Factors associated with the psychosis continuum among homeless people: Comparison between natives and migrants in the SAMENTA study.

Background: In the last decades, there has been a documented increase in the proportion of migrants among homeless people in Europe. While homelessness is associated with psychosis, little is known about the factors associated with psychosis among migrants in this context. Methods: Our study analyzed data collected in the SAMENTA cross-sectional survey conducted among 859 adult French-speaking homeless people living in the Greater Paris area. We analyzed the prevalence of psychosis and psychotic-like experiences (PLE) and associated factors by migrant status, using bivariate analysis and multivariable logistic regression models. Results: Our sample comprised 280 natives and 559 migrants in France. Psychosis was significantly more prevalent among natives (21.6 %) than among migrants (7.5 %) (p = 0.003). The total prevalence of PLE was 30.8% (95 % CI: 24.3 - 38.2), and not statistically different between groups (p = 0.215) or sex (p = 0.528). Adverse events over the past year were associated with the increased odds of psychosis in both groups and with PLE among migrants. Sexual abuse during childhood was associated with both outcomes among natives. Among migrants, exposure to war or life-threatening events increased the odds of psychosis and PLE. Increased odds of psychosis were found among migrants who had been living in France for more than 10 years (OR = 3.34, 95 % CI: 1.41-7.93, p = 0.007). Conclusion: Differences were found in the factors associated with the psychosis continuum by migrant status, they highlight the impact of experiences related to migration. Prospective studies are needed to better understand these underlying pathways.

Predicting treatment resistance in schizophrenia patients: Machine learning highlights the role of early pathophysiologic features.

Detecting patients with a high-risk profile for treatment-resistant schizophrenia (TRS) can be beneficial for implementing individually adapted therapeutic strategies and better understanding the TRS etiology. The aim of this study was to explore, with machine learning methods, the impact of demographic and clinical patient characteristics on TRS prediction, for already established risk factors and unexplored ones. This was a retrospective study of 500 patients admitted during 2020 to the University Hospital Group for Paris Psychiatry. We hypothesized potential TRS risk factors. The selected features were coded into structured variables in a new dataset, by processing patients discharge summaries and medical narratives with natural-language processing methods. We compared three machine learning models (XGBoost, logistic elastic net regression, logistic regression without regularization) for predicting TRS outcome. We analysed feature impact on the models, suggesting the following factors as markers of a high-risk TRS profile: early age at first contact with psychiatry, antipsychotic treatment interruptions due to non-adherence, absence of positive symptoms at baseline, educational problems and adolescence mental disorders in the personal psychiatric history. Specifically, we found a significant association with TRS outcome for age at first contact with psychiatry and medication non-adherence. Our findings on TRS risk factors are consistent with the review of the literature and suggest potential in using early pathophysiologic features for TRS prediction. Results were encouraging with the use of natural-langage processing techniques to leverage raw data provided by discharge summaries, combined with machine leaning models. These findings are a promising step for helping clinicians adapt their guidelines to early detection of TRS.

A recovery-oriented day hospital in psychiatry: A springboard for reintegration.

Psychiatric disorders are common and can cause psychological disabilities. While the creation of day hospitals (DHs) was intended to direct psychiatric care towards community settings, they may have paradoxically contributed to a form of chronicity. Furthermore, the heterogeneity and lack of evaluation of care within DHs prevent the availability needed to collect objective data on users outcomes. In this article, we aim to describe and measure the effects of a transformation of practice within a sector-based DH initially focused on traditional institutional psychiatry towards a rehabilitation model of care which offers different therapeutic tools, structured in three stages, and whose main objective is professional integration. This retrospective mirror study compares, before and after the transformation of this DH, several indicators including the rate of professional integration and its maintenance after two years. We found that this psychosocial rehabilitation model for care allowed a very clear increase in the professional integration rate and its maintenance at two years while reducing the length of stay to around 18 months. These promising results therefore highlight the pivotal role of DHs as "stepping stones" in addressing psychological disabilities towards recovery.

Characteristics and correlates of seclusion and mechanical restraint measures in a Parisian psychiatric hospital group.

Introduction: Seclusion or restraint (S/R) are last-resort measures used in psychiatry to ensure the safety of the patient and the staff. However, they have harmful physical and psychological effects on patients, and efforts to limit their use are needed. We describe the characteristics and correlates of S/R events in four Parisian psychiatric centers. Methods: Within a 3-month period, November 5, 2018 to February 3, 2019, we recorded data for patients experiencing an S/R measure as well as characteristics of the measures. We studied the mean duration of a S/R event, the time between hospital admission and the occurrence of the event, as well as correlates of these durations. We also examined factors associated with use of a restraint versus a seclusion measure. Results: For the 233 patients included, we recorded 217 seclusion measures and 64 mechanical restraints. Seclusion measures mostly occurred after the patient's transfer from the emergency department. The duration of a seclusion measure was about 10 days. Patients considered resistant to psychotropic treatments more frequently had a longer seclusion duration than others. The mean duration of a mechanical restraint measure was 4 days. Male sex and younger age were associated with experiencing mechanical restraint. Discussion: S/R measures mostly occur among patients perceived as resistant to psychotropic drugs who are arriving from the emergency department. Developing specific emergency department protocols might be useful in limiting the use of coercive measures.

Constipation in hospitalized psychiatric patients: An underestimated common phenomenon. Retrospective epidemiological study in an adult psychiatric hospital setting.

OBJECTIVE: Constipation is more common in patients with mental disorders than in the general population. However, its frequency in hospitalized patients, its association with drugs and how teams become aware of it and take care of it are not fully identified. METHOD: The retrospective study included 141 male and 127 female new patients admitted for routine treatment at France's largest psychiatric hospital between November 15 and December 11, 2017. A physician reviewed electronic medical records to diagnose constipation and record variables of interest: socio-demographic factors, diagnosis, drugs prescribed and taken. We calculated an anticholinergic impregnation score (AIS) for each patient by using a validated French scale. Patients were then classified into two groups by state of constipation defined by the physician. Univariate and multivariate analyses were used to study the frequency of constipation, factors associated with it and its management. RESULTS: The prevalence of constipation was 38% (95% CI 32-44). Associated factors were taking antipsychotics and the burden of anticholinergic treatment. On multiple regression analysis, the only remaining factor was anticholinergic treatment: AIS≥5 was associated with constipation (odds ratio 1.80 [95% CI 1.07-3.14], P=0.027). Only 44.0% of patients were prescribed a preventive laxative, systematically in half of the cases. Above all, only 11.2% were administered this laxative (i.e., 25% of that prescribed). Digestive transit was poorly recorded in the table of constants (34.7%). We found one case of sub-occlusion as a severe case. CONCLUSION: Constipation is common in psychiatric inpatients. The more the patient is prescribed drugs with a pronounced anticholinergic effect, the greater the risk. Alongside the preventive measures common to all psychiatric patients which must be promoted (concerning diet, physical activity, etc.), polymedication with this type of anticholinergic must be better monitored to prevent complications: prescription and administration of a preventive laxative, monitoring transit in the table of constants. Thus, a better knowledge of the subject and specific training are essential.

Characteristics of older patients in the largest French psychiatric emergency centre.

Despite an increasing number of adults older than 60 years with psychiatric disorders, there are few studies on older patients in psychiatric emergencies and no European data. We aimed to describe the population of patients aged 60 years and older who presented to the main French psychiatric emergency centre and identify predictors of psychiatric hospitalization. This monocentric study included 300 consecutive patients aged 60 years and older. Patients presenting because of psychiatric emergencies were frequently female and lived autonomously. More than 40% had a history of at least one psychiatric hospitalization and 44% had consulted a psychiatrist in the previous 6 months. The most common reasons for consultation were depression, anxiety, sleep disorders and suicidal thoughts. Psychiatric disorders were mainly mood disorders; neurotic, stress-related and somatoform disorders; and schizophrenic, schizotypal and delusional disorders. Only 10% had a diagnosis of organic mental disorders. Overall, 39% of the patients were admitted to the psychiatric hospital. Factors predicting hospitalization were a history of psychiatric hospitalization, suicidal thoughts and a diagnosis of a mood disorder or schizophrenia/schizotypal/delusional disorder. In conclusion, among people aged 60 years and older who consulted for psychiatric emergencies, 39% had to be hospitalized in psychiatry and only psychiatric factors influenced the decision to hospitalize. Our study highlights the need for further studies of older people in psychiatric emergencies in Europe, to anticipate the needs of this specific population and adapt multidisciplinary mental health care.