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Background: Analyzing MR scans of low-grade glioma, with highly accurate segmentation will have an enormous potential in neurosurgery for diagnosis and therapy planning. Low-grade gliomas are mainly distinguished by their infiltrating character and irregular contours, which make the analysis, and therefore the segmentation task, more difficult. Moreover, MRI images show some constraints such as intensity variation and the presence of noise. Methods: To tackle these issues, a novel segmentation method built from the local properties of image is presented in this paper. Phase-based edge detection is estimated locally by the monogenic signal using quadrature filters. This way of detecting edges is, from a theoretical point of view, intensity invariant and responds well to the MR images. To strengthen the tumor detection process, a region-based term is designated locally in order to achieve a local maximum likelihood segmentation of the region of interest. A Gaussian probability distribution is considered to model local images intensities. Results: The proposed model is evaluated using a set of real subjects and synthetic images derived from the Brain Tumor Segmentation challenge –BraTS 2015. In addition, the obtained results are compared to the manual segmentation performed by two experts. Quantitative evaluations are performed using the proposed approach with regard to four related existing methods. Conclusion: The comparison of the proposed method, shows more accurate results than the four existing methods.

IntroductionTardive syndromes (TS) resulting from prolonged exposure to dopamine receptor blocking agents are frequent. Clozapine is considered to have a low risk of causing new onset TS and accounts therefore as an interesting option in patients with invalidating TS.ObjectivesOur study aims to describe clozapine indications in patients experiencing TS.MethodsPresentation of the clinical cases of five patients, who experienced different kinds of TS secondary to 1st and 2nd generation anti-psychotic treatment.ResultsWe present the cases of AB aged 41, MJ aged 40, HM aged 31 and AS aged 30, diagnosed with schizophrenia; and FB aged 24,diagnosed with schizoaffective disorder. Adverse side effects to conventional anti-psychotics such as limb and trunk tremors were described for AB, choreic limb movements, axial and segmental dystonia for MJ, AS, FB and oculogyration for FB. All patients were switched to atypical anti-psychotics without improvement of the TS. The switch to clozapine, associated with abotulinum injection for MJ, led to regression of the TS and improvement of clinical signs. In fact, according to several studies, clozapine seems to be an interesting option when invalidating TS occurs. The low prevalence of TS under clozapine can be explained by its low affinity for striatal-D2 receptors, its anti-serotonin and anti-cholinergic effects.ConclusionsClozapine should be considered in symptomatic patients who develop TS while receiving other anti-psychotics. Further research on mechanism of TS and clozapine effect on TS is needed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Objectif Determiner les caracteristiques des patients SAOS depressifs. Methodes Etude transversale descriptive et analytique incluant 100 malades nouvellement diagnostiques de SAOS. Les donnees ont ete recueillies a partir des dossiers medicaux et au cours d’un entretien psychiatrique au cours duquel les questions de l’echelle HAD de la depression. Resultats La depression a ete diagnostiquee dans 39 %. Parmi les apneiques deprimes, une depression severe a ete notee dans 49 % des cas. La depression etait plus observee chez les SAOS severes (p = 0,990) et etait plus severe dans ce groupe (p = 0,650). Compares aux non depressifs, les patients SAOS diagnostiques depressifs etaient plus de sexe feminin (p = 0,000), avaient un bas niveau socio-economique (p = 0,000) et plus de comorbidites coronaires (p = 0,003). Le nombre de patients ayant des troubles cognitifs et des troubles de la libido etait significativement plus eleve dans le groupe des depressifs (p = 0,004). Le nombre des patients presentant des troubles cognitifs, des troubles de la libido et une alteration du sommeil etait significativement plus eleve dans le groupe des SAOS severes (respectivement p Conclusion Dans notre serie, la depression etait frequente chez les femmes apneiques de bas niveau socio-economiques ayant des comorbidites coronaires. Associes au SAOS, les symptomes de la depression sont accentues imposant un diagnostic precoce et une prise en charge adequate.

Objectif Determiner la prevalence de l’anxiete chez les patients SAOS ainsi que les caracteristiques des patients SAOS anxieux. Methodes Etude transversale descriptive et analytique incluant 100 malades nouvellement diagnostiques de SAOS. En plus des dossiers medicaux, les donnees ont ete recueillies a partir d’un entretien psychiatrique au cours duquel les questions de l’echelle HAD de l’anxiete ont ete posees. Resultats Le score HAD moyen de l’anxiete etait de 9,96. La prevalence de l’anxiete etait de 46 % et etait plus importante dans le groupe des SAOS severes mais sans difference significative (p = 0,754) L’anxiete d’intensite severe etait notee dans 37 % des cas et etait plus importante dans le groupe des SAOS severes (p = 0,121). Le score HAD moyen de l’anxiete etait plus eleve chez les femmes par rapport aux hommes (711,15 vs 7,74, p = 0,000). Compares aux non anxieux, les patients SAOS anxieux etaient plus de sexe feminin (p Conclusion L’anxiete est une comorbidite frequente chez les SAOS notamment severe de sexe feminin, sans profession et ayant un bas niveau socio-economique. Son depistage s’impose car elle peut alterer la qualite de vie des apneiques et leur adherence au traitement.

International audience; Segmentation of gliomas in magnetic resonance imaging (MRI) images is a crucial task for early tumor diagnosis and surgical planning. Although many methods for brain tumor segmentation exist, the improvement of this process is still difficult. Indeed, MRI images show complex characteristics and the different tumor tissues are difficult to distinguish from the normal brain tissues; especially the low-grade glioma (LGG), distinguished by their infiltrating character. In fact, it is difficult to extract the tumor from the surrounding healthy parenchyma tissue without any risk of neurological functional sequelae. The purpose of this paper is to provide an overview about a new MRI brain tumor segmentation method based on the local phase information. We applied the proposed method on a set of selected images (Flair, T1 and T1c). Those images were from patients with low-grade glioma. The preliminary results obtained seem to be interesting.

IntroductionPsychiatric disorders frequently occur in patients with temporal lobe epilepsy (TLE) (70%). This combination further reduces the quality of life of patients as diagnosis is difficult and therapeutic opportunities are often missed.ObjectivesThe aim of this case study is to show the possible association between TLE and psychiatric semiology and its therapeutic implications.MethodsPresentation of the clinical case of Mr BH who experienced psychosis like symptoms, was finally diagnosed with TLE and put under anti-epileptic drugs.ResultsMr BH, aged 22, with no family or personal history, was admitted for aggressive behavior, self-harm, pyromania, and depression. Three years prior to onset of psychiatric symptoms, he reports episodes of pulsatile- left-temporal headache followed by hypertonic movements of the neck. Symptoms were intermittently followed by total amnesia or impaired consciousness. The patient explained symptoms by an inner presence that he called “his twin” and to whom he attributed those behaviors contrary to his will. The discovery of bilateral hippocampal atrophy in magnetic resonance imaging with a normal electroencephalography suggested the diagnosis of TLE with post-ictal psychotic disorders. Patient was put initially on diazepam and olanzapine with partial improvement. Association of valproate led to progressive but then complete disappearance of symptoms and so confirmed our diagnosis.ConclusionsIt is often difficult to attach psychiatric symptoms to epilepsy. The diagnosis should be done on a set of clinical, radiological and electrical arguments.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionAkathisia is commonly known for its objective components such as rocking while standing or sitting and lifting feet. However, little is known about its psychiatric impact that can even lead to suicidal attempts.ObjectivesThe aim of this study is to investigate the main psychiatric symptoms associated with akathisia in a Tunisian sample of patients under treatment for Schizophrenia, Schizoaffective or Bipolar Disorder.MethodsFifteen patients were diagnosed with akathisia using the Barnes Akathisia Scale. Psychiatric symptoms related to akathisia such as mood lability, sadness, anxiety, aggressivity, suicidal ideation, insomnia and social and professional impairment were assessed.ResultsThe average age of the sample was 47 years. The average antipsychotic chlorpromazine-equivalent total dosage was 1756 mg. All patients reported at least one psychiatric symptom imputed to akathisia. These were: mood lability (n = 11), inner restlessness (n = 10), anxiety (n = 10), sadness (n = 10), aggressivity (n = 6), and insomnia (n = 12). Eight patients described suicidal ideation and five confessed having committed a suicide attempt. Four and ten said akathisia had professional and social impact respectively. The prevalence of psychiatric symptoms did not differ according to sex, age, diagnosis, illness duration, presence of a comorbid anxiety disorder, the number and types of antipsychotics used, the antipsychotic chlorpromazine-equivalent total dosage or the reported drug compliance.ConclusionsPsychiatric symptoms resulting from Akathisia remain frequently undetected. Special interest by the clinician is required to elicit these symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionPsychiatrists used to focus on some chronic illness such as schizophrenia and bipolar disorder. However, non–psychiatric chronic illness also need psychiatric follow-up. Indeed, the reciprocal impact of chronic illness and depression is becoming increasingly clear. There is evidence that living with a chronic illness can increase the risk for depression and that depression can impair the quality of life (QoL).ObjectivesWe aim to assess the prevalence of depression in a chronic disease such as hemophilia and to evaluate the patients’ QoL.MethodsThirty-seven adults from the hemophilia treatment center were screened for depression using the Hamilton Scale for Depression. QoL was assessed using the norm based scores of the SF-36. When the group's score was below 47, the quality of life was below the average.ResultsThe average age of our population was 26.5 years. 46% were married, 27% achieved a superior level of education and 30% were jobless. Good social and professional integration were reported in 70% and 76% respectively. 77% of our sample had depressive symptoms which were mild (30%), moderate (24%) or severe (13%). The physical and mental Component Scores (PCS and MCS) of the SF-36 scored 46.48 and 43.45 respectively. PCS and MCS were significantly lower in patients with depressive symptoms (P = 0.002/P = 0.048). However, depressive symptoms and SF-36 scores did not differ according to education level, marital and professional status.ConclusionsPsychiatrists should be aware of the psychological impact of general chronic illness. Psychiatric consultations must be implemented in every general hospital.Disclosure of interestThe authors have not supplied their declaration of competing interest.