RESUMEN
Important discrepancies exist between physicians in deciding when to perform involuntary hospitalization measures (IHMs). The factors underlying these differences are poorly known.We conducted a two-year single-center retrospective study in France on patients who were referred to the emergency department (ED) with an IHM certificate written by a private-practice General Practitioner (GP). For each consultation, the official IHM motive was categorized into four groups: Suicide; Psychosis, Mania, or Melancholia (PMM); Agitation; and Other. The alcohol status of the patient was also noted. The factors underlying the ED psychiatrists' confirmation of the use of IHMs were determined using a logistic regression model. One hundred eighty-nine cases were found (165 patients; 44.2 ± 16 years, 41.3% women). The ED psychiatrists confirmed the use of IHMs in 123 instances (65.1% agreement rate). Multivariate analyses found that IHM disagreement was significantly associated with patient alcohol status and the reason for referral. Specifically, there was an increased risk of IHM disagreement when the patient had an alcohol-positive status (OR = 15.80; 95% CI [6.45-38.67]; p < 0.0001) and when the motive for IHM was "agitation" compared with "suicide" (OR = 11.44; 95% CI[3.38-38.78]; p < 0.0001). These findings reflect significant disparities between GPs and ED psychiatrists regarding the decision to proceed to an IHM.
Asunto(s)
Trastorno Bipolar/epidemiología , Trastorno Depresivo/epidemiología , Médicos Generales , Tratamiento Psiquiátrico Involuntario/estadística & datos numéricos , Tratamiento Involuntario/estadística & datos numéricos , Psiquiatría , Trastornos Psicóticos/epidemiología , Adulto , Consumo de Bebidas Alcohólicas , Trastorno Bipolar/psicología , Toma de Decisiones Clínicas , Consenso , Trastorno Depresivo/psicología , Servicio de Urgencia en Hospital , Femenino , Francia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Agitación Psicomotora , Trastornos Psicóticos/psicología , Estudios Retrospectivos , SuicidioRESUMEN
Though the carrying out of involuntary psychiatric care (IPC) mainly follows from a subjective appraisal of the patient's state, some specific clinical criteria have been proposed on regards to the underlying disorder. French national recommendations are synthesized hereby, and completed by a literature review. In psychotic disorders, the level of insight and the impact of delusion(s) are the essential criteria that should recommend to carry out IPC. In mood disorders, the appraisal is different depending on the underlying clinical state. In depressive or mixed states, IPC should be considered mainly in case of suicidal risk or jeopardizing physical consequences. In mania, IPC should result from a poor level of insight, or from the onset of significant social or occupational aftermaths. For suicidal states, it is necessary to appreciate suicidal risk and underlying psychiatric disorder. In addictive disorders, repeated risk-taking and denial should be the main criteria for considering IPC. In eating disorders, the occurring of both danger of death and denial of care should lead to possible IPC. Personality disorders are severity factors of emergency psychiatric states which can result in IPC. They are not criteria for IPC by themselves. For patients with dementia, mostly behavioural disturbances can require IPC.