Voyages pathologiques : actualités du concept et caractérisation d’une cohorte dans un service d’urgences psychiatriques

Abstract

ObjectivesPathological Journey or Pathological Trip is a concept often used but defined imprecisely in the recent scientific literature and usual classifications. After a brief history of this concept, appeared in France in the 19th century [5], we suggest a definition to differentiate pathological journey from other clinic entities, such as fugue or wandering. The pathological journey would be a departure to a specific destination, induced by delusional ideas or by a state of disorganization. MethodsWe led a retrospective study from patients in the biggest French psychiatric emergencies unit, in Paris, admitted for a pathological journey in 2019. Socio-demographics data (gender, age, professional activity, financial resources, place of life, marital status, family and friendly entourage), medical history, clinical features (such as delusional or suicidal ideas, hallucinations, diagnostic hypothesis), trip characteristics (such as place of departure, final wanted destination, duration of the trip) and orientation at the end of the consultation (hospitalization or not) have been notified. A comparative study between patients according to the reason of departure (to run away from something or to look for something) has been led too. ResultsA total of 217 patients are included. Men are majority, with an average age of 40 years, with psychiatric history (89%) and diagnosis of delusional disorder (F20-29 according to the ICD-10, 87%) or mood disorder (10%). They are still followed by a psychiatrist and still take their medication for the most part. They often haven’t hotel or other place to live at the destination or during the trip (62%) and the trip has often begin recently, less than 10 days for 75%. 95% of patients require an hospitalization, without the patient consent in the most part, and only 5% needed a physical restraint in the unit. The comparative study between patients by the reason of departure finds no significant result. DiscussionWe don’t find here specific characteristics by the motivation of departure, but these patients are often homeless and without ressources during the pathological trip. A particular care of these vulnerable and at-risk patients should be accentuated by the care teams and physicians. Complementary studies are necessary to identify specific characteristics and to improve the patient care management, and maybe to avoid departures of these vulnerable patients in the future. ConclusionsPathological trip is a still-used concept, described for more a century, and is frequently observed in general and psychiatric emergencies units. Its definition is not precise and is not mentioned by the actual references (ICD-10, DSM-5), and it could make the identification of this behavior more difficult. These units are often the first to meet and identify this behavior and to guide to offer adequate care to these vulnerable patients.