Regards croisés sur le confinement : personnes vivant avec des troubles psychiques, aidants familiaux et soignants.

AIMS: The study examines the experience of people living with mental disorders and their family during the spring 2020 confinement in France, as well as the care they received during this period. It also focuses on the experiences of caregivers and how they reorganized themselves during this same period. METHOD: Using both qualitative and quantitative methods, three surveys were conducted during the confinement. Data was collected through two online questionnaires and semi-direct individual interviews with service users, families, and caregivers. RESULTS: The responses to our questionnaires from 173 family members, 68 service users and 40 caregivers show that people suffering from mental disorders adapted well to the confinement. Compared to the general population, there was no instance of psychiatric over-morbidity. However, the families suffered more from psychological difficulties. The deployment of remote consultations, responsiveness and availability of professionals were helpful for users. On the other hand, rapid adaptation that caregivers had to undergo made them experience a sense of loss of the actual meaning of their work. Families suffered from the lack of availability of caregivers. CONCLUSION: The mental health of people suffering from mental disorders involved in this study was not impacted by the confinement. They made use of the various protective resources. The habit of having a solitary life and the knowledge of available resources may have played a favorable role. Peer support has been particularly supportive. Further studies are needed to evaluate the hypothesis of a "second psychiatric wave" due to the global pandemic.

Impact of switching or initiating antipsychotic treatment on body weight during a 6-month follow-up in a cohort of patients with schizophrenia.

OBJECTIVE: Although weight gain is one of the most widely studied adverse effects of second-generation antipsychotics, only relatively few studies have specifically evaluated the long-term effect of switching antipsychotic medication on body weight. We aimed to evaluate the impact of switching antipsychotics on body mass index (BMI) during a 6-month follow-up period in a large cohort of patients with schizophrenia. METHOD: Data came from a 6-month prospective naturalistic survey in 6007 patients with schizophrenia. RESULTS: We prospectively studied the effect on BMI of initiating or switching antipsychotic medication after 6 months of treatment among 3801 patients with schizophrenia in a real-life setting. Patients who were being treated with clozapine or olanzapine at baseline were more likely to experience a decrease in BMI during the follow-up period than the patients who were being treated with a conventional antipsychotic (odds ratio, 2.25 and 1.68, respectively). Patients treated with aripiprazole and, to a lesser extent, those treated with risperidone were more likely to experience a decrease in BMI during follow-up than patients treated with conventional antipsychotics (odds ratio, 2.96 and 2.06, respectively). CONCLUSIONS: Our findings suggest that switching antipsychotics could be an effective strategy for reducing or preventing weight gain.

The organization of psychiatric care in France: current aspects and future challenges.

In the last four decades, psychiatric care in France has led to the development of catchment area-based service provision. Within each geographical area teams are now responsible for psychiatric care both at outpatient and inpatient levels. However, financial and economic constraints have led to a reduction in beds and staffing levels. The numbers of psychiatrists in private practice has remained more or less the same over the years due to steady demand and other factors. As in many other western European countries, de-institutionalization has been a major driver in the evolution of psychiatric care delivery in France. This is linked with several developments, including the introduction of more efficient pharmaceutical drugs which have reduced the likelihood of relapse. Other factors which have influenced this include the progressive 'de-stigmatization' of psychiatric disorders and policy changes leading to significant bed reduction. All of these factors are inter-linked and have influenced psychiatric care delivery. In this paper we provide an overview of the current state of psychiatric care and its delivery in France.

Two-year study of relapse prevention by a new education program in schizophrenic patients treated with the same antipsychotic drug.

It is not clear whether patient's psycho-education enhances compliance to antipsychotic treatments and reduces the number of relapses. Here we investigated the impact of a new psycho-educational program (SOLEDUC) on the one- and two-years rate of relapse (primary outcome measure) and a number of clinical assessments (secondary outcome measures). This was a multicentric French clinical trial (51 centers) of Phase IV, open, controlled, randomized, consisting in two parallel groups: the Soleduc group (N=111) and the control group (N=109). All subjects received a variable dose over the 2-year period of the same antipsychotic drug (amisulpride). Soleduc consisted of a 7-session program (1h per session), presented three times (at baseline, 6-months and 12-months). Patients in the control group received a non-specific psychosocial training for an equivalent period of time. The models of Andersen-Gill (AG) and Prentice, Williams and Peterson (PWP) were used to analyze relapses. Patients in the Soleduc group attended 14.8+/-6.1 sessions (mean+/-SD), including 17 patients who never attended a session. Intent to treat analysis showed less patients relapsing in the Soleduc group as compared to the control group (21.6% versus 28.4% after 1 year and 84.4% versus 90.8% after 2years), but the differences were not statistically significant. Relapse risk was significantly reduced for patients who followed at least 7 modules (p=0.015 AG-test; p<0.001 PWP-test). In conclusion, no significant differences in relapse rates were found between patients attending the Soleduc program and the control group. Attendance of at least 7 out of 21 program sessions was required to see a modest, but significant two-year relapse prevention in schizophrenia. Other well designed studies are required to evaluate the medical impact of patient's education programs.