Dauriac-Le Masson V, Peiffer C, Barruel D, Perquier F, Gourevitch R
Département d'Information Médicale, GHT Paris-psychiatrie et neurosciences, centre hospitalier Sainte Anne , 1 rue Cabanis, 75014 Paris, France.
GHT Paris-psychiatrie et neurosciences, centre hospitalier Sainte Anne, 1 rue Cabanis, 75014 Paris, France.
Encephale. 2019 Nov;45(5):405-412. doi: 10.1016/j.encep.2019.05.005. Epub 2019 Aug 14.
The French mental health law, first enacted on July 5, 2011, introduced the possibility of psychiatric commitment in case of extreme urgency (imminent peril - ASPPI). The decision of involuntary admission can then be made by the hospital director based on a medical certificate, without the need of a third party request. This procedure was intended to be applied on an exceptional basis, but its use is steadily increasing against the other types of involuntary care. Our study aimed at comparing the characteristics of patients who had received an indication for involuntary admission due to imminent peril (ASPPI) or at the request of a third party (ASPDT/u) in a psychiatric emergency ward, according to sociodemographic and clinical characteristics and regarding the potential implication of a third party.
An observational study was conducted among patients from the Centre Psychiatrique d'Orientation et d'Accueil (CPOA), located at Sainte-Anne hospital in Paris, from August 1st to 31st, 2016.
One hundred and fifty patients with an indication for involuntary commitment were included, 101 of whom for ASPDT/u (67 %) and 49 for ASPPI (33 %). For more than half of the patients from the ASPPI group, a third party had been identified with (39 %) or without (17 %) contact information. Compared to ASPDT/u patients, ASPPI individuals were more socially vulnerable, showed more negligence, and had a lower mean functioning score. The indication for ASPPI status was also associated with behavioural quirks, prior psychiatric hospitalization (especially as an ASPPI patient) and with the diagnosis of chronic psychosis instead of mood disorder.
Our exploratory results help to better understand how the ASPPI procedure is used in psychiatric emergency wards six years after enactment of the law. They highlight the differences between ASPPI patients and ASPDT/u and raise ethical issues regarding involuntary psychiatric care.
法国心理健康法于2011年7月5日首次颁布，引入了在极端紧急情况下（迫在眉睫的危险——ASPPI）进行精神科强制收治的可能性。非自愿住院的决定可由医院院长根据医疗证明做出，无需第三方申请。该程序本应在特殊情况下使用，但与其他类型的非自愿治疗相比，其使用却在稳步增加。我们的研究旨在根据社会人口统计学和临床特征以及第三方的潜在影响，比较在精神科急诊病房因迫在眉睫的危险（ASPPI）或应第三方请求（ASPDT/u）而接受非自愿住院指征的患者的特征。
2016年8月1日至31日，对位于巴黎圣安妮医院的精神科定向与接待中心（CPOA）的患者进行了一项观察性研究。
纳入了150名有非自愿住院指征的患者，其中101名因ASPDT/u（67%），49名因ASPPI（33%）。对于ASPPI组超过一半的患者，已确定有（39%）或无（17%）联系信息的第三方。与ASPDT/u患者相比，ASPPI个体在社会上更脆弱，表现出更多疏忽，且平均功能评分更低。ASPPI状态的指征还与行为怪癖、既往精神科住院治疗（尤其是作为ASPPI患者）以及慢性精神病而非心境障碍的诊断有关。
我们的探索性结果有助于更好地理解该法律颁布六年后，ASPPI程序在精神科急诊病房是如何使用的。它们突出了ASPPI患者与ASPDT/u患者之间的差异，并引发了关于非自愿精神科护理的伦理问题。
