Impact of sunlight exposure on the age of onset of bipolar disorder

Introduction

Bipolar disorder is a multifactorial disorder influenced by multiple genetic and environmental factors.There is limited understanding of how non-genetic factors may impact the age of onset of bipolar disorder

Objectives

To study the age of onset of bipolar disease in Tunisia (where the average duration of sunshine is 8 hours/day) and compare it to the age of onset in countries with a lower duration of sunshine (Germany 0.17h/day; Norway 1.40h/day).

Methods

We conducted a retrospective study of 100 patients with bipolar disorder type I followed at the psychiatric department Aziza Othmana at Razi hospital.The data collection was done using a pre-established paper form exploring sociodemographic and clinical data.The duration of sunshine was estimated according to the average number of hours of sunshine per day in each country collected through meteorological sites.

Results

Our population was predominantly male (60%) with a mean age of 48.7 years.The first episode was manic in 76% of cases. The mean age of onset in our sample was 25.86 years, with extremes ranging from 13 to 49 years.An early onset (threshold age=21 years) was found in 36% of the Tunisian population. The age of onset was earlier in patients with a family history of bipolar disorder: 22.76 years vs 28.23 years. A late onset (threshold age=37 years) was found in 13% of the Tunisian population.

Conclusions

The study confirmed that there is an inverse relationship between the degree of sunlight and the age of onset of the disease, especially in the presence of a family history of mood disorders

Disclosure

No significant relationships.

Burnout among pharmacists in Tunisia during COVID-19 pandemic

Introduction

Both public and private sector pharmacists were instrumental in containing this health crisis in Tunisia. The high workload had a considerable impact on their mental health during the outbreak of the Corona Virus.

Objectives

This study aims to assess burnout and the psychological toll of the pandemic among pharmacists in Tunisia during covid-19.

Methods

258 Tunisian pharmacists working in the public and private sector participated in a questionnaire. Burnout was assessed by the Maslach burnout scale. Regression analysis was used to assess the impact of the pandemic on Tunisian pharmacists.

Results

80% of the respondents were women. Participants ranged in age from 22 to 62, 60% were married, 57% had at least one child, and 42% had been working for less than five years. The burnout scale revealed 76% burnout among them. Univariate linear regression showed that female gender (p = 0.014 <0.05) was associated with the development of burnout.

Conclusions

The considerable prevalence of burnout among pharmacists during the COVID-19 pandemic in Tunisia can be attributed to the enormous and overwhelming responsibilities that any health care worker endured.

Disclosure

No significant relationships.

Uric acid levels among Tunisian patients with bipolar disorder during different phases of illness

Introduction

Bipolar disorder is a recurrent chronic disorder characterised by fluctuation of mood state. Recent studies focused on the involvement of adenosine and the purinergic system in the pathophysiology of bipolar disorder.

Objectives

We aimed to investigate the difference in (SUA) levels between different phases of relapse and remission period.

Methods

For this aim a prospective study was conducted during six months at Razi psychiatric Hospital in Tunisia with patients diagnosed with BD The socio-demographic, clinical data were gathered from patient and a psychometric assessment using YMRS and Beck scale was employed. Uric acid level was studied during relapse and remission period.

Results

Among 30 consentent patients included in the study : 65.7% were women, The age of the participants varied between 22 and 65 years old. Uric acid level at the relapse varied between 328 and 499 mmol/L and level of controlled value at the remission period which is eight weeks under treatment varied between 137 and 307 mmol/L. Patients under antipsychotic treatment were 55.9% the other were under lithium or mood stabilizer. There is no significant difference between patients with bipolar disorder type I or II neither for the molecule chosen for treatment (p<0.05).

Conclusions

Bipolar disorder is a chronic psychiatric disease which needs to be regulary controlled. Uric acid levels were higher in manic or depressive phases as compared with euthymia phase. Uric acid could be used as a trait marker in bipolar disorder and help psychiatrist to monitor patients and to adjust treatment in order to avoid relapsing.

Disclosure

No significant relationships.

Predictors of male sexual dysfunction in post traumatic stress disorder

Introduction

Post-traumatic stress disorder affects emotional, social and professional functioning. It can also affect physical and sexual health.

Objectives

The aim of this study is to write down the prevalence of sexual dysfunction in men with PTSD and to economize on potential predictors of sexual dysfunction.

Methods

A total of 30 male patients with PTSD were included in this study. We collected socio-demographic and clinical data and we used Post-Traumatic Stress Disorder (PCLS) and International Erectile Function Index (IIEF15) scales.

Results

The mean PTSD severity score was 65.43 ± 2.95. The mean score for revitalization, avoidance, cognitive and mood alteration, and hypervigilance were 15.80 ± 1.44, respectively; 8 ± 0; 24.07 ± 1.20 and 17.57 ± 2.95. The mean IIEF-15 score was 51.16 ± 6.82. The mean sub-scores were 3.93 ± 0.52 for sexual desire; 18.80 ± 5.68 for erectile function; 8.93 ± 8.97 for orgasmic function; 5.13 ± 1.10 for satisfaction with intercourses and 4.13 ± 1.16 for overall satisfaction. The IIEF15-EF score was negatively correlated with the presence of a personal medical history (p = 0.02) and the impairment cognitions and mood score (p = 0.023). The IIEF-OF score was significantly associated with reviviscence, hypervigilance, cognition and mood alterations (p = 0.015; 0.041; 0.045). The IIEF-15 SD score was negatively correlated with altered cognition and mood (p = 0.007).

Conclusions

Our study focused on the importance of assessing sexual function in men followed for PTSD and helps to understand the association of PTSD with different types of sexual dysfunction.

Sexual function assessment in men with PTSD

Introduction

Exposure to extreme traumatic events can lead to post-traumatic stress disorder (PTSD). This disorder affects emotional, social and professional functioning. Recent studies suggest that it can lead to sexual dysfunction.

Objectives

The aim of this study is to compare the level of sexual dysfunction between men with PTSD and control subjects.

Methods

A total of 30 male PTSD patients and 30 controls were included in this study. We used the Post-Traumatic Stress Disorder Check Scale (PCLS) to assess the intensity of PTSD symptoms and the International Erectile Function Index (IIEF15) to assess sexual dysfunction of both patients and controls.

Results

The mean IIEF-15 score was 51.16 ± 6.82 in patients followed for PTSD versus 77.33 ± 2.02 in healthy controls with a non-significant difference (p = 0.26). Three patients (10%) had an alteration of desire while the control reported only dysfunction but there was no significant difference between the mean scores of IIEF-SD (p = 0.22). No patient or control had erectile dysfunction and there was no significant difference between the IIEF-EF sub-scores in the 2 groups (p = 0.20). The mean sexual intercourse satisfaction (SD) score in the patients was 5.13 ± 1.10 versus 8.86 ± 0.40 with a non-significant difference (p = 0.09). Altered satisfaction with intercourse was noted in 15% (n = 5) of subjects with PTSD versus a single control.

Conclusions

It is important that practitioners address the subject of sexuality in patients followed for PTSD and refer their patients, if necessary, to a sexology consultation.

Characteristics of offenders referred for psychiatric forensic examination

Introduction

Forensic psychiatry is facing major challenges related to criminal responsibility with an increasing number of offenses and the entanglement of several factors affecting offenders differently.

Objectives

The aim of this study is to determine the characteristics of offenders referred for forensic psychiatric examination.

Methods

We studied the medical files of all the offenders referred to the forensic psychiatry unit in Razi hospital for an examination between January 2010 and October 2020.

Results

The number of people who have undergone a forensic psychiatric examination was 256. Three files were not usable due to lacking data. The offenders were men in 95.7% (242) of the cases. Their average age was 35 years with a range of 17-53 years. They were mostly single (64%) with primary education (58.1%). Forty percent of the studied population were unemployed and 70% of them lived with their parents. Drug abuse was found in half of the cases and the average number of taken drugs is two illicit substances per person. A criminal record was found in 43% of the cases with an average number of two offenses per person. Offenders were found to suffer from schizophrenia in 29% of the cases, personality disorder in 17% of the cases and from intellectual disability in 16.6% of the cases. No psychiatric disorder was found in 24% of the cases

Conclusions

Despite having in common many vulnerability factors, such as low educational level, unemployment and drug abuse, an important number of offenders referred for forensic psychiatric examination weren’t affected by a psychiatric disorder.

Disclosure

No significant relationships.

Psychotic relapse from COVID-19 pandemic: Clinical features

Introduction

The COVID-19 pandemic affected today more than 76,000,000 worldwide, and more than half of humanity has been placed in quarantine. This pandemic affects mental health problems and influences the onset of symptoms.

Objectives

The aim of this review is to analyze the impact of the COVID-19 pandemic on psychotic disorders and its interaction with the various risk factors.

Methods

We undertook a review of the impact of COVID-19 pandemic on psychosis. We carried out a systematic review of electronic databases using the keywords “COVID-19”, “pandemics”, “psychotic disorders”, and “delusions”. Relevant literature was limited to articles conducted around the world and published between January and December 2020.

Results

We identified ten papers addressing incident cases of psychosis relapse linked to coronavirus pandemic. In multiple cases, psychotic symptoms were characterized by delusional thoughts about being infected by the coronavirus. The limited access to regular medications and psychosocial interventions was the main factor to psychotic relapse. This review included one cross-sectional clinical study comparing the impact of this pandemic on patients suffering from severe mental illness compared with healthy controls and they found that patients with mental disorders reacted to the pandemic and the lockdown restrictions with higher anxiety levels than the general public. Our study also revealed that elderly people suffering from psychosis and other chronic illness were the most vulnerable to relapse.

Conclusions

Psychotic disorders can relapse during stressful events like COVID-19 pandemic. Therefore, specific attention to these vulnerable subjects is crucial to prevent relapses in times of worldwide pandemic.

Disclosure

No significant relationships.

Therapeutic monitoring of mood stabilizers in bipolar disorder

Introduction

Efficacy of lithium is well documented in the literature, making it the gold standard treatment. However, its use declines with the advent of anticonvulsants. This raises the question about monitoring of mood stabilizers in practice.

Objectives

The aims of this study were to determine the prophylactic lithium response in patients followed for bipolar disorder and compared to those of anticonvulsants and assess the mood stabilizers monitoring procedures in clinical practice.

Methods

A retrospective study was conducted, over a period of six months, with patients followed for bipolar disorder stabilized under the same mood stabilizer (lithium or anticonvulsant) for at least one year. The participants were divided into two groups according to the mood stabilizing treatment. The two groups were compared according to socio-demographic, clinical and evolutionary profiles as well as the prophylactic response to treatment.

Results

Patients included were 64 in the study, 28 received lithium and 36 received anticonvulsants. The socio-demographic profile and clinical characteristics were similar in two groups, except for the average total number of mood episodes. Retrospective evaluation of the prophylactic response by ALDA scale showed a significantly higher mean total score in patients receiving lithium (5.9 ± 2.8 versus 2.58 ± 2.4, p = 0.025).). Ten of them were in compliance with the recommendations; while 19.44% received anticonvulsants had all the monitoring parameters within the recommended time frame.

Conclusions

Thymoregulators significantly modify the disease’s prognosis. Practitioners will attach particular special attention to distinguish the therapeutic efficacy of the side effects which are numerous and sometimes serious.

Antidepressants effect on sexual dysfunction in men with PTSD

Introduction

Various therapeutic approaches for post-traumatic stress disorder have been the subject of numerous studies. Antidepressants are sometimes used in PTSD. They improve the symptoms of PTSD. But their effect is not clear on the sexual dysfunctions that accompany this disorder.

Objectives

The aim of this study is to display the effect of antidepressants on sexual dysfunctions in men with PTSD.

Methods

A total of 30 male patients with PTSD were included in this study. The International Erectile Function Index (IIEF15) was used to assess sexual dysfunction in participants before treatment and two months after starting antidepressant treatment.

Results

Half of the patients (50%) used sertraline, 23% paroxetine, 20% fluoxetine and 7% escitalopram.The mean IIEF-15 score was 51.16 ± 6.82 in patients with PTSD before initiation of treatment. The average scores of the areas of sexuality studied by this scale were 3.93 ± 0.52 for sexual desire; 18.80 ± 5.68 for erectile function; 8.93 ± 8.97 for orgasmic function; 5.13 ± 1.10 for satisfaction with intercourse and 4.13 ± 1.16 for overall satisfaction. After 2 months of use of the antidepressant treatment, there was a statistically significant improvement in sexual functions: significant increase in the total score of the IIEF15 (p <0.001), and in the mean scores of the areas of sexuality.

Conclusions

Antidepressant treatment could, by improving post-traumatic symptoms, improve sexual dysfunction.

COVID-19 pandemic and first episode of psychosis: Clinical characteristics

Introduction

The rapid spread of the SARS‐CoV‐2 pandemic among the world poses challenges to the management of both physical and mental health. This unexpected situation could predict an exacerbation of anxiety, depressions, obsessions, and even multiple cases of psychosis.

Objectives

The aim of this literature review is to identify and analyze studies conducted in 2020 that investigate the incidence of psychotic disorders, related to COVID-19 pandemic and describe its symptoms.

Methods

A systematic search in the PubMed electronic database was performed using keywords “COVID-19”, “pandemics”, “psychotic symptoms”, and “ first episode of psychosis” Relevant literature was limited to articles describing studies conducted and published in 2020.

Results

9 papers met the inclusion criteria. The selected studies reported 20 cases of psychosis in patients with no psychiatric history, directly triggered by stress derived from the COVID-19 pandemic and by social distancing and quarantine. All cases were characterized by sudden behavioral changes out of character, increased concern about coronavirus risk infection, anxiety, psychomotor agitation, and insomnia. In multiple cases, psychotic symptoms were characterized by thoughts of reference, persecution, and structured delusional. 5 patients were convinced that COVID-19 Pandemic was part of a conspiracy and that someone was trying to infect them by diffusing the COVID-19 or other pollutants. Half of the patients had the delusional conviction that they got infected and they were contagious.

Conclusions

COVID-19 pandemic appears to be the trigger for precipitating psychosis which has a high risk of suicidal behavior. During pandemics, mental health professionals should carry out more focused diagnostic and therapeutic strategies.

Disclosure

No significant relationships.

Amisulpride-induced agranulocytosis: A case report

Introduction

Agranulocytosis is a potentially life-threatening haematological side effect induced by typical and atypical neuroleptic. When agranulocytosis is associated with a specific anti-psychotic, the medication should be discontinued. This severe side effect is troublesome.

Case report

We report the case of a 60-year-old man, treated with amisulpride for schizophrenia, who developed an agranulocytosis. This patient had been treated with first and second generation anti-psychotic drugs during his life and had already been exposed to many neuroleptics without any signs of toxicity. However, after three days of the introduction of amisulpride he presented a rapid onset agranulocytosis (leukocytes 1.2 G/L and neutrophils 0.4 G/L). After discontinuation of amisulpride, blood count returned to normal. The favorable evolution after discontinuation of treatment: the normality of biological and cytological examinations is in favor of a causal relationship between this severe neutropenia al introduction of amisulpride.

Conclusion

This case report highlights the risk of amisulpride in inducing agranulocytosis, a risk underestimated in regard of the clozapine risk to induce agranulocytosis or neutropenia. For this reason, it seems reasonable to recommend performing a blood count before introduction and during the treatment by anti-psychotics.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Correlation between childhood trauma and cognitive impairment in patients with schizophrenia

Introduction

Abusive childhood experiences are claimed to be more prevalent in people with schizophrenia (SCZ) than in the general population. The exposure to childhood trauma can have adverse effects on cognitive function.

Objectives

To investigate whether there is a relationship between childhood trauma (CT) and cognitive functioning in patients with SCZ.

Methods

Fifty-eight outpatients with stable SCZ were recruited. The participants completed the Childhood Trauma Questionnaire retrospectively assessing five types of childhood trauma (emotional, physical and sexual abuse, and emotional and physical neglect). They also completed a neurocognitive battery comprising the following tests: the Hopkins Verbal Learning Test–Revised (HVLT-R), the Letter Digit Substitution Test (LDST), the Stroop Test (ST), the “Double Barrage” of Zazzo (DBZ), the Modified Card Sorting Test (MCST), the Verbal Fluency (VF), the Trail Making Test-Part A (TMT-A) and the Digit Span (DS).

Results

The patients with a history of physical abuse (P = 0.03) or emotional neglect (P = 0.07) performed worse at the delayed recall of the HVLT-R. A history of emotional neglect was also correlated to a significantly worse performance in theTMT-A (P < 0.0001), while physical abuse was correlated to worse DS (P = 0.015). High emotional abuse scores were significantly correlated to poorer efficiency in DBZ (P = 0.025).

Conclusions

The results need replication, but underline the necessity of investigating biological and psychosocial mechanisms underlying these subjects’ cognitive impairment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Association of high-sensitivity C-reactive protein with susceptibility to Schizophrenia in Tunisian population

The pathogenic mechanisms underlying Schizophrenia (SZ), one of the most frequent mental disorders, are complex and poorly understood. Several evidences suggest that inflammatory processes may underpin some of its neurobiological correlates. The aim of this study was: (i) to analyze the potential association between circulating levels of the C-reactive protein (CRP), a crucial inflammatory marker, and Schizophrenia in Tunisian patients and healthy controls (HC) cohorts; (ii) to investigate the genetic diversity of three CRP variants (rs1417938, rs1130864 and rs1205) and; (iii) to analyze a potential relationship between expression and genetic data and clinical and socio demographical characteristics. CRP polymorphisms were exanimated for 155 patients and 203 HC by taqMan5'-nuclease. High-sensitivity CRP (hs-CRP) serum level was measured in 128 clinically stable out-patient SZ patients and 63 HC subjects via an automated biochemical analyzer. We found that hs-CRP levels were significantly higher in SZ patients as compared to HC. No significant differences were found when the proportions of CRP variants were compared in patients and HC. Further analysis according to clinical and socio demographical characteristics revealed a positive association with age and hypertension. Our data on an original Tunisian sample confirm the previous finding in others population groups.

Antidepressants-Induced Sexual Troubles

Introduction

For a long time, antidepressants sexual side effects have been neglected. Currently, no reliable scientific data is available regarding the nature and frequency of sexual dysfunction induced by antidepressants. The aim of our study was to evaluate the prevalence and type of sexual dysfunction induced by antidepressants, and to identify factors associated with the occurrence of these disorders.

Methodology

A descriptive and analytical cross-sectional study extending over a period of two week. For the purpose of this research, a socio-demographic card, the Arizona Sexual Experiences Scale (ASEX) and the Psychotropic-Related Sexual Dysfunction Questionnaire (SALSEX) were used.

Results

Fifty-five patients were recruited. The diagnosis of major depressive episodes was dominant (49.1%). Moreover, fluoxetine and tricyclic were in top of the list of antidepressants with respective proportions of 41.8% and 38.2% and respective dose 20.86 mg/24 h and 72.38 mg/24 h. The score using the ASEX scale was 14.63 ± 5.23. Using the SALSEX scale, 47.3% of patients claimed to have had sexual disorders secondary to antidepressants with a moderate score of 9.19 ± 2.56. Furthermore, sexual disorders were more common in the elderly aged of 45 (66.66%) as well as in patients started on paroxetine (66.66%) and on sertraline (66.66%) (P ≤ 0.05).

Conclusion

The sexual side effects of antidepressants have a major impact on the quality of life and adherence to treatment. They also represent an important risk factor for relapse and recurrence in major depression, in this context, the prescription of an antidepressant.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Antipsychotic polypharmacy among schizophrenia outpatients

Introduction

Since their introduction by Delay and Deniker in the 1950s, neuroleptic drugs have significantly modified the evolutionary prognosis of schizophrenia. Their combination has also become a widespread practice.

Objectives

The aim of this study was to analyze the associations of neuroleptic drugs by describing the characteristics of types and doses, understanding the reasons for these associations and studying the relationship existing in such situation regarding adherence to treatment, tolerance and the number of hospitalizations.

Methods

Our study was retrospective, descriptive and analytical. It has been conducted from March, 1st to May, 30th 2015 and involved 70 stabilized patients diagnosed with schizophrenia according to DSM 5. Clinical characteristics were collected from patients and their medical records. Evaluations were conducted using PANSS, MARS and GAS.

Results

Overall, 70 male patients were recruited. The mean age was 40 years old: 30% received classical monotherapy while 70% were treated only by an atypical antipsychotic. Among patients receiving two drugs, 85% received classical bitherapy while 9% were under both classical and atypical drugs. Only 6% received atypical bitherapy. Chlorpromazine equivalent doses in case of monotherapy was 325.92 mg/day, while it reached 1148.65 mg/day in case of drugs association. Administration of a combined therapy had poor tolerance rate and all patients suffered from adverse effects. Adherence to treatment was better while receiving monotherapy (88% versus 45%) and the number of hospitalizations was lower with an average of 3 against 10.

Conclusion

Our study revealed several shortcomings in our current management of patients with schizophrenia and addressed the implication of socioeconomic status on therapeutic outcomes.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Are neurocognition and facial emotion recognition related in schizophrenia?

Introduction

Patients with schizophrenia (SCZ) show impairments in many social cognition domains including facial emotion recognition (FER). The existence of a relationship association between FER and neurcognitive functioning (NF) remains uncertain.

Objectives

To investigate the association between ToM functioning and neurocognitive functioning in SCZ.

Methods

FER was evaluated in 58 patients with stable schizophrenia with a newly validated FER task constructed from photographs of the face of a famous Tunisian actress representing the Ekman's six basic emotions. They also completed a neurocognitive battery comprising the following tests: the Hopkins Verbal Learning Test–Revised (HVLT-R), the Letter Digit Substitution Test (LDST), the Stroop Test (ST), the “Double Barrage” of Zazzo (DBZ), the Modified Card Sorting Test (MCST), Verbal Fluency (VF), the Trail Making Test-Part A (TMT-A) and the Digit Span (DS).

Results

Patients who performed better in the FER task had better performance in the VF task (P = 0.001) and in the immediate recall of the HVLT-R (P = 0.021). No correlations were found with the other neurocognitive tests.

Conclusions

Our results suggest that FER represents an autonomous cognitive function which does not necessarily require good NF.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Clinical symptomatology and facial emotion recognition in schizophrenia: Which relationship?

Introduction

Patients with schizophrenia show impairments in social cognitive abilities, such as recognizing facial emotions. However, the relationships between specific deficits of emotion recognition and with clusters of psychotic remain unclear.

Objectives

To explore whether facial emotion recognition was associated with severity of symptoms and to which presentation of psychotic symptoms.

Methods

Facial emotion recognition (FER) were evaluated in 58 patients with stable schizophrenia with a newly validated FER task constructed from photographs of the face of a famous Tunisian actress representing the Ekman's six basic emotions (happiness, anger, disgust, sadness, fear, and surprise). Symptomatology evaluation comprised the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia (CDSS) and the Clinical Global Impressions Scale Improvement and severity (CGI).

Results

Patients who failed to identify anger had significantly higher scores in hyperactivity item (P < 0.0001). The patients who had a difficulty to identify sadness had more grandiosity (P ≤ 0.002). The impairment in happiness recognition was correlated with hallucination (P = 0.007) and delusion (P = 0.024) items. Incapacity to identify fear was associated to lack of judgment and insight (P = 0.004).

Conclusions

Deficits in recognition of specific facial emotions may reflect severity of psychiatric symptoms. They may be related to specific clusters of psychotic symptoms, which need to be confirmed in further studies.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Clinical symptomatology and empathy in schizophrenia: Which relationship?

Introduction

The impairment of cognitive and affective empathy among patients with schizophrenia (SCZ) may represent a significant feature of the illness. However, the relationship between those impairment and dimensions of psychosis remains unclear.

Objectives

To explore whether cognitive and affective empathy are associated with severety of different psychotic symptoms.

Methods

Cognitive and affective empathy were evaluated in 58 patients with stable schizophrenia with the Questionnaire of Cognitive and Affective Empathy (QCAE) comprising five subscales intended to assess cognitive and affective components of empathy. Symptomatology evaluation comprised the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia (CDSS) and the Clinical Global Impressions Scale Improvement and severity (CGI).

Results

Patients with better cognitive empathy had less total CDSS scores (P = 0.036, r = −0.449) and lower CGI-severity scale scores (P = 0.01, r = −0.536). Patients with better affective empathy had lower scores (which means a better improvement) at the CGI-improvement scale (P = 0.03, r = −0.461).

Conclusions

Our results suggest that empathy with its different component is not totally independent of the clinical state of the patient. Further studies are required to confirm whether empathy deficits are state or trait aspects of SCZ.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Antipsychotics-induced leukopenia and neutropenia: A case report and review of literature

Introduction

Antipsychotic drugs effectively control psychotic symptoms, but may cause important side effects, significantly increasing morbidity and mortality. Hematologic abnormalities are frequent and may be life-threatening in some patients. Many prospective investigations confirmed neutropenia as a frequent occurrence with virtually all atypical antipsychotics.

Objective and methods

Define epidemiological, clinical and therapeutic characteristics of antipsychotics – induced leukopenia and neutropenia through a case report and a review of literature.

Case report

Patient 28 years old native of Tunis, with family history: brother who suffer of undifferentiated schizophrenia. Since the age of 16 years he has been followed for disorganized schizophrenia (DSM IV). He was initially put under Haldol Decanoate (2 months), fluphenazine (2 months), amisulpride (3 months), sulpride (2 months), olanzapine (3 months), Rispreridone (1 month), aripiprazole (5 months) leukopenia/neutropenia is occurring during treatment with each molecule and which promptly resolved after discontinuation. Reduced white blood cell count has also been reported after addition of lithium. Actually an ECT is proposed for this patient.

Conclusion

This case report shows the importance of hematological monitoring during the course of typical or atypical treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

How do social cognition dimensions relate to DSM-5 dimensions of psychosis?

Introduction

Existing research shows that individuals with schizophrenia (SCZ) show substantial deficits in social cognitive domains, including facial emotion recognition (FER), empathy, and Theory of Mind (ToM). Their exact relationship with the different dimensions included in the “Clinician- Rated Dimensions of Psychosis Symptom Severity” of the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) remains unexplored.

Objectives

To investigate the relationship between different social cognition dimensions and the dimensions of psychosis included in the DSM-5.

Methods

Fifty-eight outpatients with stable SCZ completed the Intention-Inferencing Task (IIT), a non-verbal ToM task and the Questionnaire of Cognitive and Affective Empathy (QCAE). They also completed a newly developed and validated FER task constructed from photographs of the face of a famous Tunisian actress and evaluating the ability to correctly identify Ekman's six basic facial emotions. The clinician-rated dimensions of psychosis symptom severity was used to evaluate 8 dimensions of psychosis.

Results

The patients presenting higher cognitive empathy capacities had less present abnormal psychomotor behaviour scores (P = 0.05). Higher levels of affective empathy were correlated to lower present delusions score (P = 0.037). Better scores in the IIT were correlated to less present negative scores (P = 0.013) and less impaired cognition scores (P = 0.009). FER task score didn’t correlated with any clinical dimension.

Conclusions

Our results suggest the existence of specific relationships between social cognition dimensions and psychosis dimensions. Further studies are needed to confirm these relationships.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Affective disorders in multiple sclerosis

Background

Psychiatric disorders have a remarquable frequency in multiple sclerosis. The leading group of these disorders consists of affective disorders. These psychiatric conditions can worsen the outcome of multiple sclerosis, thus contributing to increase the burden of the disease to both patients and relatives. Managing such a complicated situation needs a focus on the underlying links between affective disorders and multiple sclerosis.

Objective

To examine the hypotheses proposed to explain the high prevalence of affective disorders in patients with multiple sclerosis.

Methods

Literature was reviewed using the Medline database and the following keywords “bipolar disorder” “affective disorder”, “mania” and “multiple sclerosis”.

Results

PubMed research returned 13 results. After manual inspection, 10 articles were retained and examined. The cause of the high comorbidity between multiple sclerosis and mood disorders is regarded as being multifactorial: the medication used in multiple sclerosis possibly inducing/exacerbating mood disturbances, the demyelinazing brain lesions which could bring about depression or mania, genetic overlapping with affective disorders and last the psychological reactions and adjustment difficulties to the neurological handicap.

Conclusion

Despite the fact that the higher prevalence of affective disorders in multiple sclerosis is well established, these disorders still remain underdiagnosed and undertreated. A shift towards a better assessment of the psychiatric comorbidity in multiple sclerosis patients and the optimal treatment of those disorders is fundamental.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Do patients with better neuro-cognition have better theory of mind?

Introduction

Theory of mind (ToM) has repeatedly been shown to be compromised in many patients with schizophrenia (SCZ). By contrast, the association between ToM deficits and neuro-cognitive functioning (NF) remains uncertain.

Objectives

To investigate the association between ToM functioning and neuro-cognitive functioning in SCZ.

Methods

Fifty-eight outpatients with stable SCZ completed the intention-inferencing task (IIT), in which the ability to infer a character's intentions from 28 short comic strip stories is assessed. They also completed a neuro-cognitive battery comprising the following tests: the Hopkins Verbal Learning Test–Revised (HVLT-R), the Letter Digit Substitution Test (LDST), the Stroop Test (ST), the “Double Barrage” of Zazzo (DBZ), the Modified Card Sorting Test (MCST), Verbal Fluency (VF), the Trail Making Test-Part A (TMT-A) and the Digit Span (DS).

Results

The performance in the IIT significantly correlated with performance in some neuro-cognitive tests including efficiency in DBZ, number of uncorrected mistakes in ST, number of correct categories in MCST and the time needed to succeed the TMT-A. No correlations were found between performance in the ITT and in memory tasks (HVLT-R and DS).

Conclusions

ToM may rely on some neuro-cognitive functions (mainly attention and executive functioning). Elucidating the exact relationship between ToM and NF may be useful as both are targeted in specific psychotherapeutic interventions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Is empathy correlated to patients’ level of cognitive impairment in schizophrenia?

Introduction

Empathy, which refers to the ability to understand and share the thoughts and feelings of others, may be compromised in schizophrenia (SCZ). Yet the relationship between empathy and neurocognitive functioning remains unclear.

Objectives

To explore whether cognitive and affective empathy are associated with the neurocognitive functioning in SCZ.

Methods

Fifty-eight outpatients with stable SCZ completed the Questionnaire of Cognitive and Affective Empathy (QCAE) comprising five subscales intended to assess cognitive and affective components of empathy. They also completed a neurocognitive battery comprising the following tests: the Hopkins Verbal Learning Test–Revised (HVLT-R), the Letter Digit Substitution Test (LDST), the Stroop Test (ST), the “Double Barrage” of Zazzo (DBZ), the Modified Card Sorting Test (MCST), Verbal Fluency (VF), the Trail Making Test-Part A (TMT-A) and the Digit Span (DS).

Results

Better affective and cognitive empathy correlated with better performance in the ST (less hesitations and less errors). Patients with better cognitive empathy performed better in the MCST (more categories achieved; P = 0.029) and in the LDST (more substitutions per minute; P = 0.031).

Conclusions

Our results bolster support for the presence of an association between NF and the decreased cognitive and affective empathy in schizophrenia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Body dysmorphic disorder and psychosis: A case report and review of literature

Introduction

Patients with body dysmorphic disorder (BDD) are concerned about a slight or non-existent defect on their appearance, causing significant stress and interfering on their social and professional life.

Despite its prevalence and psychosocial impact, this disorder remains unknown by many clinicians.

Methods and objective

Through a review of literature and illustration in our case report we will define: the symptomatology of this pathology, psychopathological models of the disorder and the etiopathogenic assumptions associated with it, in terms of risk factors and neurobiological correlations.

Case report

Patient 33 years old unmarried having been the victim of an AVP at the age of 25 years causing him a head injury above right eye for which he undergoes cosmetic surgery three times but the patient still not satisfied with installation of psychotic and delusional disorders requiring the use of antipsychotics.

Conclusion

The complexity of body dysmorphic disorder should not discourage clinicians to confront this disease. The management requires more than putting under medical treatment associated to psychotherapy, we also need a good relationship of trust and maintain effective working alliance.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The association between childhood trauma and empathy in patients with stable schizophrenia

Introduction

Empathy, which refers to the ability to understand and share the thoughts and feelings of others, has emerged as an important topic in the field of social neuroscience. It is one of the most understudied dimensions of social cognition in schizophrenia (SCZ).

Objectives

To investigate the relationship between cognitive and affective empathy and CT in SCZ.

Methods

Fifty-eight outpatients with stable SCZ completed the Childhood Trauma Questionnaire retrospectively assessing five types of childhood trauma (emotional, physical and sexual abuse, and emotional and physical neglect). They also completed the Questionnaire of Cognitive and Affective Empathy (QCAE) comprising five subscales intended to assess cognitive and affective components of empathy.

Results

Patients with a history of sexual abuse better emotion contagion scores (P = 0.048) which means that develop more easily self-oriented emotional state matching the affective states of others. Patients with a history of emotional neglect or/and in denial of CT had higher scores in perspective taking score (P = 0.017). Perspective taking assesses the extent to which respondents can take another's perspective or see things from another's point-of-view.

Conclusions

Investigating psychosocial mechanisms, specifically the role of CT, underlying the development of empathic capacities is important since empathy can represent a treatment-target.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Panic disorder and quality of life: a tunisian study

Introduction

Panic disorder with or without agoraphobia is one of the most disabling anxiety disorders. It has severe consequences on psychosocial functioning and quality of life of patients.

The aim of our study was to evaluate the quality of life in a population of patients treated for panic disorder.

Methods

Thirty patients were evaluated using a standardized questionnaire exploring socio-demographic parameters, clinical parameters and evolutionary parameters. It also explore the the disorder impact on social life, family and work.

Assessing the quality of life was performed using the (SF-36). This scale includes 36 questions divided into eight dimensions.

Statistical analysis was performed by SPSS in its 18th version.

Results

The average age of our population was 42.07 years with extremes ranging from 22 to 71years. The sex ratio was 1.

The socioeconomic level was low in 56.7% of cases, medium in 40% of cases and high in 3.3% of cases.

Half of the patients reported having marital conflicts; these conflicts had led to divorce in 3.3% of cases.

Regarding the professional impact of panic disorder, 33.3% of patients were off work, and 20% used sick leave.

The overall average scores of the SF-36 of all patients ranged from 0 to 76 with an average of 37, 98 and a standard deviation of 18.46.

Ninety percent had impaired quality of life (overall mean score of less than 66, 7) All dimensions are altered in 100% of the cases except D1 (physical dimension) that is altered in 63.7% of cases.

[Devic's neuromyelitis optica in children: a case report and review of the literature]

Devic neuromyelitis optica (NMO) or Devic's syndrome is an uncommon clinical syndrome associating unilateral or bilateral optic neuritis and transverse myelitis. Usually reported in adults, childhood cases constitute a distinctive clinical entity.

CASE REPORT

We report a case of NMO occurring in a 9-year-old girl, admitted for paraplegia, sphincter troubles as acute installation bladder retention and of a sudden decline of the visual acuity. Magnetic resonance imaging (MRI) revealed abnormalities of spinal cord signal with hypo intensity in T1-weighted images and hyper intensity in T2-weighted images along the spinal cord. However, the cerebral region was normal. Visual evoked potentials were consistent with retrobulbar optic neuropathy. Our patient received corticosteroids (methyl prednisolone) during 5 days followed by oral prednisone. At week three, an immunosuppressant (azathioprine) was added. Clinical outcome was favourable with disappearance of sphincter troubles, a correction of the visual acuity and a progressive disappearance of motor troubles.

CONCLUSION

Pediatric Devic's NMO is rare. It is a different clinical entity with an excellent visual and neurological prognosis. Review of the literature shows that recurrence is rare in children and seems to be without long-term sequelae with corticosteroids and immunosuppressant therapy.