Titre : | L'utilisation de psychotropes chez le sujet âgé : trop ou trop peu ? (1999) |
Titre traduit : | [Drug use in the elderly. Use of psychotropic drugs in the elderly: overuse or underuse?] |
Auteurs : | FREMONT P. |
Type de document : | Article : Périodique |
Dans : | Presse Médicale (La) (Vol.28, n°32, 23 octobre 1999) |
Article en page(s) : | 1794-1799 |
Langues: | Français |
Discipline : | PRO (Produits, mode d'action, méthode de dépistage / Substances, action mode, screening methods) |
Mots-clés : |
Thésaurus mots-clés PSYCHOTROPES ; PERSONNE AGEE ; CONSOMMATION |
Résumé : |
FRANÇAIS :
Le premier des trois problèmes de l'utilisation de psychotropes chez le sujet âgé est lié au cadre général de leur utilisation. Ces médicaments amènent en effet à des prises de positions idéologiques. Les prescripteurs se situant ainsi "en pour" ou "en contre", justifient souvent leurs prescriptions par la nécessité de tenir compte de l'entourage. Le deuxième type de problèmes est celui posé par la clinique des troubles psychiatriques chez les sujets âgés. Elle est réduite trop souvent au classique : dépression, démence, confusion. Une bonne analyse clinique devrait permettre de mieux diagnostiquer la dépression qui est à l'heure actuelle largement sous-estimée et sous traitée. Le 3ème problème concerne la classe thérapeutique utilisée. Il est classique de dénoncer l'utilisation inadaptée des neuroleptiques et de remettre en cause leur inefficacité dans les troubles du comportement du patient dément. (A partir du résumé de la revue) ENGLISH : POORLY DEFINED USE: The first of three leading problems in the use of psychotropic drugs in elderly subjects is related to the overall situation of their use, often tainted by an iideologicali point of view. Prescribers are ifori or iagainsti psychotropic and justify their prescription by the need to take into account the general situation rather than strictly clinical arguments. Some prescriptions are written for the family or institutions. Even the definition of the elderly subject is extremely vague and is generally taken to include subjects over 65, a very heterogeneous group. Too few studies have been devoted to subjects over 80. NEED FOR GOOD CLINICAL ANALYSIS: The second type of problem is raised by the clinical expression of psychotic disorders in the elderly, too often considered to be limited to the classical signs of depression, dementia, and confusion. A careful clinical analysis is essential before prescription, with an adapted therapeutic response to each pathological situation. In addition, good clinical analysis would allow better diagnosis of depression, a condition largely underestimated and undertreated. BY THERAPEUTIC CLASS: It is now classical to denounce inappropriate use of neuroleptics and question their efficacy in controlling behavioral disorders in dementia. This attitude results from the impact of the adverse effects. Several authors have emphasized the contribution of new antipsychotic drugs but very few controlled studies have been reported. For antidepressors, the current consensus would suggest that prescription doses are generally insufficient and treatment durations too short. Finally, though it is widely accepted that use of benzodiazepines should be limited in dose and duration, data on drug use however show the contrary, emphasizing the difficulty in changing habits. New compounds including thymoregulators are increasingly used for elderly subjects but here again, like for antipsychotic drugs, too few studies have been published and many points remain to be elucidated. |
Domaine : | Autres substances / Other substances |
Refs biblio. : | 50 |
Affiliation : | Service de psychiatrie, Centre Hospitalier de Lagny sur Marne, Lagny, France |
Numéro Toxibase : | 1100547 |
Centre Emetteur : | 11 SEDAP |
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