Profil de consultants dans un service de pédopsychiatrie d’un hôpital général

Abstract

ObjectivesWe propose to explore the sociodemographic, clinical and therapeutic characteristics of patients who presented to a child and adolescent psychiatric outpatient department. MethodsIt is a retrospective descriptive study focused on patients who consulted at the first time the child and adolescent psychiatric outpatient department of the Mongi Slim Hospital between January and November 2018. We have collected the sociodemographic data of the child and his parents. We specified who accompanied the child the consultation in a child psychiatry consultation, the reason for consultation and the origin of the request for the child psychiatry consultation. The psychiatric diagnoses were retained according to the criteria of the DSM-5. For patients requiring follow-up, the indicated management methods have been specified. After collection, the statistical processing of the data was carried out using SPSS 20.0 software. ResultsWe collected 1013 cases. The children average age was 8 years and 5 months with extremes ranging from 7 months to 19 years. The sex-ratio was estimated at 1.54. In the case of an age of over 11 years, the female sex was predominant with a sex-ratio equal to 0.86; (P < 10−3). The consultants lived in the north of Tunisia in 98.7% of cases, within 94.9% of cases in the north-eastern governorates. The children were the eldest of their siblings in 35% of cases. Children attended primary school in 49.3%. We find that 879 patients were accompanied by one or both parents while five adolescents (four girls and one boy) consulted alone in the service. Among the 1013 patients included in our study, 65.84% (667 patients) were referred to our consultation by doctors. The reasons for consultations were academic difficulties in 23.4%, behavioral problems in 15.1% and language disorders in 11.3% of cases. We did not retain a diagnosis according to DSM-5 criteria for 76 consultants (7.5%), a psychiatric diagnosis was made for 768 patients (75.8%) and a psychiatric diagnosis was suspected, but deferred for 169 consultants (16.7%). Twenty-five of them had an associated organic comorbidity. The psychiatric diagnoses were intellectual disability in 15.69%, depressive disorders in 12.63%, adjustment disorders in 9.47% and autism spectrum disorder in 9.2%. Following the first consultation, we indicated a psychiatric follow-up for 919 consultants (90.7%), among which 635 patients (69.1%) consulted again. Among the 919 patients requiring follow-up, hospitalization in psychiatric hospital was indicated in 11 patients (1.2%). We indicated psychotherapy for 326 patients (35.5%). The psychotherapies indicated were of the type: Listening and support in 280 patients (85.9%), Eye Movement Desensitization And Reprocessing in 23 patients (7.1%), Cognitive and Behavioral Therapy in 21 patients (6.4%) and Narrative Exposure Therapy for Kids in 2 patients (0.6%). One or both parents were referred to an adult psychiatric consultation in 61 cases (6%). An intervention by the child protection representative was requested in 7.6% of cases (70 patients) while an intervention with the school structures attended was necessary for 17.2% of the consultants (158 patients). Medication was necessary in 14.25% of cases. The prescribed therapeutic classes were anxiolytics (23.7%), neuroleptics (16%), psychostimulants (16%) and antidepressants (13%). The most prescribed drugs were Hydroxyzine in 23.7%, Methylphenidate (14.5%), Risperidone (11.4%) and Sertraline (11.4%). ConclusionKnowing the profile of the child psychiatry outpatient will allow us to adapt the training of future doctors and child psychiatrists according to needs and to the specificities of the population.