[Suicidal behaviors in bipolar disorder type 1]. / Les conduites suicidaires dans le trouble bipolaire de type 1.

OBJECTIVES: Bipolar disorder is one of the most common and severe psychiatric conditions. It is frequently complicated by suicidal behaviors, and patients with BD are among those at higher risk of suicide. The aims of our study were to evaluate the predictive factors of suicidal behaviors in patients with BD type 1, through the assessment of their socio-demographic, clinical and evolutionary characteristics as well as to study the implications of the childhood traumas and impulsivity as predictive factors for suicidal behaviors in these patients with bipolar disorder. METHODS: One hundred patients with bipolar disorder type 1were recruited in order to conduct a cross-sectional, analytical and comparative study. The recruitment involved a first group made up of 40 patients suffering from type 1 bipolar disorder with a history of suicidal acts. This group was compared with a second group made up of 60 patients with no history of attempted suicide. We used a pre-established collection sheet for collecting socio-demographic, clinical and therapeutic data. We also used the Childhood Trauma Questionnaire for the assessment of childhood adversities, the Barratt Impulsivity Scale in its eleventh version for the assessment of impulsivity levels and the Global Assessment of Functioning Scale for the evaluation of overall functioning. RESULTS: The suicidal behaviors in patients with bipolar disorder were significantly associated with: female gender (P<0.001), professional instability (P=0.002), family history of BD (P=0.02), family history of other psychiatric disorders (P=0.003), frequency of depressive episodes (P=0.002), shorter remission (P=0.025), more subsyndromal symptoms (P=0.029), sexual abuse dimension (P=0.009), and a high level of impulsivity (P<0.001). The predictive factors for suicidal behaviors in multivariate analysis, after adjusting for the confounding variables were: childhood sexual abuse (P=0.01; adjusted OR 4.5; 95% CI 1.44-14.2), a high level of impulsivity (P=0.002; adjusted OR 6.6; 95% CI 2-20), a higher rate of depressive episodes (P=0.003; adjusted OR 5; 95% CI 1.69-14.2) and more subyndromal symptoms (P=0.007; adjusted OR 5.8; 95% CI 1.63-20). CONCLUSIONS: Suicide prevention is an important mental health subject. It would be imperative to include systematic screening for childhood adversities and adequate management of bipolar disorder and impulsivity.

[Foveal choroidal thickness assessment with SD-OCT in high myopic glaucoma]. / Épaisseur choroïdienne fovéolaire en OCT-SD dans le glaucome du myope fort.

PURPOSE: To measure macular choroidal thickness (CT) using spectral domain optical coherence tomography (OCT) in high myopic eyes with primary angle-open glaucoma (POAG), and to investigate whether the choroid is thinner in these eyes compared to high myopic eyes without glaucoma. PATIENTS AND METHODS: We conducted a cross-sectional study of forty-eight eyes with high myopic glaucoma matched with 48 highly myopic eyes without glaucoma by age, central corneal thickness and axial length (AL). OCT scans were performed with the spectral domain OCT (Topcon 2000). The subfoveal CT was measured between the Bruch membrane and the internal aspect of the sclera. RESULTS: In the subgroup without glaucoma, matched with the subgroup with glaucoma (P=0.57), by age, central corneal thickness (P=0.33) and AL (P=0.10), the mean subfoveal CT was 96.32 µm ± 39.56 µm. In the subgroup with glaucoma, the mean subfoveal CT was 50.44 µm ± 16.36 µm. The comparison between the two subgroups found a statistically significant difference in subfoveal CT (P<10(-4)). CONCLUSIONS: Foveal choroidal thickness is reduced in highly myopic eyes with glaucoma. The choroidal thinning can be a useful parameter for the diagnosis and the follow-up of highly myopic patients with glaucoma.

[Peripapillary changes detected by SD OCT in eyes in high myopia]. / Étude des anomalies péripapillaires en SD OCT dans la myopie forte.

PURPOSE: To study the morphologic alterations around the optic disc by spectral optical coherence tomography (SD OCT) in eyes with high myopia. PATIENTS AND METHODS: Two hundred eyes (113 patients) with high myopia were included. The participants had complete ophthalmologic examinations and OCT examinations. OCT scans were obtained around the optic in each patient. RESULTS: We detected by OCT, a peripapillary detachment in 14 eyes (11.0%), a retinischisis peripapillary in 10 eyes (5%) and paravascular abnormalities as microfolds and paravascular cysts in 80 eyes (40%). A statistically significant difference was found between patients with microfolds paravascular and the rest of the patients concerning age (P=0.0034) and axial length (P=0.001). The patients with paravascular cysts were older (P=0.0022), had a greater axial length (P=0.0044) and a high rate of posterior staphyloma compared to other patients. CONCLUSION: Perpapillary changes detected by SD OCT in eyes in high myopia are relatively frequent and don't always present a clinical or ophthalmoscopic changes.