Is the French criminal psychiatric assessment in crisis?

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.

[Differences in psychiatric expertise of responsibility for schizophrenic persons accused of murder: Study with experts of the Court of Appeal of Aix-en-Provence].

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.

[Differences in psychiatric expertise of responsibility: Assessment and initial hypotheses through a review of literature].

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.

[Management, needs and expectations of patients suffering from bipolar I disorders (The ECHO study - France)].

Aim: The ECHO study is the first French study directly asking patients with bipolar I disorders on the history and experiences of their disease, their perceptions of care, their sociofamilial relationships, and their expectations regarding what should be done by healthcare professionals and their environment.

Method: Three hundred euthymic patients suffering from bipolar disorder I were interviewed using a semi-standardized evaluation through telephone interviews. These patients were selected according to the quota method of nationally representative INSEE 99 to be representative of the French population.

[Patients' perception of seclusion in psychiatry: ethical perspectives].

Objective: Although seclusion is legally sanctioned in France, its use remains controversial, and debate continues over ethical and therapeutic aspects of the practice. Seclusion continues to be widely used in the management of disturbed behaviour in hospitalized patients. Although recent studies serve to strengthen the link between the use of seclusion and negative patient responses, they are limited in extending our understanding of the seclusion experience.

[Psychometric properties of the Activities Daily Life Scale (ADL)].

Objective: Deficits in social functioning are an important core feature of mental health. Recently in France, the Activities Daily Life (ADL) scale has been proposed by the French authorities to assess social functioning for all hospitalized patients in a psychiatric ward. The perspective is to use this scale in the financing and organization of mental health services in France.

Validation of a professionals' satisfaction questionnaire with electronic medical records (PSQ-EMR) in psychiatry.

Background: Electronic medical records (EMR) are currently being implemented in psychiatric hospitals throughout Europe. The perceptions of health care professionals can contribute important information that may predict their acceptance of and desired mode of use for EMR, thus guiding EMR implementation.

Aims: To develop a self-administered instrument designed to assess health care professionals' satisfaction regarding EMR in a psychiatric hospital, based only on the professional point of view, according to the psychometric standards.

Two-year study of relapse prevention by a new education program in schizophrenic patients treated with the same antipsychotic drug.

It is not clear whether patient's psycho-education enhances compliance to antipsychotic treatments and reduces the number of relapses. Here we investigated the impact of a new psycho-educational program (SOLEDUC) on the one- and two-years rate of relapse (primary outcome measure) and a number of clinical assessments (secondary outcome measures). This was a multicentric French clinical trial (51 centers) of Phase IV, open, controlled, randomized, consisting in two parallel groups: the Soleduc group (N=111) and the control group (N=109).

[Therapeutics approach of adult patients with acute and chronic psychotic states: REALITE survey].

A retrospective observational pharmaco-epidemiological survey was conducted during 24 weeks between October 2004 and March 2005 in metropolitan France (384 investigators) to more clearly define the use of loxapine in acute and chronic psychotic states. The objective of this national survey was to specify the clinical and therapeutic profile of patients managed by this antipsychotic in two cohorts of adult patients: one in "acute phase" (prescription of loxapine during the previous 4 weeks), the other in "maintenance phase" (prescription of loxapine for more than 8 weeks). The two groups of the recruited population (1,511 patients) presented identical sociodemographic data.

The role of captodiamine in the withdrawal from long-term benzodiazepine treatment.

Background And Objectives: Discontinuation of benzodiazepines can be associated with the emergence of a withdrawal syndrome which compromises successful termination of treatment. The objective of the present study was to evaluate whether a six week administration of captodiamine during benzodiazepine discontinuation could prevent emergence of a benzodiazepine withdrawal syndrome and thus facilitate discontinuation of these drugs.

Subjects And Methods: A controlled, randomised, double-blind trial of captodiamine versus placebo was conducted in 81 subjects presenting mild to moderate anxiety and treated for at least 6 months with a stable dose of benzodiazepine.

Switching antipsychotic medications: general recommendations and switching to amisulpride.

As more and more novel antipsychotic agents are introduced, the need for practical guidelines on switching these medications is becoming increasingly important. Indications for a switch include situations where the patient or his family/caregiver requests a change in medication, where the patient cannot tolerate current treatment, where they have comorbid physical or psychiatric conditions or where they have achieved only a partial remission, are refractory to treatment or have relapsed. Cross-tapering is generally the most acceptable method of switching, although abrupt withdrawal may be necessary in some cases, such as when a patient develops a severe or acute reaction to their current treatment.

[The use of therapeutic isolation and confinement in psychiatry. A prospective study].

Despite recent developments in psychopharmacology and a better understanding of agitation patterns in psychiatric patients, the use of seclusion and restraint procedures remains a matter of daily practice. Little or no time is spent on its teaching in a formal way. There is almost no literature on these issues, and it has grown only since legal procedures initiated by patients, which forced practitioners to spend some time analysing these methods.

[Malignant hyperthermia and neuroleptic malignant syndrome: report of 4 clinical cases].

Very numerous publication in the literature suggest the probable relationship between three clinical entities: peranesthesic malignant hyperthermia (PMH), exercitional malignant hyperthermia (EMH) and neuroleptic malignant syndrome (NMS). We briefly describe the clinical history and define, as subjects of research, the personal and familial histories of neuromuscular disease of 4 of our patients having presented with neuroleptic malignant syndrome, as recommended by the European group on malignant hyperthermia, the reference contracture test on neuromuscular fibers and anatomic and cytopathological investigations of neuromuscular fibers. We compare the results for our 4 patients having presented with neuroleptic malignant syndrome and their courses.

[Self-assessment questionnaire of alcoholic craving (ECCA Questionnaire: Behavior and Cognition in Relation to Alcohol: French translation and validation of the Obsessive-Compulsive Drinking Scale].

Clinical, neurobiological and neuropsychological hypotheses suggest that the dimension of alcohol craving includes the concept of both obsessive thoughts about alcohol use and compulsive behaviors toward drinking. Anton et al. (1995) developed a 14 items self-rating scale, the Obsessive Compulsive Drinking Scale (OCDS) which includes items for assessing three dimensions: global, and the obsessive and the compulsive subdimensions.

[Evaluation of efficacy and tolerance of amisulpride in treatment of schizophrenic psychoses].

Amisulpride is a benzamide derivative atypical antipsychotic characterized by selective blockade of dopamine D3 and D2 receptors, limbic selectivity and preferential blockade of dopamine autoreceptors at low doses. Its efficacy on predominant negative symptoms of schizophrenia at low doses, and on the positive symptoms at doses from 400 to 1,200 mg/day has been demonstrated in several controlled studies. The aim of our study was to assess the use in psychiatric clinical practice under naturalistic conditions, efficacy and safety of amisulpride and patient's ability to cope with social skills during a 3-month period of treatment with a follow-up at 6 months.

[What is the meaning of "stabilization" in schizophrenic patients?].

Unlabelled: The notion of stabilization in schizophrenia has been investigated, in France, through a survey of 875 psychiatrists. This survey, which has been conducted on the 9th, 10th and 11th of December 1997, looked into the clinical, therapeutic and socio-demographic variables, and the means of patient management, which are used by psychiatrists to ascertain that their patients are stabilized. The data was collected by each psychiatrist by way of a questionnaire administered to his or her next three patients, either at the hospital or in private practice (2,464 questionnaires were completed).

[Absence of frontal lobe dysfunction and working memory deficits in young schizophrenic patients].

The impairment in tasks requiring intact frontal lobe functions has been repeatedly shown in schizophrenics. However, the relative roles of confounding factors, like duration of the disease, social withdrawal, or antidopaminergic medication, are not clearly demonstrated. We studied the performance of 12 young active patients, with chronic residual schizophrenia that had recent onset, and 12 control subjects, with frontal lobe tests and with a battery designed to explore working memory.

[Social trajectory and schizophrenia].

On the occasion of the Clozapine symposium we have had cause to reflect on the social life-histories of schizophrenic patients. After an analysis of a cohort of 40 patients aged over 65 years, whose medical records had been kept up since the start of their disease, we have set up a methodology which enables us to study the social life-histories of these patients. Our aim is ultimately to compare the course of the disease with the treatments received by these patients and the therapeutic structures they have been offered.

[Alzheimer's disease and informed consent of incapacitated people: propositions aimed at improving the procedure].

Ethical considerations must be given priority when deciding whether or not to include an Alzheimer's Disease patient in a study leading to direct individual benefits. Although the law applies to ethics, the Huriet-Serusclat law was nevertheless written in the spirit of the major ethical declarations of the last 50 years (Nurenberg, Helsinki, Tokyo..

[Frontal lobe dysfunction and depressive state: relation to endogenous character of depression].

A dysfunction of dorsolateral prefrontal cortex (DLPF) in major depression is suggested by functional imagery and comparative neuropsychology. However, assessment of frontal lobe syndrome with DLPF-dependent tests led to controversial results. To clarify these findings, we administered 5 of these tests (Wisconsin Card Sorting Test, Stroop Test, Trail Making Test, Tower of Toronto, verbal fluency) to 16 major depressive subjects and their 16 controls, before and after 21 days of treatment.

[Lumbar canal stenosis. Retrospective study of 158 operated cases].

The authors report the results of a retrospective study of 158 lumbar spinal stenosis (LSS), all operated (111 degenerative, 26 congenital, 21 mixed). Eighty seven percent of the patients had a low-back pain and 81.6% a radicular pain.

[Prevention of late post-traumatic epilepsy by phenytoin in severe brain injuries. 2 years' follow-up].

The high incidence rate and the invalidating nature of post-traumatic epilepsy after severe brain injury have encouraged the authors to review the prophylactic treatment of this type of epilepsy. Thirty-four out of 86 randomised patients with brain injuries admitted into a neurotraumatology intensive care unit were treated prophylactically, immediately after the injury, with an intravenous hydantoin injection in a dose sufficient to provide stable and effective blood levels. This was followed by dose-adjusted oral administration maintained for a minimum period of 3 months.