Successful clozapine rechallenge after neutropenia using lithium carbonate : a case report

Introduction

Clozapine is widely known as the drug of choice in treating refractory schizophrenia. However, clozapine prescription requires close clinical and biological monitoring to prevent harmful side effects like agranulocytosis, neutropenia and myocarditis.

Objectives

To show the benefits of lithium carbonate in the clozapine rechallenge of a patient with neutropenia under clozapine.

Methods

We present the clinical case of a patient who developed neutropenia under clozapine, we rechallenged with clozapine after lithium treatment to stimulate hematopoietic functions.

Results

A 42-year-old man diagnosed with refractory schizophrenia, under clozapine for 11 years with a good clinical response at a dosage of 500mg per day (clozapine serum level 328ng/ml), developed a neutropenia (BCC at 840/mm³) within an interval of 2 months. Clozapine treatment was suspended and the patient presented a severe psychotic relapse requiring hospitalization. During hospitalization the patient remained symptomatic under haloperidol 15mg daily. At week 3 of clozapine cessation, neutrophil count reached 1510/mm³. After week 4 we introduced lithium carbonate and while reaching 500mg per day we observed an increase in the neutrophil count to 4850/mm³. We rechallenged with clozapine at week 12 after a poor clinical response, with incremental dosage to 150mg per day in 17 weeks. The blood cell count did not show any abnormalities and the patient had a good clinical response up to 11 months after the clozapine rechallenge.

Conclusions

Despite the lack of guidelines assessing clozapine rechallenge after neutropenia, the use of lithium carbonate may be considered to stimulate hematopoietic functions.

Disclosure

No significant relationships.

« A reason why » : Suicide attempt after Coronavirus infection

Introduction

COVID19 pandemic had an important emotional and psychological impact due to the higher rates of boredom, fear, stress, anxiety, depression, etc. (Brooks et al., 2020). Cases of suicide during the COVID-19 pandemic are increasingly reported. According to an Indian study, the main cause of suicide was fear or anticipation of COVID-19 infection.

Objectives

To illustrate a case of suicide attempt after COVID-19 infection.

Methods

We report the case of a Tunisian man who did a suicide attempt after his infection with the coronavirus.

Results

A 35-year-old Tunisian man, married, an official, with no medical or psychiatric history who was admitted in the Oto-rhino-laryngology department, after a suicide attempt by strangulation, five days after the diagnosis of COVID-19 infection. In fact, the patient was very stressed about his infection and feared transmitting the virus to his family. During his quarantine, he became anxious, had insomnia and suicidal thoughts. He was isolated in his room, and prohibit his family to approach his room. He told us that he could not support this anxiety and he decided to suicide to end this situation and save his family.

Conclusions

The COVID-19 pandemic may increase suicide rates. Psychological consequences of this pandemic including suicide may continue to incur later than this actual worldwide crisis. Mental health promotion is the key to prevent and mitigate such mental health consequences.

Disclosure

No significant relationships.

Schizophrenia and Multiple Sclerosis: Common pathways, common risk-factors

Introduction

Schizophrenia (SCZ) is a severe mental disorder that is among the leading causes of disability worldwide. Multiple sclerosis (MS) is a chronic inflammatory neurological disease with a major impact on the quality of life of young adults. Despite the distinct nature of these two disorders, research studies have identified similarities in underlying pathological mechanisms and risk factors.

Objectives

To illustrate, through a case report, the central role of inflammation in schizophrenia and its relationship with multiple sclerosis.

Methods

Case Report of a 31-year-old male patient with schizophrenia who has been diagnosed with multiple sclerosis.

Results

Mr M. is a 31 year old patient who was diagnosed with schizophrenia at age 17. Between the ages of 25 and 27, the patient had two severe psychotic relapses each one requiring inpatient treatment. At that time, he experienced predominantly severe positive symptoms and persistent suicidality. He was initially prescribed amisulpride up to 600mg, followed by haloperidol up to 45mg daily. Due to poor clinical response, the patient was put on clozapine 400mg/d and has been stabilized since 2017, with outpatient checkups. The patient has reported vertigo and trouble walking in August 2021. He has been referred to the Neurology Department. Clinical, biological and imaging findings were highly suggestive of Multiple sclerosis and the patient has received short courses of intravenous corticosteroids.

Conclusions

This case report highlights the possible association between Multiple Sclerosis and schizophrenia. Further research is needed to clarify the role of inflammation in the central nervous system in schizophrenia and the overlap with Multiple Sclerosis.

Disclosure

No significant relationships.

validation of a scale for assessing patient satisfaction with the quality of care received in psychiatric settings

Introduction

The complexity of the feeling of satisfaction makes its measurement complex, in this context our work aims to develop a simple and practical measurement tool to identify problems within the processes of psychiatric care in order to provide corrective interventions.

Objectives

to validate the psychometric properties of a scale designed for us to assess patients’ satisfaction with the quality of psychiatric care received.

Methods

This is a validation study conducted on a sample of 200 patients followed at RAZI Hospital in Tunisia, outside any period of hospitalization. The questionnaire consisted of 28 items and was structured around eight dimensions (the patient’s perception of his or her own mental disorder, the quality of the doctor-patient relationship, the quality of the nursing team-patient relationship, the organisational aspect and conditions of the hospital ward, the therapeutic discharge planning, the respect of human rights, and the quality of the patient’s health, The organisational aspect and conditions of the hospital ward, Therapeutic discharge planning, Respect for patients’ human rights, Satisfaction with overall care and Loyalty.

Results

Both face validity and content validity were satisfactory. Internal consistency was sufficient with a Cronbach’s alpha of 0.913. The inter-dimensional correlation reflected statistically significant and logical correlations within our scale. Temporal stability was satisfactory. An exploratory factor analysis revealed seven factors with a Kaiser-Meyer-Olkin score of 0.852.

Conclusions

Our scale has demonstrated good psychometric properties. It can be reliably used as a measure of the satisfaction of Tunisian patients with the psychiatric care received.

Disclosure

No significant relationships.

Epidemiological and clinical profile of suicide attempts in Tunisian adolescents

Introduction

Suicidal behavior remains an important clinical problem and a major cause of death in youth.

Objectives

The purpose of this study was to describe the epidemiological and clinical profile of adolescents with suicide attempts.

Methods

This is a retrospective descriptive study that focused on a population of Tunisian adolescents aged between 10 and 19 years old and who were hospitalized after a suicide attempt between between January, 1st 2010 and November,15th 2018, in Razi Hospital.

We used a pre-established questionnaire that explored the sociodemographic and clinical data of patients.

Results

Sixty adolescents were included in this study. The average age of the respondents was 14.3±2 years. The sex-ratio (m/f ) was 0, 36. The suicidal adolescent was a female (73%), single (98%), enrolled in school (66%) with school failure history (52%). Family history of suicide was reported in 8%. Fifty adolescents (83%) lived with their parents and the relationship with them was described as disturbed in 60% of them. A history of physical and sexual abuse was reported in 25% during first adolescence and 15% during second adolescence. The most frequent diagnoses were adjustment disorder with depressed mood (45%) and depression (28%). Drug ingestion was the most common mean of suicide (63%), in an impulsive way in 82% of cases.

Conclusions

Development of repeated epidemiological surveys makes it possible to better understand the prevalence of suicide attempts in adolescents and to implement suicide prevention programs.

Disclosure

No significant relationships.

the impact of shared medical decision making on patient satisfaction in psychiatry

Introduction

The era of the paternalisation of the patient is over, gradually giving way to new models, in particular that of “shared medical decision making”, with the aim of responding to the growing desires of the patient and giving priority to his autonomy.

Objectives

to establish the influence of the new active position of the patient in the therapeutic process on the satisfaction of the psychiatric patient.

Methods

This is a descriptive cross-sectional study that took place over a period of 5 months from April 2019 to August 2019 in two university hospital psychiatry departments of Razi Hospital in Tunisia . The questionnaire was administered outside any period of hospitalisation, in order to increase the reliability of responses. We used a pre-established form including socio-demographic data, clinical data concerning the patient’s mental disorder followed by a patient satisfaction questionnaire regarding the quality of care received in a psychiatric setting.

Results

The patients interviewed in our study reported a good level of satisfaction (67.5%) with their involvement in the therapeutic process. However, 45.5% of the patients expressed dissatisfaction with the information provided to them by their doctor about their mental health status. The majority of the subjects surveyed expressed satisfaction with the quality of the interviews conducted during hospitalisation (71%) and with the time spent with the doctor (67%).

Conclusions

Despite the fact that providing information to patients with mental health problems is a key element of patient satisfaction, not enough doctors actually include it in their daily practice.

Disclosure

No significant relationships.

Time of onset of hematological side effects with Clozapine

Introduction

Clozapine use is not deprived of serious complications that can condition treatment strategies, particularly hematological. Recognizing the time it takes for these effects to set, can therefore help to better screen their appearance, improving healthcare.

Objectives

To study the time of onset of hematological adverse reactions in patients treated with Clozapine.

Methods

A longitudinal, retrospective and descriptive study on a period of 20 years starting from the first of January 2000, at the psychiatry department A of the Razi hospital in Tunisia. This study was conducted on patients treated by Clozapine. The data was collected from patients’ medical files using a pre-established sheet.

Results

The studied sample included 64 patient. Hematological disorders were found in 21 patients (32.8%). The mean time of onset of hematological adverse reactions was 119.71±126.56 days. Indeed, some patients had presented more than one hematological disorder and this at different times. Mild to moderate neutropenia had a mean time of onset of 502.57±908.32 days. The time of onset of eosinophilia was 937.75±1725.87 days, 297.67 ± 444.93 days for thrombocytopenia, 741±1268.85 days for leukopenia, 69.25 ± 48.19 days for hyperleukocytosis and 183. 33±231.80 days for anemia. Two cases of agranulocytosis were noted: one case occurred 10 years and three months from treatment beginning and the second case occurred after 7 months of treatment onset.

Conclusions

The time of onset of hematological side effects with clozapine varies widely and cannot be predicted with precision. Early, more frequent and regular surveillance is therefore necessary in this population.

Disclosure

No significant relationships.

“I have brain fog…” About cognitive impairment after COVID-19

Introduction

Much has been learned about SARS-CoV-2. However, the mechanism of short or long-term neuropsychiatric symptoms remains unclear. several hypotheses, including lack of oxygen caused by lung damage, inflammation affecting brain cells, or Lack of blood flow caused by swelling of the small blood vessels in the brain, have been advanced to explain these symptoms.

Objectives

Herein, we presented a case of cognitive impairment diagnosed after infection with COVID 19.

Methods

We discussed, through a clinical case, the possible mechanisms and risk factors of cognitive impairment following COVID 19 infection.

Results

This case concerned a 28 –year-old patient. He had no personal or family psychiatric. In August 2021, he presented a SARS-CoV-2 infection without hypoxemia or respiratory failure. On day 10 the patient recovered. Two days after, he consulted our psychiatric department as he experienced impairment in memory. He had impairment in attention and executive function, and in particular verbal fluency. He said that his thinking was sluggish, fuzzy, and not sharp. He denied any alcohol or drug abuse. He was euthymic and he had no depressive symptoms. Arterial blood gas, laboratory, and clinical findings were normal. A brain CT scan with contrast was performed and did not show any abnormality.

Conclusions

This case highlighted the possible cognitive consequences of COVID-19 during the recovery phase. Further work is required to identify risk factors of psychiatric symptoms following COVID-19 infection and their management.

Disclosure

No significant relationships.

Clozapine cessation

Introduction

Approximately 30% of individuals diagnosed with schizophrenia suffer from treatment-resistant or refractory schizophrenia. The gold standard for treatment is clozapine. However, a significant number of patients discontinue clozapine treatment and this carries a poor prognosis.

Objectives

This study explores patients’ motives for cessation of clozapine therapy and its prevalence.

Methods

A longitudinal, retrospective and descriptive study on a period of 20 years, at the psychiatry department A of the Razi hospital in Tunisia. Data was collected from the medical files of patients trated by clozapine using a pre-established sheet.

Results

The studied sample included 64 patient records. Treatment with clozapine was stopped spontaneously or following a medical decision in 37 patients (57.8%). The total number of clozapine stops in these 37 patients was 70. Indeed, each one of these patients had stopped treatment at least once. Clozapine was discontinued by some patients in the study sample for poor compliance(45.9%), for adverse side effects of treatment (16.2%) and by treating physicians for poor response treatment (8.1%). Clozapine was discontinued by 11 patients for hematological adverse reactions, representing 27.9% of the total number of clozapine discontinuations. Withdrawal of clozapine was indicated in 2 cases of agranulocytosis(18.2%), in 2 cases of moderate neutropenia(18.2%), in 3 cases of eosinophilia (27.2%), in 3 cases of thrombocytopenia (27.2%) and in 1 case of severe anemia (9.2%).

Conclusions

Clozapine discontinuation was essentially caused by poor patients’ observation and hematological adverse reactions appearance.Future research should seek to further investigate clozapine cessation factors in order to better benefit from the medical virtues of this molecule.

Disclosure

No significant relationships.

Delusion of pregnancy : The role of prolactin

Introduction

A delusion of pregnancy is defined as a fixed false belief that one is pregnant in the absence of any evidence to support the pregnant state. Different mechanisms have been advanced to explain this phenomenon.

Objectives

Herein, we present a case of hyperprolactinemia with delusion of pregnancy during the use of Amisulpride.

Methods

Herein, we present a case of hyperprolactinemia with delusion of pregnancy during the use of Amisulpride.

Results

This case concerns a 39-year-old, divorced Tunisian woman with the diagnosis of schizoaffective disorder,She has never been pregnant. She was taking Amisulpride at the dose of 400 mg per day with 100mg of Haldol Decanoate. In June 2021, she was admitted to our department as she expressed the thought that she was pregnant. No other psychotic symptoms were reported. There was no history of alcohol or illicit drug use. The physical examination was normal. The blood pregnancy test was negative. A measure of serum prolactin was performed and revealed a high prolactin level at 700 ng/ml. Amisulpride was discontinued. We then recorded the serum prolactin level at one month and then at three months after we stopped Amisulpride. We found that as her prolactin levels decreased her complaint of pregnancy also diminished. Actually, the patient has a normal level of prolactin and has no pregnancy delusion.

Conclusions

Clinicians should be aware that delusion of pregnancy in psychotic patients may be caused by side effects of the treatment. Monitoring of serum prolactin levels in patients under Amisulpride may help to improve the management of these patients.

Disclosure

No significant relationships.

Treatment-resistant schizophrenia : the relationship between clozapine plasma concentration and clinical outcome

Introduction

Clozapine is highly effective in patients with treatment-resistant schizophrenia but, to ensure optimal clinical response it is important to optimize its use and this depends on adequate pharmacological monitoring.

Objectives

Evaluate the therapeutic response rate according to clozapine plasma concentration.

Methods

It was a cross-sectional, retrospective and analytical study, carried out over a period of six months, in the F and A psychiatry departments of the Razi hospital in Tunis, including patients followed for treatment-resistant schizophrenia and receiving clozapine. We evaluated the response to clozapine using the Brief Psychiatric Rating Scale (BPRS).

Results

The average age was 37.7 ± 9.4. The mean age of introduction of clozapine was 31 years and the mean time to its introduction was 9.3 years. Clozapine was administered as a single drug in 85% of cases. The mean dose of clozapine was 373 mg/day. The mean of clozapine plasma concentration was 386.5 ng/ml with a minimum of 89 ng/ml and a maximum of 913 ng/ml. The clinical response rate to clozapine was 25% with a BPRS good response threshold value of less than 35. Patients with clozapine levels above the conventional cut-off of 350 ng/ml (n=34) had a response rate of 34.6%. A response rate of 37% was observed in the group of patients with a clozapine plasma concentration interval of 200-350 ng/ml. There was no statistically significant difference in therapeutic response (p=0186)

Conclusions

Our study revealed a therapeutic response variation according to plasma clozapine concentration and showed the existence of a non-negligible and effective response rate.

Disclosure

No significant relationships.

Treatment-resistant Bipolar Disorder and Thyroid Cancer

Introduction

Bipolar disorder (BD) is a chronic and recurrent illness frequently associated with functional deterioration and treatment challenges. High rates of thyroid dysfunction have been found in patients with BD, compared to the general population.

Objectives

To illustrate through a case-report the therapeutic challenges of treatment-resistant bipolar disorder and its relationship with thyroid dysfunction.

Methods

Case report of a 41-year-old male patient with BD and comorbid anxiety disorders who has been diagnosed with thyroid cancer and underwent total thyroidectomy.

Results

Mr B is a 41 year old patient diagnosed with BD and comorbid anxiety disorders (panic disorder, social anxiety disorder and generalized anxiety disorder) at age 18. He has presented in total 17 relapses and was hospitalized 7 times between the ages of 18 and 24. He experienced predominantly major depressive episodes with mixed features and debilitating anxiety symptoms. He was put on several treatments including a combination of mood stabilizers, antidepressants and benzodiazepines. Due to unsatisfactory treatment response, he was put on clozapine 150mg to 175mg/d combined with valproic acid, clonazepam. In 2009, the patient developed a nodular goiter caused by papillary thyroid carcinoma and underwent total thyroidectomy and radioactive iodine therapy. Following the surgical operation and stabilization of thyroid functioning, a decrease in the number of relapses and the severity of mood and anxiety symptoms have been noted.

Conclusions

This case reports highlights the importance of thyroid function assessment in patients with bipolar disorder and the possible correlation to treatment resistance and symptom severity.

Disclosure

No significant relationships.

Impact of the COVID19 pandemic on patients followed in psychiatry

Introduction

In the literature, some studies consider psychiatric patients to be vulnerable to COVID-19, in contrast to other studies that find them rather protected.

Objectives

To determine the impact of the COVID 19 pandemic on patients undergoing psychiatric care.

Methods

This is a descriptive and cross-sectional study that took place in the psychiatry department A at Razi hospital in Tunisia. We conducted a comparison of patient follow-up between the period of March 2018-2019 and March 2020-2021. For this we used a form including socio demographic data, data concerning the COVID-19 situation, clinical data while comparing the follow-up of patients (hospitalizations, mode of relapses, consultations in the emergency room…)

Results

100 patients were included, 60% were men, mean age 44 years (+/- 11 years) [19-65 years]. Ninety-seven percent of patients had no personal history of COVID-19 infection. Comparing the pre-pandemic year (2018-2019) and the pandemic year (2020-2021), we note an increase in the rate of emergency room visits of (17.5%) as well as a relapse rate requiring hospitalization in our department in 48%, this figure was 30% in 2019. A statistically significant increase was noted for depressive and anxiety relapses (p=0.04; r=0.7). Fear of catching the virus while attending hospital facilities (17.6%), geographical isolation (17.6%), unavailability of treatment (17%) and poor insight (41.2%) were the primary causes of poor adherence.

Conclusions

The patients followed in our department have presented during this COVID-19 pandemic several relapses of their psychiatric pathologies compared to the previous year.

Disclosure

No significant relationships.

Medical residents and COVID-19

Introduction

The covid-19 pandemic is a difficult global phenomenon that causes a lot of anxiety and uncertainty. This situation has involved reactions of fear. Healthcare professionals are necessarily in contact with patients, but may find themselves torn between the duty to care and the duty to protect themselves and their relatives.

Objectives

To assess perceived stress among medical residents in Tunisia

Methods

We conducted a descriptive study among a representative sample of residents working at a teaching hospital in Tunis during the first half of 2021 in different departments. We prepared a questionnaire for the study divided in two parts: socio-demographic data; professional data (function, practice setting); data related to contact with covid-19 patients ; questions on fear of covid-19 contamination and the Perceived stress scale (10items)

Results

Our sample consists of 100 residents in 10 different specialties, including 70 in services with direct contact with Covid-19 patients. Stress management is rated good for 30 residents, average for 40 residents and poor for 30 residents. This management depends on the number of guards, the number of patients examined, the technical platform available and especially the period of the pandemic.

Conclusions

Medical residents are in the front line in university hospitals in tunisia. The stress to which they are subjected depends on the working conditions and coping skills of each of them.

Disclosure

No significant relationships.

Particularities of suicide attempts in late adolescence in Tunisia

Introduction

Suicide attempts in late adolescence deserves special attention.

Identifying particularities of suicidal behavior in this age group seems important in order to detect suicidal ideations.

Objectives

Describe the characteristics of suicide attempts in late adolescence among hospitalized patients.

Methods

This is a retrospective descriptive study that was conducted in our psychiatry department in Razi Hospital, Tunisia. It focused on a population of Tunisian adolescents aged between 15 and 19 years old and who were hospitalized after a suicide attempt between January, 1st 2010 and November,15th 2018.We used a pre-established questionnaire that explored the sociodemographic and clinical data of patients.

Results

Thirty adolescents were included. Twenty-three of them (77%) were female. Mean age of suicidal adolescents was 16.5 years. They were mostly living with their families (80%). Intentional drug ingestion was reported in 56% of cases. Half of the adolescents were indifferent regard the suicide attempt. Conflictual family environment was reported to be a triggering factor of the suicidal thoughts in 60% of cases, and romantic breakup in 20% of cases. In fact, these adolescents were diagnosed with adjustment disorder with depressed mood in 47% of them and depression (28%).Adolescent suicide attempts were correlated with a conflictual family environment (p=0.04) and the presence of academic difficulties (p<10-3).

Conclusions

Family dysfunction and conflictual environment are predictors of suicide risk in the late adolescence. Prevention strategies should be reviewed and focus more on these factors.

Disclosure

No significant relationships.

Associated factors of repeated suicidal behavior

Introduction

Suicide is a dramatic suicidality complication and a significant worldwild public health problem. Sixty percent of suicidal deaths are preceded by at least one suicide attempt.

Objectives

to search and estimate the factors predicting a suicidal recidivism

Methods

We conducted a retrospective descriptive survey, achieved in psychiatric departement A of Razi hospital on 60 patients hospitalized during a period of 10 years (from January 2010 to December 2019) and have committed at least a suicide attempt. Data collected from medical folders in order to explore sociodemographic and clinical characteristics of the patients.

Results

The mean age of the sample was 30 years. A high prevalence of female was objectified. There were a low level of education for 53%, most of patients (55%) were unemployed and came from urban area. Among our patients, 39% attempted suicide for a one time. 61% of patients attempted suicide for several times. The main risk factors related to recidivism of suicidal behavior were unemployment, family history of psychiatric disorders and family instability.

Conclusions

The analysis of these results justifies preventive actions in order to face the increase of suicidal recidivism by searching for these associated factors. Therefore, a multidisciplinary intervention approach is required.

Disclosure

No significant relationships.

Mixed features in depression: frequency and associated factors

Introduction

Mixed states in mood disorders present significant clinical and prognostic challenges. Although the DSM-5 has broadened diagnostic criteria for mixed states with the development of the ‘mixed features’ specifier and its application to unipolar depressive disorders, some mixed episodes might still be overlooked.

Objectives

to evaluate the frequency and the factors associated with mixed depression according to the broader Koukopoulos criteria in a sample of patients with a major depressive episode

Methods

We included 99 consecutive patients presenting for a major depressive episode of bipolar (n=10) or unipolar major depressive (n=89) disorder at our outpatient clinic. Major depression was ascertained using SCID- IV criteria, and mixed features were determined using Koukopoulos’ diagnostic criteria

Results

Mean age of the sample was 35.5 years [14-58]. Women accounted for 63.6% of patients. Mixed features were found in 19.5% (n=19) of the sample, 80% (n=8) among patients with bipolar disorders (BD) and 12.3% (n=11) among those with major depressive disorder (MDD). Individuals with mixed features had more substance abuse (p=0.005) and more suicide attempts (p=0.01). Individuals receiving antipsychotics had a lower risk of mixed features (p=0.000) while antidepressant treatment did not have any affect. A family history of BD, psychosis, suicide and substance abuse were found in these patients. Mixed features in depression were more frequent in patients with BD than in MDD.

Conclusions

Our study showed a high frequency of mixed features in depression, especially bipolar depression when Koukopoulos criteria are applied. Special attention should be given to these patients given the association with substance use and suicidality

Disclosure

No significant relationships.

Which antipsychotics can we use for obsessive-compulsive symptoms in schizophrenia?

Introduction

Obsessive-compulsive symptoms (OCS) are common in schizophrenia, with a prevalence ranging from 12 to 25%. They affect negatively disease outcome. Patients with comorbid OCS present more frequently resistant psychotic symptoms. Besides, the appearance and aggravation of OSC are more commonly reported with atypical antipsychotics.

Objectives

To present through a clinical case and a brief literature review the treatment challenge of obsessive-compulsive symptoms in schizophrenia.

Methods

We reported the case of Mr. M.S., treated in our department since 2008 for comorbid schizophrenia and OCS, and discussed therapeutic alternatives through a literature review.

Results

Mr. M.S. a 34-year-old male diagnosed with comorbid schizophrenia and OCS at age 20. To control psychotic symptoms, the patient received several trials of anti-psychotics with little improvement. We concluded that it was resistant schizophrenia. The introduction of clozapine reaching 300 mg daily led to significant improvement of psychotic symptoms but worsened OCS. The adjunction of fluoxetine and cognitive-behavioral therapy (CBT) was unsuccessful to manage obsessive symptoms. We opted for the association of aripiprazole 20 mg daily and clozapine, the doses of which were gradually tapered down to 150 mg daily. This association has guaranteed the improvement of both psychotic and obsessive symptoms.

Conclusions

Conclusion This clinical vignette highlights the need for clinical awareness about the possible exacerbation of OCS with atypical antipsychotics in schizophrenia.

Disclosure

No significant relationships.

Social rhythms and occupational functioning disturbance in remitted bipolar patients

Introduction

Biological rhythm disturbance is etiologically involved in mood disorders. Previous literature focused on studying sleep disruption in bipolar disorders (BD). However, only a few studies addressed the influence of social rhythms and occupational functioning as they may affect circadian regularity and consequently be a critical pathway to mood symptoms.

Objectives

The main aim of this study was to assess biological rhythms in remitted bipolar patients and to evaluate their social rhythms and occupational functioning.

Methods

We recruited a total of 80 euthymic outpatients with BD and 80 control subjects. Biological rhythm disruptions were assessed using the Biological Rhythm Interview of Assessment in Neuropsychiatry (BRIAN), an interviewer administered questionnaire that assesses disruptions in sleep, eating patterns, social rhythms, and general activity.

Results

Patients with BD experienced greater biological rhythm alterations than the control group (BRIAN total scores 35.26±9.21 vs. 25.84±2.68). In addition to their sleep-wake rhythm (mean scores 11.1±3.95 vs. 7.41±1.41), patients were particularly more impaired than the control group with regards to social rhythms (7.31 ± 2.57 vs. 5.24 ± 1.06) and general activity (8.9 ± 3.35 vs. 7.01 ± 1.4).

Conclusions

Our study indicated that patients with BD experience major disruptions in their social rhythms and occupational functioning. These alterations may lead to unstable biological rhythms and to a higher risk of mood episodes. Therefore, consolidating social rhythms and functioning appears to be a crucial step for preventing relapses in patients with BD.

Disclosure

No significant relationships.

Adolescents’ attitudes towards e-cigarette in Tunisia

Introduction

E-cigarette use has increased over the last years. Many studies have examined teenagers’ attitudes towards smoking, but did not examine adolescents’ attitudes towards e-cigarettes.

Objectives

The aim of this study was to examine high school students’ attitudes regarding e-cigarette safety, addictive properties and social norms and to compare e-cigarettes perceptions among e-cigarette users and non-users in Tunisia.

Methods

A survey was conducted with a sample of 234 students in Mohamed Ali high school in Sfax, a town in South of Tunisia, in February 2020. Socio-demographic data and questions about vaping and attitudes towards e-cigarettes were used to evaluate students’ perceptions towards e-cigarettes.

Results

Among high school students aged 15 to 20, 58,8% have ever used e-cigarette, 38,3% had done so within the previous 30 days and 20,5 % were regular users of vapes. 53.8% of students believed that e-cigarettes are harmful. 78.4% of them thought they were less harmful than regular cigarettes and 50.5% thought they could be addictive, 45.4% of students believed e-cigarette smoking decreased anxiety and a third thought it made them sociable (33.3%) and confident (30.6%).Adolescents who used e-cigarettes had significantly more favorable e-cigarette attitudes than non-users: they believed they were less harmful than tobacco (p=0,019), they were not addictive (p=0,005), they decreased anxiety (p=0,001) and they made the user sociable (p<0,001) and confident (p=0,01).

Conclusions

Our results suggest the need to provide teenagers with the correct information about e-cigarettes risks, and the balance risk-benefit of their use.

Disclosure

No significant relationships.

Problematic facebook use during COVID-19 pandemic among Tunisian women

Introduction

Due to COVID-19 pandemic, the Tunisian government officially announced a lockdown on March 2020. This decision caused a significant change in the everyday life of Tunisians such as movement restriction revealing the psychosocial aspect of this crisis.

Objectives

This study aims to assess the impact of the COVID-19 pandemic on the mental health of Tunisian women and its association with social media addiction.

Methods

This study was conducted using an online survey, between April 25 and May 6, 2020. Women were asked about sociodemographic information, lockdown conditions. The Facebook Bergen Addiction Scale (FBAS) was used to evaluate addiction to Facebook and social media. The Depression Anxiety and Stress Scales (DASS-21) was used to evaluate depression, anxiety and stress.

Results

We included 751 participants. Scores of the FBAS ranged from 6 to 30 and the mean score was 16.49 (± 5.4). Forty percent (n = 300) of respondents might have facebook addiction, as per the scale. A significant positive correlation was found between Facebook addiction score and DASS scores of depression (p = 0.001, r = 0.43), anxiety (p = 0.001, r = 0.39) and stress (p = 0.001, r = 0.41).

Conclusions

Women who have higher rates of distress are more likely to have a problematic Facebook use during the COVID-19 pandemic which suggests that smartphone and internet use may be part of coping strategies implemented for the emotional distress secondary to this pandemic.

Disclosure

No significant relationships.

Impact of COVID-19 pandemic on gender-based violence in Tunisia

Introduction

Violence against women is a public health problem worldwide. During humanitarian crises such as wars, violence expands mainly to the detriment of the most vulnerable groups.

Objectives

This study aims to assess the effect of the COVID-19-related lockdown on gender-based violence.

Methods

This study was conducted using an online survey, between April 25 and May 6, 2020. Women were asked about sociodemographic information, lockdown conditions, history involving exposure to violence before and during the COVID-19 lockdown and its types.

Results

The number of included participants was 751. The age ranged from 18 to 69 years. Violence against women increased significantly during the lockdown (from 4.4 to 14.8%; p < 0.001). Psychological abuse was the most frequent type of violence (96%). Almost 90% (n = 98) of those who experienced violence during the lockdown did not seek assistance. Women who had experienced abuse before the lockdown were at an increased risk of violence during lockdown (p < 0.001; OR = 19.34 [8.71–43.00]).

Conclusions

Strengthening strategies to protect women during periods of crisis is urgent. However, a change in mentalities would take more time to set up. Violence against women necessitates a fundamental long-term struggle and practical intervention strategies.

Disclosure

No significant relationships.

A delusion of pregnancy in man with hyperprolactinemia

Introduction

A delusion of pregnancy in men has been rarely reported in psychiatric disorders. The literature on this delusion in male schizophrenia is limited. It was reported especially in medical conditions. In psychiatric disorders, it has been explained for a long time by psychodynamic theories.

Objectives

To present a case of a pregnancy delusion in man associated temporally to neuroleptic-induced hyperprolactinemia and a review of literature of medical and psychological etiologies of this symptom

Methods

We presented a case of a pregnancy delusion in man associated temporally to neuroleptic-induced hyperprolactinemia and we elucidated through a review of literature of medical and psychological etiologies of this symptom.

Results

Case report A 46-year-old man, unmarried, who had a mild intellectual disability and a 22-year history of schizophrenia. He was admitted to our hospital for psychotic relapse due to the interruption of his medication. This patient had been treated for years with long action injection medication. On admission he was disorganized, verbalizing a poorly-systematized fuzzy delirium. And he believed he was pregnant. Serum prolactin levels was 38 ng/ml (3-25ng/ml). He was put on Haldol decanoate 150mg/month, chlorpromazine 150mg/day, and diazepam 15mg/day.

Conclusions

The presentation of a delusion of pregnancy in man is rather infrequent. The delusion may have many social, psychological, and biological determinants to its genesis. This case highlights the importance of medical investigations notably the assay of prolactin in the assessment of patients who present with delusions of pregnancy.

Disclosure

No significant relationships.

Psoriasis and psychiatric disorders

Introduction

Psoriasis is a common psychophysiological chronic skin disease with an important impact on patient’s quality of life. The prevalence of psychiatric conditions in psoriasis may range from 24% to 90%. The mechanisms that may explain this relationship still remain debatable.

Objectives

The purpose of this work was to report two cases of psychiatric comorbidities associated with psoriasis and to discuss the possible etiopathogenic mechanisms behind this connection.

Methods

To report two cases of psychiatric comorbidities associated with psoriasis.

Results

Case1 Mr. A.K. is a 30-year-old male patient. He was admitted to our department in February 2020 for acute mania with psychotics features.the patient reported that since 2010, he was treated for psoriasis with local treatment (cortisone cream). The lesions did not grow or expand. Case2 Mr.A.B.is a 27-year-old male patient, with past history of psoriasis under local treatment. He is treated since 2019 in our department for schizophrenia.

Conclusions

High levels of pro-inflammatory cytokines observed in psoriasis may in part explain the associated psychiatric disorders. The psychodermatologic approach would be beneficial for the adequate management of patients suffering from psoriasis.

Disclosure

No significant relationships.

Electronic cigarettes use among teenagers in Tunisia

Introduction

Electronic cigarettes (e-cigarettes) are battery-powered devices developed with the goal of mimicking the action of smoking. Their use has increased over the past years.

Objectives

The aim of this study was to evaluate the prevalence of the use of e-cigarettes among teenagers in high school and to examine the predictor factors.

Methods

A survey was conducted with a sample of 234 students in Mohamed Ali high school in Sfax, a town in the south of Tunisia, in February 2020. We estimated e-cigarette prevalence among adolescents and the predictor factors of vaping.

Results

Among high school students aged 15 to 20, 58,8% have ever used e-cigarette, 38,3% had done so within the previous 30 days and 20,5 % were regular users of vapes. The mean age of e-cigarette users was 16,59 +/- 0,908 years old, 83,3% of e-cigarettes users were males. Male gender, high socio-economic level, practicing leisure activities, smoking cigarettes and drinking alcohol were associated with regular use of e-cigarettes. Overall, 51, 6% of never smoking students reported ever use of e-cigarettes. The main reason for initiating e-cigarettes use was curiosity (65%).

Conclusions

Our findings showed the significant use of e-cigarettes among high school students thus it would be interesting to provide adolescents with information about the use of e-cigarettes and other tobacco products.

Disclosure

No significant relationships.

Tunisians peoples dealing with death in COVID-19 pandemic: Lived experiences of grief

Introduction

As Dame Cecily Saunders said, “How people die remains in the memory of those who live on.” For Muslim people, funerals and burial procedures are crucial moments that help them come to terms with the loss of a loved one. The COVID-19 pandemic has disrupted usual experiences of grief since funerals and burials are held without the presence of family. Approaches to support grief are needed to be adapted to these particular circumstances.

Objectives

Describe the lived experiences of grief of the Muslim Tunisian family for patients who died due to COVID -19.

Methods

This was a qualitative study with a phenomenological approach. Data of patients who died due to COVID -19 were collected. One family member or more of each deceased was contacted. Semi directive interview was conducted to help participants to describe the lived experience.

Results

30 persons participated in this study. The reactions of participants towards death were crying, being sad, and being choked. The reactions of grief were influenced by several factors. These included: the circumstances of the deceased, relationship with him, the hospitalization in an intensive care unit, doctors’ expectation, and the average length of stay in hospitals before the death. Islamic religious beliefs influenced the way family experienced grief, mainly toward the management of the dead body and the imposed funeral protocol.

Conclusions

This study describes the devastating impact of COVID-19 toward lived experiences of grief of Muslim Tunisian. In light of these results, grief therapies should be adapted and evaluated in this population.

Disclosure

No significant relationships.

Impact of the COVID-19 pandemic and the lockdown period on the number of hospitalizations for acute mania

Introduction

COVID-19 pandemic has affected social interaction and healthcare worldwide especially during the period of lockdown. As a result of this pandemic in Tunisia, the activity of hospital services and all non-emergency acts, in several specialties have been reduced. In psychiatry, such measures have not been taken. In the social zeitgeber hypothesis social rhythm disrupting life events such as eating, activity, and social patterns, may lead to the onset of manic episodes.

Objectives

The objective of this study was to evaluate the impact of the COVID-19 pandemic on the frequency of acute mania in the context of bipolar disorder during the lockdown and post lockdown period compared to the same period during last year in a psychiatric department in Tunisia.

Methods

We assessed the number of hospitalizations in our department for acute mania in the context of bipolar disorder during the lockdown period in our country, (from March 1st and May 30, 2020) and during the two months following it. We compared this frequency to that of the previous year during the same periods.

Results

During the lockdown period, 17 patients were hospitalized for acute mania in the context of bipolar disorder. Sixty-seven patients were hospitalized in 2019 during the same period for acute mania. Nine hospitalizations for acute mania in the post lockdown period (between June and July 2020), were noted compared to 16 hospitalizations in the same period in 2019.

Conclusions

Lockdown seemed to have a protective effect from affective episodes in bipolar disorder. Perceiving increased connectedness among families may explain these findings.

Mental health of Tunisian women during the first wave of COVID-19 pandemic

Introduction

The coronavirus disease 2019 (COVID-19) pandemic created a situation of general distress. Although the focus has been initially more on the physical health during the pandemic, mental health concerns linked to the lockdown have quickly risen.

Objectives

The aim of this study was to evaluate the impact of the first wave of COVID-19 pandemic on Tunisian women’s mental health.

Methods

An online survey was conducted during the first wave of COVID-19 pandemic using the Depression Anxiety and Stress Scales (DASS-21). We also collected sociodemographic information and mental health status.

Results

A total of 751 women completed the questionnaire. More than half of the participants (57.3%) reported extremely severe distress symptoms, and 53.1% had extremely severe stress symptoms as per the DASS-21. Those who had a history of mental illness were found to have more severe symptoms of depression, anxiety and stress.

Conclusions

As this study was the first one to evaluate the acute impact of COVID-19 on mental health in Tunisia, Arab world and in Africa, it may be a sound basis for developing an effective psychological intervention aimed at women in these regions.

Disclosure

No significant relationships.

Academic procrastination in university students: Associated factors and impact on academic performance

Introduction

Academic procrastination is a specific sub-type of procrastination, assessing the tendency to delay academic tasks in connection with the preparation of courses or exams.

Objectives

To determine the impact of academic procrastination on studies and academic performances and identify associated factors.

Methods

We conducted a cross-sectional descriptive study in students from three different universities: a medical school, a law school and an engineering school. Socio-demographic, clinical and academic data were collected. Procrastination was assessed using the Academic Procrastination Scale. We further administered the Short Version of the impulsive behaviour scale, the Satisfaction with Life Scale, the Perfectionism scale, and the one item Self-esteem Scale.

Results

Our sample consisted of 1019 students. The mean age was 22 ± 2.25 years, and 62% were females. About one third of study participants used tobacco or alcohol, and 10% used drugs (cannabis or others). We found a significant positive correlation between procrastination and academic failure (r=0.22 p= 0.00) and a negative correlation with academic success (r= -0.27 p=0.00). Multivariate regression analysis showed the following risk factors for academic procrastination: alcohol consumption (ORa= 1.74 [1.14; 2.67]), study field (with reference to medicine: law ORa= 1.50 [1.02; 2.19], engineering studies ORa= 2.01 [1.34; 3.02]), and impulsivity (ORa= 2.11 [1.55; 2.86]).

Conclusions

Academic procrastination has a negative impact on academic achievement and performance. This impact appears to differ depending on the field of study. It also seems closely related to impulsiveness and alcohol use. Our findings might contribute to find new ways of helping students to improve academic performance.

Disclosure

No significant relationships.

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.

[Contribution of pulmonary CT angiography in assessing the severity of acute pulmonary embolism]

Chest CT angiography has taken a major role in the management of patients with suspected pulmonary embolism. Meanwhile, it became necessary to determine the severity criteria at the time of diagnosis in order to properly assess the risk/benefit of treatment to consider. In recent years, pulmonary CT angiography has emerged as a useful tool for assessing the severity of acute lung embolism, based on morphological criteria. The two main approaches that were studied were the quantification of obstruction of pulmonary arterial bed and recognition of signs of right heart failure. The aim of our work is to define the morphological parameters in cardiovascular pulmonary CT angiography and to determine their value in the current clinical prognostic stratification of acute pulmonary embolism of, especially their correlation with the risk of developing signs of clinical severity at diagnosis and at 3 months of the occurrence of pulmonary embolism.

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.

[Role of radiotherapy in stage I testicular seminomas: about 25 cases]

Notre travail se proposait de rapporter les résultats d’une étude rétrospective, descriptive, portant sur 25 séminomes testiculaires de stade I et de préciser la place de la radiothérapie dans la prise en charge de cette entité. Entre janvier 2001 et décembre 2009, 25 patients atteints d'un séminome testiculaire de stade I ont été pris en charge au service de radiothérapie de l’institut national d’oncologie de Rabat. L’orchidectomie première a été réalisée par voie inguinale. Le bilan d’extension initial comportait un dosage de bHCG totale, d’alphafoetoprotéine, et une exploration des aires ganglionnaires sus- et sous-diaphragmatiques par une tomodensitométrie. L’irradiation adjuvante a été délivrée au moyen d’un accélérateur linéaire. L'âge médian est de 33 ans (18-52 ans). La tumeur testiculaire siégeait à droite chez 16 malades et à gauche chez les 9 autres. La radiothérapie était délivrée dans les aires ganglionnaires lomboaortiques pour 18 patients, lomboaortiques et iliaques homolatérales pour les 7 autres et ceci par deux faisceaux antéropostérieurs, délivrant une dose de 20 à 25 Gy en 10 à 14 fractions. La tolérance immédiate était excellente. La durée médiane de surveillance était de 73 mois. Vingt trois patients sont actuellement vivants, en situation de rémission complète. Un patient a rechuté au niveau pulmonaire 22 mois après la fin de sa radiothérapie. Un patient a été perdu de vue. Il n’a pas été observé de toxicité à long terme, en particulier gastro-intestinale. Aucune tumeur ou pathologie hématologique secondaire n’a été rapportée. La radiothérapie prophylactique reste le traitement adjuvant de référence des séminomes de stade I. La tolérance immédiate est satisfaisante et l’augmentation du risque de cancer secondaire est négligeable par rapport au bénéfice thérapeutique. Toutefois une surveillance armée ainsi qu’une chimiothérapie adjuvante avec un cycle de carboplatine sont aussi efficaces.

Merkel cell carcinoma occurring in a black woman: a case report

BACKGROUND

Merkel cell carcinoma is a rare, very aggressive neuroectodermal tumor of the skin. It is typically located on sun-exposed skin and frequently found in white men aged between 70 and 80 years.

CASE PRESENTATION

We report a case of a 58-year-old black woman diagnosed with Merkel cell carcinoma of the posterior face of the right elbow. She had biopsy excision and was lost to follow-up. Four months later, she presented with recurrent disease on the inferior third of the right arm with three ipsilateral axillary lymph node metastases. Amputation of the right arm and ipsilateral axillary lymph node dissection were performed, followed by adjuvant radiotherapy. Six months later, the patient died as a result of respiratory failure caused by lung metastasis. To the best of our knowledge, no specific studies have been done comparing the course and the characteristics of Merkel cell carcinoma in white and black populations, and no similar case has been reported in the literature.

CONCLUSIONS

The Merkel cell carcinoma is very rare in black people. As described elsewhere in the literature, our patient had a poor outcome despite radical management. To date, to the best of our knowledge, there has been no comparison of the prognosis of this tumor in white and black populations.

Extra-axial ependymoma of the cerebral convexity: A very rare intracranial adult tumor

Background Ependymomas are rare adult tumors that originate from the ventricular system or the ependymal surface of the central canal. Extra-axial supratentorial ependymomas are extremely rare, and only five cases have been reported to date in the English literature. Case presentation A 46-year-old previously healthy male presented with a gradual painless loss of vision in the right eye. Cerebral MRI showed a right parietal-occipital lesion resembling an atypical meningioma. Surgical resection was performed, and immunohistochemical staining results concluded that it was a very uncommon location of a grade 3 ependymoma. Favorable outcome was observed one year after completion of postoperative radiotherapy. Conclusion Clinical and imaging aspects are misleading in rare brain tumors, and immunohistochemistry is essential to re-address diagnosis.

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.

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.

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.