Délires paranoïaques, dangerosités et homicides

[Isolation and restraint in psychiatry: practice and feedback from professional experiences]

A psychiatric nurse since 2013, who became a clinical psychologist in 2022, I have had the opportunity, on numerous occasions, to use isolation and therapeutic restraint as part of my nursing practice, mainly in a closed psychiatric admissions service. These therapeutic tools, specific to psychiatry, are used in a very specific theoretical and legislative framework. Their use always leads to reflection, both individually and as a team. Indeed, their use must remain the last therapeutic bulwark to be used because it can be experienced with difficulty or even in a traumatic way by the patient, which can damage the relationship of trust with the carers. Thus, it is important that this practice be supervised and discussed with the patient and the team in order to be as appropriate as possible.

[Soothing in units for difficult patients and in psychiatric intensive care units]

In the units for difficult patients (UMD) and the intensive psychiatric care units (Usip), patients whose mental pathologies have or could generate violent acts which can go as far as committing homicide are taken care of. If, during the psychiatric care of these patients, isolation and restraint measures can be put in place as a last resort, in general it is the symptomatological and behavioral appeasement of these persons that is sought in an alternative way.

[Isolation and restraint in units for difficult patients and in psychiatric intensive care units]

The units for difficult patients (UMD) and the intensive psychiatric care units (Usip) are psychiatric services that are not successively sectorized, created to meet the needs of intensive care in a closed environment and sometimes of a forensic nature. These two systems are used to care for patients whose clinical condition often makes it too complex to maintain them in sector psychiatric units, and many of their operating rules differ. This is not the case for seclusion and restraint measures and the application of the law governing these measures.

[Social care for patients hospitalized in units for difficult patients]

The units for difficult patients are secure psychiatric wards that receive people suffering from mental illnesses with a risk of dangerous behaviour. Within the framework of the global care of these patients, the intervention of social service assistants plays an essential role. The objective is to induce the psychosocial benefits necessary for the stabilization and evolution of these patients.

[Management of patients with addictions in units for difficult patients]

The links between mental pathologies and violent acts, which can go as far as homicide, are a major concern for many mental health professionals. Addictive co-morbidities, which are increasingly frequent, are an additional risk factor for some of these patients to commit dangerous acts. Psychiatric and psychological care for pathological perpetrators of such violence can be provided under certain conditions in units for difficult patients, with addiction treatment if necessary.

[Units for difficult patients in the mental health care system]

The links between mental pathologies and violent acts, which can go as far as homicide, are a major concern for many mental health professionals. Psychiatric and psychological care of pathological perpetrators of such violence can be carried out under certain conditions in units for difficult patients.

Homicides committed by delusional patients in the early 20th and 21st centuries: A study conducted in a French secure unit

Homicides committed by delusional patients are the object of a rich scientific literature, which puts the risk of such acts occurring into perspective when analyzing the offenders' sociodemographic and clinical characteristics. However, few articles detail the themes and mechanisms underlying those patients' delusions. To help bridge that gap, the authors conducted this retrospective descriptive study, including two samples of delusional homicidal patients, one from near present day and one from nearly a century ago. This study considered similarities observed in the literature (such as patients' sociodemographic profile, clinical data, and acting-out dynamics), but also explored the characteristics of delusion. In the 2015-2019 sample, the typical patient profile was: single male (31.5 years old on average), without child, unemployed, and with psychiatric history (56.6%). Most patients suffered from schizophrenic disease (83%) with non-systematized delusions exhibiting multiple themes in 80% of cases. Four principal types of delusion were observed: persecutive (100%), mystical (43.3%), megalomaniac (30%), and bodily (30%). The mechanisms were interpretative, hallucinatory, and intuitive. There was a societal influence in 23.3% of the cases (most often terrorist acts). The 1910-1914 historical sample revealed several differences: patients were older, more often married and employed. There were more diagnoses of chronic delusional disorder (30%). Persecutory delusion was constant (100%), and the other delusional themes were the "intimate relationship" type (50%)-jealousy, erotomanic-and the bodily type (40%). Additional studies are useful in order to reinforce our findings, and to further investigate the possibilities of prevention.