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La prescription des antipsychotiques chez le sujet âgé

Antipsychotic prescription amongst the elderly

  • Article de Synthèse / Review Article
  • Published:
Les cahiers de l'année gérontologique

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.

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.

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Authors and Affiliations

  1. Pavillon J, hôpital Pasteur, 30, avenue de la Voie-Romaine, F-06002, Nice cedex, France

    M. Benoît

  2. Rue Lombards, F-56700, Hannebont, France

    E. Camus

  3. Service de gérontologie, centre hospitalier de Beauvais, 40, avenue Léon-Blum, BP 40319, F-60021, Beauvais, France

    X. Cnockaert

  4. Hôpital Purpan, 1, place du Docteur-Baylac, F-31059, Toulouse cedex 09, France

    F. Nourashemi

  5. 65, boulevard des Invalides, F-75007, Paris, France

    M. P. Pancrazi

  6. Hôpital médicopsychologique, établissement public de santé Charcot, 30, rue Marc-Laurent, BP 20, F-78375, Plaisir, France

    J. Plas

  7. Hôpital Les Magnolias, 77, rue du Perray, F-91160, Ballainvilliers, France

    M. I. Agostino

  8. Service de médecine interne, CHU Bichat, 46, rue Henri-Huchard, F-75018, Paris, France

    J. -F. Alexandra

  9. Service de psychiatrie, hôpital Corentin-Celton, 4, parvis Corentin-Celton, F-92130, Issy-Les-Moulineaux, France

    B. Beaufils

  10. Résidence la Cyprière, rue de la Plaine, F-34990, Juvignac, France

    J. -P. Cano

  11. Clinique Kerglanchard, CHG de Quimperle, F-29300, Quimperle, France

    C. Hazif-Thomas

  12. Hôpital de jour (Abrapa), 7, rue du Docteur-Nessmann, F-67200, Strasbourg, France

    B. Kruczek

  13. CHU Bellevue, pavillon 12, 25, boulevard Pasteur, F-42100, Saint-Étienne, France

    B. Laurent

  14. Service de neurologie, hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, F-13009, Marseille, France

    B. F. Michel

  15. LNCF CNRS FRE 2131, 31, chemin Joseph-Aiguier, F-13402, Marseille cedex 20, France

    A. Nieoullon

  16. Cabinet médical Les Anémones, 71, boulevard Carnot, F-06400, Cannes, France

    J. -P. Polydor

  17. fédération des maladies du système nerveux, centre de neuropsychologie et du langage, pavillon Paul-Castaigne (sous-sol), Hôpital de La Pitié-Salpêtrière, 47-83, boulevard de l’Hôpital, F-75651, Paris cedex 13, France

    M. Sarazin

  18. Centre de prévention et de traitement des maladies du vieillissement, pôle de gérontologie, 39, avenue Charles-Flahault, F-34295, Montpellier cedex 05, France

    C. Jeandel

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  1. M. Benoît
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  2. E. Camus
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Benoît, M., Camus, E., Cnockaert, X. et al. La prescription des antipsychotiques chez le sujet âgé. cah. année gerontol. 1, 149–163 (2009). https://doi.org/10.1007/s12612-009-0022-z

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