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Theses

Evaluation du mésusage des benzodiazépines et de ses conséquences chez les patients atteints de pathologies psychiatriques

Abstract : Benzodiazepines are widely used in populations with psychiatric disorders, due to their indication in the treatment of insomnia and anxiety. Misuse of these drugs appears to be frequent, and can potentially lead to serious adverse reactions, particularly in a population weakened by psychiatric morbidity. Yet it is little explored. The objective of this thesis work was therefore to evaluate the use and misuse of benzodiazepines in populations with psychiatric disorders in France. In a first part, we showed in a narrative review of the literature that in this particular population, benzodiazepine misuse seemed particularly frequent, but that its benefit/risk balance and impact were poorly known. In a second part, we showed, by exploring a medico-administrative database, that misuse was associated with poor general health on the one hand, and with the presence of a psychiatric disorder on the other. We have also shown that there is an over-risk of misuse independent of the psychiatric disorder. In the third part, a study conducted on patient files from a psychiatric hospital showed that even if misuse remained very frequent, it seemed to decrease compared to the ambulatory population. Finally, we have shown that stopping benzodiazepines during a hospital stay, even for a short period of time, seems possible. Although the study had some methodological limitations, it appeared to invalidate the need to develop specific benzodiazepine use guidelines for this population. In the current state of knowledge, first prescriptions are a privileged target. It is essential to alert, inform and train clinicians, prescribers, pharmacists and even patients on the indications and importance of following the guidelines for the proper use of benzodiazepines, particularly in patients with a psychiatric disorder.
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Arnaud Panes. Evaluation du mésusage des benzodiazépines et de ses conséquences chez les patients atteints de pathologies psychiatriques. Médecine humaine et pathologie. Université de Bordeaux, 2019. Français. ⟨NNT : 2019BORD0293⟩. ⟨tel-02498539⟩

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