Psychiatric disorders among patients admitted to a French medical emergency service

Abstract 

Objective

The authors assessed the prevalence of psychiatric disorders among a population of patients examined in the emergency service of a French general hospital. They compared patients with and without psychiatric disorders. They also compared patients where the primary motive of emergency was psychiatric to those whose psychiatric disorders were secondarily diagnosed by a systematic assessment.

Method

Five hundred consecutive patients admitted to the emergency service of Bichat Claude Bernard Hospital (Paris, France) were interviewed with standardized questionnaires. Demographic details were collected along with information on current and past contacts with emergencies and psychiatric services. Psychiatric disorders were identified using a structured psychiatric interview, the Mini International Neuropsychiatric Interview (MINI). Domestic violence was identified with a specific checklist validated for this purpose.

Results

Prevalence of psychiatric disorders was 38% (189 patients). Forty (8%) patients were primary psychiatric cases referred to the emergency department for psychiatric reasons, while 149 (30%) were secondary psychiatric cases, as revealed by a systematic assessment of their mental state. Psychiatric patients, primary or secondary, were more often homeless (13.6% vs. 1.95%). They had been more often referred to the emergency department after an aggressive (7.4% vs. 3.5%) or violent behavior (5.8% vs. 0.9%) and less often after an accident (8.4% vs. 14.3%). Psychiatric patients were more often examined after an episode of domestic violence (21.7% vs. 6.8%). Psychiatric diagnoses, according to the DSM-IV criteria, were depression (80 cases), generalized anxiety disorder (34 cases) acute alcohol intoxication (21 cases), alcohol dependence (20 cases), schizophrenia (16 cases), posttraumatic stress disorder (14 cases), drug abuse (4 cases), agoraphobia (4 cases), alcohol abuse (3 cases), anorexia nervosa (3 cases), mania (2 cases) and obsessive compulsive disorder (2 cases). The proportion of psychiatric diagnoses was equivalent in primary and secondary psychiatric cases except for schizophrenia (more often a primary demand for psychiatric help) and acute alcohol intoxication (more often revealed by a systematic assessment of the mental state).

Conclusion

Thirty-eight percent of the patients examined in a French emergency service presented with psychiatric disorders. The majority of the patients (78%) were not referred to the emergency service for psychiatric reasons. Patients seen in an emergency service should thus be identified as a population at risk for psychiatric disorders whatever their reason for utilizing this service.

Keywords: Emergency service, Depression, Alcohol dependence, Suicide attempt