[Clinical and evolutionary characteristics of bipolar disorder according to the polarity of the first episode]

The polarity of the inaugural episode seems to determine the clinical and evolutionary profile of bipolar disorder. To study the clinical and evolutionary characteristics bipolar disorder according to the polarity of the first episode. We undertook a retrospective, descriptive and comparative study including all the patients reached of bipolar disorder I and II [DSM IV TR] who were hospitalized between January 1 2000 and December 31 2006. The minimal duration of follow-up was 4 years. Patients were divided into two groups according to the polarity of the first episode: maniac or hypomaniaque and depressive. The characteristics sociodemographic, clinical, evolutionary and therapeutic were raised and compared between the two groups. The sample was composed of 38 patients [23 men and 15 women]. The first episode was of polarity maniac in 57.89% of cases. This mode of beginning was related to a later polarity preferentially maniac, more often punctuated of characteristics psychotics with a sur representation of the addictives conduits and bipolar disorder of type I an episode index of depressive polarity was associated to more chronic evolution, marked by a stronger recurrence of episodes particularly depressive episodes, with a raised suicidal risk and a high representation of the bipolar disorder II. The clinical and evolutionary profile of the bipolar disorder seems strongly related to the polarity of the first episode. The strategies of prevention must take account of the inaugural polarity

Acute psychosis under efavirenz in a HIV patient

Efavirenz is one of the most prescribed HIV drugs, it can have number of psychiatric adverse effects varying from sleeping disorders to psychotic symptoms. Through a case-report study we tried to evaluate the imputability of an acute psychosis to Efavirenz. Mr. B is 25-year-old, he had hemophilia A, he has been infected by HIV and HVC during one of the transfusion sessions. He'd had Combined therapy, component of Epivir, Zerit and Efavirenz. Three months after Efavirenz's prescription he presented a schizophreniform disorder according to DSM IV criteria. The onset of psychotic manifestations, 3 months after prescription is not in favor of drug's etiology. Neuropsychiatric side effects generally appear rapidly after the first dose and usually decrease during the first four months. Psychotic disorders are generally rare. However those side effects have been reported 03 years after drug introduction. Such information has an impact on drug prescription. In fact, efavirenz had been stopped, although the improvement of CD4 and the difficulty to prove the imputability of psychotic syndrome to efavirenz