[Reflection on the psychiatric financial allocation in France]. / Réflexion sur la péréquation financière de psychiatrie en France.

For 25years work has been underway in France for the implementation of an alternative to public financing of health care. In the absence of progress, some regional health agencies are engaged in work related to the reallocation of public finances between psychiatric institutions. We propose a reflection with suggestion on the method proposed by the Provence Alpes Côte d'Azur Regional Health Agency. Without questioning the need for a reallocation of resources between psychiatric institutions, the method proposed here needs to evolve further to be applied in a legitimate and appropriate manner. There is a kind of urgency for a reallocation of resources between psychiatric institutions in France, but it implies a collective thinking and especially the definition of evaluation procedures for the selected models. These conditions are necessary to guarantee the quality of French psychiatry and equity in access to psychiatric care.

Early psychological care of the French victims of the Costa Concordia shipwreck.

Most of the French passengers who survived the shipwreck of the cruise ship Costa Concordia were repatriatedfrom Italy to Marseille, one of the stopovers of the cruise. The shipwreck happened during the nightof 13th-14th January 2012 and entailed the forced evacuation of 4195 passengers and crewmembers.Thirty-two persons died and 2 others are still reported missing. The massive and unexpected inflow of402 French citizens in the port of Marseille required the quick setting up of welcome facilities, not only tosolve logistical problems, but also to address psychological and sometimes even medical problems. ThePrehospital Psychological Emergency Service (CUMP) and the Prehospital Emergency Medical Service(SAMU) of Marseille examined 196 persons in total, and were able to avoid a great number of emergencyadmissions deemed necessary because of difficult psychological situations (death, missing or lost persons,acute stress). The objective of this report is to rapidly present the emergency committee as a whole andto describe in more detail the work that the CUMP accomplished during the 36 hours necessary to takecharge of the majority of the French passengers of the Costa Concordia.

[RÉALITÉ LT, a pharmacoepidemiological study of semiology and therapeutic strategy of patients with schizophrenia treated by antipsychotic loxapine in routine clinical practice]. / RÉALITÉ LT : Recherche Épidémiologique sur l'Activité de la Loxapine et ses Indications en Thérapeutique quotidiennE lors d'une utilisation à Long Terme. Étude pharmacoépidémiologique : sémiologie et stratégie thérapeutique d'une population de patients présentant des troubles schizophréniques traités par loxapine.

INTRODUCTION: Data concerning the clinical and therapeutic characteristics of patients with schizophrenia treated by antipsychotic in naturalistic conditions are useful. Two national pharmacoepidemiological studies were conducted in France, a retrospective survey RÉALITÉ and a prospective study RÉALITÉ LT, to examine the use of loxapine, first in acute and chronic psychotic states and second in long-term treatment prescribed for patients with schizophrenia. AIM OF STUDY: The aim of RÉALITÉ LT is to specify the clinical characteristics of schizophrenic patients treated by loxapine for at least 4 months and the description of the methods of use of this antipsychotic medication during a 6-month follow-up in "real life" conditions. DESIGN OF STUDY: RÉALITÉ LT is an epidemiologic, observational, longitudinal, prospective (during a half-year period), multicenter and national study of the prescription of loxapine in routine clinical practice. For this study, 645 patients with schizophrenia treated by loxapine were recruited, assessed by PANSS, CGI, GAF, MeDra-SOC-PT for side effects and Girerd questionnaire for compliance; statistical analysis used SAS 9.2. RESULTS: Six hundred and forty-five adult patients were included and assessed at inclusion, month 3 and 6. These patients were mostly male (69%), with an average age of 41, inactive (68%), lonely with no child (79%), under psychiatric care for more than 5 years (81%), less than one third were inpatients. The subtypes of schizophrenia were paranoid (59%), disorganised (21%), undifferentiated or residual (10%), the outcome of psychotic illness was episodic (50%) or continuous (33%). The daily mean dosage of loxapine was 168,4 mg/d, in antipsychotic loxapine monotherapy (27%) or in combination with other antipsychotics (63%); it was often associated with psychotropic medications (anxiolytic [72%], antidepressant [21%], normothymic [19%]). The stability of the dosage of loxapine during the 6 months follow-up (60%) was associated with strict loxapine monotherapy or antipsychotic monotherapy (loxapine associated with other psychotropic medication). Safety, side effects and compliance were compared with previous studies. DISCUSSION AND CONCLUSION: These results are discussed, comparing the two pharmacoepidemiological studies RÉALITÉ and RÉALITÉ LT, loxapine is used in compliance with the two indications (smpc) and French guidelines (HAS, Haute Autorité de santé).

[Patients' perception of seclusion in psychiatry: ethical perspectives]. / L'isolement en psychiatrie: point de vue des patients et perspectives éthiques.

OBJECTIVE: Although seclusion is legally sanctioned in France, its use remains controversial, and debate continues over ethical and therapeutic aspects of the practice. Seclusion continues to be widely used in the management of disturbed behaviour in hospitalized patients. Although recent studies serve to strengthen the link between the use of seclusion and negative patient responses, they are limited in extending our understanding of the seclusion experience. The objective of this work was two-fold: to examine the perceptions and experiences of patients about their seclusion experience and then suggest ways of improving the use of seclusion in relation to an ethical perspective. METHOD: We conducted face-to-face semi-structured interviews with inpatients in a French Public Psychiatric Hospital, 3 weeks after their seclusion. They were conducted until no new ideas emerged in the content analysis, comprising 30 patients. Interviews were conducted using an interview guide by a physician. Specific attention was paid to their perceptions of seclusion. This guide was based on the concepts of medical ethics (autonomy, beneficence, non-malfeasance). Interviews were retranscribed and content analysis was performed by two of the authors who were skilled in textual analysis. Data analysis was performed using SPSS 15.0 software. RESULTS: Autonomy was challenged by 50% of interviewed patients. For 70% of patients, there was a lack of information and explanation during the seclusion on therapeutics, practices, procedures, expected length of time in seclusion and behaviours. This can contribute to perception of this process as punishment expressed by the patients. The dominant view of patients was that more effective communication about seclusion was needed. A majority of patients perceived the beneficence of the health professionals even if most of them did not express a benefit from this experience: only 26% believed that seclusion made them calm down and 36% that seclusion helped them to feel and behave better. The level and the quality of the relationship with staff during and following the seclusion experience was a major source of satisfaction for patients and can counter-balance their negative perception of seclusion. The non-malfeasance was questioned by patients. The therapeutic value of seclusion was not recognized by a majority of them. Seclusion from the patient's perspective appears to invoke a complex range of feelings that include helplessness (76%), anger (60%), humiliation (60%), depression (50%), and fear (63%). For 60% of patients, the act of placing them in seclusion had a profound negative impact. Seventy-six percent of them considered that seclusion could be prevented. CONCLUSION: Despite advances in our knowledge and understanding of mental illness, seclusion continues, and is likely to continue, as a treatment option for a number of patients. In our study, a certain number of trends were observed. Globally, there is some tension concerning ethical principles. Attention to the specific needs of patients while in seclusion may serve to reduce the punitive connotations linked to the practice. What is needed is a permanent ethical reevaluation of seclusion. For this purpose, healthcare professional staffs may be useful for a truly ethical reflection. The aim is to recognize the patient as the agent of his/her own empowerment through appropriate information. This approach should not only provide the patient with the opportunity to understand why the seclusion occurred, but also some means for overcoming the negative effects of the procedure.

Validation of a professionals' satisfaction questionnaire with electronic medical records (PSQ-EMR) in psychiatry.

BACKGROUND: Electronic medical records (EMR) are currently being implemented in psychiatric hospitals throughout Europe. The perceptions of health care professionals can contribute important information that may predict their acceptance of and desired mode of use for EMR, thus guiding EMR implementation. AIMS: To develop a self-administered instrument designed to assess health care professionals' satisfaction regarding EMR in a psychiatric hospital, based only on the professional point of view, according to the psychometric standards. METHODS: The development was supervised by a steering committee and undertaken by three standard steps. Item generation was derived from 115 face-to-face interviews with health care professionals in a French, public, psychiatric hospital. The item-reduction process resulted in a 25-item questionnaire. The validation process was based on construct validity, reliability and some aspects of external validity. RESULTS: The final version of the questionnaire contained 25 items that described five dimensions, leading to a global score. The factor structure accounted for 72% of the total variance. Internal consistency was satisfactory (item-internal consistency over 0.40 and Cronbach's alpha coefficients ranged from 0.86 to 0.95). The scalability was satisfactory with INFIT statistics inside an acceptable range. Scores of dimensions were strongly positively correlated with visual analogue scale scores (all p < 0.001). External validity showed statistical associations between scores and age, gender, seniority in psychiatry and ward type. Participation rate was 66%. CONCLUSION: The availability of a reliable and valid questionnaire (professionals' satisfaction questionnaire with electronic medical records [PSQ-EMR]) concerning health care professionals' satisfaction regarding EMR in psychiatry, exclusively generated from interviews with health care professionals, enables legitimate feedback to be incorporated into EMR implementation in order to formulate a high-quality health care.

[Psychometric properties of the Activities Daily Life Scale (ADL)]. / Caractéristiques psychométriques de l'échelle des activités de la vie quotidienne (AVQ).

OBJECTIVE: Deficits in social functioning are an important core feature of mental health. Recently in France, the Activities Daily Life (ADL) scale has been proposed by the French authorities to assess social functioning for all hospitalized patients in a psychiatric ward. The perspective is to use this scale in the financing and organization of mental health services in France. The ADL scale is a 6-item (dressing/undressing, walking/mobility, eating/drinking, using toilets, behaviour, relationships/communication) heteroquestionnaire completed by a health care professional at the beginning of each hospitalization, assessing functioning of patients suffering from mental health diseases. However, limited consensus exists on this scale. The psychometric properties of the ADL scale have not been assessed. There is a pressing need for detailed examination of its performance. The aim of this study was to explore ADL psychometric properties in a sample of hospitalized patients in a psychiatric ward. METHOD: We retrospectively analyzed data for all episodes of care delivered to hospitalized patients in a psychiatric ward in our French Public Hospital from January 1, 2008 to June 30, 2008. The study involved retrospective review of administrative and medical databases. The following data were collected: age, gender, diagnoses based on the International Classification of Diseases - 10th version, ADL scale and Assessment of Social Self-Sufficiency scale (ASSS). The psychometric properties were examined using construct validity, reliability, external validity, reproducibility and sensitivity to change. Data analysis was performed using SPSS 15.0 and WINSTEP software. RESULTS: A total of 1066 patients completed the ADL scale. Among them, 49.7% were male, mean age was 36.5 ± 10.8, and 83.5% were single. Schizophrenia, schizotypal and delusional disorders (40.0%), mood disorders (27.9%) and mental and behavioural disorders due to psychoactive substance use (12%) were the most common diagnoses. Factor analysis with varimax rotation identified a 2-factor structure accounting for 82% of the total variance. The first dimension (ADL 1) comprised four items and represented personal care activities. The second dimension (ADL 2) comprised two items and represented social functioning. A floor effect was reported for ADL 1 and its unidimensionality was not satisfactory: two items showed an INFIT statistic outside the acceptable range. Internal consistency was satisfactory for the two dimensions: each item achieved the 0.40 standard for item-internal consistency. The correlation of each item with its contributory dimension was higher than with the other (item discriminant validity). Cronbach's alpha coefficients ranged over 0.70 in the whole sample. Concerning external validity, positive correlations were not systematically found between ADL and ASSS dimensions. The score of ADL 1 had medium to high correlations with four dimensions scores of the ASSS, while the score of ADL 2 were not at all or weakly correlated with ASSS dimension scores. Globally, ADL did not cover sentimental life and social relationships. There were statistical associations between ADL and age or gender: women and subjects older than 60 had a higher level of dependency. We didn't find any association with marital status or diagnoses. The ADL scale presented a good reproducibility but was not sensitive to change. CONCLUSION: The psychometric properties of the ADL scale were not sufficient for several parameters such as validity or sensitivity to change, contrary to other available French scales. The use of a heteroquestionnaire rather than a self-administered questionnaire should be discussed by professionals and the French authorities. These results should be taken into account in the use of the ADL scale for the economic and administrative management of psychiatry. Further research should be conducted to confirm these results.

[Establishment of an electronic medical record in a psychiatric hospital: evolution of professionals' perceptions]. / Mise en place d'un dossier patient informatisé dans un établissement public de psychiatrie : évolution des perceptions des professionnels de santé

OBJECTIVE: The potential benefits of the application of an electronic medical record (EMR) in medical care are well recognized. However, if these benefits are to be accomplished, professionals must adopt and utilize EMR as a part of their practice. The aim of this study was to assess the evolution of the health care professionals' opinions of EMR and their use on a period of 1 year in a French Public Psychiatric Hospital. SETTING: Our institution is a 204-bed psychiatric hospital, employing 328 professionals and comprising three sectors: six units of complete hospitalisation (102 beds), one unit of week hospitalisation (15 beds), one unit of emergency (seven beds) and one unit of night hospitalisation (15 beds). Three extrahospital structures include the day hospitalisation (65 places), the medicopsychological centres (CMP) and the part-time therapeutic reception centres (CATTP) of the three sectors. METHODS: We conducted face-to-face, semi-structured interviews with health care professionals of a public psychiatric hospital on two occasions: 1 month after the establishment of the EMR (t0) and one year later (t1). All the solicited people agreed to participate in the investigation. The interviews were conducted until no new ideas emerged in the content analysis performed in real time, comprising 60 care professionals at t0 (10 psychiatrists, 42 nurses and eight paramedical professionals) and 55 at t1 (six psychiatrists, 42 nurses and seven paramedical professionals). Content analysis was performed by two members of the steering committee who were skilled in textual analysis. A descriptive analysis was also performed. The variables were described by proportions and means. The proportions were compared using the Chi-squared test or Fisher exact test where appropriate. A two-tailed p-value of greater than 0.05 was considered to indicate statistical significance. Statistical analyses were carried out using SPSS version. RESULTS: The proportion of EMR use remained stable and high (respectively 97% in 2007 and 93% in 2008). However, there was an increase in the proportion of pages used in 2008 (77% of the pages) compared to 2007 (58%) (p=0.02). The analysis of interviews highlighted some elements which explained the "under-utilization" of the EMR: "the record contains too many pages", "complete all the pages is sometimes hard", "It's difficult to have a global vision of the EMR". These difficulties are reported in an equivalent way between 2007 and 2008. For the "good users", the EMR had real strengths: "the EMR contains information recorded in a synthetic and precise way"; "the EMR provides complete and rapid information on the patient". There is an improvement of positive perceptions between 2007 and 2008; for example 38% of respondents in 2008 (against 18% in 2007) appreciated the multidisciplinary nature of the EMR and 51% in 2008 (against 40%) in 2007 appreciated the "centralisation of data". The general opinion on EMR had not changed between 2007 and 2008: 70% of professionals had a favourable opinion. Similarly, we did not find statistical difference between 2007 and 2008 on the perception of the impact of EMR on the quality of relationships between professionals and between professionals and patients. The impact on the quality of care remained high. In 2007, 72% of professionals reported that EMR could have a positive impact on the care of patients against 85% in 2008 (non significant). The main impact was the improvement of the continuity and coordination of care. The proportion of professionals who did not consider that EMR could deteriorate impact on professionals-patients relationships was not statistically different between in 2007 (44%) and 2008 (56%). Sixty-six percent of professionals in 2008 against 50% in 2007 did not consider that EMR deteriorates relationships between professionals (p=0.06). However, the rates of adverse opinions remained high in 2008 on the impact of EMR on relationships in general. This was directly related to the "loss of time in completing the EMR". However, in analysing the verbatim, there was a change of potential consequences of this loss of time. "The lack of availability for patients" was less expressed than "the loss of oral communication between professionals" which was reported more frequently. CONCLUSION: This study allowed us to identify the residual problems which each hospital could face, 1 year after setting up an EMR. This preliminary work constitutes the first step in the development of a measurement tool of the use and perception of the EMR by health care professionals.

[Perception and use of an electronic medical record system by professionals of a public psychiatric hospital]. / Perception et utilisation d'un dossier patient informatisé par les professionnels d'un établissement public de psychiatrie.

OBJECTIVES: The aim of this study was to evaluate the interest taken by the health care providers in the electronic medical file and its use within the quality improvement process. SETTING: Our institution is a 204-bed psychiatric hospital, employing 328 professionals and comprising three sectors: six units of complete hospitalisation (102 beds), one unit of week hospitalisation (15 beds), one unit of emergency (7 beds) and one unit of night hospitalisation (15 beds). Three extrahospital structures include the day hospitalisation (65 places), the medicopsychological centers (CMP) and the part-time therapeutic reception centers (CATTP) of the three sectors. METHODS: We conducted face-to-face, semi-structured interviews with health care providers of a public psychiatric hospital. All the solicited people agreed to answer the investigation. The interviews were conducted until no new ideas emerged in the content analysis performed in real time, comprising 60 care providers: 10 psychiatrists, 42 nurses and eight paramedical professionals. Content analysis was performed by two members of the steering committee who were skilled in textual analysis. A descriptive analysis was also performed. The variables were described by proportions and means. The proportions were compared using the Chi-squared test or Fisher exact test where appropriate. A two-tailed P-value of greater than 0.05 was considered to indicate statistical significance. Statistical analyses were carried out using SPSS version 13.0. RESULTS: Ninety-six percent of the interviewed subjects used the electronic medical file. The average number of daily use was seven (S.D.=5). Sixty-seven percent had a favorable opinion of the electronic medical file. Physicians had more frequent favorable opinions than nurses who considered that electronic medical files cannot capture real nursing activity. Health care providers considered that electronic medical file could be associated with improved quality of care, but two points should be taken into account: the increased documentation time (slow system response, multiple screens, the lack of computer knowledge, the absence of bedside documentation technology...) and dysfunctions in the information processing system. This could have an impact on documentation completeness, and quality and could also lead to a reduction of time devoted to care. CONCLUSION: This study proposes tracks of improvement in the use of the DPIP. In spite of this, a true debate must be initiated on these new information systems in psychiatry since their real objectives can be perceived as ambiguous, so that programs of clarification, education and reinsurance can be set-up.

Assessment of psychiatric inpatient satisfaction: a systematic review of self-reported instruments.

BACKGROUND: There is a growing concern about satisfaction with inpatient psychiatric services. There are currently numerous satisfaction instruments available to psychiatric inpatients, but little guidance on which among them to select. AIMS: To provide an overview of the psychometric properties and the content of satisfaction instruments available to psychiatric inpatients. METHODS: Systematic searches of Medline database to identify inpatient satisfaction questionnaires. Assessment of the instruments according to relevant psychometric properties. RESULTS: Fifteen satisfaction instruments were identified. The target population differed according to the instrument. Methods used to generate items were heterogeneous. These instruments were based on a mixed approach including patients' points of view, expert opinions, and literature reviews, causing the content of questionnaires to vary. Reliability and validity were not systematically tested. CONCLUSION: The validation of a common inpatient satisfaction instrument is a major challenge. Recommendations for the future development of satisfaction instruments may include: item generation based exclusively on the patient's point of view; a validation process on a large and representative population; and an instrument combining generic (core questionnaire) and specific (additional modules) approaches.

[Epileptic psychosis]. / Les psychoses de l'épilepsie.

A relationship between serious psychiatric disorders and epilepsy has been observed since antiquity. An association between schizophrenia and epilepsy has been noted since the turn of century, but this relationship appeared to be uncertain. From the 1950s on, a number of studies were devoted to this subject. Epileptic patients are more risk for psychosis than the general population. Others psychiatric syndromes, some of which have been individualized recently, can occur in patients with epilepsy: alternative psychosis, affective states, postictal psychoses, postoperative psychoses. In this article we present the different aspects of the psychoses of epilepsy. Their knowledge allows in most cases a precise diagnosis and an appropriate treatment.

Three-dimensional structure of the Hospital Anxiety and Depression Scale in a large French primary care population suffering from major depression.

Few studies have been specifically carried out to characterize the dimensional structure of the Hospital Anxiety and Depression Scale (HADS) and those that have, have yielded contradictory results. We have examined the factor structure and sensitivity to change of the HADS in a large French outpatient primary care population treated with sertraline for major depression (DSM-IV criteria). Factor analysis of the HADS was performed in 2669 outpatients and in subsamples using a principal component procedure with Varimax rotation. Concurrent change sensitivity of the HADS was compared with that for the Hamilton Depression Rating Scale (HDRS) after at least 45 days of sertraline treatment. Three distinct factors emerged from the HADS factor analysis: a "depression" factor and two separate anxiety subscales: "psychic anxiety" and "psychomotor agitation" whose mean reductions in scores from baseline were significantly correlated (0.36-0.45) with the reduction of the HDRS baseline score. These new data provide support for the use of the HADS's three-dimensional structure to measure improvement of selected symptoms of anxiety during antidepressant therapy.

[Psychiatric disorders in juvenile myoclonic epilepsy]. / Troubles psychiatriques dans l'épilepsie myoclonique juvénile.

Mild personality problems have been described in patients with juvenile myoclonic epilepsy (JME), but clinical practice shows that JME can be diagnosed in patients with more or less severe psychiatric disorders (PD). The presence in JME patients of personality disorders has been described repeatedly, but never quantified. We thus decided to evaluate, using the DSM IV, the current prevalence and types of PD in a large series of consecutive, newly referred patients with JME. Among 170 consecutive JME cases referred to two departments of epileptology (Marseilles and Nice) between 1981 and 1998 (66 males, 104 females; aged 11.7-70; mean+/-SD 32.4+/-10.4 follow-up 12.7+/-10 [0.5-52]), we found 45 patients (26.5p.100) with PD. According to the DSM IV, they could be classified as severe mental retardation (main diagnosis) (one case); pervasive developmental disorders (2 cases); tic disorder (1 case); enuresis (1 case); psychotic disorders (5 cases, including schizophrenia paranoid type (1 case), disorganized type (1 case), delusional disorder (1 case), unspecified (2 cases)); depressive disorders (3 cases); generalized anxiety (6 cases); anorexia nervosa (2 cases); personality disorders (24 cases, including borderline personality (11 cases), dependent personality (5 cases), histrionic personality (2 cases), obsessive-compulsive personality (1 case), not specified (5 cases)). Sudden unexplained death occurred in 2 cases (borderline personality and pervasive developmental disorder not otherwise specified, respectively) and death due to pneumonia in 1 cases (anorexia). Although uncommonly severe cases of JME may have been selected in our referral centers, it appears that JME may be associated with PD. Comparatively mild personality disorders are the most common finding, and may be part of the clinical picture to some extent, while severe PD are less common, and probably coincidental. The presence of PD does not exclude the diagnosis of JME, and PD may represent a further challenge in the comprehensive care of these patients.

Clinical factors of drug resistance in juvenile myoclonic epilepsy.

Juvenile myoclonic epilepsy is a comparatively benign form of idiopathic generalised epilepsy. Little is known about the prevalence of difficult to treat or drug resistant patients. Among 155 consecutive patients with newly diagnosed juvenile myoclonic epilepsy evaluated between 1981 and 1998 and followed up for at least 1 year (61 men, 94 women; aged 15-70 years, mean 33 (SD 10.3); onset of juvenile myoclonic epilepsy at the age of 14.5 (SD 3.7), range 6-26; follow up 1-52 years, mean 13.5 (SD 9.9)), there were 15 pseudoresistant patients (9.7%: lack of compliance (eight), insufficient treatment (three), abnormal lifestyle (four)) and 24 patients (15.5%) who had persisting seizures despite adequate therapy and lifestyle. Clinical features associated with drug resistance were (1) the presence of psychiatric problems (58.3% v 19%; chi(2) p<0.001) and (2) independently, the combination of seizure types (Fischer's exact 2 by 4, p=0.0026). Three types were present in 62.5% of resistant patients versus 23.3% in non-resistant patients (chi(2), p=0.0001). None of the resistant patients had myoclonic jerks as the only seizure type or a combination of absences and myoclonic jerks. Family history of epilepsy, age at onset of seizures, sex, presence of photoparoxysmal response, results of conventional neuroimagings (CT and MRI), and delayed diagnosis were not significantly associated with drug resistance. There is thus a significant subgroup of patients with juvenile myoclonic epilepsy who pose difficult therapeutic problems, and the prevalence of resistant cases may be increased in the experience of a referral epilepsy centre.

Is schizophrenia a risk factor for epilepsy or acute symptomatic seizures?

PURPOSE: The precise prevalence of epilepsies and seizures in patients with schizophrenia remains unclear. METHODS: To assess the prevalence of epilepsy and of acute symptomatic seizures in schizophrenics, we conducted a survey in a urban sector of Marseilles that includes 56,910 inhabitants, among whom 1,154 had been treated for psychiatric disorders, including 460 for schizophrenia or paranoid disorder (PD) (DSM III-R 295 and 297.1, respectively; mean age, 41.9 years; range, 17-79 years; 215 men and 245 women). RESULTS: All 460 patients were receiving long-term neuroleptic drug therapy, and 397 had been hospitalized at least once in the past year, whereas 63 were followed up as outpatients only. Seizures were present in the history of 12 patients: five had various forms of chronic epilepsy (four men, one woman; DSM III-R 295.1, one case; 295.3, two cases; 295.9, two cases), and three of these experienced seizures only after the onset of their psychiatric condition; five had acute symptomatic seizures (four men, one woman; 295.1, two cases; 295.3, 295.9, and 297.1, one case), and two had only pseudoepileptic events (both 295.3). CONCLUSIONS: This survey shows that the prevalence of epilepsy and acute symptomatic seizures is comparatively low in patients with schizophrenia or PD (10.8 per thousand each, respectively), and that the prevalence of a history of seizures (21.7 per thousand in this study) is not particularly increased in this middle-aged population. In contrast to childhood-onset autistic disorders, schizophrenia or PD are not major risk factors for epilepsy or acute symptomatic epileptic seizures.