Encephale-Revue De Psychiatrie Clinique Biologique et Therapeutique最新文献

Mental disorders are on the increase, while access to care is becoming increasingly difficult for those affected. This article presents the "Projet de Liaison Universitaire de TerritOire du Nord" (PLUTON), an initiative to improve access to psychiatric care in an area of the Hauts-de-France region and to combat medical desertification. Initially conceived as a response to a health crisis, PLUTON has gradually evolved to rethink the organisation of psychiatric care in a given area. The aim was to preserve the structure of sector-based care while adding a university dimension to clinical, research and teaching activities. The success of this project is the result of an innovative, collaborative approach based on the pooling of existing resources. This tried and tested methodology means that the project can be easily and effectively replicated in other areas.

Background: Studies have shown that psychiatrists have a higher suicide rate compared to the general population and other medical specialists.

Aim: To evaluate the prevalence, methods, and factors associated with suicide attempts (SA) among Moroccan psychiatrists.

Method: A cross-sectional online survey was carried out in August 2023 using an anonymous questionnaire created online on Google Forms.

Results: In all, 142 Moroccan psychiatrists practicing in the private and public sectors were included. Among these, 7.7% had a history of lifetime suicide attempts. Factors associated with TS among Moroccan psychiatrists are the personal history of depressive and anxiety disorders, the high scores of perceived stress, the psychoactive substances use; including tobacco, alcohol, and anxiolytics, as well as the family history of psychiatric disorders and the family history of suicide.

Conclusion: Suicide attempts among Moroccan psychiatrists are a serious mental health problem that has a negative impact on the psychiatrist himself, his entourage, and the quality of care provided to patients.

Introduction: Tele-expertise is a care tool that has developed significantly in certain medical disciplines such as dermatology, ophthalmology and cardiology in France in recent years. At Brest University Hospital, we have been able to set up tele-expertise in psychiatry since April 2023, via a secure platform (Omnidoc), on assistance with prescribing or de-prescribing psychotropic drugs. The aim of this study is to evaluate its contribution after 18 months of use.

Methods: A total of 166 tele-expertise requests were received and analyzed between April 2023 and September 2024. For each tele-expertise, we collected: the response time, the number of opinions given, the breakdown of requests by requesting physician's specialty, the number of different requesting physicians, the number of requests per requesting physician, the number of post-opinion consultations, the psychiatric diagnosis evoked and the number of requests for assistance with deprescribing. A satisfaction questionnaire was sent to each requesting physician who had requested at least one opinion during the period studied.

Results: A total of 152 tele-expertise requests were included in the final analysis. The average response time was 4hours over the study period, with a median response time of 1hour. Ninety-five percent of requesting physicians were satisfied with the quality of exchanges with the psychiatrist. Ninety-three percent of requesting physicians also felt that the tele-expertise had improved patient management. Fifty nine percent of requesting physicians prescribed psychotropic drugs differently since they had sought advice. Fifty eight percent felt they had learned how to better prescribe or deprescribe psychotropic drugs. Ninety-four percent thought they would use tele-expertise again and/or recommend it to a colleague. Finally, requests for help in deprescribing psychotropic drugs concerned only 6 of the 152 requests (3.9%).

Conclusion: The introduction of tele-expertise in psychiatry, focusing on medication via a secure platform, has been much appreciated by GPs in particular. It could improve patient care and encourage city-hospital collaboration.

Background: The co-occurrence of Post-Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI) is common in military personnel, leading to complex clinical challenges and poor prognosis. To enhance the care of PTSD patients, a TBI screening protocol was developed at a French Military Training Hospital (MTH). The Ohio State University Traumatic Brain Injury Identification Method (OSU TBI-ID), a self-administered questionnaire, was translated into French (OSU TBI-ID Fr) to help standardize screening. This study aims to evaluate the feasibility and tolerance of the TBI screening protocol, to explore its potential to improve clinical outcomes for military personnel suffering from PTSD, and to assess TBI prevalence in our population.

Design: This observational, retrospective, monocentric study was conducted at the MTH psychiatric unit. PTSD military personnel and veterans were screened for TBI using three questionnaires: OSU TBI-ID Fr, the PTSD Checklist for DSM-5 (PCL5), and the Rivermead Post-Concussion Symptoms Questionnaire (RPQ). Data on patient characteristics and screening results were extracted from medical records to determine TBI prevalence. Feasibility was assessed based on the proportion of eligible patients who underwent screening, with reasons for non-participation documented. Tolerance was evaluated by recording side effects. Exploratory analyses included subgroup comparisons based on TBI or Repeated subconcussive Head Impacts (RHI) and correlations between PCL5 and RPQ scores.

Results: Of the 233 PTSD patients treated in the psychiatry unit, 14.1% (n=33) completed the TBI screening between September 2022 and March 2023. Among the screened patients, 39.4% (n=13) had a history of TBI, and 48.5% (n=16) had been exposed to RHI. Three participants reported anxiety while completing OSU TBI-ID Fr. The average PCL5 score was 45.8, and the average RPQ score was 25.7. The main barriers to screening in the rest of the eligible population were lack of time, oversight, and interview setting (e.g., teleconsultation).

Discussion and conclusion: This study introduces the French version of the OSU TBI-ID as a standardized TBI screening tool for military personnel with PTSD. The high prevalence of undiagnosed TBI, often discovered through screening, highlights the importance of early detection. This study demonstrates the acceptability and tolerance of the OSU TBI-ID Fr in this population and suggests its potential to improve care by enabling earlier TBI identification. Future research should focus on refining the protocol, enhancing its applicability across settings, and optimizing integrated care pathways to improve clinical outcomes.

Cerebrovascular abnormalities may predispose, precipitate, or perpetuate depressive symptoms in old adults, supported by the hypothesis of vascular depression. These depressive episodes are sometimes accompanied by atypical neurological symptoms associated with localized vascular lesions in the brain. We present the case of an 84-year-old man with vascular depression who experienced visual hallucinations and dizziness, coinciding with the incidental discovery of a cerebellar stroke. Based on this clinical case, we discuss the hypothesis of perceptual and affective cerebellar functions.

To permit swift care of psychiatric and suicidal crisis, a post-emergency department unit (named UPSAM) opened on 25th March 2024 at the Angers University hospital. This unit permits a brief stay in a secure environment during which psychiatric care allows a decrease in suicidal ideation and etiological diagnosis followed by a multimodal suicide prevention strategy and ambulatory care organization. For 6 months 348 patients were hospitalized from all 3 corresponding departments. The mean length of stay was 5.6 days resulting in mean bed occupancy of 87.4% discharge; only 37.9% of patients needed public psychiatric care. UPSAM permitted a decrease in waiting time before hospitalization, with a mean delay before hospitalization of 59.4hours in April and 27.4hours in September. Other models of short-stay unit have been tested and showed efficacy in decreasing emergency department waiting time. Further work is needed to better understand appropriate care regimens according to clinical and topographical situations.