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Le Centre Psychiatrique d'Orientation et d'Accueil, est le plus grand centre d'urgences psychiatriques français, avec plus de 10 000 consultations par an. L'objectif de notre étude observationnelle rétrospective est de décrire la population des patients de 15 à 18 ans (18 ans exclus) consultant dans notre centre (motifs de consultation, diagnostics psychiatriques, décision d'orientation en précisant vers quelles structures ces mineurs sont orientés) et de proposer un modèle prédictif de décision d'hospitalisation. Tous les patients consécutifs âgés de plus de 15 ans et de moins de 18 ans consultant au CPOA entre le 1er janvier 2017 et le 31 décembre 2021 ont été inclus dans l'étude. Les caractéristiques de notre échantillon sont décrites en termes de proportions pour les variables qualitatives et de moyennes et d'écarts types, pour les variables quantitatives. La probabilité d'être hospitalisé a été modélisée sur l'ensemble de l'échantillon à l'aide d'un modèle Probit multivarié, pour lequel ont été vérifiées les hypothèses de validité. Nous avons répertorié 2712 passages correspondant à 1873 patients inclus dans notre étude (âge moyen = 16,2 ± 0,72, 54 % de filles) soit à 5,2 % en moyenne de la file active totale. Les principaux motifs de consultation ont été les idéations dépressives (22 %), les angoisses (19 %), et les idées suicidaires (18 %). Les troubles psychiatriques les plus fréquemment diagnostiqués selon la 10e révision de la Classification Internationale des Maladies ont été F30–39 (troubles de l'humeur) (34 %), F40–48 (troubles névrotiques, troubles liés à des facteurs de stress et troubles somatoformes) (24 %) et F60–69 (trouble de la personnalité et du comportement) (11 %). Parmi les patients relevant d'une indication d'hospitalisation, soit 27 % au total, 85 % ont été orientés sur des structures pour adultes et moins de 12 % sur des structures d'hospitalisation dédiées à l'adolescent, alors que parmi les patients orientés en ambulatoire, soit 65 % au total, seulement 11 % ont été dirigés sur des consultations pédopsychiatriques. Un âge plus élevé, une tentative de suicide la semaine précédant le passage aux urgences psychiatriques, des conduites et idées suicidaires, des comportements hétéro-agressifs, d'agitation ou d'excitation psychomotrice, des idées délirantes, une errance, une fugue ou un voyage pathologique ainsi qu'un diagnostic de type F20–F29 (Schizophrénie, trouble schizotypique et troubles délirants) et F30–F39 sont des facteurs significativement prédictifs d'une indication d'hospitalisation. L'hospitalisation en psychiatrie des adolescents consultant aux urgences psychiatriques est un problème majeur. Les facteurs prédictifs sont des indicateurs d'une nécessité absolue de soins immédiats renforcés avec hospitalisation. Malheureusement le manque de structures dédiées aux adolescents sont tels que trois quarts des adolescents se retrouvent hospitalisés en structures pour adultes, et ce qui n'est pas adapté ni acceptable. The CPOA (Centre Psychiatrique d'Orientation et d'Accueil) is the largest psychiatric emergency center in France, with more than 10,000 consultations per year. The aim of our retrospective observational study is to describe the population of patients aged 15 to 18 years (18 years old not included) consulting our center (reasons for consultation, psychiatric diagnoses, referral decision by specifying the structures to which these minors are referred) and to describe a predictive model for the decision to hospitalize. All consecutive patients aged over 15 and under 18 consulting in the CPOA between January 1, 2017 and December 31, 2021 were included in the study. The characteristics of our study sample are described in terms of proportions for qualitative variables and with means and standard deviations for quantitative variables. The probability of being hospitalized was modeled on the entire sample using a multivariate Probit model for which the hypotheses of validity were tested. We have recorded 2712 visits, corresponding to 1873 patients included in our study (mean age = 16.2 ± 0.72, 54% girls), i.e. an average of 5.2% of the total patients. The main reasons for consultation were depressive ideations (22%), anxiety (19%), and suicidal thoughts (18%). The most frequently diagnosed psychiatric disorders according to the 10th revision of the International Classification of Diseases were F30-39 (mood disorders) (34%), F40-48 (neurotic, stress-related and somatoform disorders) (24%) and F60–69 (personality and behavioral disorders) (11%). Among the patients with an indication for hospitalization, i.e. 27%, 85% were admitted in adult units and fewer than 12% in adolescent specific units, while among the patients with an outpatient care, i.e. 65% in total, only 11% were referred to child psychiatry consultations. An older age, a suicide attempt in the week preceding the visit to the psychiatric emergency department, suicidal behaviour and suicidal ideations, hetero-aggressive behaviour, psychomotor agitation or excitement, delusions, wandering, running away or pathological travel, and a diagnosis of type F20–F29 (Schizophrenia, schizotypal disorder and delusional disorders) and F30–F39 were significantly predictive of a decision to hospitalize. Psychiatric hospitalization of adolescents consulting due to psychiatric emergencies is a major problem. The predictive factors for hospitalization reflect an absolute need for immediate care. Unfortunately the lack of structures dedicated to adolescents is such that three quarters of adolescents end up hospitalized in adult structures, which is neither appropriate nor acceptable. [ABSTRACT FROM AUTHOR]

Abstract: Aims: Describing, analyzing and comparing the teenage population from 15 to 20years old who was consulting a psychiatrist during one year, in the pedopsychiatric and adult psychiatric services of a given geographic sector. Methods: We conducted a retrospective survey based on the files/cases of teenagers having consulted at least once over the year 2008, in one or the other ambulatory care service. Grid-in questions were elaborated specifically for the purpose of this survey, in order to collect sociodemographic data, analyze medical courses, psychiatric histories and therapeutic support. Results: Over the year 2008, 184 teenagers from 15 to 20years old were admitted in consultation among which 112 on the ambulatory pedopsychiatric department and 72 on the adult psychiatric department. The consultant teenagers having in the pedopsychiatric department are younger, they were more often referred by their school institution, more than half of them were living within a single-parent family and were diagnosed a personality or a neurotic disorder, whereas teenagers consulting in adult psychiatry department were referred by institutions, their family or a doctor, are more likely to be out of school (17 %), and were more often diagnosed with mood disorder or troubles related to their environment. Against all expectations, they do not have more psychiatric history (hospitalization). However, their care differs according to where they consult. Pedopsychiatrists more often refer their patients to a therapist (29 % versus 13 %) and prescribe less often medicinal treatment (24 % versus 40 %). Conclusion: Teenagers who are monitored in psychiatric department for adults hardly differ from those who were monitored in pedopsychiatric department. Far from competing pedopsychiatric and adult psychiatric departments are complementary. A prospective survey over several years and extra surveys covering other geographical sectors would allow to confirm these data. [Copyright &y& Elsevier]