Factors Affecting the Agreement Between Emergency Psychiatrists and General Practitioners Regarding Involuntary Psychiatric Hospitalizations.
Important discrepancies exist between physicians in deciding when to perform involuntary hospitalization measures (IHMs). The factors underlying these differences are poorly known.We conducted a two-year single-center retrospective study in France on patients who were referred to the emergency department (ED) with an IHM certificate written by a private-practice General Practitioner (GP). For each consultation, the official IHM motive was categorized into four groups: Suicide; Psychosis, Mania, or Melancholia (PMM); Agitation; and Other. The alcohol status of the patient was also noted. The factors underlying the ED psychiatrists' confirmation of the use of IHMs were determined using a logistic regression model. One hundred eighty-nine cases were found (165 patients; 44.2 ± 16 years, 41.3% women). The ED psychiatrists confirmed the use of IHMs in 123 instances (65.1% agreement rate). Multivariate analyses found that IHM disagreement was significantly associated with patient alcohol status and the reason for referral. Specifically, there was an increased risk of IHM disagreement when the patient had an alcohol-positive status (OR = 15.80; 95% CI [6.45-38.67]; p < 0.0001) and when the motive for IHM was "agitation" compared with "suicide" (OR = 11.44; 95% CI[3.38-38.78]; p < 0.0001). These findings reflect significant disparities between GPs and ED psychiatrists regarding the decision to proceed to an IHM.
Inserm, U1144, Paris, F-75006, France; Université Paris Descartes, UMR-S 1144, Paris, F-75006, France.|Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144 Paris F-75013, France.|AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Département de Psychiatrie et de Médecine Addictologique, 75475 Paris Cedex 10, France.
Pierre Alexis
PA
Geoffroy
Département de Biostatistiques, CHU Lille, Lille, France.
Alain
A
Duhamel
Département de Biostatistiques, CHU Lille, Lille, France.
Hélène
H
Behal
Service de Psychiatrie de l'adulte, CHU Lille, Lille, France.
Nadia
N
Zouitina-Lietaert
Pôle de l'Urgence, CHU Lille, Lille, France.
Julie
J
Duthilleul
Service d'Addictologie, CHU Lille, Lille, France.
Louise
L
Marquette
Pôle de l'Urgence, CHU Lille, Lille, France.
François
F
Ducrocq
Service de Psychiatrie de l'adulte, CHU Lille, Lille, France.|SCALab, UMR CNRS 9193, Univ Lille, Lille, France.
Guillaume
G
Vaiva
Service d'Addictologie, CHU Lille, Lille, France.|INSERM U1171, Univ Lille, Lille, France.
Benjamin
B
Rolland
D000328:Adult; D000428:Alcohol Drinking; D001714:Bipolar Disorder / Q000453:epidemiology* / Q000523:psychology; D000066491:Clinical Decision-Making; D032921:Consensus; D003866:Depressive Disorder / Q000453:epidemiology* / Q000523:psychology; D004636:Emergency Service, Hospital; D005260:Female; D005602:France / Q000453:epidemiology; D058005:General Practitioners; D006801:Humans; D000074441:Involuntary Treatment / Q000706:statistics & numerical data*; D000076083:Involuntary Treatment, Psychiatric / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011570:Psychiatry; D011595:Psychomotor Agitation; D011618:Psychotic Disorders / Q000453:epidemiology* / Q000523:psychology; D012189:Retrospective Studies; D013405:Suicide