[Towards better management for sexual offenders: Presentation and conclusions of a public hearing concerning prevention, assessment, and care]

In France, since the law of June 17, 1998, sexual offenders may be convicted to ambulatory mandatory care, articulated with the justice. Twenty years after the implementation of this law, while social and technological developments have redefined certain aspects of delinquency, reference documents and practice guidelines remain to be updated. This is why the professionals of the main structures and associations dealing with perpetrators of sexual violence organized a public hearing under the sponsorship of the French Federation of Resource Centers for Sexual Violence Perpetrators (FFCRIAVS) according to the methodology and with the accompaniment of the High Authority of Health. This article presents the global methodology of the public hearing "Sexual Offenders: Prevention, Evaluation and Care" which was conducted on June 14 and 15, 2018. Thirty-three experts replied to27 questions and presented their conclusions to an Audition Committee and an audience of 200 persons representative of the civil and professional society. After a public debate, the hearing committee prepared a report in which they proposed propositions in order to better care for sexual offenders.

[Definition, derogation and application of the professional secrecy within the frame of court ordered cares: A systematic review of the French legal and health literature since 1998]

INTRODUCTION

Guaranteed by several legal and deontological dispositions, professional secrecy is an essential aspect of medical care, especially concerning the therapeutic alliance. Since the creation in French law of court-ordered treatment, some information is likely to be shared between actors either from the field of healthcare or of justice. This questions the type of information that can be shared and the variances existing between the different types of court-ordered treatments, which are to be known by the professionals.

METHODS

Following the methodology of the French Haute Autorité de Santé, a systematic review of the legal and health literature has been conducted. Different databases such as PubMed, Cairn and Legifrance have been reviewed with the following keywords « secret », « injonction de soins » (court-ordered treatment) and « obligation de soins » (obligation of care). Only the French literature since 1998 has been retained and because it is often less pronounced by the courts, the case of the therapeutic injunction, which represents the third type of court-ordered care, has been excluded.

RESULTS

Concerning the court-ordered treatment, on the one hand, the coordinating physician addresses the elements required in the control of measure to the Executive Magistrate. On the other hand, the Executive Magistrate sends a copy of the piece of the procedure to the coordinating physician, who transmits it to the general practitioner. The therapist can derogate from the medical secrecy in some circumstances as said in the law, either through the coordinating physician or the Executive Magistrate. In the case of obligation of care, where there is no coordinating physician, the general practitioner is still submitted to the classical rules of medical secrecy and only has to produce certificates of the follow-up with the patient.

DISCUSSION

Some authors have expressed their reservations about these new laws of derogation, especially concerning the blurred lines of the exception to these laws. Others have underlined the astonishing differences between court-ordered treatment and the obligation of care for almost similar clinical situations.

CONCLUSION

The rules of shared information must be known by the professionals and stated clearly to the patient at the beginning of treatment. Then, professionals are invited to remain thoughtful concerning the nature of this information. Finally, and as the public hearing of June 2018, promoted by the FFCRIAVS (Fédération Française des Centres Ressources pour les Intervenants auprès des Auteurs de Violences Sexuelles), said, it could be interesting to promote meeting spaces between the different actors of the management of people under court ordered cares, so as to better identify the limits of each one.

Correlations of cerebello-thalamo-prefrontal structure and neurological soft signs in patients with first-episode psychosis

OBJECTIVE

This study aimed at determining brain structural imaging correlates of neurological soft signs (NSS) in patients suffering from a first-episode psychosis.

METHOD

Fifty-two patients with a DSMIV diagnosis of first-episode psychosis (schizophrenia or schizophrenia spectrum disorder) were consecutively included. Subjects were assessed using a standardized neurological examination for motor coordination, motor integration and sensory integration. Anatomical magnetic resonance images (MRI) were analysed in the whole brain using optimized voxel-based morphometry.

RESULTS

Neurological soft signs (NSS) total score (P-corrected = 0.013) and motor integration subscore (P-corrected = 0.035) were found to negatively correlate with grey matter structure of the dorsolateral prefrontal cortices. Motor coordination subscore was positively correlated with grey matter structure of the thalami (P-corrected = 0.002) and negatively with white matter structure of the cerebellum (P-corrected = 0.034). The addition of age and gender as covariate yielded similar results. We did not find any correlation between neither sensory integration subscore and grey matter structure nor NSS total score, motor integration subscore and voxel-based morphometry (VBM) white matter structure.

CONCLUSION

Structural alteration in the cerebello-thalamo-prefrontal network is associated with neurological soft signs in schizophrenia, a candidate network for 'cognitive dysmetria'.