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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.

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

Background Tobacco smoking has been associated with suicide, impulsivity and depression in non-clinical populations with differences across sexes. Objective To determine the role of tobacco smoking in Treatment-Resistant Depression (TRD) according to sex in a precision-medicine approach. Method The FACE-TRD cohort is a national cohort of TRD patients recruited in 13 resistant depression expert centers between 2014 and 2021 and followed-up at 6 months. A standardized one-day long comprehensive battery was carried out, including trained-clinician and patient-reported outcomes, and patients were reevaluated at 6 months on their smoking and psychiatric hospitalization outcomes. Results 355 TRD participants were included (222 women). The smoking rate was much higher in TRD women compared to the French general population (34% vs 24%) while it was comparable for men (approximately 29%). In multivariate analyses, compared to non-smoking women, female smokers had significantly increased number of lifetime psychiatric hospitalizations (standardized beta B = 0.232, p = 0.014) and electro-convulsive therapy (adjusted odds ratio (aOR) = 2.748, p = 0.005), increased suicidal ideations (aOR = 4.047, p = 0.031), history of suicide attempt (aOR = 1.994, p = 0.033), and increased impulsivity (B = 0.210, p = 0.006) and were more frequently treated by benzodiazepines (aOR = 1.848, p = 0.035) and third- or fourth-line TRD treatments (antipsychotics aOR = 2.270, p = 0.006, mood stabilizers aOR = 2.067 p = 0.044). Tobacco smoking at baseline was predictive of psychiatric hospitalization within 6 months in persistent smoking women (aOR = 2.636, p = 0.031). These results were not replicated in men, for whom tobacco smoking was only associated with increased clinician-rated and self-reported depressive symptoms (respectively B = 0.207, p = 0.022 and B = 0.184, p = 0.048). The smoking cessation rate at 6 months was higher in women than in men (12% vs. 7%). No patient was administered nicotine substitute or varenicline at the two timepoints. Interpretation Combining these results and those of the literature, we recommend that active tobacco cessation should be promoted in TRD to improve depression, suicide and impulsivity especially in women. Female smokers appear as a specific population with heavier mental health outcomes that should be specifically addressed.

Research has consistently shown high levels of post-traumatic stress disorder (PTSD) in correctional settings. We aimed to compare the prevalences of trauma exposure, subthreshold PTSD, and full PTSD in incarcerated people with those observed in the general population. We used the Mini-International Neuropsychiatric Interview to screen for psychiatric disorders among men upon admission to jail (N = 630) and non-incarcerated men living in the same geographic area (the northern district of France; N = 5793). We utilized a multinomial regression model to assess the association between admission to jail and the prevalences of trauma exposure, subthreshold PTSD, and full PTSD. We employed logistic regression models to verify the interaction between admission to jail and PTSD status on the presence of psychiatric comorbidities. Full PTSD was overrepresented among men in jail after adjustment for all covariates (OR [95% CI] = 3.49 [1.55-7.85], p = 0.002). The association between PTSD status and the presence of at least one psychiatric comorbidity was also more important upon admission to jail than in the general population. Admission to jail was not associated with a higher prevalence of trauma exposure (OR [95% CI] = 1.12 [0.85-1.46], p = 0.419) or subthreshold PTSD (OR [95% CI] = 1.17 [0.81-1.68], p = 0.413). These results suggest higher prevalence rates of full PTSD and psychiatric comorbidities associated with PTSD symptoms in incarcerated people than in the general population. The provision of trauma-focused interventions tailored to these clinical specificities should be considered for the jail population.

General Hospital Psychiatry - Sous presse. Epreuves corrigees par l'auteur. Disponible en ligne depuis le mercredi 30 juin 2021

The COVID-19 pandemic and quarantine measures have sparked debate regarding their traumatic nature. This cross-sectional study reports the prevalence rate of probable post-traumatic stress syndrome (PTSD) and associated factors among French university students. A total of 22,883 students completed the online questionnaire. The prevalence rate of probable PTSD, assessed using the PTSD Checklist for DSM-5, was 19.5% [19.0–20.0]. Female (1.32 [1.21–1.45]) or non-binary gender (1.76 [1.35–2.31]), exposure to a non-COVID-19-related traumatic event (3.37 [3.08–3.67]), having lived through quarantine alone (1.22 [1.09–1.37]), poor quality of social ties (2.38 [2.15–2.62]), loss of income (1.20 [1.09–1.31]), poor quality housing (1.90 [1.59–2.26]), low-quality of the information received (1.50 [1.35–1.66]) and a high level of exposure to COVID-19 (from 1.38 [1.24–1.54] to 10.82 [2.33–76.57] depending on the score) were associated with PTSD. Quarantine was considered potentially traumatic by 78.8% of the students with probable PTSD. These findings suggest the pandemic context and lockdown measures could have post-traumatic consequences, stimulating debate on the nosography of PTSD.

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.

International audience; No abstract available

International audience; Objective: In addition to heredity, exposure to early-life adversity is an important predisposing risk factor of suicidal behaviour. Although the association between Childhood Trauma (CT) and suicide risk is well documented, interactions between CT and suicidal behaviour in Treatment-Resistant Depression (TRD) populations have received little coverage. This study aimed to evaluate i) association between CT and suicidal behaviour in a TRD population, and ii) the role of personality traits and impulsiveness as potential factors of mediation in these associations.Methods: Patients were recruited from a cohort of the French network of TRD expert centers. Depressive symptom severity, CT, suicidal behaviour, personality traits, and impulsiveness were assessed with the Montgomery-Åsberg Depression Rating Scale (MADRS), the Childhood Trauma Questionnaire (CTQ), the Columbia Suicide Severity Rating Scale (CSSRS), the Structured Clinical Interview for DSM-IV, the Big Five Inventory, and the Barratt Impulsivness Scale (BIS) respectively.Results: Among the 256 patients with a baseline CTQ, in relation to suicide risk for the current depressive episode, we found an association with the total CTQ scores mediated by the intensity of the current episode in a model adjusted for age and sex (total effect: β = 0.171; p = 0.011, direct effect: β = 0.135; p = 0.043; indirect effect: β = 0.036; p = 0.048). Focusing on CT subtypes, we detected an association between suicide risk and physical neglect in a model adjusted for age and sex (β = 0.301; p = 0.002), without any mediation by the intensity of the current episode. There was no mediation effect from personality traits nor impulsiveness. With regards to CSSRS to assess suicidal ideation, we did not find any association with the total CTQ score and CT subtype scores.Conclusion: We report a strong association between suicidal behaviour and CT (in particular childhood physical neglect) in a TRD population.

Objective To assess the prevalence of and risk factors for posttraumatic stress disorder (PTSD) in patients with COVID-19. Methods We conducted a cohort study between March and May 2020 at the Lille University Hospital (France), including all patients with laboratory-confirmed COVID-19. Psychological distress symptoms were measured 3 weeks after onset of COVID-19 symptoms using the Impact of Event Scale-6 items (IES-6). The evaluation of PTSD symptoms using the PTSD Checklist for DSM-5 (PCL-5) took place 1 month later. Bivariate analyses were performed to analyze the relationship between PCL-5 scores and the demographic and health variables. The significant variables were then introduced into a multivariable linear regression analysis to establish their relative contributions to the severity of PTSD symptoms. Results 180 patients were included in this study, and 138 patients completed the 2 evaluations. Among the 180 patients, 70.4% patients required hospitalization, and 30.7% were admitted to the intensive care unit. The prevalence of PTSD was 6.5%, and the predictive factors of PTSD included psychological distress at the onset of the illness and a stay in an intensive care unit. Conclusions The prevalence of PTSD in patients with COVID-19 is not as high as that reported among patients during previous epidemics. Initial psychological responses were predictive of a PTSD diagnosis, even though most patients showing acute psychological distress (33.5% of the sample) improved in the following weeks. PTSD symptoms also increased following a stay in an intensive care unit. Future studies should assess the long-term consequences of COVID-19 on patients' mental health.

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.

Resume Position du probleme La prevalence des troubles psychiatriques est elevee dans les prisons francaises. Pourtant, l’efficience des dispositifs de soins en place (unites sanitaires en milieu penitentiaire [USMP], services medico-psychologiques regionaux [SMPR] et unites d’hospitalisation specialement amenagees [UHSA]) est peu etudiee. L’objectif principal de cette etude est de decrire, dans les vingt prisons du Nord de la France (Hauts-de-France, Eure, Seine-Maritime), le recours aux hospitalisations psychiatriques a temps complet ainsi que l’offre de soins psychiatriques dans les unites sanitaires de ces etablissements. Methodes Nous avons realise une etude descriptive a partir de bases medico-administratives et de resultats d’enquete. Pour chaque etablissement penitentiaire, pour l’annee 2016, les donnees suivantes ont ete collectees : 1) effectifs et taux d’occupation des postes pour les professionnels de la sante mentale et 2) taux d’hospitalisation en psychiatrie (a l’UHSA de Lille-Seclin ou dans les hopitaux de secteur psychiatrique). Resultats L’offre de soins est incomplete et inegale selon les prisons : 40 % des postes de psychiatres ne sont pas pourvus dans les unites sanitaires etudiees. L’acces a l’UHSA varie considerablement selon l’etablissement d’origine : plus celui-ci est eloigne de l’UHSA, moins les personnes incarcerees y sont hospitalisees. Aucune correlation n’a ete retrouvee entre la distance prison–UHSA et le taux d’hospitalisation toute orientation confondue (UHSA et hopitaux de secteur psychiatrique). Conclusion Malgre les avancees permises par la creation des UHSA, l’acces aux soins psychiatriques reste problematique depuis la prison ; ceci s’explique par l’eloignement geographique de certains etablissements, le nombre de places limite en UHSA et les effectifs medicaux insuffisants dans les USMP.

In the current literature, two distinct and opposite models are suggested to explain the consciousness disorders in schizophrenia. The first one suggests that consciousness disorders rely on a low-level processing deficit, when the second model suggests that consciousness disorders rely on disruption in the ability to consciously access information, with preserved unconscious processing. The current study aims to understand the mechanisms associated with visual consciousness disorder in order to pave the road that will settle the debate regarding these hypotheses. During a functional magnetic resonance imaging session, 19 healthy participants (HC) and 15 patients with schizophrenia (SCZ) performed a visual detection task to compare the neural substrates associated with the conscious access to the visual inputs. The visual detection threshold was significantly higher in SCZ than in HC [t(32) = 3.37, p = 0.002]. Whole-brain ANOVA demonstrated that around the visual detection threshold patients with SCZ failed to activate a large network of brain areas compared to HC. (1) During conscious vision, HC engaged more the left cuneus and the right occipital cortex than patients with SCZ, (2) during unconscious vision, HC engaged a large network that patients with SCZ failed to activate, and finally, (3) during the access to consciousness process, patients with SCZ failed to activate the anterior cingulate cortex. These results suggest that the consciousness disorders in schizophrenia rely on specific dysfunctions depending on the consciousness stage. The disorders of the conscious vision are associated with dysfunction of occipital areas while the ones associated with unconscious vision rely on a large widespread network. Finally, the conscious access to the visual inputs is impaired by a dysfunction of the anterior cingulate cortex. The current study suggests that none of the two suggested models can explain consciousness disorders in schizophrenia. We suggest that there is an alternative model supporting that the conscious access to visual inputs is due to a disengagement of the supragenual anterior cingulate during the unconscious processing of the visual inputs associated with a sensory deficit.

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.

International audience; Childhood maltreatment is associated with major depressive disorder (MDD). It not only increases the risk of lifetime MDD, but it also aggravates its course. Among depressed patients, 20-30% of them experience treatment-resistance depression (TRD). We aimed to assess the association between childhood maltreatment, severity of depression in a unipolar TRD sample, and patient outcomes after one-year of follow-up. Methods: Patients were recruited for a prospective cohort from the French network of TRD expert centers. Depressive symptom severity was assessed with the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Quick Inventory of Depressive Symptomatology self-report (QIDS-SR). Childhood maltreatment was evaluated with the Childhood Trauma Questionnaire (CTQ).Results: In total, 256 patients filled in the CTQ at baseline between 2012 and 2019. At baseline, the MADRS score was associated with CTQ score (β = .185; p = .004). QIDS was also associated with CTQ scores (β = .27; p < .001). Regarding the different subtypes of childhood maltreatment, MADRS was associated with physical (β = .21; p = .005) and sexual abuse (β = .22; p = .002), while QIDS with physical abuse (β = .304; p < .001) and physical neglect (β = .254; p < .001). However, we did not find any significant association focusing on the other types of traumas. During a 1-year follow-up focusing on remission, CTQ scores (baseline) were less important in remittent patients [n = 38; CTQ score = 39.26 (9.68)] than in nonremittent ones [n = 92; CTQ score = 46.02 (17.53)] (p = .027). There was no significant difference among remitters and nonremitters based on trauma subtypes. At baseline, CTQ scores had a significant influence on remission at 1 year (χ2 (1) = 5.57; p < .05). We lost this influence adding MADRS scores at baseline in the model (p = .063).Conclusion: We highlighted a significant association between the severity of depressive disorders and childhood maltreatment in the TRD population. Information about a history of childhood maltreatment helps in identifying individuals who could be less likely to go into remission after treatment.

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.

INTRODUCTION: 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.METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.FUNDING: None.TRIAL REGISTRATION: Ethical approval was obtained from the Capital Region of Denmark and the Danish Patient Safety Authority.

Background: Major depressive disorder (MDD) is among the most common psychiatric disorders. One-third of patients are usually unresponsive to several lines of treatment. This study aimed to describe the FondaMental French cohort of patients with treatment-resistant depression (TRD) and to estimate utility and healthcare resource use outcomes. Methods: Patients with TRD were evaluated prospectively over four years (baseline, 6, 12, 18, 24, 36 and 48 months) in a real-world clinical setting. Interim analyses focused on the first two consecutive years. Four MDD-related states (major depressive episode (MDE), response, remission, recovery) were defined based on the MADRS (Montgomery&ndash, &Aring, sberg depression rating scale) and other clinical events. Health status was assessed with the EuroQol 5 Dimensions 5 Level (EQ-5D-5L) questionnaire. Utility values were estimated as preference measures that the patients assigned to their overall health status. Results: This study was based on 252 patients with TRD. The mean utility value by health state was 0.41, 0.63, 0.80, and 0.90, for MDE, response, remission, and recovery, respectively. At baseline, 59% of patients had an MADRS score of at least 28. Their baseline average utility value was lower compared to the other patients (0.43 versus 0.58, p &lt, 0.001). This significant difference persisted at the following visits. The rate of patients in MDEs having at least one hospitalisation for depression or other reasons than depression was generally higher than that in the other health states. Conclusion: This study documented patterns in healthcare resource consumption, quality of life, and other characteristics in patients with TRD, both globally and by health state and depression severity.

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.

Depuis la promulgation de la loi du 5 juillet 2011, la mission d’assurer la protection des droits des personnes hospitalisées en psychiatrie sans leur consentement et d’éviter les prises en charge abusives a été confiée au juge des libertés et de la détention. Actuellement, près d’une saisine sur dix aboutit à une mainlevée par le juge des libertés et de la détention, en dépit de la nécessité de soins estimée par les psychiatres. Afin d’améliorer notre compréhension des missions du juge des libertés et de la détention, et des fondements sur lesquels sont basées ses décisions, nous avons réalisé une enquête qualitative auprès des juges des libertés et de la détention du Tribunal de Grande Instance de Lille reposant sur un questionnaire semi-structuré. Les résultats mettent en évidence l’importance d’un respect très précis des procédures afin d’éviter les levées de soins sans consentement immédiates, ainsi que la nécessité d’une description clinique précise et justifiant la procédure de soins psychiatriques sans consentement engagée dans les certificats médicaux. L’intervention du juge des libertés et de la détention auprès des patients souffrant de troubles psychiatriques peut être un signe que la société les considère comme des citoyens, respectés en leurs droits. Toutefois, cette nouvelle mission nécessite un apprentissage progressif, basé sur des échanges réciproques avec les médecins et les soignants. The procedure of involuntary hospitalization in France has been recently modified by the law of 5 July 2011. Since that time, a liberty and custody judge has been appointed to guarantee the rights of psychiatric inpatients and to prevent abusive hospitalizations. Currently, for one involuntary hospitalization in ten a release is decided by the liberty and custody judge although psychiatrists consider that psychiatric care is necessary. In order to improve our understanding of the role of liberty and custody judges, and how they make their decisions, we conducted a qualitative survey of liberty and custody judges in the Tribunal de Grande Instance of Lille. Three judges were questioned, based on a semi-structured interview. Judges’ responses have highlighted the need for psychiatrists to strictly respect the legal procedures and to accurately describe the clinical signs and symptoms that justify the procedure of involuntary hospitalization in the medical certificates. The intervention of liberty and custody judges for patients with psychiatric disorders represents a breakthrough for patients’ rights in France, reflecting that they are considered as citizens, with the same rights as others. Nonetheless, this new mission needs a progressive learning, based on mutual exchanges with doctors and caregivers. 45;6

Les unités hospitalières spécialement aménagées (UHSA) accueillent des personnes détenues qui souffrent d’un trouble psychiatrique nécessitant une prise en charge hospitalière à temps complet. Les pathologies non psychiatriques sont surreprésentées chez les patients souffrant de troubles psychiatriques, mais aussi chez les personnes détenues. Les patients hospitalisés en UHSA sont donc largement exposés à ces pathologies et il apparaît indispensable de s’intéresser à l’organisation de la médecine générale dans ces établissements. L’objectif de cette étude est d’effectuer un état des lieux des soins médicaux généraux en UHSA, au moyen d’une enquête par questionnaire menée auprès des médecins coordonnateurs de l’ensemble des établissements. Les résultats montrent qu’au sein de chaque UHSA, il existe un poste de médecin généraliste, senior ou interne. L’examen physique, le bilan biologique et l’électrocardiogramme sont systématiquement réalisés à l’entrée des patients dans 7, 5 et 9 établissements, respectivement. Toutefois, plusieurs limites sont à soulever. D’abord, dans 3 UHSA seulement les médecins prennent contact avec le médecin traitant du patient. Ensuite, l’extraction du patient est systématique lorsqu’une consultation spécialisée est demandée. Or, pour 6 UHSA, il n’est pas exceptionnel que certaines extractions soient annulées, sans qu’un avis médical ne soit systématiquement demandé. Enfin, le respect du secret médical vis-à-vis de l’administration pénitentiaire est parfois difficile à assurer au cours de ces extractions. À partir des observations réalisées, des pistes d’amélioration pour l’organisation des soins médicaux généraux en UHSA sont proposées autour de quatre grands axes : la structure et l’organisation générale ; l’activité de médecine générale ; le lien avec les partenaires de soin et l’articulation avec l’administration pénitentiaire. The UHSA (UHSA) are French psychiatric units for inmates which admit detainees suffering from a psychiatric disorder requiring full-time hospital care. Non-psychiatric pathologies are overrepresented in patients with psychiatric disorders but also in detainees. As a result, patients hospitalized in UHSA are largely exposed to non-psychiatric conditions, and exploring the organization of general medical care for these patients appears very relevant. The aim of this study is to review the general medical care in all French UHSA. A descriptive study was carried out through a survey of the nine facilities. All UHSA benefit from the intervention of a general practitioner. The physical clinical examination, the biological assessment and the electrocardiogram are systematically performed at the patient's admission in 7, 5 and 9 establishments, respectively. However, the offer of general medical care in UHSA seems disparate and sometimes insufficient. Specialized consultations are regularly requested during hospitalizations, but no establishment benefits from a telemedicine system or specialized consultations on site. The extraction of the patient to the general hospital is therefore systematic when such a consultation is needed. But the number of penitentiary escorts per day is limited. In 6 UHSA, medical extractions are thus regularly canceled by the penitentiary administration, sometimes without a medical opinion. Finally, the patient's regular physician is only contacted in 3 UHSA during hospitalizations. Based on these results, ways of improving the organization of general medical care in UHSA are proposed through four main axes: the structure and general organization; the general medical care; the link with the healthcare partners and the articulation with the penitentiary administration. 45;2

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.

International audience

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.