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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
Pandemic COVID 19 and healthcare professionals: Mental health impact and depression
- R. Ben Soussia, R. Melki, M. H. Aoun, W. Bouali, L. Zarrouk
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S805-S806
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Introduction
The SARS-COV2 pandemic represents a problematic and disruption of global health. Repeated exposure to stressful situations leads to increased psychological distress.
ObjectivesTo determine the psychoaffective impact of the Covid-19 pandemic on the mental health of health professionals in Tunisia, assess the intensity of depressive symptoms professionals and determine factors associated with the development of these symptoms.
MethodsThis was a multicenter, cross-sectional, descriptive and analytical study conducted among health professionals, from May 2nd, 2020 to June 30th, 2020 in Tunisia. The health professionals included were physicians, nurses, dentists, and pharmacists. Using an electronic form << Google Form >>, a questionnaire was drawn up with 32 items. Assessment of depressive symptoms was performed using the PHQ-9 psychometric scale.
Statistical analysis was performed using SPSS 21.0 statistical software. Regarding the analytical study, a professional with a PHQ-9 scale score between 10 and 27 was considered as having moderate to severe depressive symptoms while a score between 15-27 was in favor of severe depressive symptoms.
ResultsCaregivers were predominantly female 69.5% with a mean age of 30.74 years. Anxiety-depressive psychiatric history was found in 11.8% of the subjects. The majority of the professionals were doctors (77.8%) and 9.4% of the participants were nurses. The majority of participants worked in university hospitals (84.2%). One third of the participants, (34.3%) worked in departments with Covid-19 patients with respective rates of 57% for nurses and 36% for physicians. Dentists and pharmacists did not work in Covid-19 circuits.
The mean score on the PHQ-9 scale was equal to 8.62 ± 5.35. Depressive symptoms were noted in 37.4% of the professionals, with moderate to severe intensity in 35.5% of cases. Participants with a psychiatric history of depression or anxiety disorder had significantly higher depressive symptom scores (p<0.001) with 6 times higher the risk of developing moderate to severe depressive symptoms (p<0.0001, OR 6.25, CI [2.35-16.61] and almost 3 times higher the risk of experiencing severe depressive symptoms (p=0.05, OR=2.93, CI [1.09-7.88]). The nursing profession had high odds ratios for the occurrence of moderate to severe depressive symptoms (p=0.002, OR=4.41, CI [1.58-12.28]) and severe depressive symptoms (p=0.02, OR=3.82, CI [1.28-11.39]). A significant relationship was established, between the development of depressive symptoms of moderate to severe intensity with the history of depressive disorder or anxiety disorder (p=0.001) and the nursing profession (p=0.01).
ConclusionsThe optimization of prevention, the creation of specific treatment, the promotion of health education and specific hygiene rules would participate in improving the mental health of health professionals.
Disclosure of InterestNone Declared
Impact of somatic and addictive comorbidities on the quality of life of patients with schizoaffective disorder
- W. Bouali, N. Faouel, R. Ben Soussia, F. Zaouali, L. Zarrouk
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S590
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Introduction
Schizoaffective Disorder is frequently associated with somatic and addictive comorbidities. This association can change the expression of the disease as well as its prognosis. In addition, this association can affect many functional and psychosocial aspects that can lead to impaired quality of life (QOL) and overall functioning of patients.
Objectivesthe aims of this work were to study the impact of somatic and addictive comorbidities on QOL and global functioning of patients followed for schizoaffective disorder.
MethodsThis is a cross-sectional study carried out at the psychiatric consultation of the University Hospital of Mahdia for a period of 6 months. The evaluation of the QOL was made using a generic instrument for measuring quality of life: the SF-36 in its version in literary Arabic using the Global Evaluation of Functioning scale .
Resultsfifty-two patients with schizoaffective disorder were included in the study. The age of the patients varied from 29 to 62 years with an average of 38 years. The sex ratio (M/F) was 1.6. Singles accounted for 46.2%. Somatic comorbidities were found in 30.8% of patients. Diabetes ranked first (13.5%) followed by arterial hypertension (9.6%) then epilepsy (3.8%). Addictive comorbidities were noted in 63.5% of patients. Tobacco, alcohol and Cannabis were the most consumed substances with respective rates of 57.7; 28.8 and 13.5%. The evaluation of the QoL of the patients revealed that 80.8% of the patients had scores attesting to an altered QoL. Regarding the evaluation of global functioning by EGF, (65.4%) of patients had a score of less than 70 attesting to an impairment of global functioning. The analytical study of correlation between the dimensions of the SF-36 and somatic comorbidities found that dimension D1 (physical activity) is significantly influenced by somatic comorbidities (10-4). The deterioration in the global functioning of the patients was not correlated with the presence of somatic comorbidities (p=0.28). The change in QoL was not correlated with the consumption of psychoactive substances (0.32 for alcohol and p=0.23 for drug addiction).
ConclusionsIt is accepted that the objectives of the management of patients suffering from schizoaffective disorder go beyond the remission of clinical symptoms to the improvement of QoL and socio-professional functioning. Larger-scale work is needed to study the influence of comorbidities associated with schizoaffective disorder on these dimensions.
Disclosure of InterestNone Declared
Self-esteem is associated with loss of autonomy and depression in the elderly
- W. Bouali, M. Kacem, W. Haouari, L. Zarrouk
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S846-S847
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Introduction
Self-esteem is an important aspect of adaptive processes at all ages of life and particularly in older adults: it is linked to the quality of adaptation, well-being, life satisfaction and health.
Objectivesstudy the links between self-esteem, autonomy and depression in the elderly
MethodsThis is a descriptive and analytical study carried out over four months in the offices of three doctors. The population of the study were the consultants whose age was over 65 years the study was made using a pre-established sheet with certain socio-demographic characteristics, the pathological antecedents of subjects. We assessed self-esteem using the Rosenberg scale, autonomy using the activities of daily living scale (KATZ index), and depression using the mini GDS. The analysis of the results was carried out using SPSS 17 software.
ResultsOur sample is made up of 54 consultants. The average age was 68 years old. The sex ratio was equal to 0.875. Negative self-esteem, loss of autonomy, depression were observed respectively in 40%, 56.7%, 36.7% of cases. We found an association between negative self-esteem and loss of autonomy (p=0.01) on the one hand, and depression (p<0.0001) on the other.
ConclusionsOur work showed an association between loss of autonomy, depression and negative self-esteem. Depression and negative self-esteem could be a consequence of the loss of autonomy or contributing factors?
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
Antipsychotics in elderly people: to prescribe or to ban?
- M. Zbidi, W. Bouali, M. Kacem, W. Haouari, L. Zarrouk
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S940
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Introduction
The prescription of psychotropic drugs is a major health problem , especially in the elderly. In fact, many studies highlight the misuse of psychotropic drugs and in particular the over-prescription of antipsychotics in the elderly which would be deleterious and not indicated.
ObjectivesTo evaluate the prescription of antipsychotics in hospitalized elderly people in a psychiatric environment and to compare them with data from the literature.
MethodsThis is a retrospective descriptive study of patients aged over 65, hospitalized in the psychiatry department between January 2017 and December 2021 and who received first- or second-generation antipsychotic treatment during their hospitalization.
ResultsOur sample consisted of 20 patients. More than half of our sample (55%, N=11) had at least one somatic history. More than 20% of subjects, was polymedicated; and for only one patient, the ECG showed an elongation of the space QT counter indicating the use of antipsychotics. The most common diagnosis found was schizophrenia with a rate of 35%,followed by paranoia (20%), and chronic hallucinatory psychosis (15%). More than a quarter of our sample (30%, N=6) received antipsychotic treatment of first generation (AP1G), 10 patients (50%) received antipsychotic treatment of second generation(AP2G) and three patients (15%) received a combination of AP1G and AP2G. More than a quarter of our patients (30%, N=6) reported adverse effects due to neuroleptic treatment.
ConclusionsThe results of our study highlighted different indications for which an antipsychotic treatment was prescribed for an elderly person despite a ground often flawed, polymedicated and where the undesirable effects are superimposed.
Disclosure of InterestNone Declared
Evaluation of social autonomy of schizophrenic patients
- M. Zbidi, W. Bouali, W. Haouari, M. Kacem, R. Bensoussia, L. Zarrouk
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S1077-S1078
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Introduction
Schizophrenia is a debilitating and mutilating mental illness, generally progressing in a Chronic way . It is at the origin of a limitation of social autonomy and source of psychological distress .
Objectivesevaluate the effective social autonomy of schizophrenic patients.
Methodsit is a cross-sectional study carried out at the EPS psychiatry consultation in Mahdia during a period of 3 months, with schizophrenic patients meeting the DSM 5 criteria, having an age varying from 19 to 65 years and whose duration of evolution was at least of one year. Have been excluded those in a state of decompensation, presenting a severe organic disease or having a major cognitive impairment. Information was collected from patients and fromtheir medical records using a pre-established questionnaire. The scale of social autonomy (EAS) of Legay with 17 items grouped into 5 dimensions was used for the evaluation.
ResultsThe general characteristics of the 360 schizophrenic patients who met the inclusion criteria, revealed an average age of 40.2 years, a sex ratio of 2.33, a majority of single (55.8%), a low level of education(66.7%), an absence of professional activity (67.3%) and a deteriorated socioeconomic level (68.6%).Clinical Characteristics noted an average onset age of the disorder of 26 years, an average duration of evolution of 14 years and a preponderance of the residual type and of the episodic evolutionary course with residual symptoms between episodes respectively in 40.6 and 76.4%. The average of EAS scores were 39.08. Three quarters of the population (75.7%) had a score below 59. 24.3% of patients had scores between 60 and 108 signifying impaired social autonomy.
ConclusionsThe evaluation of effective social autonomy is essential for any therapeutic project considering psychosocial integration and rehabilitation of schizophrenic patients.
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
Determinants of postpartum post-traumatic stress disorder
- R. Ben Soussia, F. Nour, W. Bouali, I. BelHAdj, H. Bouchahda, L. Zarrouk
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S503
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Introduction
Post-traumatic stress disorder, following stress of a particular intensity, is often related to the perception of childbirth as a traumatic event requiring the optimization of follow-up and the interest of early detection.
ObjectivesTo determine the factors associated with post-traumatic stress disorder related to childbirth.
MethodsThis is a longitudinal prospective analytical study carried out in the obstetrics gynecology department of the Tahar Sfar Mahdia hospital. The study population was women who gave birth during the study period from March 15, 2020 to September 15, 2020. We used a pre-established questionnaire including sociodemographic and clinical characteristics as well as a psychometric part containing the psychiatric scale for screening for post-traumatic stress disorder.
ResultsOur sample included 120 women. The average age was 28.2±5.3.Five participants (4.2%) had a psychiatric history .
Thirty-five patients (29.1%) had a pathological obstetric history. However, fifteen patients (12.5%) were hospitalized during their pregnancies. Psychometric assessment revealed a prevalence of PTSD at 5.8% with PTSD symptomatology in 18.4% of women.
Twenty-two patients (18.3%) described the childbirth as painful and traumatic.
The frequency of PTSD was higher in women with a history of abortion (6.9%)
Postpartum PTSD was statistically associated with a low level of education (p=0.02), postpartum complications (p=0.05) and sex of the newborn (p=0.01)
ConclusionsThe detection of factors associated with postpartum posttraumatic stress disorder seems to be essential for comprehensive and multidisciplinary management of women at risk.
Disclosure of InterestNone Declared
Exploring women’s sexuality during pregnancy : sociodemographic, culturel and relational characteristics
- R. Ben Soussia, R. Melki, H. Ben Sassi, W. Bouali, D. Toumi, L. Zarrouk
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S1098-S1099
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Introduction
Pregnancy is a period of important physical, psychological and hormonal changes. All these changes affect daily life, relationships with others, the relationship with the body and particularly the intimate and sexual aspect within the couple.
Objectivesto describe the sociodemographic and clinical profile of pregnant women, explore their perceptions and practices regarding sexuality during an uncomplicated pregnancy and to assess the impact of pregnancy on the couple’s sexuality.
MethodsThis is a cross-sectional, descriptive study conducted among pregnant women followed at the outpatient prenatal and women in immediate postpartum who gave birth in the obstetrics department of EPS Tahar Sfar Mahdia, during a period of 6 months from 01 September 2019 to 28 February 2020. The evaluation of women’s sex life during pregnancy was conducted using a predefined questionnaire and the validated scale translated into Arabic “Arabic Female Sexual Function Index (ArFSFI)”.
ResultsA total of 110 patients were included. The average age of the patients was 30.2 +/- 4.98 years. In 60 % of the cases, the patients were from rural areas. More than half (55%) of our patients had a primary education and were housewives (64%). They were married for love in 59% and the marriage was arranged for 41% of the women. More than 2/3 of our patients (71%) reported a good marital relationship. In relation to the current pregnancy: the majority of patients (70%) were in immediate post partum, the pregnancy was desired (98.1%), well experienced (62%).
For most of the patients (58,2%), sexual intercourse was possible and without risk during the whole pregnancy, but some women thought about the risk of abortion or premature delivery (37.3%), the risk of metrorrhagia (10%) and the risk of infection (6.4%). Most patients (87.2%) reported a decrease in the frequency of sexual intercourse during pregnancy. Most women reported a decrease in desire (51.8%), and sexual satisfaction (55.6%) during their pregnancies. For partner sexuality, desire was stationary for 89% and sexual satisfaction was decreased in 61.1% of cases. Almost half of our patients (42.7%) talked about sexuality : to the husband in 74% of cases, followed by social networks in 58% of cases. The motivation for talking about sexuality was in the majority of cases (61.7%) secondary to a complication (metrorrhagia/ Threatned premature labor..).The mean FSFI total score was 25.3 ± 2.8. More than 2/3 of the patients (70%) had a score <26.55 indicating female sexual dysfunction.
ConclusionsPerforming sexual acts during pregnancy has very low risk, contraindications are rare and specific. It is therefore important that patients be informed and reassured on this subject. Information on sexuality during pregnancy should be systematically provided to women during their pregnancy follow-up.
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
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
Music therapy and depression : the alternative approach
- M. Zbidi, W. Bouali, M. Hnia, M. Kacem, R. Bensoussia, L. Zarrouk
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S418
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Introduction
Depression is a highly prevalent disorder associated with reduced social functioning, impaired quality of life, and increased mortality. This disease is one of the most common reasons for the use of complementary and alternative therapies. Music therapy is a therapeutic approach that uses musical interaction as a means of communication and expression.
ObjectivesTo assess, through a systematic review, the effectiveness of music therapy in patients with depression disorder, and to design a research protocol for a randomised controlled trial of group music therapy for depressed patients in a Psychiatry Department.
MethodsWe conducted a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA).We systematically searched 3 databases (Pubmed, Google Scholar and SciElo) and reviewed randomized controlled trials. The evaluation of the trials was made using the CONsolidated Standards of Reporting Trials (CONSORT) guidelines.The review included studies of 16-to-80-year-old impatients and outpatients of both genders with clinical depression using any diagnostic criteria such as ICD 10 (WHO 1992) or DSM 5 Research Diagnostic Criteria. Change in depressive symptoms was measured with various scales. An experimental protocol was then designed to conduct a randomized controlled trial for depressed patients in the Psychiatry Department at the University Hospital of Mahdia, seeking to supplement scientific knowledge in the field of music therapy that has not yet been explored.
ResultsA total of 13 articles were included in the study: The analysis of these articles highlighted a predominance of Anglo-Saxon papers and an increasing rate of publication over time.The duration of treatment varied between 2 weeks and 10 weeks and the number of music therapy sessions varied between 4 sessions and 20 sessions.Two major music therapy approach were identified, active method where patients are the ones making music and receptive or passive methods where patients will receive the music.12 researches included in our review reached the conclusion that music therapy had a significant positive effect on patients as the score scales were significantly lower after the end of the therapy. Only one included research found no significant difference between music therapy group and treatment as usual.In addition the results of all studies came on the conclusion that music therapy improved symptoms of anxiety and scores were significantly lower.
ConclusionsThis systematic review and meta-analysis suggests that music therapy has an effect on reducing depressive symptoms to some extent. However, high-quality trials evaluating the effects of music therapy on depression are required. Thus,the aim of our study protocol is to contribute to the development of this therapy
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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- Journal:
- 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
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
Assessment of addictive behaviors in patients with schizophrenia
- M. Kacem, W. Bouali, H. Babba, F. Zaouali, 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. S669
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Introduction
Schizophrenia, a chronic and complex psychiatric pathology, can be isolated. However, it can be associated with other comorbidities and thus be accompanied by addictive behaviors that complicate their management.
ObjectivesThe objectives of our study were to estimate the prevalence and identify the characteristics of addictive behaviors in patients with schizophrenia.
MethodsA retrospective study of 151 patients with schizophrenia hospitalized in the psychiatry department of 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 the 36-45 age group (38.4%). All patients were male. Three quarters of the patients (75.5%) were users of psychoactive substances (PAS): nearly three quarters (72.8%) were addicted to tobacco, more than one third (39.7%) were addicted to alcohol, more than one quarter (29.1%) were addicted to cannabis and nearly one quarter (26.5%) were addicted to other PAS. In more than half of the cases (54.4%), the age of onset of substance use was between 16 and 25 years. The use of PAS preceded the onset of schizophrenia in 62.3% of cases. The relationship with the entourage was marked by hetero-aggressiveness in 77.5% of patients, withdrawal from the entourage in 16.6% of patients and conflict in 5.3% of patients. The impact on the relationship with oneself was marked by self-aggressiveness in 18.5% of patients. Concerning the professional impact, three quarters of the patients (76.1%) had to stop working. The majority of patients (84.1%) continued their usual treatment, while 15.2% of patients stopped it. Only one patient required an increase in dose.
ConclusionsSubjects suffering from schizophrenia are particularly vulnerable to addictions, mainly to tobacco and alcohol. They are thus a group more at risk of the deleterious effects of psychoactive substances and of the aggravation of the clinical and psychosocial evolution of their psychiatric disorders. Measures for early detection and treatment of their addictive behaviors even before the onset of schizophrenia should be proposed.
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
Alcohol use: prevalence and associated factors in a sample of Tunisian students
- R. Ben Soussia, N. Faouel, W. Bouali, E. Gharbi, M. Ben Fredj, L. Zarrouk
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S673-S674
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Introduction
The use of alcohol, in particular its harmful use and alcohol dependence, represent a public health problem of interest to all age groups. Indeed, alcohol is responsible for a heavy burden of disease and a considerable socio-economic burden.
ObjectivesTo determine the prevalence of alcohol use and the main factors associated with it in a sample of Tunisian students.
MethodsThis is an analytical cross-sectional study carried out during the 2020/2021 academic year with a sample of Tunisian students. We used an anonymous self-administered questionnaire distributed online via social networks. Our questionnaire included a section focusing on socio-demographic characteristics and the AUDIT test (Alcohol Use Disorders Identification Test) to detect alcohol addiction.
ResultsOur study enrolled 772 students .The average age of the study population was 23.29 ±3.25.Two hundred ninety-nine students (38.7%) consumed alcohol. The mean age at first use was 18.44 (3.09). Fifty-two alcohol users (17.4%) presented a risk of alcohol dependence. The first consumption contexts were mostly “between friends” (57.4%) and “party time “(23.5%).The main effects sought were the effect of disinhibition (64.5%) and social integration (41.1%) were predominant responses. The determining factors of alcohol consumption were age (p<10-3), male gender (p<10-3), and the presence of grade repetition (p<10-3), wealthy socioeconomic level (p<10-3), and participation in community life (p<10-3).
ConclusionsAlcohol use and especially alcohol dependence may have harmful effects on student’s life. It is relevant to screen this addiction to better its prevention.
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