[Treatment initiation in psychotic and manic episodes: French attitudes collected by Focus Group]. / L'initiation thérapeutique dans les épisodes psychotiques et maniaques : recueil des attitudes françaises par Focus Group.

An accurate treatment of first episodes in schizophrenia and bipolar disorders has a significant impact on compliance and prognosis. However, existing therapeutic guidelines may be poorly respected and may concern only typical clinical situations. Medical attitudes in clinical practice have been collected and structured on the basis of small interactive meetings (Focus Group [FG]), and a synthesis of practical attitudes has been compared with updated guidelines. The FG method applied to treatment initiation in schizophrenia and bipolar disorder is seen as complementary to evidence-based guidelines. It reveals that, in a reflexive manner, clinical attitudes are often more diverse and frequently consider first treatments after global evaluation, taking more into account external factors such as clinicians' experience, patient's history and willingness, clinical setting, and environment. A symptomatic approach is sometimes preferred, and a better alliance is always considered as a main objective. The FG method could be a supplementary support to continuous medical education.

[Management, needs and expectations of patients suffering from bipolar I disorders (The ECHO study - France)]. / Prises en charge, besoins et attentes de patients souffrant de troubles bipolaires I (Étude ECHO - France).

AIM: The ECHO study is the first French study directly asking patients with bipolar I disorders on the history and experiences of their disease, their perceptions of care, their sociofamilial relationships, and their expectations regarding what should be done by healthcare professionals and their environment. METHOD: Three hundred euthymic patients suffering from bipolar disorder I were interviewed using a semi-standardized evaluation through telephone interviews. These patients were selected according to the quota method of nationally representative INSEE 99 to be representative of the French population. RESULTS: Ninety-nine percent of patients consulted at least once for psychological signs before the correct diagnosis was established. The average age at the time of diagnosis was of 30.1 years (± 11.3). The average time between first consultation for psychological symptoms and diagnosis is about 5 years. In 92% of cases, the psychiatrist is the health professional that made the diagnosis; 74% of patients were also followed by a general practitioner. One hundred percent of participants had been hospitalized for manic episodes (criterion for inclusion in the study) and 86% were also hospitalized for depressive symptoms. The experience of hospitalization is positive (feeling of security for 84% of the sample, feelings of being helped for 81% of the sample), although these experiences are also associated with the perception of confinement (52% of the sample). At the time of the interview, 97% of these patients were followed by one or more health professionals. Only 34% of these patients were taking a mood stabilizer (lithium, anticonvulsant or atypical antipsychotic with indications in France for bipolar disorder), while 44% were taking an antidepressant and 38% were taking anxiolytics; 84% of patients had experienced side effects related to their current treatment. Acceptance of the disease is difficult and only 56% of patients personally feel they suffer from bipolar disorders. Patients believe that their mental health problems have a significant impact on their lives, including impact on their self-esteem and happiness. Relationships with family, friends but also sexual relations are affected. Even in the euthymic phase, 44% of patients have difficulties in their daily tasks. Three quarters of patients said they had already experienced rejection or discrimination related to their disease. Finally, patients gave a score of 6.4 out of 10 to assess the impact of the disorder on their quality of life. Patients request more dialogue with health professionals and a more personalized treatment, taking into account side effects. They also want more information on the treatment. They would also like to be supported, together with their families, and advised on how to cope with the disease.

Improved symptom control, functioning and satisfaction in French patients treated with long-acting injectable risperidone.

OBJECTIVE: To investigate the efficacy and tolerability of direct initiation of long-acting injectable risperidone (LAIR) in adults with schizophrenia or other psychotic disorders requiring a change of treatment. METHODS: Patients clinically stable for one month or more on their previous medication received 25 mg of LAIR (increased to 37.5 or 50 mg, if necessary) every 14 days for six months. RESULTS: Of 202 patients (70% male, mean age 38 years), the majority (86%) had DSM-IV schizophrenia (mainly paranoid). Previous treatments were atypical antipsychotics (65%), depot (34%) and oral (9%) conventional neuroleptics. Mean total positive and negative syndrome scale (PANSS) score was significantly reduced from baseline to treatment endpoint (79.4 versus 68.3, P<0.001), as were all subscale and symptom factor scores. The clinical global impression-disease severity (CGI-S), general assessment of functioning (GAF), health-related quality of life (SF-36) and patient satisfaction with treatment were also improved significantly. At endpoint, 31% rated the treatment as 'very good' compared with 8% at baseline. The total extrapyramidal symptoms rating scale (ESRS) and Parkinsonism subscale scores were reduced significantly (P<0.001) from baseline at one month and further improved until treatment endpoint. CONCLUSION: LAIR significantly improved disease symptoms, patient functioning, movement disorders, health-related quality of life and treatment satisfaction. It therefore provides a useful option for the management of patients with psychotic disorders.