M. Nasr

Sociodemographic and Clinical Profile of Frequent Visitors to Psychiatric Emergency

Introduction The frequent use of psychiatric emergency poses problems due to the loss of their adaptative capacity and diagnosis, orientation and therapeutic difficulties for clinicians. Aims To estimate the prevalence of frequent visitors to psychiatric emergency and to describe their sociodemographic and clinical characteristics. Methods It is a cross-sectional study of twelve months including patients who consulted at least twice to medical emergency department in the university hospital of Mahdia. Data were collected using a predefined questionnaire. Results The prevalence of recurrence was 30,2%. The main characteristics were: a mean age of 35,5 years, a male gender (64,5%), being unemployment (72,3%), a single status (71%), a request from the family (55,5%) and the presence of psychiatric personal history (91,6%). Previous hospitalizations were noticed in 69% of cases. 44,5% of the patients had problems with the primary support group and the social environment. In 78,6% of cases, patients had visited emergency twice to four times. The most encountered reason for consultation was heteroagressivity (27%) and the most frequent syndromic diagnosis was psychomotor excitation (25.2%). Hospitalization concerned 47.1% of patients. Schizophrenia and bipolar disorder were the most diagnosed disorders in 54,2% and 25% of cases. Conclusion Absence of intermediate structures and lack of coordination between the various stakeholders involved in the management of patients are the two main encountered problems.

The acting out in patients with Schizophrenia examined in a forensic psychiatric assessment

Introduction Many studies have shown that schizophrenic patients are responsible for the highest rates of violence among all the mentally ill patients. Aims of the study Describe the socio-demographic and clinical characteristics of patients with schizophrenia examined in a forensic psychiatric assessment and identify the risk factors of violence in these patients. Methodology A retrospective study carried out in the psychiatric department of university hospital of Mahdia during fifteen years involving 40 patients with schizophrenia examined in a forensic psychiatric assessment following a forensic act. These patients were compared to a population of 40 patients followed in the same establishment for the same disease and without criminal record. Results Age average of 36.08 years, male (95%), rural origin (65%), primary level education (47.5%), single (65%), unemployed (65%) and average socio-economic level (65%). Personal psychiatric history (87.5%), personality disorder (12.5%), judiciary history (12.5%) and substance abuse (57.5%). Subtypes of schizophrenia: undifferentiated (52.5%) and paranoid (30%). They have committed serious physical assaults (55%) and aggression against property (27.5%). The victim was mostly a family member (40%), under the influence of toxic (22%), driven by delusions of persecution (61%), with hallucinatory mechanism (55%). The psychiatric expert has concluded an abolition of discernment in 77.5% of cases. Risk factors of acting out were: rural origin, alcohol and psychoactive substances use, productive forms of schizophrenia, poor adherence and irregular monitoring. Conclusion The knowledge of risk factors improves the management and allows us better prevention of violence among our patients.

Mentally ill patients who committed sexual and physical assaults: A study about 37 cases of expertise reports

Introduction Several studies suggest the existence of a relationship between major mental disorders and crime. However, it is important to emphasize that violent behaviors do not affect all patients and that issues of criminality among mentally ill persons only represents a small proportion. Aims The objective of this study is to establish the general and clinical profile of perpetrators of sexual and physical assaults. Methods This is a retrospective study of the records of forensic psychiatric expertise, conducted in the psychiatry department of the University Hospital of Mahdia during the period from May 1st 2000 to May 31st 2013. Results The general profile of the population the study was characterized by a mean age of 39 years, a sex ratio of 8.25, unemployment in 73% of cases and by the presence of a psychiatric personal history 54% of cases. Sexual and physical assaults accounted for 54.5% of cases. It was essentially in descending order: assault and battery (65%), rape (16.2%) and incest (5.4%). As for the clinical profile, schizophrenia and epilepsy were recorded each in 13.5% of cases, major depressive disorder in 8.1% of cases, bipolar disorder in 5.4% and substance abuse in 5.4% of cases. A personality disorder was observed in 48.6% cases, essentially antisocial personality (55%). Comorbidity with addictive behavior was observed in 56.7% of cases. Conclusion It is necessary to characterize a subgroup of patients with mental disorders, likely to commit violent crimes, in order to prevent acting out behaviors and adapt their management.

Psychiatric Emergency: Factors Associated with the Decision of Hospitalization

Introduction Hospitalization is a major therapeutic tool for management of psychiatric emergencies. However, the doctor does not have a specific consensus outlining the most important variables in order to sit this decision. Aims Our purpose was to identify the factors affecting the decision of hospitalization in a psychiatric service via emergencies. Methods It is a cross-sectional study conducted in the medical emergency department of university hospital in Mahdia during twelve months. The Canadian Triage and Acuity Scale (CTAS) was used to specify the degree of emergency. Results Among the 513 patients referred to the emergency room, 201 were hospitalized with a prevalence of 39,5%. The most represented age group was between 25 and 34 years old in 35,3% of cases and the sexe ratio (M/F) was 2,65. The factors having an impact on the decision of hospitalization were: male gender, single status, low socioeconomic level, absence of professional activity, presence of family or personal psychiatric history, previous hospitalizations in psychiatric department, precipitating event, heteroagressivity and restlessness as reasons of consultation, demand for care from third parties and level 2 in CTAS reflecting a true emergency. Conclusion The identification of these factors contributes to make an objective decision regarding the psychiatric hospitalization.