Manifestations neuropsychiatriques des accidents vasculaires cérébraux à Kinshasa

CHAPITRE 6. CONCLUSIONS ET RECOMMANDATIONS

6.1. Conclusions

Les troubles psychiatriques post-AVC sont fréquents parmi les patients hospitalisés à Kinshasa. La prévalence observée dans le cadre de la présente étude s'élevait à 56 % soit un peu plus d'un patient sur deux. Le trouble psychiatrique le plus fréquent est la dépression. Selon que les patients étaient évalués cliniquement (examen clinique neuropsychiatrique) ou à l'aide des échelles SADQ et HADS, la prévalence de la DPAVC s'élevait à 44% ou à 64%. Elle était associée de manière significative à la démence diagnostiquée au Minicog. Le genre, le niveau scolaire, la latéralisation et la localisation des lésions n'étaient pas associés à la dépression post-AVC. Les résultats obtenus dans cette étude suggèrent que le dépistage des troubles cognitifs permet de détecter les patients à risque de présenter un trouble psychiatrique en post-AVC. Ils rappellent la nécessité urgente d'inclure une évaluation neuropsychiatrique systématique lors de la prise en charge des patients victimes d'un accident vasculaire cérébral.

6.2. Recommandations

A l'autorité publique nous recommandons :

ü La mise en place au CNPP et dans les grandes formations médicales publiques des équipes pluridisciplinaires « Stroke Unit » pour une prise en charge plus efficace des patients victimes d'un AVC. Le volet psychopathologique de la maladie jusque là non pris en compte devrait à présent être intégré dans la stratégie des soins.

ü La mise en place d'un registre provincial et national des AVC pouvant permettre des études épidémiologiques et cliniques

ü La mise sur pied d'une campagne d'information et de formation des professionnels de la santé sur les troubles psychiatriques en post-AVC

Aux professionnels de santé nous recommandons :

ü de prêter une attention particulière sur les troubles psychiatriques. Au vu de l'état actuel des connaissances, une prise en charge correcte des patients victimes d'un AVC ne peut se passer d'une évaluation psychiatrique.

ü d'utiliser le Minicog pour dépister les patients déments et ainsi repérer les patients susceptibles de présenter un trouble psychiatrique en vue d'une prise en charge précoce.

ü d'informer, d'éduquer et de conscientiser la population sur les troubles psychiatriques post-AVC.

Aux autorités des Cliniques Universitaires de Kinshasa, du Centre Neuro Psycho Pathologique et du Centre Hospitalier du Mont Amba nous recommandons :

ü d'initier une expérience pilote sur la tenue d'un Registre des AVC reçus dans ces différentes formations médicales

ü de s'engager à faire bénéficier à tout patient atteint d'AVC au sein de ces trois institutions  d'une prise en charge neuropsychiatrique en attendant la mise en place effective d'une « Stroke Unit ».

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