[Definition, derogation and application of the professional secrecy within the frame of court ordered cares: A systematic review of the French legal and health literature since 1998]. / Définitions, dérogations et applications du secret professionnel dans le cadre des soins pénalement ordonnées : revue de la littérature médicale et juridique française depuis 1998.

INTRODUCTION: Guaranteed by several legal and deontological dispositions, professional secrecy is an essential aspect of medical care, especially concerning the therapeutic alliance. Since the creation in French law of court-ordered treatment, some information is likely to be shared between actors either from the field of healthcare or of justice. This questions the type of information that can be shared and the variances existing between the different types of court-ordered treatments, which are to be known by the professionals. METHODS: Following the methodology of the French Haute Autorité de Santé, a systematic review of the legal and health literature has been conducted. Different databases such as PubMed, Cairn and Legifrance have been reviewed with the following keywords « secret ¼, « injonction de soins ¼ (court-ordered treatment) and « obligation de soins ¼ (obligation of care). Only the French literature since 1998 has been retained and because it is often less pronounced by the courts, the case of the therapeutic injunction, which represents the third type of court-ordered care, has been excluded. RESULTS: Concerning the court-ordered treatment, on the one hand, the coordinating physician addresses the elements required in the control of measure to the Executive Magistrate. On the other hand, the Executive Magistrate sends a copy of the piece of the procedure to the coordinating physician, who transmits it to the general practitioner. The therapist can derogate from the medical secrecy in some circumstances as said in the law, either through the coordinating physician or the Executive Magistrate. In the case of obligation of care, where there is no coordinating physician, the general practitioner is still submitted to the classical rules of medical secrecy and only has to produce certificates of the follow-up with the patient. DISCUSSION: Some authors have expressed their reservations about these new laws of derogation, especially concerning the blurred lines of the exception to these laws. Others have underlined the astonishing differences between court-ordered treatment and the obligation of care for almost similar clinical situations. CONCLUSION: The rules of shared information must be known by the professionals and stated clearly to the patient at the beginning of treatment. Then, professionals are invited to remain thoughtful concerning the nature of this information. Finally, and as the public hearing of June 2018, promoted by the FFCRIAVS (Fédération Française des Centres Ressources pour les Intervenants auprès des Auteurs de Violences Sexuelles), said, it could be interesting to promote meeting spaces between the different actors of the management of people under court ordered cares, so as to better identify the limits of each one.

[Towards better management for sexual offenders: Presentation and conclusions of a public hearing concerning prevention, assessment, and care]. / Audition publique auteurs de violences sexuelles : prévention, évaluation, prise en charge des 14 et 15 juin 2018 : perspectives et préconisations.

In France, since the law of June 17, 1998, sexual offenders may be convicted to ambulatory mandatory care, articulated with the justice. Twenty years after the implementation of this law, while social and technological developments have redefined certain aspects of delinquency, reference documents and practice guidelines remain to be updated. This is why the professionals of the main structures and associations dealing with perpetrators of sexual violence organized a public hearing under the sponsorship of the French Federation of Resource Centers for Sexual Violence Perpetrators (FFCRIAVS) according to the methodology and with the accompaniment of the High Authority of Health. This article presents the global methodology of the public hearing "Sexual Offenders: Prevention, Evaluation and Care" which was conducted on June 14 and 15, 2018. Thirty-three experts replied to27 questions and presented their conclusions to an Audition Committee and an audience of 200 persons representative of the civil and professional society. After a public debate, the hearing committee prepared a report in which they proposed propositions in order to better care for sexual offenders.

[Mental health care in French correctional facilities during the Covid-19 pandemic]. / Prisons confinées : quelles conséquences pour les soins psychiatriques et la santé mentale des personnes détenues en France ?

OBJECTIVE: The impact of the Covid-19 pandemic on the 11 million people currently incarcerated worldwide is the subject of many concerns. Prisons and jails are filled with people suffering from many preexisting medical conditions increasing the risk of complications. Detainees' access to medical services is already limited and overcrowding poses a threat of massive contagion. Beyond the health impact of the crisis, the tightening of prison conditions worries. On March 16, 2020, in France, the lockdown measures have been accompanied by specific provisions for prisons: all facilities have suspended visitations, group activities and external interventions. Over 10,000 prisoners have been released to reduce the prison population and the risk of virus propagation. These adjustments had major consequences on the healthcare system in French prisons. The objectives of this article are to describe the reorganization of the three levels of psychiatric care for inmates in France in the context of Covid-19 pandemic and to have a look at the impact of lockdown measures and early releases on mental health of prisoners. METHODS: This work is based on a survey conducted in April 2020 in France among psychiatric healthcare providers working in 42 ambulatory units for inmates and in the 9 full-time inpatient psychiatric wards exclusively for inmates called "UHSAs" (which stands for "unités hospitalières spécialement aménagées", and can be translated as "specially equipped hospital units"). A review of the international literature on mental healthcare system for inmates during the Covid-19 epidemic has also been performed. RESULTS: The Covid-19 epidemic has been rather contained during the period of confinement in French prisons but the impact of confinement measures on the prison population is significant. The three levels of psychiatric care for inmates have implemented specific measures to ensure continuity of care, to support detainees during Coronavirus lockdown and to prevent an infection's spread. Among the most important are: limitation of medical consultations to serious and urgent cases, creation of "Covid units", cancellation of voluntary psychiatric hospitalizations, reinforcement of preventive hygiene measures and reshuffling of medical staff. Prolonged confinement has consequences on mental health of detainees. Currently, mental health workers are facing multiple clinical situations such as forced drug and substance withdrawal (linked to difficulties in supplying psychoactive substances), symptoms of anxiety (due to concerns for their own and their relatives' well-being) and decompensation among patients with severe psychiatric conditions. Early releases from prison may also raise some issues. People recently released from prison are identified as at high risk of death by suicide and drug overdose. The lack of time to provide the necessary link between health services within prisons and health structures outside could have serious consequences, emphasizing the well-known "revolving prison doors" effect. DISCUSSION: The current lockdown measures applied in French jails and prisons point out the disparities between psychiatric care for inmates and psychiatric care for general population. Giving the high vulnerability of prison population, public health authorities should pay more attention to health care in prisons.

[Insight and psychiatric dangerousness: A review of the literature]. / Insight et dangerosité psychiatrique : revue de la littérature.

INTRODUCTION: Violence committed by individuals with severe mental illness has become an increasing focus of concern among clinicians, policy makers, and the general public, often as the result of tragic events. Research has shown in the past two decades an increased risk of violence among patients with mental disorder. Nevertheless, of those suffering from mental illness, perpetrators of other directed violence form a minority subgroup. The means by which there is this association between mental illness and violence has remained controversial. Factors such as positive psychotic symptoms, medication non-adherence, alcohol or psychoactive substance abuse and antisocial personality were found to be predictive of violence. Overall, literature provides support to the assertion that violent behavior of mentally ill patients is a heterogeneous phenomenon that is driven by multiple inter-related and independent factors. Furthermore, psychiatrists are often asked to predict an individual's future dangerousness, in a medical or a legal context. In the process of risk assessment of dangerousness, more focus has been placed on dynamic risk factor. In this context, lack of insight has established itself both as a part of violence risk models and as a clinical item in structured approaches to measure dangerousness. However, few studies have tested these associations. The main purpose of this paper is to review the literature concerning the relationship between insight and dangerousness and discuss the contributions of the insight in the assessment of dangerousness in patients with mental illness. We included twenty studies that evaluated the association between insight and variable such as physical or verbal violence, aggressiveness, hostility or sexual aggression. RESULTS: According to the findings of this review, the strength and specific nature of this relationship remain unclear due to considerable methodological and conceptual shortcomings, including heterogeneity in the definition and assessment of violence, a minority of prospective studies and the lack of systematic consideration of possible confounding variables. However, the ability of the patient to perceive their illness is an important element to be considered in assessing the dangerousness both medically and legally. Higher belief flexibility and lower confidentiality of individual judgment, which reflect greater cognitive insight, may be associated with a lower incidence of violence, in particular in schizophrenia by decreasing the degree of confidence related to psychotic symptoms. CONCLUSION: In the growing efforts to reduce stigma associated with mental illness, it is important to identify a subgroup of patients at risk of violence and provide them with targeted treatment. In this sense, it seems important in the future to continue in this field of research to determine if the lack of insight is a covariate of a worsened condition or a specific violence risk factor per se.

Low time resolution in schizophrenia Lengthened windows of simultaneity for visual, auditory and bimodal stimuli.

The guarantee of perceptual coherence for events through everyday life situations depends upon the capacity to correctly integrate series of multi-sensory experiences. Patients with schizophrenia have been shown to reveal a deficit in integrating, i.e., "binding", perceptual information together. However, results in the literature have also suggested the reverse effect. Indeed, in certain paradigms patients have revealed more binding phenomenon than healthy controls and reported experiencing two distinct events as occurring "together". This finding suggests that patients may require longer time intervals between two distinct events before being able to perceive them as "one-after-the-other". The question here was to test whether this perceptual binding abnormality in schizophrenia is confined to events within the same modality or whether it is also present across sensory modalities. Thirty patients with schizophrenia were compared with 33 normal controls using a simultaneity judgement paradigm. There were two uni-modal conditions in which stimuli were presented in the same modality (visual or auditory) and one bimodal condition (audio-visual). Participants were presented with stimuli varying across a range of inter-stimulus intervals (ISI). They were required to judge whether they experienced two stimuli as occurring "together" or "one-after-the-other". Compared to controls and in all conditions, patients needed larger ISI to experience two stimuli as "one-after-the-other" (all ISI x Group interactions p<5 x 10(-5)). These abnormalities correlated with the disorganization dimension but not with the dosage of chlorpromazine equivalent. The increase of the time interval needed to perceive two stimuli as "one-after-the-other", reflect an abnormally low time resolution in patients with schizophrenia. We discuss the possible involvement of anatomical disconnectivity in schizophrenia which would specifically affect the time integration properties of neural assemblies.