Disorders In France Research Articles

État des lieux et caractérisation des activités assistées par l’animal proposées en France aux enfants présentant des troubles du spectre autistique

Assessment and characterisation of animal-assisted interventions proposed to children with autism spectrum disorders in France. Animal assisted interventions (AAI) cause the emergence of a new category of service animals which aim to improve welfare and good health of people. AAI are very successful and are proposed to a variety of audiences including children with autism spectrum disorders (ASD). ASD are neurodevelopmental conditions which require early, continuous, global and coordinate interventions needing involvement of an interdisciplinary team. AAI are not a therapy but can be a support for management and treatment of ASD. AAI are common in intervention facilities for children with ASD but there is no data to assess the extent and the practices of AAI. We decided to make an assessment of AAI for children with ASD within intervention facilities in France. A questionnaire was sent to 2645 facilities and 386 responded. 60,1% of surveyed facilities use AAI for children with ASD. A wide range of species, settings, professionals, activities and difficulties have all been able to be defined. Despite their strong motivation and their will to maintain the AAI, facilities encounter many difficulties. It would be appropriate to start providing information and guidance to help facilities in AAI. Involvement of veterinarians or other animal experts is especially missing and would be necessary in order to implement good practices with animals and to ensure animal welfare.

Exposure to Traumatic Events and Posttraumatic Stress Disorder in France: Results From the WMH Survey.

This study examined the prevalence of traumatic events and the conditional probability of posttraumatic stress disorder (PTSD) associated with both specific and broad classes of events in a nationally representative sample from France. The sample (N = 1,436) was a part of the European Study of the Epidemiology of Mental Disorders Survey (ESEMeD), under the WHO World Mental Health Surveys-2000 initiative. Overall, exposure to any traumatic event was 72.7%, which appeared to be lower than what has been reported in Sweden (80.8%), similar to data from the Netherlands (71.1%), and higher than what has been reported in Spain (54.0%), Italy (56.1%), Northern Ireland (60.6%) or the U.S (55.9%). Lifetime prevalence of PTSD was 3.9%, lower than in the United States (7.8%), Sweden (5.6%), or Northern Ireland (8.8%), but higher than in Spain (2.2%) or Italy (2.4%). Being beaten up by a romantic partner (25.0%), having a child with serious illness (23.5%), and rape (21.5%) were associated with the highest risk of PTSD. The average duration of PTSD was 5.3 years (0.2-28.1). The burden of PTSD in France appeared to come from the consequences of violence and social network events suggesting that prevention efforts might focus on limiting the occurrence of exposure to avoidable events such as violence as well as provide support for persons exposed to social network events.

The management of opiate use disorders in France: results of an observational survey of general practitioners.

BackgroundWhen opioid-agonist treatments were approved in France in 1995, opiate use disorders began to be managed and treated by general practitioners (GPs), who have since then been encouraged to treat substance use disorders (SUDs) for heroin and other illegal substances. The objective of this study was to describe rates of: 1) SUDs in general practices in France; 2) characteristics of GPs treating SUDs; and 3) clinical practices surrounding SUDs. To place these data in the context of SUD treatment, we also gathered information from practicing SUD specialists.MethodsBetween December 2011 and January 2012, a nationally representative sample of GPs and SUD specialists were interviewed by phone, using a 12-item questionnaire that covered number of SUD patients, types of SUDs, and treatments. Data collected were confidential, and analysis was blinded with regard to physician identity.ResultsForty-four percent of GPs and 68 % of specialists were included in the analysis. The mean number of patients estimated to have been seen at least once in the previous year was 3036 for GPs and 920 for specialists. Ninety-six percent of GPs reported having patients with SUDs. Tobacco, alcohol, and psychoactive drugs were the SUDs most frequently encountered by GPs, whereas tobacco, alcohol, heroin, and cannabis were most frequently encountered by specialists. Forty-three percent of GPs saw at least one patient with a heroin use disorder (HUD), and 82 % of GPs treating patients with HUDs had prescribed an opioid-agonist treatment during the previous 12 months.ConclusionsThe results of this study suggest that a large number of GPs now treat patients with opiate use disorders and that doctors appear to be convinced of the benefits of opioid-agonist therapy and have overcome their initial concerns. This represents a significant change in practice patterns since the introduction of opioid-agonist treatments in France.

Malaria continues to select for sickle cell trait in Central Africa

Sickle cell disease (SCD) is a genetic disorder that poses a serious health threat in tropical Africa, which the World Health Organization has declared a public health priority. Its persistence in human populations has been attributed to the resistance it provides to Plasmodium falciparum malaria in its heterozygous state, called sickle cell trait (SCT). Because of migration, SCT is becoming common outside tropical countries: It is now the most important genetic disorder in France, affecting one birth for every 2,400, and one of the most common in the United States. We assess the strength of the association between SCT and malaria, using current data for both SCT and malaria infections. A total of 3,959 blood samples from 195 villages distributed over the entire Republic of Gabon were analyzed. Hemoglobin variants were identified by using HPLCy (HPLC). Infections by three species of Plasmodium were detected by PCR followed by sequencing of a 201-bp fragment of cytochrome b. An increase of 10% in P. falciparum malaria prevalence is associated with an increase by 4.3% of SCT carriers. An increase of 10 y of age is associated with an increase by 5.5% of SCT carriers. Sex is not associated with SCT. These strong associations show that malaria remains a selective factor in current human populations, despite the progress of medicine and the actions undertaken to fight this disease. Our results provide evidence that evolution is still present in humans, although this is sometimes questioned by scientific, political, or religious personalities.

Critically examining ‘Flashpoints’ theory

This critical appraisal of the ‘Flashpoints’ model raises the potential for its operational application as a vehicle for threat and risk assessment based on contextual intelligence. The model has been successfully used to analyse different types of disorder events, including urban disorders, football violence and single issue protest. An extra level of structuration to take account of police traditions and doctrines was added to the six interdependent levels of the original model. Inclusion of this seventh level provided better contextual understanding of police agency at the ‘interactional’ level of the model. This framework was applied to findings from a comparative study of public disorders in France and Britain, providing valuable insights into the nature and style of the approaches adopted in the two countries. This version of the model proved effective and thorough in its coverage of the critical areas. Due to their interdependence and overlapping nature, the seven levels ensured that the necessary ground was covered. The ‘Flashpoints’ model is ultimately a framework for providing contextual intelligence and showed promise as a tool for community threat assessment. Its contextual levels of analysis do not have to be used after the event. Its use would give police commanders a better understanding of the precursors of disorder and deviance within the communities they serve. At the very least it would evidence analysis and evaluation of local conditions and an ongoing commitment and desire to anticipate and mitigate contingencies.

Gender differences in mental disorders and suicidality in Europe: Results from a large cross-sectional population-based study

IntroductionWhen evaluating gender differences in mental disorders and suicidality, specifically between European countries, studies are sparse and frequently hindered by methodological issues, such as the limited items evaluated and inconsistent sampling designs. MethodsIn ten European countries participating in the World Mental Health Survey Initiative, lifetime internalizing and externalizing disorders and suicidality were assessed among 37,289 respondents. Disorders were classified using DMS-IV criteria. Odds ratios (OR) for gender differences were calculated using logistic regression, while trends across age-groups were tested via gender×age interaction. ResultsWithin countries, prevalence of any lifetime internalizing disorder ranged from 10.8% to 44.5% among women and 5.9% to 26.5% among men, with women having consistently higher odds than men (OR range: 1.52–2.73). Prevalence of any lifetime externalizing disorders ranged from 0.2% to 6.6% among women and 2.2% to 22.4% among men, with women having consistently lower odds than men (OR range: 0.05–0.35). Any lifetime suicide attempt was found in 0.8–5.4% of women and 0.3–2.4% of men, showing inconsistent relative gender-differences across countries (OR range: 0.77–4.72). Significant effects in gender OR across age-groups were not observed for any internalizing disorder or suicide attempt, yet were present for any externalizing disorder in France (p=0.01), the Netherlands (p=0.05), and Spain (p=0.02). LimitationsMental disorders were assessed with the CIDI 3.0 and not psychiatric evaluations. Suicidality does not fully represent more important clinical events, such as suicide mortality. ConclusionsConsistent across European countries, internalizing disorders are more common among women and externalizing disorders among men, whereas gender differences in suicidality varied.

Attention deficit hyperactivity disorder in France and Ireland: Parents’ groups’ scientific and political framing of an unsettled condition

Attention Deficit Hyperactivity Disorder (ADHD) is an unsettled condition whose history is characterised by controversy among medical professionals. Its emergence has frequently been interpreted as an example of the growing ‘medicalisation’ of society and the individualisation of social issues. This article examines how groups representing children with ADHD in France and Ireland engage within this contested medical domain to develop different politics of knowledge around the disorder which become visible in their ‘epistemic efforts’. These efforts emerge from, and enact, groups’ understandings of ADHD as a condition, and frame their development of a politics of healthcare as a basis for articulating claims to appropriate services and treatment. We show how, in Ireland, organisations remain committed to a biomedical approach to ADHD, although their practical efforts are oriented towards complementing medication with non-pharmaceutical treatments. In France, the key parents’ group opposes any paradigm that focuses exclusively on one aspect of the disorder, be it social, psychological or neurological; rather, it struggles to ‘open up’ the scientific domain of ADHD. Our empirical material therefore enables us to demonstrate patients’ organisations’ politics of knowledge as situated practices which aim to reshape the different networks of expertise on ADHD that exist in each country, and to explore medicalisation as a complex set of processes which is neither a solution to parents’ problems, nor an end point for their actions.

Rural-urban variation in incidence of psychosis in France: a prospective epidemiologic study in two contrasted catchment areas

BackgroundThe aim of our study is to provide data on the incidence of psychotic disorders in France and compare the incidence rates in populations with different levels of urbanization.MethodsWe prospectively included the incident cases of psychotic disorders from two catchment areas with contrasted levels of urbanization. In the more rural area, we also calculated incidence rates in three different groups of population defined by the size of towns in which they live (small, medium and large towns).ResultsThe annual incidence of psychosis was greater in the urban area (36.02/100000 person-year at risk) than in the rural area (17.2/100000 person-year at risk).Non-affective psychoses were the majority of cases and their incidence was greater in males and younger subjects. The affective psychoses were slightly more frequent in women and showed less variation with age. In the rural centre, greater levels of urbanicity were associated with an increase in the incidence of all psychoses (affective and non-affective).ConclusionsOur study confirms previous observations of increased incidence rates for non-affective psychoses in the more urbanized areas and suggests that a similar pattern might be present for affective psychoses.

Health-Related Quality of Life and Utility Scores in People with Mental Disorders: A Comparison with the Non-Mentally Ill General Population

There is a lack of comparable health-related quality of life (HRQoL) and utility data across all mental disorders and all inpatient and outpatient settings. Our objective was to investigate the HRQoL and utility scores of people with mental disorders in France, treated in outpatient and inpatient settings, and to identify the HRQoL and utility score losses attributable to mental disorders compared to the non-mentally ill general population. A cross-sectional survey was conducted to assess HRQoL (SF-12) and utility scores of patients with mental disorders and followed in four psychiatric sectors in France. Scores were described by demographic and clinical characteristics and were then adjusted on age and gender and compared with those of the non-mentally ill general population. Median HRQoL and utility scores were significantly lower in patients with mental disorders than in the non-mentally ill general population; median differences amounted to 5.4 for the HRQoL physical score, to 11.8 for the HRQoL mental score and to 0.125 for the utility score. Our findings underscore the negative impact of mental disorders on HRQoL in France and provide a baseline to assess the global impact of current and future organizational changes in the mental health care system.

Evaluation of the Housing First program in patients with severe mental disorders in France: study protocol for a randomized controlled trial

BackgroundRecent studies in North American contexts have suggested that the Housing First model is a promising strategy for providing effective services to homeless people with mental illness. In the context of the highly generous French national health and social care system, which is easily accessible and does not require out-of-pocket payment, the French Health Ministry insists on rigorous techniques, including randomized protocols, to evaluate the impact of Housing First approaches in France.Method and designA prospective randomized trial was designed to assess the impact of a Housing First intervention on health outcomes and costs over a period of 24 months on homeless people with severe mental illness, compared to Treatment-As-Usual. The study is being conducted in four cities in France: Lille, Marseille, Paris and Toulouse. The inclusion criteria are as follows: over 18 years of age, absolutely homeless or in precarious housing, and possessing a ‘high’ level of need: diagnosis of schizophrenia or bipolar disorder and moderate to severe disability according to the Multnomah Community Ability Scale (score ≤ 62) and at least one of the following three criteria: 1) having been hospitalized for mental illness two or more times in any one year during the preceding five years; 2) co-morbid alcohol or substance use; and 3) having been recently arrested or incarcerated. Participants will be randomized to receiving the Housing First intervention or Treatment-As-Usual. The Housing First intervention provides immediate access to independent housing and community care. The primary outcome criterion is the use of high-cost health services (that is,, number of hospital admissions and number of emergency department visits) during the 24-month follow-up period. Secondary outcome measures include health outcomes, social functioning, housing stability and contact with police services. An evaluation of the cost-effectiveness and cost-utility of Housing First will also be conducted. A total of 300 individuals per group will be included.DiscussionThis is the first study to examine the impact of a Housing First intervention compared to Treatment-As-Usual in France. It should provide key information to policymakers concerning the cost-effectiveness and health outcomes of the Housing First model in the French context.Trial registrationThe current clinical trial number is NCT01570712

Current status and management of patients with bipolar disorder in France in 2011

Current status and management of patients with bipolar disorder in France in 2011

Special education and care services for children, adolescents, and adults with autism spectrum disorders in France: Families’ opinion and satisfaction

This study focused on parents' satisfaction with the special education and care services proposed to their child with autism spectrum disorders (ASD). Data were collected in three regions of France, using a questionnaire designed for the purpose of this study. Among the 530 families contacted, 212 filled in the questionnaire (response rate = 40.8%). Results showed that parents were globally satisfied with providers' involvement and motivation, but they felt they were not involved enough in their child's individualized program, that communication with providers was insufficient and that the services lacked ASD's specific tools and interventions. Among all families interviewed, parents of adolescents were the most unsatisfied and we hypothesized that this could be due to the specific issues regarding developmental changes and concern about the future at this period of life. Congruently with the literature, variables related to parental overall satisfaction were a regular communication with professionals, a specific, regularly updated individual program in which parents are associated, and specialized tools and interventions. The implications of these findings are discussed as well as future directions for clinicians to improve service delivery and allow the persons with ASD and their families to be more involved in the services.

The cost of mental disorders in France

AbstractAims: To provide burden estimates of mental disorders in France and compare the results with findings from other countries and EU in general.Method: Stepwise top down approach, consisting of analyses of existing data sets, national surveys and ad hoc surveys. Mental disorder was defined by diagnoses in the chapter ‘Mental and behavioural disorders’ from the International Classification of Diseases, tenth revision (ICD-10), excluding, dementia and mental retardation. Disease burden was measured by total health care costs, social care costs, lost output and loss of well being, 2007 data was used consistently.Results: The total cost of mental health care was estimated at €13.4 billion, or 8% of total healthcare expenditures. Total cost of health and social services was estimated at €6.3 billion, including €1.3 billion for informal care. Total cost of lost production amounted to €24.4 billion, €20.0 billion for lost output and €4.4 billion for workers' compensation. Mental disorders resulted in a total loss of 2.2 million QALY and a total cost of lost well being of €65.08 billion. The total costs of mental disorders were estimated at €109 billion, 20% of which are actual money spent and 80% the social value of disease consequences.Conclusion: In France with a population of 65 million, an estimated 12 million inhabitants currently suffer from one or more mental disorders. The true size and burden of mental disorders in France was significantly underestimated by policy makers in the past.

Public and Nonprofit Funding for Research on Mental Disorders in France, the United Kingdom, and the United States

To document the investments made in research on mental disorders by both government and nonprofit nongovernmental organizations in France, the United Kingdom, and the United States. An exhaustive survey was conducted of primary sources of public and nonprofit organization funding for mental health research for the year 2007 in France and the United Kingdom and for fiscal year 2007-2008 in the United States, augmented with an examination of relevant Web sites and publications. In France, all universities and research institutions were identified using the Public Finance Act. In the United Kingdom, we scrutinized Web sites and hand searched annual reports and grant lists for the public sector and nonprofit charitable medical research awarding bodies. In the United States, we included the following sources: the National Institutes of Health, other administrative entities within the Department of Health and Human Services (eg, Centers for Disease Control and Prevention), the Department of Education, the Department of Veterans Affairs, the Department of Defense, and the National Science Foundation and, for nonprofit funding, The Foundation Center. We included research on all mental disorders and substance-related disorders using the same keywords. We excluded research on mental retardation and dementia and on the promotion of mental well-being. We used the same algorithm in each country to obtain data for only mental health funding in situations in which funding had a broader scope. France spent $27.6 million (2%) of its health research budget on mental disorders, the United Kingdom spent $172.6 million (7%), and the United States spent $5.2 billion (16%). Nongovernmental funding ranged from 1% of total funding for mental health research in France and the United States to 14% in the United Kingdom. Funding for research on mental disorders accounts for low proportions of research budgets compared with funding levels for research on other major health problems, whereas the expected return on investment is potentially high.

Prevalence, characteristics and comorbidities of anxiety disorders in France: Results from the “Mental Health in General Population” Survey (MHGP)

Purpose Only a few European countries have carried out large, community-based, national surveys about psychiatric morbidity. Here is presented the first national French survey, aiming to estimate the prevalence of anxiety disorders and associated comorbidities according to sociodemographic characteristics. Materials and methods The Mental Health in General Population (MHGP) database is derived from a representative national survey of the French adult population ( n = 36,105), conducted between 1999 and 2003. Data collection was done using an anonymous face-to-face interview. The presence of anxiety disorders (generalized anxiety disorder, panic disorder, agoraphobia, social phobia and post-traumatic stress disorder) was assessed using the Mini International Neuropsychiatric Interview. Results The overall prevalence of anxiety disorders was estimated to be 21.6%, generalized anxiety disorder being the most prevalent one (12.8%). Women, young people, and people earning low income were identified as the more at risk. Major depressive episode, alcohol abuse and drug addiction frequently co-occur with anxiety disorders (28.3, 4.4 and 2.8% respectively). Conclusion The MHGP study showed that anxiety disorders are highly prevalent in France with a high frequency of comorbidities. Our results highlight the need for considering anxiety disorders as a public health priority in France as well as in other European countries.

Trente ans d'étude de la maladie de Rendu-Osler en France : démographie historique, génétique des populations et biologie moléculaire

Résumé La maladie de Rendu-Osler est une génopathie héréditaire qui a fait l’objet de plusieurs études interdisciplinaires au fil des trois dernières décennies. Une enquête épidémiologique menée dans les années 1980 a d’abord permis d’en établir la prévalence en France à un niveau nettement plus élevé que ce qui était alors admis, et de pointer l’existence de zones de forte concentration. L’étude généalogique et l’étude de démographie historique qui ont suivi, centrées sur le principal pôle de concentration, n’ont pas permis de prouver la théorie d’un effet fondateur unique à l’échelle nationale, mais d’émettre des hypothèses quant à la date d’apparition d’une mutation locale. Enfin, l’identification, au cours des dernières années, des gènes responsables de cette maladie a permis d’en établir la grande hétérogénéité génétique et d’identifier un grand nombre de mutations différentes présentes sur le territoire français. Toutefois, de nombreux malades résidant dans le principal pôle de concentration étudié précédemment partagent une mutation unique associée à un haplotype spécifique. Au terme de cette étude, exceptionnelle par son aspect interdisciplinaire et sa durée, les différentes démarches convergent pour affirmer l’existence d’un effet fondateur local, et s’accordent sur une datation approximative de cette mutation.

Évaluation des préoccupations corporelles dans les troubles des conduites alimentaires par le Body Shape Questionnaire

Eating disorders are characterized by severe disturbance in eating behavior. A disturbance in perception of body shape and weight is an essential feature of both anorexia nervosa (AN) and bulimia nervosa (BN). Eating disorder patients demonstrate the same characteristic attitude about body image, such as fear of fatness or pursuit of thinness. Moreover, perturbed body image is a common diagnostic category of anorexia and bulimia (DSM-IV-TR, CIM-10). Cooper et al. [Int J Eat Disord 6 (1987) 485-94] developed a one-dimensional, 34 items questionnaire in order to measure the worries about weight and shape of the body, called the "Body Shape Questionnaire" (BSQ). Its concurrent validity has been shown using the corporal dissatisfaction subscale of the eating disorders inventory (EDI) [Int J Eat Disord 2 (1983) 15-34], the drive for thinness and body dissatisfaction and the Eating Attitude Test (EAT) [Psychol Med 9 (1979) 273-79]. The total score of the BSQ ranges from 34 to 204. Lower scores indicate lower concerns about body shape. The BSQ provides a means of exploring the role of extreme obsession about the body's appearance in the development, pursuit and treatment of eating disorders. From this point of view, the BSQ is a tool widely used in research on the eating disorders. Recently, It has been validated in a French non-clinical population [Encephale 31 (2005) 161-73]. However, the validity of the BSQ has not been reported in patients with eating disorders in France. This was addressed in the present study. The first aim of this study was to assess perturbed body image with the French version of the BSQ in eating disorder patients. The second aim was to assess the sensitivity to change. The sample was composed of patients hospitalized for eating disorders (DSM-IV-TR). During their hospitalization, they were submitted to this questionnaire at the beginning and at the end of their care. The BSQ was compared with commonly used heteroquestionnaires such as the body dissatisfaction and drive for thinness subscale of the Eating Disorder Inventory (EDI-2), the Eating Attitude Test (EAT) and the Clinical Global Impression (CGI). Sensitivity to change was assessed by comparing total score at inclusion and at the end of hospitalization. Statistical analyses included Pearson's correlation coefficients, analysis of variance and t test. As Body Mass Index (BMI) can interfere with the BSQ score, it was included as confounding variables in the model in all analyses. Forty-five patients were included in the study. There were 21 patients with restricting subtype of AN, 17 patients with purging subtype of AN and seven BN. The mean age was 27.2+/-6.8 years, the mean length of hospital stay was 3.7+/-1.4 months, and the mean duration of the disorders was 10.7+/-6.3 years. The global BSQ score was high in the three groups of patients: 131.6+/-11.2. There was no significant difference between groups. There was no influence of the BMI on the BSQ scores. Correlation coefficient was significant for all scales with the BSQ except with the CGI. The higher correlation (r) was 0.58 with the drive for thinness subscale of the EDI-2. The change in scores between Day 0 and the end of hospitalization was significant (p<0.0001). The French version of the BSQ thus appears to be valid and accurate and should permit the study of perturbed body image in French eating disorder patients. However, sensitivity to change remains to be confirmed to evaluate response to treatment. Studies measuring this variable at different stages of the illness and recovery should be conducted.

Agomelatine

Novartis and Servier are developing agomelatine for the treatment of depression. Agomelatine is a specific melatonin (MT1 and MT2) receptor agonist that also has antagonistic activities at serotonin-(2C) (5-HT(2C)) receptors. Novartis believes agomelatine is comparable to current standard therapies for depression with improved tolerability, including a low propensity to cause sexual dysfunction and weight gain. Clinical development is being conducted in the US for the treatment of depression; approval for this indication was declined in the EU, apparently due to insufficient data. Servier has also conducted a trial of the agent in patients with generalized anxiety disorder in France, South Africa and Finland, and a phase II trial in sleep disorders in France. In March 2006, Servier and Novartis signed a licensing agreement for agomelatine. Novartis obtained the exclusive rights for the development and marketing of agomelatine in the US and several other countries. Servier retained the rights to the product in the rest of the world. The clinical development plan for agomelatine includes phase III trials being conducted under the parAGOn clinical trial programme. One US-based trial that began in March 2007 (NCT00463242) is recruiting 490 patients with depression who will receive placebo or agomelatine 25 or 50 mg for 8 weeks and will then receive open-label agomelatine for 52 weeks. Novartis is also conducting an 8-week phase III trial (NCT00411099) comparing the safety and efficacy of agomelatine 25 and 50 mg in patients with major depressive disorder. A follow-up, 52-week open-label extension study (CAGO178A2301E) will also be conducted. Another phase III study underway is NCT00411242, which has the same design and is also followed by a 52-week open-label extension study (CAGO178A2302E). These studies are all expected to be completed by January 2009. In July 2006, the Committee for Medicinal Products for Human Use recommended the refusal of marketing authorisation for agomelatine for the treatment of depression. Servier had applied for a re-examination of the finding but withdrew the request in November 2006. Servier's MAA was not supported due to insufficient data and no recent development has been reported in this indication in the EU. Agomelatine prevented relapse in patients with depression compared with placebo and was well tolerated in an international phase III trial.

Time Between Schizophrenia Onset and First Request for Disability Status in France and Associated Patient Characteristics

This study examined a sample of French persons with schizophrenia to explore the occupational history between onset of illness and first request for disability status, the duration of this period, and the demographic and clinical characteristics associated with a long duration. Persons with schizophrenia or schizoaffective disorder (N=110) requesting a disability allowance or the status of disabled worker for the first time were assessed by using a standardized questionnaire that collected information on clinical, occupational, and income history. Characteristics associated with a long duration were explored by using multivariate analyses. The majority of persons (92%) worked at least once during their lifetime, but this proportion fell dramatically to less than half after the onset of illness. Nearly half of the participants did not receive any income outside of financial support from the family after the onset of illness. The median delay between the onset of illness and the first request for disability status was four years. The characteristics independently predicting a long duration (that is, any time longer than the median, or four or more years) of the period between illness onset and first request were older age, higher educational level, a longer period of working after illness onset, and more than one psychiatric hospitalization. Professionals who choose to delay requesting disability benefits for their clients in order to promote social rehabilitation may paradoxically exacerbate the social consequences of the disease because of clients' lack of resources. Future studies should further explore the implicit and explicit criteria used by mental health professionals and social workers in deciding whether a person with schizophrenia should request disability benefits.

General practitioners are bearing an increasing burden of the care of common mental disorders in France

In France, general practice is playing an increasing role in the management of common mental disorders. This is due to a variety of factors, among which the way general practice and specialised mental health services have evolved over time. Methods: A description of the status quo in France, with a comparison between France, the UK and the Netherlands. A review of reasons for the present position. Results: The general practitioner (GP) is often the only medical carer to be contacted in cases of psychological distress and over 80% of psychotropic medications are prescribed in this setting. Although most common forms of mental disorder can be managed at the primary care level, GPs need to be able to refer patients rapidly to specialised mental health services. Yet there are delays for consultations with both private and public psychiatrists along with difficulties in finding beds for full-time hospitalisation. The situation is predicted to get worse with the reduction in the number of psychiatrists and GPs forecasted for the coming years. 'Psychiatric sectorisation' has led to a substantial development of community mental health care services, yet this has not compensated fully for the reduction in full-time hospital beds. Furthermore, community mental health care services remain relatively isolated from other community health services with very limited exchanges with general practice. Conclusion: GPs report an urgent need for training in mental health. Along with improving their ability to accurately detect and treat mental disorders, it is crucial also to improve communication between GPs and psychiatrists and increase shared case-management. Structural changes are also necessary to ensure a quicker and easier access to specialised mental health care services.