Psychose et toxicomanie en milieu carcéral

L’abus de substance est un phénomène particulièrement fréquent dans la population psychotique, pouvant atteindre pratiquement un patient sur deux selon certaines études. Le but de cet article est de s’intéresser à ce phénomène dans le cadre du milieu carcéral, en se focalisant sur la dépendance aux opiacés et les traitements de substitution chez les patients psychotiques. Au niveau du Service Médico-Psychologique Régional de la maison d’arrêt de Seysses, nous avons retrouvé la présence d’un trouble psychotique chez environ 10 % des patients recevant un traitement de substitution aux opiacés, ces patients psychotiques sous traitement de substitution représentent 1 % des détenus. Après avoir fait le point sur les données épidémiologiques disponibles dans la littérature concernant cette comorbidité en milieu libre et carcéral,nous nous appuierons sur une vignette clinique ainsi que sur les données de la littérature, afin de dégager des pistes de réflexions concernant les hypothèses explicatives, les conséquences possibles et la prise en charge de cette comorbidité

Clinical features and outcomes of COVID-19 patients hospitalized for psychiatric disorders: a French multi-centered prospective observational study

International audienceBackground: Patients with psychiatric disorders are exposed to high risk of COVID-19 and increased mortality. In this study, we set out to assess the clinical features and outcomes of patients with current psychiatric disorders exposed to COVID-19.Methods: This multi-center prospective study was conducted in 22 psychiatric wards dedicated to COVID-19 inpatients between 28 February and 30 May 2020. The main outcomes were the number of patients transferred to somatic care units, the number of deaths, and the number of patients developing a confusional state. The risk factors of confusional state and transfer to somatic care units were assessed by a multivariate logistic model. The risk of death was analyzed by a univariate analysis.Results: In total, 350 patients were included in the study. Overall, 24 (7%) were transferred to medicine units, 7 (2%) died, and 51 (15%) patients presented a confusional state. Severe respiratory symptoms predicted the transfer to a medicine unit [odds ratio (OR) 17.1; confidence interval (CI) 4.9-59.3]. Older age, an organic mental disorder, a confusional state, and severe respiratory symptoms predicted mortality in univariate analysis. Age >55 (OR 4.9; CI 2.1-11.4), an affective disorder (OR 4.1; CI 1.6-10.9), and severe respiratory symptoms (OR 4.6; CI 2.2-9.7) predicted a higher risk, whereas smoking (OR 0.3; CI 0.1-0.9) predicted a lower risk of a confusional state.Conclusion: COVID-19 patients with severe psychiatric disorders have multiple somatic comorbidities and have a risk of developing a confusional state. These data underline the need for extreme caution given the risks of COVID-19 in patients hospitalized for psychiatric disorders