L'auteur revoit la documentation abordant l'influence des facteurs sexuels sur l'efficacité des traitements les plus couramment utilisés en psychiatrie. Il propose d'optimaliser l'efficacité et la tolérance des thérapies en tenant compte du sexe du patient.
Méthode:
Une vue d'ensemble aborde successivement les traitements pharmacologiques, psychothérapeutiques et autres (psychochirurgie, électroconvulsivothérapie (ECT). Des conclusions intermédiaires sont tirées pour chaque chapitre.
Résultats:
Les publications sur le sujet sont rares et inégales. D'un point de vue pharmacologique, les différences intersexuelles sont marquées et touchent tant l'absorption, la distribution, le métabolisme, que l'excrétion des substances. Il en résulte des variations dans la biodisponibilité qui ont des répercussions sur l'efficacité et les effets secondaires; celles-ci touchent les antidépresseurs, les neuroleptiques, le lithium, et aussi les hypnotiques, sédatifs et anxiolytiques. Le cycle menstruel et la prise de contraceptifs oraux sont à l'origine d'interactions significatives. L'influence de l'effet sexospéciflque sur l'efficacité des psychothérapies a été peu étudiée. Certaines différences semblent toutefois possibles, mais un effort de recherche important devra être consenti avant de pouvoir tirer des conclusions reproductibles. Certains types de traitement «physiques», tels la psychochirurgie et l'ECT, semblent peu influencés par le sexe du patient.
Conclusions:
Il existe une influence certaine du sexe du patient sur l'efficacité du traitement qui lui est administré. Cette influence est toutefois souvent limitée, mais elle entre en ligne de compte dans l 'optimalisation de la réponse et de la tolérance à la thérapie. La recherche dans ce domaine de la psychiatrie devrait être encouragée.
GodfroidIO. Vers une psychiatrie de la femme. Rev Fr Gynécol Obstét1997; 92: 157–8.
2.
GodfroidIO. La psychiatrie de la femme. I. Les affections psychiatriques spécifiques au sexe féminin. Rev Fr Gynécol Obstét1997; 92: 159–69.
3.
GodfroidIO. La psychiatrie de la femme. II. Les affections psychiatriques de fréquence plus élevée chez la femme: Hypothèse de l'organisation cérébrale. Rev Fr Gynécol Obstét1997; 92: 229–39.
4.
GodfroidIO. A propos des affections psychiatriques spécifiques au sexe masculin. Encéphale1998; 24: 69–70.
5.
YonkersKAChantilisSJ. Recognition of depression in obstetric/gynecology practices. Am J Obstet Gynecol1995; 173: 632–8.
6.
ZlotnickCSheaMTPilkonisPAElkinIRyanC. Gender, type of treatment, dysfunctional attitudes, social support, life events, and depressive symptoms over naturalistic follow-up. Am J Psychiatry1996; 153: 1021–7.
7.
PajerK. New strategies in the treatment of depression in women. J Clin Psychiatry1995;56(suppl 2):30–7.
8.
DavidsonJPeltonS. Forms of atypical depression and their response to antidepressant drugs. Psychiatr Res1986; 17: 87–95.
9.
FrankECarpenterLLKupferDJ. Sex differences in recurrent depression: Are there any that are significant?Am J Psychiatry1988; 145: 41–5.
10.
Lewis-HallF. Gender differences in psychotropic medications. Mount Sin J Med1996; 63: 326–9.
11.
PreskornSHMacDS. Plasma level of amitriptyline: Effect for age and sex. J Clin Psychiatry1985; 46: 276–7.
12.
GeurtsTBPGoorissenEMSitsenJMA. Summary of drug interactions with oral contraceptives. New York: Parthenon Publishing; 1993.
13.
KendallDAStancelGMEnnaSJ. The influence of sex-hormones on antidepressant-induced alterations in neurotransmitter receptor binding. J Neurosci1982; 2: 354–60.
14.
AbernethyDRGreenblattDJShaderRI. Imipramine disposition in users of oral contraceptives steroids. Clin Pharmacol Ther1984; 35: 792–7.
15.
EdelbroekPMZitmanFGvan der KleinKnoppert EAMVan PuttenPMDe WolffFA. Therapeutic drug monitoring of amitriptyline: Impact of age, smoking and oral contraceptives on drug and metabolic levels in bulimic women. Clin Chim Acta1987; 165: 177–87.
16.
HartterSWetzelHHammesEHiemkeC. Inibition of antidepressant demethylation and hydroxylation by fluvoxamine in depressed patients. Psychopharmacol1993; 110:302–8.
17.
PreskornSH. Clinically relevant pharmacology of selective serotonin reuptake inhibitors. An overview with emphasis on pharmacokinetics and effects on oxidative drug metabolism. Clin Pharmacokinet1997; 32Suppl 1: 1–21.
18.
KlamerusKJParkerVDRudolphRLDerivanATChiangST. Effets of age and gender on venlafaxine and O-desmethylvenlafaxine pharmacokinetics. Pharmacotherapy1996; 16: 915–23.
19.
YonkersKAKandoJCColeJOBlumenthalS. Gender differences in pharmacokinetics and pharmacodynamics of psychotropic medication. Am J Psychiatry1992; 149: 587–95.
20.
PriestR. Therapy-resistant depression. Int Clin Psychopharmacol1993; 7: 201–2.
21.
ChouinardGAnnableI. Pimozide in the treatment of newly schizophrenic patients. Psychopharmacol1982; 76: 13–9.
22.
SeemanM. Gender differences in schizophrenia. Can J Psychiatry1982; 27: 108–11.
23.
JesteDVLindamerLAEvansJLacroJP. Relationship of ethnicity and gender to schizoprenia and pharmacology of neuroleptics. Psychopharmacol Bull1996; 32:243–51.
24.
SeemanMV. Interaction of sex, age and neuroleptic dose. Compr Psychiatry1983; 24: 125–8.
25.
NicoleL. Schizophrénie: Différences selon le sexe. Rev Can Psychiatrie1992; 37: 116–20.
26.
VilleneuveALanglierPBedardP. Estrogens, dopamine and dyskinesias. Can Psychiatr Assoc J1978; 23: 68–70.
27.
SalokangasRKR. Gender and the use of neuroleptics in schizophrenia. Further testing the oestrogen hypothesis. Schizophr Res1995; 16: 7–16.
28.
LiebermanJASaffermanAZPollackSSzymanskiSJohnsCHowardA, et autres. Clinical effects of clozapine in chronic schizophrenia: Response to treatment and predictor of outcome. Am J Psychiatry1994; 151: 1744–52.
29.
JannMWLiuHCWeiFCLinSKLinSKHuWH et autres. Gender differences in plasma clozapine levels and its metabolites in schizophrenic patients. Hum Psychopharmacol1997; 12: 489–95.
30.
LindströmEErikssonBHelldrenAVon KnorringLEberhardG. Efficacy and safety of risperidone in the long-term treatment of patients with schizophrenia. Clin Ther1995; 17: 402–12.
31.
MaderSRMeibachRC. Risperidone in the treatment of schizophrenia. Am J Psychiatry1994; 151: 825–35.
32.
WongSLCaoGMackRJGrannemanGR. Pharmacokinetics of sertindole in healthy young and elderly male and female subjects. Clin Pharmacol Ther1997; 62: 157–64.
33.
YassarRJesteDV. Gender differences in tardive dyskinesia: A critical review of the literature. Schizophr Bull1992; 18: 701–15.
AbemethyDRGreenblattDJDivollMArendtROchsHRShaderRI. Impairment of diazepam by low-dose estrogen-containing oral-contraceptive steroids. N Engl J Med1982; 306: 791–2.
36.
GilesHGSellersEMNaranjoCAFreckerRCGreenblattDJ. Disposition of intravenous diazepam in young men and women. Eur J Clin Pharmacol1981; 20: 207–13.
ConradCDHamiltonJA. Recurrent premenstrual decline in serum lithium concentration. J Am Acad Child Psychiatry1986; 26: 852–3.
39.
ChamberlainSHahnPMCassanPReidRL. Effect of menstrual cycle phase and oral contraceptive use on serum lithium levels after a loading dose of lithium in normal women. Am J Psychiatry1990; 147: 907–9.
40.
ShusterEA. Epilepsy in women. Mayo Clin Proc1996; 71: 991–9.
41.
GodfroidIO. Placebo I. L'effet placebo: Une gifle à la science?Ann Méd Psychol1997; 155: 436–43.
42.
GodfroidIO. Placebo II. Psychiagénie et hypothèse de l'organisation cérébrale. Ann Méd Psychol1998; 156: 108–14.
43.
ZeldowPB. Sex differences in psychiatric evaluation and treatment. Arch Gen Psychiatry1978; 35: 89–93.
44.
BrownLS. Gender-role analysis: A neglected component of psychological assessment. Psychotherapy1986; 23: 243–8.
45.
SchaverienJ. Desire and the female analyst. J Analyt Psychol1996; 41:261–87.
46.
KirshnerLAHauserSTGenackA. Effects of gender on short-term therapy. Psychother Theory Res Pract1978; 15: 158–67.
47.
KrawitzRWatsonC. Gender, race and poverty: Bringing the sociopolitical into psychotherapy. Aust N Z J Psychiatry1997; 31: 474–9.
48.
ZerbeKJ. Feminist psychodynamic psychotherapy of eating disorders. Theoretic integration informing clinical practice. Psychiatr Clin North Am1996; 19: 811–27.
49.
ThaseMEReynoldsCFFrankESimonsADMcGearyJFasiczkaAL, et autres. Do depressed men and women respond similarly to cognitive behavior therapy?Am J Psychiatry1994; 151: 500–5.
50.
Nolen-HoeksemaS. Sex differences in unipolar depression: Evidence and theory. Psychol Bull1987; 101: 259–82.
51.
AngstJDobler-MikolaA. The Zurich Study: A prospective epidemiological study of depressive, neurotic, and psychosomatic symptoms, IV: Recurrent and nonrecurrent depression. Eur Arch Psychiatry Neurol Sci1985; 234: 408–16.
52.
HogartyGEGreenwaldDUlrichRFKornblithSJDiBarryALCooleyS, et autres. Three-year trials of personal therapy among schizophrenic patients living with or independent of family, II: Effects on adjustment of patients. Am J Psychiatry1997; 154: 1514–24.
53.
WeiszJRWeissBHanSSGrangerDAMortonT. Effects of psychotherapy with children and adolescents revisited: A meta-analysis of treatment outcome studies. Psychol Bull1995; 117: 450–68.
54.
HodgkissADMaliziaALBartlettJRBridgesPK. Outcome after the psychosurgical operation of stereotactic subcaudate tractotomy, 1979–1991. J Neuropsychiatry Clin Neurosci1995; 7: 230–4.
55.
CosgroveGRRauchSL. Psychosurgery. Neurosurg Clin N Am1995; 6: 167–76.
56.
HayPSachdevPCummingSSmithJSLeeTKitchenerP et autres. Treatment of obsessive-compulsive disorder by psychosurgery. Acta Psychiatr Scand1993; 87: 197–207.
57.
BaerLRauchSLBallantineHTJrMartuzaRCosgroveRCasernE, et autres. Cingulotomy for intractable obsessive-compulsive disorder. Prospective long-term follow-up of 18 patients. Arch Gen Psychiatry1995; 52: 384–92.
58.
Wirz-JusticeAGrawPKrauchiKGisinBJochumAArendtJ et autres. Light therapy in seasonal affective disorder is independant of time of day or circadian phase. Arch Gen Psychiatry1993; 50: 929–37.
59.
ThompsonJWWeinerRDMyersCP. Use of ECT in the United States in 1975, 1980, and 1986. Am J Psychiatry1994; 151: 1657–61.
60.
CoffeyCELuckeJWeinerRDKrystalADAqueM. Seizure threshold in electroconvulsive therapy: I. Initial seizure threshold. Biol Psychiatry1995; 37: 713–20.
61.
CoffeyCELuckeJWeinerRDKrystalADAqueM. Seizure threshold in electroconvulsive therapy (ECT) II. The anticonvulsant effect of ECT. Biol Psychiatry1995; 37: 777–88.
