[Resistance to sectorisation: example of the governorate of Nabeul in Tunisia]

Sectorisation was introduced in Tunisia in 1999. The objective of this study was to examine the difficulties and resistance to the sectorisation of psychiatric care in the state of Nabeul. A transversal study was conducted over a period of 5 months from 1 November 2014 to 31 March 2015 on 96 patients resident in the state of Nabeul and treated at Razi hospital. Patients were aged between 18 and 69 years old [ sex ratio equal to one], 55.2% were single and 46% had a low socio-economic level [n=44]. Chronic psychotic disorder was diagnosed in 64.3%, depression in 12.3%, bipolar disorder in 18.8% and mental retardation in 3% of cases. Most of them refused to continue psychiatric treatment in the second or the first line of care. Resistance to sectorisation was associated with a low socioeconomic level [P = 0.039], availability of a companion [P = 0.04], celibacy [P = 0.04], gender [P = 0.05] and negatively correlated to psychotic disorder diagnosis. It was concluded that the environment plays an important role in the choice of the place of care. Subjects treated for mental illness were found to have greater trust in the structures that treated the acute episode of their illness, and paradoxically felt less stigmatized in Razi hospital

[ name in schizophrenia: a study of 60 patients]

Clinical aspects in schizophrenia suggest a unique relationship with the proper name. Discuss the validity of the hypothesis that the non-transmission of the surname may be a vulnerability factor in schizophrenia. Descriptive cross-sectional study conducted among 60 patients with schizophrenia and their families. Data were collected using a semi-structured interview. Seven patients carried a different surname from their father [11.6% of participants]. The disparity has only concerned the child with schizophrenia. Family characteristics [birth rank, desired character of pregnancy, family history of schizophrenia] and evolutif profile of the disease were comparable between patients with a family name according to the father and those with a different surname. It appears that patients with schizophrenia maintain a special relationship with the proper name, which could be involved in the genesis of schizophrenia. Our early hypothesis, supported by the psychoanalytic, transgenerational and behavioral theories, would be a plausible starting point for studies with a broader spectrum including witnesses of the general and psychiatric populations

[Validity and reliability of the Tunisian version of section G of the composite international diagnostic interview, relative to Schizophrenia]

Early diagnosis of schizophrenia can improve its outcome. Hence, screening policies should be held and suitable tools must be available for general practitioners. To translate the section G [about schizophrenia] of the Composite International Diagnostic Interview to the Tunisian dialect and to check its validity and reliability. The Arabic version of section G of the Composite International Diagnostic Interview has been translated to the Tunisian dialect by psychiatrists speaking fluently both languages. Metric features of the instrument [sensitivity, specificity and predictive values] were assessed by checking its results against those of the gold standard i.e. the expert's opinion owing to the criteria of the Diagnostical and Statistical Manual of mental disorders 3rd revised edition. Reliability has been measured by the index of observer agreement. The instrument showed a low sensitivity of 45% [32% - 58%] and a high specificity of 96% [93% - 99%]. It looked as a diagnostical test that can avoid wrong diagnoses of such a serious and stigmatizing illness. These values are similar or even better than those of literature. The observer agreement index was 0.83 showing a very good reliability. The interviews mean duration was 20 minutes. The instrument showed no variability towards the sex, the age or the educational level of interviewees. Even though section G of the Composite International Diagnostic Interview failed to detect most cases with schizophrenia and showed a poor sensitivity, this instrument can be useful for screening strategies carried out by lay interviewers in the general population

[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