Psychiatric wards that only exceptionally use isolation and mechanical restraint may be suspected of using "chemical restraint". However, in the case of these services, the hypothesis of a reduction in the general level of restraint can also be formulated. Prior to a comprehensive study to test these hypotheses, the current research aims to assess indicators which define high levels of the use of these measures and a relevant sample. The study was conducted in three facilities with 254 hospitalized patients over a week. Five per cent experienced isolation, 2% mechanical restraint, and 13% received high doses of medication (including "as needed" treatments). These figures are below literature data and national averages. Variances exist among centers, with one showing higher percentages for all three measures. While confirming the feasibility of studying these measures together, the study suggests the need for longer observations and continuous evaluation of prescription practices to better reflect yearly isolation and restraint trends. Future studies should involve more centers and include case studies for a nuanced understanding of administration practices in relation to prescriptions. (c) 2024 L'Encephale, Paris.

Les services de psychiatrie qui ne recourent qu’exceptionnellement à l’isolement et la contention mécanique peuvent être soupçonnés de recourir à la « contention chimique ». Cependant, face à ces services, l’hypothèse d’une diminution du niveau général de contrainte peut également être formulée. Préalablement à une recherche d’ampleur visant à tester ces hypothèses, la présente étude vise à tester les indicateurs permettant de définir des hauts niveaux de recours à ces mesures et un échantillon pertinent. L’étude a été déployée dans trois établissements auprès des patients hospitalisés sur une semaine donnée, à savoir 254 patients. Cinq pour cent des patients de l’échantillon ont fait l’objet d’une mesure d’isolement et 2 % d’une mesure de contention. Les hautes doses ont concerné 13 % des patients (en comptant les traitements si besoin) et 9 % des patients (en les excluant). Ces données sont inférieures aux données de la littérature et aux moyennes nationales. Des différences apparaissent cependant entre les centres, l’un d’eux affichant, pour les trois mesures des pourcentages plus élevés que les deux autres. Cette étude confirme la faisabilité d’étudier conjointement les trois mesures, la pertinence des indicateurs utilisés et les possibilités d’extraction des données. Cependant, la semaine étudiée ne paraissant pas le reflet de ce qui s’observe sur l’ensemble de l’année en matière d’isolement et de contention, il serait opportun de multiplier les semaines d’observation, voire d’évaluer en continu les pratiques de prescription. Les futures études devront aussi inclure un nombre plus important de centres et inclure également des études de cas, permettant d’approcher plus finement les pratiques d’administration en rapport avec celles de prescriptions.

The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) is a structured interview that assesses the frequency and severity of each symptom of posttraumatic stress disorder (PTSD) in relation to a single traumatic stressor over a 1-month period, allowing the trained interviewer to infer a current or lifetime diagnosis congruent with the 5th Edition of the Diagnostic and Statistical Manual of the American Psychiatric Association. This study evaluated the psychometric properties of the original English language CAPS-5 translated to French. Participants (N = 168) were recruited in clinical settings of France, Lebanon, and Canada. The psychometric properties of the measure were found to be excellent, as good-to-strong interitem consistency was found (α = .90; ITC = .52; ICC = .30), while also finding strong convergent validity between the CAPS-5 total score and the severity score of a self-report PTSD measure (r = .82): the PCL-5. The test-retest reliability was excellent, with Cohen's κ = 1.00 and the intraclass coefficient (ICC) = .95. However, no latent factor structure model was deemed a strong fit to the data. Overall, the reliability and validity of the French CAPS-5 and are consistent with those of the original CAPS-5. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Increasing evidence suggests that childhood trauma (CT) is a major risk factor for schizophrenia but the underpinning mechanisms of their association remain unclear. Our aim is to review the literature on the association between CT and brain imaging measurements in adult schizophrenia subjects. We conducted a systematic review of the existing neuroimaging literature on CT and schizophrenia. We reviewed studies considering adult subjects with schizophrenia, schizoaffective disorder or first episode schizophrenia. A total of 15 studies were included. The most replicated result was the association in schizophrenia patients between CT and decreased total cerebral grey matter, particularly in the prefrontal cortex. In addition, studies suggest a different sensitivity to early stressors between schizophrenia subjects, their sibling and healthy unrelated subjects. In schizophrenia, CT is associated with alterations of white matter integrity in the inferior and superior longitudinal fasciculus, the inferior fronto-occipital fasciculus and the forceps major. Functional connectivity studies suggest an association between CT and a network including the amygdala, the anterior cingulate cortex, the precuneus/posterior cingulate cortex region and the temporo-parietal junction.

Background Posttraumatic stress disorder (PTSD) is a comorbidity often ignored and unexplored in patients with schizophrenia, despite a possible impact on its symptomology. Links and interactions between these disorders are still unknown. This article proposes a systematic review of the prevalence of PTSD in schizophrenia spectrum disorders (SSD). Methods and findings Thirty-eight studies were included. Results Results were heterogeneous with range of prevalence of PTSD varying between 0% and 55%. These wide ranges of prevalence were explained by the utilization of different assessment tools of trauma exposure, not all validated and heterogeneous population of SSD (schizoaffective disorders, comorbid addiction disorders mainly). Nevertheless, 78,9% of the studies found a prevalence of PTSD superior to 10 %. Conclusion Our review suggests a high rate of prevalence of PTSD in schizophrenia, which may be underestimated due to symptoms overlap. Moreover, the absence of difference in trauma exposure between SSD and the general population evokes an increased liability to trauma in patients with SSD.