The term ‘psychotropic drug’ is used to define medication that acts on the central nervous system by modifying certain mental processes. Generally speaking, these are medicines used to treat mild or serious mental illness and to alleviate pain.

Due to their psychoactive properties, psychotropic medicines may cause dependency if used chronically or if abused.

Psychotropic medication is sometimes consumed outside any medical context and may be misappropriated or even trafficked in the same way as illegal drugs.

France’s Interministerial Mission to Combat Drugs and Drug Addiction (MILDT) asked Inserm to produce a collective expert opinion on the consumption of psychotropic medication and the misuse and drug dependency associated therewith so that a scientific light can be thrown on these phenomena, with the addition of useful recommendations for improving the regulations and current prevention and care arrangements in France.

To comply this request, Inserm has created a multi-disciplinary group of 11 experts in the fields of epidemiology, drug monitoring, public health, sociology, anthropology, toxicology, psychiatry and neurobiology. The group analysed more than 1100 international scientific publications, making it possible to report on the main findings concerning the French situation.

Principal classes of psychotropic drugs

The conclusions obtained through the collective effort of experts contributes to the debate of healthcare professionals involved and the social debate.

Impact of chlordecone exposure on the development of infants

In an article published in the journal Environmental Research, researchers from Inserm (Inserm Unit 1085 – IRSET Institute for Research in Environmental and Occupational Health, in Rennes and Pointe à Pitre) in liaison with Canadian, Belgian and American researchers have investigated whether exposure to chlordecone (a pesticide used until 1993 on banana plantations in the Antilles) had an impact on the cognitive, visual and motor skills development of very young children. 1042 women were monitored during and after pregnancy and 153 infants were monitored at the age of 7 months. The results of this study show that pre- or post-natal exposure to chlordecone is associated with adverse effects on the cognitive and motor skills development of infants. They are not confirmed for older children, for whom the study is continuing.

Chlordecone is a pesticide used in theAntillesfor more than 20 years to combat banana weevil. However, its widespread use (prohibited in theAntillesfrom 1993) and persistence in the environment have caused permanent soil pollution and contamination of the population. Chlordecone is now considered to be an endocrine disruptor and a neurotoxin, and is classified by the WHO as potentially carcinogenic to humans.

To evaluate the impact on health of exposure to chlordecone, the team led by Sylvaine Cordier in Rennes and Luc Multigner in Pointe à Pitre set up a large mother and child cohort in Guadeloupe, known as TIMOUN[1] (meaning ‘child’ in Creole). The general aim of the study is to evaluate the health impact of chlordecone exposure on pregnancy and on pre- and post-natal development. The cohort consisted of 1042 women, who were monitored with their children from their pregnancy during the period 2005-2007. Researchers were particularly interested in the impact of pre-natal and post-natal exposure to chlordecone on the cognitive, visual and motor skills development of infants at the age of 7 months.

153 infants, both boys and girls, were monitored at the age of 7 months.

Pre-natal exposure to chlordecone was estimated from the levels in the umbilical cord blood. Post-natal exposure was estimated from levels in the mother’s breast milk and from the frequency of consumption by the infants of foodstuffs likely to be contaminated with chlordecone. Visual memory, visual acuity and the motor skills development of the infants was then tested.

Pre-natal exposure to chlordecone was found to be associated significantly with a reduction in the score for visual preference for novelty[2] and a low score on the fine motor skills development scale[3].

Post-natal exposure to chlordecone, estimated from the consumption of contaminated foodstuffs, was found to be associated, at the limit of statistical significance, with a reduction in the speed of acquiring visual memory and a reduction in visual preference for novelty. However, post-natal exposure to chlordecone through breastfeeding does not appear to be associated with any change in psychomotor development.

In conclusion, pre-natal exposure to chlordecone or post-natal exposure via food consumption is associated at the age of 7 months with adverse effects on cognitive and motor skills development in infants.

Although these observations based on small cohorts do not identify serious problems, they can nevertheless be compared with certain problems described in the past in adults exposed to chlordecone at work, characterised by short-term memory problems and the presence of intention tremor.

The researchers wonder whether these associations observed in infants at 7 months of age could be predictors of permanent problems when they are older. According to Sylvaine Cordier and Luc Multigner, “only by monitoring the children in future years will we be able to answer these questions”. The children in the TIMOUN cohort are now being monitored at the age of 7 years.

Sorry, this press release is only available in French.

Florent de Vathaire, Research Director at Inserm (Epidemiology and Public Health Research Centre, Unit 1018 – University Paris-Sud, Institut Gustave Roussy, Villejuif) and his team have been studying the relation between doses of ionising radiation received to the pancreas during radiotherapy treatment for childhood cancer and the long-term risk of diabetes. The results of their research are published today in The Lancet Oncology

© F.Pattou/Inserm

This study was based on analysis of a cohort of 2,500 people in France and the UK who were treated for childhood cancer before 1986, who have been well for at least 20 years, and who answered a detailed questionnaire on their state of health.

Enfin, pour les auteurs, « le pancréas doit être considéré comme un organe critique lors de la planification de radiothérapie, en particulier chez les enfants ». Ils soulignent : « Jusqu’à présent, le pancréas est l’un des rares organes à ne pas être considéré à risque de complication des tissus normaux dans les directives nationales pour la radiothérapie du cancer. Nos résultats indiquent que le pancréas est un organe à risque pendant la radiothérapie et doit être couturé lors de la planification du traitement, afin de limiter au maximum son irradiation »

After an average monitoring period of 27 years, 65 of the childhood cancer survivors had developed diabetes.

The incidence of diabetes at the age of 45 was found to be 2.3% (95%CI: 0.8% – 6.4%) in individuals who have not received radiotherapy and 6.6% (4.8% – 9.0%) in those that have had radiotherapy. The researchers have demonstrated that the determining factor in increased risk of developing diabetes as adults is the radiation dose received during radiotherapy for childhood cancer and, specifically, the dose to the tail of the pancreas, where the islets of Langerhans are concentrated. It seems that radiation to other parts of the pancreas does not have a significant effect. The incidence of diabetes at the age of 45 is 16.3% (95%CI: 10.9% – 24.0%) in respondents that received over 10 Gray (Gy)[1] to the tail of the pancreas. In the case of low or moderate doses, the risk of developing diabetes later in life increased by 65% (95%CI: 23% – 170%) for each Gy received to the tail of the pancreas.

This is the first study carried out on the relation between the radiation dose received to the pancreas, regardless of the source, and the risk of developing diabetes.

If confirmed by subsequent studies, the linear nature of the relation found by Florent de Vathaire and his co-researchers implies an increased risk of diabetes even for low and moderate doses and this is bound to have implications for public health.

According to the authors, “the pancreas needs to be regarded as a critical organ when planning radiation therapy, particularly in children.” They point out that: “up to now, the pancreas is one of the few organs which, in national guidelines on radiation therapy for cancer, is not thought to entail any risk of complications in normal tissue.   Our results show that the pancreas is at risk during radiation therapy and needs to be analysed in depth when planning treatment in order to keep its irradiation to the absolute minimum.”

Road transport is one of the main vectors of animal epidemics. It is vital to understand how potentially infected animals are transported and exchanged within a country. A French-Italian team, including researchers from the Centre de physique théorique (CNRS/Aix-Marseille Université / Université du Sud Toulon Var) and the Epidémiologie, systèmes d’information, modélisation (Inserm/UPMC)[1] unit, has just presented large-scale numerical simulations to test potential scenarios of a cattle epidemic in Italy. The model is the first to take into account day-to-day variations in the Italian animal transportation network and could lead to new prevention and monitoring strategies. This work has been published on the website of the Journal of the Royal Society Interface.

Transportation of farm animals over long distances is vital for their rearing and for the agri-food industry.  However, it also facilitates the spread of pathogens. This was illustrated by the Foot and Mouth Disease epidemic that hit the UK in 2001 and cost around 8 billion GBP, and the 2006 swine fever epidemic in Germany in 2006, whose indirect costs are estimated at 60 million euros. Furthermore, there is increasing concern that animal diseases could pose a threat to human health, as recently shown by bird flu and the H1N1 virus.

To study how potentially infected animals are exchanged and transported within a country, and how this can affect the spread of an epidemic, the researchers used data from the movement records of 5 million cattle throughout 2007 in Italy. They built a model using tools from the complex network analysis. In mathematics, a network is a series of points (“nodes”) interconnected by communication paths. In the present case, the nodes were farms and the paths represented animal transport routes between them.

This model is novel in that it takes into account changes occurring from one week to another and even from one day to the next in the Italian animal transport network. Traditional models, by comparison, are based on a fixed network, which can lead to inadequate prevention and health screening measures. The researchers built digital simulations to predict how a disease in any Italian farm would propagate by road throughout the country. More importantly, this work could help identify the farms that require priority surveillance once an epidemic breaks out or is suspected. Moreover, in the case of a crisis, the model could be used to trace the path of infection back to the farm of origin. Finally, the research shows that the most important farms to monitor are not only those where animal transport is the busiest, although simpler models that do not account for network dynamics would predict this. Because standard characteristics are insufficient to identify the farms at risk, the researchers are now developing mathematical models to achieve this.

Although this work takes a pure science approach in developing new mathematical models, it could easily serve as a basis for creating a powerful, user-friendly tool for animal health authorities. In addition, the researchers hope to extend their study to the rest of Europe.

© P.Bajardi, A.Barrat, L.Savini and V.Colizza Epidemic propagation paths Each white dot on the main map represents a farm (node), and the lines represent animal transportation. Digital simulations of epidemics can detect groups of farms, defined by the same propagation scenario. Such groups are shown in color on the main map. Farms in a particular group can be located within a single area or be geographically dispersed. The maps at the sides of the figure show several propagation paths originating in the red group (left) or the blue group (right) from the main map: propagation paths are similar for different origins within the same group.

© P.Bajardi, A.Barrat, L.Savini and V.Colizza Geographic distribution of groups of farms in the Italian cattle transportation network Each white dot on the main map represents a farm (node) and the lines represent animal transportation routes. Digital simulations of epidemics can detect groups of farms, defined by the same propagation scenario. Each color shows a different group of farms, illustrating that farms in the same group can be located in a single area or be geographically dispersed. The networks illustrated at the top of the figure correspond to epidemic propagation paths for each of the groups shown on the map: each group has a different propagation route.

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The HLY (Healthy Life Years) indicates how long people can expect to live without disability. It has been computed annually for each Member State of the European Union since 2005. These figures are released in the framework of the first annual meeting of the European Joint Action on Healthy Life Years (EHLEIS), organized in Paris on April 19, 2012 (ASIEM, 6 rue Albert de Lapparent, from 1:30pm) by the French Ministry of Health. The European Joint Action on Healthy Life Years (EHLEIS) is led by FRANCE, and coordinated by the French National Institute of Health and Medical Research (INSERM).

In 2009 men in the European Union (EU27) could expect 61.3 Healthy Life Years (HLY), representing almost 80% of their life expectancy (LE) at birth of 76.7 years. Women could expect 62 HLY, 75% of their life expectancy (LE) at birth of 82.6 years in 2009.

2010 values for men

In 2010, Sweden has the longest life expectancy at birth (79.6 years) for men in the European Union and Lithuania the shortest (68 years), a gap of almost 12 years. Swedish men also have the most Healthy Life Years (71.7 years) with men in the Slovak Republic having the least (52.3 years), a gap of almost 20 Healthy Life Years. And again Sweden has the highest proportion of years lived without disability (HLY/ LE) in 2010 with 90% of life expectancy without limitations in usual activities. Men in the Slovak Republic on the other hand spend the lowest proportion without disability (73%), a difference of 17 percentage points. This suggests that for men the longer the life expectancy the greater the proportion lived without disability.

In this short period 2008-2010 and despite its low life expectancy and HLY for men, Lithuania experienced the largest gain in HLY, almost three years, whilst the Netherlands saw the largest decline (a loss of 1.3 years). So there is also a tendency for health expectancies in Europe to converge since the gap between Lithuania and the Netherlands fell by more than four HLY in just 3 years. See attached tables for all figures 2008-20010 by Member State.

 

Better health outcomes for women

In 2010, France and Spain have the longest life expectancy at birth (85.3 years) for women in the European Union and Bulgaria the shortest (77.4 years), a gap of nearly eight years. In 2010 Malta has the highest HLY (71.6 years) for women and the Slovak Republic the lowest (52.1 years), the gap being the same as for men at almost 20 years. However for women in 2010, it is in Bulgaria that the proportion of years lived without disability (HLY/LE) reaches its maximum with 87% of life spent free of activity limitation. This contrasts with the Slovak Republic where women spend the shortest proportion (66%), a difference of 21 points. The results for Bulgaria show that a short life expectancy combined with a low prevalence of activity limitation leads to a large proportion of life expectancy apparently free of disability.

In the short time period 2008-2010, it is again Lithuania that experienced the largest gain in HLY in women (2.4 years), confirming the observation made for men, whilst Finland saw the largest decline (a loss of 1.7 years). As in men, women’s health expectancies show some convergence.

Differences between men and women

Whilst the gap in life expectancy (LE) between men and women is around 6 years (5.9 years) in the European Union in 2009, the gap in HLY is less than one year (0.7 years). Thus the proportion of years lived without disability is 5 percentage points lower for women compared to men (75% vs. 80%).

In 2010, Lithuania has the largest gap in life expectancy (LE) between men and women (10.9 years) and Sweden the smallest (4 years). Lithuania has also the largest gap in HLY (4.6 years) and the Slovak Republic the least (0.2 years). When these two measures are looked at in combination, Portugal has the largest gap in the proportion of years free of disability (HLY/LE) between men and women at almost 9 percentage points and Bulgaria the smallest gap at around about 3 percentage points. But in all European countries women live longer than men and spend a greater proportion of their lives with disabilities. Differences in HLY between men and women are much smaller than differences in life expectancy and in seven cases out of 27 (see figures for 2009), men experience a slightly more HLY than women. This is indeed the case in 2009 for Belgium, Denmark, Italy, the Netherlands, Portugal, Spain and Sweden, a significant number of western European countries.

France, which has the longest female life expectancy in 2009, occupies the 10th place in terms of HLY, illustrating a case where long life does not coincide with a low report of activity limitation. French men occupy respectively the 8th place (out of 27 MS) in terms of life expectancy and 11th place for HLY with respect to 2009 values.