Sante Mentale au Quebec最新文献

Literature seems to establish a two-way relationship between psychoactive substance use and the presence of victimization. Indeed, substance can be used by a victim to overcome the different impacts lived because of the criminal acts experienced. On the other side, psychoactive substance use may increase the risks of a person being victim of criminal acts. It is therefore no wonder that an important proportion of people who consult for a problem of consumption/addiction to psychoactive substances have already been victims of criminal acts. Since the clinical profiles of these individuals is severe and complex, it appears important that the clinicians working with this person be aware of the presence of victimization in their life in order to help them. The objective of this project is to document the difficulties and the challenges encountered by the addiction clinicians in their interventions with people having already been victims of criminal acts and to present possible solutions to help improve interventions and promote their recovery. Thirty-two addiction clinicians (N = 9 Men) have taken part in individual meetings of about 60 minutes. Once transcribed in verbatim form, the interviews have been analyzed under a continuous theming method following the steps put forward by Braun and Clarke (2006). The results of the qualitative analysis highlighted the four following aspects: (1) Perception of clinicians regarding the portrait of people consulting in a public intervention center specializing in addiction; (2) Perception of addiction clinicians regarding the possible interactions between substance use and victimization; (3) The stakes of substance abuse intervention with the victims of a criminal act and (4) Suggestions to improve services for people with substance addiction and being criminal act victims. The results put forward the complexity of intervention with people with a problem of consumption/addiction and who were victims of criminal act victims. The results highlight the complexity of the intervention with people with a problem of consumption/addiction and who were victims of criminal acts, as well as the need for training addiction clinicians about victimization.

Objective Mental health services for persons presenting a first episode of psychosis include specialized interventions that are effective in treating psychosis, but they do not include treatments that prevent aggressive behaviour (AB). This article presents the results of studies in an effort to incite these services to evaluate the risk of AB and to intervene rapidly to prevent these behaviours as well as treating the psychotic disorder. Method This article presents a narrative review of the scientific studies. We have reviewed publications in French and English reporting studies, reviews, and meta-analyses focused on the antecedents, correlates, and effective treatments for AB and criminality of persons described as presenting severe mental disorder, schizophrenia, or a first episode of psychosis. Results The review of scientific studies confirms that persons developing or presenting schizophrenia are at increased risk to engage in AB, crime, and homicide relative to the general population. Before a first episode of psychosis approximately one third of patients display AB. One subgroup of these persons, those who present the highest risk of AB and criminality, have a history of conduct disorder since childhood. Another subgroup who also begin engaging in AB before a first episode of psychosis display AB as anxiety and positive symptoms increase. The association between positive psychotic symptoms and AB varies according to the phase of illness and the age of onset of AB. Further, other factors such as substance misuse (especially cannabis use), difficulty in recognizing emotions in the faces of others, impulsivity, and physical victimization are related to AB. In addition to effective treatments for psychosis and social skill training, treatment programs aimed at preventing AB and antisocial behaviours, and the associated factors are needed, as well as interventions that aim to reduce victimization. Conclusion The extant literature identifies different profiles of patients and factors associated with AB that can be identified at a first episode of psychosis. Consequently, first episode services could play an important role in preventing AB. To do this, they would need to simultaneously treat the psychosis and the AB. The implementation of such treatments would involve challenges such as convincing treatment teams of the benefits of such an approach and convincing patients needing these treatments to comply. Increasing patients' motivation and compliance remains an important challenge.

Objectives Anxiety and depression are the most prevalent disorders observed in health care services and are frequently comorbid with other disorders. Although Cognitive-Behavioral Therapy (CBT) has widely been shown efficacious to treat anxiety and mood disorders, studies that have focused on its effectiveness in the presence of comorbidity have been few and show conflicting results. Thus, the implications of the presence of comorbid disorders for treatment are still unknown. In an attempt to answer these questions, this study explores the impact of comorbidity on CBT for anxiety and mood disorders in a university-based clinic. Methods A total of 293 clients consulting for anxiety and/or mood disorders at the Service de Consultation de l'École de Psychologie de l'Université Laval (SCEP) between 2007 and 2018 took part in the study. Clients were excluded if they presented uncontrolled psychotic, manic or substance abuse symptoms as their principal complaint. Clients without comorbid disorders where compared to clients who had comorbid disorders on different measures before and after receiving therapy to examine if comorbidity had an impact on CBT effectiveness to treat the principal disorder. The impact of treatment on comorbid disorders was also investigated. Effectiveness was assessed on several measures before and after treatment including the severity of diagnoses (measured with a structured interview), anxiety and mood symptoms as well as quality of life. Repeated measures ANOVAs and t-tests were used. Results Before initiating therapy, clients with comorbid disorders had significantly more severe symptoms than clients without comorbid disorders. However, following therapy, both groups had significantly less severe principal disorders and reached a clinically significant change in equivalent proportions. Furthermore, the number and severity of comorbid disorders significantly decreased following therapy. Conclusion These findings suggest that although the presence of comorbid disorders leads to more severe symptoms, it does not affect the effectiveness of CBT for the principal disorder. Furthermore, comorbid disorders improved even though they were not specifically targeted by treatment. In concordance with the literature, it is thus suggested to keep focusing treatment on the principal disorder, whether comorbid disorders are present or not.