Quetiapine-associated thrombocytopenic purpura in a young man with a first episode schizophrenia.

BACKGROUND: We aimed to contribute to the current limited literature addressing quetiapine-associated thrombocytopenia. We report the case of a young man with a first episode schizophrenia who experienced thrombocytopenic purpura following the administration of quetiapine co-prescribed with valproic acid. CASE REPORT: HA is a 19-year-old single man who had no history of systemic or hematologic diseases and no personal psychiatric history. He presented with psychotic symptoms that have been continuously evolving since ten months. His psychiatrist put him on treatment with 400 mg/day of quetiapine and 1500 mg/day of valproic acid over a three-week titration. Twelve days later, the patient developed a sudden onset of thrombocytopenic purpura without fever, which resolved over two weeks after cessation of both drugs. CONCLUSION: Although uncommon and reversible, thrombocytopenia induced by quetiapine can be life-threatening. Clinicians should carefully follow-up the hematological data when prescribing quetiapine. The unnecessary use of valproic acid should be avoided as a first-line treatment for young people with first-episode schizophrenia.

[Suicidal behaviors in bipolar disorder type 1]. / Les conduites suicidaires dans le trouble bipolaire de type 1.

OBJECTIVES: Bipolar disorder is one of the most common and severe psychiatric conditions. It is frequently complicated by suicidal behaviors, and patients with BD are among those at higher risk of suicide. The aims of our study were to evaluate the predictive factors of suicidal behaviors in patients with BD type 1, through the assessment of their socio-demographic, clinical and evolutionary characteristics as well as to study the implications of the childhood traumas and impulsivity as predictive factors for suicidal behaviors in these patients with bipolar disorder. METHODS: One hundred patients with bipolar disorder type 1were recruited in order to conduct a cross-sectional, analytical and comparative study. The recruitment involved a first group made up of 40 patients suffering from type 1 bipolar disorder with a history of suicidal acts. This group was compared with a second group made up of 60 patients with no history of attempted suicide. We used a pre-established collection sheet for collecting socio-demographic, clinical and therapeutic data. We also used the Childhood Trauma Questionnaire for the assessment of childhood adversities, the Barratt Impulsivity Scale in its eleventh version for the assessment of impulsivity levels and the Global Assessment of Functioning Scale for the evaluation of overall functioning. RESULTS: The suicidal behaviors in patients with bipolar disorder were significantly associated with: female gender (P<0.001), professional instability (P=0.002), family history of BD (P=0.02), family history of other psychiatric disorders (P=0.003), frequency of depressive episodes (P=0.002), shorter remission (P=0.025), more subsyndromal symptoms (P=0.029), sexual abuse dimension (P=0.009), and a high level of impulsivity (P<0.001). The predictive factors for suicidal behaviors in multivariate analysis, after adjusting for the confounding variables were: childhood sexual abuse (P=0.01; adjusted OR 4.5; 95% CI 1.44-14.2), a high level of impulsivity (P=0.002; adjusted OR 6.6; 95% CI 2-20), a higher rate of depressive episodes (P=0.003; adjusted OR 5; 95% CI 1.69-14.2) and more subyndromal symptoms (P=0.007; adjusted OR 5.8; 95% CI 1.63-20). CONCLUSIONS: Suicide prevention is an important mental health subject. It would be imperative to include systematic screening for childhood adversities and adequate management of bipolar disorder and impulsivity.

[Knowledge of breastfeeding among mothers before maternity discharge]. / Niveau de connaissance des mères vis-à-vis de l'allaitement maternel à la sortie de la maternité.

OBJECTIVES: The aim of our study was to assess the knowledge of parturients about breastfeeding and to analyze the factors influencing this level of knowledge. METHODS: It was a prospective, descriptive and analytical, cross-sectional study carried out over a period of six months including 500 parturients who gave birth at the maternity unit of the National Center for Maternity and Neonatalogy of Tunis during the period from July to December 2020. Sociodemographic, obstetrical and breastfeeding related data were collected through individual interviews carried out before leaving the postpartum service using a questionnaire written in Tunisian dialectal Arabic. RESULTS: The average age of the mothers was 31.5 years. Housewives accounted for 73.3 % of cases. Forty-four percent of the women surveyed were first-time mothers. The main source of information was relatives (74.8 %). The prevalence of breastfeeding was 93.8 %. Knowledge about breasfeeding was insufficient in 76.4 % of cases. The level of knowledge was insufficient in particular regarding signs of effective breastfeeding, signs of awakening of the newborn, lactogenesis, and diet of breastfeeding women. Unemployment of the parturient age over 30 and primiparity negatively influenced the knowledge of parturients. CONCLUSION: The level of knowledge of parturients was heterogeneous but generally insufficient. Health education programs on MA targeting subjects most at risk of insufficient knowledge should be put in place in order to improve the knowledge base and hopefully improve the breastfeeding rates.

[Incidence and risk factors of depression after a first coronary acute syndrome: A prospective study among 110 patients]. / Incidence et facteurs de risque de la dépression post syndrome coronarien aigu : étude prospective auprès de 110 patients.

AIM: The purpose of this study was to estimate the incidence of post-acute coronary syndrome (ACS) depression and to identify predictive factors for the onset of this disorder. PATIENTS AND METHODS: We conducted a prospective, multicentric study across four cardiology departments, during the period from June to December 2018. A depressive symptom screening was performed using the Hospital Anxiety and Depression Scale, in-hospital (T0) and on average 42.1±7.9 days after hospital discharge (T1). RESULTS: A total of 110 patients were enrolled with an average age of 57±8.1 years. Sex ratio was 3.78. The incidences of depressive symptomatology at T0 and T1 were respectively 19.1% and 6.2%. Mean and cumulative incidences of depressive symptomatology were respectively 12.7% and 25.5%. According to the univariate analysis, drinking alcohol, overweight and anxiety were associated with the incidence of depressive symptomatology after SCA at T0. In binary logistic regression, drinking alcohol was the independent predictor of the incidence of depression after ACS at T0 with an odds ratio of 4.680 and CI of 95% [1.449; 15,107]; P=0.01. In univariate analysis, drinking alcohol, high risk of hospital mortality, according to the GRACE score, and non performing coronary angiography were statistically associated with the overall incidence of depressive symptomatology. CONCLUSION: Depression screening must be a part of the evaluation of the ACS. A repeated evaluation of depression is also recommended.

[Correlates of psychopathic personality traits in a sample of college students in Tunisia]. / Les corrélats des traits de personnalité psychopathiques dans un échantillon d'étudiants universitaires en Tunisie.

BACKGROUND: Although psychopathy and its predictive factors are well documented in clinical samples, studies in non-clinical populations are relatively rare. We proposed to assess psychopathy traits in a population of Tunisian university students and to analyze their predictive factors. METHOD: This was a cross-sectional study of 516 university students enrolled at three major Tunisian universities (Faculty of Humanities and Social Sciences of Tunis, National Engineering School of Tunis, Faculty of Medicine of Tunis). Participants responded to a survey sheet containing sociodemographic data and the Levenson Self-Report Psychopathy Scale. RESULTS: The students were female in 63.2 % of the cases, with a mean age of 22.7years. The socio-economic level was middle class in 62.4% of the cases. More than one-quarter of students (26.7%) consumed tobacco. The majority of students (81.4%) spent their free time on the Internet, while 11.8% participated in associative work. Psychopathy scores were relatively high (mean LSRPS scores=64.8) with no noticeable gender differences. Psychopathic traits were significantly associated with university (P=0.017), maternal occupational status (P=0.038), and tobacco use (P=0.029). In addition, the total psychopathy score was significantly lower among students sharing activities with their families (P=0.044) and among students participating in associational work (P=0.025). The multivariate multiple regression has retained as predictive factors of psychopathic traits the fact of being the eldest of his siblings and the associative work. CONCLUSION: Prevention strategies should be put in place to prevent psychopathy and its individual and social impacts in young adults in general, and in university students in particular, especially promoting associative activity in the university environment which is currently lacking in our context.

[Assessment of mental states at risk of psychotic transition in a sample of young male prisoners in Tunisia]. / Évaluation des états mentaux à risque de transition psychotique dans un échantillon de jeunes détenus de sexe masculin en Tunisie.

BACKGROUND: Prevalence of psychotic disorders in a prison population is higher than in the general population. Recent research has shown that early intervention is feasible in prison settings, and that approximately 5% of screened prisoners have met ultra-high-risk (UHR) for psychosis criteria. We aimed to identify the prevalence of the UHR states for developing psychosis in a group of newly incarcerated men in the Jendouba Civil Prison and to analyze the association between UHR states and socio-demographic data and substance use. METHOD: We carried-out a cross-sectional study among 120 prisoners. Every prisoner was interviewed using the Comprehensive Assessment of At-Risk Mental States (CAARMS). The Social and Occupational Functioning Assessment Scale (SOFAS) was used to assess the participant's level of functioning. RESULTS: We found a prevalence of subjects meeting the UHR criteria of 21.3%. UHR subjects had significantly more psychiatric family history (P=0.035), personal history of suicide attempt(s) (0.035) and self-injury (P=0.013) compared to non-UHR subjects. Clinical self-evaluation found significantly more depression and anxiety in the UHR group (P=0.020 and P=0.035, respectively). In addition, social and occupational functioning was significantly more impaired in the UHR group (P=0.007). UHR subjects used significantly more cannabis in lifetime (P=0.015) as well as in the past year (P=0.022) and had a significantly higher frequency of cannabis use (P=0.01) compared to non-UHRs. CONCLUSION: Prison mental health teams face the challenge of identifying prisoners who need mental health services and providing early care to this vulnerable group; this challenge may offer a unique opportunity for intervention among a population that might not otherwise have had access to it.

[Distribution of corneal thickness in the Tunisian population: Study by anterior segment optical coherence tomography]. / Distribution de l'épaisseur cornéenne centrale dans la population tunisienne : étude par tomographie en cohérence optique du segment antérieur.

GOALS: To describe the distribution of the central corneal thickness (CCT) in the Tunisian population. METHODS: A prospective descriptive study was performed in 201 right eyes of 201 randomly selected healthy Tunisian subjects without glaucoma. We measured the spherical error by autorefraction, the axial length using A-scan ultrasound biometry and the central corneal thickness using anterior segment optical coherence tomography (DRI TRITON OCT). RESULTS: We examined 201 eyes. The mean age was 47±13.5 years (18 to 77 years). The M/F sex ratio was at 0.46 (137 women and 64 men). The mean CCT was 508,1µm (standard deviation 31,5µm) and ranged from 440 to 600µm. In our population 43.8% had a CCT less than 500µm, and 89.1% had a CCT less than 550µm. No statistically significant correlation was observed between CCT and age, sex, spherical error or axial length. CONCLUSION: Central corneal thickness in the Caucasian Tunisian population is less than CCT in the European and Asian populations. CCT is independent of age, sex, spherical error or axial length. These results must be confirmed by larger multicentric studies.

[Anatomo-functional study in branch retinal vein occlusion using Swept Source Optical Coherence Tomography Angiography]. / Occlusion de branche veineuse rétinienne : analyse anatomo-fonctionnelle par Swept Source Optical Coherence Tomography Angiographie (OCT-Angiographie).

INTRODUCTION: The purpose of our study was to describe the microvascular abnormalities on OCT-angiography in eyes with branch retinal vein occlusion (BRVO), to measure the surface of the foveal avascular zone (FAZ) and the capillary density, and to establish anatomic-functional correlations. METHODS: We conducted an observational prospective study in the ophthalmology department of Habib Thameur Hospital in Tunis, which included 17 eyes of patients with unilateral BRVO. We studied the microvascular abnormalities and areas of capillary non-perfusion in the deep and superficial capillary plexuses (DCP, SCP). The area of the FAZ was measured in the SCP and correlated to visual acuity. The foveal and parafoveal capillary density was measured with flow quantification software. RESULTS: The mean patient age was 57.94 ±18.04 years. Male:female ratio was approximately 1. Fourteen eyes (82.4%) showed cystoid macular edema which was significantly correlated to poor visual acuity (P=0.02). Vascular congestion was present in 12 eyes (70.60%) in the DCP and 8 eyes (47.1%) in the SCP. Intraretinal loops were found in 5 eyes (29.4%) in the DCP and 8 eyes (47.1%) in the SCP. Thirteen eyes (76.5%) exhibited vascular tortuosity in the DCP, and 14 eyes (82.4%) in the SCP. Areas of capillary non-perfusion were observed in 12 eyes (70.60%). The mean area of the FAZ was 617.53±525.75µ in eyes with BRVO. Enlargement of the FAZ was correlated to visual loss (P=0.01). Mean foveal capillary density was 15.49% (±5.18%), and mean peripheral capillary density was 44% (±4.75%). There was no correlation between vascular density and visual acuity in our series. CONCLUSIONS: OCT-angiography is part of the current diagnostic workup for RVO. It has a relevant role in establishing a prognosis by studying the area of the FAZ and the capillary density.

[Impact of duration of untreated psychosis on quality of life and cognitive functions]. / Impact de la durée de psychose non traitée sur la qualité de vie et les fonctions cognitives.

OBJECTIVES: The duration of untreated psychosis is defined as the interval between the first psychotic symptoms and the first starting treatment. The duration of untreated psychosis is highly variable but often prolonged and may be influenced by several factors. Some studies suggested that duration of untreated psychosis is associated with poor outcome. The objectives of this study were to assess the duration of untreated psychosis in a Tunisian cohort and its impact on the quality of life and the cognitive functions of schizophrenic patients at 2 years. METHODS: We conducted a cross sectional study at Razi Hospital between January 2014 and June 2014 that included patients with Schizophrenia diagnosis as defined in the DSMIV-TR with regular monitoring for at least 2 years. Eligible participants are those who had been hospitalized for the first time, between January 2011 and December 2012 for a first psychotic episode. Data were collected from medical records and by interviewing the patients and their family. Duration of untreated psychosis was determined using the Symptom Onset in Schizophrenia Inventory. The quality of life was assessed by the 'Short Form-36 Health Survey' scale in its Arabic version. All patients were evaluated with 'The Tunisian Cognitive Battery' composed of 7 tests. Patient scores are expressed as 'Z scores', which represents the position of the scores in a term of standard deviation from the mean of healthy subjects established by the authors of the battery. We divided the population into two groups based on the duration of untreated psychosis median. A short duration of untreated psychosis was lower than the median, and a long duration of untreated psychosis was equal to or greater than the median. RESULTS: Our sample involved 42 patients with a mean age of 31.38 years. The average duration of untreated psychosis was 75.38 weeks with a range from 2 to 364 weeks and a median duration of 47.5 weeks. Patients with a short duration of untreated psychosis had a better quality of life with better scores for the majority of the dimensions and a significant difference in the limitations score due to the mental state (P=0.01). For cognitive function, the short duration of untreated psychosis was significantly correlated with a free recall of 'Hopkins Verbal Learning Test'. CONCLUSION: Our study suggest that the average duration of untreated psychosis in Tunisia is comparable to the one reported in the literature and that a short duration of untreated psychosis is correlated with better outcomes in terms of quality of life and verbal learning.

[Psychological distress and caregiving burden among spouses of women with breast cancer]. / Niveau de détresse psychologique et de fardeau perçu chez les conjoints de femmes atteintes d'un cancer du sein.

Breast cancer is a chronic disease that affects both patients and their caregivers. Spouses, in particular, will generally assume the role of primary caregiver and experience significant physical, social, economic and emotional stress. In the face of cancer, being the spouse of a patient is synonymous with unmet psychosocial needs and a new role assignment, that of a primary caregiver. In addition, cancer confronts spouses with fear of partner loss. This leads to a set of adverse consequences such as depression, anxiety, uncertainty, stress, etc. Several studies have shown that breast cancer reduces the quality of life of patients' spouses and increases their emotional distress, their psychosocial needs, and their responsibilities within the family. Spouses may live a complex powerful emotional experience, which is equal to or greater than that experienced by patients during the diagnosis and treatment process. These multiple solicitations contribute to the heavy symptom burden. Therefore, in the context of breast cancer, identifying vulnerable spouses and providing them with appropriate support would help ensure better adherence to the care of their wives at different stages of the disease.