[COVID-19 Pandemic: Psychosocial impact among healthcare professionals in Tunisia]

OBJECTIVE

To determine the psycho-affective impact of the Covid-19 pandemic on the mental health of health professionals in Tunisia and to estimate the associated factors.

METHODS

This is a multicenter, cross-sectional, descriptive and analytical study of health professionals carried out from May 2, 2020 to June 30, 2020 in Tunisia. Healthcare professionals included doctors, nurses, dentists and pharmacists. The participants answered a pre-established questionnaire using an electronic "Google Form". This questionnaire gathered demographic data and medical history. It included two psychometric scales, the GAD-7 (General Anxiety Disorder-7) and the PHQ-9 (Patient Health Questionnaire-9) to assess the prevalence and intensity of anxiety symptoms and depressive symptoms respectively.

RESULTS

The study included 203 healthcare professionals. The professionals had a mean age of 30.74±6.33years, 69.5 % were women, and the majority were doctors (77.8 %). Among professionals, 9.4 % were nurses, 7.4 % were dentists, and 5.4 % were pharmacists. A third of the participants 34.3 % worked in departments with Covid-19 patienfor having moderate to severe anxiety symptoms.

CONCLUSION

In order to ensure better patient care, early detection of psychiatric disorders and the implementation of specific strategies to ensure better mental health among healthcare professionals are priorities not only during the current pandemic but also in the event of a future similar pandemic.

Coping strategies in parents of children with chronic Adrenal insufficiency

Introduction

Being the parent of a child followed for a chronic pathology can require different resources and coping skills.

Objectives

to determine the adaptation strategies of the parents of children monitored for adrenal insufficiency in the face of their children’s pathology

Methods

We conducted a descriptive cross-sectional study carried out with parents of children with Adrenal Insufficiency followed at the pediatric outpatient clinic in Taher Sfar Mahdia University Hospital between February 2019 and April 2020. We used a pre-established questionnaire collecting sociodemographic data and the strategies of coping using the Brief-COPE Board.

Results

A total of 38 parents of children with adrenal insufficiency and 38 control parents participated in the study. The Brief-Cope board’s study of Coping strategies revealed that the strategies most used by parents of children with Adrenal insufficiency were, in descending order: religion (92.1%), support emotional (73.7%), distraction (63.9%), behavioral disengagement and acceptance (57.9%), instrumental support (52.6%), expression of feelings (50%), positive reinterpretation (39.5%), blame (38.9%), denial and humor (36.8%), active coping and planning (36.1%). On the other hand, those used by the control population were in descending order: religion (94.4%), distraction (84.2%), blame (78.9%), acceptance (72.2%) %), emotional support (69.4%), humor (63.9%), behavioral disengagement (61.1%), active coping (47.2%), expression of feelings (44 , 7%), planning (41.7%), instrumental support (30.6%), positive reinterpretation (22%), denial (19.4%).

Conclusions

Psychological support for the parents of children with chronic illnesses would be necessary to prevent parental burnout and improve their ability to adapt to their experiences

Disclosure

No significant relationships.

Socio-demographic and clinical characteristics of the perpetrators of sexual assaults assessed at the psychiatric department of Mahdia

Introduction

Sexual assault constitutes a major problem in Tunisian society. There is no definitive typology of the characteristics of those who sexually assault. The great diversity of sexual assault behaviors and the different underlying motivations do not allow us to describe a typical profile of the sexual assailant. There may be cognitive, personality trait, lifestyle, and pathway distortions involved in the etiology and maintenance of deviant sexual behaviors.

Objectives

To establish the socio-demographic and clinical profile of the perpetrators of sexual assault appraised in the psychiatric service of Mahdia.

Methods

This is a descriptive retrospective file-based study on all subjects assessed at the Taher Sfar Mahdia psychiatric department for sexual assault during the period from January 01, 2010 to December 31, 2020.

Results

Our sample consisted of 18 interviewed subjects. The median age was 40 years with extremes of age of the accused ranging from 30 to 61 years. The entire population is male. He was essentially of average socio-economic level. A psychiatric diagnosis was retained in 50% of the perpetrators of sexual assault: bipolar disorder (27.7%), schizophrenia (11.1%), antisocial type personality disorders (5.5%) and mental retardation (5.5%). Indecent assault was the most common assault followed by rape. The minors were victims in 33.3% of the cases Among those arrested, 72% were considered responsible for their acts and only one is considered irresponsible.

Conclusions

The studies having focused on the characteristics of the sexual aggressors concluded with a profile of the young man, single and badly inserted which does not constitute in any case a typical profile.

Disclosure

No significant relationships.

sexual offenders : Epidemiological and Criminological Profile

Introduction

Sexual assault is a major problem in Tunisian society. There is no definitive typology of the characteristics of those who sexually assault. A great diversity of sexual aggression behaviors and different motivations can be described.

Objectives

It is about a retrospective survey, achieved from data of Medical Expertise of the sexual offenders achieved in psychiatric departement of hospital of mahdia. This study revealed 18 cases during the period from January 2010 to December 2020.

Methods

The objective of the work was to describe the epidemiological and criminological profile of the sexual assaults.

Results

Mean age of the sample was 40 years [30-61]. Aggressors were almost exclusively males, have medium socioeconomic status and without a regular job. Fifty percent of the perpetrators had a psychiatric diagnosis: bipolar disorder (27.7%), schizophrenia (11.1%), antisocial personality disorder (5.5%) and intellectual disability (5.5%). Indecent assault (27.7%) was the most frequent aggression then the rape (22,2%). Thirty three per cent of the victims were minor.Among these expertised patients, 72% were considered responsible for their actions and only one was considered irresponsible.

Conclusions

Studies on the characteristics of sexual offenders have concluded to the profile of the young, single and unemployed male, but it can’t be a commun profile.

Disclosure

No significant relationships.

Epidemiological and clinical aspects of psychiatric disorders in Tunisian prisons

Introduction

The estimation of the percentage of mentally ill among prisoners and of the most severe psychiatric disorders has been the subject of few studies in Tunisia.

Objectives

To study in a general way the extent of psychiatric disorders among prisoners. To describe the socio-demographic and judicial characteristics of prisoners. To describe the clinical, evolutionary and therapeutic characteristics of the main psychiatric disorders.

Methods

This is a cross-sectional and descriptive study, carried out over a period of 4 months (February 2021-May 2021) on one hundred and twelve inmates of the civil prison of Mahdia followed in psychiatry. Data were collected using a pre-established questionnaire. It is made up of 30 items.

Results

The prevalence of mental disorders in prison was 9.03%. The descriptive study revealed an average age of 37.57 years, a majority having a single marital status (62.5%), the professional activity before imprisonment were workers in 61.6%, a history of imprisonment more than twice in 62.5% of cases and 50.89% declared having been victims of physical acts, psychological or sexual abuse during their childhood. Murder, armed robbery, drug trafficking and rape were the most frequent offenses with respective rates of 25.2; 17.07; 13.82 and 9.75%. Anxiety was noted in 53.57% of cases, of the respondents, depressive syndrome was in 28.57% of cases, schizophrenia was reported in 18, 75% of cases and substance-related disorders were noted in 21.42% of cases.

Conclusions

Longitudinal studies should, in the coming years, try to understand the impact of imprisonment on the onset and evolution of psychiatric disorders.

Disclosure

No significant relationships.

Epidemioclinical profile of intimate partner abusers

Introduction

Domestic violence is a critical global and social phenomenon.

Objectives

- To describe the socio-demographic and clinical characteristics related to the abuser in the context of domestic violence. - To study risk factors for acting out in the abuser.

Methods

We conducted a descriptive cross-sectional study related to male abusers of their wives who consulted the Forensic Medicine Department of Taher Sfar Hospital in Mahdia between January 2020 and October 2020 for a forensic examination.

Results

We collected 67 cases of domestic violence out of a total of 688 female consultants. The age of the abuser exceeded 35 years in 84% of cases. The average age of the abusers was 33.8 years. Almost half of the abusers had a primary school education. In 43% of the cases, the abuser was unemployed or had a job with a salary below the minimum wage. We found an association between domestic violence and the unfavorable professional status of the spouse. Only in 6% of the cases did the abuser have a psychiatric disorder. He had a history of chronic alcoholism in 35% of the cases and the use of illicit substances (cannabis) in 9% of the cases. Approximately one out of every two abusers (48%) was under the influence of alcohol at the time of the violent act. Alcoholism was associated with all forms of domestic violence. He had a criminal history in 30% of cases.

Conclusions

Our results provide real areas for reflection regarding the adoption of specific therapeutic strategies with domestic violence abusers.

Disclosure

No significant relationships.

Prevalence of anxiety in parents of Children with Adrenal insufficiency: a case control study

Introduction

Adrenal insufficiency is a rare medical condition which can occur in children. Parents, being the primary support and support for the child, are generally involved in the care of their sick child.

Objectives

To estimate the prevalence of anxiety symptoms and associated factors in parents of children with adrenal insufficiency.

Methods

This is an analytical cross-sectional case-control study over a period of 4 months in 2019, carried out with parents of children with Adrenal Insufficiency followed at the pediatric outpatient clinic in Taher Sfar Mahdia University Hospital. We used an anonymous questionnaire that included a socio-demographic fact sheet and the Hamilton anxiety scale for exploring anxiety symptoms.

Results

A total of 38 parents of children with Adrenal insufficiency and 38 control parents participated in the study. The current age of the child was between 1 and 16 years old with an average of 9.1 and standard deviation of 4.22 For the assessment of anxiety, 55.3% of the parents had a score greater than 20 attesting to the presence of an anxiety symptomatology. In addition, only 26.3% of control parents presented anxious symptoms. There is a significant difference between the two populations (p = 0.010 OR = 3.459). Anxiety was associated with having a child with SI (OR=3.4), female gender (OR=4.2), unemployment (OR=6.33), and low socioeconomic status.

Conclusions

Parents have a considerable burden in the care and management of their child with a chronic illness, which takes time and a lot of patience. Detecting anxiety symptoms in this population will help them manage it.

Disclosure

No significant relationships.

Prevalence of Facebook Addiction in a Teenage Population: About 110 Cases

Introduction

Facebook use among Teenagers has become a very common phenomenon. Its use can resuly in Facebook addiction .

Objectives

To estimate the prevalence of problematic Facebook use among a sample of school-going adolescents.

Methods

This is a cross-sectional and descriptive study carried out among 110 school-going adolescenthe at 2 state colleges in Sidi Bouzid. We used a pre-established self-questionnaire containing 2 parts: a part exploring the socio-demographic data of the adolescent and a psychometric part: Bergen Facebook addiction Scale.

Results

Study participants had a mean age of 14.4 years with extremes of 12 to 17 years. The sex ratio (M / F) (46/64) of the participants was 0.71.In our population, 13 students (11.8%) were smokers. Two students (1.8%) consumed alcohol. Cannabis use was noted in only one student.The majority of students (102), or 92.7%, had been online for more than a year.The daily Facebook connection time was more than 4 hours for 20.9%. Boredom was the number one reason for logging into Facebook for 82 students (74.5%) followed by curiosity for 45 students (40.9%). Fifteen students (13.6%) were addicted to Facebook (score> 10 on the Bergen Addiction Scale.

Conclusions

Facebook can be a useful and interesting tool to maintain and develop a network of relationships and create new ones. Its problematic use or addiction to Facebook has become a new scourge of public health. Faced with the negative impact of this addiction, It would be necessary to rationalize this use.

Disclosure

No significant relationships.

Mental Confusion of Neurological Etiology in 41 cases

Introduction

The confusional state is the clinical expression of a temporary acute cerebral decompensation. It is expressed by a global, fluctuating and reversible alteration of cognitive functions. It is a frequent reason for consultation in the emergency room.

Objectives

To determine the epidemiology, neurological etiologies and their risk factors.

Methods

Retrospective study based on the files of 41 hospitalized patients with confusional syndrome.

Results

We collected 41 patients. The mean age was 72.9 years. The sex ratio was 1.25. The antecedents found were arterial hypertension and diabetes in 10 patients, a history of stroke was ischemic in 21 cases and hemorrhagic in 6 cases, cerebral metastasis in 5 cases, hepatic encephalopathy in 6 cases and a toxic cause in 4 cases. Mental confusion was acute in 23 patients and subacute in 18. The confusional manifestations observed were essentially temporospatial disorientation in 27 patients, obnubilation in 22 cases, difficulty in paying attention and concentrating in 24 cases, and vague and slow verbal expression in 11 cases. A metabolic disorder was found in 15 patients, such as hyperkalaemia (7 cases) and hyperglycaemia (8 cases). Etiological treatment was instituted with recourse to sedative treatment in 18 patients due to agitation. The evolution was marked by a total regression of confusion in 11 cases, lacunar amnesia in 7 cases, prolonged mental confusion in 6 cases and death in 3 patients.

Conclusions

Elderly subjects are at risk due to the vulnerability of brain structures to pathologies and treatments associated with this period of life. Early treatment can improve the prognosis.

Disclosure

No significant relationships.

Determinants of burnout in the service of gynecology Mahdia: about 122 cases

Introduction

The Burnout syndrome occurs preferentially in individuals subjected to intense stress conditions. The nursing staff in Obstetrics Gynecology is an example of this.

Objectives

To assess the prevalence of Burnout and its determinants in the obstetrics gynecology service - Mahdia.

Methods

We conducted an analytical cross-sectional study carried out with the medical and paramedical staff of the gynecology-obstetrics department of the Taher Sfar Mahdia hospital during a period of 3 months.We used a pre-established self-questionnaire containing 2 parts: a part exploring the socio-demographic data of the population and a psychometric part evaluating Burnt out using the “Maslach Burnout” scale inventory ”.

Results

Our sample consisted of 122 medical and paramedical personnel.The sex ratio was 4.3 (99/23), the mean age was 30.5 with values ranging from 25 to 55 years.Of the participants, 59 (48.3%) were single .Nine (7.4%) of the participants were smokers and 2 (1.6%) consumed alcohol.The majority of the population (96.7%) did not have a psychiatric history, 88 (80.3%) reported an organ history.A high level of burnout was noted in 64.8% of our population with 14.8% severe burnout. The presence of burnout was significantly associated with the consumption of psychoactive substances (p = 0.05) and professional rank (p = 0.04) .Nurses, residents and senior doctors werethose most at risk of developing burnout. It was also significantly related to the absence of other professional activities such as research (p = 0.05) and training continuing medical care (p = 0.05).

Conclusions

Psychological intervention strategies with these suffering health promoters would be desirable.

Disclosure

No significant relationships.

Sexual assault in the mahdia region : Epidemiological peculiarities of victims

Introduction

Women around the world are still victims of violence and discrimination in many areas. In Tunisia, discrimination against women remains a reality, and they are often more vulnerable to violence, especially sexual violence, compared to men.

Objectives

To describe the epidemiological characteristics of victims of sexual assault in the Mahdia region in Tunisia

Methods

This is a descriptive and retrospective study of 110 sexual assault cases examined at the legal medecin department of Mahdia University Hospital between January 2016 and August 2018.

Results

The majority of victims were female (80 %). All genders, 77% were under the age of 25 years old. The median age of the men was 11.5 years. The median age of women was 18. The urban origin was more common (55.5%). Only 8.1% were married compared to 87.4% single. Only 2.7% said they were divorced and only one woman was a widow. 41.8% of the sample said they were still in school and almost 29,1% of the cases were out of work. 3.6% reported a history of sexual assault. The sexual act was the same in all situations. The perpetrator was unique in 73.6% of cases, male (100%), known to his victim (57%) or even a member of the family circle (14%). Sexual assault by penetration was mostly reported (51%), and it was almost exclusively penile(98.2%).

Conclusions

Sexual violence remains under-reported. The statistical data do not allow to know the phenomenon of its whole, because the majority of acts remain unknown, due to the absence of complaints or medical consultations.

Depressive symptoms and related factors in elderly diabetic patients

Introduction

Diabetes is a major public health problem in Tunisia. Its prevalence increases with age. In addition, depression, at the top of mental disorders list, mainly remain undiagnosed, in particular in the elderly and consequently untreated.

Objectives

The aim of this study was to estimate depressive symptoms and related factors in elderly diabetic patients.

Methods

This is a cross-sectional study, conducted among type 2 diabetic patients aged ≥ 60 years old, attending Mahdia’s primary health center, from January 2019 to March 2019. Depressive symptoms were assessed by using the Geriatric Depression Scale (GDS).

Results

95 diabetic patients were recruited. The average age was 75 ± 7.4 years and the sex ratio was 0.9. In our sample, 68.4% of patients were categorized according to having depressive symptoms. The proportion of participants with mild and severe depression symptoms were 25.3% and 43.1%, respectively. Analytical results demonstrate many factors which were significantly associated with depressive symptoms: female gender, living alone, history of hypertension, presence of complication, and using insulin (p < 0.05).

Conclusions

Our study shows that depressive symptoms are common in elderly subjects with diabetes, and there have been many significant risk factors associated with it. So there is need for physicians to detect, confirm, and treat depression in elderly diabetic patients.

Depression and anxiety disorders in chronic hemodialysis patients

Introduction

Depression and anxiety are among the most common comorbid illnesses in people with end-stage renal disease. They are under-recognized in hemodialysis (HD) patients.

Objectives

The aim of this study was to assess the prevalence of depression and anxiety disorders among HD patients and its associated factors.

Methods

A cross-sectional study including patients on hemodialysis at the dialysis unit of the University Medical Center of Mahdia, Tunisia, conducted from December 2016 to January 2017. A standard self-administered questionnaire-the Hospital Anxiety and Depression Scale (HADS) was used in the study to measure the presence and severity of anxiety and depression in the study population.

Results

were collated from 55 patients. Overall, 32.7% of patients reported depression and 23.6% reported anxiety. Among symptoms, depression had a significant correlation with diabetes, high blood pressure, and duration of dialysis (p<0.05). Regarding anxiety, this significant correlation was only seen with the duration of dialysis.

Conclusions

The current study showed that the prevalence of depression and anxiety in hemodialysis patients is important and correlates with clinical variables, so effective interventions for mental health should be taken into consideration and the impact of these interventions should be investigated.

Predictors of poor adherence in schizophrenia

Introduction

Schizophrenia is a chronic mental disorder that requires long-term treatment. Non-adherence to antipsychotics is common and associated with poor outcomes.

Objectives

Our study is aimed to describe the therapeutic adherence and to identify the factors associated with poor adherence among schizophrenic patients.

Methods

This was a cross-sectional study conducted at psychiatry consultation of the university medical center of Mahdia, Tunisia. Data collection occurred between the months of January and March 2018, including patients suffering from schizophrenia. The evaluation of adherence was performed using the MARS scale (Medication Adherence Rating Scale).

Results

In our sample of 131 schizophrenic patients, there is a male predominance (76%), as well as unmarried status (58.7%), unemployed (72%). The rate of non compliance treatment was 73%. Low levels of education, poor insight and polytherapy were associated to poor adherence. Although patients aged more than 40 years, who were married and diagnosed with undifferentiated schizophrenia were good compliant to treatment (p<0.05).

Conclusions

We suggest a proper treatment strategy for each patient based on the identification of non adherence risk factors.

Clinical profile and outcome of bipolar disorder patients receiving electroconvulsive therapy

Introduction

Bipolar disorder (BD) is a serious and extremely recurrent illness frequently associated with cognitive and functional deterioration that poses many treatment challenges. However, over the years, with the evolution of more and more mood stabilizers and neuroleptics, there were controversies surrounding the use of electroconvulsive therapy (ECT).

Objectives

The present study was an attempt at studying the clinical profile of BD patients who receive ECT and to study its effectiveness.

Methods

Retrospective data were collected from all bipolar patients submitted to acute ECT treatment, between June 2015 and June 2016, at the Department of Psychiatry of the University Hospital of Mahdia, Tunisia.

Results

During the study period, among all the patients who received ECT, 47% were diagnosed to have bipolar disorder. ECT was administered most commonly for mania with psychotic symptoms, followed by severe depression with psychotic symptoms. Most of patients showed more than 65% response (based on reduction in the standardized rating scales) with ECT. Few patients (18.7%) reported some kind of side effects.

Conclusions

ECT resulted very effective for all BD acute depressive and manic episodes not responding to conventional pharmacologic management.

Depression and anxiety among diabetics in primary care : a cross-sectional study

Introduction

Diabetes mellitus is one of the most frequent chronic diseases in Tunisia. Individuals with diabetes mellitus may have concurrent mental health disorders and are shown to have poorer disease outcomes.

Objectives

The aim of this study was to determine the prevalence of depression and anxiety in diabetics attending the primary care setting.

Methods

This was a cross-sectional survey carried out over two months and including diabetic patients followed up at the consultation for chronic diseases at the primary care center of Hiboun, in Mahdia, Tunisia. The validated Hosiptal Anxiety and Depression scale (HAD) questionnaire was used as a screening tool for the symptoms of depression and anxiety.

Results

A total of 64 patients (24 men and 40 women) was enrolled. The average age was 54.5 ± 7.2 years. The mean duration of diabetes was 8.2 ± 2.3 years. The average HbA1c level was 9.1%.Over 48% of patients were overweight. The prevalence of Depression and anxiety among patients with diabetes from our study was 29.6% and 40.6%, respectively. Depression was found to be significantly associated with marital status of widowed, HbA1c level of more than 8.5%, and a family history of psychiatric illness. anxiety was significantly associated with females, unmployement and HbA1c level of more than 8.5%.

Conclusions

Screening of high risk Type II diabetics for depression and anxiety symptoms in the primary care setting is recommended at regular intervals.

Quincke-edema induced by chlorpromazine: About two cases

Introduction

Quincke-edema has been specifically associated with using certain drugs including chlorpromazine as detailed through two clinical cases.

Objectives

Illustration of two clinical cases about angioedema induced by Chlorpromazine.

Methods

We reviewed clinical data from two patients who committed a suicide attempt and then transferred to the psychiatry department after their somatic stabilization: the first was 27-year-old followed in psychiatry since childhood for intellectual deficiency and admitted to the emergency department for the suicide attempt by taking 14 tablets of chlorpromazine 100 mg and the second was a 20-year-old patient, admitted to the emergency department for suicide attempt by Raticid.

Results

The first patient presented a delusional persecution-themed syndrome with auditory hallucinations. Therefore, he was initially put on injectable treatment with Haloperidol 15mg and Diazepam 30mg then oral relay after 48h by Risperidone 4 mg and Chlorpromazine 200 mg. On the fourthday of his hospitalization, he presented a Quincke edema without laryngeal impairment. We stopped chlorpromazine and eliminated the other causes of this edema, resulting in a gradual regression of symptomatology. The second patient was put on chlorpromazine. On the second day, the patient presented a Quincke edema without laryngeal impairment. Somatic examination and biological exploration did not reveal any abnormalities. We stopped chlorpromazine and put the patient on Dexamethasone 3 days in a row resulting in a good outcome.

Conclusions

These two cases identified a Quincke-edema reaction associated with the use of Chlorpromazine, this complication can lead to life-threatening manifestations and warrants greater awareness of the potential for recurrence.

Electroconvulsive therapy in the psychiatric depatement of the Mahdia EPS over two years

Introduction

The electroconvulsive therapy is an ancient therapeutic technique used in the traitment of certain psychiatric diseases.

Objectives

discuss the technical aspects, indications, therapeutic response and tolerance of ECT

Methods

This was a descriptive retrospective study that interested all patients who were hospitalized in the psychiatric department of the Mahdia University Hospital in 2017 and 2018 and were benefited from ECT sessions

Results

The number of patients who received ECT was 34, representing 4.33% of patients, 25 men and 9 women with an average age of 39, the number of ECT sessions was 785. The major diagnosis was bipolar disorder in 47,1% of patients, followed by schizophrenia in 35,3% and major depressive disorder in 14,7 %. Resistance to treatment and major suicidal risk were the main indications. All sessions were performed in a bilateral temporal mode. the initial energy delivered varied between 50 and 101 millicoulombs. The duration of the crise obtained was predominantly between 21 and 30 seconds. The average number of sessions during the attack phase was 13.88, whereas it was 2.5 sessions during the consolidation phase. The mean scores of the psychometric evaluations showed a marked improvement, especially in the mania scores (65.89%) and the beck depression inventory (63.55%). Only four incidents were reported in all patients. Only five patients (14,7%) had side effects and the most marked effect was anterograde amnesia.

Conclusions

Mental health programs in Tunisia should promote the generalization of this method throughout the Tunisian territory, given the efficacy demonstrated in mood disorder, several psychoses and other psychiatric pathologie.

Depression in people with multiple sclerosis

Introduction

Depression is the most common syndrome associated with Multiple Sclerosis (MS) with a high prevalence during a lifetime.

Objectives

To assess the prevalence of depression in patients treated in neurology for MS.

Methods

We performed a retrospective study on 17 patients diagnosed with MS and confirmed with the criteria of Mac Donalds 2010 with a follow-up in the neurology department of the EPS Mahdia for a period of nine years (2006–2014), then addressed to a psychiatric consultation for depression.

Results

In total 17 patients were hospitalised in the neurology department during the study. Ages ranged from 20 to 39 years with an average of 33 years. The average course of the disorder is 5 years. We objectified a female predominance with 82%, a professional activity was found in 76% of patients. The comorbidities found are mainly hypertension, diabetes and asthma, respectively in 11%, 5% and 5%. Depression was clinically confirmed in 9 patients, that to say, 52% of our sample addressed in the psychiatric consultation, whose 6 received an antidepressant (fluoxetine) and 3 received paroxetine. An anxiolytic was given to the half of these patients.

Conclusion

The association between MS and depression would, therefore, be neither fortuitous nor only related to non-specific factors of any chronic disease. Specifying the relative share of these explanatory factors is probably one of the challenges for future researches in this area.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Schizoaffective disorder and life quality

Introduction

schizoaffective disorder is a nosographic entity characterized by a combination of symptoms of schizophrenia with mood episodes. The fact that its diagnosis is difficult, and often oscillates between schizophrenia and bipolar disorder raises the problem of its care and the outcome of patients who suffers from it.

Objective

To evaluate the quality of life of treated patients with schizoaffective disorder.

Materials and methods

This is a cross-sectional study realized at the psychiatric consultation of Mahdia hospital during a 6month period. Data were collected from patients and from their medical records using a predefined questionnaire.

Results

A total of 52 patients were included, the average age was 38 years. The majority of patients (63.5%) were unemployed. The use of psychoactive substances was noted in 63.5% of patients. Multiple linear regression analysis allowed us to find that 12 factors were more significantly associated with impaired quality of life which were, in descending order of importance: the EAS score > 39, the EGF score ≤ 70, the null or partial adherence, the presence of side effects seriously affecting daily activity, the depressive subtype, the lack of employment, the socio-economic level, the lack of stable budgetary resources, an age > 60years, the widowed and divorced marital status, the PANSS score (≥ 45) and negative symptomatology (PANSS).

Conclusion

The diagnosis of schizoaffective disorder has a triple relevance: clinical, prognostic and therapeutic. Identifying a schizoaffective disorder and the risk factors that may affect the quality of life provides a significant practical impact for the patient's benefit.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Major depressive disorder: Recurrence risk factors

Introduction

Despite the frequency and the severity of depressive episodes, the major depressive disorder (MDD) is today inadequately diagnosed and treated, and the risk factors for its recurrence are not well elaborated. The objectives of this study were to describe the sociodemographic, clinical evolutionary and therapeutic features of this disorder and to identify the factors involved in the risk of its recurrence.

Methods

This is a retrospective, descriptive and analytical study, involving 150 patients with MDD, isolated episode or recurrent major depressive disorder (RMDD) with a follow-up for at least two years. Data collection was performed using two pre-established questionnaires for the MDD isolated episode and for the RMDD respectively with 51 and 92 items. A study of the recurrence period was performed by Kaplan–Meier method. The Cox-test was used to determine the survival curves and to look for the risk factors significantly associated with MDD recurrence.

Results

A total of 150 patients was gathered, predominantly female, married and from urban origin. The average age at the beginning of the disorder was 35 years. The recurrence period was 109 months and the factors associated with recurrence were the early age of onset of the disorder, family history of mood disorders, the severity of MDE index, residual symptoms and discontinuation of treatment.

Conclusion

The study of factors involved in MDD recurrence is of a particular importance since it allows not only to know the group of patients at risk but also to improve their therapeutic care.

Disclosure of interest

The authors have not supplied their declaration of competing interest.