[Prevalence of mental disorders in French prisons: A systematic review]. / Prévalence des troubles psychiatriques en population carcérale française : une revue systématique de la littérature.

INTRODUCTION: The prevalence of psychiatric disorders among prisoners remains a major public health issue worldwide. In France, despite the increasing number of persons who are incarcerated (+30% between 1992 and 2002 with a 120% prison overcrowding), and a historical concern about the mental health of persons in detention and its management, no systematic review has been published on this subject. The aim of this article is to present the results of a systematic review of the literature on the prevalence of psychiatric disorders in French prisons. METHOD: The reporting of this systematic review conforms to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) checklist. We searched the PubMed and Web of Science databases. We used combinations of keywords relating to prison (prison*, jail*, inmate*), to psychiatry ("mental health", psychiatr*), and to France (France, French). This work was completed with a search through the digital libraries of the École des Hautes Études en Santé Publique (EHESP) and of the Système Universitaire de Documentation (Sudoc) to obtain data from academic works and the gray literature. References cited in studies included in this review were also examined. All references published up to September 2022, written in English or French, presenting the results of original quantitative studies on the prevalence of psychiatric disorders in correctional settings were included. Two researchers independently extracted data from included references according to a pre-established protocol. RESULTS: Among 501 records identified, a total of 35 papers based on 24 epidemiological studies met the eligibility criteria for inclusion in this review: 16 were cross-sectional, 7 retrospective and 1 both cross-sectional and retrospective. All papers were published between 1999 and 2022. We found one European study, 5 international studies, 18 regional or local studies. Of these, 21 studies had all-male or mixed gender samples (but when the sample was mixed gender, it was always at least 92% male). Almost half of the studies (n=11) involved a small sample of fewer than 500 persons. Half of the studies involved a sample of recently incarcerated persons: 6 involved a random sample of persons in detention, and 1 involved a sample of people incarcerated for more than 5 years. The last 5 studies focused on persons aged over 50 years and incarcerated for more than one year (n=1), incarcerated for sexual offences (n=2), placed in disciplinary cells (n=1) or in a special wing for radicalized or suspected radicalized individuals (n=1). Nine studies used standardized and validated diagnostic tools. According to the 4 studies involving representative samples and using standardized and validated diagnostic tools, the prevalence of the following psychiatric disorders was: 29.4-44.4% for anxiety disorders, 5-14.2% for PTSD, 28-31.2% for mood disorders, 6.9-17% for psychotic disorders, 32% for personality disorders and 11% for ADHD. CONCLUSION: This systematic review of the literature highlights the high prevalence of psychiatric disorders in French prisons. The data collected are in line with international studies. The great methodological heterogeneity of the papers included in this review calls for further rigorous research to better understand the rates of mental disorders in French prisons and to explore their determinants.

[Psychiatric emergencies in teleconsultation: legal and practical aspects]. / Urgences psychiatriques en téléconsultation, aspects juridiques et pratiques.

In the context of the Covid-19 pandemic, teleconsultation is an obvious solution in psychiatry to ensure continuity of care and facilitate access. However, the digitisation of ambulatory practices raises a certain number of reservations, in particular concerning the remote management of psychiatric emergencies. These situations, because of the specific aspects they cover, are in fact upsetting texts and recommendations of good practice in terms of teleconsultation. Thus, the questions of eligibility of people suffering from psychiatric disorders, the identification of an immediate self- or hetero-aggressive risk during teleconsultation and the establishment of a measure of psychiatric care without consent at the end of a teleconsultation require specific reflection in order to allow the practitioner to anticipate and manage the situation in the best possible way.

Circular inference in bistable perception.

When facing ambiguous images, the brain switches between mutually exclusive interpretations, a phenomenon known as bistable perception. Despite years of research, a consensus on whether bistability is driven primarily by bottom-up or top-down mechanisms has not been achieved. Here, we adopted a Bayesian approach to reconcile these two theories. Fifty-five healthy participants were exposed to an adaptation of the Necker cube paradigm, in which we manipulated sensory evidence and prior knowledge. Manipulations of both sensory evidence and priors significantly affected the way participants perceived the Necker cube. However, we observed an interaction between the effect of the cue and the effect of the instructions, a finding that is incompatible with Bayes-optimal integration. In contrast, the data were well predicted by a circular inference model. In this model, ambiguous sensory evidence is systematically biased in the direction of current expectations, ultimately resulting in a bistable percept.

[Addiction management in prisons]. / Prise en charge des addictions en milieu carcéral.

High levels of substance-related disorders among incarcerated people have been documented and there is a lot of drug users in French prisons. Several health and social workers are involved in the management of people dealing with addictions in prison. The coordination between substance use and mental health services in correctional settings and in the community is fundamental to ensure treatment continuity for these people.

[Suicide in prison: Epidemiology and prevention]. / Le suicide en prison : épidémiologie et dispositifs de prévention.

Suicide is one of the most important causes of death in prison around the world. In France, suicide rate for prisoners is 18.5 suicides per 10,000 inmates: seven times more common than in the general population. Among the risk factors identified in the literature, those most strongly associated with suicide in prison are physical isolation in custody, psychiatric history and history of suicide attempts. The prevention of suicide in prison involves several measures including treatment of psychiatric disorders, improvement of living conditions in custody, social support of prisoners and use of specific tools and programs by prison supervisors. No program for prevention of suicidal recurrence has ever been implemented. We propose to adapt « VigilanS ¼, a program already applied in the general population, to the prison population.