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.

Comparison of Mineral Contents in Three Different Tobacco Formulations / 生物医学与环境科学（英文）

We identified and quantified a variety of mineral elements in 18 tobacco samples purchased from a Tunisian market. In total, 25 mineral elements have been measured in cigarettes, water pipe tobacco, and smokeless tobacco using inductively coupled plasma-optical emission spectroscopy following microwave-assisted digestion. Statistical analyses were performed using SPSSTM, version 18.0. The lowest concentrations of all studied elements were observed in water pipe tobacco. Significantly higher concentrations of Al, Fe, Mg, Na, Ca, Cr, and Co were found in smokeless tobacco, while cigarettes brands contained the highest concentrations of K, Mn, Ni, Ba, and Sr. There was no significant difference between the mineral contents of local and foreign cigarettes and conventional and light cigarettes. Our findings demonstrated that local smokeless tobacco appears to be the most hazardous tobacco type. The concentration of minerals in light cigarettes was not significantly different from the concentration in conventional cigarettes.

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 of Specific learning disorders in a cohort of children with school failure]

Specific learning disorders [SLD] are poorly known and studied in Tunisia. A National research project on their prevalence was launched recently. Aim of this study was to estimate prevalence of SLD in a cohort of children with school failure. Cross-sectional descriptive study with a population of 287 First and Third grade Primary School students, screened by their teachers as facing learning problems through a systematic screening process based on achievement and behavior. Multidisciplinary assessment consisted in general medical examination, child psychiatry, child neurology, speech therapy and psychology [cognitive]. 180 students have been assessed. Prevalence of SLD over study population was 32%, which gives a general population prevalence 6.4%. Most common SLDs were dyslexia and dyscalculia. Most of children with SLD came from disadvantaged social groups. Despite methodological limitations, this first study on SLD sheds some light on their prevalence in Tunisian students, and opens perspectives for future more focused studies and interventions for their management in Tunisia

[Influence of consanguinity on clinical characteristics and affective disorders frequency in relatives of bipolar I patients]

The genetic transmission of bipolar disorder remained undetermined up to now, partly due to clinical and genetically heterogeneity. In Tunisia, genetic study will profit from the existence of high rates of consanguinity. To determine the rate of consanguinity in bipolar I disorders sample and to compare the clinical characteristics and the frequency of affective disorders in first and second degree relatives of probands with and without consanguinity. One hundred thirty subjects met DSM-IV criteria for a bipolar I disorder were recruited. Available Information was obtained from a structured clinical interview, collateral history and medical records. The family investigation allowed completion of genealogies over three generations. The comparison was based on the clinical characteristics [age of onset, numbers of affective episodes, nature and severity of the last affective episode] and the frequency of affective disorders in first and second degree relatives of probands with and without consanguinity. The rate of consanguinity was estimated to 28, 5%It was higher in patients with family history of affective disorders: 34, 2%versus 20, 4%[p=0, 08]. Bipolar I patients with consanguinity were characterised by a high frequency of affective episodes and a more severe of the last affective episode, but theses differences were not significantly. However, the frequency of affective disorders was significantly increased in first degree relatives of probands with consanguinity: 10, 5%versus 6, 1%[p=0, 01], and in first and second degree relatives of probands with consanguinity: 4, 5%versus 2, 9%[p=0, 02]. The influence of consanguinity on the clinical characteristics and the frequency of affective disorders in first and second degree relatives of bipolar patients is en favour the recessive polygenetic transmission of bipolar disorders

[Validation of a school children addictive behaviors questionnaire]

The aim was to develop and validate an addictive behaviors screening tool in school children

Methodology: A cross sectional study including a self administrated 223 item questionnaire developed in Arabic language. The questionnaire included identification of the student and seven life domains: school, family, addiction, relationships with peers, leisure and well being. risky behaviors and personality traits. N = 854 high school children. of Monastir City

Results: the questionnaire Alpha Cronbach's Coefficient ranged between 0.3 and 0.8. Only items with a coefficient higher than 0.6 were maintained in the final version. The time reliability by using the Bland and Altman method 15 days after the first measure showed a Pearson's coefficient of 0.81. Validity evaluated by principal components analysis led to 3 independent factors consisting respectively in 20, 4 and 3 well correlated items: family, school and risky behaviors

Conclusion: validated version of the questionnaire consisted in 102 items, easy to, read and understand. This version doesn't require much time to be filled in and takes into consideration cultural particularities of the school children of Monastir. It could be considered as an interesting tool for both the assessment and the prevention of addictive behaviors in school