The study was carried out at the Moussa DIOP Clinic, psychiatry department of the Fann University Hospital Center, in the Rez de Chaussée Gauche division.

The service is made up of 4 hospitalization divisions located at the Moussa DIOP clinic, including the RCG, the outpatient unit which deals with outpatient monitoring of patients. The “Ker xaléyi” child psychiatry unit, for its part, receives children in consultation and day hospitalization. There is also the integrated care center for addictions.

The RCG division has 18 beds including a large third category room with 4 beds intended exclusively for men and 14 individual rooms.

The main objective of our work was to evaluate the prescription of latest generation neuroleptics in a psychiatric service in Dakar.

Our study brings informations about the use of these drugs in front of the lack of data about the prescription of latest generation neuroleptics.

The secondary objectives were to:

– draw up the socio-demographic profile of patients

– draw up the clinical and therapeutical profile of patients

– determine the use of conventional neuroleptics

– determine the association of classic neuroleptics with latest generation neuroleptics

The best represented age group (the modal class) in our sample of patients was the 25 - 40 years age group

Our sample was mostly made up of men.

Of the 223 cases, for 74 cases the level of education was not specified.

Most of the patients were inactive.

The patients were predominantly single without children.

44.7% of the patients had an average socio-economic level.

Two patients had dyskinesia due to neuroleptics.

Three patients had neurovegetatives disorders as dry mouth troubles, 50 patients had neuroendocrine disorders.

63 patients were smoking.

There was no personal medical history found.

33% of patients were taking Halopéridol, 31% chlorpromazine and 5% under Rispéridone.

The most common diagnostic was schizophrenia.

Five patients had received latest generation neuroleptics.

There were several files that were incomplete. 397 files had been consulted and only 223 retained.

It was also difficult to summon patients for further information.

In our study, the sex ratio was 4.8. This male predominance is an epidemiological constant found in most of the studies carried out [4]. According to some authors, women are much more likely to suffer from “internalized disorders” (affective emotional shock or anxiety) that do not always require a request for help, while men are affected by “externalized disorders” sometimes requiring a request. In emergency [5].

In terms of age groups, subjects between the ages of 26 and 40 represented the majority of study subjects. This distribution is in accordance with certain results from epidemiological studies carried out in Senegal with a prevalence of mental illnesses in this age group [6] [7].

A phenomenon that can be explained according to Meggle [et al.] Reported by Porquet O. by the fact that this age coincides with periods of vulnerability (adolescence and entry into an active life) therefore often confronted with problems of schooling, unemployment, sexuality, drugs [8].

These results should give cause for concern because showing a certain socioeconomic impact, this age group constituting the active force of a population.

The majority of the subjects in our study were single with no children, as other studies of mental illness reach the same conclusions [7] [9]. This large number of single people can be part of the relationship problem of young subjects.

This also testifies to the marginalization of the mentally ill at the origin of their difficulty of socio-professional integration [10].

Regarding the level of study, the presence of subjects who attended only Koranic school is a reflection of our Senegalese society where religious instruction still occupies a large place [11]. The large number of cases limited to primary education is in line with the average level of schooling in Senegal according to the UNICEF report in 2016 [12].

The socio-economic situation is generally average, with a predominance of low-income subjects representing almost half of the 104/223 cases. A study on the economic profiles of patients at CHU Fann in 2014 found similar results [7].

This is explained by the level of economic development, which is disparate and globally low in Senegal with a minimum wage of around $250 for men and a highly developed informal sector with unregulated earnings [13]. While the cost of hospitalization is $8 per day for the large room and $16 per day for the cabins. The length of hospitalization varies between 3 to 4 weeks.

That makes an average total of $168 excluding all drug billing. It should be noted that there are also additional costs related to professional support in the event of the unavailability of an accompanying family member to be at the patient’s bedside day and night. These paid to the accompanying person amount to around $4 per day.

This finding partly explains the difficulties in taking care of patients (non-compliance with treatment), the financial part of which is entirely dependent on families, since social security does not exist.

Psychoses were the most common diagnoses with 142 cases.

Schizophrenia was the most common (75 cases out of 225), in agreement with the results of most of the studies carried out [14] [15] [16].

The study population is predominantly young. Young age is a source of vulnerability for mental illness, especially schizophrenia [17].

Of the 128 patients who had already taken a neuroleptic, 68% or 53% had received conventional neuroleptics in bitherapy (most often Haloperidol and Chlorpromazine). Our results show that classical neuroleptics are still prescribed in more than half of the patients, in bitherapy.

Combinations of classic neuroleptics could find reason in the perpetuation of prescribing habits of the old, or in the many symptoms of schizophrenia, the pathology most found in the study, which may therefore relate to several molecules with different clinical effects.

Eighteen patients or 14% received standard neuroleptics as monotherapy.

Our results show a weak monotherapy not in accordance with the consensus recommendations [18] which encourage it, thus avoiding the many side effects. Could this be due to insufficient results with a single neuroleptic?

Our results show the low prescription of latest generation neuroleptics. Indeed, only 4% had received only latest generation neuroleptics (Risperidone) and 5 patients, or 4%, had received a treatment combining conventional neuroleptics and latest generation neuroleptics.

This could be explained on the one hand by their high cost beyond the reach of low-income families. The average cost of a box of Risperidone is $120, the generic is $50. Lack of income for families is a significant factor that practitioners take into account in their prescriptions. So very often, taking into account the purchasing power, they limit themselves to conventional neuroleptics, to at least ensure that the treatment does not risk being interrupted for financial problems. All these elements are mediated by a quality therapeutic relationship between the psychiatrist, the patient and the family, and a psychoeducation for a good adherence to the treatment.

On the other hand, this would be justified by the difficulties of acquisition in our context. Indeed, atypical neuroleptics are not available in all pharmacies, families with a member living abroad often order them outside the country.