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Improving the treatment and remission of major depression in homeless people with severe mental illness: the multicentric French Housing First (FHF) program. French Housing First Study Group Running title: Major depression in homeless people with severe mental disorders

Abstract : Objective The aim of this study was to investigate the factors associated with violent behavior in a large multicenter sample of Homeless Schizophrenia (SZ) and Bipolar Disorder (BD) (HSB) subjects. Methods This multicenter study was conducted in 4 French cities: Lille, Marseille, Paris and Toulouse. Violent behavior was defined by at least one episode of verbal or physical violence in the last 6 months. Results Overall, 675 HSB patients, mean aged 38 years and 82.5% men were included, 458 SZ (68.4%) and 212 BD (31.6%). During the 6 months before evaluation, 213 (34.3%) committed at least one physical or verbal violence. In multivariate analysis, violence has been associated with younger age (aOR = 0.96[0.94–0.99], p = .001), number of nights in the street (aOR = 1.01[1.01–1.01]), BD diagnosis (aOR = 1.63[1.01–2.65], p = .04), higher current illness severity (CGI score) (aOR = 1.32[1.07–1.64], p = .01), higher rates of current manic episode (aOR = 2.24[1.32–3.81], p = .002), current alcohol use disorder (aOR = 2.05 [1.33–3.15], p = .001), antisocial personality disorder (aOR = 2.51[1.55–4.07], p < .001) and with antidepressant consumption (aOR = 2.01[1.01–4.04], p = .04). No specific antipsychotic or mood stabilizer has been associated with decreased rates of violent behavior, however clozapine, lithium and carbamazepine remained poorly prescribed. Conclusion In case of violent behavior in HSB subjects, clinicians should focus in priority on the treatment of mania, antidepressant iatrogenic effect and alcohol use disorder by pharmacological and non-pharmacological treatments. Clozapine, lithium and carbamazepine should be chosen as the treatments of reference in this population but may be hard to manage in some cases. The current clinical trial number is NCT01570712.
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Guillaume Fond, L. Boyer, M. Boucekine, V. Girard, S. Loubière, et al.. Improving the treatment and remission of major depression in homeless people with severe mental illness: the multicentric French Housing First (FHF) program. French Housing First Study Group Running title: Major depression in homeless people with severe mental disorders. Progress in Neuro-Psychopharmacology and Biological Psychiatry, Elsevier, 2019, 90, pp.92-96. ⟨10.1016/j.pnpbp.2018.11.006⟩. ⟨hal-02473616⟩

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