General Practice Department, Toulouse III University, 31063 Toulouse, France; UMR1027 Inserm, Toulouse III University, 31000 Toulouse, France.
General Practice Department, Toulouse III University, 31063 Toulouse, France.
Therapie. 2019 Oct;74(5):537-546. doi: 10.1016/j.therap.2019.03.004. Epub 2019 Apr 2.
Benzodiazepines and related drugs are the most commonly prescribed drugs in the treatment of insomnia, and referral to psychotherapy is rare when recommended as first-line treatment for chronic insomnia. The frequency of referral to psychologists, of use of alternative drugs to benzodiazepines, either prescribed by general practitioners (GPs) or dispensed by community pharmacies, is unknown in France. We aimed to describe the non-pharmacological approaches recommended, such as cognitive behavioral therapies (CBT), and the drugs, including alternatives drugs to benzodiazepines, used by GPs and community pharmacies for patients complaining of insomnia.
A cross-sectional study was conducted during 3 months in 2015 on the management of individual GPs' patients and pharmacies' customers consecutively consulting for insomnia in the Midi-Pyrénées region of southwest France. Participating GPs and pharmacists completed a form, for each patient, on their management (drugs, sleeping advices, referral to psychotherapy).
Fifty-five GPs included 263 patients and 43 community pharmacies included 354 customers in the study. Among patients, 193 (73,4%) had already used benzodiazepine. Thirty-eight patients (14.4%) and 2 customers (0.5%) were recommended non-drug therapies (mostly CBT). Benzodiazepines were prescribed 188 times (69.1% of the prescriptions) by GPs. Alternative drugs prescribed were mostly antihistamines (n=26; 9.6%) and antidepressants (n=17; 6.3%). Antihistamines were the most commonly dispensed drugs by pharmacists (n=149; 39.4%).
While non-pharmacological treatments, such as CBT, are safe and widely recommended, benzodiazepines and antihistamines remain widely used despite the lack of long term benefit and the risk of adverse drug reactions.
苯二氮䓬类药物和相关药物是治疗失眠最常用的药物，当被推荐为慢性失眠的一线治疗药物时，很少向心理治疗师转诊。在法国，向心理学家转诊的频率、替代苯二氮䓬类药物的使用频率（无论是由全科医生 (GP) 开具还是由社区药房配药）尚不清楚。我们旨在描述推荐的非药物治疗方法，如认知行为疗法 (CBT)，以及全科医生和社区药房用于治疗抱怨失眠的患者的药物，包括替代苯二氮䓬类药物的药物。
2015 年 3 个月期间，在法国西南部米迪-庇里牛斯地区，对个体全科医生的患者和药房的顾客进行了一项横断面研究，这些患者和顾客连续因失眠就诊。参与的全科医生和药剂师为每位患者填写了一份表格，内容包括他们的治疗管理（药物、睡眠建议、向心理治疗师转诊）。
55 名全科医生纳入了 263 名患者，43 家社区药房纳入了 354 名顾客。在患者中，193 名（73.4%）已经使用过苯二氮䓬类药物。38 名患者（14.4%）和 2 名顾客（0.5%）被推荐使用非药物疗法（主要是 CBT）。全科医生开具了 188 次苯二氮䓬类药物处方（占处方的 69.1%）。开出的替代药物主要为抗组胺药（n=26；9.6%）和抗抑郁药（n=17；6.3%）。抗组胺药是药剂师最常配发的药物（n=149；39.4%）。
尽管长期获益有限且存在药物不良反应风险，但非药物治疗方法（如 CBT）安全且广泛推荐，苯二氮䓬类药物和抗组胺药仍广泛使用。
