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Background Studies about the two most used and validated instruments for the early detection of Bipolar Disorder (BD), the 32 - item Hypomania Checklist (HCL - 32) and the Mood Disorder Questionnaire (MDQ), are scarce in non-Western countries. This study aimed to explore the reliability, factor structure, and criterion validity of their Arabic versions in a sample of Tunisian patients diagnosed with mood disorders. Methods The sample included 59 patients with BD, 86 with unipolar Major Depressive Disorder (MDD) and 281 controls. Confirmatory factor analysis was applied to show that a single global score was an appropriate summary measure of the screeners in the sample. Receiver Operating Characteristic analysis was used to assess the capacity of the translated screeners to distinguish patients with BD from those with MDD and controls. Results Reliability was good for both tools in all samples. The bifactor implementation of the most reported two-factor model had the best fit for both screeners. Both were able to distinguish patients diagnosed with BD from putatively healthy controls, and equally able to distinguish patients diagnosed with BD from patients with MDD. Conclusion Both screeners work best in excluding the presence of BD in patients with MDD, which is an advantage in deciding whether or not to prescribe an antidepressant.

The clinical spectrum of stiff-person syndrome (SPS) encompasses a wide range of signs including psychiatric symptoms (PS).Our objective was to provide an overview of the spectrum of PS in SPS through a systematic literature search and 2 illustrative case reports.We reported 2 anti-glutamic acid decarboxylase-positive SPS cases that presented with phobic disorder, and we performed a systematic review by following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles published in PubMed, MEDLINE on Ovid, Embase, and via a manual search before October 20, 2020, were selected by 2 independent reviewers. Original studies, case reports, editorials, commentaries, and letters to the editor reporting cases of SPS with PS were all included. Conference abstracts, reviews and book chapters, unavailable articles, and those not reporting SPS cases or PS were excluded. Quantitative summary data were calculated.In addition to our 2 cases, we identified 237 cases of SPS with PS from 74 additional included publications totaling 239 patients. Anxiety (56%) and depression (45%) were the most common PS in SPS. Mean diagnostic delay was 4.7 years. Among the 3 SPS phenotypes, the classic form was predominant (77%), followed by stiff-limb syndrome (13%) and progressive encephalomyelitis with rigidity and myoclonus (10%). The most frequent etiology of SPS with PS was autoimmune (90%), followed by cryptogenic (7%) and paraneoplastic forms (7%). These patients were mainly treated with immune-mediated therapies and GABAergic drugs.Our review revealed that the most common PS of SPS are anxiety and depression occurring mostly in autoimmune and classic forms, allowing a clearer understanding of this entity, which may lead to earlier diagnosis and better outcome.

Stigmatization of patients with mental illness is a worldwide phenomenon which can jeopardize help seeking and treatment adherence and contribute to low self-esteem and quality of life.To assess stigmatization as perceived and experienced by patients with severe mental illness in Tunisia.This is a cross-sectional descriptive study conducted at Razi Hospital La Manouba, Tunisia in clinically stabilized patients with bipolar disorder and schizophrenia followed at our outpatient clinic. Patients gave their opinion on a total of 31 statements related to stigma relevant to the Tunisian cultural context.The study sample consisted of 105 patients with an average age of 38.3 years and a sex ratio of 1.5. Negative perceptions or experiences prevailed in 19 out of 31 statements, mostly referring to received and endorsed stigma.Study participants expressed apprehension about disclosure of mental illness, mainly due to fears about family reputation and job opportunities, however, a large majority actually disclosed their mental illness to their surroundings. Male participants had less positive opinions than women regarding former mental patients becoming teachers and experienced more stigma than women in the professional field.Besides actions towards public attitudes, patient-centered-approaches, both tailored to the Tunisian cultural context, are necessary to raise awareness of the public and to reduce endorsed stigma in this vulnerable group of the population.

This chapter provides an overview of the current situation and the challenges Tunisia faces in the field of dementia care. Tunisia is a country in full demographic transition, witnessing an ageing of its population and an increase in dementia incidence and prevalence. There is growing awareness that the healthcare system needs to be better oriented towards this emerging problem. During the last 10 years, a number of public and private initiatives were implemented to improve diagnosis, treatment, training, and research on dementia. The major challenges facing dementia care in Tunisia include the need for early diagnosis and intervention, better coordination of care circuits, wider implementation of day care and residential care with the concurrent establishment of rigorous quality standards, and financial and psychological support for caregivers. Currently, a National Dementia Strategy is being developed in order to address these challenges. There is growing awareness among politicians and healthcare providers that the healthcare system needs to be more oriented towards the emerging problem of dementia in Tunisia. During the last ten years, a number of public and private institutions with focus on dementia care have been created. However, family members remain the cornerstone of dementia care in Tunisia. Currently, a National Dementia Strategy is being developed in order to address the following challenges: (1) the need for early diagnosis and intervention; (2) better coordination of care circuits; (3) wider implementation of day care and residential care with the concurrent establishment of rigorous quality standards; and (4) financial and psychological support for caregivers.