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Objective: To identify temporal trajectories of anxiolytic benzodiazepine (A-BZD) use over 10 years among new A-BZD users aged 50 and older and describe treatment patterns and demographic and clinical characteristics associated with each trajectory., Method: A representative cohort of the French national health insurance fund users was tracked from 2006 through 2015. We used latent class mixed models to identify the trajectories., Results: We observed four trajectories among new users (no A-BZD dispensing in 2005) plus one non-use trajectory. The proportion of occasional use among users was 60%; early increasing use, 10%; late increasing use, 17%; and increasing/decreasing use, 13%. Prevalence of occasional use decreased with age in women, but not men. Duration of treatment episodes and doses differed between trajectories. Multiple regression analyses with occasional use as the reference showed that the other three trajectories shared characteristics (age, coprescriptions of other psychotropic drugs, and more general practitioner consultations) but differed by the presence at inclusion or occurrence during follow-up of psychiatric, neurodegenerative, and somatic conditions., Conclusion: We found four different long-term temporal trajectories in new A-BZD users (occasional, early increasing, late increasing, and increasing/decreasing use). Difficulties quitting or reducing consumption may be very different for each trajectory, requiring tailored care approaches., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The aim of this study was to describe and analyse the links between the consumption of psychotropic drugs and smoking, based on data from individuals subscribing to a health insurance organisation (a mutuelle) in France in 2005. Data on smoking status, depression, anxiety and alcohol consumption from a large transversal epidemiological study carried out in 2005 were analysed in parallel to individual data concerning the reimbursement of medical prescriptions for psychotropic drugs. We compared reimbursement data for psychotropic drugs between individuals who had smoked for at least 15 years and continued to smoke and individuals who had stopped smoking after at least 15 years of smoking. This group of ex-smokers was subdivided into three subgroups on the basis of the number of years elapsed since the time point at which the individual had been smoking for 15 years: 1 to 9 years, 10 to 19 years and 20 years or more. "Ex-smoker" status was associated with a lower risk of psychotropic drug prescription than "current smoker" status (OR=0.81 for anxiolytics, OR=0.74 for antidepressants). Analysis of the subgroups of smokers and ex-smokers also showed that mean annual consumption of antidepressants and anxiolytics was significantly lower for individuals who had stopped smoking after at least 15 years of the habit than for those who continued to smoke (respectively 1.34 versus 0.65 for anxiolytics, and 1.17 versus 0.62 for antidepressants). Our findings suggest that stopping smoking is associated with a decrease in the consumption of psychotropic drugs. They highlight the need to evaluate the medium- and long-term effects of stopping smoking on psychotropic drug consumption in more detail, taking into account the anxious and depressive disorders to which smokers are particularly prone., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Refractory suffering of terminally ill people may be physical (pain, dyspnea, vomiting...) or existential (spiritual sufferings, anxiousness...). End-of-life decisions are often around ethics. Decision making near the end of life consists in witholding and withdrawing life-support treatment and prescribing both of treatments with risk of double effect and sedation for distress. In France, such decisions are defined by the deontology code and by the law of April 22nd, 2005 concerning the end of life and patients' rights. Recommendations from medical societies specify the means of implementation: obtaining other medical opinions, the patient's informed consent and full transparency of the decision (noted in the patient's medical chart)., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Many reviews exist about the use of psychotropic in children with depression (American academy of child and adolescent psychiatry en 2007 [Aacap] 2007, Food and drug administration [FDA] 2004, Afssaps 2008). Antidepressants are the most important long-term treatment: only fluoxetine has been effective and is authorised in France since August 2006. The risk of suicidality and sexual maturation alteration need to be control. Psychotherapy is needed to involve efficacy and tolerability treatment. Other IRS and IRSNA are used, but another study must be conducted in currently practice condition.

Catatonia may be encountered in psychiatric disorders, but also in general medical conditions. Cases of catatonia associated with systemic lupus erythematosus (SLE) are rare. Several articles have described this symptomatic association, as well as its management, using electroconvulsive therapy, plasma exchange or benzodiazepines. We report three cases here of patients who presented with catatonia during a lupus relapse, in whom treatment with lorazepam improved the catatonic symptomatology, thus allowing the associated condition to be treated. We touch on several points about the diagnosis, etiology and treatment of catatonia, when it is associated with SLE.

Seven placebo-controlled trials have shown that pregabalin has a modest effect on generalised anxiety in the short term. Pregabalin has not been shown to be as effective as a benzodiazepine or better tolerated.

Over the past 20 years, hypnotic drug use has diminished in France, while consumption of anxiolytics and neuroleptics has remained stable and antidepressant use has risen. Data from the ESEMeD survey (European Study of Epidemiology of Mental Disorders) conducted in 2002 in Germany, Belgium, Spain, France, Netherlands and Italy showed that use of anxiolytics during the previous year (including recurrent use) was less frequent in Germany than elsewhere. Belgium and France had a higher prevalence of antidepressant consumption. Among depressed patients, fewer than one-third reported antidepressant use (no difference among the countries), while one-third said they used anxiolytics (higher rate in France). One-quarter of patients with anxiety stated they used a benzodiazepine (lower rate in Germany). Age, psychiatric disorders and neurological disorders were strongly associated with benzodiazepine use. Factors strongly associated with antidepressant use were age (bell-shaped curve), female sex, and psychiatric disorders.

Objective: To study adjunctive medications used with antipsychotic agents in schizophrenia via comparisons of antidepressant, anxiolytic and antiparkinsonian co-prescribing., Method: In the context of a national naturalistic prospective observational study, a database containing all the prescriptions from 100 French psychiatrists during the year 2002 was analysed. The inclusion criteria were a diagnosis of schizophrenia or schizoaffective disorder and age over 18. A log-linear model and generalised linear mixed models were used., Results: In all 5,257 prescriptions for 922 patients were analysed. The proportion of patients who were prescribed an antiparkinsonian drug was 32.9%. Amisulpride, haloperidol, phenothiazines with a sedative action and depot typical antipsychotics proved more likely to be prescribed with antiparkinsonians. The frequency of antidepressant and anxiolytic prescriptions was 51.2% and 52.3%, respectively. Associations between atypical antipsychotics (except clozapine) and antidepressants were positive while associations between typical antipsychotics and antidepressants were not. There were no differences among antipsychotics for the prescription of anxiolytics., Conclusions: Atypical antipsychotics can be expected to be less likely associated with antiparkinsonians. This result is indeed found for olanzapine, clozapine and to a limited extent for risperidone. Furthermore, a trend towards a positive association between atypical antipsychotics and antidepressants appears. In view of the antidepressive action of certain atypical antipsychotics, this result is surprising. The increase in the prescriptions of anxiolytics concerns all types of antipsychotics. In view of the increase in associated medications in schizophrenia and the difficulty of estimating it in randomised trials, this study underlines the contribution of naturalistic studies on this score.

Objective: To differentiate, over a 5-year period, non-compliant (NC) from compliant (C) consumers of psychotropic drugs according to their demographic characteristics and views on: their faith in the prescriber, the effects of consumption, opinion of family and friends and information received., Method: Among 166 consumers (mean age 55 yrs), two questions for each psychotropic drug consumed for 5 Years classified them as NC or C. Data were collected by auto-assessments and telephone interviews., Results: Thirty-nine percent of consumers were defined as NC. The majority of psychotropic drugs were prescribed by general practitioners, whose patients were less compliant than psychiatrist's patients. The NC were more inclined to feel positive effects after taking the drug and stated they could do without it. Ninety percent of consumers had a positive attitude to psychotropes and 40% spoke about their consumption to friends and family notably among the NC. Only 12% of consumers do not seek information on psychotropic drugs because they trusted their prescriber., Discussion: Psychotropic drug consumers require therapeutic education better adapted to their expectations.

Background: The objectives of this study were to describe the use of benzodiazepines in the elderly and to identify socio-demographic and medical factors associated with this use., Methods: Data on the use of sedative and sleeping drugs were collected from a self-reported questionnaire, in a sample of 1265 elderly subjects (aged 60 to 70 years) interviewed at the first follow-up examination of the EVA Study (Epidemiology of Vascular Aging Study)., Results: Use of sedative or sleeping drugs was reported by 28.7% of the participants and use of benzodiazepines by 23%. Most of the benzodiazepines used (71%) had anxiolytic indications, 48% were long-acting compounds (elimination half-life>=20 h.). Among benzodiazepine users, 71% reported using benzodiazepines daily and 77% reported they had been taking benzodiazepines for at least 2 years. Nearly two third of the benzodiazepine users reported taking their medications as prescribed. When they were not compliant, they took benzodiazepines less often and/or at slighter doses than prescribed. Use of benzodiazepines was associated with symptoms of depression or anxiety (women: odds-ratio=2.6 [1.7-4.1]; men: odds-ratio=4.4 [2.4-7.8]) and with regular use of at least three non-psychotropic drugs (women: odds-ratio=2.0 [1.4-2.9]; men: odds-ratio=1.8 [1.1-3.1]). Women with a high educational level or with moderate alcohol consumption were less likely to take benzodiazepines; these associations were not found in men., Conclusions: The present study shows that benzodiazepines are the sedative and sleeping drugs most widely used by the elderly. Nearly three quarters of benzodiazepine users were chronic users.

Objectives: The objective of this study was to describe determinants of current and subsequent benzodiazepine use in an elderly population, the Paquid cohort., Methods: The study was conducted on a cohort of 2,792 community-dwelling subjects 65 years of age or more living in the Gironde department, southwestern France. Benzodiazepine use and its correlates were studied with data collected at inclusion in the cohort. Longitudinal analysis over a 5-year period of follow-up was done to identify baseline predictors of subsequent use., Results: At baseline, prevalence rate of benzodiazepine use was 31.9%. It was associated with female gender [odds ratio (OR) = 2.0; 95% confidence interval (CI): 1.66, 2.46], previous psychiatric disease (OR = 2.87; 95% CI: 2.31, 3.56), concomitant antidepressant use (OR = 2.45; 95% CI: 1.59, 3.78), depressive symptomatology (OR = 1.70; 95% CI: 1.28, 2.26), multiple drug use (OR = 1.82; 95% CI: 1.50, 2.21), multiple chronic diseases (OR = 1.37; 95% CI: 1.12, 1.67) and poor self-perceived health (OR = 1.63; 95% CI: 1.33, 2.0). For the 1926 benzodiazepine non-users at inclusion and followed during 5 years, incidence rate of subsequent use was 5.37 per 100 person-years (95% CI: 4.76, 5.98). In multivariate Cox proportional hazards regression analysis, previous psychiatric diseases, poor self-perceived life satisfaction and polymorbidity were significantly associated with subsequent benzodiazepine use., Conclusions: Elderly people are heavy users of benzodiazepines. Independently from mental health status, those in poor health were most at risk of benzodiazepine use.

Benzodiazepines are well tolerated by young adults whereas in elderly people they are less safe and globally induce more central nervous system side-effects and falls. Falls result from a decrease of vigilance and an alteration of postural reflex. This latter includes the reception of sensory information and central integration modulated mainly by dopaminergic D2 receptors and motor stimulation. Benzodiazepines act simultaneously on the three stages, decreasing their efficacy. The risk increases when certain other drugs are coprescribed, especially synergistic drugs such as another psycholeptic drug, an aminoside or a centrally active antihypertensive drug. Thus their co-prescription with a benzodiazepine increases the risk of falls. The pharmacokinetic parameters of benzodiazepines may be modified or remain constant during ageing. The choice of molecules whose parameters do not vary seems advisable. Whatever the selected benzodiazepine, it is obvious that it must be administered at the lowest possible dose, this dose being increased only if necessary, the overall prescription being time limited.

For many years, the use of benzodiazepines has been particularly high in France. This use can be described through pharmacy delivery. A cross-sectional one-day survey was conducted in June 1999, within a randomly selected network of community pharmacies in Aquitaine. Pharmacists were asked to interview each patient presenting with a prescription form including at least one benzodiazepine. A total of 58 pharmacies participated in this study; 328 patients were included representing 356 benzodiazepines prescribed. Among the 20 different benzodiazepines concerned, bromazepam, lorazepam and alprazolam represented more than half (54 per cent) of the prescriptions. The mean age of the patients was 62 years (median: 64) and 70 per cent of them were women. Most patients (93 per cent) were known to the pharmacist and 86 per cent had benzodiazepines prescribed by a single physician. In most cases (77 per cent), the prescribed benzodiazepine had been used for more than one year and in one quarter for more than five years. For 81 per cent of chronic users, no dose increase was observed. This study confirmed that long-term use of benzodiazepines is frequent, particularly in the elderly. This use is commonly accepted by health professionals as well as by patients, although it clearly reflects the dependence potential of benzodiazepines.

Many hypotheses have been made to explain the high rate of benzodiazepine consumption in France, including a general cultural and/or familial tendency to use certain types of psychotropic drugs. This study explored the association between lifetime medication use by parents and their children. Two hundred and twenty-one young patients (158 boys and 63 girls) consulting at a child and adolescent psychiatry department, six to 16 years of age (mean = 9.7 years), were screened for lifetime use of psychotropic drugs using a structured interview. Parents were asked about their own consumption, as well as their children's. Lifetime consumption rates (at least once) were 22.2% in boys and 20.6% in girls, and 19.6% in children less than 11 years old. Higher rates were found in patients with emotional disorders (anxiety disorders and depression). In parents, 45.1% of mothers and 24.1% of fathers reported using medications at least once. A significant association was found between child and parental medication use: 34.1% of children had positive lifetime consumption when their mothers also used medications at least once versus only 13.6% in other children (odds ratio = 3.31 [1.68-6.50]; P = 0.001). The most significant association was found between medication use by girls and their mothers (odds ratio = 12.1 [2.38-61.5]; P = 0.003). These data point to the existence of a family pattern of psychotropic drug consumption, especially in females.

The anxiolytics withdrawal constitutes a frequently desirable therapeutic situation in which it is necessary to integrate clinical data related to the disorder for which they were prescribed as well as the pharmacological and psychological aspects. Personality features and emotional environment of the patient are to be considered. This withdrawal follows a first step in which the anxiolytics were initially prescribed. This situation happens in medicine in multiple clinical situations. However, because of the phenomena of tolerance and dependence but also according to the efficacy of the anti-depressants in most anxiety disorders, benzodiazepines are described in France as over-prescribed molecules. General rules of prescription are a prelude to a good withdrawal process. This last must always be prevented especially when the dosage is high occurring after a long duration treatment. A good guideline for the initial prescription is a good ticket to anticipate the withdrawal time.

A one-year case-control study was performed by occupational physicians in 328 injures people and 662 controls in order to investigate a possible relationship between the consumption of benzodiazepines and the occurrence of industrial injuries. Benzodiazepine consumption was found to be related to sex (females) and age but not to a higher frequency of industrial injuries. It is suggested that knowledge of being at risk might be a factor reducing the consumption of benzodiazepines.

A pharmacoepidemiological survey was carried out in a rural region of France (Brittany) with the help of 54 general practitioners, all of whom belong to a clinical research group. The aim of the survey was 3-fold: to determine the frequency (incidence and prevalence) of anxiolytic and hypnotic drug prescriptions, the sociological characteristics of these drug consumers, and the indications and reasons for prescribing this class of drugs. The population of hypnotic drug and sedative consumers was strikingly dominated by women, 60 years old and over, retired or without a profession. Prescription analysis revealed that these drugs were essentially benzodiazepines whose prevalence and incidence were 17 and 1.76%, respectively. A high frequency of prescription renewals (78%) and an elevated percentage of long-term treatments (more than 9 years) were also noted. Insomnia and dependence are the two main "risk factors" for drug treatments lasting more than one year.

From 8 original observations and from an overview of published cases, the authors make out two kinds of mental disorders connected with benzodiazepines use: 1) transient global anterograde amnesia; 2) amnesic complex automatism. Consequences for forensic medicine are finally investigated.