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Husky MM, Léon C, du Roscoät E, Vasiliadis HM. Factors associated with past-year medication use and psychotherapy in adults with suicidal ideation in France. Int J Soc Psychiatry 2023:207640221148320. [PMID: 36629370 DOI: 10.1177/00207640221148320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The objective of the study is to assess the sociodemographic and clinical factors associated with past-year medication use and/or psychotherapy among adults with suicidal ideation in the past 12 months. METHODS Data were drawn from the 2017 Health Barometer survey, a large computer-assisted telephone survey on a representative sample of the general population aged 18 to 75 years living in metropolitan France (n = 25,319). Logistic and multinomial regression analyses were used to study past-year medication use and/or psychotherapy as a function of sociodemographic and clinical factors. Analyses were restricted to individuals reporting suicidal ideation in the past year (n = 1,148). RESULTS Overall, 43.6% of adults with suicidal ideation reported no treatment for a mental health reason in the past year; 36.6% reported using medication only, 4.8% psychotherapy only, and 15.0% both. Sociodemographic and clinical factors associated with increased probability of treatment varied as a function of the type of treatment received. Adjusting for key factors including clinical factors, older adults with suicidal ideation were more likely than younger adults to receive medication only. CONCLUSIONS The findings point to differential inequalities in access to medication and psychotherapy among adults with suicidal ideation in the general population of France.
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Affiliation(s)
- Mathilde M Husky
- Laboratoire de psychologie EA4139, Université de Bordeaux, France
| | | | - Enguerrand du Roscoät
- Laboratoire Parisien de Psychologie Sociale (LAPPS), EA 4386, Université Paris Nanterre, France
| | - Helen-Maria Vasiliadis
- Centre de recherche Charles-Le Moyne, Campus de Longueuil Université de Sherbrooke, Canada.,Département des sciences de la santé communautaire, Université de Sherbrooke, Canada
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2
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A Cross-Sectional Study of Treatments for Behavioral Disorders Following Traumatic Brain Injury: Comparison With French Recommendations. J Head Trauma Rehabil 2020; 34:E51-E60. [PMID: 30499933 DOI: 10.1097/htr.0000000000000452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To give a cross-sectional overview of ongoing management of behavioral disorders following traumatic brain injury (TBI) in a region of France, to compare this with recent recommendations from the French Society of Physical Medicine and Rehabilitation (SOFMER), and to evaluate associations between treatments and participant characteristics. SETTING Outpatients referred to medical or community-based facilities in a region of France. PARTICIPANTS One hundred twenty-nine adults with moderate to severe TBI, in the postacute period (over 3 months postinjury). DESIGN Cross-sectional cohort study. MAIN MEASURES Sociodemographic data, ongoing interventions including psychotherapy and medication, behavioral disorders assessed by the Behavioral Dysexecutive Syndrome Inventory (BDSI). RESULTS Thirty-three percent of participants received ongoing psychotherapy and 43% were on medication. The most prescribed medications were antidepressants (21%), neuroleptics (18%), anxiolytics (16%), and mood stabilizers (14%). Eighty-five participants (71%) presented a current Behavioral Dysexecutive Syndrome (BDS) according to the BDSI. These participants more frequently received treatment (P = .004), psychotherapy (P = .048), medications (often 2 or more) (P = .007), and particularly antiepileptic mood stabilizers (P = .037) compared with those without BDS. CONCLUSION Although recommended as first-line treatment, few participants with BDS received psychotherapy. Medications were overused, especially neuroleptics in view of their potential adverse effects. In contrast, recommended medications, such as mood stabilizers and β-blockers, did not appear to be highly prescribed whatever the evolution. Compliance with recommendations seemed insufficient.
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3
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Campanha AM, Ravagnani B, Milhorança IA, Bernik MA, Viana MC, Wang YP, Andrade LH. Benzodiazepine use in Sao Paulo, Brazil. Clinics (Sao Paulo) 2020; 75:e1610. [PMID: 32667494 PMCID: PMC7337218 DOI: 10.6061/clinics/2020/e1610] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 04/02/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To report the prevalence and factors associated with the use of benzodiazepines in the general population and those with a mental health condition in the metropolitan area of São Paulo, Brazil. METHODS 5,037 individuals from the Sao Paulo Megacity Mental Health Survey data were interviewed using the Composite International Diagnostic Interview, designed to generate DSM-IV diagnoses. Additionally, participants were asked if they had taken any medication in the previous 12 months for the treatment of any mental health condition. RESULTS The prevalence of benzodiazepine use ranged from 3.6% in the general population to 7.8% among subjects with a mental health condition. Benzodiazepine use was more prevalent in subjects that had been diagnosed with a mood disorder as opposed to an anxiety disorder (14.7% vs. 8.1%, respectively). Subjects that had been diagnosed with a panic disorder (33.7%) or bipolar I/II (23.3%) reported the highest use. Individuals aged ≥50 years (11.1%), those with two or more disorders (11.2%), those with moderate or severe disorders (10%), and those that used psychiatric services (29.8%) also reported higher use. CONCLUSION These findings give an overview of the use of benzodiazepines in the general population, which will be useful in the public health domain. Benzodiazepine use was higher in those with a mental health condition, with people that had a mood disorder being the most vulnerable. Furthermore, females and the elderly had high benzodiazepine use, so careful management in these groups is required.
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Affiliation(s)
- Angela Maria Campanha
- Nucleo de Epidemiologia Psiquiatrica (LIM-23), Departamento e Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Departamento de Farmacia, Universidade Estadual de Maringa, Maringa, PR, BR
- *Corresponding author. E-mail:
| | - Beatriz Ravagnani
- Nucleo de Epidemiologia Psiquiatrica (LIM-23), Departamento e Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Igor André Milhorança
- Nucleo de Epidemiologia Psiquiatrica (LIM-23), Departamento e Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Instituto de Matematica e Estatistica, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Márcio Antonini Bernik
- Programa de Ansiedade, Departamento e Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Maria Carmen Viana
- Departamento de Medicina Social, Programa de Pos-Graduacao em Saude Coletiva, Centro de Estudos e Pesquisa em Epidemiologia Psiquiatrica (CEPEP), Universidade Federal do Espirito Santo, Vitoria, ES, BR
| | - Yuan-Pang Wang
- Nucleo de Epidemiologia Psiquiatrica (LIM-23), Departamento e Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Laura Helena Andrade
- Nucleo de Epidemiologia Psiquiatrica (LIM-23), Departamento e Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Revranche M, Husky M, Kovess-Masfety V. [Use of psychotherapy among adults with a history of suicide attempt: Results form a large population-based study]. Encephale 2019; 45:513-521. [PMID: 31542213 DOI: 10.1016/j.encep.2019.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 07/01/2019] [Accepted: 07/18/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The current study aims to identify the factors associated with the use of psychotherapy among adults with a history of suicide attempt. METHODS A large cross-sectional survey (N=22,138) was conducted in four regions of France to characterize mental health care needs in the general population. Data were collected between April and June 2005 by trained interviewers using a computer-assisted telephone interviewing system (CATI). Sociodemographics, past-year mental disorders, lifetime and 12-month history of suicide attempts, and use of psychotherapy were assessed. RESULTS Overall, 7.1% of adults reported having undergone psychotherapy in the course of their life, and 2.0% in the previous 12 months. While 8.3% of adults with a lifetime suicide attempt (prior to the previous 12 months) underwent a psychotherapy in the previous 12 months, 27.5% of adults with a past-year suicide attempt underwent a psychotherapy in the previous 12 months. Psychotherapy was provided by psychiatrists (49.5%), psychologists (28.2%), and psychoanalysts (10.6%). While the frequency of psychotherapy sessions was greater among those with a prior attempt as compared to those with no prior attempt [Chi2 (10)=21.35, P=.019], there was no difference in therapy duration [Chi2 (8)=6.71, P=.568]. Compared to adults who did not report a prior attempt, those with a prior suicide attempt were 3,3 more likely to undergo psychotherapy with a psychologist [AOR=3.31 (2.54-4.31)]. Among adults with a prior suicide attempt, increased odds of undergoing a psychotherapy in the course of their life was predicted by higher education [AOR=2.81 (1.56-5.06)], living in the Paris region [AOR=2.06 (1.32-3.23)], and being a woman [AOR=1.50 (1.08-2.09)]. Increased odds of undergoing a psychotherapy in the previous 12 months was predicted by a major depressive disorder [AOR=2.59 (1.57-4.27)], any anxiety disorder [AOR=1.79 (1.07-2.97)], higher education [AOR=3.60 (1.29-10.0)], living in a city of 20,000 to 100,000 inhabitants [AOR=2.71 (1.13-6.50)] and more [AOR=2.50 (1.12-5.57)] (outside of the Paris region), a 2000 to 3000 euros monthly income [AOR=2.37 (1.15-4.85)]. DISCUSSION One third of adults with a lifetime suicide attempt and close to half of those with a past-year attempt have received some form of psychotherapy in the course of their life. In line with prior work, higher education and income level predicted past-year use of psychotherapy among adults with a prior suicide attempt. These findings highlight the association between major depressive disorder or anxiety disorders and increased odds of undergoing psychotherapy in the previous 12 months among adults with prior attempt. While pharmacological treatment, inpatient hospitalizations for mental health problems, visits with a general practitioner or specialized physician are free of charge in France, psychotherapy provided by psychologists or psychotherapists is currently not covered by the French Social Security health care system. As the treatment of mental disorders plays an important role in the reduction of suicide risk, supporting evidence-based psychotherapy through its reimbursement appears to be an important public health issue.
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Affiliation(s)
- M Revranche
- Faculté de psychologie, université de Bordeaux, 33000 Bordeaux, France
| | - M Husky
- Laboratoire de Psychologie EA4139, institut universitaire de France, université de Bordeaux, 33000 Bordeaux, France.
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Grenier S, Payette MC, Gunther B, Askari S, Desjardins FF, Raymond B, Berbiche D. Association of age and gender with anxiety disorders in older adults: A systematic review and meta-analysis. Int J Geriatr Psychiatry 2019; 34:397-407. [PMID: 30444008 DOI: 10.1002/gps.5035] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 11/03/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To provide an estimate of 12-month and lifetime prevalence of Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) anxiety disorders in older adults based on published studies on this topic and to identify the impact of gender and age. METHODS/DESIGN A systematic review and meta-analysis was performed. Six databases were searched, and manual searches through reference lists of selected articles and reviews were performed. When the information was available, summary effects were calculated for the prevalence of each anxiety disorder and for every age and gender subgroups. Summary odd ratios (OR) were calculated to compare the prevalence of an anxiety disorder according to age and gender. RESULTS A total of 6464 studies were identified, and 16 studies were included in the meta-analyses. Prevalence was significantly higher in women than men for generalized anxiety disorder (12 month OR = 6.10, P = 0.001; lifetime OR = 1.96, P = 0.001), 12-month social anxiety disorder (OR = 2.07, P = 0.01), and lifetime post-traumatic stress disorder (OR = 1.93, P = 0.002). The prevalence of specific phobia was significantly lower in both the 75 to 84 and 85 years and above age groups when compared with the 65 to 74 years age group (OR = 0.70, P = 0.004 and OR = 0.63, P = 0.01, respectively). CONCLUSIONS Our results suggest that the tendency for women to experience a greater prevalence of anxiety disorders remains present in older adults. Specific phobia was the only disorder to be less frequent with advancing age. This is likely to change with the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria because this new DSM version now indicates that fear of falling is a possible type of specific phobia and fear of falling is generally more frequent in the oldest age groups.
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Affiliation(s)
- Sébastien Grenier
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada.,Département de psychologie, Université de Montréal, Montréal, Quebec, Canada
| | - Marie-Christine Payette
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada.,Département de psychologie, Université du Québec à Montréal, Montréal, Quebec, Canada
| | - Bruno Gunther
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada.,Département de psychologie, Université de Montréal, Montréal, Quebec, Canada
| | - Sorayya Askari
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada
| | - Frédérique F Desjardins
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada.,Département de psychologie, Université de Montréal, Montréal, Quebec, Canada
| | - Béatrice Raymond
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada.,Département de psychologie, Université du Québec à Montréal, Montréal, Quebec, Canada
| | - Djamal Berbiche
- Département des Sciences de la Santé Communautaire, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Roquet M, Garlantezec R, Remy-Neris O, Sacaze E, Gallien P, Ropars J, Houx L, Pons C, Brochard S. From childhood to adulthood: health care use in individuals with cerebral palsy. Dev Med Child Neurol 2018; 60:1271-1277. [PMID: 30171608 DOI: 10.1111/dmcn.14003] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2018] [Indexed: 11/29/2022]
Abstract
AIM To analyse the health care usage of individuals with cerebral palsy (CP) as a function of age and ambulatory status. METHOD In total, 970 self-administered questionnaires relating to health care usage were sent, via a clinical network of professionals and institutions, to children and adults with CP in Brittany, France. Frequency of use of different aspects of health care were analysed as a function of age and ambulatory status. Multivariate logistic regression evaluated differences in the frequency of each health care type with age; the transition from childhood to adulthood was specifically analysed. RESULTS The response rate was 53% (282 adults, 230 children). Use of medication (particularly psychotropic and analgesic) increased with age, while physical-types of health care (rehabilitation, physical medicine and rehabilitation follow-up, and equipment) decreased with age, independently of ambulatory status. Use of other treatments, such as botulinum toxin injections, was not influenced by age. The provision of rehabilitation was particularly affected by the period of transition. INTERPRETATION Although health care needs change naturally in adulthood, the large decrease in usage of specific types of rehabilitation after the transition to adulthood suggested individuals had difficulty accessing this type of health care after childhood. These results provide objectives for the development of patient-centred, transitional consultations, and longitudinal studies. WHAT THIS PAPER ADDS Use of medication, particularly psychotropic and analgesic drugs, increased with age in individuals with cerebral palsy. Use of orthoses, physical medicine and rehabilitation physician follow-up, and rehabilitation decreased with age. Transition from childhood to adulthood involved significant changes in health care usage.
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Affiliation(s)
- Marion Roquet
- Médecine Physique et de Réadaptation, CHRU Brest, Brest, France.,Fondation Ildys, Brest, France
| | | | - Olivier Remy-Neris
- Médecine Physique et de Réadaptation, CHRU Brest, Brest, France.,Université de Bretagne Occidentale, Brest, France.,Laboratoire de Traitement de l'Information Médicale, INSERM, UMR 1101, Brest, France
| | | | - Philippe Gallien
- Médecine Physique et de Réadaptation, CMPR Notre Dame De Lourde, Rennes, France
| | - Juliette Ropars
- Laboratoire de Traitement de l'Information Médicale, INSERM, UMR 1101, Brest, France.,Service de Pédiatrie, CHRU Brest, Brest, France
| | - Laetitia Houx
- Médecine Physique et de Réadaptation, CHRU Brest, Brest, France.,Fondation Ildys, Brest, France.,Laboratoire de Traitement de l'Information Médicale, INSERM, UMR 1101, Brest, France
| | - Christelle Pons
- Médecine Physique et de Réadaptation, CHRU Brest, Brest, France.,Fondation Ildys, Brest, France.,Laboratoire de Traitement de l'Information Médicale, INSERM, UMR 1101, Brest, France
| | - Sylvain Brochard
- Médecine Physique et de Réadaptation, CHRU Brest, Brest, France.,Fondation Ildys, Brest, France.,Université de Bretagne Occidentale, Brest, France.,Laboratoire de Traitement de l'Information Médicale, INSERM, UMR 1101, Brest, France
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Barberot P, Gibaja V, Benkhedda C, Dobre D, Tournebize J, Kahn JP. [Identification of abuse/dependence cases by the French addictovigilance network (FAN): A pilot study of the addictovigilance center and the psychotherapeutic center of Nancy (France)]. Therapie 2018; 74:389-397. [PMID: 30392700 DOI: 10.1016/j.therap.2018.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/27/2018] [Accepted: 10/08/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES France is the only European country with a dedicated addictovigilance network (French addictovigilance network [FAN]). However, the reporting of cases of abuse/dependence is insufficient. In an attempt to overcome this under-reporting, data from the medical information systems program (PMSI) is regularly used to identify cases. Since addictions are frequently associated with psychiatric comorbidities, a pilot study was conducted for the first time in a psychiatric hospital. It aims, through a PMSI request, to identify the sociodemographic characteristics and psychiatric diagnoses of patients consuming psychoactive substances (PAS) and the PAS types consumed. METHODS This is a retrospective observational study conducted over a nine-month period at the psychotherapeutic center of Nancy (CPN). The codes used for the PMSI request are those of the international classification of diseases, tenth revision (ICD-10), codes F10 to F19 that characterize mental and behavioral disorders associated with the use of PAS. Cases presenting the four criteria necessary for an addictovigilance notification: (1) identified notifier, (2) identified patient, (3) known consumed product (s) and (4) presence of an effect related to the abuse/dependence of PAS; were retained and analyzed. RESULTS On an initial number of 252 cases, 82 cases of abuse/dependence were retained. The selected sample is predominantly male (67%). Cannabis (29%) and heroin (15%) are the most common illicit PAS. Regarding drugs, the consumption of benzodiazepines, a predominantly female phenomenon, is observed in 34% of subjects. Sixty-four per cent of the subjects were diagnosed "disorders related to the use of PAS", 14% as neurotic disorders, 9% as schizophrenia and 5% as of the mood disorders. CONCLUSION This study identified a significant number of potentially reportable cases to the French Addictovigilance Network and demonstrated the interest of investigating cases of abuse/dependence in a psychiatric hospital.
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Affiliation(s)
- Pauline Barberot
- Centre d'évaluation et d'information sur la pharmacodépendance et addictovigilance (CEIP-A), CHRU de Nancy, hôpital central, 29, avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France.
| | - Valérie Gibaja
- Centre d'évaluation et d'information sur la pharmacodépendance et addictovigilance (CEIP-A), CHRU de Nancy, hôpital central, 29, avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France; French Addictovigilance Network (FAN), 54035 Nancy, France
| | - Célia Benkhedda
- Centre d'évaluation et d'information sur la pharmacodépendance et addictovigilance (CEIP-A), CHRU de Nancy, hôpital central, 29, avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France
| | - Daniela Dobre
- Département de l'information médicale et unité de recherche et d'investigation clinique, Centre psychothérapique de Nancy, 54520 Laxou, France
| | - Juliana Tournebize
- Centre d'évaluation et d'information sur la pharmacodépendance et addictovigilance (CEIP-A), CHRU de Nancy, hôpital central, 29, avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France; French Addictovigilance Network (FAN), 54035 Nancy, France
| | - Jean-Pierre Kahn
- Centre d'évaluation et d'information sur la pharmacodépendance et addictovigilance (CEIP-A), CHRU de Nancy, hôpital central, 29, avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France; French Addictovigilance Network (FAN), 54035 Nancy, France; Unité 6, Centre psychothérapique de Nancy, pôle de psychiatrie et psychologie clinique, 54520 Laxou, France; Université de Lorraine, 54035 Nancy, France
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Design, rationale and feasibility of a multidimensional experimental protocol to study early life stress. Contemp Clin Trials Commun 2018; 7:33-43. [PMID: 29696166 PMCID: PMC5898516 DOI: 10.1016/j.conctc.2017.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 04/06/2017] [Accepted: 05/03/2017] [Indexed: 11/24/2022] Open
Abstract
There is a rapidly accumulating body of evidence regarding the influential role of early life stress (ELS) upon medical and psychiatric conditions. While self-report instruments, with their intrinsic limitations of recall, remain the primary means of detecting ELS in humans, biological measures are generally limited to a single biological system. This paper describes the design, rationale and feasibility of a study to simultaneously measure neuroendocrine, immune and autonomic nervous system (ANS) responses to psychological and physiological stressors in relation to ELS. Five healthy university students were recruited by advertisement. Exclusion criteria included chronic medical conditions, psychotic disorders, needle phobia, inability to tolerate pain, and those using anti-inflammatory medications. They were clinically interviewed and physiological recordings made over a two-hour period pre, during and post two acute stressors: the cold pressor test and recalling a distressing memory. The Childhood Trauma Questionnaire and the Parental Bonding Index were utilised to measure ELS. Other psychological measures of mood and personality were also administered. Measurements of heart rate, blood pressure, respiratory rate, skin conductance, skin blood flow and temporal plasma samples were successfully obtained before, during and after acute stress. Participants reported the extensive psychological and multisystem physiological data collection and stress provocations were tolerable. Most (4/5) participants indicated a willingness to return to repeat the protocol, indicating acceptability. Our protocol is viable and safe in young physically healthy adults and allows us to assess simultaneously neuroendocrine, immune and autonomic nervous system responses to stressors in persons assessed for ELS.
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Key Words
- ANS, Autonomic nervous system
- Adverse-childhood-events
- CPT, Cold pressor test
- CTQ, Childhood Trauma Questionnaire
- Childhood-stress
- Childhood-trauma questionnaire
- DASS, Depression, Anxiety and Stress Scale
- DS14, Type D Scale
- ECG, lectrocardiogram
- ELS, Early life stress
- EPQRs, Eysenck Personality Questionnaire Revised – short form
- HPA, Hypothalamic-pituitary-adrenal
- PBI, Parental Bonding Instrument
- PTSD, Post-traumatic Stress Disorder
- Parental-bonding-instrument
- RDM, Recall of distressing memory
- Type D scale (DS14)
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Dumesnil H, Apostolidis T, Verger P. Opinions of general practitioners about psychotherapy and their relationships with mental health professionals in the management of major depression: A qualitative survey. PLoS One 2018; 13:e0190565. [PMID: 29385155 PMCID: PMC5791973 DOI: 10.1371/journal.pone.0190565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 11/23/2017] [Indexed: 11/21/2022] Open
Abstract
Background French general practitioners (GPs) refer their patients with major depression to psychiatrists or for psychotherapy at particularly low rates. Objectives This qualitative study aims to explore general practitioners' (GP) opinions about psychotherapy, their relationships with mental health professionals, their perceptions of their role and that of psychiatrists in treating depression, and the relations between these factors and the GPs' strategies for managing depression. Methods In 2011, in-depth interviews based on a semi-structured interview guide were conducted with 32 GPs practicing in southeastern France. Verbatim transcripts were examined by analyzing their thematic content. Results We identified three profiles of physicians according to their opinions and practices about treatment strategies for depression: pro-pharmacological treatment, pro-psychotherapy and those with mixed practices. Most participants considered their relationships with psychiatrists unsatisfactory, would like more and better collaboration with them and shared the same concept of management in general practice. This concept was based both on the values and principles of practice shared by GPs and on their strong differentiation of their management practices from those of psychiatrists, Conclusion Several attitudes and values common to GPs might contribute to their low rate of referrals for psychotherapy in France: strong occupational identity, substantial variations in GPs' attitudes and practices regarding depression treatment strategies, representations sometimes unfavorable toward psychiatrists. Actions to develop a common culture and improve cooperation between GPs and psychiatrists are essential. They include systems of collaborative care and the development of interdisciplinary training common to GPs and psychiatrists practicing in the same area.
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Affiliation(s)
- Hélène Dumesnil
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | | | - Pierre Verger
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
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10
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Driot D, Bismuth M, Maurel A, Soulie-Albouy J, Birebent J, Oustric S, Dupouy J. Management of first depression or generalized anxiety disorder episode in adults in primary care: A systematic metareview. Presse Med 2017; 46:1124-1138. [DOI: 10.1016/j.lpm.2017.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/28/2017] [Accepted: 10/04/2017] [Indexed: 01/09/2023] Open
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Etchepare F, Pambrun E, Verdoux H, Tournier M. Trends in patterns of antidepressant use in older general population between 2006 and 2012 following publication of practice guidelines. Int J Geriatr Psychiatry 2017; 32:849-859. [PMID: 27357262 DOI: 10.1002/gps.4536] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 05/26/2016] [Accepted: 06/02/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The French regulatory agency published in 2006 practice guidelines related to the management of depressive and anxiety disorders. The main objective of the study was to assess their impact regarding use and monitoring of antidepressant drug treatment in older patients. The secondary objective was to identify factors associated with compliance with practice guidelines. METHODS A historical fixed cohort study with dynamic follow-up time was conducted in 16,144 subjects aged 65 years and over, initiating antidepressant treatment and registered in the National Health Insurance Database between 2006 and 2012. Compliance with guidelines was assessed from year to year using segmented regression analysis. Multiple logistic regressions were used to identify factors associated with compliance with guidelines. RESULTS Duration of antidepressant treatment was compliant with guidelines in 13.0% of patients aged 65-74 years and 18.5% of patients aged 75 years and over. Biological monitoring was performed in 12.6% of patients aged 65-74 years and 18.5% of patients aged 75 years and over. No significant change of rate of compliance with guidelines was observed over the study period. Compliance of prescriptions with guidelines was associated with patient's age, specialty of the prescriber, presence of chronic disease, year of treatment initiation, and presence of a university hospital in the area of residence. CONCLUSION While treatment duration and biological monitoring were often inadequate in older patients, the publication of guidelines by the French health regulatory authorities did not lead to any significant and sustained improvement in their patterns of antidepressant use. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Fanny Etchepare
- INSERM U1219, Bordeaux, France.,Univ. de Bordeaux, Bordeaux, France
| | | | - Hélène Verdoux
- INSERM U1219, Bordeaux, France.,Univ. de Bordeaux, Bordeaux, France.,Centre Hospitalier Charles Perrens, Bordeaux, France
| | - Marie Tournier
- INSERM U1219, Bordeaux, France.,Univ. de Bordeaux, Bordeaux, France.,Centre Hospitalier Charles Perrens, Bordeaux, France
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12
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Grimaldi-Bensouda L, Nordon C, Rossignol M, Jardon V, Boss V, Warembourg F, Reynolds R, Kurz X, Rouillon F, Abenhaim L. Antiepileptic drugs and risk of suicide attempts: a case-control study exploring the impact of underlying medical conditions. Pharmacoepidemiol Drug Saf 2017; 26:239-247. [DOI: 10.1002/pds.4160] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 10/05/2016] [Accepted: 12/05/2016] [Indexed: 01/19/2023]
Affiliation(s)
| | | | - Michel Rossignol
- Department of Epidemiology, Biostatistics and Occupational Health; McGill University; Montreal Canada
| | - Vincent Jardon
- Service de Psychiatrie; Centre Hospitalier Régional Universitaire de Lille; Lille France
| | - Virginie Boss
- Service de Psychiatrie; Centre Hospitalier Régional Universitaire de Lille; Lille France
| | - Frédérique Warembourg
- Service de Psychiatrie; Centre Hospitalier Régional Universitaire de Lille; Lille France
| | | | - Xavier Kurz
- Inspections & Human Medicines, Monitoring & Incident Management; European Medicines Agency; London UK
| | - Frédéric Rouillon
- Clinique des Maladies Mentales et de l'Encéphale, Centre Hospitalier Sainte Anne; Université Paris V René Descartes; Paris France
| | - Lucien Abenhaim
- LASER Research; Paris France
- Department of Epidemiology; London School of Hygiene & Tropical Medicine; London UK
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13
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De Maricourt P, Gorwood P, Hergueta T, Galinowski A, Salamon R, Diallo A, Vaugeois C, Lépine JP, Olié JP, Dubois O. Balneotherapy Together with a Psychoeducation Program for Benzodiazepine Withdrawal: A Feasibility Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2016; 2016:8961709. [PMID: 27956923 PMCID: PMC5124454 DOI: 10.1155/2016/8961709] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 10/11/2016] [Indexed: 11/21/2022]
Abstract
Benzodiazepines should be prescribed on a short-term basis, but a significant proportion of patients (%) use them for more than 6 months, constituting a serious public health issue. Indeed, few strategies are effective in helping patients to discontinue long-term benzodiazepine treatments. The aim of this study was to assess the feasibility and the impact of a program including cognitive behavioural therapy, psychoeducation, and balneotherapy in a spa resort to facilitate long-term discontinuation of benzodiazepines. We conducted a prospective multicentre cohort study. Patients with long-term benzodiazepine use were recruited with the aim of anxiolytic withdrawal by means of a psychoeducational program and daily balneotherapy during 3 weeks. The primary efficacy outcome measure was benzodiazepine use 6 months after the program, compared to use at baseline. A total of 70 subjects were enrolled. At 6 months, overall benzodiazepine intake had decreased by 75.3%, with 41.4% of patients completely stopping benzodiazepine use. The results also suggest a significantly greater improvement in anxiety and depression symptoms among patients who discontinued benzodiazepines compared to patients who only reduced their use. Our findings suggest that balneotherapy in association with a psychoeducative program is efficient in subjects with benzodiazepine addiction.
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Affiliation(s)
- P. De Maricourt
- Service Hospitalo Universitaire de Santé Mentale et de Thérapeutique, Université Paris Descartes, Centre Hospitalier Sainte Anne, Paris, France
- INSERM UMR 894, PRES Sorbonne Centre de Psychiatrie et Neurosciences, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - P. Gorwood
- INSERM UMR 894, PRES Sorbonne Centre de Psychiatrie et Neurosciences, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Th. Hergueta
- Laboratoire de Psychopathologie et Processus de Santé (EA 4057), Institut de Psychologie, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - A. Galinowski
- Service Hospitalo Universitaire de Santé Mentale et de Thérapeutique, Université Paris Descartes, Centre Hospitalier Sainte Anne, Paris, France
| | - R. Salamon
- Institute of Public Health, Epidemiology and Development “ISPED”, Bordeaux University, Bordeaux, France
| | - A. Diallo
- Institute of Public Health, Epidemiology and Development “ISPED”, Bordeaux University, Bordeaux, France
| | - C. Vaugeois
- Le Manoir Clinic, 09400 Ussat les Bains, France
| | - J. P. Lépine
- APHP, Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Vidal, Paris, France
| | - J. P. Olié
- Service Hospitalo Universitaire de Santé Mentale et de Thérapeutique, Université Paris Descartes, Centre Hospitalier Sainte Anne, Paris, France
- INSERM UMR 894, PRES Sorbonne Centre de Psychiatrie et Neurosciences, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - O. Dubois
- Saujon Clinic, BP 30, 17600 Saujon, France
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Semoun O, Sevilla-Dedieu C. Psychotropic Drug Consumption Among Older People Enrolled in a French Private Health Insurance Plan. Drugs Real World Outcomes 2016; 2:217-225. [PMID: 27747568 PMCID: PMC4883211 DOI: 10.1007/s40801-015-0029-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background In France, little information exists on psychotropic drug consumption in the elderly. Objective This study aimed to describe the patterns of psychotropic drug consumption, including the extent of inappropriate prescribing, in elderly subjects enrolled in a large health insurance plan in France (MGEN). Methods In 2011, 5840 MGEN affiliates aged at least 65 years were randomly selected. Reimbursement claims were organized into a 1-year cross-sectional data set. The EphMRA (European Pharmaceutical Market Research Association) classification was used to identify prescriptions of psychotropic drugs, and the Laroche criteria to identify potentially inappropriate medications (PIMs). Treatment duration was estimated using WHO defined daily doses (DDDs). A multivariate analysis was performed to identify factors associated with the prescription of PIMs. Results In 2011, 2213 subjects (37.9 %) made at least one reimbursement claim for a psychotropic drug, with the claims rate increasing with age. The mean annual volume of prescriptions per user was 193 DDDs. General practitioners were found to generate most of these prescriptions (81.8 %). Of these 2213 users, only 137 (6.2 %) had consulted a mental health specialist, and this rate decreased with age. Moreover, 1428 (64.5 %) subjects were prescribed at least one PIM, rising to 1711 (77.3 %) when including concomitant use of psychotropic drugs. Finally, the number of psychotropic drugs prescribed was associated with a higher odds ratio (OR) of PIM prescription. Conclusions Efforts should be made to reduce psychotropic drug prescriptions in elderly patients. This may contribute to reduce the amount of PIM prescriptions and the occurrence of iatrogenic side effects.
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Affiliation(s)
- Oren Semoun
- MGEN Foundation for Public Health, 3 Square Max Hymans, 75748, Paris Cedex 15, France
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15
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Fagot JP, Cuerq A, Samson S, Fagot-Campagna A. Cohort of one million patients initiating antidepressant treatment in France: 12-month follow-up. Int J Clin Pract 2016; 70:744-51. [PMID: 27484351 DOI: 10.1111/ijcp.12850] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 06/23/2016] [Indexed: 11/28/2022] Open
Abstract
AIMS Previous studies have shown that the recommended minimum 6-month period for antidepressant treatment is actually observed for only a minority of patients. The objectives of this study were to characterise patients with newly prescribed antidepressant treatment in France and identify factors possibly associated with insufficient duration of treatment or the occurrence of certain events such as sick leave, hospitalisations and suicide attempts. METHODS Data were extracted from the French health insurance database (SNIIRAM) and the national hospitalisation database (PMSI) for patients covered by the main French health insurance scheme representing 75% of the French population. Patients were included if they had a newly prescribed antidepressant in 2011, but no prior psychiatric diagnosis identified in the databases and no significant psychiatric medication (such as antipsychotic or mood stabiliser) in 2009-2010. RESULTS A total of 998 710 patients (2% of the overall population), with a mean age of 50 years and 66% of females, initiated an antidepressant in 2011, which was prescribed by a general practitioner in 89% of cases. Five generic names, including three selective serotonin reuptake inhibitors, accounted for 75% of first prescriptions. Only one reimbursement was observed for 40% of patients. Treatment duration was less than 6 months for more than 80% of patients, more frequently for low income earners, and varied according to age, gender and region. The median time lag between first visit and antidepressant initiation was 27 days. Hospitalisation related to a psychiatric disease over the following 12 months was observed for 3% of patients. CONCLUSION Duration of treatment and follow-up were both insufficient for the majority of French patients initiating antidepressant treatment in 2011, which may reflect poor quality of care for people with mood or anxiety disorders, possibly because of overdiagnosis and inappropriate drug treatment, or poor adherence and side effects, or poor follow-up.
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Affiliation(s)
- Jean-Paul Fagot
- Strategy and Research Department, Caisse nationale de l'assurance maladie, Paris, France
| | - Anne Cuerq
- Strategy and Research Department, Caisse nationale de l'assurance maladie, Paris, France
| | - Solène Samson
- Strategy and Research Department, Caisse nationale de l'assurance maladie, Paris, France
| | - Anne Fagot-Campagna
- Strategy and Research Department, Caisse nationale de l'assurance maladie, Paris, France.
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Pons C, Brochard S, Gallien P, Nicolas B, Duruflé A, Roquet M, Rémy-Néris O, Garlantezec R. Medication, rehabilitation and health care consumption in adults with cerebral palsy: a population based study. Clin Rehabil 2016; 31:957-965. [DOI: 10.1177/0269215516663286] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To evaluate medication, rehabilitation and healthcare consumption in adults with CP as a function of Gross Motor Function Classification System (GMFCS) level. Design: Questionnaire-based cross-sectional study. Setting: Brittany, a French county. Subjects: Adults with cerebral palsy. Interventions: Questionnaires relating to drugs, orthotic devices, mobility aids, rehabilitation and medical input were sent to 435 members of a unique regional French network dedicated to adults with cerebral palsy. The questionnaire was completed by the participant or a helper if necessary. Results: Of the 282 responders, 7.8% had a GMFCS level of I, 14.2% II, 17.7% III, 29.1% IV and 31.2% V. Participants consumed a large amount of healthcare. Almost three-quarters took orally administered drugs, of which antispastic and antiepileptic drugs were among the most frequent. Nearly all patients had at least one type of rehabilitation, 87.2% had physiotherapy, 78% used at least one mobility aid and 69.5% used at least one orthotic device. The frequency of numerous inputs increased with GMFCS level. Specificities were found for each GMFCS level, e.g. participants with GMFCS level IV and V had a high level of medical input and a greater use of trunk-supporting devices, antireflux and laxative. Profiles could be established based on GMFCS levels. Conclusions: Adults with cerebral palsy use a large amount of drugs, mobility aids, orthotic devices, rehabilitation and medical input. Healthcare is targeted at cerebral palsy-related issues. GMFCS is a determinant of healthcare consumption and thus a useful tool for clinical practice to target care appropriately.
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Affiliation(s)
- Christelle Pons
- Physical medicine and rehabilitation, CHRU Brest, France
- Fondation ILDYS, Brest, France
- Université de Bretagne Occidentale, Brest, France
- Laboratoire de Traitement de l’Information Médicale, Brest, France
| | - Sylvain Brochard
- Physical medicine and rehabilitation, CHRU Brest, France
- Fondation ILDYS, Brest, France
- Université de Bretagne Occidentale, Brest, France
- Laboratoire de Traitement de l’Information Médicale, Brest, France
| | - Philippe Gallien
- Physical medicine and rehabilitation, Pôle MPR Saint Hélier, Rennes, France
| | - Benoit Nicolas
- Physical medicine and rehabilitation, Pôle MPR Saint Hélier, Rennes, France
| | - Aurélie Duruflé
- Physical medicine and rehabilitation, Pôle MPR Saint Hélier, Rennes, France
| | - Marion Roquet
- Physical medicine and rehabilitation, CHRU Brest, France
| | - Olivier Rémy-Néris
- Physical medicine and rehabilitation, CHRU Brest, France
- Université de Bretagne Occidentale, Brest, France
- Laboratoire de Traitement de l’Information Médicale, Brest, France
| | - Ronan Garlantezec
- Public Health departement, CHU Rennes, University Rennes 1 Rennes, France
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Etchepare F, Pambrun E, Bégaud B, Verdoux H, Tournier M. Compliance of psychotropic drug prescription with clinical practice guidelines in older inpatients. Fundam Clin Pharmacol 2015; 30:82-92. [DOI: 10.1111/fcp.12167] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/26/2015] [Accepted: 11/03/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Fanny Etchepare
- Inserm U657; Inserm; Bordeaux F-33000 France
- Université de Bordeaux; F-33000 Bordeaux France
| | | | - Bernard Bégaud
- Inserm U657; Inserm; Bordeaux F-33000 France
- Université de Bordeaux; F-33000 Bordeaux France
- Centre Hospitalier Universitaire; F-33000 Bordeaux France
| | - Hélène Verdoux
- Inserm U657; Inserm; Bordeaux F-33000 France
- Université de Bordeaux; F-33000 Bordeaux France
- Centre Hospitalier Charles Perrens; F-33000 Bordeaux France
| | - Marie Tournier
- Inserm U657; Inserm; Bordeaux F-33000 France
- Université de Bordeaux; F-33000 Bordeaux France
- Centre Hospitalier Charles Perrens; F-33000 Bordeaux France
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18
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Quintana MI, Andreoli SB, Peluffo MP, Ribeiro WS, Feijo MM, Bressan RA, Coutinho ESF, Mari JDJ. Psychotropic Drug Use in São Paulo, Brazil--An Epidemiological Survey. PLoS One 2015; 10:e0135059. [PMID: 26252517 PMCID: PMC4529275 DOI: 10.1371/journal.pone.0135059] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 07/17/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of one month psychotropic drug use in São Paulo, Brazil, and to assess the gap treatment between the presence of mental disorders and psychotropic drug users. METHOD A probabilistic sample of non-institutionalized individuals from the general population of São Paulo (n = 2336; turnout: 84.5%) who were 15 years or older were interviewed by a trained research staff, applying the Composite International Diagnostic Interview 2.1 (CIDI WHO) (depression, anxiety-phobia, OCD\PTSD, alcoholism sections), and an inventory investigating psychotropic drug use during the 12-month and one-month periods immediately preceding the interview. Logistic models were fitted to investigate associations between psychotropic drug use as well as socio-demographic and clinical variables. RESULTS The one month prevalence of psychotropic drug use in São Paulo was 5.89%, the most commonly used drugs were antidepressants (3.15%) and tranquilizers (2.67%). A higher consumption of psychotropic drugs (overall, antidepressants and tranquilizers) was observed among women (OR:2.42), older individuals (OR:1.04), individuals with higher levels of formal education (1.06), and individuals with a family (OR:2.29) or personal history of mental illness (OR:3.27). The main psychotropic drug prescribers were psychiatrists (41%), followed by general practitioners (30%); 60% of psychotropic drugs were obtained through a government-run dispensing program. Most individuals who obtained a positive diagnosis on the CIDI 2.1 during the previous month were not using psychotropic medication (85%). Among individuals with a diagnosis of moderate to severe depression, 67.5% were not on any pharmacological treatment. CONCLUSION There is a change in the type of psychotropic more often used in São Paulo, from benzodiazepines to antidepressants, this event is observed in different cultures. The prevalence of use is similar to other developing countries. Most of the patients presenting a psychiatric illness in the month prior to testing were not receiving any sort of psychiatric medication. This may be explained by a failure to identify cases in primary care, which could be improved (and access to treatment could be facilitated) if professionals received more specialized training in managing cases with mental health problems.
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Affiliation(s)
- Maria Ines Quintana
- Universidade Federal de São Paulo—Escola Paulista de Medicina, Psychiatry Department, São Paulo, Brazil
- * E-mail:
| | - Sergio Baxter Andreoli
- Universidade Federal de São Paulo—Escola Paulista de Medicina, Psychiatry Department, São Paulo, Brazil
- Universidade Catolica de Santos, Santos, Brazil
| | | | - Wagner Silva Ribeiro
- Universidade Federal de São Paulo—Escola Paulista de Medicina, Psychiatry Department, São Paulo, Brazil
| | - Marcelo M. Feijo
- Universidade Federal de São Paulo—Escola Paulista de Medicina, Psychiatry Department, São Paulo, Brazil
| | - Rodrigo Affonseca Bressan
- Universidade Federal de São Paulo—Escola Paulista de Medicina, Psychiatry Department, São Paulo, Brazil
| | | | - Jair de Jesus Mari
- Universidade Federal de São Paulo—Escola Paulista de Medicina, Psychiatry Department, São Paulo, Brazil
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19
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Azevedo Da Silva M, Dugravot A, Balkau B, Roussel R, Fumeron F, Elbaz A, Canonico M, Singh-Manoux A, Nabi H. Antidepressant medication use and trajectories of fasting plasma glucose, glycated haemoglobin, β-cell function and insulin sensitivity: a 9-year longitudinal study of the D.E.S.I.R. cohort. Int J Epidemiol 2015; 44:1927-40. [PMID: 26245205 DOI: 10.1093/ije/dyv153] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Use of antidepressants is seen to be a risk factor for type 2 diabetes, even though the underlying mechanisms remain unclear. We examined whether antidepressant use was associated with change in fasting plasma glucose, glycated haemoglobin (HbA1c), β-cell function (HOMA2-%B) and insulin sensitivity (HOMA2-%S) over time. METHODS Participants in the French D.E.S.I.R. cohort study included over 4700 men (48.1%) and women, free of diabetes, aged 30-65 years at baseline in 1994-96 (D.E.S.I.R. 0), who were followed for 9 years at 3-yearly intervals (D.E.S.I.R. 3, 1997-99; 6, 2000-02; 9, 2003-05). Antidepressant use, fasting plasma glucose, HbA1c, HOMA2-%B and HOMA2-%S were assessed concurrently at four medical examinations. Linear mixed models were used to examine the cross-sectional and longitudinal associations of time-dependent antidepressant use with changes in these four biological parameters. RESULTS Mean fasting plasma glucose and HbA1c increased whereas HOMA2-%B and HOMA2-%S decreased over the follow-up. In a fully adjusted model, there were no differences in: mean fasting plasma glucose (β = 0.01 mmol/l, P = 0.702); HbA1c (β = 0.01 %, P = 0.738); HOMA2-%B (β = 0.00, P = 0.812); or HOMA2-%S (β =-0.01, P = 0.791) at baseline (1994-96) between antidepressant users and non-users. The interaction term with time also suggested no differences in the annual change in: fasting plasma glucose (β = 0.00 mmol/l, P = 0.322); HbA1c (β = 0.00 %, P = 0.496); HOMA2-%B (β = 0.00, P = 0.609); or HOMA2-%S (β = 0.00, P = 0.332) between antidepressant users and non-users. Similar associations were observed in analyses of type and cumulative use of antidepressants over follow-up. CONCLUSION Our longitudinal data show that use of antidepressants is not associated with altered glucose metabolism, suggesting that the association between antidepressant use and diabetes reported by previous studies may not be causal. Detection bias or clinical ascertainment bias may account for much of this apparent association.
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Affiliation(s)
- Marine Azevedo Da Silva
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, F-94807, Villejuif, France, University Paris Sud 11, UMRS 1018, F-94807 Villejuif, France,
| | - Aline Dugravot
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, F-94807, Villejuif, France, University Paris Sud 11, UMRS 1018, F-94807 Villejuif, France
| | - Beverley Balkau
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, F-94807, Villejuif, France, University Paris Sud 11, UMRS 1018, F-94807 Villejuif, France
| | - Ronan Roussel
- Service d'Endocrinologie, Diabétologie et Nutrition, DHU FIRE, Hôpital Bichat Assistance Publique-Hôpitaux de Paris, Paris, France, INSERM, Centre de Recherche des Cordeliers, Paris, France, Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France and
| | - Frédéric Fumeron
- INSERM, Centre de Recherche des Cordeliers, Paris, France, Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France and
| | - Alexis Elbaz
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, F-94807, Villejuif, France, University Paris Sud 11, UMRS 1018, F-94807 Villejuif, France
| | - Marianne Canonico
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, F-94807, Villejuif, France, University Paris Sud 11, UMRS 1018, F-94807 Villejuif, France
| | - Archana Singh-Manoux
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, F-94807, Villejuif, France, University Paris Sud 11, UMRS 1018, F-94807 Villejuif, France, Department of Epidemiology and Public Health, University College London, London, UK
| | - Hermann Nabi
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, F-94807, Villejuif, France, University Paris Sud 11, UMRS 1018, F-94807 Villejuif, France
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20
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Campanha AM, Siu ER, Milhorança IA, Viana MC, Wang YP, Andrade LH. Use of psychotropic medications in São Paulo Metropolitan Area, Brazil: pattern of healthcare provision to general population. Pharmacoepidemiol Drug Saf 2015; 24:1207-14. [PMID: 26154976 DOI: 10.1002/pds.3826] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 05/22/2015] [Accepted: 06/04/2015] [Indexed: 11/06/2022]
Abstract
PURPOSE We estimate the proportion of psychotropic medication use (PMU) among adults in São Paulo Metropolitan Area, Brazil. We investigated whether socio-demographic factors, comorbidity, and disease severity influence PMU among individuals with psychiatric disorders. METHODS Data are from the São Paulo Megacity Mental Health Survey, a cross-sectional, population-based study, the Brazilian branch of the World Mental Health Survey Initiative. Trained lay interviewers face-to-face assessed psychiatric disorders and PMU through the Composite International Diagnostic Interview. Respondents were asked about use of healthcare service and prescribed medications for mental disorders in the previous year. Information on PMU was collected for 2935 adult residents in the area and among those with disorders who received treatment. RESULTS Around 6% of respondents reported PMU in the past year: hypnotics or sedatives were used by 3.7% and antidepressants by 3.5%. Among individuals with 12-month disorders, only 14% reported past year PMU. Gender, age, education, income, occupational status, comorbidity, and severity were significant predictors for PMU. Among those with 12-month DSM-IV disorders who obtained treatment in healthcare settings, almost 40% received medication only. Among those treated in specialty mental health service, around 23% received combination of medication and psychotherapy. CONCLUSION Our study has pointed out that the recent trend of access to mental healthcare in Brazil depicts unmet needs, characterized by a low prevalence of PMU among individuals with psychiatric disorders. Policies that improve appropriate access to prescribed drugs for those most in need are urgent public health priority.
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Affiliation(s)
- Angela Maria Campanha
- Section of Psychiatric Epidemiology (LIM-23), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, SP, Brazil.,Department of Pharmacy, State University of Maringá, Maringá, PR, Brazil
| | - Erica Rosanna Siu
- Section of Psychiatric Epidemiology (LIM-23), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Igor André Milhorança
- Institute of Mathematics and Statistics, University of São Paulo, São Paulo, SP, Brazil
| | - Maria Carmen Viana
- Department of Social Medicine, Health Sciences Center, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - Yuan-Pang Wang
- Section of Psychiatric Epidemiology (LIM-23), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Laura Helena Andrade
- Section of Psychiatric Epidemiology (LIM-23), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, SP, Brazil
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Braunstein D, Donnet A, Pradel V, Sciortino V, Allaria-Lapierre V, Lantéri-Minet M, Micallef J. Triptans use and overuse: A pharmacoepidemiology study from the French health insurance system database covering 4.1 million people. Cephalalgia 2015; 35:1172-80. [DOI: 10.1177/0333102415570497] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 01/10/2015] [Indexed: 01/03/2023]
Abstract
Introduction The objective of this study was to estimate and to characterize the actual patterns of triptan use and overuse in France using a drug reimbursement database. Methods We included all people covered by the French General Health Insurance System (GHIS) from the Provence-Alpes-Côte-d’Azur (PACA) and Corsica administrative areas who had at least one dispensed dose of triptans between May 2010 and December 2011. All dispensed doses of triptans, migraine prophylactic treatment and psychotropic medications were extracted from the GHIS database. Triptan overuse was defined as triptan use >20 defined daily doses (DDD) per month on a regular basis for more than three consecutive months. Risk of overuse was assessed using logistic regression adjusted for gender and age. Results We included 99,540 patients who had at least one prescription of a triptan over the 20 months of the study. Among them, 2243 patients (2.3%) were identified as overusers and received 20.2% of the total DDD prescribed. Twelve percent of overusers and 6.9% of non-overusers were aged more than 65 years (OR: 1.81). Overusers did not have a greater number of prescribers and pharmacists than non-overusers. They were more frequently prescribed a prophylactic medication for migraine treatment (56.8% vs 35.9%, OR: 2.36), benzodiazepines (69.9% vs 54.7%, OR: 1.93) and antidepressants (49.4% vs 30.2%, OR: 2.33). Conclusions This work suggests that triptan overuse may be due to insufficient prescriber awareness of appropriate prescribing. The off-label prescription of triptans among the elderly necessitates investigating their cardiovascular risk profile in this sub-group.
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Affiliation(s)
- David Braunstein
- Aix Marseille Université, CNRS 7289 – Institut de Neurosciences Timone, Centre d’Evaluation et d’Information sur la Pharmacodépendance & Addictovigilance PACA-Corse, Service de Pharmacologie Clinique et Pharmacovigilance, France
| | - Anne Donnet
- Centre d’évaluation et de traitement de la douleur, hôpital Timone, Pôle Neurosciences Cliniques, Hôpital de la Timone, France
- INSERM/UdA, France
| | - Vincent Pradel
- Aix Marseille Université, CNRS 7289 – Institut de Neurosciences Timone, Centre d’Evaluation et d’Information sur la Pharmacodépendance & Addictovigilance PACA-Corse, Service de Pharmacologie Clinique et Pharmacovigilance, France
| | - Vincent Sciortino
- Direction Régionale du Service Médical de l’Assurance Maladie Provence-Alpes-Côte d'Azur et Corse (CNAMTS), France
| | - Véronique Allaria-Lapierre
- Direction Régionale du Service Médical de l’Assurance Maladie Provence-Alpes-Côte d'Azur et Corse (CNAMTS), France
| | - Michel Lantéri-Minet
- INSERM/UdA, France
- Département d’Evaluation et traitement de la Douleur, Pôle Neurosciences Cliniques du CHU de Nice, Hôpital Cimiez, France
| | - Joëlle Micallef
- Aix Marseille Université, CNRS 7289 – Institut de Neurosciences Timone, Centre d’Evaluation et d’Information sur la Pharmacodépendance & Addictovigilance PACA-Corse, Service de Pharmacologie Clinique et Pharmacovigilance, France
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Mercier A, Benichou J, Auger-Aubin I, Lebeau JP, Houivet E, Van Royen P, Peremans L. How do GP practices and patient characteristics influence the prescription of antidepressants? A cross-sectional study. Ann Gen Psychiatry 2015; 14:3. [PMID: 25632295 PMCID: PMC4308843 DOI: 10.1186/s12991-015-0041-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Accepted: 01/07/2015] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Under-prescription of antidepressants (ADs) among people meeting the criteria for major depressive episodes and excessive prescription in less symptomatic patients have been reported. The reasons influencing general practitioners' (GPs) prescription of ADs remain little explored. This study aimed at assessing the influence of GP and patient characteristics on AD prescription. METHODS This cross-sectional study was based on a sample of 816 GPs working within the main health care insurance system in the Seine-Maritime district of France during 2010. Only GPs meeting the criteria for full-time GP practice were included. The ratio of AD prescription to overall prescription volume, a relative measure of AD prescription level, was calculated for each GP, using the defined daily dose (DDD) concept. Associations of this AD prescription ratio with GPs' age, gender, practice location, number of years of practice, number of days of sickness certificates prescribed, number of home visits and consultations, number and mean age of registered patients, mean patient income, and number of patients with a chronic condition were assessed using univariate and multivariate analysis. RESULTS The high prescribers were middle-aged (40-59) urban GPs, with a moderate number of consultations and fewer low-income and chronic patients. GPs' workload (e.g., volume of prescribed drug reimbursement and number of consultations) had no influence on the AD prescription ratio. GPs with more patients with risk factors for depression prescribed fewer ADs, however, which could suggest the medications were under-prescribed among the at-risk population. CONCLUSIONS Our study described a profile of the typical higher AD prescriber that did not include heavy workload. In future work, a more detailed assessment of all biopsychosocial components of the consultation and other influences on GP behavior such as prior training would be useful to explain AD prescription in GP's practice.
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Affiliation(s)
- Alain Mercier
- />Department of General Practice, Rouen University, CIC Inserm 0204, 1 rue de Germont, 76031 Rouen Cedex, France
- />Department of General Practice, University Paris 13, Sorbonne Paris Cité, Bobigny, France
- />Department of Family practice, Faculty of Medicine, Rouen University, 20 Bd Gambetta, 76000 Rouen, France
| | - Jacques Benichou
- />Department of Biostatistics, Inserm U 657, University of Rouen, Rouen University Hospital, 1 rue de Germont, 76031 Rouen Cedex, France
| | - Isabelle Auger-Aubin
- />Department of General Practice, Département de médecine générale, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- />EA Recherche clinique coordonnée ville-hôpital, Méthodologies et Société (REMES), 75010 Paris, France
| | - Jean-Pierre Lebeau
- />Department of General Practice, Tours University, 10, Boulevard Tonnellé, B.P. 3223, 37032 Tours Cedex 1, France
| | - Estelle Houivet
- />Department of Biostatistics, Inserm U 657, University of Rouen, Rouen University Hospital, 1 rue de Germont, 76031 Rouen Cedex, France
| | - Paul Van Royen
- />Department of Primary and Interdisciplinary Care, Faculty of Medicine, Health Science University of Antwerp, Antwerp, Belgium
| | - Lieve Peremans
- />Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
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Abstract
Antidepressants are currently the treatment of choice for major depressive disorder (MDD). Nevertheless, a high percentage of patients do not respond to a first-line antidepressant drug, and combination treatments and augmentation strategies increase the risk of side effects. Moreover, a significant proportion of patients are treatment-resistant. In the last 30 years, a number of studies have sought to establish whether exercise could be regarded as an alternative to antidepressants, but so far no specific analysis has examined the efficacy of exercise as an adjunctive treatment in combination with antidepressants. We carried out a systematic review to evaluate the effectiveness of exercise as an adjunctive treatment with antidepressants on depression. A search of relevant papers was carried out in PubMed/Medline, Google Scholar, and Scopus with the following keywords: "exercise," "physical activity," "physical fitness," "depressive disorder," "depression," "depressive symptoms," "add-on," "augmentation," "adjunction," and "combined therapy." Twenty-two full-text articles were retrieved by the search. Among the 13 papers that fulfilled our inclusion criteria, we found methodological weaknesses in the majority. However, the included studies showed a strong effectiveness of exercise combined with antidepressants. Further analyses and higher quality studies are needed; nevertheless, as we have focused on a particular intervention (exercise in adjunction to antidepressants) that better reflects clinical practice, we can hypothesize that this strategy could be appropriately and safely translated into real-world practice.
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Minguez L, Di Poi C, Farcy E, Ballandonne C, Benchouala A, Bojic C, Cossu-Leguille C, Costil K, Serpentini A, Lebel JM, Halm-Lemeille MP. Comparison of the sensitivity of seven marine and freshwater bioassays as regards antidepressant toxicity assessment. ECOTOXICOLOGY (LONDON, ENGLAND) 2014; 23:1744-1754. [PMID: 25185786 DOI: 10.1007/s10646-014-1339-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/25/2014] [Indexed: 06/03/2023]
Abstract
The hazards linked to pharmaceutical residues like antidepressants are currently a major concern of ecotoxicology because they may have adverse effects on non-target aquatic organisms. Our study assesses the ecotoxicity of three antidepressants (fluoxetine, sertraline and clomipramine) using a battery of marine and freshwater species representing different trophic levels, and compares the bioassay sensitivity levels. We selected the following bioassays: the algal growth inhibition test (Skeletonema marinoi and Pseudokirchneriella subcapitata), the microcrustacean immobilization test (Artemia salina and Daphnia magna), development and adult survival tests on Hydra attenuata, embryotoxicity and metamorphosis tests on Crassostrea gigas, and in vitro assays on primary cultures of Haliotis tuberculata hemocytes. The results showed high inter-species variability in EC50-values ranging from 43 to 15,600 µg/L for fluoxetine, from 67 to 4,400 µg/L for sertraline, and from 4.70 µg/L to more than 100,000 µg/L for clomipramine. Algae (S. marinoi and P. subcapitata) and the embryo-larval stages of the oyster C. gigas were the most sensitive taxa. This raises an issue due to their ecological and/or economic importance. The marine crustacean A. salina was the least sensitive species. This difference in sensitivity between bioassays highlights the importance of using a test battery.
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Affiliation(s)
- Laetitia Minguez
- UMR BOREA (Biologie des ORganismes et Ecosystèmes Aquatiques), CNRS-7208/MNHN/UPMC/IRD-207/UCBN, Esplanade de la Paix, 14032, Caen Cedex, France,
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Etchepare F, Sanglier T, André M, Verdoux H, Tournier M. Antidepressant treatment patterns in younger and older adults from the general population in a real-life setting. Int J Geriatr Psychiatry 2014; 29:928-35. [PMID: 24477963 DOI: 10.1002/gps.4081] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 12/23/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The treatment of depression in real-life settings appears to be influenced by health care systems. Antidepressant drugs have been found to be underused in the older population relative to younger adults when refunding of such drugs is poor. No study assessed the pattern of antidepressant use according to age in a universal health care system. The objective is to assess whether the pattern of antidepressant drug use differs between younger and older adults with respect to treatment duration, adherence to treatment, coprescription of other psychotropic drugs, switch, or combination of antidepressant drugs. METHODS A historical cohort study included 7747 older (65+ years) and 27,306 younger (younger than 65 years) adults representative of the beneficiaries of the French national health care insurance system who initiated a new antidepressant treatment. Follow-up after treatment initiation was at least 6 months. RESULTS Older patients had a significantly longer duration of treatment than younger adults (hazard ratio = 0.90; 95%CI[0.88-0.93]). Adherence was more often good in older than in younger adults when the treatment was initiated by a general practitioner (23.4% vs. 16.7%; Odds ratio (OR) = 1.35[1.25-1.46]), a hospital practitioner (OR = 1.68[1.40-2.03]) or another specialist (OR = 1.60[1.19-2.17]). The coprescription of psychotropic drugs decreased with older age in men (OR = 0.77[0.70-0.85]) and increased with older age in women (OR = 1.14[1.07-1.22]). Switches and combinations of antidepressants were not associated with age. CONCLUSION In a universal health care system, with similar reimbursement of drugs regardless of age, treatment duration, and adherence were better in the older patients than in the younger ones.
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Affiliation(s)
- Fanny Etchepare
- INSERM U657, Bordeaux, France; Université de Bordeaux, Bordeaux, France
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Mercier A, Auger-Aubin I, Lebeau JP, Schuers M, Boulet P, Van Royen P, Peremans L. Why do general practitioners prescribe antidepressants to their patients? A pilot study. Biopsychosoc Med 2014; 8:17. [PMID: 25110516 PMCID: PMC4126991 DOI: 10.1186/1751-0759-8-17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 07/25/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The frequency of antidepressant (ADs) prescription is high, with general practitioners (GPs) responsible for about 80% of the prescriptions. Some studies considered prescriptions meet DSM criteria, while others stress inadequate use. The importance of biological and psychosocial determinants of GP prescription behaviour remains little explored. We aimed to describe the importance of these biological and psychosocial determinants and their weight in the daily practice of GPs'. METHODS During a week chosen at random, 28 GPs collected the AD prescriptions made within the previous six months, regardless of the reason for the patient contact. Bio psychosocial and AD treatment characteristics were recorded for all patients. In a random sample of 50 patients, patient characteristics were assessed via a structured face-to-face interview with the GP. RESULTS The frequency of AD prescription was 8.90% [3.94 -17.02]. The GPs initiated 65.6% [60.1-70.8] of the prescriptions. The rate of AD prescription for non-psychiatric conditions was 18%. Patients had from 1 to 9 conditions, showing a high level of multi-morbidity. There was a strong influence of past medical history and contextual problems, such as work related problems. CONCLUSION AD prescription is related to complex contextual situations and multi-morbid patients. GPs use a bio psycho social approach, rather than a purely biological assessment. Awareness of these influences could improve prescription by GPs.
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Affiliation(s)
- Alain Mercier
- Department of General Practice, Rouen University and CIC Inserm 0204, University of Rouen, Rouen, France
- Department of Family practice, Rouen University, Faculty of Medicine, 20 Bd Gambetta, Rouen 76000, France
| | | | | | - Matthieu Schuers
- Department of General Practice, Rouen University and CIC Inserm 0204, University of Rouen, Rouen, France
| | - Pascal Boulet
- Department of General Practice, Rouen University and CIC Inserm 0204, University of Rouen, Rouen, France
| | - Paul Van Royen
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Lieve Peremans
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
- Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
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Goodfellow B. Addiction and Psychiatry. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2014. [DOI: 10.1080/00207411.2014.1003728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Feuillet F, Bellanger L, Hardouin JB, Victorri-Vigneau C, Sébille V. On Comparison of Clustering Methods for Pharmacoepidemiological Data. J Biopharm Stat 2014; 25:843-56. [DOI: 10.1080/10543406.2014.920855] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Fovet T, Amad A, Adins C, Thomas P. Psychotropes en milieu pénitentiaire : de la fiole à l’AMM. Presse Med 2014; 43:520-8. [DOI: 10.1016/j.lpm.2013.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 07/01/2013] [Accepted: 08/19/2013] [Indexed: 10/25/2022] Open
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30
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Bocquier A, Cortaredona S, Boutin C, David A, Bigot A, Sciortino V, Nauleau S, Gaudart J, Giorgi R, Verger P. Is exposure to night-time traffic noise a risk factor for purchase of anxiolytic–hypnotic medication? A cohort study. Eur J Public Health 2013; 24:298-303. [DOI: 10.1093/eurpub/ckt117] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mura G, Carta MG. Physical activity in depressed elderly. A systematic review. Clin Pract Epidemiol Ment Health 2013; 9:125-35. [PMID: 24009640 PMCID: PMC3758953 DOI: 10.2174/1745017901309010125] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 06/06/2013] [Accepted: 06/07/2013] [Indexed: 12/25/2022]
Abstract
Background: exercise may reduce depressive symptoms both in healthy aged populations and in old patients diagnosed with MDD, but few specific analysis were conducted on the efficacy of exercise as an adjunctive treatment with antidepressants, which may be probably more useful in clinical practice, considered the high prevalence of treatment resistant depression in late life, the low cost and safety of physical activity interventions. Objective: to establish the new findings on the effectiveness of exercise on depression in elderlies, with particular focus on the efficacy of the exercise as an adjunctive treatment with antidepressants drug therapy. Method: the search of significant articles was carried out in PubMed/Medline with the following key words: “exercise”, “physical activity”, “physical fitness”, “depressive disorder”, “depression”, “depressive symptoms”, “late life”, “old people”, and “elderly”. Results: 44 papers were retrieved by the search. Among the 10 included randomized controlled trials, treatment allocation was adequately conceived in 4 studies, intention-to-treat analysis was performed in 6 studies, but no study had a double-blinded assessment. We examined and discussed the results of all these trials. Conclusion: in the last 20 years, few progresses were done in showing the efficacy of exercise on depression, due in part to the persistent lack of high quality research, in part to clinical issues of management of depression in late life, in part to the difficult to establish the real effectiveness of exercise on depressive symptoms in elderlies. However, there are some promising findings on physical activity combined with antidepressants in treatment resistant late life depression.
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Affiliation(s)
- Gioia Mura
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy
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Mercier A, Auger-Aubin I, Lebeau JP, Schuers M, Boulet P, Hermil JL, Van Royen P, Peremans L. Evidence of prescription of antidepressants for non-psychiatric conditions in primary care: an analysis of guidelines and systematic reviews. BMC FAMILY PRACTICE 2013; 14:55. [PMID: 23641784 PMCID: PMC3648410 DOI: 10.1186/1471-2296-14-55] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 04/24/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Antidepressants (ADs) are commonly prescribed in primary care and are mostly indicated for depression. According to the literature, they are now more frequently prescribed for health conditions other than psychiatric ones. Due to their many indications in a wide range of medical fields, assessing the appropriateness of AD prescription seems to be a challenge for GPs. The aim of this study was to review evidence from guidelines for antidepressant prescription for non-psychiatric conditions in Primary Care (PC) settings. METHODS Data were retrieved from French, English and US guideline databases. Guidelines or reviews were eligible if keywords regarding 44 non-psychiatric conditions related to GPs' prescription of ADs were encountered. After excluding psychiatric and non-primary care conditions, the guidelines were checked for keywords related to AD use. The latest updated version of the guidelines was kept. Recent data was searched in the Cochrane Database of Systematic Reviews and in PubMed for updated reviews and randomized control trials (RCTs). RESULTS Seventy-eight documents were retrieved and were used to assess the level of evidence of a potential benefit to prescribing an AD. For 15 conditions, there was a consensus that prescribing an AD was beneficial. For 5 others, ADs were seen as potentially beneficial. No proof of benefit was found for 15 conditions and proof of no benefit was found for the last 9. There were higher levels of evidence for pain conditions, (neuropathic pain, diabetic painful neuropathy, central neuropathic pain, migraine, tension-type headaches, and fibromyalgia) incontinence and irritable bowel syndrome. There were difficulties in summarizing the data, due to a lack of information on the level of evidence, and due to variations in efficacy between and among the various classes of ADs. CONCLUSIONS Prescription of ADs was found to be beneficial for many non-psychiatric health conditions regularly encountered in PC settings. On the whole, the guidelines were heterogeneous, seemingly due to a lack of trials assessing the role of ADs in treatment strategies.
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Affiliation(s)
- Alain Mercier
- Department of General Practice, Rouen University and CIC Inserm 0204, University of Rouen, Rouen, France
| | | | | | - Matthieu Schuers
- Department of General Practice, Rouen University and CIC Inserm 0204, University of Rouen, Rouen, France
| | - Pascal Boulet
- Department of General Practice, Rouen University and CIC Inserm 0204, University of Rouen, Rouen, France
| | - Jean-Loup Hermil
- Department of General Practice, Rouen University and CIC Inserm 0204, University of Rouen, Rouen, France
| | - Paul Van Royen
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Lieve Peremans
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
- Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
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Magalon-Bingenheimer K, Magalon D, Zendjidjian X, Boyer L, Griguer Y, Lançon C. Dépression en médecine générale. Presse Med 2013; 42:419-28. [DOI: 10.1016/j.lpm.2012.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 09/03/2012] [Accepted: 09/12/2012] [Indexed: 10/27/2022] Open
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Bruley des Varannes S, Ducrotté P, Vallot T, Garofano A, Bardoulat I, Carrois F, Ricci L. Gastroesophageal reflux disease: impact on work productivity and daily-life activities of daytime workers. A French cross-sectional study. Dig Liver Dis 2013; 45:200-6. [PMID: 23238032 DOI: 10.1016/j.dld.2012.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 10/30/2012] [Accepted: 11/06/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Few studies have evaluated the impact of gastroesophageal reflux disease symptoms on work productivity and no French data are available. AIM To compare the impact of typical symptoms of nocturnal vs diurnal gastroesophageal reflux disease on work productivity and daily activities. METHODS A French prospective, multicenter, observational study was performed in primary care setting. Patient characteristics, symptomatology and treatment were reported. Work productivity loss was assessed using the work productivity and activity impairment questionnaire, predictors were identified using multivariate regression models, and estimated cost was calculated. RESULTS 716 eligible patients (mean age: 46.3 years) were included by 407 physicians. Nocturnal symptoms were reported in 50.8% of patients and exclusively diurnal symptoms in 49.2%. Mean work productivity and daily activities decreased by 31.4% and 32.6%, respectively (both p<0.001). Work productivity was influenced by symptom intensity, diurnal symptoms occurrence, regurgitation and diurnal sleepiness. The mean associated cost per patient/week (€313) was higher in patients with diurnal symptoms (without (€346) or with nocturnal (€312) symptoms) than in patients with exclusive nocturnal symptoms (€253) (p<0.001). CONCLUSION Gastroesophageal reflux disease incurs high work productivity loss especially in patients with diurnal symptoms. Further medico-economic analyses are needed to estimate the cost effectiveness ratio according to therapeutic strategies.
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Affiliation(s)
- Stanislas Bruley des Varannes
- Institut des Maladies de l'Appareil Digestif (IMAD), CHU Hôtel Dieu, 1 place Alexis Ricordeau, 44 093 Nantes, France
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Danel T, Plancke L, Amariei A, Benoit E, Gautier S, Capele C, Vaiva G. La prescription de psychotropes durant la grossesse dans le Nord-Pas-de-Calais. Therapie 2013; 68:31-6. [DOI: 10.2515/therapie/2013005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 09/14/2012] [Indexed: 11/20/2022]
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Nicoli M, Bouchez S, Nieto I, Gasquet I, Kovess V, Lépine JP. Idéation et conduites suicidaires en France : prévalence sur la vie et facteurs de risque dans l’étude ESEMeD. Encephale 2012; 38:296-303. [DOI: 10.1016/j.encep.2011.02.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 12/09/2010] [Indexed: 10/17/2022]
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Binder-Foucard F, Reitzer C, Jégu J, Schweitzer B, Koehl F, Kopferschmitt J, Velten M. Use of psychotropic drugs, systemic antihistamines and medications for cough in 6-year-old children: a survey in the Bas-Rhin Region, France. Pharmacoepidemiol Drug Saf 2012; 21:1112-7. [PMID: 22826205 DOI: 10.1002/pds.3326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 06/15/2012] [Accepted: 07/02/2012] [Indexed: 11/10/2022]
Abstract
PURPOSE The use of drugs in France is among the highest in developed countries. Among them, psychotropic medication in children has always been a matter of concern. Furthermore, on the basis of concerns about safety and efficacy, international authorities have either advised against the use of cough and cold medication or considered such an action. This survey aims to assess the prevalence of use of psychotropic drugs, antihistamines and medications for cough as well as parents' knowledge about the drugs used in 2009. METHODS The study is based on a representative sample of 6-year-old children who were in kindergarten in 2009. School physicians asked their parents to answer a standardized questionnaire. Data were collected about the child, his or her family, and the consumption of psychotropic drugs, antihistamines, and medications for cough in the past 12 months. The Anatomical Therapeutic Chemical (ATC) classification system was used to classify the drugs used. RESULTS The data from 5707 children were analyzed. The proportion of children who consumed at least one psychotropic drug was 0.68% (ATC code N). Antihistamines for systemic use were by far the most frequently consumed drugs (ATC code R06), with a prevalence of 17.54%. The great majority of antihistamines for systemic use were meant to treat cough, not insomnia or agitation. CONCLUSION The use of psychotropic drugs was low in 2009 in the French region of Bas-Rhin. The promotion of alternatives to antihistamines for systemic use to treat cough should nevertheless be strengthened.
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Affiliation(s)
- Florence Binder-Foucard
- Laboratoire d'épidémiologie et de santé publique - EA 3430, Faculté de médecine, Université de Strasbourg, Strasbourg Cedex 67085, France.
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Sarlon E, Duburcq A, Neveu X, Morvan-Duru E, Tremblay R, Rouillon F, Falissard B. Imprisonment, alcohol dependence and risk of delusional disorder: a cross-sectional study. Rev Epidemiol Sante Publique 2012; 60:197-203. [PMID: 22608012 DOI: 10.1016/j.respe.2011.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 11/13/2011] [Accepted: 11/22/2011] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Compared to the general population, an excess of psychotic illnesses, major depression and dependence disorders among prisoners has been reported. However, the impact of prison on detainees' psychopathology has rarely been studied. OBJECTIVE To determine the mental disorders liable to develop or regress on entry into prison and over time. METHOD Two samples of French prisoners detained in local prisons were interviewed using the same methodology. The first sample consisted of 267 new arrivals. The second was a random sample of 450 prisoners. Diagnoses were assessed using a thorough methodology: each prisoner was interviewed for approximately 2 hours by two clinicians. One of the clinicians used a structured clinical interview, which generates DSM IV diagnoses (MINI plus v 5.0); the second completed the procedure with an open clinical interview. The final DSM IV diagnoses were obtained as a consensus between the two approaches. Multilevel logistic regressions were used to take into account potential confounders. RESULTS Prevalence rates of mental disorders were substantially higher in prison even for the sample of newcomers (major depression disorder: 24.7%, substance dependence: 17.6% and schizophrenia: 4.1%). Alcohol dependence disorder was significantly more frequent in the sample of newcomers (OR 1.84 [1.01-3.51]). No significant difference was evidenced between samples for substance dependence disorder. Psychotic disorders were significantly less frequent at entry into prison, particularly delusional disorder (OR 0.29 [0.08-0.98]). CONCLUSION This study shows the contrasted potential effects of prison on psychopathology: alcohol dependence disorders were significantly more frequent for the newcomers, while the frequency of delusional disorders was lower. This evidence is arguing in favour of the validity of the old concept: prison psychosis. Moreover, prisoners should receive relevant help from clinicians to cope with these disorders.
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Affiliation(s)
- E Sarlon
- Inserm, U669, Maison de Solenn, National Institute of Health and Medical Research, 97, boulevard du Port-Royal, 75679 Paris, France.
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Grimaldi-Bensouda L, Engel P, Massol J, Guillemot D, Avouac B, Duru G, Lert F, Magnier AM, Rossignol M, Rouillon F, Abenhaim L, Begaud B. Who seeks primary care for sleep, anxiety and depressive disorders from physicians prescribing homeopathic and other complementary medicine? Results from the EPI3 population survey. BMJ Open 2012; 2:e001498. [PMID: 23180389 PMCID: PMC3532988 DOI: 10.1136/bmjopen-2012-001498] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To describe and compare patients seeking treatment for sleep, anxiety and depressive disorders (SADD) from physicians in general practice (GPs) with three different practice preferences: strictly conventional medicine (GP-CM), mixed complementary and conventional medicine (GP-Mx) and certified homeopathic physicians (GP-Ho). DESIGN AND SETTING The EPI3 survey was a nationwide, observational study of a representative sample of GPs and their patients, conducted in France between March 2007 and July 2008. PARTICIPANTS 1572 patients diagnosed with SADD. PRIMARY AND SECONDARY OUTCOMES The patients' attitude towards complementary and alternative medicine; psychotropic drug utilisation. RESULTS Compared to patients attending GP-CM, GP-Ho patients had healthier lifestyles while GP-Mx patients showed similar profiles. Psychotropic drugs were more likely to be prescribed by GP-CM (64%) than GP-Mx (55.4%) and GP-Ho (31.2%). The three groups of patients shared similar SADD severity. CONCLUSION Our results showed that patients with SADD, while differing principally in their sociodemographic profiles and conventional psychotropic prescriptions, were actually rather similar regarding the severity of SADD in terms of comorbidities and quality of life. This information may help to better plan resource allocation and management of these common health problems in primary care.
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Affiliation(s)
- Lamiae Grimaldi-Bensouda
- Equipe d'accueil “Pharmacoépidémiologie et maladies infectieuses”, Institut Pasteur, Paris, France
- LA-SER, Paris, France
| | | | - Jacques Massol
- UFR de Médecine, Université de Franche Comté, Besançon, France
| | - Didier Guillemot
- Institut Pasteur, Paris, France
- Cyklad Group, Rillieux-la-Pap, France
| | | | | | - France Lert
- INSERM U1018, Centre for Epidemiology and Population Health, Villejuif, France
| | | | - Michel Rossignol
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- LA-SER Centre for Risk Research, Montreal, Canada
| | - Frederic Rouillon
- Centre Hospitalier Sainte-Anne, Université Paris V René Descartes, Paris, France
| | - Lucien Abenhaim
- Department of Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- LA-SER Europe Limited, London, United Kingdom
| | - Bernard Begaud
- INSERM U657, Université Bordeaux Segalen, Bordeaux, France
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Characteristics Associated With Use of Homeopathic Drugs for Psychiatric Symptoms in the General Population. Eur Psychiatry 2011; 28:110-6. [DOI: 10.1016/j.eurpsy.2011.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 10/25/2011] [Accepted: 10/28/2011] [Indexed: 11/16/2022] Open
Abstract
AbstractObjectiveTo explore which patient characteristics are associated in naturalistic conditions with the lifetime use of homeopathic treatment for psychiatric symptoms.MethodLifetime use of psychotropic treatment was explored in a sample of 36,785 persons, participating in the Mental Health Survey in the General Population. Characteristics associated with use of homeopathic treatments, associated or not with conventional psychotropic drugs, were explored using multivariate analyses.ResultsUse of homeopathic treatment for psychiatric symptoms was reported by 1.3% of persons. Younger age, female gender and high educational level were associated with use of homeopathy. Half of homeopathy users presented at least one Mini International Neuropsychiatric Interview (MINI) diagnosis, most frequently anxiety disorders. Their diagnostic profile was similar to that of persons reporting use of anxiolytics or hypnotics. Compared to persons with no lifetime use of psychotropic drugs, persons using homeopathy were more likely to present with a diagnosis of mood disorder or anxiety disorder. Compared to those using conventional psychotropic drugs, they presented less frequently with psychiatric disorders, with the exception of anxiety disorders.ConclusionHomeopathic treatment for psychiatric symptoms appears to be used mainly to reduce anxiety symptoms in the general population.
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Mercier A, Auger-Aubin I, Lebeau JP, Van Royen P, Peremans L. Understanding the prescription of antidepressants: a Qualitative study among French GPs. BMC FAMILY PRACTICE 2011; 12:99. [PMID: 21943348 PMCID: PMC3188468 DOI: 10.1186/1471-2296-12-99] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 09/24/2011] [Indexed: 11/29/2022]
Abstract
Background One-tenth of France's population is prescribed at least one antidepressant, primarily by General Practitioners. The reasons for this high prescription rate remain unclear. One-third of these prescriptions may not comply with clinical practice guidelines, and 20% are potentially unrelated to any psychiatric condition. Our aim was to explore how GPs declare they use antidepressants in daily practice and understand their reasons for prescribing them. Method Six focus groups including a total of 56 rural and urban GPs, with four interviews were performed. The topic guide focused on reasons for prescribing antidepressants in various primary care situations. Phenomenological analysis was performed by four researchers. Results Antidepressants were seen as useful and not harmful. Personal assessment based on experience and feeling determined the GPs' decisions rather than the use of scales. Twenty-four "non-psychiatric" conditions possibly leading to prescription of antidepressants in primary care were found. Conclusions The GPs reported prescribing antidepressants for a wide range of conditions other than depression. The GPs' decision making process is difficult and complex. They seemed to prefer to focus on their difficulties in diagnosing depression rather than on useless overtreatment. Instead of using the guidelines criteria to detect potential cases of useful prescription, physicians tend to use their own tools based on gut feelings, knowledge of the patient and contextual issues.
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Affiliation(s)
- Alain Mercier
- Department of General Practice, Rouen University and CIC Inserm 0204, Rouen University, Rouen, France.
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Lerat MC, Cabelguenne D, Lassia J, Meunier F, Zimmer L. Impact of pharmacist and clinician dual intervention on prescribed benzodiazepines in prisoner patients: a retrospective study. Fundam Clin Pharmacol 2010; 25:762-7. [PMID: 21166860 DOI: 10.1111/j.1472-8206.2010.00902.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
High-dose benzodiazepine (BDZs) represents an important risk factor for dependence, particularly in a prison environment. In Lyon's prison, BDZs and/or opioid maintenance treatment are often prescribed to patients with mental disorders. The aim of this retrospective study was to assess the impact of psychiatrist and pharmacist collaboration on reducing the BDZs dose prescribed to prisoner patients. Since 2001, clinicians and pharmacists have been holding monthly meetings to develop prescribing guidelines and discuss those patients receiving high-dose BDZs. All prescribed psychotropic drugs were noted for each included patient in the control (before guidelines) and intervention groups. Criteria used to define each patient profile included age, diagnosis (mental disorder), and concomitant treatment (opioids, antidepressants). To compare each group, the daily dose of prescribed BDZs was used as a quantitative variable and expressed in diazepam equivalent. Four hundred and seventy-three patients were included, 222 in the control group and 251 in the intervention group. The two groups showed no difference in terms of diagnosis. The daily dose of BDZ was higher in the control group when all patients were considered (mean(CONTROL GROUP) = 46 mg in diazepam equivalent vs. mean(INTERVENTIION GROUP) = 34 mg) and for each of the following patient categories: 'mental disorder' (48 mg vs. 30 mg), 'no opioid treatment' (44 mg vs. 31 mg), 'buprenorphin treatment' (58 mg vs. 63 mg), 'no antidepressant treatment' (41 mg vs. 29 mg), and 'antidepressant treatment' (53 mg vs. 38 mg). The results of this retrospective study show the positive impact of multidisciplinary intervention on reducing the prescribed daily dose of BDZs. This experience confirms the positive impact that pharmacist feedback on prescriptions and the development of treatment guidelines by clinician and pharmacist collaboration have on improving the prescribing practice in a prison environment.
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Affiliation(s)
- Marie-Cecile Lerat
- Hospices Civils de Lyon, Lyon Sud Hospital, Pharmacy Departement, France
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Psychotropic drug use among older people in general practice: discrepancies between opinion and practice. Br J Gen Pract 2010; 60:e156-62. [PMID: 20353661 DOI: 10.3399/bjgp10x483922] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The use of psychotropic drugs has increased over recent years in France. GPs are the first prescribers, especially for older patients. AIM To analyse discrepancies between GPs' opinions and practice when prescribing psychotropic drugs to older patients. SETTING Postal surveys sent to GPs all over mainland France. DESIGN OF STUDY Cross-sectional postal study. METHOD A questionnaire collected data on characteristics of GPs' practices, their opinions about psychotropic drug consumption in older people, and a full description of their last older patient receiving a psychotropic drug and seen last by the GP on that particular day. RESULTS A total of 350 participating GPs saw 2498 patients aged > or =65 years. Among these patients, the prevalence of psychotropic use was 32.1% (803/2498) for anxiolytics/hypnotics, and 17.5% for antidepressants (438/2498). A total of 91% of GPs agreed that it was possible to reduce or stop psychotropic drugs for these patients. Characteristics of 339 patients taking psychotropic drug were reported: 85.8% (291/339) received at least one anxiolytic/hypnotic and 56.9% (193/339) received at least one antidepressant; there were prescribed for more than 1 year in 68.4% (199/291) and 43.5% (84/193) of the cases respectively. GPs stated that it was possible to reduce or stop anxiolytic/hypnotic drugs for only 27% (79/291) of these patients. Barriers to doing this were patients' refusal (79%), and the absence of any local offer of psychotherapy (73%) or alternative therapy (70%). CONCLUSION A mismatch exists between GPs' intent (91%) and practice (27%) regarding reduction of psychotropic prescription in individuals aged > or =65 years. The barriers encountered should be examined further to help physicians improve management of psychotropic prescription.
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Norton J, de Roquefeuil G, David M, Boulenger JP, Ritchie K, Mann A. Prévalence des troubles psychiatriques en médecine générale selon le patient health questionnaire : adéquation avec la détection par le médecin et le traitement prescrit. Encephale 2009; 35:560-9. [DOI: 10.1016/j.encep.2008.06.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 06/24/2008] [Indexed: 10/21/2022]
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Authier N, Boucher A, Lamaison D, Llorca PM, Descotes J, Eschalier A. Second Meeting of the French CEIP (Centres d’Évaluation d’Information sur la Pharmacodépendance). Part II: Benzodiazepine Withdrawal. Therapie 2009; 64:365-70. [DOI: 10.2515/therapie/2009051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2009] [Indexed: 11/20/2022]
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Micallef-Roll J, Lapeyre-Mestre M. Second Meeting of the French CEIP (Centres d’Évaluation et d’Information sur la Pharmacodépendance). Part I: How to Evaluate and Prevent the Abuse and Dependence on Hypnotic/Anxiolytic Drugs? Therapie 2009; 64:355-64. [DOI: 10.2515/therapie/2009054] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Accepted: 07/27/2009] [Indexed: 11/20/2022]
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Peretti-Watel P, Legleye S, Baumann M, Choquet M, Falissard B, Chau N. Fatigue, insomnia and nervousness: gender disparities and roles of individual characteristics and lifestyle factors among economically active people. Soc Psychiatry Psychiatr Epidemiol 2009; 44:703-9. [PMID: 19148558 DOI: 10.1007/s00127-008-0487-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Revised: 11/19/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND Individuals with certain personal, family and job characteristics are at elevated risk of poor mental health. Yet, the respective role of obesity, smoking, alcohol abuse, low education, income, living and family conditions, and socio-occupational category in fatigue/insomnia (FI), nervousness (N) and frequent drug use for those disorders (DFI and DN) among men and women and in gender disparities are not well known. METHODS We studied gender differences in FI, N, DFI, DN, and in their correlated, and whether the gender differences were mediated by individual and lifestyle factors among 3,450 active subjects aged 18-64, randomly selected from North-eastern France. Subjects completed a post-mailed questionnaire. Data were analyzed via adjusted odds ratio (ORa) computed with the logistic regression model. RESULTS Women were more affected than men for FI (21.3 vs. 13.1%, OR adjusted for age ORa 1.80, 95% CI 1.50-2.16), DFI (11.6 vs. 7.1%, ORa 1.74, 1.38-2.21), N (14.7 vs. 9.9%, ORa 1.58, 1.28-1.94), and for DN (12.1 vs. 5.7%, ORa 2.29, 1.79-2.94). These differences were not mediated by the individual characteristics studied. Multivariate analysis showed that the risk patterns varied between the two sexes. Smoking was related to N in men as well as in women; alcohol abuse to DFI in men only; lack of family support to all outcome variables in men and women; low educational level to DFI in men only; low income to FI, N and DN in men and to FI and DN in women; being unmarried to DN in men; being divorced/separated to N and DN in women; being a manual worker to FI and being a farmer to DFI in men; and being a manual worker to DN and being an employee to FI in women (1.50 <or= ORa <or= 2.95). CONCLUSIONS Women suffered more from fatigue/insomnia and nervousness and used more drug for those disorders than men. Socio-demographic and lifestyle factors played significant roles among men and women but they did not explain the gender disparities.
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Dupuy G, Vorspan F, Lépine JP. Épidémiologie des usages de substances addictives : résultats d’études réalisées en France et perspectives internationales. ANNALES MEDICO-PSYCHOLOGIQUES 2009. [DOI: 10.1016/j.amp.2009.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Desjeux G, Aspar AM, Colonna-d’Istria E, Raude D, Birioukoff M, Balaire C, Codaccioni A, Thevenin-Garron V. Consommation de médicaments psychotropes chez les militaires d’active en 2005. Encephale 2009; 35:249-55. [DOI: 10.1016/j.encep.2008.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Accepted: 07/02/2008] [Indexed: 11/16/2022]
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