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

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

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

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

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

IntroductionPatients with bipolar disorder (BD) frequently experience residual symptoms, problems in psychosocial functioning, cognitive impairment, and poor quality of life (QOL).Objectives* To evaluate the QOL of euthymic patients with BD compared to healthy controls (HC). * To identify factors associated with its deterioration.MethodsThis is a comparative and analytical study, conducted over 3 months, involving 30 euthymic patients with BD, followed up in the outpatient psychiatry department of Hedi Chaker University Hospital in Sfax (Tunisia). They were compared to 34 HC. General, clinical and therapeutic data were collected using a pre-established questionnaire. QOL was assessed with the «36 item Short-Form Health Survey» (SF-36).ResultsThe mean ages of BD patients and HC were 44.17 years and 40.1 years, respectively. Compared with HC, patients with BD had decreased overall SF-36 scores (53.73 vs 73.78; p=0.000) and decreased physical and psychological subdomain scores (p=0.001; p=0.000). The study of the relationship between the dimensional average scores and different variables revealed correlations between; physical health problems and somatic disease (p=0.021) and unemployment (p=0.001), impaired general health and somatic disease (p=0.02) and psychotropic association (p=0.021), emotional health problems and psychiatric family history (p=0.023), pain and psychotropic association (p=0.031), and impaired global QOL and psychiatric family history (p=0.05).ConclusionsOur results confirm the impairment of the QOL of patients with BD even in euthymic periods. Many factors have been associated, including demographic and clinical variables. The improvement of QOL is to consider these factors in the management of these patients.

IntroductionThe impact of intimate partner violence (IPV) can be devastating on women’s psychology. Moreover, IPV may destroy women’s self-esteem and self-identity.ObjectivesTo identify sociodemographic characteristics associated with IPV and to assess self-esteem among women victims of IPV.MethodsIt was a descriptive and analytical study over a period of 03 months from June 1st to August 31st, 2018 including all cases IPV female victims in forensic department at Habib BOURGUIBA University Hospital, Sfax. In addition to epidemiological data, Rosenberg scale were used to assess the victim’s self-esteem.Results Among 142 female IPV victims, only 60 (22.3%) agreed to answer our questionnaire. Their median age was 33.5 years (27-41 years). Victims did not pass high school in 61.7% of cases and they were unemployed in 53.3% of cases. Most women got married at 23 years-old (20-26). The average length of marriage was 7 years (3-14 years). Bruises and abrasions were the most frequent lesions (58.3% and 56.7% of cases). Rosenberg Scale score’s mean was 28.3 ± 4.3. Self-esteem was low or very low among 70% of victims.ConclusionsFemale victims of IPV do not have a specific profile and low self-esteem is quite common among them. Additional research is needed to better understand the extent of the problem and to develop more effective reporting methods.DisclosureNo significant relationships.

IntroductionMany researches addressing quality of life (QOL) has been demonstrated its impairment during acute episodes of bipolar disorder (BD) and major depressive disorder (MDD).ObjectivesTo compare QOL between patients with remitted MDD and remitted BD and healthy controls (HC).MethodsA comparative and analytical study, conducted over 3 months in the outpatient psychiatric department of Hedi Chaker University Hospital in Sfax (Tunisia) among 30 patients with remitted BD, 30 patients with remitted MDD and 34 HC. QOL was assessed with the «36 item Short-Form Health Survey» (SF-36).Results Compared with HC, the MDD and the BD groups had significantly lower scores for the total of the SF-36 and its sub-domains (table 1). Physical scores were lower in patients with MDD, compared with patients with BD (table 1). Table 1: Comparison of SF-36 sub-domain scores between MDD, BD patients, and HC.Sub-domains of the SF36MDDBDHCPMean physical score - Physical functioning - limitation due to physical health - Pain - General health45.5 67 42.5 60 48.559,28 69,00 44,17 67,13 56,8377,86 84,26 71,03 83,50 72,050.000 0.003 0.005 0.001 0.000Mean psychic score - limitation due to emotional problems - Social functioning - Energy/fatigue - Emotional well-being 47.25 41 55.8 40 5248,19 48.89 43.48 46.5 53.8668,66 76.97 75.52 56.02 66.120,000 0.000 0.000 0.002 0.007Mean global score50.8853,7373,780,000ConclusionsQOL of patients with mood disorders such as MDD and BD suffered damage even in euthymic periods.

IntroductionFactors causing anxiety among healthcare professionals (HCP) are increasing, and psychosocial causes are the most common. During the COVID-19 pandemic, HCP are exposed to additional stressful factors.ObjectivesThe aim of this study was to assess the prevalence of trait-anxiety and its associated factors towards the COVID-19 outbreak among Tunisian HCP.MethodsA cross-sectional descriptive and analytical study conducted among Tunisian HCP during November and December 2020. The data were collected by an online questionnaire including the sociodemographic information and the “General anxiety questionnaire of Spielberger” (STAI-Y-B) which was used to assess the trait-anxiety.ResultsA total of 135 HCP participated in this study (47.4% female and 52.6% male). The average age was 31.98 years (SD=6.59). Of the participants, 3% were nurses, 8.1% were interns, 48.1% were residents, 34.8% were specialist doctors and 5.9% were generalist doctors. Concerning marital status, 61.5% were single, 36.3% were married and 2.2% were divorced. Of HCP involved in the study, 13.3% of the participants had a history of chronic somatic-disorder and 11.9 % of them had a history of a psychiatric disorder. The prevalence of trait-anxiety in HCP was 53.3%. The analysis showed that anxious HCP were more younger (p=0.002) and had history of a psychiatric disorder (p=0.017) compared to non-anxious HCP. However, no significant difference was found by gender, marital status and professional degree according to trait-anxiety.ConclusionsIn our study, we found that more than the half of HCP were anxious and these one were more younger and had history of psychiatric disorders.DisclosureNo significant relationships.

Introduction Benzodiazepines (BZD) are widely used in patients with bipolar disorder (BD) and their effectiveness is well documented. Therefore, there are major risks associated with BZD use including abuse and dependence. Those risks can be related to the patients’chacteristics, the particularities of BD and the prescribers.ObjectivesTo determine the factors associated with chronic use of BZD in patients with BD.MethodsWe conducted a cross-sectional, descriptive and analytical study among a sample of patients with BD (DSM-5) followed in psychiatric outpatient of Hedi Chaker university hospital in Sfax. We used the Benzodiazepine Cognitive Attachment Scale (ECAB) to determine dependent patientsResultsAmong the 61 included patients, 50 (82%) had a chronic use of BZD (> 3 months). They had a mean age of 49.3 years (± 14.02 years) and a low socio-economic level in 44%. The type of BD was dominated by type II (66%). Initial episode type was depressive in 78%. The average number of depressive episodes was 2.92±2.3. A rate of 65.5% of patients have already attempted BZD withdrawal. Chronic BZD use was significantly correlated with BZD dependence (p=0.000), low socioeconomic level (p=0.04), depressive type of the initial episode (p=0.011), the depressive recurrence (p=0.000) and the absence of any attempt to discontinue BZD (p=0.011).ConclusionsChronic use of BZD in patients with BD is prevalent. In order to minimize this problem in this population, it is important to enhance programs to improve psychiatrist-prescribing behavior and to use cognitive-behavioral therapies in combination with medication to help withdrawal.

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.

PURPOSE To report variations in the inheritance pattern and clinical presentation of crystalline retinopathies. METHODS Two different families with crystalline retinopathy were studied with a complete family history and ophthalmologic examination including Goldmann kinetic perimetry and electroretinography. Genetic studies were performed in one of the families. RESULTS One of the families had a clearly autosomal dominant mode of inheritance while the other family most likely follows an autosomal recessive pattern. Several members in each family had significant retinal pigment epithelial atrophy, intraretinal crystals, relatively pink optic nerves, and paracentral visual field defects, all of which are clinical features resembling those of Bietti crystalline retinopathy. Examination of peripheral leukocytes using transmission electron microscopy in selected affected members showed no evidence of classical lysosomal crystals that are characteristics for Bietti crystalline retinopathy. No pathogenic mutations were identified in the CYP4V2 gene. CONCLUSIONS Not all crystalline retinopathies are Bietti's. Further genetic, biochemical, and pathologic studies are required to better differentiate between these retinopathies.

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.

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 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 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.

That the Archives of Ophthalmology is devoting this issue to genomics in ophthalmology just over one year from its two issues on genetics in ophthalmology is a testament to that fact that the era of genomic medicine is rapidly being incorporated into ophthalmology.(1) The evolution of genetic medicine has been accelerated following the full sequencing of the human genome,(2) the HapMap Project,(3) and the identification important genetic components to complex diseases such as macular degeneration and glaucoma.(4–7) Science has moved forward at a rapid pace. Now is the time to put this knowledge into clinical practice. Approximately 71% of respondents to a recent survey wanted more information from their physicians about genetic conditions in their family.(8) Our patients are looking for us as ophthalmologists to take the lead.