Self-harm, self-poisoning or self-injury, irrespective of the motivation, is a central risk factor for suicide. Still, there is limited knowledge of self-harm among patients with substance use disorders (SUDs) who die by suicide.

We aimed to describe the prevalence of a history of self-harm and identify the factors associated with self-harm, comparing individuals who died by suicide with and without SUDs.

We used data from the Norwegian Surveillance System for Suicide in Mental Health and Substance Use Services, which is based on a national linkage between the Norwegian Cause of Death Registry and the Norwegian Patient Registry, to identify individuals who died by suicide within 1 year after last contact with mental health or substance use services (n = 1140). A questionnaire was retrieved for 1041 (91.3%) of these individuals. We used least absolute shrinkage and selection operator (LASSO) regression to select variables and compared patients with and without SUDs. Conditional selective inference was used to improve 90% confidence intervals and p-values.

The prevalence of self-harm was 55% in patients with SUDs and 52.6% in patients without SUDs. Suicidal ideation (odds ratio 2.98 (95% CI 1.74–5.10)) emerged as a factor shared with patients without SUDs, while personality disorders (odds ratio 1.96 (1.12–3.40)) and a history of violence (odds ratio 1.86 (1.20–2.87)) were unique factors for patients with SUDs.

A history of self-harm is prevalent in patients with SUDs who die by suicide and is associated with suicidal ideation, a history of violence and personality disorders in patients with SUDs.

Substance use may be associated with the onset of psychotic symptoms, necessitating treatment for individuals with comorbid mental health and substance use disorders (MHD/SUD). COVID-19 significantly impacted individuals with MHD/SUD, reducing access to appropriate care and treatment. Changes in drug availability and prices during the pandemic may have influenced drug consumption. This study aimed to determine the frequency of substance-induced psychosis (SIP) during COVID-19 among individuals with MHD/SUD and to explore substance fidelity by following patterns of SIP over time.

In this retrospective cohort study, we analyzed data from all individuals with MHD/SUD registered in 2019–2021 in the Norwegian Patient Register. We used graphical approaches, descriptives, and Poisson regression to study occurrence and risk of SIP episodes in the three-year observation period. Sankey diagrams were used to examine trajectories of psychotic episodes induced by various substances.

Despite a decrease in individuals diagnosed with SIP during COVID-19, SIP episodes increased overall. We observed a decline in cannabis-induced psychosis, but a rise in SIP episodes involving amphetamines and multiple substances. Among individuals with recurrent SIP episodes, the psychosis was more often induced by different substances during COVID-19 (2020: RR, 1.50 [95% CI, 1.34–1.67]; 2021: RR, 1.30 [95% CI, 1.16–1.46]) than in 2019.

During COVID-19, fewer individuals were hospitalized with SIP, but those patients experienced more episodes. There were fewer cannabis-induced psychotic episodes, but more SIP hospitalizations caused by central stimulants and more SIP diagnoses caused by different substances, possibly reflecting changes in drug availability and pricing.

The change in symptoms necessary to be clinically relevant in obsessive-compulsive disorder (OCD) is currently unknown. In this study, we aimed to create an empirically validated threshold for clinical significance or minimal important difference (MID).

We analyzed individual participant data from short-term, double-blind, placebo-controlled registration trials of selective serotonin reuptake inhibitors in adult OCD patients. Data were collected from baseline to week 12. We used equipercentile linking to equate changes in the Clinical Global Impression (CGI) scale to changes in the Yale-Brown Obsessive-Compulsive Scale (YBOCS). We defined the MID as the YBOCS change linked to a CGI improvement of 3 (defined as “minimal improvement”).

We included 7 trials with a total of 1216 patients. The CGI-scores and YBOCS were moderately to highly correlated. The MID corresponded to 4.9 YBOCS points (95% CI 4.4–5.4) for the full sample, or a 24% YBOCS-decrease compared to baseline. The MID varied with baseline severity, being lower in the group with mild symptoms and higher in the group with severe symptoms.

By linking the YBOCS to the CGI-I, this is the first study to propose an MID in OCD trials. Having a clearly defined MID can guide future clinical research and help interpretation of efficacy of existing interventions. Our results are clinician-based; however, there is further need for patient-reported outcomes as anchor to the YBOCS.

Alcohol use and alcohol use disorder (AUD) is related to numerous somatic and psychiatric disorders resulting in a high contribution to global burden of disease and premature death. The need to identify and treat alcohol use disorder is high. Yet there is a large treatment gap. Too few people with AUD are recognized and are being offered treatment. In some countries well under 10 percent of those with a treatable AUD are ever offered treatment. Furthermore, there is a dearth of effective treatments and relapse rates remain high. This symposium will address some topics that may change this situation.

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The delicate balance between the need to ensure quality patient care and the reality of physicians dealing with psychiatric diseases poses a major challenge within the medical field. This issue raises fundamental ethical, legal, and medical questions, highlighting the complexity of decision-making regarding professional aptitude for practitioners affected by mental disorders.

To examine the impact of psychiatric diseases on the medical aptitude of physicians.

This was a retrospective descriptive study that focused on physicians with psychiatric diseases referred to the occupational pathology clinic at Charles Nicolle Hospital in Tunis for medical evaluations of their work aptitude between January 1, 2021, and September 15, 2023.

During the study period, we collected data from 20 patients. The mean age was 38 ± 11 years, with a sex-ratio (F/M)of 4.5. Five examined physicians had family histories of psychiatric disorders. Medical specialties were the most represented (N=17), including three general practitioners, two family medicine practitioners, and two anesthesiologists. The study population included 10 residents, eight hospital assistants, and two medical interns. The most common psychiatric diagnosis was depression (N=7), followed by bipolar disorder (N=5). The medical treatment prescribed was combinations of antidepressants and anxiolytics in seven cases, antipsychotics in five cases, and antidepressants in two cases. Medication adherence was noted in 10 physicians. Fourteen physicians had taken long-term sick leave, with an average duration of 203 days. Five physicians were declared fit to continue their regular professional activities, seven physicians were declared fit with restrictions on night work, and one physician was declared fit with workplace accommodations.

This study highlights the challenges surrounding the medical aptitude of physicians with psychiatric diseases. However, it is imperative to promote mental health awareness and to implementsupport measures to ensure both compassion for physicians and patient safety.

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Internet use can become uncontrollable, leading to physical and psychological suffering and what is known as cyberaddiction.

To assess the frequency of cyberaddiction in a population of young doctors.

We conducted a cross-sectional, descriptive study of a population of young doctors. We collected socio-professional and medical data using a Google Forms self-questionnaire. The Young scale was recommended for screening for cyberaddiction. A score ≥5 indicates Internet addiction. The Hospital Anxiety and Depression Scale (HAD) was adopted to reveal anxiety-depressive disorders.

A total of 45 physicians responded to our survey. The mean age was 29.93±4.8 years. The sex ratio (M/F) was 0.3. Participants were single in 69% of cases. Residents represented 64% of the population. Physicians were family medicine residents in 11% of cases. The mean Young’s score was 3.13±1.97/8. Cyberaddiction was noted in 24% of cases. A definite anxiety-depressive disorder was found in 6.7% and 13.3% of cases respectively. Internet addiction was significantly associated with female gender (p<0.05) and a positive HAD (A) score (p=0.03).

According to the results of our study, cyberaddiction is common among medical staff. A preventive strategy is needed to counter the harmful effects of this addiction.

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Excessive use of tobacco, alcohol and other illicit drugs has a negative impact on the physical and mental health and work capacity of users. Physicians are no exception to these dreadful practices.

To assess tobacco and alcohol use among medical staff and the factors associated with these uses.

Descriptive cross-sectional study of physicians practicing in different Tunisian hospitals. The levels of tobacco and alcohol dependence were assessed by the Fangeström and AUDIT tests. Anxiety and depression disorders were screened by the hospital anxiety and depression scale (HAD)

A total of 45 physicians participated in our study. The average professional seniority was 3.36 ± 3.5 years. The mean age was 32.11 ± 6.08 years with a sex ratio (M/F) of 0.32. The participants were medical residents in 64% of the cases. The frequency of smoking was estimated at 24%. The level of smoking dependence was high in 9% of cases. Men were more addicted to nicotine than women (p=0.014). Alcohol consumption was 18%, made up of 62% of women; with a strong dependence rate in 25% of users. Definite anxiety disorders were found in 7% of cases and definite depressive disorders were present in 13% of cases. No correlation between medical specialty, grade, anxiety disorders and level of dependence was observed.

Doctors seem to be particularly affected by addictive behaviours and psycho-emotional disorders which could sustain these practices. Awareness-raising sessions and special monitoring must be introduced to combat these scourges.

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Clozapine is the standard treatment for managing treatment-resistant schizophrenia (TRS). However, concerns arise due to potential hematologic side effects, such as agranulocytosis, especially during the COVID-19 pandemic.

This study aims to investigate the association between clozapine treatment and an increased risk of severe COVID-19 infection in patients with TRS.

A retrospective study reviewed clinical records of forensic patients with TRS from 2020 to 2022 at Razi Hospital’s forensic psychiatry department in Tunisia. Twenty-five patients, including 18 on clozapine treatment, were included.

All patients were male, with an average age of 39.7 years. Twenty-three patients received at least one vaccine dose. Twenty-two patients contracted COVID-19. Among those treated with clozapine, two required intensive care unit admission and oxygen therapy without intubation. Clozapine treatment remained uninterrupted, with no dose escalation during infection episodes. Lymphopenia was the most commonly reported hematologic abnormality.

While there may be an association between clozapine use and an increased risk of COVID-19 infection, no clear correlation with infection severity and antipsychotic treatment was established in this study. Further research is needed to explore this potential association comprehensively.

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Being a doctor is a profession with special medical requirements. Therefore, the assessment of medical fitness for work among physicians remains a complex decision, particularly for those with psychiatric disorders.

To assess the fitness for work decisions among physicians with psychiatric disorders.

Descriptive and retrospective study including physicians with psychiatric disorders referred to the occupational department of the Charles Nicolle Hospital in Tunis for a medical fitness for work from January 1, 2018 to August 30, 2023.

The study included 28 patients with a female predominance (sex ratio M/F at 0.3) and a mean age of 44.1 ± 12 years. Participants were general practitioners (N=12), junior doctors (N=10), specialists (N=5) and one dentist. They worked in the public health sector in 93% of cases, and had a mean professional seniority of 12.4 ± 9.3 years. A psychiatric history was found in 20 patients. Current psychiatric disorders recorded were: depression (N=15), bipolar disorder (N=7), anxiety-depressive disorder (N=4), personality disorders (N=1) and addiction (N=1). Concerning the fitness for work, six patients were fit for work and 11 were temporarily unfit. Job adjustments were proposed for 11 physicians, mainly night shift exemption.

Physicians are exposed to several occupational hazards and require strict medical qualifications. The impact of psychiatric disorders on medical fitness for work is considerable, and could be avoided by appropriate prevention by occupational health practionnairers, starting from professional orientation.

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Chronic exposure to damaging noise can lead to hearing loss . People suffering from hearing problems find it increasingly difficult to communicate and become withdrawn. This lack of contact can lead to the onset of anxiodepressive disorders .

To study the epidemiological and clinical particularities of hearing loss in patients with psychoaffective disorders.

To study the impact of this association on the medical aptitude for work.

Retrospective descriptive study of depressive patients with hearing loss who consulted the Occupational Medicine Department at Charles Nicolle Hospital over a six-year period from January 2016 to November 2022.

Out of 150 patients with hearing loss who consulted our service, 10 patients had an axio-dépressive disorder . Seven were men and three were women. The mean age was 43 ± 5 years and the mean job seniority was 11 years [3-20]. they belonged to the telecommunications (n=6), industry (n=2), printing(n=1), and transport sectors (n=1) . The job positions were : teleconsultant (n=6), operator machine (n=3) and driver (n=1)  the symptoms presented by the patients were hearing loss (n=4), otalgia (n=1) , diziness (n=1), tinnitus(n=1) . The average time to onset of symptoms was 13±8 years [1-35] . The hearing deficits presented by the patients were: sensorineural hearing loss (n=7), mixed hearing loss (n=1) and conductive hearing loss (n=2). The mean of Hearing loss were 34±9 dB in the right ear and 34±6 dB in the left ear . A declaration of the deafness as an occupational disease was indicated in two of the cases. the univariate statistical study showed that anxiety-depressive disorders were associated with tinnitus (p=0,036,OR=4,2[0,99-17,659]) and the position of teleconsultant (p=0,009,OR=5,622[1,338-23,627] . Eviction from exposition to noise was indicated in seven cases

According to our study, hearing loss in patients with anxio-depressice disordes is associated with tinnitus and teleconsultant job position . Early screening early screening of people at risk is recommended.

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Patients with mental illness, particularly those with treatment-resistant schizophrenia, are at increased risk of severe COVID-19. The protective effect of vaccination against severe disease has been demonstrated, and vaccination of vulnerable individuals was a priority during the vaccination campaign. However, the effect of vaccination on the psychiatric symptoms of the disease is not well understood.

To investigate the impact of COVID-19 vaccination on psychiatric symptoms and somatic symptoms in patients hospitalized for treatment-resistant schizophrenia.

Thirty patients hospitalized for treatment-resistant schizophrenia with a history of medico-legal acts were admitted to the forensic psychiatry department at Razi Hospital in Manouba, Tunisia. The consent of patients and/or their relatives was obtained before vaccination, and potential side effects were explained to patients and their families. A neuropsychiatric assessment and clinical examination of patients were performed by their referring psychiatrist before vaccination and one month after.

The patients were all male, with a mean age of 42.3 years.No patient had an allergic reaction to the vaccine. No patient was infected with the virus one month after vaccination. On the clinical level, 30% of patients had general symptoms such as fatigue and myalgia, which improved spontaneously within a few days. On the psychiatric level, exacerbation of positive symptoms such as hallucinations and delusions was found in 26% of patients. No increase in the frequency of agitation episodes or risk of hetero-aggressive behavior was reported. Sleep disturbances such as difficulty falling asleep and fragmented sleep were reported. The most common functional complaints reported by patients were palpitations, which were a source of somatic concern.

Several side effects of the vaccine have been documented and are taken into account in the daily practice of practitioners, but psychiatric effects are poorly reported and are sometimes attributed to the underlying disease. A complete examination, objective assessment, and regular follow-up are necessary to identify symptoms early and prevent relapses.Because of the small size of the sample;results could not be generelized.Further studies on a larger scale should be conducted.

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The driver’s job is a safety job requiring a meticulous neuropsychological assessment, which can affect the decision on fitness to drive. Professional driving benefits from codified regulations concerning neuropsychological disorders.

To describe the socio-professional characteristics of drivers with psychiatric illnesses

To specify the impact of these pathologies on decisions on fitness for work

Retrospective descriptive study of drivers with psychiatric disorders who consulted the occupational pathology and fitness for work department of the Charles Nicolle Hospital for fitness for work assessment during the period from January 2016 to January 2023.

Out of 98 drivers who consulted our department for an aptitude assessment, nine (n=9) patients had a psychiatric disorder. The average age was 45±7 years. They were all men. They were bus (n=7), light car (n=1), and lorry (n=1) drivers. They belonged to the transport (n=7) and service (n=2) sectors. Length of service ranged from one year to 35 years. The pathologies presented by the patients were: anxiety-depressive disorder (n=7) , bipolar disorder (=1) and drug-addiction (n=1). They were being treated with antidepressants (n=7), anxiolytics (n=3), and thymoregulators (n=1). The medico-legal decision was to avoid professional driving (n=7) and to avoid professional driving at night (n=2).

psychiatric illnesses can compromise fitness to work. The role of the occupational physician in the primary and secondary prevention of people at risk is important.

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