La pédopsychiatrie de consultation–liaison intrahospitalière : étude prospective sur 215 interventions

Practice Patterns Revisited in Pediatric Psychosomatic Medicine

BACKGROUND

Given the heightened focus on the implementation of integrated care and population health management strategies, there is a critical need for an analysis of pediatric psychosomatic medicine (PPM) programs.

OBJECTIVE

The goal was to survey current practice patterns in academic PPM programs in North America regarding their service composition, clinical consultation services, changes in service demand, funding, and major challenges so as to inform and support advocacy efforts on behalf of children in their need for responsive and effective PPM services.

RESULTS

With a 52.5% survey response rate from 122 child and adolescent psychiatry programs in North America, the demand for PPM services was reported to have significantly increased over the past decade as seen in the described expansion in clinical consultation services and the reported higher patient acuity, as well as new responsibilities in the care of youth with psychiatric illnesses who require boarding on medical inpatient services. Although an increased willingness by hospital administrators to fund PPM services was apparent, adequate funding remained a core issue. Although the value of research is well recognized, few programs are engaged in systematic PPM investigation.

CONCLUSION

This survey provides evidence that the current field of PPM appears to be in an increasingly stronger position within academic medical centers. It is just as apparent today, as it has been in the past, that there is a need to communicate at local, regional, and national levels that PPM is an essential behavioral health service.

[Clinic of somatoform disorders in abused adolescents]

Child abuse represents a contributing factor to develop various psychopathological disorders, such as somatoform disorders.

OBJECTIVES

Improving the detection of child abuse, based on the analysis of somatoform disorders and the comparison between non-abused and abused patients, in a population of hospitalized teens in a general pediatric ward.

METHODS

A retrospective study at the University Hospital of Nantes, involving every adolescents from 11 to 16 y.o. hospitalized in pediatric ward and cured by the child psychiatrist medical team, whatever the reason, over the year 2012 (n=231).

RESULTS

Thirty-three percent of hospitalized adolescents had history of abuse. Physical abuses were dominant (54% vs. 24% sexual vs. 22% psychological). Our study highlight a statistically significant difference on the frequency of somatoform disorders between abused adolescents and not abused witness population (70% vs. 40%; P=0.0001). Gastrointestinal complaints (25% vs. 14.2%; P=0.0434) and musculoskeletal pains (13.2% vs. 4.5%; P=0.0291) appeared more significantly in abused adolescents population rather than non-abused adolescents. Somatoform disorders were not related to the frequency or type of abuse, except for gastrointestinal complaints, being more frequent in patients who were psychologically abused (51.7% vs. 26.7% sexual vs. 11.8% physical; P=0.005).

CONCLUSION

Somatoform disorders are an interesting way to spot adolescents suffering from abuse, justifying a systematic investigation for child abuse. It remains, however, a warning not directing to any specific type of abuse.

[Experience of liaison psychiatry in Morocco: transversal study over 24 months]

INTRODUCTION

Liaison psychiatry is a discipline caring for psychiatric disorders in patients of general hospitals. It involves clinical, educational, and research aspects. The liaison psychiatry supports patients hospitalized for full-time in medical and surgical departments, patients admitted in day-hospital and patients treated in the emergency department. In this transversal study, we assessed the liaison psychiatry impact that is still in development stage in Morocco. This study lasted 24 months, and was conducted at the University Hospital in Fez, Morocco.

OBJECTIVES

The goal of this work was to evaluate the prevalence of psychiatric disorders managed by liaison psychiatry, identify those requiring medical and surgical departments of such psychiatric support, and classify the motivations involved in their needs.

METHODS

This transversal study was initiated in January 2010 and has lasted 24 months. The study recruited 180 patients requiring psychiatric consultation from different medical and surgical departments at the University Hospital in Fes, Morocco. The psychiatric assessment was based on a psychiatric interview using the MINI. The data were collected by a certified psychiatrist using a questionnaire containing 24 items. After initial psychiatric assessment, the follow-up was proposed to the patient in the psychiatric department.

RESULTS

During this study, 22 medical and surgical departments of our University Hospital had requested a psychiatric assessment for their patients. Most demands were respectively emitted by the Department of Dermatology (16%) and Nephrology (11%). The most common motivations for psychiatric consultations were respectively psychomotor agitation (17%) and an evaluation of suicide attempts (17%). Depressive and psychotic disorders were the most diagnosed disorders with 47% and 11% respectively. The psychiatric support was based on pharmacological treatment in 60% of cases. Finally, the outcome was favourable in 80% of followed cases.

CONCLUSION

Hospitalized patients in different medical and surgical departments of the University Hospital of Fez have demonstrated a high prevalence of psychiatric disorders. This constitutes a very strong motivation to setup a department of liaison psychiatry. This would allow a better psychiatric support and follow-up of patients.