Unipolar Mania: A Particular Aspect of Bipolar Disorder in Tunisia

OBJECTIVE: Unipolar mania is a clinical reality in our daily practice. Many authors suggested that bipolar patients can have only manic episodes without depressions. These findings lead us to explore more this particularity. METHODS: We conduct a retrospective, descriptive and comparative study including 173 patients, followed for bipolar disorder type I, according to the Diagnostic and Statistical Manual of Mental Disorders fifth edition criteria, during the period between January 2008 and December 2015. Two groups were identified. The first one was composed of 98 patients who had presented only manic episodes. The second group contained the rest of the sample. Unipolar mania was defined as the presence of three or more manic states without a depressive episode during the period of the study. RESULTS: One hundred seventy three patients were included in the study. The average age of the sample was 43 years old. The first episode was manic in 129 patients (74.6%). The dominant polarity was manic in 90.8% of the cases. Seasonal characteristic and psychotic symptoms were observed in respectively 11.0% and 53.2% of the sample. Rapid cycling evolution was observed among 2.3% of patients. The unipolar manic profile accounted for 56.6% of the population. This result is equivalent to an annual incidence of 8%. Comparing the two groups, we did not find a significant difference concerning the sociodemographic and clinical variables except for the number of suicide attempts (p=0.014). CONCLUSION: Our study shows that unipolar mania is clinical evidence. More studies should be conducted in order to understand its nosological and psychopathological foundations.

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.

[Prevalence and correlates of major depressive episodes in Sousse primary care setting: assessment with Tunisian version of CIDI

Major depression is a mental disorder that is associated with high morbidity and significant mortality. It is common among primary care attenders. Few is known about major depression prevalence and associated factors, which would prevent general practitioners from diagnosing it in primary care centres and treating it adequately. To determine prevalence and correlates of major depressive episodes [MDE] in a representative sample of primary care attenders in the area of Sousse [Tunisia]. A random and representative sample of primary care attenders was obtained by a two-stage sampling procedure. First, 30 primary care centres [20 urban and 10 rural] were selected, with stratification according to residency location. Second, 1246 consenting participants were systematically recruited among those centres attenders. Participants were screened, by trained interviewers, with Tunisian version of " Composite International Diagnostic Interview " CIDI.2.1. After data entry in ishell program, MDE diagnosis was obtained according to ICD-10 criteria. Mean age in our sample was 43.4 +/- 17.62 years, with feminine [70.9%] and urban [67.8%] predominance. MDE was found in 26.4% of participants. Associated factors were female gender, marital statute of widowed or divorced and rural residency. This study provided data about high prevalence of MDE in the area of Sousse primary care centres and its correlated factors