TRIAGE OF CHILDREN WITH MENTAL HEALTH DIFFICULTIES PRESENTING IN A&E IN A GENERAL HOSPITAL

In Wexford and Waterford, an “out of hours” child psychiatric service has been developed, in order to provide help when the regular Child Psychiatry services (CAMHS) are not accessible. Providing a service for under 18 years old patients with mental health issues presenting in the Emergency Department (ED) of a General hospital, it functions with extremely limited resources (a consultant psychiatrist and a doctor in psychiatric training), and therefore needs an efficient triage procedure. The purpose of this article is to review the literature about existing triage tools, and especially the 2016 Irish Children’s Triage System (ICTS) and to discuss how to optimise triaging our specific patients in this new ‘out of hours’ CAMHS cover for Waterford /Wexford area. Conclusion: A post triage tool and some clinical changes could improve the service

MANAGEMENT OF ARFID (AVOIDANT RESTRICTIVE FOOD INTAKE DISORDER) IN A 12-YEAR-OLD ON A PAEDIATRIC WARD IN A GENERAL HOSPITAL: USE OF MIRTAZAPINE, PARTIAL HOSPITALISATION MODEL AND FAMILY BASED THERAPY

Background: Avoidant Restrictive Food Intake Disorder (ARFID), at the cross roads of eating and feeding disorders, is sometimes called an "umbrella diagnosis" as it covers a certainly large and rather heterogeneous list of eating symptoms. It came with the DSM5 (2013) but still, there are no clear guidelines re diagnosis and treatment. Purpose: Through this case, we aim to report not only a presentation of ARFID, but also how this relatively new and emerging diagnostic category has been identified and managed on a Pediatric Ward, in a General Hospital. Subject and methods: This study reports the case of a 12y old girl Irish girl with ARFID treated by a multi-disciplinary team on a Pediatric Ward in a general hospital. A literature review regarding ARFID was concomitantly carried on, in order to consider the current therapeutic options recommended. Results: 3 admissions on a pediatric Ward were necessary for this patient with ARFID, who was successfully managed with a partial hospitalization model, Family Based Treatment (FBT) and Mirtazapine. Conclusions: The dynamic around the management of this condition is the occasion to discuss the other therapeutic options suggested these days, and more specifically the different pharmacological molecules that have also been used in young patients with ARFID and the importance of involving a multi-disciplinary team

TRIAGE OF CHILDREN WITH MENTAL HEALTH DIFFICULTIES PRESENTING IN A&E IN A GENERAL HOSPITAL

In Wexford and Waterford, an “out of hours” child psychiatric service has been developed, in order to provide help when the regular Child Psychiatry services (CAMHS) are not accessible. Providing a service for under 18 years old patients with mental health issues presenting in the Emergency Department (ED) of a General hospital, it functions with extremely limited resources (a consultant psychiatrist and a doctor in psychiatric training), and therefore needs an efficient triage procedure. The purpose of this article is to review the literature about existing triage tools, and especially the 2016 Irish Children’s Triage System (ICTS) and to discuss how to optimise triaging our specific patients in this new ‘out of hours’ CAMHS cover for Waterford /Wexford area. Conclusion: A post triage tool and some clinical changes could improve the service

Creation of an out of hours child and Adolescent Mental Health emergency service

Both Wexford and Waterford Counties are badly suffering from the lack of Child and Adolescent Mental Health Services (CAMHS). This is directly connected to the lack of CAMHS consultants to lead these services. Accessing the existing CAMHS services, especially in emergency, is particularly difficult as the waiting lists are ever growing, and therefore delaying the possibility of an early first appointment. An emergency “out of hours” child psychiatric service has been developed, in order to provide help when the CAMHS services are not accessible. Providing a service for under 18 years old patients with mental health issues presenting in Accident and Emergency (A&E) or hospitalised on a Ward (Paediatric, psychiatric or other) and also sometimes “off-site”, it functions with extremely limited resources (a consultant psychiatrist and a doctor in psychiatric training), and therefore needs an efficient triage procedure. The triage tool that was chosen is the Irish Child Triage System (ICTS) that was launched in Ireland by the RCSI in 2016. It operates in Wexford General Hospital (WGH) and in University Hospital Waterford (UHW). Between February and August 2018, every intervention provided by the Consultant Psychiatrist responsible for this “emergency out of hours” service was recorded; this includes interventions on both sites (WGH and UHW), In A&E but also on the Wards (Pediatric, Psychiatric, Medical and Surgical), both face to face consultations with the Consultant but also phone supervisions provided by the Consultant to the Doctor in psychiatric training on call for Psychiatry (UHW). The purpose of this article is to review the first figures of attendance of this new service provided and to discuss its profitability. Within 7 months, a total of 675 interventions was provided by the Consultant Psychiatrist on call for this new out of hours CAMHS service

La pandémie du Covid-19 : surdosage médiatique, craintes et bientôt antonomase ? Une pandémie exposant deux

1. Le surdosage scientifique et médiatique inhérent à la pandémie. Depuis fin décembre 2019, la floraison exponentielle de toutes les formes de communications, qu’elles soient gouvernementales, institutionnelles, digitales, analogiques, scientifiques ou émanant de médias en tous genres, finissent par créer une pandémie « au carré » et, par transitivité, à générer et accentuer l’angoisse dans la population, qu’elle soit soignante ou non-soignante. [...

Aspects médico-psychologiques relatifs à l’épidémie de coronavirus (Covid-19) : l’apport de la théorie de la détection du signal et du concept de lieu de contrôle

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COVID-19, Vaccination and Healthy Living: Protecting Yourself or Exposing Others? The Kiss that Kills

At a time when vaccines are spreading, there are still pockets of resistance, mainly of a social, psychological and behavioral nature, but also of an economic and health nature in developing countries. We focus here on the social, psychological and behavioral aspects of this resistance. The struggle against Covid-19 is becoming less and less immunological and more and more intrapsychic and social. It is therefore these parameters that need to be targeted. To this end, media campaigns to promote health, but above all to reduce resistance, are therefore quite essential and take precedence over hygiene measures, which citizens are completely saturated with

Le « normal » et le « pathologique » à la lumière de la liberté : petit essai de re-conceptualisation

La question du « normal » et du « pathologique » – bien que souvent abordée par le passé – reste assez omniprésente et, par certains aspects, non résolue, au travers de la diversité de nos consultations et de nos activités d’expertise. En témoignent les mises à jour récursives du DSM et autres CIM/ICD. En témoigne également notre propension naturelle à identifier ce qui pose problème (le « pathologique ») davantage que ce qui n’en pose pas. Comment faire la différence à tout moment ? Quelles sont les marges endéans lesquelles pouvons-nous nous positionner ? (Abraham, 1964). Le présent article a pour but de fournir une réponse claire, simple et pragmatique nous permettant de nous positionner sans perte de temps à cet égard