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INTRODUCTION Post-traumatic Stress Disorder (PTSD), depression and anxiety are the most common psychiatric consequences among parents of children with epilepsy. OBJECTIVES We aimed to investigate the prevalence and predictors of PTSD, depression and anxiety in a sample of parents of children with epilepsy. METHODS A survey of 135 parents of children with epilepsy, treated in the pediatric neurology department at the Sfax Teaching Hospital in Tunisia, was conducted in the last quarter of 2019. The PTSD Checklist for DSM-5 and the Hospital Anxiety and Depression Scale (HADS) were used to assess, respectively, PTSD, depression and anxiety in parents. Associations with clinical and demographic variables with PTSD, depression and anxiety were evaluated in a logistic regression model. RESULTS Results revealed PTSD rates of 20.7%, depression rates of 28.9% and anxiety rates of 55.6%. The main factors associated with PTSD on multivariable analysis were female gender (P=0.026, ORa=13.1), insufficient involvement of partner in disease management (P

Background Anti-TNF treatment failure in patients with IBD is common and frequently related to low drug concentrations. DNA methylation sites from whole blood have been identified as effective biomarkers predicting treatment response to methotrexate and etanercept in patients with rheumatoid arthritis. We sought to define differences in DNA methylation associated with primary non-response (PNR) to anti-TNF treatment in patients with Crohn’s disease. Methods The Personalised Anti-TNF Therapy in Crohn’s disease (PANTS) study is a prospective UK-wide study investigating anti-TNF treatment failure in patients with active luminal Crohn’s disease. DNA methylation from whole blood was assessed using the Illumina EPIC Beadchip at baseline, weeks 14, 30 and 52. We compared DNA methylation profiles in a subset of adalimumab- and infliximab-treated patients who experienced PNR at week 14 and were not in remission at week 54 (infliximab = 99, adalimumab = 94) with patients who responded at week 14 and were in remission at week 54 (infliximab = 99, adalimumab = 93). Low anti-TNF drug concentration was defined as an infliximab level Epigenome-wide association (EWAS) analysis was performed using linear mixed models, where p values < 9 x 10-8 were considered significant. Because we observed significant changes in CD4 and CD8 T cells, B cells, NK cells, monocytes and granulocytes following anti-TNF treatment we adjusted our models for derived cell proportions (Figure 1). Results Overall, between baseline and week 14, we observed 4999 differentially methylated probes (DMPs) annotated to 2376 genes. Pathway analysis identified 108 significant gene ontology terms enriched in biological processes related to immune system processes and responses (Figure 2). EWAS analysis at baseline identified 48 DMPs annotated to 36 genes associated with PNR (Figure 3). The majority of DMPs (40/48) were hypermethylated (p < 0.001): of those annotated to genes, 25 were located in the gene body, 5 in the 5’ untranslated regions (UTR), 4 in transcription start sites and the remaining in 3’UTR. When EWAS analysis at baseline was stratified by anti-TNF drug concentration, 27 DMPs annotated to 17 genes were associated with PNR and low drug concentration. Of these, 11 DMPs were independently associated with low anti-TNF drug concentration at week 14 (Figure 4). We did not identify any DMPs associated with PNR with adequate drug concentration. Conclusion Our data suggests that baseline DNA methylation profiles may be used as a predictor for anti-TNF drug concentration at week 14.

Resume Objectifs Dans ce travail, nous nous sommes proposes de determiner la prevalence de la depression et de l’anxiete et d’evaluer la qualite de vie (QDV) chez une population tunisienne de malades atteints du syndrome des apnees-hypopnees obstructives du sommeil (SAHOS), et d’apprecier, dans un second temps, leur evolution sous l’effet de la ventilation en pression positive continue (VPPC). Methodes Nous avons mene une etude prospective, ayant porte sur 33 patients apneiques suivis pour SAHOS modere ou severe, au service de pneumologie au CHU Hedi Chaker de Sfax. Ils ont recu un traitement par VPPC pendant trois mois de facon reguliere. Deux echelles, l’Hospital Anxiety and Depression Scale (HADS) et la 36 item Short-Form Health Survey (SF-36) ont ete remplies avant et apres le traitement afin d’evaluer l’effet de trois mois de traitement par VPPC. Resultats La prevalence de la depression, selon l’echelle HADS, chez les patients de l’etude etait de 45,5 % et celle de l’anxiete etait de 21, 2 %. La QDV, selon l’echelle SF-36, etait alteree dans 81,8 % des cas. Le traitement par VPPC a entraine une amelioration significative avec une baisse des scores moyens de la depression (9,7 vs 6,3 ; p Conclusions Le traitement par VPPC a eu un effet benefique sur les symptomes anxieux et depressifs et sur la QDV des malades atteints du SAHOS, dans la majorite des cas. Les malades insuffisamment ameliores devraient beneficier d’une prise en charge specialisee.

Resume Objectifs Les objectifs de notre etude etaient d’evaluer le deficit metacognitif chez des malades atteints de schizophrenie et d’etudier ses liens avec les donnees sociodemographiques, cliniques et therapeutiques. Methodes Il s’agissait d’une etude transversale a visee descriptive et analytique, portant sur 74 patients atteints de schizophrenie et suivis aux consultations externes du service de psychiatrie « C » au CHU Hedi Chaker a Sfax. Les patients ont ete evalues cliniquement par les echelles suivantes : Metacognition Assessment Scale-Abbreviated (MAS-A), echelle d’insight (Q8) et Positive and Negative Symptoms Scale (PANSS). Resultats L’evaluation metacognitive a montre que la totalite de nos patients atteints de schizophrenie avaient un deficit metacognitif. Les principaux facteurs associes au deficit metacognitif etaient : l’inactivite professionnelle (p = 0,015), le niveau scolaire primaire (p = 0,045), le faible insight (p = 0,001), la symptomatologie negative (p Conclusion Au vu de nos resultats, il convient de proposer des moyens therapeutiques specifiques agissant sur ces facteurs. Un programme d’entrainement metacognitif, adapte a cette population vulnerable, constitue une priorite permettant d’ameliorer leur qualite de vie. Les professionnels de la sante mentale en Tunisie devraient se munir d’outils therapeutiques adaptes, notamment en proposant des formations en remediation cognitive.

Resume Le but de cette etude etait de dresser le profil sociodemographique, clinique, criminologique et medicolegal des auteurs d’homicide intrafamilial et de comparer celui des sujets souffrant de maladies mentales graves a celui des sujets indemnes de telles maladies. Il s’agissait d’une etude retrospective qui a porte sur 60 dossiers de sujets inculpes pour homicide ou tentative d’homicide intrafamilial, examines, dans le cadre d’expertises psychiatriques penales, au service de psychiatrie « C » au CHU Hedi Chaker a Sfax, entre le 1er janvier 1996 et le 31 decembre 2018. Les auteurs d’homicide intrafamilial etaient majoritairement de sexe masculin (81,7 %). Leur âge moyen etait de 35,2 ans. Ils avaient des antecedents de violence a l’encontre de leur victime dans 60 % des cas. Le crime etait premedite dans 48,3 % des cas et commis par une arme blanche dans 63,7 % des cas. Quatre-vingts pour cent presentaient un trouble mental. Parmi ceux-ci, 41,7 % presentaient une maladie mentale grave. La conclusion de l’expertise etait la demence au sens legal au moment des faits dans 45 % des cas. Les auteurs d’homicide malades mentaux graves avaient plus frequemment des antecedents de tentative(s) de suicide et de violence envers la victime (p = 0,017 et p = 0,033 respectivement) et etaient plus frequemment delirant au moment du crime (p

Psychiatric signs and symptoms occur frequently in individuals with central nervous system diseases. Inadequately treated, these comorbid conditions affect patient rehabilitation, compliance with treatment and quality of life. Their management poses a major challenge given the variable efficacy and safety profiles of available psychotropic drugs and increased risk of drug interaction. This review aims to summarize the existing literature on the prescription of psychotropic drugs for management of psychiatric disorders among persons with central nervous system's diseases.

Resume Nos objectifs etaient de determiner la frequence de la demotivation chez les sujets âges (SA) vivant en institution et d’etudier ses liens avec les facteurs cliniques. Cette etude transversale, descriptive et analytique, a porte sur 30 SA vivant a la maison de retraite de Sfax. Le score de la demotivation augmentait de facon significative avec la non-participation aux activites de groupe au sein de l’institution, l’absence de pratiques religieuses, l’absence de sorties de l’institution et l’existence d’un deficit auditif. Il etait positivement correle au score de depression et negativement correle aux scores d’autonomie et des fonctions cognitives. Nos resultats ont montre que la demotivation du SA en institution est associee a la depression, a la dependance et aux troubles cognitifs et ont suggere le role protecteur de la foi religieuse.

Resume But de l’etude Evaluer le retentissement de l’intervention de crise lors du naufrage de Kerkennah survenu en juin 2018 sur les intervenants, tant positivement que negativement. Materiels et methodes Il s’agissait d’une etude transversale, descriptive et analytique. Elle a concerne tous les professionnels des services de psychiatrie au CHU Hedi-Chaker de Sfax (Tunisie) et au service de medecine legale au CHU Habib Bourguiba de Sfax (Tunisie), ayant contribue directement ou indirectement a la prise en charge des victimes et/ou des familles des victimes du naufrage susmentionne. Nous avons utilise l’echelle de l’impact de l’evenement IES-R pour depister la presence d’un etat de stress post-traumatique (ESPT) et l’echelle du stress percu PSS pour evaluer le niveau du stress. Resultats Ont ete inclus 34 intervenants. Les reactions positives les plus frequentes etaient la prise de conscience des difficultes sociales et humaines (94,1 %) et l’amelioration des habiletes pour le travail en equipe (85,3 %). Un ESPT etait probable chez neuf intervenants (26,5 %) ; deux psychiatres et sept exercant en medecine legale. Treize intervenants (38,2 %) avaient un niveau de stress pathologique au PSS. Un ESPT etait significativement plus frequent chez les intervenants ayant une fonction ouvriere (p = 0,007). Un stress pathologique etait significativement plus frequent chez les intervenants hommes (p = 0,022), ouvriers (p Conclusion Une attention particuliere devrait etre accordee aux professionnels en psychiatrie et surtout en medecine legale, a la suite des interventions en situation de catastrophe, car ils risquent eux aussi de presenter des symptomes traumatiques.

Introduction Working memory (WM) deficit in bipolar disorder (BD) is heterogeneous and seems to be affected by both, demographic and clinical aspects, of the patient. Objectives To assess the WM performance in euthymic bipolar patients (BP) comparing to healthy controls (HC) and to identify demographic and clinical factors associated with it. Methods A case-control study was conducted among euthymic bipolar patients according to DSM-5. The recruitment of patients was performed in the outpatient psychiatric unit in the university hospital Hedi Chaker in Sfax during the period from January to December 2020. The HC were matched to BP on gender, age and education level. The Screening for Cognitive Impairment in Psychiatry scale (SCIP) was used to assess the WM performance by the WM test (WMT). Results We recruited 61 BP (37 males and 24 females) and 40 HC (20 males and 20 females). The average age of BP was 41.75 years (SD=11.6 years). The BD group included 47 BD type I and 14 BD type II patients. The mean duration of illness was 9.75 years (SD=7.93 years). Thirty-seven BP (60.7%) had a history of psychotic symptoms. The WMT score was significantly lower among BP than HC (p Conclusions BP have shown significant impaired performance in WM even during euthymia. Female gender of patient, type II of BD and psychotic symptoms seem to be the predictors of this impairment. Disclosure No significant relationships.

Introduction The COVID pandemic brought an overwhelming impact on hospital systems and personnel in the world. Objectives Our study aimed to examine the impact of the COVID pandemic on the attitude and mental health of healthcare professionals working in COVID departments. Methods We included 23 healthcare professionals working in the COVID departments of the Hospitals of Sfax. Sociodemographic data, medical history and COVID related details were collected from the participants. Their mental health was assessed by the Hospital anxiety and depression scale (HADS). Results In our sample, 26.1% were men and 73.9% were women, they were aged from 26 to 52. They worked for 57 hours per week, including 27.38 hours of direct contact with COVID positive patients and 5.43 nightshifts per month. A rate of 52.2% of the participants claimed having enough protection tools and 13% confirmed having enough equipment for patient management. 30.4% feared the lack of equipment and 39.1% considered themselves trained enough to manage COVID patients. As for the protective measures, 95.7% reduced contact with family members, 30.4% stopped visiting their parents, 8.7% left the family house and 4.3% didn’t take any particular measure. The mean HADS depression score was 9.61, and 60.86% had a Depression score equal or greater than 8, indicating depression. As for the HADS Anxiety score, its mean was 10.61 and 69.56% had a score equal or greater than 8, indicating anxiety. Conclusions The pandemic had a big impact on healthcare professionals working in COVID departments, as shows the relatively high depression and anxiety rate. Disclosure No significant relationships.

Introduction Facing educational difficulties related to COVID-19, some teachers can no longer adapt, making them potential candidates for burnout. Objectives We aimed to assess burnout among high school teachers during the COVID-19 pandemic and to determine its prevalence and factors associated with it. Methods We conducted a cross-sectional, descriptive and analytical study, carried out on google drive in May 2021, and relating to 97 Tunisian junior and secondary school teachers from the Sfax region. Burnout was evaluated by the Burnout Measure Short version (BMS-10). Results The sex-ratio (M/F) of our population was 0.32 and the average age was 44.23 ± 7.81 years old. The labor load was low, medium and high in respectively 1.4%, 57.6% and 41% of cases. Almost a third of participants (30.6%) reported a low satisfaction with working conditions. The average BMS score was 40.19 ± 13.98. According to the BMS scores, 36.1% of teachers had a very low to a low degree of burnout, 23.6% had burnout while 40.3% had a high to very high degree of exposure to burnout. Furthermore, the BMS score was associated with the female gender (p=0.002), sleep disturbances (p Conclusions In this study, Tunisian high school teachers in times of COVID-19 reported a high burnout rate. Thus, the protection of this vulnerable population must be an important component of public health measures. Disclosure No significant relationships.

Introduction Violence is recognised by the WHO as a major and ubiquitous public health problem, that is constantly worsening. Objectives The aim of our work was to estimate the frequency of aggressions against nurses in psychiatric and emergency departments, and to identify the factors associated with it. Methods This was a cross-sectional, descriptive and analytical study. It took place between January and March 2021, at both hospitals of Sfax (Tunisia).This study targeted 60 nurses in the psychiatry and emergency services. Results The sample comprises 35 nurses (58%) from psychiatric services and 25 nurses (42%) from emergency services, mainly females (51%) and with average age of 35 years.(+/-9). The nurses interviewed were exposed to violence quite often, in 93% of cases. Almost all nurses (90 %) experienced verbal violence, 70 % experienced physical violence and more than half (62 %) experienced psychological violence. Nearly 11% of nurses reported a sexual violence. Factors that explain or contribute to violence mentioned by the participants were as follows; The Verbal violence was significantly correlated with poor reception conditions (p=0.013). The Sexual violence was significantly correlated with young age of nurse (p=0.005). As for psychological violence, it was significantly correlated with work overload (p=0.004), a poor caregiver-patient relationship (p=0.02) and poor patient care (p=0.04). Conclusions Our study showed that violence against nurses was frequent in psychiatric and emergency departments. Various factors could modulate their occurrence such as training and improvement of the working conditions. Disclosure No significant relationships.

Introduction Impairments of empathy have been observed in patients with various psychiatric Disorders. Yet, little research on empathy concerning mood disorders exists. Objectives To compare empathy levels in euthymic bipolar patients (BP) and healthy controls (HC). Methods A cross-sectional and comparative study of 78 patients followed for bipolar disorder, during euthymia, at the psychiatric outpatient clinic at CHU Hédi Chaker in Sfax, and 78 age-gender matched HC. We used a socio-demographic and clinical data sheet and the Questionnaire of Cognitive And Affective Empathy (QCAE) to assess empathy with its two dimensions : “Affective empathy” and “Cognitive empathy”. Results The average age was 36.27 years, the sex ratio was 5.5. Bipolar I disorder was diagnosed in 88.5% of patients. The mean age of onset was 27.73 years, and the mean duration of illness was 8.4 years. Total scores of empathy as well as scores of cognitive and affective empathy were higher in HC than in BP. *Total QCAE BP vs HC : 72.49 vs 80.53 *Cognitive empathy BP vs HC : 43.21 vs 94.24 *Affective empathy BP vs HC : 29.36 vs 30.44 A significant difference in QCAE score and cognitive empathy score between BP and HC was found (p Conclusions In our study, euthymic BP have been less empathetic than HC. Research on the subject are small and few. Thus, more studies are needed to confirm our results on the effect of mood disorders on empathy. Disclosure No significant relationships.

Introduction With the advancement of technology over the last years, gaming is no longer reserved to adolescents. It has become a growing phenomenon within young adults which should,’t be overlooked as it is accompanied with the risk of addiction. Objectives To study the factors involved in video games addiction behaviors in adults Methods We conducted a cross-sectional, descriptive and analytical study. Data were collected using a self-administered questionnaire on social networks. We solicited adults between 18–40 years. We used the gaming addiction scale (GAS) in its validated Arabic short version. Results A hundred and nine participants were included. The mean age was 29.6 ±10.3 with a sex ratio of 1.5.The mean age of the beginning of regular gaming was 16.3± 8.64. we found that40.4% of our participants preferred the mode Massively Multiplayer Online Role Playing Games (MMORPG) while others played casual single player games. A play time of over 20 hours per week was reported by 11.9%of participants. According to the GAS, 25.7%were addicted gamers. Our participants spent an average of 7.94±6.71 hours before they play their first game of the day. We found that the score of Gas was significantly correlated to the male gender of the participants (p Conclusions Our study showed that contextual factors play an important role in understanding gaming addiction in young adults as a holistic phenomenon,embedding the problematic behavior within the context of the individual the game and gaming practices. Disclosure No significant relationships.

Introduction During the COVID-19 pandemic time, teachers have to adapt to many changes that could potentially make them more vulnerable to psychological distress. Objectives To determine the prevalence and the factors for anxiety during the COVID-19 epidemic among the high school teachers in Sfax, Tunisia. Methods This was a cross-sectional study, for descriptive and analytical purposes, conducted on google drive in May 2021.We involved 97 junior and secondary school teachers from Sfax, Tunisia, practicing in public high schools. Anxiety was assessed by using Generalized Anxiety Disorder tool (GAD-7). Results The average age of the participants was 44.23 years old with a sex-ratio (M/F) of 0.32. Since the advent of COVID-19, 54.2% had presented sleep disturbances while 10.4% had suicidal thoughts. Among all participants, 77.8% were afraid of the virus transmission within the classroom or the school and 81.3% reported regular mask wear at work. The median score on the GAD-7 was 6.5 (Q1=3, Q3=11). Scores’ distribution indicated that 68% of the participants had no to mild symptoms of anxiety while 32% had moderate to severe anxiety. Furthermore, the presence of anxiety was associated to the female gender (p=0.01), sleep disturbances (p Conclusions During the COVID-19 outbreak, high school teachers in Sfax, Tunisia have high levels of anxiety.This can lead to a decreased effectiveness of their complex work. Disclosure No significant relationships.

Introduction Prolonged exposure to Video games may have several negative cognitive and emotional consequences.However, a few investigations have explored the effects of video games addiction on sleep. Objectives To study the effects of gaming addiction on sleep patterns in young adults Methods We conducted a cross-sectional, descriptive and analytical study.Data were collected using a self-administered questionnaire on social networks targeting young adults between 18–40 years. We used the gaming addiction scale (GAS) in its validated Arabic short version. We also used the validated Arabic version of the Pittsburgh Sleep Quality Index (PSQI) to assess the sleep quality of our participants. Results One hundred and nine participants were included. The mean age was 29.6 ± 10.3. Males accounted for 60.6% of the study population. The mean Gas score was 13.11± 6.08.According to the GAS,25.7% were addicted gamers. The mean PSQI score was 7.25± 3.15. A poor sleep quality pattern (score > 6) was found in 59.6% of the participants. We found that the GAS score was significantly correlated to the total score of PSQI( P=0.003). We also found that the group with poor sleep quality had higher GAS scores (p= 0.014). We found a correlation between the GAS score and the following components of the PSQI: subjective sleep quality ( p= 0.01), sleep disturbances (p=0.024) and the use of sleep-promoting medication ( p=0.046) Conclusions Our study showed that video gaming behavior had a significant effect on sleep quality. This can have negative consequences on life quality, together with an impaired performance at awakening. Disclosure No significant relationships.

Introduction Numerous studies have documented high rates of functional impairment among bipolar disorder patients, even during phases of euthymia. Objectives To study different domains of functioning impairment in bipolar patients during euthymic phase. Methods A cross-sectional and descriptive study of 78 patients followed for bipolar disorder, during euthymia, at the psychiatric outpatient clinic at CHU Hédi Chaker in Sfax. We used a socio-demographic and clinical data sheet and the Functioning Assessment Short Test (FAST) to assess functionning : A functional impairment was retained for a total FAST score > 11. Results The average age was 36.27 years, the sex ratio was 5.5. Bipolar I disorder was diagnosed in 88.5% of patients. The mean age of onset was 27.73 years, and the mean duration of illness was 8.4 years. *The mean total score at the FAST was 22.23. *Functioning was altered on 69.2% of patients. *The occupational and the cognitive functioning were the two most altered domains in our population (respective mean scores : 8.69 and 5.74). *Autonomy was altered on 17.9% of patients. *Occupationnal functioning was altered on 76.9% of patients. *Cognitive functioning was altered on 70.5% of patients. *Financial issues were observed on 34.6% of patients. *Interpersonal relationships were altered on 41% of patients. *Leisure time difficulties were present with 24.4% of patients. Conclusions This work has focused on the very high frequency of functional handicap in euthymic bipolar patients. Thus, several measures must be put in place to prevent or mitigate the negative effects of the impaired functioning on these patients. Disclosure No significant relationships.

Introduction Although gaming addiction has received a great deal of attention from researchers, few studies have evaluated its effect on health related quality of life in adults Objectives To study the relationship between gaming addiction and perceived health status Methods We conducted a cross-sectional, descriptive and analytical study.Data were collected using a self-administered questionnaire on social networks targeting adults between 18 and 40 years. We used the gaming addiction scale (GAS) in its validated Arabic short version. we also used the 36-Item Short Form Health Survey questionnaire (SF-36) in its validated Arabic version Results One hundred and nine participants were included. The mean age was 29.6 ±10.3. Males accounted for 60.6% of the study population. A history of anxiety or depression was found in 4.6 % of participants and 3.6% had an organic affection .The mean GAS score was 13.11± 6.08. According to this scale, 25.7% were addicted gamers. We found a significant difference between the group of participants considered addicts and those who were not in the following items: vitality (p=0.002), mental health (p=0.004) and role limitation due to emotional health (p=0.05). We found a correlation between the GAS score and role limitation due to physical problems ( p= 0.41), role limitations due to emotional problems (p=0.004 ), vitality( p=0.005) and mental health ( p= 0.001). Conclusions Our data showed significantly lower health related quality of life related to higher exposure to games especially in the psychological health.In future researches, the effect of gaming addiction on other domains of quality of life can be investigated Disclosure No significant relationships.

Background Conflicting evidence exists regarding whether low baseline Triggering Receptor Expressed on Myeloid cells (TREM)1 whole-blood gene expression predicts response or non-response to anti-tumour necrosis factor agents in patients with Ulcerative Colitis (UC) or Crohn’s Disease (CD). This study investigated whether baseline TREM1 expression predicted outcomes following adalimumab treatment in patients with UC or CD in the SERENE Phase 3 studies. Methods The SERENE studies (SERENE-UC, NCT02065622; and SERENE-CD, NCT02065570) compared a higher adalimumab induction dosing regimen versus the standard regimen in patients with UC or CD. Whole-blood TREM1 expression was analysed by RNA sequencing in patients who received standard-dose adalimumab and had clinical and endoscopic outcomes at Week 8 or 52 in SERENE-UC (n=95 for Week 8 and n=70 for Week 52 outcomes), or Week 12 or 56 in SERENE-CD (n=106 for all Week 12 outcomes; n=48 for clinical and n=50 for endoscopic outcomes at Week 56). Outcome definitions are summarised in Table 1. A 2-sample t-test was used to compare baseline TREM1 gene expression (log2 counts per million) in clinical or endoscopic remitters or responders versus non-remitters or non-responders at Weeks 8 and 52 (SERENE-UC) or Weeks 12 and 56 (SERENE-CD). Results In SERENE-UC, baseline TREM1 expression did not predict clinical remission at Week 8 (Figure 1a; p=0.7942) and was only weakly predictive of clinical remission at Week 52 (Figure 1b; p=0.04997). Further, it was not predictive of clinical response at Week 8 or Week 52, nor of endoscopic remission or endoscopic response (Figure 1c) at Week 8 (p>0.05 in all cases), although a weak correlation was observed with both endoscopic remission (p=0.0484) and endoscopic response (p=0.01162; Figure 1d) at Week 52. In SERENE-CD, baseline TREM1 expression was not linked to endoscopic or clinical outcomes at either Week 12 or Week 56 (p>0.05 in all cases; Figure 2a–d). Stratification by adalimumab quartiles did not increase the ability of baseline TREM1 expression to predict clinical outcomes in either study. Of note, a highly positive correlation was observed between baseline TREM1 expression and neutrophils in endoscopic responders and non-responders in both studies. Regardless of clinical or endoscopic response or non-response, TREM1 expression decreased over time following adalimumab treatment. All results obtained with standard-dose adalimumab were replicated with the higher dose (data not shown). Conclusion The findings of this study suggest that baseline whole-blood TREM1 gene expression is not a robust predictor of clinical or endoscopic outcomes following adalimumab treatment in patients with UC or CD.

Resume Position du probleme Les conduites de consommation de substances psychoactives, notamment celle de l’alcool, suscitent un interet mediatique accru depuis la revolution, en Tunisie. En fait, la Tunisie dispose de peu d’etudes epidemiologiques sur ce sujet ; ce qui ne permet pas d’avoir une idee claire sur l’ampleur reelle du probleme et sur ses differents determinants. Objectifs Evaluer la prevalence de la consommation d’alcool chez les adolescents scolarises de la region de Sfax, deuxieme ville du pays du point de vue demographique, et determiner ses liens avec les deux dimensions de la personnalite : recherche de sensations et impulsivite. Methodes Il s’agissait d’une etude transversale ayant inclus 317 eleves des etablissements publics de la region de Sfax. Les participants ont rempli, apres consentement, une fiche de renseignements epidemiologiques, l’echelle « Alcohol Use Disoders Identification Test » (AUDIT), l’echelle d’impulsivite de Barratt (BIS-11) et l’echelle de recherche de sensations (SSS-V). Resultats L’âge moyen des eleves etait de 15,79 ± 1,5 ans avec un sex-ratio de 1,07. La prevalence des experimentateurs (ayant consomme de l’alcool au moins une fois dans leur vie) etait de 19,6 %. Celle des consommateurs actuels (ayant consomme de l’alcool plus d’une fois au cours des 12 derniers mois precedant l’enquete) etait de 8,8 %. Parmi ces derniers, et selon l’AUDIT, 42,8 % presentaient une dependance a l’alcool. L’etude des dimensions de la personnalite a montre une association significative entre la consommation actuelle d’alcool et la recherche de sensations (p Conclusion Il ressort de notre etude que les dimensions de recherche de sensations et d’impulsivite sont associees a la consommation d’alcool chez les adolescents tunisiens scolarises. Cette conduite semble assez frequente et souvent problematique chez eux.

Introduction The constraints linked to COVID-19 may reduce resilience and intensify depressive feelings especially in vulnerable populations such as teachers. Objectives To understand the psychological distress in terms of depression of the COVID-19 pandemic among secondary school teachers in Sfax, Tunisia and to determine the correlated factors. Methods This was a descriptive and analytical cross-sectional study of 97 medium and high school teachers from Sfax, Tunisia. The study was conducted on google drive in May 2021, including an information sheet and the Patient Health Questionnaire (PHQ)-9 to assess depression. Results In our study, the sex-ratio (M/F) was 0.32 and the average age was 44.23 years old. The median professional seniority was 16 years (minimum=1, maximum=37). Suicidal thoughts were described by 10.4% of teachers while 54.2% reported the presence of sleep disturbances since the onset of the pandemic. The median PHQ-9 score was 8 (Q1=4, Q3=15). The distribution of scores indicated that 59.7% of participants had no to mild symptoms of depression while 40.3% had moderate to severe depression. Furthermore, the presence of depression was associated with an age ≤ 40 years old (p=0.037), a professional seniority ≤ 20 years (p=0.035), the female gender (p=0.005), the presence of sleep disturbances (p Conclusions It seems that COVID-19 health situation in education have led to the emergence of a teacher overexertion and a depth adaptation to the new environment demands. Thus, clinical attention to the depression level of the teachers is certainly warranted. Disclosure No significant relationships.

Introduction Exposure to violence affects employees and has implications for the quality of care provided. Objectives This study aims to describe the effects of workplace violence on nurses in psychiatric and emergency departments. Methods This was a cross-sectional and descriptive study involving 60 nurses practising in the psychiatry and emergency services at the Hedi Chaker and Habib Borguiba University Hospital in Sfax. We collected the socio-demographic and professional data of the participants using a pre-established questionnaire. Results The average age was 35 years and 51 % of respondents were female. Ninety-three percent of the respondents were victims of an act of violence. The violence was verbal in 90%, physical in 70%, psychological in 62% and sexual in 11% of cases. The classification of acts of violence according to the scale of seriousness of the national observatory of violence in health care revealed a predominance of level 1 violence characterised by insults (66%) and level 2 violence with threats to physical integrity (65%). Level 3 violence (physical violence) was the most frequent (70%). Two cases of level 4 violence with knives were reported. These acts of violence generated wounds in 21%, fractures in 10%, haematomas in 10% and bruises in 8% of cases. Thirty-six nurses (60%) reported that the act of violence was responsible for a feeling of insecurity. Conclusions The results of this study indicate the need for hospital center managers to set up organizational policies against workplace violence and to apply them in a rigorous and transparent manner. Disclosure No significant relationships.

Introduction Vaccines are effective interventions that can reduce the high burden of COVID19 globally. However, public vaccine hesitancy is a pressing problem for public health authorities. Objectives This study aimed to assess the prevalence of vaccination within mentally ill population and to point out the factors of acceptance and reticence. Methods We conducted a cross-sectional, descriptive and analytical study. It was carried out on a clinical population who consult in the psychiatry department in Sfax’s university hospital Hedi Chaker. Patients included in our study were aged between 21 and 69 years and were not in a decompensation phase of their psychiatric illness Results Forty five patients were included. The mean age was 45±13 years old. Our population was made up of 3 women (6.7%) and 42 men (93.3%).A rate of 42.2% of the patients was of urban origin, 15.6% lived with a partner, 77.8% were unemployed and 46.7% were schizophrenic. In our study population, five patients had COVID 19 (11.1%), fourteen patients (31.1%) were vaccinated and eight patients (17.8%) asked their psychiatrist to vaccine. The main reasons of vaccination were their belief that vaccination decreases the chance of contracting COVID 19 and its complications (0.00) ,that COVID is lethal (0.002), and the fact that they trust it (0.001). Thirtyone patients (68.9%) refused vaccination, mainly due to reading or hearing negative information about vaccination (0.025). Vaccination wasn’t correlated neither to the fact that it could be a conspiracy nor to the diagnostic. Conclusions Our study reveals that one third of mentally ill patients are vaccinated. The reasons of acceptance of vaccination are multiple in opposite of the hesitancy factors Disclosure No significant relationships.

Introduction Nurses may be particularly at risk of violence exposure at work which can cause psychological trauma and even develop post-traumatic stress disorder (PTSD), which is a serious mental health disorder. Objectives The aim of this study was to determine the prevalence of PTSD among nurses in psychiatry and emergency departments and to identify the factors associated with it. Methods This was a cross-sectional, descriptive and analytical study. It concerned 60 nurses working in the psychiatry (35 nurses) and emergency (25 nurses) departments of the Hedi Chaker and Habib Borguiba University Hospital in Sfax. The screening of PTSD was carried out by the « post-traumatic stress evaluation questionnaire » (PTSQ). Results Direct trauma exposure was reported by 93% of participants, of which 48.3% experienced the act of violence more than 4 times. According to the PTSQ, 48.3% of the nurses had PTSD with a mean score of 50.93. Hyper-arousal was the most frequently observed outcome in victims (85%), followed by re-experience (83%) and avoidance (80%) symptoms. The presence of PTSD was correlated with female gender (p=0.002), the young age of the nurse (p=0.04), and the absence of peri-traumatic reactions (p=0.001). Conclusions Our study shows that PTSD is a pathology frequently encountered in psychiatric and emergency nurses. Hence the need to put in place strategies against violence in hospitals and to apply them rigorously in order to better manage this phenomenon and manage its repercussions on health workers . Disclosure No significant relationships.

Introduction Social media networks are becoming omnipresent in our lives, and more and more available to everyone including patients with mental illnesses. Objectives Our study aimed to examine the prevalence of social media use in individuals with schizophrenia and schizoaffective disorder, and to examine the association of severity of symptoms with social media use. Methods A total of 38 patients with schizophrenia or schizoaffective disorder were recruited from the outpatient unit of the department C of psychiatry in Hedi Chaker hospital of Sfax, Tunisia. Socio-demographic information as well as details about their social media use were collected from all the patients. Severity of schizophrenia symptoms was assessed on the Positive and Negative Syndrome Scale (PANSS). A logistic regression was used to explore the association between social media use and clinical characteristics of the participants. Results Of the 38 study participants, 23.7% used social media. Facebook was the most popular social media site. The number of social media users were highest among participants aged 21–30 years old, married participants, residents of an urban region, employed participants and patients with a tertiary education level. Age and PANSS negative score were significantly and negatively associated with social media use. Conclusions Less than one fourth of patients with schizophrenia and schizoaffective disorder use social media and may be suitable candidates for treatment programs supported by social media platforms , especially those of a young age and a low severity of negative symptoms . Disclosure No significant relationships.

Introduction Burden among family caregivers of patients with mental illness can be mediated by resilience and perceived social support. Objectives The present study aimed to explore the relationship between perceived social support and resilience levels among caregivers of patients with mental illness and to identify its associated factors. Methods This was a cross-sectional, descriptive and analytical study conducted on caregivers of patients followed in the outpatient psychiatry department at the university hospital of Sfax (Tunisia), during septembre 2021. Resilience was assessed with the Connor–Davidson Resilience Scale and the social support with the social provisions scale. High scores indicate high resilience and support. Results We have involved 34 family caregivers with an average age of 47.47 years(SD=12.4 years). The mean resilience score of caregivers was 42.85 and the mean social support score was 28.09(SD=5.54). The score of resilience correlated positively with the score of social support among family caregivers of patients (r= 0.76 ; p=0.0001). Furthermore, resilience and social support were significantly lower among caregivers with a history of chronic illness (p=0.0001 and 0.002 respectively). Regarding clinical factors, the scores of social support and resilience decreased significantly with the duration of providing care to patients (r=-0.60; p=0.0001 and r=-0.75; p=0.0001 respectively). Similarly, they decreased significantly with the number of hospitalizations of patients (r=-0.53; p=0.001 and r=-0.62; p=0.0001 respectively). Conclusions The findings suggests that high social support promotes better resilience among family caregivers of patients with mental illness. So, a better adjustement to the role of caregiver can be effectively achieved by improving the perceived social support. Disclosure No significant relationships.

Introduction Schizophrenia (SCZ) is considered one of the most disabling mental illnesses with significant family, social and occupational repercussions resulting in impaired quality of life (QOL). Objectives To assess the QOL of patients with SCZ or schizoaffective disorder (SAD) and to analyze the sociodemographic and clinical factors associated with its alteration. Methods This was a cross-sectional, descriptive and analytical study, which began in December 2019, conducted with 60 subjects followed for SCZ or SAD, at the psychiatry outpatient unit of the Hedi Chaker University Hospital in Sfax (Tunisia). General, clinical and therapeutic data were collected using a pre-established questionnaire. QOL was assessed with the «36 item Short-Form Health Survey» (SF-36). Results Patients enrolled had SCZ in 78.2% and SAD in 21.8% of cases. The mean age was 47.2 years and the sex ratio M/F was 4.5. They were single in 63.7% of cases and unemployed in 61.8%. Psychiatric family history, the presence of personal somatic illnesses and tobacco use were found in 43.6%, 61.8% and 67.3% of cases, respectively. The average QOL score was 57.7, the average physical health score was 61.1, and the average mental health score was 54.3. Female sex (p=0.02), being single (p=0.039), lack of work activity (p=0.00), tobacco use (p=0.05), and presence of medical history (p=0.034) were statistically correlated with impaired QOL. Conclusions QOL in SCZ and SAD is impaired. This result encourages us to conceive of the patient in his whole life and not only from the point of view of the disease. Disclosure No significant relationships.

Introduction The COVID pandemic had a heavy impact on the mental health of people in general and healthcare professionals in particular. Objectives Our study aimed to examine the the prevalence of post-traumatic stress symptoms among healthcare professionals working in COVID departments, and assess their professional quality of life. Methods Our sample consisted of 23 healthcare professionals who are working in the COVID departments of the Hospitals of Sfax. We collected their sociodemographic data, their medical history and COVID-related details. Their mental health was assessed by the Impact of Event scale (IES-R) and the professional quality of life scale (ProQOL-5) Results The sex ratio in our study was 17:6, with a mean age of 31.79 years. They carried out 5.43 nightshifts per month, 57 hours of work per week including 27.38 hours of direct contact with COVID positive patients. A rate of 21.74% of the patients had a high IES-R score, indicating severe post traumatic stress symptoms. As for the subscales of the professional quality of life score, 21.73% of the participants had a low compassion satisfaction score, 65.21% of the participants had a moderate one and 13% had a high one. A rate of 91.3% of the participants had a moderate burnout score, the mean was 29.39. The secondary traumatization score was low in 26% of the cases, moderate in 60.86%, high in 13% and the mean was 27.91. Conclusions COVID healthcare professionals are at a relatively high risk of developing burnout and post-traumatic stress symptoms. Disclosure No significant relationships.

Introduction Technologies such as the phone , the computer , and social media network nowadays are becoming more and more available to everyone including patients with mental illnesses. Objectives Our study aimed to examine the prevalence of technology use in individuals with schizophrenia and schizoaffective disorder. Methods Study participants were recruited from the outpatient unit of the department C of psychiatry in Hedi Chaker hospital of Sfax , Tunisia. A total of 38 male patients were recruited , from whom the diagnosis of schizophrenia or schizoaffective disorder according to the DSM-5 criteria had been confirmed. Socio-demographic and clinical information as well as details about their technology use were was collected from all the patients. Results Of the 38 study participants, 65.8% owned a cell phone , and 52.6% used the cell phone to send or receive messages. A rate of 21.1% owned a computer , 34.2% had internet access and 28.9% had an email account. A rate of 23.7% used social media. Facebook was the most popular social media site. 72% of cell phone owners would like to communicate with their doctor via text messages , and 68% would like to be reminded of their appointments via text messages. Among social media users , 55.6% expressed their interest in a social-media-based doctor-patient communication and appointment reminders. Conclusions Our findings suggest that these technologies afford an opportunity to improve the management of these patients. Disclosure No significant relationships.

Introduction Online sports betting (OSB) is frequently associated with gambling disorder (GD). In Tunisia, no study on this has been done so far. Objectives To detect GD in a population of Tunisian OSB players, and to identify its risk factors. Methods This was a cross-sectional study of 58 male OSB players in the city of Sfax. The GD was assessed by a questionnaire relating to the DSM-V criteria. Depression, anxiety and stress were assessed using the DASS scale, gambling motivations using the GMQ-F scale, and impulsivity using the UPPS-P scale. Results The mean age was 37.4 ± 8.29 years. The prevalence of JAP was 53.4%. On univariate analysis, the factors associated with GD were university level of education, the practice of other gambling, daily gambling, gambling spending > 300 Dinars / month , gambling duration > 3 years, the frequency of winning >1 win /6months , the occurrence of a Big Win, total GMQ-F score, coping motivation , and financial motivation. In the multivariate study, GD risk factors were gambling spending > 300 Dinars / month (p = 0.011; ORa = 223.16), financial motivation (p = 0.022; ORa = 3.967), pathological stress (p = 0.036; ORa = 224.388) and inversely associated with the age at onset of gambling (p = 0.026; ORa = 0.751) and the UPPS score (p = 0.011; ORa = 0.6). Conclusions Our results push us to deepen our knowledge and our studies concerning this problem in our country and to reflect on the management and prevention measures. Disclosure No significant relationships.

Introduction Religiosity is among the factors that determine the doctor’s relationship with his addict patient and the empathy he should have. Objectives To verify whether future doctors are aware of the addictogenic power of certain substances and certain behaviors and to study their perception of different addictions according to religiosity. Methods This was a cross-sectional study with interns and externs of the Sfax medical faculty, in November 2016, via an anonymous questionnaire. Results 141 students were included and 98,6% declared to be believers. The average age was 23 years. The sex ratio was 0.38. Alcoholism was the addiction most considered as a sin (87.9%), smoking 51.8%, hookah 45.4%, cannabis 78%, gambling 77.3%, internet addiction 16.3%, video game addiction 15.6%, work addiction 8.5%, and exercise addiction 5.7%. Female gender was more often correlated with perceived alcoholism, cannabis addiction, and gambling as sins (p = 0.002; p Conclusions According to our study, most medical students have a religiously hostile attitude to many addictions. Improving medical training in addictology would allow them to adopt the necessary empathic attitude, without being judgmental. Disclosure No significant relationships.

Introduction Sexual dysfunction (SD) is prevalent among psychiatric patients than general population. Objectives To assess the SD and quality of life (QOL) of patients with schizophrenia, and to identify the factors associated with it. Methods This was a cross-sectional, descriptive and analytical study, which began in December 2019, conducted with 60 subjects followed for SCZ or SAD, at the psychiatry outpatient unit of the Hédi Chaker University Hospital in Sfax (Tunisia). General, clinical and therapeutic data were collected using a pre-established questionnaire. The Arizona Sexual Experiences Scale (ASEX) and the 36 item Short-Form Health Survey (SF-36) were used to evaluate subjective sexual dysfunction and QOL respectively. Results Patients enrolled had SCZ in 78.2% and SAD in 21.8% of cases. The mean age was 47.2 years. Psychiatric family history, the presence of personal somatic illnesses and tobacco use were found in 43.6%, 61.8% and 67.3% of cases, respectively. The average score of ASEX was 18.21. QOL was altered in 73.3% of participants with an SGM of 53.29. The psychic component was more altered than the physical one with average scores estimated respectively at 48 and 58.44. Participants with SD were more likely to have tobacco consumption (p= 0.025), history of suicide attempt (p=0.023) and they are treated by a combination of several treatments (p=0.025). Impaired QOL was not statistically correlated with SD (p=0.5) Conclusions The physicians should pay attention to SD during the assessment and treatment of patients with schizophrenia. Disclosure No significant relationships.

Introduction Resilience has been described as an individual’s ability to adjust or adapt to significant adverse or traumatic circumstances. Objectives The aims of this study were to assess the resilience of caregivers of patients with mental disorders and to identify its associated factors. Methods We conducted a descriptive and analytical cross-sectional study among caregivers of patients followed in the outpatient psychiatry department at the university hospital of Sfax(Tunisia), during septembre 2021. Resilience was assessed using Connor–Davidson Resilience Scale(CD‑RISC).The total scores range from zero to 100. The cut-off scores for this questionnaire is 50, with higher score indicating higher resilience. Results Our sample included 34 family caregivers. The mean age was 47.47 years (SD=12.4 years)and the sex ratio (M/F) was 1.42. They were the parents of patients in 35.3% of cases. The mean duration of providing care to patients was 8.62 years. The mean resilience score of caregivers was 42.85 and 26.5% of them were resilients. The Caregivers with low socioeconomic level (p=0.004), a history of chronic illness (p=0.0001), a long duration of providing care (p=0.001), a stressful events (0.002) and those victims of agressive behaviors committed by patients (p=0.0001) were more likely to have a low resilience score. Conclusions Our results stated that three out four cargivers have low level of resilience. Interventions targeting stress related to social events and burden of care, and violence committed by patients in their family environment should be integrated to increase the caregivers’resilience. Disclosure No significant relationships.

Post-traumatic Stress Disorder (PTSD), depression and anxiety are the most common psychiatric consequences among parents of children with epilepsy.We aimed to investigate the prevalence and predictors of PTSD, depression and anxiety in a sample of parents of children with epilepsy.A survey of 135 parents of children with epilepsy, treated in the pediatric neurology department at the Sfax Teaching Hospital in Tunisia, was conducted in the last quarter of 2019. The PTSD Checklist for DSM-5 and the Hospital Anxiety and Depression Scale (HADS) were used to assess, respectively, PTSD, depression and anxiety in parents. Associations with clinical and demographic variables with PTSD, depression and anxiety were evaluated in a logistic regression model.Results revealed PTSD rates of 20.7%, depression rates of 28.9% and anxiety rates of 55.6%. The main factors associated with PTSD on multivariable analysis were female gender (P=0.026, ORa=13.1), insufficient involvement of partner in disease management (P10These findings suggest that clinicians should pay more attention to psychological health of parents of children with epilepsy and help healthcare providers to develop preventive and intervention strategies for parents of such children.

Research indicates that many patients with schizophrenia experience deficits in metacognitive capacity defined as the ability to form complex representations of themselves and others. The aim of the current study was to assess metacognitive deficit in patients with schizophrenia. These variables were collected together with many other sociodemographic, clinical and therapeutic data.We conducted a descriptive and analytical cross-sectional study in the psychiatry department at the Hedi Chaker University Hospital in Sfax (Tunisia). Patients were in a non-acute phase, defined by the absence of any psychiatric symptoms during the last four weeks, also, no changes in medication during the previous month had been required. An informed written consent was obtained, following which patients completed questionnaires assessing sociodemographic and clinical data during structured interviews. Symptoms and severity of the illness were assessed using the Positive and Negative Symptoms Scale (PANSS). Insight was assessed using the Insight Scale (Q8). In addition, the Metacognition Assessment Scale-Abbreviated (MAS-A) was used to assess metacognitive capacities. The MAS-A contains four dimensions: self-reflectivity, awareness of the mind of others, decentration, and mastery. Higher scores reflect an ability to effectively respond to psychological challenges on the basis of psychological knowledge.We recruited 74 adults with schizophrenia disorder. The diagnosis was with DSM5. Their average age was 45 years (SD=9.84 years) with a sex ratio (M/F) of 1.552. Nineteen patients (25.5%) were married, and low educational level was present in 43% of cases. Forty patients (54%) were unemployed. Metacognitive deficit was detected in all the patients. They had low levels in all four dimensions of metacognition. The most affected dimension in our series was "Mastery". All patients had an overall insight score less than six (the average score was 2.73) with poor awareness in 62% of patients. The main factors correlated with metacognitive deficit were: occupational inactivity (P-0.015), Primary education level (P=0.045), tobacco consumption (P=0.002), low insight (P-0.001), negative symptomatology (P10-3) and the use of first generation of antipsychotics (P=0.003). The multivariate analysis showed that three factors (occupational inactivity, low insight and the presence of negative symptomatology) were predictors of metacognitive deficits.Based on our results, occupational inactivity, negative symptomatology and low insight are predictors of metacognitive deficit in schizophrenia. Specific therapeutics should be proposed to act on these factors. A metacognitive training program, tailored to this vulnerable population, is a priority to improve their quality of life.

Psychiatric signs and symptoms occur frequently in individuals with central nervous system diseases. Inadequately treated, these comorbid conditions affect patient rehabilitation, compliance with treatment and quality of life. Their management poses a major challenge given the variable efficacy and safety profiles of available psychotropic drugs and increased risk of drug interaction. This review aims to summarize the existing literature on the prescription of psychotropic drugs for management of psychiatric disorders among persons with central nervous system's diseases.

Our objective was to investigate the prevalence and the environmental determinants of alcohol use among students in the region of Sfax in Tunisia. We carried out a cross-sectional study among 315 middle and high school students. We used the Alcohol Use Disorders Identification Test (AUDIT) to identify risky alcohol consumption, and we used the Parenting Styles and Dimensions Questionnaire (PSDQ) to assess the students’ perceptions of their parents’ parenting styles. The results show that 19.7% reported drinking alcohol at least once in their lifetime. Among them, 21% scored as dependent alcohol users, according to the AUDIT. Those who drank alcohol at least once were more likely to have parents with a permissive parenting style (p

IntroductionInternet addiction (IA) is a significant public health issue among adolescents. There is considerable evidence that IA is associated with various psychosocial harms.ObjectivesThe aim of this study was to measure the prevalence of internet addiction among secondary school.MethodsThis cross-sectional study was conducted among 152 students enrolled in secondary school. The participants had filled the Internet Addiction Test of Young and a data file regarding the socio-demographic information, physical and information about the internet access and use.ResultsThe sample consisted of 90 males and 62 females with a mean age of 13.14 ± 1.2 years. The majority of participants had their own smartphone (83.6%). The average duration of connection among participants was 5.3 hours per day. The prevalence of IA was 14,5%. Results showed that 46,8% feel their internet use significantly hinders their family relationships. Twenty participants (13,2%) reported that they connected to the internet while they were in classroom. The prevalence of IA was higher among boys than girls (p= 0.018). There was, also, a significant relation between IA and having academic difficulties (p=0.037).ConclusionsThe prevalence of IA is elevated in Tunisia. Many negative consequences are identified. Urgent measures should be taken to counter the problem.

IntroductionPeople with a schizophrenia experience higher levels of stigma.ObjectivesOur aim was to explore the relationship between internalized stigma, depression and quality of life (QoL) in these patients.MethodsThis is a cross-sectional and analytical study including 37 stabilized patients with schizophrenia or schizoaffective disorder followed up in the outpatient psychiatry department at Hedi Chaker hospital university of Sfax, between August and October 2019. The Internalized Stigma of Mental Illness scale (ISMI-29) was used to assess internalized stigma and its five dimensions. We used the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF) to assess QoL and the Calgary Depression Scale (CDS) to evaluate depression.Results73% of these patients were followed for schizophrenia and 27% for schizoaffective disorder. The global mean score of ISMI was 71.95. The mean scores of alienation, stereotype endorsement, perceived discrimination, social withdrawal and stigma resistance were 15.16, 16.54, 12.95, 15.65 and 11.38, respectively. The Q-LES-Q-SF mean score was 65.51. According to CDS, 18.9% of patients had depression with a mean score of 2.27. Internalized stigma scores (global and the five dimensions scores) were significantly and negatively associated with QoL enjoyment satisfaction score (respective p: pConclusionsOur results confirmed that internalized stigma is associated with impaired QoL and depression in stabilized patients with schizophrenia-spectrum diagnosis.

IntroductionInvestigating family member’s attitudesabout schizophrenia is an important step in its management. They likely influence the family’s help-seeking decisions and affect both adherence with biomedical interventionsand social integration of the patients.ObjectivesDescribe families’ beliefs about the symptoms and the treatments of schizophrenia.MethodsWe led a transversal study including 32 relatives of patients with schizophrenia (DSM 5). We collected data for both patients andrelatives. We asked relatives to respond by “yes/no/I am not certain” to the questionnaireincluding items dealing with symptoms and optimal cures forschizophrenia.ResultsThe mean age of the relatives was 60.8 years; 71.9% were parents; 37.5% were illiterate; 46.9% reported having another family member with a mental disorder (MD) and 15.5% of relatives were able to label the term “schizophrenia”. Nine participants (28%) believed that the patient makes shame to the family’s member and 72% of them was convinced that patient is dangerous.The majority of participants (90.6%) provedthe need for drugs and 65.6% attested the utility of psychotherapies.However, they believed innon-medical practices such as reading Holy Koran verses (87.5%), charity and exorcism (62.5%). Family history of MD was correlated to traditional practices (p=0.038). The belief that patient is dangerous and that he makes shame were associated with advanced age of relatives (p=0.000 and 0.037 respectively). Significant correlationwas found betweennon medical practices and erratic follow-up (p=0.043).ConclusionsThis study points outthe need to improve the psychoeducation of family members of persons with schizophrenia.

IntroductionFamily caregivers of psychotic patients are exposed to violence and stress. However, associated psychological outcomes are poorly characterized in this population.ObjectivesThe aim of this study was to clarify the relationship between violence directed towards caregivers of patients with psychosis and developing post-traumatic stress disorder (PTSD).MethodsParticipants were family caregivers of psychotic patients (n=95). They completed a questionnaire assessing sociodemographic characteristics. Sociodemographic and clinical data of patients were collected from medical records. We used the perceptions of prevalence of aggression scale (POPAS) to measure the frequency and severity of aggression directed at the respondent in the past and the Impact of Event Scale-Revised (IES-R) to evaluate PTSD.ResultsA rate of 75.8% of caregivers reported experiencing moderate to severe levels of aggression. Decreased contact with patient (p=0.00), male gender (p=0.00), older age (p=0.00) and parent relationship (p=0.01) of caregivers, diagnosis of schizophrenia or schizoaffective disorder (p=0,00) and poor adherence to treatment (p=0,00) in affected relatives were associated with experiences of moderate–severe aggression. More than a half of caregivers (54.7%) reported potentially significant levels of PTSD which correlated with the level of aggression (p=0.00).ConclusionsOur findings suggest that a large proportion of family caregivers of patient-initiated violence in psychosis reported experiencing a great distress and a high level of PTSD symptomatology. So, more attention should be paid to the support needs of caregivers who are faced with potentially life threatening aggressive behaviour by psychotic family members.

IntroductionInteractions between infertility and sexuality are numerous and complex. Recently more attention is being paid to the impact of infertility on the marital sexuality.ObjectivesThe aim of this study was to determine the effects of infertility on sexual functions.MethodsA cross-sectional descriptive study, the obstetric gynecology department Basic demographic information was collected. Respondents were surveyed regarding sexual impact and perception of their infertility etiology.ResultsOur patients had an average age of 33.2. The average number of years of infertility was 3.9 years.. The most common cause of female infertility was an ovulat disorder (36%), that of male infertility was sperm production defect. The confrontation with a diagnosis of infertility marks a difference in the way couples organize their sexual life. In our study, sexual problems after this diagnosis were experienced by 38% of women. Sexual dysfunction was detected as a pain problem (24%), a desire problem (10%), an arousal problem (4%), and an orgasm problem in 6% and. Faced with this situation, women felt guilty (46%), angry (72%) and anxious (82%). Infertility was perceived as the worst experience of life by 78% of our patients.ConclusionsInfertility can interfere negatively in women sexuality. The investigation of sexual difficulties in infertility consultations must be systematic.

IntroductionMany studies showed an increased incidence of psychotic disorders (PD) among immigrants.ObjectivesStudy the characteristics of patients suffering from PD and having immigration experience (IE) by comparing them to patients without IE.MethodsA retrospective controlled study, involving 58 male patients having IE and suffering from PD (DSM 5) who were followed in the psychiatry department of Hedi Chaker University Hospital in Sfax (Tunisia), between January 2013 and December 2018.They were compared to 60 male patients suffering from PD who lack the IE. Samples were matched on age and socio-economic status. Data was collected from their medical records.ResultsThe mean age was 36 years old. The countries of destination were almost European (65.5%). The most common PD were schizophrenia (62%) and schizoaffective disorder (19%). The use of psychoactive substances (PS) was noted in 55% of cases.The average time interval between the onset of the PD and immigration was 4,7 years. The mean age of the onset of PD was 27 years old. The mean age of PD onset was earlier among patients having IE (27 year old vs 28.5 year old, p=0.24).The use of PS was significantly higher in these patients (p=0.04).ConclusionsOur study identified some of the features associated with PD that occur during an immigration experience such as the use of PS. Further studies should be conducted in collaboration with countries of destination of immigrants to clarify the relationship between immigration and PD.

IntroductionThe COVID-19 pandemic may cause elevated levels of anxiety in healthcare professionals (HCP). Identifying factors that could help maintain mental health especially social support could be helpful in facing this stressful situation.ObjectivesThe aim of this study was to asses the relationship between the trait-anxiety and perceived social support among Tunisian HCP in the current pandemic wave of COVID-19.MethodsA cross- sectional descriptive and analytic study conducted among Tunisian HCP during November and December 2020. The data were collected by an online questionnaire. The trait-anxiety was assessed using the “General Anxiety questionnaire of Spielberger” (STAI-Y-B). We used the “Social Support Questionnaire” to measure availability and satisfaction regarding perceived social support.ResultsParticipants were 135 HCP, and aged from 24 to 61 years old (average age 31.98 years). The sex ratio was 1.1 (71 males and 64 females). Of HCP involved in the study, 61.5% were single, 36.3% were married and 2.2% were divorced. The average scores of availability and satisfaction regarding perceived social were 7.79 (SD=3.56) and 28.41 (SD=6.75), respectively. Seventy-two of the HCP had a trait-anxious. Analysis showed that social support satisfaction scores were significantly lower in trait-anxious HCP (pConclusionsOur study highlighted the existence of a deficit on perceived social support satisfaction among trait-anxious Tunisian HCP. Perceived social support as a determinant of trait anxiety should be the focus of social work in this period.DisclosureNo significant relationships.

The obstructive sleep apnea hypopnea syndrome (OSAHS) is a chronic stressor that may alter the emotional state and quality of life (QOL) of patients suffering from it. In this work, we proposed to estimate the prevalence of depression and anxiety, to assess the QOL in a Tunisian population of apneic patients, and to assess their evolution under continuous positive airway pressure (CPAP).We conducted a prospective study, involving 33 apneic patients followed for SAHOS with moderate or severe class disease in the pneumology department at Hedi Chaker university hospital in Sfax, Tunisia. They received CPAP treatment for three months. We used an epidemiological record. Two scales, the Hospital Anxiety and Depression Scale (HADS) and the 36-item Short-Form Health Survey (SF-36), were completed before and after treatment to evaluate the effect of three months of treatment with CPAP.The prevalence of depression in the study's patients, according to the HADS, was 45.5% and that of anxiety was 21.2%. After 3months of CPAP, the prevalence of depression and anxiety had become 18.2% and 6.1%, respectively. QOL was impaired in 81.8% of cases before treatment, according to the SF-36. This figure had decreased to 69.7% after 3months of treatment with CPAP. Apart from the third dimension (physical pain), all other dimensions were significantly improved after 3months of CPAP treatment. The treatment with CPAP induced a significant improvement in the average scores of depression (P0.001), anxiety (P=0.002) and QOL (P0.001).These results attest to the importance of the frequency of anxio-depressive disorders as well as an altered QOL in patients with OSAHS. CPAP treatment was shown to be effective in improving these parameters, but this efficacy was partial. Specialized care may be needed in cases of residual anxio-depressive symptoms.

IntroductionImproving the quality of sexual life of patients has become a major therapeutic objective in the management of Chronic Inflammatory Bowel Diseases (CIBD).ObjectivesTo assess the prevalence of sexual dysfunction (SD) in patients with CIBD in remission and compare it to healthy controls (HC), and to determine the associated factorsMethodsThis was a cross-sectional study, conducted over 8 months, involving 36 patients with CIBD, who attended the gastroenterology outpatient of Hedi Chaker University Hospital in Sfax (Tunisia). They were compared to 36 HC. Sexual function was assessed with the “Female sexual Function Index” and the “International Index of Erectile Function”.ResultsIn the sample of CIBD, the prevalence of SD was 65.4% in women and 50% in men. Compared to controls, patients with male gender had significantly more impaired erection and orgasm (p=0.005; p=0.002 respectively), and those with female gender had significantly more impaired sexual arousal and desire (p=0.003; p=0.028 respectively). In the sample of patients, having a poor marital harmony and a fewer sexual attraction towards partner were correlated with decreased desire (p=0.017) in men and with sexual arousal (p=0.024) and decreased desire (p=0.048) in women. The number of relapses negatively affects erection (p=0.038) and orgasm (p=0.048). Depression correlated with a decreased orgasm (p=0.001) and desire (p=0.048) in men, and with a decreased sexual arousal (p=0.006) in women.ConclusionsSD is common in CIBD, hence the need for a multidisciplinary approach to allow improvement of the quality of life of these patients, and of their partners.

IntroductionGaming is a source of addiction for adolescents. It is recognized as a behavioral and mental health condition, both by the American Psychiatric Association and by the World Health Organization.ObjectivesTo determine the prevalence of gaming addiction among secondary school students.MethodsThis cross-sectional study was conducted between September and October of 2020 among students enrolled in secondary school. The participants had filled the Game addiction scale and a data file regarding the socio-demographic information, physical and information about the internet access and use.ResultsThe initial sample was composed of 180 secondary school students. Among them 28 were excluded because they did not play video games. Final sample consisted of 152 students (90 males, 62 females) with a mean age of 13.14 ± 1.2 years. The average duration of connection among participants was 5.3 hours per day. Nearly one quarter of the participants (24,3%) played videogames more than 20 h per week. The prevalence of gaming addiction was 21,7%. The participants with gaming addiction were, on average, younger than those who were not addicted to gaming Game-addicted individuals were more likely to be male than female (13,8% vs 7,9%; p=0,036). There was, also, a significant relation between IA and having academic difficulties (p=0.042).ConclusionsBased on our study findings, that gaming addiction is a challenging problem among Tunisian adolescents. We recommend authorities consider gaming addiction a serious problem for the young population and make this growing phenomenon an adolescent health priority.DisclosureNo significant relationships.