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Violence against women in marriage is greatly affects the mental health of women; it is associated with an alteration of the quality of life of victims and with a high incidence of mental disorders. However, a few studies were conducted in Arabic countries.
to estimate the prevalence of the violence against women in the marriage and to explore the relationship between the violence against women in the marriage and anxiety and depression symptoms.
It was a descriptive and analytical cross-sectional study carried on 197 married women (mean age: 32.32 ± 5.94 years; range: 19 and 50 years) recruited in family planning center of Monastir (Tunisia), which were assessed by the Woman Abuse Screening Tool questionnaire and the Hospital Anxiety Depression questionnaire.
The lifetime prevalence of violence against women in the marriage was 56.9%. The most common form of violence was psychological (56.9%), followed by economic violence (41.1%), physical violence (32%) and sexual violence (10.6). The frequency of anxiety and depressive symptoms was three times higher among women victims of violence: 33.9% versus 10.5% (P< 0.0001) for anxiety symptoms and 17.8% versus 5.9% (P = 0.012) for depressive symptoms.
Our study has demonstrated the association between violence against women in marriage and anxiety and depression symptoms. These results justify the implement of screening and support programs for Tunisian women victims of violence in marriage.
About a third of patients with schizophrenia have persistent auditory verbal hallucinations resulting in persistent distress, functional disability, and frequent loss of behavioral control.
To estimate the prevalence of persistent auditory hallucinations in a sample of schizophrenic patients, to specify their characteristics and to identify their clinical associated factors.
This was a cross-sectional, descriptive and analytical study carried-on 144 out-patients (101 men and 43 women, mean age 38.24 ± 10.58 years) followed for schizophrenia in the psychiatry department of the university hospital of Monastir. The assessment was consisted by the collect of epidemiological, clinical and therapeutic data and the use of the Hoffman's auditory hallucinations rating scale (AHRS), and the positive and negative symptoms scale (PANSS).
The prevalence of persistent auditory hallucinations (score of the AHRS ≥ 5) was 40.3%. The total mean score on the AHRS was 10.7 ± 7.8 for all patients and 19.4 ± 7.7 for patients with persistent auditory hallucinations. The items of the AHRS with higher sub scores were the number, the influence and the reality of the voices. The clinical associated factors with persistent auditory hallucinations after multivariate analysis were the family history of physical illness, the absence of tobacco consumption, the hallucinatory onset of disorders, the notion of prior hospitalization and continuous course.
Our results support the multidimensional nature of auditory hallucinations and confirm the existence of interindividual differences in these hallucinations. Persistent auditory hallucinations were associated with poor prognosis, requiring more effective therapeutic strategies.
Paraoxonase (PON), an enzyme, is a key process in the pathophysiology of atherosclerosis.
We aim to investigate the variations of PON1 activity in Tunisian bipolar I patients treated with thymoregulators.
Patients and methods
Our study included 78 patients with bipolar I disorder, diagnosed according to the DSM-IV, and 64 controls aged 35.97±11.55 years and 36,31±18.26 years respectively. 41 patients were treated by valproic acid, 16 under carbamazepine and 21 under lithium. PON1 activity was determined by kinetic methods using Konelab 30 equipment.
Compared to controls, patients treated by thymoregulators had a significantly lower paraoxonase activity (p=0.004). Furthermore, PON1 was significantly correlated with c-HDL values (r=0.5612; P< 0.001). The lowest PON1 levels were noted in patients treated with lithium (150±94UI/L) and the highest levels were showed in those under carbamazepine (260±185UI/L), but this difference was not significant. In patients under lithium, we showed that this parameter was significantly lower when illness duration was more than 12 years, the lithium posology exceeds 1000 mg/day and the lithium plasmatic concentrations were more than 0.54 mmol/L. However, there was no significant difference among gender, age, cigarette smoking and alcoholic beverage.
Bipolar patients had a significant decrease in PON1 activity that contributes to increased risk of cardiovascular diseases. This perturbation could be related to treatment with thymoregulators and particularly lithium. Therefore, such patients should require specific care and clinics should track the effects of treatment on physical and biological parameters, and should facilitate access to appropriate medical care.
Given the concept of bipolar spectrum which extends across the family, healthy relatives of bipolar patients, which are a population at high risk for developing mood disorders, may have temperamental deregulations.
To compare the mean scores of affective temperaments among patients with familial bipolar I disorder and their unaffected first-degree relatives.
This was a cross-sectional study, concerning 50 families of bipolar I disorder which have at least two patients with bipolar I disorder (DSM-IV-TR). We have included 80 clinically recovered patients with bipolar I disorder and 120 unaffected first-degree relatives. The affective temperaments were assessed by Tunisian version of TEMPS-A. Dominant affective temperament is the temperament witch score was more than 2 SD of mean scores.
Mean scores of cyclothymic and hyperthymic temperaments were higher in bipolar I patients than in their healthy relatives. The difference was significant for only hyperthymic temperament (p=0.038) but it was not significant after adjustment for age, sex and school level. The rate of dominant affective temperament was not differed between bipolar I patients (26.3%) and their healthy relatives (20%). Investigating the role of family, we showed a significant association with depressive (p< 10-3), cyclothymic (p=10-3), irritable (p=0.023) and anxious (p=0.003) temperaments.
Our findings suggest that patient with family bipolar I disorder and their unaffected first-degree relatives had a temperamental deregulation which confirms the concept that affective temperaments are a potential phenotype of bipolar condition.
Recent studies have suggested that the deficit of glutathione (GSH), a major antioxidant, seems to play a role in the pathophysiology of schizophrenia. Moreover, oxidative stress may contribute to the development of neurological abnormalities, including tardive dyskinesia and parkinsonism symptoms.
To determine plasma glutathione levels and to explore their association with neurological soft signs (NSS) in patients with chronic and first-episode schizophrenia.
A case-control study carried-out on three groups: sixty clinically stable patients with chronic schizophrenia, twentythree patients with first-episode schizophrenia and thirty matched healthy controls. Glutathione levels: total (GSHt), reduced (GSHr) and oxidized glutathione (GSSG) were determined by spectrophotometry. NSS were assessed in three groups by a standardized neurological examination (Krebs et al., 2000).
Plasmatic GSHt and GSHr levels were significantly decreased in patients with chronic and first-episode schizophrenia. All NSS scores were significantly higher in two groups of patients compared to controls. No association was found between NSS scores and glutathione levels in patients with chronic schizophrenia. However, in patients with firstepisode, a negative correlation was found between GSHt levels and involuntary movement sub-score (r= -0.62, p=0.008).
These results suggest that GSH deficit is not related to the stage of disease and may be an important indirect biomarker of oxidative stress in schizophrenia. The association between low GSHt level as a marker of oxidative stress and involuntary movements could suggest that oxidative stress may contribute to the brain damage which leads to an increased prevalence of these NSS.
Several studies have shown a glutathione (GSH) deficit in patients with schizophrenia. It may in part arise from a genetically compromised synthesis of GSH, the major cellular antioxidant and redox-regulator. First-degree relatives of patients with schizophrenia share many susceptibility genes of this disease.
The objectives of this study were to determine plasma glutathione levels in patients with schizophrenia and their unaffected first-degree relatives of compared to healthy controls and to examine the correlation between glutathione levels and schizotypy scores in unaffected relatives.
We included 60 patients with schizophrenia, 33 of their unaffected siblings and 30 healthy controls with no family psychiatric history. The blood glutathione levels: total (GSHt), reduced (GSHr), and oxidized glutathione (GSSG) were measured by spectrophotometry. Schizotypy scores were assessed by the schizotypal personality questionnaire (SPQ).
GSHt and GSHr were significantly lower in patients than in controls, whereas there was no difference in glutathione levels between unaffected relatives and healthy controls. Moreover, no correlation was found between glutathione levels and schizotypy scores in unaffected relatives of patients with schizophrenia.
These results reveal that unaffected relatives of patients with schizophrenia didn’t have a GSH deficit. in the same group, no correlation was found between glutathione levels and schizotypy scores which considered a vulnerability marker for schizophrenia. These findings disagree with our hypothesis that GSH deficit could be a biological marker of vulnerability to schizophrenia. However, further studies are necessary to explore this hypothesis.
The concept of symptomatic and functional remission represents an important challenge in the care of the mentally ill particularly in patients with schizophrenia. However, the association of symptomatic remission with broader functional outcome was not yet documented in non-developing countries including Tunisia.
To evaluate the frequency of symptomatic remission in a sample of Tunisian out-patients with schizophrenic and to explore the relationship between symptomatic remission and social functioning.
It is a cross-sectional study carried-out on 115 out-patients with chronic schizophrenia (87 males, 28 females, mean age= 37.56 ± 10.2 years). Symptomatic remission was assessed by the eight core items of the positive and negative syndrome scale (PANSS). A score of mild or less on all eight core symptoms constitutes symptomatic remission. This symptom level should be maintained for six months. The social functioning was assessed by the Social and Occupational Functioning Assessment Scale (SOFAS) and the Social Autonomy Scale (SAS).
The symptomatic remission was observed in 50.4% of patients. The mean score of the SOFAS was 48.47 ± 14.44 and the mean score of the SAS was 56.6 ± 16.84. A significant association was showed between the SOFAS score and the symptomatic remission (P>0.0001) and between the SAS score and the symptomatic remission (P>0.0001).
Patients with symptomatic remission showed a significant trend for better social functioning. These results suggest that the concept of remission has important implications for the treatment of patients with chronic schizophrenia.
Impairments in oculomotor performances such as saccade tasks were reported in patients with schizophrenia. Correlation between oxidative stress markers and ocular saccades has not been studied.
To explore the relationship between markers of oxidative stress (antioxidant enzyme activities and glutathione levels) and saccadic parameters (frequency and latency) in a sample of patients with schizophrenia.
Thirty clinically stable patients with schizophrenia (24 men and 6 women, mean age = 29.9 ± 6.3 years) and 25 control subjects matched for age (13 men and 12 women, mean age = 29.3 ± 4.9 years) were recruited. Frequency and latency of saccadic tasks (anticipatory and compensatory saccades) were recorded with an oculometry. The erythrocyte activities of antioxidant enzymes: Superoxide Dismutase (SOD), Glutathione Peroxidase (GSH-Px) and Catalase (CAT) were measured. Glutathione (GSH) levels were determined in blood samples.
Patients had significantly lower activities of all antioxidant enzymes and levels of total and reduced GSH compared with controls. High saccades frequency was found in patients compared to controls. The saccade latencies were higher in patients compared to controls. in the patients, a negative correlation was found between total and reduced GSH and frequency of compensatory back-up saccades. Square-wave-jerks were negatively correlated with oxidized GSH level and SOD activity.
The decrease of antioxidant defenses (SOD activity and GSH levels) was associated with the saccadic frequency in patients with schizophrenia, suggesting the involvement of oxidative stress in the pathophysiology of oculomotor abnormalities in schizophrenia.
Neurological soft signs (NSS) are minor or subtle neurological signs indicating non-specific cerebral dysfunction. They have been conceptualized as neurodevelopmental markers that mediate the biological propensity for the development of psychosis. Their interaction with the environmental factors such as cannabis use remains little studied.
To study the relationship between the NSS and the use of cannabis which is considered an environmental risk factor of psychotic disorder.
Sixty one in-patients (fifty three men and eight women; mean age: 28.9 ± 9.4 years) with a first-episode non affective psychosis according with DSM-IV were recruited. Neurological evaluations were carried-out by using the NSS scale of Krebs et al. (2000). We ascertained the use of cannabis with the cannabis subsection, included within the section of substance use, in the Composite International Diagnostic Interview (CIDI).
The prevalence of cannabis use was 16.4%. The mean NSS total score was 15.3 ± 6.7. Significant lower NSS total score was found in cannabis users: 11.2 ± 5.6 versus 16.0 ± 6.7 (p=0.04). There was also an inverse but not significant relation between the use of cannabis and the motor coordination and the involuntary movements sub-scores.
Similar results have been reported in patients with schizophrenia and first-episode psychosis suggesting the existence of fewer NSS in the cannabis user patients. The cannabis could enhance the effects of genetic risk factors for psychosis. More work in the area of genetic-environment interactions in predicting psychosis is necessary.
Depression is one of the most common mental illnesses in the elderly and its consequences are severe.
To measure the prevalence of depression in elderly cancer patients and subsequently determine the sociodemographic and clinical factors correlated with this disorder.
We conducted a descriptive and analytical cross-sectional study of patients aged over than 65 years old, suffering from cancer and who had no cognitive impairment, admitted in 2013 in the Oncology and palliative care unit of Gabes regional Hospital (Tunisia). We used a self-rating questionnaire to detect sociodemographics and clinical variables, the Geriatric depression scale (GDS) to assess depressive symptoms, and the Activity of Daily Living to determine the degree of autonomy.
At the end of our investigation, we included 60 patients. The prevalence of depression was 48%. Depression was significantly correlated with: marital status (widower subjects were more depressed (74% vs. 34%, P = 0.007)), less degree of autonomy (80% vs. 38%, P = 0.04), fatigue (62% vs. 26%, P = 0.007), pain (59% vs. 26%, P = 0.02), family psychiatric history (80% vs. 20%, P = 0.02), family history of death by cancer (72% vs. 38%, P = 0.01), WHO condition (67% vs. 34%, P = 0.04) and the presence of co morbidity in particularly diabetes (69% vs. 41%, P = 0.05).
Depression is prevalent in oncogeriatric environments. This could compromise quality of support and care of these patients. Close collaboration between oncologist and psychiatrist is needed to support and relieve these patients.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Schizotypal traits are considered a phenotypic-indicator of schizotypy, a latent personality organization reflecting a putative liability for psychosis. To date, no previous study has examined the comparability of factorial structures across samples originating from different countries and cultures. The main goal was to evaluate the factorial structure and reliability of the Schizotypal Personality Questionnaire (SPQ) scores by amalgamating data from studies conducted in 12 countries and across 21 sites.
The overall sample consisted of 27 001 participants (37.5% males, n = 4251 drawn from the general population). The mean age was 22.12 years (s.d. = 6.28, range 16–55 years). The SPQ was used. Confirmatory factor analysis (CFA) and Multilevel CFA (ML-CFA) were used to evaluate the factor structure underlying the SPQ scores.
At the SPQ item level, the nine factor and second-order factor models showed adequate goodness-of-fit. At the SPQ subscale level, three- and four-factor models displayed better goodness-of-fit indices than other CFA models. ML-CFA showed that the intraclass correlation coefficients values were lower than 0.106. The three-factor model showed adequate goodness of fit indices in multilevel analysis. The ordinal α coefficients were high, ranging from 0.73 to 0.94 across individual samples, and from 0.84 to 0.91 for the combined sample.
The results are consistent with the conceptual notion that schizotypal personality is a multifaceted construct and support the validity and utility of SPQ in cross-cultural research. We discuss theoretical and clinical implications of our results for diagnostic systems, psychosis models and cross-national mental health strategies.
Recent genetic studies have revealed that the interleukin (IL) 1 gene complex is associated with schizophrenia in the Caucasian population; however, data from the North African population are limited. To further assess the role of interleukin 1 receptor antagonist protein (IL1Ra) in schizophrenia, we examined a functional multiallelic polymorphism localised in intron 2 of this receptor gene associated with an altered level of IL1Ra.
In the present case–control study, we have analysed the (86 bp)n polymorphism of the interleukin 1 receptor antagonist (IL1RN) gene (RS 1794068) by polymerase chain reaction genotyping in 259 patients with schizophrenia and 178 healthy controls from the Tunisian population.
We showed that the frequencies of the IL1RN*2/2 genotype and allele 2 were higher in the patient group compared with the control group, and the difference was statistically significant [13.5% vs. 5.6%, p = 10−3, odds ratio (OR) = 3.2% and 32.8% vs. 21.9%, p = 3 × 10−4, OR = 1.76, respectively). When we evaluated the association between this genetic polymorphism and the clinical variables of schizophrenia, we found that the frequencies of the 2/2 genotype and allele 2 were significantly higher in the male patient group (p = 10−4 and 10−5, respectively) compared with the male control group, indicating a substantially increased risk for sex-onset schizophrenia with inheritance of the IL1RN2 allele. When the association between the genotypes and outcome was evaluated by multiple logistic regression analysis, the adjusted OR for the IL1RN genotypes remained statistically significant [1.39; 95% confidence interval (CI) = 1.11–1.73; p = 0.003].
The intron 2 polymorphism in IL1RN or a genetic polymorphism at proximity seems to be associated specifically with schizophrenia in the Tunisian male population.
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