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Master Thesis

Décompensation du patient psychotique nécessitant une intervention du Smur : profil du patient et place du médecin généraliste dans le parcours de soins

Abstract : Introduction
Psychoses, of which schizophrenia is the most common, are a public health problem. The decompensation of schizophrenic psychotic patients is the second reason for interventions of the SMUR (Mobile Emergency and Resuscitation Structure) of Guadeloupe. Our objective was to describe the profile of psychotic patients attending the Community Mental Health Centers (CMP) with an acute psychotic episode (EPA).
Methods
A retrospective case-control study was carried out in the SMUR department of the University Hospital Center of Pointe-à-Pitre (PAP) and in the CMP of PAP / Abymes. It covered schizophrenic patients who presented with decompensation SMUR from January to December 2015. It was supplemented by a descriptive observational study on the relationships of 40 general practitioners with the CMP and their overall management of the psychotic patient.
Results
35 patients with EPA and 77 controls were included. They were middle-aged (44 years), men (65.7%), surrounded by their ascendants, unemployed, with low incomes (p = 0.049), had few addictions, and little psychosocial (p = 0.001) and medical (p = 0.0003) supervision. The EPA occurs approximately 1 year after a period of non-compliance and is preceded by a hospitalization of less than 12 months. Only one-third of general practitioners were satisfied with relations with the CMP and 63 % said they had no contact with the CMP of their commune. Faced with a non-agitated psychotic patient, 52.5 % referred him to a city psychiatrist.
Conclusion
The medico-psycho-social structures in our region seem insufficient to prevent decompensation. Early diagnosis, regular evaluation of the psychotic patient, the SAMU-CMP protocol collaboration and the creation of a network of coordinated care between patients, general practitioners and CMP are possible ways of improving long-term care and prevention of EPA.
Document type :
Master Thesis
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Submitted on : Friday, October 27, 2017 - 5:13:38 PM
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Jamila Carpin. Décompensation du patient psychotique nécessitant une intervention du Smur : profil du patient et place du médecin généraliste dans le parcours de soins. Médecine humaine et pathologie. 2017. ⟨dumas-01625537⟩

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