Hôpital Delafontaine, Secteur de Psychiatrie Infanto-Juvénile, Saint-Denis, France.
Psychiatrie de l'enfant et de l'adolescent-Site Orsay, GH Nord-Essonne, Bures sur Yvette, France.
PLoS One. 2021 Jun 10;16(6):e0252610. doi: 10.1371/journal.pone.0252610. eCollection 2021.
Many medical disorders may contribute to adolescent psychoses. Although guidelines for thorough organicity investigations (OI) exist, their dissemination appears scarce in nonacademic healthcare facilities and some rare disorders remain undiagnosed, many of them presenting without easily recognized phenotypes. This study aims to understand the challenges underlying the implementation of OI in non-academic facilities by practitioners trained in expert centers.
Sixteen psychiatrists working at French non-academic facilities were interviewed about their use of OI for adolescents suspected of early psychosis. Interviews were analyzed with Grounded Theory.
Organicity investigations were found to be useful in rationalizing psychiatric care for the young patient all the while building trust between the doctor and the patient's parents. They also are reassuring for psychiatrists confronted with uncertainty about psychosis onset and the consequences of a psychiatric label. However, they commonly find themselves facing the challenges of implementation alone and thus enter a renunciation pathway: from idealistic missionaries, they become torn between their professional ethics and the non-academic work culture. Ultimately, they abandon the use of OI or delegate it to expert centers.
Specific hindrances to OI implementation must be addressed.
许多医学疾病都可能导致青少年精神疾病。虽然有全面的器质性疾病调查（OI）指南，但在非学术医疗保健机构中，它们的传播似乎很少，一些罕见的疾病仍然未被诊断，其中许多疾病没有明显的表型。本研究旨在了解在专家中心培训的从业者在非学术机构中实施 OI 时所面临的挑战。
对 16 名在法国非学术机构工作的精神科医生进行了访谈，了解他们对疑似早期精神病的青少年进行 OI 的使用情况。使用扎根理论对访谈进行了分析。
OI 调查被发现对合理治疗年轻患者的精神疾病很有用，同时在医生和患者家长之间建立信任。对于那些对精神病发作的不确定性以及精神病标签的后果感到不确定的精神病医生来说，它们也很有帮助。然而，他们通常发现自己独自面对实施的挑战，因此进入了一种放弃的途径：从理想主义的传教士，他们在职业道德和非学术工作文化之间左右为难。最终，他们放弃使用 OI 或将其委托给专家中心。
必须解决 OI 实施的具体障碍。
