The French Society of Child and Adolescent Psychiatry and Associated Disciplines (SFPEADA) reacts in a press release to the publication of the report of the High Council for Family, Childhood and Age (HCFEA) and its media exploitation (see our article).
The SFPEADA has taken note of the report of the High Council for Family, Childhood and Age (HCFEA) entitled “When the Children are in bad shape, how can you Help them? » made public on March 13, 2023. We welcome the report he presents on the situation of child and adolescent psychiatry in France. We support all the steps allowing to inform the decision makers of the difficulties that the professionals of child-juvenile psychiatry expose concerning the assumption of responsibility of the children and the teenagers in this field. The proposals made are in line with other reports, abundantly cited and rightly so, which reinforces the weight of the conclusions.
However, the chapter on psychotropic drugs poses a problem because it is capable of causing an erroneous understanding of the situation, or even leading to very regrettable breaks in care.
A- The data concerning the increase in the prescriptions of psychotropic drugs in France in the pediatric population are known. The phenomenon has been constant for more than 10 years, well documented by the EPI PHARE study and in numerous scientific studies. This increase is observed in parallel with an increase in anxiety, depressive and/or eating disorders observed over the same period. The ESCAPAD studies of the OFDT as well as the Health Barometer of Public Health France have recently reminded us of this. It is therefore predictable that more disorders lead to more treatments, including more prescriptions for psychotropic drugs. Of course, the question of over-prescription also arises as in all medical specialties, think of the over-prescription of antibiotics for example. It should be noted that more than 60% of prescriptions, especially in the oldest patients, are not made by psychiatrists.
B- Contrary to what is suggested for anxiety disorders or depressive disorders, drug treatments are very rarely a first-line solution.. And in all cases, these prescriptions are carried out in a framework of individualized care by a doctor, ideally a psychiatrist specializing in children and adolescents with therapeutic support and in the best of cases psychotherapy. When comparing the prescription rates of the psychotropics mentioned to the prevalences of the disorders they treat, there is no major bias, with a few exceptions such as prescriptions for hypnotics. The prescription is one of the therapeutic responses, it is far from being the only one.
C- To prescribe is to assess the balance between benefits and risks. Two recent works, both solid and published in World Psychiatry, by Correl et al, in 2021 and Solmi et al., in 2020, show that the effectiveness is much higher than the undesirable effects for a large number of psychotropic drugs: Antipsychotics in Schizophrenic and Bipolar Disorders, Methylphenidate in Attention Disorders, Antidepressants in Major Depressive States and in Chronic Anxiety Disorders. Marketing Authorizations (MA) are few in the pediatric population because the pharmaceutical industry has no interest in filing an expensive file for a market that it considers too weak. Consequently, as in paediatrics, practitioners rely on scientific literature when prescriptions prove necessary.
Finally, the SFPEADA thinks of the children, adolescents and their families who have overcome their reluctance to accept drug treatment and who today feel better, have better social, school or professional integration. The biased presentation of this report might be of a nature to worry them and represent a new form of stigmatization of mental illness and psychological suffering.
The SFPEADA generally welcomes the work of the HCFEA. We regret all the more that this document might raise potentially illegitimate questions with families receiving adapted child psychiatric care.
Dr Jean CHAMBRY
President of the SFPEADA
On behalf of the SFPEADA Board of Directors
