[Prescription of antipsychotics in elderly patients with dementia in a psychiatric hospital: Impact of recommendations of the French health authority]. / Prescription des antipsychotiques chez les sujets âgés avec une démence dans un hôpital psychiatrique : impact des recommandations de l'HAS.

OBJECTIVES: Behavioral and psychological symptoms have a high prevalence in dementia. They include mood disorders, psychotic disorders and behavioral disorders such as aggression or screaming. Despite a number of side effects and an increased mortality, antipsychotic drugs are widely prescribed for treatment of this disorder. In France, this increased risk of mortality led in 2009 to the adoption of guidelines concerning all antipsychotics. The guidelines propose a sensible use of antipsychotics after the establishment of non-pharmacological measures. The aim of this study is firstly to assess the impact of the French drug agency warnings on use of antipsychotics in elderly patients with dementia in our psychiatric hospital between 2008 and 2013. Secondly, we compare the prescription of antipsychotics between geriatric psychiatry and other adult medical departments in 2013. METHOD: Thirty elderly with dementia were included in 2008 and 116 in 2013. We compare the prescriptions of antipsychotics in terms of percentage of subjects under antipsychotics. For these patients, we measure average number of different antipsychotics prescribed during the hospital stay or on the exit prescription, the average daily dosage per patient, the presence or the absence of association of antipsychotics. RESULTS: We show that the percentage of subjects under antipsychotics increased between 2008 and 2013 while the average dosage decreased in adult wards except in the geriatric psychiatry ward where the average dosage increased. There is no difference in the average number of different antipsychotics prescribed. In 2013, the geriatric department prescribed more antipsychotics but with lower dosages and lesser associations than in other departments. CONCLUSIONS: The impact of the French guidelines is limited in our psychiatric hospital. It is probable that the lack of means, both human and pharmacologic, as well as the possible worsening of the severity of the behavior and psychotic disorders in patients with dementia make difficult the application of these recommendations for the psychiatric hospital.

Optimisation of operational management practices for the detention basins.

The objective of this study is to develop new operational management practices for detention basins during rainfall events in order to limit flooding risk and, at the same time, to reduce pollutant discharges by optimising the settling process. For this work, a methodology was developed to study the integration of the stormwater treatment into existing detention structures. In this article, it was applied on two experimental sites. The current operation of the basins and "on/off" regulation studies were first carried out to quantify the freedom to act to change the control schemes. Relying on the support of these studies, new operational rules based on the current or "on/off" principle were then elaborated and tested on the experimental basins using a hydraulic model. Finally, their efficiency to protect against flooding and to reduce pollutant discharges was assessed.