We read with interest the paper by Fovet and colleagues1 wherein the authors conducted a cross sectional survey to estimate prevalence rates of psychiatric disorders (PDs) and substance use disorders (SUDs) in 622 (599 men and 23 women) randomly selected inmates who had recently been committed to the French general population prison system in the north of France. The Mini International Neuropsychiatric Interview was used as screening program. The prevalence rates of PDs and SUDs among newly arrived prisoners were compared with a sample of subjects representative of general population. The findings are interesting and show that nearly two third of the newly incarcerated people had at least one PDs or SUDs. Noteworthy, 41.6% of newly admitted inmates had two or more psychiatric comorbidities. Moreover, more than 30% of the sample had a suicide risk while 6.9% had any psychotic syndrome (isolated or recurrent). Apart from dysthymia and current isolated psychotic syndrome, the prevalence rates of PDs and SUDs were significantly higher in prison sample than in general population, matched on age and sex. These results did not surprise us. We conducted a cross-sectional study including a sample of 141 male prisoners, admitted to Monza detention centre between January 2017 and March 2019. Subjects eligible for this study were aged between 18 and 65 years, suffering from any SUD but not reporting a previous diagnosis of “psychosis” or “schizophrenia” or taking antipsychotics. The Brief Psychiatric Rating Scale was administered to assess the presence of positive psychotic symptoms. Forty-five of them (31.9%) presented psychotic symptoms. We found that those with a history of previous incarceration (aOR=3.27, p=0.02) and suicide attempts inside (aOR=12.13, p=0.004) or outside prison (aOR=4.57, p=0.003) had significantly increased the likelihood of psychotic symptoms. Moreover, we found that psychotic subjects reported more frequently substance misuse than the counterpart (aOR=1.61, p=0.03). These results have been achieved comparing psychotic and non-psychotic inmates through multivariate logistic regression analyses using as covariates age, age at first imprisonment and age of onset of SUD (Table 1) . Table 1 about here The combined interpretation of our results with those of Fovet's study emphasises that several subjects both at risk of psychotic disorders and criminal behavior may not be fully detected by outpatient mental health services. This aspect is of current interest because inmates with an undiagnosed or untreated psychotic disorder potentially have a worse outcome than healthy ones2. Indeed, we found that people with psychotic symptoms were potentially at high risk of criminal involvement, since more frequently incarcerated. Moreover, our study shows that psychotic symptoms are significantly related to increasing risk of suicide attempt, both inside and outside of prison, although we cannot entirely exclude that multiple incarcerations might be a confounder. This result is in line with previous findings suggesting that prisoners may have high rates of suicide attempt not merely within prison, but also after release, particularly in the first months3. Nevertheless, inmates with dual diagnosis may be at increased risk of resumption of difference substances after release, which in turn may rise the risk of both overdose death and psychotic disorders. In this regard, we found that poly-abuse may be associated with the presence of psychotic symptoms. Although the measure of psychotic symptoms was restricted to four items of The Brief Psychiatric Rating Scale, our study shows that psychotic offenders should be considered a fragile population. Therefore, as reported by Fovet and colleagues, the detection of psychiatric and SUDs on admission to prison facilities should be promoted in order to initiate adequate treatment. Nevertheless, an appropriate community-based treatment after the release from prison is definitely an important part of the management of these patients to reach a successful reintegration and to avoid post-release mortality4. Finally, mental healthcare access should be promoted among disadvantaged areas as well as novel integrated treatments for patients with a dual diagnosis should be introduced and implemented5
Capuzzi, E., Caldiroli, A., Buoli, M., Clerici, M. (2020). Commentary on “Mental disorders on admission to jail: A study of prevalence and a comparison with a community sample in the north of France”. Cambridge University Press:.
Commentary on “Mental disorders on admission to jail: A study of prevalence and a comparison with a community sample in the north of France”
Capuzzi, E.
Primo
;Clerici, M.Ultimo
2020
Abstract
We read with interest the paper by Fovet and colleagues1 wherein the authors conducted a cross sectional survey to estimate prevalence rates of psychiatric disorders (PDs) and substance use disorders (SUDs) in 622 (599 men and 23 women) randomly selected inmates who had recently been committed to the French general population prison system in the north of France. The Mini International Neuropsychiatric Interview was used as screening program. The prevalence rates of PDs and SUDs among newly arrived prisoners were compared with a sample of subjects representative of general population. The findings are interesting and show that nearly two third of the newly incarcerated people had at least one PDs or SUDs. Noteworthy, 41.6% of newly admitted inmates had two or more psychiatric comorbidities. Moreover, more than 30% of the sample had a suicide risk while 6.9% had any psychotic syndrome (isolated or recurrent). Apart from dysthymia and current isolated psychotic syndrome, the prevalence rates of PDs and SUDs were significantly higher in prison sample than in general population, matched on age and sex. These results did not surprise us. We conducted a cross-sectional study including a sample of 141 male prisoners, admitted to Monza detention centre between January 2017 and March 2019. Subjects eligible for this study were aged between 18 and 65 years, suffering from any SUD but not reporting a previous diagnosis of “psychosis” or “schizophrenia” or taking antipsychotics. The Brief Psychiatric Rating Scale was administered to assess the presence of positive psychotic symptoms. Forty-five of them (31.9%) presented psychotic symptoms. We found that those with a history of previous incarceration (aOR=3.27, p=0.02) and suicide attempts inside (aOR=12.13, p=0.004) or outside prison (aOR=4.57, p=0.003) had significantly increased the likelihood of psychotic symptoms. Moreover, we found that psychotic subjects reported more frequently substance misuse than the counterpart (aOR=1.61, p=0.03). These results have been achieved comparing psychotic and non-psychotic inmates through multivariate logistic regression analyses using as covariates age, age at first imprisonment and age of onset of SUD (Table 1) . Table 1 about here The combined interpretation of our results with those of Fovet's study emphasises that several subjects both at risk of psychotic disorders and criminal behavior may not be fully detected by outpatient mental health services. This aspect is of current interest because inmates with an undiagnosed or untreated psychotic disorder potentially have a worse outcome than healthy ones2. Indeed, we found that people with psychotic symptoms were potentially at high risk of criminal involvement, since more frequently incarcerated. Moreover, our study shows that psychotic symptoms are significantly related to increasing risk of suicide attempt, both inside and outside of prison, although we cannot entirely exclude that multiple incarcerations might be a confounder. This result is in line with previous findings suggesting that prisoners may have high rates of suicide attempt not merely within prison, but also after release, particularly in the first months3. Nevertheless, inmates with dual diagnosis may be at increased risk of resumption of difference substances after release, which in turn may rise the risk of both overdose death and psychotic disorders. In this regard, we found that poly-abuse may be associated with the presence of psychotic symptoms. Although the measure of psychotic symptoms was restricted to four items of The Brief Psychiatric Rating Scale, our study shows that psychotic offenders should be considered a fragile population. Therefore, as reported by Fovet and colleagues, the detection of psychiatric and SUDs on admission to prison facilities should be promoted in order to initiate adequate treatment. Nevertheless, an appropriate community-based treatment after the release from prison is definitely an important part of the management of these patients to reach a successful reintegration and to avoid post-release mortality4. Finally, mental healthcare access should be promoted among disadvantaged areas as well as novel integrated treatments for patients with a dual diagnosis should be introduced and implemented5
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