Search

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 Patients with schizophrenia have shown a high mortality rate, and life expectancy is shortened by 10-20 years. This seems to be mainly caused by metabolic and cardiovascular diseases. Several risk factors are identified, including sedentary lifestyle, poor diet, low socioeconomic status, cognitive dysfunction, and antipsychotics iatrogenicity. Objectives We aimed to explore somatic pathologies reported in patients with schizophrenia, and to assess risk factors predisposing to these impairments. Methods We conducted a retrospective descriptive and analytical study, based on clinical and psychiatric observations of 60 patients with schizophrenia, hospitalized in psychiatry “B” department, Hedi Chaker university hospital (Sfax, Tunisia), during the period between 2015 and 2017. Results Among our patients, 38.3% suffered from somatic comorbidities: diabetes (21.7%), hypertension (15%), coronary disease (15%), hyperlipidaemia (15%), respiratory diseases (6.7%). Tobacco consumption was reported in 53.3% of patients. It was significantly associated with the occurrence of cardiovascular diseases (p=0.036). Alcohol abuse was noted in 16.7%, while obesity was reported in 6.7% of patients. Significant associations were found between obesity and diabetes (p=0.001), and between organic diseases and cognitive disorganisation (p=0.022). Somatic comorbidities were more frequent in patients with low socio-economic level (p=0.015). Among our patients, 83.3% were treated with conventional antipsychotics while 38.3% were treated with atypical antipsychotics (AAP). We showed that AAP were associated with the occurrence of organic diseases (p=0.037). Conclusions Physical health of patients with schizophrenia requires a serious attention. Coordinated care between psychiatrists and other healthcare professionals should monitor the physical health of these patients to prevent a premature death. Disclosure of Interest None Declared

Introduction relapse and frequent rehospitalizations. The length of stay (LOS) of these patients has been a concern of researchers. The ability to identify determinants of LOS at admission – and, thus, identify patients who are likely to need a longer stay early on – may help treatment planning. Objectives We aimed to investigate socio-demographic and clinical profile of inpatients with schizophrenia, and to identify factors associated with LOS. Methods It was a retrospective study carried out among 90 inpatients with schizophrenia admitted to the psychiatry “B” department, Hedi Chaker university hospital (Sfax, Tunisia), during the period between January 2015 and December 2019. Data collection was performed through the patients’ medical records. Statistical analysis was performed using SPSS v.25. Results The mean age of our patients was 32 years. Among them, 57.78% were women. The mean LOS was 28 days. Factors found to be significantly associated with LOS were: the number of admissions (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 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 Depression is a common mental disorder whose management remains delicate, given the trans-nosographic nature of this syndrome. Two common types of depression are bipolar and unipolar depression. Although they share many similar symptoms, several differences between the two pathologies are suggested in prior studies. Objectives We aimed to compare the disease characteristics and evolution of unipolar and bipolar depressed patients. Methods We conducted a retrospective descriptive and analytical study among medical records of 167 patients hospitalized for a depressive episode (DE) at the Psychiatry “B” Department, Hedi Chaker University Hospital (Sfax, Tunisia), during the period between 2015 and 2017. Patients were divided into two groups according to DSM-5 criteria: those with bipolar disorder I or II (bipolar depression) versus those with major depressive disorder (unipolar depression). Results The mean age of our patients was 37.6 years, with a female predominance (sex-ration F/M =1.7). The age of onset of the disease was earlier in bipolar depressed patients (29.36 versus 31.89), without a significant relationship. Family psychiatric history was significantly more prevalent in bipolar disorder patients (73.5% versus 37.3%; p

Introduction: Depression is a common mental disorder whose management remains delicate, given the trans-nosographic nature of this syndrome. Two common types of depression are bipolar and unipolar depression. Although they share many similar symptoms, several differences between the two pathologies are suggested in prior studies. Objectives: We aimed to compare the disease characteristics and evolution of unipolar and bipolar depressed patients. Methods: We conducted a retrospective descriptive and analytical study among medical records of 167 patients hospitalized for a depressive episode (DE) at the Psychiatry "B" Department, Hedi Chaker University Hospital (Sfax, Tunisia), during the period between 2015 and 2017. Patients were divided into two groups according to DSM-5 criteria: those with bipolar disorder I or II (bipolar depression) versus those with major depressive disorder (unipolar depression). Results: The mean age of our patients was 37.6 years, with a female predominance (sex-ration F/M =1.7). The age of onset of the disease was earlier in bipolar depressed patients (29.36 versus 31.89), without a significant relationship. Family psychiatric history was significantly more prevalent in bipolar disorder patients (73.5% versus 37.3%; p<0.001). Bipolar patients are more likely to be unemployed (65.3% versus 50.8%), but without a significant relationship. Bipolar patients were more likely to be hospitalized for suicide attempts (44.9% versus 35.6%; p=0.2). Conclusions: Distinguishing between major depressive disorder and bipolar disorder is important because there are differences in the optimal management of these conditions. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

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 [ABSTRACT FROM AUTHOR]

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 [ABSTRACT FROM AUTHOR]

Introduction: relapse and frequent rehospitalizations. The length of stay (LOS) of these patients has been a concern of researchers. The ability to identify determinants of LOS at admission – and, thus, identify patients who are likely to need a longer stay early on – may help treatment planning. Objectives: We aimed to investigate socio-demographic and clinical profile of inpatients with schizophrenia, and to identify factors associated with LOS. Methods: It was a retrospective study carried out among 90 inpatients with schizophrenia admitted to the psychiatry "B" department, Hedi Chaker university hospital (Sfax, Tunisia), during the period between January 2015 and December 2019. Data collection was performed through the patients' medical records. Statistical analysis was performed using SPSS v.25. Results: The mean age of our patients was 32 years. Among them, 57.78% were women. The mean LOS was 28 days. Factors found to be significantly associated with LOS were: the number of admissions (p<0.001, r=0.404), involuntary hospitalization (p=0.001), violence and disturbance of public order as a reason of admission (p < 0001) and the lack of social support (p=0.039). As for the clinical symptoms, hallucinations were significantly associated with a longer LOS (p=0.001). Conclusions: Our findings highlighted several factors associated with a longer LOS. This may be helpful to the management of hospitalization and ensuring that any periods of liberty deprivation do not last longer than necessary to provide appropriate treatment. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Introduction: Patients with schizophrenia have shown a high mortality rate, and life expectancy is shortened by 10-20 years. This seems to be mainly caused by metabolic and cardiovascular diseases. Several risk factors are identified, including sedentary lifestyle, poor diet, low socioeconomic status, cognitive dysfunction, and antipsychotics iatrogenicity. Objectives: We aimed to explore somatic pathologies reported in patients with schizophrenia, and to assess risk factors predisposing to these impairments. Methods: We conducted a retrospective descriptive and analytical study, based on clinical and psychiatric observations of 60 patients with schizophrenia, hospitalized in psychiatry "B" department, Hedi Chaker university hospital (Sfax, Tunisia), during the period between 2015 and 2017. Results: Among our patients, 38.3% suffered from somatic comorbidities: diabetes (21.7%), hypertension (15%), coronary disease (15%), hyperlipidaemia (15%), respiratory diseases (6.7%). Tobacco consumption was reported in 53.3% of patients. It was significantly associated with the occurrence of cardiovascular diseases (p=0.036). Alcohol abuse was noted in 16.7%, while obesity was reported in 6.7% of patients. Significant associations were found between obesity and diabetes (p=0.001), and between organic diseases and cognitive disorganisation (p=0.022). Somatic comorbidities were more frequent in patients with low socio-economic level (p=0.015). Among our patients, 83.3% were treated with conventional antipsychotics while 38.3% were treated with atypical antipsychotics (AAP). We showed that AAP were associated with the occurrence of organic diseases (p=0.037). Conclusions: Physical health of patients with schizophrenia requires a serious attention. Coordinated care between psychiatrists and other healthcare professionals should monitor the physical health of these patients to prevent a premature death. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

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 [ABSTRACT FROM AUTHOR]

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 [ABSTRACT FROM AUTHOR]