Use of Clozapine for Borderline Personality Disorder: A Case Report

Patients with borderline personality disorder (BPD) show significant impairment in functioning, particularly in the interpersonal and social domains. Prior reports suggest that clozapine may be effective in the management of BPD. We present the case of a patient with BPD who experienced persistent suicidal ideation and was treated with clozapine at a state psychiatric hospital. After treatment failure with other psychotropic medications, clozapine medication was initiated; not only did suicidal ideation cease, but social and professional functioning also greatly improved to the point of no longer requiring intensive levels of observation or restrictive procedures. Clozapine appears to be efficacious in the management of suicide attempts and self-injurious behavior. Moreover, it appears to be promising as a therapeutic measure for ameliorating the global functioning of patients with severe BPD. Larger, randomized, blinded, and controlled prospective studies are needed to confirm these findings and to determine optimal dosage.

[Attitude of general practitioners faced to schizophrenia]

The chronic character of schizophrenia, the suffering that it generates, its triple social and human economic cost, make of it a major stake of public health. The general practitioners are the first actors in the tracking of onset schizophrenia and the follow-up of this chronic pathology. To study knowledge, the attitudes and the practices of the general practitioners faced to schizophrenia. A descriptive cross-sectional study, using an autoquestionnaire, including 300 general practitioners registered in the table of the order of the Doctors of the area of Large Tunis, exerting in private and public sectors. The rate of answer was 22.6% [68] of general practitioners. The middle age of the participants was 48.1 years [ +/- 8.3]. The sex ratio was 1.6; including 58.8% exerting in the private sector. Meadows the fifth [19.1%] of them knew the exact prevalence of schizophrenia in the general population, whereas 77.9% did not have any idea of the rate of suicide among patients. 76.5% of the doctors estimated that prodromal signs preceded the emergence of schizophrenia. The odd behaviors, hallucinations/delirum and social withdrawal constituted the most evocative symptoms in respectively 80.8%; 79.4% and 64.7%. In case of onset- schizophrenia; 20.5% of the experts thought that it was not necessary to prescribe any treatment and 48.5% were unable to mention the exact drug to be prescribed in case of first episode psychotic. Our results highlight gaps in knowledge and the practical conduits of the general practitioners faced to schizophrenia. Measurements aiming the improvements in education and the sensitizing of the general practitioners are necessary

[Social representations of the psychiatric care in Tunisia]

The progress in the field of the treatment of the mental illnesses is considerable. However, the clinical reality confirms the delay in access to care for numerous patients. This avoidance is due, in big part, to the pejorative representations of the psychiatrics' system care. To assess the social images in the Tunisian population, regarding 3 stereotypes: "insane", "mentally ill" and "depressive". The used instrument is the socio-anthropological questionnaire of the " Mental health in general population: images and realities" survey. The medicinal treatment occupies the first place of the planned care for an "insane" and for the "mentally ill". For the "depressive" and for our self, population would rather use relational support. Also, we notice that the family, in spite of its suffering and of the undergone daily load, is given is a central place in perception of the care for psychiatric pathologies. Finally, an "insane" is not perceived as possibly cured while it is more expected for the "mentally ill" and even more for the "depressive", even without any medical intervention. In the term of our analysis, let us underline the misunderstanding of the available therapeutic possibilities in psychiatry and the necessity of large-scale raising awareness

[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

[ psychiatrist faced to the ordinance on request]

The psychiatrist often receives ordinances on request to inspect the medical files of the patient. Does the response to this request constitutes a violation of the medical secrecy? The texts of law governing the ordinance on request do not oblige the doctor to give an answer and do not expose him to sanctions in case of justifiable refusal. Moreover, the code of ethics, the penal code and the law relating to the personal data protection prohibit the response to an ordinance on, request. Thus, the communication of the medical files, in response to an ordinance on request is a violation of the medical secrecy and exposes the psychiatrist to serious sanctions