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Objective: The objective of this systematic review was to investigate which specific and especially neurocognitive factors related to schizophrenia, were associated with homicide risk. Methods: A systematic English-French Medline literature search of cohort studies, case-control studies and transversal studies published from January 1999 to December 2009 was performed combining the MeSH terms “schizophrenia”, “homicide”, “violence”, “mental process”, “cognition”, “risk”, “risk factors”,. Abstract selection was based on the STROBE checklist for observational studies and on the consort statement for clinical trials. Results: Of the 366 selected studies, 65 observational or prospective studies, 10 systematic reviews and meta-analysis and 2 interventional studies met the selection criteria and were included in the final analysis. Firstly, we highlighted that historical (past violence, juvenile detention, physical abuse, parental arrest record), dispositional (male gender, young age, low socioeconomic status) and contextual (recent divorce, unemployment, victimisation) factors could be considered as general homicide-related factors. Clinical factors (clinical paranoid, delusions of persecution or thought insertion, substance abuse, disorganized thinking, long duration of untreated psychosis, stopped monitoring or treatment) were more schizophrenia-specific factors for homicide. Most of the excess risk appears to be mediated by substance abuse. Secondly, our results suggested that schizophrenics with a history of aggressive behaviour compared to those without such history, had better performances on global neuropsychological tests exploring executive functions but performed more poorly as considering orbitofrontal functions. Conclusions: We suggest that every comprehensive psychiatric assessment should explore the risk of homicide, including historical, dispositional, contextual, clinical and neurocognitive (low insight capacity, impaired frontal functions) factors of violence. [Copyright &y& Elsevier]

Depuis sa création, le centre psychiatrique d'orientation et d'accueil (CPOA) reçoit et prend en charge les patients mineurs de 16 à 18 ans. Parmi eux le taux de patients mineurs non accompagnés (MNA) n'a cessé d'augmenter, passant de 10 % en 2016 à 12 % en 2018. La rencontre des patients MNA survient le plus souvent à l'acmé de la crise, quand leurs ressources personnelles sont dépassées et que ces jeunes expriment un état de souffrance psychique sévère. Notre objectif était de comprendre qui sont ces jeunes MNA que l'on accueille, tant dans leurs particularités que dans les points communs cliniques et thérapeutiques qu'ils partagent avec les autres adolescents. Nous avons pour cela mené une étude de cohorte rétrospective et observationnelle sur les 52 patients MNA accueillis au CPOA en 2018 afin de dresser leur portrait, d'identifier les spécificités de leur prise en charge, de leur orientation et de leur accès aux soins, pour ensuite mettre en regard ces résultats à ceux des autres patients mineurs non MNA accueillis au CPOA la même année. Les MNA rencontrés au CPOA en 2018 sont le plus souvent des garçons âgés de 16 à 17 ans, aux ressources limitées et dans une grande détresse psychique exprimée par une symptomatologie psychiatrique aiguë. Les MNA présentent davantage de crise suicidaire (19 %) que les patients mineurs non MNA (13 %) et leur prise en charge montrait davantage de consultations prolongées au CPOA (44 % contre 41 %) dénotant les dimensions de précarité et d'isolement qui compliquent la sectorisation et l'étayage ambulatoire de ces jeunes. Cette étude a également permis de nous interroger sur l'existence de prises en charge en urgence pour les MNA. Même s'il existe peu de recommandations à ce jour, il est important de se saisir d'une réintroduction du temps dans l'urgence, afin de recréer une unité de lieu et de temps suffisamment contenante pour des jeunes dont le parcours de vie est émaillé de ruptures. Since its creation, the Psychiatric Guidance and Reception Centre (CPOA) has received and cared for patients aged 16 to 18. Among them, the rate of Unaccompanied Minor Refugees (UMR) has steadily increased, from 10% in 2016 to 12% in 2018. Meeting UMR patients most often occurs at the peak of their crisis, when their personal resources are overwhelmed and when they experience a severe state of psychological suffering. Our objective was to understand who UMR are concerning the particularities and the similarities they could share at clinical and therapeutic levels with other adolescents. We conducted a retrospective and observational cohort study of the 52 UMR received at the CPOA in 2018 in order to draw a portrait of them, to identify the specificities of their care, their guidance and their access to care, and to compare them with other young non UMR patients. UMR we met at CPOA in 2018 were most often boys aged 16 to 17, with limited resources and in great psychological distress. UMR had more suicidal behaviors (19%) than other minor patients (13%), and our results showed more prolonged consultations for UMR than non UMR at the CPOA (44% versus 41%), indicating that the isolated situation of UMRs complicates their ambulatory support. This study also allowed us to question the existence of emergency care specially dedicated to UMR. Although there are few recommendations to date, it seems important to reintroduce time into their care, in order to recreate a unit, which has sufficient place and time for these young patients whose lives are marked by many breakdowns. [ABSTRACT FROM AUTHOR]