Résumé
Objective: the aim of this study is to analyze the determinants of the abolition or alteration of discernment within the meaning of article 122-1 of the French penal code in individuals charged with criminal offenses. The primary objective is to identify the psychiatric diagnoses associated with a disturbance of discernment. The secondary objective is to examine other medical, judicial or sociodemographic variables influencing the expert assessment of discernment. Materials and methods: this retrospective study is based on 222 pre-sentencing psychiatric expert reports conducted at the University Hospital (CHU) of Montpellier between 2020 and 2022 by eleven forensic psychiatrists, under an agreement between the Montpellier Judicial Court and the CHU. A complete abolition of discernment was determined in 12 subjects, and an alteration of discernment in 36 subjects. We compared the reports concluding with an alteration or abolition of discernment to those concluding with preserved discernment, focusing on socio-demographic characteristics, the alleged offenses, judicial, psychiatric, and addiction history, the diagnosis at the time of the offense, the relationship between the offense and the disorder, and psychiatric dangerousness. Results: the diagnoses established at the time of the offense most often involved neurological disorders such as intellectual disability and dementia (OR=53.98, p<0.01), psychotic disorders (OR=44.1, p<0.01), depressive disorders (OR=6.45, p=0.02), and substance use disorders (OR=6.27, p=0.01). The diagnosis of a manic episode was systematically associated with a disturbance of discernment. Other factors were inversely correlated with a discernment deficit, such as being male (OR=0.11, p=0.01), committing sexual offenses (OR=0.12, p<0.01) or physical violence (OR=0.20, p=0.03), having children (OR=0.14, p<0.01), and active use of tobacco, alcohol, and/or cannabis (OR=0.22, p=0.01). Conclusion: this study highlights the transdiagnostic nature of discernment disorders and the role of substances in impairing judgment in individuals. Discernment is a multifaceted concept; clarifying a consensual definition and standardizing practices would reduce heterogeneity in conclusions, improve their reproducibility, and harmonize expert findings and the legal response, thus likely contributing to a reduction in the overrepresentation of individuals with mental disorders in the prison population. Moreover, most of the expert evaluations in this study concern sexual offenses committed by individuals with no discernment disturbance. These offenses seem to be more frequently committed by criminals rather than by individuals suffering from mental disorders that impair their cognitive abilities.