Symptom Profile of Psychiatric Patients With Psychosis or Psychotic Mood Disorder in Prison

First-episode psychosis among people who are incarcerated: What is hidden behind the "prison psychosis" concept?

"Prison psychosis" is a historical concept that is still used in clinical practice, but little explored in research. In this short paper, we propose to revisit this concept by studying first-episode psychosis (FEP) in the prison population. We analyzed a series of incarcerated people who were hospitalized for a FEP from November 2020 to May 2021 in a French facility. We dated the onset of the first psychotic symptoms (PSs) in relation to the date of incarceration and of hospitalization and we calculated the duration of untreated psychosis (DUP). While the characteristics of our sample were consistent with what we know about people diagnosed with psychosis in correctional settings (young men with positive symptoms and psychiatric comorbidities), we found great heterogeneity in the DUP and in the chronological sequence between incarceration and the onset of PSs. This preliminary but original work shows the diversity of first diagnosis of psychosis in prison, reflecting the multiplicity and complexity of interactions between psychosis and incarceration.

Psychiatric disorders and management of sexual offenders in the prison psychiatric consultation unit of Marseille

Since 2017, complaints of sexual violence have increased in France. At the same time, the management of sexual offenders has been at the center of international public health policies. The prevalence of mental disorders among sexual offenders is an essential field of research. There are some published studies on the prevalence of psychiatric disorders in sexual offenders in detention, but there are few recent published studies among French individuals who were detained. Our objectives were to determine the prevalence of psychiatric disorders among persons detained for sexual offenses and the level of care received according to their diagnosis. For this purpose, we carried out a retrospective observational study from January 2017 to October 2021 of all adult sexual offenders, whether accused or convicted, who were seen in the psychiatric consultation unit of Les Baumettes prison, Marseille, France. The primary outcome measure was the psychiatric diagnosis entered in the medical records. One hundred forty-two patients were included in analysis. All patients were men, and the majority (n = 97, 68.3%) of these patients presented with at least one psychiatric disorder, principally a personality disorder (31.7%). 10.6% presented with a schizophrenic disorder, 4.9% a bipolar disorder, 3.5% a depressive disorder, 5.6% pedophilic paraphilia, and 25.4% an addictive disorder. Their management and comorbid addictions were analyzed in subgroups for each psychiatric disorder. Patients appeared to receive an appropriate level of care for their diagnosed disorder. It seems important to develop structured assessment of recidivism risk for better management of sexual offenders.

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.

Psychosis in German prisoners: Comparison of the clinical appearance of psychotic disorder of an imprisoned population with a not detained community group

Surveys confirm risk factors for the incarceration of patients with psychosis including homelessness and comorbidity. There is also agreement that severe psychosis can lead to violence. Data describing prisoners with psychosis in Germany are scarce. We aimed to compare patients with psychosis in a prison hospital and patients with psychosis in a community hospital. Demographic data were collected, as well as comorbidity in the form of substance dependence and a psychiatric assessment using the German version of the 18-item Brief Psychiatric Rating Scale (BPRS) and the Positive and Negative Syndrome Scale (PANSS). In the prison hospital group more patients were homeless (17 versus 2%) and non-German (36 versus 4%). There were also more patients with substance dependence or abuse in the prison hospital group. The total scores of BPRS and PANSS were lower in the prison hospital group (BPRS, 43.8 versus 51.2; PANSS, 71.5 versus 83.7). We assume that social disintegration for mentally disturbed offenders prior to incarceration hindered effective treatment. To avoid further social disintegration and possible further deterioration of mental health status of released offenders, which may lead to reoffending after imprisonment, discharge management after release from prison should be improved.

Utilization of Hospital-Level Mental Health Care Services for Inmates in France: A Transversal Study

OBJECTIVES

No study has assessed utilization of hospital-level mental health care for French prisoners. In particular, the impact of unités hospitalières spécialement aménagées (UHSAs; "specially equipped hospital units"), the full-time inpatient psychiatric wards for inmates created in 2010, remains unknown. The aim of this study was to describe the overall patterns of psychiatric hospitalization for detained people in France during 2016.

METHODS

The study was conducted by using a national psychiatric hospital discharge database. The authors identified incarcerated people who were hospitalized in UHSAs, general psychiatric hospitals, maximum-security unités pour malades difficiles (UMDs; "units for difficult patients"), and day treatment hospitals for inmates known as services médico-psychologiques régionaux (SMPRs; "regional medical-psychological services"), from January 1 to December 31, 2016.

RESULTS

In 2016, 4,392 incarcerated patients (7,027 admissions) were hospitalized (92% males). Overall, 1,944 patients were hospitalized in UHSAs, 1,787 in general psychiatric hospitals, 97 in UMDs, and 1,465 in SMPRs. That year, 815 patients (19%) were admitted to at least two different facilities. The mean cumulative length of stay per patient was 86.7 days (95% confidence interval=80.1-93.3; median=27 days), with longer durations of stay in UMDs and SMPRs than in UHSAs and general psychiatric hospitals.

CONCLUSIONS

Despite the recent creation of UHSAs, the hospitalization of inmates in general psychiatric hospitals remains frequent in France. Future research should consider the value of further developing UHSAs.