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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
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
Toxic encephalopathy after an overdose of cocaine : a case serie
- R. Zouari, F. Nabli, D. Ben Mohamed, M. Z. Saeid, S. Ben Sassi
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S672-S673
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Introduction
cocaine is a widely used illegal drug, known for its fast ability to induce euphoria and arousal. However, cocaine exposure can contribute to several mental and physical effects. Cocaine induced brain damage can be divided into 3 mechanisms: direct effect leading to toxic encephalopathy, secondary to vascular damage causing vasculitis, stroke and vasospasm, and tertiary effect due to hypoxia through a cardiovascular collapse.
ObjectivesHere, we report 2 young men who developed a subacute encephalopathy with different clinical and radiological presentation after a cocaine overdose
Methodsa case serie
Resultswe present two men aged respectively of 28 (P1) and 42 years-old (P2). Both had a history of alcohol consumption and toxicomania (mainly cocaine) during the past year. They manifested, 2 weeks following a cocaine overdose, with gait disorder and confusion. On examination, P1 was apathic and confused. He had a subcortical frontal syndrome with gait apraxia and grasping reflex, along with a quadri-pyramidal syndrome. While patient P2 developed a cognitive decline, parkinsonism with dystonic posture of the trunk and the right limbs, and a pseudobulbar syndrome. Brain MRI was performed in both patients and showed a bilateral multifocal leukoencephalopathy (P1) and the presence of bilateral hyper T2 and FLAIR weighted images affecting basal ganglia, the mesencephalon and the periventricular cerebral white matter. Cerebrospinal fluid (CSF) analysis showed no pleocytosis and normal proteinorrachia. Electroencephalogram was also normal. Infectious differential diagnosis including Human Immunodeficiency Virus (HIV) and syphilis were excluded and metabolic screening including copper analysis, serum and CSF lactate were normal. The urine toxic screening, performed 20 days following the drug overdose, was negative. Both patients were treated with benzodiazepine and fluids without significative improvement. They were discharged with major cognitive and motor impairment.
Conclusionscocaine toxicity is associated with high morbidity and mortality. Usually, cocaine abuse can lead to cardio-vascular, pulmonary and nervous complication. Neuropsychiatric sequelae are uncommon with less recovery potential. To date, there is no drug to prevent or cure cocaine addiction. The key is to educate the patient when he or she presents to the emergency department. Patients should be urged to seek drug counseling.
Disclosure of InterestNone Declared
Sexual dysfunction and motor disability in Parkinson’s disease: any link?
- A. A. Mousli, R. Zouari, A. Lahmer, S. zakaria, A. Rachdi, F. Nabli, S. Ben Sassi
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1095
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Introduction
Parkinson’s disease (PD) is a chronic, neurodegenerative disorder leading to dopamine deficiency. Phenotypically, there is a wide spectrum of motor and non-motor symptoms (NMS). Among NMS, sexual dysfunction (SD) is one of the most disabling and crippling symptom. However, SD are usually neglected and underdiagnosed in PD patients.
ObjectivesOur study aimed to estimate the effect of motor disability and the disease course on sexual dysfunction in PD patients.
MethodsThis retrospective study included 42 patients (18 males and 24 females) from the department of neurology of the National Institute of Neurology Mongi Ben Hmida in Tunis, Tunisia, diagnosed with PD between 1999 and 2022. The diagnosis of PD was confirmed according to the Movement Disorder Society (MDS) diagnostic criteria of PD. The MDS Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) motor was used to estimate motor disability and Hoehn and Yahr (H&Y) stage was used to rate disease severity. The SD of PD patients was measured by applying the sexual items of Scales for Outcomes in Parkinson’s Disease - Autonomic Dysfunction (SCOPA-AUT).
ResultsSD was observed in only 11 patients (26.2%) with a sex-ratio of M/F = 1.2 and a mean age of 52 (between 40 and 72). The mean age of PD onset was 47. According to the MDS-UPDRS part III, 1 patient had a severe motor disorder (MDS-UPDRS> 59), and according to the H&Y scale, no patient had a severe stage of the disease. Nine patients had motor complications such as motor fluctuations and L-Dopa induced dyskinesia.
The SD described by our patients were: women reported Vaginal Dryness (4 patients), with difficulties reaching an orgasm (3 patients); men reported erectile dysfunction (6 patients), and difficulties in reaching an orgasm (6 patients). Among these patients, 3 were treated for SD with Tadalafil (all males).
In our study, no significant gender-related differences were found in scores related to SD in patients with PD. Neither the disease severity nor the motor disability was significantly associated to sexual disorders (respectively p=0.26 and p=0.12). Also, Motor complications induced by L-Dopa medication, assessed by the part IV of MDS-UPDRS scale, had no significant effect in the occurrence of SD in PD (p=0.78).
ConclusionsSexual behavior has neuronal and hormonal modulation. Lack of dopamine seems to have an important role in the development of SD. However, it occurs independently of the disease severity and the motor disability. Thus, clinicians should be aware of the importance of assessing and treating such symptoms since the beginning of the disease.
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
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
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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- 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
N-Hexane neuropathy: from addiction to disability!
- L. Hlioui, R. Zouari, D. Ben Mohamed, M. Z. Saied, J. Ketata, F. Nabli, S. Ben Sassi
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S665
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Introduction
Voluntary poisoning with neurotoxic products in order to achieve euphoria is common especially among young people. Neurological complications are quite likely and can be serious and irreversible.
ObjectivesWe aim to describe the peripheral neuropathies secondary to N-Hexane intoxication in a Tunisian population.
MethodsA retrospective descriptive study was carried out in our department of neurology in the NationalInstitute of Neurology of Tunis including patients diagnosed with N-Hexane neuropathy. All patientshad a history of a N-Hexane exposure. The diagnosis was confirmed after excluding other etiologiesthrough appropriate investigations. Clinical and para-clinical data as well as follow-up were assessed.
ResultsWe selected 38 patients with a mean age of 22.7 years [14-36]. Among them, 37 were glue-sniffer and 1 had a voluntary toxic exposure to paint. An associated cannabis consumption was found in 6 patients. All of them had a low socio-economic background and 17 were unemployed. Time to onset of neurological signs ranged from 5 months to 11 years. The clinical exam showed a quadriparesis (15,7%), a paraparesis (58%), sensory involvement (55,2%) amyotrophy (40%) and abolished tendon reflexes in lower limbs (81,5%). Swallowing disorder and optic neuritis were found in one case. The electroneuromyogram revealed an axono-demyelinating sensory-motor polyneuropathy (PN) in 16 cases and a demyelinating motor PN in 9 cases. Vitamin therapy, motor rehabilitation and psychotherapy sessions have been indicated. Only 6 patients showed slight clinical improvement after withdrawal. The rest of our patients did not quit; 84% of them became bedridden.
ConclusionsGlue-sniffer related neuropathy is very common in our country especially in adolescents and young adults with low socio-economic background. The neurological outcome is serious and usually irreversible if exposure is persistent.
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
Electroencephalographic frequency activity of patients with bipolar disorder
- M. Mnif, L. Triki, N. Smaoui, D. Jardak, S. Omri, I. Gassara, R. Feki, M. Maalej, J. Ben Thabeut, L. Zouari, N. Charfi, K. Masmoudi, M. Maalej
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S705
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Introduction
Bipolar disorder (BD) is a common psychiatric condition. However, it is underdiagnosed. Electroencephalography (EEG) has been proposed as a neurophysiological biomarker to delineate psychotic disorders.
ObjectivesTo compare the EEG tracings of patients with BD with those of normal subjects to aid in diagnosis.
MethodsThis was a cross-sectional, descriptive, and analytical case-control study conducted with patients followed for BD in the psychiatry "C" department at the Hedi Chaker hospital in Sfax. Patients were assessed by the Young Mania Scale (YMRS), the Hamilton HDRS-17 Scale, and the Medication Adherence Report Scale (MARS). Healthy controls were included. All participants benefited from an EEG. It was undertaken in resting eyes closed testing conditions at the service of the functional exploration at the Habib Bourguiba hospital in Sfax. The powers of each band were measured using the power spectral density method called absolute power (AP). Statistical analyses were carried out.
ResultsFifteen bipolar patients and 15 healthy controls, all male, were included. The average age of bipolar was 36.07 ± 10.50 years. The one of health control was 47.93 ± 15.61 years. There were no significant differences in age between bipolar patients and healthy controls. The mean scores on the HDRS-17 and YMRS and MARS scales were 2.73±2.08, 1.67±3.53 and 5.8±2.83 respectively.
At the quantitative EEG, differences appeared to be insignificant. There was an overall decrease in AP for alpha band particularly in the parietal and occipital lobes in bipolar patients (158,84 ± 447,71 μV2 and 188,21 ± 415,55 μV2 respectively) compared to controls (335,15 ± 994,73 μV2 and 400,24 ± 1109,95 μV2 respectively). An overall increase in AP for delta and beta was found for bipolar patients compared to controls.
ConclusionsOur main finding was a higher delta and beta frequency activity, and lower alpha frequency activity in bipolar patients compared to controls, which may aid in the diagnosis of this disorder.
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
Quantitative electroencephalogram study in patients with schizophrenia : a literature review
- D. Jardak, N. Smaoui, L. Triki, M. Mnif, I. Gassara, R. Feki, M. Maalej, N. Charfi, J. Ben thabet, L. Zouari, S. Omri, M. Maalej
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S259
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Introduction
There has been a continuous effort to discover and specify the neural correlates of schizophrenia (SCZ) based on spontaneous electroencephalogram (EEG) records. Besides contributing to a more effective diagnosis, biomarkers can be crucial to SCZ to hope for therapeutic progress.
Objectivesa literature review was conducted to ascertain whether or not quantitative EEG spectral abnormalities are consistent enough to warrant additional effort towards developing them into a clinical diagnostic test for schizophrenia.
MethodsA systematic search of the databases , ScienceDirect, and PubMed was conducted using the following words : schizophrenia, electroencephalography, neurobiology. The Preferred Items Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in the construction of this literature review. Primary research articles that reported descriptive EEG results, included comparisons of subjects with and without antipsychotic therapy, and excluded patients with epilepsy were included in the analysis. We analyzed pooled data, where possible, from studies with a similar intervention and methodology.
ResultsOur study included 11 articles on quantitative EEG changes in schizophrenic patients divided as follows: 2 articles on the genetics of SCZ and EEG data, 3 articles on the psychopathology of SCZ and EEG data, 2 articles on hemispheric coherence, and finally 4 articles on the effect of treatment on EEG.Increased beta activity can be considered as an inherited feature of SCZ. Elevated delta/theta and gamma activity may serve as a specific biomarker for this condition. The delta wave may be a neurophysiological tool to differentiate between negative and positive forms of SCZ.EEG tracings of schizophrenic patients showed increased intra- and inter-hemispheric coherence compared to healthy subjects. Treatment with an antipsychotic drug was associated with a more marked increase in frequency bands in patients receiving an atypical antipsychotic drug.
ConclusionsIt is important to study the electroencephalographic changes not only to better understand the etiopathogenesis of SCZ, but also to search for specific physiological biomarkers.
Disclosure of InterestNone Declared
Specificity of homicide in tunisian women
- R. Ouali, N. Smaoui, A. Chamseddine, I. Gassara, R. Feki, M. Maalej, N. Charfi, J. Ben Thabet, L. Zouari, 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, pp. S884-S885
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Introduction
Homicide is the most serious, radical and irreversible criminal act. It arouses a multitude of questions and fears. Committed by women, the homicide seems more unusual and weird.
ObjectivesOur objective is to describe the circumstances of the homicide committed by Tunisian women
MethodsThis study was retrospective and descriptive. It focused on the files of criminal psychiatric expertise 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)
ResultsThis study included 21 women who committed homicide.The majority of victims of homicide or attempted homicide (85.6%) belonged to the family circle of the accused.Five women (23.8% ) committed this act against their children and four women (19.1%) committed this act against their husbands.The means most used in homicide and its attempt were immolation (23.8%), strangulation (23.8%) and blows (23.8%).
Among those charged with homicide or its attempt, seven (33.3%) presented a personality disorder, 14.3% a depressive disorder, 14.3% a moderate intellectual disability, 4.8% a schizophrenia and 4. 8% mild intellectual disability.
ConclusionsThis female criminality, in particular homicide, would find their explanations in different factors and the existence of a mental disorder at the origin of deviant behavior in women seems to be a significant factor in the determinism of such behavior. Much effort remains to be made to apply preventive measures.
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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- 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
Predictors of caregiver burden among parents of children with neurological impairement
- A. Mellouli, S. Zouari, N. Smaoui, O. Jallouli, S. Omri, W. Bouchaala, I. Gassara, S. Ben Nsir, F. Kamoun, M. Maâlej, C. Charfi Triki
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S947-S948
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Introduction
Many neurological, sensory and behavioural deficits, are linked with significant limitations in the overall functioning not only of the child but also his/her closest family, and poses a great challenge for the primary parental caregivers.
ObjectivesTo assess the caregiver burden in parents of children with neurological impairement (NI), and itsrelated factors.
MethodsA total of33 caregivers of children with NI participated in this cross-sectional, descriptive and analytical study, carried out in Child Neurology Department of the University Hospital in Sfax (Tunisia), between February and April 2021.
The Zarit-Caregiver-Burden-Scale (Zarit-CBS) was administered.
ResultsThe average age of the caregivers (27 mothers and 6 fathers) was 38,33 ± 6,53 years. Among the parents, 17.14% had another disabled child and 30.3% had a mediocre health status. Mother caregivers constitutes the majority of caregiving (82.85%).
The average of the number of children in the family was 1.97±1.18 and the average age of the children (21 boys and 12 girls) was 7,58±4,29 years. Near to the half of them (51,51%) had intellectual disability.Over 54.54% of the children had a functional independence, while 21.21% required help in walking and 24.24% were unable to walk. The intervention was based on motor rehabilitation (57,57%), adequate equipment (24,24%), ergotherapy (45,45%) and speech therapy (60,6%).After the intervention, 63,63% of children had an improvement and 30,3% had a stationary state.
The mean score of Zarit-CBS was 52,45±14,26. The caregiver burden was noted in 96,96%.
The total Zarit-CBS score was associated with the number of children in the family (p=0.047).
There was no significant relationship between Zarit-CBS and the severity of impairement (p=0.418).
ConclusionsGiven the variety of factors affecting caregiver burden, specific interventions may promote parental caregivers’well-being, and consequently lead to improved quality of care provided to children with NI.
Disclosure of InterestNone Declared
To what extent does the Tunisian law protect women against violence ?
- E. Mhiri, M. Maalej, I. Gassara, R. Feki, 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. S1128
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Introduction
Tunisia, a pioneer in the Arab world in terms of promoting the status of women, has adopted a strategy to combat violence against women and now has a legal arsenal to protect women’s rights.
ObjectivesTo study the contribution of the Tunisian jurisdiction in terms of protection of women victims of violence.
MethodsA review of the different legal texts, using the key words: “Women”, “Violence”, “Jurisdiction” and “Protection”.
Results*The National Survey on Violence against Women in Tunisia is a long process that involved the efforts of several stakeholders.
*In 2011, Tunisia was the first country in the region to have ratified and lifted all specific reservations to CEDAW (Committee on the Elimination of Discrimination Against Women). Violence against women is considered a threat to peace and security.
*Secondly, the adoption of Article 46 of the new Constitution of 2014 obligated the State to combat violence against women and make it its priority.
*The adoption of Organic Law 58/17 of 11 August 2017 finally gave the status of victim to the abused Woman. This law came into force in 2018.
*A number of mechanisms have been put in place, including the establishment of the National Observatory to Combat Violence against Women.
*Most magistrates still resist the application of Law 58/17, which contributes to the resurgence of violence against women, especially during periods of slackening of the justice system, such as the COVID lockdown period.
ConclusionsDespite the revolutionary legal arsenal acquired for the protection of women in Tunisia, there is still a gap between legislation and practice, and the rate of violence against women continues to increase. Nationwide awareness-raising campaigns aiming to spread awareness among women of their rights are necessary.
Disclosure of InterestNone Declared
Perceived stress and resilience in family caregivers of patients with mental illness : relationship and correlates
- S. Kolsi, N. Charfi, I. Gassara, R. Feki, S. Omri, N. Smaoui, L. Zouari, J. Benthabet, M. Maalej, 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. S1086
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Introduction
Family members play an important role in the life of many adults with mental disorders and are under considerable amounts of stress that may affect caregiver’s physical health, quality of life and resilience.
ObjectivesThe present study aimed to explore the relationship between the perceived stress and the resilience levels among caregivers of patients with mental illness and to identify their associated factors.
MethodsThis was a cross-sectional, descriptive and analytical study conducted on caregivers of patients suffering from mental illness. It was conducted in the outpatient psychiatry department at the university hospital of Sfax (Tunisia), during september 2021.
We used the Connor–Davidson Resilience Scale to assess resilience and the Perceived Stress Scale (PSS-10) to assess the level of stress. High scores indicate high resilience and perceived
ResultsThe sample included 34 family caregivers of patients with mental illness. The mean age was 47.47 years (SD=12.4 years) and the sex ratio (M/F) was 1.42.
The mean resilience score of caregivers was 42.85 and the mean perceived stress score was 24.94 (SD=6.36).
The score of resilience correlated negatively with the score of perceived stress among family caregivers (r=-0.751 ; p=0.0001).
The Caregivers with low socioeconomic level were more likely to have a low resilience score (p=0.004) and to have high stress levels (p=0.04).
The level of perceived stress increased significantly in case of long duration of providing care (r=0.697 ; p= 0.001), the presence of stressful events (p=0.029) and the presence of agressive behaviors committed by patients (p= 0.001). However, the level of resilience decreased significantly in those same cases (p=0.001; p=0.002; p=0.0001 respectively)
ConclusionsOur findings suggest that high level of perceived stress among familiy caregivers impact negatively their capacity of resilience. So, interventions targeting stress related to stressful events and violence committed by patients in their family environment should be integrated to increase the caregivers’resilience.
Disclosure of InterestNone Declared