The impact of the COVID pandemic on the attitude and mental health of healthcare professionals working in COVID departments

Introduction

The COVID pandemic brought an overwhelming impact on hospital systems and personnel in the world.

Objectives

Our study aimed to examine the impact of the COVID pandemic on the attitude and mental health of healthcare professionals working in COVID departments.

Methods

We included 23 healthcare professionals working in the COVID departments of the Hospitals of Sfax. Sociodemographic data, medical history and COVID related details were collected from the participants. Their mental health was assessed by the Hospital anxiety and depression scale (HADS).

Results

In our sample, 26.1% were men and 73.9% were women, they were aged from 26 to 52. They worked for 57 hours per week, including 27.38 hours of direct contact with COVID positive patients and 5.43 nightshifts per month. A rate of 52.2% of the participants claimed having enough protection tools and 13% confirmed having enough equipment for patient management. 30.4% feared the lack of equipment and 39.1% considered themselves trained enough to manage COVID patients. As for the protective measures, 95.7% reduced contact with family members, 30.4% stopped visiting their parents, 8.7% left the family house and 4.3% didn’t take any particular measure. The mean HADS depression score was 9.61, and 60.86% had a Depression score equal or greater than 8, indicating depression. As for the HADS Anxiety score, its mean was 10.61 and 69.56% had a score equal or greater than 8, indicating anxiety.

Conclusions

The pandemic had a big impact on healthcare professionals working in COVID departments, as shows the relatively high depression and anxiety rate.

Disclosure

No significant relationships.

The impact of traumatic childhood events on functioning in patients with schizophrenia

Introduction

A history of adverse childhood experiences (ACEs) can increase the risk of schizophrenia spectrum disorders and might be related to unfavorable clinical and functional outcomes of psychosis

Objectives

To assess the relationship between the history of ACEs and functioning in stabilized patients with schizophrenia or schizoaffective disorder.

Methods

We conducted a cross-sectional, descriptive and analytical study. It was carried out on out patients with stabilized schizophrenia or schizoaffective disorder. The diagnosis of schizophrenia and schizoaffective disorder was established based on DSM-5 criteria. We used the ACEs scale to screen for traumatic events that occurred in the childhood and we used the Functional Assessment Staging Scale (FAST) to assess the patients’ ability to function and perform tasks of daily living

Results

Seventy five patients were included.The mean age was 39.81 ±9.96 years.The sex ratio was 4 .34. The mean score of ACE was 3.55 ± 2.41 and 88% of patients had experienced at least one traumatic event.The mean sore of the FAST scale was 33 ± 14.95.The total score of FAST was significantly higher in case of physical negligence in childhood (p=0.018). No correlation was found with the others ACEs.The FAST sub score of cognitive functioning correlated with the history of parents separation (p= 0.47) and physical negligence (p= 0.03). we also found that The FAST sub score of interpersonal relationships correlated with the history of emotional abuse (p=0.021)

Conclusions

Our data has shown that ACEs contribute to functioning impairment in schizophrenia and schizoaffective disorder.This impairment affects mainly the cognitive functioning and the interpersonal relationships

Disclosure

No significant relationships.

Evaluation of functioning among euthymic bipolar patients

Introduction

Numerous studies have documented high rates of functional impairment among bipolar disorder patients, even during phases of euthymia.

Objectives

To study different domains of functioning impairment in bipolar patients during euthymic phase.

Methods

A cross-sectional and descriptive study of 78 patients followed for bipolar disorder, during euthymia, at the psychiatric outpatient clinic at CHU Hédi Chaker in Sfax. We used a socio-demographic and clinical data sheet and the Functioning Assessment Short Test (FAST) to assess functionning : A functional impairment was retained for a total FAST score > 11.

Results

The average age was 36.27 years, the sex ratio was 5.5. Bipolar I disorder was diagnosed in 88.5% of patients. The mean age of onset was 27.73 years, and the mean duration of illness was 8.4 years. *The mean total score at the FAST was 22.23. *Functioning was altered on 69.2% of patients. *The occupational and the cognitive functioning were the two most altered domains in our population (respective mean scores : 8.69 and 5.74). *Autonomy was altered on 17.9% of patients. *Occupationnal functioning was altered on 76.9% of patients. *Cognitive functioning was altered on 70.5% of patients. *Financial issues were observed on 34.6% of patients. *Interpersonal relationships were altered on 41% of patients. *Leisure time difficulties were present with 24.4% of patients.

Conclusions

This work has focused on the very high frequency of functional handicap in euthymic bipolar patients. Thus, several measures must be put in place to prevent or mitigate the negative effects of the impaired functioning on these patients.

Disclosure

No significant relationships.

Resilience and perceived social support among family Caregivers of patients with mental illness : what links ?

Introduction

Burden among family caregivers of patients with mental illness can be mediated by resilience and perceived social support.

Objectives

The present study aimed to explore the relationship between perceived social support and resilience levels among caregivers of patients with mental illness and to identify its associated factors.

Methods

This was a cross-sectional, descriptive and analytical study conducted on caregivers of patients followed in the outpatient psychiatry department at the university hospital of Sfax (Tunisia), during septembre 2021. Resilience was assessed with the Connor–Davidson Resilience Scale and the social support with the social provisions scale. High scores indicate high resilience and support.

Results

We have involved 34 family caregivers with an average age of 47.47 years(SD=12.4 years). The mean resilience score of caregivers was 42.85 and the mean social support score was 28.09(SD=5.54). The score of resilience correlated positively with the score of social support among family caregivers of patients (r= 0.76 ; p=0.0001). Furthermore, resilience and social support were significantly lower among caregivers with a history of chronic illness (p=0.0001 and 0.002 respectively). Regarding clinical factors, the scores of social support and resilience decreased significantly with the duration of providing care to patients (r=-0.60; p=0.0001 and r=-0.75; p=0.0001 respectively). Similarly, they decreased significantly with the number of hospitalizations of patients (r=-0.53; p=0.001 and r=-0.62; p=0.0001 respectively).

Conclusions

The findings suggests that high social support promotes better resilience among family caregivers of patients with mental illness. So, a better adjustement to the role of caregiver can be effectively achieved by improving the perceived social support.

Disclosure

No significant relationships.

Quality of life of patients with schizophrenia

Introduction

Schizophrenia (SCZ) is considered one of the most disabling mental illnesses with significant family, social and occupational repercussions resulting in impaired quality of life (QOL).

Objectives

To assess the QOL of patients with SCZ or schizoaffective disorder (SAD) and to analyze the sociodemographic and clinical factors associated with its alteration.

Methods

This was a cross-sectional, descriptive and analytical study, which began in December 2019, conducted with 60 subjects followed for SCZ or SAD, at the psychiatry outpatient unit of the Hedi Chaker University Hospital in Sfax (Tunisia). General, clinical and therapeutic data were collected using a pre-established questionnaire. QOL was assessed with the «36 item Short-Form Health Survey» (SF-36).

Results

Patients enrolled had SCZ in 78.2% and SAD in 21.8% of cases. The mean age was 47.2 years and the sex ratio M/F was 4.5. They were single in 63.7% of cases and unemployed in 61.8%. Psychiatric family history, the presence of personal somatic illnesses and tobacco use were found in 43.6%, 61.8% and 67.3% of cases, respectively. The average QOL score was 57.7, the average physical health score was 61.1, and the average mental health score was 54.3. Female sex (p=0.02), being single (p=0.039), lack of work activity (p=0.00), tobacco use (p=0.05), and presence of medical history (p=0.034) were statistically correlated with impaired QOL.

Conclusions

QOL in SCZ and SAD is impaired. This result encourages us to conceive of the patient in his whole life and not only from the point of view of the disease.

Disclosure

No significant relationships.

Gambling disorder risk factors in a population of online sports betting players in Sfax

Introduction

Online sports betting (OSB) is frequently associated with gambling disorder (GD). In Tunisia, no study on this has been done so far.

Objectives

To detect GD in a population of Tunisian OSB players, and to identify its risk factors.

Methods

This was a cross-sectional study of 58 male OSB players in the city of Sfax. The GD was assessed by a questionnaire relating to the DSM-V criteria. Depression, anxiety and stress were assessed using the DASS scale, gambling motivations using the GMQ-F scale, and impulsivity using the UPPS-P scale.

Results

The mean age was 37.4 ± 8.29 years. The prevalence of JAP was 53.4%. On univariate analysis, the factors associated with GD were university level of education, the practice of other gambling, daily gambling, gambling spending > 300 Dinars / month , gambling duration > 3 years, the frequency of winning >1 win /6months , the occurrence of a Big Win, total GMQ-F score, coping motivation , and financial motivation. In the multivariate study, GD risk factors were gambling spending > 300 Dinars / month (p = 0.011; ORa = 223.16), financial motivation (p = 0.022; ORa = 3.967), pathological stress (p = 0.036; ORa = 224.388) and inversely associated with the age at onset of gambling (p = 0.026; ORa = 0.751) and the UPPS score (p = 0.011; ORa = 0.6).

Conclusions

Our results push us to deepen our knowledge and our studies concerning this problem in our country and to reflect on the management and prevention measures.

Disclosure

No significant relationships.

Identification of violence in the hospital environment: perceptions of nurses

Introduction

Violence is recognised by the WHO as a major and ubiquitous public health problem, that is constantly worsening.

Objectives

The aim of our work was to estimate the frequency of aggressions against nurses in psychiatric and emergency departments, and to identify the factors associated with it.

Methods

This was a cross-sectional, descriptive and analytical study. It took place between January and March 2021, at both hospitals of Sfax (Tunisia).This study targeted 60 nurses in the psychiatry and emergency services.

Results

The sample comprises 35 nurses (58%) from psychiatric services and 25 nurses (42%) from emergency services, mainly females (51%) and with average age of 35 years.(+/-9). The nurses interviewed were exposed to violence quite often, in 93% of cases. Almost all nurses (90 %) experienced verbal violence, 70 % experienced physical violence and more than half (62 %) experienced psychological violence. Nearly 11% of nurses reported a sexual violence. Factors that explain or contribute to violence mentioned by the participants were as follows; The Verbal violence was significantly correlated with poor reception conditions (p=0.013). The Sexual violence was significantly correlated with young age of nurse (p=0.005). As for psychological violence, it was significantly correlated with work overload (p=0.004), a poor caregiver-patient relationship (p=0.02) and poor patient care (p=0.04).

Conclusions

Our study showed that violence against nurses was frequent in psychiatric and emergency departments. Various factors could modulate their occurrence such as training and improvement of the working conditions.

Disclosure

No significant relationships.

Prevalence of vaccination against the Covid19 within mentally ill population and acceptance and hesitancy factors

Introduction

Vaccines are effective interventions that can reduce the high burden of COVID19 globally. However, public vaccine hesitancy is a pressing problem for public health authorities.

Objectives

This study aimed to assess the prevalence of vaccination within mentally ill population and to point out the factors of acceptance and reticence.

Methods

We conducted a cross-sectional, descriptive and analytical study. It was carried out on a clinical population who consult in the psychiatry department in Sfax’s university hospital Hedi Chaker. Patients included in our study were aged between 21 and 69 years and were not in a decompensation phase of their psychiatric illness

Results

Forty five patients were included. The mean age was 45±13 years old. Our population was made up of 3 women (6.7%) and 42 men (93.3%).A rate of 42.2% of the patients was of urban origin, 15.6% lived with a partner, 77.8% were unemployed and 46.7% were schizophrenic. In our study population, five patients had COVID 19 (11.1%), fourteen patients (31.1%) were vaccinated and eight patients (17.8%) asked their psychiatrist to vaccine. The main reasons of vaccination were their belief that vaccination decreases the chance of contracting COVID 19 and its complications (0.00) ,that COVID is lethal (0.002), and the fact that they trust it (0.001). Thirtyone patients (68.9%) refused vaccination, mainly due to reading or hearing negative information about vaccination (0.025). Vaccination wasn’t correlated neither to the fact that it could be a conspiracy nor to the diagnostic.

Conclusions

Our study reveals that one third of mentally ill patients are vaccinated. The reasons of acceptance of vaccination are multiple in opposite of the hesitancy factors

Disclosure

No significant relationships.

Resilience in Family caregivers of Tunisian patients with psychiatric disorders

Introduction

Resilience has been described as an individual’s ability to adjust or adapt to significant adverse or traumatic circumstances.

Objectives

The aims of this study were to assess the resilience of caregivers of patients with mental disorders and to identify its associated factors.

Methods

We conducted a descriptive and analytical cross-sectional study among caregivers of patients followed in the outpatient psychiatry department at the university hospital of Sfax(Tunisia), during septembre 2021. Resilience was assessed using Connor–Davidson Resilience Scale(CD‑RISC).The total scores range from zero to 100. The cut-off scores for this questionnaire is 50, with higher score indicating higher resilience.

Results

Our sample included 34 family caregivers. The mean age was 47.47 years (SD=12.4 years)and the sex ratio (M/F) was 1.42. They were the parents of patients in 35.3% of cases. The mean duration of providing care to patients was 8.62 years. The mean resilience score of caregivers was 42.85 and 26.5% of them were resilients. The Caregivers with low socioeconomic level (p=0.004), a history of chronic illness (p=0.0001), a long duration of providing care (p=0.001), a stressful events (0.002) and those victims of agressive behaviors committed by patients (p=0.0001) were more likely to have a low resilience score.

Conclusions

Our results stated that three out four cargivers have low level of resilience. Interventions targeting stress related to social events and burden of care, and violence committed by patients in their family environment should be integrated to increase the caregivers’resilience.

Disclosure

No significant relationships.

Working memory performance in euthymic bipolar patients

Introduction

Working memory (WM) deficit in bipolar disorder (BD) is heterogeneous and seems to be affected by both, demographic and clinical aspects, of the patient.

Objectives

To assess the WM performance in euthymic bipolar patients (BP) comparing to healthy controls (HC) and to identify demographic and clinical factors associated with it.

Methods

A case-control study was conducted among euthymic bipolar patients according to DSM-5. The recruitment of patients was performed in the outpatient psychiatric unit in the university hospital Hedi Chaker in Sfax during the period from January to December 2020. The HC were matched to BP on gender, age and education level. The Screening for Cognitive Impairment in Psychiatry scale (SCIP) was used to assess the WM performance by the WM test (WMT).

Results

We recruited 61 BP (37 males and 24 females) and 40 HC (20 males and 20 females). The average age of BP was 41.75 years (SD=11.6 years). The BD group included 47 BD type I and 14 BD type II patients. The mean duration of illness was 9.75 years (SD=7.93 years). Thirty-seven BP (60.7%) had a history of psychotic symptoms. The WMT score was significantly lower among BP than HC (p<0,001). The female gender, the type II of BD and the history of psychotic symptoms correlated with a poorer performance on WMT (p=0.019; 0.017 and 0.002, respectively).

Conclusions

BP have shown significant impaired performance in WM even during euthymia. Female gender of patient, type II of BD and psychotic symptoms seem to be the predictors of this impairment.

Disclosure

No significant relationships.

The impact of gaming addiction on Health-Related Quality of Life in adults

Introduction

Although gaming addiction has received a great deal of attention from researchers, few studies have evaluated its effect on health related quality of life in adults

Objectives

To study the relationship between gaming addiction and perceived health status

Methods

We conducted a cross-sectional, descriptive and analytical study.Data were collected using a self-administered questionnaire on social networks targeting adults between 18 and 40 years. We used the gaming addiction scale (GAS) in its validated Arabic short version. we also used the 36-Item Short Form Health Survey questionnaire (SF-36) in its validated Arabic version

Results

One hundred and nine participants were included. The mean age was 29.6 ±10.3. Males accounted for 60.6% of the study population. A history of anxiety or depression was found in 4.6 % of participants and 3.6% had an organic affection .The mean GAS score was 13.11± 6.08. According to this scale, 25.7% were addicted gamers. We found a significant difference between the group of participants considered addicts and those who were not in the following items: vitality (p=0.002), mental health (p=0.004) and role limitation due to emotional health (p=0.05). We found a correlation between the GAS score and role limitation due to physical problems ( p= 0.41), role limitations due to emotional problems (p=0.004 ), vitality( p=0.005) and mental health ( p= 0.001).

Conclusions

Our data showed significantly lower health related quality of life related to higher exposure to games especially in the psychological health.In future researches, the effect of gaming addiction on other domains of quality of life can be investigated

Disclosure

No significant relationships.

The psychological impact of the COVID-19 pandemic on secondary school teachers in Sfax, Tunisia : anxiety disorders

Introduction

During the COVID-19 pandemic time, teachers have to adapt to many changes that could potentially make them more vulnerable to psychological distress.

Objectives

To determine the prevalence and the factors for anxiety during the COVID-19 epidemic among the high school teachers in Sfax, Tunisia.

Methods

This was a cross-sectional study, for descriptive and analytical purposes, conducted on google drive in May 2021.We involved 97 junior and secondary school teachers from Sfax, Tunisia, practicing in public high schools. Anxiety was assessed by using Generalized Anxiety Disorder tool (GAD-7).

Results

The average age of the participants was 44.23 years old with a sex-ratio (M/F) of 0.32. Since the advent of COVID-19, 54.2% had presented sleep disturbances while 10.4% had suicidal thoughts. Among all participants, 77.8% were afraid of the virus transmission within the classroom or the school and 81.3% reported regular mask wear at work. The median score on the GAD-7 was 6.5 (Q1=3, Q3=11). Scores’ distribution indicated that 68% of the participants had no to mild symptoms of anxiety while 32% had moderate to severe anxiety. Furthermore, the presence of anxiety was associated to the female gender (p=0.01), sleep disturbances (p<0.001), suicidal thoughts (p=0.006), and to the conviction that wearing masks blocks the transmission of voice, information or emotions between teacher and student (p=0.025).

Conclusions

During the COVID-19 outbreak, high school teachers in Sfax, Tunisia have high levels of anxiety.This can lead to a decreased effectiveness of their complex work.

Disclosure

No significant relationships.

Post-traumatic stress symptoms and professional quality of life among healthcare professionals working in COVID departments

Introduction

The COVID pandemic had a heavy impact on the mental health of people in general and healthcare professionals in particular.

Objectives

Our study aimed to examine the the prevalence of post-traumatic stress symptoms among healthcare professionals working in COVID departments, and assess their professional quality of life.

Methods

Our sample consisted of 23 healthcare professionals who are working in the COVID departments of the Hospitals of Sfax. We collected their sociodemographic data, their medical history and COVID-related details. Their mental health was assessed by the Impact of Event scale (IES-R) and the professional quality of life scale (ProQOL-5)

Results

The sex ratio in our study was 17:6, with a mean age of 31.79 years. They carried out 5.43 nightshifts per month, 57 hours of work per week including 27.38 hours of direct contact with COVID positive patients. A rate of 21.74% of the patients had a high IES-R score, indicating severe post traumatic stress symptoms. As for the subscales of the professional quality of life score, 21.73% of the participants had a low compassion satisfaction score, 65.21% of the participants had a moderate one and 13% had a high one. A rate of 91.3% of the participants had a moderate burnout score, the mean was 29.39. The secondary traumatization score was low in 26% of the cases, moderate in 60.86%, high in 13% and the mean was 27.91.

Conclusions

COVID healthcare professionals are at a relatively high risk of developing burnout and post-traumatic stress symptoms.

Disclosure

No significant relationships.

The use of technologies and social media in patients with schizophrenia and schizoaffective disorder

Introduction

Technologies such as the phone , the computer , and social media network nowadays are becoming more and more available to everyone including patients with mental illnesses.

Objectives

Our study aimed to examine the prevalence of technology use in individuals with schizophrenia and schizoaffective disorder.

Methods

Study participants were recruited from the outpatient unit of the department C of psychiatry in Hedi Chaker hospital of Sfax , Tunisia. A total of 38 male patients were recruited , from whom the diagnosis of schizophrenia or schizoaffective disorder according to the DSM-5 criteria had been confirmed. Socio-demographic and clinical information as well as details about their technology use were was collected from all the patients.

Results

Of the 38 study participants, 65.8% owned a cell phone , and 52.6% used the cell phone to send or receive messages. A rate of 21.1% owned a computer , 34.2% had internet access and 28.9% had an email account. A rate of 23.7% used social media. Facebook was the most popular social media site. 72% of cell phone owners would like to communicate with their doctor via text messages , and 68% would like to be reminded of their appointments via text messages. Among social media users , 55.6% expressed their interest in a social-media-based doctor-patient communication and appointment reminders.

Conclusions

Our findings suggest that these technologies afford an opportunity to improve the management of these patients.

Disclosure

No significant relationships.

Do people with bipolar disorder have a lack of empathy?

Introduction

Impairments of empathy have been observed in patients with various psychiatric Disorders. Yet, little research on empathy concerning mood disorders exists.

Objectives

To compare empathy levels in euthymic bipolar patients (BP) and healthy controls (HC).

Methods

A cross-sectional and comparative study of 78 patients followed for bipolar disorder, during euthymia, at the psychiatric outpatient clinic at CHU Hédi Chaker in Sfax, and 78 age-gender matched HC. We used a socio-demographic and clinical data sheet and the Questionnaire of Cognitive And Affective Empathy (QCAE) to assess empathy with its two dimensions : “Affective empathy” and “Cognitive empathy”.

Results

The average age was 36.27 years, the sex ratio was 5.5. Bipolar I disorder was diagnosed in 88.5% of patients. The mean age of onset was 27.73 years, and the mean duration of illness was 8.4 years. Total scores of empathy as well as scores of cognitive and affective empathy were higher in HC than in BP. *Total QCAE BP vs HC : 72.49 vs 80.53 *Cognitive empathy BP vs HC : 43.21 vs 94.24 *Affective empathy BP vs HC : 29.36 vs 30.44 A significant difference in QCAE score and cognitive empathy score between BP and HC was found (p<10-3).

Conclusions

In our study, euthymic BP have been less empathetic than HC. Research on the subject are small and few. Thus, more studies are needed to confirm our results on the effect of mood disorders on empathy.

Disclosure

No significant relationships.

Clinical determinants of social media use in patients with schizophrenia and schizo-affective disorder

Introduction

Social media networks are becoming omnipresent in our lives, and more and more available to everyone including patients with mental illnesses.

Objectives

Our study aimed to examine the prevalence of social media use in individuals with schizophrenia and schizoaffective disorder, and to examine the association of severity of symptoms with social media use.

Methods

A total of 38 patients with schizophrenia or schizoaffective disorder were recruited from the outpatient unit of the department C of psychiatry in Hedi Chaker hospital of Sfax, Tunisia. Socio-demographic information as well as details about their social media use were collected from all the patients. Severity of schizophrenia symptoms was assessed on the Positive and Negative Syndrome Scale (PANSS). A logistic regression was used to explore the association between social media use and clinical characteristics of the participants.

Results

Of the 38 study participants, 23.7% used social media. Facebook was the most popular social media site. The number of social media users were highest among participants aged 21–30 years old, married participants, residents of an urban region, employed participants and patients with a tertiary education level. Age and PANSS negative score were significantly and negatively associated with social media use.

Conclusions

Less than one fourth of patients with schizophrenia and schizoaffective disorder use social media and may be suitable candidates for treatment programs supported by social media platforms , especially those of a young age and a low severity of negative symptoms .

Disclosure

No significant relationships.

Evaluation of empathy among euthymic bipolar patients

Introduction

Bipolar disorder (BD) is a mental illness marked by extreme swings in the mood, energy, and thinking. Although it’s not an official symptom of the disease, some research suggests that it also may affect the empathy.

Objectives

To investigate empathic responding in patients with BD in euthymic state of illness and to determine associated factors.

Methods

A cross-sectional and descriptive study of 78 patients followed for bipolar disorder, during euthymia, at the psychiatric outpatient clinic at CHU Hédi Chaker in Sfax. We used a socio-demographic and clinical data sheet and the Questionnaire of Cognitive And Affective Empathy (QCAE) to assess empathy with its two dimensions : “Affective empathy” and “Cognitive empathy”.

Results

The average age was 36.27 years, the sex ratio was 5.5. Bipolar I disorder was diagnosed in 88.5% of patients. The mean age of onset was 27.73 years, and the mean duration of illness was 8.4 years. 78.2% of patients had a good adherence to treatment. 60.3% of them had residual depressive symptoms during eutymia. QCAE total score was 72.49. (Maximum possible score 124) Cognitive empathy score was 43.21. (Maximum possible score 76) Affective empathy score was 29.36. (Maximum possible score 48) Affective empathy was associated with female gender (p=0), good adherence to treatment (p=0.01) and residual depressive symptoms (p=0.001).

Conclusions

Our study shows that bipolar patients have fairly good levels of empathy. However, in order to better substantiate empathy in BD, comparative studies seem necessary.

Disclosure

No significant relationships.

Perception of addictions and religiosity in medical students

Introduction

Religiosity is among the factors that determine the doctor’s relationship with his addict patient and the empathy he should have.

Objectives

To verify whether future doctors are aware of the addictogenic power of certain substances and certain behaviors and to study their perception of different addictions according to religiosity.

Methods

This was a cross-sectional study with interns and externs of the Sfax medical faculty, in November 2016, via an anonymous questionnaire.

Results

141 students were included and 98,6% declared to be believers. The average age was 23 years. The sex ratio was 0.38. Alcoholism was the addiction most considered as a sin (87.9%), smoking 51.8%, hookah 45.4%, cannabis 78%, gambling 77.3%, internet addiction 16.3%, video game addiction 15.6%, work addiction 8.5%, and exercise addiction 5.7%. Female gender was more often correlated with perceived alcoholism, cannabis addiction, and gambling as sins (p = 0.002; p <0.001 and p = 0.043, respectively). Gambling was significantly more condemned by the participants who fasted (p <0.001). Prayer was significantly correlated with religious disapproval of addictions to tobacco, hookah, alcohol, cannabis and gambling (respectively p <0.001, p = 0.001, p <0.001 , p <0.001, p <0.001). Smoking, hookah and alcohol were significantly more perceived as sins by veiled women (respectively p = 0.011, p = 0.002, p = 0.040).

Conclusions

According to our study, most medical students have a religiously hostile attitude to many addictions. Improving medical training in addictology would allow them to adopt the necessary empathic attitude, without being judgmental.

Disclosure

No significant relationships.

Factors related to Gaming addiction in adults

Introduction

With the advancement of technology over the last years, gaming is no longer reserved to adolescents. It has become a growing phenomenon within young adults which should,’t be overlooked as it is accompanied with the risk of addiction.

Objectives

To study the factors involved in video games addiction behaviors in adults

Methods

We conducted a cross-sectional, descriptive and analytical study. Data were collected using a self-administered questionnaire on social networks. We solicited adults between 18–40 years. We used the gaming addiction scale (GAS) in its validated Arabic short version.

Results

A hundred and nine participants were included. The mean age was 29.6 ±10.3 with a sex ratio of 1.5.The mean age of the beginning of regular gaming was 16.3± 8.64. we found that40.4% of our participants preferred the mode Massively Multiplayer Online Role Playing Games (MMORPG) while others played casual single player games. A play time of over 20 hours per week was reported by 11.9%of participants. According to the GAS, 25.7%were addicted gamers. Our participants spent an average of 7.94±6.71 hours before they play their first game of the day. We found that the score of Gas was significantly correlated to the male gender of the participants (p<0.000), a higher number of weekly gaming hours (p<0.000),a lower number of hours before gaming (P<0.000) and the mode of games (p<0.000).

Conclusions

Our study showed that contextual factors play an important role in understanding gaming addiction in young adults as a holistic phenomenon,embedding the problematic behavior within the context of the individual the game and gaming practices.

Disclosure

No significant relationships.

Depressive disorders among Tunisian high school teachers in the face of COVID-19

Introduction

The constraints linked to COVID-19 may reduce resilience and intensify depressive feelings especially in vulnerable populations such as teachers.

Objectives

To understand the psychological distress in terms of depression of the COVID-19 pandemic among secondary school teachers in Sfax, Tunisia and to determine the correlated factors.

Methods

This was a descriptive and analytical cross-sectional study of 97 medium and high school teachers from Sfax, Tunisia. The study was conducted on google drive in May 2021, including an information sheet and the Patient Health Questionnaire (PHQ)-9 to assess depression.

Results

In our study, the sex-ratio (M/F) was 0.32 and the average age was 44.23 years old. The median professional seniority was 16 years (minimum=1, maximum=37). Suicidal thoughts were described by 10.4% of teachers while 54.2% reported the presence of sleep disturbances since the onset of the pandemic. The median PHQ-9 score was 8 (Q1=4, Q3=15). The distribution of scores indicated that 59.7% of participants had no to mild symptoms of depression while 40.3% had moderate to severe depression. Furthermore, the presence of depression was associated with an age ≤ 40 years old (p=0.037), a professional seniority ≤ 20 years (p=0.035), the female gender (p=0.005), the presence of sleep disturbances (p<0.001) as well as with suicidal thoughts (p=0.006).

Conclusions

It seems that COVID-19 health situation in education have led to the emergence of a teacher overexertion and a depth adaptation to the new environment demands. Thus, clinical attention to the depression level of the teachers is certainly warranted.

Disclosure

No significant relationships.

Sexual dysfunction and quality of life among Tunisian patients with schizophrenia

Introduction

Sexual dysfunction (SD) is prevalent among psychiatric patients than general population.

Objectives

To assess the SD and quality of life (QOL) of patients with schizophrenia, and to identify the factors associated with it.

Methods

This was a cross-sectional, descriptive and analytical study, which began in December 2019, conducted with 60 subjects followed for SCZ or SAD, at the psychiatry outpatient unit of the Hédi Chaker University Hospital in Sfax (Tunisia). General, clinical and therapeutic data were collected using a pre-established questionnaire. The Arizona Sexual Experiences Scale (ASEX) and the 36 item Short-Form Health Survey (SF-36) were used to evaluate subjective sexual dysfunction and QOL respectively.

Results

Patients enrolled had SCZ in 78.2% and SAD in 21.8% of cases. The mean age was 47.2 years. Psychiatric family history, the presence of personal somatic illnesses and tobacco use were found in 43.6%, 61.8% and 67.3% of cases, respectively. The average score of ASEX was 18.21. QOL was altered in 73.3% of participants with an SGM of 53.29. The psychic component was more altered than the physical one with average scores estimated respectively at 48 and 58.44. Participants with SD were more likely to have tobacco consumption (p= 0.025), history of suicide attempt (p=0.023) and they are treated by a combination of several treatments (p=0.025). Impaired QOL was not statistically correlated with SD (p=0.5)

Conclusions

The physicians should pay attention to SD during the assessment and treatment of patients with schizophrenia.

Disclosure

No significant relationships.

Assessement of burnout among high school teachers during the COVID-19 pandemic in Sfax, Tunisia

Introduction

Facing educational difficulties related to COVID-19, some teachers can no longer adapt, making them potential candidates for burnout.

Objectives

We aimed to assess burnout among high school teachers during the COVID-19 pandemic and to determine its prevalence and factors associated with it.

Methods

We conducted a cross-sectional, descriptive and analytical study, carried out on google drive in May 2021, and relating to 97 Tunisian junior and secondary school teachers from the Sfax region. Burnout was evaluated by the Burnout Measure Short version (BMS-10).

Results

The sex-ratio (M/F) of our population was 0.32 and the average age was 44.23 ± 7.81 years old. The labor load was low, medium and high in respectively 1.4%, 57.6% and 41% of cases. Almost a third of participants (30.6%) reported a low satisfaction with working conditions. The average BMS score was 40.19 ± 13.98. According to the BMS scores, 36.1% of teachers had a very low to a low degree of burnout, 23.6% had burnout while 40.3% had a high to very high degree of exposure to burnout. Furthermore, the BMS score was associated with the female gender (p=0.002), sleep disturbances (p<0.001), suicidal thoughts (p<0.001) and with a medium to a high labor load (p=0.045).

Conclusions

In this study, Tunisian high school teachers in times of COVID-19 reported a high burnout rate. Thus, the protection of this vulnerable population must be an important component of public health measures.

Disclosure

No significant relationships.

Association Between Workplace Bullying Occurrence and post-traumatic stress disorder Among Healthcare Professionals in Tunisia

Introduction

Nurses may be particularly at risk of violence exposure at work which can cause psychological trauma and even develop post-traumatic stress disorder (PTSD), which is a serious mental health disorder.

Objectives

The aim of this study was to determine the prevalence of PTSD among nurses in psychiatry and emergency departments and to identify the factors associated with it.

Methods

This was a cross-sectional, descriptive and analytical study. It concerned 60 nurses working in the psychiatry (35 nurses) and emergency (25 nurses) departments of the Hedi Chaker and Habib Borguiba University Hospital in Sfax. The screening of PTSD was carried out by the « post-traumatic stress evaluation questionnaire » (PTSQ).

Results

Direct trauma exposure was reported by 93% of participants, of which 48.3% experienced the act of violence more than 4 times. According to the PTSQ, 48.3% of the nurses had PTSD with a mean score of 50.93. Hyper-arousal was the most frequently observed outcome in victims (85%), followed by re-experience (83%) and avoidance (80%) symptoms. The presence of PTSD was correlated with female gender (p=0.002), the young age of the nurse (p=0.04), and the absence of peri-traumatic reactions (p=0.001).

Conclusions

Our study shows that PTSD is a pathology frequently encountered in psychiatric and emergency nurses. Hence the need to put in place strategies against violence in hospitals and to apply them rigorously in order to better manage this phenomenon and manage its repercussions on health workers .

Disclosure

No significant relationships.

The effects of Workplace violence on healthcare workers in Tunisia

Introduction

Exposure to violence affects employees and has implications for the quality of care provided.

Objectives

This study aims to describe the effects of workplace violence on nurses in psychiatric and emergency departments.

Methods

This was a cross-sectional and descriptive study involving 60 nurses practising in the psychiatry and emergency services at the Hedi Chaker and Habib Borguiba University Hospital in Sfax. We collected the socio-demographic and professional data of the participants using a pre-established questionnaire.

Results

The average age was 35 years and 51 % of respondents were female. Ninety-three percent of the respondents were victims of an act of violence. The violence was verbal in 90%, physical in 70%, psychological in 62% and sexual in 11% of cases. The classification of acts of violence according to the scale of seriousness of the national observatory of violence in health care revealed a predominance of level 1 violence characterised by insults (66%) and level 2 violence with threats to physical integrity (65%). Level 3 violence (physical violence) was the most frequent (70%). Two cases of level 4 violence with knives were reported. These acts of violence generated wounds in 21%, fractures in 10%, haematomas in 10% and bruises in 8% of cases. Thirty-six nurses (60%) reported that the act of violence was responsible for a feeling of insecurity.

Conclusions

The results of this study indicate the need for hospital center managers to set up organizational policies against workplace violence and to apply them in a rigorous and transparent manner.

Disclosure

No significant relationships.

The relationship between sleep problems and gaming addiction in adults

Introduction

Prolonged exposure to Video games may have several negative cognitive and emotional consequences.However, a few investigations have explored the effects of video games addiction on sleep.

Objectives

To study the effects of gaming addiction on sleep patterns in young adults

Methods

We conducted a cross-sectional, descriptive and analytical study.Data were collected using a self-administered questionnaire on social networks targeting young adults between 18–40 years. We used the gaming addiction scale (GAS) in its validated Arabic short version. We also used the validated Arabic version of the Pittsburgh Sleep Quality Index (PSQI) to assess the sleep quality of our participants.

Results

One hundred and nine participants were included. The mean age was 29.6 ± 10.3. Males accounted for 60.6% of the study population. The mean Gas score was 13.11± 6.08.According to the GAS,25.7% were addicted gamers. The mean PSQI score was 7.25± 3.15. A poor sleep quality pattern (score > 6) was found in 59.6% of the participants. We found that the GAS score was significantly correlated to the total score of PSQI( P=0.003). We also found that the group with poor sleep quality had higher GAS scores (p= 0.014). We found a correlation between the GAS score and the following components of the PSQI: subjective sleep quality ( p= 0.01), sleep disturbances (p=0.024) and the use of sleep-promoting medication ( p=0.046)

Conclusions

Our study showed that video gaming behavior had a significant effect on sleep quality. This can have negative consequences on life quality, together with an impaired performance at awakening.

Disclosure

No significant relationships.

[Post-traumatic stress disorder, depression and anxiety in parents of children with epilepsy]

INTRODUCTION

Post-traumatic Stress Disorder (PTSD), depression and anxiety are the most common psychiatric consequences among parents of children with epilepsy.

OBJECTIVES

We aimed to investigate the prevalence and predictors of PTSD, depression and anxiety in a sample of parents of children with epilepsy.

METHODS

A survey of 135 parents of children with epilepsy, treated in the pediatric neurology department at the Sfax Teaching Hospital in Tunisia, was conducted in the last quarter of 2019. The PTSD Checklist for DSM-5 and the Hospital Anxiety and Depression Scale (HADS) were used to assess, respectively, PTSD, depression and anxiety in parents. Associations with clinical and demographic variables with PTSD, depression and anxiety were evaluated in a logistic regression model.

RESULTS

Results revealed PTSD rates of 20.7%, depression rates of 28.9% and anxiety rates of 55.6%. The main factors associated with PTSD on multivariable analysis were female gender (P=0.026, ORa=13.1), insufficient involvement of partner in disease management (P<10^-3, ORa=12.1) and duration of epilepsy less than 12 months (P=0.001; ORa=0.1). Female gender (P=0.006, ORa=18.1) and restriction of social life (P=0.006, ORa=4.1) were associated with depression. Factors associated with anxiety were insufficient involvement of partner in disease management (P=0.03, ORa=4.6) and PTSD (P=0.005, ORa=9.1).

CONCLUSION

These findings suggest that clinicians should pay more attention to psychological health of parents of children with epilepsy and help healthcare providers to develop preventive and intervention strategies for parents of such children.

[Metacognitive deficit in schizophrenia: Characteristics and links]

OBJECTIVES

Research indicates that many patients with schizophrenia experience deficits in metacognitive capacity defined as the ability to form complex representations of themselves and others. The aim of the current study was to assess metacognitive deficit in patients with schizophrenia. These variables were collected together with many other sociodemographic, clinical and therapeutic data.

METHODS

We conducted a descriptive and analytical cross-sectional study in the psychiatry department at the Hedi Chaker University Hospital in Sfax (Tunisia). Patients were in a non-acute phase, defined by the absence of any psychiatric symptoms during the last four weeks, also, no changes in medication during the previous month had been required. An informed written consent was obtained, following which patients completed questionnaires assessing sociodemographic and clinical data during structured interviews. Symptoms and severity of the illness were assessed using the Positive and Negative Symptoms Scale (PANSS). Insight was assessed using the Insight Scale (Q8). In addition, the Metacognition Assessment Scale-Abbreviated (MAS-A) was used to assess metacognitive capacities. The MAS-A contains four dimensions: self-reflectivity, awareness of the mind of others, decentration, and mastery. Higher scores reflect an ability to effectively respond to psychological challenges on the basis of psychological knowledge.

RESULTS

We recruited 74 adults with schizophrenia disorder. The diagnosis was with DSM5. Their average age was 45 years (SD=9.84 years) with a sex ratio (M/F) of 1.552. Nineteen patients (25.5%) were married, and low educational level was present in 43% of cases. Forty patients (54%) were unemployed. Metacognitive deficit was detected in all the patients. They had low levels in all four dimensions of metacognition. The most affected dimension in our series was "Mastery". All patients had an overall insight score less than six (the average score was 2.73) with poor awareness in 62% of patients. The main factors correlated with metacognitive deficit were: occupational inactivity (P-0.015), Primary education level (P=0.045), tobacco consumption (P=0.002), low insight (P-0.001), negative symptomatology (P<10-3) and the use of first generation of antipsychotics (P=0.003). The multivariate analysis showed that three factors (occupational inactivity, low insight and the presence of negative symptomatology) were predictors of metacognitive deficits.

CONCLUSION

Based on our results, occupational inactivity, negative symptomatology and low insight are predictors of metacognitive deficit in schizophrenia. Specific therapeutics should be proposed to act on these factors. A metacognitive training program, tailored to this vulnerable population, is a priority to improve their quality of life.

Chronic inflammatory bowel diseases and sexuality: Inevitable disorders?

Introduction

Improving the quality of sexual life of patients has become a major therapeutic objective in the management of Chronic Inflammatory Bowel Diseases (CIBD).

Objectives

To assess the prevalence of sexual dysfunction (SD) in patients with CIBD in remission and compare it to healthy controls (HC), and to determine the associated factors

Methods

This was a cross-sectional study, conducted over 8 months, involving 36 patients with CIBD, who attended the gastroenterology outpatient of Hedi Chaker University Hospital in Sfax (Tunisia). They were compared to 36 HC. Sexual function was assessed with the “Female sexual Function Index” and the “International Index of Erectile Function”.

Results

In the sample of CIBD, the prevalence of SD was 65.4% in women and 50% in men. Compared to controls, patients with male gender had significantly more impaired erection and orgasm (p=0.005; p=0.002 respectively), and those with female gender had significantly more impaired sexual arousal and desire (p=0.003; p=0.028 respectively). In the sample of patients, having a poor marital harmony and a fewer sexual attraction towards partner were correlated with decreased desire (p=0.017) in men and with sexual arousal (p=0.024) and decreased desire (p=0.048) in women. The number of relapses negatively affects erection (p=0.038) and orgasm (p=0.048). Depression correlated with a decreased orgasm (p=0.001) and desire (p=0.048) in men, and with a decreased sexual arousal (p=0.006) in women.

Conclusions

SD is common in CIBD, hence the need for a multidisciplinary approach to allow improvement of the quality of life of these patients, and of their partners.

Attitudes of relatives of patients with schizophrenia

Introduction

Investigating family member’s attitudesabout schizophrenia is an important step in its management. They likely influence the family’s help-seeking decisions and affect both adherence with biomedical interventionsand social integration of the patients.

Objectives

Describe families’ beliefs about the symptoms and the treatments of schizophrenia.

Methods

We led a transversal study including 32 relatives of patients with schizophrenia (DSM 5). We collected data for both patients andrelatives. We asked relatives to respond by “yes/no/I am not certain” to the questionnaireincluding items dealing with symptoms and optimal cures forschizophrenia.

Results

The mean age of the relatives was 60.8 years; 71.9% were parents; 37.5% were illiterate; 46.9% reported having another family member with a mental disorder (MD) and 15.5% of relatives were able to label the term “schizophrenia”. Nine participants (28%) believed that the patient makes shame to the family’s member and 72% of them was convinced that patient is dangerous.The majority of participants (90.6%) provedthe need for drugs and 65.6% attested the utility of psychotherapies.However, they believed innon-medical practices such as reading Holy Koran verses (87.5%), charity and exorcism (62.5%). Family history of MD was correlated to traditional practices (p=0.038). The belief that patient is dangerous and that he makes shame were associated with advanced age of relatives (p=0.000 and 0.037 respectively). Significant correlationwas found betweennon medical practices and erratic follow-up (p=0.043).

Conclusions

This study points outthe need to improve the psychoeducation of family members of persons with schizophrenia.

Gaming addiction among Tunisian adolescent

Introduction

Gaming is a source of addiction for adolescents. It is recognized as a behavioral and mental health condition, both by the American Psychiatric Association and by the World Health Organization.

Objectives

To determine the prevalence of gaming addiction among secondary school students.

Methods

This cross-sectional study was conducted between September and October of 2020 among students enrolled in secondary school. The participants had filled the Game addiction scale and a data file regarding the socio-demographic information, physical and information about the internet access and use.

Results

The initial sample was composed of 180 secondary school students. Among them 28 were excluded because they did not play video games. Final sample consisted of 152 students (90 males, 62 females) with a mean age of 13.14 ± 1.2 years. The average duration of connection among participants was 5.3 hours per day. Nearly one quarter of the participants (24,3%) played videogames more than 20 h per week. The prevalence of gaming addiction was 21,7%. The participants with gaming addiction were, on average, younger than those who were not addicted to gaming Game-addicted individuals were more likely to be male than female (13,8% vs 7,9%; p=0,036). There was, also, a significant relation between IA and having academic difficulties (p=0.042).

Conclusions

Based on our study findings, that gaming addiction is a challenging problem among Tunisian adolescents. We recommend authorities consider gaming addiction a serious problem for the young population and make this growing phenomenon an adolescent health priority.

Disclosure

No significant relationships.

Sexual dysfunction in infertile couples

Introduction

Interactions between infertility and sexuality are numerous and complex. Recently more attention is being paid to the impact of infertility on the marital sexuality.

Objectives

The aim of this study was to determine the effects of infertility on sexual functions.

Methods

A cross-sectional descriptive study, the obstetric gynecology department Basic demographic information was collected. Respondents were surveyed regarding sexual impact and perception of their infertility etiology.

Results

Our patients had an average age of 33.2. The average number of years of infertility was 3.9 years.. The most common cause of female infertility was an ovulat disorder (36%), that of male infertility was sperm production defect. The confrontation with a diagnosis of infertility marks a difference in the way couples organize their sexual life. In our study, sexual problems after this diagnosis were experienced by 38% of women. Sexual dysfunction was detected as a pain problem (24%), a desire problem (10%), an arousal problem (4%), and an orgasm problem in 6% and. Faced with this situation, women felt guilty (46%), angry (72%) and anxious (82%). Infertility was perceived as the worst experience of life by 78% of our patients.

Conclusions

Infertility can interfere negatively in women sexuality. The investigation of sexual difficulties in infertility consultations must be systematic.

Metacognition, symptoms and general functioning in patients with schizophrenia

Introduction

Poorer metacognitive abilities are recognized as strong predictors of social functioning deficits in individuals with schizophrenia.

Objectives

The aim of the current study is to examine metacognitive functioning in people with schizophrenia and to explore correlations between metacognition, symptoms and general functioning.

Methods

It was a cross-sectional study involving outpatients diagnosed with schizophrenia and followed in the psychiatry “C” department at Hedi Chaker university Hospital, in Sfax -Tunisia, between may and december 2018. Sociodemographic, clinical and therapeutic data were measured using self-reported questionnaires, and metacognition was assessed with the Metacognition Assessment Scale – Abbreviated version (MAS-A). The general functioning was measured with The Global Assessment of Functioning (GAF).

Results

A total of 74 participants participated in the study. The average age was 34.1 ± 11.8 years and the sex-ratio was 1.6. The average score of global assessment of functioning was 49.39±10. Means and standard deviations on MAS scores were as follows: self-reflectivity 4.18 (1.46), understanding of others’ minds 3.20 (1.06), decentration 2.5 (1.8), mastery 2.54 (1.85), and the MAS total scores 12.42 (6.17). The results indicate that poor social functioning is associated with metacognitive difficulties (r=0.27, p<10-3). Greater metacognition was significantly correlated with fewer negative symptoms (r= -0.62, p<10-3), but metacognition was not significantly correlated with positive psychotic symptoms, cognitive disorganisation, excitement or emotional distress

Conclusions

These findings underscore the importance of interventions designed to enhance the patients’ metacognitive capacities, that is, the more proximal capacities linked to poorer social functioning.

[Effects of continuous positive airway pressure on depression, anxiety and quality of life in obstructive sleep apnea hypopnea syndrome patients]

INTRODUCTION

The obstructive sleep apnea hypopnea syndrome (OSAHS) is a chronic stressor that may alter the emotional state and quality of life (QOL) of patients suffering from it. In this work, we proposed to estimate the prevalence of depression and anxiety, to assess the QOL in a Tunisian population of apneic patients, and to assess their evolution under continuous positive airway pressure (CPAP).

METHODS

We conducted a prospective study, involving 33 apneic patients followed for SAHOS with moderate or severe class disease in the pneumology department at Hedi Chaker university hospital in Sfax, Tunisia. They received CPAP treatment for three months. We used an epidemiological record. Two scales, the Hospital Anxiety and Depression Scale (HADS) and the 36-item Short-Form Health Survey (SF-36), were completed before and after treatment to evaluate the effect of three months of treatment with CPAP.

RESULTS

The prevalence of depression in the study's patients, according to the HADS, was 45.5% and that of anxiety was 21.2%. After 3months of CPAP, the prevalence of depression and anxiety had become 18.2% and 6.1%, respectively. QOL was impaired in 81.8% of cases before treatment, according to the SF-36. This figure had decreased to 69.7% after 3months of treatment with CPAP. Apart from the third dimension (physical pain), all other dimensions were significantly improved after 3months of CPAP treatment. The treatment with CPAP induced a significant improvement in the average scores of depression (P<0.001), anxiety (P=0.002) and QOL (P<0.001).

CONCLUSIONS

These results attest to the importance of the frequency of anxio-depressive disorders as well as an altered QOL in patients with OSAHS. CPAP treatment was shown to be effective in improving these parameters, but this efficacy was partial. Specialized care may be needed in cases of residual anxio-depressive symptoms.

[Variations in immunological parameters after treatment of a manic episode]

Bipolar disorder is a chronic and disabling mental illness affecting approximately 1-2% of the general population, characterized by the occurrence of manic episodes alone or alternating with depressive episodes. Bipolar disorder is associated with significant morbidity, mortality and personal suffering. The mechanisms underlying the onset and progression of bipolar disease are still poorly understood. Recently, immunological dysfunctions have been suggested in the pathogenesis of bipolar disorder, and many studies have focused on the interaction between bipolar disorder and immunity. Immunological changes have been widely studied during depressive episodes but less explored during manic episodes. The objective of our study was to explore changes in serum proteins and autoantibodies after treatment for a manic episode of bipolar I disorder. This study was carried out over a 30-month period from January 2017 to June 2019, in collaboration between the psychiatry department B of the Hédi Chaker CHU and the immunology department of the Habib Bourguiba CHU, in Sfax, Tunisia. It focused on a sample of 45 bipolar patients with manic relapse, naïve to psychotropic treatment, or discontinuing treatment for a period of at least three months and without a history of autoimmune disease. The study was conducted in two stages : on admission and after treatment. The mean plasma levels of IgG and complement C3 fraction were significantly higher in bipolar patients with relapsing mania. Studies of variation in immunoglobulins and complement fractions during relapses of bipolar disorder have all objected to variations in these serum proteins, but their results were inconsistent regarding the direction of variation and the fractions affected. After treatment, there was a statistically significant increase in the mean plasma levels of IgG and IgA and a decrease in the mean plasma level of the C4 fraction of complement. No significant variation in autoantibodies was noted after treatment. The mean plasma IgM level was significantly lower with sodium valproate. On atypical antipsychotic medication, the mean plasma level of fraction C3 was statistically lower, whereas on conventional antipsychotic medication it was statistically higher. This is in line with the data in the literature which support the immunomodulatory role of thymoregulators and antipsychotics. Serum proteins have been more sensitive than autoantibodies to the effect of psychotropic therapy during manic relapse.

[The handling of psychotropics in diseases of central nervous system]

Psychiatric signs and symptoms occur frequently in individuals with central nervous system diseases. Inadequately treated, these comorbid conditions affect patient rehabilitation, compliance with treatment and quality of life. Their management poses a major challenge given the variable efficacy and safety profiles of available psychotropic drugs and increased risk of drug interaction. This review aims to summarize the existing literature on the prescription of psychotropic drugs for management of psychiatric disorders among persons with central nervous system's diseases.

Depression and quality of life in schizophrenia-spectrum

Introduction

The coming out of depressive disorders seems to be associated with severity of schizophrenia’s disease and with poor quality of life (QoL).

Objectives

The aim of our study was to assess the relationship between depression and QoL in patients with schizophrenia.

Methods

This is a cross-sectional and analytical study including stabilized patients with schizophrenia or schizoaffective disorder followed up in the outpatient psychiatry department at Hedi Chaker hospital university of Sfax (Tunisia), between August and October 2019. We used the Calgary Depression Scale (CDS) to evaluate depression and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF) to assess QoL.

Results

We recruited 37 patients with a mean age of 49.14 years and a sex ratio of 4.66. Seventy-three (73%) of patients were followed for schizophrenia and 27% for schizoaffective disorder. They were married in 43.2% and 35.1% of patients had a regular work. According to CDS, 18.9% of patients had depression with a mean score of 2.27 (SD 2). QLESQSF mean score was 65.51. Depression was negatively correlated with Quality of Life Enjoyment and Satisfaction (r=-0.59, p<0.001). We did not find a significant difference in depression according to the socio-demographic characteristics of the respondents or the clinical features of the disease.

Conclusions

It is clear that depression in patients with schizophrenia is associated with significant functional disability. Strategies to overcome the burden of depression may instil hope for functional recovery.

Beliefs about schizophrenia’s causes among family members

Introduction

Investigating family members’ causal beliefs regarding schizophrenia is an important step in the management of the illness; it may affect adherence to treatment of patients with schizophrenia.

Objectives

To investigate the beliefs about the causes of schizophrenia among families of patients with schizophrenia.

Methods

We led a cross sectional descriptive study involving 32family members of patients suffering from schizophrenia who were followed in the psychiatry department of Hedi Chaker University Hospital in Sfax (Tunisia), between May to September 2019. Data was collected from the medical records and the questionnaire designed to the study.

Results

The mean age of the relatives was 60.8 years, with a sex-ratio of 1.6. The relatives included 20 fathers (62.5%), six wives (18.8%), three mothers (9.4%), and three sisters (9.4%). Among them, 37.5 % were illiterate; 37.5% lived in rural area. Fourteen participants (43.8%) had cited at least two possible causes of schizophrenia. The most frequently cited causes were emotional shock (81%) and god’s will or fate (72%) followed by witchcraft (37.7%). The belief of God’s will and fate was associated with poor compliance to treatment (p=0.06). The belief of supernatural cause was correlated to rural origin (p=0.000) and advanced age of participants (p=0.000).Significant correlation was also found between family history of mental disorders and beliefs on hereditary causes (p=0.000).

Conclusions

These results suggest that family members of patients suffering from schizophrenia need to be better informed about its main causes to improve both compliance to treatment and social integration of this patients.

Quality of life and mood disorders

Introduction

Many researches addressing quality of life (QOL) has been demonstrated its impairment during acute episodes of bipolar disorder (BD) and major depressive disorder (MDD).

Objectives

To compare QOL between patients with remitted MDD and remitted BD and healthy controls (HC).

Methods

A comparative and analytical study, conducted over 3 months in the outpatient psychiatric department of Hedi Chaker University Hospital in Sfax (Tunisia) among 30 patients with remitted BD, 30 patients with remitted MDD and 34 HC. QOL was assessed with the «36 item Short-Form Health Survey» (SF-36).

Results

Compared with HC, the MDD and the BD groups had significantly lower scores for the total of the SF-36 and its sub-domains (table 1). Physical scores were lower in patients with MDD, compared with patients with BD (table 1). Table 1: Comparison of SF-36 sub-domain scores between MDD, BD patients, and HC.Sub-domains of the SF36MDDBDHCPMean physical score - Physical functioning - limitation due to physical health - Pain - General health45.5 67 42.5 60 48.559,28 69,00 44,17 67,13 56,8377,86 84,26 71,03 83,50 72,050.000 0.003 0.005 0.001 0.000Mean psychic score - limitation due to emotional problems - Social functioning - Energy/fatigue - Emotional well-being 47.25 41 55.8 40 5248,19 48.89 43.48 46.5 53.8668,66 76.97 75.52 56.02 66.120,000 0.000 0.000 0.002 0.007Mean global score50.8853,7373,780,000

Conclusions

QOL of patients with mood disorders such as MDD and BD suffered damage even in euthymic periods.

Study of risk factors for suicide attempts in patients with bipolar disorder

Introduction

Bipolar disorder (BD) has the highest suicide attempt rate among psychiatric disorders. Many factors are associated with the risk of suicide attempt in BD, but the relation between them has still not been explicitly stated.

Objectives

This study aimed to examine the clinical variables characterizing patients with BD with prior suicide attempt (PSA).

Methods

This was a descriptive and analytical study, conducted over 3 months, involving 31 euthymic patients with BD, followed up in the outpatient psychiatry department of Hedi Chaker University Hospital in Sfax (Tunisia). General, clinical and therapeutic data were collected using a pre-established questionnaire. Quality of life (QOL) was assessed with the «36 item Short-Form Health Survey» (SF-36). Impulsivity was assessed with the Barratt Impulsiveness Scale (BIS-11).

Results

The mean age was 47.25 years and the sex ratio was 1.6. Family history of suicide attempts was found in 25% of cases. Mean score of SF36 was 34 and high degree of impulsivity was noted in 62.5% of cases. The frequency of BD patients with PSA was 12.3% (N=8), with two of these (25%) having more than one PSA. Comorbid alcohol abuse (p=0.000), somatic illness (p=0.013), high degree of impulsivity (p=0.032), and impaired quality of live (p=0.003) were significantly more frequent in BD patients with PSA.

Conclusions

We found several clinical variables associated with PSA in BD patients. Even though these retrospective findings did not address causality, they could be clinically relevant to better understanding suicidal behavior in BD and adopting proper strategies to prevent suicide in higher risk patients.

Internalized stigma, depression and quality of life in schizophrenia

Introduction

People with a schizophrenia experience higher levels of stigma.

Objectives

Our aim was to explore the relationship between internalized stigma, depression and quality of life (QoL) in these patients.

Methods

This is a cross-sectional and analytical study including 37 stabilized patients with schizophrenia or schizoaffective disorder followed up in the outpatient psychiatry department at Hedi Chaker hospital university of Sfax, between August and October 2019. The Internalized Stigma of Mental Illness scale (ISMI-29) was used to assess internalized stigma and its five dimensions. We used the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF) to assess QoL and the Calgary Depression Scale (CDS) to evaluate depression.

Results

73% of these patients were followed for schizophrenia and 27% for schizoaffective disorder. The global mean score of ISMI was 71.95. The mean scores of alienation, stereotype endorsement, perceived discrimination, social withdrawal and stigma resistance were 15.16, 16.54, 12.95, 15.65 and 11.38, respectively. The Q-LES-Q-SF mean score was 65.51. According to CDS, 18.9% of patients had depression with a mean score of 2.27. Internalized stigma scores (global and the five dimensions scores) were significantly and negatively associated with QoL enjoyment satisfaction score (respective p: p<0.001;p<0.001; p=0.004; p<0.001; p<0.001; p<0,001; p<0.001). Global ISMI score and the four first dimensions scores were positively associated with depressive patients (respective p: p=0.002, p<0.001, p=0.025, p=0.001 and p=0.003) while stigma resistance was negatively correlated with depression (p<0.001).

Conclusions

Our results confirmed that internalized stigma is associated with impaired QoL and depression in stabilized patients with schizophrenia-spectrum diagnosis.

Factors associated with post-traumatic stress disorder in family caregivers of psychotic patients

Introduction

An association can be found between patient with psychosis and perpetrating acts of violence. So, the caregiving role can impact negatively on psychosis carer psychological health and wellbeing.

Objectives

The aim of this study was to identify the factors associated with post-traumatic stress disorder (PTSD) in family caregivers of psychotic patients following exposure to aggression.

Methods

This cross-sectional study was carried out involving 95 family caregivers of psychotic patients followed in psychiatry. Data were gathered from caregivers about their experiences in providing care. Sociodemographic and clinical data of patients were collected from medical records.We used the perceptions of prevalence of aggression scale (POPAS) to measure the frequency and severity of aggression directed at the respondent in the past and the Impact of Event Scale-Revised (IES-R) to evaluate PTSD.

Results

The caregivers were male in 51.6% and with low educational level in 46.3% of cases. A rate of 75.8% of caregivers reported experiencing moderate to severe levels of aggression. More than a half of caregivers (54.7%) reported potentially significant levels of PTSD. Decreased contact with patient (p=0.01), male gender (p=0.00), older age (p=0.00), living far from patient (p=0.00), parent relationship of caregivers (p=0.00), diagnosis of schizophrenia or schizoaffective disorder (p=0.00) and poor adherence to treatment (p=0.00) in affected relatives were associated with the presence of PTSD following exposure to moderate to severe aggression.

Conclusions

These findings highlight the need for interventions to promote family psychoeducation and to provide psychosocial support for caregivers of patients in order to prevent the traumatic impact of violence on them.

Prevalence of internet addiction in tunisian adolescents

Introduction

Internet addiction (IA) is a significant public health issue among adolescents. There is considerable evidence that IA is associated with various psychosocial harms.

Objectives

The aim of this study was to measure the prevalence of internet addiction among secondary school.

Methods

This cross-sectional study was conducted among 152 students enrolled in secondary school. The participants had filled the Internet Addiction Test of Young and a data file regarding the socio-demographic information, physical and information about the internet access and use.

Results

The sample consisted of 90 males and 62 females with a mean age of 13.14 ± 1.2 years. The majority of participants had their own smartphone (83.6%). The average duration of connection among participants was 5.3 hours per day. The prevalence of IA was 14,5%. Results showed that 46,8% feel their internet use significantly hinders their family relationships. Twenty participants (13,2%) reported that they connected to the internet while they were in classroom. The prevalence of IA was higher among boys than girls (p= 0.018). There was, also, a significant relation between IA and having academic difficulties (p=0.037).

Conclusions

The prevalence of IA is elevated in Tunisia. Many negative consequences are identified. Urgent measures should be taken to counter the problem.

Quality of life in euthymic patients with bipolar disorder

Introduction

Patients with bipolar disorder (BD) frequently experience residual symptoms, problems in psychosocial functioning, cognitive impairment, and poor quality of life (QOL).

Objectives

* To evaluate the QOL of euthymic patients with BD compared to healthy controls (HC). * To identify factors associated with its deterioration.

Methods

This is a comparative and analytical study, conducted over 3 months, involving 30 euthymic patients with BD, followed up in the outpatient psychiatry department of Hedi Chaker University Hospital in Sfax (Tunisia). They were compared to 34 HC. General, clinical and therapeutic data were collected using a pre-established questionnaire. QOL was assessed with the «36 item Short-Form Health Survey» (SF-36).

Results

The mean ages of BD patients and HC were 44.17 years and 40.1 years, respectively. Compared with HC, patients with BD had decreased overall SF-36 scores (53.73 vs 73.78; p=0.000) and decreased physical and psychological subdomain scores (p=0.001; p=0.000). The study of the relationship between the dimensional average scores and different variables revealed correlations between; physical health problems and somatic disease (p=0.021) and unemployment (p=0.001), impaired general health and somatic disease (p=0.02) and psychotropic association (p=0.021), emotional health problems and psychiatric family history (p=0.023), pain and psychotropic association (p=0.031), and impaired global QOL and psychiatric family history (p=0.05).

Conclusions

Our results confirm the impairment of the QOL of patients with BD even in euthymic periods. Many factors have been associated, including demographic and clinical variables. The improvement of QOL is to consider these factors in the management of these patients.

Anxiety among healthcare professionals during the COVID-19 pandemic: Predictive role of social support

Introduction

The COVID-19 pandemic may cause elevated levels of anxiety in healthcare professionals (HCP). Identifying factors that could help maintain mental health especially social support could be helpful in facing this stressful situation.

Objectives

The aim of this study was to asses the relationship between the trait-anxiety and perceived social support among Tunisian HCP in the current pandemic wave of COVID-19.

Methods

A cross- sectional descriptive and analytic study conducted among Tunisian HCP during November and December 2020. The data were collected by an online questionnaire. The trait-anxiety was assessed using the “General Anxiety questionnaire of Spielberger” (STAI-Y-B). We used the “Social Support Questionnaire” to measure availability and satisfaction regarding perceived social support.

Results

Participants were 135 HCP, and aged from 24 to 61 years old (average age 31.98 years). The sex ratio was 1.1 (71 males and 64 females). Of HCP involved in the study, 61.5% were single, 36.3% were married and 2.2% were divorced. The average scores of availability and satisfaction regarding perceived social were 7.79 (SD=3.56) and 28.41 (SD=6.75), respectively. Seventy-two of the HCP had a trait-anxious. Analysis showed that social support satisfaction scores were significantly lower in trait-anxious HCP (p<0.001). However, there was no significant difference in the score of availability according to trait-anxiety (p=0.49).

Conclusions

Our study highlighted the existence of a deficit on perceived social support satisfaction among trait-anxious Tunisian HCP. Perceived social support as a determinant of trait anxiety should be the focus of social work in this period.

Disclosure

No significant relationships.

The factors associated with chronic benzodiazepine use in bipolar patients

Introduction

Benzodiazepines (BZD) are widely used in patients with bipolar disorder (BD) and their effectiveness is well documented. Therefore, there are major risks associated with BZD use including abuse and dependence. Those risks can be related to the patients’chacteristics, the particularities of BD and the prescribers.

Objectives

To determine the factors associated with chronic use of BZD in patients with BD.

Methods

We conducted a cross-sectional, descriptive and analytical study among a sample of patients with BD (DSM-5) followed in psychiatric outpatient of Hedi Chaker university hospital in Sfax. We used the Benzodiazepine Cognitive Attachment Scale (ECAB) to determine dependent patients

Results

Among the 61 included patients, 50 (82%) had a chronic use of BZD (> 3 months). They had a mean age of 49.3 years (± 14.02 years) and a low socio-economic level in 44%. The type of BD was dominated by type II (66%). Initial episode type was depressive in 78%. The average number of depressive episodes was 2.92±2.3. A rate of 65.5% of patients have already attempted BZD withdrawal. Chronic BZD use was significantly correlated with BZD dependence (p=0.000), low socioeconomic level (p=0.04), depressive type of the initial episode (p=0.011), the depressive recurrence (p=0.000) and the absence of any attempt to discontinue BZD (p=0.011).

Conclusions

Chronic use of BZD in patients with BD is prevalent. In order to minimize this problem in this population, it is important to enhance programs to improve psychiatrist-prescribing behavior and to use cognitive-behavioral therapies in combination with medication to help withdrawal.

Intimate partner violence and self-esteem

Introduction

The impact of intimate partner violence (IPV) can be devastating on women’s psychology. Moreover, IPV may destroy women’s self-esteem and self-identity.

Objectives

To identify sociodemographic characteristics associated with IPV and to assess self-esteem among women victims of IPV.

Methods

It was a descriptive and analytical study over a period of 03 months from June 1^st to August 31^st, 2018 including all cases IPV female victims in forensic department at Habib BOURGUIBA University Hospital, Sfax. In addition to epidemiological data, Rosenberg scale were used to assess the victim’s self-esteem.

Results

Among 142 female IPV victims, only 60 (22.3%) agreed to answer our questionnaire. Their median age was 33.5 years (27-41 years). Victims did not pass high school in 61.7% of cases and they were unemployed in 53.3% of cases. Most women got married at 23 years-old (20-26). The average length of marriage was 7 years (3-14 years). Bruises and abrasions were the most frequent lesions (58.3% and 56.7% of cases). Rosenberg Scale score’s mean was 28.3 ± 4.3. Self-esteem was low or very low among 70% of victims.

Conclusions

Female victims of IPV do not have a specific profile and low self-esteem is quite common among them. Additional research is needed to better understand the extent of the problem and to develop more effective reporting methods.

Disclosure

No significant relationships.

A descriptive study of fratricide in tunisia

Introduction

Violence between brothers and / or sisters is one of the most important forms of violence within families. To understand homicides between them, the hypothesis of rivalry has been put forward. But how is it really in reality?

Objectives

To construct both the clinical and medicolegal profile of perpetrators of fratricide and sororicide.

Methods

This is a retrospective study of 12 cases of fratricide, which were examined in the context of criminal psychiatric expertise in the psychiatry department of Hedi Chaker University Hospital in Sfax (Tunisia), between January 2002 and December 2018.

Results

The mean age of offenders was 31.9 years; they were all male. Eight fratricide perpetrators were unmarried and had an irregular occupation. They had a psychiatric follow-up prior to homicide in 5 cases. Previous criminal records were noted in one third of the cases. Three perpetrators of fratricide were using psychoactive substances. History of violence against the victim was presented in 7/12 of cases, and the victim was younger than the perpetrator in 5 cases. Aggression was premeditated in 4 cases. The knife was the most used weapon (11/12). Seven offenders suffered from a major mental illness. The most common diagnosis was schizophrenia (6/12). The experts had concluded that 8 cases were in a state of insanity at the time of the offense.

Conclusions

Our data indicates that fratricides are lack preparation and most often preceded by violence. It seems to be important to do other researches to assess psychopathology and assess risk factors for fratricide.

Trait-anxiety among healthcare professionals in COVID-19 pandemic

Introduction

Factors causing anxiety among healthcare professionals (HCP) are increasing, and psychosocial causes are the most common. During the COVID-19 pandemic, HCP are exposed to additional stressful factors.

Objectives

The aim of this study was to assess the prevalence of trait-anxiety and its associated factors towards the COVID-19 outbreak among Tunisian HCP.

Methods

A cross-sectional descriptive and analytical study conducted among Tunisian HCP during November and December 2020. The data were collected by an online questionnaire including the sociodemographic information and the “General anxiety questionnaire of Spielberger” (STAI-Y-B) which was used to assess the trait-anxiety.

Results

A total of 135 HCP participated in this study (47.4% female and 52.6% male). The average age was 31.98 years (SD=6.59). Of the participants, 3% were nurses, 8.1% were interns, 48.1% were residents, 34.8% were specialist doctors and 5.9% were generalist doctors. Concerning marital status, 61.5% were single, 36.3% were married and 2.2% were divorced. Of HCP involved in the study, 13.3% of the participants had a history of chronic somatic-disorder and 11.9 % of them had a history of a psychiatric disorder. The prevalence of trait-anxiety in HCP was 53.3%. The analysis showed that anxious HCP were more younger (p=0.002) and had history of a psychiatric disorder (p=0.017) compared to non-anxious HCP. However, no significant difference was found by gender, marital status and professional degree according to trait-anxiety.

Conclusions

In our study, we found that more than the half of HCP were anxious and these one were more younger and had history of psychiatric disorders.

Disclosure

No significant relationships.

Subsyndromal symptoms in bipolar disorder

Introduction

The inter-critical phase in bipolar disorder may contain symptoms that do not meet the diagnostic criteria for a thymic episode. According to studies, these symptoms are common and usually associated with impaired psychosocial and family functioning.

Objectives

Study the subsyndromal symptoms in remitted patients with bipolar disorder, and their functioning repercussions.

Methods

We conducted a cross-sectional, descriptive and analytical study, in the outpatient psychiatry department of the University Hospital in Sfax (Tunisia) among 30 remitted patients with bipolar disorder. We used: the Montgomery And Asberg Depression Rating Scale (MADRS), the Angst Hypomania Questionnaire and the FAST test to assess functioning levels.

Results

The average age of our population was 44.37±15.45 years with a sex ratio (M/F) =0.66. Most of them lived in urban areas (60%) and half of them did not go beyond the primary school level. Most did not have a constant job (76.6%). The average number of previous thymic episodes was 2±1.33 times/year. A quarter of the patients (26.6%) had hypomanic symptoms in the intercritical phase and 20% had depressive symptoms. Hypomanic symptoms were correlated with tobacco use (p=0.035). Depressive symptoms weremore frequent in men (p=0.074). Functioninglevel was lower in subjects living in rural areas (p=0.065).

Conclusions

Our study suggests that residual symptoms were frequent with a significant functional impact. As a result, their identification and management are highly essential to improve the overall functioning of patients with bipolar disorder.

Post-traumatic stress disorder and professional quality of life among psychiatric staff

Introduction

Psychiatric staff could be exposed to various types of violence that might have potential consequences on their psychological balance.

Objectives

To detect post-traumatic stress disorder (PTSD). To assess the professional quality of life among psychiatric hospital workers.

Methods

A descriptive cross-sectional study was conducted in the psychiatric department of the Hedi Chaker University Hospital in Sfax. The questionnaire study had three major components: the baseline participant characteristics,the post-traumatic stress disorder Checklist (PCL-5) for which a total symptom severity score cutoff of 38 was recommended as the cutoff for a positive screening test and the Professional Quality of Life Scale (ProQOL).

Results

Thirty-one participants completed the questionnaire. The sex-ratio was 0.93. The mean age was 41.5 years. All participants were exposed to physical or verbal assault. Physical aggression was the most traumatic behavior reported by 39.3% of psychiatric professionals. A feeling of insecurity when performing professional tasks was reported by 93.3% of participants. Among participants, 41.9% expressed the desire to change workplace. The mean score on the PCL-5 was 21.6 ± 15.35. Five participants (16.7%) had a PCL-5 score ≥ 38. The Compassion Satisfaction mean score was 37.48 ± 5.64. The burnout mean score was 26.41 ± 7.3 and the mean score at the secondary traumatic stress scale was 27 ±6.7.

Conclusions

PTSD could result from stressful events encountered in the course of managing patients in mental health departments. Attention to post-traumatic event interventions may be useful both to reduce the rate of PTSD and to improve the professional quality of life among psychiatric staff.