Encephale
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Atypical antipsychotics have a favourable risk/benefit profile in early onset schizophrenia (EOS). However, despite increasing use of psychotropic medication in children and adolescents, their endocrine and metabolic side-effects (weight gain, obesity, and related metabolic abnormalities such as hyperglycaemia and dyslipidemia) are of particular concern, especially within this paediatric population that appears to be at greater risk as compared with adults for antipsychotic-induced metabolic adverse effects. In addition to medication, many factors contribute to weigh gain in psychiatric patients, including sedentary lifestyle and poor diet. Excessive weigh gain has several deleterious effects in psychiatric patients, including stigmatization and further social withdrawal, and non compliance with medication. Furthermore, excessive corpulence may evolve to a metabolic syndrome with a high-risk state for future cardiovascular morbidity and mortality in adult age. Because youths are still developing at the time of psychotropic drug exposure, in a context of physiological changes in hormonal and endocrines levels and body composition, most reference values need to be adjusted for gender, age and growth charts. Hence, sex- and age-adjusted BMI percentiles and BMI Z scores are crucial to assess weight gain in children and adolescents. ⋯ Alternative treatment should be considered in some cases. Other antipsychotics, like aripiprazole, may have a better benefit/risk ratio and then may be prescribed as a first prescription or as a switch. Associations of antipsychotics may also be of interest but we lack controlled studies in children and adolescents. In some cases, alternative treatments like repetitive trans-cranial magnetic stimulations (rTMS) may be required. Their efficacy and their place in the therapeutic strategy of pharmacoresistant schizophrenia in children and adolescents have to be assessed in regard to metabolic and blood side effects of clozapine.
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Depression is a quite common condition, and its treatment is mainly provided by General Practitioner (GP). It is already known that detection and treatment requires significant improvement. The well known and high consumption of antidepressant drugs in France, the highest of all other European countries, requires specific studies. The causes of this situation are not clear and seem to be numerous: Patient's demands, social claims; lack of initial and continuous medical education, bad GP demographic trends, and lack of them in rural areas; pharmaceutical company pressure; and organisation of the health care system. GP are the main medical actors of the primary care system in France. The aim of this study was to survey GP perceptions on secondary care services, seek the views and barriers to the provision of good services, and ask them about perceptions and solutions they could suggest. ⋯ Despite an unavoidable questioning on the dysfunctions of the health care system, quality of care and probably pharmaceutical consumption for the depressed patient might be improved by simple tools, such as adapted CME for primary care physicians, and communication improvement between secondary and primary care systems.
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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. ⋯ 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.
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According to research in sport psychology, anxiety is one of the most important and studied topics. Since its conceptualisation, many scales assessing sport anxiety have appeared in the English language. At present, the multidimensional conceptualisation of anxiety is dominant. Smith et al. developed a self-report questionnaire to assess the anxiety trait in sport (Sport Anxiety Scale, SAS). As a consequence, it seems important to have such an instrument in French language in order to fill in questionnaires on lack of self-report so as to assess cognitive and somatic anxiety traits. ⋯ The CFA results on both models are acceptable (chi(2)/ddl=1.60, Comparative fit index (CFI)=0.98, Global fit index (GFI)=0.92, Standardized root mean square residual (SRMR)=0.05, Root mean square error of approximation (RMSEA)=0.05) and Cronbach's alpha for each scale ranged from 0.86 for cognitive trait anxiety to 0.89 for somatic trait anxiety. The ANOVAs show a difference according to gender (girls were more anxious than boys); level (the higher the level, the more the sportsmen were anxious) and type of sport (those who practiced collective sports were more anxious than those who practised individual sports). To conclude, and waiting for other researches using the French version of SAS, it appears that this scale is generally acceptable, and can be a useful tool for research on the anxiety trait in sport.
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French legislation makes mandatory for healthcare providers the disclosure of hospital infection (HI) risk and actual occurrence to the patient. Given the specific diseases encountered in psychiatry, some difficulties may be expected in practical application of this regulation. ⋯ Whereas a very large proportion of HCW in psychiatry support delivering information to patients about HI, our study shows HCW's lack of awareness of regulations and lack of declared practices. Among factors explaining this contrast, a lower perceived HI risk and severity level are to be mentioned. Training programs focusing on risk and mechanisms of HI could be offered to professionals in psychiatry. The issue of specific communication difficulties with psychiatric patients should be addressed as well. In order to develop information on HI, specific methods suited to those patients should be developed.