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Despite the increased focus on non-clinical psychosis populations, no community surveys have properly investigated the phenotypal expression of Psychotic like experiences (PLEs) in the Arab-Muslim world. We aimed to examine the prevalence and correlates of PLEs in a large sample of Tunisian college students. A total of 1489 students (64.3% female, aged 18-40) participated in a cross-sectional survey. The Positive Subscale of Community Assessment of Psychotic Experiences was used to measure PLEs. The rates of PLEs found in our work were relatively high compared with those found in previous international studies, with 51.4% of the participants reporting at least one positive PLE 'nearly-always'. After controling for confounding variables, other drug use in the past year represented the only substance use variable among the significant predictors in the final model. Our findings should raise awareness of the need for implementing an early intervention programs in our region.

Background: The death distress would be one of the most important problems in the older population and would be more pronounced in some vulnerable older subjects, including those living in nursing homes facilities. We aimed to assess death obsession (DO) in elderly without dementia living in nursing homes, and to examine the association between DO and religiosity., Methods: We carried out a cross-sectional survey involving 42 old subjects living in Manouba nursing home. The "Mini-Mental State Examination", the "Geriatric Depression Scale", the "Activity of Daily Living", the "Cumulative Illness Rating Scale-Geriatric", the "Death Obsession Scale", the "Brief religious coping scale" and the "Arabic Religiosity Scale" were used to assess cognitive functions, depression, level of dependency, comorbidities, death obsession, religious coping and religiosity, respectively., Results: We found relatively high death obsession scores, with no gender differencies (mean scores = 33.1 ± 18.1). The death obsession was significantly and positively associated with comorbidity scores (p = 0.04). No significant correlation was found between death obsession scores and religiosity and religious coping scores in the bivariate analysis. Similarly, multiple hierarchical regression found that religious variables (global religiosity and religious coping) did not significantly contribute to the variance of the death obsession., Conclusion: Older people living in nursing homes have specific psychosocial and spiritual needs, that health care providors should recognize, assess and care for, early and adequately.

Background: Death distress is a significant problem in the older population and may be more pronounced in certain vulnerable older people, including those living in nursing home facilities. We aimed to assess death obsession (DO) in elderly people without dementia living in nursing homes, and to examine the association between DO and religiosity., Methods: We carried out a cross-sectional survey involving 42 elderly subjects living in a nursing home in Manouba, Tunisia. The "Mini-Mental State Examination", "Geriatric Depression Scale", "Activity of Daily Living", "Cumulative Illness Rating Scale-Geriatric", "Death Obsession Scale", "Brief Religious Coping Scale" and "Arabic Religiosity Scale" were used to assess cognitive functions, depression, level of dependency, comorbidities, death obsession, religious coping, and religiosity, respectively., Results: We found relatively high death obsession scores, with no gender differences (mean scores = 33.1 ± 18.1). Death obsession was significantly and positively associated with comorbidity scores (p = 0.04). No significant correlation was found between death obsession scores and religiosity and religious coping scores based on the bivariate analysis. Similarly, multiple hierarchical regression revealed that religious variables (overall religiosity and religious coping) did not significantly contribute to variance in death obsession., Conclusion: Older people living in nursing homes have specific psychosocial and spiritual needs which health care providers should recognise, assess and treat appropriately, at an early stage.

Background: Sleep disorders are a common complaint in breast cancer patients. These women suffer from fear of death, fear of suffering, treatment complications as well as social devaluation; all leading to feelings of hopelessness. The objectives of this work were to evaluate the quality of sleep in a group of breast cancer women, and to analyze the association between sleep quality, depression, and hopelessness., Methods: A cross-sectional study was carried out over a period of 3 months, including 50 women suffering from breast cancer and having received a surgical treatment of their disease. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). The evaluation of depression was performed using the Beck Depression Inventory (BDI-II). Hopelessness was measured with the Beck hopelessness scale (BHS). All participants were screened using the Arab-language version of these scales., Results: Of 66% of breast cancer patients were considered as poor sleepers (PSQI scores >5), 30% of our sample had a moderate to severe depression, and 24% had a high level of hopelessness. PQSI scores were negatively correlated with depression (P < 0.001) and hopelessness scores (P < 0.001). Multivariate analysis retained as main predictors of the sleep quality habitation and hopelessness scores. After controlling for demographic (age) and social (habitation) variables, hopelessness significantly contributed to sleep quality., Conclusion: Hopelessness was positively associated to sleep disorders in women suffering from breast cancer. Hopelessness requires an appropriate management in order to prevent depression and suicide and to improve the quality of life of these patients., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Religiosity has been hypothesized to play protective roles against suicide. In Tunisia, despite the gravity of the issue after the 2011 Revolution and the rise of suicide rates among adolescents and young adults, a significant lack of data remains. The present work aimed to evaluate the associations between suicide and religiosity in university students. The Suicidal Ideations Questionnaire and The Arabic Religiosity scale were used to determine associations between suicidality and religiosity. We found a strong negative correlations found between suicidal ideations and the three sub-scores of religiosity after controlling for the associations between psychosocial variables and suicidal ideations scores. Our findings emphasize the importance of assessing the role of religiosity to the subject and understanding how suicide is conceptualized and perceived in the subject's religion when dealing with suicidal ideation and behaviors among college students. A better knowledge of religious beliefs and even an integration of Islamic beliefs and practices in the psychotherapeutic process of Muslim youth may be helpful to cope with suicide.

Cannabis use is widespread among people at ultra-high risk (UHR) for psychosis. The causal link as well as the temporal link between cannabis use and further occurrence of psychosis in UHR people remain inconclusive. Current science data supported an increased risk of transition to psychosis in cannabis users who are genetically predisposed to psychosis. This risk would be even greater in the presence of a family history of psychosis, in case of a strong use and an early onset use. Several models have been cited to explain the link between cannabis use and the subsequent onset of psychosis or prepsychotic states: cannabis-induced modifications of some brain structures, a dysregulation of the hypothalamic-pituitary axis and an alteration of normal neurological development via the endocannabinoid system. Cannabis represents a modifiable risk for psychosis. Current interventions aim to reduce or stop the cannabis use in order to reduce the risk of transition to psychosis., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Objective: We aimed to evaluate the links between different sleep parameters and suicidal ideation and behavior in remitted bipolar I patients., Methods: One hundred eight remitted bipolar I patients were recruited from the psychiatry department of Razi Hospital. The third item of the "Hamilton Depression Rating Scale" was used to evaluate current suicidal behaviors. Circadian typology, daytime sleepiness and sleep quality were evaluated using the "Horne and Ostberg Morningness-Eveningness Questionnaire," the "Epworth Sleepiness Scale," and the "Pittsburgh Sleep Quality Index," respectively., Results: Current suicidal ideation and behavior were significantly associated with circadian typology, daytime sleepiness, and sleep quality. After controlling for demographic variables (age and gender) and psychosocial factors (depression and substance use), suicidal ideation significantly contributed to sleep quality. Depression was a significant predictor within the second step when entered with other psychosocial variables; however, once suicide variables were included, depression was no longer a significant predictor., Conclusions: An evaluation of sleep's quality should be included in the suicide risk assessment of bipolar I patients., (© 2019 Wiley Periodicals, Inc.)

Background: Current research has shown that experiencing childhood trauma may predispose individuals for psychosis and expression of Psychotic like experiences (PLEs). We aimed to examine the prevalence and characteristics of PLEs and depressive and negative experiences in a sample of Tunisian college students, and to evaluate the impact of childhood traumas in the occurrence and severity of these experiences at the time of the survey., Method: A total of 482 college students (63.7% female; aged 18-32) participated in a cross-sectional survey. The Positive Subscale of Community Assessment of Psychotic Experiences (CAPE) was used to measure PLEs. The Childhood Trauma Questionnaire was used to assess childhood trauma and neglect., Results: 53.5% (n = 258) of the students reported at least one positive PLE 'nearly always', and 40.9% (n = 197) reported at least one negative PLE with this frequency. After controlling for demographic variables (gender, age) and psychosocial factors (drug use, depression, anxiety and stress), sexual abuse significantly contributed to PLEs., Conclusion: There is a need for further cross-cultural research regarding the phenotypal expression of PLEs and its associated variables. Child sexual abuse victims should receive systematic and complete psychological screening during their adolescence/ early adulthood including, among others, PLEs and psychotic symptoms., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Childhood adversity rates would be higher in subjects at ultra-high risk of psychosis than in the general population. In addition to reference ideas, magical thoughts and social dysfunction, subjects at ultra-high risk of psychosis with a history of childhood trauma would experience more severe and specific symptoms. Childhood trauma, especially sexual abuse, was associated with the transition to psychosis. Several models have been cited to explain the link between trauma and the subsequent onset of psychosis or prepsychotic states: dysfunctional cognitive patterns, affective dysregulation, attachment styles, biological mechanisms, and epigenetic regulation. No methods of trauma assessment has been developed or validated in subjects at ultra-high risk of psychosis. Current interventions aim to prevent or reduce the adversities of childhood and improve their coping skills. Neuroleptic prescription is only recommended if there is a significant increase in prepsychotic symptoms., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Aim: Depression is prevalent in patients with type 2 diabetes. It may have a negative impact on the management of diabetes mellitus and could affect weight. The main aim of the investigation was to evaluate the effect of antidepressant treatment (sertraline) on anthropometric variables and glycemic control in depressed type 2 diabetic patients., Methods: Thirty three type 2 diabetic outpatients depressed received open-label sertraline therapy for up to 12 weeks. Clinical outcome measures included the 17-item Hamilton depression rating. Changes in the anthropometrics variables were evaluated by measuring weight, waist circumference and by calculating body mass index at three, six and 12 weeks of treatment. In addition, fasting, postprandial plasma glucose level, glycosylated hemoglobin-A 1C measures, lipid and renal profile were obtained before and during sertraline therapy., Results: Weight decreased significantly (-2kg; p=0.000) and body mass index decreased from 30.41kg/m 2 to 29.6kg/m 2 (p=0.000). Patients lost on average seven centimeters in waist circumference (p=0.000). We also observed a modest, non-significant reduction in fasting, postprandial and glycosylated hemoglobin. We observed a significant reduction in mean score according to the Hamilton depression scale (p=0.000) CONCLUSION: Our study results suggested that sertraline produced a benefic effect on weight, body mass index and waist circumference at 12-week follow up., (Copyright © 2018 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

Background: Neurosurgical brain interventions may result in lesions that can cause epilepsy. Diagnosis may be delayed in some situations. Meanwhile, violent behavior can occur during postictal delirium states. Although benign behavioral manifestations are well documented in literature, violent offenses in post-neurosurgical epilepsy have been rarely reported. Here we describe 2 such cases, focusing on management and emphasizing the need for prevention., Case Description: Both patients were suffering from post-neurosurgical epilepsy and offended during postictal delirium states. The first patient had generalized epilepsy and committed an attempted rape. The second patient had temporal lobe epilepsy and committed an attempted homicide. Both patients were well managed using anticonvulsant medication after the offenses., Conclusions: Early diagnosis and regular follow-up are measures to take into consideration to prevent violent behavior in patients with post-neurosurgical epilepsy., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Introduction: Schizophrenia increases the risk of offending. Recidivism rates are significant. Literature doesn't provide recidivism risk factors specific to patients with schizophrenia independently of the offenses' types., Objective: Identifying recidivism risk factors in schizophrenia patients independently of the offenses' types., Methods: We conducted a case-control study. All included patients were admitted, at least once, to the forensic psychiatry unit in Razi Hospital between January 1st, 1985 and December 31st, 2014 after a decision of irresponsibility by reason of insanity. All those who reoffended during this period were considered as cases. Univariate and multivariate analyses were performed to identify recidivism risk factors., Results: We included 25 cases and 38 controls. Eight recidivism risk factors were identified. Living in poor urban neighborhoods (P = 0.023; OR = 4.86), having been unemployed (P = 0.042; OR = 2.18) and not having lived with the family (P = 0.039; OR = 1.36) after discharge were considered as risk factors. The same applied to alcohol (P = 0.026; OR = 4.89) and cannabis use disorders (P = 0.018; OR = 6.01). A hospitalization shorter than 6 months multiplied the risk by 1.79 (P = 0.046). A combination of conventional antipsychotics (P = 0.023; OR = 4.81) and a poor adherence to treatment (P = 0.001; OR = 10.42) were considered as recidivism risk factors too., Conclusions: All eight recidivism risk factors are dynamic. This makes recidivism prevention conceivable. Measures involving the patient, the health care system, patients' families, society and the government should be undertaken., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

On March 18, 2015, two gunmen attacked the Bardo museum in Tunis, Tunisia, killing 23 foreign tourists. We assessed PTSD and depression symptoms 4-6 weeks after the event among museum workers, in relation to sociodemographic factors and social support, and we analysed the determinants and predictor factors of PTSD and depression symptoms among the participants. Our findings indicated that 68.6% of the respondents had posttraumatic stress symptoms above the cutoff point (IER-S scores >33), and 40.6% reported severe levels of depressive symptoms (DASS-depression scores >20). Male and female participants did not significantly differ in terms of their symptom severities. Low social support was the best predictor of PTSD and depression symptoms. Our results suggest that interventions designed to reinforce ties within social networks may be particularly helpful for victims in the aftermath of a terrorist attack.

Introduction: Recent studies indicate that bipolar disorder is associated with a profound impairment in almost all areas of functioning. This study aims to evaluate functional recovery in type 1 bipolar patients during remission period., Method: We conducted a cross-sectional study of euthymic type 1 bipolar patients followed up on an ambulatory basis. In the analysis to be reported here we used Hamilton Depression Scale, Young Mania Rating Scale (YMRS), Rosenberg Self-Esteem Scale, and Functioning Assessment Short Test (FAST)., Results: More than half of the study population (53.3%) had overall functional impairment. The overall functioning was associated with age, education level, professional activity, the number of manic and depressive episodes, the number of hospitalizations, a higher HDRS score as well as with the two self-esteem subscores: "self-confidence" and "self-deprecation"., Conclusion: Our results suggest that a paradigm shift in the treatment of bipolar disorders should happen and that the goals of therapy should be modified from symptomatic remission to functional remission., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêts.

Purpose: admission to nursing homes is often associated with major changes in the way the elderly live, possibly leading to sleep disorders. The aim of our study was to assess sleep quality in the elderly without dementia living in nursing homes, to determine the prevalence of sleep disorders, and to examine the links between sleep quality and sociodemographic features, comorbidities, and degree of dependency., Methods: we carried out a cross-sectional survey, involving old people living in Manouba nursing home. Assessment of sleep was performed using Pittsburgh Sleep Quality Index. We excluded subjects with severe motor or sensory impairments as well as individuals with cognitive impairment., Results: thirty-two patients were included in the study. The majority (68.8%) were male, institutionalized for an average period of 6.3 years. Mean age was 71.6 years. More than half of the subjects (56.3%) had depression, and 93.8% had one or more chronic conditions. About one third (37.5%) of residents were dependent in one or more activities of daily living and 25% were confined to bed or to a wheelchair. The majority of residents (73%) were identified as "poor sleepers" based on a global Pittsburgh Sleep Quality Index score >5. Sleep disorders were attributed to nocturia, nocturnal or premature awakenings and pain. We noted a fairly large percentage (18.8%) of hypnotic drugs intake among participants. Our results also showed a strong association between poor sleep quality and depression (p<0.001)., Conclusion: early detection of sleep disorders in nursing home residents can help them to get an optimized and efficacious treatment.