Guilhème Pérodeau

Medications as social phenomena

This article discusses medications as socially embedded phenomena, using the class of psychoactive medications as a primary example. The analytical perspective is systemic, constructivist, and critical. We suggest that the ‘rational use of drugs’ paradigm fails to appreciate various legitimate rationalities motivating medication usages and is therefore inadequate to understand the place of medications in society. Medications have complex life cycles, with diverse actors, social systems, and institutions determining who uses what medications, how, when and why. Such understanding permits analyzing medications simultaneously as entities and representations. We outline recent changes in usage patterns of psychoactive medications (notably prescriptions to children), in pharmaceutical marketing practices (notably direct-to-consumer advertising), and in the construction of knowledge about drugs (notably the role of the Internet in legitimating consumers’ viewpoints). These changes indicate that medication life cycles evolve and mutate with social and technological change. These life cycles are viewed, then, as systems – part of other social, cultural, and economic systems, themselves in constant change. This perspective provides fertile ground to raise several research questions in order to understand better the nature of medications, their effects, and their place in society.

Benzodiazepine use and quality of sleep in the community-dwelling elderly population.

Background: About 50% of the elderly population report being dissatisfied with their sleep. Although benzodiazepines are the most prescribed drugs to treat sleep complaints, the effectiveness of their use on the quality of sleep is not well documented. Objectives: This study aimed to assess the association between benzodiazepine use and global sleep quality, as well as six components of sleep quality. Methods: Data from the cross-sectional Quebec Survey on Seniors’ Health (n = 2798) conducted in 2005–2006 were used. Quality of sleep was self-reported and use of benzodiazepines was assessed during the previous year. Results: Benzodiazepine users reported poorer quality of sleep than non-users. The association between benzodiazepine use and each of the six quality of sleep components studied were similar except for the daytime dysfunction component. Conclusion: The results suggest that there is no evidence that using benzodiazepines is associated with better quality of sleep than non-users in the elderly population. Future longitudinal population-based studies are needed to assess improvements in quality of sleep in the elderly associated with the use of benzodiazepines.

Mental Health for Older Adults and Benzodiazpine Use

Benzodiazepine (BZD) drug use among community-dwelling seniors is a significant health issue. Although long-term use of BZDs by seniors is a recognized problem, little is known about the mental health of the consumers. Better knowledge of their mental health would help nurses in identifying the psychological needs of this population. The goals of this longitudinal study1 (n = 138) were to describe the mental health status of long-term users of BZDs and to compare it with the mental health of seniors who have either begun or stopped consuming BZDs over a 1-year period (from Phase 1 to Phase 2). Results showed that one third of long-term users of BZDs do not present any mental health problem. Furthermore, no differences were observed between the mental health statuses of new users of BZDs, individuals who stopped using BZDs, and long-term users of BZDs. In conclusion, at least one third of long-term users of BZDs should stop using these drugs, and nurses should play a leading role in helping these seniors withdraw from BZD consumption.

Psychotropic Drug Use and the Relation Between Social Support, Life Events, and Mental Health in the Elderly

This study aimed to determine if self-reported social support and life events explained differences in levels of anxiety and depression among 109 elderly psychotropic drug users compared to 90 nonusers (aged 62 to 98). Two thirds of the respondents were French-speaking, mostly female (82.1%) and widowed (57.4%), and recipients of a home care program in Montreal, Canada. The life event and social support scales, broken down by item value, did not differentiate users from nonusers, except for feelings of loneliness reported by 40% of users compared to only 16% of nonusers (p < .001). Analysis of the relation between psychiatric symptomatology and psychosocial variables, broken down by item value, showed greater sensitivity among users to perceived (subjective) lack in social support. In contrast, only “feelings of loneliness” had an effect on the level of mental health of nonusers. There was no effect with regard to objective items of social support.

Mental health, stress correlates and psychotropic drug use or non-use among aged caregivers to elders with dementia.

The goal of the study was to compare caregivers who used psychotropic drugs with caregivers who were non-users in order to pinpoint differences in coping styles between the two groups. We performed a secondary analysis of a study on the stress and psychological well-being of persons caring for relatives with dementia. We compared elderly caregivers, as either psychotropic drug users ( n = 61) or non-users ( n = 133), over various psychosocial characteristics relating to the care-giving context. Results reveal that users, as compared to non-users were: (a) more disturbed (appraised a greater stress) by the relatives dysfunctional behaviours, after controlling for the frequency of the behaviours; and (b) experienced more conflict during interpersonal interactions, although their appraisal of self-satisfaction with formal and informal support to their care-giving activities did not differ significantly. Strikingly, users combined and called on a greater number of problem-focused and emotion-reducing coping strategies than did non-users. They more frequently used affective regulation and information seeking coping styles. Stress-related measures (especially stress appraisal and conflict) contributed more to the variation in mental distress of users than of non-users. Results provide a theoretical and empirical rationale for therapeutic interventions such as the cognitive behavioural approach.

Les psychotropes et le vieillissement normal: une perspective psychosociale et socio-économique *

The goal of this study was to examine the reaction (anxiety, depression, and helplessness) and adaptive strategies (problem-solving and emotion-reducing) of community-dwelling elderly, confronted by one specific chronic stressor. We have conducted three face-to-face home interviews on a monthly basis with a follow-up interview seven months later. There were 237 psychotropic drug users and non-users, of high or low socio-economic status. Not only were low socio-economic psychotropic drug users more anxious about the targeted hassle of the week, but they also relied on and used more problem-solving strategies than non-drug users. It is suggested that psychotropic drug use be looked at as a strategy like any others rather than as passive behaviour when facing daily hassles. Moreover, using a high number of coping strategies is not synonymous with being good at coping with chronic stress. Various recommandations for clinical intervention are put forward.

Chronic Psychotropic Drug Use Among Frail Elderly Women Receiving Home Care Services

Over the years, psychotropic drugs have been prescribed for symptoms of anxiety and/or insomnia. Elderly women are especially at risk of chronic use and ensuing side-effects. We examined psychosocial processes associated with long-term psychotropic drug use. We conducted in-depth interviews with 21 frail elderly women in a home care program and 14 of their primary caregivers. Results yielded a descriptive model of chronic use that takes into account antecedents of use, initial and subsequent prescription processes, individual contextual circumstances, the effect of the social context, and the womens cognitive strategies employed to make prolonged use coherent with their self-image.

Systemic model of chronic benzodiazepine use among mature adults

Objectives: Our goal was to build a systemic model of chronic use among community-dwelling mature benzodiazepine (BZD) users. BZDs are commonly prescribed for symptoms of anxiety and/or insomnia despite their documented side effects over time. Method: We conducted in-depth interviews with 23 mature (50 years and over) users, 14 women and 9 men, as well as 9 general practitioners and 11 pharmacists. We chose the grounded theory approach for our analysis. Results: Results yielded a systemic model of chronic BZD use, illustrating onset and maintenance of use, and taking into account individual life context, intervening conditions (e.g. family and doctor--patient interactions) and structural factors (medicalization, ageism, influence of the media and pharmaceutical industry, etc.). Based on our findings, we suggest that intervention should go beyond medical issues and extend to the individuals perception of aging in the modern society, as well as attitudes of families and health professionals regarding long-term BZD use. Family members should be involved in the weaning process and adoption of new life habits. General practitioners should be better trained regarding geriatric psychosocial issues and offer alternatives to prescribe psychotropic drugs such as cognitive behavior therapy for insomnia. Also, as a society, we should reconsider the highly medicalized stance we take to compensate for age-related losses. The influential role of the pharmaceutical industry in the process is discussed. Conclusion: We conclude that a predominantly biomedical perspective on human development diminishes patient-centered care within a socially contextualized, individual perspective.

The predictive utility of health preoccupations and outcome expectancies prior to benzodiazepine withdrawal

Aim: The aim of this study was to examine the predictive utility of measuring health preoccupations and outcome expectancies prior to tapered benzodiazepine (BZD) withdrawal. Method: In an initial exploratory study, 44 adult participants (18–65) with a principal diagnosis of either anxiety or insomnia or both and wishing to discontinue BZD use were administered a Benzodiazepine Withdrawal Outcome Expectancy Scale (B-WOES) pre- and post-tapered withdrawal. Results: Two factors emerged from the health preoccupation section of the B-WOES: personal well-being and somatic concerns. A third subscale was derived from the section of the B-WOES measuring outcome expectancies if BZD were discontinued: an enhanced positive experience factor. A replication on a second independent sample of 38 adult participants (18–65) confirmed the three-factor structure. Conclusion: In the pooled data, the first two preoccupation subscales emerged as significant predictors of outcome following a tapered withdrawal program, so health preoccupations as well as outcome expectancies prior to discontinuation may impact on the discontinuation process.

Brian L. Mishara et Robert G. Riedel. Le vieillissement. 3e éd. Paris: Presse Universitaire de France, 1994.

This is the third edition of a book published at the beginning of the 80s. According to Mishara and his colleagues, as many studies in gerontology have been undertaken in the last decade as the previous 50 years. In order to update the last edition, the authors kept the same format as in the other editions. Leaving aside more recent studies showing the same conclusions as in the earlier editions, the authors instead added studies which present new elements or which possibly may invalidate or confirm ambiguous results from the past. The themes discussed are practically the same as in the previous edition. A new chapter was added on the use of medicines and drugs by the elderly. The chapters pertaining to death and grief are of particular interest. This book, although academic, has a flowing style and is a great added value to a library if the reader does not have any of the previous editions.