Chrétien P, Caillet P, Bouazzaoui F, Kaladjian A, Younes N, Sanchez S
Hôpitaux Champagne Sud, centre hospitalier Troyes, 101, avenue Anatole-France, CS 10718, 10003 Troyes cedex, France.
CHU de Nantes, 29, chemin de la Basse Gaudinière, 44300 Nantes, France.
Encephale. 2019 Feb;45(1):46-52. doi: 10.1016/j.encep.2017.12.011. Epub 2018 Mar 2.
Depressive disorders affect nearly 350 million people worldwide and are the world's leading cause of incapacity. Patients who are depressed preferentially approach their general practitioner (GP), who is their first point of contact, in 50-60% of cases. The aim of our study is to assess whether the orientation of patients suffering from anxiety-depressive disorder towards a GP in a general emergency is a factor associated with hospitalization when compared to patients who present themselves spontaneously for the same disorders. Our secondary objective was to identify the different profiles of patients who were hospitalized for these disorders as an emergency.
We conducted a cross-sectional study for the year 2015, targeting patients who presented as general emergencies at the centre hospitalier de Troyes and who had received a psychiatric diagnosis in the context of an anxiety or depressive disorder.
Five hundred and twenty four patients were included. A univariate analysis showed that referral by the attending physician was associated with hospitalization in 57.9% vs. 42.1% cases (P=0.007), at an odds ratio at 1.98 [1.22-3.21] by multivariate analysis. Analysis by ascending hierarchical classification made it possible to identify 3 profiles for hospitalized patients: 1) patients with a known psychiatric history, a history of past or current follow-ups directed by a psychiatrist, with at least one psychotropic treatment, the presence of psychotic symptoms and a low suicidal risk compared to the rest of the study population; 2) patients without a psychiatric history, or a history of past or ongoing psychiatric follow-up and the absence of ongoing psychotropic treatment. These patients were referred by a GP (67% vs 23%, P<0.001) and their suicidal risk was higher (59% vs 26%, P<0.001); 3) patients about whom the psychiatrist had little information at the time of the emergency consultation.
The relevance of GPs in orientation towards emergencies pleads in favor of a partnership and an early exchange between treating physicians and the psychiatrists.
抑郁症影响着全球近3.5亿人，是导致失能的首要原因。在50%-60%的病例中，抑郁患者会优先找他们的全科医生（GP），全科医生是他们的首要接触对象。我们研究的目的是评估与因同样病症自发就诊的患者相比，患有焦虑抑郁症的患者在一般急诊中找全科医生就诊这一情况是否是与住院相关的一个因素。我们的次要目标是确定因这些病症作为急诊而住院的患者的不同特征。
我们针对2015年进行了一项横断面研究，目标是在特鲁瓦中心医院以一般急诊就诊且在焦虑或抑郁障碍背景下接受过精神科诊断的患者。
共纳入524名患者。单因素分析显示，主治医师转诊的患者住院率为57.9%，而自发就诊患者的住院率为42.1%（P=0.007），多因素分析的优势比为1.98[1.22-3.21]。通过升序分层分类分析，得以确定住院患者的3种特征：1）有已知精神病史、有过去或当前由精神科医生指导的随访史、至少接受过一种精神药物治疗、有精神病性症状且与研究人群其他患者相比自杀风险较低的患者；2）无精神病史、无过去或当前精神科随访史且无正在进行的精神药物治疗的患者。这些患者由全科医生转诊（67%对23%，P<0.001），且自杀风险较高（59%对26%，P<0.001）；3）在急诊会诊时精神科医生了解信息较少的患者。
全科医生在指导急诊方面的相关性支持治疗医生与精神科医生之间建立合作关系并尽早交流。
