R. Rafrafi

Spectrum of Autoantibodies in Tunisian Psychiatric Inpatients

One hundred and three psychiatric inpatients (74 men) were assessed for a wide spectrum of autoantibodies including antinuclear, antismooth muscle, antimitochondrial, antiDNA, anti-phospholipid, anti-cardiolipin IgG and IgM, antikeratin, rheumatoid factor, antithyroperoxydase, antigliadin IgA and IgG, antitransgutaminase, and antiendomysium antibodies. Four groups of patients were considered separately, including 47 with schizophrenia, 23 with schizoaffective disorder, 16 with bipolar disorder and 17 patients with other different psychiatric diagnosis. Forty one healthy, age- and sex-matched blood donors were used as a control group. There were no significant difference in the prevalence of the different autoantibodies between patients (N = 103) and controls except for antigliadin IgG (30.1 vs 9.8 respectively, p = 0.01). Presence of autoantibodies was influenced by age but not by sex or treatment. As for diagnosis categories, patients with bipolar disorder presented significantly more autoantibodies than the three other categories and controls. These results point out a possible autoimmune activation in at least a subgroup of psychiatric patients especially amongst those suffering from bipolar disorder.

Pronostic social des schizophrénies en Tunisie : étude transversale à propos de 60 cas

INTRODUCTION Transcultural studies suggest that the social outcome of schizophrenia might be better in developing countries than in industrialized ones. This study aims to check this hypothesis and attempted to identify prognostic indicators of schizophrenia among Tunisian patients. METHODS This study included all the outpatients responding to DSM IV criteria of schizophrenia for at least five years, during the study period. The assessment tools were: an interview with the patients and their families, data from medical records and the Global Assessment of Functioning scale (GAF) applied for the premorbid period, at two years after onset, at five years, and during the interview (current assessment). The social outcome was assessed by marital and labour market status, social network, sexuality and the GAF score. The outcome was considered to be good, if the current GAF >60, intermediate if GAF was between 31 and 60 and severe if GAF <or=30. The three prognostic subgroups were compared in order to look for prognostic indicators. RESULTS Informed consent was obtained from 60 patients (85.7% of outpatients) and from 56 families. The sex-ratio was 4 (48 men/12 women), the mean age of patients was 39.3 years; the mean follow-up was 14.7 years ([5-45]). School level was six years primary school in the majority of cases, and the living conditions were poor in 48.3% of cases (n=29). During the interview, only 21.6% (n=13) of patients were married. The majority of patients, who were working before the first episode, had lost their job. 76.6% (n=46) did not have any social contacts and only 23.3% (n=14) had any sexual activity. Thus, the social outcome was good in 21% of patients, intermediate in 11.1% and severe in 67.9%. Most social indicators (GAF score, labour market status, social network) revealed a fairly similar progress: a significant decline between the premorbid period and two years after the onset. The course reached a plateau after two years. According to current GAF scores, outcome was good in 25% (n=15) of cases, intermediate in 55% (n=33) of them and severe in 20% (n=12). Some indicators were found to be correlated with this outcome: patient related factors; late language development (correlated with intermediate prognosis [p=0.03]); a comorbid axis II diagnosis (correlated with poorer outcome p=0.04); a poor premorbid global functioning (higher premorbid GAF scores were correlated with a better outcome [p<0.03]); family history related factors; consanguinity in parents (correlated with intermediate-severe prognosis [p=0.04]); elderly father at birth (correlated with severe prognosis [p=0.04]). CONCLUSION Even if these results are limited in their generalisation, this Tunisian sample argues that schizophrenias prognosis is not better in such a developing country.

Impact of Stigma On Euthymic Patients with Bipolar Disorder Type I

Introduction Stigma is a serious concern for people with bipolar disorder (PBD). It may have critical yet insidious repercussions on the course of the illness and may represent a barrier to recovery. Objectives To determine the influence of social stigma and internalized stigma on residual affective symptoms, treatment adherence, global functioning and metacognitive functioning in a population of euthymic PBD. Methods A Cross-sectional study was conducted on 32 outpatients with bipolar disorder I (BDI). Residual affective symptoms were evaluated using the Young Mania Rating Scale (YMRS) and the Hamilton Rating Scale for Depression (HRSD). Social stigma and internalized stigma were evaluated using the Discrimination and Stigma Scale (DISC). The Medication Adherence Rating Scale (MARS), the Global Assessment of Functioning (GAF) and the Metacognition Assessment Interview (MAI) were also used. Results Higher rates of social stigma were correlated with poorer global functioning (p=0.029) and poorer adherence to medication (p=0.022). However, higher social stigma correlated with better metacognitive capacities (p=0.0001, r=-0.61); good metacognition may lead to a better perception of social stigma. Self stigma was significantly correlated to residual depressive symptoms (p=0.0001) and to poorer global functioning (p=0.018) and poorer adherence to treatment (p=0.002). Better metacognitive capacities were also correlated with the ability to overcome stigma. Conclusions Social stigma and self stigma may have negative impact on several aspects of the BD that are essential to the outcome such as medical adherence, functioning and residual symptoms. Targeting stigma may help PBD achieve recovery.

EPA-1205 – Remission and recovery in schizophrenia: associated socio-demographic and clinical features

Introduction Recovery is an important concept in schizophrenia that has not been well defined or researched. It is crucial to determine its predictors. Aims To determine sociodemographic and clinical factors associated with remission and recovery in a population of patients with schizophrenia. Methods The design was an observational, cross-sectional and analytic study. We recruited all of the outpatients with schizophrenia or schizoaffective disorder (according to DSM IV-TR) who consulted psychiatry ward F from the 1/2//2013 to the 31/3/2013. Clinical and sociodemographic data for patients were gathered using an ad-hoc structured questionnaire. Clinical remission was defined according to criteria from the Remission in Schizophrenia Working Group (RSWG). Recovery was defined according to the following criteria from a Meta-Analysis by Jaaskelainen et al. (2013): a clinical remission (RSWG criteria) with a social remission (Global Assessment of Functioning score >=61) and no hospitalisation in the last two years. Results Our sample comprised 44 patient (65.9% were females and 34.1% were males). Remission was achieved in 36.4% of the cases and was correlated with paranoid schizophrenia (p=0.024) and schizoaffective disorder (0.02) diagnoses. Recovery was achieved in 15.9% of the cases and had higher rates in females (p=0.4). Conclusions Better remission rates in paranoid schizophrebia and schizoaffective disorder is a finding which is broadly consistent with numerous previous studies. In opposite, the fact that female patients are more likely to achieve recovery remains controversial.

EPA-1162 – Underrecognition of dementia in nursing home residents in tunisia

Background & aims Dementia is one of the most common neuropsychiatric disorders in nursing home residents. Despite a high prevalence and a major impact on daily activities, dementia remains largely underdiagnosed and therefore rarely treated in nursing homes throughout the world. This study aims to determine the prevalence of dementia among residents of Manouba nursing home (in Tunis) and to identify the proportion of recognised cases of dementia among this population. Methods A cross-sectional study was performed from September to October 2012 among all consenting residents of Manouba nursing home. Sociodemographic data were collected by the means of a semi-structured questionnaire. Cognitive functions were assessed using the Montreal Cognitive Assessment (MoCA) test in its Arabic version. We excluded subjects who could not take the MoCA test because of a severe sensory deficit or a severe psychiatric condition. Results At the time of the study, the population of Manouba nursing home residents consisted of 116 subjects. After applying the exclusion criteria, we retained 77 subjects: 48 males (62.3%) and 29 females (37.7%). The average age was 72.6 years. The average MoCA score was 14.4 +/− 6.5 (range: 3 to 29). The prevalence of dementia in our population was 58.4% (n=45). Among these 45 subjects with dementia, only three (or 6.7% of dementia cases) were already diagnosed as such. Of these three patients, only one was on anticholinesterase treatment. Conclusion Dementia is largely underrecognised and hence undertreated in nursing homes in Tunisia as in other countries. Routine screening for cognitive deficits seems paramount in order to ensure early diagnosis and treatment of this debilitating condition.

710 – Risperidone-associated deep venous thrombosis: case report and review

Deep venous thrombosis (DVT) is a rare but potentially life-threatening adverse effect of antipsychotic medication. In this paper, we present a case of DVT that occurred during the first month of risperidone use. The patient Mr. M., aged 33, presented with a delusion of persecution based on a purely interpretative mechanism. The diagnosis of a delusional disorder of the persecution type was made and the patient was started on risperidone 2mg bid. Two weeks later, the patient was admitted to the internal medicine department for femoro-iliac DVT. Etiological investigation ruled out common congenital as well as acquired causes for thrombophilia, and DVT was hence attributed to risperidone use. The patient quickly responded to heparin then warfarin treatment. Risperidone was switched to amisulpride. Although antipsychotics have been widely used for more than fifty years, their association with DVT has not been discovered until recently. DVT usually occurs during the first three months of antipsychotic use and is more common with atypical and low-potency typical drugs than with high-potency conventional antipsychotics. Amisulpride appears to be the antipsychotic drug least associated with DVT. This case highlights a scarce yet serious side effect associated with antipsychotic use. Caution should be applied when initiating such a treatment in patients with a high risk of thrombosis. Occurrence of DVT in a patient on antipsychotic medication should lead to the current treatment being stopped, and if necessary, switched to either amisulpride or a highpotency conventional drug.