Examining the hikikomori syndrome in a French sample of hospitalized adolescents with severe social withdrawal and school refusal behavior.

While the term hikikomori (HKM) has spread internationally to describe a chronic and severe form of social withdrawal, its place in current nosography and its transposition into non-Asian cultures are still debated. A retrospective chart review was conducted to determine the rate and the clinical profiles of HKM among a French sample of adolescent inpatients. Data were obtained from 191 adolescents aged 12-18 years (M = 15.0, 44% boys) consecutively admitted in two inpatient units from January 2017 to December 2019. Using a retrospective diagnosis of HKM based on Teo and Gaw's criteria, we compared socio-demographic characteristics, clinical features, and treatment outcomes between HKM patients and those with other forms of social withdrawal and/or school refusal (SW/SR). At admission, 7% of participants met HKM criteria (n = 14, M = 14.3, 64% boys), one out of six adolescents with SW/SR. Among those with SW/SR, HKM + vs. HKM- participants had higher rates of anxiety disorder (Odd Ratio, OR = 35.2) and lower disruptive behavioral disorder (OR = 0.03). A minority of the participants with anxiety and depressive disorders met the HKM criteria (respectively, 15% and 9%), but those with HKM had a longer duration of symptoms, longer hospitalization, and required more daily care facilities at discharge compared to HKM-. While HKM syndrome could not be delimitated from anxiety disorder, it was associated with specific clinical features and treatment outcomes. The clinical characteristics observed were consistent with the features reported in Asian HKM adults, supporting face validity of this clinical concept in adolescent inpatients with different cultural contexts.

Mental Healthcare Utilization among Homeless People in the Greater Paris Area.

The healthcare utilization of homeless people is generally considered insufficient, and studies often suffer from methodological bias (institutionalized vs. street samples). To adapt public health policies in France, epidemiological data on this population are scarce. The objective of this study was to analyze the use of psychiatric care by homeless people with mental health problems in the Greater Paris area and to define the factors influencing this use. The data were from the SAMENTA survey performed in 2009 with a representative random street sample of 859 homeless people from the Greater Paris area. The survey studied the use of psychiatric care (lifelong use, current follow-up, discontinuation of follow-up and treatment) and factors potentially associated with this use for people with a diagnosis of a psychotic, mood or anxiety disorder, with the diagnosis established with an original survey device. Because of our complex sampling design, we describe data for only a weighted estimated prevalence, weighted estimation of the number of people in the population (N) and unweighted total subgroup studied in the survey (n). Among 840 homeless people with useable data, 377 (N = 9762) had a psychiatric disorder. The use of whole-life care for these people may seem high, estimated at 68.7%, but few people were followed up for their disorders (18.2%); individuals with a psychotic disorder were more frequently followed up (36.5%) than others were (p < 0.05). Among those followed up (n = 86, N = 1760), 63.0% were taking medication. Access to care for these people seemed preserved, but the maintenance of care seemed problematic; indeed, among people with a lifelong whole use of care (n= 232, N = 6705), 72.3% could be considered to have discontinued care. The factors that improved lifetime health service utilization or follow-up were socio-demographic (age < 42 years, more educated), social (with social security coverage, not living in a hotel), and medical (psychotic disorder, personality disorder, suicide risk, somatic chronic illness, perception of mental suffering). Improving the care of homeless people with psychiatric disorders requires improving access to care for those isolated from the health system (in particular those living in hotels) and to guarantee continuity of care, by adapting the organization of the care system and promoting social rehabilitation.

Clinical and nonclinical predictors of test ordering in psychiatric emergency.

OBJECTIVE: This naturalistic prospective study explored the predictors of laboratory test ordering in a psychiatric emergency department. METHODS: We used a standardized questionnaire to collect clinical and nonclinical features in 527 consecutive patients. RESULTS: Test ordering was independently predicted by age, spoken language, referral by relatives, eating disorders, and somatic complaints. Having been referred by a general practitioner predicted test ordering only in the absence of a clinical report. Alcohol- and substance-related symptoms predicted test ordering only in patients older than 35 years. Age did not predict test ordering in patients consulting for anxiety or suicidal ideation. CONCLUSION: Clinicians should be aware of possible biases when assessing the need of laboratory tests in patients presenting with psychiatric complaints.

[Emergency situations in psychiatry]. / Situations urgentes en psychiatrie.

Emergencies in psychiatry depend both on the diagnosis of the pathology (past diagnosis or that revealed by the emergency), and on the situations that caused the crisis, of which their reactional nature demands specific treatment. There is an emergency when this is felt by any of the protagonists: the patient, the doctor or the entourage. The response in the environment can be indifferent, aggravating or pacifying. The behavioural outbursts in the agitated and aggressive situations necessitate a symptomatic treatment of the agitation, investigation of the underlying somatic or psychiatric pathology, and an evaluation of the milleu often at the origin of the aggravation or agitation. New types of emergency psychiatric consultations are currently being observed, underlaid by outbursts of anxieties and anguish, and this occuring across the board. Patients with diverse pathological anxieties arrive in the emergency department with an imperative demand to be relieved. Thus psychiatirc emergency go from behavioural to more intra-psychi situations, and necessitate an evaluation and an immediate response.

[Psychiatric presentation of disseminated lupus erythematosus. When "calling wolf"]. / Présentation psychiatrique d'un lupus érythémateux disséminé. Quand on cherche le loup.

INTRODUCTION: Neurological or psychiatric manifestations are frequent during systemic lupus erythematosus (SLE). When faced with acute psychiatric symptoms, it is important to envisage the possibility of an organic origin. OBSERVATION: A 36 year-old woman consulted for motor deficiency of the right lower body and paresthesia of the left arm. She exhibited severe psychiatric disorders suggesting conversion hysteria, mania, paranoia and acute psychosis. The existence of an acute delusional disorder, associated with an episode of articular lupus 7 years earlier, led to the diagnosis of SLE. DISCUSSION: The physiopathology of delusional disorders in patients exhibiting SLE is not well known. According to one hypothesis, ribosomal anti-protein P antibodies would bind to the neurones in certain cerebral localizations. Above all, knowledge of lupus in the course of delusional disorders has important therapeutic consequences, particularly on the use of high doses of corticosteroids.