Encephale
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The knowledge of psychotropic medication consumption is a Public Health stake for the armies and their social partners. Indeed, indirectly, it permits not only assessment of the state of health or the mental state of the working militaries, but also the development of actions to increase consumers' and prescribers' awareness of the main effects of psychotropic drugs and their side effects. The evaluation of the consumption of psychotropic drugs is based on the reimbursements requested from the "Caisse nationale militaire de Sécurité sociale", a particular scheme of the health fund, to which every working military is affiliated. ⋯ Our results show that the consumer's profile in the class of the working militaries does not differ from that found in other studies conducted on professionals. The GP is the main prescriber of psychotropic drugs, but this kind of prescription is different from the psychiatrist's. The military doctor is little implicated in the prescription of psychotropics, the link between aptitude and use is obviously the main explanation. The good use of psychotropic medication has to be reinforced for both consumers and prescribers. Other alternatives than the call on medicine have to be reinforced by improving the prevention and the management of psychological disorders and psychiatric affections.
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In the 1990s, cannabis consumption in France increased considerably. So, in 10 years, the number of adolescents reporting regular cannabis use (10 or more times during the last 12 months) tripled. In 2004, an official program to address problems related to cannabis addiction was implemented. As part of this program, specific outpatient settings for cannabis use disorders were created. ⋯ The cannabis users seen in our specific setting are a fairly homogeneous group and for the most part addicted to cannabis only, but with very high rates of dependence. Indeed, other than tobacco dependence, 80% of the users were only dependent on, or abused on cannabis in the last 12 months. In comparison with the cohort of French cannabis users (n=4202) seen at specific outpatient settings for marijuana users in 2005, cannabis users seen in Lariboisière Hospital are older, the percentage of females is greater, they are more dependent on marijuana and have a high prevalence of affective and anxiety disorders.
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Case Reports
[A case of Usher's syndrome associated with psychotic symptoms: diagnosis and follow-up in a psychiatric unit].
Usher's syndrome is a heterogeneous autosomal recessive disorder characterised by dual sensory impairment: profound congenital hearing impairment and progressive visual loss due to retinitis pigmentosa, sometimes associated with vestibular dysfunction. Some patients develop a psychotic illness, the etiology of which is still debated. Diagnosis may be difficult, and there are only a few reports in the psychiatric literature. ⋯ Access to mental health services is particularly difficult for deaf and deaf-blind people, and difficulties in communication are a challenge for patients and for caregivers too. Antipsychotic medications are helpful for associated psychotic symptoms. Potential link between Usher syndrome and psychosis is still unclear and needs further studies.
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In our daily practice in public hospitals, we are regularly confronted with the paradox of helping patients, who do not ask for help. Although the French law is clearly defined to allow us to treat patients suffering from psychiatric conditions, who are unable to give their consent, it is not the case for those with addictive disorders. In fact, their disorder does not always (or does not yet) justify treatment without their consent, according to the 1990 law (psychiatric treatment without the patient's consent). ⋯ Pathology begins when an individual can no longer choose what he/she needs to do. We do not consider that a brief-concrete approach is better than any other approach, but its pragmatic nature seems to fit in with the new conception of addiction therapy, with earlier intervention. However, is it possible to make changes outside of a crisis situation? We are unable to answer this question, except to say that the best time for change is that chosen by the patient.