Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-22T19:34:58.316Z Has data issue: false hasContentIssue false
  • English
  • Français

Health management of older persons with chronically medicated psychotic disorders: the results of a survey in France

Published online by Cambridge University Press:  11 August 2011

Christophe Arbus ,
Jean-Pierre Clement ,
Thierry Bougerol ,
Patrick Fremont ,
Sylvie Lancrenon  and
Vincent Camus
Christophe Arbus*
Affiliation:
University of Toulouse and Paul Sabatier University, Laboratoire du Stress Traumatique–LST (EA 4560), Purpan-Casselardit, Hospital, Toulouse, France
Jean-Pierre Clement
Affiliation:
Adult Psychiatry Service, Hospital Centre Esquirol, Limoges, France
Thierry Bougerol
Affiliation:
Adult Psychiatry Service, CHU Grenoble, France
Patrick Fremont
Affiliation:
Adult Psychiatry Service, Hospital Centre of Lagny-Marne-la-Vallée, Lagny sur Marne, France
Sylvie Lancrenon
Affiliation:
Sylia-Stat, Bourg la Reine, France
Vincent Camus
Affiliation:
CHRU Tours & INSERM U930, University François Rabelais, Tours, France
*
Correspondence should be addressed to: Christophe Arbus, Department of Psychiatry and Medical Psychology, Purpan-Casselardit Hospital, 31059 Toulouse, France. Phone: +33 561772351; Fax: +33 561777646. Email: [email protected].
Get access

Abstract

Background: The medical care of elderly patients with psychotic disorders is a matter of major concern. The aim of the study was to investigate health conditions and treatment of elderly patients with psychotic disorders in France.

Methods: The SAGE (Schizophrenia AGEd) study (observational, cross-sectional) was a survey conducted among 123 physicians in France, regarding prescriptions of antipsychotic drugs in elderly patients (≥60 years) suffering from psychotic disorders. The survey was based on a questionnaire addressing the mental and somatic health management of the patients.

Results: Data from 930 patients (mean age: 70.4 years) were collected. Most patients (58.5%) suffered from schizophrenia, 20.8% had delusional disorder and 20.6% hallucinatory chronic psychosis (very-late-onset schizophrenia-like psychosis). 70.8% of them were outpatients, while 29.2% were inpatients. The severity of psychotic symptoms was assessed in 97.8% of patients, but cognitive function was only evaluated in 41.6%. Some 46.5% of patients were treated with atypical antipsychotics alone, 36.2% with classical antipsychotics alone and 17.3% received a combination of both, atypical and classical antipsychotics; 36.3% patients were given antiparkinsonian medication, of whom only 17.8% as preventive treatment; 51.1% of patients had somatic comorbidities, particularly cardiovascular disorders (34.0%). Evaluation of renal and/or liver function to adjust the dose of treatment was done in only 32.1% of patients. Over the previous 12 months, almost half of the patients had had no ECG, glycemia or creatininemia investigated and HDL-cholesterol and triglycerides were available for less than one-third of them.

Conclusions: Antipsychotic and antiparkinsonian drug prescriptions in French aged psychotic patients follow only partially the clinical guidelines and recommendations of consensus conferences. Moreover, cognitive, cardiac and metabolic aspects are not fully managed as expected.

Keywords

psychosesschizophreniaelderlymedical caresurveyantipychotics
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 3 , March 2012 , pp. 496 - 502
Copyright
Copyright © International Psychogeriatric Association 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alexopoulos, G. S., Streim, J., Carpenter, D. and Docherty, J. P. for the Expert Consensus Panel for Using Antipsychotic Drugs in Older Patients (2004). Using antipsychotic agents in older patients. Journal of Clinical Psychiatry, 65 (Suppl. 2), 5–99.Google ScholarPubMed
Brodaty, H. et al. (2003). A randomized placebo-controlled trial of risperidone for the treatment of aggression, agitation, and psychosis of dementia. Journal of Clinical Psychiatry, 64, 134–143.CrossRefGoogle ScholarPubMed
Charles, M.-A. et al. (2008). Monitoring the obesity epidemic in France: the Obepi Surveys 1997–2006. Obesity, 16, 2182–2186.CrossRefGoogle ScholarPubMed
De Hert, M. et al. (2006). Prevalence of diabetes, metabolic syndrome and metabolic abnormalities in schizophrenia over the course of the illness: a cross-sectional study. Clinical Practice and Epidemiology in Mental Health, 2, 14. doi: 10.1186/1745-0179-2-14.CrossRefGoogle ScholarPubMed
Dixon, L. et al. (2000). Prevalence and correlates of diabetes in national schizophrenia samples. Schizophrenia Bulletin, 26, 903–912.CrossRefGoogle ScholarPubMed
Drimer, T. et al. (2004). Effects of discontinuation of long-term anticholinergic treatment in elderly schizophrenia patients. International Clinical Psychopharmacology, 19, 27–29.CrossRefGoogle ScholarPubMed
Friedman, J. I. et al. (2001). Six-year follow-up study of cognitive and functional status across the lifespan in schizophrenia: a comparison with Alzheimer's disease and normal aging. American Journal of Psychiatry, 158, 1441–1448.CrossRefGoogle ScholarPubMed
Gray, R. (2005). The NICE guidelines for schizophrenia. Psychiatry, 4, 11–13.CrossRefGoogle Scholar
Gury, C. (2004). Schizophrénie, diabète et antipsychotiques. L'Encéphale, 30, 382–391.CrossRefGoogle Scholar
Harvey, P. D. (2001). Cognitive impairment in elderly patients with schizophrenia: age related changes. International Journal of Geriatric Psychiatry, 16, S78–S85.3.0.CO;2-V>CrossRefGoogle ScholarPubMed
Harvey, P. D. et al. (1998). Symptoms, cognitive functioning, and adaptive skills in geriatric patients with lifelong schizophrenia: a comparison across treatment sites. American Journal of Psychiatry, 155, 1080–1086.CrossRefGoogle ScholarPubMed
Hennekens, C. H. et al. (2005). Schizophrenia and increased risks of cardiovascular disease. American Heart Journal, 150, 1115–1121.CrossRefGoogle ScholarPubMed
hopital.fr (2010). La Psychiatrie. Available at: http://www.hopital.fr/Hopitaux/L-hopital-et-vous/La-psychiatrie.Google Scholar
Jeste, D. V. et al. (2005). Atypical antipsychotics in elderly patients with dementia or schizophrenia: review of recent literature. Harvard Review of Psychiatry, 13, 340–351.CrossRefGoogle ScholarPubMed
Jones, D. R. et al. (2004). Prevalence, severity, and co-occurrence of chronic physical health problems of persons with serious mental illness. Psychiatric Services, 55, 1250–1257.CrossRefGoogle ScholarPubMed
Kusnik-Joinville, O. et al. (2008). Prevalence and treatment of diabetes in France: trends between 2000 and 2005. Diabetes and Metabolism, 34, 266–272.CrossRefGoogle Scholar
Lefebvre, N. et al. (2006). Comorbidités somatiques chez les patients souffrant de schizophrenie traitée: recommandations actuelles. Annales Medico-psychologiques, Revue Psychiatrique, 164, 159–164.CrossRefGoogle Scholar
Lehman, A. F. et al. (2004a). The Schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations 2003. Schizophrenia Bulletin, 30, 193–217.CrossRefGoogle ScholarPubMed
Lehman, A. F., Lieberman, J. A., Dixon, L. B., McGlashan, T. H., Miller, A. L., Perkins, D. O. and Kreyenbuhl, J. for the American Psychiatric Association; Steering Committee on Practice Guidelines (2004b). Practice guideline for the treatment of patients with schizophrenia, second edition. American Journal of Psychiatry, 161 (Suppl. 2), 1–56.Google ScholarPubMed
Limosin, F. (2009). Schizophrenia and the elderly patient. L'Encéphale, 35 (Suppl. 1), S41–S44.CrossRefGoogle ScholarPubMed
Marder, S. R. et al. (2004). Physical health monitoring of patients with schizophrenia. American Journal of Psychiatry, 161, 1334–1349.CrossRefGoogle ScholarPubMed
Masand, P. S. and Gupta, S. (2003). Long-acting injectable antipsychotics in the elderly: guidelines for effective use. Drugs and Aging, 20, 1099–1110.CrossRefGoogle ScholarPubMed
McEvoy, J. P. et al. (2005). Prevalence of the metabolic syndrome in patients with schizophrenia: baseline results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III. Schizophrenia Research, 80, 19–32.CrossRefGoogle ScholarPubMed
Nasrallah, H. A. et al. (2006). Low rates of treatment for hypertension, dyslipidemia and diabetes in schizophrenia: data from the CATIE schizophrenia trial sample at baseline. Schizophrenia Research, 86, 15–22.CrossRefGoogle ScholarPubMed
Rosenheck, R. A. et al. (2006). Cost-effectiveness of second-generation antipsychotics and perphenazine in a randomized trial of treatment for chronic schizophrenia. American Journal of Psychiatry, 163, 2080–2089.CrossRefGoogle Scholar
Ruetsch, O., Viala, A., Bardou, H., Martin, P., Vacheron, M. N. (2005). Prise de poids pharmaco-induite par les psychotropes et sa prise en charge: revue des données de la littérature. L'Encéphale, 31, 507–516.CrossRefGoogle Scholar
Sokal, J. et al. (2004). Comorbidity of medical illnesses among adults with serious mental illness who are receiving community psychiatric services. Journal of Nervous Mental Disorders, 192, 421–427.CrossRefGoogle ScholarPubMed
Thorpe, L. (1997). The treatment of psychotic disorders in late life. Canadian Journal of Psychiatry, 42 (Suppl. 1), S19–S27.Google ScholarPubMed
White, L. et al. (2006). Long-term outcomes in chronically hospitalized geriatric patients with schizophrenia: retrospective comparison of first generation and second generation antipsychotics. Schizophrenia Research, 88, 127–134.CrossRefGoogle ScholarPubMed
WHO (2007). ICD-10: Mental and Behavioural Disorders. Geneva: World Health Organization.Google Scholar
Wirshing, D. A., Pierre, J. M., Erhart, S. M., Boyd, J. A. (2003). Understanding the new and evolving profile of adverse drug effects in schizophrenia. Psychiatric Clinics of North America, 26, 165–190.CrossRefGoogle ScholarPubMed
Wooltorton, E. (2002). Risperidone (Risperdal): increased rate of cerebrovascular events in dementia trials. Canadian Medical Association Journal, 167, 1269–1270.Google ScholarPubMed
Wooltorton, E. (2004). Olanzapine (Zyprexa): increased incidence of cerebrovascular events in dementia trials. Canadian Medical Association Journal, 170, 1395.CrossRefGoogle ScholarPubMed