Le voyage pathologique est un concept souvent utilisé mais mal défini dans la littérature scientifique. Après un rapide historique du concept [5], nous proposerons une définition afin de le distinguer d’autres entités cliniques, comme la fugue ou l’errance.

Nous avons mené une étude rétrospective dans le plus grand service d’urgences psychiatriques français, à Paris, portant sur les patients admis pour voyage pathologique en 2019. Les données sociodémographiques, les éléments cliniques et l’orientation au terme de la consultation ont été relevés. Une comparaison selon le motif du voyage pathologique (fuite d’un objet ou recherche d’un objet) a été réalisée.

217 dossiers ont été retenus pour cette étude. Les patients sont en majorité des hommes (65 %), d’âge moyen 40 ans, avec des antécédents psychiatriques (89 %) et un diagnostic de trouble délirant (87 %). Un tiers des patients sont en rupture de suivi (35 %) ou de traitement (36 %). La quasi-totalité des patients (95 %) est hospitalisée après le passage aux urgences, souvent sous contrainte (82 %). La comparaison selon le motif de départ ne retrouve pas de différence significative.

La surveillance de ces patients vulnérables reste importante dans le suivi psychiatrique. Des études complémentaires sont nécessaires pour identifier des éléments spécifiques et améliorer la prise en charge de cette conduite.

Le voyage pathologique reste un concept clinique d’actualité et fréquemment rencontré dans les services d’urgences générales et psychiatriques. Une définition plus précise permettrait de mieux identifier cette conduite pathologique, pour mieux orienter et proposer une prise en charge adéquate à ces patients.

Pathological Journey or Pathological Trip is a concept often used but defined imprecisely in the recent scientific literature and usual classifications. After a brief history of this concept, appeared in France in the 19th century [5], we suggest a definition to differentiate pathological journey from other clinic entities, such as fugue or wandering. The pathological journey would be a departure to a specific destination, induced by delusional ideas or by a state of disorganization.

We led a retrospective study from patients in the biggest French psychiatric emergencies unit, in Paris, admitted for a pathological journey in 2019. Socio-demographics data (gender, age, professional activity, financial resources, place of life, marital status, family and friendly entourage), medical history, clinical features (such as delusional or suicidal ideas, hallucinations, diagnostic hypothesis), trip characteristics (such as place of departure, final wanted destination, duration of the trip) and orientation at the end of the consultation (hospitalization or not) have been notified. A comparative study between patients according to the reason of departure (to run away from something or to look for something) has been led too.

A total of 217 patients are included. Men are majority, with an average age of 40 years, with psychiatric history (89%) and diagnosis of delusional disorder (F20-29 according to the ICD-10, 87%) or mood disorder (10%). They are still followed by a psychiatrist and still take their medication for the most part. They often haven’t hotel or other place to live at the destination or during the trip (62%) and the trip has often begin recently, less than 10 days for 75%. 95% of patients require an hospitalization, without the patient consent in the most part, and only 5% needed a physical restraint in the unit. The comparative study between patients by the reason of departure finds no significant result.

We don’t find here specific characteristics by the motivation of departure, but these patients are often homeless and without ressources during the pathological trip. A particular care of these vulnerable and at-risk patients should be accentuated by the care teams and physicians. Complementary studies are necessary to identify specific characteristics and to improve the patient care management, and maybe to avoid departures of these vulnerable patients in the future.

Pathological trip is a still-used concept, described for more a century, and is frequently observed in general and psychiatric emergencies units. Its definition is not precise and is not mentioned by the actual references (ICD-10, DSM-5), and it could make the identification of this behavior more difficult. These units are often the first to meet and identify this behavior and to guide to offer adequate care to these vulnerable patients.