Persistent auditory hallucinations in out-patients with schizophrenia.

Objectives to estimate the prevalence of persistent auditory hallucinations (AHs) in a group of schizophrenic patients, to evaluate their dimensions and to identify their clinical associated factors. Method This was a cross-sectional study carried-on 144 out-patients followed for schizophrenia, according DSM-IV-TR criteria. The assessment was consisted by the collect of epidemiological, clinical and therapeutic data and the use of the Hoffman's auditory hallucinations rating scale (AHRS), and the positive and negative symptoms scale (PANSS). Results The prevalence of persistent AHs (AHRS score ≥ 5) was 40.3%. The mean total score of the AHRS was 10.7±7.8 for all patients and 19.4±7.7 for patients with persistent AHs. The AHs dimensions with higher sub-scores were the number, the influence and the reality of the voices. The PANSS items most related to the AHRS total score were P3 "hallucinatory activity", G1 "somatic concerns", G4 "tension" and the G5 "mannerisms and posture disorders". The clinical associated factors with persistent AHs after multivariate analysis were the absence of tobacco consumption, the hallucinatory onset of disorders, the notion of previous hospitalization and the continuous course. Conclusion Our results support the multidimensionality of AHs and confirm the existence of inter individual differences in the characteristics of these hallucinations. Persistent AHs were associated with poor prognosis, requiring more effective therapeutic strategies.

[Risperidone treatment for polydipsia and severe hyponatremia in a schizophrenic patient]. / Traitement par rispéridone d'une polydipsie avec hyponatrémie sévère chez un patient schizophrène.

We report the case of a patient with undifferentiated schizophrenia since 10 years, who presented a polydipsia and severe hyponatremia. This patient responded well to a combination of an atypical antipsychotic (risperidone 4 mg/day) and a behavioral approach based on fluid restriction.

Correlations between obstetric complications and neurological soft signs in Tunisian patients with schizophrenia.

The objective of this study was to examine the correlations between a history of obstetric complications (OC) and neurological soft signs (NSS) in Tunisian patients with schizophrenia. Forty-six patients were assessed using the Krebs et al. NSS scale. History of OC was obtained from the patients' mothers using the McNeil­Sjöström scale. Although there was no significant difference in NSS between patients with and without OC, there were negative correlations between OC total score and motor coordination and integration sub-scores. These negative correlations suggest that OC could enhance the effects of genetic risk factors for schizophrenia.

Neurological soft signs in euthymic bipolar I patients: A comparative study with healthy siblings and controls.

Neurological Soft Signs (NSS) are endophenotypic markers widely studied in schizophrenia and remain poorly evaluated in bipolar disorder. The aims of this paper were to determine the prevalence and scores of NSS in bipolar I patients, compared to healthy siblings and controls and to explore correlations with socio-demographic and clinical features of patients. This was a case-control study comparing 92 euthymic bipolar I patients, 44 of their healthy siblings and 60 control subjects. The neurological assessment was performed through the NSS scale validated by Krebs et al. (2000). Bipolar I patients were also assessed with the Bech-Rafaelsen Mania Scale (MAS), the Hamilton Depression Rating Scale (HDRS) and the Global Assessment of Functioning (GAF). The raters were not blinded to groups. The prevalence and the total score of NSS were significantly higher in bipolar I patients compared to their healthy siblings and controls. The sibling group had significantly higher NSS prevalence and total score than controls. No correlation was found between NSS total score and socio-demographic and clinical features of patients, except a negative correlation with the school level and the GAF score. In conclusion, bipolar I patients have motor and sensory signs, which are unrelated to their clinical features.

[Seasonal depressive disorder: a controlled study in Tunisian psychiatric sample]. / Les depressions saisonnieres: etude comparative d'une population hospitaliere Tunisienne.

Seasonal affective disorder is considered as a clinical subtype of major depression. The criteria for seasonal pattern has been recently described in the international classification of mental disorders. The aim of this study was to compare the clinical characteristics of patients with major depression and with a seasonal and a non seasonal pattern. The study was conducted at the psychiatric ward at Monastir university hospital. 16 inpatients with major depression and seasonal pattern, diagnosed with DSM-IV criteria, were matched in age, sex and diagnostic sub-type to 32 inpatients with non seasonal mood disorders. Clinical symptoms and short term course during the most recent depressive episode were obtained. The onset of the depression with seasonal pattern was frequently in winter. It was marked by significantly higher rates of anxiety. The patients with seasonal depression had significantly higher rates of dysphoria, atypical vegetative symptomatology and lower rates of psychotic characteristics and suicidal thoughts. No differences were found as to the psychiatric family histories or the age at the first depressive episode. This study could focus of the novel psychiatric entity and may lead to the development of the genetic and neurobiologic research related to seasonal affective disorder.

Compound heterozygosity of novel missense mutations in the gamma-glutamyl-carboxylase gene causes hereditary combined vitamin K-dependent coagulation factor deficiency.

Hereditary combined vitamin K-dependent (VKD) coagulation factor deficiency is an autosomal recessive bleeding disorder associated with defects in either the gamma-carboxylase, which carboxylates VKD proteins to render them active, or the vitamin K epoxide reductase (VKORC1), which supplies the reduced vitamin K cofactor required for carboxylation. Such deficiencies are rare, and we report the fourth case resulting from mutations in the carboxylase gene, identified in a Tunisian girl who exhibited impaired function in hemostatic VKD factors that was not restored by vitamin K administration. Sequence analysis of the proposita did not identify any mutations in the VKORC1 gene but, remarkably, revealed 3 heterozygous mutations in the carboxylase gene that caused the substitutions Asp31Asn, Trp157Arg, and Thr591Lys. None of these mutations have previously been reported. Family analysis showed that Asp31Asn and Thr591Lys were coallelic and maternally transmitted while Trp157Arg was transmitted by the father, and a genomic screen of 100 healthy individuals ruled out frequent polymorphisms. Mutational analysis indicated wild-type activity for the Asp31Asn carboxylase. In contrast, the respective Trp157Arg and Thr591Lys activities were 8% and 0% that of wild-type carboxylase, and their compound heterozygosity can therefore account for functional VKD factor deficiency. The implications for carboxylase mechanism are discussed.