[Factors related to treatment compliance in bipolar disorder]

Background: Medication non-adherence is a major problem in patients with bipolar disorder as it is associated to poor clinical outcomes with frequent relapses and consequently poor quality of life. The reasons that patients are non adherent with medication are not well understood by clinicians who often consider it as related to the illness itself

Aims: To assess sociodemographic, clinical and therapeutic factors related to medication compliance in bipolar disorder

Methods: A cross-sectional study was conducted at the department of psychiatry of FarhatHached Hospital of Sousse. We included 50 outpatients with bipolar disorder type I or II according to the criteria of the DSM-IV TR. The sociodemographic, clinical and therapeutic data were collected and adherence was evaluated with the Medication Adherence Report Scale [MARS] of Thompson

Results: The mean age of our patients was of 31.9 years. The most frequent diagnosis was the bipolar disorder type I [60 %]. Most of the participants were single [n=30; 60%], unemployed and living with their families. Factors associated to medication non-adherence were: young age, addiction, complexity and adverse effects of medications, lack of information about the disease and utility of treatments, low income and type I of bipolar disorder

Conclusion: Improving medication compliance strategies in bipolar patients must take into account psycho education of patients about their disease and simplification of prescriptions that must be also well tolerated mainly in young subjects, having addictive behaviors and low income

[Prevalence of alcoholism in primary care in the governorate of Sousse]

Background: The prevalence related to alcohol use disorders in adults is 1.7%. It varies around the world. In Tunisia, as in most Arab and Muslim countries, alcohol consumption is still a taboo and little studied

Aims:To estimate the prevalence of alcohol abuse and dependence and to assess associated socio-demographic factors in primary care patients in Sousse governorate

Method: It's a descriptive study carried out between June and November 2006. The sample included 30 primary care units in Sousse governorate, chosen by a stratified random method. We used the Composite International Diagnostic Interview [CIDI 2.1] translated and validated in Tunisian dialect

Results: Our sample included 2577 participants. The lifetime prevalence of alcohol abuse and during the last 12 months were 2.8% and 1%. Those of alcohol dependence were respectively 0.7% and 0.3%. Only one case of alcohol abuse was found among women and no cases of dependence have been noticed. For men's, the prevalence of alcohol abuse at the lifetime and during the last 12 months were 12.8% and 4.5%. For men's alcohol dependence, prevalence rates were 3% and 1.6%. Associated factors with abuse or alcohol dependence were studied in men's sample [n=560]. Alcohol abuse was more common after multivariate logistic regression in the age group betwen18 and 34 years and in those with a diploma. Alcohol dependence was associated with only high level of education

Conclusion: Our study provides further evidence that alcohol abuse and dependence in primary care remain low compared to other international studies and highlights the role of primary care physicians in the screening of these health problems especially among men

[Effects of tobacco on antipsychotic treatments and their extrapyramidal symptoms in schizophrenia]

The prevalence of cigarette smoking is significantly higher among patients with schizophrenia than in the general population. Several authors explained this excess of smoking by the self-medication hypothesis. It suggests that patients with schizophrenia smoke to reduce psychotic symptoms or antipsychotic side effects. In this study, we aimed to evaluate the prevalence of tobacco consumption in patients with schizophrenia and to test if smoking reduces psychotic and extra-pyramidal symptoms. We included 115 patients with schizophrenia [DSM IV] treated with conventional antipsychotics. We assessed psychotic symptoms with the Positive and Negative Syndrome Scale [PANSS] and extrapyramidal symptoms with the Simpson-Angus scale. Prevalence of smoking was 60% [80% in men and 22.5% in women]. The majority of them started their consumption before their illness. Smokers and non-smokers had similar rates of psychotic and extrapyramidal symptoms with comparable doses of antipsychotics and anticholinergic agents which were prescribed for similar durations. In this study, patients with schizophrenia smoke a lot for reasons other than reducing psychotic or extrapyramidal symptoms

[Effectiveness of acupuncture in treating schizophrenia: a clinical randomised trial about 31 patients]

Acupuncture is one of the most popular types of complementary/alternative medicine in the world. It is sometimes used as a treatment for schizophrenia mainly in China. To assess the contribution of acupuncture in the treatment of patients treated for schizophrenia in Tunisian population. Our study is a clinical randomized trial about 31 hospitalized patients with schizophrenia or schizo-affectif disorder [DSM IV]. They were evaluated by the Positive and Negative Syndrome Scale [PANSS], the Scale for the Assessment of Negative Symptoms [SANS] and the Scale for the Assessment of Positive Symptoms [SAPS] the first and 23rd day of the study. Manual acupuncture was used for 10 sessions at the rate of three sessions per week. All patients were under drug therapy. Among them, 15 were treated by acupuncture and 16 by sham acupuncture. Scores of the PANSS, SAPS and SANS were similar in the two groups at the end of the study. Our study did not provide any evidence for the effectiveness of acupuncture in treating schizophrenic symptoms