Biomedical subjects

F Pochard

Publications and source records attributed to F Pochard.

24 records · Page 2Linked to original sources

PubMedDate not supplied

[Questionnaire on professional satisfaction with psychiatric emergency services: the professionals' opinion].

Professional's satisfaction concerning medical wards to which they address their patients are scarce, but is part of quality evaluation. The primary care network criticizes often the access to specialized psychiatric cares in emergency. The rapid emergency crisis team (ERIC) is a mobile emergency and post-emergency crisis team depending from public services. It has for purpose to offer early access to specialized care before admission to psychiatric hospital, which general practitioners or other members of social network alert it for a crisis psychiatric situation. The aim of this study was to evaluate the adequacy of ERIC to the needs of professionals, and to improve the collaboration within the network. We performed a mailed study using a questionnaire to 150 general practitioners, 25 private psychiatrists, 7 social circonscriptions, and 5 police departments depending on our intervention's catchment area. Forty-two percent of the professionals answered. Emergency psychiatric crisis situations are scarce, and professional's satisfaction is excellent. ERIC is considered as useful, and the accessibility is underlined. However, information transmitted at the end of the intervention is criticized by the professionals. This study allows to improve some of the procedures and will help to an evolution of our functioning. Moreover, it allows to propose a strategy of prevention oriented to early access to specialized cares.

Catchment Area, Health↗

PubMedDate not supplied

[Suicidal action and sacrificial violence: systemic and anthropological hypothesis].

Studies concerning suicidal behavior show practical limitations of epidemiology and risk factor analysis. Suicidal behaviour is usually considered as a consequence of mental disease, but suicide cannot be studied without addressing the context of the acting-out. Suicide attempt can be interpreted as a thematic relational act, in which the central phenomenon is anger. Using the anthropological hypothesis of scapegoating described by René Girard and a theoretical systemic approach, we propose a vision of suicide attempts in a micro-social context, offering a new interpretation of the acting-out. Application of the hypothesis to the suicidal context shows that suicidal behavior may be considered as a relationship modality. The understanding of rivalry mechanisms and integration of care in a context which takes account of the complexity of suicidal behaviour offers the possibility of developing potentially valuable approaches to prevention.

Acting Out↗

PubMedDate not supplied

[Psychiatric disorders in intensive care units].

The diagnosis and treatment of psychiatric disorders in intensive care patients have been for a long time neglected. They are nowadays better recognized and managed. These disorders are mainly: delirium; anxiety disorders, from simple anxiety to panic disorder with agitation; adaptation disorders with depressive mood; brief psychotic disorders with persecution ideas. The manifestations of psychiatric disorders occur not only during the stay in intensive care unit (ICU) but also after transfer from ICU and several months after discharge from hospital. Part of psychiatric disorders is caused by organic or toxic causes (metabolic disturbances, electrolyte imbalance, withdrawal syndromes, infection, vascular disorders and head trauma). Nevertheless some authors estimate that they are due to the particular environment of ICU. The particularities of these units are: a high sound level (noise level average between 50 and 60 dBA), the absence of normal day-night cycle, a sleep deprivation, a sensory deprivation, the inability for intubated patients to talk, the pain provoked by some medical procedures, the possibility to witness other patients' death. Although most patients feel secure in ICU, some of them perceive ICU's environment as threatening. Simple environmental modifications could prevent the apparition of some psychiatric manifestations: efforts should be made to decrease noise generated by equipment and staff conversations, to provide external windows, visible clocks and calendar, to ensure adequate sleep with normal day-night cycle and to encourage more human contact. Psychotropic drugs are useful but a warm and empathetic attitude can be very helpful. Some authors described specific psychotherapeutic interventions in ICU (hypnosis, coping strategies.). To face anxiety, many patients have defense attitudes as psychological regression and denial. Patient's family is suffering too. Relative's hospitalization causes a crisis in family. Unpredicted illnesses often force family members to reorganize in order to regain their equilibrium. Every family should be proposed a psychological support. Caregivers can be distressed as well. This stress is due to their high responsibility and the fact that they face disease and death. Simple measures can lessen stress'effect and prevent the burn-out syndrome . In conclusion, the importance of a liaison psychiatrist-intensive care physician collaboration must be emphasized in order that patients and their family have a better psychological support. Psychological management should be proposed during the hospitalization and after discharge from hospital.

Adaptation, Psychological↗

PubMedDate not supplied

[Survey of management methods for patients in a state of agitation at admission and emergency departments in France].

UNLABELLED: The increasing prevalence of the agitation states in the emergency department (ED) is a problem little studied on the epidemiological plan. OBJECTIVE: To define the prevalence of the agitation states in the ED in France, to determine predicative criteria of the agitation states to prevent a potentially dangerous situation and take care as fast as possible of it, to know current practices in front of these situations, and to collect the recommendations of the departmental managers of the ED to improve this management. METHOD: A questionnaire of appraisal was sent to the 464 managers of the ED of hospitals and clinics in metropolitan France, containing 21 questions. RESULTS: 137 (29.5%) departmental managers answered. The average of admittances by ED is 24,000 a year. The estimated prevalence of the number of situations of agitation represents 1.22% of the total of admittances. The average prevalence a month and by service of verbal attacks is 36.3, that of the physical attacks is 1.14. The number of attacks (and their consequences) correlate with admittances by ED. The intervention of the police is required on average 17 times a year and by ED. Only 29.5% of the ED consider to have premises adapted for the management of the agitated patients; 32.3% of the ED have a protocol established for the agitation states; 16.3% of services accumulate a protocol and a training of the professionals; 10.5% of establishments have at the same moment adapted premises, a protocol and a forming of the staff for the management of the agitated patients. Among the agitated patients, those that profit by a sedation represent on average 67.7% and it varies according to ED. The sedative treatment used in first intention is loxapine in intramuscular injection for 84% of them. The predicative factors identified of agitation states are intoxications, mainly the alcohol (88%) and the poly drug addiction (46.3%). More than half of the ED recommend in a systematic way and for lack of diagnostic orientation the dosages of alcohol, drugs, glycaemia and bloody electrolytes; 85% of the departmental managers consider that a better management of the agitation states rests on the presence of adapted premises and on a specific forming of the nursing staff. CONCLUSION: The management of the agitated patients in the ED requires the placing of protocols and of specific trainings as well as of adapted premises. The major prevalence of attacks imposes realization of epidemiological studies and the priority placing of a coherent politics, considering the potential and often real gravity of these behavioural problems.

Adult↗

PubMedDate not supplied

[Anxiety and depressive disorders in cardiovascular diseases].

Cardiovascular diseases are often associated with anxiety and depression. The literature gives different interpretations of this comorbidity. Psychopathological factors have been successively studied as risk factors, comorbid disorders and factors influencing the prognostic. The authors describe the incidence and the prevalence of anxiety and depression, first in coronary heart disease and secondly before cardiac surgery. The prognostic significance of these psychological factors is also reviewed. Physiopathological hypothesis and practical application in clinical practice are proposed.

Adaptation, Psychological↗

PubMedDate not supplied

[Security and home emergency psychiatric interventions].

Sectorisation of cares leads professionals to a confrontation with violent home patients. These interventions need a maximal security for professionals. Emergency Mobile Crisis Team (ERIC) has more than 6,000 crisis home interventions' experience. The aim of this study was to assess violent situations during a 42 months experience. We present 70 situations of danger for professionals, and their consequences. Difficulties lead to procedural safety measures, which are presented. Prevention of violence during intervention needs an acute preparation, a clear evaluation of context, and passive or active securisation measures. Occurrence of acting-out is low, but situations considered as dangerous are frequent. We propose some pragmatic issues to increase security in crisis home interventions.

Accidents, Occupational↗