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Psychotic disorders among homeless subjects attending a psychiatric emergency service



Homelessness is an increas- ing problem among subjects with severe mental illnesses and little is known about the characteristics of homeless subjects with psychosis using emergency psychiatric services. The aims of the present study were to assess the frequency of psychotic disorders among subjects attending a psychiatric emergency service and to explore the clinical and demographic characteristics of these subjects and the management proposed by the emergency staff.


All homeless patients (n = 104) consecutively attending a psychiatric emergency service were included over a 6-month period. Patients were categorised according to ICD-10 diagnoses as presenting with psychotic disorder (schizophrenia and other non-affective psychotic disorders) versus other disorders. A random sample of matched non-homeless controls (n = 71) was included over the same period.


Nearly one out of three homeless subjects (32.7%) presented with a psychotic disorder, a higher proportion than that found in non-homeless subjects (15.7%). Compared to non-homeless subjects with psychosis, homeless subjects with psychosis were more likely to be male and to present with drug use disorder. The likelihood of being hospitalised after attending the psychiatric emergency services did not significantly differ between the two groups. Compared to homeless subjects with other psychiatric disorders, homeless subjects with psychosis were more likely to be single, to have a history of psychiatric hospitalisation and presented less frequently with anxiety or depressive symptoms motivating admission.


Most homeless subjects with psychosis attending a psychiatric emergency service were already identified as suffering from a severe mental illness, suggesting that homelessness was a consequence of a break in contact with mental health services. Since homelessness is incompatible with the adequate management of psychosis, strategies have to be developed in mental health organisations in combination with outside partnerships, to drastically reduce the frequency of this condition in subjects with psychosis.

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  1. 1.

    Susser E, Struening EL, Conover S (1989) Psychiatric problems in homeless men. Lifetime psychosis, substance use, and current distress in new arrivals at New York City shelters. Arch Gen Psychiatry 46:845–850

  2. 2.

    Kovess V, Mangin Lazarus C (1999) The prevalence of psychiatric disorders and use of care by homeless people in Paris. Soc Psychiatry Psychiatr Epidemiol 34:580–587

  3. 3.

    Fichter MM, Quadflieg N (2001) Prevalence of mental illness in homeless men in Munich, Germany: results from a representative sample. Acta Psychiatr Scand 103:94–104

  4. 4.

    Folsom D, Jeste DV (2002) Schizophrenia in homeless persons: a systematic review of the literature. Acta Psychiatr Scand 105:404–413

  5. 5.

    Folsom DP, Hawthorne W, Lindamer L, et al. (2005) Prevalence and risk factors for homelessness and utilization of mental health services among 10,340 patients with serious mental illness in a large public mental health system. Am J Psychiatry 162:370–376

  6. 6.

    Babidge NC, Buhrich N, Butler T (2001) Mortality among homeless people with schizophrenia in Sydney, Australia: a 10-year follow-up. Acta Psychiatr Scand 103:105–110

  7. 7.

    Hwang S (2001) Mental illness and mortality among homeless people. Acta Psychiatr Scand 103:81–82

  8. 8.

    Breakey WR, Fischer PJ, Kramer M, et al. (1989) Health and mental health problems of homeless men and women in Baltimore. JAMA 262:1352–1357

  9. 9.

    Gelberg L, Linn LS, Mayer-Oakes SA (1990) Differences in health status between older and younger homeless adults. J Am Geriatr Soc 38:1220–1229

  10. 10.

    Padgett D, Struening EL, Andrews H (1990) Factors affecting the use of medical, mental health, alcohol, and drug treatment services by homeless adults. Med Care 28:805–821

  11. 11.

    North CS, Smith EM (1993) A systematic study of mental health services utilization by homeless men and women. Soc Psychiatry Psychiatr Epidemiol 28:77–83

  12. 12.

    Koegel P, Sullivan G, Burnam A, Morton SC, Wenzel S (1999) Utilization of mental health and substance abuse services among homeless adults in Los Angeles. Med Care 37:306–317

  13. 13.

    McNiel De, Binder RL (2005) Psychiatric emergency service use and homelessness, mental disorder, and violence. Psychiatr Serv 56:699–704

  14. 14.

    Brousse C, De La Rochère B, Massé E (2002) Hébergement et distribution de repas chauds. Le cas des sans-domicile. INSEE première 823

  15. 15.

    Marpsat M (2003) Les personnes sans domicile. Qui sont elles ?, Mission d’Information sur la Pauvreté et l’Exclusion Sociale (Mipes) en Ile de France

  16. 16.

    Verdoux H, Tignol J (2003) Focus on psychiatry in France. Br J Psychiatry 183:466–471

  17. 17.

    World Health Organisation (1992) The ICD-10 Classification of mental and behaviour disorders: clinical descriptions and diagnostic guidelines. WHO, Geneva

  18. 18.

    Statacorp (2001) Stata statistical software: release 7.0. STATA corporation, College Station, TX

  19. 19.

    Nordentoft M, Knudsen HC, Jessen-Petersen B, et al. (1997) Copenhagen community psychiatric project (CCPP): characteristics and treatment of homeless patients in the psychiatric services after introduction of community mental health centres. Soc Psychiatry Psychiatr Epidemiol 32:369–378

  20. 20.

    Jablensky A (1997) The 100-year epidemiology of schizophrenia. Schizophr Res 28:111–125

  21. 21.

    Lehman AF, Dixon LB, Kernan E, Deforge BR, Postrado LT (1997) A randomized trial of assertive community treatment for homeless persons with severe mental illness. Arch Gen Psychiatry 54:1038–1043

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Correspondence to Prof. Hélène Verdoux.

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Cougnard, A., Grolleau, S., Lamarque, F. et al. Psychotic disorders among homeless subjects attending a psychiatric emergency service. Soc Psychiat Epidemiol 41, 904–910 (2006).

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  • homelessness
  • psychosis
  • emergency psychiatric service use