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.

[Association of Cushing syndrome and anti-phospholipid syndrome: about one case]

Cushing syndrome is a pro-thrombotic state that contributes to an increase in mortality. The antiphospholipid syndrome is characterized by repetitive thrombosis associated with the presence of autoantibodies against phospholipids or membrane proteins. Their association has not yet been described. We report the case of a 47 year old patient in whom the hormonal exploration of an adrenal incidentaloma led to the diagnosis of Cushing syndrome. He returned five years later with cerebral thrombophlebitis, bilateral lower limbs phlebitis and bilateral pulmonary emboli. An antiphospholipid syndrome was confirmed by positive anti-cardiolipin and anti-beta2 glycoproteine-I antibodies. The patient recovered after anti-coagulant treatment and resection of the adrenal adenoma. Thrombo-embolic complications during Cushing syndrome, especially when severe and extensive, must lead to the search for another acquired thrombotic condition, especially the antiphospholipid syndrome