Quantifying efficacy of investigation during a simulated psychiatric interview.

INTRODUCTION: Simulation is a very promising educational tool. It provides medical students with clinical experience without jeopardizing patients' health. This tool can be implemented in psychiatry training in order to develop interview and specific assessment skills which is why the Université de Lorraine relies increasingly on simulation in teaching psychiatry to its residents. However, there are few objective indicators in that field that make it possible to assess learners. This study aims to assess the relevance of a quantitative measure for objectivising the investigation efficiency by psychiatry residents of a suicidal risk during a simulated psychiatric interview. METHODS: A simulation exercise was offered to 20 psychiatric trainees from the Université de Lorraine. Their mission was to identify relevant information for assessing and guiding a standardized patient with suicidal risk during a psychiatric interview. The key judgemental criterion was the I2/Q ratio which corresponds to the squared number of relevant items collected by the interviewer divided by the number of questions. When dealing with emergency cases it is indeed important to collect as many key items in as little time as possible. This score was assessed by two examiners based on the analysis of filmed interviews. RESULTS: The mean I2/Q ratio was 1.13 (SEM±0.2) and ranged between 0.25 and 2.86. Statistical analysis showed a positive correlation between I2/Q ratio and students' clinical experience (R=0.46, P=0.04). The interclass correlation coefficient (ICC) of the I2/Q ratio between the two examiners was 0.94. CONCLUSION: I2/Q ratio may provide a consistent quantitative measure of a student's efficiency in assessing suicidal risk. Further research is now needed to evaluate its consistency in other clinical cases.

[Absence of mitral valve prolapse during panic attacks induced by sodium lactate]. / Absence de prolapsus mitral au cours d'attaques de panique provoquées par lactate de sodium.

The recent identification of a new type of anxiety state, panic attack, has drawn attention to common pathways between panic disorder and cardiac somatization, particularly mitral valve collapse. A double-blind study was set up, using doppler-echocardiography during a panic attack induced by sodium lactate infusion. The results showed that there was no relationship between panic attack and mitral valve collapse, and that the lactate infusion-anxiety rate was only 35 percent.

[Organization of psychiatric emergencies in the general hospital]. / L'organisation des urgences psychiatriques à l'hôpital général.

The authors try to define the notion of psychiatric emergency "pathology covering a whole line of situations characterized by their particularly acute and dramatic behaviors, their constant dealing with human relations, the high frequency of acting out and their usually rapid resolutions" (translated from Védrinne). They make a brief overview of french psychiatric emergencies departments organization in France either in psychiatric hospitals or in general hospitals. They report the Nancy psychiatric emergencies room's experience, which was born in 1987 and is based on an agreement between the psychiatric "secteurs" and the general hospital. This agreement provides psychiatrists and psychiatric nurses 24h/24, working in a psychiatric room within the medical emergencies department. This experience agrees with the recent french law about psychiatric emergencies.

[Sexual violence: necessity of multidisciplinary management]. / Les violences sexuelles: nécessité d'une prise en charge multidisciplinaire.

In the 300,000 inhabitant city-area of Nancy (France), admission of women victims of sexual violence follows a special procedure. That has been jointly set by the Justice Department, Police and Emergency Rooms of both the Maternite Régionale and the University General Hospital. Nevertheless, we have recently conclude the management and follow-up of victims were generally not good enough. Early management of the psychological shock and formation of all intervening parties have to be improved. As both a gynecologist attached to the Maternite regionale and the Commission for the Fight of violence against women to take initiatives aimed at increasing public awareness (congresses ...). These initiatives have driven to the creation of a meeting place where a multidisciplinary team takes care of victims and leads talking groups including both victims and authors of violence. The organization of such a multidisciplinary management team is slow and difficult. Strong political will and compassion are needed to achieve that task. In the process, power and knowledge of every member of the team have continuously to be called into question.