L’évaluation des pratiques professionnelles est un indicateur. Une étude un jour donné montre un taux de 62 % de polythérapie antipsychotique. Une revue de pertinence est réalisée.

Un audit rétrospectif inclu les patients schizophrènes ayant au moins 2 antipsychotiques, hospitalisés au minimum 20 jours et sortis entre le 01/06/2012 et le 01/06/2013. Une grille d’audit évalue la tolérance. L’échelle de PANSS modifiée évalue l’efficacité. Une revue de pertinence est réalisée avec 4 psychiatres : tolérance et efficacité sont cotées sur une échelle de 0 à 3 en entrée et en sortie. 41 dossiers patients de 4 unités de courts séjours sont analysés. L’âge médian est de 34 ans. La durée médiane de séjour est de 42 jours ; 9,8 % des patients ont 1 antipsychotique, 70,7 % en ont 2, 18,3 % en ont 3 et 1,2 % en ont 4. Au cours du séjour, les symptômes positifs régressent (−1,4), les négatifs et généraux s’atténuent (−0,6 et −0,7). La prise de poids moyenne est de 3,6 kg. La prescription de correcteurs anticholinergiques diminue (−0,1 %), celle des substituts salivaires et des laxatifs augmente (0,5 et 0,6 %). La pertinence évolue peu : +0,1 point pour l’efficacité et +0,2 pour la tolérance. L’association à un antipsychotique anxiolytique/sédatif se retrouve 9 fois sur 10, généralement associé aux benzodiazépines. Des associations sont réalisées avec des spécialités ayant un profil d’action complémentaire au niveau des récepteurs.

Certaines associations n’ont jamais fait l’objet d’études, mais d’autres sont validées par la littérature. La pertinence entrée-sortie évolue peu : les patients sont souvent stabilisés par la reprise du traitement, l’arrêt des toxiques et/ou la réassurance du cadre hospitalier avec le même traitement. Certaines situations cliniques nécessitent une association d’antipsychotiques. Elles doivent être justifiées par des données issues de la littérature. La réévaluation de la tolérance et de l’efficacité doit être régulière. La monothérapie doit rester un objectif.

Dans le cadre de la sécurisation du circuit du médicament, l’établissement s’est doté d’un automate de dispensation. Il permet de faire une dispensation journalière individuelle des formes sèches prescrites en systématique. Chaque jour, une bande de sachet par patient est produite (1 sachet = 1 spécialité et 1 horaire). Nous avons évalué la part des traitements non administrés et leur impact économique. Les 16 unités de soins conservent les sachets non administrés. La pharmacie les collecte. Une base de données Excel est incrémentée pendant un mois : nombre de sachets et contenus. Une cause probable de non administration est recherchée via le Pharma. L’outil statistique de l’automate indique le nombre de sachets fabriqués sur la période. Le coût unitaire des médicaments est extrait du logiciel Pharma. Les coûts humain et en consommables ne sont pas traités.

4,12 % des sachets sont rendus, ce qui représente 3,94 % du coût global journalier (16,03 €/j). Les principaux motifs sont les sorties/permissions (47 %), une utilisation de la dotation (19 %), une modification de prescription (15 %) ou la prescription non conditionnelle des hypnotiques et anxiolytique au coucher (14 %). Les classes médicamenteuses retrouvées sont les antipsychotiques (21 %), les anxiolytiques (21 %), les hypnotiques (11 %), les normothymiques (7 %) et les antidépresseurs (5 %). Parmi les autres, on retrouve majoritairement des correcteurs, des médicaments à visée cardiovasculaires et des vitamines. Extrapolés sur un an, le coût des retours représente 0,79 % du budget annuel de la pharmacie. Cette part a pu être partiellement diminuée par :

– une communication efficace et constante avec les services afin d’anticiper les sorties et permissions des patients ;

– la sensibilisation des médecins à prescrire en si besoin les prises du soir ;

– un rappel des horaires de production Bien que l’impact économique soit faible, la sensibilisation de l’ensemble des acteurs doit donc être poursuivie.

This article presents a case study of Czech that opens the possibility of unifying various second-position phenomena as instances of an interface condition on head extension. The condition requires a head to undergo at least two instances of merge within its phase. The core of the article explores properties of T0. It is shown that any merge (external or internal, merge of a head or a phrase) yields a well-formed structure. Since it does not matter to the requirement what category merges to T0, the condition must be stated as a general requirement on what category may be the root.

This article reexamines the puzzling issue of where subjects, lexical and null,are located in Spanish and offers a novel explanation for the incompatibility ofpreverbal lexical subjects with fronted focussed constituents. Both SpecIP andthe left periphery appear to be potential landing sites for subjects, accordingto discourse-pragmatic factors. Assuming that pro is a clitic,it is argued that the aforementioned incompatibility can be captured by a simplerule: SpecIP must be empty for focus fronting to occur. This is the case withpro, which adjoins to Infl, or with postverbal subjectssince they remain in SpecVP. From this analysis it follows that: 1) the subjectfield in Spanish is less articulated than is generally assumed, 2) thedifferences between Spanish and other null subject languages with respect to theavailability of preverbal subjets can be reduced to this rule and a differentordering of focus and topic phrases, and 3) it is unnecessary to posit twodifferent topic positions.

Over 40 years of archaeological investigations along the south coast of Papua New Guinea has identified a rapid succession of cultural changes during the late Holocene. The so-called ‘Papuan Hiccup’ (c. 1200–800 cal bp) is a poorly understood period of socio-economic upheaval along the coast, identified mainly from changes in archaeological ceramic styles and settlement patterns. During this period, the region-wide Early Papuan Pottery (EPP) tradition diverges into separate, localised ceramic sequences that have generic associations with local ethnographic wares. A correspondence between the timing of the Papuan Hiccup and a period of peak El Niño-Southern Oscillation (ENSO) activity implies a link between cultural and climate change. This paper explores this relationship further by examining changes in interaction networks along the south coast of Papua New Guinea, specifically focusing on chert artefacts. Chemical characterisation (portable X-Ray Fluorescence; pXRF) and technological analysis are used to map changes in lithic technology over time, including access to raw materials and technological organisation, at the site of Taurama, a prehistoric coastal village site that was occupied both prior to and after the Papuan Hiccup. Although the sample sizes are small and the interpretations necessarily circumscribed, it is argued that changes in the number of chert sources being exploited and in the intensity of core reduction at Taurama may be related to climate change in the region.

This article investigates the use of non-referential subjects in contemporary Swedish. Given that Swedish has developed a strong subject requirement, expletive subjects are expected to be used in all clauses which lack a referential subject. In spoken Swedish, however, expletive and quasi-argument subjects are optional in utterances where there is an initial det ‘it’ which is linked to an empty position inside a finite or non-finite complement. The paper establishes that there are certain similarities between these examples and tough constructions but that the examples involving finite complements cannot be subsumed under a predication analysis which seems appropriate for the tough cases. Based on a number of authentic recorded examples, I discuss the processing of utterances with fronted anaphoric pronouns and point to certain similarities with parasitic gaps. The paper closes with a comparison with other Germanic languages.

It is well-known that grammatical movement is somehow linked to functional heads. There is less agreement on the excact nature of this correlation. According to one view, phrases are moved to the specifier positions of functional heads because functional heads attract them. According to another view, movement is not triggered by functional heads alone, but depends on the larger grammatical context. For instance, one such proposal says that T (tense) becomes attractive only when selected by finite C (complementizer), while V becomes attractive when selected by v* (transitivizer). What attracts phrases are therefore the C–T system and the v*–V system as a whole, not the individual functional heads; moved phrases are then sandwitched between the two heads. In this article, we present evidence in favor of this view by looking at first language acquisition. The data shows that in child Finnish, subject determiner phrases (DPs) move into the position of grammatical subject if and only if the full complementizer system has matured. Movement to the (Spec, TP) subject position therefore depends on the presence of C.

The Extended Projection Principle (EPP) has remained a controversial topic in generative grammar. This article proposes to derive the EPP from a generalized theory of nominal case and verbal agreement. According to the proposal presented in this article, morphosyntactic features such as case and verbal phi-features are valued uniformly by the closest asymmetrically c-commanding element, whereas the PF interface is constrained so as to prevent verbs from being valued nominal case and nominals by verbal phi-features. This constraint together with a new theory of valuation explains the appearance of the EPP. The theory is applied to the investigation of negative clauses in Finnish and other languages, Finnish (elliptical) non-finite negative clauses, expletive constructions, multiple wh-movement in a variety of languages, multiple agreement both in the finite and nominal domains, and asymmetries between finite and non-finite clauses.

This paper focuses on the origin of the V2 property in the history of Germanic. Considering data from Gothic and Old English (OE), it is suggested that the historical core of the V2 phenomenon reduces to V-to-C movement that is triggered in operator contexts. Therefore, the historical system shares basic properties with limited V2 in Modern English. It is shown that apparent deviations from this pattern that can be observed in Gothic can be attributed to the influence of Greek word order. Concerning the apparently more elaborate V2 properties of OE, it is claimed that a large part of them in fact do not involve a Spec-head relation, but rather result from linear adjacency between the clause-initial element and a finite verb located in T0. Special attention is paid to the placement of pronominal subjects in OE, which are claimed to occupy SpecTP. This contrasts with a lower position of full subjects due to the absence of an EPP in OE. Finally, the loss of superficial V2 orders in the Middle English period is attributed to the development of an EPP feature in T.