[Psychotherapeutic practices in France: results of a professional-based health insurance participant survey]. / Usage des psychothérapies en France: résultats d'une enquête auprès des mutualistes de la MGEN.

INTRODUCTION: Today in France, little empirical data on the use of psychotherapy is available. This paper presents an empirical study of psychotherapeutic practices, from the patient's point of view. We will present results regarding frequency of psychotherapies, patients' characteristics, associations between different kinds of therapy, where they take place, and the reasons given for beginning psychotherapy. METHODOLOGY: Data is based on a general and mental health survey conducted by MGEN(1) foundation among 6,500 persons, as well as on general population data collected by the BVA survey institute. RESULTS: Depending on the population studied, between 5 to 11.5% of people have had psychotherapy sessions at least once in their lifetime. Women born at the beginning of the sixties and men born at the beginning of the fifties are those who consulted the most. The vast majority of these psychotherapies are individual, in private practice. They often last more than one year, with a frequency of once per week or more. Thirty percent declare that they have undergone several psychotherapies. The reasons for consultation reported by users are mainly depression or anxiety. There are significant differences between genders for the reasons for consultation, women being concerned by depression, problems with sleep and food, and men being concerned by obsessive thoughts and addiction (alcohol, tobacco). People undergoing psychotherapy give an average of 2.5 reasons for this psychotherapy, and only 28% gave only one reason. A relationship exists between the number of consecutive treatments and the number of reasons given for undergoing psychotherapy. More than 25% of the psychotherapies last less than 6 months. "Intensive psychotherapy" (at least 6 months and a frequency of 2 to 3 times per month) concern 5.9% of the whole population studied, and represent 51.4% of all psychotherapies. People are quite satisfied by their psychotherapy; 90% are satisfied with the results and 60% believe that their condition has been much improved in a durable manner. 16.6% were unsatisfied with the results. There is (in women only) an association between satisfaction and intensity of treatment; satisfaction is lower in those women undergoing intensive psychotherapy; 77. 7% of users have also used some sort of drugs for the problem (80.6% of women and 69.9% of men) with psychotropic drugs most frequently used: 70.8% of the psychotherapy users had taken such drugs for their problem (women 72.9%, men 65.4%). CONCLUSION: In France, psychotherapies are playing an important role and it is necessary to study these techniques better in order to give them the place they deserve in the French mental health policy.

[Clinical and socio-demographic profile of patients with schizophrenia according to the antipsychotic treatment prescribed]. / Analyse du profil socio-démographique et clinique de patients schizophrènes en fonction du traitement neuroleptique reçu.

INTRODUCTION: Data concerning the characteristics of patients with schizophrenia and their treatment in day hospitals are scarce. Guidelines for clinical practice are, however, regularly published. Recommendations from the 1994 Consensus Conference underline the necessity of antipsychotic monotherapy in the long term treatment of schizophrenia. In the US the Schizophrenia Patient Outcome Research Team (PORT) published in 1999 treatment recommendations concerning the use of antipsychotics in the acute phase and in maintenance. For maintenance, the recommended dose should be between 300 and 600 mg/day (CPZ equivalents) (recommendation n 4). AIM OF THE STUDY: The aim of this study is to establish the socio-demographic and clinical profile of patients according to the dose of antipsychotic medication prescribed. The study also examines the use of antipsychotic polypharmacy. DESIGN: of the study. For this study, 116 patients treated in 12 different day hospital units were recruited. Inclusion criteria were: a DSM IV diagnosis of schizophrenia, being treated in a day hospital and having received antipsychotic medication for at last 2 months. Instruments were the MINI for a standardized diagnosis of schizophrenia, the CGI and the PANSS. Prescribed doses were transformed in chlorpromazine (CPZ) equivalents, in order to establish comparisons between patients. RESULTS: The population sample was composed of 72 male (61.5%) and 44 female (38.5%) patients. The mean age was 36.4 years old. The mean education level was 11.3 years. A large majority (n=103, 88%) of patients was celibate, 65 patients (55.6%) lived on their own, the others lived with their family (45 patients, 38.5%) or with a spouse (7 patients, 6%). A large majority of patients (75.6%) received some form of state allowance. Only 1.7% were receiving a salary. The mean antipsychotic dose was 660 mg/day and 68% of patients were treated with an atypical antipsychotic (amisulpride, clozapine, olanzapine, risperidone). Thirty-two percent of patients were treated with doses between 600 and 1,000 mg/day and 24% with doses above 1,000 mg/day. When comparing patients according to the dose level they were receiving (<300 mg/day; 300 to 599 mg/day; and 600 to 999 mg/day;>1,000 mg/day), there was no significant difference between groups for socio-demographic variables. Patients treated with doses below 300 mg/day had a better psychosocial profile and were more often treated with loxapine, haloperidol and risperidone. Patients treated with doses above 1,000 mg/day were more often receiving clozapine. There was still a substantial number of patients treated with conventional antipsychotics in the above 1,000 mg/day range. Patients receiving an antipsychotic monotherapy were more often treated with clozapine or olanzapine and presented a higher rate of positive symptoms. DISCUSSION: These results are discussed in comparison with present guidelines concerning the treatment of patients with schizophrenia.