IntroductionIschemic (veno-occlusive, low flow) priapism is a painful and persistent penile erection unrelated to sexual desire or stimulation. In some cases, it is an adverse event of antipsychotic medications.Materials and methodsAn Internet search was initiated using the search engines: Direct Sciences; Medline and keywords “Penile erection; priapism; Antipsychotic agents; Side effects” and we illustrated our literature review by a clinical vignette of a man aged 38 years followed for schizophrenia placed under Fluphenazine 125 mg/month from 5 years who consulted us in may 2015 because of priapism and he described painful and prolonged erection episodes evolving for approximately 5 days.DiscussionMedical literature mentions many cases of venous priapism in patients treated by conventional or atypical neuroleptics. About 30% of venous priapisms could be related to drugs of which approximately 50% to neuroleptics. This side effect is related to alpha1-adrenergic blocking properties of these treatments, more or less important depending on the drugs in this class. After emergency treatment, the priapism is the problem of the continued neuroleptic treatment. The substitution of one molecule by another alpha-1 blocking properties to the less marked is recommended.ConclusionThe venous priapism is a uro-andrological emergency requiring prompt treatment to prevent erectile sequelae.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Bipolar disorders are frequent troubles touching 1 to 2% of the general population. The average age of disease onset is between 20 and 25 years. While the early onset is predictive of a more severe disorder, the late start, with elderly people, raises the problem of the frequency of secondary mania. Methodology:
IntroductionSchizophrenia is a chronic mental disorder that can lead to poor social and professional performances.Objectives and AimsTo assess the study's subjects' social and professional functioning and compare the results to those reported in the literature in order to have an idea about the efficiency of the rehabilitation methods available to the patients affected by schizophrenia in Tunisia.MethodsWe have evaluated the social and the professional functioning of 30 patients (20 females and males) whom have been seen in the aftercare unit between February and June 2014 using indirect indicators(marital status and employment) and the Social and Occupational Functioning Assessment Scale (SOFAS).ResultsThe mean age of patients was 37.5 years. The majority of the subjects were single (80%). Three patients divorced after their first hospitalization. The majority of the patients (86%) were employed before they have been diagnosed with schizophrenia. Two thirds of these subjects lost their jobs after the first hospitalization and were still unemployed when the study has been conducted. The average SOFAS score is 46 which is indicates the existence of a significant impairment in the social or the professional functioning.ConclusionsMeasures of rehabilitation are still insufficient. This could be explained by several factors which are related to the patients, their families, the society and the healthcare system.
In Tunisia, as in all the countries of the world, addictions present nowadays a problem of public health. Indeed, the judicial system turns to repressive legal ways to fight against this phenomenon, of which the confinement of holders, consumers and drug dealers. Once in the prison environment, what about the evolution of addictions to drugs?To study the influence of the prison environment on the use of drugs, we proceed to a descriptive transverse study with about fifty prisoners and accused for detention, consumption or drug trafficking realized in 2 prisons of Tunis (Manouba and Mornaguia).The data collection is realized during the interview with the prisoners, through a structured index card. We raise the sociodemographic characteristics of the prisoners, the motives for confinement, and especially the drivings of abuse and for dependence of psychoactive substances there.More than 60 % of the incomers in prison presents a problem related to a consumption of alcohol and / or drugs and require adapted care. The prison concentrates the drug users and does not establish an efficient repressive tool of the second recurrence nor the reduction of the risks.The confinement can establish a unique opportunity of screening of a harmful use and/or a dependence whatever is the psychoactive product, to deliver messages of prevention and to propose an adapted care to the needs for the detained person.
Introduction:Hypothyroidism is rarely associated with psychosis. This association has been reported since 1880 and described for the first time by Asher in 1949. Case report: We report the case of a 60-year-old woman who presented at the age of 36 years a hyperthyroidism treated by benzylthiouracile, propranolol, and radioactive iodine. At the age of 49, she presented a hypothyroidism handled by a supplementation of thyroid hormones. The same year, she was admitted in psychiatric care for behavioral disorders, anorexia and insomnia. The diagnosis of hysteria was initially retained and the patient was lost sight of during 4 years. She was then re-hospitalized for psychomotor instability, delusions, insomnia, auditory and visual hallucinations, after she had stopped the treatment. Skin excoriations, caused by suspect cenesthetic hallucinations, were found in the examination. The diagnosis was chronic paranoid schizophrenia and the patient was treated with a long-acting antipsychotic associated to a supplementation of thyroid hormones. She was then lost from sight until 2014, when she was admitted for physical aggression, soliloquy, delusions of persecution auditory and visual hallucinations, and insomnia. The examination found significant dermal infiltration, a xerosis complicated with excoriations, a flushed face , macroglossia, hoarseness , difficulty in breathing and bradycardia. The biology revealed a rate of TSH=45.76uui/ml and FT4 <1pmol/l. Thyroid hormones have then been gradually introduced. The evolution was favorable with the disappearance of psychotic and somatic symptoms. Conclusion:Though hypothyroidism is usually associated to a depressive symptomatology, it may, as shown by this case, be associated to psychotic symptoms.
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