Introduction
In recent years, advances in the areas of both bipolar disorder (BD) and borderline personality disorder (BPD) have generated considerable interest in the relationship between these two ...conditions, since that they are commonly comorbid.
Objectives
We aimed to investigate the impact of BPD on course of illness in patients with BP.
Methods
We conducted a cross-sectional, descriptive and analytical study among 30 psychiatric outpatients diagnosed with BD in the Psychiatry « B » department, Hedi Chaker Hospital (Sfax, Tunisia). The McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) was used to screen for BPD. Clinical outcomes (hospital stays, comorbidities, suicidality…) were compared between BD- patients with or without BPD comorbidity.
Results
The mean age was 41.63 years, with a sex ratio of ½. Among the patients, 2/3 were diagnosed with BD-I, while 1/3 presented a BD-II. Physical comorbidities, comorbid anxious and eating disorders were noted respectively in 36.7%; 16.7% and 43.3% of patients. Suicidal attempts were reported in 46.7% of cases. According to MSI-BPD, a comorbid BPD was noted in 30% of our sample. Patients with BD-II were significantly more likely to present BDP traits (50%) than those with BD-I (20%) (p<0.001). Patients with BPD were significantly more likely to attempt suicide (p=0.033), and to present physical comorbidities (p<0.001) and comorbid eating disorders (p<0.001).
Conclusions
Our study showed that BPD darkens the prognosis of BD, because of worse outcomes related to suicide, physical and psychiatric comorbidities. Thus, its co-occurrence complicates the management of BD.
Disclosure
No significant relationships.
Introduction
Violence against women is now widely recognized as an important public health problem with substantial consequences on mental health, that is why health professionals should be ...identifying, preventing, and responding to violence against women more effectively.
Objectives
To study the prevalence and predictors of anxiety and depression among women victim of domestic violence
Methods
Our study was descriptive and analytical cross-sectional, carried out with women examined in the context of medical expertise, from May until October 2021. An anonymous survey was asked to these ladies. The HADS was used to screen for anxiety and depression
Results
75 responses was collected The age group of 26-35 years represents the highest percentage 44%. 98.7%were victim of verbal violence,94.7% of physical violence, 97.3% of psychological violence and 54.7 % of sexual violence According to the HAD, anxiety was retained in 72% and depression in 56%. Women who filed for divorce developed more depression (p=0.01). Women with a history of infertility were more anxious than others (p=0.025). Anxiety and depression were significately correlated with : the husband alcohol (p=0.01) and cannabis consumption(p=0.015). The ladies victims of sexual violence such as an unusual type of relationship developed more anxiety (p=0.045). An history of aggression during pregnancy was a risk factor of anxiety (p=0.035)
Conclusions
Our work has shown the association between violence against women and anxiety-depressive symptoms. The results of our work inspire us to reflect on and develop actions on the scourge of violence against women in a conjugal environment and its psychological repercussions.
Disclosure
No significant relationships.
Post-ictal psychosis: A case report Turki, M.; Ouali, R.; Ellouze, S. ...
European psychiatry,
04/2021, Letnik:
64, Številka:
S1
Journal Article
Recenzirano
Odprti dostop
Introduction
People suffering from chronic diseases, especially epilepsy, are more likely to suffer from neurobehavioral disorders, like psychotic states. Postictal psychosis (PIP) is one of these ...potentially serious complications, that classically follows exacerbations of seizures.
Objectives
The present paper aimed to study the clinical and therapeutic aspects of PIP.
Methods
We report a case of PIP, which involved a patient hospitalized in psychiatry department, and discuss it in light of the relevant literature.
Results
We report the case of a 27-year-old man, with medical history of generalized epilepsy which was well stabilized under treatment (carbamazepine 600 mg/day). The patient was hospitalized for dangerous behaviors after having experienced 2 episodes of seizure activity in context of poor therapeutic adherence. Psychiatric assessment revealed a psychomotor instability, a pressured speech and hallucinatory behavior. There were no delirium symptoms. Neurological examination showed no localization signs, and cerebral imaging was normal. The patient was treated with benzodiazepines (Diazepam), associated to antipsychotics (Haloperidol). His antiepileptic drug was quickly reintroduced. After 48 hours of treatment, psychiatric symptoms improved. The patient returned to its baseline condition after 7 days.
Conclusions
The short-term prognosis of PPI is often favorable, compared to other psychotic disorders. However, more severe psychiatric disorders can potentially develop in the long-term, raising diagnostic and therapeutic difficulties. Thus, a good collaboration between psychiatrists and neurologists is highly desirable in order to better adapt the treatment.
Disclosure
No significant relationships.
Introduction
Psychiatric symptoms associated with Primary hyperparathyroidism (PHPT) involved several presentations; the most characteristic is depression. However, PHPT remains often overlooked by ...physicians when making differential diagnosis for patients with psychiatric disorders, particularly in the elderly.
Objectives
We proposed to describe the clinical and therapeutic characteristics of major depression secondary to PHPT.
Methods
We report a case of PHPT revealed by depression. Then, we conducted a literature review using “PubMed” database and keywords “primary Hyperparathyroidism”, “depression”.
Results
A 73-year-old man presented with a 3-month history of depressed mood, loss of interest, clinophilia, poor concentration, and weight loss. These symptoms were associated with epigastralgia and constipation not responding to symptomatic treatment. The etiological assessment was normal. The diagnosis of major depression was established, and the patient was treated with Sertraline (25 mg/day). After one month of treatment, somatic and psychiatric symptoms worsened. Physical examination revealed a deteriorated general condition, dehydration, and cardiac arrhythmia. Blood analysis revealed renal failure, hypercalcemia (4.2mmol/L), hypophosphatemia (0.4mmol/L), and increased parathyroid hormone level (180 pg/ml). The patient was hospitalized in intensive care unit. Cervical echography showed 2 hyperparathyroid adenomas, and diagnosis of PHPT was established. Under symptomatic treatment, the patient’s somatic and psychiatric condition improved. An hyperparathyroidectomy is undergone soon.
Conclusions
This case highlighted the importance of considering a primary psychiatric disorder as a diagnosis of exclusion, especially in the elderly. PHPT is one of differential diagnoses for psychiatric symptoms, like depression, whose management is conditioned by that of the somatic disease.
Introduction
Wernicke’s encephalopathy is a potentially fatal neurological emergency caused by thiamine deficiency. Although it is often associated with chronic alcoholism, it can also occur in all ...situations that lead to a thiamine deficiency such as undernutrition and exclusive artificial feeding.
Objectives
In this work, we propose to study the clinical and treatment concerns of Wernicke’s encephalopathy complicating catatonic schizophrenia.
Methods
We retrospectively report the case of a patient who developed a Wernicke’s encephalopathy in the aftermath of catatonic schizophrenia.
Results
Mr H.L, a 47-year-old-male has been followed in psychiatric hospital since the age of 27 for catatonic schizophrenia. He has been hospitalized in July 2020 because of oral intake refusal, social isolation and lack of self-care with a poor compliance to treatment. Examination of the patient revealed catalepsy, mutism and negativism. He was treated with antipsychotics drugs, benzodiazepines and parenteral nutrition. About six weeks after his hospitalization, the patient developed horizontal nystagmus and ataxic gait. Magnetic resonance imaging was consistent with Wernicke encephalopathy. Vitamin B1 dosage was 32nmol/l. Parenteral thiamine replacement therapy was initiated with clinical improvement
Conclusions
Catatonic schizophrenia can be associated with severe malnutrition and thus with thiamine deficiency and Wernicke’s encephalopathy. An early intervention by supplying prophylactic thiamine given parenterally in high-risk patients is crucial to avoid Korsakoff syndrome, as well as cardiovascular and neuropsychiatric complications associated with thiamine deficiency.
Introduction
Infertile males experience considerable psychological distress, with feelings of inadequacy, marginalization, guilt and loss ofself-esteem.
Objectives
Our study aims to investigate the ...impact of male infertility on men’s self-esteem and to study risk factorsfor low self-esteem.
Methods
We conducted a cross sectional, descriptive and analytical study, including 108 infertile men who presented to the laboratory of reproductive biology and the unit of assisted medical procreation of Military Hospital of Tunis between June and September 2019. For each patient, we collected sociodemographic and clinical data. We used Rosenberg scale to assess self-esteem.
Results
The average age of participants was 36.8 years. Eleven patients had a history of varicocele (10.18%) and six of them sufferedfrom associated erectile dysfunction (5.55%). Infertility was primary in most of patients (77.8%) with an average duration of 3.32 years. 25% of patients had at least one previous failed assisted reproductive attempt. Spermogram abnormalities were found in 78.7% of patients. The mean score of Rosenberg scale was 30.68±4.35. Low self-esteem was associated with older age (p=0.006), lower educational level (p=0.019) and longer duration of infertility (p=0.022). Men who had children had better self-esteem (p=0.022). No associations were found between self-esteem and erectile dysfunction or previous failed assisted reproductive technique attempt.
Conclusions
Our results show that infertility reduces men’s self-esteem, especially of patients with lower educational level and longer duration of infertility. Physician dealing with infertility should be aware of these psychosocial aspects and offer help when needed.
Introduction
Elevated prevalence of somatic disorders (SD) in patients with mental diseases is well recognized and studied since latest years. However, their detection remains too late, which darken ...the prognosis of both diseases, and complicate the therapeutic management.
Objectives
We aimed to determine the prevalence of SD in psychiatric inpatients, and to assess relationships between the two diseases.
Methods
We analyzed retrospectively the medical records of 94 male patients hospitalized for the first time in psychiatry “B” department, Hedi Chaker hospital (Sfax, Tunisia), in the period from January 1
st
until December 31
st
, 2019.
Results
The mean age of patients was 36.88 years. Among them, 22.3% used cannabis and 37.2% consumed alcohol. Schizophrenia (41,5%) and bipolar disorders (20.2%) were the most common psychiatric diagnoses. During their hospitalization, at list one SD was noted in 53.2%: cardiovascular diseases 21.3% (electrocardiographic anomalies 19,1%); infections 9.6% and hepatic pathologies 8.5 %. The SD was comorbid with psychiatric disease in 90%, and represented a side effect of psychotropics in 10% of patients with SD. Older Patients were more likely to present SD during hospitalization, without a significant association. Patients with schizophrenia were significantly more likely to present infections (p=0.031). Repolarization disorders are more common in patients with cannabis use (p = 0.006).
Conclusions
Our study pointed the high prevalence of SD in patients with mental illnesses, especially in those with schizophrenia and cannabis use. Thus, the somatic assessment should be a systematic practice to identify patients at risk for somatic complications and ensure timely their transfer to a specialized setting.
Introduction
Compared to specialized care, primary care is considered to be more accessible, less stigmatizing, and more comprehensive since it manages physical ailments along with mental disorders ...(MD). Thus, MD are mainly treated by general practitioners (GP), even though their ability to diagnose and treat these diseases is often considered unsatisfactory.
Objectives
This study aimed to analyze perceptions of GP capacity to manage MD, and to assess the difficulties encountered during this management.
Methods
A cross-sectional web-based survey design was adopted between August 22 and September 23, 2020, so that 47 responses of GP were included.
Results
The mean age of respondents was 37.3 years. Among them, only 17% attended a post-university psychiatric training. On average, 6.3% of GP visits were MD-related. Anxious disorders and depression were perceived as very frequent respectively in 82.9% and 40.4% of cases. Among GP, 17% considered bipolar disorder as a difficult pathology to diagnose, followed by schizophrenia (12.7%), while the pathologies perceived to be most difficult to treat were dementia (17%), acute agitations (14.9%) and schizophrenia (10.6%). Anxiolytics and antidepressants use was very frequent (40.4% and 27.7% respectively), and 34% needed training in antipsychotics prescription. Difficulties encountered during MD management were related to lack of psychiatric continuing education (19.4%) and lack of collaboration with mental health professionals (12.5%). Among participants, 93.6% requested a psychiatric training: theoretical 29.3%, practice exchange 24.7%.
Conclusions
Our study confirmed that MD related visits are common in primary care and highlighted several obstacles in their management. Further continuous education, training,and collaboration between practitioners is required.
Introduction
Over half of patients with mental disorders are seen by primary care physicians. However, as for patients with somatic problems, referral to psychiatrists seems to be sometimes ...necessary.
Objectives
The present study aimed to identify reasons and difficulties perceived by general practitioners (GP) in mental health referrals.
Methods
A cross-sectional web-based survey was conducted between August 22 and September 23, 2020, so that 47 responses of GP were included.
Results
The mean age of respondents was 37.3 years. Their seniority as doctors was 8 years on average. Among them, only 17% attended a post-university psychiatric training. The participants reported that they refer on average 32.5% of patients with mental disorders to psychiatrist: 85.1% to psychiatric hospital, 40.4% to liberal psychiatrists and 21.3% to clinical psychologists. Regarding the reasons for referral to mental healthcare structures, 70.2% of doctors justified their doing so by their insufficient training in mental healthcare; 66% by a need for hospitalization, 57.4% by the presence of delusions, while in 27.7 % of cases, the transfer was carried out at the request of the patient or his family. The difficulties mentioned by GP were patient refusal to consult a psychiatrist (70.2%) and difficulties related to the management delay (44.7%).
Conclusions
Patient and health system factors, as well as physicians experience seem to have important influences on mental health referral. Open communication and ease of consultation with psychiatrists can make the care of patients with mental health problems even more rewarding to the primary care physician.
Introduction
Depression in the elderly represents a major public health problem, due to its high prevalence and its deleterious consequences in terms of morbidity and mortality, in particular by ...suicide.
Objectives
1-Draw up the socio-demographic and clinical profile of elderly patients hospitalized in psychiatry for a major depressive episode 2-Determine the semiological and therapeutic characteristics of depression in the elderly.
Methods
Participants were outpatients of Psychiatry B department in Hedi chaker University Hospital Center in Tunisia, over the age of 65, hospitalized in psychiatry for a major depressive episode, recruted between 2000 and 2015. The data was collected using a pre-established sheet containing socio-demographic information, the clinical and evolutionary characteristics of the depressive episode and the therapeutic data concerning the depressive episode.
Results
30 patients were included in this study with an average age (69 Y) and sex ratio (0.66). More than half (53.3%, 16 patients) had a history of chronic somatic disease. The average length of hospitalization was 26 days. The most frequent reason for hospitalization is sadness of mood (43.3%) with cognitive impairment as the predominant clinical symptomatology (40%). 93.3% of the population received as treatment an antidepressant mainly Fluoxetine (50%).
Conclusions
Depression and its different modes of expression in the elderly is a serious condition with direct effects on quality of life. Early detection is desirable in order to set up appropriate management, and thus prevent the occurrence of complications such as suicide.
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