Le syndrome de Klinefelter : une prédisposition au crime sexuel ?

BackgroundSeveral studies have reported over-representation of psychiatric disorders among patients with Klinefelter’ Syndrome (KS), with forensic complications.ObjectiveConsider determinants of sexual assault in patient with KS.ReviewIn this work, we present the case of Jules, 23 years old, with KS, benefiting from steroid replacement therapy, convicted of rape of a minor and evaluated in this context. We question here the role of his genetic pathology and of his hormonal treatment in this sexual assault.FindingsAccording to evidence from the literature, it is not possible to determine with certainty the fair value of each factor and their impact on the occurrence of the sexual criminal act. Indeed, although the crime rate among KS subjects is higher than in the general population, the majority of them have never been in trouble with the law; moreover, these subjects were no more likely to commit violent sexual acts than were criminals without KS. As for hormonal treatment, it seems that testosterone is better viewed as a facilitator of initiating an aggressive response than as a primary inductor.ConclusionIn conclusion, the onset of sexual violence that accompanied the introduction of hormonal treatment into a patient with KS suggests an effective involvement of steroid replacement therapy, even small, in the criminal act. This must incite clinicians to extreme prudence and to take account of multidisciplinary expertise (psychiatrist, endocrinologist) in order to reconsider the continuation of the treatment in this particular forensic context. Finally, we discuss other factors that can precipitate such a violent act.     

Histoire et fonctions des Unités pour Malades Difficiles (1re partie). Du quartier de sûreté à l’Unité pour Malades Difficiles de Villejuif,plus d’un siècle de prise en charge

This article is the first in a series of three, dedicated to the history and functions of what is known as a UMD in France: Unités pour Malades Difficiles, or “Units for Difficult Patients”. This particular article focuses on the oldest such secure structure, UMD Henri Colin, created in 1910 in Villejuif as a quartier de sûreté, or a “secure ward”. The article aims to detail evolutions in treatment and the types of patient treated over more than one hundred years, parallel to social change. Four distinct chronological periods are examined, for their perspective on professional practice as much as for the reasons given for patients’ admission and the psychopathological profiles of “dangerous” patients. Clinical vignettes are used to illustrate this historical evolution.     

Dangerosité psychiatrique et responsabilité pénale atténuée : à propos de la condamnation à la réclusion à perpétuité d’un schizophrène auteur d’un homicide sexuel sadique

The second paragraph of article 122-1 of the French Criminal Code provides for a reduced penalty in criminal matters (Court of Assizes) when the offender is suffering at the time the act is committed from a mental disorder that reduces his liability. This legal provision is not always respected, as shown by the sentencing to life imprisonment of a chronic psychotic patient who committed a sexual homicide (sadistic rape). The Court of Assizes found that the great dangerousness of this schizophrenic, with a multiple criminal record and who had refused his treatment, justified his conviction, while the psychiatric expertise concluded that he should benefit from a reduction on his criminal liability. The sentence was passed without the level of severity of his mental state having been verified by a new expert. The author therefore questions the “ethical” nature of this court decision which, albeit legal, is contrary to the spirit of the law. There was no appeal against the sentence.     

« Melting-PainTherapy » à l’unité pour malades difficiles de Cadillac : le patient est un artiste !

In Melting-PainTherapy workshop, we offer an innovative art therapy activity set in the unit for difficult patients in Cadillac, Gironde, France. Our hospital hosts patients with mental issues that let them, or may lead them, to commit one or more dangerous acts. Organized by nurses with a strong and highly developed artistic sensitivity, it is aimed towards patients who voluntarily participate, once, or more, or on a regular basis to our art project, while working alone with a nurse. In this workshop, the patient is an artist. He gets to create, express himself, realize and manage his possibilities, limitations, frustrations, constraints and relationship to himself and others. The Melting-PainTherapy concept revolves around the elaboration of collective art pieces meant to advance the individuals on rotative canvases.     

L’éducation thérapeutique de patients souffrant de schizophrénie ayant commis ou pouvant commettre un ou des passage(s) à l’acte dangereux

Schizophrenia is a chronic mental pathology with polymorphous symptoms that have an invalidating impact on an emotional, interpersonal, behavioural and social level. In certain cases this pathology can increase the risk of self-harm or harm to others, making it necessary to put protocoles in place for specifically-adapted treatment, put forward notably by care units that deal with dangerous patients. The patient's therapeutic education, orientated towards acquiring knowledge about the illness and skills for dealing with it in day-to-day life, is now a recognised practice, having proven its effectiveness in the treatment of chronic psychiatric patients. There is significant interest in this method for treating dangerous mental patients. In this interview, the psychologist Diane Brulin-Solignac shares her knowledge and experience of this therapeutic practice.     

Prises en charge de situations psycho-légales complexes aux urgences psychiatriques

During a significant and clinically-varied influx of patients arriving at emergency psychiatry units, for some of these people the problem with regard to forensic psychology arises of rapid resolutions to complex situations. These situations are alluded to in this presentation: treatments in danger of non-completion when close relations refuse to sign a third-party agreement; psychiatric expertise in emergency departments; the evaluation of patients in administrative or police border control retention centers; refusal of somatic care; unclassifiable situations.     

Profile of the perpetrator of the Nice terror attack that took place on 14th July 2016: A terrorist whose modus operandi may have been imitated in other European attacks

The perpetrator of the Nice terrorist attack was a 31-year-old Tunisian with a history of domestic violence. Up until shortly before the mass murder, he is deemed to have had no particular interest in religion. He led an unbridled sex life with both women and men, drank alcohol, ate pork and took toxic substances. His profile, one that is difficult to class among the recent typologies of radicalised persons, shows that Islamic terrorists can be diverse in terms of their backgrounds. This wide-ranging diversity must be integrated into the detection and prevention of this type of terrorism. As successive apparent imitations seem to suggest, the Nice terror attack may have played a role in subsequent attacks on European soil, particularly due to the easily accessible modus operandi involved in the attacks, as well as for its destructive capabilities.