to live much much better. And this is not the parents fault. This is not the education. This is not the environment. This is for them. This is a genetic problem. I have to say again that these are genes at the origin, but some of normal genes could be hampered by shocks and with epigenetic modifications. So to conclude there is a third way which would be a mental health way of saying how a minister of health, Mr. Bill, what I would like to for conclusion to say that in facing this difficult human condition, this huge suffering with a very high risk of disease killing people, first we have tools. First of all, we have to explain to people that dark thoughts never, never are normal. If you feel this kind of thoughts, you have to call someone. For instance, a clinician, a psychologist, a psychologist. Second, we can use very easily this kind of test and describe. I just described why there are plenty of them. But this one is very useful and very well known test. It takes one an hour by phone at a distance or whatever to make the diagnosis much more precise than the impression of a psychiatrist or clinician. Second, you can use genetic tests for educational reasons. And third, medical imaging is just incredible. We made extraordinary progress and this gives data for some kind of somatic disease, I insist. Thank you. Thank you very much, Jean-Pierre, for this brief course of the Psychiatrics. It's extremely interesting.