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Tunisia is a lower-middle-income country located in North Africa with strengths and challenges to its mental health system. We present an overview of available services, facilities, and human resources to offer mental health care in Tunisia. We conducted a cross-sectional study, where data for the year 2017 was collected between May 2018 and May 2019 by consulting stakeholders involved in the health field in Tunisia. We compare this information with data published in the WHO-AIMS report (2008), which presents mental health data in Tunisia for the year 2004. Successes of the mental health system in Tunisia include an increase in the ratios of psychiatrists and psychologists, with these ratios being higher than those of other lower-middle-income countries; a flourishing child-psychiatry practice; and an increase in people being treated for mental health conditions. Challenges include psychiatrists being over-represented in large cities along the coastline and in the private sector, and most people receiving treatment in specialized mental health facilities. The further operationalization of the National Strategy for Mental Health Promotion is envisioned, through the training of non-specialists in mental health care and incentives offered to psychiatrists to work in the country's interior and the public sector. [ABSTRACT FROM AUTHOR]

Benzodiazepines may be prescribed to manage anxiety and insomnia in patients with depression. However, as noticed during our daily practice, a considerable proportion of patients treated for depression and receiving benzodiazepines developed a dependence to these medicines. Our aims were to estimate the proportion of patients with depression who develop a benzodiazepine dependence and to identify its correlates. We conducted a comparative study in Razi Hospital's outpatient psychiatry unit (Tunisia). We included patients aged 18 to 65 years who were diagnosed with depression during the first three quarters of 2014. Included patients were prescribed benzodiazepines. Follow-up period was of 2 years. A multivariate analysis was performed to identify dependence-associated factors. We included 54 patients, and 52% developed a benzodiazepine dependence during the follow-up period. Two associated factors were identified: a daily mean benzodiazepine dose of more than 9.5 milligrams of diazepam equivalents prior to taper off (p =.001) and a benzodiazepine taper-off initiated after the fifth week of benzodiazepine intake onset (p =.007). The proportion of patients who developed a benzodiazepine dependence was high. Low doses and time-limited benzodiazepine prescription should be taken into consideration when managing patients with depression in order to prevent dependence. [ABSTRACT FROM AUTHOR]

To address the rise in mental health conditions in Tunisia, a training based on the Mental Health Gap Action Programme (mhGAP) Intervention Guide (IG) was offered to primary care physicians (PCPs) working in the Greater Tunis area. Non-specialists (such as PCPs)' training is an internationally supported way to target untreated mental health symptoms. We aimed to evaluate the programme's impact on PCPs' mental health knowledge, attitudes, self-efficacy and self-reported practice, immediately following and 18 months after training. We conducted an exploratory trial with a combination of designs: a pretest-posttest control group design and a one-group pretest-posttest design were used to assess the training's short-term impact; and a repeated measures design was used to assess the training's long-term impact. The former relied on a delayed-intervention strategy: participants assigned to the control group (Group 2) received the training after the intervention group (Group 1). The intervention consisted of a weekly mhGAP-based training session (totalling 6 weeks), comprising lectures, discussions, role plays and a support session offered by trainers. Data were collected at baseline, following Group 1's training, following Group 2's training and 18 months after training. Descriptive, bivariate and ANOVA analyses were conducted. Overall, 112 PCPs were randomized to either Group 1 (n = 52) or Group 2 (n = 60). The training had a statistically significant short-term impact on mental health knowledge, attitudes and self-efficacy scores but not on self-reported practice. When comparing pre-training results and results 18 months after training, these changes were maintained. PCPs reported a decrease in referral rates to specialized services 18 months after training in comparison to pre-training. The mhGAP-based training might be useful to increase mental health knowledge and self-efficacy, and decrease reported referral rates and negative mental health attitudes among PCPs in Tunisia and other low- and middle-income countries. Future studies should examine relationships among these outcome variables. [ABSTRACT FROM AUTHOR]

Introduction: Tardive seizure refers to a spontaneous seizure, which occurs after electroconvulsive therapy (ECT). It is a rare and poorly understood phenomenon that can lead to other serious consequences such as status epilepticus. Risk factors may be associated, and its management is by no means consensual. However, tardive seizure remains little explored in the absence of feedback and data sharing. The purpose of this study was to report the prevalence of late-onset seizures following ECT during the acute phase of treatment at the stimulation unit of Razi Hospital during its seven years of activity and to identify variables associated with this adverse event., Methods: This is a descriptive and retrospective study that was carried out at the ECT unit of Razi Hospital, Tunisia, based on the medical records of patients treated with ECT between December 2015 and September 2023. Every recorded ECT session during the initial course of treatment with available EEG tracings was included in the study. Maintenance ECT sessions, undocumented sessions, those without clinical observations, and/or those without EEG tracings were all excluded. A tardive seizure was retained according to criteria that included both recorded motor manifestations such as "motor jerks" or "generalized tonic-clonic seizures" which began spontaneously after ECT and the resumption of a state of consciousness concurrent with an equivocal EEG tracing., Results: A total of 162 patients received at least one course of ECT during the research period. Ultimately, we included 1931 well documented sessions that were completed for 157 patients in all. Of the 157 patients, seven had experienced at least one late seizure after receiving ECT, accounting for 4.45% of patients. Among the 1931 sessions, 11 late seizures were noted. The prevalence of tardive seizures in our series was 0.57%. Several factors have been associated to the onset of a tardive seizure, including being a male, the presence of a neurological lesion, treatment that lowers the epileptogenic threshold, anesthesia with etomidate, stimulation charge near seizure threshold or maximum electrical load, prolonged induced seizure, and poor post-ictal suppression on the induced seizure tracing., Conclusion: Despite the dearth of information, tardive seizure following ECT is considered to be a rare event. Risk factor management would be the first action to be taken to prevent such an event., Competing Interests: Disclosure of interest The authors declare that they have no competing interest., (Copyright © 2024 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)