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Introduction Conjugal homicide refers to the act of killing a current or former intimate life partner, regardless of their marital status. This type of behavior is still inadequately addressed by prevention programs, as it is often regarded as exceptional compared to other forms of domestic violence. Objectives To describe the sociodemographic, clinical, and criminological data of individuals who commit spousal homicide. Methods This is a retrospective descriptive study of 21 psychiatric expertise files conducted between January 2002 and September 2023 in the psychiatric department of Hedi Chaker Hospital in Sfax. Sociodemographic, clinical, and criminological data were collected from criminal psychiatric expertise files and supplemented with information from medical records. Results The perpetrators of spousal homicide were predominantly male (85.7%), had an educational level above secondary school (57.1%), were married (85.7%), and had an average age at the time of the act of 40.3 years. Most of them had no psychiatric history (81%) or legal history(85%), and only 19% were using psychoactive substances. Among the perpetrators, 66.7% had a history of violence against their partners, with threats of homicide in 19% of cases. The majority of homicides occurred during the day (42.9%), in a public place (28.6%), were perpetrated in isolation (95.2%), happened impulsively (47.6%), and employed a single method (81%), with knives being the primary weapon (42.9%). In 76.2% of cases, the perpetrators of spousal homicides were found criminally responsible, while 19% were hospitalized in a psychiatric setting as part of a judicial non-prosecution decision. Conclusions The study of specific characteristics of spousal homicides holds crucial importance for the early detection of domestic violence situations that carry a lethal risk. By highlighting these particularities, it enables the development of more targeted prevention strategies. Disclosure of Interest None Declared

Introduction Pregnant women are particularly vulnerable to a wide variety of psychiatric symptoms, including anxiety related to pregnancy and childbirth. Objectives The purpose of our study was to determine the sociodemographic characteristics of pregnant women and investigate their relationship with pregnancy-related anxiety. Methods The study was conducted from February to July 2023 among pregnant women in their 3rd-trimester consulting at the Gynecology-obstetrics department of the Hedi Chaker University Hospital of Sfax, Tunisia. Women with obstetric conditions favorable to vaginal delivery (cephalic presentation and eutrophic fetus) were interviewed using a questionnaire including their sociodemographic characteristics and the brief version of the pregnancy-related anxiety questionnaire PRAQ-R2. Results A total of 350 women were included in our study. The mean age of the participants was 28 years [16-41 years] with the majority being married (95.7%). One hundred and eighty-eight women (53.7%) did not graduate from high school and 213 (60.9%) were housewives. Half of the participants (52.9%) lived in the city, and 38.9% reported low income. Almost half of them (46.28%) were multiparous. The mean score of the PRAQ-R2 was 31.24 ± 7.53. We found a positive correlation between the PRAQ-R2 scale score and age younger than 30 years (p

Introduction The coronavirus pandemic has affected mental health since its outbreak in 2019 and several studies have revealed that obsessive-compulsive disorder (OCD) patients were adversely affected. Objectives The aim of our present report is to study the impact of the coronavirus infection on OCD. Methods We illustrate a case of new emerging obsessions and compulsions after a COVID-19 infection in a patient consulting at the Psychiatry C department of the Hedi Chaker University Hospital. Results Mr. HB first presented in our outpatient unit of the Psychiatry C department at the age of 32. His medical history was unremarkable except for a COVID-19 infection in June 2022 that did not cause any organic complications. His family history was negative without neurological and psychiatric diseases. Further history revealed that OCD symptoms already started before his infection with COVID-19. At that time, he suffered from compulsions with the urge to constantly wash his hands and check rituals, but his symptoms were not severe enough to make him seek a psychiatric consult or treatment. However, since July 2022, soon after his infection with COVID-19, he suffered from new obsessions and compulsions, he would spend hours calculating all the numbers he sees and counting the number of letters in the words he came across. Non-surprisingly, OCD symptoms caused relevant problems in social life, and at work, he had difficulties concentrating and working. Due to his symptoms, he had neglected hobbies, avoided social contact, spent less time with his family, and even had suicidal thoughts. Therefore, pharmacotherapy with clomipramine was initiated with a maximal dose of 150 mg/d. Because of adverse events and lack of efficacy, he stopped medication and decided to consult our department to seek a different treatment. Therefore, sertraline was started at the dose of 50 mg/d along with psychotherapy. Conclusions People with OCD are likely to be more susceptible to the mental health impact of COVID-19. Responses to the pandemic are not only associated with an increase in all Obsessive-Compulsive (OC) symptoms and their severity but also the emergence of new types of obsessions and compulsions. Consequently, therapists should consider the effects of the pandemic on all OC symptom dimensions and adjust their treatment plans accordingly. Disclosure of Interest None Declared

Introduction The prevalence of suicidal behavior in individuals diagnosed with Bipolar Disorder Type 1 is a topic of great concern within the field of psychiatry and mental health research. Bipolar Disorder Type 1 is characterized by extreme mood fluctuations that can contribute to a heightened risk of suicidal ideation, attempts, and completions in affected individuals. Objectives - To examine the socio-demographic and clinical profiles of Bipolar Type 1 patients admitted to the “C” psychiatry department at Hedi Chaker Hospital in Sfax, Tunisia. - To identify and understand the factors associated with suicidal behavior in this population. Methods We conducted a retrospective descriptive and analytic study of hospitalized patients suffering from bipolar disorder type 1 in the psychiatry department “C”, Hedi Chaker Hospital, Sfax Tunisia from 2021 to 2023. Socioeconomic data and clinical profiles of patients were collected from archived files. Results The total number of patients was 98, with an average age of 36.74 ± 12.3 years. The majority were single (67%), living with their families (76.5%), jobless (45.9%), and receiving family support (94.9%). In terms of psychoactive substance use, 81.6% have used tobacco, 46.9% have used alcohol, and 34.7% have used cannabis. Concerning family history, 55% of patients had at least one family member being treated for a mood disorder. Among them, 7.1% had attempted suicide, and 6.1% had died by suicide. Concerning the clinical profile of the study population, 28.6% had a personal somatic history. The diagnosis of bipolar disorder was made at the age of 27.52±8.6 years. 11.2% had a comorbid personality disorder with bipolar disorder. The majority of patients were on antipsychotics (95.9%), 84.7% were using mood stabilizers, 33.7% were prescribed anxiolytics, and only 4.1% were on antidepressants. Treatment compliance was poor in 61.2% of cases and 63.3% of patients had a poor insight. Ten percent of these patients had attempted suicide, 50% during a depressive episode, 50% occurring during a depressive episode, 30% during a manic episode, and 40% of attempts were related to discontinuation of treatment. 3.1% had used hanging, and 3.1% had engaged in voluntary drug ingestion as a method of self-harm. None of the suicide attempts necessitated intensive care hospitalization, but 60% of the individuals were admitted to psychiatric care. There was a statistically significant correlation between suicide attempts and a family history of suicide (p=0.049). Conclusions Bipolar patients face a heightened risk of suicide, which is closely tied to the distinctive attributes of the disorder, including biological factors, thymic decompensation, and psychological aspects. Consequently, managing their condition necessitates a tailored approach, demanding ongoing vigilance for individuals diagnosed with bipolar disorder. Disclosure of Interest None Declared

Introduction Caregivers in the Sfax region, Tunisia, having been at the forefront in the face of the Covid-19 pandemic, were therefore faced with intense stress. It seemed useful and interesting to us to study their adaptation strategies during this period of pandemic. Objectives The aims of our study were to identify the coping strategies used by Tunisian Healthcare workers (HCW) during the Covid-19 pandemic and to study the links of the different coping strategies with perceived social support and trait anxiety. Methods A cross-sectional, descriptive, and analytical study conducted among 254 Tunisian HCW working at the Habib Bourguiba and Hedi Chaker university hospitals in Sfax, during period from January 2021 to April 2021. the questionnaire used included an information sheet and three scales; “Social support questionary 6” (SSQ-6), “State Trait Inventory Anxiety Form Y2” (STAI-Y2), and “Ways of Coping Checklist” (WCC). Results Using the WCC scale, the strategy most used by participants was the problem-focused one (M = 2.98 ±0.53), followed by the emotion-focused strategy (M = 2.65 ±0 .58), and that centered on the search for social support (M = 2.64 ±0.59). Using the SSQ-6, the mean score for the availability of perceived social support was equal to 8.91±4.59 and the score mean perceived satisfaction was equal to 28.63±5.84. The prevalence of trait anxiety was 50%, according to the STAI-Y2. Statistical tests showed that problem-focused coping was the strategy most adopted by non-anxious participants. They also showed that the higher the availability of perceived social support, the more the social support-seeking coping strategy was chosen, and the higher the perceived satisfaction with perceived social support, the less the emotion-focused strategy was chosen. Conclusions It seems necessary to propose a learning program for coping strategies to counter the potential emergence of ineffective strategies and to reinforce the use of effective strategies, in order to improve or maintain optimal well-being of health personnel. Disclosure of Interest None Declared

Introduction Fear of childbirth is attracting growing interest because of its impact on the experience of pregnancy and on the progress of childbirth and it seems that some women are more susceptible to fear of childbirth than others are. Objectives Our objective is to identify pregnancy factors that predict the fear of childbirth. Methods We approached 350 pregnant women consulting at the Gynecology-Obstetrics department of the Hedi Chaker University Hospital of Sfax. We collected their sociodemographic and clinical data. Fear of childbirth was assessed using the French version of the Traumatic Event Scale (TES), adapted to assess fear of childbirth. Results The mean age of the participants was 28 years (16-41) and the mean gestational weak was 36.27. Half of the participants (53.7%) were nulliparous, and eight reported a history of infertility. The pregnancy was not planned in 61% of cases. As many as 67% of the participants had regular checkups, 50.3% had exaggerated somatic symptoms and 34.3% had pregnancy-related diseases. The mean score for the TES was 48.73 ± 13.72. We found a positive correlation between the TES score and nulliparity (p=0.01), gestational age ≥ 40 weeks (p=0.01), planned pregnancy (p=0.002), exaggerated somatic symptoms (p=0.03), and pregnancy-related diseases (p

Introduction The evaluation of manic behavior with later onset is crucial, as various organic factors such as medications, infections, metabolic disturbances, tumors, and epilepsy can serve as potential etiological causes. While not universally observed, most studies indicate a connection between late-onset mania and neurological disorders like neurosyphilis. Objectives Our study aims to investigate the relationship between late-onset mania and neurosyphilis. Methods In this paper, we present a case of neurosyphilis presenting exclusively with symptoms of mania. Results A 72-year-old Tunisian woman with no prior medical or psychiatric history was referred to the psychiatric emergency room due to alterations in her mental state and behavior over the past ten days. During the psychiatric assessment, she displayed increased motor activity, fluctuating emotions, and rapid flow of ideas. The general physical examination yielded no notable findings. The serum Venereal Disease Research Laboratory (VDRL) test returned a strongly positive result (+++), and the TPHA examination confirmed a positive result at a titer of 1/60. In the serologic analysis of cerebrospinal fluid, VDRL was also positive, thereby confirming the diagnosis of neurosyphilis (NS). The diagnosis of mania secondary to a medical condition was established. The patient was treated with ceftriaxone and antimanic medications, resulting in a significant improvement in her psychiatric symptoms within a few days. Conclusions This case underscores the importance of conducting serologic testing for syphilis in patients who present with manic symptoms, experience a late-onset mental disorder, and have no prior history or family history of affective disorders. Disclosure of Interest None Declared

Introduction Emigration has a substantial impact on Tunisia’s healthcare sector. Graduates, including medical students at different educational levels, as well as general practitioners and specialists, often choose to emigrate. Some do so to pursue further studies abroad, while others seek careers and settlement primarily in Europe. This phenomenon exerts a significant influence on the quality of healthcare systems in their home countries. Objectives To evaluate the inclination to emigrate among medical residents employed in Tunisian healthcare institutions and to identify the factors associated with this intention. Methods This is a descriptive cross-sectional study conducted among medical residents undergoing their training in various healthcare facilities in Tunisia. The study employed an online questionnaire to assess the degree of satisfaction with various aspects of their professional life and the socio-economic situation in the country, as well as their intention to emigrate. Satisfaction levels were measured using a 4-point Likert scale, ranging from “very dissatisfied” to “very satisfied”. Results A total of 50 physicians participated in the survey. Among them, 72% were female, 80% were single, with an average age of 27.72 years at the time of the study. Regarding their professional status, 84% worked in university hospitals, 16% specialized in surgery, 40% specialized in medicine, and 44% were family physicians. The majority were students from the Faculty of Medicine in Sfax (56%), with 30% in Monastir, 8% in Tunis, and 6% in Sousse. The study found that 68% of medical residents expressed an intention to emigrate. Among the participants, 74% were dissatisfied with their working conditions, and 68% were dissatisfied with workplace safety. Additionally, 84% were dissatisfied with their salaries, 40% with their workload, 54% with supervision, and the quality of training provided in their hospitals. The political situation in the country and social security were considered unsatisfactory by 92% and 90% of the participants, respectively. Among the potential reasons studied to explain this emigration phenomenon, working conditions were a factor in 54% of cases, salary in 56%, training in 36%, and quality of life in 56%. Conclusions The emigration of young Tunisian medical professionals is driven by a range of factors, including working conditions, salaries, training opportunities, and quality of life. To counteract this phenomenon, it is crucial to enhance these aspects in order to retain these talented individuals in the country and thereby bolster the Tunisian healthcare system. Disclosure of Interest None Declared

Introduction Tunisian emigrants may consume psychoactive substances in other countries. This community is exposed to sociocultural and legal contexts different from those in Tunisia and the degree of acculturation would tend to increase over time. However, data on the use of psychoactive substances, particularly cannabis, in this particular population are scarce. Objectives This study aims to determine the profile of Tunisian young adults residing abroad who use cannabis. Methods We conducted a cross-sectional, descriptive and analytic study. It was carried out in the form of an online survey. We focused on young Tunisians people who have completed their secondary studies at the pilot high school of Sfax and currently residing abroad. Data collection was through Google Forms administred questionnaire. Results Thirty-five participants were included in our study. Cannabis use behavior affected 48.6% of them (N=17)) and it was done with friends in a festive setting in 88% of cases (N=15). Cannabis use was more common among people who were single (p=0.001), living alone (p=0.047), had a psychiatric history (p=0.032) and hanging out with friends who also smoked cannabis (p=0.032).Cannabis use was also more common among cigarette smokers (p=0.000) and alcohol consumers (p=0.000). It was significantly more common among people who shared erroneous beliefs about cannabis, that it is a mild drug (p= 0.024) and that it does not cause dependence (p= p=0.042). Conclusions Cannabis use among Tunisian young adults residing abroad seems to be a form of poly-consumption, more common among singles, living alone and having a psychiatric vulnerability. These findings underscore the need for targeted interventions and educational initiatives to address cannabis use within this specific population. Disclosure of Interest None Declared

Introduction Cannabis use is very common worldwide. Its consumption could be explained by recreational purposes as it can be motivated by some psychiatric disorders such as depression, anxiety or low self-esteem. Objectives This study aims to explore the relationship between cannabis use, depression, anxiety and self-esteem among a population of Tunisian adults living abroad. Methods A cross-sectional online survey was carried out using a self-administered questionnaire on young Tunisians people who have completed their secondary studies at the pilot high school of Sfax and currently residing abroad. The survey questionnaire was designed on Google Forms. It included a data collection sheet and psychometric scales “Cannabis Abuse Screening Test” (CAST), “Hospital Anxiety and Depression Scale” (HADS) and”Rosenberg’s self-esteem scale”. Results The sample consisted of 35 Tunisian young adults. 17 participants (48.6%) reported a cannabis use behavior. It was done with friends in a festive setting in 88% of cases (N=15). According to the CAST, 17,6% (N=3) of cannabis users were at high risk of cannabis dependence. Anxiety was present in 17,6% (N=3) and depression in 17,6% (N=3) of participants. Self-esteem was low in 23,53% (N=4) of participants. Cannabis use was not associated with the presence of current emotional disorders such as anxiety and depression (p=0.894 and p=0.933 respectively). It was also not associated with lower self-esteem (p=0.585). Conclusions Cannabis use is relatively common among young Tunisian emigrants without evolving towards dependence inseveral cases. This behavior seems to be more influenced by social factors and misrepresentations about cannabis than by psychological disturbance. Disclosure of Interest None Declared

Introduction The burnout syndrome is a blend of physical exhaustion and emotional fatigue that impairs an individual’s performance at work. In Tunisia, factors like working hours, the frequency of monthly shifts, and the physical and emotional abuse that physicians face from patients have collectively led to a significant incidence of burnout among medical professionals. Objectives To evaluate the prevalence of burnout syndrome among medical residents working in healthcare facilities in Tunisia and to pinpoint the contributing factors. Methods This study is a descriptive cross-sectional survey conducted among medical residents completing their training in various healthcare facilities in Tunisia. The study employed an online self-administered questionnaire and assessed burnout across three dimensions: personal burnout, professional burnout, and relational burnout, using the Copenhagen Burnout Inventory (CBI). Results A total of 50 physicians took part in the survey. Among them, 72% were female, 80% were single, and the average age at the time of the study was 27.72 years. Concerning their professional status, 84% worked in university hospitals, 16% specialized in surgery, 40% specialized in medicine, and 44% were family physicians. The majority were students from the Faculty of Medicine in Sfax (56%), with 30% in Monastir, 8% in Tunis, and 6% in Sousse. Regarding their work hours, more than 40 hours per week were reported by 32% of participants. According to the CBI scale, 12% of participants had scores indicating severe personal burnout, while 20% had scores indicating moderate personal burnout. Additionally,16% reported severe professional burnout, and 12% had scores suggesting severe relational burnout. In contrast, only 8% had scores indicating moderate relational burnout. The sociodemographic and professional factors that were studied, such as weekly working hours, monthly shifts, specialty, and workplace, did not show a significant correlation with the presence of burnout syndrome. Conclusions Burnout syndrome among medical resident physicians not only impacts their physical and mental well-being but also reduces their effectiveness and motivation at work. It is essential to introduce stress management strategies within hospitals to foster a healthier work-life balance. Disclosure of Interest None Declared

Introduction While postictal mania is a well-recognized clinical condition, it has received less research attention compared to other postictal manifestations. Objectives Drawing upon an analysis of a case report that underscores the clinical and therapeutic challenges associated with comorbid epilepsy and mania, a literature review was carried out to investigate the connection between these two disorders. Methods We illustrate a case of comorbidity between mania and epilepsy and provide a concise review of the literature summarizing the key characteristics of this association. Results This case pertains to Mr. M, a 44-year-old male with a history of frontal epilepsy characterized by secondary partial generalization, which was partially controlled with sodium valproate. He was admitted to our service due to acute agitation following a loss of consciousness lasting a few minutes. Upon admission, the patient exhibited symptoms of mental confusion. A neurological examination did not uncover any abnormalities. Brain computed tomography revealed mild frontal atrophy. Video electroencephalography conducted during the interictal period and outside the episodes of confusion did not reveal any abnormalities. The patient was restarted on sodium valproate (20 mg/kg/day) and clonazepam (2 mg/day). Following a lucid interval of ten days, the patient started to manifest psychiatric symptoms, which included irritability, hostility towards his spouse, increased talkativeness, thought pressure, and an unusual sense of familiarity, raising suspicion of post-ictal mania. Conclusions Based on this clinical case and the existing scientific literature, post-ictal mania occupies a distinct position among the mental disorders observed in the post-ictal period. Therefore, clinicians must be aware of these conditions to facilitate accurate diagnosis and appropriate management. Disclosure of Interest None Declared

Introduction Psychotropic substance use among medical residents represents a critical concern due to its potential impact on patient care and practitioner well-being. This topic looks into the prevalence and characteristics of psychotropic substance use, including prescription medications and illicit drugs, among individuals pursuing medical residency. Understanding the scope of the problem and its distinctive features is essential for developing targeted interventions and support mechanisms within the medical community. Objectives To assess psychotropic substance use among medical residents, describe its characteristics and determine the prevalence of problematic use. Methods We conducted a cross-sectional and descriptive studyamong Tunisian medical residents over a three-month period (August - September 2022) using an online survey. Different specialties and levels of residency were included. An online self-questionnaire was used including a data collection form and the DAST-10 (Drug Abuse Screening Test) scale. The data was analyzed using the SPSS 20th version software Results Among the 80 residents in our study, 19 (23.8%) reported psychotropic substance use, and 12 (15%) reportedthat they had misused psychotropic drugs at least once in their lives (without a prescription and/or with a prescription but not following the instructions). The most commonly psychotropic drugs used were benzodiazepines, followed by amphetamines, analgesics, anesthetics, and pregabalin (28%, 16%, 12%, 12%, 12%, respectively). Consumption was regular for 41.7% of those who reported psychotropic drugs misuse. The initiation of psychotropic use followed a desire to experiment various substances (41.7%), a medical prescription (33.3%), or their availability due to medical practice (25%). Self-medication and recreational use were the most common reasons for use (41.7% each). Furthermore, 31.6% of consumers revealed a problematic substance use as assessed by the DAST-10 scale. Conclusions Our study showed a concerning prevalence of psychotropic substance use among medical residents, benzodiazepines being the most prevalent. Notably, 15% acknowledged misuse and a significant proportion displayed problematic substance use. These results highlight the potential health risks and the importance of addressing this issue within the medical community. Disclosure of Interest None Declared

Introduction In an increasingly interconnected world, migration has become a defining characteristic of the 21st century. While immigration offers new beginnings and prospects, it also presents unique challenges, particularly concerning mental health. The experience of migrating can exert pressure on mental health through factors such as acculturation stress, discrimination, and economic hardships. These challenges can, in turn, contribute to the development of mental health issues. Objectives To study the socio-demographic and clinical profile of immigrants hospitalized in the “C” psychiatry department, Hedi Chaker Hospital, in Sfax, Tunisia. Methods We conducted a retrospective descriptive study of immigrants hospitalized in the psychiatry department “C”, Hedi Chaker Hospital, Sfax Tunisia from 2011 to 2023. Socioeconomic data and clinical profiles of immigrants were collected from archived files. Results The total number of immigrants hospitalized during these 12 years was 32, with an average age of 28.81 years ±7.8 years, all of them were males, as the psychiatric department “C” only hospitalizes men. All were of African origin, of whom 21.9% (n=7) had Libyan nationality, 15.6% (n=5) had Somali nationality and 12.5% (n=4) had Sudanese nationality. Communication with them was possible in 87.5% of cases, primarily through the native Arabic language in 56.3% of instances. Illegal immigration was the most prevalent form, accounting for 75% of cases. During the immigration process, 18.8% of individuals reported experiencing violence.” The majority of hospitalized immigrants were single (71.9%), had a primary school education (37.5%), a low socio-economic level (81.3%), and no profession (59.4%). 21.9% of them had received social assistance, and 59.4% lived in a refugee camp. Psychoactive substance consumption was reported by 53.1% of our study population. Regarding the clinical profile of the population, 21.9% had a history of somatic conditions, 43.8% had a psychiatric history, including 9.4% who had attempted suicide, and 34.4% who had experienced traumatic events since arriving in Tunisia. The primary reason for hospitalization was behavioral disorders in 71.9% of cases and suicide attempts in 15.6%. The most prevalent diagnoses were schizophrenia (50%), and bipolar disorder (18.8%). Upon discharge, 15.6% encountered administrative issues. Conclusions Hospitalized immigrants exhibit diverse socio-demographic and clinical profiles. These findings underscore the significance of acquiring a deeper understanding of the mental health needs and existing barriers to healthcare within various immigrant communities. This is particularly crucial as immigration continues to be a central focus in Tunisia’s public policies and discussions. Disclosure of Interest None Declared

Introduction Carbamazepine is effectively used in treatment of bipolar disorder for its thymoregulatory virtues, but it can induce numerous side effects, including skin eruptions that can be severe sometimes. Objectives To study the relationship between toxidermia and treatment with carbamazepine. Methods We report the case of a patient who developed a toxidermia following the intake of carbamazepine. Results Mr. AD, 19 years old, with medical history of diabetes, has been diagnosed with bipolar disorder since the age of 17. He was initially treated with risperidone with an irregular follow-up. He was hospitalized in our department for a manic episode with psychotic features with agitation and refusal of treatment. The patient was put on injectable treatment 15 mg/day of Haloperidol and 20 mg/day of diazepam. After 5 days in hospital, we switched to the oral route, gradually increasing haloperidol doses to 30mg, reducing diazepam doses and introducing carbamazepine for thymoregulatory purposes. Carbamazepine was progressively increased up to a dose of 800mg per day. Fourteen days after the introduction of carbamazepine, the patient presented a generalized rash requiring the discontinuation of this medication. He was treated with an anti-histamine and local corticosteroids, on the advice of dermatologists. In the days following discontinuation of carbamazepine, skin lesions regress and then disappear. Biologically, we observed a rise in eosinophilic polynuclear cells to 580, followed by a gradual decrease after stopping the treatment. A pharmacovigilance opinion was sought, concluding that carbamazepine was responsible for the toxidermia, given the delay in onset and the favorable evolution after discontinuation of the incriminating treatment. Moreover, this undesirable effect is well described in the literature. Hence the contraindication to further use of carbamazepine in Mr. AD. In addition, the patient was put on sodium valproate with good tolerance. Conclusions Each prescribed drug must be considered as potentially capable of causing cutaneous reactions as an adverse effect. Both the prescriber and the patient must be made aware of this phenomenon. The attitude can be modulated on a case-by-case basis, after specialist advice, depending on the severity of the rash and the disease to be treated. Disclosure of Interest None Declared

Introduction The psychopathology of female crime perpetrators is not well understood since female criminality rates have remained distinctly lower than male criminality. This study draws on over 20 years of psychiatric expertises to identify sociodemographic, clinical, and forensic characteristics of female perpetrators. Objectives - To describe the epidemiological and clinical profile of female offenders examined for criminal psychiatric expertise. - Describe the criminological and forensic characteristics of these women. Methods Retrospective and descriptive study, which focused on 56 criminal psychiatric expertise files of female offenders, examined at the psychiatric department “C” at the CHU Hedi Chaker in Sfax, Tunisia, over a period of 24 years. For each offender, we examined the expert report and the judicial research report. We then transcribed the socio-demographic and clinical information, as well as the criminological and forensic characteristics, onto a pre-established form. Results The accused women in our study had an average age of 35 years and 06 months, and 67.86% of the cases were under 40 years of age, with an educational level no higher than primary school in 62.5% of cases. They were unemployed in 71.4% of cases. Among the accused examined, 76.8% had mental disorders, including 46.6% with personality disorders, 16.3% with intellectual disability, 16.3% with bipolar disorder, 9.3% with depressive disorder, 9.3% with psychotic disorder, and 2.3% with substance use disorder (anxiolytic). We recorded 55.4% offences against persons, including 37.5% homicides and attempted homicides, and 44.6% offences against property, including 23.2% thefts. Dementia in the legal sense was identified in 30.4% of cases. Bipolar disorder accounted for 41.1% of legally demented subjects. Conclusions It emerges that the profile of the female criminal is that of a woman under 40, with a low educational and economic level, and most often with an antisocial personality or intellectual disability. It would therefore be important to step up primary prevention work by better educating these at-risk women and to combat the factors contributing to dangerousness among the mentally ill by optimizing their psychiatric care. Disclosure of Interest None Declared

Introduction Psychological vulnerability and problematic psychotropic drug use among medical residents are critical and intricate areas of study in the field of healthcare and mental well-being. This topic looks into the potential links between the psychological vulnerabilities experienced by medical residents, which are frequently associated with the demanding nature of their profession, and their use of psychotropic drugs in a way that poses problems or risks. Exploring this relationship is critical for understanding the mental health challenges that medical residents face and developing effective strategies to support their psychological well-being. Objectives to identify the psychological factors linked to problematic psychotropic drug use in medical residents. Methods We conducted a cross-sectional descriptive and analytical study among Tunisian medical residents between August and September 2022. We used a self-administered questionnaire with a data collection form, the DAST-10 (Drug Abuse Screening Test) scale, and the DASS-21 (Depression, Anxiety, and Stress Scale) in an online survey. Data was analyzed using the 20th version of the SPSS software. Results The sample consisted of 80 medical residents. Among them, 23.8% (n=19) had reported a previous use of psychotropic drugs, and 15% (n=12) a misuse (without a prescription and/or without following the prescription). The DAST-10 revealed that 6 residents (31.6%) had problematic use of psychotropic drugs. A high level of stress on the DASS-21 scale was associated with a problematic use (p=0.01) and a misuse (p=0.01) of psychotropic drugs. Furthermore, residents with high stress levels were more likely to demonstrate problematic use of psychotropic drugs (p=0.004). Such problematic use was correlated with personal history of anxiety disorders (p=0.01). Furthermore, residents with problematic psychotropic drug use had higher anxiety and depression scores on the DASS-21 scale (p>0.05). Conclusions Our findings revealed a concerning prevalence of psychotropic drug use among medical residents and an association with high stress levels. This result emphasizes the need for targeted interventions to support young doctors’ mental health. Disclosure of Interest None Declared

Introduction Non-adherence to treatment is a major concern for mental health professionals. Knowledge of prescribed medications can influence patients’ willingness to adhere to them. Objectives The aim of this study was to assess the knowledge of patients with mental disorders about their prescribed medication and to evaluate their attitudes and beliefs toward treatment. Methods Our quantitative descriptive study involved 52 patients hospitalized in the psychiatric “C” department of the Hedi Chaker University Hospital in Sax between the 23rd and 30 October 2023. Excluded were aggressive patients, those who were unable to communicate, and those who refused to participate. Thirty-nine patients were included. For each patient, we collected sociodemographic, clinical, and disease progression data, as well as information, beliefs, and attitudes concerning the prescribed treatment. Results The mean age of our patients was 35.49 ± 10.24 years, with an exclusively male sample. Most patients had no occupation (69.2%). Only 10.3% were married. Over half of the patients had achieved primary school (61.5%) and lived in rural areas (64.1%). The mean duration of the mental disorder was 10.69 ± 9.07 years. Patients were hospitalized 3.62 times on average. The most frequent diagnoses were schizophrenia (35.9%) and bipolar disorder (33.3%). More than half of the patients (61.5%) knew the color and shape of the prescribed medication, and 48.2% knew the name and dose. The source of treatment information was mainly doctors (33.3%) and family members (15.4%). Adherence to treatment was poor in 69.2% of cases. The majority of patients denied stopping treatment and 12.8% reported that they stopped treatment because of financial difficulties. Twenty-four patients confirmed that taking the treatment made people see them differently and that they preferred not to reveal they were taking it. Two-thirds of patients reported that the treatment relaxed them (71.8%) but could be stopped when they felt better (69.2%). Conclusions It is essential for mental health professionals to develop and implement effective intervention strategies that maximize therapeutic impact and reduce the risk of relapse. Disclosure of Interest None Declared

Introduction Orthorexia and exercise addiction can lead to serious health problems, such as malnutrition and exercise-related injuries. Objectives The aims of our study were to assess the prevalence of exercise addiction and orthorexia nervosa in Tunisian students at the Institute of Physical Education in order to investigate the relationship between these different health dimensions. Methods An anonymous self-administered questionnaire was distributed to students in the Sfax and Gafsa sports sections during March 2023. The orthorexic tendency was assessed using the ORTO-15 questionnaire. An ORTO-15 score below 40 points indicates orthorexic tendencies. The Exercise Addiction Inventory (EAI) was used to study exercise addiction Results In our study, 240 students were included. Mean scores on the ORTO-15 and EAI scales were 38.6 ± 8 and 16.6 ± 4.1 respectively. Participants at risk of exercise addiction had a statistically significant tendency towards orthorexia (p

Introduction Eating disorders and sports addiction are becoming increasingly common among athletes.It’s important to be aware of these disorders in order to improve their overall prevention. Objectives The aim of our study was to determine the links between exercise addiction (EA) and eating disorders in Tunisian students at the Institute of Physical Education and to examine the factors associated with these disorders. Methods An anonymous self-administered questionnaire was distributed to students in the Sfax and Gafsa sports sections during March 2023. The Exercise Addiction Inventory (EAI) was used to study exercise addiction. It is a scale whose purpose is to separate individuals into 3 groups: those at risk of exercise addiction (score ≥ 24), those non-addicts with symptoms (score 13 to 23) and those non-addicts without symptoms (score 0 to 12). Eating disorders were assessed using the SCOFF-F questionnaire ( Sick, Control, One stone, Fat, Food), with a score of 2 or more indicating possible eating disorders. Results We collected 240 participants. The mean SCOFF-F and EAI scores were 1.7±1.3 and 16.6 ± 4.1 respectively. Among the participants, 52.9% of students were at risk of developing eating disorders and 2.5% of students were at risk of exercise addiction. In our study, 82.5% of students took part in regular physical activity in a gym. The main reasons for going to the gym were muscle strengthening (57.9%) and preparation for a sporting competition (37%). Among students exercising outside the institute, the mean SCOFF score was significantly higher for those doing so to prepare for a sports competition (p=0.001), for professional obligations (p=0.005) or for weight loss (p=0.001). Participants at risk of exercise addiction had a higher mean SCOFF score, but the difference was not significant (p=0.051). Conclusions Our study shows that eating disorders were widespread among Tunisian athlete students, and were higher among students at risk of exercise addiction. Disclosure of Interest None Declared

Introduction Violence against women is a public health problem worldwide and a violation of human rights. It affects women’s lives due to its potential short-, medium- or long-term physical and psychological consequences. Objectives The aim of our study is to explore the link between violence against women and self-esteem. Methods A descriptive cross-sectional study was conducted from March to August 2023 among Tunisian women consulting in three health care centers in Sfax, Tunisia. We have included women victims of violence (psychological, physical, sexual, and economic). We have used a semi-structured interview and the Rosenberg scale to determine the quality of self-esteem. Results Among one hundred interviewed women, fifty-four women who had reported being violence victims were included in our study. The mean age of the participants was 44 years with the majority being married (87 %). Only 29.6% had a high school level and 51.9% had a profession. A total of 29.6% had a low socioeconomic status. We found that 79.6% are victims of domestic violence (57.4% being victims of spousal violence). Psychological violence seemed to be the most frequent type (59.3%). Almost all those who were abused (90.6%) experienced psychological (emotional) violence. The mean score of the Rosenberg self-esteem scale was 31.54. Self-esteem was very low in 16.7%, low in 37%, medium in 18.5%, and high in 27.8% of the women. A statistically significant association was found between being a victim of spousal violence and low self-esteem (p=0.032). The semi-structured interview demonstrates that women with low self-esteem are more likely to accept violence. Conclusions These results justify the implementation of screening and support programs for women victims of violence to improve their self-esteem. Disclosure of Interest None Declared

Introduction Family members play an important role in the life of many adults with mental disorders and are under considerable amounts of stress that may affect caregiver’s physical health, quality of life and resilience. Objectives The present study aimed to explore the relationship between the perceived stress and the resilience levels among caregivers of patients with mental illness and to identify their associated factors. Methods This was a cross-sectional, descriptive and analytical study conducted on caregivers of patients suffering from mental illness. It was conducted in the outpatient psychiatry department at the university hospital of Sfax (Tunisia), during september 2021. We used the Connor–Davidson Resilience Scale to assess resilience and the Perceived Stress Scale (PSS-10) to assess the level of stress. High scores indicate high resilience and perceived Results The sample included 34 family caregivers of patients with mental illness. The mean age was 47.47 years (SD=12.4 years) and the sex ratio (M/F) was 1.42. The mean resilience score of caregivers was 42.85 and the mean perceived stress score was 24.94 (SD=6.36). The score of resilience correlated negatively with the score of perceived stress among family caregivers (r=-0.751 ; p=0.0001). The Caregivers with low socioeconomic level were more likely to have a low resilience score (p=0.004) and to have high stress levels (p=0.04). The level of perceived stress increased significantly in case of long duration of providing care (r=0.697 ; p= 0.001), the presence of stressful events (p=0.029) and the presence of agressive behaviors committed by patients (p= 0.001). However, the level of resilience decreased significantly in those same cases (p=0.001; p=0.002; p=0.0001 respectively) Conclusions Our findings suggest that high level of perceived stress among familiy caregivers impact negatively their capacity of resilience. So, interventions targeting stress related to stressful events and violence committed by patients in their family environment should be integrated to increase the caregivers’resilience. Disclosure of Interest None Declared

Introduction In Tunisia, Sexual assaults constitute a pervasive problem that concerns the health care system and the country’s judicial authorities alike. Objectives The aims of our study were to estimate the incidence of sexual assault encountered in the context of forensic psychiatric assessment and to assess the criminological profile of sexual assault perpetrators. Methods We conducted a retrospective study of a series of sexual assault perpetrators examined in a forensic psychiatric assessment in the psychiatry C department at Hedi Chaker university Hospital in Sfax, from January 2010 to December 2021. Results Over the period of 11 years (2010 to 2021), we collected 374 forensic psychiatric assessment files. Among them, 49 were those of sexual assaults (13.10%). It was a rape assault in 54.4% of cases. Aggravating circumstances have been noted in 87% of cases. These were mainly assaults on minors (54.3%) and assaults associated with physical violence (38.4%). The victim gender was female in 63% of cases, with an average age of 21 years 9 months. and was among the relatives of the sexual assault perpetrator in 28.3% of cases. Conclusions Rape seems to represent a non-negligible proportion of the offenses motivating a forensic psychiatric assessment in Tunisia. Sexual assaults against minors are frequent, despite undeniable under-reporting. Disclosure of Interest None Declared

Introduction Schizophrenia is a chronic psychotic disorder characterized by a high prevalence of sexual dysfunctions (SD). SD can affect the quality of life (QOL) of patients, cause low self-esteem and self-stigma. Objectives To evaluate the sexual functioning, the QOL, and the internalized stigma among outpatients with schizophrenia. To determine the links between SD, the QOL, and the internalized stigma. Methods A cross-sectional, analytical study was conducted between Mars and September 2019. It included 53 outpatients with schizophrenia in clinical remission for at least two months. We used the Arizona Sexual Experiences Scale (ASEX) to assess sexual functioning, the Internalized Stigma of Mental Illness scale (ISMI) to assess the subjective experience of stigma, and the 36-item Short-Form Health Survey (SF-36) to evaluate the QOL. Results The average age of patients was 42.28 years old, and their sex ratio was 3.81. The average ASEX score was 19.77±5.99, and 67.9% of participants had at least one SD. The mean ISMI score was 2.47±0,34. 60,4% of patients had a high level of internalized stigma. The QOL was impaired in 66% of the cases. We found correlations between SD and a high level of internalized stigma (p=0.011) and its subscales «alienation » (p=0.013), «stereotype endorsement» (p=0.034) and « discrimination experience» (p =0.001). SD correlated with impaired QOL (p

Introduction Sexual dysfunctions (SD) are common in patients with schizophrenia. The link between schizophrenia and sexuality is complex. Studies have shown that SD can be linked to the side effects of antipsychotic medications, but also to symptoms of illness. Objectives To identify the clinical and therapeutic factors associated with SD in outpatients with schizophrenia. Methods A cross-sectional and analytical study was conducted between Mars and September 2019. It included 53 outpatients with schizophrenia in clinical remission for at least two months. We used the Positive and Negative Symptom Scale (PANSS) to assess clinical symptoms and the Arizona Sexual Experiences Scale (ASEX) to assess sexual functioning. Results The average age was 42.28 ±10.49 years old. The sex ratio was 3.81. The mean age of onset was 27.09±5,46 years. The mean duration of illness was 18.11±9.29 years. First-generation antipsychotics were prescribed in 77.4% of cases, while second-generation antipsychotics were prescribed in 39.6% of cases. The average ASEX score was 19.77±5.99, and 67.9% of participants had at least one SD. the analytical study revealed significantly higher average scores for the PANSS-negative subscale (p=0.006) and the PANSS total score (p=0.04) in patients with SD. SD correlated with first-generation antipsychotic treatments (p=0.02). Conclusions Our results show that SD are frequent in patients with schizophrenia and that they are related to the severity of the symptoms, in particular the negative symptoms of illness, and the prescription of first-generation antipsychotics. Disclosure of InterestNone Declared

Introduction The female criminal phenomenon will gradually become a reality and the participation of women in criminogenic currents is clearly increasing .Tunisian society, like all other societies, has not escaped this phenomenon. Objectives Our objective is to describe the criminological and forensic characteristics of the expertized women. Methods This study was retrospective and descriptive. It focused on the files of criminal psychiatric expertise carried out in the psychiatry department "C" at the Hedi Chaker hospital in Sfax and involved female accused subjects. We have collected all the criminal expert reports carried out over a period of 24 years (from January 1, 1998 to December 31, 2021). Results Out of a total of 864 criminal psychiatric expert opinions carried out over a period of 24 years, we collected 56 expert opinions in which the accused was a woman (6.48%). Among the offenses committed, we identified 31 offenses against persons (55.4%) and 25 offenses against property (44.6%). Homicides represent 37.5% of offenses (N=21) and in second place are thefts (23.2%). Twenty-seven offenses took place at the victim’s home (48.2%) and 13 (23.2%) at the accused’s home. The offense was committed under the influence of a psychic disturbance (disorganization, delusional syndrome, psychic excitation, hallucinatory injunctions, cognitive deficit) in 30.4% of cases. Dementia in the legal sense was retained in 30.4% of cases. Conclusions Given the frequency of mental illness among accused women, it would be interesting to optimize their psychiatric care in order to fight against violent acts. Disclosure of Interest None Declared

Introduction Tunisia, a pioneer in the Arab world in terms of promoting the status of women, has adopted a strategy to combat violence against women and now has a legal arsenal to protect women’s rights. Objectives To study the contribution of the Tunisian jurisdiction in terms of protection of women victims of violence. Methods A review of the different legal texts, using the key words: “Women”, “Violence”, “Jurisdiction” and “Protection”. Results *The National Survey on Violence against Women in Tunisia is a long process that involved the efforts of several stakeholders. *In 2011, Tunisia was the first country in the region to have ratified and lifted all specific reservations to CEDAW (Committee on the Elimination of Discrimination Against Women). Violence against women is considered a threat to peace and security. *Secondly, the adoption of Article 46 of the new Constitution of 2014 obligated the State to combat violence against women and make it its priority. *The adoption of Organic Law 58/17 of 11 August 2017 finally gave the status of victim to the abused Woman. This law came into force in 2018. *A number of mechanisms have been put in place, including the establishment of the National Observatory to Combat Violence against Women. *Most magistrates still resist the application of Law 58/17, which contributes to the resurgence of violence against women, especially during periods of slackening of the justice system, such as the COVID lockdown period. Conclusions Despite the revolutionary legal arsenal acquired for the protection of women in Tunisia, there is still a gap between legislation and practice, and the rate of violence against women continues to increase. Nationwide awareness-raising campaigns aiming to spread awareness among women of their rights are necessary. Disclosure of Interest None Declared

Introduction Mania is a serious psychiatric condition, characterized by high rates of relapse and significant dysfunction. An early understanding of the factors involved with the manifestations of this disease is critical as to help estimate impact and plan appropriate treatment modalities. Objectives To assess demographic and clinical characteristics in a first bipolar mania and describe the associations between these factors. Methods A retrospective study was carried out for descriptive and analytical purposes targeting the demographic and clinical characteristics of patients admitted for the first time for a mania within the psychiatry « C » department of Sfax, Tunisia between 2019 and 2022. Results Our study included 50 male inpatients, with a median age of 31.8 years (min=18, max=62) at the moment of their hospitalisation. One third of the patients was married. Only 18% got postsecondary education and 65.3% had a profession. A total of 26.5% had a low socioeconomic status. Twenty-four percent suffered from substance abuse and 14% had a criminal record. Personal psychiatric history was noted in 32% of cases and a personal medical history in 16% of cases. Psychotic features were found in 89.8% of patients. Heteroaggressiveness was present in three quarters of cases, whereas an expansive mood was found in half the population. Twenty percent of patients had a poor insight. A statistically significant association was found between being employed and the absence of personal psychiatric history (p=0.017), whereas personal medical history was associated with a poor insight (p=0.049). Substance abuse was correlated with having a criminal record (p=0.006) and heteroagressiveness (p=0.012). The presence of psychotic features was positively associated with expansive mood (p=0.022). Conclusions This study confirms that some epidemiological factors are strongly associated with clinical characteristics of the bipolar mania. Early interventions over these factors may contribute to a potential reduction in morbidity and mortality of this disease. Disclosure of Interest None Declared

Introduction Resting state electroencephalogram (EEG) abnormalities in schizophrenia (SCZ) suggest alterations in neural oscillatory activity. However, few studies have examined EEG coherence in this population. Objectives Therefore, this study investigated whether these electrophysiological characteristics differentiate schizophrenic patients from healthy controls. Methods This was a cross-sectional, descriptive, and analytical case-control study. The selected patients were followed for SCZ at the psychiatry "C" department at the Hedi Chaker hospital of Sfax. Patients were assessed by the Positive and Negative Schizophrenia scale (PANSS) and the Treatment Adherence Scale (MARS). They all benefited from an EEG at the service of functional explorations in Sfax. Student’s test was performed to compare the coherence values between groups. Results Thirty men including 15 schizophrenic patients and 15 age- and sex-matched controls were included. The average age was 40 years ±12.72 years for schizophrenics and 47.93 ± 15.61 years for healthy controls. Schizophrenics had an average PANSS of 64.6±22.7, and an average MARS score of 5.8 ± 3.09. In terms of intra-hemispheric coherence, Schizophrenic patients generally exhibited higher coherence at the Delta band compared to healthy controls. In contrast, schizophrenic patients appeared to have decreased intra-hemispheric connectivity for other frequency bands, particularly between the frontal and other brain lobes bilaterally. Conclusions In this study, we found that the schizophrenic patients had significantly higher coherence in the delta frequency band compared to the normal controls. These findings suggest that EEG can be a sensitive measure for diagnosing SCZ. Disclosure of Interest None Declared

Introduction Bipolar disorder (BD) is a common psychiatric condition. However, it is underdiagnosed. Electroencephalography (EEG) has been proposed as a neurophysiological biomarker to delineate psychotic disorders. Objectives To compare the EEG tracings of patients with BD with those of normal subjects to aid in diagnosis. Methods This was a cross-sectional, descriptive, and analytical case-control study conducted with patients followed for BD in the psychiatry "C" department at the Hedi Chaker hospital in Sfax. Patients were assessed by the Young Mania Scale (YMRS), the Hamilton HDRS-17 Scale, and the Medication Adherence Report Scale (MARS). Healthy controls were included. All participants benefited from an EEG. It was undertaken in resting eyes closed testing conditions at the service of the functional exploration at the Habib Bourguiba hospital in Sfax. The powers of each band were measured using the power spectral density method called absolute power (AP). Statistical analyses were carried out. Results Fifteen bipolar patients and 15 healthy controls, all male, were included. The average age of bipolar was 36.07 ± 10.50 years. The one of health control was 47.93 ± 15.61 years. There were no significant differences in age between bipolar patients and healthy controls. The mean scores on the HDRS-17 and YMRS and MARS scales were 2.73±2.08, 1.67±3.53 and 5.8±2.83 respectively. At the quantitative EEG, differences appeared to be insignificant. There was an overall decrease in AP for alpha band particularly in the parietal and occipital lobes in bipolar patients (158,84 ± 447,71 μV2 and 188,21 ± 415,55 μV2 respectively) compared to controls (335,15 ± 994,73 μV2 and 400,24 ± 1109,95 μV2 respectively). An overall increase in AP for delta and beta was found for bipolar patients compared to controls. Conclusions Our main finding was a higher delta and beta frequency activity, and lower alpha frequency activity in bipolar patients compared to controls, which may aid in the diagnosis of this disorder. Disclosure of Interest None Declared

Introduction Many neurological, sensory and behavioural deficits, are linked with significant limitations in the overall functioning not only of the child but also his/her closest family, and poses a great challenge for the primary parental caregivers. Objectives To assess the caregiver burden in parents of children with neurological impairement (NI), and itsrelated factors. Methods A total of33 caregivers of children with NI participated in this cross-sectional, descriptive and analytical study, carried out in Child Neurology Department of the University Hospital in Sfax (Tunisia), between February and April 2021. The Zarit-Caregiver-Burden-Scale (Zarit-CBS) was administered. Results The average age of the caregivers (27 mothers and 6 fathers) was 38,33 ± 6,53 years. Among the parents, 17.14% had another disabled child and 30.3% had a mediocre health status. Mother caregivers constitutes the majority of caregiving (82.85%). The average of the number of children in the family was 1.97±1.18 and the average age of the children (21 boys and 12 girls) was 7,58±4,29 years. Near to the half of them (51,51%) had intellectual disability.Over 54.54% of the children had a functional independence, while 21.21% required help in walking and 24.24% were unable to walk. The intervention was based on motor rehabilitation (57,57%), adequate equipment (24,24%), ergotherapy (45,45%) and speech therapy (60,6%).After the intervention, 63,63% of children had an improvement and 30,3% had a stationary state. The mean score of Zarit-CBS was 52,45±14,26. The caregiver burden was noted in 96,96%. The total Zarit-CBS score was associated with the number of children in the family (p=0.047). There was no significant relationship between Zarit-CBS and the severity of impairement (p=0.418). Conclusions Given the variety of factors affecting caregiver burden, specific interventions may promote parental caregivers’well-being, and consequently lead to improved quality of care provided to children with NI. Disclosure of Interest None Declared

Introduction Bipolar disorder is one of the leading causes of disability among young adults. Given the heterogeneity of the disorder and the complexity of its etiopathogenesis, combination therapy is often considered as part of the treatment regimen. Objectives To assess the place of non-pharmacological interventions as a co-adjuvant to pharmacological treatment, to discuss the role of polytherapy in the management of bipolar disorder and to underline the drug to drug interactions to keep in mind. Methods We present a critical review of recent international recommendations for the management of bipolar disorder. Two main evidence-based guidelines were included: The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders and The 2018 Canadian Network for Mood and Anxiety Treatment. Results According to guidelines, the outcomes in bipolar disorder are improved when medication is combined with evidence-based psychological treatment and lifestyle changes. As to polytherapy, it is often recommended to maximise the treatment efficacy. Studies have shown that combination treatments tend to work faster and more effectively than monotherapy especially in episodes with higher index severity. For the management of agitation, an adjuctive treatment by Haloperidol with midazolam or promethazine can be prescribed. In acute mania, combination therapy with quetiapine, aripiprazole, risperidone or asenapine and lithium or divalproex is recommended as first-line treatment options. Combinations of mood-stabilizing drugs may be more often necessary when rapid cycling is present. In a manic episode with mixed features the use of divalproex with an atypical antipyshcotic is recommended. In bipolar I depression, lurasidone and lamotrigine are often used as adjunctive therapies. When anxious distress is present, the combination of olanzapine and fluoxetine has shown to be effective. In a depression with atypical features, tranylcypromine (IMAO) can be added to lithium, divalproex or a second generation antipsychotic for a better result. Adjunctive treatment of olanzapine with fluoxetine may be necessary in a depression with mixed features. However, in bipolar II depression and for maintenance treatment no adjunctive therapies are recommended. Finally, it is important to consider the adverse effects resulting from polytherapy. Using lithium as an adjunctive medication may increase the risk of tremor and acute dystonic reactions and can be a contributing factor for neuroleptic malignant syndrome, whereas divalproex can be an inducer or an inhibitor of some atypical antipsychotics. Conclusions Rational polytherapy allows better and faster control over symptoms of bipolar disorder and should be considered after a detailed discussion of risks and benefits. Disclosure of InterestNone Declared

Introduction Sexual violence is a worldwide public health concern. Nevertheless, the psychopathology of perpetrators of sexual assault still nowadays poorly documented. Objectives The aim of this study was to assess the characteristics of sexual aggressors with mental disorders. Methods It was a retrospective study that included a series of sexual aggressors examined in forensic psychiatric assessment in the psychiatry C department at Hedi Chaker university Hospital in Sfax, from January 2010 to December 2021. Data were collected from psychiatric expert reports. Results The sample was exclusively composed of men with an average age of 37 years and 07 months (± 12.75 years). 54.4% of sexual aggressors suffered from mental disorder. Personality disorder was the most prevalent psychiatric disorder and the antisocial type was noted in 23.9% of cases. Sexual aggressors suffering from mental disorder were more likely to commit rape followed by murder (p=0.05). They used physical violence far more than the others did (p=0.007) and they were more apt to threaten their victims with weapon during the assault (p=0.038). They were also more likely to abuse the power given by their professional roles (15,2 % versus 5,6 %; p=0.07). They more frequently attacked unknown victims (p=0.019). Conclusions More than half of sexual aggressors suffered from psychiatric disorder. Therefore, the detection and treatment of psychiatric morbidity among sexual aggressors may minimize the risk of recidivism. Disclosure of Interest None Declared

Introduction While bipolar disorder–obsessive compulsive disorder overlap is quite common, sexuality remains a largely unexplored area of this clinical entity. Objectives Illustrate through a clinical vignette the case of a patient with diagnosed homosexual obsessive –compulsive disorder (OCD) comorbid with bipolar disorder (BD). Methods The clinical case report was prepared through the review of the patient´s clinical record. Results We report a rare case of a 22 year-old man who was diagnosed with Homosexual Obsessive–compulsive Disorder comorbid with Bipolar Disorder, admitted to our department for a suicide attempt. He came from a religious and conservative background and suffered from intrusive, unwanted mental images of homosexual behaviour since the age of 17. He presented periods of remission from his obsessive thoughts, while showing signs of elevated mood, talkativeness, restlessness, agitation and hyperactivity that would last for a few days, with recrudescence of obsessive and depressive symptoms again afterwards. The present case showed a significant reduction in depressive symptoms and in the impact of his obsessive intrusive thoughts after prescription of Risperidone and Sodium Valproate along with Exposure and Response Prevention Therapy conducted over a period of 6 weeks. Conclusions The homosexual OCD comorbid with bipolar disorder can cause important distress and impairment and severely impact a person’s life in multifaceted ways. Correct diagnosis, adequate medication and psychotherapy provide the effective treatment. Disclosure of Interest None Declared

Introduction Schizophrenia (SCZ) is a common and disabling psychiatric condition. Its diagnosis is entirely clinical. Many researchers have looked into electroencephalogram (EEG) power spectrum analysis for SCZ to find specific abnormalities. Objectives The objective of this study was to analyze the EEG of patients with SCZ using power spectral density and to compare them with those of healthy controls, in order to look for specificities. Methods This was a cross-sectional, descriptive, and analytical case-control study conducted with patients followed for SCZ in the psychiatry "C" department at the Hedi Chaker hospital in Sfax. Healthy controls were included. Patients were assessed by the Positive and Negative schizophrenia scale (PANSS). All participants benefited from an EEG at rest condition at the service of the functional exploration at the Habib Bourguiba hospital in Sfax. We have measured the powers of each band using Welch power spectral density method called absolute power (AP). Statistical analyses were carried out. Results Fifteen schizophrenics and 15 controls, all male, were included. The average age of schizophrenics and healthy controls was 40 years ±12.72 years and 47.93 ± 15.61 years respectively. There were no significant differences in age between patients and controls. Schizophrenics had a mean PANSS of 64.6±22.7. At the quantitative EEG, differences appeared to be insignificant. There was an overall decrease in AP for the alpha band particularly in the parietal and occipital lobes in schizophrenics (53,16 ± 48,83 μV2 and 75,17 ± 56,28 μV2 respectively) compared to controls (335,15 ± 994,73 μV2 and 400,24 ± 1109,95 μV2 respectively). There was also an overall decrease in AP for the different frequency bands in schizophrenics compared to controls. However, values persisted high in the temporal lobe for all frequency bands. Conclusions In conclusion, this decrease in AP for the alpha band in the parietal and occipital lobes in schizophrenics can be a sensitive biomarker for diagnosing SCZ. Disclosure of Interest None Declared

Introduction Homicide is the most serious, radical and irreversible criminal act. It arouses a multitude of questions and fears. Committed by women, the homicide seems more unusual and weird. Objectives Our objective is to describe the circumstances of the homicide committed by Tunisian women Methods This study was retrospective and descriptive. It focused on the files of criminal psychiatric expertise and involved female accused subjects.We have collected all the criminal expert reports carried out over a period of 24 years (from January 1, 1998 to December 31, 2021) Results This study included 21 women who committed homicide.The majority of victims of homicide or attempted homicide (85.6%) belonged to the family circle of the accused.Five women (23.8% ) committed this act against their children and four women (19.1%) committed this act against their husbands.The means most used in homicide and its attempt were immolation (23.8%), strangulation (23.8%) and blows (23.8%). Among those charged with homicide or its attempt, seven (33.3%) presented a personality disorder, 14.3% a depressive disorder, 14.3% a moderate intellectual disability, 4.8% a schizophrenia and 4. 8% mild intellectual disability. Conclusions This female criminality, in particular homicide, would find their explanations in different factors and the existence of a mental disorder at the origin of deviant behavior in women seems to be a significant factor in the determinism of such behavior. Much effort remains to be made to apply preventive measures. Disclosure of Interest None Declared

Introduction Psychotic disorders have been consistently associated with aggressive behaviors. Psychiatrists are frequently asked to perform assessment regarding potentially aggressive patients. Thus, many psychometric instruments can be useful for identifying the risk of violence and thereby offering appropriate treatment for these individuals. Objectives The aims of this study were to assess the risk of agressive behavior in inpatients with schizophrenia or schizoaffective disorder and to determine its correlates. Methods Using face-to-face interviews, inpatients diagnosed with schizophrenia or schizoaffective disorder, in psychiatric department of the University Hospital in Sfax (Tunisia) were included in this cross-sectional, descriptive and analytical study, carried out between novembre 2020 and octobre 2022. The modified overt aggression scale (MOAS) and historical clinical risk management-20 (HCR-20) questionnaire were used for data acquisition. The HCR-20 score of 20 was used as threshold to divide the sample to violent patients (scoring>20) and non-violent patients (scoring ≤ 20). Results The sample consisted of 60 male inpatients. The mean age was 38.23± 10.37 years. In our sample, 68.3% were single, 35% didn’t reach the secondary educational level, 16.7% used psychoactive substance(s), 35% had prior criminal record, 30% had a history of suicidal attempt and 81.7% had previous hospitalization. The mean score of MOAS was 13.08±8.19. The mean total HCR-20 score was 19.25±5.26. The Historical, Clinical and Risk Management subscales showed mean scores of 8.33±2.96, 5.62±1.89, and 5.28±2.42, respectively. The violent patients represented 45% of the sample. The mean scores of the items H3, H10, C1, C2, C4 and R5 of HCR-20 were respectively : 1.33±0.79, 1.20±0.77, 1.22±0.88, 0.38±0.71, 1.30±0.64 and 1.28±0.73. There was no statistical difference between the two groups in socio-demographic factors. A history of suicidal attempts was significantly more common in the group of violent patients (p=0.029). Regarding the HCR subscales, H3 score (relationship instability) and H10 score (Prior supervision failure) were significantly higher among violent patients (p=0.018 and 0.003 respectively). The C1 score (lack of insight), the C2 score (negative attitudes) and the C4 score (impulsivity) were also significantly higher among violent patients (p=0.016, 0.009 and 0.005 rescpectively). The item R5 (stress) of the risk management subscale was significantly higher in the group of violent patients (p=0.003). The total MOAS score detected severe agression in the nonviolent group (p=0.031). Conclusions Our study suggests the efficacy of HCR-20 in identifying and distinguishing between violent and nonviolent patients with schizophrenia or schizoaffective disorder. The use of such reliable instrument in clinical psychiatric settings should be encouraged. Disclosure of Interest None Declared

Introduction Caregiving negatively affects the psychological and physical health of the caregivers, especially in parents of children with neurological impairement (NI).Furthermore, the behavior and demands of the patient make the caregivers encounter increased stress levels and negative thoughtsabout the future that may lead to depression in caregivers. Objectives To assess the relationship between caregiver burden and symptoms of depression in parents of children with NI. Methods A total of 33 caregivers of children with NI, participated in this cross-sectional, descriptive and analytical study, carried out in Child Neurology Department of the University Hospital in Sfax (Tunisia), between February and April 2021. The Zarit-Caregiver-Burden-Scale (Zarit-CBS) and the Beck Depression Scale were administered. Results The average age of the caregivers (27 mothers and 6 fathers) was 38,33 years ± 6,53 years. Among the parents, 81,81% didn’t exceed the secondary educational level and75,75% of them had an irregular occupation. The average age of the children (21 boys and 12 girls) was 7,58±4,29 years.Near to the half of them (51,51%) had intellectual disability.Over 54.54% of the children had a functional independence, while 21.21% required help in walking and 24.24% were unable to walk. The intervention was based on motor rehabilitation (57,57%), adequate equipment (24,24%), ergotherapy (45,45%) and speech therapy (60,6%).After the intervention, 63,63% of children had an improvement and 30,3% had a stationary state. The mean score of Zarit-CBS was 52,45±14,26. The caregiver burden was noted in 96,96%. The mean score of Beck was 9,33±5,48. The depression was noted in 78,78%. The total Zarit-CBS score had positive correlation with Beck scores (p=0.038). Conclusions There is a positive relationship between the caregiver burden and depression symptoms. Thus, effort should be made to relieve caregiver burden in parents of children with NI. Disclosure of Interest None Declared

Introduction There has been a continuous effort to discover and specify the neural correlates of schizophrenia (SCZ) based on spontaneous electroencephalogram (EEG) records. Besides contributing to a more effective diagnosis, biomarkers can be crucial to SCZ to hope for therapeutic progress. Objectives a literature review was conducted to ascertain whether or not quantitative EEG spectral abnormalities are consistent enough to warrant additional effort towards developing them into a clinical diagnostic test for schizophrenia. Methods A systematic search of the databases , ScienceDirect, and PubMed was conducted using the following words : schizophrenia, electroencephalography, neurobiology. The Preferred Items Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in the construction of this literature review. Primary research articles that reported descriptive EEG results, included comparisons of subjects with and without antipsychotic therapy, and excluded patients with epilepsy were included in the analysis. We analyzed pooled data, where possible, from studies with a similar intervention and methodology. Results Our study included 11 articles on quantitative EEG changes in schizophrenic patients divided as follows: 2 articles on the genetics of SCZ and EEG data, 3 articles on the psychopathology of SCZ and EEG data, 2 articles on hemispheric coherence, and finally 4 articles on the effect of treatment on EEG.Increased beta activity can be considered as an inherited feature of SCZ. Elevated delta/theta and gamma activity may serve as a specific biomarker for this condition. The delta wave may be a neurophysiological tool to differentiate between negative and positive forms of SCZ.EEG tracings of schizophrenic patients showed increased intra- and inter-hemispheric coherence compared to healthy subjects. Treatment with an antipsychotic drug was associated with a more marked increase in frequency bands in patients receiving an atypical antipsychotic drug. Conclusions It is important to study the electroencephalographic changes not only to better understand the etiopathogenesis of SCZ, but also to search for specific physiological biomarkers. Disclosure of Interest None Declared

Introduction Despite the potential for EEG abnormalities to provide insight into the neurophysiology of disease processes, studies that measure EEG power and coherence in bipolar disorder (BD) are rare. Objectives We investigated whether the resting electroencephalogram (EEG) in patients with BD showed altered synchronization Methods This was a cross-sectional, descriptive, and analytical case-control study, conducted with patients followed for BD in the psychiatry department "C" at the Hedi Chaker hospital in Sfax compared to healthy controls. Patients were assessed by the Hamilton Depression Scale (HDRS-17), and the Young Mania Scale (YMRS). EEG was also recorded at the service of the functional exploration at the Habib Bourguiba hospital in Sfax. Functional connectivity between pairs of EEG channels was measured for 4 frequency bands delta [0.5 – 3.5 Hz], theta [4 – 7.5 Hz], alpha [8 – 12.5 Hz], and beta [13 – 30 Hz]. Statistical analyses were carried out. Results Thirty subjects including 15 patients with BD and 15 age- and sex-matched controls were included. The mean age of bipolar and control was 36.07 ± 10.50 and 47.93 ± 15.61 years, respectively. The mean scores on the HDRS-17 and YMRS were 2.73±2.08, and 1.67±3.53 respectively. Bipolar patients showed a decrease of connectivity in the delta band, and the decreases were greatest between the left frontal lobe and the right frontal, parietal and temporal lobes on the one hand and between the left temporal and right parietal lobes on the other hand. For the theta band, there was poor connectivity between the left frontal lobe and the right frontal and temporal lobes on the one hand and between the right central area and the left parietal, temporal and occipital lobes. Conclusions Bipolar patients had poorer intra and interhemispheric connectivity, which may be a key feature of BD. Disclosure of Interest None Declared

Introduction Numerous guidelines are bending the rule of monotherapy as initial treatment of acute manic episodes and suggest the importance of polytherapy in maximising the treatment efficacy. Objectives To assess the polytherapy used in the management of acute manic episodes and the degree of conformity of our prescriptions with international guidelines. Methods A retrospective study was carried out for descriptive purposes, targeting the drugs prescribed among patients admitted for the first time for a manic episode within the psychiatry « C » department of Sfax, Tunisia between 2019 and 2022. Patients who received ambulatory care prior to the current episode were excluded. Results Our study included 50 male inpatients, with a median age of 31.8 years (min=18, max=62) at the moment of their hospitalisation. Nearly two thirds were single, 82% didn’t get postsecondary education and 65.3% had a profession. The majority (73.5%) belonged to upper-middle class and 67.3% had social security. A quarter of the patients suffered from substance abuse and 14% had a criminal record. Around 89.8% individuals presented a manic episode with psychotic features. The symptoms included mainly heteroaggressiveness in three quarters of cases, agitation in 77.1% and insomnia 76.1%. Insight was good in 79.6% of cases. Polytherapy was preferred to monotherapy in 86% of cases. Bitherapy was used in 74% of cases and tritherapy in only 12%. The most frequent combination was a mood stabilizer plus a second-generation antipsychotic (46%), risperidone plus sodium valproate being used in 34% of cases. Conclusions Overall, our prescriptions were in line with the international guidelines and the choice of polytherapy was well argued. Combination therapy is the suggested way to increase treatment efficacy, however, vigilance is required because of the increased risk of side effects. Disclosure of Interest None Declared

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 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 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

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 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

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 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 Bipolar disorder (BD) is a mental illness marked by extreme swings in the mood, energy, and thinking. Although it’s not an official symptom of the disease, some research suggests that it also may affect the empathy. Objectives To investigate empathic responding in patients with BD in euthymic state of illness and to determine associated factors. 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 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. 78.2% of patients had a good adherence to treatment. 60.3% of them had residual depressive symptoms during eutymia. QCAE total score was 72.49. (Maximum possible score 124) Cognitive empathy score was 43.21. (Maximum possible score 76) Affective empathy score was 29.36. (Maximum possible score 48) Affective empathy was associated with female gender (p=0), good adherence to treatment (p=0.01) and residual depressive symptoms (p=0.001). Conclusions Our study shows that bipolar patients have fairly good levels of empathy. However, in order to better substantiate empathy in BD, comparative studies seem necessary. 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.