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Risk assessment of agressive behavior in schizophrenia and schizoaffective disorder : a cross-sectional study
- A. Mellouli, N. Charfi, I. Gassara, N. Smaoui, S. Omri, R. Feki, L. Zouari, M. Maâlej, J. Ben Thabet, M. Maâlej Bouali
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S1047-S1048
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Introduction
Psychotic disorders have been consistently associated with aggressive behaviors. Psychiatrists are frequently asked to perform assessment regarding potentially aggressive patients. Thus, many psychometric instruments can be useful for identifying the risk of violence and thereby offering appropriate treatment for these individuals.
ObjectivesThe aims of this study were to assess the risk of agressive behavior in inpatients with schizophrenia or schizoaffective disorder and to determine its correlates.
MethodsUsing face-to-face interviews, inpatients diagnosed with schizophrenia or schizoaffective disorder, in psychiatric department of the University Hospital in Sfax (Tunisia) were included in this cross-sectional, descriptive and analytical study, carried out between novembre 2020 and octobre 2022.
The modified overt aggression scale (MOAS) and historical clinical risk management-20 (HCR-20) questionnaire were used for data acquisition. The HCR-20 score of 20 was used as threshold to divide the sample to violent patients (scoring>20) and non-violent patients (scoring ≤ 20).
ResultsThe sample consisted of 60 male inpatients. The mean age was 38.23± 10.37 years.
In our sample, 68.3% were single, 35% didn’t reach the secondary educational level, 16.7% used psychoactive substance(s), 35% had prior criminal record, 30% had a history of suicidal attempt and 81.7% had previous hospitalization.
The mean score of MOAS was 13.08±8.19. The mean total HCR-20 score was 19.25±5.26. The Historical, Clinical and Risk Management subscales showed mean scores of 8.33±2.96, 5.62±1.89, and 5.28±2.42, respectively.
The violent patients represented 45% of the sample.
The mean scores of the items H3, H10, C1, C2, C4 and R5 of HCR-20 were respectively : 1.33±0.79, 1.20±0.77, 1.22±0.88, 0.38±0.71, 1.30±0.64 and 1.28±0.73.
There was no statistical difference between the two groups in socio-demographic factors.
A history of suicidal attempts was significantly more common in the group of violent patients (p=0.029).
Regarding the HCR subscales, H3 score (relationship instability) and H10 score (Prior supervision failure) were significantly higher among violent patients (p=0.018 and 0.003 respectively). The C1 score (lack of insight), the C2 score (negative attitudes) and the C4 score (impulsivity) were also significantly higher among violent patients (p=0.016, 0.009 and 0.005 rescpectively).
The item R5 (stress) of the risk management subscale was significantly higher in the group of violent patients (p=0.003).
The total MOAS score detected severe agression in the nonviolent group (p=0.031).
ConclusionsOur study suggests the efficacy of HCR-20 in identifying and distinguishing between violent and nonviolent patients with schizophrenia or schizoaffective disorder. The use of such reliable instrument in clinical psychiatric settings should be encouraged.
Disclosure of InterestNone Declared
Characteristics of suicide attempts seen in emergency service
- R. Ouali, R. Masmoudi, F. Guermazi, A. Mellouli, O. Chakroun, R. Sellami, E. Derbel, I. Feki, J. Masmoudi, N. Rekik
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S865
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Introduction
The suicidal phenomenon constitutes a real public health problem not only by the human losses it causes, but also by the psychological and social problems to which it testifies.
ObjectivesThe objective was to describe suicide attempts in patients hospitalized in the emergency room.
MethodsA descriptive cross-sectional study was carried out with patients admitted to vital emergencies for attempted suicide over a period of 6 months.
We excluded Patients with major cognitive impairment, which prevents understanding of the questionnaire
A data collection sheet was used for the evaluation of the suicide attempts.
ResultsOur sample consisted of 101 suicide attempts. Using non-physical methods (drugs, caustics, pesticides, gases) was reported in 91.9% of cases and while physical methods (hanging, phlebotomy, drowning) in 8.9% of cases. Self-poisoning by medications was the most frequent (51%) method used in suicide attempt. The majority of suicide attempts were reactive (77.2%). Family or marital conflicts were the precipitating factor most mentioned (74%). The suicidal act was unpremeditated in 66% of cases. Communication of suicidal intent either verbally or in writing was reported in 34.7% of cases. The passage to the suicidal act was preceded by taking alcohol in 7% of cases and cannabis in 3% of cases. In 44.6% of cases, regret was the attitude most adopted by suicide attempters towards the act. The somatic state on admission was unstable on the cardiac level in 23% of the cases, on the respiratory level in 27% of the cases and on the neurological level in 38% of the cases
ConclusionsThe data from our study suggest that suicidal attempts were mostly unpremeditated. Clinicians should not minimize the significance of impulsive attempts, as they are associated with a similar level of lethality as premeditated attempts
Disclosure of InterestNone Declared
Caregiver burden in parents of children with neurological impairement and its relation with depression
- A. Mellouli, S. Zouari, N. Smaoui, W. Bouchaala, I. Gassara, O. Jallouli, R. Feki, S. Ben Ncir, F. Kamoun, M. Maâlej, C. Charfi Triki
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S826
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Introduction
Caregiving negatively affects the psychological and physical health of the caregivers, especially in parents of children with neurological impairement (NI).Furthermore, the behavior and demands of the patient make the caregivers encounter increased stress levels and negative thoughtsabout the future that may lead to depression in caregivers.
ObjectivesTo assess the relationship between caregiver burden and symptoms of depression in parents of children with NI.
MethodsA total of 33 caregivers of children with NI, participated in this cross-sectional, descriptive and analytical study, carried out in Child Neurology Department of the University Hospital in Sfax (Tunisia), between February and April 2021.
The Zarit-Caregiver-Burden-Scale (Zarit-CBS) and the Beck Depression Scale were administered.
ResultsThe average age of the caregivers (27 mothers and 6 fathers) was 38,33 years ± 6,53 years. Among the parents, 81,81% didn’t exceed the secondary educational level and75,75% of them had an irregular occupation.
The average age of the children (21 boys and 12 girls) was 7,58±4,29 years.Near to the half of them (51,51%) had intellectual disability.Over 54.54% of the children had a functional independence, while 21.21% required help in walking and 24.24% were unable to walk.
The intervention was based on motor rehabilitation (57,57%), adequate equipment (24,24%), ergotherapy (45,45%) and speech therapy (60,6%).After the intervention, 63,63% of children had an improvement and 30,3% had a stationary state.
The mean score of Zarit-CBS was 52,45±14,26. The caregiver burden was noted in 96,96%.
The mean score of Beck was 9,33±5,48. The depression was noted in 78,78%.
The total Zarit-CBS score had positive correlation with Beck scores (p=0.038).
ConclusionsThere is a positive relationship between the caregiver burden and depression symptoms. Thus, effort should be made to relieve caregiver burden in parents of children with NI.
Disclosure of InterestNone Declared
Aggression and its association with childhood trauma in euthymic bipolar disorder patients
- A. Mellouli, R. Masmoudi, R. Ouali, F. Guermazi, I. Feki, R. Sellami, J. Masmoudi
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S694
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Introduction
Aggression and negative behaviours are used to be present in individuals with bipolar disorder, who are sensitive to life events. Thus, many studies investigated the emergence of impulsivity and aggression in the developmental process and revealed its relationship with childhood adversities.
ObjectivesThe aim of this study was to determine the relationship between childhood trauma and aggressive behaviour in euthymic patients with bipolar disorder.
MethodsIt was a cross-sectional descriptive and analytical study involving patients diagnosed with bipolar disorder and followed in the psychiatric department at the University Hospital ofSfax (Tunisia).
All subjects completed the Childhood trauma questionnaire (CTQ) and the Buss–Perry Aggression Scale (BPAS). Euthymiawas defined as a score on the Montgomery-Åsberg Depression Rating Scale (MADRS) not higher than 14 and by a score on theYoung Mania Rating Scale (YMRS)not higher than seven.
ResultsWe included 35 patients. Their mean age was 46.69 ± 12.01 years with a sex ratio (M/F) =0.45. Most of them lived in urban areas (91.42%) and had a moderate socioeconomic level(88.57%).
The most frequent trauma type was physical neglect with 74.28%, followed by emotional abuse (42.85%), emotional neglect (42.85%), physical abuse (37.14%) and sexual abuse (31.42%).
The mean score of CTQ was 58.57 ±9.51. Theaverage total score of BPAS was 82.26 ±14.57.
The mean scores of subscales of BPAS were 25.49±4.59 for physical aggression, 13.74±3.51for verbal aggression, 19.14±6.22 for anger and 23.89±5.57 for hostility.
A statistically significant and positive correlation was determined between CTQ and BPAS (p=0.011). The score of BPAS was significantly correlated with physical abuse (p=0.003) and physical neglect (p=0.014).
ConclusionsThe relationship between CTQ and BGHA scores suggests the possibility that childhood trauma may be one determinant of aggression in patients with bipolar disorder. Considering the childhood trauma history in the evaluation of these patients may prevent their aggression and thus their psychosocial functioning.
Disclosure of InterestNone Declared
Course of bipolar disorder in patients with Childhood maltreatment
- A. Mellouli, R. Masmoudi, F. Guermazi, F. Cherif, I. Feki, R. Sellami, J. Masmoudi
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S693
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Introduction
Patients with mood disorders have the greater frequency of childhood trauma compared with the general population, and adverse childhood experiences can exert a negative impact on their clinical course. Therefore, many studies confirmed the relationship between childhood traumas and the disadvantageous features of the illness course.
ObjectivesThe aim of this study was to determine the impact of negative childhood experiences on the clinical course of bipolar disorder.
MethodsIt was a cross-sectional descriptive and analytical study involving patients diagnosed with bipolar disorder and followed in the psychiatric department at the University Hospital of Sfax (Tunisia).Personal information form and Childhood trauma questionnaire (CTQ) were used for data acquisition. Euthymia was defined as a score on the Montgomery-Åsberg Depression Rating Scale (MADRS) not higher than 14 and by a score on the Young Mania Rating Scale (YMRS) not higher than seven.
ResultsWe included 35 patients. Their mean age was 46.69 ± 12.01 years with a sex ratio (M/F)=0.45.
The average onset of bipolar disorder was 28.37±10.26 years and the average disease duration was 18.26 ± 11.55 years.
Almost the third of our population had a suicidal attempt (31.42%) and a violence history (28.57%). A family history of bipolar disorder was found in 57.14% of the patients.
The patients have been hospitalized at least once in 42.85% of cases.
Our patients have presented psychotic symptoms in 51.42% of cases and mixed characteristics in 57.14% of cases.
Emotional, physical and sexual abuse were reported by 42.85%, 37.14% , 31,42% of patients, respectively, while 74,28% and 42.85% of patients reported physical neglect and emotional neglect.
Early age at illness onset was significantly associated with total CTQ score (p=0.014) and the subtype sexual abuse (p=0.009). The presence of psychotic symptomswas significantly associated with total CTQ score (p=0.003) and emotional neglect (p=0.025). Physical neglect was associated with mixed characteristics (p=0.015). Emotional abuse was associated with a greater number of hospitalisations (p=0.023).
ConclusionsOur results suggest that childhood trauma is associated with a more severe course of bipolar illness. Clinical assessment of patients with bipolar disorder should include investigation of exposure to childhood trauma in order to determine appropriate therapeutic strategies.
Disclosure of InterestNone Declared
Predictors of caregiver burden among parents of children with neurological impairement
- A. Mellouli, S. Zouari, N. Smaoui, O. Jallouli, S. Omri, W. Bouchaala, I. Gassara, S. Ben Nsir, F. Kamoun, M. Maâlej, C. Charfi Triki
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S947-S948
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Introduction
Many neurological, sensory and behavioural deficits, are linked with significant limitations in the overall functioning not only of the child but also his/her closest family, and poses a great challenge for the primary parental caregivers.
ObjectivesTo assess the caregiver burden in parents of children with neurological impairement (NI), and itsrelated factors.
MethodsA total of33 caregivers of children with NI participated in this cross-sectional, descriptive and analytical study, carried out in Child Neurology Department of the University Hospital in Sfax (Tunisia), between February and April 2021.
The Zarit-Caregiver-Burden-Scale (Zarit-CBS) was administered.
ResultsThe average age of the caregivers (27 mothers and 6 fathers) was 38,33 ± 6,53 years. Among the parents, 17.14% had another disabled child and 30.3% had a mediocre health status. Mother caregivers constitutes the majority of caregiving (82.85%).
The average of the number of children in the family was 1.97±1.18 and the average age of the children (21 boys and 12 girls) was 7,58±4,29 years. Near to the half of them (51,51%) had intellectual disability.Over 54.54% of the children had a functional independence, while 21.21% required help in walking and 24.24% were unable to walk. The intervention was based on motor rehabilitation (57,57%), adequate equipment (24,24%), ergotherapy (45,45%) and speech therapy (60,6%).After the intervention, 63,63% of children had an improvement and 30,3% had a stationary state.
The mean score of Zarit-CBS was 52,45±14,26. The caregiver burden was noted in 96,96%.
The total Zarit-CBS score was associated with the number of children in the family (p=0.047).
There was no significant relationship between Zarit-CBS and the severity of impairement (p=0.418).
ConclusionsGiven the variety of factors affecting caregiver burden, specific interventions may promote parental caregivers’well-being, and consequently lead to improved quality of care provided to children with NI.
Disclosure of InterestNone Declared
Subsyndromal symptoms in bipolar disorder
- A. Mellouli, R. Feki, S. Omri, N. Smaoui, M. Maalej Bouali, N. Charfi, J. Ben Thabet, L. Zouari, M. Maalej
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- Journal:
- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, pp. S203-S204
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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.
ObjectivesStudy the subsyndromal symptoms in remitted patients with bipolar disorder, and their functioning repercussions.
MethodsWe 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.
ResultsThe 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).
ConclusionsOur 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.
IMPROVING WHEAT YIELDS THROUGH N FERTILIZATION IN MEDITERRANEAN TUNISIA
- C. MARIANO COSSANI, CHOKRI THABET, HAFEDH J. MELLOULI, GUSTAVO A. SLAFER
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- Experimental Agriculture / Volume 47 / Issue 3 / July 2011
- Published online by Cambridge University Press:
- 04 May 2011, pp. 459-475
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Rainfed wheat is frequently exposed to periods of water stress that generate low and variable grain yields. Field experiments (with studies in Tunisia and Morocco) carried out in the context of a European research project of co-operation with Mediterranean partner countries (WatNitMED) showed that nitrogen (N) fertilization may be a tool to increase productivity of rainfed wheat in Mediterranean environments. However, most farmers in Northern Africa do not fertilize their rainfed cereals. In the present study, we aimed to analyse whether the generally accepted positive yield response to N fertilization in rainfed Mediterranean conditions corresponds to actual advantages achieved in the fields of working farmers, attempting a further up-scaling of knowledge from field experiments to real fields. We attempted to apply research results to Tunisian working farmers’ fields by conducting a farm pilot experiment. The pilot experiment was conducted in two different regions (a low-yielding region and a relatively high-yielding region) of cereal production in Tunisia, where wheat production represents typical rainfed Mediterranean agro-ecosystems in North Africa. First, we compared the yield response to N fertilization against unfertilized conditions (a common situation for many of the farmers in North Africa), and secondly we compared what the farmers suggested as an optimal N fertilization practice in their fields against the WatNitMED's recommendation which was based on an N-fertilization scheme derived from field experiments from the European research project in Mediterranean conditions. The WatNitMED fertilization scheme suggested higher rates of fertilization than those considered optimal by farmers (on average 40 kg N ha−1 higher). Unfertilized grain yield across both locations ranged from about 1 to 3.5 Mg ha−1 (typical of farmers’ yields in the region), and fertilizing increased grain yields in most situations. Within the two alternative fertilization treatments, WatNitMED fertilization produced higher yields than the fertilization rate considered optimal by farmers. This trend was observed at the low-yielding location as well as at the high-yielding location. These responses demonstrated that fertilization in working farmers’ field conditions may be a reliable means of improving dryland wheat grain and straw yields. They also showed that rates of fertilization regarded as optimal by real farmers were below the optimum for these regions.
Une méthode tabou pour l'ordonnancement multiprocesseur avec délais de communication
- Dalila Tayachi, Philippe Chrétienne, Khaled Mellouli
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- RAIRO - Operations Research / Volume 34 / Issue 4 / October 2000
- Published online by Cambridge University Press:
- 15 August 2002, pp. 467-485
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- October 2000
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This paper deals with the problem of scheduling n tasks on m identical processors in the presence of communication delays. A new approach of modelisation by a decision graph and a resolution by a tabu search method is proposed. Initial solutions are constructed by list algorithms, and then improved by a tabu algorithm operating in two phases. The experiments carried on arbitrary graphs show the efficiency of our method and that it outperformed the principle existent heuristics.