[Preventing emergency? Preventing agitation?].
Explore the source record for details and available documents.
Emergency Services, Psychiatric↗
Biomedical subjects
M J Guedj
Publications and source records attributed to M J Guedj.
[Indications for EEG in mental confusion and behavior problems].
Even in 1998 at the time of brain imaging, EEG recording is undoubtedly useful in clinical psychiatry when a true cerebral disease takes the form of an acute psychiatric disorder. Though the real place of EEG recording cannot be yet accurately quantified, it may help guide the diagnosis, as it is of either positive (ie, confirming the diagnosis via additional information) or negative (ie, rejecting various etiologies) value. Most of the time, only the former is considered in published studies. The clinical value of EEG recording in psychiatry emergency unit is therefore still not clearly established. The study of patients admitted during two years in the emergency unit at Sainte-Anne hospital (Paris, France) does not bring new conclusions, mainly because of bias in the modalities of admission and follow-up. As well, the role of EEG recording for the diagnosis of non-psychiatric diseases in psychiatry emergency units cannot be defined today. The authors review clinical situations where EEG recording is still highly advisable.
Behavioral Symptoms↗
[The practice of restraint in a psychiatric emergency unit].
The practice of physical restraint is relatively frequent in medical emergency and geriatric units. Its use in psychiatry is controversial. Although distinct, it is often associated with seclusion, as a response to or prevention of agitated mentally ill patients'behavior. A detailed review of the literature shows the scarceness of work defining the exclusive use of restraint without seclusion. We report a naturalistic study over 6 Months, covering 76 cases having required restraint. The study of the international literature concerns nursing care, geriatric, child-adolescent psychiatric and adult psychiatric reviews. The restraint is a usual practice in general care like emergency, intensive care or geriatric units in order to prevent the patients from falling or to administrate certain care. Legal action has been reported as a consequence of lack of information or agreement of the family. The psychiatric use of restraint is conceived as an additional measure to seclusion, which is a controversial procedure from a therapeutic point of view as well as because of its long duration of application. The practice of restraint described in French literature, from Pinel (in to Daumézon and from French hospital regulations to "transparency forms", seems to be more easily accepted for its short duration and its careful prescription in order to maintain relations with the patients, including agitated children. We made a 6 Months retrospective study in a Parisian psychiatric emergency unit receiving an average of 30 patients a day. The rate of restraint is 1.4%. The objective was to describe the main clinical, epidemiological and situational characteristics and to define quality criteria concerning restraint regarding to the existing standards. We had at our disposal a restraint protocol in order to avoid its prescription as a punishment or for the comfort or the convenience of an insufficient staff. The decision of the restraint is directly prescribed by a physician or decided in emergency by the nurses and then rapidly confirmed by medical prescription. In short, most restrained patients are male, the average age is 32 Years old, and the diagnoses associated with restraint in order of frequency are schizophrenia, personality disorders, acute psychotic episodes, manic episodes and toxic abuses. The main early-warning signs are aggressiveness, delusions, opposition, paranoiac thoughts and distrust. The average duration is 2 hours with continuous clinical supervision and a relational contact maintained. Our study confirms the notion of cumulate restraint days. Actually, 43% of the restraints happen on the same day as others do. The high rate on those days could be as Fischer hypothesized the result of instinctive, aggressive and sexual release of the staff, as well as the consequence of an increase in anxiety and agitation of the other patients. The legal framework is more the duty of assistance to a person in danger than constrained hospitalization, which is not systematically pronounced. No injury or somatic complication occurred during restraint. Neither complaint from the patient or his family nor sick leave of staff was recorded. The specific use of restraint can be compared to the existing standards for using the seclusion room. Among those standards only 1 of 23 criteria was not verified. The others was applicable or without object. The therapeutic use of restraint requires the development of specific quality standards, and the existing criteria concerning seclusion represent a necessary but insufficient answer. We emphasize the need to take into account the early warning signs, a response to the cumulative restraint days, as well as a satisfaction study on patients and the feasibility of such a study in an emergency service.
Adult↗
[Therapeutics approach of adult patients with acute and chronic psychotic states: REALITE survey].
A retrospective observational pharmaco-epidemiological survey was conducted during 24 weeks between October 2004 and March 2005 in metropolitan France (384 investigators) to more clearly define the use of loxapine in acute and chronic psychotic states. The objective of this national survey was to specify the clinical and therapeutic profile of patients managed by this antipsychotic in two cohorts of adult patients: one in "acute phase" (prescription of loxapine during the previous 4 weeks), the other in "maintenance phase" (prescription of loxapine for more than 8 weeks). The two groups of the recruited population (1,511 patients) presented identical sociodemographic data. Selection criteria were adapted to the data collected to ensure statistically relevant analysis: 696 patients in acute phase and 633 patients in maintenance phase. The acute phase group was predominantly composed of known patients (82% of patients had a psychotic history) with schizophrenia (47%) or mood disorders (57%) who had already presented acute episodes (an average of 5.4). The current episode consisted of a state of agitation (88%) lasting an average of two weeks, requiring hospitalization (87%), scheduled admission [HDT (admission at the request of another person) in 47.5% of cases and HO (statutory admission) in 40.8% of cases] and prescription of loxapine monotherapy (56%) at a mean daily dose of 177,3 mg. The maintenance phase group comprised a population of known patients (87.5%), schizophrenics (63%), presenting psychotic symptoms (dissociation 82%, delusions 74%) or mood disorders (71%) requiring voluntary hospitalization (78%) for a mean duration of 180 days and a prescription of loxapine monotherapy in 28% of cases at a mean daily dose of 131.6 mg. The loxapine-haloperidol combination (21%) was prescribed more frequently in the second group in the case of chronic disorders; in the other cases, loxapine was coprescribed with the main second generation antipsychotics: risperidone (16%), olanzapine (16%), amisulpride (11%). CGI assessment of the overall study population revealed a marked or very marked clinical improvement with no significant adverse effects in more than 80% of cases.
Acute Disease↗