Thiamine Deficiency Neuropathy in a Patient with Malnutrition due to Melancholic Depression.

Introduction: Melancholic depression is a daily clinical reality in psychiatry. It is a therapeutic emergency that can jeopardize life if not promptly and adequately treated. Apart from its high suicidal risk, complications related to the under-nourishment state are to be feared. Case Presentation. A 36-year-old woman was admitted with depressive symptoms, significant weight loss, and total functional impotence. Laboratory investigations revealed severe thiamine (vitamin B1) deficiency. An electromyography confirmed a sensory axonal neuropathy involving all four extremities suggesting a deficiency origin. Discussion. Vitamin and mineral deficiencies have been described in patients with malnutrition resulting from psychiatric illness (anorexia nervosa, eating disorders, severe depression, etc.). Thiamine is an essential cofactor in several biochemical pathways. Its deficiency can lead to neuropsychiatric morbidity. Conclusion: In our case, the rapid weight loss facilitated a cascade of complications related to nutritional deficiencies. Based on our clinical observations and the literature, thiamine deficiency should be considered in the presence of malnutrition and vulnerability, both on an organic and psychiatric level.

Fatal pulmonary embolism in patients on antipsychotics: case series, systematic review and meta-analysis.

Since the 1950 s, several studies have reported that patients using first generation and/or second-generation antipsychotics had increased risk of venous thromboembolism events. These events include deep vein thrombosis and/or pulmonary embolism (PE). However, data about fatal PE in patients on antipsychotics (APs) remain scarce. Thus, the current study aimed to investigate sociodemographic, clinical and pharmacological characteristics related to psychiatric patients on APs and who died from a fatal PE. We reported a case-series, then conducted a literature review of relevant studies and performed a meta-analysis of studies with usable data. The main outcome of the study suggested a significantly high risk of fatal PE in patients using APs compared to nonusers (Odds Ratio=6.68, with 95% confidence interval 1.43-31.11). Clozapine was the most incriminated drug. Low potency first generation APs were the second most exhibited medication. Studies about the topic remain scarce with a high heterogeneity and a high probability of bias. Further studies are needed to ascertain this risk and to establish target preventive measures in this particularly vulnerable population.

[Antipsychotic prescription amongst the elderly].

INTRODUCTION: The treatment of certain psychotic, behavioural and delusional symptoms in the elderly frequently involves the prescription of antipsychotics. Prescribing such drugs to elderly patients has recently been called into question, leaving physicians with little or nothing to treat a range of symptoms that are often complex and difficult to treat. AIMS: The study aimed to evaluate the prescription of antipsychotics amongst elderly and to compare it with data in the literature. METHODS: This retrospective cohort study included patients aged 65 and older admitted to the psychiatric ward of Mahdia University Hospital over the period from 2014 to 2018 who received antipsychotic treatment during their hospitalization. RESULTS: The sample consisted of 44 elderly patients, with 31.8% patients using atypical agents, 34.1% using typical agents, 27.3% received both of them and 6.8% received a long-acting injectable antipsychotic. A majority of the elderly study sample were men (75 %). The mean (SD) age of the study sample was 69.8 years. 61.3% had at least somatic comorbidity. The most common diagnosis was schizophrenia with 31.8%, followed by dementia (27.3%). 34.1% reported adverse effects due to antipsychotic treatment. CONCLUSION: The study findings suggest that there is a need to be cautious when prescribing antipsychotic in the elderly population. Patient education and regular follow-up of patients can be instrumental in minimizing the adverse outcomes associated with the use of antipsychotics in the the aging population.

[Epidemioclinical and legal aspects of sexual abuse among minors in Monastir, Tunisia]. / Aspects épidémiocliniques et suites judiciaires des abus sexuels chez les mineurs à Monastir, Tunisie.

INTRODUCTION: Child sexual abuse is a disturbing reality and a major public health problem. Indeed, it is a subject that has long been treated as taboo, with dramatic consequences on physical and mental health as well as on social wellbeing of the victims. The purpose of this study was to highlight the epidemiological and clinical features as well as the legal aspects of child sexual abuse. METHODS: we conducted a retrospective descriptive study at the psychiatric outpatient service of the University Hospital of Monastir over a period of 12 years and 6 months. All children younger than 18 years diagnosed with suspected or confirmed sexual assault were included. RESULTS: a total of 93 children, victims of sexual abuse were enrolled. The average age of patients was 10 years, with a standard deviation of 3.9 years. Sex-ratio M/F was 0.9. The most common sexual contact was touching (47,3% of cases). The majority of abusers were male (93,5%). In more than half of the cases (53,8%) they were relatives of the child and in 28% of cases intra-familial abuse was reported. Initial psychiatric assessment showed mental disorders in 70% of cases. CONCLUSION: sexual abuse is a very broad field of violence which varies widely in nature and intensity. Although, in some types of sexual abuse occasionally there is a lack of physical traces, the emotional and psychological impact is ubiquitous and characterized by numerous clinical manifestations.

Clinical and genetic influencing factors on clozapine pharmacokinetics in Tunisian schizophrenic patients.

Clozapine (Clz) is an atypical antipsychotic, which its pharmacokinetics can be influenced by several factors. The CYP1A2 and CYP2C19, major enzymes implicated in Clz metabolism, present an interethnic variation on their activity caused by single nucleotide polymorphisms (SNPs). The present study investigated the influence of genetic and nongenetic factors on Clz pharmacokinetics in a southern Mediterranean population. We included adult Tunisian schizophrenic patients having received Clz and undergone a therapeutic drug monitoring (TDM) of Clz by morning C0 monitoring. The genomic DNA was extracted using a salting-out procedure. CYP1A2*1F (rs762551;-163C>A), CYP1A2*1C (rs2069514;-3860 G>A) and CYP 2C19*2 (rs4244285; 681G>A) was analyzed using PCR-RFLP. Fifty-one patients were enrolled in the study. The mutant allele (CYP1A2*1F) was the most frequently detected (58.8%). For CYP1A2*1F, Clz dose-normalized (C0/D ratio) was as high as 1.28 ± 0.37 in CC versus 0.67 ± 0.32 ng mL-1 per mg day-1 in AA group (p < 0.001). The influence of genetic (CYP1A2*1F, CYP1A2*1C and CYP2C19*2) and nongenetic parameters (age, weight, gender, tobacco, coffee, and alcohol consumption) on the variation of the Clz C0/D ratio was investigated. Only the CYP1A2*1 F polymorphism correlates significantly with the Clz C0/D variation and could explain 24% of its variability. Our data support a critical role of the CYP1A2 -163C>A on the variation of Clz exposure in Tunisian schizophrenic patients. Considering its narrow therapeutic range, CYP1A2 genotyping combined with TDM of Clz may improve efficacy and safety of this drug. Further studies are needed to investigate this issue.

Hunger strike in prison: medical, ethical and legal aspects.

BACKGROUND: A hunger strike is a common form of protest in prison and is a potential cause of many types of problems, both for facility administrators and health care staff. Issues of conflict of rights and obligations involved, and how to treat people who are subject, have created major controversies. OBJECTIVES: To identify and review published studies that discuss the medical, ethical and legal considerations of managing a hunger strike in a prison setting from a physician's perspective. METHODS: A database search using "Medline" "Ovid" and "Science Direct was conducted to identify relevant publications. We included case series, guidelines and, review articles. RESULTS: The physician must clearly inform the striker of the risks and provide clinical assessment and regular monitoring of the concerned. The role of the psychiatrist is to detect an initial mental pathology underlying or secondary to fasting and assess the capacity of the striker's judgment. Thus, the clinician is faced with two paradoxical obligations: to assist and respect the striker's will. In addition, medical intervention is possible if the prognosis is life-threatening even without the patient's consent. CONCLUSION: The current practice of non-consensual attitude among hunger-striking seeking in detention needs a closer inquiry. Medical practitioners should be aware of their ethical and legal responsibilities, and that they should act independently of government or institutional interests.

Psychiatric emergencies : Factors associated with suicide attempts.

BACKGROUND: Among psychiatric emergencies, suicide attempt is a frequent reason for consultation. The magnitude of this phenomenon is not only related to its increasing frequency or life-threatening, but also to the psychosocial consequences of suicidal gesture both on the patient and his entourage. OBJECTIVES: To determine the prevalence of suicide attempts in psychiatric emergency department patients and to identify associated factors. METHODS: This is a cross-sectional study carried out in the emergency department of Mahdia University Hospital during a three months period, including consultants for whom a psychiatric opinion was solicited. Regarding statistical analyzes, we studied associations between suicide attempt and sociodemographic, contextual, anamnestic and clinical variables. RESULTS: Forty-four suicidal patients were included, with a prevalence of 0.5% of all emergencies. The patients mean age was 26.6 years with a female predominance (sex ratio = 0.29). Self-induced intoxication was the most widely used method (93.2%). Reactional suicidal attempts accounted for 75%. Many factors were significantly associated with suicide attempts: young age, female gender, secondar y level of education, students, presence of trigger factor, family and personal history of suicide attempt and the provenance of the examination request from a physician. CONCLUSION: This  study highlights  a particular  profile  of patients at  high  risk  of suicide,   a codified action is to begin, including all health care providers to prevent  its  occurrence. This primary prevention is only possible through  the  identification of  risk  factors  associated with it.

Catatonia in patients with dementia: a case report.

Catatonia occurring as part of a clinical picture of dementia has been reported with almost all types of dementia. It remains under-diagnosed in older adults and those with dementia. We review a case of a young patient admitted in our psychiatric department for catatonia and after efficient treatment with Lorazepam, assessment revealed a dementia. Catatonia is a severe neuropsychiatric syndrome with an excellent prognosis if recognized and treated without delay.

Psychiatric disorders in the acoustic neuroma: about a case.

Neurofibromatosis type 2 (NF2) is a rare autosomal dominant disorder characterized by formation of central nervous system tumors. They are associated to significant morbidity due to multiple problems such as hearing loss that can lead to many psychiatric disorders.