Les effets iatrogènes des psychotropes chez le sujet âgé sont fréquents ; les raisons en sont nombreuses, mais d’une manière générale, on peut dire que le dénominateur commun à ce phénomène est un ralentissement métabolique, aussi bien au niveau de la distribution des médicaments que de la métabolisation puis de l’élimination.

L’objectif de notre travail est de préciser la comorbidité associée à cette thérapeutique dans cette tranche d’âge en milieu hospitalier et d’indiquer les moyens préventifs de cette iatrogénie.

Notre étude est rétrospective, portant sur 35 patients, âgés de 65ans et plus, ayant reçu un traitement psychotrope dans un service de médecine interne.

L’âge moyen de nos patients est de 70ans. Le sex-ratio F/H est de 1,2. La majorité de nos patients recevaient un traitement neuroleptique (76 %). Nos malades, dans une proportion importante, présentaient des troubles psychotiques (34 %), proportion supérieure à celle des malades qui souffrent de troubles anxiodépressifs (20 %). La comorbidité somatique est dominée par les affections cardiovasculaires (51 %), les maladies métaboliques (37 %) et les atteintes neurologiques (37 %).

La fréquence et la sévérité des effets indésirables des psychotropes sont accrues chez la personne âgée. Certains effets indésirables sont communs à plusieurs classes thérapeutiques, d’autres sont propres à certaines classes thérapeutiques ou à certaines molécules. Quelques règles guident la prescription des psychotropes dans cette tranche d’âge.

The iatrogenic effects of psychotropic drugs in the elderly are common, and the reasons are many but in general we can say that the common denominator in this is a metabolic slowdown both in the distribution, metabolism and elimination of drugs.

The aim of this study is to clarify the comorbidity associated with this therapy in this slice of age in hospital circle and to indicate the measures of prevention of this iatrogenic.

Our study is retrospective including 35 old patients (age≥65 years), who received a psychotropic treatment in a department of internal medicine.

The sex ratio F/H is 1.2. The average age of patients was 70.26 years±6.81. The main indications for psychotropic drugs are: psychiatric disorders associated with dementia states (13 cases or 37%), psychotic states (12 cases or 34%), mental confusion and anxiodepressive syndromes, respectively in 17% and 20% of cases. Neuroleptic treatment is prescribed in 27 cases (71%), followed by anxiolytics (17 cases; 48%), and antidepressants (nine cases; 25%). Somatic comorbidity is dominated by the vascular affection (51%), metabolic (37%), neurological (37%), hematologic (25%) disease and infection (22%). We noted an important difference with the literature data on the use of atypical antipsychotics (two patients only), and inhibiting the reuptake of serotonin (one patient). Infectious complications especially respiratory and urinary tract are frequent and sometimes dangerous. They occur most often after sedation and prolonged immobilization (five cases). We noted, in this context, two cases of severe dehydration and acute renal failure. Two patients developed delirium under antiparkinsonian. Orthostatic hypotension and fall-related injuries are relatively common (respectively 10 and four cases). Six psychotic patients suffering from tardive dyskinesia. Two patients developed deep vein thrombosis. We found no cases of malignant hyperthermia or sudden death. Outside of psychotropics, antihypertensives, anti-inflammatory and antidiabetics drugs are the major drug classes prescribed in our patients. The potential risks most frequently observed were hypotension, hypoglycemia, and acute renal failure. The respect of counter indication is also a pillar in the management to avoid under and over-dosages sometimes fatal.

The frequency and severity of side effects of psychotropic drugs has increased in the elderly. Some side effects are common to several therapeutic classes; others are specific to certain classes of drugs or certain drugs. A few rules guide the prescription of psychotropic drugs in the elderly.