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Master Thesis

Devenir des traitements psychotropes prescrits à la sortie d’une hospitalisation en psychiatrie de la personne âgée

Abstract : The frequency of psychiatric disorders is high in the elderly population since almost half of those people over the age of 65 is suffering from a psychiatric disorder in France. In this context, one third of people over the age of 65 uses psychotropic drugs in France. This prescription of psychotropic drugs may prove to be inappropriate (over or underused) and sometimes difficult to adapt to an outpatient, especially in this particularly exposed and vulnerable population of elderly people. This is a major and complex public health problem in France and there are few specific studies concerning the elderly, particularly regarding the continuity of care in psychiatry. This observational and retrospective study carried out between July and September 2016 deals with 51 patients hospitalized at least twice in a gerontopsychiatry ward of the UNIVA at Charles Perrens hospital center in Bordeaux. The collection of data was carried out on the patients's computerized medical records. Our main objective was to observe what happened to a psychotropic treatment prescribed during an hospitalization in gerontopsychiatry and thus to describe the frequency of treatment changes occurring in an outpatient clinic following an hospitalization in a psychiatric unit, the motivations of these therapeutic changes and the characteristics of the treatment and the patient associated with them. The results show that 49% of the patients (N = 25) were involved in a therapeutic change, 55% of them were stopped and 45% were initiated. The changes were essentially made by the psychiatrist at 22% versus 6% performed by the general practitioner. These changes were mainly due to a relapse for 14% of patients. For 14% of them, the information concerning the change of treatment carried out on an outpatient basis was not mentioned in the files. The factors significantly associated with the occurrence of a post-discharge therapeutic change were first short-term hospitalization and the advanced age of the patient. Our study revealed a significant discontinuity of care in terms of prescribing medications after an hospitalization in a psychiatric ward for the elderly. It is likely that facilitating access to expert advice in a short period of time would avoid a significant number of hospital admissions. This organization would require more flexibility and a greater supply of care in the psychiatry of the elderly, but also a genuine willingness on the part of general practitioners to maintain ambulatory care and to be supervised in such care. It remains essential to preserve the quality of communication between ambulatory and hospital doctors, which is crucial for the continuity and the quality of care.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01508827
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Submitted on : Friday, April 14, 2017 - 6:39:03 PM
Last modification on : Wednesday, August 23, 2017 - 4:41:48 PM

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Élodie Rochet. Devenir des traitements psychotropes prescrits à la sortie d’une hospitalisation en psychiatrie de la personne âgée. Médecine humaine et pathologie. 2017. ⟨dumas-01508827⟩

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