G. Amara

Intérêt des anticholinestérasiques dans les dépressions du sujet âgé

BACKGROUND Depression in the elderly is characterized by an atypical expression with delusion, major anxiety, behaviour disorders, somatic complains or cognitive impairment. These clinical aspects are suspected to be at the origin of the poor response to antidepressants observed in these cases. It is currently indicated to add sedative medicines to antidepressants, when a major anxiety is associated with depression, or an antipsychotic in the delusional forms of the depression. However, it is not consensually established that cholinesterase inhibitors can be helpful in depression with cognitive impairment. Cholinesterase inhibitors are efficient among patients with Alzheimer disease. They improve cognitive performances and slow down the degenerative process during the first years of treatment. Today, new findings on neurobiological mechanisms of depression involve a located degenerative process, with some similar anomalies in the brain in both depression and pre-Alzheimer states. New therapeutic trials have shown that cholinesterase inhibitors can be also efficient on depressed symptoms among patients with Alzheimer disease. These evidences support the hypothesis that the association of cholinesterase inhibitors to antidepressants can bring more benefits to depressed elderly patients. AIM Through a review of the literature and a case report, we tried to specify whether cholinesterase inhibitors can be useful in the treatment of depression among the elderly. CASE REPORT We report the case of a 68-year-old man who had presented, four years ago, a second episode of major depression with a cognitive impairment. Treated with an antidepressant (venlafaxine), the improvement was poor with major anxiety, slow thoughts, and an evidence of a persistent cognitive impairment. Despite normal cerebral scanning images, we decided to add a cholinesterase inhibitor (donepezil) to the same antidepressant. With this association, we rapidly obtained a total remission from depression with restitution of cognitive performances. This state is still maintained until today (four years after the last depressive episode) with no new mood relapses. Recent cerebral scanning images did not show any degenerative process. CONCLUSION The association of cholinesterase inhibitors and an antidepressant seems a good alternative, when the response to antidepressant is partial in depression with cognitive impairment in the elderly. However, further therapeutic trials are still needed, to prove the usefulness of cholinesterase inhibitors among depressed elderly patients.

P02-89 Suicidal attempts in primary care: Prevalence and correlates in a Tunisian area

Aims This study aimed to determine prevalence and correlates of suicidal attempts in an adult primary care population in Sousse (Tunisia). Method Sampling followed a stratified multistage probability cluster design from witch a representative sample of adult primary care population of Sousse was obtained. The sample was composed of 1249 subjects aged 18 years or more. Subjects were interviewed by trained clinicians using the Tunisian version of Composite International Diagnostic Interview 2.1. General and clinical characteristics of subjects who had reported previous suicidal attempts were compared with those of the remainder using t test and Chi-2 test. Results Mean age in our sample was 43.4 ± 17.62 years, with female gender (70.9%) and urban residency (67.8%) predominance. 62.3% of participants were married, 27.3% celibates and 10.4% divorced or widowed. 68.4% of them had low educational level and 70% were out of work during the last 12 months. Suicidal attempts were found in 2.9% of participants. They were correlated to less than 40 years age (p=0.036) and to the diagnosis of major depressive episodes (p -3 ), recurrent major depressive disorder (p=0.005) and dysthymic disorder (p -3 ). Among major depressive episodes, only severe ones were associated to higher prevalence of suicidal attempts (p -3 ). Conclusion Prevalence of suicidal attempts in Sousse primary care population was 2.9%. It was correlated to low age and to depressive disorders.

P01-170 Suicidal attempts among bipolar patients: Correlation with affective temperaments and life events

Aims In this study, we focused on the correlations between life events, affective temperaments and suicidal attempts among patients with bipolar disorder. Methods Patients with DSM IV diagnosis of bipolar I or bipolar II disorders were recruited from psychiatric consultation of the Farhat Hached Hospital in Sousse. All bipolar patients were in remission for at least four weeks. Suicidal attempts were checked by interrogating patients and consulting medical observations. Affective temperament dimensions were determined by using the Arabic version of TEMPS-A. The assessment of life events was based on the Paykel scale. Results A total of 57 patients (47 with bipolar I disorder and 10 with bipolar II disorder) have participated in the study, with a mean age of 41,8 ± 11,3 years and a gender ratio of 2,29. Suicidal attempt number was positively correlated with depressive (p=0,021) and anxious (p=0,015) temperament, early orphanage (p=0,008) and the total number of life events (p=0,011). It was also correlated with the global negative impact of these events (p=0,036). Conclusion According to our findings, life events and their negative impact, early parental loss and anxious and depressive temperaments predispose to suicidal attempts among patients with bipolar disorder. Further prospective studies are required to confirm these results.

P01-17 Gender prevalences of alcohol abuse and dependence in primary care

Aims In Tunisia and in most Muslim countries, alcohol consumption has remained taboo. The aim of our study was to determine the prevalence of alcohol abuse and alcohol dependence in an adult primary care population and to compare gender prevalences and characteristics. Method This is a cross-sectional prevalence survey conducted in the district of Sousse from June to November 2006. Thirty primary care centers have been randomly selected. The sample was composed of 2576 subjects aged 18 years and more. Participants were interviewed by psychiatrists and medical trainers using the Composite International Diagnostic Interview, which was translated into the Tunisian dialect and validated. Results Females represented 78% of the whole sample. The lifetime prevalence rates of alcohol abuse and alcohol dependence were respectively 2,9% and 0,7%. The lifetime prevalences in the male subgroup were 12,9% for alcohol abuse and 3% for alcohol dependence. Only one case of alcohol abuse was found in the female subgroup. Conclusion The related alcohol disorders among the men of our study are as frequent as among occidental ones. The related alcohol disorders among women were unexpectedly very low. However, a similar result was reported in an other study conducted in the United Arabic Emirates. This gender alcohol use discrepancy, found in our study, led to two main interrogations. The first one concerning the usefulness of the alcohol disorder structured interviews among Arabic women and the second concerning the Arabic women beliefs about alcohol consumption (Is it a result of religious thoughts or a deny?).

P01-219 Suicidal attempts and life events among depressive adult outpatients

Aims Although a relationship between experience of problematic life events and suicidal behaviour has been recognized during last decades, few studies of life events have been realized among depressive adults. The aim of this study was to determine the correlations between life events and suicidal attempts among depressive adult patients. Methods Eighty adult outpatients were recruited from the psychiatric department of Farhat Hached hospital of sousse (in Tunisia). All patients were followed up for a Major Depressive Disorder (MDD) according to the DSM IV criteria. They also were in remission for at least four weeks. For life events we used the EVE scale of Ferreri which permitted to assess event nature, event number and patient strategies in front of stressful life events. Results The gender ratio of the sample was 1.35 and the mean age was 44.4 ± 12.9 years. Twenty five percent of the sample have committed at least one suicidal attempt. Suicidal attempts were positively correlated with the total number of life events (p = 0.001), the number of early life events (p = 0.024) and the number of stressful life events (p Conclusion To prevent suicide, psychotherapies focusing on stress coping could be a good therapeutic alternative among patients with MDD.

Assessment of high-risk eating behaviours among an adolescent female sample: prevalence and cultural aspect of the body shape

Background Eating disorders are frequent among women and usually begin during adolescence. Many studies have shown the tight link between these disorders and body shape concerns, particularly the current aesthetic body shape model concern.The aim of this study is to determine high-risk eating behaviour frequency among a sample of adolescent females. It also aims at pooling their opinions concerning the ideal image of womans body.