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Introduction Posttraumatic stress disorder (PTSD) is common in survivors of acute life-threatening illness, but little is known about the burden of PTSD in survivors of stroke attack. Objectives This study estimated the prevalence of PTSD in post-stroke in the elderly and to look for the factors which are correlated with it. Methods Participants were outpatients of Psychiatry B department in Hedi chaker University Hospital Center in Tunisia, over the age of 65, hospitalized in psychiatry for a major depressive episode, recruted between 2000 and 2015. The data was collected using a pre-established sheet containing socio-demographic information, the clinical and evolutionary characteristics of the depressive episode and the therapeutic data concerning the depressive episode. Results 30 patients were included in this study with an average age (69 Y) and sex ratio (0.66). More than half (53.3%, 16 patients) had a history of chronic somatic disease. The average length of hospitalization was 26 days. The most frequent reason for hospitalization is sadness of mood (43.3%) with cognitive impairment as the predominant clinical symptomatology (40%). 93.3% of the population received as treatment an antidepressant mainly Fluoxetine (50%). Conclusions clinicians should be mindful that PTSD can be a devastating mental health condition and should consider screening for PTSD in stroke survivors.

Introduction: Bipolar disorder is a severe mental disorder that implies a high risk of suicide. Cannabis is the most commonly abused drug among patients with bipolar disorder and has been found to increase the duration and the intensity of symptoms. Objectives: The aims of this study was to establish the prevalence of cannabis use and suicide attempts in patients with a type 1 bipolar disorder and to study the association between them. Methods: A cross-sectional and retrospective study of 150 patients. Demographic data and the course of the disease were extracted from patients' medical files. Results: The average age was 35.97±11.55 years. A psychiatric family history was noted in 79 patients (52.7%). Twenty-five patients had psychiatric comorbidities. Eighteen patients had a personality disorder. Thymic episodes was of manic type in 48% of cases and of depressive type in 36 % of cases. The average duration of the disease was 15.95 ± 9.6 years. Therapeutic adherence was good in 44.7% of cases. A history of suicidal ideation was found in 94 patients and suicide attempts was found in 35 patients. Thirteen patients were cannabis users. Suicidal attempts was significantly associated with cannabis use (p=0.013), especially in male patients (p=0.025). Conclusions: Despite some limitations, this study estimate a strong association between cannabis use disorder and suicidal attempts in patients with bipolar disorder. Further studies are needed to clarify the nature of this relationship and that mechanism. [ABSTRACT FROM AUTHOR]

Introduction: In addition to its influence on social and emotional life, bipolar disorder type I (BD I) also seems to have consequences on sexuality. Sexual dysfunction is classically described in depression, however, few studies have described the sexual behavior of stabilized bipolar patients. Objectives: The aim of this work was to evaluate the sexual function of women followed for BD I whose aim is to stimulate interest and debate in this little known area. Methods: This is a one-year descriptive study (March 2019-March 2019) that took place in the "A" psychiatry department at Razi Hospital. Eighty women followed for BD I were recruited. The assessment of sexual function was made using the Psychotropic-Related Sexual Dysfunction scale (PRSexDQ-SALSEX). Results: According to the PRSexDQ-SALSEX scale, 81% of patients (n = 65) had sexual dysfunction. Forty-one (51%) patients reported having sexual dysfunction since the beginning of treatment. No patient had spontaneously reported sexual dysfunction to her doctor. Forty-three patients (54%) had impaired sexual pleasure, 46 patients (58%) had dysorgasmia, 48 (60%) reported having anorgasmia and 39 (49%) had vaginal lubrication dysfunction. Forty-five percent of patients (n=36) reported that although they experienced a change in their sexuality and an impact on their relationship, they never considered discontinuing their treatment on their own. Conclusions: Our results suggest the importance of assessing the sexual dysfunction of patients with BD I including euthymic phase. The therapist must therefore be less reluctant and ashamed to discuss the subject of sexuality during consultations. [ABSTRACT FROM AUTHOR]

Introduction: Bipolar disorder is a severe and recurrent psychiatric disorder with a high rate of suicide. The anti-suicidal benefit of lithium on suicidal behavior in bipolar disorder is well established. Data are mixed on the effects of other mood stabilizers. Objectives: The aims of our study were to highlight the preventive action of other mood stabilizers on suicide in bipolar disorder population. Methods: A cross-sectional retrospective and comparative study included 150 patients with bipolar type I disorder, diagnosed according to the DSM-5. Demographic data and the course of the disease were extracted from patients' medical files. Results: The average age was 35.97±11.55 years. The average age of onset of the disease was 26.23±7.88 years. The first thymic episode was of manic type in 48% of cases. The average duration of the disease was 15.95 ± 9.6 years. Valproic acid was the most used tymoregulator (80%) and carbamazepine was prescribed in 17 patients (11.3%). A history of suicidal ideation was found in 94 patients (62.7%). The prevalence of suicide attempts was 23.3% (n = 35). Suicidal attempts, were significantly less common in patients who were treated with a valproic acid (p=0.016). Conclusions: Our results suggest that the prescription of the valproic acid in bipolar patients may be associated with a reduced risk of suicidal acts and may be a good alternative to lithium use. Other specific studies on the effects of valproic acid on suicide risk are recommended. [ABSTRACT FROM AUTHOR]

Introduction: Bipolar disorders are one of the most severe psychiatric disorders, implying a high degree of morbidity and incapacity for patients. Some factors contribute to modifying the clinical profile and the course of the disease. Objectives: The aims of our study were to determine the Clinical and evolutionary aspect of bipolar disorder type 1 in a Mediterranean population. Methods: A cross-sectional and retrospective study included 150 Tunisian patients. Demographic data and the course of the disease were extracted from patients' medical files. Results: Forty-six patients had a family history of bipolar disorder. Sixty-nine patients (46%) were smokers. Twenty-six patients (17.3%) were alcohol users. Aggressive behavior was found in 26.7% of cases. A criminal record was found in 18 patients (12%). The average age of onset of the disease was 26.23 ± 7.88 years old. The time between onset of disorders and follow-up in psychiatry was more than one year in 50 patients (33.3%). The first thymic episode was predominantly manic (48%), and severe with psychotic features (57,3%). The average number of years of disease progression was 15.95 ± 9.6 years. the average number of relapses was 7.28±5.38. Therapeutic compliance was good in 44.7% of cases. The average number of treatment discontinuations per year was 2.17±1.32 because of side effects in 15.7% of cases. Conclusions: Numerous other studies have confirmed this clinical aspect, especially in the tropical and Mediterranean regions. European and American studies do not find the same results. Other comparative studies are desirable. [ABSTRACT FROM AUTHOR]

Introduction: Suicidal behavior is a major public health problem, and its prevention is a challenge. This behavior is more common in association with mood disorders and especially with bipolar disorder. Objectives: The aims of our study were to determine the prevalence and peculiarities of suicidal behavior in a population of bipolar patients. Methods: A cross-sectional, descriptive and retrospective study included 150 patients with a type 1 bipolar disorder diagnosed according to DSM 5 criteria. Demographic data and the course of the disease were extracted from patients' medical files. Results: A family history of bipolar disorder was noted in 51.4% of suicidal patients. Eighteen patients had a personality disorder. A history of suicidal ideation was found in 62.7% of cases. The prevalence of suicide attempts was 23.3%. The mean age at the first suicide attempt was 32.06±9.3 years. The average number of suicide attempts was 2.66 ± 2.83. In 88.6% of the cases, the suicide attempt was concomitant with a thymic relapse (Itwas a depressive episode in 83.9% of cases, and a mixed episode in 12.9% of cases). The attempt was made by a drug ingestion in 57% of cases. Suicide attempt was significantly associated with age(p=0.005), family history of suicide (p=0.008), family history of bipolar disorder(p=0.002), duration of disease(p=0.008), and personality disorder(p=0.014). Conclusions: The prevention of suicidal behavior in bipolar disorder need more assessment of vulnerability factors. A close and sustained clinical supervision can improve the management of suicidal risk in these patients. [ABSTRACT FROM AUTHOR]

Introduction: Suicide is a major social and clinical problem. Clinical characteristics associated with suicidal risk in bipolar disorder, include affective temperament types. Objectives: The aims of our study were to compare the temperament traits of two patients groups with a type I bipolar disorder, those who have attempted suicide and those who have not attempted suicide. Methods:Across-sectional, comparative and retrospective study of 150 patients in remission. Realized over a period of six months, from October 2018 to May 2019. Demographic data, duration and the course of the disease were extracted from patients' medical files. Affective temperaments were evaluated by the validated Tunisian version of the TEMPS-A scale. Results: The average age was 42, 25±10 years. The gender ratio (M / F) was 1,67. Thirty-five patients (23%) did at least one suicide attempt. The average age at the first suicide attempt was 32.06 ± 9.3 years. Hyperthymic temperament was the most common temperament found in our population (32%). The suicidal attempt was significantly associated with higher depressive temperament scores (P= 0,048). Conclusions: This study identified the independent contribution of temperament traits to suicidal behavior. Assessing the temperament of patients with bipolar disorder may result in deep insight into suicidal behavior and facilitate intervention for those at risk. [ABSTRACT FROM AUTHOR]

Introduction: Current literature report the occurrence of manic states in hypothyroid subjects after hormone supplementation. However, after drug overdose of levothyroxine, little research have described the induction of delayed mixed states. Objectives: Our aim is to present a case of overdose of levothyroxine with suicidal intention in a women diagnosed with bipolar II disorder. Methods: A case report and narrative review of recent work. Results: A 40-year old female patient with bipolar II disorder and ankylosing spondylitis was brought to the Emergency Service after committing a suicidal overdose of paracetamol (>7gr), methotrexate (>40mg) and levothyroxine (>1250 mcg). Antidote and four days of clinical observation was needed. Psychopathological assessment revealed the occurrence of depressive symptoms, so patient was admitted to our inpatient unit. Olanzapine 5mg/day and citalopram 10mg/day were initiated in the first 24-48 hours. After 4 days, the patient presented tachycardia (130-150 beats/min), irritability, suicidal ideation, tremor and worsening of depressive symptoms. Electrocardiography did not reveal any arrhythmia. Laboratory (4th day): thyroid stimulating hormone (TSH) < 0.01 µU/mL (0.40 -4.00), free T4 (fT4) >7.77 ng/dL (0.80-1.80) and free T3 (fT3): 22.50 pg/mL (2.00-4.40). Diagnoses: Severe hyperthyroidism due to exogenous thyroid hormone and mixed state in bipolar disorder. Thyrotoxicosis remitted and mixed symptoms improved. Olanzapine was increased to 10 mg/day. Normalization of fT3 and fT4 was achieved. TSH normalized within several days later. Conclusions: Levothyroxine is a lipophilic molecule that can be accumulated for several days. Continuous monitoring is mandatory. Affective symptoms should be also monitored as psychotropic medications after normalization. [ABSTRACT FROM AUTHOR]