Devenir fonctionnel et thérapeutiques psycho-sociales dans le trouble bipolaire

Abstract

Ce travail avait pour objectifs d’évaluer la qualité de vie des patients présentant un trouble bipolaire type I et d’identifier les facteurs de risque quant à l’origine de cette altération. Cette étude transversale réalisée à la consultation de psychiatrie de l’EPS de Mahdia durant une période de quatre mois a concerné 104 patients bipolaires type I. Les variables étudiées portaient sur les caractéristiques générales des patients, les caractéristiques cliniques et évolutives du trouble bipolaire type I et les données concernant la prise en charge. L’échelle générique de qualité de vie, la SF-36, (Short Form) a été utilisée pour l’évaluation. Une standardisation des scores moyens initiaux a été effectuée. Le score moyen global (SMG) à la SF-36 était de 52,2 et 78,8 % des patients avaient une qualité de vie altérée. Une standardisation a révélé une composante mentale particulièrement plus altérée que celle physique. Les régressions logistiques ont permis d’identifier que la survenue d’une altération de la qualité de vie était en rapport avec des paramètres sociodémographiques et thérapeutiques. La mesure de la qualité de vie permet de concevoir toute personne souffrant de trouble bipolaire dans sa vie entière et non pas seulement sous le seul angle de la maladie.Bipolar disorder affects many psychosocial and functional aspects, leading to a real social handicap and an alteration in quality of life.To evaluate bipolar patients’ quality of life and to identify the risk factors responsible for a deterioration.Our cross-sectional study lasted for four months and included 104 bipolar patients treated at the psychiatry consultation of the university hospital in Mahdia. The data were collected through a questionnaire composed of 52 items exploring the general characteristics of subjects, the clinical and evolutional characteristics of bipolar disorder and providing information on the treatment. Quality of life was measured using the SF-36 (Short form) generic scale. A global average score was calculated and it was considered that quality of life was altered if the score was less than 66.7, according to the threshold value of Léan. Moreover, an average score was calculated for each dimension, thus permitting us to identify those most affected. We standardized initial average scores.The assessment of quality of life revealed a global average of 52.2 and an alteration in 78.8% of patients. The study of the dimensional average scores revealed that all dimensions were affected. The standardization also revealed deterioration in all dimensions, the mental component being particularly more affected than the physical component with respectively estimated scores of 31.7 and 40.5. The analytic approach concerned the relationship between qualitative and quantitative variables and the occurrence of an alteration in quality of life. For this effect, a bivariate study displayed a statistically significant correlation between the eight dimensions of the SF-36 and 8 variables. In order to take into account the relationships that link each variable to the others, and to avoid the bias of the bivariate study, a logistic regression analysis was performed. Only 4 variables with discriminating weight emerged from this analysis. According to the number of dimensions affected, the following factors were classified in decreasing order: absence of leisure activities, lack of stable budgetary resources, absence of professional activity and the association of a psychotropic medication.This clinimetric approach permitted us to consider the global life of each patient suffering from bipolar disorder.