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Impulsivity as a trait characteristic is increased in bipolar disorder and may be a core factor of the illness. The objectives of our work are to evaluate the level of impulsivity among patients with bipolar disorder and to study its relation with mood state, alcohol misuse, suicide attempts and other socio-demographic and clinical factors. We measured impulsivity in 60 subjects with bipolar disorder in relationship to socio-demographic and clinical variables. The subjects completed Data included socio-demographic details and clinical variables, the Barratt Impulsiveness Scale (BIS-11) in an Arabic version to assess impulsivity, The Mini International Neuropsychiatric Interview "MINI" version 05 to screen for alcohol abuse or dependence and mood graphic rate scale (MGRS) to evaluate mood state. Our results show that the mean score of BIS-11 was 71.5. Fifty-five per cent of the patients had a high level of impulsiveness. No differences were found relating to mood state. Impulsivity was related to Male gender, lower educational level, early age of onset, smoking, alcohol and drug misuse and prior suicide attempts. The treatment of patients with BD should consider to reduce impulsivity to improve morbidity., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Leila Mnif,1 Rim Sellami,2 Jawaher Masmoudi2 1Department of Psychiatry “D”, Razi University hospital, Tunis, 2Department of Psychiatry “A”, Hédi Chaker University Hospital, Sfax, Tunisia Introduction: Post-stroke emotional incontinence and bipolar disorder are two disorders that involve the dysfunction of brain structures responsible for emotional regulation. The objective of this work is to study the links between these disorders through a clinical case. Case report: We present the case of a 43-year-old man without previous psychiatric history who experienced emotional incontinence after cerebrovascular events. He reacted promptly to selective serotonin reuptake inhibitor treatment. However, he experienced his first episode of hypomania after 6 months of antidepressant therapy. Adjunctive therapy with valproic acid and low-dose paroxetine was eventually added, resulting in complete improvement of both emotional incontinence and hypomania after 4 additional months of treatment. Conclusion: The clinician should carefully explore any history of premorbid bipolar disorder, personality disorder characterized by mood instability, and family history of bipolar disorder. Keywords: stroke, emotional incontinence, bipolar disorder

Introduction: The early diagnosis of bipolar II disorder remains difficult in clinical practice, hence the importance of psychometric tests. Objectives: To detect hypomania in patients followed for a major depressive disorder (MDD) and to determine factors which are correlated with it. Methods: This was a cross-sectional, descriptive and analytical study. It involved 40 psychiatric outpatients, who were followed for MDD (isolated or recurrent episode) at the Hedi Chaker University Hospital in Sfax (Tunisia), from January 26 to February 10, 2020. The study was conducted using a questionnaire and the Angst Hypomania Checklist-20 (HCL-20). Results: The sex ratio (M/F) was 0.66with an average age of 54.8 years. MDD started at an average age of 41.45 years. According to HCL-20, half of our sample had hypomania. The presence of hypomania was correlated with young age (p = 0.022), academic failure (p = 0.038) and smoking (p = 0.003). In addition, there was a statistically significant relationship between the presence of hypomania and the characteristics of the disease: number of depressive episodes ≥ 2 (p = 0.013), psychotic features (p = 0.038), melancholic features (p=0,025) and premature discontinuation of treatment (p = 0.003). Conclusions: Our study confirmed that bipolar depression is still underdiagnosed and poorly treated. Questioning a patient about a history of hypomania would be a delicate task and would require the help of a scale, in particular the HCL -20. [ABSTRACT FROM AUTHOR]

Introduction: Quality of life is a broad and complex concept, but essentially refers to an individual's well-being in a spectrum of life domains. Objectives: The aim of the present study was to investigate the relationship between spirituality, religiosity (S/R) and quality of life (QOL) among bipolar disorder (BD) patients. Methods: Data were collected between July and December 2017. Participants were enrolled from the Mood Consultation of the Psychiatry (A) Department of the University Hospital HediChaker. We assessed symptoms of mania [Young Mania Rating Scale (YMRS)], depression [Beck scale], quality of life [World Health Organization Quality of Life-Brief Version (WHOQOL-BREF)]andquality of life aspects related to spirituality, religiousness and personal beliefs [World Health Organization Quality Of Life -Spirituality, Religiousness and Personal Beliefs (WHOQOL-SRPB)] Results: Our sample included 60 patients. It consisted of 55% of female and the mean age was 44.94 (SD=12.76). The sample included 68% of participant diagnosed with BDI and 32% with BDII The median score of quality of live was 3 (minimum=1; maximum=5). Themedian of physic, psychic, social and environmental quality of life was respectively (25, 31, 81 and 19) (Minimum=0; Maximum=100). The mean score of WHOQOL-SPRB was 14.82 (Minimum=4, Maximum= 20). S/R were correlated to psychic, social and environmental quality of life (p=0.006, p=0.011, p=0.016). We did not find a significant association between physic quality of life and S/R (p=0.234). Conclusions: Our study suggests that spirituality, religiosity have an important influence on most aspects of the quality of life among bipolar patients. [ABSTRACT FROM AUTHOR]

Introduction: Impulsivity is not a classical psychiatric diagnosis like schizophrenia, depression, bipolar or borderline personality disorder. It is a symptom that could occur in almost all psychiatric disorders and in some neurological or systemic diseases. Objectives: In this study we examine the influence of bipolar disorder's (BD) treatment on the impulsivity. Methods: We performed a cross sectional study on 30 patients diagnosed with BD and consulting at the Psychiatric department of HediChaker Hospital. Patients were euthymic during the time of the study confirmed by administration Young Mania Rating Scale (YMRS) and Montgomery Depression Rating Scale (MDRS). The socio-demographic data and treatment models were obtained. Impulsivity was evaluated using the Barratt Impulsiveness Scale (BIS-11). Results: The study sample consisted of 30 patients (10 men and 20 women). The mean age of the sample was 45.83 years (SD= 11. 63). Seventeen patients (56.7%) were married. Half of the participants were using an association of mood stabilizer (MS) and an antipsychotic (AP), 36.7% and 13.3% were receiving respectively only mood stabilizer or an antipsychotic. The mean BIS11 score was 75. 60 (SD=5.51) and 76.7% had a high level of impulsivity. No correlation was found between the level of impulsivity (BIS-11 scores) and using MS, AP or MS+AP (p=0.199; p=0.933; p=0.195). Conclusions: Further studies should be realized to identify pharmacological treatment of impulsivity among people with BD. [ABSTRACT FROM AUTHOR]

Introduction: Impulsivity is a psychiatric symptom that seems to be more prevalent in some mental disorders such as bipolar disorders (BD). It is a trait that seems to be influenced by many sociodemographic variables across BD. Objectives: The aim of our study is to examine the relationship between impulsivity and these variables. Methods: We performed a cross sectional study on 30 patients diagnosed with BD and consulting at the Psychiatric department of Hedi Chaker Hospital. Patients were euthymic during the time of the study confirmed by administration Young Mania Rating Scale (YMRS) and Montgomery Depression Rating Scale (MDRS). The socio-demographic data was obtained. Impulsivity was evaluated using the Barratt Impulsiveness Scale (BIS-11) Results: The study sample consisted of 30 patients (10 men and 20 women). The mean age of the sample was 45.83 years (SD= 11. 63). Seventeen patients (56.7%) were married. More than half of the subjects (76.7%) were unemployed and 26.7% were not educated. Of the studied patients 83.3% were drug free, 43.3% were smoker and 16.7% were alcoholic. The mean BIS11 score was 75. 60 (SD=5.51) and 76.7% had a high level of impulsivity. No correlation was found between the level of impulsivity (BIS-11 scores) and age, gender, marital status, being a current smoker, using drug or alcohol or job status (p=0.082; p=0.760; p=0.087: p=0.977; p=0.847; p=0.708). Conclusions: Further studies should be realized to fully characterize impulsivity in BD and, therefore, make it a target for future therapeutic models. [ABSTRACT FROM AUTHOR]

Introduction: Several studies have shown that residual mood symptoms affect the psychosocial functioning of patients with bipolar disorder (BD) in euthymia. Objectives: To evaluate specific areas of functioning in this population and to explore the relationship with residual mood symptoms. Methods: This is a descriptive and analytical cross-sectional study including patients with BD (DSM V) in euthymia followed on ambulatory basis to the Mood Disorders Unit of the Psychiatry A Department at Hedi Chaker Hospital in Sfax between January and April 2019. Patients were considered euthymic if they scored below 7 on the Young Mania Assessment Scale (YMRS) and under 8 on the Hamilton Depression scale (HDRS-17). Residual manic and depressive mood symptoms were assessed using YMRS and HDRS-17. The Short Function Evaluation Test (FAST) was used to evaluate the overall and specific functionning domains. The alteration of the domain-specific functioning is defined by the following thresholds: autonomy>1, professional functioning>1, cognitive functioning>2, financial problems>1, interpersonal relations>3 and leisure time>3. Results: We recruited 62 patients with a mean age of 45.65 years (SD = 13.3) and a sex ratio 1.13.The medians of YMRS and HDRS scores were respectively 2[0-5] and 2[0-7]. Global functionning impairment was observed in 85.5% of patients. Marked impairment of professional and cognitive functioning was observed in 98.4% and 77.4%, respectively. Alteration of the relational sphere was significantly more frequent in patients with residual depressive symptoms (p=0.009); impairment of autonomy was significantly more frequent in subjects with manic residual symptoms (p=0.005). Conclusions: Residual symptoms should be considered as specific targets of treatment to improve functioning. [ABSTRACT FROM AUTHOR]

Introduction: Bipolar disorder (BD) is a chronic, recurring illness that can lead to serious disruptions in functioning. Objectives: To evaluate functionning in this population and to explore the relationship with socio-demographic and clinical features of BD. Methods: This is a descriptive and analytical cross-sectional study including patients with BD (DSM V) in euthymia, followed on an ambulatory basis to the Mood Disorders Unit of the Psychiatry A Department at Hedi Chaker Hospital University of Sfax between January and April 2019. Patients were considered euthymic if they scored less than 7 on the Young Mania (YMRS) rating scale and less than 8 on the Hamilton Depression scale (HDRS-17). The Short Function Evaluation Test (FAST scale) was used to evaluate functionning. Global functional impairment is defined by a total FAST score>11. Results: We recruited 62 patients with a mean age of 45.65 years (SD=13.3) and a sex ratio of 1.13. 88.7% of patients were followed for BD I and 11.3% for BD II. The mean age of onset was 29.37 years (SD=11.6). The mean numbers of manic and depressive episodes were respectively 3.73 (SD=3.8) and 2.48 (SD=2.9). The mean FAST score was 28.97 (SD=15). Overall impairment was observed in 85.5% of patients. Impaired functionning was significantly more frequent in patients with a history of surgery (p=0.046), in those with a higher number of depressive episodes (p<0.001) and in subjects with partial remission (p=0.01). Conclusions: Thus, the treatment should target not only the improvement of symptoms but also the reduction of the incapacity of patients. [ABSTRACT FROM AUTHOR]

Introduction: The recurrence of bipolar disorder due to poor treatment adherence can be explained by different factors. The poor awareness of the disorder seems to be the major cause. Objectives: To evaluate insight in patients followed for euthymic bipolar disorders and determine the factors correlated with it, mainly the self-esteem. Methods: A cross-sectional descriptive and analytical study of 33 euthymic subjects with bipolar I and II disorders (DSM 5) and followed up at the psychiatric consultation in Hédi Chaker university Hospital of Sfax. Data collection was performed using a sheet exploring socio-demographic and clinical data. We used Birchwood insight scale to assess the quality of insight and Rosenberg's Self-Esteem scale. Results: The average age of our patients was 44,52±12,99 years old. The sex ratio =0.32.Patients were followed for bipolar I disorder (60.6%). The first episode of the disease was depressive in(51.5%) of cases. The average number of depressive episodes was1.97±1.87. The last episode was depressive in(57.6%) or manic in(42.4%). There were no psychotic characteristics in(42.4%) of cases. The patients had good insight in(54.5%). The average of self-esteem score was27±7.85and it was low in 51.5% of cases. Factors correlated with good insight were bipolar II disorder(p=0.001), high number of depressive episodes(p=0.013) and absence of psychotic characteristics(p=0.003) during the last episode. In addition, good insight was significantly associated with low self-esteem(p=0.023). Conclusions: Our study shows that a poor insight depends mainly on the clinical characteristics of bipolar disorders. Moreover, low self-esteem seems to be linked to it. For this reason, our attention should be focused on psychoeducation to improve insight, especially during episodes, in order to facilitate integration and increase patients' self-esteem. [ABSTRACT FROM AUTHOR]

Introduction: Post-stroke emotional incontinence and bipolar disorder are two disorders that involve the dysfunction of brain structures responsible of emotional regulation. The objective of this work is to study the links between these disorders through a clinical case. Case report: It was a 43 year old patient who consulted for an emotional incontinence appeared after an ischemic stroke with lenticulocapsular and right semioval center lesions. Treatment with antidepressant was marked by the appearance of hypomania. Discussion and conclusion: The appearance of a pharmacologically induced hypomania in this patient could suggest a link between emotional incontinence and bipolar disorder. Especially that periventricular areas and deep subcortical structures, involved in emotional regulation, are affected in these disorders. More attentiveness against antidepressant treatment is required, because of the potential risk of a pharmacological hypomania. [ABSTRACT FROM AUTHOR]

Introduction: Evidence is accumulating that mitochondrial dysfunction is involved in the pathophysiology of some psychiatric disorders such as Bipolar Disorder and Schizophrenia. In addition, among their other symptoms, people diagnosed with mitochondrial disease have high rates of psychiatric disorders. Leigh syndrome is a heterogeneous disorder, usually due to a defect in oxidative metabolism. The symptoms begin in the childhood by neurological troubles. Few reports mention psychiatric disorders. The objective of this work is to study relations between mitochondrial dysfunction and psychiatric disorders through a case of Leigh Syndrome. Case report: It was a 20 year-old male patient, who had taken L-Dopa to treat severe extrapyramidal symptoms caused by Leigh syndrome. He developed, four months ago, acute psychotic symptoms such us audio-visual hallucinations, persecution and mystic delirium. The cerebral MRI had shown signal abnormalities in Basal Ganglia. This aspect was similar to those observed in the MRI having been practiced five years ago. The EEG recording was normal.The CSF and blood lactate levels were normal. The hypothesis that drug (L-Dopa) caused psychiatric disorders was possible. But, the digression of medicine was impossible due to the severity of extrapyramidal symptoms. The evolution under atypical antipsychotic was only partial. Discussion and conclusion: In this case, the CSF lactate levels mean that mitochondrial dysfunction is not an overall explanation for these psychiatric disorders but may at least play a partial role. Psychiatric disorders may be induced by drugs or may just be a simple comorbidity. [Copyright &y& Elsevier]

There is a growing interest about comorbidity between bipolar disorders and epilepsy expressed in three perspectives: clinical, therapeutic and neuroscientist. The prevalence of bipolar disorder among epileptic patients is about 0.1 to 5%. At a clinical level, there are peri-ictal, inter-ictal bipolar troubles and those induced by the treatments (drugs, electric and surgical) of the epilepsy. It seems that bipolar disorders have clinically specific characteristics (rapid cycles, less severe symptoms with each episode), where there is an association with epilepsy. Then, therapeutic management of bipolar disorders among epileptic patients is specific. The objective of this work is developed through a literature review, the clinical, the therapeutic and the evolutive characteristics of these disorders when found simultaneously. [Copyright &y& Elsevier]

Introduction Insight is defined as the recognition that one has a mental disorder, the ability to identify its symptoms, and cognizance of the need for treatment. Lack of insight into having a mental disorder is found to be associated with a poorer clinical outcome, treatment noncompliance, and a more severe cognitive impairment. Objective Compare the insight and medication adherence in a population of schizophrenia and bipolar disorder patients. Methodology We assessed and compared the insight and compliance of 60 patients with schizophrenia (n=30) and bipolar disorder (n=30) recruited in Psychiatry department Sfax, Tunisia. Insight was assessed using the rating scale of consciousness disorder (Q8). Adherence was assessed using the Drug Attitude Inventory [ICD-10]. Results Patients were mainly young adults, male (70%) and did not live in a couple (61.7%). About half of them (43.3%) had no profession. Insight was low in 15% of patients, intermediate in 53.3%, and good in 31.7% of cases. Bipolar disorder patients displayed better insight into having a mental disorder compared to schizophrenia patients (p=0.04) Good adherence was observed in 64.4% of patients. Factor influencing adherence in both populations was the type of treatment: patients treated with atypical antipsychotics have better compliance (p = 0.005). A good insight was significantly correlated with good adherence (p = 0.000) Conclusion Our results showed that bipolar disorder patients have better insight compared to schizophrenia patients. So it is necessary; in schizophrenia; to work on awareness of the disorder and the need for treatment to improve adherence. [ABSTRACT FROM AUTHOR]

Introduction Bipolar and unipolar disorders share a common depressive clinical manifestation, but have not the same treatment. An early recognition of bipolar depression has an important impact on the prognosis of bipolar disorder. Objectives Our study aims at evaluating the prevalence of hypomania among patients with major depression and revealing the factors that distinguish between unipolar and bipolar depression. Methods Our cross-sectional study, in progress, includes outpatients with major depressive disorder, from the University Hospital in Sfax (Tunisia). We use the Angst’s Hypomania Checklist (HCL-20) to detect episodes of hypomania misdiagnosed by the present psychiatrist. Preliminary Results Twenty patients were included. The average age of onset of disease was 31 years. More than half of patients were females (55%). Tobacco dependence was found in 35% of patients, alcohol dependence in 20% of them. Patients had a family history of bipolar disorder in 25% of cases. They attempted suicide in 15% of cases. Hypomania prevalence was 45%. Hypomanic episode was more frequent in early-onset disease, when there is a history of attempted suicide, and in case of atypical or psychotic features. Addiction to tobacco or alcohol, presence of somatic comorbidity and mixed features were also more frequent in patients with past hypomania. Conclusion Our results show that bipolar disorder is underdiagnosed in depressive patients. Systematic search for hypomania, based on a clinical interview or a screening tool, is necessary to avoid misdiagnosis of bipolar disorder and therefore inappropriate treatment. [ABSTRACT FROM AUTHOR]

Introduction: The classic opinion of a favorable prognosis of bipolar disorders, compared to schizophrenia, is refuted by modern conceptions. Objectives: The aim of this study was to assess the quality of life (QOL) in bipolar patients compared to schizophrenic patients’, and to identify clinical and sociodemographic variables statistically associated to a poor QOL in bipolar disorder patients. Methods: One hundred and twenty outpatients, 50 with bipolar disorder and 70 with schizophrenia, according to DSM-IV-TR criteria, were included in the study. The QOL has been assessed, in all patients, using the «36 item Short-Form Health Survey» (SF-36). Results: Thirty-six percent of the bipolar patients had a poor QOL, versus 37% among the schizophrenic patients. The bipolar patients had the score of the standardized vitality subscale significantly lower than schizophrenic patients’ (p=0.036); the latter had the standardized general health subscale score significantly lower (p=0.03). There were no other statistically significant differences. The multivariate analyses showed three variables significantly correlated to a poor QOL in bipolar patients: age at the time of the study ≥40 years (p=0.01), professional irregularity or inactivity (p=0.005), age at onset ≥25 years (p=0.004). Conclusion: Our survey of the QOL in bipolar patients showed that it did not differ globally from the schizophrenic patients’, with the SF-36 scale. Results reported in the literature are not in agreement. Further longitudinal studies on several months, with other assessments, would permit to verify the validity of our results. [ABSTRACT FROM AUTHOR]