INTRODUCTION: The processing of sensory information determines the development and growth of a child's abilities. Dysfunction in the processing of sensory stimuli can affect a child's behavior and can disrupt development. Sensory Regulation Disorders are frequently associated with Autism Spectrum Disorder (ASD), with the DSM-5 even including it as a diagnostic criterion. However, they are also observed in other neurodevelopmental disorders. At present, the frequency of Sensory Regulation Disorders in children consulting child psychiatry has never been evaluated, although it seems to be a population at risk. OBJECTIVES: To evaluate the frequency of sensory regulation disorders in children between 3 and 6 years old who first consult a child psychiatrist in Marseille. To determine whether certain reasons for consultation are correlated with the presence of sensory regulation disorders. METHODS: A multicenter cross-sectional study was conducted for four months in Marseille. Sensory regulation disorders were assessed by the second version of Dunn's short sensory profile. RESULTS: Fifty-eight patients were included. A significant difference was found between the frequency of SRT in our primary child psychiatry population and the general population. Subgroup analyses according to the reason for consultation showed that there would be more SRT in the Motor Instability/Inattention, Conduct Disorder and Socialization Disorder subgroups. CONCLUSION: We observed a higher frequency of SRT in the child psychiatry consultation population. SRT could explain, or at least partly participate in, the children's symptomatology. The results are in favor of an early detection of SRT in the population of children consulting child psychiatry. The evaluation of the sensory profiles of these children allows a better understanding of the child's functioning and an adjustment of the intervention and support strategies proposed to the family.
Autism Spectrum Disorder , Child Psychiatry , Neurodevelopmental Disorders , Child , Humans , Child, Preschool , Autism Spectrum Disorder/diagnosis , Autism Spectrum Disorder/epidemiology , Cross-Sectional Studies , Neurodevelopmental Disorders/diagnosis , Neurodevelopmental Disorders/epidemiology , Cognition
Folie à deux is a psychiatric illness involved in homicides. OBJECTIVE: To study the mechanisms leading to homicide and determine homicide risk factors in folie à deux patients through a literature review and the study of a complex clinical case. MATERIALS AND METHODS: We included articles available on PubMed, ScienceDirect or Cairn that address the forensic implications of folie à deux. Then, we analyzed the criminal psychiatric assessments of two murderers (husband and wife) of a child in a case of folie à deux. RESULTS: Seventeen articles were included. In the cases examined, homicides were committed with great violence, usually against a victim in the family circle, and were sometimes followed by suicide. The main risk factor for homicide was the combination of mystical and persecutory delusions. The homicides occurred in response to destabilization of the delusional dyads. Concerning the clinical case, we described the circumstances surrounding the killing and analyzed the four expert reports that permit us to infer the occurrence of induced psychosis, which is a form of folie à deux. DISCUSSION: Psychiatrists must attain a better knowledge of folie à deux to allow early identification of risk situations and to improve their assessments.
Criminals/psychology , Delusions/psychology , Homicide/psychology , Shared Paranoid Disorder/psychology , Expert Testimony , Female , Forensic Psychiatry , Humans , Male , Risk Factors , Shared Paranoid Disorder/epidemiology , Suicide
INTRODUCTION: People suffering from autism spectrum disorders (ASD) provide atypical responses to sensorial stimulations, indicating specific sensory processing. These responses vary from one another and within the same individual with ASD, resulting in maladaptive functional capacities in everyday life. Factors explaining those specificities are poorly defined and need to be better identified. OBJECTIVES: To examine the relationship between sensory modulation symptoms (SMSs) and maladaptive behaviors in a group of children with ASD. To study how the sensory processing patterns in ASD are related to chronological age, intensity of autistic symptoms, and associated intellectual disability. METHOD: A transversal observational study of a group of children with ASD was conducted for 1 year in an Autism Resource Centre in Marseille, France. The SMSs were assessed using the Dunn short sensory profile. The adaptive behaviors and social quotient were assessed using the Vineland adaptive behavior scale. RESULTS: Forty-five children with ASD completed both scales. Significant correlations were found between SMS intensity and the children's adaptive behaviors. Furthermore, chronological age and intellectual disability showed a significant relationship with SMS intensity; chronological age and intellectual disability were also found to be significantly related. However, the severity of autistic symptoms was not associated with the intensity of SMSs. CONCLUSION: These outcomes give a better understanding of sensory processing in ASD. The analysis of sensory processing is valuable during the diagnostic phase and for the development of individualized/custom-tailored interventions.
The criminal psychiatric assessment in France seems to be facing growing criticism related to disagreements between experts and, on the other hand, a lack of interest of psychiatrists for the assessment. We start by explaining the current framework of the criminal psychiatric assessment in France, which differs from the assessment used in English-speaking countries, where Roman law applies. Then, we will describe the disagreements through a literature review and two clinical vignettes. Finally, we will try to understand the causes of discrepancies between experts and the reasons for a supposed lack of interest of the psychiatrists for the expertise. For this, we conducted a survey among the psychiatric experts. We individually questioned experts on the discrepancies and on their awareness of the expertise. We found that 75% of the experts we surveyed had already faced the divergent opinion of a colleague. In addition, the experts were divided on their conclusions related to the fictional scenario we gave them for an a priori assessment (a person with schizophrenia who was accused of murder), particularly in the specific contexts that we submitted to them. The main cause of disagreement between experts was the various schools of thought that influence the psychiatric experts in the forensic discussion and, therefore, the conclusions of a case. Moreover, the experts believed that the decrease in the number of psychiatric experts could be attributed to the adverse financial situation of the assessment, the considerable workload required, and the extensive responsibility that falls on the expert. Calling on a team of forensic experts to perform assessments seems to be the first solution to this crisis. Furthermore, if the experts were better compensated for the assessments, more people would want to undertake this work.
Forensic Psychiatry , Crime/legislation & jurisprudence , Crime/psychology , Expert Testimony/legislation & jurisprudence , Forensic Psychiatry/legislation & jurisprudence , Forensic Psychiatry/organization & administration , France , Humans , Mental Disorders/diagnosis , Psychiatry/legislation & jurisprudence , Psychiatry/organization & administration
INTRODUCTION: In France, forensic psychiatric assessment plays a central role in the relationship between psychiatry and justice. The psychiatric expert is commissioned to determine whether or not the accused has a mental disorder and to specify whether or not it affected discernment at the time of offense. Nowadays, psychiatric expertise is coming under more and more criticism, particularly regarding divergences between experts. OBJECTIVES: Our objectives were to find points of divergence between experts, try to understand causes and suggest ways to try to reduce them. METHODS: For this we conducted a study, between July 2012 and January 2013, with psychiatric experts of the Court of Appeal of Aix-en-Provence through semi-structured interviews. We focused on a limited context: psychiatric expertise of responsibility for schizophrenic persons accused of murder. We questioned the experts about the issue of criminal liability of a person with schizophrenia in general but also in clinical situations we thought particularly involved in disagreements. RESULTS: We recruited a population of 17 psychiatrists, mostly males of average age of 58 years, working mostly in the department of adult psychiatry of a hospital. We highlighted the differences between the experts, first with regards to the issue of liability in general. Experts divided seemed to keep in majority (52.9 %) the alternative between abolition and alteration of discernment when faced with a schizophrenic person accused of murder. The differences were even more pronounced in specific contexts. Thus, the fact that the person had suffered from delirium at the time of the offense led half of the experts (47.1 %) to conclude a systematic abolition of discernment, while the other half made such a conclusion when the delirium was directly linked to the facts. Discontinuation of neuroleptic treatment, drug abuse or existence of premeditation changed the conclusions of the experts in half the cases, more in the sense of an increased accountability in the cases of drug abuse or premeditation, and in the direction of a reduction of liability in case of cessation of treatment. The denial of facts by the accused caused fewer disagreements between experts. Among experts, 76.5 % had already observed differences, which, according to them, were based primarily on schools of thought, or personal views (64.7 %), which could distort clinical evaluation and especially forensic interpretation of the relationship between pathology and facts. The experts thought it was possible and desirable to reduce differences and proposed different solutions for this, especially the return to dual expertise and colleges of experts. DISCUSSION: Our results were consistent with those in the literature. Based on proposals from experts and data from the literature, we identified five perspectives likely to reduce differences: first it would be useful to put in place a better specific training in forensic psychiatry and expertise, not only theoretical but also in terms of practical training through tutoring. We would identify a jurisprudence in forensic psychiatric assessment and identify consensual points. It would be good to allow experts to acquire sufficient experience not just through tutorials but also by statutory changes. Moments of exchange between experts - including a return to dual expertise and the organization of work meeting - could also reduce differences. Finally, we propose legislative changes: not only to rewrite the paragraph 2 of Article 122-1 of the French Penal Code, but also to give priority to the expertise of responsibility on the expertise of dangerousness. CONCLUSION: We showed that there were differences between the experts mainly concerned with the forensic interpretation, and that they seemed linked to schools of thought or to personal views of each expert. To reduce the differences, we discussed five perspectives.
Expert Testimony/legislation & jurisprudence , Forensic Psychiatry/legislation & jurisprudence , Homicide/legislation & jurisprudence , Homicide/psychology , Schizophrenic Psychology , Adult , Antipsychotic Agents/therapeutic use , Commitment of Mentally Ill , Dangerous Behavior , Female , France , Humans , Liability, Legal , Male , Middle Aged , Patient Compliance , Psychiatry , Surveys and Questionnaires
INTRODUCTION: Forensic psychiatric assessment regarding liability ensures a balance between justice and psychiatry. In France, criminal assessment is not contradictory. The psychiatric expert is commissioned by judges to determine whether or not the accused has a mental disorder and specify whether it affects discernment and control of actions at the time of offense. Its mission focuses on the mental element required to constitute an offense, and is structured around Article 122-1 of the Criminal Code. This article, composed of two paragraphs, distinguishes the framework of the abolition of discernment a cause of non-imputability and therefore of a statement of lack of criminal responsibility due to mental disorder and the framework of the alteration of discernment. Nowadays expertise seems to meet discomfort, with criticism focusing on possible differences among psychiatric experts, without specific studies having been conducted to confirm it. OBJECTIVES: Our objective was to identify the main points of disagreement between psychiatric experts and to propose explicative hypotheses. MATERIALS AND METHODS: For this, we carried out a literature review on PubMed, Science Direct and Cairn, and studied the report of the 2007 public hearing on forensic psychiatric assessment with contributions from different authors. The keywords were: forensic psychiatry, psychiatric court report, psychiatric expertise, differences among experts, legal responsibility, and discernment. We defined differences as disagreements between experts, or as a mismatch in conclusions and approaches of experts. RESULTS: The differences among experts concerned mainly forensic interpretation, i.e. the discussion of the relationship between pathology and offense, particularly in contexts that involve a larger forensic discussion, including interruption of medication, use of drugs, association with antisocial personality, premeditation, denial of facts, especially when the accused suffers from a mental illness (especially schizophrenia). For a finding of abolition of discernment, an expert must consider two requirements, one temporal (the mental disease must be active during offense) and the other causal that involves seeking a direct and exclusive relationship between the offence and the mental state, according to expert jurisprudence. Some experts do not comply with these two requirements or this jurisprudence, whence differences. There were also diagnostic differences and disputes relating to the concept of "alteration of discernment". Disagreements appeared to be related primarily to personal ideologies or different schools of thought that influenced interpretations and conclusions of experts, e.g. accountability as a therapeutic response for the psychotic person. Then, the lack of clarity of expert mission regarding necessary causal relationship between any disease and crime to demonstrate to conclude an abolition of discernment, could also contribute to differences. Moreover, time available to achieve the mission is too short and the expert would not devote enough time to an expert examination, which could lead to less good expertise and differences; especially as observed clinical examination in expertise is sometimes difficult, misleading, due to pathological reticence of accused mentally ill but also sometimes due to possible simulations. Finally, the low quality of some expert reports due in part to the less well-trained experts, but also the particular conditions of achievement of expertise, especially in prisons were mentioned by some authors as causes of differences. DISCUSSION: It appears from this review of literature that differences mainly concern forensic interpretation and are mainly explained by ideologies. This synthesis is a preliminary work prior to a study among psychiatric experts.
Dissent and Disputes , Expert Testimony/legislation & jurisprudence , Insanity Defense , Mental Competency/legislation & jurisprudence , Mental Disorders/diagnosis , Mental Disorders/psychology , France , Humans , Observer Variation
INTRODUCTION: The return of restraint in psychiatry raises many ethical issues for caregivers. However their experience is little explored in literature. OBJECTIVES: Our objective was to study the feelings of caregivers facing restraint with regard to an ethical perspective and to identify areas for improvement. METHOD: Between November 2011 and February 2012 a descriptive cross-sectional epidemiological study was performed in two psychiatric emergency services and two closed units in which doctors and nurses were individually interviewed using semi-structured questionnaires. Five topics were explored: indications and contexts, impact on the patient, caregiver-patient relationship, perspective on the practice and feelings of caregivers on which we insist particularly. Results were presented in tables with percentages and possibly diagrams. The notable responses of caregivers were also cited. RESULTS: Twenty nurses and nine psychiatrists, mostly female, were recruited. They all had participated in experiments of restraint. The self-aggressiveness, the aggressiveness against other persons and agitation were the most frequent indications. In the patients, caregivers identified misunderstanding (79.3%) and anger (75.9%). The majority of nurses (75%) felt that there was an improvement in the caregiver-patient relationship after the episode of restraint compared to what it had been in the moments preceding this measure. The emotional experience of caregivers was rich, intense and predominantly negative type of frustration (35% of nurses; 66.7% of doctors), anger (30 and 33.3%) and lack of feeling (35 and 44.4%). The feelings of doctors and nurses were not completely similar. For caregivers it was "a difficult but necessary experience" (82.75%), "an act of care and safety" (68.9%). All psychiatrists and almost half of the nurses (45%) said they did not feel the same when they used seclusion. In their opinion, seclusion entailed a less painful experience because of its therapeutic properties. More than half of the caregivers thought that there were alternatives to restraint: the strengthening of containing function in the hours before the use of restraint; the use of seclusion at the time of the decision to restrain. They identified contexts (80%) encouraging the use of restraints, not only related to the patient, the lack of resources but also institutional contexts, in particular conflicts or divisions in the health care team. DISCUSSION: The misunderstanding of the patient led us to wonder about the quality of the information he/she received: it was sometimes too formal and did not take into account the uniqueness of the patient. The frustration of caregivers could concern the lack of resources but also be directed towards a patient or caregiver. In addition, there were often cleavages between doctors and nurses that stemmed from a misunderstanding, also with rivalries and power struggles. From the literature and caregivers' reflections we identified three prospects to reduce the use of restraint and modify feelings of caregivers: 1) develop better crisis management upstream through increasing resources and improving training; 2) promote patients support in using ethical principles of autonomy and beneficence by showing them solicitude, inviting them to tell themselves and helping them to regain their own experience; 3) develop an afterthought in setting up institutional reflection time by restoring a central role in clinical team meetings in psychiatry, possibly supplemented by supervision, but also through regional ethical spaces. CONCLUSION: In our investigation, we found that caregivers had a predominantly negative experience with frustration, anger and a lack of feeling. Among caregivers we also identified awareness of ethical issues that may be for the first time for a change.
Attitude of Health Personnel , Ethics, Medical , Mental Disorders/therapy , Restraint, Physical/ethics , Restraint, Physical/psychology , Adolescent , Adult , Aggression/ethics , Aggression/psychology , Cooperative Behavior , Cross-Sectional Studies , Emergency Services, Psychiatric/ethics , Female , France , Humans , Interdisciplinary Communication , Male , Mental Disorders/psychology , Nurse-Patient Relations/ethics , Patient Isolation/ethics , Patient Isolation/psychology , Patient Safety , Patient Satisfaction , Physician-Patient Relations/ethics , Psychomotor Agitation/psychology , Psychomotor Agitation/therapy , Self-Injurious Behavior/psychology , Self-Injurious Behavior/therapy , Surveys and Questionnaires , Treatment Outcome , Young Adult
Families of 241 patients among 913 cases of idiopathic scoliosis were surveyed. The data suggest two possible modes of inheritance: either an autosomal dominant inheritance with incomplete penetrance and more frequent manifestation in girls than boys, or a genetic heterogeneity with a mixture of dominant and multifactorial modes of inheritance.
Scoliosis/genetics , Abnormalities, Multiple/genetics , Adolescent , Age Factors , Child , Child, Preschool , Female , Genes, Dominant , Humans , Infant , Male , Maternal Age , Paternal Age , Sex Chromosomes , Sex Factors
Cystic Fibrosis , Breathing Exercises , Celiac Disease/etiology , Child , Child, Preschool , Cystic Fibrosis/complications , Cystic Fibrosis/diagnosis , Cystic Fibrosis/therapy , Female , France , Hospitals, Special , Humans , Infant , Leukocytosis/etiology , Lipid Metabolism , Liver Function Tests , Male , Physical Therapy Modalities , Prognosis , Pulmonary Emphysema/etiology , Respiratory Tract Diseases/etiology , Sputum/microbiology , Sweat/analysis
Cholecalciferol/pharmacology , Alkaline Phosphatase/blood , Calcium/blood , Calcium/urine , Child , Child, Preschool , Citrates/blood , Citrates/urine , Creatinine/urine , Diuresis , Female , Humans , Intestinal Mucosa/drug effects , Magnesium/blood , Magnesium/urine , Male , Phosphates/blood , Phosphates/urine , Statistics as Topic
