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Temperamental dysregulation may constitute the link between predisposing genetic factors and affective disorders. Evaluate affective temperaments in bipolar patients, healthy siblings and controls, and address the relationship between affective temperaments and recent life events in these groups. Sixty bipolar patients, 60 patients' siblings and 60 controls were recruited. Assessment of life events in the last 6 months was performed using the Paykel's interview for recent life events. The Arabic version of Temperament Evaluation of Memphis, Pisa, Paris and San Diego – Auto-questionnaire was used to evaluate affective temperaments. Bipolar patients and siblings showed higher scores in cyclothymic and hyperthymic temperaments compared to controls. There were no significant differences in scores of irritable and anxious temperaments between the three groups. There was a strong relationship between anxious/cyclothymic temperaments and the high number of recent life events in bipolar patients and siblings. Contrary to bipolar patients and siblings, the number of recent life events in controls was not related to any dimension of affective temperament. Cyclothymic and hyperthymic temperaments were associated with bipolarity in patients and they could be characteristic traits of healthy siblings. Anxious/cyclothymic temperament might at least partially explain the high number of recent life events in bipolar patients and in siblings. [ABSTRACT FROM AUTHOR]

Background: Non-adherence to treatment in patients with schizophrenia is associated with increased hospitalization, higher health care costs, and poorer long-term outcomes in terms of relapse rates. It is established that a negative drug attitude was a risk factor for non-adherence in long-term schizophrenia. The scale "Drug Attitude Inventory" is one of the scales designed to assess this concept. It has been translated and validated in different languages. However, its psychometric properties have not yet been studied in our sociocultural context. Objectives: The aims of this study were to translate into Tunisian Arabic dialect the scale "Drug Attitude Inventory" with 30 dichotomous items (DAI-30) and validate it in Tunisian sociocultural context in patients with schizophrenia. Materials and methods: This study was performed in 234 outpatients with schizophrenia, recruited through a random drawing. These patients are in remission and meet remission criteria proposed by "The Remission in schizophrenia Working Group".We recruited 30 patients for pretest and 204 patients for linguistic validation. Forward and backward translation of the DAI-30 was performed according to the protocol of the "MAPI Research Institute". This final version was submitted to 24 experts and followed by a pretest. Construct validity has been established by performing a principal component analysis factor on a sample of 204 patients. Internal consistency was assessed by Cronbach alpha coefficient and inter-rater reliability was assessed by the use of Intra-Class Correlation coefficient (ICC). For the test-retest reliability evaluation, the "r" Pearson's coefficient was used between the DAI scores obtained in the initial evaluation and those obtained at 15 days. Results: Regarding construct validity, factor analysis revealed seven factors that were responsible for 59.9% of the variance. The study of internal consistency between the 30 items was rated good (α = 0.88). The test--retest reliability was satisfactory (r = 0.99, p b 10-3), as well as inter-rater reliability (ICC = 0.99). Conclusion: In the Tunisian cultural context, the DAI-30 presented seven factors with good consistency and an inter-rater reliability. [ABSTRACT FROM AUTHOR]

Background: Medication non-adherence is a major problem in patients with bipolar disorder as it is associated to poor clinical outcomes with frequent relapses and consequently poor quality of life. The reasons that patients are non adherent with medication are not well understood by clinicians who often consider it as related to the illness itself.   , Aims: To assess sociodemographic, clinical and therapeutic factors related to medication compliance in bipolar disorder., Methods: A cross-sectional study was conducted at the department of psychiatry of FarhatHached Hospital of Sousse. We included 50 outpatients with bipolar disorder type I or II according to the criteria of the DSM-IV TR. The sociodemographic, clinical and therapeutic data were collected and adherence was evaluated with the Medication Adherence Report Scale (MARS) of Thompson., Results: The mean age of our patients was of 31.9 years. The most frequent diagnosis was the bipolar disorder type I (60 %). Most of the participants were single (n=30; 60%), unemployed and living with their families. Factors associated to medication non-adherence were: young age, addiction, complexity and adverse effects of medications, lack of information about the disease and utility of treatments, low income and type I of bipolar disorder., Conclusion: Improving medication compliance strategies in bipolar patients must take into account psycho education of patients about their disease and simplification of prescriptions that must be also well tolerated mainly in young subjects, having addictive behaviors and low income.

Background: The prevalence related to alcohol use disorders in adults is 1.7%. It varies around the world. In Tunisia, as in most Arab and Muslim countries, alcohol consumption is still a taboo and little studied., Aims: To estimate the prevalence of alcohol abuse and dependence Band to assess associated socio-demographic factors in primary care patients in Sousse governorate., Method: It's a descriptive study carried out between June and November 2006. The sample included 30 primary care units in Sousse governorate, chosen by a stratified random method. We used the Composite International Diagnostic Interview (CIDI 2.1) translated and validated in Tunisian dialect., Results: Our sample included 2577 participants. The lifetime prevalence of alcohol abuse and during the last 12 months were 2.8% and 1%. Those of alcohol dependence were respectively 0.7% and 0.3%. Only one case of alcohol abuse was found among women and no cases of dependence have been noticed. For men's, the prevalence of alcohol abuse at the lifetime and during the last 12 months were 12.8 % and 4.5 %. For men's alcohol dependence, prevalence rates were 3% and 1.6 %. Associated factors with abuse or alcohol dependence were studied in men's sample (n=560). Alcohol abuse was more common after multivariate logistic regression in the age group betwen18 and 34 years and in those with a diploma. Alcohol dependence was associated with only high level of education., Conclusion: Our study provides further evidence that alcohol abuse and dependence in primary care remain low compared to other international studies and highlights the role of primary care physicians in the screening of these health problems especially among men.

Background: Panic and phobic disorders are the most common anxiety disorders in the general population. They can be a source of suffering, disability and are often complicated by other psychiatric disorders., Aims: To estimate the prevalence of panic disorder, agoraphobia, social phobia and specific phobia and to assess associated sociodemographic characteristics in primary care patients in Sousse governorate., Methods: A systematic sample of 1246 adults who presented to 30 different primary care units in Sousse for a medical appointment was recruited in a cross- section epidemiological study. The Composite International Diagnostic Interview (CIDI 2.1) was used to diagnose the concerned anxiety disorders., Results: The lifetime prevalence of panic disorder, agoraphobia, social phobia and specific phobia were respectively 1.3%, 2.5%, 6.2% and 24.6%. The female gender was significantly predominant in social and specific phobia. The young age was found significantly in subjects with social phobia. These anxiety disorders were significantly predominant in rural areas, except for social phobia. All of these disorders have a chronic course with an index of chronicity ranging from 71 to 80%., Conclusion: Our study provides further evidence of the high prevalence of anxiety disorders in primary care and highlights the particular need for general physicians to diagnose and treat correctly these disorders.

Background: Stress is a part of the nursing profession and it is reflected in higher rates of depression and anxiety disorders. aim : This study aimed to determine the prevalence of major depression episodes (MDE), Dysthymia and generalized anxiety disorder (GAD), as well as their associated factors, in a representative sample of nurses in Sousse Farhat Hached teaching hospital, using the Tunisian version of CIDI., Methods: It's a descriptive study, carried out among a representative sample of the nursing staff of Sousse Farhat Hached teaching hospital (N=228). The data obtained was the result of an interview using the CIDI sections related to MDD, dysthymia and GAD. Sociodemographic, medical and professional data were also collected., Results: The MDE prevalence was estimated at 7.5% and was associated with the female gender, the remoteness of the workplace, the number of persons on the participant's charge, the personal antecedents of mental and organic pathologies, the job satisfaction related to internal relationships and security as well as with the wish to change position. The prevalence of Dysthymia was 5.7% and was associated with family antecedents of mental pathologies. The prevalence of TAG (4.4%) was associated with remoteness of the workplace, personal antecedents of mental pathologies and with satisfaction related to material conditions., Conclusion: The important issues of human and financial consequences of stress at work require the use of large-scale measures that should be incorporated into a strategy covering all factors and involving both health authorities and administrative occupational medicine.

Background: Mental disorders are common in general medicine consultation. According to international studies, their prevalence in primary care varies from 34 to 54%. In Tunisia, the general practitioner role, as well as the difficulties that encountered them in the management of these disorders, are little known., Aim: The objective of this work was to pull opinions of the general doctors and the psychiatrists concerning the current role of the general doctors, the difficulties that encountered them, as well as the possible solutions in promoting mental disorder management., Methods: It was a descriptive investigation carried out in Mars 2008, near 200 doctors (100 general practitioners and 100 psychiatrists). A questionnaire was drawn up with two parts: the first for collecting the doctors' opinions concerning general practitioner mental disorder management and the strategies of improving it. The second was devoted to the assessment of the collaboration between general practitioners and psychiatrists., Results: The answer's rate was 45.5%. The majority of the general doctors qualified as secondary their role in the mental disorder management and limited to the tracking of patients with mental disorders. This modest implication of the general practitioners in the treatment and the follow-up of patients with mental disorders could be explained by the lack of competence and training recognized by them and also reported by the majority of psychiatrists. Doctors in this investigation have proposed to set up training programs for managing mental diseases and to organize regularly common scientific conferences between general practitioners and psychiatrists in order to improve their collaboration., Conclusion: This investigation has permitted to identify reciprocal expectations of general practitioners and psychiatrists. They both agreed upon the need of a more important implication of the general practitioners in the mental disorder management and the necessity of psychiatrists' involvement in the general practitioners training and information.

Background: Major Depressive Disorder (MDD) is often comorbid with personality disorders which are known to change its clinical aspects and worsen its outcome., Aim: This study aimed to compare clinical and outcome aspects of a female depressed inpatients group according to the existence or not of a comorbid personality disorder., Methods: The study was carried in the psychiatry female inpatient unit of Farhat Hached hospital of Sousse. All entrances to the unit from January 1999 to August 2002 were retrospectively reviewed. 160, corresponding to MDD, were selected. Assessment was based on demographic characteristics, medical history, axis I comorbid disorders, clinical aspects of the index episode and outcome characteristics., Results: 77 patients (48.1%) had personality disorder. Compared to those without comorbid personality disorder, these patients were younger (p < 10-4), with higher educational level (p = 0.005) and better vocational functioning (p = 0.018). They also had an earlier age at onset of their depression (p < 10-4), more previous suicide attempts (p = 0.012) and more axis I comorbid disorders (p < 10-4). Comorbid personality disorders were correlated to an impaired outcome, with higher rate of relapses (p = 0.021), more recurrences (p = 0.026), more persistent symptoms (p < 10-4) and more suicide attempts (p = 0.031).

Background: Personality disorders are common among patients seeking psychiatric care and often coexist with axis I disorders. Cluster B types are reported as being the most common in those patients. They are often correlated with specific demographic features, higher rates of axis I comorbidity and impaired outcome., Aim: This study aimed to describe general and clinical features of personality disorders types in a Tunisian outpatient psychiatric unit and to determine characteristics of cluster B personality types, compared to those of cluster A and C., Methods: This study was held in Sousse psychiatric outpatient unit, from January 2000 to December 2004. 148 cases were retrospectively recruited and assessed according to axis I and axis II DSM-IV criteria., Results: Personality disorders prevalence was 6%. 85.1% of patients had at least one current axis I disorder, which mainly consisted of depressive disorder (42.3%). Cluster B types were the most frequent (54.7%). Comorbid addictive and somatoform disorders were more frequent in cluster B. Anxiety disorders were more frequent in cluster C and psychotic disorders were more frequent in cluster A., Conclusion: Our results show prevalence and clinical profile of personality disorders in a Tunisian clinical population. Cluster B types were the most frequent and seem to have specific comorbid disorders. This support the idea that patients with cluster B personality types need adapted psychiatric care.