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- W2407896695 abstract "La question de la dangerosité est un sujet central en psychiatrie, puisqu’elle est source de stigmatisation pour de nombreux patients et qu’elle représente un élément majeur de la prise en charge médicale, mais aussi juridique et sociale. Ces dernières années de nombreuses études ont défini des sous-groupes de patients à risque. Si des facteurs tels que les symptômes positifs, une mauvaise compliance au traitement et des comorbidités tels que les troubles liés à l’usage de substance ou les traits de personnalité antisociaux ont été décrits comme prédictifs de violence, peu d’études se sont focalisées sur la corrélation entre dangerosité psychiatrique et niveau d’insight. Nous proposons une revue de la littérature portant sur l’association entre insight et dangerosité psychiatrique en abordant la dangerosité par le biais de la violence, l’agressivité, l’hostilité, l’impulsivité ou les agressions sexuelles. Les résultats sont hétérogènes, un certain nombre de biais méthodologiques peuvent l’expliquer : un manque d’uniformité dans les critères de jugement ou les méthodes de mesure choisies, le design ou la non prise en compte de facteur de confusion potentiels. Nous discutons ensuite du rôle de l’insight en tant que facteur protecteur vis-à-vis du risque de passage à l’acte, par le biais d’une meilleure observance thérapeutique, d’une plus grande flexibilité quant à ses croyances et d’une plus basse certitude quant à son jugement individuel. Concernant ce dernier point, l’étude plus spécifique de l’association entre insight cognitif et dangerosité psychiatrique semble prometteuse et encore peu exploité dans la littérature à ce jour. Violence committed by individuals with severe mental illness has become an increasing focus of concern among clinicians, policy makers, and the general public, often as the result of tragic events. Research has shown in the past two decades an increased risk of violence among patients with mental disorder. Nevertheless, of those suffering from mental illness, perpetrators of other directed violence form a minority subgroup. The means by which there is this association between mental illness and violence has remained controversial. Factors such as positive psychotic symptoms, medication non-adherence, alcohol or psychoactive substance abuse and antisocial personality were found to be predictive of violence. Overall, literature provides support to the assertion that violent behavior of mentally ill patients is a heterogeneous phenomenon that is driven by multiple inter-related and independent factors. Furthermore, psychiatrists are often asked to predict an individual's future dangerousness, in a medical or a legal context. In the process of risk assessment of dangerousness, more focus has been placed on dynamic risk factor. In this context, lack of insight has established itself both as a part of violence risk models and as a clinical item in structured approaches to measure dangerousness. However, few studies have tested these associations. The main purpose of this paper is to review the literature concerning the relationship between insight and dangerousness and discuss the contributions of the insight in the assessment of dangerousness in patients with mental illness. We included twenty studies that evaluated the association between insight and variable such as physical or verbal violence, aggressiveness, hostility or sexual aggression. According to the findings of this review, the strength and specific nature of this relationship remain unclear due to considerable methodological and conceptual shortcomings, including heterogeneity in the definition and assessment of violence, a minority of prospective studies and the lack of systematic consideration of possible confounding variables. However, the ability of the patient to perceive their illness is an important element to be considered in assessing the dangerousness both medically and legally. Higher belief flexibility and lower confidentiality of individual judgment, which reflect greater cognitive insight, may be associated with a lower incidence of violence, in particular in schizophrenia by decreasing the degree of confidence related to psychotic symptoms. In the growing efforts to reduce stigma associated with mental illness, it is important to identify a subgroup of patients at risk of violence and provide them with targeted treatment. In this sense, it seems important in the future to continue in this field of research to determine if the lack of insight is a covariate of a worsened condition or a specific violence risk factor per se." @default.
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- W2407896695 date "2017-04-01" @default.
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- W2407896695 title "Insight et dangerosité psychiatrique : revue de la littérature" @default.
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