Admission to jail and psychotic symptoms: a study of the psychotic continuum in a sample of recently incarcerated men.

PURPOSE: We sought to measure the prevalence of psychotic symptoms (PSs) and psychotic disorders (PDs) in a sample of men entering jail and to compare these prevalences with those observed in the general population. We also aimed to explore the sociodemographic and clinical factors associated with PSs and PDs. METHODS: The Mental Health in the Prison Population (MHPP) survey interviewed 630 incarcerated men upon admission to jail, using the Mini International Neuropsychiatric Interview. We looked for associations between sociodemographic and clinical characteristics and the presence of lifetime PSs and PDs in the MHPP and Mental Health in the General Population (MHGP) surveys, which used the same methodology to collect data from the jail and general populations of the same geographical area. RESULTS: A higher proportion of PSs without PDs was found in the MHGP group (25.3% vs. 17.8%, p < 0.001), whereas a higher prevalence of PDs was found in the MHPP group (7.0% vs. 2.6%, p < 0.001). The multivariable model indicated that subjects who were single or separated/divorced/widowed and had a history of trauma exposure were at joint risk of PSs and PDs, whereas entering jail was not associated with either PSs or PDs after adjustment for all covariates. CONCLUSION: The present study shows that PDs, but not PSs, are more prevalent in men entering jail than in the general population. This overrepresentation could be further explained by the exposure to vulnerability factors found in this population rather than by any specificity related to entering jail.

Impact of follow-up by peer support workers on mental health service users' global functioning and self-stigmatisation.

OBJECTIVES: The introduction of the first French professional peer support workers training program. (« Médiateurs de santé pairs en santé mentale ¼) led to a series of evaluations. After a number of qualitative studies demonstrating benefits of peer support for all stakeholders, our objective was to evaluate its direct effects for users by focusing on repeated quantitative measures: global functioning and self-stigma scores. The hypothesis was that peer support would improve the former and decrease the latter. METHOD: The procedure was based on a one-year follow-up of two groups of mental health service users. Both groups received usual care, either with or without additional peer support. All of them were asked to respond to three questionnaires at the beginning of the study and 6 and 12 months later: a sociodemographic and clinical questionnaire, a global functioning scale and a self-stigmatization scale. Samples included 85/64/35 participants at the three stages for the PHM group, and 205/157/105 for the control group. RESULTS: Peer support improved global functioning. Nevertheless, it had no impact on self-stigmatization scores which remained rather low throughout the observational period. CONCLUSIONS: Despite difficulties concerning follow-up of service users during the course of the study and the reluctance to integrate a new profession based on experiential knowledge, it appears that the hope of recovery can improve global functioning of people with mental disorders. The reasons for low self-stigmatization and its stability over time remain to be explored.

Building an empowerment program to improve the health of patients with severe mental disorders / Exemple de coconstruction d'un programme d'empowerment en faveur de la santé des personnes vivant avec des troubles psychiques

Introduction: Risk factors and cardiovascular diseases are overrepresented in people with severe and persistent mental disorders. A person diagnosed with schizophrenia or bipolar disorder is two to three times more likely to die of cardiovascular disease than the general population. Purpose of research: An empowerment program has been co-created to reduce these health inequalities. It is one part of the COPsyCAT project. The people-centered approach has been used. The participation of the patients, caregivers, and health professionals was decisive. Results: Stakeholders redefined the objectives of the program. The aim is to improve quality of life, rather than reducing cardiovascular risk. Existing tools -that have been evaluated for their usability - were selected to allow for self-directed patient orientation, so that the constraints between psychiatry and primary care could be circumvented. The program is based on the pooling of existing resources in a territory. The individual power of action and the organization of healthy offers are thus designed to reinforce each other. Conclusions: This article concretely describes the steps through to which the COPsyCAT empowerment program was designed, in co-construction by the researchers of the study, the users and user associations and healthcare professionals at based on their experiential knowledge. The feasibility of the program and the appropriation of tools in real situations will soon be evaluated. The measure of the program's effectiveness on cardiovascular risk will come in second time.

Introduction: Au sein de la population présentant des troubles psychiques sévères et persistants, on observe une surreprésentation des facteurs de risque et des pathologies cardiovasculaires. Une personne chez qui un diagnostic de schizophrénie ou de troubles bipolaires a été porté aurait deux à trois fois plus de risque de mourir d'une maladie cardiovasculaire que la population générale. But de l'étude: Dans le cadre du projet « Collaboration patient-soignant pour une meilleure prise en charge des troubles cardiovasculaires des patients souffrant de troubles psychiques au long cours ¼ (COPsyCAT), un programme d'empowerment a été coconstruit pour réduire ces inégalités de santé. La prise en compte de l'expérience et des besoins des patients, de leurs aidants et des professionnels de santé est au cœur de chacune des étapes méthodologiques suivies pour la création du programme. Résultats: Les parties prenantes ont défini le programme comme devant viser l'amélioration de la qualité de vie et non la réduction du risque cardiovasculaire. Des outils ont été sélectionnés selon leur maniabilité pour permettre l'orientation autogérée des patients, de telle sorte que les contraintes inhérentes aux cloisonnements entre psychiatrie et soins primaires soient contournées. Le programme se base sur la mutualisation des ressources existantes sur un territoire. Pouvoir d'agir individuel et construction de contexte favorable à la santé sont ainsi pensés pour se renforcer mutuellement et agir sur des leviers réformateurs. Conclusions: Cet article décrit concrètement les étapes grâce auxquelles le programme d'empowerment COPsyCAT a été conçu, en coconstruction par les chercheurs de l'étude, les usagers et associations d'usagers et les professionnels de santé à partir de leurs savoirs expérientiels. La faisabilité du programme et l'appropriation des outils en situation réelle va être prochainement évaluée. La mesure de l'efficacité du programme sur le risque cardiovasculaire viendra dans un second temps.

Gender-related associations between psychiatric disorders and alcohol use disorder: Findings from the french "Mental health in the general population" survey.

Women with alcohol use disorder (AUD) might be particularly vulnerable to psychiatric comorbidities. However, population surveys have yielded disparate findings. We used data from the French Mental Health in the General Population survey to investigate gender-related risks of psychiatric comorbidities associated with AUD. A cross-sectional survey based on face-to-face interviews, including the Mini International Neuropsychiatric Interview, was conducted among 38,717 subjects. Logistic regression models were used to assess risks of psychiatric comorbidities associated with AUD. After adjustment for socio-demographics and other psychiatric disorders, both women and men with AUD were at higher risk of comorbid depressive disorder (odds ratio [OR] = 2.6, 95% confidence interval [CI]: 2.0-3.4 in women, and OR = 2.0, 95% CI: 1.7-2.4 in men), bipolar I disorder (2.5; 1.4-4.4 in women vs. 2.6; 1.9-3.4 in men), and psychotic disorder (1.6; 1.01-2.5 in women vs. 1.8; 1.4-2.3 in men). Women with AUD exhibited an increased risk of comorbid panic disorder (OR = 1.6, 95% CI: 1.1-2.2) while the increased risk of post-traumatic stress disorder (PTSD) was significant in men only (OR = 2.6, 95% CI: 1.6-4.2). The increased risk of comorbid substance use disorder (SUD) was more elevated in women, compared to men (12.9; 8.1-18.1 vs. 4.8; 4.0-5.8 in men). Most of psychiatric conditions were over-represented in both women and men with AUD, relative to controls. Gender-specific findings were that women with AUD had an increased risk of comorbid SUD or panic disorder, while men had a significantly higher risk of comorbid PTSD.

Substance Use, Substance Use Disorders, and Co-Occurring Psychiatric Disorders in Recently Incarcerated Men: A Comparison with the General Population.

INTRODUCTION: The rates of alcohol and illegal drug use and the prevalence of alcohol and illegal drug use disorders (AUDs and DUDs) are high in prison populations, particularly in men entering jail. However, these rates have never been exhaustively assessed and compared to those of the general population in France. METHODS: We based our research on two surveys, conducted in the same French region, which included a total of 630 men entering jail and 5,793 men recruited from the general population. We used the Mini-International Neuropsychiatric Interview to assess alcohol and drug use, AUD, DUD, as well as co-occurring psychiatric disorders, and we examined differences in prevalence rates between the two populations. Logistic regression models were performed to (i) identify the factors associated with AUD and DUD and (ii) test whether the interaction between admission to jail and the presence of AUD, DUD, or both is linked to the presence of at least one co-occurring psychiatric disorder. RESULTS: Compared to the general population sample, the prevalence of AUD (33.8% vs. 8.7%, p < 0.001) and DUD (at least one type of drug: 28.7% vs. 5.0%, p < 0.001; cannabis: 24.0% vs. 4.7%, p < 0.001; opioids: 6.8% vs. 0.4%, p < 0.001; stimulants: 5.2% vs. 0.8%, p < 0.001) was significantly higher in the jail population sample, as well as the rates of past-year use of various substances (alcohol: 62.1% vs. 56.4%, p = 0.007; at least one type of illegal drug: 50.0% vs. 14.4%, p < 0.001; cannabis: 45.6% vs. 13.9%, opioids: 9.4% vs. 0.7%; stimulants: 8.6% vs. 1.9%). Admission to jail was associated with a higher risk of AUD (aOR = 3.80, 95% CI: 2.89-5.01, p < 0.001) or DUD (aOR = 4.25, 95% CI: 3.10-5.84, p < 0.001). History of trauma was also associated with both AUD (aOR = 1.81, 95% CI: 1.53-2.14, p < 0.001) and DUD (aOR = 2.15, 95% CI: 1.74-2.65, p < 0.001), whereas history of migration was only associated with DUD (aOR = 1.38, 95% CI: 1.12-1.71, p = 0.003). AUDs and DUDs were more strongly associated with co-occurring psychiatric disorders in incarcerated men than in the general population. Among individuals with AUD, DUD, or both, co-occurring anxiety and mood disorders were particularly more frequent in jail than in the general population. DISCUSSION/CONCLUSION: As in most countries, AUD and DUD are highly prevalent among men entering jail in France. Our results also suggest that incarceration constitutes an independent vulnerability factor for a dual disorder, which supports a systematic assessment and treatment of psychiatric disorders in men entering jail and diagnosed with an AUD or DUD.

Smoking in psychiatry: realities and implications for its management / Le tabagisme en psychiatrie : réalités et implications pour sa prise en charge

OBJECTIVE: This study looks at tobacco use among persons with psychiatric disorders and its management in public psychiatric units in France. METHODS: A thematic analysis based on semi-directive interviews with 10 patients and 9 caregivers was carried out. RESULTS: Patients use tobacco to deal with their emotions and mood swings. However, mental health professionals, who only focus on mental disorders and addictions that have a direct impact on behaviors, disregard smoking addiction. Moreover, tobacco is sometimes integrated into the way services operate. However, it would be too simplistic to reduce the issue of smoking cessation to a matter of goodwill of caregivers. The structural dimension of smoking was evident, particularly in psychiatric hospitals, where it was an important bargaining chip and activity. CONCLUSIONS: Patients desire to receive individualized smoking-cessation interventions. This underlines the relevance of a public health intervention co-construction that goes beyond simply prescribing nicotine substitutes. This intervention should take into account characteristics of tobacco consumption among psychiatric patients, and the need to offer such interventions when patients are stabilized. In the meantime, psychiatric caregivers should be encouraged to engage in shared decision-making processes with patients for tobacco-use reduction and cessation.

Objectif: Cette étude s'intéresse à la place du tabagisme dans la vie des personnes porteuses de troubles psychiques et à sa prise en charge chez les patients des secteurs de psychiatrie publique en France. Méthode: L'analyse thématique est basée sur des entretiens semi-directifs menés auprès de 10 patients et 9 soignants. Résultats: Le tabac est vécu par les patients comme une modalité de gestion émotionnelle en lien avec leurs vicissitudes psychiques. Pour autant, les professionnels de la psychiatrie, se centrant sur les troubles psychiques et les addictions ayant un impact sur le comportement, se sentent peu concernés par cette addiction. Le tabac est d'ailleurs parfois intégré au mode de fonctionnement des services. Toutefois, réduire la question du sevrage tabagique à la bonne volonté des soignants serait simplificateur. La dimension structurelle du tabagisme ressortait notamment à l'hôpital psychiatrique, où il constituait une monnaie d'échange et une activité importante. Conclusions: L'individualisation de la prise en charge du sevrage tabagique, souhaitée par les patients, souligne la pertinence d'une co-construction d'une intervention de santé publique dépassant la seule prescription de substituts nicotiniques. Cette intervention devra tenir compte des caractéristiques de la consommation de tabac des patients pris en charge en psychiatrie, de la nécessité qu'elle soit proposée à un moment où leur état est stable, tout en accompagnant les soignants de psychiatrie pour favoriser leur engagement dans un processus de décision partagée des objectifs à atteindre en termes de consommation tabagique et de temporalité du processus de sevrage.

Psychiatric and primary care professionals' suggestions for reducing cardiovascular risks for psychiatric patients / Propositions des professionnels pour réduire le risque cardiovasculaire des patients psychiatriques

INTRODUCTION: Cardiovascular diseases represent one of the major causes of mortality in France and are the main cause of excess mortality in people suffering from long-term mental disorders (LTMD), apart from causes related to suicide. AIM OF THE STUDY: The aim of this article is to identify, from the point of view of primary care and psychiatric professionals, psychiatric users’ expectations and needs in order to help them improve their medical and paramedical management of cardiovascular risk (CVR). METHOD: This is a prospective, multi-centered qualitative study carried out in two phases: An exploratory phase, with individual interviews at the beginning of the study to enable the creation of ad hoc collective interview grids, followed by a proper qualitative study, which is in line with medical anthropology and the sociology of health systems. RESULTS: The 30 psychiatric professionals interviewed agreed on the need for better coordination with out-of-hospital care providers. Even if openness is advocated, there is a reminder of the specificities of psychiatry and the importance of taking these specificities into account in general. The 26 primary care professionals show a desire to learn more about psychiatric disorders, pathologies, and treatments in order to facilitate the management of these patients with specific needs. CONCLUSION: The cross-referencing of these results will allow to propose an appropriate intervention in order to induce convincing effects on the reduction of the CVR in people suffering from LTMD.

Introduction: Les maladies cardio-vasculaires représentent une des causes majeures de mortalité en France. Elles sont la cause principale de surmortalité des personnes souffrant de troubles psychiques au long cours (TPLC) en dehors des causes liées au suicide. But de l'étude: Cet article vise à identifier, selon le point de vue de professionnels de soins primaires et de la psychiatrie, leurs attentes et leurs besoins pour apporter aux usagers de la psychiatrie une meilleur prise en charge médicale et paramédicale du risque cardiovasculaire (RCV). Méthode: Il s'agit d'une étude qualitative prospective et multicentrique réalisée en deux temps : une phase exploratoire, par entretiens individuels en début d'étude afin de permettre la création des grilles d'entretiens collectifs ad hoc, suivie d'une étude qualitative proprement dite, qui s'inscrit dans la lignée de l'anthropologie médicale et de la sociologie des systèmes de santé. Résultats: Les 30 professionnels de la psychiatrie interrogés s'accordent sur la nécessité d'une meilleure coordination avec les soignants en extra hospitalier. Même si une ouverture est prônée, on observe un rappel des spécificités de la psychiatrie et l'importance d'une prise en compte générale de ces spécificités. Les 26 professionnels de soins primaires témoignent d'une volonté de mieux connaître les troubles, pathologies et traitements psychiatriques pour faciliter la prise en charge de ces patients à besoins spécifiques. Conclusion: Le croisement de ces résultats permettra de proposer une intervention appropriée en vue d'induire des effets probants sur la réduction du RCV chez les personnes souffrant de TPLC.

Reducing cardiovascular risk in people living with long-term psychiatric disorders / Réduire le risque cardiovasculaire chez les personnes vivant avec des troubles psychiques

INTRODUCTION: This qualitative study based on focus group study aims to identify experiences, expectations, and representations of people with long-term mental illness and their caregivers regarding cardiovascular disease and its risk factors. The aim of this work is to build a cardiovascular risk reduction program for people affected by long-term mental illness. RESULTS: Four major themes were identified in the corpus: (1) knowledge concerning physical health, (2) barriers to the implementation of better practices, (3) levers towards a healthier life and (4) expectations and needs for a better lifestyle. CONCLUSIONS: This work has provided us with concrete elements for the creation of a cardiovascular risk reduction program for people living with long-term mental illness. The challenges of this program will be to adapt to the needs and expectations of people living with long-term mental illness while facilitating the role of caregivers.

Introduction: Cette étude qualitative, basée sur des Focus Groups, vise à identifier les expériences, attentes et représentations des personnes ayant des troubles psychiques au long cours (TPLC) ainsi que des aidants concernant les maladies cardiovasculaires et leurs facteurs de risque. Le but de ce travail est de construire un programme de réduction du risque cardiovasculaire (CV), destiné aux personnes concernées par ces troubles. Résultats: Quatre thèmes majeurs ont été identifiés dans le corpus : (1) les connaissances et acquis concernant la santé physique, (2) les freins à la mise en place de meilleures pratiques, (3) les leviers vers une vie plus saine et (4) les attentes et besoins pour une meilleure hygiène de vie. Conclusions: Ce travail nous a fourni des éléments concrets pour la création d'un programme de réduction du risque CV pour les personnes vivant avec un TPLC. Les enjeux de ce programme seront de s'adapter aux besoins et aux attentes des personnes vivant avec un TPLC tout en facilitant le rôle des aidants.

Religiosity and prevalence of suicide, psychiatric disorders and psychotic symptoms in the French general population.

We aimed to examine the association between religious beliefs and observance and the prevalence of psychiatric disorders, psychotic symptoms and history of suicide attempts in the French general population. The cross-sectional survey interviewed 38,694 subjects between 1999 and 2003, using the MINI. Current religious beliefs and observance were identified by means of two questions: "are you a believer?" and "are you religiously observant?". We studied the association between religiosity and psychiatric outcomes using a multivariable logistic regression model adjusted for sociodemographic characteristics, including migrant status. Religious beliefs were positively associated with psychotic symptoms and disorders [OR = 1.37, 95% CI (1.30-1.45) and OR = 1.38, 95% CI (1.20-1.58)], unipolar depressive disorder [OR = 1.15, 95% CI (1.06-1.23)] and generalized anxiety disorder [OR = 1.13, 95% CI (1.06-1.21)], but negatively associated with bipolar disorder [OR = 0.83, 95% CI (0.69-0.98)], alcohol use disorders [OR = 0.69, 95% CI (0.62-0.77)], substance use disorders [OR = 0.60, 95% CI (0.52-0.69)] and suicide attempts [OR = 0.90, 95% CI (0.82-0.99)]. Religious observance was positively associated with psychotic symptoms and disorders [OR = 1.38, 95% CI (1.20-1.58) and OR = 1.25, 95% CI (1.07-1.45)], but negatively associated with social anxiety disorder [OR = 0.87, 95% CI (0.76-0.99)], alcohol use disorders [OR = 0.60, 95% CI (0.51-0.70)], substance use disorders [OR = 0.48, 95% CI (0.38-0.60)] and suicide attempts [OR = 0.80, 95% CI (0.70-0.90)]. Among believers, religious observance was not associated with psychotic outcomes. Religiosity appears to be a complex and bidirectional determinant of psychiatric symptoms and disorders. In this respect, religiosity should be more thoroughly assessed in epidemiological psychiatric studies, as well as in clinical practice.

Repenser les partenariats entre écoles primaires et secteurs de psychiatrie infanto-juvénile en temps de COVID-19.

INTRODUCTION: On a global scale, bringing together schools and public child psychiatry services is favored to promote the development of early interventions that could improve health trajectories, from prevention to treatment, for children exposed to psychological and psychiatric difficulties. In a public health perspective, contextualizing these practices is essential in order to ensure their sustainability and efficiency. This article sheds light on the stakes of these partnerships and their advantages in responding to the health, social, and economic mark that has been left behind by the crisis accompanying the brutal onset of the Covid-19 epidemic. AIMS: Improving the health care management for children with mental health problems or problems of a psychological nature implies taking into account their environment beyond the therapeutic framework. Interventional research, currently underway, is taking place in several sites in France: primary schools, Medical-psychological centers (CMP), and Local Committees on Mental Health (CLSM). The goal is to provide an inventory and an analysis of the partnership and interventional structures that are most efficient, based on the needs and available resources at each site. This research envisages a diversification and a contextualization of the offer of care, with great concern for equity and therapeutic efficacy, starting from school. RESULTS: More than simple results, our aim is to make suggestions as to how to better accompany the end of confinement and the months to come. The development of partnerships in regions that are strongly marked by social and economic inequalities is a priority in terms of public health and the direction of local policies. These partnerships would contribute to a global strategy of evaluating the needs and the personalized accompaniment of children. Formalizing the intervention with the interface being the school sector will support the school staff in overcoming the health crisis that is affecting their institution. The steady rise of CLSMs will enhance local coordination and collaboration to help the most psychologically vulnerable children and aid their parents, given their situation, to support the development of their children. CONCLUSION: Restoring human and material resources to existing structures, notably in the sector of child psychiatry so that it can accomplish its public service mission seems to be a priority today. Establishing school-CMP-CLSM partnerships can contribute to providing local policy direction in the interest of elaborating individual and collective strategies that can ensure needs-adapted care that is accessible to as many children as possible.

Alcohol Use Disorder Is Differently Associated With Psychotic Symptoms According To Underlying Psychiatric Disorders: A General Population Study.

AIMS: Psychotic symptoms can occur in the general population, and alcohol use disorder (AUD) is an identified vulnerability factor. However, it remains unclear how AUD is associated with psychotic symptoms, depending on the underlying psychiatric condition.We aimed to compare the prevalence of psychotic symptoms among subjects with different types of psychiatric disorders, i.e. unipolar or bipolar disorders, anxiety disorders, psychotic disorders or no psychiatric disorder, depending on whether or not there was an underlying AUD. METHODS: In a 38,694-subject general population study, we compared the likelihood of occurrence of seven types of psychotic symptoms, depending on the AUD status and the underlying psychiatric disorders, after adjustment for age, sex, marital status, education and income levels. RESULTS: In unipolar depression and anxiety disorders, almost all types of psychotic symptoms were found associated with AUD (odds ratios (ORs) between 1.98 and 2.19). In contrast, in bipolar disorder, only auditory hallucinations were associated with AUD (OR = 2.50). In psychotic disorders, only thought broadcasting was more frequent among subjects with AUD (OR = 1.78). CONCLUSION: Our findings in depression and anxiety disorders are in line with the 'dual diagnosis' concept, which posits that comorbid psychiatric/addictive disorders form distinctive entities that are more frequently associated with non-specific severity factors, here psychotic symptoms. The co-occurrence of AUD in bipolar/psychotic disorders was not associated with a generalized increased occurrence of psychotic symptoms but altered their manifestations with an increased risk of auditory hallucinations for bipolar disorder and thought broadcasting for psychotic disorders.

A Latent Class Analysis of Manic and Psychotic Symptoms.

Bipolar spectrum disorders encompass heterogeneous clinical manifestations and comorbidities. A latent class analysis (LCA) was performed in 1846 subjects who experienced an episode of abnormally elevated or irritable mood to identify homogeneous groups of subjects, based on the distribution of 11 manic and 7 psychotic symptoms. LCA identified five classes: 1) two classes with irritability and with low and high level of psychosis (respectively "irritable," 29.1% of the sample, and "irritable-psychotic," 16.2%); 2) a class with expansive mood and hyperactivity ("expansive-hyperactive," 12.7%); and 3) two classes with manic symptoms and high and low level of psychosis ("manic-psychotic," 15.0%, and "manic," 27.2%). "Irritable" displayed lower rates of depressive episode, panic, and substance use disorders. Manic-psychotic displayed higher rates of depressive episode, panic, generalized anxiety, and substance use disorders. Use of mental health treatment more frequent in manic-psychotic and manic classes. Five classes of bipolar spectrum disorders were characterized by different sociodemographic and clinical patterns.

How service users and carers understand, perceive, rephrase, and communicate about "depressive episode" and "schizophrenia" diagnoses: an international participatory research.

BACKGROUND: For ICD-11, the WHO emphasized the clinical utility of communication and the need to involve service users and carers in the revision process. AIMS: The objective was to assess whether medical vocabulary was accessible, which kinds of feelings it activated, whether and how users and carers would like to rephrase terms, and whether they used diagnosis to talk about mental health experiences. METHOD: An innovative protocol focused on two diagnoses (depressive episode and schizophrenia) was implemented in 15 different countries. The same issues were discussed with users and carers: understanding, feelings, rephrasing, and communication. RESULTS: Most participants reported understanding the diagnoses, but associated them with negative feelings. While the negativity of "depressive episode" mostly came from the concept itself, that of "schizophrenia" was largely based on its social impact and stigmatization associated with "mental illness". When rephrasing "depressive episode", a majority kept the root "depress*", and suppressed the temporal dimension or renamed it. Almost no one suggested a reformulation based on "schizophrenia". Finally, when communicating, no one used the phrase "depressive episode". Some participants used words based on "depress", but no one mentioned "episode". Very few used "schizophrenia". CONCLUSION: Data revealed a gap between concepts and emotional and cognitive experiences. Both professional and experiential language and knowledge have to be considered as complementary. Consequently, the ICD should be co-constructed by professionals, service users, and carers. It should take the emotional component of language, and the diversity of linguistic and cultural contexts, into account.

[Rethinking partnerships between primary schools and child psychiatry public health services in times of COVID-19]. / Repenser les partenariats entre écoles primaires et secteurs de psychiatrie infanto-juvénile en temps de COVID-19.

INTRODUCTION: On a global scale, bringing together schools and public child psychiatry services is favored to promote the development of early interventions that could improve health trajectories, from prevention to treatment, for children exposed to psychological and psychiatric difficulties. In a public health perspective, contextualizing these practices is essential in order to ensure their sustainability and efficiency. This article sheds light on the stakes of these partnerships and their advantages in responding to the health, social, and economic mark that has been left behind by the crisis accompanying the brutal onset of the Covid-19 epidemic. AIMS: Improving the health care management for children with mental health problems or problems of a psychological nature implies taking into account their environment beyond the therapeutic framework. Interventional research, currently underway, is taking place in several sites in France: primary schools, Medical-psychological centers (CMP), and Local Committees on Mental Health (CLSM). The goal is to provide an inventory and an analysis of the partnership and interventional structures that are most efficient, based on the needs and available resources at each site. This research envisages a diversification and a contextualization of the offer of care, with great concern for equity and therapeutic efficacy, starting from school. RESULTS: More than simple results, our aim is to make suggestions as to how to better accompany the end of confinement and the months to come. The development of partnerships in regions that are strongly marked by social and economic inequalities is a priority in terms of public health and the direction of local policies. These partnerships would contribute to a global strategy of evaluating the needs and the personalized accompaniment of children. Formalizing the intervention with the interface being the school sector will support the school staff in overcoming the health crisis that is affecting their institution. The steady rise of CLSMs will enhance local coordination and collaboration to help the most psychologically vulnerable children and aid their parents, given their situation, to support the development of their children. CONCLUSION: Restoring human and material resources to existing structures, notably in the sector of child psychiatry so that it can accomplish its public service mission seems to be a priority today. Establishing school-CMP-CLSM partnerships can contribute to providing local policy direction in the interest of elaborating individual and collective strategies that can ensure needs-adapted care that is accessible to as many children as possible.

Understanding geographic variations in psychiatric inpatient admission rates: width of the variations and associations with the supply of health and social care in France.

BACKGROUND: Inpatient care accounts for the majority of mental health care costs and is not always beneficial. It can indeed have detrimental consequences if not used appropriately, and is unpopular among patients. As a consequence, its reduction is supported by international recommendations. Varying rates of psychiatric inpatient admissions therefore deserve to draw attention of researchers, clinicians and policy makers alike as such variations can challenge quality, equity and efficiency of care. In this context, our objectives were first to describe variations in psychiatric inpatient admission rates across the whole territory of mainland France, and second to identify their association with characteristics of the supply of care, which can be targeted by dedicated health policies. METHODS: Our study was carried out in French psychiatric sectors' catchment areas for the year 2012. Inpatient admission rates per 100,000 adult inhabitants were calculated using data from the national psychiatric discharge database. Their variations were described numerically and graphically. We then carried out a negative binomial regression to identify characteristics of the supply of care (public and private care, health and social care, hospital and community-based care, specialised and non-specialised care) which were associated with these variations while adjusting our analysis for other relevant factors, in particular epidemiological differences. RESULTS: Considerable variations in inpatient admission rates were observed between psychiatric sectors' catchment areas and were widespread on the French territory. Institutional characteristics of the hospital to which each sector was linked (private non-profit status, specialisation in psychiatry and participation to teaching activities and to emergency care) were associated with inpatient admission rates. Similarly, an increase in the availability of community-based private psychiatrists was associated with a decrease in the inpatient admission rate while an increase in the capacity of housing institutions for disabled individuals was associated with an increase in this rate. CONCLUSIONS: Our results advocate for a homogenous repartition of health and social care for mental disorders in lines with the health needs of the population served. This should apply particularly to community-based private psychiatrists, whose heterogeneity of repartition has often been underscored.

A latent class analysis of psychotic symptoms in the general population.

OBJECTIVE: Individuals with psychotic symptoms may actually correspond to various subgroups, characterized by different patterns of psychotic symptoms as well as specific sociodemographic and clinical correlates. We aimed to identify groups of individuals from the general population with specific patterns of psychotic symptoms. METHODS: In a 38,694-subject survey, a latent class analysis was performed to identify subgroups based on the distribution of seven psychotic symptoms taken from the Mini International Neuropsychiatric Interview. The different classes were subsequently compared according to sociodemographic and clinical correlates. RESULTS: The best fit was obtained with a four-class solution, including the following: (1) a class with a low prevalence of all psychotic symptoms ('LOW', 85.9%); (2) a class with a high prevalence of all psychotic symptoms ('HAL + DEL', 1.7%); and classes with a high prevalence of (3) hallucinations ('HAL', 4.5%) or (4) delusions ('DEL', 7.9%). The HAL + DEL class displayed higher rates of history of trauma, social deprivation and migrant status, while the HAL and DEL classes displayed intermediate rates between HAL + DEL and LOW. HAL + DEL displayed the highest rates of psychotic and non-psychotic disorders and the use of mental health treatment, while HAL and DEL displayed intermediate rates of these disorders between HAL + DEL and LOW. In comparison to the HAL class, psychotic and substance use disorders were more frequent in the DEL class, while anxiety and mood disorders were less frequent. CONCLUSION: These findings support the hypothesis of a continuum model relating the level of psychotic symptoms to the level of global psychopathology.

Prevalence and predictors of no lifetime utilization of mental health treatment among people with mental disorders in France: findings from the 'Mental Health in General Population' (MHGP) survey.

PURPOSE: No lifetime utilization of mental health treatment (NUMT) is an indicator of the treatment gap among people in need of treatment. Until now, the overall prevalence and predictors of NUMT have never been explored in France. METHODS: In a 39,617-respondent survey, participants were assessed for NUMT, i.e., no lifetime psychotherapy, psychopharmacotherapy, or psychiatric hospitalization. Mental disorders were investigated using the Mini International Neuropsychiatric Interview (MINI 5.0.0). MINI diagnoses were grouped into five categories: mood disorders (MDs); anxiety disorders (ADs); alcohol use disorders (AUDs); substance use disorders (SUDs); and psychotic disorders (PDs). Using multivariable logistic regression models, we explored the factors associated with NUMT among the MINI-positive respondents. The odds ratio and 95% confidence interval were calculated for each factor. RESULTS: In total, 12,818 (32.4%) respondents were MINI-positive, 46.5% of them reported NUMT (35.6% for MDs, 39.7% for PDs, 42.8% for ADs, 56.0% for AUDs, and 56.7% for SUDs). NUMT was positively associated with being male [OR 1.75 (1.59-1.91)] and practising religion [OR 1.13 (1.02-1.25)] and negatively associated with ageing [per 10-year increase: OR 0.88 (0.85-0.91)], being single [OR 0.74 (0.66-0.84)], being a French native [OR 0.67 (0.60-0.75)], and experiencing MDs [OR 0.39 (0.36-0.43)], ADs [OR 0.47 (0.43-0.52)], AUDs [OR 0.83 (0.73-0.96)], SUDs [OR 0.77 (0.65-0.91)], or PDs [OR 0.50 (0.43-0.59)]. CONCLUSIONS: In France, NUMT rates were the highest for AUDs and SUDs. Additionally, suffering from MDs or ADs increased the lifetime treatment utilization for people having any other mental disorder. This finding emphasizes the need to better screen AUDs and SUDs among people treated for MDs or ADs.

Geographic variations in involuntary care and associations with the supply of health and social care: results from a nationwide study.

BACKGROUND: Involuntary psychiatric care remains controversial. Geographic disparities in its use can challenge the appropriateness of the care provided when they do not result from different health needs of the population. These disparities should be reduced through dedicated health policies. However, their association with the supply of health and social care, which could be targeted by such policies, has been insufficiently studied. Our objectives were therefore to describe geographic variations in involuntary admission rates across France and to identify the characteristics of the supply of care which were associated with these variations. METHODS: Involuntary admission rate per 100,000 adult inhabitants was calculated in French psychiatric sectors' catchment areas using 2012 data from the national psychiatric discharge database. Its variations were first described numerically and graphically. Several factors potentially associated with these variations were then considered in a negative binomial regression with an offset term accounting for the size of catchment areas. They included characteristics of the supply of care (public and private care, health and social care, hospital and community-based care, specialised and non-specialised care) as well as adjustment factors related to epidemiological characteristics of the population of each sector's catchment area and its level of urbanization. Such variables were extracted from complementary administrative databases. Supply characteristics associated with geographic variations were identified using a significance level of 0.05. RESULTS: Significant variations in involuntary admission rates were observed between psychiatric sectors' catchment areas with a coefficient of variation close to 80%. These variations were associated with some characteristics of the supply of health and social care in the sectors' catchment areas. Notably, an increase in the availability of community-based private psychiatrists and the capacity of housing institutions for disabled individuals was associated with a decrease in involuntary admission rates while an increase in the availability of general practitioners was associated with an increase in those rates. CONCLUSIONS: There is evidence of considerable variations in involuntary admission rates between psychiatric sectors' catchment areas. Our results provide lines of thoughts to reduce such variations, in particular by supporting an increase in the availability of upstream and downstream care in the community.

Thirty-day Readmission Rates and Associated Factors: A Multilevel Analysis of Practice Variations in French Public Psychiatry.

BACKGROUND: Inpatient psychiatric readmissions are often used as an indicator of the quality of care and their reduction is in line with international recommendations for mental health care. Research on variations in inpatient readmission rates among mental health care providers is therefore of key importance as these variations can impact equity, quality and efficiency of care when they do not result from differences in patients' needs. AIMS OF THE STUDY: Our objectives were first to describe variations in inpatient readmission rates between public mental health care providers in France on a nationwide scale, and second, to identify their association with patient, health care providers and environment characteristics. METHODS: We carried out a study for the year 2012 using data from ten administrative national databases. 30-day readmissions in inpatient care were identified in the French national psychiatric discharge database. Variations were described numerically and graphically between French psychiatric sectors and factors associated with these variations were identified by carrying out a multi-level logistic regression accounting for the hierarchical structure of the data. RESULTS: Significant practice variations in 30-day inpatient readmission rates were observed with a coefficient of variation above 50%. While a majority of those variations was related to differences within sectors, individual patient characteristics explained a lower part of the variations resulting from differences between sectors than the characteristics of sectors and of their environment. In particular, an increase in the mortality rate and in the acute admission rate for somatic disorders in sectors' catchment area was associated with a decrease in the probability of 30-day readmission. Similarly, an increase in the number of psychiatric inpatient beds in private for-profit hospitals per 1,000 inhabitants in sectors' catchment area was associated with a decrease in this probability, which also varied with overall sectors' case-mix characteristics and with the level of urbanisation of the area. DISCUSSION: The extent of the variations and the factors associated with it question the adequacy of care and suggest that some of them may be unwarranted. Our findings should however be interpreted in consideration of several limits inherent to data quality and availability as we relied on information from administrative databases. While we considered a wide range of factors potentially associated with variations in 30-day readmissions, our model indeed only explained a limited part of the variations resulting from differences between sectors. IMPLICATIONS FOR HEALTH POLICIES: Our findings underscored that practice variations in psychiatry are a reality that merits the full attention of decision makers as they can impact the quality, equity and efficiency of care. A specific data system should be established to monitor practice variations in routine to promote transparency and accountability. IMPLICATIONS FOR FURTHER RESEARCH: Few associations were found between variations in 30-day inpatient readmissions and the supply of care. The routine collection of detailed organizational characteristics of health care providers at a national level should be supported to facilitate additional research work, both in France and in other contexts.