Factors Affecting the Management of Somatic Comorbidity in Tunisian Patients with Schizophrenia.

Schizophrenia is often accompanied by somatic comorbidities, which make the management challenge of such patients more difficult. In this study, we proposed to identify the sociodemographic and clinical factors correlating with somatic comorbidities in patients with schizophrenia to facilitate screening and prevention. It was a retrospective descriptive study of 78 schizophrenia patients in clinical remission and followed in outpatient psychiatry. In addition to the acquired records, other data were provided by the clinical and biological examinations performed for each patient. The evaluation of the therapeutic adherence was carried out using the Drug Attitude Inventory (DAI).Seventy-six patients (97.4%) had somatic comorbidities with a mean of 3.83 (± 1.81). This number increased significantly in males, older patients, couples, urban patients, and those receiving a combination therapy. According to a multivariate study, the four predictors of an increased risk of comorbidities were age, use of psychoactive substances, waist size and therapeutic adherence.Our findings focus on somatic comorbidities risk in schizophrenia patients, requiring particular vigilance in their follow-up, and suggest some modifiable clinical factors that might be a preferred target for reducing or preventing the occurrence of such disorders.

The Management of Depressed Patients by the Tunisian General Practitioners: A Critical Trans-sectional Study.

Under-diagnosed and under-treated, depression has a pejorative prognosis. The general practitioners (GP) represent the most often consulted healthcare professionals by depressed patients. The aim was to describe how the Tunisian GPs manage the depressed patients and to note the difficulties they encounter in order to suggest corrective measures. A survey was conducted among 140 GPs in Sfax Governorate. The percentage of the GPs whose responses conformed to the scientific data in at least 67% of the items was 31.4%. Four factors were correlated to a good management of depression: age (p = 0.028), masculine gender (p = 0.016), long career (p = 0.034) and participation to continuous medical education sessions on depression (p = 0.01). Our study revealed inadequacies in the management of depression by the GPs. GPs were invited to sensitizing meetings. A training on depression was assured for the future internship supervisors by the commission of medicine of family in the Faculty of Medicine of Sfax.

A study of the relationship between eating disorders, stress level and selfesteem among medicine students.

BACKGROUND: Stress of the higher studies leads to various disorders, especially eating ones. Such disorders, once present, may influence body image and self-esteem of young students. AIM: to assess the prevalence of eating disorders among a group of Medicine students and to study its links with stress level and selfesteem. METHODS: It was a descriptive and analytic cross-sectional study, including 60 medicine students that were investigated during their revision for the final year exam. The participants had filled the perceived stress scale, the eating attitude test EAT-40 and The Rosenberg self-esteem scale. RESULTS: The eating disorders were found in 11% of the participants. Those had a low to a very low self-esteem in 40% of cases and a high perceived stress level in 36, 4% of cases. The eating disorders were significantlymore frequent among the female students (p=0, 03), the more sedentary (p=0,019), having a low to a very low self-esteem (p=0,032) and a high perceived stress level (p=0,001). CONCLUSION: Our study shows that the prevalence of eating disorders is not negligible among medicine students. Their presence depends on certain personal aspects (physical activities, body image satisfaction) and contextual aspects (period of exams, stress). If existing, they would affect negatively the self-esteem, especially of the girls. These various results pave the way for a multidisciplinary approach to students particularly vulnerable to eating disorders.

[Emotional disorders and inflammatory bowel disease]. / Troubles émotionnels associés aux maladies inflammatoires chroniques de l'intestin.

BACKGROUND: The co-occurrence of emotional disorders (alexithymia, depression and anxiety) and inflammatory bowel disease (IBD) is reported in the literature. There are several possible explanations for this co morbidity. AIM: To evaluate the prevalence of alexithymia, anxiety and depression among patients with IBD and to compare them with a control group of healthy individuals and to discuss the relation between emotional disorders and IBD. METHODS: We built a case - control study of 50 patients with IBD (ulcerative colitis (UC) and Crohn's disease (CD)). The control group compounded 50 subjects without IBD and paired according sex, age, and school level. Alexithymia was assessed with the 20-item version of the Toronto Alexithymia Scale (TAS -20). Participants completed the Hospital Anxiety and Depression Scale (HADS), which is a 14-item self-report scale providing separate subscale scores for anxiety (HADS-A) and depression (HADS-D). RESULTS: Among the group of patients, the rates of anxiety, depression and alexithymia were, respectively, 52%, 44% and 54%. In this group, there were significantly more anxious, depressed, and alexithymic subjects than in the control group (p respectively, 0,007, 0,015 and 0,002). The anxiety and the depression were more frequent among patients who had active disease or symptoms than those in remission (p respectively, 0,011 and 0,035). CONCLUSION: The comorbidity of emotional disorders and IBD seems to be frequent. Therefore, clinicians should look for those disorders in patients with IBD, by using specific scales. The adjunction of emotional disorder treatment, if needed, would allow optimizing the management of MICI.

[Clinical and therapeutic particularities of depression in the elderly]. / Particularités cliniques et thérapeutiques de la dépression chez le sujet âgé.

Depression in older people slightly differs from younger subjects adults. Generally, typical depressive symptoms are overlooked by other symptoms. The most frequent ones are excessive preoccupation with health and complaints about physical symptoms. Anxiety is a common accompaniment of depression in later life. Poor subjective memory or dementia-like and psychotic symptoms are also common in depression in the elderly. The exogenous depression, the most common forms of depression in elderly people, has a little response to antidepressants. The endogenous depression is associated with high risk of suicide. Depression in older people often coexists with physical disorders. The most frequently encountered is Parkinson's disease. Depression could also be one of the side effect of the use of drugs for physical illnesses. The Tricyclic antidepressants (TCAs) are generally too toxic for elderly people and should not be considered as drugs of first choice. Currently, the drugs of choice are the serotonin-selective reuptake inhibitors (SSRIs). They have an antidepressant effect similar to that of (TCAs), but they are less toxic. The antidepressant treatment in the elderly is usually initiated at a low starting dose, ideally no more than half the usually recommended for the adults. For psychotic depression a combination of an antidepressant used in conjunction with antipsychotic drug is more effective than an antidepressant administered alone. The treatment should be continued for six months at least in order to reduce the risk of relapse. Moreover, long-term treatment is recommended because of the high risk of recurrence.

[Sociocultural, clinical and psychological profile of the epileptic consulting in adult psychiatry, relative to 197 cases]. / Profil socioculturel, clinique et psychologique de l'épileptique consultant en psychiatrie adulte, à propos de 197 cas.

BACKGROUND: In the Sfax area and the south of Tunisia, epileptics are not all followed by neurologist. Some are addressed to psychiatrist. This fact raises the question of the motivations of such an orientation. The objectives of our survey were to point out the socio-cultural, clinical and psycho(patho)logical profile of the epileptic consulting in adult psychiatry, in Sfax teaching hospital, and to confront it to literature data coming from the studies dealing with the epileptic treated in neurological wards. METHODS: It was a retrospective survey assesing the epileptic whose first consultation occurred from the 1st January 1999 to 31st December 2003. RESULTS: The studied sample included 197 cases. The sex-ratio (male/female) was 2.18. The rate of generalised seizures was 84.4%. The aetiology was known or presumed to be genetic in 48.2%. Sixty-nine per cent of the epileptics had mental disorders Our results and literature data showed that, compared with the epileptic treated in neurological wards, the consultants in psychiatry had epilepsy treated in a more classical way, more difficult to stabilise and frequently associated with mental disorders. By another way, we point out that in the area of our survey, although a department of neurology does exist, some epileptics without mental disorder are still addressed to psychiatrist, at least up to the period of the survey. CONCLUSION: Anyway, what seems to be more important is that the treatment should have realistic objectives. Psychotherapeutic support is fundamental to help epileptics to lead a decent life.