RESUMO
ABSTRACT Objective: This study aimed to estimate the prevalence of mental disorders in the population of Martinique, as part of the survey entitled 'Mental Health in the General Population - Images and Realities ' (Santé Mentale en Population Générale - Images et Réalités). The survey was a multicentre epidemiological study in the general population, conducted in mainland France and French overseas islands between 1997 and 2006, under the authority of the World Health Organization Collaborating Centre for Training and Research in Mental Health (Lille, France). Methods: The study took place in 2000. Participants aged 18 years or over were recruited in public places, using the quota sampling method, and interviewed using the Mini International Neuropsychiatric Interview. Results: A total of 900 participants (52.7% women) with a mean age of 43 years completed the survey. Lifetime prevalence of any mental disorder was 29%. Mood (15%) and anxiety disorders (17%) were the most frequent. The rate of suicide attempts was low (4.2% lifetime), while the frequency of suicidal thoughts was high (11% past month) and similar to the frequency in mainland France. Conclusion: Mental disorders, especially mood and anxiety disorders, were as frequent in Martinique as in mainland France. The lower rates of suicide attempts, in spite of high rates of suicidal thoughts, might deserve further investigation. Our results should strengthen the development of a system of diagnosis and care for these disorders, especially to prevent suicidal behaviours and reduce morbidity and mortality.
RESUMEN Objetivo: Este estudio tuvo por objeto estimar la prevalencia de los trastornos mentales en la población de Martinica, como parte de la encuesta intitulada 'Salud Mental en la Población General - Imágenes y Realidades ' (Santé mentale at Population Générale - Images et Réalités). La encuesta fue un estudio epidemiológico multicéntrico en la población general, realizado en Francia continental y en las islas francesas de ultramar entre 1997 y 2006, bajo la autoridad del Centro de Colaboración de la Organización Mundial de la Salud para la Formación y la Investigación de la Salud Mental (Lille, Francia). Métodos: El estudio tuvo lugar en el año 2000. Los participantes mayores de 18 años fueron reclutados en lugares públicos, utilizando el método de muestreo por cuotas, y entrevistados usando la Mini Entrevista Neuropsiquiátrica Internacional. Resultados: Un total de 900 participantes (52.7% mujeres) con edad promedio de 43 años completó la encuesta. La prevalencia de por vida de cualquier trastorno mental fue de 29%. Los estados de ánimo (15%) y los trastornos de ansiedad (17%) fueron los más frecuentes. La tasa de intentos de suicidio fue baja (4.2% por tiempo de vida), mientras que la frecuencia de los pensamientos suicidas fue alta (11% el mes pasado) y similar a la frecuencia en la Francia continental. Conclusión: Los trastornos mentales, especialmente los estados de ánimo y los trastornos de ansiedad, eran tan frecuentes en Martinica como en la Francia continental. Las tasas más bajas de intentos de suicidio, a pesar de los altos índices de pensamientos suicidas, podrían merecer investigación adicional. Nuestros resultados deben fortalecer el desarrollo de un sistema de diagnóstico y cuidado para estos trastornos, especialmente para prevenir comportamientos suicidas y reducir la morbilidad y la mortalidad.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Transtornos Mentais/epidemiologia , Fatores Socioeconômicos , Prevalência , Inquéritos Epidemiológicos , Martinica/epidemiologiaRESUMO
Owing to their agonist action on dopaminergic systems, cannabinoids may play a major role in substance dependency and schizophrenia. We examined the (AAT)n triplet repeat polymorphism nearby the CNR1 gene, which encodes human cannabinoid (CB1) receptor, in a male Afro-Caribbean population. The allelic and genotypic distributions were significantly different in non-schizophrenic cocaine dependents (n = 97), schizophrenic cocaine dependents (n = 45) and matched controls (n = 88) (P < 10(-4)). The frequency of the (AAT)12 repeat allele was increased in non-schizophrenic cocaine dependents and schizophrenic cocaine dependents vs controls (25.3 and 26.7 vs 5.7%) (P < 10(-4)). Our results support that the (AAT)n polymorphism nearby the CNR1 gene could be associated with predisposition to cocaine dependency.
Assuntos
Moléculas de Adesão Celular Neuronais/genética , Transtornos Relacionados ao Uso de Cocaína/genética , Neuropeptídeos/genética , Receptores de Superfície Celular/genética , Esquizofrenia/genética , Repetições de Trinucleotídeos/genética , Adulto , Animais , População Negra/etnologia , Transtornos Relacionados ao Uso de Cocaína/complicações , Transtornos Relacionados ao Uso de Cocaína/etnologia , DNA/análise , Feminino , Frequência do Gene , Humanos , Masculino , Martinica/epidemiologia , Polimorfismo Genético , Protocaderinas , Esquizofrenia/complicações , Esquizofrenia/etnologiaRESUMO
UNLABELLED: It is recommended to reduce by one half the dosages of tricyclic antidepressants for patients over 65 years of age, in order to avert the occurrence of side-effects. The question we studied was: is it rightful to prescribe tricyclic antidepressants at half-dose to hospitalized elderly people? It is important, for the following reasons, to specify the rules of prescription of tricyclics in elderly patients: 1) The elderly population is on the increase; 2) There is a high prevalence of depression in elderly patients; 3) Depression exposes the elderly person to an increased risk of suicide; 4) Depression influences the prognosis of associated organic disorders 5) Recourse to tricyclic antidepressants is often necessary within this population group because of treatment resistant forms of depression which impose the use of different families of antidepressants and thus resort to tricyclics despite their lower tolerance. OBJECTIVES AND METHODS: The aim of our study is to evaluate whether the half doses of tricyclics recommended for an elderly person are sufficient in the case of an hospitalized patient. In order to provide some answer to this question, we have carried out a retrospective study. We have studied a sample of patients over-65, hospitalized at the Clinique des Maladies Mentales et de l'Encéphale, over a period of two years, with a ICD 10 diagnosis of moderate or severe intensity major depressive episode, and treated effectively with return to the euthymia. Creatinemia was prescribed systematically to each patient on entry. Only patients with normal renal function were retained. Laboratory norms are between 45 and 120 micromol/liter. The routine practice of imipraminic blood dosages allowed the comparison of blood levels obtained among patients treated with posologies inferior or equal to 75 mg/day imipraminic, to those treated with more than 75 mg/day imipraminic for a least a week. The percentage observed were compared using the Khi2 test with Yates correction. We retained the blood concentrations of the mother molecule for tertiary amines (imipramine, clomipramine and amitriptyline). The samples were taken after at least seven days of treatment at the same dose, and twelve to thirteen hours after the last taking. The maxima of blood levels were respectively: desipramine 200 ng/ml, clomipramine 258 ng/ml, imipramine 163 ng/ml, amitriptyline 129 ng/ml. Research for evidence in favor of toxicity (fall, delirium, convulsion, reduction of dosage before discharge), was done through revision of patients' clinical files. RESULTS: The test group consisted of 87 individuals. The average age was 71.3 years (SD: 5.09). Mean creatinemia was 83.73 mmol/l (SD: 26.89). The population thus selected divided into 4 groups: 61 (70.1%) were given imipraminics, 10 (11.5%) serotonin recapture inhibitors, 11 (12.7%) other antidepressants essentially of mianserine and 5 (5.7%) treatment by electroconvulsivotherapy. The imipraminics prescribed were desipramine, imipramine, clomipramine and amitriptyline. Among the 61 patients treated with imipramine, blood level dosage was practised on 48 patients (79%). Two subgroup were distinguished: 13 (21%) received dosages inferior ou equal to 75 mg/day and 48 (79%) superior to 75 mg/day. The mean dosage found in the sub-group of patients treated with dosages superior to 75 mg/day was 140 mg/day (SD: 30). The subgroup treated with dosages superior to 75 mg/day was more frequently monitored than the subgroup receiving dosages inferior or equal to 75 mg/day, respectively 40/48 (83%), and 8/13 (62%). This difference is statistically nonsignificant (p > 0.10). The analysis of dosages used showed that:--among the dosages effected upon patients receiving doses inferior or equal to 75 mg/day, 1 (12.5%) exceeded the maximal value of therapeutic range.--Among the dosages effected upon patients receiving dosages superior to 75 mg/day, 9 (22%) exceeded the maximal value of the therapeutic range. The difference is statistically significant (p < 0.001). On revision of clinical files, no patient presented any element that might lead one to suspect toxicity such as defined in "Objectives and Methods". CONCLUSION: In our study, patients were hospitalized and so benefited from closer observation than one can expect in outpatients. In this particular context, the dosages used are close to those advocated for the general population. With the elderly subject, the systematic prescription of half-dose tricyclics runs the risk of infratherapeutic dosage. It is thus preferable to resort to blood level dosage and to look for a maximum dose tolerance before concluding ineffectuality. This allows one to monitor whether the blood levels obtained are included in the therapeutic range; to avoid toxic doses and to check weak compliance in the elderly patient. Our findings do not oppose the use, for the elderly hospitalized depressive, of doses of imipraminics close to those of a young subject. To confirm these results it would be desirable to carry out o prospective study, including a systematised evaluation of adverse effects and a comparison of clinical effectiveness for parallel groups of elderly patients receiving different doses of imipraminic antidepressants.