Les antipsychotiques de seconde génération ont amélioré de façon considérable les conditions de vie des patients atteints de pathologie mentale sévère. Certains d’entre eux entraînent une prise de poids qui peut être importante avec des complications métaboliques graves. De plus, ils sont prescrits à des patients vulnérables, présentant de nombreuses comorbidités et un taux de mortalité cardiovasculaire élevé. La prévention du syndrome métabolique par des mesures simples permet d’améliorer la santé physique des patients. Parmi les acteurs de cette prise en charge, les médecins généralistes sont des partenaires privilégiés pour les psychiatres. Afin d’évaluer les pratiques actuelles en médecine générale dans le champ de la psychiatrie, nous avons interrogé 204 médecins généralistes des Hauts-de-Seine ayant accepté de participer à l’enquête. Les résultats montrent que bien que prescripteurs d’antipsychotiques, les médecins généralistes manquent d’informations sur ces molécules et sur la prévention de leurs effets indésirables. Parmi eux, le syndrome métabolique est encore peu dépisté par les médecins généralistes, à qui font souvent défaut les conseils et recommandations à ce propos de la part des psychiatres traitants. En conclusion, nous proposons d’améliorer l’information des médecins généralistes sur leur rôle dans la prévention du syndrome métabolique et de sensibiliser psychiatres et médecins généralistes sur la nécessité d’une prise en charge conjointe et coordonnée des patients atteints de pathologie mentale sévère.

Second-generation antipsychotics have improved living conditions of patients affected by severe mental illness. Some of them can induce weight gain with metabolic complications. Furthermore, they are prescribed to vulnerable patients, with comorbidity and high cardiovascular mortality rate. Prevention of a metabolic syndrome by simple measures improves patient’s physical health. General practitioners are privileged partners for psychiatrists.

This study was conducted to assess the prevention and management of a metabolic syndrome in patients treated with antipsychotics in general practice. With this in mind, at first we needed to explore how general practitioners prescribe antipsychotics.

To assess the general practice, we interviewed 204 general practitioners in the Hauts-de-Seine. Our database was the yellow pages of this area (September 2007). We then conducted a random draw using random digits. We called 507 general practitioners, 410 of whom were sent a questionnaire. We received the return of 204 questionnaires. Each questionnaire consisted of four parts: the general practitioner’s profile, psychiatry in his/her practice, the prescription of antipsychotics and the management of metabolic syndromes in patients treated with antipsychotics.

The general practitioner’s response rate was 49.7%. The results show that although they prescribe antipsychotics, general practitioners need more information on these molecules and on their side effects. Indeed 57% of them feel they are not given enough information on antipsychotics, but 69% have already initiated antipsychotic treatment and 17% do so regularly. Furthermore, a metabolic syndrome is insufficiently detected by general practitioners, although they know of its prevalence after the introduction of antipsychotic treatment. Thus, 81% reported having been confronted with this problem, but only 54% of them calculated the body mass index of patients taking antipsychotics, and 26% measured waist circumference. These results are consistent with studies tracking metabolic syndrome performed in all patients, so, general practitioners do not conduct specific monitoring of patients on antipsychotics. However, they are faced with difficulties related to adherence to treatment because of weight gain. In such cases, 16% of respondents start a new treatment, without a psychiatrist’s opinion. These results confirm the results of previous studies on the risks of such prescriptions in general practice, when not supervised.

In conclusion, we suggest that information of general practitioners about their role in prevention of metabolic syndromes should be improved, and psychiatrists and general practitioners should be informed on the necessity of joint care of patients affected by severe mental illness.