[Drug use in the elderly. Use of psychotropic drugs in the elderly: overuse or underuse?].
POORLY DEFINED USE: The first of three leading problems in the use of psychotropic drugs in elderly subjects is related to the overall situation of their use, often tainted by an ìideologicalî point of view. Prescribers are ìforî or ìagainstî psychotropic and justify their prescription by the need to take into account the general situation rather than strictly clinical arguments. Some prescriptions are written for the family or institutions. Even the definition of the elderly subject is extremely vague and is generally taken to include subjects over 65, a very heterogeneous group. Too few studies have been devoted to subjects over 80. NEED FOR GOOD CLINICAL ANALYSIS: The second type of problem is raised by the clinical expression of psychotic disorders in the elderly, too often considered to be limited to the classical signs of depression, dementia, and confusion. A careful clinical analysis is essential before prescription, with an adapted therapeutic response to each pathological situation. In addition, good clinical analysis would allow better diagnosis of depression, a condition largely underestimated and undertreated. BY THERAPEUTIC CLASS: It is now classical to denounce inappropriate use of neuroleptics and question their efficacy in controlling behavioral disorders in dementia. This attitude results from the impact of the adverse effects. Several authors have emphasized the contribution of new antipsychotic drugs but very few controlled studies have been reported. For antidepressors, the current consensus would suggest that prescription doses are generally insufficient and treatment durations too short. Finally, though it is widely accepted that use of benzodiazepines should be limited in dose and duration, data on drug use however show the contrary, emphasizing the difficulty in changing habits. New compounds including thymoregulators are increasingly used for elderly subjects but here again, like for antipsychotic drugs, too few studies have been published and many points remain to be elucidated.
Frémont
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Service de psychiatrie, Centre Hospitalier de Lagny sur Marne, Lagny. fremontpmv@aol.com
D000368:Aged; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy*; D011618:Psychotic Disorders / Q000188:drug therapy*; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000145:classification / Q000627:therapeutic use*
D011619:Psychotropic Drugs