Ce travail présente une enquête menée chez des patients dits « déficitaires » hospitalisés au long cours à l’hôpital Paul-Guiraud, établissement public de santé mentale (Villejuif-94), dans le but d’affiner la connaissance des traitements de cette population particulière. Une enquête médicale répertoriant les patients atteints d’autisme ou polyhandicapés a servi de base pour l’analyse de 57 traitements (14 % des patients de Paul-Guiraud) et comparaison à d’autres enquêtes menées dans les populations communément hospitalisées en psychiatrie. L’évaluation des traitements a été obtenue au moyen d’un questionnaire permettant de cibler les objectifs thérapeutiques des prescripteurs et d’obtenir des renseignements cliniques complémentaires. L’analyse des traitements a été réalisée sur l’ensemble des patients puis les médicaments à fort taux de prescriptions ont été comparés entre le groupe des patients atteints d’autisme et celui des polyhandicapés. Du fait de la comorbidité importante, de la polysymptomatologie et de l’absence de consensus sur la prise en charge médicamenteuse de l’autisme, le traitement de ces patients est empreint d’une forte polymédication (8±0,8 médicaments par patient). Les neuroleptiques semblent former la base du traitement de ces patients déficitaires (82 % de prescriptions) avec une prédilection pour la cyamémazine prescrite comme anxiolytique (46 % des prescriptions de neuroleptiques). Les posologies sont élevées entraînant une forte prescription de correcteurs des effets secondaires des neuroleptiques. Le traitement est très peu remanié (17,5 % des patients voient leur traitement psychiatrique remanié et 7 % des patients, leur traitement somatique). Enfin, bien que les patients atteints d’autisme soient cliniquement différents des polyhandicapés, aucune différence statistiquement significative n’a été démontrée dans leur thérapeutique. Comme il ne nous a pas été possible de faire une distinction précise de ces deux populations (patients atteints d’autisme et polyhandicapés) seulement à partir des médicaments utilisés et des doses prescrites, nous pouvons conclure à une prise en charge médicamenteuse identique.

This paper presents a survey conducted on a population of multi-handicapped patients and autistic adults hospitalised long term in the Paul Guiraud mental health Hospital in Villejuif France.

The aim of the survey is to deepen the knowledge of the treatments for this specific population.

A preliminary medical investigation was conducted on the population in order to target different groups of patients. Once patients had listed and defined their medical needs, prescriptions were analysed to assess whether clinical characteristics had an impact.

Thus, the analysis of treatments was carried out for the 57 patients (14% of the hospital population) and compared to other investigations conducted on the population commonly hospitalised in Psychiatry.

The evaluation of the treatments was obtained through a questionnaire which enabled us to target the therapeutical goals and to obtain additional clinical information.

The drugs with a high rate of prescription were compared between the autistic group and the multi-handicapped group.

The important comorbidity and the multi-symptomatology of autism often involves the polymedication of these patients (8±0.8 drugs per patient).

Fifty per cent of the treatments are referred to as somatic treatments. The average length of stay (22.3 years) and the high average age are aggravating factors for polymedication.

The average number of psychotropic molecules also appears higher than in the populations studied in the literature. The heterogeneity of clinical forms of autism and polyhandicap encourages prescribers to multidrug therapy.

The prescriptions usually remain stable (17.5% of psychiatric treatment is adapted and only 7% of somatic treatment).

Epilepsy and constipation are the main treated somatic disorders.

In psychiatry, the oral route is the privileged route of administration (81% of treatments) with, more specifically, the use of drinkable solutions for the psychiatric treatment.

Neuroleptic drugs are the basic treatment of these patients (82% of prescriptions). The aim of the prescription of neuroleptics is essentially to obtain behavioural or antipsychotic sedation. Cyamemazin is the most prescribed drug (46% of neuroleptic prescriptions), mainly for its anxiolytic effects.

Co-prescription is frequent (55.3%) and corresponds to 53% of co-prescriptions of an association of phenothiazine and butyrophenone.

Doses are high, which implies the prescription of treatments against the neuroleptics side-effects (86% of patients have such a prescription).

The rate of prescriptions of the other psychotropic drugs (hypnotics, anxiolytics, etc.) is approximately equivalent between our population and the “classical” hospitalised psychiatric population, except for antidepressants (7% of prescriptions) because the differential diagnosis is difficult in these patients.

Nearly 60% of patients have prescriptions of hypnotic drugs. However, this figure is tempered by prescriptions of drugs “if necessary” in two-thirds of the cases. Finally, only 30% of patients have systematic hypnotic prescriptions.

Although autistics are clinically different from multi-handicapped patients, no statistically significant difference was demonstrated in their prescriptions, which implies a similar pharmacological management.

It is difficult to clearly distinguish these two populations only according to the type of drugs used and the doses prescribed.