Analyse de la prescription, de l'efficacité et de la tolérance des inhibiteurs de l'acétylcholinestérase dans la maladie d'Alzheimer

Résumé En suisse, trois inhibiteurs de l'acétylcholinestérase sont disponibles pour le traitement symptomatique de la maladie d'Alzheimer légère à modérée. Il s'agit du donépézil (Aricept®), de la galantamine (Reminyl®) et de la rivastigmine (Exelon®). Leur prescription est maintenant largement répandue, sur la base d'études ayant confirmé leur efficacité et leur tolérance. Le but de la présente étude a été d'évaluer si de tels résultats se retrouvent dans notre hôpital. Nous avons analysé les dossiers hospitaliers et interviewé les proches et les médecins traitants de 103 patients chez qui un tel traitement a été proposé ou initié dans notre centre de gériatrie, entre janvier 2001 et juillet 2003. Nos résultats montrent que le donépézil fut la molécule la plus fréquemment prescrite (50,6% des cas), suivie par la galantamine (44,2%). Après une année de traitement, seulement 54% des patients (n = 51) prenaient encore leur traitement. Une faible majorité des patients (52% selon les médecins traitants, 62% selon les proches) a favorablement répondu au traitement. Nos résultats confirment l'efficacité de ces molécules mais dans une proportion moindre que celle publiée dans la littérature et sans dégager de supériorité d'une molécule sur une autre. Sur le long terme (une année), le pourcentage d'abandon a été élevé et supérieur aux données de la littérature. Nous estimons que le grand âge des patients de notre collectif explique en partie cette discordance de résultats.

Development of mental disorders one year after exposure to psychosocial stressors; a cohort study in primary care patients with a physical complaint.

BACKGROUND: Mental disorders, common in primary care, are often associated with physical complaints. While exposure to psychosocial stressors and development or presence of principal mental disorders (i.e. depression, anxiety and somatoform disorders defined as multisomatoforme disorders) is commonly correlated, temporal association remains unproven. The study explores the onset of such disorders after exposure to psychosocial stressors in a cohort of primary care patients with at least one physical symptom. METHOD: The cohort study SODA (SOmatization, Depression and Anxiety) was conducted by 21 private-practice GPs and three fellow physicians in a Swiss academic primary care centre. GPs included patients via randomized daily identifiers. Depression, anxiety or somatoform disorders were identified by the full Patient Health Questionnaire (PHQ), a validated procedure to identify mental disorders based on DSM-IV criteria. The PHQ was also used to investigate exposure to psychosocial stressors (before the index consultation and during follow up) and the onset of principal mental disorders after one year of follow up. RESULTS: From November 2004 to July 2005, 1020 patients were screened for inclusion. 627 were eligible and 482 completed the PHQ one year later and were included in the analysis (77%). At one year, prevalence of principal mental disorders was 30/153 (19.6% CI95% 13.6; 26.8) for those initially exposed to a major psychosocial stressor and 26/329 (7.9% CI95% 5.2; 11.4) for those not. Stronger association exists between psychosocial stressors and depression (RR = 2.4) or anxiety (RR = 3.5) than multisomatoforme disorders (RR = 1.8). Patients who are "bothered a lot" (subjective distress) by a stressor are therefore 2.5 times (CI95% 1.5; 4.0) more likely to experience a mental disorder at one year. A history of psychiatric comorbidities or psychological treatment was not a confounding factor for developing a principal mental disorder after exposure to psychosocial stressors. CONCLUSION: This primary care study shows that patients with physical complaints exposed to psychosocial stressors had a higher risk for developing mental disorders one year later. This temporal association opens the field for further research in preventive care for mental diseases in primary care patients.

Presentación de REICESMA - Red Española de Investigación en Cuidados de Enfermería de Salud Mental y Adicciones

La Red Española de Investigación en Cuidados de Enfermería de Salud Mental y Adicciones (REICESMA) es una estructura formada por grupos enfermeros de investigación que desarrollan su actividad científica en el ámbito de los cuidados de la enfermería de salud mental y adicciones. REICESMA es un proyecto de larga evolución: como es sabido, no se puede crear una red de forma espontánea sino que se requieren unas bases y unos requisitos previos imprescindibles. Si revisamos esos requisitos en plan descendente, el paso previo y el que se mantiene en todo el proceso de construcción y desarrollo de una red de investigación es la existencia de Grupos de Investigación. Podríamos aceptar que a partir de la existencia de dos Grupos de Investigación ya se podría configurar una Red. Seguramente es posible, pero en nuestra visión de REICESMA la estructura ha de ser mucho más amplia. Nuestro punto de referencia (aunque no necesariamente tiene que ser el punto de llegada) son las convocatorias oficiales de reconocimiento de redes /los criterios de definición de Red en los que se detalla que una Red deberá estar formada por al menos 10 grupos de investigación de cuatro más comunidades autónomas.

Shorter time since inflammatory bowel disease diagnosis in children is associated with lower mental health in parents.

AIM: This study assessed the mental health of parents of children with inflammatory bowel disease (IBD), compared their mental health with age-matched and gender-matched references and examined parental and child predictors for mental health problems. METHODS: A total of 125 mothers and 106 fathers of 125 children with active and inactive IBD from the Swiss IBD multicentre cohort study were included. Parental mental health was assessed by the Symptom Checklist 27 and child behaviour problems by the Strengths and Difficulties Questionnaire. Child medical data were extracted from hospital records. RESULTS: While the mothers reported lower mental health, the fathers' mental health was similar, or even better, than in age-matched and gender-matched community controls. In both parents, shorter time since the child's diagnosis was associated with poorer mental health. In addition, the presence of their own IBD diagnosis and child behaviour problems predicted maternal mental health problems. CONCLUSIONS: Parents of children with IBD may need professional support when their child is diagnosed, to mitigate distress. This, in turn, may help the child to adjust better to IBD. Particular attention should be paid to mothers who have their own IBD diagnosis and whose children display behaviour problems.

Trajectòries de la psicomotricitat: la vivència corporal com a accés a la pròpia identitat i a la representació mental

En aquest article es realitza una descripció històrica i una crítica de les diferents tendències que ha seguit l'estudi i desenvolupament de les teoríes psicomotrius en la infància, així com una proposta que enfoca la psicomotricitat des d'un plantejament bàsicament preventiu i educador.

Assessing the associations between mental disorders, cardiovascular risk factors, and cardiovascular disease : the CoLaus/PsyCoLaus study

Background: Cardio-vascular diseases (CVD), their well established risk factors (CVRF) and mental disorders are common and co-occur more frequently than would be expected by chance. However, the pathogenic mechanisms and course determinants of both CVD and mental disorders have only been partially identified.Methods/Design: Comprehensive follow-up of CVRF and CVD with a psychiatric exam in all subjects who participated in the baseline cross-sectional CoLaus study (2003-2006) (n=6'738) which also included a comprehensive genetic assessment. The somatic investigation will include a shortened questionnaire on CVRF, CV events and new CVD since baseline and measurements of the same clinical and biological variables as at baseline. In addition, pro-inflammatory markers, persistent pain and sleep patterns and disorders will be assessed. In the case of a new CV event, detailed information will be abstracted from medical records. Similarly, data on the cause of death will be collected from the Swiss National Death Registry. The comprehensive psychiatric investigation of the CoLaus/PsyCoLaus study will use contemporary epidemiological methods including semi-structured diagnostic interviews, experienced clinical interviewers, standardized diagnostic criteria including threshold according to DSM-IV and sub-threshold syndromes and supplementary information on risk and protective factors for disorders. In addition, screening for objective cognitive impairment will be performed in participants older than 65 years.Discussion: The combined CoLaus/PsyCoLaus sample provides a unique opportunity to obtain prospective data on the interplay between CVRF/CVD and mental disorders, overcoming limitations of previous research by bringing together a comprehensive investigation of both CVRF and mental disorders as well as a large number of biological variables and a genome-wide genetic assessment in participants recruited from the general population.