Search

Objective: The authors investigated the association between death of older people and use of psychotropic drugs before and during the Western European August 2003 heatwave. Method: A retrospective population-based case-control study was conducted using the French social security insurance national database. &posure to psychotropic drugs in cases aged 70 -100 years who died before (N = 2,093) and during (N = 9,531) the August 2003 heatwave was compared with those of survivors matched for age, gender, and presence of chronic illness, by using conditional logistic regressions. Results: The association between death and psychotropic drug use was modified by level of external temperature (Wald X² = 13.1, degree of freedom = 1, <0.001). Use of any psychotropic drug was associated with a 30% increased risk of death during the heatwave, with a signficant dose-response relationshijp between the number ofpsychotropic drugs and the risk of death (adjusted odds ratio [aOR] for linear trend 1.25, 95% confidence interval [95% C4 1.21-1.29). During the heatwave, therapeutic classes independently associated with an increased risk of death were ant/depressants (aOR 1.71,95% Ci 1.5 7-1.86) and antzpsychotics (aOR 209,95% (2k 1.89235), whereas exposure to anxiolytics/hypnotics use (aOR 085, 0.79-0.91) was associated with a decreased risk. Findings remained unchanged after adjustment on cardiotropic, ant/dementia, or anhi-parkinsonian drug use. Conclusion: Our findings suggest that a causal relationship may exist between psychotropic drug use during a heatwave and increased risk of death in older people. The risk/benefit ratio of antidepressant and antijpsychotic drugs should be carefully assessed in older people during a heatwave. (Am J Geriatr Psychiatry 2009; 17:1059-1067) [ABSTRACT FROM AUTHOR]

Abstract: Background: The quality of the relationship between patient and therapist can be considered a cornerstone of psychiatric practice. Nonadherence is one of the leading problems affecting antipsychotic effectiveness in schizophrenic patients and represents a poor prognostic factor for schizophrenia. Among the factors influencing adherence, the clinician''s style of communication and the therapeutic relationship (TR) are recognized as key points. The measures of TR have been broadly explored in psychotherapy process but have received little attention in the treatment of severe mental illness in the context of routine mental health. Our objective was to build a self-rating scale easy to use in clinical psychiatric practice to assess TR, including drug-taking aspects and the relationship with the clinician on a day-to-day basis. A secondary objective was to assess the scale''s validity and the association between TR and adherence. Methods: The study was conducted with 92 consenting inpatients who met specified criteria for schizophrenia and schizoaffective disorders (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). Assessments of TR were obtained by the 4-Point ordinal Alliance Self-report and an 8-cm visual analog scale completed by the patient 1 week before discharge, after the remission of acute symptomatology. Adherence behavior was estimated with a new valid and reliable questionnaire called the Medication Adherence Rating Scale. Factor analysis was performed. Results: Internal consistency was assessed by calculating Cronbach α, which revealed a highly satisfactory value (α = .91). After oblique rotation was run, 2 understandable factors were extracted that we termed empathy experienced and psychoeducation. Conclusions: Therapeutic relationship with the clinician can be considered a prerequisite for positive treatment course and outcome. The detection of subpopulations characterized by determinants of poor TR could be the first step toward improving schizophrenia prognosis linked to poor adherence. [Copyright &y& Elsevier]