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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
Assessment of addictive behavior in patients with schizophrenia
- M. Zbidi, W. Bouali, H. Baba, M. Kacem, S. Younes, L. Zarrouk
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1077
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Introduction
Schizophrenia, a chronic and complex psychiatric pathology, can be isolated. However, it may have other comorbidities and thus be accompanied by addictive behaviors complicating their management.
Objectivesto estimate the prevalence and identify the characteristics of addictive behavior among patients with schizophrenia.
MethodsA retrospective study of 151 patients with schizophrenia and hospitalized in the psychiatry department of the Taher Sfar university hospital in Mahdia from January 2017 to December 2021.
ResultsThe mean age of the patients was 39.8 ± 11.23 years with a predominance of age group 36-45 years (38.4%). All of the patients were males . Three quarters of patients (75.5%) were users of psychoactive substances (PSA): nearly three quarters (72.8%) dependent on tobacco, more than a third (39.7%) dependent on alcohol, more a quarter (29.1%) dependent on cannabis and almost a quarter (26.5%) dependent on other SPA. In more than half of the cases (54.4%), the age at which SPA consumption began was between 16 and 25. SPA use preceded the onset of schizophrenia in 62.3% of case. The relationship with the entourage was marked by hetero-aggressiveness in 77.5% of the patients, a withdrawal from the entourage for 16.6% of the patients and a conflict for 5.3% of the patients. The impact on the relationship with oneself was marked by self-aggressiveness in 18.5% of patients. Regarding professional impact, three quarters of patients (76.1%) had to stop working. The majority of patients (84.1%) continued their usual treatment, while 15.2% of patients stopped it. In only one patient increased doses were necessary.
ConclusionsSubjects suffering from schizophrenia are particularly vulnerable to addictions, mainly to tobacco and alcohol. They are therefore a group at greater risk of harmful effects of psychoactive substances and at worsening the clinical course of their psychiatric illness. Screening and treatment measures their addictive behaviors early on, even before schizophrenia sets in, should be offered.
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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- 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
Socio-demographic, clinical and therapeutic features of patients treated for schizoaffective disorder using cannabis
- W. Bouali, W. Haouari, S. Brahim, N. Faouel, L. Zarrouk
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S679
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Introduction
Psychotic disorders were formerly associated with cannabis use. It could accelerate the course of the illness and thus, constitutes a severity factor in terms of prognosis.
ObjectivesTo define the socio-demographic, clinical and therapeutic profiles of patients suffering from schizoaffective disorder (ASD) and who are consuming cannabis.
MethodsA retrospective study of 16 patients diagnosed with ASD, who were hospitalized at the psychiatric department of Tahar Sfar Mahdia’s hospital, and whose toxicology test results during the hospitalization came back positive for tetrahydrocannabinol.
Results16 patients were gathered, all male, the average age was 26 years. The average age of first hospitalization was 25 years, 41.9% were unemployed. 76.3% of our sample were single. Three quarters of patients were hospitalized without consent. The average hospital stay was 30.33 days. Our patients had required during their stay an average dosage of antipsychotic, equivalent to chlorpromazine, of 752.42 +/- 342.79 mg. The average scores of psychometric scales were: BPRS = 55.72 +/- 14.11, SAPS = 41.5 +/- 14.80 and 42.11 +/- 18.88.
ConclusionsCurrently, it is recognized that prolonged use of cannabis is an exogenous risk factor. The association between cannabis and schizoaffective disorder may amend the treatment modalities. It requires, thereby, an integrated and simultaneous treatment of schizophrenia and addictive behavior.
Disclosure of InterestNone Declared
Prescription of benzodiazepines and related drugs in the Psychiatry Department in the Psychiatry department of Tahar Sfar, Mahdia hospital
- S. Brahim, W. Bouali, M. E. bakhouch, M. Kacem, S. Khouadja, R. Ben Soussia, S. Younes, L. Zarrouk
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S305-S306
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Introduction
Benzodiazepines are the most widely prescribed drugs worldwide for insomnia and anxiety disorders. However, few studies have been conducted on the professional practice of these drugs for patients with psychiatric disorders .
ObjectivesTo describe the prescribing practices of benzodiazepines for patients with psychiatric disorders at the Psychiatry Department of the EPS Taher Sfar Mahdia.
MethodsThis is a retrospective study of patients who were admitted for the first time to the psychiatry department of the EPS Taher Sfar in Mahdia and had a prescription of benzodiazepines during their hospitalization.
ResultsA total of 234 patients were included in our study. We found that 77.8% of patients on benzodiazepines had a prescription for benzodiazepines for a period of less than 3 months. Secondly, we determined that 66.2% of patients who had a benzodiazepine’s prescription had a taper dose of benzodiazepines before the withdrawal. No patients with contraindications to benzodiazepines had a prescription of these medications. The maximum indicated dosage was respected in 92.3% of the prescriptions. Lorazepam was the most used drug, accounting for 49.1% of prescriptions. Our study showed that 46.2% of prescriptions were for anxiolytic purposes only, 43.2% were for hypnotic purposes only. Our analysis also showed a higher proportion of males in the < 3 months group with 82.9% which is significantly higher than for females. (p=0.004).
Our analytical study concluded that gender (p=0.004), professional status (p=0.014), history of addiction (p=0.003), cannabis use (0.025) were related to the duration of benzodiazepine prescription. We noted that 89.9% (n=71) of patients with a documented history of addiction had been prescribed benzodiazepines for less than 3 months. We were also able to conclude that there were correlations between the duration of prescription and medical and/or surgical history (p=0.002), the molecule prescribed (p=0.0001) as well as the renewal of the prescription (0.0001).
However, we did not find a correlation between the associated psychiatric disorders and the duration of prescription. As well for associated psychotropic drugs and duration of prescription
ConclusionsWe can conclude that misuse of benzodiazepines exists, but to a much lesser extent than in the literature. A larger-scale study would be essential to establish a Tunisian overview of benzodiazepine prescription practices.
Disclosure of InterestNone Declared
Cannabis and cognitive deficiency: a descriptive study
- M. Kacem, W. Bouali, M. Henia, S. Brahim, L. Zarrouk
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S563-S564
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Introduction
Cannabis is the most widely used illicit drug; 3.8% of the world’s population consumes cannabis on a regular basis. Cannabis use–associated alterations in the domain of cognition have been extensively studied.
ObjectivesTo research memory deficiency in the young consumers of cannabis in Tunisia.
MethodsThis is a transversal descriptive study conducted during two months (January and February 2022). The research involved about 137 participants aged between 18 and 35 years old, exhaustively recruited amid emergency patients of Mahdia Hospital regardless of the reason for their health care seeking. The patients were declared as consumers of cannabis and accepted to be part of this study. Therefore, Data were collected on a pre-determined data sheet that included various information (age, sex, lifestyle, personal and family psychiatric history, age when first used cannabis and the rate of cannabis use …).
Principally, a Functional Impact Assessment (ERF: French abbreviation for échelle d’évaluation des Répercussions Fonctionnelles ) scale was used to assess and review working memory.
ResultsIn our study population, there was a noticeable male predominance of 71%. Hence, the age structure ranged between 18 years old and 35 years old. Among the latters, 65.9% were single, and 29.7% experienced school failure. In this sample, 23.2% had a psychiatric history like depression, bipolarity, etc. The average age of the first use of cannabis was between 18 and 25 years old in 70% of cases.
Besides, a high percentage of association of other substances was found among cannabis users as follows: use of alcohol 72.5%, tobacco 74.6%, ecstasy 41.3%, and cocaine 25.4%. First and foremost, the use of cannabis was considered as a means of indulgence for 66.7% of the study population, as an anxiolytic for 26.8%, and as a sedative for 23.9%.
Additionally, the effect of cannabis use on working memory deficiency according to the functional impact assessment scale was: no deficiency in 19% of cannabis users, minimal in 34%, mild in 32%, moderate in 9%, fairly severe in 4%, very severe in 1%, and extreme in 1% of cases.
More importantly, the percentage of consumers with significant memory deficiency (moderate to extreme) was 15%.
ConclusionsThe assumption of the effect of cannabis on memory and cognitive deficiency remains controversial and leads us to suggest further in-depth study of this subject.
Disclosure of InterestNone Declared
Sociodemographic and clinical characteristics of employees on long-term sick leave
- S. Brahim, W. Bouali, S. Khouadja, M. Kacem, R. Ben Soussia, S. Younes, L. Zarrouk
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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
Mental health in the workplace is a rapidly developing field of research, which involves the well-being of the individual on a psychological and social level. However, this balance can be suddenly disrupted and can have such a repercussion that the individual finds himself unable to do his job. In this case, he can benefit from a work stoppage called long term sick leave, governed for the public sector, by the decree number 59-239 of August 24, 1959.
ObjectivesTo study the socio-demographic and clinical profile of public sector employees who have been on long-term sick leave and examined as part of the assessment of their ability to work.
MethodsIt is a retrospective study that focused on all public sector employees on long-term sick leave, examined as part of the evaluation of their ability to work in the psychiatric service CHU MAHDIA during the period from January 2013 to April 2014.
ResultsWe collected 73 patients. The mean age at the time of the examination was 51.1 years. There was a clear female predominance 67% and the sex ratio was 0.48. The vast majority were married (71%), of average socioeconomic status (52%) and high school level (43%). Most of the patients (67%) were from the Ministry of Public Health, followed by the Ministry of Education with 26% of the study population. The average length of service was 20.4 years with extremes between 3 and 36 years. The average length of leave was 13 months. The most frequent diagnosis of the prescribing physician was adaptation disorder (41%), major depressive disorder (27%). Somatic comorbidity was found in 38% of cases, dominated by hypertension, diabetes and cervicarthritis in 50%, 28% and 18% respectively. At the end of the leave, 82% of the patients were able to return to work. For the other patients, a professional reclassification was necessary.
ConclusionsLong-term sick leave has a heavy economic burden for society and serious socio-economic and psychological repercussions on the patient. Hence the interest in identifying vulnerable subjects and jobs at risk in order to prevent the occurrence of psychopathological 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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- 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
Assessment of self-esteem among Tunisian cannabis users
- M. Kacem, W. Bouali, M. Henia, S. Brahim, L. Zarrouk
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S669
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Introduction
Self-esteem plays a role in the adaptive functioning of the human being. It could be a protective factor regarding multiple risks particularly substance use.
ObjectivesThe aim of this study is to assess self-esteem among a group of young Tunisian users of cannabis.
MethodsThe total study sample was composed of 137 participants, who took part of a transversal descriptive study during two months (January and February 2020). These partakers were comprehensively recruited among Emergency patients of Mahdia Hospital. Thereupon, the main criteria for the selection of these patients was their consumption of cannabis, regardless of their primary health care seeking reason or purpose.
The research was carried out upon their declaration of cannabis consumption and their compliance to be part of such a study. Thus, Data were collected on a pre-determined data sheet that included various information (age, sex, lifestyle, personal and family psychiatric history, age at which they started their cannabis consumption and the rate of cannabis use …).
Accordingly, Self-esteem was assessed using the Rosenberg Self-Esteem Scale (RSES). Consequently, the interview took place after the subject’s verbal and informed consent and the assurance of anonymity and confidentiality of the interview content.
ResultsIn our study population, the cannabis consumers were young adults aged between 18 and 35 years old, with a male predominance of 71%. Among those users, 65.9% were single and 29.7% dropped out of school or experienced academic failure. On a socio-economic level, we concluded to a rate of 5.8% (lower class), 60.9% (middle class) and 33.3% (upper class).
Besides, 40.8% were employed. In total, 23.2% had a psychiatric history. Furthermore, the use of other substances was also prominent and frequent as follows: alcohol 72.5%, tobacco 74.6%, ecstasy 41.3% and 25.4% cocaine. The use of cannabis was considered as a means of indulgence and pleasure for 66.7%, as an anxiolytic for 26.8% and as a sedative for 23.9%.
Self-esteem, among those cannabis users, was very low in 20% of cases, low in 38% of cases, medium in 15% of cases and high in 25% of cases. Consequently, more than half of the study population remains below the medium average according to RSES.
ConclusionsThese results lead us to question the relation between cannabis and self-esteem. The question that is evolved about the use of cannabis is the following: Is it used as a remedy or is it the cause of self-esteem deficiency?
Disclosure of InterestNone Declared
Fatal pulmonary embolism related to anti-psychotics: forensic implications. About four autopsy cases with review of the literature
- M. Kacem, W. Bouali, Y. Mahjoub, S. Brahim, L. Zarrouk
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S882
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Introduction
The association between the intake of antipsychotic drugs and the occurrence of thromboembolic complications is widely described in the literature. The occurrence of this complication may call into question the medical responsibility of the attending physician.
ObjectivesThe objective of this work is to describe the physiopathological mechanisms involved in the occurrence of thromboembolic complications in a patient under antipsychotic treatment, whether or not associated with physical restraint and to discuss the forensic implications.
MethodsOur study is retrospective on cases of fatal pulmonary embolism, discovered at autopsy, in connection with the taking of antipsychotics. The autopsies were carried out in the Department of Forensic Medicine of the Tahar Sfar University Hospital in Mahdia. The cases were collected over a period of 04 years. A review of the literature was carried out. We only selected articles published until February 2021 and dealing with cases of patients on antipsychotics, diagnosed with pulmonary embolism by performing a chest CT scan or during an autopsy.
Results915 autopsy cases were performed during the study period. Twenty cases of pulmonary embolism, discovered at autopsy, were collected. Four cases were related to the taking of antipsychotics (incidence 0.004%), including two men and two women, aged between 25 and 52 years. They were all on antipsychotic treatment for at least 5 years, with the exception of one case who was put on 3 antipsychotics, 7 days before his death, with indication of physical restraint.
After analysis of the memorial data, the external examination and the autopsy, the results of additional examinations, the death was attributed, in the 4 cases, to a massive fibrino-cruoric pulmonary embolism.
A selection of 45 studies regarding thromboembolic complications associated with taking antipsychotics, was included in the final review.
ConclusionsThe reported cases provided additional evidence on the involvement of antipsychotics in the occurrence of thromboembolic complications. Psychiatrists should be careful when prescribing these treatments. The establishment of therapeutic guidelines, taking into account the thromboembolic risk factors, becomes essential, in order to avoid the occurrence of a complication which could engage both the vital prognosis of patients and the responsibility of the physician.
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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- 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
Recurrence and profile of reconsultants: descriptive study of 162 patients
- S. Brahim, W. BOUALI, K. Mohamed, K. Sabria, B. S. Rim, Y. Samira, Z. Lazhar
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S287
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Introduction
Emergency psychiatric consultation requests present certain specificities both in the situations encountered and in their management, due to a close relationship between the consultant and his environment. They do not only correspond to psychiatric emergencies, in the strict sense of the term, but also to psychological emergencies with their possible social dimension. They require an adapted response that can be decisive for the future
ObjectivesTo determine the epidemiological and clinical characteristics of patients reconsultants in the emergency medical department.
MethodsThis is a cross-sectional study, conducted over a period of 12 months, from 01 April 2020 to 31 March 2021, in the emergency medical department of Mahdia University Hospital.
ResultsDuring the study period, 162 reconsultations for psychiatric emergencies were recorded. the age ranged from 18 to 61 years with an average of 35 years. The level of education was primary or secondary in 78.8% of cases. The majority of reconsultants had single marital status (70%). The absence of professional activity and social security coverage was found in 72.3 and 49% of cases respectively. The presence of family and personal psychiatric history was noted in 29.8% and 91.5% of reconsultants respectively. Heteroaggressiveness followed by instability were the most frequently encountered reasons for consultations with 23.4% and 12.8% of cases respectively. The presence of a triggering factor was found in 63.8% of cases where problems with the main support group followed by those related to the social environment and those related to access to health services were the most reported with 49.23 and 13% respectively. The syndromic psychiatric diagnoses were, in decreasing order of frequency, psychomotor excitement (23.4%), delusional syndrome (17%), dissociative syndrome (12.8%) and somatic conversion (12.8). For reconsultants, relational approach and/or injectable treatment were the most used therapeutic means immediatly (49%). Neuroleptics and benzodiazepines were prescribed in 38% and 13% of cases, respectively. The decision to hospitalize in a psychiatric department concerned 45% of reconsultants.
ConclusionsReferral decisions favored the organization of ambulatory follow-up, with a decrease in the rate of hospitalization. These results make it possible to identify the evolutionary trends of the population consulting in emergency
Disclosure of InterestNone Declared
Sexual dysfunctions, internalized stigma and quality of life in patients with schizophrenia
- A. BEJAR, N. SMAOUI, I. GASSARA, R. FEKI, S. OMRI, M. MAALEJ BOUALI, N. CHARFI, J. BEN THABET, L. ZOUARI, 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
Schizophrenia is a chronic psychotic disorder characterized by a high prevalence of sexual dysfunctions (SD). SD can affect the quality of life (QOL) of patients, cause low self-esteem and self-stigma.
ObjectivesTo evaluate the sexual functioning, the QOL, and the internalized stigma among outpatients with schizophrenia.
To determine the links between SD, the QOL, and the internalized stigma.
MethodsA cross-sectional, 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 Arizona Sexual Experiences Scale (ASEX) to assess sexual functioning, the Internalized Stigma of Mental Illness scale (ISMI) to assess the subjective experience of stigma, and the 36-item Short-Form Health Survey (SF-36) to evaluate the QOL.
ResultsThe average age of patients was 42.28 years old, and their sex ratio was 3.81. The average ASEX score was 19.77±5.99, and 67.9% of participants had at least one SD.
The mean ISMI score was 2.47±0,34. 60,4% of patients had a high level of internalized stigma. The QOL was impaired in 66% of the cases.
We found correlations between SD and a high level of internalized stigma (p=0.011) and its subscales «alienation » (p=0.013), «stereotype endorsement» (p=0.034) and « discrimination experience» (p =0.001).
SD correlated with impaired QOL (p<0.001), emotional limitation (0.050), and social functioning (0.031).
ConclusionsOur study highlights the importance of the impact of SD on the prognosis of schizophrenia through internalized stigma and altered QOL.
Disclosure of InterestNone Declared
Cannabis Consumption Among Musicians: About A Series Of 37 Cases
- S. Brahim, W. Bouali, I. Ghachem, M. Kacem, S. Khouadja, R. Ben Soussia, S. Younes, L. Zarrouk
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S677
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Introduction
Many musicians have suffered the consequences of drug addiction. What about cannabis use?
ObjectivesTo describe the epidemiological characteristics of cannabis users among musiciens
To study the prevalence of anxiety and depression disorders among these consumers
MethodsA descriptive and retrospective study of the epidemiological characteristics and prevalence of depression and anxiety in a population of 37 musicians who consume cannabis. This sample was selected among 202 musicians having participated in an anonymous questionnaire
ResultsThe prevalence of cannabis use among musicians in our study is about 18.31%. 76% of them are professionnals with sex ratio of 6.25. The mean age of these musicians is 27 years old. They started using cannabis at a mean age of 21 years old. The history of school failure was found in 1/3 of all cases, with a younger age at the onset of cannabis use (18 years old vs 22 years old in absence of school failure). 72.4% of cannabis users are single, 27.5% are in a relationship, 66.7% of the 37 musicians are Tabaco smokers, 55.6% are alchoolics, and 19,4% are using other drugs. 16.7% of these musicians are followed for depressive disorder, anxiety or bipolar disorder. The mean duration of cannabis use is 7 years, often in group of people. The first contact with cannabis occurs after the start of learning music in 44.4% of cases (a mean of 12 years after).The average consumption is about 4 times per week, mostly outside the musical activity in 3/4 of the cases. 53.6% believe that cannabis can cause a decline in their health. 10 musicians increased cannabis use and 8 of them believe that it can improve their performance and creativity. On the other hand, only 9 musicians wish to wean the use of cannabis. 19/29 musicians (65.5%) have an anxiety (A) and/or depression (D), that is proven to be moderate to severe respectivelly in 2/3 and half of cases, The mean of the A score and D score of the HAD scale is 10 and 9, respectivelly.
ConclusionsThe reasons of cannabis addiction are various: fleeing reality, seeking the anxiolytic or sedatif effects and improving performance.
Disclosure of InterestNone Declared
Addictive behaviors in schizophrenic patients: Descriptive and analytical study
- W. Bouali, H. Babba, F. Zaouali, M. Kacem, S. Brahim, L. Zarrouk
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1092
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Introduction
The association of an addictive disorder (harmful use, abuse or dependence) with a schizophrenic disorder is the rule. Genetic vulnerability and social and economic factors are common to both disorders.
Objectivesdetermine the impact of addictive behavior on patients suffering from schizophrenia.
MethodsA descriptive and analytical retrospective study of 150 patients with schizophrenia hospitalized in the psychiatry department of Taher Sfar University Hospital in Mahdia from January 2017 to December 2021.
ResultsThe average age of the patients was 39.8 ± 11.23 years with a predominance of the age group 36-45 years (38.4%). All of the patients were male. Three quarters of the patients (75.5%) were consumers of psychoactive substances (PSA): nearly three quarters (72.8%) were dependent on tobacco, more than a third (39.7%) were dependent on alcohol, more than a quarter (29.1%) dependent on cannabis and almost a quarter (26.5%) dependent on other SPAs. Criminal history, suicide attempts and hospitalization in psychiatry were significantly more frequent in patients who consumed SPA than those who did not consume (39.5% vs 8.1%; p=0.008, 17.5% vs 2.7%; p=0.02, 89.5 % vs 75.7%; p=0.03, respectively). Patients who consumed SPA had significantly more positive signs of schizophrenia (51.8% vs 10.8%; p=0.001) and were significantly less observant to treatment (55.3% vs 16.3%; p=0.001) than those who did not consume. Hetero-aggressiveness, self-aggressiveness and job change were significantly more frequent in patients with addictive behaviors than those without addiction (86.8% vs 48.7%; p=0.001, 23.7% vs 2.7%; p= 0.004, 14.9% vs 0%; p=0.015, respectively). Multivariate analysis revealed that criminal history, hetero-aggressiveness, predominant positive symptomatology and work stoppage were the factors independently associated with SPA consumption in patients with schizophrenia in our study (β=14.7 95% CI 3.23–67.01, p=0.001, β=0.099, 95% CI 0.03–0.31, p=0.001, β=7.18, 95% CI 2.09–24.67, p=0.002, β=5.24 95% CI 1.27–21.7; p=0.02, respectively).
ConclusionsAccording to our study, addictive comorbidities concern three quarters of our patients. They expose them to a higher risk of legal problems, hetero-aggressiveness, predominance of positive signs and instability at work. These results encourage the development of methods for early diagnostic identification of addictive behavior comorbid with schizophrenia as well as integrated care combining psychiatric and addictological care.
Disclosure of InterestNone Declared
Impact of Somatic and Addictive Comorbidities on the Quality of Life of Patients With Schizoaffective Disorder: A cross-sectional study
- M. Asgharzadeh, W. Bouali, S. Khouadja, R. Ben Soussia, S. Younes, L. Zarrouk
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S128
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Introduction
Schizoaffective disorder is a mental health disorder frequently associated with somatic and addictive comorbidities. This association can be dangerous as it may change the expression of the disease and its prognosis and may even affect the quality of life (QOL) and the overall functioning of patients.
ObjectivesThis study aimed to investigate the impact of somatic and addictive comorbidities on QOL and the overall functioning of patients with schizoaffective disorder.
MethodsThis paper is a cross-sectional descriptive study conducted at the Department of Psychiatry within outpatient settings over six months. We evaluated the QOL using the SF-36 and Global Assessment of Functioning scale (GAF). We included all patients suffering from a schizoaffective disorder and excluded patients with associated mental impairment, those we could not assess because of another disability, and those with missing records.
ResultsFifty-two patients with schizoaffective disorder met our inclusion criteria with an average age of 38. This study found somatic comorbidities in 30.8% of patients, where diabetes ranked first (13.5%), followed by high blood pressure (9.6%). We noted addictive comorbidities in 63.5% of patients, with tobacco, alcohol, and Cannabis being the most consumed substances, with respective rates of 57.7 %,28.8 %, and 13.5%.
The QOL assessment revealed an impaired QOL score in 80.8% of patients, whereas 65.4% had a GAF score lower than 70 indicating a deterioration of functioning level. Our results showed that dimension D1 (physical activity) of the SF-36 was strongly influenced by somatic comorbidities, according to an analytical investigation of the association between these two variables (p = 10-4). We also found that the deterioration in the patient’s global functioning was not significantly related to somatic comorbidities (p = 0.28). Furthermore, our studies showed no association between impaired quality of life and substance abuse.
ConclusionsSomatic comorbidities and substance abuse have a detrimental effect on patients with pre-existent schizoaffective disorder, and the goals of patient care with a schizoaffective illness go beyond the remission of clinical symptoms to the improvement of quality of life and socio-professional functioning.
Disclosure of InterestNone Declared
Sexual aggressors with mental disorders: characterization of a Tunisian sample
- A. Chamseddine, N. Charfi, S. Ajmi, I. Gassara, N. Smaoui, R. Feki, S. Omri, L. Zouari, J. Ben Thabet, M. Maâlej Bouali, M. Maâlej
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S879
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Introduction
Sexual violence is a worldwide public health concern. Nevertheless, the psychopathology of perpetrators of sexual assault still nowadays poorly documented.
ObjectivesThe aim of this study was to assess the characteristics of sexual aggressors with mental disorders.
MethodsIt was a retrospective study that included a series of sexual aggressors examined in forensic psychiatric assessment in the psychiatry C department at Hedi Chaker university Hospital in Sfax, from January 2010 to December 2021. Data were collected from psychiatric expert reports.
ResultsThe sample was exclusively composed of men with an average age of 37 years and 07 months (± 12.75 years). 54.4% of sexual aggressors suffered from mental disorder. Personality disorder was the most prevalent psychiatric disorder and the antisocial type was noted in 23.9% of cases.
Sexual aggressors suffering from mental disorder were more likely to commit rape followed by murder (p=0.05). They used physical violence far more than the others did (p=0.007) and they were more apt to threaten their victims with weapon during the assault (p=0.038). They were also more likely to abuse the power given by their professional roles (15,2 % versus 5,6 %; p=0.07). They more frequently attacked unknown victims (p=0.019).
ConclusionsMore than half of sexual aggressors suffered from psychiatric disorder. Therefore, the detection and treatment of psychiatric morbidity among sexual aggressors may minimize the risk of recidivism.
Disclosure of InterestNone Declared
Antipsychotic prescription amongst the elderly: Descriptive and analytical study
- W. Bouali, R. Omezzine Gniwa, S. Younes, M. Kacem, L. Zarrouk
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S943
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Introduction
Antipsychotics are frequently used to treat certain delusional, psychotic and behavioral symptoms in the elderly. However, the data in the literature show a great variability in the practices of different teams as well as numerous misuses in the use of this therapeutic class.
ObjectivesThe aims of this work were to evaluate the prescription of antipsychotics in the elderly admitted in a psychiatric department and to compare them with the Information in the literature.
MethodsThis was a retrospective and descriptive study carried out in the Psychiatry Department at Mahdia Hospital. We included all patients aged 65 years and older, admitted between January 2016 and December 2021 and having received antipsychotic treatment.
ResultsOur sample consisted of 53 patients with a mean age of 69.8 years with a standard deviation of 4.2. The sex ratio (M/W) was 2.7. The most common diagnoses in our sample were schizophrenia and dementia with rates of 31.8% and 27.3% of cases respectively. Regarding antipsychotic treatment, 34.1% received first generation oral antipsychotic treatment (AP1G), 31.8% received second-generation oral antipsychotic treatment (AP2G), 27.3% received a combination of AP1G and AP2G and 6.8% received a long-acting injectable antipsychotic. More than a quarter of our patients (34.1%) reported adverse events due to antipsychotic treatment.
ConclusionsThe results of our study highlighted various indications for which an antipsychotic treatment was prescribed in an elderly person despite an often poor and multi-medicated health status, to which side effects were added.
Disclosure of InterestNone Declared
Clinical characteristics and sociodemographic profile of patients with First Bipolar Mania
- M. Gardabbou, R. Feki, I. Gassara, N. Smaoui, M. Maalej Bouali, N. Charfi, L. Zouari, J. Ben Thabet, S. Omri, M. Maalej
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S705
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Introduction
Mania is a serious psychiatric condition, characterized by high rates of relapse and significant dysfunction. An early understanding of the factors involved with the manifestations of this disease is critical as to help estimate impact and plan appropriate treatment modalities.
ObjectivesTo assess demographic and clinical characteristics in a first bipolar mania and describe the associations between these factors.
MethodsA retrospective study was carried out for descriptive and analytical purposes targeting the demographic and clinical characteristics of patients admitted for the first time for a mania within the psychiatry « C » department of Sfax, Tunisia between 2019 and 2022.
ResultsOur study included 50 male inpatients, with a median age of 31.8 years (min=18, max=62) at the moment of their hospitalisation. One third of the patients was married. Only 18% got postsecondary education and 65.3% had a profession. A total of 26.5% had a low socioeconomic status. Twenty-four percent suffered from substance abuse and 14% had a criminal record. Personal psychiatric history was noted in 32% of cases and a personal medical history in 16% of cases. Psychotic features were found in 89.8% of patients. Heteroaggressiveness was present in three quarters of cases, whereas an expansive mood was found in half the population. Twenty percent of patients had a poor insight. A statistically significant association was found between being employed and the absence of personal psychiatric history (p=0.017), whereas personal medical history was associated with a poor insight (p=0.049). Substance abuse was correlated with having a criminal record (p=0.006) and heteroagressiveness (p=0.012). The presence of psychotic features was positively associated with expansive mood (p=0.022).
ConclusionsThis study confirms that some epidemiological factors are strongly associated with clinical characteristics of the bipolar mania. Early interventions over these factors may contribute to a potential reduction in morbidity and mortality of this disease.
Disclosure of InterestNone Declared
Impact of cannabis use on Schizo-affective disorder
- M. Zbidi, W. Bouali, W. Haouari, M. Kacem, S. Khouadja, L. Zarrouk
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S586
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Introduction
Schizoaffective disorder (SAD) is a nosographic entity characterized by an association of schizophrenic symptoms with thymic episodes. Addictive substance abuse behaviours precede or appear concomitantly with thymic and/or schizophrenic symptoms for the majority of patients.
ObjectivesThe objective of our work was to specify the sociodemographic ,clinical and therapeutic characteristics of this population and to compare them to a group of schizophrenic patients who do not use cannabis.
MethodsThis is a retrospective descriptive study of patients with Schizoaffective Disorder (SAD) meeting the criteria of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, 5th Version (DSM-5), hospitalized between January 2015 and December 2021 in the psychiatry department of the EPS Tahar Sfar Mahdia.
ResultsOur sample was composed of two groups: A first group formed by patients with a positive toxicological assessment to tetra-hydro-cannabinol (n=14) and a second group witha negative toxicological assessment (n=36). In SAD subjects using cannabis, the average age at first hospitalization was younger (27.5 years) than in the other groups, hospitalization was earlier (27.27 vs 33.58; p=0.04), the duration in number of days of hospitalization was greater (29.33 vs. 24.67; p=0.02) and they had required during their hospital stay a higher dosage of antipsychotics in equivalent doses of chlorpromazine (723 vs 603; p=0.04). There was a significant difference (p ≤ 0.04) in the psychometric scales (BPRS, SAPS and SANS) in favour of patients who did not use cannabis.
ConclusionsThe deleterious psychic effects of chronic cannabis use have long been suspected for a long time. Patients followed for SAD present more frequently than the reference population addictive behaviours towards cannabis which is associated with many negative events affecting clinical symptomatology, evolution, prognosis and therapeutic response.
Disclosure of InterestNone Declared