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Resume Introduction Depuis la promulgation de la loi du 5 juillet 2011, les hospitalisations en soins psychiatrique sans consentement (SPSC) sont systematiquement controlees par le juge des libertes et de la detention (JLD). En cas d’irregularite constatee dans la procedure, le JLD peut ordonner la mainlevee de la mesure. A notre connaissance, aucune etude ne s’est interessee aux mainlevees des mesures de soins decidees pour les patients detenus hospitalises sans leur consentement en unites hospitalieres specialement amenagees (UHSA). L’objectif de cette etude est de decrire les motifs de mainlevee des mesures de SPSC en UHSA, et de les comparer a ceux observes dans un service de psychiatrie generale. Methode Nous avons effectue une analyse retrospective des motifs de mainlevees des mesures de SPSC prononcees entre 2011 et 2018 dans deux unites du meme hopital : une unite de soins pour les patients detenus et une unite de soins de psychiatrie generale). Nous avons extrait les caracteristiques sociodemographiques et les informations judiciaires telles que la date et le motif de mainlevee, la presence du patient a l'audience. Nous avons evalue les taux de mainlevee en rapportant leur nombre au nombre total d’admission en SPSC de l’unite pour chaque annee. Nous avons ensuite examine les motifs retenus par les JLD pour l’ensemble des mainlevees. Resultats Cent quarante-six mainlevees ont ete examinees entre 2011 et 2018, 73 concernaient les patients de l’unite de psychiatrie generale et 73 les patients de l’UHSA. Certains motifs ont ete observes de maniere equivalente en UHSA et en psychiatrie generale (absence de notification des droits aux patients, absence de publication de la delegation de signature, non-respect de la redaction du certificat medical, absence d’examen somatique), alors que d’autres ont ete specifiquement retrouves pour les patients de l’UHSA, comme l’impossibilite pour le patient de communiquer avec son avocat ou l’absence de dangerosite immediate pour le patient ou pour autrui. Conclusion Cette etude de 73 mainlevees consecutives en UHSA met en evidence certaines specificites pour les SPSC en milieu penitentiaire. Les futurs travaux devront repliquer ce type d’etude au niveau national, mais egalement envisager finement les consequences des mainlevees sur la sante mentale des personnes concernees et sur l’evolution des soins qui leur sont proposes.

ImportanceThe Conséquences de la pandémie de COVID-19 sur la santé mentale des étudiants (COSAMe) survey was conducted among university students in France during the COVID-19 pandemic and found that although there was a slight decrease in anxiety, depression, and stress between the first lockdown (T1) and 1 month after it ended (T2), the prevalence of suicidal ideation had increased between these periods and 1 in 5 students had probable posttraumatic stress disorder (PTSD) at T2. These results emphasize the need to explore the long-term consequences of the COVID-19 pandemic.ObjectivesTo measure the prevalence of mental health symptoms among university students in France 15 months after the first lockdown (T3) and to identify factors associated with outcomes.Design, Setting, and ParticipantsThis cross-sectional study reports data from the third measurement time of the repeated COSAMe survey, which took place from July 21 to August 31, 2021, through an online questionnaire sent to all French university students.Main Outcomes and MeasuresThe prevalence of suicidal thoughts, PTSD (PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition] [PCL-5]), stress (Perceived Stress Scale), anxiety (State-Trait Anxiety Inventory), and depression (Beck Depression Inventory) at T3 were gender- and degree-standardized and compared with prevalence rates at T1 and T2. Multivariable logistic regression analyses identified risk factors.ResultsA total of 44 898 students completed the questionnaires. They were mainly women (31 728 [70.7%]), and the median (IQR) age was 19 (18-21) years. Standardized prevalence rates of stress, anxiety, depression, suicidal thoughts, and PTSD were 20.6% (95% CI, 20.2%-21.0%), 23.7% (95% CI, 23.3%-24.1%), 15.4% (95% CI, 15.1%-15.8%), 13.8% (95% CI, 13.5%-14.2%), and 29.8% (95% CI, 29.4%-30.2%), respectively. Compared with the decreased prevalence rates at T2, there was an increase at T3 for stress (2.5% increase), anxiety (13.9% increase), and depression (22.2% increase). The prevalence of suicidal ideation continued to increase from T1 (10.6%) to T3 (13.8%), and the prevalence of probable PTSD increased from 1 in 5 students to 1 in 3 students between T2 and T3. Female and nonbinary participants; participants without children and living in an urban area; and those with financial difficulties, a chronic condition, psychiatric history, COVID-19 history, social isolation, and low perceived quality of information received were at risk of all poor outcomes at T3 (eg, stress among women: adjusted OR, 2.18; 95% CI, 2.05-2.31; suicidal thoughts among nonbinary respondents: adjusted OR, 5.09; 95% CI, 4.32-5.99; anxiety among students with children: adjusted OR, 0.68; 95% CI, 0.56-0.81; depression among students living in a rural area: adjusted OR, 0.80; 95% CI, 0.75-0.85).Conclusions and RelevanceThese results suggest severe long-lasting consequences associated with the pandemic on the mental health of students. Prevention and care access should be a priority.

PTSD is frequent in prison, with a lifetime prevalence of 17.8% among male inmates, and of 40.1% among female inmates. Despite those high rates, only a limited number of studies have been published about this disorder in the prison population, and PTSD is still widely underdiagnosed in jail. We conducted a review of the literature to identify the PTSD sociodemographic characteristics and specificities among incarcerated populations. Some epidemiological characteristics of PTSD are identical in both the general and the prison populations, with a higher prevalence among women than men, high rates of comorbidity with depression and anxiety disorders, and high suicide rates. PTSD after committing a violent crime seems to be common but is greatly underdiagnosed, mostly because of a lack of knowledge about this entity. The occurrence is especially high when the offender suffers from a severe mental illness at the time of the offence. Homicidal crimes are the most at risk to lead to PTSD. Every inmate should be screened for this diagnosis by psychiatrists practicing in prisons. Inmates are exposed to many traumatic events during their time in detention. Yet, little is known about the mental health consequences of imprisonment. PTSD after exposure to a traumatic event while in detention should be systematically explored, and future studies need to consider this matter. The high levels of PTSD among imprisoned people could be explained by the exposition of prisoners to repetitive traumatic events, especially during childhood, and by the multiple risk factors for PTSD found in this population. In France, screening for and treatment of PTSD in prison are insufficient. Strategies must be elaborated by the institutions created in 2019 (Centre National de Ressource et de Resilience et Centre Regionaux de Psychotraumatismes) to improve the health of inmates suffering from PTSD. Complex PTSD should also be studied in the prison population.

Background Depersonalization is a complex phenomenological experience initially described as a psychological disturbance of self-awareness. Among the different dimensions underlying depersonalization, emotional numbing appears to be a key symptom but remains a poorly understood phenomenon. Method We conducted a systematic review, following PRISMA guidelines, of studies investigating electrodermal activity, a well-documented marker of bodily arousal expression of emotion. Studies were selected from the PubMed, Scopus, Web of Science and PsychINFO databases. Results Among the 64 studies initially identified, 11 were finally included, involving 148 patients with depersonalization disorder and 173 healthy subjects for whom depersonalization symptoms were assessed. The main results of these studies suggest that depersonalization is marked by a high skin conductance level and attenuated skin conductance responses to negative stimuli. Limitations Due to discrepancies in methodology, we were not able to conduct quantitative analyses. Moreover, the studies included had limited sample sizes, restricting the generalizability of the results. Conclusion Though further evidence is required, it appears from electrodermal studies that depersonalization is associated with hypervigilance and emotional detachment during threatening situations. However, because emotional numbing might not be restricted to negative events, we proposed perspectives for future research, stressing the need to explore emotional responses of patients with depersonalization to positive situations.

Refugees arrive in Denmark by different paths and canals. In some municipalities all refugees are offered a systematic health assessment when they receive a residence permit. The conducted assessments in Copenhagen and Aarhus have resulted in five studies and this review sums up some of the important results. Vitamin-D deficiencies, anaemia, latent tuberculosis, and symptoms of PTSD are just some of the most frequent conditions seen in newly arrived refugees. A health assessment upon resettlement has several important purposes and should be offered to all newly arrived refugees in Denmark.

BackgroundCriminal responsibility is a key concept in the criminal sanctioning of people diagnosed with mental health disorders who have committed crimes. In France, based on the recommendations of one or more expert psychiatrists, a judge can declare a person not criminally responsible on account of mental disorder (NCRMD) if, at the time of the offense, the person was presenting a psychiatric disorder that abolished or altered his/her capacity for discernment and/or ability to control his/her actions. In such a case, the judge also generally orders an involuntary psychiatric hospitalization. The objectives of this study were to (1) describe longitudinal retrospective administrative data of psychiatric hospitalizations for people found NCRMD, (2) identify the age, sex, and principal diagnoses of these individuals, and (3) characterize the trajectories of their psychiatric care before and after NCRMD psychiatric hospitalization.MethodsWe used discharge reports from the French national hospital database called Programme de médicalisation des systèmes d'information (PMSI) to gather longitudinal data that describe psychiatric hospitalizations for people found NCRMD between 2011 and 2020, the age, sex, and principal diagnoses of these patients, the length of their hospitalization, and the trajectories of their psychiatric care before and after their NCRMD psychiatric hospitalization.ResultsWe identified 3,020 patients who were hospitalized for psychiatric care after having been found NCRMD between 2011 and 2020. The number of admissions on these grounds has remained stable over this period, ranging from 263 in 2011 to 227 in 2021. They were mostly young men diagnosed with a psychotic disorder (62%). The majority (87%) were hospitalized in general psychiatric hospitals, and only 13% were admitted to maximum-security units (Unités pour malades difficiles, UMD). The median duration of hospitalization for these patients was 13 months. Our results show that 73% of the patients had already been hospitalized prior to their NRCMD hospitalization. The rehospitalization rate within 5 years of discharge from NCRMD psychiatric hospitalization was 62%.ConclusionWe conducted the first study investigating the psychiatric hospital treatment of people declared NCRMD in France. There is an urgent need for further studies to investigate the clinical characteristics of these patients.

Background The risk factors for radicalization and terrorism represent a key research issue. While numerous data on the sociological, political, and criminological profiles of radicalized people and terrorists are available, knowledge about psychiatric disorders among these populations remains scarce and contradictory. Method We conducted a systematic review of the literature regarding psychiatric disorders among both radicalized and terrorist populations. Results We screened 2,856 records and included a total of 25 articles to generate a complete overview. The vast majority of studies were of poor methodological quality. We assessed three population groups: people at risk of radicalization, radicalized populations, and terrorist populations. The results showed important variations in the prevalence rates of psychiatric disorders depending on the study population and methodology. People at risk of radicalization have been reported to have depressive disorders, but contradictory findings exist. Psychiatric disorders range from 6% to 41% in the radicalized population and from 3.4% to 48.5% among terrorists. Among terrorists, psychiatric disorders are more frequent for lone-actor terrorists than for those in groups. Conclusion We were not able to identify a significant association between radicalization, terrorism, and psychiatric disorders in our systematic review. However, some research suggests high rates of psychiatric disorders in subgroups of radicalized people and lone-actor terrorists. Further studies using standardized psychiatric assessment methods are urgently needed.

The municipality of Copenhagen offers general health assessment (GHA) to all newly resettled refugees, conducted at the Section of Immigrant Medicine, Hvidovre Hospital. This study described their disease burden and sociodemographic characteristics.In this cross-sectional study, all adult individuals assessed from 1 January 2017 to 30 January 2019 were included. Doctors performed the GHA, including a structured questionnaire, clinical examination and blood testing.In total, 160 refugees were included. Few suffered from communicable diseases (e.g., 1% hepatitis B virus) or other somatic diseases (4% diabetes Type 2). However, deficiencies such as vitamin D deficiency (76%), vitamin B12 deficiency (31%) and anaemia (12%) were frequent. The majority reported headache (54%) or other pain (53%). Furthermore, signs of post-traumatic stress disorder were frequent (33%) and significantly associated with experience of torture, prison and persecution.The population presented with pertinent health issues such as vitamin deficiencies, mental health issues and symptoms of pain. Few suffered from non-communicable or communicable diseases. Our results suggest that an offer of specialised services at municipality level for all newly resettled refugees may be beneficial. Furthermore, the study underlines the need for more research within the field of refugee health.None.Ethical approval was obtained from the Capital Region of Denmark and the Danish Patient Safety Authority.

No study has assessed utilization of hospital-level mental health care for French prisoners. In particular, the impact ofThe study was conducted by using a national psychiatric hospital discharge database. The authors identified incarcerated people who were hospitalized in UHSAs, general psychiatric hospitals, maximum-securityIn 2016, 4,392 incarcerated patients (7,027 admissions) were hospitalized (92% males). Overall, 1,944 patients were hospitalized in UHSAs, 1,787 in general psychiatric hospitals, 97 in UMDs, and 1,465 in SMPRs. That year, 815 patients (19%) were admitted to at least two different facilities. The mean cumulative length of stay per patient was 86.7 days (95% confidence interval=80.1-93.3; median=27 days), with longer durations of stay in UMDs and SMPRs than in UHSAs and general psychiatric hospitals.Despite the recent creation of UHSAs, the hospitalization of inmates in general psychiatric hospitals remains frequent in France. Future research should consider the value of further developing UHSAs.

Background As almost all mental disorders are associated with increased suicidal-related behavior, anhedonia might be a trans-diagnostic dimension to target for suicide prevention. Methods For this 3-year-long prospective study, 2,839 outpatients with mood disorders were recruited. They were divided in: (a) two groups according to the occurrence or not of suicidal ideation during the follow-up, and (b) two groups according to the occurrence or not of suicide attempts during the follow-up. Anhedonia was assessed using a composite score (the French version of the 14-item Snaith-Hamilton Pleasure Scale and item 13 of the Quick Inventory of Depressive Symptomatology scale) at inclusion and at 6, 12, 24, and 36 months after inclusion. Results Patients with mood disorders and anhedonia at least at one follow-up visit had a 1.4-fold higher risk of suicidal ideation (adjusted odds ratio = 1.35; 95% confidence interval [1.07, 1.70]), even after adjustment for confounding factors of suicide risk (i.e., bipolar or unipolar disorder, sex, age, marital status, education level, antidepressant intake, personal history of suicide attempt, at least one childhood trauma, and mean of the maximum depression score during the follow-up). Conversely, association between anhedonia and suicide attempt did not remain significant after adjustment. Conclusions The significant association between anhedonia and suicide ideation in patients with mood disorders stresses the need of targeting hedonia in mood disorders, and of research focusing on the position to pleasure in life through eudaimonia.

Resume Ces dernieres annees, les unites hospitalieres specialement amenagees (UHSA) ont permis un certain nombre d’avancees pour l’acces aux soins psychiatriques des personnes detenues en hospitalisation complete avec ou sans consentement. Cependant, il n’existe toujours qu’une seule modalite de soins psychiatriques sans consentement en milieu penitentiaire : les soins sur decision d’un representant de l’etat (SDRE) qui ne peuvent etre mis en place que si « le patient constitue un danger pour lui-meme ou pour autrui ». Cette « dangerosite » apparait donc comme une condition indispensable pour la mise en place de soins psychiatriques sans consentement pour les personnes incarcerees. Ainsi, il existe une difference majeure avec les soins psychiatriques sans consentement en milieu « libre » (i.e. hors incarceration) pour lesquels cette condition n’est pas necessaire et il y a actuellement, en France, des criteres de soins psychiatriques sans consentement specifiques pour les patients detenus. Outre le fait que cette situation interroge le cadre general des soins psychiatriques sans consentement, elle apparait en contradiction totale avec la loi no 94-43 du 18 janvier 1994 relative a la sante publique et a la protection sociale, dont l’objectif est d’assurer, en prison, une qualite et une continuite des soins equivalentes a celles offertes a l’ensemble de la population.

Background For incarcerated people, the immediate post-release period is characterized by a range of negative outcomes. The appointment scheduling delay for a psychiatric community consultation in this period is unknown. Methods A fictional 24-year-old patient with a diagnosis of bipolar disorder with comorbid cannabis use disorder was created and implemented in two different contexts: (1) a release from a prison of the French North district within 48 h (prison-released patient), (2) a move from another district to the French North district within 48 h (outpatient-moving patient). An independent investigator called the 39 outpatient psychiatric clinics of the French North district to get an appointment as quickly as possible for the two fictional patients. Results In 12 centers out of 39, no appointment could be scheduled for the prison-released patient. For the 27 other centers, there was no statistical difference between the 2 fictional patients’ delay. Three centers refused to make an appointment for the prison-released patient while an appointment was given for the outpatient-moving patient. For the prison-released patient, the median delay was 21 days, which is not consistent with optimal support during the high-risk period of release. Limitations Only outpatient psychiatric clinics of the French North district were called. Caution is then needed before generalizing the results. Conclusions French mental health system does not allow for a proper management of the transition from prison to the community for people with mood disorders during the immediate post-release period.

Key Points Question What is the mental health state of university students in France who were confined during the coronavirus disease 2019 (COVID-19) pandemic, and what factors are associated with the development of mental health symptoms? Findings This survey study of 69 054 students who experienced quarantine found high prevalence rates of severe self-reported mental health symptoms. Among risk factors identified, female or nonbinary gender, problems with income or housing, history of psychiatric follow-up, symptoms compatible with COVID-19, social isolation, and low quality of information received were associated with altered mental health. Meaning The findings of this study suggest that students’ mental health is a public health issue that has become even more critical in the context of a pandemic, underlining the need to reinforce prevention, surveillance, and access to care., This survey study measures the prevalence of self-reported mental health symptoms, identifies associated factors, and assesses care seeking among university students in France who experienced quarantine during the coronavirus disease 2019 (COVID-19) pandemic., Importance The coronavirus disease 2019 (COVID-19) pandemic and quarantine measures have raised concerns regarding their psychological effects on populations. Among the general population, university students appear to be particularly susceptible to experiencing mental health problems. Objectives To measure the prevalence of self-reported mental health symptoms, to identify associated factors, and to assess care seeking among university students who experienced the COVID-19 quarantine in France. Design, Setting, and Participants This survey study collected data from April 17 to May 4, 2020, from 69 054 students living in France during the COVID-19 quarantine. All French universities were asked to send an email to their students asking them to complete an online questionnaire. The targeted population was approximately 1 600 000 students. Exposure Living in France during the COVID-19 quarantine. Main Outcomes and Measures The rates of self-reported suicidal thoughts, severe distress, stress, anxiety, and depression were assessed using the 22-item Impact of Events Scale–Revised, the 10-item Perceived Stress Scale, the 20-item State-Trait Anxiety Inventory (State subscale), and the 13-item Beck Depression Inventory, respectively. Covariates were sociodemographic characteristics, precariousness indicators (ie, loss of income or poor quality housing), health-related data, information on the social environment, and media consumption. Data pertaining to care seeking were also collected. Multivariable logistic regression analyses were performed to identify risk factors. Results A total of 69 054 students completed the survey (response rate, 4.3%). The median (interquartile range) age was 20 (18-22) years. The sample was mainly composed of women (50 251 [72.8%]) and first-year students (32 424 [47.0%]). The prevalence of suicidal thoughts, severe distress, high level of perceived stress, severe depression, and high level of anxiety were 11.4% (7891 students), 22.4% (15 463 students), 24.7% (17 093 students), 16.1% (11 133 students), and 27.5% (18 970 students), respectively, with 29 564 students (42.8%) reporting at least 1 outcome, among whom 3675 (12.4%) reported seeing a health professional. Among risk factors identified, reporting at least 1 mental health outcome was associated with female gender (odds ratio [OR], 2.10; 95% CI, 2.02-2.19; P

BACKGROUND: The aim of this study was to estimate the prevalence of metabolic syndrome (MetS) and its components in a cohort of French patients with treatment-resistant depression (TRD) and to determine correlations with sociodemographic, clinical, and treatment-related factors. METHODS: From 2012 to 2018, 205 patients who met DSM-IV criteria for major depressive episode with moderate-to-severe symptoms (Montgomery-Asberg Depression Rating Scale score ≥ 20), and at least Stage II resistance according to Thase and Rush criteria were enrolled in the FondaMental Advanced Centers of Expertise in Resistant Depression (FACE-DR) cohort. Data on sociodemographic and clinical characteristics, lifestyle information, and treatment and comorbidities were collected, and a blood sample was drawn. MetS was defined according to the criteria of the International Diabetes Federation. RESULTS: Overall, 38% of individuals with TRD met criteria for MetS. The frequency of MetS was significantly higher in men than in women only for patients aged 40 years or older (46.3% vs 35.2%, P = .0427). Moreover, whereas the management for diabetes was good, less than one-third of the patients with high blood pressure or dyslipidemia were treated for these conditions. Multivariate analysis showed that individuals with abnormal plasma c-reactive protein levels had a 3-fold increased risk (95% CI, 1.5-5.2) of having MetS, independent of other potential confounders. CONCLUSION: The prevalence of MetS is higher in patients with TRD than in those with other psychiatric disorders and characterized by a considerable undertreatment of some components of MetS in this population. Diagnosis and treatment of the components of MetS should be systematically performed to prevent the occurrence of cardiovascular diseases in patients with TRD. These findings highlight the need for integrated care, with more interaction and coordination between psychiatrists and primary care providers.

Points essentiels La gestion des etats d’agitation constitue une problematique courante dans les services d’urgences, suscitant un sentiment d’insecurite aupres du personnel soignant. Ces etats d’agitation font l’objet de prises en charge variees en ce qui concerne les traitements medicamenteux utilises. Des Comites d’experts ont donc emis des recommandations sur les traitements psychotropes a utiliser dans les situations d’agitations liees a des troubles psychiatriques. Neanmoins, il n’apparait pas de demarche a suivre precise concernant l’utilisation des traitements injectables. Par ailleurs, les strategies medicamenteuses les plus employees ne beneficient d’aucune evaluation quant a leur efficacite et leur tolerance par rapport aux autres molecules disponibles. Pour evaluer le plus fidelement possible les pratiques courantes, il est necessaire que les etudes modifient au minimum l’organisation des services, et les modalites de prise en charge habituelle. Le developpement de nouvelles etudes apparait primordial afin de faire emerger des conduites medicamenteuses a tenir pour les agitations, basees sur des preuves experimentales robustes et applicables en pratique courante.

Management of agitation is a frequent problematic of emergency departments that often leads to feelings of insecurity among clinicians. There are various practices regarding the drugs to be used in the management of agitations. Guidelines have been proposed by different groups of experts concerning the antipsychotic drugs that should be used for agitations in psychiatric conditions. Nevertheless, there is no clear-cut procedure referring to the utilization of intramuscular drugs in this situation. Moreover, there is no comparison available between the commonly used medications and other drugs, both in terms of superiority of efficacy and tolerance. In order to accurately assess these practices, evaluation protocols must minimize the interference with the service organization and the routine care. Further studies are required in order to develop guidelines about medications that have to be used to handle agitations, which must be based on robust evidence and applicable to emergency services.

Objective: Borderline and antisocial personality disorders (PDs) share common clinical features (impulsivity, aggressiveness, substance use disorders [SUDs], and suicidal behaviours) that are greatly overrepresented in prison populations. These disorders have been associated biologically with testosterone and cortisol levels. However, the associations are ambiguous and the subject of controversy, perhaps because these heterogeneous disorders have been addressed as unitary constructs. A consideration of profiles of people, rather than of exclusive diagnoses, might yield clearer relationships. Methods: In our study, multiple correspondence analysis and cluster analysis were employed to identify subgroups among 545 newly convicted inmates. The groups were then compared in terms of clinical features and biological markers, including levels of cortisol, testosterone, estradiol, progesterone, and sulfoconjugated dehydroepiandrosterone (DHEA-S). Results: Four clusters with differing psychiatric, criminal, and biological profiles emerged. Clinically, one group had intermediate scores for each of the tested clinical features. Another group comprised people with little comorbidity. Two others displayed severe impulsivity, PD, and SUD. Biologically, cortisol levels were lowest in the last 2 groups and highest in the group with less comorbidity. In keeping with previous findings reported in the literature, testosterone was higher in a younger population with severe psychiatric symptoms. However, some apparently comparable behavioural outcomes were found to be related to distinct biological profiles. No differences were observed for estradiol, progesterone, or DHEA-S levels. Conclusions: The results not only confirm the importance of biological markers in the study of personality features but also demonstrate the need to consider the role of comorbidities and steroid coregulation.

La Presse Medicale - In Press.Proof corrected by the author Available online since vendredi 9 octobre 2015

La Presse Medicale - In Press.Proof corrected by the author Available online since vendredi 6 mars 2015