Malgré sa gravité, le trouble bipolaire demeure largement sous-estimé au profit des dépressions unipolaires et de la schizophrénie. En particulier, des facteurs culturels contribuent à modifier le profil épidémiologique et clinique du trouble et à induire des errances diagnostiques. C’est dans ce contexte que nous avons effectué une étude comparative entre deux groupes de 40 patients bipolaires vivant dans des environnements géographiques et culturels distincts (France et Tunisie) pour tenter d’identifier d’éventuelles différences symptomatiques ou évolutives. Les résultats retrouvent des différences significatives, en particulier une prédominance des épisodes maniaques aussi bien comme mode inaugural de la maladie que comme modalité évolutive dans ce pays du Sud. Par delà les biais méthodologiques, ces différences suggèrent l’influence de facteurs d’environnement tels les conditions climatiques de température et d’ensoleillement. Il est important à l’heure de la mondialisation que les thérapeutes soient sensibilisés à la dimension culturelle du trouble bipolaire afin d’offrir le bénéfice précoce des traitements spécifiques au plus grand nombre. Par ailleurs, la primauté de la manie dans les pays du Sud pourrait fournir une autre clé de compréhension et de traitement de la maladie bipolaire.

Bipolar disorders are one of the most potentially severe psychiatric disorders, implying a high degree of morbidity and incapacity for patients. Indeed, the World Health Organization in 1996 ranked them as the sixth most disabling condition worldwide. Major advances have been achieved in their understanding and management. However, too many patients do not yet benefit from them. As a matter of fact, bipolar disorders are still underestimated and under-recognized, being too often misdiagnosed with major depression or schizophrenia; the DSM-IV acknowledges the trend of clinicians to overdiagnose schizophrenia (rather than bipolar disorder), especially in ethnic groups and young people. Indeed, cultural factors may impact the symptomatology and the course of the disease. In particular, it has been shown by many authors that schizophrenia-like features are more likely to be found in southern countries. Similarly, the same authors have reported more manic than depressive episodes during the course of bipolar disorder.

We aimed at comparing individuals with bipolar disorder living in two distinct geographic and cultural environments, namely France and Tunisia.

Our study included two samples of 40 patients each, natives from the country, who were admitted during 2007 to the hospitals of Razi (Tunis, Tunisia) and Le Vinatier (Lyon, France) and suffering from a bipolar disorder according to the DSM-IV criteria. The French sample was constituted by all the patients meeting the inclusion criteria and the Tunisian one was selected by matching the patients by gender and duration of the disorder.

Our results were consistent with the existing literature, showing many similarities and some marked differences such as a greater rate of manic episodes in the onset and during the course of the illness as well. The main result was the type of the first episode: mania in three quarter cases in Tunisia and depressive in the same proportion in France. The same figures applied to the recurrences. Unipolar mania, in particular, was three times more common in Tunisia than in France.

Beyond the methodological biases (in-patients recruitment, diagnosis habits, cultural tolerance), these differences are also probably linked to climatic factors, such as temperature and photoperiod.

The early detection of bipolar disorder is of crucial importance to provide specific treatments to patients. In a world where psychiatrists are more and more exposed to meet patients from various backgrounds, it is necessary to be aware of culture-bound features. Besides, the primacy of mania, in southern countries, may be a key to deepen our understanding of bipolar disorder and consequently its management.