Les souffrances somatiques intéressent la santé mentale à bien des égards mais quelques psychiatres sont encore réticents à se préoccuper des soins somatiques pour des raisons supposées de défaut de compétence et d’altération du lien psychothérapique, alors que parallèlement quelques confrères somaticiens présentent une certaine appréhension à suivre des patients souffrant de troubles psychiques. Nous avons réalisé un audit clinique ciblé sur la prise en charge somatique des patients hospitalisés en psychiatrie pour proposer la mise en œuvre d’actions d’améliorations. Nous avons rétrospectivement analysé sur une durée de deux ans les dossiers médicaux de tous les patients reçus en hospitalisation complète de psychiatrie et qui présentaient au moins une anomalie du bilan hépatique. Ces dossiers ont été analysés grâce à une grille de lecture polarisée sur les troubles hépatiques et référençant : les antécédents, les facteurs de risque d’hépatopathies, la réalisation d’examens clinique(s) et paraclinique(s) supplémentaire(s), la mention d’un diagnostic étiologique, l’organisation d’une prise en charge et le référencement dans le courrier de sortie de tous ces éléments. Nos résultats retrouvent qu’il conviendrait d’établir une base référentielle précise et formalisée détaillant les principes de la prise en charge somatique des patients hospitalisés en psychiatrie. Nous concluons par la nécessité de bénéficier de la présence d’un médecin généraliste référant dans chaque service de psychiatrie.

Somatic suffering concerns mental health in many ways, but numerous psychiatrists are still reluctant to take an interest in somatic care due to a supposed lack of expertise and an alteration of the psychotherapeutic link, whilst in parallel numerous fellow physicians are quite apprehensive about treating patients with mental disorders.

We have undertaken a targeted clinical audit regarding the somatic treatment of in-patients in a psychiatric unit to propose the implementation of measures of improvement.

Our study focused on the identification and treatment of abnormal liver function tests, a subject that has been overlooked in the literature, yet from clinical experience the results are often abnormal in psychiatric unit in-patients. We analysed retrospectively over a period of two years the medical records of psychiatric unit in-patients with abnormal results for at least one of the following hepatic markers: aspartate-aminotransferase (AST), alanine transaminase (ALT), gamma-glutamyltransferase (GGT), alkaline phosphatase (ALP) and bilirubin.

In total, 188 liver test results were abnormal, with an average of 1.7 per patient. The abnormal test results were in decreasing order: elevation in GGT (80 % of patients), elevation in transaminases (65.5 % for each), elevation in ALP (19.1 %) and elevation in bilirubin (7.27 %). Abnormal transaminase levels were lower than 10N, with a peak between 1N and 3N for ALT and a peak between 1N and 5N for AST. The elevation in GGT was between 1N and 34N, although 71.6 % of these values were below 5N. ALP was below 3N. The medical history was traced in 93.6 % of the records. A somatic clinical examination was only reported in 39 records (35.5 %) and was carried out by a hepato-gastroenterologist (HGE) in 30.8 % of cases, the establishment's emergency physician in 25.7 % of cases and the psychiatrists in 12.9 % of cases. Patients with abnormal liver function test results frequently underwent other biological and morphological examinations. A discharge letter was found in almost all cases. Abnormal liver function test results were indicated in less than 45 % of these discharge letters, whilst over half reported the establishment of a future treatment coordinated by the GP, in close collaboration with the gastroenterologist in at least half the cases.

Our study was carried out in an open psychiatric unit in the heart of a general hospital that mainly receives patients suffering from thymus and anxiety disorders, addictive disorders, somatoform disorders, personality disorders and psycho-organic disorders. Patients suffering from schizophrenia or schizoaffective disorders comprised less than 10 % of admissions. Our retrospective study of over 750 hospital admissions over a period of two years found only 62.93 % of patients underwent liver function tests, which proved to be pathological in nearly 30 % of cases. Following a well-defined anamnesis, just over a third of patients underwent a physical examination whilst in hospital, more often a while after admission and not in the psychiatric unit. The consultation of fellow hospital physicians was limited even if the gastroenterologist was called upon in 30 % of cases. It was sometimes the treatment pathway or the fortuitous presence of co-morbidities that enabled the anaesthetist or emergency physician to carry out this clinical examination. However, when this physical examination was scheduled, clinical hepatobiliary signs were discovered in 30 % of patients.

An accurate, formalised reference database detailing the principles of the somatic treatment of psychiatric unit in-patients should be established. Our results indicate the necessity of a referring physician in each psychiatric department.