Management of patients with autism spectrum disorder in psychiatric emergency: a single-centre retrospective study.

Abstract

Autism spectrum disorder (ASD) is one of the most prevalent neurodevelopmental disorders (NDDs) and is frequently associated with psychiatric and somatic comorbidities. As a result, individuals with ASD use emergency departments more frequently than the general population. However, the core features of ASD pose specific challenges in emergency department care, particularly for adult patients and emergency staff frequently report limited training in this area. While paediatric presentations of ASD in the emergency department are well documented, the international literature on adults remains limited. we conducted a single-centre retrospective study including all patients aged 15 years and older with a diagnosis of ASD who attended the Centre Psychiatrique d'Orientation et d'Accueil (CPOA), GHU Paris (Groupe Hospitalo-Universitaire) between 12 January 2016 and 31 December 2023. The objectives were to estimate the prevalence of ASD in this psychiatric emergency setting and to describe the patients' socio-demographic and clinical characteristics, mode of arrival, reasons for consultation and referral following the emergency visit. Among 69 447 patients who attended the CPOA during this period, 484 (0.7%) had a diagnosis of ASD. This population was predominantly male (71.9%), with a mean age of 25.1 years. The most frequent reasons for consultation were hetero-aggressive behaviour (37.0%) and anxiety (31.0%). Overall, 39.2% of patients were hospitalised, including 17.3% involuntarily, and 6.2% required physical restraint. The number of consultations involving patients with ASD increased significantly between 2016-2023. This study provides a clearer understanding of the clinical and organisational challenges associated with the management of adult patients with ASD in psychiatric emergency departments. Although this study was descriptive and did not assess specific interventions, the observed patterns, in line with previous literature, suggest that adopted care strategies may help better address the needs of this population.