Retour d’activité suite à la création de d’une consultation psychiatrique non sectorisée ouvertes aux classes préparatoires du 5^e et 6^e arrondissement.

Étude rétrospective sur l’activité de la consultation et sur les entretiens médicaux entre décembre 2017 et juillet 2018.

Quinze étudiants ont été reçus avec une moyenne de 5,2±2,9 entretiens par jeune. Trois quarts ont bénéficié d’un suivi régulier ou en si besoin. Un tiers avait déjà un traitement psychotrope mise en place avant la consultation ; à la fin de l’année, deux tiers en avait un. Les pathologies les plus retrouvées sont un épisode dépressif caractérisé (41 %), des troubles de l’adaptation (29 %), des troubles anxieux (12 %). Deux élèves ont été orientés vers le centre d’accueil et de crise pour une hospitalisation.

La consultation CPGE a permis d’offre un accès aux soins psychiatriques sans passer par la structure d’urgence et avec un temps de consultation plus court qu’en centre médico-psychologique. Elle a permis d’évaluer, suivre et d’orienter, y compris vers la structure hospitalière quand cela était nécessaire mais également de maintenir certains jeunes dans leurs études. Au regard de la demande de psychothérapie et des délais d’attentes dans les structures étudiantes déjà existantes, il paraîtrait judicieux d’allouer davantage de moyens pour les soins de psychothérapies en aval de la consultation.

Part of the French post-secondary education system is the Classes Préparatoires aux Grandes Écoles (High School Preparatory Classes) which consists of two intensive years (or three years sometimes) to pass the entrance examination of the Grandes Écoles. Grandes Écoles are highly selective, elite, and prestigious institutions [10Power A. France's educational elite – Telegraph, The Telegraph  :  (2003). 

Cliquez ici pour aller à la section Références]. The difficulties for these students are a higher stress (succeed the entrance examination), lack of time (all their time is dedicated to studies). The access to public psychiatric health system depends on where you live. Due to their schedule, they spend most of their time in the high school and they can’t consult in the psychological centre whom they depend [9Petitjean F. The Sectorization System in France Int J Ment Health - INT J MENT Health 2009 ;  38 : 25-38 [cross-ref]

Cliquez ici pour aller à la section Références]. In these conditions, in December 2017, public psychiatric care of the 5th and 6th districts of Paris created a psychiatric consultation in one high school opened to the students in Classes Preparatoires which signed a convention with the psychiatric ward.

This study aims to debrief the activity and the student profiles in the first year of this consultation.

The patients are composed of students registered in Classes Préparatoires from the 5th and 6th district of Paris and who came to the psychiatric consultation, aged from 16 to 19 years old and referred by school nurses, school doctors, psychiatric ward or student himself. Retrospective study based on the activity of the consultation and medical files of psychiatrics consultations between December 2017 and July 2018.

Fifteen students consulted with a mean of 5.2±2.9 consultations per students, eleven of them were oriented by school nurses. Eleven students benefited from a regular follow-up or an “in case of need” consultation. Five students had already received a psychotropic drug before the consultation; at the end of the year, ten of them received medication. The most prescribed category of medication are antidepressants and anxiolytics with seven patients apiece. The most represented disorders are a major depressive disorder (41%), adaptative disorder (29%), anxiety disorder (12%). Four students stopped their studies in the high school during the academic year. Two students needed to be hospitalized in the psychiatric ward of the district, they continued their education in their high school after hospitalization.

The consultation for the Classes Préparatoires aux Grandes Écoles allowed an access to a psychiatric offer next to the place those students spend most of their time, without going to an emergency structure and with a shorter waiting time compared to the psychological centre in public health system. This consultation enables the evaluation, the follow-up and the orientation of the students, including the hospitalization when it is needed but also to sustain some students in their studies. In views of requesting a psychotherapy and the usual waiting time in the psychotherapeutic centre for students which already exist, there is important need to provide increased resources for these students.