Nos objectifs ont été d’évaluer l’observance et les effets indésirables neurologiques des neuroleptiques ainsi que les facteurs qui y sont associés chez 40 patients âgés atteints de schizophrénie. L’âge moyen des patients était de 71,28 ans avec une sex-ratio de 1,66. La durée moyenne d’évolution de la maladie était de 45 ans et 4 mois. Une bonne observance thérapeutique était corrélée à un âge inférieur à 70 ans (p<0,0001), au sexe masculin (p=0,005) et plus importante chez ceux qui vivent dans un milieu familial ou institutionnel (p=0,003). Il n’y avait pas de relation entre l’observance et les effets extrapyramidaux contrairement aux résultats de plusieurs études. Les troubles neurologiques étaient significativement associés à la prise de neuroleptiques classiques (p=0,006). Ainsi, la monothérapie à la dose minimale efficace et l’utilisation des antipsychotiques atypiques doivent être recommandées.

IntroductionWomen during the postpartum period experience many physiological, psychological, and social changes. Quality of life (QOL) is a sense of well-being and arises from satisfaction or dissatisfaction with various aspects of life including health, employment, socioeconomic state, psychological-emotional state, and family.ObjectivesThe purpose of this study was to identify influence of childbirth experience and postpartum depression on QOL.MethodsThis is a descriptive cross-sectional study regarding 150 postpartum women receiving cares in the hospital of Sfax and examined during the first and the sixth week post-delivery. Data collection tools in this study were demographic questionnaire, Edinburgh Postnatal Depression Scale (EPDS), and world health organization quality of life-bref (WHOQOL-bref). Data were analyzed using SPSS.ResultsThe mean age of our sample (n = 150) was 29.61 years. During the sixth week study period, 126 of 150 were examined.A personal psychiatric history of depression was found in 9.3% of cases.The current pregnancy was undesired in 15.3% of cases.The prevalence of postpartum depression in the first week was 14.7% and 19.8% in the sixth week after delivery.The mean score of quality of life was 81.62 ± 9.09.Scores of quality of life and all its dimensions were significantly lower in depressive women.ConclusionBecause enormous changes develop in postpartum women, we suggest supportive measures for mother by her mother-in-law family, and caregivers to improve the QOL and health status of the mother and her child and to prevent postpartum depression.Disclosure of interestThe authors have not supplied their declaration of competing interest.

BackgroundTunisia has experienced a considerable increase in degenerative diseases associated with aging including in particular dementia and Alzheimer's disease.ObjectivesTo evaluate the diagnostic procedures of cognitive impairments in general medicine and to identify obstacles concerning the early diagnosis of dementia in these patients.MethodsAn email questionnaire was sent to a sample of general practitioners (GPs) working in the Sfax region, Tunisia.ResultsWe received 55 answers. When facing a mnesic complaint, 20% of GPs perform a screening of cognitive disorders. Among reasons leading to early identification, memory complaints (76.4%) was the most mentioned by GPs surveyed. the Mini Mental State was the most used (34.5%) by general practitioners. Twenty-nine point one percent (29.1%) of physicians conducted a comparative assessment 6 to 12 months later if the initial evaluation was normal and 83.6% send the patient to a specialist in case of a detected disorder. For GPs, in 58.2% of the cases, the major impediment is the lack of time, in 32.7% of the cases it is patient's and family's denial and in 23.6% of the cases it is the absence of effective medical treatment. A cross analysis shows that GPs who have had further training in geriatrics have a better approach.ConclusionOur study shows a lack in the early identification of cognitive impairment in the elderly by GPs. Develop simple cognitive tests, reinforce training of doctors and promote research to develop new drugs would improve early diagnosis and management of dementia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionAcne vulgaris is a common skin disease that affects the majority of adolescents. The physical changes of acne may have negative effects on the psychological structure of adolescents such as anxiety and depression. Alexithymia has been suggested to be an important symptom in psychodermatological patients.ObjectiveOur study aims to access depression in adolescents with A. vulgaris and to evaluate its relationship with alexithymia.MethodsThis is a descriptive cross-sectional study regarding 50 adolescents followed in the outpatient dermatology unit of Hédi Chaker University hospital in Sfax (Tunisia). To assess depression, we used a psychometric tool: Beck Depression Inventory (BDI). The Toronto Alexithymia Scale (TAS-20) was used to evaluate alexithymia. The severity of acne was evaluated with the Global Acne Evaluation (GEA) Scale.ResultsThe mean age of adolescents was 15 years 9 months. Almost all of adolescents was female (82%), and live in urban area.The severity of A. vulgaris was mild in 50%, moderate in 32% and severe in 18%.The prevalence of depression was 48%. Twenty-four percent of them have a major depression. Forty-six percent of patients scored positive for alexithymia.The occurrence of depression was significantly associated to alexithymia (P = 0.003).ConclusionThis study showed a positive correlation between alexithymia and depression.These results can be useful in treatment based on processing of emotional information and regulation of emotions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionThe haemodialysis, one of the main treatment modalities of chronic renal failure, imposes a great psychosocial burden on elderly patients, which may cause many psychological impacts.ObjectiveThe aim of this study was to screen anxiety and depression in elderly patients on haemodialysis, taking into account factors that may contribute to.MethodsOur study was transversal, descriptive carried out among 38 elderly patients aged more than 60 years with chronic kidney failure on haemodialysis. The structured questionnaire used in this study was gathered information on socio-demographic and disease characteristics. We used the hospital anxiety and depression scale (HADS) to access anxiety and depression.ResultsThe mean age of our sample was 71 years. The sex-ratio (♂/♀) was 1.92.,patients were mainly married (73.7%), and have a low school level (76.3%). The mean haemodialysis duration was 5 years ± 4.68. The most common cause of renal failure was polycystic kidney disease (18.4%), diabetes (15.8%), while in 28.9% the cause was unknown. Anxiety was found in 18.4% of patients and it was associated with both low school (P = 0.02) and socio-economic level (P = 0.04). The prevalence of depressive symptoms was 42.1%. It was correlated to the unknown cause of kidney failure and the short duration haemodialysis (P = 0.03).ConclusionThese data suggest that depression and anxiety are highly prevalent in elderly patients with renal failure on dialysis. This result shows the need for interdisciplinary teamwork in improving the quality of life of those patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionThe elderly suicide is a major public health problem that is gaining more and more ground, given the aging population problem. This has rarely been the subject of forensic studies in Tunisia.ObjectivesTo identify the sociodemographic and clinical characteristics of elderly suicide victims over 60 years and to determine what factors might increase suicide risk in this population.MethodsWe conducted a retrospective study on suicide victims aged 60 and over, autopsied in forensic medicine department of the Habib Bourguiba university hospital in Sfax (Tunisia), on a 10-year period (January 2006–December 2015).ResultsWe identified 34 cases with an average age of 66 years. The sex ratio was 2.77. Suicide victims were alone in 38.2% of cases. They were inactive professionally in 32.4% of cases. Almost half of them (44.1%) had a psychiatric history, 40% of depressed pace, 26.7% of bipolar disorder and 13.3% of schizophrenia.Three main factors were identified as precipitating the passage to suicidal act: family conflicts (26.5%), financial difficulties (11.8%) and loss of autonomy (5.9%).Suicide methods were hanging (50%), immolation and drug intoxication (11.8%), hit by train and poisoning (8.8%), jumping from height (5.9%) and drowning (2.9%). In 55.8% of cases, suicide took place at home.ConclusionElderly suicide seems to be a huge but largely preventable public health problem. Its prevention is essentially based on the identification of risk situations and the detection and treatment of depression: major suicide risk factor in this population.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionBenzodiazepines (BZD) are the most consumed psychotropic drugs by the elders. This prescription can lead to the dependence which is a major public health problem particularly in this population.ObjectivesTo study the prevalence of dependence of the (BZD) in elderly subjects followed as outpatients and to identify the factors associated with it.MethodsIt was a cross-sectional study of 60 patients aged 65 years and older followed at the psychiatric consultation of the UH Hédi Chaker of Sfax; for 3 months. We used:– Questionnaire containing demographic and clinical data.– The cognitive scale of attachment to benzodiazepines (ECAB), a score ≥ 6 indicates dependence.ResultsThe average age of patients was 67.78 years, with a sex-ratio M/W = 0.46. They were smoking in 58.3% of cases. The most frequent psychiatric disorders were mood disorders (40%) followed by anxiety disorders (13.3%). The absence of diagnosis was observed in 23.3% of cases. A psychotropic drugs were associated with BZD in 86.7%. The most prescripted BZD was lorazépam (90%). Withdrawal signs were present in 90% of cases. The prevalence of BZD dependence has been estimated at 80%.BZD dependence was significantly correlated with smoking (P = 0.00), with psychotropics association (P = 0.04) and with signs of withdrawal (P = 0.001).ConclusionIt appears from our study the importance of BZD dependence in the elderly what it is a source of withdrawal difficulty. So we need make more effort to comply with recommendations regarding the prescription of these molecules.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionChildbirth represents for women a time of vulnerability to postpartum mood disorders. These disorders range in severity from the early maternal blues to postpartum psychosis. Along this spectrum is postpartum depression (PPD) that may have many risk factors.ObjectivesThe study aims to examine the prevalence of PPD and associated risk factors among a sample of Tunisian women receiving cares in the hospital of Sfax.MethodsThis is a descriptive cross-sectional study regarding 150 parturients examined during the first and the sixth week post-delivery. The EPDS (Edinburgh postnatal depression scale) was used to assess PPD.ResultsThe total sample had a mean age of 29.61 years. During the sixth week study period, 126 of 150 were examined. Almost all of the women have a low school level (82.7%). Only 9.3% had a personal psychiatric history. Multiparity was found in 43.3% of cases. The current pregnancy was undesired in 15.3% of cases. Sympathetic signs of pregnancy were reported by 64.7% of women. The prevalence of PPD in the first week was 14.7% and 19.8% in the sixth week after delivery. The PPD was associated with the maternal age (> 35 years), the low school level, the existence of mood personal background, the parity, the difficulty to accept the pregnancy and sympathetic signs of pregnancy.ConclusionPostpartum depression is common on our sample. Identifying risk factors of PPD allows clinicians to detect subgroups of women with an increased vulnerability who might receive early psychiatric care.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Introduction Bipolar disorder is a severe mental illness characterized by intermittent episodes of mania, depression and mixed states. The presence of residual symptoms, seems to be the common factor in many studies assessing functioning in BD patients. Objective To evaluate the prevalence of residual symptoms (both depressive and manic) in euthymic patients with bipolar disorder and seek for associated factors. Methodology A total of 30 patients with bipolar disorder were enrolled for this study. They were in remission for at least two months. The patients answered the Hamilton Depression Rating Scale and the Disorder Questionnaire Mood Hirschfeld (the MDQ scale). Results The average age of our patients was 43±13 years. Most patients were from a rural area (70%), married (60%) and did not go beyond secondary school level (93.3%). Forty percent (40%) had organic personal history. Social dysfunction was found in 40% of cases, and professional difficulties in 30% of patients. Depressive residual symptoms were found in 33.3% in cases and hypomaniac ones in 26.6%. Residual depressive symptoms were significantly more frequent among married patients and having organic personal history ( P =0.025). The professional difficulties were associated with male gender ( P =0.025) and the poor quality of free interval ( P =0.03). Conclusion These results illustrate that the intercritical phase in bipolar disorder is not really euthymic. These findings are in favour of developing interventions to manage subthreshold symptoms to reduce their impact on social and professional functioning.

IntroductionChanging cultural values and increasing economic stress are leading to initiation into substance use. Despite religious and legal constraints on Muslims against the consumption of drugs, drug addiction is a widespread problem and is destroying the lives of many individuals and families, in Tunisia.ObjectivesTo examine the socio-demographic characteristics of Tunisian addicts and to identify the drugs commonly used.MethodsThis was a cross-sectional study, which included 200 patients at the addiction treatment center “Aide et Ecoute” in Sfax (Tunisia). The survey was conducted during the month of January to September 2014.ResultsOnly males were found to get treatment in the addiction center for various addictions. The mean age was 33.32 years and the mean age for starting substance use was 17.30 years. More than half (65.9%) were not married and 59.5% had involvement with criminal justice. Substance dependence was commonly seen in poor and middle socioeconomic class. The most common substance used was buprenorphine (34.8%). There was a significant relation between buprenorphine consumption and immigration (P= 0.013). Peer pressure was one of the most important factors for trial of substance in our study.ConclusionAs the mean age of initiation of substance abuse was early twenties, in liaison with schools and colleges, some recreational activities can be generated to prevent diversion of youth towards the devil of drug abuse.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionFor most individuals, basic life requirements are met through employment. It can satisfy creative urges, promote self-esteem, and provide an avenue for achievement and self-realization.ObjectiveTo assess the level of depression, anxiety and self-esteem in a population of unemployed persons.MethodIt was a cross-sectional study involving unemployed people we met in the office of employment of Sfax in Tunisia. The level of anxiety and depression was assessed by the Beck depression and anxiety inventories. The self-esteem Rosenberg scale allowed us to evaluate the level of self-esteem of our population.ResultsThe average age of oursubjects was 33 years six months. The average duration of unemployment of our population was 4 years 7 months and 38.2% of them had never worked before. The anxiety level was moderate in 38.2%, while moderate to severe depression was found in 47%. Self-esteem was low to very low in 47.1%. A low level of depression was positively correlated with a low socioeconomic level (P = 0.000), a low level of anxiety (P = 0.000) and a high self-esteem level (P = 0.000).ConclusionPeople with strong support systems and greater self-esteem seemed to experience less unemployment stress. Identifying those who are at high risk for psychological and physical problems and finding ways of preventing them from suffering the adverse effect of unemployment are important areas for further study.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionTeachers are confronted with increasing difficulties and demands that make them vulnerable to burnout.AimsTo evaluate burnout among a population of Tunisian teachers and to identify factors that may be involved.MethodsIt was a cross-sectional, descriptive and analytic study, involving 165 teachers working in 10 primary schools and 7 high schools in Sfax, Tunisia. The participants completed a self-questionnaire containing their socio-demographic and professional characteristics. They were explored by the scale of the burnout: Le Maslach Burnout Inventory General Survey (MBI-GS).ResultsThe mean age of teachers was 39.96 years. The sex ratio (M:F) was 1.32. The majority (75.2%) was married. The burnout syndrome was found in 49.7% of teachers. Moderate burnout was found in 43% of cases and severe burnout in 6.7%. The causes of burnout reported by our population were bad working conditions (71.50%), quality of working relationships (65.5%) and overload work (30.3%). Bad working conditions were associated with a high level of emotional exhaustion (P < 0.005) and a low level of professional efficacy (P < 0.001), while poor quality of work relationships and overload work were associated to a high score on cynicism (P < 0.001) and a low score on professional efficacy (P < 0.001).ConclusionAccording to our study, poor working conditions, overload work and bad quality of relationships seem to be risk factors of burnout in teachers. Preventive measures should be instituted against those factors to reduce the constraints of work and improve the professional quality of life of these individuals, essential thing to optimize the educational level in our country.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Road Traffic Accidents (RTA) are most probably the leading cause of post-traumatic stress disorder (PTSD) in developed countries but it remains under-estimated.- To determine the prevalence of PTSD in our population.- To determine the relationship between PTSD, anxiety and depression.This is a cross-sectional study which involved 120 road traffic accidents victims, followed in the outpatient orthopedic department of Sfax in Tunisia. We assessed the severity of the injuries by the AIS scale, post-traumatic stress by the PCL-S and anxiety and depression by the HADS scale.Our population was relatively young (average age≈37ans). In our population, AIS score (assessment of the severity of injuries) was higher than 3 in 62.5%. According to the HADS score, 36.7% suffer from depression and 27.5% from anxiety. In our series, the prevalence of PTSD in road accident victims was important: 54.17%. The risk factors identified were: female gender (P=0.043); rural origin (P=0.015); and the handicap caused by the accident (P=0.013). Concerning comorbidities, anxiety and depressive disorders were significantly associated with PTSD (P=0.000).Psychological consequences of RTA such as PTSD, depression and anxiety are not easily apparent. These people who have suffered from the most severe emotional shock are often neglected and/or forgotten. Language: en

Confronté à une catégorie particulière de malades, le personnel paramédical exerçant en milieu psychiatrique est soumis à des contraintes physiques et mentales sources de modifications de comportement et de retentissement sur la qualité de vie au travail. Évaluer le stress au travail chez le personnel paramédical exerçant en milieu psychiatrique. Il s’agit d’une étude transversale descriptive portant sur un échantillon de 40 personnels paramédicaux exerçant aux services de psychiatrie au CHU Hédi Chaker de Sfax. Un auto-questionnaire a permis de collecter les caractéristiques sociodémographiques et professionnelles des participants. Pour mesurer le stress au travail, nous avons utilisé le modèle de Karasek qui évalue trois dimensions : la demande psychologique, la latitude décisionnelle et le soutien social au travail. L’âge moyen des participants était de 42 ans [24–59 ans]. Le sex-ratio (H/F) était de 1,5. L’ancienneté moyenne au travail était de 15 ans. Parmi les enquêtés, 30 % étaient des travailleurs à horaire variable. Près de la moitié n’était pas satisfaite de l’emploi, se plaignait des conditions de travail (insécurité, matériel non adapté…) et désirait changer de poste. La médiane du score global de latitude décisionnelle était de 62 points, soit en faveur d’une faible latitude décisionnelle. Celle de la demande psychologique était de 22 points, soit en faveur d’une forte demande psychologique. La médiane du score de soutien social était de 20 points, soit en faveur d’un faible soutien social. L’interprétation de ces différents résultats plaçait la globalité de notre population dans le cadran « tendu » ou job strain. Seuls 20 % étaient trouvés actifs. La plupart des femmes (69 %), des jeunes âgés entre 20 et 30 ans (80 %) et des travailleurs postés (67 %) étaient en situation de job strain. Notre étude illustre bien le degré de stress auquel le personnel paramédical de psychiatrie serait exposé en milieu de travail, notamment pour les plus jeunes d’entre eux. Ainsi, faut-il analyser leurs conditions de travail, en dévoiler les difficultés, retrouver les moyens et les actions permettant d’y remédier. Complication la plus redoutable du stress en milieu de travail, l’épuisement professionnel doit être prévenu moyennant une meilleure compréhension pour une meilleure action sur le milieu professionnel.

Bipolar disorder is quite heterogeneous; first-episode polarity has been proposed as course predictor. This study aimed to compare sociodemographic and clinical aspects, as well as illness course, in bipolar 1 disorder patients according to the polarity of the first episode. We conducted a retrospective and comparative survey of all patients hospitalized in the department of psychiatry "A" in the Hedi Chaker University Hospital, in Sfax (Tunisia), during the period from January 2008 to December 2012, and in whom bipolar 1 disorder was diagnosed (DSM IV-TR). Patients whose follow-up does not exceed one year were excluded. Subjects were sorted into two groups: group 'M" those with manic/hypomanic first episode and group 'D" those with depressive one. Seventy-six patients were included (group 'M" = 58; group 'D" = 18). The depressive first episode was significantly correlated with early-onset of bipolar disorder (p = 0.01), more frequent family history of bipolar disorder (p = 0.02), more suicide attempts (p = 0.00) and higher number of mood episodes (p = 0.02). Group 'M" had more frequently psychotic features (p = 0.00) and more psychiatric hospitalization history (p = 0.04). No statistical difference was found in gender and substance abuse between the two groups. Our study confirmed literature data that bipolar patients with depressive onset seem to have a poorer prognosis.

Schizophrenia is one of the most severe psychiatric disorders. An early diagnosis and beginning of treatment may lead to a more favorable prognosis of the disease. We propose to study the clinical and evolutionary characteristics of the onset of schizophrenia. In this retrospective study, we reviewed the records of 61 patients who were hospitalized for schizophrenia in the department of Psychiatry 'A" in the University Hospital in Sfax (Tunisia), between August 2009 and January 2013. For each patient, we collected sociodemographic, clinical and evolutionary data. The average age of disease onset was 25.25 years. The majority of patients were males (78%) and single (85.2%). Paranoid schizophrenia was the most frequent type of schizophrenia (65.6%). The average duration of untreated psychosis was 2 years 11 months. The main pre-psychotic symptoms were: social isolation (48.6%), heteroaggressiveness (37.3%), irritability (34.2%), insomnia (32.3%), self-neglect (13.1%) and anxiety (4.9%). Patients were treated with oral typical antipsychotic drugs in 44.3% of cases, conventional depots in 39.3% and atypical antipsychotic drugs in 16.4%. After a hospital stay of 25 days on average, 47.5% of patients never came back. Patients followed-up at the outpatients unit had regular monitoring in 53.14% of cases and good adherence to treatment in 42.9%. Our study showed that more than half of patients were lost to follow-up or had poor adherence to treatment. Atypical antipsychotic prescription, having better neurological tolerance, and psychoeducation for the patient and his family, would be beneficial to improve the management of schizophrenia.

Major depression is associated with high risk of suicide. But it remains controversial whether the risk is higher in bipolar depression or unipolar one. 1. To identify social, clinical and temperamental factors associated with high suicide risk among patients with unipolar or bipolar depression. 2. To compare suicide risk in the two groups. This cross-sectional study, in progress, is conducted on psychiatric outpatients in the University Hospital, in Sfax (Tunisia). We include subjects with major depressive episode in the context of bipolar disorder or major depressive disorder. We use the Arabic version of the full-scale TEMPS-A auto-questionnaire and the suicidal risk assessment scale (RSD). A total of 28 depressive patients were included. Compared to unipolar patients (20), bipolar patients (8) had more frequent previous suicide attempts (25% vs 10%) and had a higher suicide risk (50% vs 25%). Among high-risk suicidal patients (16/28), 62.5% were males. The main stressful life events were: school failure (66.7%), early grief (55.6%) and family violence (44.4%). Psychotic and atypical features were found in 33.3% and 55.6%, respectively. Comorbidity with personality disorder was noted in 44.4% and with anxiety disorders in 22.2%. Cyclothymic (44.4%) and irritable (33.3%) temperaments were the most common. Our results meet those of the literature. Suicide risk is associated with male gender and traumatic events in childhood. Bipolar depression, psychotic features, affective temperaments, as well as personality disorders, and anxiety increase this risk. Attention should be paid to all these factors in depressed patients.

Introduction Excessive tobacco consumption among students has negative repercussions on their health and education. Medical students are no exception. Numerous studies have demonstrated the relationship existing between smoking and depressive disorders. Objective To study the relationship between depression, anxiety and students smoking. Method We conducted a cross-sectional, descriptive and analytical study which included 80 students of the Faculty of Medicine of Sfax in Tunisia: 40 smokers and 40 no-smokers. We used the Hospital Anxiety and Depression Scale (HADS) for screening depressive and anxious symptoms. The evaluation of tobacco dependence was performed by Fagerstrom test. Results The average age of the participants was 23 years with a male predominance (SR=1,66). The smokers were in 80% of cases males and in 55% of cases dependents. Thirty-one percent (31%) of our population were depressed and 28.7% were anxious. A statistically significant correlation was found between smoking and the presence of depression (p = 0.025) on one hand, and anxiety (p = 0.022) on the other hand. Tobacco dependence was related to male sex (p = 0.04) and depression (p = 0.03). There was no link between the same variable and anxiety. Conclusion It appears from our study a statistically significant relationship between smoking and anxio-depressive disorders. The degree of dependence is particularly related with depression. This dimension has to be considered in the therapeutic withdrawal project.

Bipolar and unipolar disorders share a common depressive clinical manifestation, but have not the same treatment. An early recognition of bipolar depression has an important impact on the prognosis of bipolar disorder. Our study aims at evaluating the prevalence of hypomania among patients with major depression and revealing the factors that distinguish between unipolar and bipolar depression. Our cross-sectional study, in progress, includes outpatients with major depressive disorder, from the University Hospital in Sfax (Tunisia). We use the Angst's Hypomania Checklist (HCL-20) to detect episodes of hypomania misdiagnosed by the present psychiatrist. Twenty patients were included. The average age of onset of disease was 31 years. More than half of patients were females (55%). Tobacco dependence was found in 35% of patients, alcohol dependence in 20% of them. Patients had a family history of bipolar disorder in 25% of cases. They attempted suicide in 15% of cases. Hypomania prevalence was 45%. Hypomanic episode was more frequent in early-onset disease, when there is a history of attempted suicide, and in case of atypical or psychotic features. Addiction to tobacco or alcohol, presence of somatic comorbidity and mixed features were also more frequent in patients with past hypomania. Our results show that bipolar disorder is underdiagnosed in depressive patients. Systematic search for hypomania, based on a clinical interview or a screening tool, is necessary to avoid misdiagnosis of bipolar disorder and therefore inappropriate treatment.