Composantes d’efficacité des programmes de traitement communautaires destinés aux personnes souffrant de désordres mentaux

Les programmes communautaires visent à aider les bénéficiaires à s'intégrer de façon permanente au sein de la collectivité. Pour ce faire, ces programmes doivent être constitués de multiples composantes qui visent à réduire ou à éliminer les difficultés présentées par ces personnes. Ces composantes sont : des chimiothérapies; des interventions visant à encourager une prise régulière des médicaments jugés nécessaires; les mécanismes de formation susceptibles d'aider tant le personnel que les patients à évaluer la symptomatologie; une relation stable; des mécanismes permettant d'inculquer aux patients les aptitudes sociales dont ils ont besoin; des programmes de formation professionnelle visant à permettre aux patients de se trouver un emploi ou d'exercer une activité significative; des mécanismes de formation visant à enseigner aux patients les aptitudes pouvant les aider à faire face au stress et à résoudre leurs problèmes; des interventions destinées à les aider à réduire leur consommation d'alcool; des milieux résidentiel, social et communautaire propices à l'amélioration de l'état des patients, afin que ceux-ci puissent accomplir des progrès soutenus et durables.Community programmes are designed to help clients establish themselves permanently in the community to succeed, these programmes must include several treatment components each addressing a specific problem presented by the clients. These components include : drug therapy, an intervention to encourage clients to take medications as prescribed ; an intervention to train staff and clients to evaluate symptoms aetiology ; a stable relationship ; social skills training ; vocational training or an intervention which aims to help clients participate regularly in an activity of their choice ; stress innoculation ; problem solving ; an intervention to reduce the use of alcohol ; residences which will provide support to the clients

Synthèse des connaissances sur les facteurs de protection liés à la délinquance

La plupart des enfants et des adolescents qui commettent des actes délinquants ne persistent pas dans la criminalité une fois à l’âge adulte. Ainsi, on conçoit qu’il y a dans l’environnement immédiat des facteurs qui protègent les enfants et les adolescents à risque. Or, la documentation sur les facteurs de protection montre des lacunes. Notamment, très peu d’études nous renseignent sur les fondements conceptuels et méthodologiques qui encadrent l’examen de ces facteurs. Cet article synthétise les connaissances sur la base de travaux empiriques sur les facteurs de protection associés aux comportements antisociaux et criminels et propose d’examiner les considérations conceptuelles, méthodologiques et les limites des études sélectionnées susceptibles d’influencer les facteurs découverts. Les résultats montrent qu’un grand nombre de facteurs de protection ont été identifiés. Le manque d’uniformité dans les résultats reflète le caractère exploratoire des études, mais aussi la quasi-absence de validation des facteurs découverts. Parmi les questions méthodologiques abordées, l’importance des caractéristiques de la population est mise en évidence. Sur la base de nos résultats, des pistes de recherche sont proposées, notamment de considérer l’hétérogénéité des populations qui affichent des risques élevés de criminalité à l’âge adulte. Les connaissances sur des facteurs de protection sont nécessaires pour éclairer les décisions politiques concernant l’investissement dans les programmes visant à prévenir la criminalité dès la petite enfance

Étude de relance auprès des détenus fédéraux traités en milieu psychiatrique : description des antécédents, du séjour, des rechutes et des récidives

While severe mental disorders have consistently been shown to be more prevalent among inmates of penal institutions than among the general population, the provision of mental health within jails, prisons and penitentiaries has always been, and continues to be, problematic. The present investigation was designed to examine the impact on patients of one organizational model of mental health care for penitentiary inmates. Ninety-nine men who were transferred from a penitentiary to a maximum security hospital for varying periods of time were followed for three years after discharge. Relapse and criminal recidivism were documented from official files. Interviews were conducted at the end of the follow-up period in order to examine subject's level of social functionning and mental state. Specific conclusions are drawn about the way in which mental health care was provided and the benefit which accrued to the patients

A comprehensive assessment of personality traits and psychosocial functioning in parents with bipolar disorder and their intimate partners

Background: Individuals with bipolar disorder (BD) often possess maladaptive traits and present with various difficulties in psychosocial functioning. However, little is known about the intimate partners of adults with bipolar disorder (BD) and how mental illnesses other than BD within couples may further complicate the picture. Such knowledge is needed to inform both couple and family interventions. Methods: Participants were parents whose children were enrolled in a prospective study: 55 with BD and their partners, and 47 healthy control couples. All completed diagnostic interviews, and questionnaires describing personality traits, negative life events, coping skills, social support, marital adjustment and inter-partner verbal aggression. Parents with BD and healthy control parents were compared, as were the intimate partners. A series of exploratory analyses focused on the average measures within couples, with and without BD, and took account of comorbid personality disorders among those with BD and major depressive disorder among their partners. Results: Intimate partners of adults with BD, relative to healthy control partners, presented with more mental disorders, higher neuroticism, lower extraversion, more emotion-focused coping, smaller social networks, less satisfaction with their social networks, and little, satisfying social contact. Additionally, they reported less consensus and satisfaction in their marital relationships, and engaged in more verbal aggression towards their partners. Participants with BD showed similar, more extreme, characteristics. Marital distress and verbal aggression were greatest among couples with an adult having BD and a comorbid personality disorder or a partner with major depressive disorder. Conclusion: This study contributes to the literature by demonstrating that both parents with BD and their intimate partners exhibit high levels of mental illness, maladaptive personality traits and psychosocial difficulties, thus limiting their partners’ ability to provide support and stability in the these high risk families. Moreover, mental illnesses other than BD may contribute to marital problems within couples. Some statistical analyses, particularly those involving comorbid conditions, were under-powered in this study. As clinical implications, the current study suggests that both individuals with BD and their partners could benefit from interventions aimed at lowering emotionality and verbal aggression, and increasing social support and effective coping skills

Punishment and psychopathy: a case-control functional MRI investigation of reinforcement learning in violent antisocial personality disordered men

Background Men with antisocial personality disorder show lifelong abnormalities in adaptive decision making guided by the weighing up of reward and punishment information. Among men with antisocial personality disorder, modifi cation of the behaviour of those with additional diagnoses of psychopathy seems particularly resistant to punishment. Methods We did a case-control functional MRI (fMRI) study in 50 men, of whom 12 were violent off enders with antisocial personality disorder and psychopathy, 20 were violent off enders with antisocial personality disorder but not psychopathy, and 18 were healthy non-off enders. We used fMRI to measure brain activation associated with the representation of punishment or reward information during an event-related probabilistic response-reversal task, assessed with standard general linear-model-based analysis. Findings Offenders with antisocial personality disorder and psychopathy displayed discrete regions of increased activation in the posterior cingulate cortex and anterior insula in response to punished errors during the task reversal phase, and decreased activation to all correct rewarded responses in the superior temporal cortex. This finding was in contrast to results for off enders without psychopathy and healthy non-off enders. Interpretation Punishment prediction error signalling in off enders with antisocial personality disorder and psychopathy was highly atypical. This finding challenges the widely held view that such men are simply characterised by diminished neural sensitivity to punishment. Instead, this fi nding indicates altered organisation of the information processing system responsible for reinforcement learning and appropriate decision making. This difference between violent offenders with antisocial personality disorder with and without psychopathy has implications for the causes of these disorders and for treatment approaches

Subtypes of Severely Mentally Ill Violent Offenders in a Spanish Forensic Psychiatric Hospital

Conduct disorder (CD) prior to age 15 identifies a subgroup of men with severe mental illness (SMI) who present a high risk for violence that persists across the life span. The present study examined male violent offenders with SMI in a forensic hospital in Spain, comparing those with SMI+CD and those without SMI-CD on the HCR-20 and PCL:SV. Violent offenders with SMI+CD obtained higher HCR-20 and PCL: SV total scores, and much higher H and factor 2 scores as compared to those without prior CD. Men with SMI+CD present a challenge to forensic psychiatric services

Getting the Phenotypes Right: An Essential Ingredient for Understanding Aetiological Mechanisms Underlying Persistent Violence and Developing Effective Treatments

In order to reduce societal levels of violence, it is essential to advance understanding of the neurobiological mechanisms involved in initiating and maintaining individual patterns of physical aggression. New technologies such as Magnetic Resonance Imagining and analyses of DNA provide tools for identifying these mechanisms. The reliability and validity of the results of studies using these tools depend not only on aspects of the technology, but also on the methodological rigour with which the studies are conducted, particularly with respect to characterizing the phenotype. The present article discusses five challenges confronting scientists who aim to advance understanding of the neurobiological mechanisms associated with persistent violence. These challenges are: (1) to develop evidence-based hypotheses and to design studies that test alternate hypotheses; (2) to recruit samples that are homogeneous with respect to variables that may be linked to neurobiological mechanisms underpinning violent behaviour; (3) to use reliable and valid measures in order to fully characterize participants so that the external validity of the results is evident; (4) to restrict the range of age of participants so as not to confuse developmental change with group differences; and (5) to take account of sex. Our goal is to contribute to elevating methodological standards in this new field of research and to thereby improve the validity of results and move closer to finding effective ways to reduce violence