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The relationships between sexual dysfunctions, psychopathology and treatment in patients with schizophrenia
- A. Bejar, N. Smaoui, R. Feki, I. Gassara, S. Omri, N. Charfi, J. Ben Thabet, L. Zouari, M. Maalej Bouali, M. Maalej
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S132
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Introduction
Sexual dysfunctions (SD) are common in patients with schizophrenia. The link between schizophrenia and sexuality is complex. Studies have shown that SD can be linked to the side effects of antipsychotic medications, but also to symptoms of illness.
ObjectivesTo identify the clinical and therapeutic factors associated with SD in outpatients with schizophrenia.
MethodsA cross-sectional and analytical study was conducted between Mars and September 2019. It included 53 outpatients with schizophrenia in clinical remission for at least two months.
We used the Positive and Negative Symptom Scale (PANSS) to assess clinical symptoms and the Arizona Sexual Experiences Scale (ASEX) to assess sexual functioning.
ResultsThe average age was 42.28 ±10.49 years old. The sex ratio was 3.81. The mean age of onset was 27.09±5,46 years. The mean duration of illness was 18.11±9.29 years. First-generation antipsychotics were prescribed in 77.4% of cases, while second-generation antipsychotics were prescribed in 39.6% of cases.
The average ASEX score was 19.77±5.99, and 67.9% of participants had at least one SD. the analytical study revealed significantly higher average scores for the PANSS-negative subscale (p=0.006) and the PANSS total score (p=0.04) in patients with SD. SD correlated with first-generation antipsychotic treatments (p=0.02).
ConclusionsOur results show that SD are frequent in patients with schizophrenia and that they are related to the severity of the symptoms, in particular the negative symptoms of illness, and the prescription of first-generation antipsychotics.
Disclosure of InterestNone Declared
Sexual dysfunction among pregnant Tunisian women
- A. Zouari, F. Guermazi, B. Amamou, R. Masmoudi, I. Feki, I. Baati, J. Masmoudi, L. Gaha
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S643
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Introduction
Sexual life is affected by physiological, psychological and social changes during pregnancy. Therefore, pregnancy is considered as a stressor affecting sexual lives of women and as a period when sexual dysfunctions can easly appear.
ObjectivesThe aim of our study was to explore the prevalence of sexual dysfunctions among pregnant womens.
Methodswe conducted a cross-sectional and descriptive study among Tunisian pregnant women. The questionnaire used was performed with Google Forms and posted on social media. It contained questions concerning personal and sociodemographic aspects and questions concerning obstetrical data such as parity, gestational age and complications during the current pregnancy. We used the Female Sexual Function Index to examine Sexual dysfunction. Total scores of 26.55 or less characterize deficiency of female sexual function.
ResultsFifteen women (44.1%) were primiparous and 19 (55.9%) were multiparous with 29% being in the first trimester, 27% in the second, and 44% in the third. Half had at least one child. Most of participants reported better satisfaction with their sexuality before pregnancy than during pregnancy (76.5% vs. 26.5%). This difference in satisfaction was statistically significant (p=0.004). A sexual dysfunction was found in 70.6% of cases and we did not identify any correlations between the presence of sexual dysfunction and sociodemographic or clinical data of the current pregnancy.
ConclusionsThe prevalence of sexual dysfunction among Tunisian pregnant women was high and not related tosocio-demographic characteristics.
Disclosure of InterestNone Declared
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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- 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
Criminological characteristics in women
- R. Ouali, N. Smaoui, A. Chamseddine, I. Gassara, R. Feki, M. Maalej, N. Charfi, J. Ben Thabet, L. Zouari, O. Sana, M. Maalej
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S885
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Introduction
The female criminal phenomenon will gradually become a reality and the participation of women in criminogenic currents is clearly increasing .Tunisian society, like all other societies, has not escaped this phenomenon.
ObjectivesOur objective is to describe the criminological and forensic characteristics of the expertized women.
MethodsThis study was retrospective and descriptive. It focused on the files of criminal psychiatric expertise carried out in the psychiatry department "C" at the Hedi Chaker hospital in Sfax and involved female accused subjects.
We have collected all the criminal expert reports carried out over a period of 24 years (from January 1, 1998 to December 31, 2021).
ResultsOut of a total of 864 criminal psychiatric expert opinions carried out over a period of 24 years, we collected 56 expert opinions in which the accused was a woman (6.48%).
Among the offenses committed, we identified 31 offenses against persons (55.4%) and 25 offenses against property (44.6%). Homicides represent 37.5% of offenses (N=21) and in second place are thefts (23.2%).
Twenty-seven offenses took place at the victim’s home (48.2%) and 13 (23.2%) at the accused’s home.
The offense was committed under the influence of a psychic disturbance (disorganization, delusional syndrome, psychic excitation, hallucinatory injunctions, cognitive deficit) in 30.4% of cases.
Dementia in the legal sense was retained in 30.4% of cases.
ConclusionsGiven the frequency of mental illness among accused women, it would be interesting to optimize their psychiatric care in order to fight against violent acts.
Disclosure of InterestNone Declared
Thrombotic complications of treatment with antipsychotic drugs : risk factors
- W. Abid, F. Chérif, N. Bouattour, R. Masmoudi, F. Guermazi, I. Feki, R. Sallemi, J. Masmoudi
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S590
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Introduction
Antipsychotic agents (AP) are widely used drugs to treat psychotic symptoms. For decades, some studies suggested that there is a relationship between using (AP) and the risk of venous thromboembolism (VTE) and pulmonary embolism (PE). The causality of this association, its risk factors, and its implications for clinical practice have not been fully elucidated.
ObjectivesWe undertook a systematic literature review to evaluate the evidence for an association between antipsychotic medication and venous thromboembolic events (VTE) and to identify risk factors for these adverse effects.
MethodsTo identify relevant studies, we searched the PubMed, Science Direct databases up using the following keywords « pulmonary embolism », « venous thromboembolism » « antipsychotics agents ». We also searched the reference lists relevant articles for related studies.
ResultsTwelve articles are included in this analysis and indicate an elevated risk of VTE in antipsychotic drug users. The results showed that compared with non-users, current AP users have significantly increased risks of VTE. The risk of venous thrombosis in obese people was higher than that in overweight people, patients not less than 65 years old had an increased risk compared with younger patients . In addition, women taking antipsychotics had a higher risk of pulmonary embolism than men. The other factors that increased risk were use of second-generation antipsychotics and antipsychotic polytherapy. The highest risk was noted in the first 3 months of treatment. Data also suggested a dose-dependent increase in the risk of thrombotic complications. For individual drugs, increased risk of VTE and PE was observed in taking clozapine , haloperidol, risperidone and olanzapine. Clozapine was associated with the highest risk. However, careful interpretation is needed because of high heterogeneity among studies and scarce data.
ConclusionsThe use of antipsychotics will increase the risk of venous thromboembolism and pulmonary embolism, which will be affected by AP and patient characteristics.
Disclosure of InterestNone Declared
Socio-demographic characteristics and clinical profile among suicide attempters
- R. Ouali, R. Masmoudi, F. Guermazi, F. cherif, I. Feki, O. Chakroun, E. Derbel, R. sellami, J. Masmoudi, N. Rekik
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S874
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Introduction
Suicide is a real public health problem. Like many other countries, Tunisia seems to be experiencing an amplification of the phenomenon. Suicide attempts are much more frequent and are estimated to be around 20 times the number of suicides
ObjectivesThe objective was to describe the sociodemographic characteristics and clinical profile of suicide attempters in patients hospitalized in the emergency room.
MethodsThis study was carried out with patients admitted to vital emergencies for attempted suicide over a period of 6 months.
A pre-made questionnaire was used to collect sociodemographic and clinical data. We used the SIS “suicide intention scale” to assess the intent of the suicide attempt and the PHQ9 “PATIENT HEALTH QUESTIONNAIRE” to assess the presence and severity of depressive symptoms.
We excluded Patients with major cognitive impairment, which prevents understanding of the questionnaire.
ResultsOur sample consisted of 101 patients. Of the participants, 69.3% were female. Their age varied between 18 and 65 years with an average age of 30.93 years. The socioeconomic level was low in 23.8% of cases. The level of education did not exceed secondary school for 91% of suicides. Almost half of suicide attempters (45%) have been professionally inactive. Participants included in our study were single in 51.5% of cases. Participants had a family history of attempted suicide in 15% of cases. Prior psychiatric follow-up was found in 34% of suicides attempts. More than a third (36.6%) of participants had moderate to severe depression according to the results of the PHQ-9. Recurrences concerned 44% of suicides attempt in our survey and the average number of previous suicides attempts was 3.9. Suicidal intent was rated strong in 47% of suicides attempts .
ConclusionsSuicidal behavior is one of the leading causes of death and disability worldwide. In our study, more than 1 in 3 suicide attempters had depression. Further research is needed to identify suicide risk factors and to examine the relationship between the presence of mental illness and suicidal attempt
Disclosure of InterestNone Declared
Combination therapy for bipolar disorder : What to combine and which cautions to take ?
- M. Gardabbou, M. Maalej, R. Feki, I. Gassara, N. Smaoui, L. Zouari, J. Ben Thabet, S. Omri, N. Charfi, M. Maalej
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S83
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Introduction
Bipolar disorder is one of the leading causes of disability among young adults. Given the heterogeneity of the disorder and the complexity of its etiopathogenesis, combination therapy is often considered as part of the treatment regimen.
ObjectivesTo assess the place of non-pharmacological interventions as a co-adjuvant to pharmacological treatment, to discuss the role of polytherapy in the management of bipolar disorder and to underline the drug to drug interactions to keep in mind.
MethodsWe present a critical review of recent international recommendations for the management of bipolar disorder. Two main evidence-based guidelines were included: The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders and The 2018 Canadian Network for Mood and Anxiety Treatment.
ResultsAccording to guidelines, the outcomes in bipolar disorder are improved when medication is combined with evidence-based psychological treatment and lifestyle changes. As to polytherapy, it is often recommended to maximise the treatment efficacy. Studies have shown that combination treatments tend to work faster and more effectively than monotherapy especially in episodes with higher index severity. For the management of agitation, an adjuctive treatment by Haloperidol with midazolam or promethazine can be prescribed. In acute mania, combination therapy with quetiapine, aripiprazole, risperidone or asenapine and lithium or divalproex is recommended as first-line treatment options. Combinations of mood-stabilizing drugs may be more often necessary when rapid cycling is present. In a manic episode with mixed features the use of divalproex with an atypical antipyshcotic is recommended. In bipolar I depression, lurasidone and lamotrigine are often used as adjunctive therapies. When anxious distress is present, the combination of olanzapine and fluoxetine has shown to be effective. In a depression with atypical features, tranylcypromine (IMAO) can be added to lithium, divalproex or a second generation antipsychotic for a better result. Adjunctive treatment of olanzapine with fluoxetine may be necessary in a depression with mixed features. However, in bipolar II depression and for maintenance treatment no adjunctive therapies are recommended. Finally, it is important to consider the adverse effects resulting from polytherapy. Using lithium as an adjunctive medication may increase the risk of tremor and acute dystonic reactions and can be a contributing factor for neuroleptic malignant syndrome, whereas divalproex can be an inducer or an inhibitor of some atypical antipsychotics.
ConclusionsRational polytherapy allows better and faster control over symptoms of bipolar disorder and should be considered after a detailed discussion of risks and benefits.
Disclosure of InterestNone Declared
Role of Body Mass Index on Perceived Stress in Medical Students
- R. Jbir, R. Masmoudi, M. Abdelkefi, S. Hentati, I. Feki, R. Sellami, J. Masmoudi
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S907
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Introduction
The study period to become a medical professional is notoriously stressful This label can be attributed to various factors like long tedious training, social expectations, long work hours, high liability, sleep deprivation, and a constant lack of time to relaxin this vulnerable area, physical appearance, either weight loss or obesity, can affect the mental health of these young people.
ObjectivesTo determine the role of body mass index (BMI) on the levels of perceived stress in medical students.
MethodsOur study was descriptive and analytical cross-sectional, carried out with medical students in the faculty of medicine of sfax (Tunisia) during October 2022.
An anonymous survey was asked to the students.
Data collection was done by a self-administered questionnaire via Google Forms administered in the students’ Facebook groups. The questionnaire was composed of a part for the collection of socio-demographic data and a psychometric scale:
- Cohen’s Perceived Stress Scale (PSS) to determine the level of stress
ResultsA total of 95 responses was collected.The average age of our sample was 25.8±3.4 with female predominance (78,9%).
The half of the population (53,7%) were residents in medicine.
The majority of them (88,4%) had an average socio-economic level and singles (83,2%) .
81,1% had a stressor related to studies in 50,5%,to family in 40 % and financial in 9,5%.
Tobacco consumption were reported by 14,7 % .
A psychiatric history was reported by 17.9% of the students, 76.5% of whom are anxiety disorders.
27.4% tried to control their weight. Several methods of weight control were used, the most frequent (65.4%) was diet, none resorted to laxatives and 8.4% consulted a nutritionist.
Almost half of the population (57,9%) slept between 5 and 7 hours.
The average body mass index was 23.64 kg/m2 (SD=3.53).
According to PSS scores, 21.1% of students had severe level of stress, 69.5% had moderate stress level while 9.5% had low level of stress.
Those followed in psychiatry had a higher level of stress (p<10-3), especially those with anxiety disorder (p=0,02).
The students pressed for weight control were more stressed than their peers.
The levels of stress were higher among underweight students (BMI < 18.5) and overweight students (BMI >25) without significantly correlations.
ConclusionsThe current study revealed that medical students, especially underweight or overweight students, are more susceptible to develop stress symptoms,that is why psychic support must be available on their university.
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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- 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
Relationship between orthorexia nervosa and self-esteem in Tunisian medical students
- M. Abdelkefi, R. Masmoudi, R. Jbir, F. Cherif, I. Feki, R. Sellami, J. Masmoudi
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S851-S852
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Introduction
The effect of self-esteem in eating disorders has been investigated in several studies, but it’s still not extensively investigated in orthorexia nervosa.
ObjectivesTo study the prevalence and factors associated with orthorexic eating behaviors in medical students and it’s relation with self-esteem.
MethodsA cross-sectional study was conducted through an online survey among medical students of the faculty of medicine of Sfax (Tunisia). Participants completed an anonymous self-administered questionnaire. We collected their sociodemographic and clinical data. Orthorexia nervosa (ON) was assessed using the self-reported scale, ORTO-15. We used the Rosenberg’s self-esteem scale to assess self-esteem.
ResultsNinety five medical students completed the survey. The mean age was 25.8±3.4 years and the sex ratio (F/M) was 3.75. The average body mass index was 23.64±3.53 kg /m2.
Fifty-eight percent of the students (58%) reported that they were dissatisfied with their eating habits, and 27.4% tried to control their weight. Several methods of weight control were used, the most frequent (65.4%) were diet and physical exercise, none resorted to laxatives and 8.4% consulted a nutritionist.
Self-esteem was very low in 27.1% and low in 34.7% of the students.
Overall, the prevalence of orthorexia among our participants was 52.6%. The mean score of the ORTO-15 was 39.19±4.48.
Orthorexia was significantly correlated with the use of weight control measures (p=0.035) and physical activity (p=0.042).
Students with low self-esteem had higher tendency for orthorexia but with no significant correlation.
ConclusionsOur study supports a non-negligible frequency of orthorexic behaviors in medical students but future studies are needed to assess the direct effect of self-esteem on orthorexia.
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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- 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
Psychiatric Adverse Effects of treatement with Corticosteroids: A Tunisian case report
- N. Boussaid, F. Guermazi, W. Abid, R. Masmoudi, I. Feki, I. Baati, J. Masmoudi
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S958
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Introduction
Corticosteroids are certainly an efficacious treatment for several inflammatory and immunologic disorders. However, their abuse can lead to dangerous consequences such as psychiatric complications. Physicians and Psychiatrists should cooperate to treat and prevent, if possible, the deleterious adverse psychiatric effects of corticosteroids.
Objectivesto describe a patient whose psychotic symptoms occured within 2 weeks of starting corticosteroid abuse, to review the literature and to suggest treatment.
MethodsTo present a case of a female young patient suffering from corticosteroid-induced psychosis due to corticosteroid abuse and review case report data published during the past quarter-century on adverse corticosteroid-induced psychiatric effects.
ResultsThe patient was investigated to exclude other causes of her psychosis and she was treated with chlorpromazine and Risperidone. Numerous cases investigating these psychiatric corticosteroid-induced symptoms were identified. Data on incidence, drug dose, onset of symptoms, course of illness and treatment were arranged.
ConclusionsCorticosteroid abuse should be put in the spotlight especially for young Tunisian females desiring to look plump. This misjudged abuse may have sever psychiatric complications. Thus we should establish strategies of prevention and cure to these psychiatric complications
Disclosure of InterestNone Declared
Negative attitudes and lack of Knowledge towards mental health problems
- N. Bouattour, F. Cherif, W. Abid, F. Guermazi, R. Massmoudi, S. Hentati, R. Sellami, I. Feki, I. Baati, J. Massmoudi
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1122
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Introduction
Negative thoughts towards mental illness are a global problem for health care professionals. Mainly it leads to late help seeking which aggravates the prognosis of the problem, denial of this situation, refusing long term medication etc.…
ObjectivesWe aim to identify the determinants leading to negative attitudes towards psychiatric problems among medical students.
MethodsThis is a descriptive and analytical cross-sectional study conducted at the Faculty of Medicine of Sfax through an anonymous questionnaire via google Forms. The degree of stigmatization was evaluated by the score « The Attribution Questionnaires AQ-27 ».
ResultsOne hundred and seven students completed the questionnaires. The Sex-ratio was 0.30 (M/F). The percentage of first- and second-year students was 24.42%, third to 6th year students was 34.57% and residents was 41.01%. Students with a personal history of psychiatric disorders presented 45.8% of our population and those with a family history of mental health problems 40.2%. Medical students who studied psychiatry as a discipline and students who had internship in the psychiatry department (third to 6th year students and residents) had lower scores of the Attribution Questionnaires AQ-27 (p=0,003 and p=0,002 respectively). Sixty per cent of the students reported that spreading listening cells when needed, media coverage of mental illness and campaigns of awareness can help us reduce mental disease’s related stigma.
ConclusionsTo conclude, in order to lower rates of stigmatization of mentally sick people, spreading awareness among medical students can be an important tool in order to understand this situation and to provide a better health care.
Disclosure of InterestNone Declared
Anxiety and depression among patients with spondyloarthritis
- A. Feki, Y. Mejdoub, I. Mnif, I. Sellami, Z. Gassara, S. Bendejemaa, M. Ezzeddine, M. H. Kallel, H. Fourati, R. Akrout, M. L. Masmoudi, S. Yaiich, S. Baklouti
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S834
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Introduction
Ankylosing spondylitis (AS) is an inflammatory rheumatic disease characterized by spinal and/or peripheral involvement, enthesitis, dactylitis, and several extra-articular manifestations. Chronic inflammation often leads to reduced spinal mobility and functional disability. The frequency of psychological problems has increased in AS patients.
ObjectivesThe objective of this study was to determine the prevalence of symptoms of anxiety and depression among AS patients and explore the underlying associated factors.
MethodsThe Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and other clinical measures were collected during the clinical trial. We evaluated also the hospital anxiety and depression scale (HADs). P values < 0.05 were considered statistically significant.
ResultsSixty-two patients with AS were included in the study. The average age was 41 years [18-65]. The diagnostic delay varied from one year to 26 years with an average of 4 years. Twenty-nine years is the average age of onset of symptoms with a standard deviation of 10 years. The mean duration of the disease was 10 ± 8 years. At baseline, the mean BASFI score was 53.9 ± 2 and BASDAI was 4.5± 2.
Clinically significant symptoms of anxiety and depression were present in 48.4% and 54.8% of patients, respectively. Depression was noted with a mean HADS depression of 10,5 ± 5,2. Anxiety was noted with a mean HADS anxiety of 11,3 ± 4,6.
In univariate analysis, anxiety was associated with the low educational level of patients (p = 0.038) and with CRP level (p= 0.041). There was a significant association between depression and anxiety (p=0.000). There was no relationship between these psychiatric disorders and disease activity, treatment modalities or functional status (p>0.05)
ConclusionsIn patients with Ankylosing spondylitis, the prevalence of risk of mental disorders is high.
Anxiety and depression are common in AS and even alter the quality of life.
Patients should be regularly screened for these disorders.
Disclosure of InterestNone Declared
Combination therapy in patients with acute bipolar mania
- M. Gardabbou, R. Feki, I. Gassara, N. Smaoui, S. Omri, M. Maalej Bouali, N. Charfi, L. Zouari, J. Ben Thabet, M. Maalej
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S704-S705
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Introduction
Numerous guidelines are bending the rule of monotherapy as initial treatment of acute manic episodes and suggest the importance of polytherapy in maximising the treatment efficacy.
ObjectivesTo assess the polytherapy used in the management of acute manic episodes and the degree of conformity of our prescriptions with international guidelines.
MethodsA retrospective study was carried out for descriptive purposes, targeting the drugs prescribed among patients admitted for the first time for a manic episode within the psychiatry « C » department of Sfax, Tunisia between 2019 and 2022. Patients who received ambulatory care prior to the current episode were excluded.
ResultsOur study included 50 male inpatients, with a median age of 31.8 years (min=18, max=62) at the moment of their hospitalisation. Nearly two thirds were single, 82% didn’t get postsecondary education and 65.3% had a profession. The majority (73.5%) belonged to upper-middle class and 67.3% had social security. A quarter of the patients suffered from substance abuse and 14% had a criminal record. Around 89.8% individuals presented a manic episode with psychotic features. The symptoms included mainly heteroaggressiveness in three quarters of cases, agitation in 77.1% and insomnia 76.1%. Insight was good in 79.6% of cases. Polytherapy was preferred to monotherapy in 86% of cases. Bitherapy was used in 74% of cases and tritherapy in only 12%. The most frequent combination was a mood stabilizer plus a second-generation antipsychotic (46%), risperidone plus sodium valproate being used in 34% of cases.
ConclusionsOverall, our prescriptions were in line with the international guidelines and the choice of polytherapy was well argued. Combination therapy is the suggested way to increase treatment efficacy, however, vigilance is required because of the increased risk of side effects.
Disclosure of InterestNone Declared
Coherence Abnormalities in Tunisian Schizophrenic patients: case-control study.
- M. Mnif, L. Triki, N. Smaoui, D. Jardak, R. Feki, G. Imen, S. Omri, N. Charfi, J. Ben Thabeut, L. Zouari, M. Maalej, K. Masmoudi, M. Maalej
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S1074-S1075
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Introduction
Resting state electroencephalogram (EEG) abnormalities in schizophrenia (SCZ) suggest alterations in neural oscillatory activity. However, few studies have examined EEG coherence in this population.
ObjectivesTherefore, this study investigated whether these electrophysiological characteristics differentiate schizophrenic patients from healthy controls.
MethodsThis was a cross-sectional, descriptive, and analytical case-control study. The selected patients were followed for SCZ at the psychiatry "C" department at the Hedi Chaker hospital of Sfax. Patients were assessed by the Positive and Negative Schizophrenia scale (PANSS) and the Treatment Adherence Scale (MARS). They all benefited from an EEG at the service of functional explorations in Sfax. Student’s test was performed to compare the coherence values between groups.
ResultsThirty men including 15 schizophrenic patients and 15 age- and sex-matched controls were included. The average age was 40 years ±12.72 years for schizophrenics and 47.93 ± 15.61 years for healthy controls. Schizophrenics had an average PANSS of 64.6±22.7, and an average MARS score of 5.8 ± 3.09.
In terms of intra-hemispheric coherence, Schizophrenic patients generally exhibited higher coherence at the Delta band compared to healthy controls. In contrast, schizophrenic patients appeared to have decreased intra-hemispheric connectivity for other frequency bands, particularly between the frontal and other brain lobes bilaterally.
ConclusionsIn this study, we found that the schizophrenic patients had significantly higher coherence in the delta frequency band compared to the normal controls. These findings suggest that EEG can be a sensitive measure for diagnosing SCZ.
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
Exploring the prevalence and factors associated with fatigue and quality of life in patients with Ankylosing Spondylitis
- A. Feki, Y. Mejdoub, I. Sellami, I. Mnif, Z. Gassara, S. Bendjmaa, M. Ezzeddine, M. H. Kallel, H. Fourati, R. Akrout, M. L. Masmoudi, S. Yaiich, S. Baklouti
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S953
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Introduction
Ankylosing spondylitis (AS) is a chronic inflammatory disease that primarily affects the axial skeleton and may alter the quality of life of patients. Fatigue, one of the major clinical features of rheumatic diseases is a major clinical feature of AS, yet it has often been ignored in clinical practice.
ObjectivesThis study aims to evaluate the quality of life in AS and to address the prevalence of fatigue in this disease and its associated factors.
MethodsWe conducted a cross-sectional study among AS patients. The Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), The Ankylosing Spondylitis Disease Activity Score (ASDAS) and other clinical measures were collected during the study.
We evaluated the psychometric characteristics of the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue subscale) and the AS Quality of Life questionnaire (ASQoL). P values < 0.05 were considered statistically significant.
ResultsSixty-two patients with AS were included in the study. The average age was 41 years [18-65]. The diagnostic delay was between 1 year and 26 years with an average of 4 years. The mean duration of the disease was 10 ± 8 years. The erythrocyte sedimentation rate (ESR) was between 2 and 50 mm/hour and the C reactive protein (CRP) level was between 1 and 45 mg/l. At baseline, the mean BASFI score was 53.9 ± 2, the mean BASDAI score was 4.5± 2 and the mean ASDAS score was 3.9 ± 2.
The mean FACIT-Fatigue score observed in these patients with AS was 20± 10,8 and the mean ASQoL score was 12,8 ± 4,8. Severe fatigue was observed in 43.5 % of patients and poor quality of life was detected in 62.9% of patients.
In univariate analysis, fatigue was associated with the low educational level of patients (p = 0.011), with sacroiliitis stage (p= 0.018) and with ASQoL score (p=0.000). ASQol was also associated with a high level of ESR (p=0.01). There was no relationship between FACIT or ASQoL and disease activity or functional status (p>0.05)
ConclusionsThis study confirms that poor QoL and fatigue were frequent in patients with AS which can expose them to the risk of psychiatric disorders like anxiety and depression. Therefore, patients suffering from AS should be regularly evaluated for these disorders.
Disclosure of InterestNone Declared
Homosexual Obsessive–compulsive Disorder Comorbid with Bipolar Disorder: A Rare Case report
- M. Gardabbou, R. Feki, N. Smaoui, I. Gassara, S. Omri, M. Maalej Bouali, N. Charfi, J. Ben Thabet, L. Zouari, M. Maalej
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S927-S928
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Introduction
While bipolar disorder–obsessive compulsive disorder overlap is quite common, sexuality remains a largely unexplored area of this clinical entity.
ObjectivesIllustrate through a clinical vignette the case of a patient with diagnosed homosexual obsessive –compulsive disorder (OCD) comorbid with bipolar disorder (BD).
MethodsThe clinical case report was prepared through the review of the patient´s clinical record.
ResultsWe report a rare case of a 22 year-old man who was diagnosed with Homosexual Obsessive–compulsive Disorder comorbid with Bipolar Disorder, admitted to our department for a suicide attempt. He came from a religious and conservative background and suffered from intrusive, unwanted mental images of homosexual behaviour since the age of 17. He presented periods of remission from his obsessive thoughts, while showing signs of elevated mood, talkativeness, restlessness, agitation and hyperactivity that would last for a few days, with recrudescence of obsessive and depressive symptoms again afterwards. The present case showed a significant reduction in depressive symptoms and in the impact of his obsessive intrusive thoughts after prescription of Risperidone and Sodium Valproate along with Exposure and Response Prevention Therapy conducted over a period of 6 weeks.
ConclusionsThe homosexual OCD comorbid with bipolar disorder can cause important distress and impairment and severely impact a person’s life in multifaceted ways. Correct diagnosis, adequate medication and psychotherapy provide the effective treatment.
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