Les cahiers de l'année gérontologique

, Volume 1, Issue 3, pp 149–163 | Cite as

La prescription des antipsychotiques chez le sujet âgé

  • M. Benoît
  • E. Camus
  • X. Cnockaert
  • F. Nourashemi
  • M. P. Pancrazi
  • J. Plas
  • M. I. Agostino
  • J. -F. Alexandra
  • B. Beaufils
  • J. -P. Cano
  • C. Hazif-Thomas
  • B. Kruczek
  • B. Laurent
  • B. F. Michel
  • A. Nieoullon
  • J. -P. Polydor
  • M. Sarazin
  • C. Jeandel
Article de Synthèse / Review Article

Résumé

La prise en charge de certains symptômes délirants, psychotiques et comportementaux du sujet âgé recourt fréquemment aux antipsychotiques. Les données de la littérature mettent toutefois en évidence une grande variabilité des pratiques selon les équipes ainsi que de nombreux mésusages dans l’utilisation de cette classe thérapeutique. Leur prescription chez les sujets âgés a été récemment remise en cause, laissant ainsi les praticiens démunis face à une symptomatologie souvent complexe et difficile à prendre en charge. En pratique clinique, le recours aux antipsychotiques paraît incontournable lorsque l’état délirant du sujet âgé revêt des conséquences graves pour lui-même et son entourage: détresse psychologique, handicap fonctionnel, mise en danger. Leur prescription devrait demeurer individualisée et limitée dans le temps, chez les patients où elle se révèle efficace et réévaluée très régulièrement. Afin de guider cette prescription sur des preuves, on ne peut que préconiser des études fondées sur une méthodologie rigoureuse. Dans tous les cas, on devra privilégier l’emploi des molécules les moins anticholinergiques, réduire au minimum la posologie et fractionner les prises dans la journée afin d’améliorer la tolérance.

Mots clés

Antipsychotiques Sujet âgé Indications Tolérance Précautions d’emploi Symptômes comportementaux et psychologiques de la démence (SCPD) 

Antipsychotic prescription amongst the elderly

Abstract

The treatment of certain psychotic, behavioural and delusional symptoms in the elderly frequently involves the prescription of antipsychotics. However, data in the literature reveals considerable variation in practice from team to team as well as significant misuse of this class of drug. Prescribing such drugs to elderly patients has recently been called into question, leaving physicians with little or nothing to treat a range of symptoms that are often complex and difficult to treat. In clinical practice, antipsychotics seem to be the only way to deal with a delusional state in an elderly patient, in cases where it has serious consequences for both patient and carers: psychological distress, functional disability, dangerous situations. They should be prescribed on a case-bycase basis, for a limited period, to patients who respond well to them, with regular reassessment of the situation. Studies based on extremely rigorous methodology are needed to guide the prescription of antipsychotics, and any such prescription should favour the use of the least anticholinergic molecules, in minimal doses, broken down into smaller components spread throughout the day so as to improve patient tolerance.

Keywords

Antipsychotics Elderly Indication Acceptance Caution (before use) Behavioural and psychologics symptoms of dementia 

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Copyright information

© Springer 2009

Authors and Affiliations

  • M. Benoît
    • 1
  • E. Camus
    • 2
  • X. Cnockaert
    • 3
  • F. Nourashemi
    • 4
  • M. P. Pancrazi
    • 5
  • J. Plas
    • 6
  • M. I. Agostino
    • 7
  • J. -F. Alexandra
    • 8
  • B. Beaufils
    • 9
  • J. -P. Cano
    • 10
  • C. Hazif-Thomas
    • 11
  • B. Kruczek
    • 12
  • B. Laurent
    • 13
  • B. F. Michel
    • 14
  • A. Nieoullon
    • 15
  • J. -P. Polydor
    • 16
  • M. Sarazin
    • 17
  • C. Jeandel
    • 18
  1. 1.Pavillon Jhôpital PasteurNice cedexFrance
  2. 2.Rue LombardsHannebontFrance
  3. 3.Service de gérontologiecentre hospitalier de BeauvaisBeauvaisFrance
  4. 4.Hôpital PurpanToulouse cedex 09France
  5. 5.ParisFrance
  6. 6.Hôpital médicopsychologique, établissement public de santé CharcotPlaisirFrance
  7. 7.Hôpital Les MagnoliasBallainvilliersFrance
  8. 8.Service de médecine interneCHU BichatParisFrance
  9. 9.Service de psychiatriehôpital Corentin-CeltonIssy-Les-MoulineauxFrance
  10. 10.Résidence la CyprièreJuvignacFrance
  11. 11.Clinique KerglanchardCHG de QuimperleQuimperleFrance
  12. 12.Hôpital de jour (Abrapa)StrasbourgFrance
  13. 13.CHU BellevueSaint-ÉtienneFrance
  14. 14.Service de neurologiehôpital Sainte-MargueriteMarseilleFrance
  15. 15.LNCF CNRS FRE 2131Marseille cedex 20France
  16. 16.Cabinet médical Les AnémonesCannesFrance
  17. 17.fédération des maladies du système nerveux, centre de neuropsychologie et du langage, pavillon Paul-Castaigne (sous-sol)Hôpital de La Pitié-SalpêtrièreParis cedex 13France
  18. 18.Centre de prévention et de traitement des maladies du vieillissement, pôle de gérontologieMontpellier cedex 05France

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