16 results on '"Gourevitch R"'
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2. Mineurs non accompagnés accueillis au centre psychiatrique d’orientation et d’accueil de l’hôpital Sainte-Anne, Paris
- Author
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Chami, L., Pham-Scottez, A., Silva, J., Trebalag, A.-K., and Gourevitch, R.
- Published
- 2022
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3. Chapitre 29 - Urgences psychiatriques et addictions
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Gourevitch, R. and David, M.
- Published
- 2023
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4. Hikikomori : éclairage sur ces patients repliés dans l’ombre
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Trebalag, A.-K., Pham-Scottez, A., Guedj, M.-J., and Gourevitch, R.
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- 2019
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5. Un cas de leucoencéphalopathie multifocale progressive à VIH avec symptômes psychiatriques
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Boukakiou, R., Lin, D.P., Bernard, A., and Gourevitch, R.
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- 2015
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6. [About a first brief psychotic episode at 57 in a context of COVID-19 infection].
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Önder M, Dufeutrelle A, Benali F, Gourevitch R, and Pham-Scottez A
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- Humans, COVID-19, Psychotic Disorders diagnosis
- Published
- 2023
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7. [Failure to draw up medical certificates increase judiciary releases].
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Gousset R, Alamowitch N, Mache C, and Gourevitch R
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- Humans, France, Paris, Antisocial Personality Disorder, Commitment of Mentally Ill, Hospitalization
- Abstract
Objectives: In France, a systematic control of compulsory psychiatric admissions has existed since the enactment of the law of July 5th 2011. The Court of Cassation clarified that the liberty and custody judges (JLD) cannot supersede the medical opinion described in the medical certificates. In 2015, the JLD ordered the release of 8.4 % of all compulsory psychiatric admissions. The goal was to compare the quality of medical certificates derived from judicial release based on medical grounds with non-released witnesses from the cohort of compulsory psychiatric admissions ordered in the Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences (GHU-Paris) between November 1, 2017 and October 31, 2018., Methods: We included as cases all the medical certificates derived from judicial release based exclusively on medical grounds from the release cohort of the GHU-Paris from November 1, 2017 to October 31, 2018, concerning the systematic control 12 days after compulsory psychiatric admissions. A witness whose compulsory care had been maintained was matched according to the same judge, place and date of hearing, mode of compulsory care and site of hospitalization. Each certificate was analyzed according to a reading grid relating to the good decisions in matters of compulsory admission and medical certificates' redaction. An overall score, based on the description of the clinical and symptomatic evolution, the level of discernment, the capacity of consent and the mode of compulsory care was awarded to each certificate., Results: Seventeen release files were included in the comparative study. Globally, the clinical progression, psychiatric symptoms, level of consciousness and ability to consent did not differ in the two groups. The grade of quality of certificate was lower in case of withdrawal (2.92±1.08 VS 3.28±0.88, P=0.026). Psychiatric symptoms in "justifiable notice" (the last medical certificate prior to the judicial hearing) were less specified in case of withdrawal (58.8 % VS 94.1 %, P=0.015). Not describing any symptoms led to a 12.51 risk of withdrawal (95 % CI=[1.16; 135.19], P=0.038). Even with witness certificate, clinical progression was noticed in only 85.3 % of cases, in 89.3 % of psychiatric symptoms, in 68.0 % of level of consciousness and 80.0 % for the ability to consent., Conclusions: Judiciary releases of compulsory psychiatric admissions exclusively based on medical grounds are not arbitrarily decided by the JLD but are based on a failure to draw up medical certificates. Doctors must comply with a careful drafting of all medical certificates: description of symptoms, clinical course, level of consciousness and ability to consent. It is necessary to be attentive to judiciary releases based on medical grounds to evaluate and improve medical practices concerning the drafting of medical certificates., (Copyright © 2022 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2023
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8. Formation des infirmiers à l’évaluation du risque suicidaire : revue de la littérature et perspectives pour la pratique avancée infirmière.
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Perot R, Bergot C, Silliau D, Gourevitch R, and Pham-Scottez A
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- Clinical Competence, France, Humans, Suicide psychology, Suicide Prevention
- Abstract
Context : Nurses are regularly confronted with suicidal people. Their involvement is essential in the detection and prevention of suicide risk.Objectives : Through a literature review, we wanted to highlight the role of the advanced practice nurse by conducting specific training to improve nursing skills in the management of people with suicidal thoughts.Method : Our literature review was carried out according to the PRISMA recommendation criteria from several databases.Results : The review showed an improvement in confidence, attitudes, and nursing skills in assessing suicide risk. However, no long-term change in practice was demonstrated.Discussion : In France, a national training program on suicide risk prevention is implemented at the regional level by the Regional Health Agencies. At the same time, since 2019, Psychiatry and Mental Health has been part of the training program for advanced practice nurses.Conclusion : The advanced practice nurse is a central player in supporting teams in increasing their skills, particularly when conducting specific training.
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- 2022
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9. [Psychiatric emergencies and sense of urgency occurring upstream from health services: What should be done?]
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Gourevitch R, Boiteux C, and Guedj-Bourdiau MJ
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- Emergencies, Health Personnel, Humans, Emergency Medical Services, Emergency Services, Psychiatric
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The French psychiatric health system is not properly organized for managing the sense of urgency felt in critical situations that occur upstream from psychiatric health services, in "inappropriate" locations (e.g. home, street, work.), particularly for patients who are unwilling to cooperate and receive health care. Emergency services, police departments, or psychiatric teams - who should take charge? Families are distraught. The authors draw the line to propose a comprehensive and coherent model. Pressing emergencies require the intervention of emergency services, who may, when necessary, receive remote counsel from psychiatric health professionals. Other situations require a quick but delayed access to specialized care, including at-home care. With this comprehensive model, the authors address both a pre-hospital emergency occurring out of a dedicated sanitary place, as well as access to care for patients who are unwilling or partly unwilling to receive health care., (Copyright © 2020 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2021
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10. [A sharp drop in psychiatric emergency admissions during lockdown].
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Flevaud L, Pham A, and Gourevitch R
- Abstract
Since France was put into lockdown on 17 March 2020 in an unprecedented step to attempt to limit the spread of coronavirus, there has been a sharp fall in the number of psychiatric emergency admissions despite the COVID-19 pandemic which has increased stress levels. The first part of this study shows the reorganisation and adaptation of mental health services to meet the needs in the psychiatric department. The second part is a brief analysis of patient flows to CPOA and the presentation of different hypotheses explaining these disruptions during lockdown. Finally, this study discusses the facts of three clinical cases during this period., (© 2020 Published by Elsevier Masson SAS.)
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- 2021
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11. [Descriptive study of the releases pronounced by the liberty and detention judge at groupe hospitalier universitaire Paris psychiatrie & neurosciences from November 2017 to October 2018].
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Gousset R, Alamowitch N, Mache C, and Gourevitch R
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- Commitment of Mentally Ill, Freedom, Humans, Paris, Mental Disorders epidemiology, Mental Disorders therapy, Neurosciences
- Abstract
Objective: In France, a systematic control of compulsory psychiatric admissions has existed since the enactment of the law of 5 July 2011. In 2015, the judge of freedoms and detention ordered the withdrawal of 8.4 % of the compulsory psychiatric admissions. The aim of the study is to describe the grounds for judiciary withdrawals of compulsory admissions ordered in the groupe hospitalier universitaire paris psychiatrie & neurosciences (GHU-Paris) between November 1, 2017 and October 31, 2018., Methods: All of the withdrawal decisions adjudged during the mentioned period in the GHU-Paris were analysed following a specific framework. The main analysis deals with the classification of the "administrative", "medical", and "mixed" grounds. The secondary analysis looks at the fundamental facts affecting the judge of freedoms and detention's decision., Results: Of the 127 orders decided by 21 judges of freedoms and detention analysed in this study, the majority were part of the systematic control of compulsory psychiatric admissions (74.8 %) and were made through a referral procedure by the director's hospital (69.3 %). The main reasons for withdrawal decisions were "mixed" (52.9 %), among which were described: failure to respect time limit (20.2 %), failure to inform the patient (11.6 %), third party's proceeding (8.7 %) and lack of documents (8.7 %). "Medical" grounds account for 31.8 % of all grounds. More precisely, failure to respect the required elements for involuntary admissions in psychiatric services was the greatest subcategory (29.5 %). "Other" grounds represented 15.8 %. No "administrative" ground was found. Judges ordered 69.3 % withdrawals within 24 hours to allow community treatment orders to be put into place. In the centre hospitalier Sainte-Anne, 70.8 % of the 24 appeals quashed the first decision by the judge of freedoms and detention., Conclusion: Several reasons justify withdrawals of compulsory psychiatric admissions. Scrupulously respecting procedures and drafting psychiatric certificates might decrease the number of withdrawals., (Copyright © 2020 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2020
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12. [Characteristics of patients who received an indication of involuntary admission, with or without the involvement of a third party, in a Parisian psychiatric emergency unit].
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Dauriac-Le Masson V, Peiffer C, Barruel D, Perquier F, and Gourevitch R
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- Adult, Commitment of Mentally Ill statistics & numerical data, Dangerous Behavior, Emergency Services, Psychiatric statistics & numerical data, Female, Humans, Male, Mental Competency legislation & jurisprudence, Mental Competency psychology, Mental Disorders diagnosis, Mental Disorders epidemiology, Mental Disorders psychology, Middle Aged, Mood Disorders diagnosis, Mood Disorders epidemiology, Mood Disorders psychology, Mood Disorders therapy, Paris, Patient Readmission legislation & jurisprudence, Patient Readmission statistics & numerical data, Psychotic Disorders diagnosis, Psychotic Disorders epidemiology, Psychotic Disorders psychology, Psychotic Disorders therapy, Referral and Consultation legislation & jurisprudence, Referral and Consultation statistics & numerical data, Young Adult, Commitment of Mentally Ill legislation & jurisprudence, Emergency Services, Psychiatric legislation & jurisprudence, Involuntary Commitment legislation & jurisprudence, Mental Disorders therapy
- Abstract
Background: The French mental health law, first enacted on July 5, 2011, introduced the possibility of psychiatric commitment in case of extreme urgency (imminent peril - ASPPI). The decision of involuntary admission can then be made by the hospital director based on a medical certificate, without the need of a third party request. This procedure was intended to be applied on an exceptional basis, but its use is steadily increasing against the other types of involuntary care. Our study aimed at comparing the characteristics of patients who had received an indication for involuntary admission due to imminent peril (ASPPI) or at the request of a third party (ASPDT/u) in a psychiatric emergency ward, according to sociodemographic and clinical characteristics and regarding the potential implication of a third party., Methods: An observational study was conducted among patients from the Centre Psychiatrique d'Orientation et d'Accueil (CPOA), located at Sainte-Anne hospital in Paris, from August 1st to 31st, 2016., Results: One hundred and fifty patients with an indication for involuntary commitment were included, 101 of whom for ASPDT/u (67 %) and 49 for ASPPI (33 %). For more than half of the patients from the ASPPI group, a third party had been identified with (39 %) or without (17 %) contact information. Compared to ASPDT/u patients, ASPPI individuals were more socially vulnerable, showed more negligence, and had a lower mean functioning score. The indication for ASPPI status was also associated with behavioural quirks, prior psychiatric hospitalization (especially as an ASPPI patient) and with the diagnosis of chronic psychosis instead of mood disorder., Conclusion: Our exploratory results help to better understand how the ASPPI procedure is used in psychiatric emergency wards six years after enactment of the law. They highlight the differences between ASPPI patients and ASPDT/u and raise ethical issues regarding involuntary psychiatric care., (Copyright © 2019 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2019
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13. [Care of unaccompanied minors in a psychiatric emergency unit].
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Trebalag AK, Breuer-Wirbel E, K'ourio H, Pham-Scottez A, Silliau D, and Gourevitch R
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- Adolescent, Child, Humans, Child, Abandoned psychology, Emergency Service, Hospital, Mental Disorders therapy, Minors psychology, Psychiatric Department, Hospital, Refugees psychology
- Abstract
Emergency psychiatric units are receiving more and more foreign unaccompanied minors: for many of these young people it is their first contact with psychiatric services. This context of crisis crystallises the administrative and legal paradoxes at work in the support of these youngsters. Coordination between emergency care, statutory bodies and community-based care enables stability to be established while the care project is being set up., (Copyright © 2019. Published by Elsevier Masson SAS.)
- Published
- 2019
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14. [Long and short stays under ASPPI: Comparison of clinical and non-clinical data from 250 initial certificates].
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Michel A, Alamowitch N, and Gourevitch R
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- Adult, Commitment of Mentally Ill legislation & jurisprudence, Female, Humans, Male, Mental Disorders classification, Mental Disorders therapy, Paris epidemiology, Psychiatric Department, Hospital statistics & numerical data, Retrospective Studies, Commitment of Mentally Ill statistics & numerical data, Electronic Health Records statistics & numerical data, Length of Stay statistics & numerical data, Mental Disorders epidemiology, Patient Admission statistics & numerical data
- Abstract
Background: On July 5, 2011, France introduced a law permitting the involuntary admission of patients considered to be in "imminent danger" into psychiatric care without the consent of the family. This is known as "admission en soins psychiatriques pour péril imminent"(ASPPI). ASPPI authorizes all physicians to hospitalize a patient without his or her consent nor the consent of a third party. This differs from previous measures as only one certificate is needed. The law also requires involuntarily admitted patients to present themselves before a judge specialized in Liberties and Detentions (juge des libertés et des détentions), 12 days following their admission. Although there has been an increase in the number of ASPPI admissions when compared to other types of involuntary admission, patients admitted by ASPPI have been hospitalized for a shorter time than others. Some authors, however, have pointed out that decision criteria are frequently interpreted in a loose manner by physicians. This study was conducted at Sainte Anne hospital in Paris., Objective: This study tried to determine if there were different clinical and non-clinical characteristics associated with the length of hospitalization under ASPPI., Methods: This study analyzed all administrative files for patients admitted under ASPPI from January 1, 2015 to December 31, 2015. These files contained the medical certificates and the court orders. The sample was split into two groups: patients hospitalized for a shorter stay and who did not present themselves to the judge and patients hospitalized for a longer stay and who did present themselves to the judge. The certificates were analyzed with a criteria grid, which includes clinical and non-clinical items. Clinical items were taken from the French High Authority of Health (Haute Autorité de Santé) 2005 recommendations. These include suicidal risk, risk to others, drug abuse, delusions or hallucinations, mood disorder and lack of selfcare. Non-clinical items include other information found in the certificate and sociodemographic information found in the administrative file., Results: Among the 250 certificates analyzed, 172 (68.8%) were associated with a long stay and 78 (31.2%) with a short stay. A bivariate analysis found no significant differences between the two groups for non-clinical characteristics and for drug abuse and mood disorder. When no suicidal risk was present, the stay was short in 21% of the certificates and long for 79%. When a suicidal risk was present the stay was short in 43% of the certificates and long for 57% (P=0.0002). When a risk to others was present the stay was short for 19% of the certificates and long for 81% (P=0.003). When delusions and hallucinations were present the stay was short in 15% of the certificates and long in 85 % (P=5×10e
-14 ). When a lack of selfcare was present the stay was short in 10% of the certificates and long for 90% (P=0.01)., Conclusion: This study identified two types of situations linked with the length of hospitalization for patients under ASPPI. In one situation, associated with a longer stay, we found acute psychiatric disorders exhibited by more delusions, hallucinations, drug abuse, and lack of selfcare. In the second situation, associated with a shorter stay, this study found more episodic situations with suicidal risk. This study suggests that some involuntary admissions could be avoided if physicians could monitor episodic situations in appropriate structures. Moreover the criteria grid we used in this study should be validated to further analyze the quality of the certificates in order to lead to more precise recommendations., (Copyright © 2017 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)- Published
- 2018
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15. [Relevance of hospitalization in addictologic care].
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Trebalag AK, Lucet C, Danon N, and Gourevitch R
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- Ambulatory Care, Humans, Length of Stay, Hospitalization, Substance-Related Disorders therapy
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Relevance of hospitalization in addictologic care. Curing drug addictions requires long-term, mostly ambulatory, care. Regardless, hospitalization may be pertinent in certain situations. In emergency situations, it is pertinent mainly for psychiatric or somatic considerations, as a result of complications or intricacies (hospitalization in a psychiatric unit, however, either free or compulsory, cannot be prescribed until an acute intoxication has subsided). As a pre-programmed medical decision, a stay in a sanitary or a medico-social setting may constitute a milestone in withdrawal or post-withdrawal care. Hospital stay may create distance from drugs or from the failing supporting environment, particularly when the patient's history includes specific debilitating past incidents, failures in ambulatory care, or post-withdrawal complications., Competing Interests: A.-K. Trebalag, N. Danon et R. Gourevitch déclarent n’avoir aucun lien d’intérêts. C. Lucet déclare avoir participé à des colloques pour Indivior et avoir été prise en charge lors de congrès par Lundbeck.
- Published
- 2018
16. [The risk/benefit ratio in psychiatry].
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K'ourio H and Gourevitch R
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- Cooperative Behavior, Dangerous Behavior, Ethics, Nursing, France, Humans, Interdisciplinary Communication, Mental Disorders psychology, Psychotherapy ethics, Psychotropic Drugs adverse effects, Psychotropic Drugs therapeutic use, Safety Management ethics, Mental Disorders nursing, Psychiatric Nursing ethics, Risk Assessment ethics
- Abstract
The risk/benefit ratio weighs up on the one hand the expected advantages and on the other the potential risks of a procedure. It is taken into consideration with every therapeutic decision, whether it concerns medication-based treatments, psychotherapy or any other type of treatment. The ethical dimension is a critical element which must be taken into account during team deliberations, whenever these are possible., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)
- Published
- 2015
- Full Text
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