[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

[Prevalence and associated factors of panic and phobic disorders in primary care]

Panic and phobic disorders are the most common anxiety disorders in the general population. They can be a source of suffering, disability and are often complicated by other psychiatric disorders. To estimate the prevalence of panic disorder, agoraphobia, social phobia and specific phobia and to assess associated sociodemographic characteristics in primary care patients in Sousse governorate. A systematic sample of 1246 adults who presented to 30 different primary care units in Sousse for a medical appointment was recruited in a cross- section epidemiological study. The Composite International Diagnostic Interview [CIDI 2.1] was used to diagnose the concerned anxiety disorders. The lifetime prevalence of panic disorder, agoraphobia, social phobia and specific phobia were respectively 1.3%, 2.5%, 6.2% and 24.6%. The female gender was significantly predominant in social and specific phobia. The young age was found significantly in subjects with social phobia. These anxiety disorders were significantly predominant in rural areas, except for social phobia. All of these disorders have a chronic course with an index of chronicity ranging from 71 to 80%. Our study provides further evidence of the high prevalence of anxiety disorders in primary care and highlights the particular need for general physicians to diagnose and treat correctly these disorders

[ physicians' perception of the general practitioner management of mental disorders: Importance, difficulties and perspectives]

Mental disorders are common in general medicine consultation. According to international studies, their prevalence in primary care varies from 34 to 54%. In Tunisia, the general practitioner role, as well as the difficulties that encountered them in the management of these disorders, are little known. The objective of this work was to pull opinions of the general doctors and the psychiatrists concerning the current role of the general doctors, the difficulties that encountered them, as well as the possible solutions in promoting mental disorder management. It was a descriptive investigation carried out in Mars 2008, near 200 doctors [100 general practitioners and 100 psychiatrists]. A questionnaire was drawn up with two parts: the first for collecting the doctors' opinions concerning general practitioner mental disorder management and the strategies of improving it. The second was devoted to the assessment of the collaboration between general practitioners and psychiatrists. The answer's rate was 45.5%. The majority of the general doctors qualified as secondary their role in the mental disorder management and limited to the tracking of patients with mental disorders. This modest implication of the general practitioners in the treatment and the follow-up of patients with mental disorders could be explained by the lack of competence and training recognized by them and also reported by the majority of psychiatrists. Doctors in this investigation have proposed to set up training programs for managing mental diseases and to organize regularly common scientific conferences between general practitioners and psychiatrists in order to improve their collaboration. This investigation has permitted to identify reciprocal expectations of general practitioners and psychiatrists. They both agreed upon the need of a more important implication of the general practitioners in the mental disorder management and the necessity of psychiatrists' involvement in the general practitioners training and information

Personality disorders in a group of psychiatric outpatients: general aspects and cluster B characteristics

Personality disorders are common among patients seeking psychiatric care and often coexist with axis I disorders. Cluster B types are reported as being the most common in those patients. They are often correlated with specific demographic features, higher rates of axis I comorbidity and impaired outcome. This study aimed to describe general and clinical features of personality disorders types in a Tunisian outpatient psychiatric unit and to determine characteristics of cluster B personality types, compared to those of cluster A and C. This study was held in Sousse psychiatric outpatient unit, from January 2000 to December 2004. 148 eases were retrospectively recruited and assessed according to axis I and axis II DSM-IV criteria. Personality disorders prevalence was 6%. 85.1%of patients had at least one current axis I disorder, which mainly consisted of depressive disorder [42.3%]. Cluster B types were the most frequent [54.7%]. Comorbid addictive and somatoform disorders were more frequent in cluster B. Anxiety disorders were more frequent in cluster C and psychotic disorders were more frequent in cluster A. Our results show prevalence and clinical profile of personality disorders in a Tunisian clinical population. Cluster B types were the most frequent and seem to have specific comorbid disorders. This support the idea that patients with cluster B personality types need adapted psychiatric care

[Comorbid personality disorders in major depressive disorder: a comparative study in a 160 Tunisian female inpatients group]

Major Depressive Disorder [MDD] is often comorbid with personality disorders which are known to change its clinical aspects and worsen its outcome. This study aimed to compare clinical and outcome aspects of a female depressed inpatients group according to the existence or not of a comorbid personality disorder. The study was carried in the psychiatry female inpatient unit of Farhat Hached hospital of Sousse. All entrances to the unit from January 1999 to August 2002 were retrospectively reviewed. 160, corresponding to MDD, were selected. Assessment was based on demographic characteristics, medical history, axis I comorbid disorders, clinical aspects of the index episode and outcome characteristics. 77 patients [48.1%] bad personality disorder. Compared to those without comorbid personality disorder, these patients were younger [p<10-4], with higher educational level [p=0.005] and better vocational functioning [p=0.01 8]. They also had an earlier age at onset of their depression [p<10-4], more previous suicide attempts [p=0.012] and more axis I comorbid disorders [p<10-4]. Comorbid personality disorders were correlated to an impaired outcome, with higher rate of relapses [p=0.021], more recurrences [p='0.026], more persistent symptoms [p<10-4] and more suicide attempts [p=0.03 1]