Patients with borderline personality disorder (BPD) show significant impairment in functioning, particularly in the interpersonal and social domains. Prior reports suggest that clozapine may be effective in the management of BPD. We present the case of a patient with BPD who experienced persistent suicidal ideation and was treated with clozapine at a state psychiatric hospital. After treatment failure with other psychotropic medications, clozapine medication was initiated; not only did suicidal ideation cease, but social and professional functioning also greatly improved to the point of no longer requiring intensive levels of observation or restrictive procedures. Clozapine appears to be efficacious in the management of suicide attempts and self-injurious behavior. Moreover, it appears to be promising as a therapeutic measure for ameliorating the global functioning of patients with severe BPD. Larger, randomized, blinded, and controlled prospective studies are needed to confirm these findings and to determine optimal dosage.

Introduction: International guidelines regarding the treatment of bipolar disorder differ noticeably from everyday practice, they stress the importance of the use of mood stabilizers as monotherapy. However, in practice polytherapy is widely used, including antipsychotic drugs, and for periods that far exceed the duration of acute episode. Objectives: Determine the frequency of long-term use of antipsychotic drugs in the treatment of bipolar disorder and identify situations that may justify this attitude. Methods: Retrospective study of all first-admitted patients with bipolar disorder in two psychiatric wards of Razi Hospital between 2006 and 2OO8 and over a three-year follow-up. Results: Our sample consisted of 72 patients. Antipsychotic agents have been used in association with mood stabilizers for a period exceeding 6 months in over 80% of patients with an average duration of 26.56 months ± 12.21 months. Long-term antipsychotic use was significantly correlated with the following factors: male gender, bad family support , poor medication adherence, presence of mixed episodes , psychotic characteristics associated, high frequency of manic recurrences, absence of symptom-free interval, delayed diagnosis as well as a doubtful diagnosis with an acute psychotic disorder or schizophreniform disorder. Conclusion: This study highlights the fact that international guidelines should be better applied in naturalistic conditions, and that clinicians have to be better informed about these recommendations.

Introduction: Schizophrenia is still one of the most difficult diseases to treat, whose direct and indirect costs remain high, both for the patient, family and society. The duration of the untreated psychosis is one of the factors likely to influence the evolution of this disease. To know the factors that may lengthen the period of care would improve the evolutionary course of the disease. Objectives: Determine the factors contributing to the delay in treatment of schizophrenia within the Tunisian population. Methodology: Retrospective study of patients in Razi hospital with schizophrenia admitted in 2004 and 2005. Results: Our sample consisted of 91 patients. The poor family support (p=0,032), the death of the mother (p< 0.00005), the lack of social security coverage (p=0,025) and the large families (p= 0,006) are the modifiable factors highlighted by our study, which contribute significantly to extend the duration of the untreated psychosis. Other factors that were correlated to longer period of support are: advanced age of onset of disorders (p=0.013), family history of psychiatric illness (p=0,03) and of schizophrenia (p=0,04) and disorganized form of schizophrenia (p=0,049). Conclusion: We can stipulate that the application of certain measurements like the improvement and the extension of the social coverage to the poorest classes and most marginalized as well as the fight against the stigmatization of the schizophrenic patients and the mentally ills in general would be more than useful.

Introduction: The use of monotherapy with mood stabilisers during bipolar disorder concerns only few patients. Neuroleptics, benzodiazepines and recently the new-generation antipsychotic molecules are widely used as adjuvant therapy to mood stabilizers, indeed beyond the indications held by the guidelines. Objectives: Modalities of prescription of psychotropic medication during the first admission and over a three-year follow-up in subjects with bipolar disorder. Aims: Evaluate the adequacy of prescribing practices in naturalistic conditions and international guidelines. Methods: Retrospective study of all first-admitted patients with bipolar disorder in two psychiatric wards of Razi Hospital between 2006 and 2OO8 and over a three-year follow-up. Results: Our sample consisted of 72 patients. Over 80% of patients had initially received an incisive antipsychotic drug in combination with mood stabilizer; it was a conventional antipsychotic in 65.3%. Sedative neuroleptics were prescribed in 40.3% of cases with a duration average of 19.21 ± 11.97 months. The combination of two antipsychotic drugs was found in 33.3% of patients. The most frequent association was "haloperidol-chlorpromazine" (79%). Benzodiazepines were prescribed in acute phase in the majority of the sample (94%) with a duration average of 27mo is ±8.4 months; it was the lorazepam in 70.6%. Conclusions: Theoretical recommendations do not always reflect the practical situations. Evaluating indications and conditions of polytherapy are critical issues in future studies on the biological treatment of bipolar disorder.

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