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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.

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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.

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Background and objectives: Early detection of psychiatric disorders in general hospital settings could facilitate a systematic assessment of anxiety and depression, and lessen their non-detection, misdiagnoses and subsequent negative impacts. We built a new short screening tool with simple Yes/No questions on anxiety and depression and examined its diagnostic capacity and acceptability.MethodsOur cross-sectional study included 608 patients examined in an emergency department at a Parisian general hospital. Their depressive and anxiety symptoms were assessed with the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Disorder 7 (GAD-7). Participants also completed the ‘GHU-checklist’, a list of 17 words evoking moods or feelings. Sensitivity and specificity of the checklist were determined using receiver operating characteristic (ROC) analysis.Results22.7% of participants had depressive symptoms as measured by the PHQ-9, while 25.4% suffered from moderate or severe anxiety. Most participants perceived positively the GHU-checklist, which had a sensitivity of 81.5% in distinguishing patients with depressive symptoms. Sensitivity was 86.0% for moderate anxiety and 94.7% for severe anxiety. The specificity ranged from 64.3% to 71.1%.ConclusionsA short 17-words checklist is able to ultra-rapidly screen for depressive and anxiety symptoms in non-psychiatric medical settings, and was perceived positively by patients. Its systematic use could facilitate a rapid and systematic assessment of these symptoms, especially in crowded and under-staffed settings such as the emergency department. (AU)

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Cerebral palsy (CP) is the most prevalent neurologic disease in children and a leading cause of severe physical disability. Research and clinical experience indicate that children with CP have abnormal neuromuscular junctions (NMJs), and we present evidence that nonapposition of neuromuscular junction components is associated with the severity of motor system deficit in CP. Leg muscle biopsies collected from ambulatory (n = 21) or nonambulatory (n = 38) CP patients were stained in order to detect acetylcholine receptor (AChR) and acetylcholine esterase (AChE). Image analysis was used to calculate the extra-AChE spread (EAS) of AChR staining to estimate the amount of AChR occurring outside the functional, AChE-delimited NMJ. Nonambulatory children exhibited higher average EAS (P = 0.025) and had a greater proportion of their NMJs with significantly elevated EAS (P = 0.023) than ambulatory children. These results indicate that physical disability in children with CP is associated with structurally dysmorphic NMJs, which has important implications for the management of CP patients, especially during surgery and anesthesia.

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