[Pharmaco-therapeutic evaluation of medical treatments of adult autistics and multi-handicapped patients in a public mental health unit]. / Les traitements psychotropes prescrits dans un établissement public de santé mentale accueillant des personnes atteintes d'autisme et des polyhandicapés.

INTRODUCTION: This paper presents a survey conducted on a population of multi-handicapped patients and autistic adults hospitalised long term in the Paul Guiraud mental health Hospital in Villejuif France. OBJECTIVE: The aim of the survey is to deepen the knowledge of the treatments for this specific population. METHODS: A preliminary medical investigation was conducted on the population in order to target different groups of patients. Once patients had listed and defined their medical needs, prescriptions were analysed to assess whether clinical characteristics had an impact. Thus, the analysis of treatments was carried out for the 57 patients (14% of the hospital population) and compared to other investigations conducted on the population commonly hospitalised in Psychiatry. The evaluation of the treatments was obtained through a questionnaire which enabled us to target the therapeutical goals and to obtain additional clinical information. The drugs with a high rate of prescription were compared between the autistic group and the multi-handicapped group. The important comorbidity and the multi-symptomatology of autism often involves the polymedication of these patients (8+/-0.8 drugs per patient). RESULTS: Fifty per cent of the treatments are referred to as somatic treatments. The average length of stay (22.3 years) and the high average age are aggravating factors for polymedication. The average number of psychotropic molecules also appears higher than in the populations studied in the literature. The heterogeneity of clinical forms of autism and polyhandicap encourages prescribers to multidrug therapy. The prescriptions usually remain stable (17.5% of psychiatric treatment is adapted and only 7% of somatic treatment). Epilepsy and constipation are the main treated somatic disorders. In psychiatry, the oral route is the privileged route of administration (81% of treatments) with, more specifically, the use of drinkable solutions for the psychiatric treatment. Neuroleptic drugs are the basic treatment of these patients (82% of prescriptions). The aim of the prescription of neuroleptics is essentially to obtain behavioural or antipsychotic sedation. Cyamemazin is the most prescribed drug (46% of neuroleptic prescriptions), mainly for its anxiolytic effects. Co-prescription is frequent (55.3%) and corresponds to 53% of co-prescriptions of an association of phenothiazine and butyrophenone. Doses are high, which implies the prescription of treatments against the neuroleptics side-effects (86% of patients have such a prescription). The rate of prescriptions of the other psychotropic drugs (hypnotics, anxiolytics, etc.) is approximately equivalent between our population and the "classical" hospitalised psychiatric population, except for antidepressants (7% of prescriptions) because the differential diagnosis is difficult in these patients. Nearly 60% of patients have prescriptions of hypnotic drugs. However, this figure is tempered by prescriptions of drugs "if necessary" in two-thirds of the cases. Finally, only 30% of patients have systematic hypnotic prescriptions. CONCLUSION: Although autistics are clinically different from multi-handicapped patients, no statistically significant difference was demonstrated in their prescriptions, which implies a similar pharmacological management. It is difficult to clearly distinguish these two populations only according to the type of drugs used and the doses prescribed.

Tabaco y medicamentos: ¿amistades peligrosas? / Tobacco and medicaments: dangerous liaison?

El estilo de vida, los hábitos alimentarios, el consumo de bebidas alcohólicas y el tabaco pueden ocasionar ciertas modificaciones en la actividad y/o toxicidad de los medicamentos. Partiendo de un análisis de la literatura científica reciente, los autores han identificado una serie de puntos en lo que concierne a las interacciones entre tabaco y medicamentos, y los mecanismos y las consecuencias terapéuticas de estas interacciones. En cuanto al tabaco, las interacciones farmacodinámicas se deben a la nicotina, mientras que las interacciones farmacocinéticas a los principales compuestos presentes en el humo de los cigarrillos.-Tabaco e interacciones farmacocinéticas: el fenómeno principal, fuente de interacciones medicamentosas, es la inducción de los citocromos 1A1, 1A2, 2E1 por los hidrocarburos aromáticos policíclicos, con una variabilidad interindividual de origen genético.-Tabaco e interacciones farmacodinámicas: la mayor parte de las interacciones objetivadas en el plan biológico no implican una adaptación de la conducta terapéutica. Sin embargo, con ciertos medicamentos, es necesario adaptar la posología o los ritmos de las tomas. Ése es el caso de ciertos antálgicos, antiulcerosos, antiarrítmicos, antidiabéticos o psicótropos.La influencia del tabaco sobre las propiedades farmacológicas de los medicamentos es especialmente difícil de evaluar y todavía se ignoran un sinnúmero de interacciones potenciales. Sería de gran interés realizar más estudios durante el desarrollo de un nuevo medicamento (AU)

[Changes in pharmacists practices (1996 - 2000) related to harm reduction policy (condoms, injecting equipment, methylmorphine) and maintenance therapy delivery (buprenorphine, methadone)]. / Evolution de l'implication du pharmacien d'officine dans la prévention des dommages liés à l'usage de drogues et la dispensation des traitements de substitution.

AIMS: To measure pharmacists involvement in harm reduction programs and in delivery of maintenance therapies in order to estimate their contribution to the new public health policy. METHOD: A longitudinal study was conducted among 327 pharmacies located in the southern suburban area of Paris (28 communities) using a standardized questionnaire. RESULTS: The response rate was 95% in 1996 and 92% in 2000. The number of condoms offered to intravenous drug users (IDU) decreased dramatically from 99% to 24% while delivered units decreased from 857 to 566 per day for needles and from 1200 to 760 per month per pharmacy for methylmorphine tablets (14.93 mg/tablet). Pharmacists delivered injecting equipment to some of their patients under opiate treatment: methylmorphine 19%, buprenorphine 35%, methadone 14%. Their contribution to the local healthcare network on addiction decreased from 38% to 20%. Nevertheless, the pharmacists attitude towards the IDU and public health policy was found to be improving with problems being mentioned for 62% of the cases in 1996 and for 16% in 2000. CONCLUSION: Pharmacists are rapidly and intensively changing their practices and are discovering a new comprehensive relationship with IDU. Better pharmacist involvement is associated with a shift in local healthcare network concentration, reinforcing the general practitioner-pharmacist partnership.

[Value of trimeprazine among hypnotics in a psychiatric facility]. / Place de l'alimémazine parmi les hypnotiques dans un établissement de soins psychiatriques.

Trimeprazine (TPZ) has been marketed in France since 1959, as tablets and solution containing respectively 5 mg and 40 mg/ml. TPZ is a phenothiazine derivative with known antihistaminic and sedative effects. The first approved indication for TPZ is in the treatment of allergy. However, its frequent sedative effects are undesirable in this indication. The second approved indication is in the treatment of insomnia (5-20 mg/day) and TPZ is an alternative to conventional hypnotics as diazepam, flunitrazepam, zolpidem, butobarbital... Due to the prescription frequency of this medicine in our hospital, we analyzed the naturalistic prescriptions mode and the clinical end point in patients hospitalized for mental illness. On the one hand, using the hospital prescription software, we analyzed: prescriptions frequency, dose regimen and drug associations with hypnotics, anxiolytics and sedative antipsychotics. On the other hand, we came into contact with physicians in order to know their opinion on TPZ and the whole point of that indication. The results showed a very high prescription frequency (139/400 patients; 35%), a marked increase in dose compared to those approved by the French Drug Administration (5-20 mg/day: 5%; 20-200 mg/day: 95%) and main drug association with hypnotics, tranquilizers or antipsychotics, respectively 38%, 65% and 91%. Clinical end points are: non addictive properties and an easily adequation of posology for the drinkable drop form in contrast with tablets. Thus, TPZ appears as a first-line hypnotic in spite of its adverse effects common to phenothiazine (atropinic and antidopaminergic effects) and is a usefull medicine for the treatment of insomnia in psychotic patients.