RESUMO
We examine the prevalence of SARS-CoV-2 infections among patients admitted to a Parisian psychiatric University Hospital Group (GHU). A total of 548 patients were admitted to the GHU...s full-time psychiatric wards between April 6 and May 3 2020. More than 80% were tested. A total of 7 patients tested positive for the SARS-Cov-2 (1.3%), with 5 patients (in 92, 5.4%) testing positive in the first week. GHU patients presented a low prevalence of SARS-CoV-2, even if all patients live in the hardest hit region in France. Social isolation and loneliness, as well as self-isolation of patients with symptoms could explain our results.
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OBJECTIVES: We assessed the prevalence of severe cardiovascular (CV) disease requiring hospitalization among patients with schizophrenia in France. METHOD: We included patients hospitalized with schizophrenia or psychotic disorder during 2015, in five French psychiatric hospitals. Patients with CV disease were defined as those with a correspondent ICD-10 code during a hospital stay in any general hospital, five years before or three years after the psychiatric hospitalization. CV disease included myocardial infarction (MI), stroke, heart failure (HF), coronary artery disease (CAD) or peripheral artery disease. Risk factors such as hypertension, obesity and diabetes were recorded. RESULTS: In total, 4424 patients with schizophrenia were included. Overall, 203 (4,6%) patients were diagnosed with CV disease, 93 (2.1%) with CAD, 86 (1.9%) with HF and 49 (1.1%) with stroke. The prevalence of hypertension, obesity and diabetes was 11.3%, 9.7% and 7.8%. The median (interquartile range) age of patients with MI and diabetes was 57 (49-70) and 56 (48-66) years. CONCLUSION: Patients with schizophrenia develop severe CV disease requiring hospitalization at an early age. These severe events are associated with a high prevalence of risk factors. Early screening and treatment of CV disease and risk factors is important to improve life expectancy and quality of life of these patients.
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Doenças Cardiovasculares , Insuficiência Cardíaca , Hipertensão , Infarto do Miocárdio , Esquizofrenia , Acidente Vascular Cerebral , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/epidemiologia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/prevenção & controle , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Infarto do Miocárdio/complicações , Infarto do Miocárdio/epidemiologia , Obesidade/complicações , Obesidade/epidemiologia , Prevalência , Qualidade de Vida , Fatores de Risco , Esquizofrenia/complicações , Esquizofrenia/epidemiologiaRESUMO
BACKGROUND: The French mental health law, first enacted on July 5, 2011, introduced the possibility of psychiatric commitment in case of extreme urgency (imminent peril - ASPPI). The decision of involuntary admission can then be made by the hospital director based on a medical certificate, without the need of a third party request. This procedure was intended to be applied on an exceptional basis, but its use is steadily increasing against the other types of involuntary care. Our study aimed at comparing the characteristics of patients who had received an indication for involuntary admission due to imminent peril (ASPPI) or at the request of a third party (ASPDT/u) in a psychiatric emergency ward, according to sociodemographic and clinical characteristics and regarding the potential implication of a third party. METHODS: An observational study was conducted among patients from the Centre Psychiatrique d'Orientation et d'Accueil (CPOA), located at Sainte-Anne hospital in Paris, from August 1st to 31st, 2016. RESULTS: One hundred and fifty patients with an indication for involuntary commitment were included, 101 of whom for ASPDT/u (67 %) and 49 for ASPPI (33 %). For more than half of the patients from the ASPPI group, a third party had been identified with (39 %) or without (17 %) contact information. Compared to ASPDT/u patients, ASPPI individuals were more socially vulnerable, showed more negligence, and had a lower mean functioning score. The indication for ASPPI status was also associated with behavioural quirks, prior psychiatric hospitalization (especially as an ASPPI patient) and with the diagnosis of chronic psychosis instead of mood disorder. CONCLUSION: Our exploratory results help to better understand how the ASPPI procedure is used in psychiatric emergency wards six years after enactment of the law. They highlight the differences between ASPPI patients and ASPDT/u and raise ethical issues regarding involuntary psychiatric care.
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Internação Compulsória de Doente Mental/legislação & jurisprudência , Serviços de Emergência Psiquiátrica/legislação & jurisprudência , Internação Involuntária/legislação & jurisprudência , Transtornos Mentais/terapia , Adulto , Internação Compulsória de Doente Mental/estatística & dados numéricos , Comportamento Perigoso , Serviços de Emergência Psiquiátrica/estatística & dados numéricos , Feminino , Humanos , Masculino , Competência Mental/legislação & jurisprudência , Competência Mental/psicologia , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Transtornos do Humor/diagnóstico , Transtornos do Humor/epidemiologia , Transtornos do Humor/psicologia , Transtornos do Humor/terapia , Paris , Readmissão do Paciente/legislação & jurisprudência , Readmissão do Paciente/estatística & dados numéricos , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/psicologia , Transtornos Psicóticos/terapia , Encaminhamento e Consulta/legislação & jurisprudência , Encaminhamento e Consulta/estatística & dados numéricos , Adulto JovemRESUMO
The paper describes an action research for indicative assessment of psychological problems of young children following the 2010 earthquake in Haiti, and the interest of using the Creole version of the questionnaire PSYCa 3-6. The survey took place in Port-au-Prince, and the evaluators were trained to a proper standardized administration of the questionnaire. BACKGROUND: The mental health needs of young children in natural disaster contexts often remain unaddressed. The lack of a rapid and simple tool for screening combined with few mental health professionals available to accurately diagnose and provide appropriate care mean that young children remain without care. Here, we present the results of psychological screening of young children aged 3 to 6 using the questionnaire PSYCa 3-6. METHODS: This study was conducted in Port-au-Prince, Haiti. The scale was translated into Haitian Creole using corroboration of independent translations and submitted twice to the parents at home, at the end of 2011 and again at the beginning of 2013. At the first stage 166 children 3 to 6 years old were included 49 of whom were included at the second stage. The results and diagnostic properties were assessed comparing the PSYCa 3-6 to the Clinical Global Impression Severity Scale as the gold standard. RESULTS: Boys were more prone to psychological disturbances than girls. The size and position among the siblings increased the score of psychological disturbance. The neighborhood and the perception of environmental violence had a significant impact on the score of psychological disturbance. The significant improvement in scores between the two examinations showed moderate resiliency whose main factors seemed to be the social support received by the family, the rapid return to school, faith and religious practice.
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Desastres , Terremotos , Resiliência Psicológica , Estresse Psicológico/epidemiologia , Ordem de Nascimento/psicologia , Criança , Pré-Escolar , Feminino , Haiti/epidemiologia , Humanos , Masculino , Características de Residência , Transtornos de Estresse Pós-Traumáticos/epidemiologiaRESUMO
BACKGROUND: In 2005, in its recommendations on the modalities of decision making for compulsory hospitalization, the French Health High Authority (HAS) had already stressed the need for rapid implementation of studies and epidemiological analyses on the subject to compensate the lack of adequate data in France. The new French law of July 5, 2011, on the rights and protection of persons under psychiatric care, establishes a judicial review of decisions for compulsory hospitalization. Therefore, healthcare professionals need to better define and characterize the criteria for such decisions, especially in their relation to psychopathology. The concept of capacity to consent to treatment includes the ability to understand (to receive information about the disease), the ability to appreciate (to weigh the risks and benefits of treatment), the ability to reason (determining the best choice rationally) and the ability to freely express a decision. However, assessment tools of capacity to consent to treatment seem to fail to predict the modality of hospitalization. OBJECTIVE: This study examined the impact of clinical and contextual characteristics on the decision in emergency services to admit patients to compulsory inpatient psychiatric units. METHOD: Data was collected from 442 successive patients admitted to hospital for care from five psychiatric emergency facilities in Paris and covered sociodemographic information, previous hospitalizations, recent course of care, clinical diagnosis, Global Assessment of Functioning scale (GAF) and Insight measured by the Q8 Bourgeois questionnaire. Patients were also assessed based on criteria established by the HAS for the severity of mental disorders and the necessity of emergency care. RESULTS: Multivariable logistic regression shows that diagnosis does not affect the decision of hospitalization. Agitation, aggressiveness toward others, being married as well as being referred by a doctor or family are all factors that increase the risk of involuntary hospitalization. Last, low Q8 and GAF scores are strong predictors for compulsory admission. CONCLUSION: Our study shows a dimensional rather than categorical assessment of patients by clinicians. Assessment of insight is the main operational criterion used by clinicians in our study. This supports using insight and GAF evaluation in clinical practice to clarify assessment and decision-making in an emergency setting regarding compulsory hospitalization.
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Internação Compulsória de Doente Mental/legislação & jurisprudência , Técnicas de Apoio para a Decisão , Serviços de Emergência Psiquiátrica/legislação & jurisprudência , Comportamento Perigoso , França , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Competência Mental/legislação & jurisprudência , Defesa do Paciente/legislação & jurisprudência , Encaminhamento e Consulta/legislação & jurisprudênciaRESUMO
Abstract: We examine the prevalence of SARS-CoV-2 infections among patients admitted to a Parisian psychiatric University Hospital Group (GHU).A total of 548 patients were admitted to the GHU...s full-time psychiatric wards between April 6 and May 3 2020. More than 80% were tested. A total of 7 patients tested positive for the SARS-Cov-2 (1.3%), with 5 patients (in 92, 5.4%) testing positive in the first week.GHU patients presented a low prevalence of SARS-CoV-2, even if all patients live in the hardest hit region in France. Social isolation and loneliness, as well as self-isolation of patients with symptoms could explain our results. (AU)
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Humanos , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave , Saúde Pública , Infecções por Coronavirus/epidemiologia , PsiquiatriaAssuntos
Registros Eletrônicos de Saúde/legislação & jurisprudência , Transtornos Mentais/diagnóstico , Internação Compulsória de Doente Mental/legislação & jurisprudência , Confidencialidade/legislação & jurisprudência , Comportamento Cooperativo , Responsabilidade pela Informação/legislação & jurisprudência , Serviços de Emergência Psiquiátrica/legislação & jurisprudência , Prova Pericial/legislação & jurisprudência , França , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Comunicação Interdisciplinar , Defesa do Paciente/legislação & jurisprudência , Encaminhamento e Consulta/legislação & jurisprudênciaRESUMO
We report two patients presenting with a subacute right hemisphere stroke. These cases demonstrate a double dissociation between unilateral neglect and anosognosia for hemiplegia. The first patient suffered from a severe left hemiplegia associated with severe and persisting unilateral neglect. He appeared fully aware of his motor impairment. The second patient had a severe left hemiplegia, without any major sign of unilateral neglect on clinical tests nor on behavioural assessment. Nevertheless, he presented a severe and sustained anosognosia for hemiplegia. These case reports support the assumption that anosognosia and unilateral neglect, although they are frequently associated, may rely on independent mechanisms.