Les niveaux de consommation de benzodiazépines en France sont préoccupants, entraînant, au-delà du risque iatrogène, un coût non négligeable.

Ce travail a pour objectif de définir l’impact de l’évaluation systématique des accès anxieux par la passation d’une échelle visuelle analogique (EVA) sur la consommation de benzodiazépines, en proposant une stratégie thérapeutique adaptée au niveau d’angoisse.

Nous avons mené une étude prospective monocentrique séquentielle. Nous avons mis en place, durant une période de trois mois, comme condition à la délivrance de benzodiazépines en « si besoin », l’évaluation des accès anxieux par une EVA ainsi qu’une alternative aux psychotropes sous la forme d’une réassurance. Nous avons ensuite comparé les consommations de benzodiazépines avant et après introduction de l’EVA. Enfin, nous avons comparé les consommations du service durant la période d’inclusion aux consommations des années précédentes à la même période de l’année.

Notre étude n’a pas permis de mettre en évidence un impact de l’introduction d’une EVA sur la consommation de benzodiazépines (p=0,44). Cependant nous avons observé une diminution de la consommation moyenne globale lors de la même période au cours de l’année précédente.

L’EVA immédiatement couplée à une stratégie de réassurance ne semble pas être une solution efficace pour réduire la consommation hospitalière de benzodiazépines.

The optimal management of psychiatric symptoms requires constant adaptation of therapeutic strategy to clinic evolution. If benzodiazepines are a treatment of choice for acute anxiety states in hospitals, their excessive consumption is a concern, revealing a preference of chemical anxiolysis to non-drug alternatives, yet effective for episodes of low or moderate intensities. Faced with an acute anxiety, choice of various therapeutic options requires evaluating its intensity in order to establish an appropriate therapeutic response. To enable systematic and accurate evaluation of an anxious state, Visual Analogue Scale (VAS) seems to be the most suitable tool. The application of VAS to measure anxiety is widely validated by previous research on the subject. We assume that the self-assessment of anxiety is likely to lead to a reduction in benzodiazepine use.

This study aims to determine the impact of systematic evaluation of acute anxious state by VAS, on consumption of benzodiazepines, by proposing a therapeutic strategy adapted to the anxiety level.

This is a comparative, prospective, multicentric study. Both studied samples came from a population of patients hospitalized in psychiatric crisis service, and recruited sequentially over a period of three months each. For the first group, our practices did not change; for the second group, we introduced VAS as a systematic tool for evaluating each acute episode. Have been included all patients over a period of six months, for which was provided a conditional anxiolytic treatment by benzodiazepine, regardless of their pathology. Then we have compared individual and overall consumption of benzodiazepines (inmg diazepam-equivalent per day of hospitalization) of the two samples. Finally, we compared the consumption of the service during the inclusion period with the consumption of the previous years at the same time of the year.

Our study did not reveal the impact of the introduction of EVA on the consumption of benzodiazepines (P=0.44). However, we observed a decrease in overall average consumption during the same period in the previous year.

The evaluation of a symptom, subjective by nature, by an outside observer, is undeniably biased. The benefit of self-evaluation has been proven in the treatment of other acute symptoms such as pain. With VAS, the objective is to better know the intensity of a symptom, to offer the patient a matched care. Its use as an investigative tool of acute anxious states in hospitals appeared to be a promising lead, especially concerning the implementation of non-pharmacological anxiolytic strategies, as an alternative to over-consumption of benzodiazepines. Unfortunately, its use to evaluate acute anxious states didn’t permit to reduce benzodiazepines’ consumption. Our results are compared with data from the actual scientific literature.

The adaptation of the therapeutic anxiolytic strategy by self-assessment of the intensity of an anxiety state appears unfortunately inappropriate, both on an individual level, and as a public health point of view. We have to try to find other ways, which would allow preferring non-drug strategies and reducing the consumption of benzodiazepines.