[Prevalence and characteristics of neuroleptic association in a patient cohort with psychotic disorders]. / Prévalence et caractéristiques de l'association de neuroleptiques chez une cohorte de patients souffrant de troubles psychotiques.

OBJECTIVES: Combined antipsychotic drugs are often prescribed, despite a lack of objective supporting data. Therefore, it is especially important to determine the scope of this practice and to better understand the characteristics of affected patients to identify which associations to study first. METHOD: We studied patients with psychotic disorders followed for at least 1 year at an outpatient psychiatric clinic in Geneva (n = 253). We collected data on prescriptions given at baseline and during that period, as well as sociodemographic and clinical data. RESULTS: During the follow-up period, 36% of patients were prescribed a neuroleptic. These patients differ by negative changing characteristics: less activity, financial assistance, nursing home placement, and numerous admissions with earlier onset of disorder. Three-quarters of patients did not change treatment during that period. Treatment stability is associated with treatment compliance and lack of hospital admission during the follow-up period. CONCLUSION: Without any scientific substantiation, patients with negative changing characteristics are often prescribed neuroleptics. Such treatment options are likely relatively inefficient strategies. Moreover, this practice risks further complicating patients who are already characterized by negative elements.

Effect of topiramate augmentation on two patients suffering from schizophrenia or bipolar disorder with comorbid alcohol abuse.

Two cases of patients with a severe comorbidity of alcohol abuse treated with topiramate are reported. The first case is a 52-year-old patient who has been suffering from schizophrenia for many years. Topiramate prescription was associated with a discontinuation of his chronic, refractory alcohol consumption. The second case is a 41-year-old patient with bipolar disorder that mainly manifests itself through manic episodes. Topiramate treatment allowed him to decrease his alcohol intake to an acceptable level. Consequently, his bipolar symptoms also improved, without the appearance of any side effects. Thus, topiramate may improve alcohol intake among patients with schizophrenia or bipolar disorder. Certain studies have shown the efficacy of topiramate in alcoholic patients without such associated disorders, but further research is needed for this special population.