Background Early identification and prevention research has provided huge advances in our understanding of early screening and identification of young people at clinical high‐risk (CHR). Most of these procedures were developed in high‐income countries, yet middle‐income countries in North Africa such as Tunisia can benefit from these empirically‐based assessment approaches. Methods Using established procedures, nine Tunisian psychiatric raters were trained on structured assessments: the CAARMS, BPRS, and SCID to high standards of interrater reliability. These raters developed a clinical high‐risk program (CHiRP) in Tunisia and recruited 10 patients who were exhibiting possible signs of CHR. These patients were evaluated to determine if they met criteria for a CHR group, such as Attenuated Psychosis. Results Trained raters met the following interrater reliability criteria for the CAARMS and BPRS (ICC = .80 or greater) and the SCID (Kappa = .75 or greater). Of 10 pilot patients, six were classified as CHR and belonging to the Attenuated Psychosis Group. One of the six patients converted to psychosis 3 months after study entry for a conversion rate of 17% which is comparable with currently published rates globally. Discussion The first CHR program has been established in Tunisia, a middle‐income country using methods developed in high income countries. Efforts aimed at assembling a group of prevention‐oriented psychiatrists, obtaining administrative support, and training raters to high levels of interrater reliability were successful. The feasibility was demonstrated for screening, assessing, treating, and following‐up of 10 CHR patients suggesting that conversion rates are comparable to those of Western and European countries.
IntroductionMental patients generally internalize some of the negative conceptions about how most people view them: they might be considered incompetent or untrustworthy or believe that people would not want to hire, or marry someone with mental illness. A lot of research on stigma has been conducted in western countries; however, little is still known on the situation in Arab-Muslim societies.ObjectivesTo evaluate social stigma as viewed by patients suffering from severe mental illness (SMI)MethodsThis is a cross-sectional study on clinically stabilized patients with schizophrenia and Bipolar Disorder (BD) according to DSM IV, who were interviewed in our out-patients clinic with the help of a semi-structured questionnaire, containing 8 opinions on the social inclusion and stigmatization of psychiatric patients, with special reference to the local cultural context (e.g.: “It is better to hide mental illness in order to preserve the reputation of my family”)ResultsWe included 104 patients, 51% with schizophrenia and 49% with BD. Mean age was 38.4 years (18–74 years); 59.6% were males. Overall social stigma scores were high. Social stigma in patients was correlated with gender, age, place of residence and diagnosis. Patients with BD showed significantly less social stigma than patients with schizophrenia.ConclusionOur results show the need for a better understanding of this phenomenon in patients with SMI, but also within Tunisian society, in order to elaborate anti stigma strategies adapted to the local context.Disclosure of interestThe authors have not supplied their declaration of competing interest.
BackgroundSchizophrenia is an invalid and severe neurodevelopmental disorder. The implication of vitamin D in the etiopathogenesis of schizophrenia shows through the activation of cellular and inflammatory pathways. It is especially vitamin D deficiency that has been associated with schizophrenia.It is within this framework that this study aims to explore the relationship between vitamin D levels and the clinical characteristics in a cohort of Tunisian patients with schizophrenia.MethodsA cross-sectional and retrospective descriptive study was conducted at the “F” psychiatry department at the Razi Hospital, Manouba over a twelve-month period from June 1st, 2015 to May 31st, 2016, including 80 patients with schizophrenia in period of clinical remission. The evaluation focused on sociodemographic and clinical characteristics. A dosage of vitamin D was performed.ResultsThe patients had an average age of 42.5 years and 70% were male. The average vitamine D level was 10,57ng/ml ±5,9. 49% of patients had vitamin D insufficiency (between 10 and 30 ng/ml) and 51% had vitamin D deficiency (<10 ng/ml). Vitamin D levels had not been affected by the clinical characteristics of the disease. A negative correlation with the total score of the negative scale (p <0.001) as well as with the severity item of the clinical global impression scale (p = 0.01) were found.DiscussionA large number of research studies in immunogenetics and molecular biology have highlighted the involvement of vitamin D in the etiopathogenesis of schizophrenia through its role in the ontogenesis of dopaminergic systems and also through its intervention in the processes of neuro-protection, immunomodulation and the reduction of oxidative stress.In addition, it has been established that people with psychotic disorders have a high prevalence of vitamin D deficiency, but the correlates and relevance of this deficiency remain unclear.
Background: Dysfunction of the hypothalamus-pituitary-thyroid axis has been shown to play a role in the pathophysiology of bipolar disorder. Autoimmune thyroiditis is the most common cause of thyroid function alteration. Thus, auto-immune thyroiditis is likely associated with bipolar disorder. It might influence its course, prognosis and/or management. Objective: To study the prevalence of positive anti-thyroid antibodies in patients with bipolar disorder and to examine the prognostic and the therapeutic implications of their presence. Methods: Literature was reviewed using the Medline database and the following keywords: 'bipolar disorder" 'antithyroid antibodies" 'thyroiditis". Results: PubMed research returned 12 results. After manual inspection, 10 articles were retained and examined. The prevalence of positive antithyroperoxydase antibodies (anti-TPO Abs) is higher in bipolar patients than in healthy controls, reaching 27%. The presence of positive anti-TPO Abs has been associated with rapidcycling, with a higher risk of lithium-induced hypothyroidism as well as with poor prognosis. Auto-immune thyroiditis appears to be related not only to bipolar disorder itself but also to the genetic vulnerability to develop the disorder. Conclusion: The presence of anti-TPO Abs is a possible endophenotype for bipolar disorder. Anti-TPO Abs should be obtained in many patients with bipolar disorder, especially in those on lithium.
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