Les anomalies morphologiques mineures dans la schizophrénie : étude d'une population tunisienne

Abstract

Minor physical anomalies are slight dysmorphic features representing subtle alterations in the development of various bodily structures in the mouth, eye, ear, head, hand, and feet areas. The aim of this study was to assess the frequency and the type of minor physical anomalies in patients with schizophrenia in a Tunisian population. One hundred adult patients (67 men, 33 women, mean age : 38 years (S.D = 10.6), mean age of onset : 24.1 years (S.D = 6.5), educational level : 8 years (S.D = 4.7)) and 143 comparison subjects (95 men, 48 women); mean age : 42.8 years (S.D = 16.6), educational level: 5.7 years (S.D = 4.7) were assessed by using Gourion's scale which consists of 41 minor physical anomalies. The total score in patients with schizophrenia (mean: 1.7, S.D = 1.34) was significantly high than in healthy subjects (mean : 1.2, S.D = 1.06). The cut-off score that optimally discriminated the patients from comparison subjects (maximizing sensitivity and specificity for schizophrenia) was two or more. A score of two or more classified 51% of the patients and 64.3% of the comparison subjects. A higher rate of minor physical anomalies was more specific and rare. Patients showed a higher rate for 20 anomalies, the differences reaching statistical significance for six of them : asymmetric ears (Patients: 5%, Controls: 0%), curved fifth finger (Patients: 7%, Controls: 0.7%), syndactily (Patients: 5%, Controls: 0%), gap between first and second toe (Patients: 12%, Controls : 2.1%), overlapping toes (Patients: 8%, Controls: 1.4%) and asymmetric feet (Patients: 7%, Controls: 0.7%). Nine anomalies were less frequent in patients and only one reached statistical significance : palate anomalies (Patients: 7%, Controls: 17.5%). Twelve anomalies were absent in both groups (large nose basis, facial asymmetry, ptosis, coloboma, low seated ears, furrowed tongue, cleft lip, abnormal palm creases, overlapping fingers, small fingernails, asymmetric hands and hyper-convex toenails). The total score was significantly correlated with the age of onset ( R = –0.21, P = 0.03) but not with illness severity (CGI score and number of hospital admissions / duration of illness). Reviewing results of similar studies in other populations, Tunisian patients with schizophrenia seem to have fewer minor physical anomalies. Only three significant frequent anomalies were concordant with results of one another study (curved fifth finger, syndactily and gap between 1 st and 2 nd toe). This large heterogeneity might be explained by ethnic variability. More studies are needed.