[Decision of emergency involuntary hospitalization: categorical or dimensional approach?].
BACKGROUND
In 2005, in its recommendations on the modalities of decision making for compulsory hospitalization, the French Health High Authority (HAS) had already stressed the need for rapid implementation of studies and epidemiological analyses on the subject to compensate the lack of adequate data in France. The new French law of July 5, 2011, on the rights and protection of persons under psychiatric care, establishes a judicial review of decisions for compulsory hospitalization. Therefore, healthcare professionals need to better define and characterize the criteria for such decisions, especially in their relation to psychopathology. The concept of capacity to consent to treatment includes the ability to understand (to receive information about the disease), the ability to appreciate (to weigh the risks and benefits of treatment), the ability to reason (determining the best choice rationally) and the ability to freely express a decision. However, assessment tools of capacity to consent to treatment seem to fail to predict the modality of hospitalization.


OBJECTIVE
This study examined the impact of clinical and contextual characteristics on the decision in emergency services to admit patients to compulsory inpatient psychiatric units.


METHODS
Data was collected from 442 successive patients admitted to hospital for care from five psychiatric emergency facilities in Paris and covered sociodemographic information, previous hospitalizations, recent course of care, clinical diagnosis, Global Assessment of Functioning scale (GAF) and Insight measured by the Q8 Bourgeois questionnaire. Patients were also assessed based on criteria established by the HAS for the severity of mental disorders and the necessity of emergency care.


RESULTS
Multivariable logistic regression shows that diagnosis does not affect the decision of hospitalization. Agitation, aggressiveness toward others, being married as well as being referred by a doctor or family are all factors that increase the risk of involuntary hospitalization. Last, low Q8 and GAF scores are strong predictors for compulsory admission.


CONCLUSIONS
Our study shows a dimensional rather than categorical assessment of patients by clinicians. Assessment of insight is the main operational criterion used by clinicians in our study. This supports using insight and GAF evaluation in clinical practice to clarify assessment and decision-making in an emergency setting regarding compulsory hospitalization.
Centre psychiatrique d'orientation et d'accueil (CPOA), centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France.
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Braitman
Département d'information médicale (DIM), centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France.
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Dauriac-Le Masson
Secteur 75G13, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France; Service d'accueil des urgences, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France.
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Beghelli
Centre psychiatrique d'orientation et d'accueil (CPOA), centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France.
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Gallois
Service de psychologie clinique et psychiatrie de liaison, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75908 Paris cedex 15, France.
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Guillibert
Secteur 75G18, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France; Service d'accueil des urgences, hôpital Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
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Hoang
Service de psychiatrie, groupe hospitalier Broca-Cochin-Hôtel-Dieu, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 1, France.
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Kahvedjian
Centre psychiatrique d'orientation et d'accueil (CPOA), centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France.
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Lana
Centre psychiatrique d'orientation et d'accueil (CPOA), centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France. Electronic address: mj.guedj@ch-sainte-anne.fr.
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MJ
Guedj
D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence*; D003617:Dangerous Behavior; D003661:Decision Support Techniques; D004637:Emergency Services, Psychiatric / Q000331:legislation & jurisprudence*; D005602:France; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence; D016743:Mental Competency / Q000331:legislation & jurisprudence; D010344:Patient Advocacy / Q000331:legislation & jurisprudence; D012017:Referral and Consultation / Q000331:legislation & jurisprudence
Commitment of mentally ill; Decision making; Emergencies; Hospitalisation sans consentement; Insight; Loi du 5 juillet 2011; Mental competency; Processus décisionnel; Urgences psychiatriques