Prescription des antipsychotiques chez les sujets âgés avec une démence dans un hôpital psychiatrique : impact des recommandations de l’HAS

Abstract

ObjectivesBehavioral and psychological symptoms have a high prevalence in dementia. They include mood disorders, psychotic disorders and behavioral disorders such as aggression or screaming. Despite a number of side effects and an increased mortality, antipsychotic drugs are widely prescribed for treatment of this disorder. In France, this increased risk of mortality led in 2009 to the adoption of guidelines concerning all antipsychotics. The guidelines propose a sensible use of antipsychotics after the establishment of non-pharmacological measures. The aim of this study is firstly to assess the impact of the French drug agency warnings on use of antipsychotics in elderly patients with dementia in our psychiatric hospital between 2008 and 2013. Secondly, we compare the prescription of antipsychotics between geriatric psychiatry and other adult medical departments in 2013. MethodThirty elderly with dementia were included in 2008 and 116 in 2013. We compare the prescriptions of antipsychotics in terms of percentage of subjects under antipsychotics. For these patients, we measure average number of different antipsychotics prescribed during the hospital stay or on the exit prescription, the average daily dosage per patient, the presence or the absence of association of antipsychotics. ResultsWe show that the percentage of subjects under antipsychotics increased between 2008 and 2013 while the average dosage decreased in adult wards except in the geriatric psychiatry ward where the average dosage increased. There is no difference in the average number of different antipsychotics prescribed. In 2013, the geriatric department prescribed more antipsychotics but with lower dosages and lesser associations than in other departments. ConclusionsThe impact of the French guidelines is limited in our psychiatric hospital. It is probable that the lack of means, both human and pharmacologic, as well as the possible worsening of the severity of the behavior and psychotic disorders in patients with dementia make difficult the application of these recommendations for the psychiatric hospital.