[The risk of reoffending, a major concern of the doctor-coordinator]. / Le risque de récidive, une préoccupation majeure du médecin coordonnateur.

Doctor-coordinators are nominated by the judge for the enforcement of sentences as soon as socio-judicial supervision with court-ordered therapy is to be implemented. Their mission is to facilitate the contact between offenders and the general practitioner likely to be working with them on the therapeutic level. The experience of the doctor-coordinator in Bordeaux sheds light on the conditions in which this function is performed. Identifying elements which may be considered as indicators of the risk of reoffending is, in daily practice, a constant concern for this specialist.

Self-perceived cognitive deficits and occupational outcome in persons with schizophrenia.

A two-year prospective follow-up study was used to explore whether self-perceived cognitive deficits (SPCD) predict occupational outcome in persons with schizophrenia. Cognitive complaints were assessed using the Scale to Investigate Cognition in Schizophrenia (SSTICS) in persons with schizophrenia requesting disability status. A higher level of SPCD was associated with better occupational outcome, independently from other characteristics. Persons with better social functioning may have a higher level of metacognition allowing a greater awareness of their cognitive difficulties. Measures of cognitive complaints should be complemented by objective testing to assess potential for vocational rehabilitation.

Characteristics associated with duration of employment of persons with schizophrenia after first contact with psychiatric services.

The aim was to explore the demographic and clinical characteristics influencing the duration of employment after onset of schizophrenia. Occupational history was assessed in persons with schizophrenia (n=102) requesting the status of disabled person for the first time. Multivariate analyses were used to explore the characteristics independently associated with duration of work after the first contact with psychiatric services. Duration of employment was categorized into "never worked", "worked less than half of the time", "worked half of the time or more". More than half of patients never worked after the first contact with psychiatric services. Compared to them, persons who were employed half of the time or more were more likely to have a higher educational level and a long duration of employment before illness onset. Persons who were employed less than half of the time presented with clinical markers of poor prognosis, i.e. higher frequency of alcohol use disorder and higher number of hospitalisations. Persons unable to keep enduring employment after illness onset may have different needs regarding social and rehabilitation management compared to those able to maintain a working activity over a long period.

Time between schizophrenia onset and first request for disability status in France and associated patient characteristics.

OBJECTIVE: This study examined a sample of French persons with schizophrenia to explore the occupational history between onset of illness and first request for disability status, the duration of this period, and the demographic and clinical characteristics associated with a long duration. METHODS: Persons with schizophrenia or schizoaffective disorder (N=110) requesting a disability allowance or the status of disabled worker for the first time were assessed by using a standardized questionnaire that collected information on clinical, occupational, and income history. Characteristics associated with a long duration were explored by using multivariate analyses. RESULTS: The majority of persons (92%) worked at least once during their lifetime, but this proportion fell dramatically to less than half after the onset of illness. Nearly half of the participants did not receive any income outside of financial support from the family after the onset of illness. The median delay between the onset of illness and the first request for disability status was four years. The characteristics independently predicting a long duration (that is, any time longer than the median, or four or more years) of the period between illness onset and first request were older age, higher educational level, a longer period of working after illness onset, and more than one psychiatric hospitalization. CONCLUSIONS: Professionals who choose to delay requesting disability benefits for their clients in order to promote social rehabilitation may paradoxically exacerbate the social consequences of the disease because of clients' lack of resources. Future studies should further explore the implicit and explicit criteria used by mental health professionals and social workers in deciding whether a person with schizophrenia should request disability benefits.