Risperidone-Induced Leukoneutropenia: Evidence from a Positive Rechallenge and Review of the Literature.

Antipsychotics can cause hematologic disorders, and they can have life-threatening consequences. Risperidone, less commonly associated with hematologic adverse effects, is an atypical antipsychotic medication used to treat conditions such as schizophrenia, bipolar disorder and irritability associated with autism. While risperidone primarily affects the central nervous system, it can have some hematologic adverse effects, although these are relatively rare. It is crucial to note that these side effects are not common, and most people taking risperidone do not experience hematologic disorders. The reporting of such disorders may be more frequent with clozapine compared to other atypical antipsychotics because clozapine treatment necessitates regular hematological monitoring 1.

Effectiveness of an educational program for reducing mental illness stigma targeting family medicine trainees in Tunisia: A quasi-experimental study.

Reducing stigma among mental health and health professionals has been an ultimate priority in many countries worldwide. This study aimed to evaluate the effectiveness of a four-session educational intervention for reducing stigma of mental illness targeting family medicine trainees in Tunisia. A quasi-experimental design was adopted with an intervention group (N = 51) and a control group (N = 56). Pre-intervention data were collected using an online survey. A four-session seminar series was implemented and organized. Post-intervention data were collected immediately after the end of the intervention then 2 months thereafter. Instruments included Attribution Questionnaire (AQ-27), Self-Determination Scale (SDS), Empowerment Scale (ES), and Recovery Scale (RS). Repeated measures analysis of covariance and multiple analysis of covariance tests were carried out. Results revealed that the intervention had moderate effects on the AQ-27 score and on six of its stigma factors including factors of the dangerousness model. The intervention improved SDS score, but not ES or RS scores. Positive effects were observed immediately after the intervention and 2 months thereafter. Regular implementation of educational programs in clinical practice would be beneficial. Developing other anti-stigma methods is needed to address the concepts of recovery and responsibility of patients with mental illness.

Affective temperaments and their relationships with life events in bipolar patients and siblings: a controlled study.

BACKGROUND: Temperamental dysregulation may constitute the link between predisposing genetic factors and affective disorders. AIMS: Evaluate affective temperaments in bipolar patients, healthy siblings and controls, and address the relationship between affective temperaments and recent life events in these groups. METHODS: Sixty bipolar patients, 60 patients' siblings and 60 controls were recruited. Assessment of life events in the last 6 months was performed using the Paykel's interview for recent life events. The Arabic version of Temperament Evaluation of Memphis, Pisa, Paris and San Diego - Auto-questionnaire was used to evaluate affective temperaments. RESULTS: Bipolar patients and siblings showed higher scores in cyclothymic and hyperthymic temperaments compared to controls. There were no significant differences in scores of irritable and anxious temperaments between the three groups.There was a strong relationship between anxious/cyclothymic temperaments and the high number of recent life events in bipolar patients and siblings. Contrary to bipolar patients and siblings, the number of recent life events in controls was not related to any dimension of affective temperament. CONCLUSIONS: Cyclothymic and hyperthymic temperaments were associated with bipolarity in patients and they could be characteristic traits of healthy siblings. Anxious/cyclothymic temperament might at least partially explain the high number of recent life events in bipolar patients and in siblings.

Factors related to treatment compliance in bipolar disorder.

BACKGROUND: Medication non-adherence is a major problem in patients with bipolar disorder as it is associated to poor clinical outcomes with frequent relapses and consequently poor quality of life. The reasons that patients are non adherent with medication are not well understood by clinicians who often consider it as related to the illness itself.    AIMS: To assess sociodemographic, clinical and therapeutic factors related to medication compliance in bipolar disorder. METHODS: A cross-sectional study was conducted at the department of psychiatry of FarhatHached Hospital of Sousse. We included 50 outpatients with bipolar disorder type I or II according to the criteria of the DSM-IV TR. The sociodemographic, clinical and therapeutic data were collected and adherence was evaluated with the Medication Adherence Report Scale (MARS) of Thompson. RESULTS: The mean age of our patients was of 31.9 years. The most frequent diagnosis was the bipolar disorder type I (60 %). Most of the participants were single (n=30; 60%), unemployed and living with their families. Factors associated to medication non-adherence were: young age, addiction, complexity and adverse effects of medications, lack of information about the disease and utility of treatments, low income and type I of bipolar disorder. CONCLUSION: Improving medication compliance strategies in bipolar patients must take into account psycho education of patients about their disease and simplification of prescriptions that must be also well tolerated mainly in young subjects, having addictive behaviors and low income.

[Prevalence of alcoholism in primary care in the governorate of Sousse]. / Prevalence de l'alcoholisme en première ligne dans le gouvernorat de Sousse.

BACKGROUND: The prevalence related to alcohol use disorders in adults is 1.7%. It varies around the world. In Tunisia, as in most Arab and Muslim countries, alcohol consumption is still a taboo and little studied. AIMS: To estimate the prevalence of alcohol abuse and dependence Band to assess associated socio-demographic factors in primary care patients in Sousse governorate. METHOD: It's a descriptive study carried out between June and November 2006. The sample included 30 primary care units in Sousse governorate, chosen by a stratified random method. We used the Composite International Diagnostic Interview (CIDI 2.1) translated and validated in Tunisian dialect. RESULTS: Our sample included 2577 participants. The lifetime prevalence of alcohol abuse and during the last 12 months were 2.8% and 1%. Those of alcohol dependence were respectively 0.7% and 0.3%. Only one case of alcohol abuse was found among women and no cases of dependence have been noticed. For men's, the prevalence of alcohol abuse at the lifetime and during the last 12 months were 12.8 % and 4.5 %. For men's alcohol dependence, prevalence rates were 3% and 1.6 %. Associated factors with abuse or alcohol dependence were studied in men's sample (n=560). Alcohol abuse was more common after multivariate logistic regression in the age group betwen18 and 34 years and in those with a diploma. Alcohol dependence was associated with only high level of education. CONCLUSION: Our study provides further evidence that alcohol abuse and dependence in primary care remain low compared to other international studies and highlights the role of primary care physicians in the screening of these health problems especially among men.

Cultural translation and Tunisian validation of the Drug Attitude Inventory (DAI-30) in outpatients with schizophrenia.

BACKGROUND: Non-adherence to treatment in patients with schizophrenia is associated with increased hospitalization, higher health care costs, and poorer long-term outcomes in terms of relapse rates. It is established that a negative drug attitude was a risk factor for non-adherence in long-term schizophrenia. The scale "Drug Attitude Inventory" is one of the scales designed to assess this concept. It has been translated and validated in different languages. However, its psychometric properties have not yet been studied in our sociocultural context. OBJECTIVES: The aims of this study were to translate into Tunisian Arabic dialect the scale "Drug Attitude Inventory" with 30 dichotomous items (DAI-30) and validate it in Tunisian sociocultural context in patients with schizophrenia. MATERIALS AND METHODS: This study was performed in 234 outpatients with schizophrenia, recruited through a random drawing. These patients are in remission and meet remission criteria proposed by "The Remission in schizophrenia Working Group". We recruited 30 patients for pretest and 204 patients for linguistic validation. Forward and backward translation of the DAI-30 was performed according to the protocol of the "MAPI Research Institute". This final version was submitted to 24 experts and followed by a pretest. Construct validity has been established by performing a principal component analysis factor on a sample of 204 patients. Internal consistency was assessed by Cronbach alpha coefficient and inter-rater reliability was assessed by the use of Intra-Class Correlation coefficient (ICC). For the test-retest reliability evaluation, the "r" Pearson's coefficient was used between the DAI scores obtained in the initial evaluation and those obtained at 15 days. RESULTS: Regarding construct validity, factor analysis revealed seven factors that were responsible for 59.9% of the variance. The study of internal consistency between the 30 items was rated good (α=0.88). The test-retest reliability was satisfactory (r=0.99, p<10(-3)), as well as inter-rater reliability (ICC=0.99). CONCLUSION: In the Tunisian cultural context, the DAI-30 presented seven factors with good consistency and an inter-rater reliability.

Life events and quality of life in female patients with dermatitis artefacta: a comparative study with siblings and controls.

BACKGROUND: If the severity of dermatitis artefacta (DA) is accepted by most authors, few published studies have sought to clarify its etiology and impact. It is in this context that this work aimed to compare Life Events (LE) and quality of life (QoL) scores in patients with DA, in their siblings and in control patients with other chronic dermatological diseases. METHODS: This is a descriptive and comparative cross-sectional study carried out in the dermatology department of Farhat Hached hospital in Sousse, Tunisia. Thirty female patients diagnosed with DA according to DSM-IV criteria were retrospectively recruited. For each patient with DA, one of her sisters, the closest in age, was enrolled in the siblings group. The control group consisted of thirty female patients with other chronic dermatological diseases, matched with DA patients for age and duration of disease progression. Assessment was based on Paykel inventory for LE and on SF-36 for QoL. RESULTS: Compared to both control groups, DA patients reported more LE with more objective negative impact of these events and had a lower score and more often impaired mean global score of QoL. CONCLUSIONS: LE would have a role in the pathogenesis of DA which seems to alter the QoL of patients. These results could help to improve the understanding of DA and incite clinicians to focus not only on the diagnosis and treatment of DA but also on the impact of this disease.

Reliability and validity of the Arizona sexual experiences scale-Arabic version in Tunisian patients with schizophrenia.

BACKGROUND: Sexual dysfunction is frequent in patients with schizophrenia compared to the general population. Screening for this dysfunction seems essential, and a scale such as the Arizona Sexual Experience (ASEX) Scale may help practitioners. The aim of this study was to assess the validity of the Arabic version of the ASEX scale. METHOD: Arabic translation of the ASEX scale was obtained by the "forward/backward translation" method. Adaptations were made after a pre-test including ten outpatients with schizophrenia. For validation, one hundred outpatients with schizophrenia were recruited in the psychiatric department in Sousse (Tunisia) during a period of three months. Internal consistency was assessed by Cronbach alpha coefficient and test-retest was conducted by use of Pearson correlation. For factor analysis, principal components analysis and Varimax rotation were adopted. RESULTS: The study of internal consistency between the 5 Items was found to be good (α=0.82). The test-retest reliability was satisfactory (r=0.92, p<10(-3)). Regarding construct validity, factor analysis revealed one factor that was responsible for 83.7% of the variance. CONCLUSION: This study assessed the reliability and validity of the Arabic version of the ASEX scale. These findings demonstrate the highly acceptable psychometric properties of ASEX in patients with schizophrenia.

Translation into Arabic and validation of the Schedule for the Assessment of Insight-Expanded Version (SAI-E) for use in Tunisia.

BACKGROUND: The Schedule for the Assessment of Insight-Expanded Version (SAI-E) consists of 11 items that encompass: awareness of having a mental illness, ability to rename psychotic phenomena as abnormal, and compliance with treatment. AIMS: To translate into Arabic and validate the Tunisian version of this instrument. METHOD: The Arabic translation of the SAI-E was obtained by the "forward/backward translation" method. Adaptations were made after a pilot study involving 20 outpatients with schizophrenia and after taking account the opinions of 15 experts in psychiatry. For validation, 150 outpatients suffering from schizophrenia were recruited by a random drawing in the psychiatric department in Sousse (Tunisia). For factor analysis, principal components analysis and Varimax rotation were adopted. Convergent validity was assessed by correlating the translated scale with the G12 item (lack of judgment and awareness of the disease) of the positive and Negative Syndrome Scale (PANSS). Internal consistency was assessed by Cronbach alpha coefficient and inter-rater reliability was assessed by the use of intra-class correlation coefficient (ICC). RESULTS: Regarding construct validity, factor analysis revealed three factors that were responsible for 70.2% of the variance. As for concurrent validity, we found a negative correlation between the score of the SAI-E and that of the G12 item of the PANSS (r=- 0.82 and p<10(-3)). The study of internal consistency between the 11 items was found to be good (α=0.82). The test-retest reliability was satisfactory (r=0.8, p<10(-3)), and so was inter-rater reliability (ICC=0.84). CONCLUSION: In the Tunisian cultural context, the SAI-E presented three factors with good consistency and an inter-rater reliability compatible with the insight dimensions that are intended to be evaluated.

High prevalence of Human Herpesvirus 8 in schizophrenic patients.

Many studies have reported an association between Herpes family viruses and an increased risk of schizophrenia, but the role of Human Herpesvirus 8 (HHV8) has never been investigated. This study aimed to assess HHV8 prevalence in schizophrenic patients as well as the possible association between HHV8 infection and schizophrenia clinical features. We consecutively enrolled 108 patients meeting fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria of schizophrenia and 108 age and sex matched controls. Data about a number of demographic characteristics and potential HHV8 risk factors of infection were collected. Standardized psychopathology measures, disease severity and functioning level were obtained using Positive and Negative Syndrome Scale (PANSS), Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Negative Symptoms (SANS), Scale for the Assessment of Positive Symptoms (SAPS), Clinical Global Impressions (CGI) and Global Assessment of functioning (GAF). The presence of anti-HHV8 antibodies was analyzed using an indirect immunofluorescence assay. A higher prevalence of HHV8 infection in schizophrenic patients than in controls was found. Marital status, having children, sexual behavior and risk factors of blood transmission were not associated with HHV8 prevalence. However, among schizophrenic patients, HHV8 prevalence was statically associated with positive symptoms. To our knowledge, this would be the first report of a possible role of HHV8 in the pathogenesis of schizophrenia. To prove this hypothesis, further investigation of HHV8 in schizophrenia with larger samples is needed.

[Prévalence et facteurs associés du panique et des troubles phobiques dans les structures de première ligne]. / Prevalence and associated factors of panic and phobic disorders in primary care.

BACKGROUND: Panic and phobic disorders are the most common anxiety disorders in the general population. They can be a source of suffering, disability and are often complicated by other psychiatric disorders. AIMS: To estimate the prevalence of panic disorder, agoraphobia, social phobia and specific phobia and to assess associated sociodemographic characteristics in primary care patients in Sousse governorate. METHODS: A systematic sample of 1246 adults who presented to 30 different primary care units in Sousse for a medical appointment was recruited in a cross- section epidemiological study. The Composite International Diagnostic Interview (CIDI 2.1) was used to diagnose the concerned anxiety disorders. RESULTS: The lifetime prevalence of panic disorder, agoraphobia, social phobia and specific phobia were respectively 1.3%, 2.5%, 6.2% and 24.6%. The female gender was significantly predominant in social and specific phobia. The young age was found significantly in subjects with social phobia. These anxiety disorders were significantly predominant in rural areas, except for social phobia. All of these disorders have a chronic course with an index of chronicity ranging from 71 to 80%. CONCLUSION: Our study provides further evidence of the high prevalence of anxiety disorders in primary care and highlights the particular need for general physicians to diagnose and treat correctly these disorders.