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In our study the comorbidity between ADHD and ED appeared to be frequent, particularly among patients with AN-BP. ED inpatients with higher level of anxiety and more abnormal eating attitudes and bulimic symptoms should be assessed for potentially associated ADHD.

Sir: Like many others, we have become concerned about the increasing use of more than 1 antipsychotic medication for the maintenance treatment of schizophrenic illness. In an effort to determine whether more than 1 medication was superior to 1 alone, we performed the following small pilot study. Method. The study was approved by the Massachusetts Mental Health Center Institutional Review Board and was conducted from August 2003 to June 2005. Ten patients with persistent serious but stable DSM-IV-defined schizophrenic illness who agreed to participate and gave written informed consent were enrolled; 3 patients served as controls and 7 as experimental subjects. No subject was in crisis or relapse. All were taking at least 2 antipsychotic medications. Two patients were taking 3 antipsychotics: 1 was taking olanzapine with quetiapine and perphenazine, and 1 was taking olanzapine with risperidone and fluphenazine. Four more patients were taking olanzapine (1 each with ziprasidone, risperidone, fluphenazine, and haloperidol decanoate). Two were taking quetiapine with risperidone, and 1 was taking ziprasidone with fluphenazine. One subject was taking clozapine and risperidone. After a baseline psychiatric interview to exclude those with concurrent substance abuse, unstable medical illness, or suicidal preoccupation, the subjects had 1 of their antipsychotic medications discontinued. An initial dose-finding phase substituted 15 mg/day of aripiprazole after a first antipsychotic was discontinued. Three of 4 subjects who withdrew from the study did so because of severe agitation. The study was then restarted using a lower starting dose of aripiprazole. As the first antipsychotic drug was tapered and discontinued, either 2.5 or 5 mg/day of aripiprazole was begun. The dose of aripiprazole was increased according to clinician decision as the second antipsychotic medication was tapered and discontinued. Control subjects continued to take their multiple antipsychotic medications as originally prescribed. All subjects were followed over the remaining period until the total study duration of 12 weeks was reached. Subjects were rated pretreatment and posttreatment with the Clinical Global Impressions scale, 1 Brief Psychiatric Rating Scale (BPRS), 2 and Positive and Negative Syndrome Scale (PANSS). 3 Results. All subjects showed a modest decrease in total BPRS scores with no meaningful difference between those who were maintained on treatment with multiple antipsychotics and those who had aripiprazole substituted for both antipsychotics. The 3 control subjects showed a reduction in total scores (mean change =-3.7), and 6 of 7 of the switched patients showed a reduction (mean change =-2.8); the seventh subject did not have baseline ratings performed. On the PANSS total score, all 3 control subjects showed a reduction in symptoms (mean change =-7.4); 6 of the 7 switched patients showed a reduction (mean change =-9.4). Global scores of psychopathology did not change in either group, although 2 switched patients were rated as improved...

The Burnout or the professional exhaustion syndrome is common among doctors, especially primary care practitioners. The rates range from 25 to 76% according to specialties.Aims:Main objective was to assess the prevalence of burnout in Tunisian primary care practitioners working in public sector in the region of the Cap Bon. Secondary objectives were to determine the risk factors and the consequences associated with this syndrome.Methods:transversal study using four scales: Anonymous auto questionnaire elaborated by the medical team, the Maslach Burnout Inventory (MBI), the Beck Depression inventory (BDI) and the state-trait anxiety inventory (STAI). The MBI explores the three dimensions of Burnout: emotional exhaustion, depersonalization and reduced personal accomplishment. In our study, the Burnout was defined by the presence of two or three pathological dimensions.Results:113 questionnaires were exploitable (85.6% of the sample). The results of the MBI showed that one third of doctors suffer from Burnout and 7.1% have severe attaints. 35% of the doctors had high score of emotional exhaustion, 21% had high depersonalization and 40% had a low score of personal accomplishment. The Burnout was significantly associated with depression (p < 0.001), suicidality (p=0.023) and anxious temperament (p< 0.001). On the other hand, a continued medical education protected significantly against the Burnout (p=0.003). Professional exhaustion was significantly related to the wish of reconversion (p=0.023) and to relational difficulties with patients and colleagues. The solutions proposed were the increase of the number of doctors and a better education of medical students in general medicine.

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