ABSTRACT
COMMON PHYSICAL HEALTH PROBLEMS IN PSYCHIATRY. Somatic psychiatric care is particularly important as life expectancy declines of 13 to 16 years among individuals with severe mental disorders, primaly due to cardiovascular and cancer-related diseases. They face a triple burden: their mental disorders, reduced life expectancy and limited healthcare access. Common comorbidities related to psychotropic medications, lifestyle and the mental condition itself, affect various organs with complex clinical expressions. The multidimensional vulnerability is attributable to the side-effects of psychotropic drugs, mental disorders, and healthcare system fragmentation, hindering access to care. The proposed solutions aim for a better integration of mental health into general healthcare, with increased awareness among caregivers for a holistic approach to health.
PROBLÈMES COURANTS DE SANTÉ PHYSIQUE EN PSYCHIATRIE. Les soins somatiques en psychiatrie revêtent une importance particulière en raison de la réduction de treize à seize ans de l'espérance de vie chez les personnes atteintes de troubles mentaux sévères, principalement à cause de pathologies cardiovasculaires et cancéreuses. Elles sont exposées à une triple peine : leurs troubles psychiques, la réduction de leur espérance de vie et un accès limité aux soins. Les comorbidités courantes, liées aux psychotropes, au mode de vie et à la pathologie mentale elle-même, touchent divers organes, avec des expressions cliniques complexes. La vulnéra bilité multidimensionnelle de ces patients est attribuable aux effets indésirables des psychotropes, aux troubles psychiques et au cloisonnement du système de santé nuisant à l'accès aux soins. Les solutions proposées visent une meilleure intégration du volet santé mentale dans les soins généraux, avec une sensibilisation accrue des soignants à une approche holistique de la santé.
Subject(s)
Mental Disorders , Humans , Mental Disorders/therapy , Psychotropic Drugs/therapeutic use , Psychotropic Drugs/adverse effects , Cardiovascular Diseases , Comorbidity , Neoplasms/complicationsABSTRACT
OBJECTIVE: Constipation is more common in patients with mental disorders than in the general population. However, its frequency in hospitalized patients, its association with drugs and how teams become aware of it and take care of it are not fully identified. METHOD: The retrospective study included 141 male and 127 female new patients admitted for routine treatment at France's largest psychiatric hospital between November 15 and December 11, 2017. A physician reviewed electronic medical records to diagnose constipation and record variables of interest: socio-demographic factors, diagnosis, drugs prescribed and taken. We calculated an anticholinergic impregnation score (AIS) for each patient by using a validated French scale. Patients were then classified into two groups by state of constipation defined by the physician. Univariate and multivariate analyses were used to study the frequency of constipation, factors associated with it and its management. RESULTS: The prevalence of constipation was 38% (95% CI 32-44). Associated factors were taking antipsychotics and the burden of anticholinergic treatment. On multiple regression analysis, the only remaining factor was anticholinergic treatment: AIS≥5 was associated with constipation (odds ratio 1.80 [95% CI 1.07-3.14], P=0.027). Only 44.0% of patients were prescribed a preventive laxative, systematically in half of the cases. Above all, only 11.2% were administered this laxative (i.e., 25% of that prescribed). Digestive transit was poorly recorded in the table of constants (34.7%). We found one case of sub-occlusion as a severe case. CONCLUSION: Constipation is common in psychiatric inpatients. The more the patient is prescribed drugs with a pronounced anticholinergic effect, the greater the risk. Alongside the preventive measures common to all psychiatric patients which must be promoted (concerning diet, physical activity, etc.), polymedication with this type of anticholinergic must be better monitored to prevent complications: prescription and administration of a preventive laxative, monitoring transit in the table of constants. Thus, a better knowledge of the subject and specific training are essential.
ABSTRACT
INTRODUCTION: The somatic problems of people living with mental illness have long been neglected. This can be explained by factors related to the illness itself, to socio-environmental determinants, but also to the organization of the health system. In France, a number of measures have been taken to improve the links between general medicine and psychiatry, with a view to providing comprehensive care. This desire to optimize coordination around the patient has led to the emergence of the concept of liaison medicine in psychiatry. METHODS: A narrative review of the literature was carried out by consulting the digital resources of the University Paris Cité, in particular the Medline, Cairn and Persée databases. RESULTS: Various care schemes have been developed to try to improve the physical health of people hospitalized in psychiatry, but these are local initiatives with no real national coordination. The training of resident students is a powerful lever for change. Protecting the physical health of people with mental illness is a global health issue, and one that is of central concern to many countries. CONCLUSION: Liaison medicine in psychiatry is of proven benefit to patients and should now be extended to the whole of France. However, efforts must also be made to strengthen the city-hospital link, as outpatient care accounts for more than 80% of the active file in psychiatry. The territorial professional health communities (CPTS) will have a decisive role to play.
Introduction: Les problèmes somatiques des personnes vivant avec une maladie mentale ont longtemps été négligés. Cela s'explique par des facteurs liés à la maladie elle-même, à des déterminants socio-environnementaux, mais aussi à l'organisation du système de santé. Des dispositifs ont ainsi vu le jour, en France, pour améliorer l'articulation entre médecine générale et psychiatrie, dans un souci de prise en soins globale. Cette volonté d'optimiser la coordination autour du patient a conduit à l'émergence du concept de médecine de liaison en psychiatrie. Méthodes: Une revue narrative de la littérature a été réalisée en interrogeant les ressources numériques de l'Université Paris Cité, notamment les bases de données Medline, Cairn et Persée. Résultats: Différents dispositifs de soins ont été élaborés pour essayer d'améliorer la santé physique des personnes hospitalisées en psychiatrie, mais il s'agit d'initiatives locales et sans coordination nationale véritable. La formation des internes de médecine générale est un puissant levier de changement. La protection de la santé physique des personnes souffrant de maladie mentale est un enjeu de santé mondial, au cÅur des préoccupations de nombreux pays. Conclusion: La médecine de liaison en psychiatrie apporte, pour les patients, un bénéfice qui n'est plus à démontrer, et il faudrait maintenant l'étendre à l'ensemble du territoire français. Cependant, l'effort doit porter aussi sur le renforcement du lien ville-hôpital, dans la mesure où l'ambulatoire représente plus de 80 % de la file active de la psychiatrie. Les communautés professionnelles territoriales de santé (CPTS) y auront un rôle déterminant à jouer.
