[Effect of payment mode on the demand for psychotherapy. Comparison of clients of psychoanalysts, of conventional psychiatry and of a free center in the Paris region].
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
V Kovess
Publications and source records attributed to V Kovess.
[Mental health surveys: methodological aspects].
Explore the source record for details and available documents.
Female↗
[Marital difficulties, divorce and infantile psychopathology (author's transl)].
Explore the source record for details and available documents.
Child↗
Selection bias in the study of spouse similarity for psychiatric morbidity in clinical samples.
The existing literature on spouse similarity for health variables can be divided into two fields of application, high blood pressure and other coronary risk factors and psychiatric morbidity. In the former field, almost all studies have been conducted on general-population samples, whereas in the psychiatric field, most of the investigations studied clinical samples, i.e., where one or both members of the couple were under psychiatric treatment. In this report, we demonstrate that studies of spouse similarity for psychiatric morbidity are subject to selection bias whenever they are conducted on clinical samples. This selection bias has a double origin. First, some bias arises from the fact that the probability of a couple being drawn for a clinical sample is dependent on whether one or both spouses are afflicted with the illness in question. A second source of bias lies in the likelihood that each spouse's help-seeking behavior is not independent of the other's. It would appear then that, owing to this selection bias, it is preferable to restrict the study of spouse similarity for psychiatric morbidity to general-population samples.
Female↗
[Prevalence and comorbidity of psychiatric disorders in the French general population].
INTRODUCTION: ESEMeD is the first international epidemiological study using a random sampling method that has allowed the prevalence of psychiatric disorders in France to be measured with precision and compared directly with that observed in other European countries. OBJECTIVES: 1) To determine the 12 month and lifetime prevalence of mood -disorders, anxiety disorders and alcohol-related disorders. 2) To estimate the comorbidity between these disorders. 3) To evaluate potential demographic risk factors for these disorders. METHODS: This was a transversal survey carried out between 2001 and 2003 of non-institutionalised subjects aged 18 or over in the general population of Germany (n = 3,555), Belgium (n = 2,419), Spain (n = 5,473), France (n = 2,894), the Netherlands (n = 2,372) and Italy (n = 4,712). In France, the sampling source was a randomly generated list of telephone numbers. Subjects were interviewed at home by professional interviewers. The WMH-CIDI questionnaire was used. RESULTS: The participation rate was 46% for France and 61% for all six countries combined. The 12 month and lifetime prevalence rates observed were respectively 6.0% and 21,4% for major depressive episodes, 1.6% and 7.9% for dysthymia, 2.1% and 6.0% for the generalised -anxiety disorders, 1.2% and 3.0% for panic disorders, 0.6% and 1.8% for agoraphobia, 2.2% and 3.9% for post-traumatic stress disorder, 1.7% and 4.7% for social phobia, 4.7% and 11,6% for specific phobia, 0.5% and 4.1% for alcohol abuse and 0.3% and 1.6% for alcohol dependence. Mood disorders and anxiety disorders were significantly more frequent in women, whilst alcohol-related disorders were more frequent in men. The prevalence of all three types of disorder was lower in elderly subjects and in those living in a rural environment. Mood disorders and alcohol-related disorders were more frequent in individuals living alone and mood disorders more frequent in those without paid employment. 38% of subjects with mood disorder also presented an anxiety disorder or an alcohol-related disorder. The comorbidity of mood and anxiety disorders was more frequent in women, younger subjects and those living alone. The comorbidity rate in subjects with anxiety disorders was 26% and did not differ between genders. For alcohol-related disorders, there was a striking difference in comorbidity rate between men and women: 26% in the former and 67% in the latter. CONCLUSION: This study underlines the high prevalence of mood disorders, anxiety disorders and alcohol-related disorders in France and demonstrates a high degree of comorbidity between them. For this reason, it is important to evaluate and take into account potential comorbidity in the management of individuals with psychiatric disorders.
Adolescent↗
[Psychotropic drug use and mental psychiatric disorders in France; results of the general population ESEMeD/MHEDEA 2000 epidemiological study].
INTRODUCTION: The use of psychotropic drugs is high in France and has increased over the last two decades. To date, no national study evaluating psychotropic drug use in the context of the diagnosis of psychiatric disorders has been performed. Such data has now been generated in the ESEMeD/MHEDEA 2000 study, which has allowed comparison of the situation in France with that in five other European countries (Germany, Belgium, Spain, the Netherlands and Italy). OBJECTIVES: 1) To describe the declared use of psychotropic drugs (globally and by therapeutic class) in order to evaluate annual prevalence, treatment duration and demographic factors associated with use. 2) To estimate the proportion of subjects with an anxiety disorder, mood disorder or alcohol-related disorder (abuse or dependence) that have been appropriately treated with an antidepressant or anxiolytic drug. 3) to evaluate the proportion of psychotropic drug users who fulfil diagnostic criteria for these three classes of psychiatric disorder. METHODS: This was a transversal survey carried out between 2001 and 2003 of non-institutionalised subjects aged 18 or over in the general population of Germany (n = 3,555), Belgium (n = 2,419), Spain (n = 5,473), France (n = 2,894), the Netherlands (n = 2,372) and Italy (n = 4,712). In France, the sampling source used was a randomly generated list of telephone numbers. Subjects were interviewed at home by professional interviewers. The WMH-CIDI questionnaire was used. RESULTS: In France, 21% of subjects interviewed (n = 580) had taken at least one psychotropic drug during the year. For 19%, this was an anxiolytic or hypnotic (AX-HY), for 6.0% an antidepressant (AD), for 0.8% an antipsychotic (AP) and for 0.4% a mood regulating drug (TY). The distribution of users of AX-HY according to treatment duration was the following: 44% (1 to 15 days), 13% (16 to 30 days), 14% (1 to 3 months), 6.7% (3 to 6 months) and 23% (> 6 months). For users of ADs, the distribution was: 21% (1 to 15 days), 7.8% (16 to 30 days), 18% (1 to 3 months), 12% (3 to 6 months) and 42% (> 6 months). For subjects fulfilling diagnostic criteria for a mood disorder in the previous year or over their lifetime, 43% and 29% respectively had taken an AX-HY in the last twelve months and 29% and 16% an AD. For those who fulfilled diagnostic criteria for an anxiety disorder in the previous year or over their lifetime, the use of an AX-HY, in the last twelve months, concerned 43% and 30% of subjects respectively, whilst that of AD concerned 16% and 14%. For previous year or lifetime alcohol-related disorders, AX-HY use, in the last twelve months, concerned 63% and 22% of subjects respectively and use of ADs 9.3% and 7.2%. Amongst users of AX-HY in the last twelve months, a previous year or lifetime diagnosis of mood disorders was made for 16% and 39% of subjects respectively. Amongst users of ADs, the respective prevalence was 31% and 64%. A twelve-month and lifetime diagnosis of anxiety disorders was identified in 22% and 37% of users of AX-HY and among 27% and 50% of users of AD respectively. A twelve-month and lifetime diagnosis of alcohol-related disorders was found in 2.5% and 6.6% of users of AX-HY and among 1.1% and 7.8% of users of AD respectively. 68% of users of AX-HY had fulfilled none of these diagnostic criteria in the previous 12 months and 46% had never fulfilled them in their lifetime. With respect to AD users, the proportion who did not meet these diagnostic criteria in the previous 12 months was 56%, compared to 20% over their lifetime. Comparison of the French data from the study with those of the entire European sample showed that the annual prevalence of AX-HY and AD use was higher in France with mean treatment durations that were shorter. For antipsychotics and mood regulators, no clear differences were observed between France and the six countries of the study taken together. DISCUSSION: Over the last two decades, use of AX-HY seems to have decreased in France, even though it remains higher than that observed in the other European countries participating in this study. This high use can be explained in part by the observation that, in around half the cases, it corresponds to occasional use. In contrast, the use of antidepressants has increased. In subjects with recent mood disorders or anxiety disorders, the use of AX-HY remains higher than that of antidepressants. Finally among users of AX-HY, only half of them had presented a mood disorder, anxiety disorder or alcohol use disorder during their lifetime, whereas this proportion rose to 80% for users of antidepressants.
Adult↗
Mental health services description. Prospects for the future.
Explore the source record for details and available documents.
Forecasting↗
How do teams practise community psychiatry?
The development of community psychiatry has modified the practice of psychiatry both with respect to place of practice (in the community) and mode of practice (focused on the multi-disciplinary team approach). Administrators, however, tend to evaluate the activities of teams working outside the hospital against the standards for a medical model based on a professional-patient relationship. These standards do not take into account activities carried out in the community. The purpose of this study is to present an instrument that will make it possible to evaluate the activities of the various professionals as a function of the time actually allocated to the various activities and the satisfaction of the different professionals involved. This demonstrates that the time spent outside clinics is very low except for the social workers, and that the professionals feel somewhat dissatisfied with this.
Attitude of Health Personnel↗
[The study of the impact of the consensus conference "Strategies for long-term therapy of patients with schizophrenia"].
UNLABELLED: The case management, treatment and psychosocial rehabilitation of schizophrenic patients is an important part of the activity of the psychiatric sector and takes up many human, scientific, organizational and financial resources. The best way to reach satisfactory results for the individual patient is still uncertain and current practice in France shows noticeable variations that have been rarely investigated in terms of outcome. A consensus conference (CC) on "Strategies for long-term therapy of patients with schizophrenia" was therefore held in Paris in 1994 to produce accurate guidelines designed to help both clinicians and patients and to improve practice. It was organized by the French Federation of Psychiatry, the National Union of Friends and Relatives of Mental Patients, and the National Agency for the Development of Health Evaluation. The conclusions of the CC were mailed, in the form of a booklet, to members of these associations (psychiatrists and relatives) and were reported in the medical and general press. METHODS: The impact of the CC was judged by (a) the psychiatrists'awareness of the existence of the CC, (b) their knowledge of its conclusions, and (c) changes in practice. The following were analyzed: press coverage; requests for the booklet; the results of a survey of a representative sample of 396 psychiatrists two years after the CC; prescription changes in the public sector in a cohort of 2,407 schizophrenic patients under treatment at the time of the CC; prescriptions to psychotic patients by a representative sample of psychiatrists in private practice. RESULTS: Awareness: Articles on the CC were published in 27 journals and newspapers, 30,000 booklets were distributed and 8,348 were mailed in response to 1,121 spontaneous requests; 78% of the psychiatrists interviewed said they were aware of the existence of the CC and 70% said they were aware of the conclusions. Knowledge: The psychiatrists' declared practice conformed with CC conclusions 41%-85% of the time depending on the recommendation. No difference in practice was noted between the psychiatrists who said they knew of the recommendations and those who said they did not. Changes in practice: A significant but small improvement in prescription habits was noted for a principal recommendation ("just one neuroleptic is enough"). One-neuroleptic prescriptions increased from 51.1% the year before the CC to 56.4% two years after the CC. The increase mainly concerned the most recently treated patients. However, during the same time-span, prescriptions of anti-cholinergics plus neuroleptics rose from 48.2% to 54.3%. CONCLUSION: It is difficult to attribute changes in practice to a CC. However, the impact of the CC seemed real even if inconstant and not great enough. Clearly, to enhance impact an action plan is needed. It should include corrective measures and focus on additional dissemination efforts, teaching and training programs, and updating of guidelines if necessary.
Adult↗
[Organization and achievement of a training for ICD-10 rating. The experience of La Verrière Psychiatric Hospital].
Referring to an International Classification of Mental Health and Behavioural Disorders is a way for psychiatrists to use a common language. The publication of the ICD-10 Chapter V made this possible. A note from the French Ministry of Health (14 January 1993) made official the use of the ICD-10th Revision in order to complete the psychiatric sector patient files. During 1992, in the La Verrière Psychiatric Hospital, all doctors, psychologists and nurses get trained in the use of the ICD-10. Twelve video inpatient cases were rated and discussed following the ICD-10 criteria. This paper reports on this experience.
Electronic Data Processing↗
[Epidemiology study on the prevalence of psychiatric disorders among Sardinian immigrants in Paris compared with Parisians and Sardinians in Sardinia].
Explore the source record for details and available documents.
Adolescent↗
[Patterns of care and socio-professional categories derived from DIM (Department of Medical Information) data regarding MGEN psychiatric management].
The influence of social factors (demographics, work statute, profession) on patterns of care like psychotropic drugs prescription, psychotherapeutic treatment or hospitalisation was studied on the population receiving care within the MGEN (a semiprivate health insurance system for the teaching related professions, the largest in France). This was possible by the use of a three year data bank (1992, 1993, 1994) where out and inpatients care were systematically recorded along some socio-demographics data in a rather detailed manner if provided within the system. The present study concerns 6,453 patients selected on the most frequent ICD 9 diagnoses as registered by the psychiatrist in charge of the patient: schizophrenia (acute, simple and persistent): 18.5% of the sample, manic-depressive psychosis 7.7%, and neurotic disorders (depressive disorders 38.3%, anxiety disorders 27% and mixed disorders 8.2%). For most of these diagnoses, hospitalization rates vary according the profession of the patient: teachers suffering from schizophrenia (simple) have higher rate of hospitalization than others professions; on the reverse university teachers and managers have the lowest rates of hospitalization for neurotic disorders. Duration of stay is rather identical within profession for psychotic disorders but again there are difference for neurotic disorders: blue collar workers, managers and university teachers have the lowest duration. Number of outpatients acts and provision of psychotherapeutic treatment either individual or group therapy show some variations between professions. Number of psychotropic drugs do not vary according profession but there is difference between men and women suffering from depressive disorders (2.97 for men, 2.72 for women). Neuroleptics are prescribed at the same rate but depot neuroleptics are prescribed mainly to blue collars workers, clerks and whose who are teaching technical matters; this applies only to men. These results are discussed according the context of the MGEN psychiatric health system.
Adult↗
[Theoretical and practical problems in the measurement of the mental health of populations. Quebec health survey].
The authors present the process of setting up a mental health inquiry. The "Enquête Santé Québec" was conducted at the request of the Ministry of Social Affairs in order to identify the problems, needs and priority intervention sectors in the health field. The inquiry was carried out on a large scale at the pilot stage, collecting information on 4,000 people in rural and urban areas. The principal options chosen are briefly discussed: type of mental health to be measured, sample methods, choice of instruments, validation work and some results.
Health Priorities↗
[Medical information departments and medical program of information systems in psychiatry. Feasibility and consequences].
Like any country France needs to better control Health costs. The DRG (Diagnostic Related Groups) system designed in the USA by Fetter appears a solution and is progressively used in short term Medicine Surgery and Obstetric (MCO) units. Recently pilote sites started to collect data in the fields of psychiatry. First the DRG system in presented: 471 groups have been used in France in MCO though the completion of RSS (Standardized summarized discharge reports). Then details are given on the way this system functions in the USA: a national basic paiement ajusted according local norms (costs of salary, urban/rural districts, teaching status of the hospital, percentage of low social class status patients). The system is presented for psychiatry in the USA where psychiatry has been temporarily excluded because the 14 psychiatric DRG did not predicted costs: length of stay varies greatly for a DRG as "psychoses" or "neurotic depression". Various explanations have been proposed, along them ICD 9 classification has been accused of poor reliability beside many errors in the codification and large variability of procedures used for similar cases in psychiatry. Many factors have been studied in order to explain costs: the type of treatment setting (patients hospitalized in psychiatric units have longer duration than in general units) but none appears satisfactory. Specially two types of factors seem greatly to influence costs: targets of the treatment and outcome facilities. At any rate hospitalisation in short term units is only one of the setting where psychiatry is treated. Medium or long term hospitalisation and outpatient settings are used far more frequently. For those applications Fetter designed other approaches: RUG (Resource utilisation groups) for the long term and AVG (ambulatory visit groups) for ambulatory care. RUG is designed for aged persons: all nurses interventions are recorded and tabulated against indicators of pathology and disabilities; 9 groups could be constructed from simple indicators.(ABSTRACT TRUNCATED AT 250 WORDS)
Ambulatory Care↗
[The patient record form in psychiatry: nomenclature of the types of management].
The patient form (PF) is a data carrier in mental health, established by the French General Department of Health to improve the annual report of each psychiatric sector, the assessment of the care given and the patients involved. We suppose that despite of national efforts to standardize the use of the PF, in practice are noticed: 1) different operative senses given to the codes of care; 2) a hierarchical system of treatments and a counting far from being unequivocal. This study undertaken in Centre Hospitalier Spécialisé de Maison Blanche investigates and compares: 1) the different operative senses given to the codes of care; 2) the use of these codes to transcribe and to count psychiatric treatments. These goals were fulfilled by a strictly anonymous questionnaire survey that ensures an analysis of the replies individually, in relation to occupational groups and to psychiatric sectors. In particular, all the psychiatrists, the nurse supervisors and the medical secretaries who worked in the hospital for at least 9 months, including 6 months at least in their current sector at the time of the survey, in the previous calendar year were concerned. Altogether that comes to 207 subjects. The administrative staff and the employees of the Medical Information Department were not involved. Upon 207 questionnaires, 58 replies were sent back i.e. a general reply rate of 28.02 +/- 6.12%. The secretaries took a more active part in the survey: 43.06 +/- 11.44% (31/72) significantly higher than the general rate (p = 0.03). The results show that regardless of the occupational groups neither the coding of treatments nor their counting are carried out the same way in different sectors respectively 70.69 +/- 11.71% and 77.59 +/- 10.73%. The operative senses of some codes like CO, AT, AP, AJ vary a lot. Sometimes the multiplicity of treatments coming under a code lead to these changes. At other times local initiatives explain the divergences. When senses are unequivocal, the hierarchical system of treatments is rather a problem. So, in case of several treatments the same day, the study makes obvious: 1) a giving up of the hierarchical system and as a result, the one of the incompatibility between some codes; 2) the coding and the count of as many as possible services the same day. The outpatient care is the 3rd of the three kinds of treatment according to the hierarchical system. It is the one for which codings and counts vary the most. It is essentially without hotel element. On the other hand accommodation twenty-four hours a day characterizes the full-time (inpatient) care. The part-time care, between both previous is a patchwork where predominates sometimes a mode of accommodation and sometimes a place for care. It is less accurate than the full-time care. The PF serves many purposes among which some are irreconcilable. It certainly allows a more accurate count of the patients who refer to a sector during a year period; but the various care and treatments are less assessed. The main subdivisions of the nomenclature of patient care maintain the dichotomy inpatient care/outpatient care. The links between the PF and the Information System Medicalization Program (ISMP) can no longer be concealed. Unfortunately, even the analysis of the data collected by the PF, for a financial assessment of the sectors, leads to very biased outcomes because of the qualitative and quantitative underestimation of care, treatments and all the necessary activities. The patient form looks like a multipurpose tool serving the minimum requirements for either descriptive, analytic or evaluative epidemiology; hospital management; planning; etc. Even though this multipurpose vocation could be a weakness, advantage could be also be taken of it to make a more efficient instrument, hence the need for some suggestions.
Ambulatory Care↗
[Interobserver variation of the Global Assessment Scale. Study of 59 patients at admission to a general adult psychiatric unit].
UNLABELLED: In France, an analysis of the evaluation of psychiatric activity was done by a work group representing thirteen hospitals spread over the entire country. The group just recently published their final report in the form of an experimentation protocol for the description of psychiatric activity. The proposed methodology leads to some modifications of the existing data collection based on individual patient information sheets "fiche par patient", more particularly concerning new items such as the Global Assessment Scale (GAS or Axis V of DSM III-R): our first impression was that this new type of evaluation seemed to us somewhat subjective. We therefore decided to analyze the reliability of the score established by psychiatrists not familiar with its use. In the beginning the GAS score was evaluated in clinical cases (patients seen at their admission by two or three psychiatrists and scored afterwards independently), then in theoretical cases (34 cases types taken from the Health-Sickness Rating Scale of Luborsky) with the objective to improve the consensus between clinicians. RESULTS: The clinical case studies made in an adult psychiatry pavilion permitted evaluating 59 patients at admission, of which 25 by three judges and respectively 40, 28 and 41 by pairs. The global accuracy of the score obtained with the clinical cases seems satisfactory for a discipline such as psychiatry (Kappa of Cohen's coefficient = 0.51, p < 0.001 for 25 patients by three judges--Kappa = 0.45, p < 0.001 for the 109 pairs of evaluations). The more detailed study of the classes obtained a satisfactory consensus for the scores below 40 and above 60 (K = 0.46 to 0.59) but not entirely satisfactory for the scores in the mid range of the scale between 40 and 60 (K = 0.22 to 0.29) which represents 39% of the patients in the study; this is improved by grouping into larger classes this part of the scale and it is therefore advisable to use it that way. For the 34 theoretical cases taken from the Luborsky HSRS evaluated independently by three judges the results obtained are clearly not as good (global Kappa = 0.29, p < 0.01). That is perhaps due to the fact that these "case types" don't use the descriptive patient models generally used in France. Keeping in mind that the mid range of the scale should be interpreted prudently, the GAS scale can nevertheless be credited with a certain global objectivity in the case of neutral study. Would it be the same if the GAS study could influence the allocation of resources? Taking into account all the clinical practices in mental health, the question of how all the data of this type evaluation could be recorded and updated should also examined.
Adult↗
[Prospective study of attempted suicide].
The present study involves a prospective review of all patients who visited the Emergency Psychiatric Service during the period from December, 6, 1993 to June, 5, 1994. A questionnaire was proposed to 1073 subjects (57.2% females; 42.8% males; mean age = 36.6 +/- 0.89). Demographic data, familial and personal characteristics, previous contacts with professional health services, and diagnosis (DSM III-R criteria) were collected. 52% of them were self-attempters, significatively younger (mean age 34.03 +/- 1.14) and more frequently females (61.5%). The parasuicides were more frequent in their families and in their personal past history. The previous contacts with health services (hospitalizations, consultations) were more frequent among patients who were admitted for psychological and/or psychiatric problems. 54% of self-attempters were repeating suicidal patients. There were more depressive disorders, parasuicides and drug/alcohol abuse in their families. A logistic regression analysis (stepwise) revealed the role of these factors in the repetition of parasuicides. This data supports the significance of a better knowledge of the potential significant factors for parasuicide. Preventive measures are necessary.
Adolescent↗