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The Epidemiological Profile of Night-Time Psychiatric Emergencies at The Dalal Xel Mental Health Center in Thies, Senegal.
The Epidemiological Profile of Night-Time Psychiatric Emergencies at The Dalal Xel Mental Health Center in Thies, Senegal.
The Epidemiological Profile of Night-Time Psychiatric Emergencies at The Dalal Xel Mental Health Center in Thies, Senegal.
ISSN No:-2456-2165
D. Data collection
Data were identified from the paper register of
consultations of patients received during the night shift.
Information such as patient demographics (age, gender,
marital status, residence, etc.) and the diagnosis on admission
for each patient admitted are captured in this register. Thus, a
Variables Workforce (n) Percentage (%) Reason for Workforce (n) Percentage (%)
Sex consultation
Male 679 59.6 states of agitation 817 25.7
Feminine 461 40.4 Insomnia 704 22.1
Age groups Auto and hetero 232 7.3
15-20 years old 182 16 physical aggression
21-30 years old 497 43.6 Delusions 202 6.4
31-40 years old 252 22.1 Hallucinations 96 3
41-50 years old 109 9.6 Incoherent remarks 91 2.9
51-60 years old 61 5.3 Verbal aggression 80 2.5
61 and over 39 3.4 Somatic complaints 336 10.6
Ethnicities Taking toxic 111 3.5
Wolofs 437 38.3 Behavioral Oddities 73 2.3
Serers 263 23.1 Refusal to eat 58 1.8
Pulhars 202 17.7 Runaways or attempted 45 1.4
Others 238 20.9 runaways
Marital status Seizures 40 1.2
Singles 368 59.7 Anxiety 70 2.2
Married 189 30.7 Irritability 48 1.5
Divorced 16 2.6 Mutism 38 1.1
Widowers 43 7.1 Acute dyskinesia 28 0.9
Educational level Therapeutic break 23 0.7
Unschooled 232 20.4 Tears 31 1
Primary 322 28.2 Memory disorders 25 0.8
Secondary 423 37.1 suicide attempts 4 0.1
Superior 163 14.3 Other reasons 28 0.9
Occupation
Unemployed 714 62.6
Teachers 168 14.7 Table 3: Distribution of patients received from January 1 to
Tradespeople 90 7.9 December 31, 2020, in night consultation at the psychiatric
Liberal functions 138 12.1 emergencies of the Dalal Xel Mental Health Center in Thies by
Retired 18 1.6 diagnostic category selected.
Other sectors 12 1.1
Place of residence
Diagnostic categories Workforce (n) Percentage
Thies 939 82.4
Dakar 74 6.5
(%)
Other regions of 111 9.7 CIM 10
Senegal Brief psychotic disorders 266 23.3
Other countries 16 1.4 Schizophrenic disorders 205 18
Hours of arrival at night duty Persistent delusional disorders 35 3.1
17.00 – 23.00 877 76.9 Depressive disorders 67 5.9
00.00 – 07.00 263 23.1 Bipolar affective disorder 181 15.9
Consultation request Neurotic and somatoform 122 10.7
Families/ Surroundings 1038 91.1 disorders
Health professionals 65 5.7 Mental disorders associated with 24 2.1
Fire/Police 37 3.2 the puerperium
Mental disorders related to the use 130 11.4
of psychoactive substances
Table 2 shows the reasons for consulting our patients. Dementia 19 1.7
Several reasons were reported, the most frequent of which OTHER PATHOLOGIES
were agitation and insomnia with respective rates of 25.7% Epilepsies 41 3.6
Medication side effects 28 2.4
and 22.1%. Suicide attempts represented only 0.1% of Infectious diseases 22 1.9
patients. It should be noted that 53.3% of patients had a
personal psychiatric history. Of the mental pathologies
selected, brief psychotic disorders predominated with 23.3% As for management, injectable drug treatment was the
of cases. They were followed by schizophrenic disorders and most used therapeutic method (67%), followed by a
bipolar affective disorders with respective rates of 18% and relational approach in 31% of cases. In addition, the type of
15.9% (Table 3). treatment used in the psychiatric ward at the Dalal Xel
mental health center in Thies was neuroleptics and
anxiolytics in 71.3% and 65.4% respectively (Table 4).
Neuroleptics were used in 25.3% as monotherapy and in
74.7% in combination with other drugs. In addition,
outpatient follow-up (68%) was the most common decision
made after the emergency consultation.
B. Clinical profile and diagnosis of patients From the point of view of the diagnostic profile, we
Psychiatric emergency interventions at the Dalal Xel note the predominance of brief psychotic disorders with a
mental health center in Thies took place in 76.9% of cases rate of 23.3% of cases followed by schizophrenic disorders
between 5 pm and 11 pm. Our findings are comparable to (18%). The high prevalence of schizophrenic brief psychotic
those of Porquet [11] in 2011 and Norroy et al [26] in 1993, disorders among patients seen in psychiatric emergencies is
with interventions in psychiatric emergencies taking place also noted in several regions of the world [10-12]. Several
more between 18:00 and 2:00 in the morning, with a factors explain this frequency, the most frequently cited of
decrease in the curve until 6:00. This aspect corresponds well which is noisy, degrading, or aggression-ridden character
to the influence of the nychthemeral period on psychiatric [29, 31]. These acute pathologies are poorly tolerated by the
symptoms with the appearance or aggravation of disorders in family circle and are difficult to treat with traditional
the evening and night periods [26]. The family or the treatment, hence the need for specialized care during the
entourage plays an important role in our psychiatric practice disease. It should be noted that diagnoses are made
it was the main requestor of care with a rate of 91.1% of summarily, urgently, and subjectively.
emergency consultations. Our results are like those found by
Porquet [11] in Senegal and by Hajji et al [10] in Tunisia. C. Therapeutic and evolutionary profile of patients
However, our results differ from those of Norroy et al [26] Emergency therapeutic management was dominated by
who showed that 52.42% of the patients received in injectable drug treatment (67%) followed by using a
psychiatric emergencies at Nancy hospital in 1993 were relational approach in 31% of cases. This differs from the
brought in by the emergency services or the fire brigade, study by Hajji et al [10] who found that the relational
compared with 15.12% brought in by their relatives. In our approach was the most used therapeutic method (67%)
context, these results show that the family is more present in followed by injectable treatment in 31% of cases. This
the life of the individual. Families are full-fledged actors in difference is partly due to the noisy and uncontrollable nature
the crisis they face [10]. Indeed, the African man lives in of the psychotic pathologies that predominate in emergency
close connection with the social environment and the social departments. As for the nature of the treatment used during
organization constitutes the key element of African culture. the on-call psychiatric shift at the Dalal Xel mental health
The individual himself is only an inessential appearance if center in Thies, neuroleptics (71.3%) and anxiolytics (65.4%)
we consider him outside the social groups from which he were the most used drugs. Our results are like those found by
necessarily proceeds [27]. In the African mental patient, Porquet [11] and Ba [12].
there is a decentralization of interest from the individual to About the decision to follow up the consultation at the
the community, leading to the extended family. Beyond the psychiatric emergency department, 32% of the patients were
individual, the urgency felt is also that of the family and the hospitalized compared to 68% followed up as outpatients.
group. This aspect is relatively specific to the psychiatric The decision to follow up as an outpatient may be explained
clinic [28, 29]. According to Collomb [30], the situation of by the fact that the presenting disorders can be managed at
the individual is much more eccentric than the Western home by the family. It may also be due to the desire not to
representation. The individual is much more situated in the isolate the patient from his or her family or to preserve his or
relationship with others, outside himself. Mental illness is her last points of reference.
experienced more as a social phenomenon that modifies the
links that unite the patient in a very tight network with the
whole group.