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IntroductionIt is widely recognized that parents and peers play a critical role in the adolescent's introduction to alcohol.ObjectivesThe aim of the study was to examine the relationship of parental and peers drinking to adolescent drinking behavior.MethodsA cross-sectional study was carried out in four colleges and schools in Sfax in Tunisia, in May and June 2016. The sample consisted of 317 pupils, and was determined through a simple randomized sampling. These adolescents were asked to answer a self-administered questionnaire, after their consent. Alcohol use disorders identification test (AUDIT) was used to evaluate alcohol dependence.ResultsThe mean age was 16 years, with a sex-ratio of 1.07. The participants reported having drunk alcohol at least once in 18.9% of cases and 41.66% of them still consume. According to AUDIT, 1.6% of alcohol users presented an alcohol misuse and 21.6% presented dependence. They reported that parents’ attitude toward their alcohol use was favorable in 27.11% of cases. Among dependent adolescents, the prevalence of fathers’ alcohol consumption was 20% while that of friends was 70%. Adolescent drinking was significantly correlated to fathers, mothers and peers drinking (P < 0.001, P = 0.004, P < 0.001 respectively), mothers and peers smoking (P = 0.05, P < 0.001 respectively), fathers and peer's cannabis use (P < 0.001, P < 0.001 respectively).ConclusionFindings suggest that negative family and peers influence increased risk of alcohol consumption in adolescents. Understanding the influences on parents’ beliefs about their children's drinking and the functions of social networks in preventing alcohol consumption may be necessary to address adolescent risky drinking.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionTardive dyskinesia (TD) is a drug-induced movement disorder that arises with antipsychotics. These drugs are the mainstay of treatment for schizophrenia. Epidemiological studies have shown mixed results on smoking's association with TD.ObjectiveTo study the association between smoking and TD induced by antipsychotics in outpatients with schizophrenia.MethodsThis was a cross-sectional study. It involved 89 patients suffering from schizophrenia, followed-up in outpatient psychiatry unit at Hédi Chaker university hospital in Sfax in Tunisia, between April and May 2016. We looked for TD in according to DSM-IV-R criteria. The intensity of TD was assessed with the Abnormal Involuntary Movement Scale (AIMS) and the level of nicotine dependence with the Fagerström Test for Nicotine Dependence (FTND).ResultsThe prevalence of smoking in patients with schizophrenia was 69.6%. Of these, 54.8% had a high or very high degree of nicotine dependence. The prevalence of TD was 33.7%. The AIMS average score was 12.13 ± 5.6 with extremes ranging from 3 to 26. TD was correlated with tobacco consumption (P = 0.003), the average number of smoked cigarettes (43.7 vs. 33.8; P = 0.004) and the Fagerström average score (7.2 vs. 6.1; P = 0.012).ConclusionThe results of this study showed a correlation between the amount of smoking and severity of TD in patients with schizophrenia. The nature of the relationship between smoking and TD needs to be clarified through an experimental study.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionMany studies have focused on the strong link between impulsivity and addictive behaviors, such as alcohol use disorders.ObjectiveOur study aimed to investigate the links between alcohol use and impulsivity in a sample of Tunisian pupils.MethodsThis was a cross-sectional study conducted in May and June 2016. It enrolled 317 pupils from four colleges and schools in Sfax (Tunisia). The participants were asked to answer a self-administered questionnaire, after their consent. Alcohol use disorders identification test (AUDIT) was used to evaluate alcohol dependence. The Barratt Impulsiveness Scale (BIS), in its 11th version, was used to assess impulsivity trait. Its three second-order factors were attentional impulsiveness, motor impulsiveness, and non-planning impulsiveness.ResultsThe mean age was 16 years with a sex-ratio of 1.07. The school children reported having drunk alcohol at least once in 18.9% of cases and 41.66% of them still consume. According to AUDIT, 1.6% of alcohol users presented an alcohol misuse and 21.6% presented dependence. According to BIS, impulsivity prevalence (IP) in the whole sample was 27.8% while it was 40% among the alcoholic participants versus 24.9% in non-alcoholic participants. The average BIS score was more important in the alcoholic participants (69.25 versus 65.53; P = 0.011). Alcohol consumption was correlated to attentional impulsiveness (P = 0.01) and motor impulsiveness (P = 0.008). Alcohol dependence was correlated to motor impulsiveness (P = 0.018).ConclusionThese results show the importance of clinically evaluating and intervening on impulsive personality traits to better prevent addictive behavior such as alcoholism among adolescents.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionAge of onset of illness may be useful in explaining the heterogeneity among older bipolar patients.ObjectiveTo examine the relationship of age of onset with clinical, demographic and behavioral variables, in older patients with bipolar disorder.MethodsThis was a cross-sectional, descriptive and analytical study, including 24 patients suffering from bipolar disorders, aged 65 years or more and followed-up in outpatient psychiatry unit at Hedi Chaker university hospital in Sfax in Tunisia. We used a standardized questionnaire including socio-demographic, behavioral and clinical data. Age of onset was split at age 40 years into early-onset (< 40 years; n = 12) and late-onset (≥ 40 years; n = 12) groups.ResultsThe mean age for the entire sample was 68.95 years. The mean age of onset was 39.95 years. The majority (60%) of patients were diagnosed with bipolar I. Few meaningful differences emerged between early-onset and late-onset groups, except that tobacco use was significantly higher in the late-onset group (66.6% vs. 16.6%; P = 0.027). No significant differences between the early-onset and late-onset groups were seen on demographic variables, family history and number of medical diagnoses or presence of psychotic features.ConclusionOur study found few meaningful behavioral differences between early versus late age at onset in older adults with bipolar disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

ObjectivesTo assess suicide risk in elderly psychiatric outpatients and to identify potential suicide risk factors in this population.MethodsThis was a cross-sectional, descriptive and analytical study, including 50 psychiatric outpatients, aged 65 years or more and attending the Hédi Chaker University Hospital, in Sfax (Tunisia), between November and December 2015. We used a hetero questionnaire including epidemiological and clinical data and three scales: the Suicidal Risk Assessment Scale of Ducher (RSD), the Hospital Anxiety and Depression Scale (HADS) and the Mini Mental State Examination (MMSE).ResultsThe sex ratio (M/F) was 1. The average age of patients was 68.62 years. The majority of them were married (68%), unemployed (98%), living in urban area (58%) and within their family (88%); they had at most a primary degree (80%) and a low socioeconomic level (74%).The prevalence of patients at risk of suicide (RSD ≥ 3) was 26%. This risk was high (RSD ≥ 7) in 18% of cases.The presence of suicidal ideation (RSD ≥ 3) was correlated with: a family history of suicide attempt (58.3% vs. 15.8%; P = 0.003), a personal history of suicide attempt (80% vs. 12.5%; P < 0.001), depressive symptoms (HAD-D ≥ 11) (36.7% vs. 10%; P = 0.05) and anxiety (HAD-A ≥ 11) (52.4% vs. 6.9%; P = 0.001).ConclusionOur study showed that among older psychiatric outpatients, one in four had suicidal thoughts. This high rate encourages us to search systematically these suicidal thoughts in this population, especially in patients with risk factors such as a family history of suicide attempt, depressive or anxious symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

ObjectiveTo identify predictive variables of chronic benzodiazepine use among elderly patients with depressive disorder.MethodsThis was a cross-sectional, descriptive and analytical study, including 41 patients suffering from depressive disorders, aged 65 years or more, treated with benzodiazepine (BZD) and followed-up in outpatient psychiatry unit at Hedi Chaker university hospital in Sfax in Tunisia. We used a standardized questionnaire including socio-demographic and clinical data. Chronic BZD use was defined as BZD availability at least 50% of the days between day 181 and day 365 following initiation.ResultsThe average age of patients was 69.29 ± 5.7 years. The sex ratio (M/F) was 0.5. The majority of them were married (78%), unemployed (82.9%) and living in urban area (61%). They had at most a primary degree (90.2%) and a low socioeconomic level (63.4%). The average time of BZD consumption was 4 years and 5 months.The prevalence of chronic BZD use in our sample was 56.1%. Duration of benzodiazepine use was greater than 1 year for all chronic BZD users. The mean dose of Benzodiazepine (Lorazepam) consumed was 3.87 ± 2.8 mg per day. Chronic BZD use was correlated with low socioeconomic level (86.3% vs 36.8%; P = 0.000), psychiatric comorbidity (72.7% vs 26.3%; P = 0.004) and recent hospitalization (59% vs 15.7%; P = 0.023).ConclusionThere is a high prevalence of chronic BZD use in our study. For the 65 years and older patients with depressive disorder, significant predictors of chronic BZD use were low socioeconomic level, psychiatric comorbidity and recent hospitalization.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Introduction Excessive tobacco consumption among students has negative repercussions on their health and education. Medical students are no exception. Numerous studies have demonstrated the relationship existing between smoking and depressive disorders. Objective To study the relationship between depression, anxiety and students smoking. Method We conducted a cross-sectional, descriptive and analytical study which included 80 students of the Faculty of Medicine of Sfax in Tunisia: 40 smokers and 40 no-smokers. We used the Hospital Anxiety and Depression Scale (HADS) for screening depressive and anxious symptoms. The evaluation of tobacco dependence was performed by Fagerstrom test. Results The average age of the participants was 23 years with a male predominance (SR=1,66). The smokers were in 80% of cases males and in 55% of cases dependents. Thirty-one percent (31%) of our population were depressed and 28.7% were anxious. A statistically significant correlation was found between smoking and the presence of depression (p = 0.025) on one hand, and anxiety (p = 0.022) on the other hand. Tobacco dependence was related to male sex (p = 0.04) and depression (p = 0.03). There was no link between the same variable and anxiety. Conclusion It appears from our study a statistically significant relationship between smoking and anxio-depressive disorders. The degree of dependence is particularly related with depression. This dimension has to be considered in the therapeutic withdrawal project.

Introduction Complications of anxiety disorders can be serious and even life-threatening in some cases. Objective The aim of our study was to identify the complications related to anxiety disorders. Methods This is a cross-sectional study of 40 patients suffering from anxiety disorders and followed to the outpatient psychiatry Hedi Chaker University Hospital in Sfax Tunisia during the month of August 2014. The subjects who participated in the survey responded to an anonymous questionnaire to collect socio-economic and demographic data, the type of anxiety disorders and the presence of psychiatric complications related disorders. Diagnoses of anxiety disorders were selected according to DSM-IV-TR. Results The rate of each anxiety disorder was as follows in our patients: Obsessive Compulsive Disorder (OCD) 31.6%, Generalized Anxiety Disorder (GAD) 15.8%, Panic Disorder(PD) without agoraphobia 21.1%, PD with agoraphobia 5.3%, Post Traumatic Stress Disorder (PTSD) 13.2%, Acute Stress Disorder(ESD) 10.5%, agoraphobia 2.6%. 55.3% of the patients were female. The mean age was 41.55 years, ranging from 18 to 67 years. 71% of patients were young people between 25 years and 45 years. 55.3% of patients lived in urban areas. 63.1% were married. 50% of the patients had, along the evolutionary course of their illness, psychiatric complications including: depression 57.9%, suicide attempts 31.6%, alcohol abuse 10.5%. Conclusion The findings underline the importance of the proper management of any anxiety disorder to reduce its complications and improve the quality of life of these patients.

Introduction Although the relationship between personality and depressive illness is complex, there is empirical evidence that some personality features such as neuroticism, harm avoidance, introversion, are related to depressive illness risk among postpartum women. Objective The aim of this study is to estimate the prevalence of postpartum depression and to evaluate its relationship with neuroticism. Methodology This is a descriptive cross-sectional study regarding 100 parturients during the first week of postpartum recruited in Obstetrics department, Sfax, Tunisia. The EPDS was used to assess depressive symptoms at early postpartum. Neuroticism was assessed by using the neuroticism scale of the NEO PI-R. Results The total sample (n=100) had a mean age of 29 years. 4% had a family psychiatric history and 6% had a personal psychiatric history. The current pregnancy was undesired in 13% of cases. Sympathetic signs of pregnancy were reported by 69% of women. The prevalence of postpartum depression in the first week was 9%. The occurrence of depression was associated with the existence of mood personal background, a difficulty to accept the pregnancy and an irregular pregnancy monitoring. Women with depressive symptoms obtained higher scores on neuroticism, depression and angry hostility than women from healthy groups. Sympathetic signs of pregnancy were significantly related to neuroticism and anxiety. Conclusion Understanding the effect of neuroticism allows clinicians to detect subgroups of women with an increased vulnerability to postpartum depression who might receive early psychological and psychiatric care.

Introduction Psychoses are severe mental disorders, which place a considerable burden on the caregivers. Families experience a lot of physical, emotional and financial distress due to a patient’s abnormal behavior, and social and occupational dysfunction. In countries like Tunisia, where rehabilitation services are almost nonexistent, the role of the family becomes more important. Objective Assess caregiver burden among relatives of patients with chronic psychoses. Methodology This is a descriptive cross-sectional study regarding 40 caregivers accompanying patients with chronic psychoses (schizophrenia, bipolar disorder and non- schizophrenic psychosis). The burden was assessed by the European version of the scale of the burden IEQ (Involvement Evaluation Questionnaire). Results The average age of our population was 48 years. Caregivers were as follows: siblings(35%), parents (27.5 %) and spouses(27.5 %). Almost all of the caregivers (80%) lived in the same household as the patient. Pathologies diagnosed in patients were schizophrenia (65%) and bipolar disorder (20%). Most caregivers have an important sense of burden (IEQ> 15) with a percentage of 77.5%. This burden was mainly due to the “tension” with a mean score of 5.6 and the 'supervision'with an average of 3.7. A significant burden was found among caregivers without occupation (p = 0.028). Patients Caregivers treated with atypical antipsychotic express less important burden (p = 0.032). Conclusion Caregivers of patients with chronic psychoses experience moderate to severe burden. Caring for the psychotic patient need to change from a patient focused approach to a combined patient and caregiver approach.

Introduction Insight is defined as the recognition that one has a mental disorder, the ability to identify its symptoms, and cognizance of the need for treatment. Lack of insight into having a mental disorder is found to be associated with a poorer clinical outcome, treatment noncompliance, and a more severe cognitive impairment. Objective Compare the insight and medication adherence in a population of schizophrenia and bipolar disorder patients. Methodology We assessed and compared the insight and compliance of 60 patients with schizophrenia (n=30) and bipolar disorder (n=30) recruited in Psychiatry department Sfax, Tunisia. Insight was assessed using the rating scale of consciousness disorder (Q8). Adherence was assessed using the Drug Attitude Inventory [ICD-10]. Results Patients were mainly young adults, male (70%) and did not live in a couple (61.7%). About half of them (43.3%) had no profession. Insight was low in 15% of patients, intermediate in 53.3%, and good in 31.7% of cases. Bipolar disorder patients displayed better insight into having a mental disorder compared to schizophrenia patients (p=0.04) Good adherence was observed in 64.4% of patients. Factor influencing adherence in both populations was the type of treatment: patients treated with atypical antipsychotics have better compliance (p = 0.005). A good insight was significantly correlated with good adherence (p = 0.000) Conclusion Our results showed that bipolar disorder patients have better insight compared to schizophrenia patients. So it is necessary; in schizophrenia; to work on awareness of the disorder and the need for treatment to improve adherence.

Objective The study of various psychiatric manifestations of tuberous sclerosis complex (TSC) and psychopharmacologic medications used to treat these disorders through a case of a patient followed for TSC and bipolar disorder, and with a review data from the literature. Methods In this case report, we present the association of Tuberous sclerosis and bipolar affective disorder in a young man. The literature data were collected by searching PubMed. Results We found in the literature various psychiatric manifestations in patients with TSC like behavioral disorders, learning disability, mental retardation, attention-deficit/hyperactivity disorder, autism spectrum disorders, mood disorders, anxiety disorders and thought disorders. The psychoactive medications most often prescribed for these disorders were antipsychotics essentially second generation (Risperidone, Quetiapine, Aripiprazole, Olanzapine), antidepressants, and anticonvulsants with mood-stabilizing properties (Clonazepam, Valproic acid). In this case report, our patient had TSC, referred to epilepsy, skin lesions(Angiofibromas, Shagreen patches)and confirmed by the neuroimaging(multiple calcified subependymal nod-ules, a thickened gyrus (cortical tuber), an astrocytoma in the right frontal region), with bipolar disorder type I manifested by manic episodes with psychotic features. The patient responded well to treatment with Quetiapine, Valproic acid and Clonazepam after resistance to Risperidone and Haloperidol. Conclusion Considering the rarity of bipolar disorder in TSC, the clinical management of these patients should be done on an individ-ual basis. However, the use of anticonvulsant mood stabilizers seems obvious because of the very high incidence of epilepsy in TSC. Quetiapine was one of the most effective antipsychotics in TSC and which showed a positive benefit for our patient at follow-up.

Introduction Major depression is a debilitating and recurrent disorder with a substantial lifetime risk and a high social cost. Aims - To establish the course of the first major depressive episode (MDE) in a population of students. - To identify the various factors involved in this process. Methods Retrospective and descriptive study on 40 students followed in Psychopedagogie’ consultation in the department of Psychiatry B, Hedi chaker hospital in Sfax Tunisia from 2009 to 2013. The statistical analysis was performed by the SPSS (version 18). Results The average age of the group was 22,8 years. Twenty-three women (57,5%) were included. All of patients were single. The socioeconomic level of the group was fair in 62,5% of cases. Twelve subjects had a family history of psychiatric illness. Prevalence of unipolar depression was 82,5%. Majority of patients were treated with only pharmacological means (77,5%). The general evolutif course in our subjects tends to improvement (37,5%). Six patients had a complete recovery. The persistence of residual symptoms was found in 12 patients. Deterioration in social and professional functioning was reported in12 patients. Six patients have had relapse. The recurrence of MDE was reported in 2 patients. Chronicity was founded in 4 patients. Two patients had a new suicide risk. One patient had an emergence of mood episode. No patient had spontaneous improvement. Nine patients have stopped the follow. The main reason of worsening was the emergence of an intercurrent stress factor (52,5%). Conclusion The negative impact of depression in our patients explains the necessity of a well adapted management.

Aims . - To measure the insight of a clinical population of schizophrenics. - To specify factors correlated with a great insight. Methods . - A cross-sectional study on 30 schizophrenic male followed in the Department of Psychiatry B, Hedi Cheker hospital in Sfax, Tunisia. - For each patient: We collected the demographic and clinical data and we used the following scales: * The Insight Scale (IS) for the measurement of ‘insight. * Positive and negative syndrome scale (PANSS) to assess the severity of symptoms. * The Drug Attitude Inventory (DAI-10) to assess the assumption relating to drugs. * The Calgary Depression Scale for Schizophrenia (CDSS) to assess depression. * The Satisfaction With Life Scale (SWLS) to determine the degree of life satisfaction. Results The average age of the group was 40,08 years. Fifteen patients had a primary school and 68% were unemployed. Socioeconomic level was low in 80% of cases. Paranoid schizophrenia was the predominant type (56%). The average duration of hospitalization was 7.28 weeks. Twenty patients consulted regularly after their first hospitalization. The insight was poor in half of cases. Twenty-six patients had a positive subjective response to treatment. The majority of subjects had no depression (84%). Eleven subjects were satisfied with their life. The great insight was correlated with positive subjective response to treatment (p = 0.023). Conclusion The great insight was associated with better drug compliance, with a limited number of relapses and a favorable disease progression. However, it was also associated with poor life satisfaction.