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Introduction In Tunisia, Sexual assaults constitute a pervasive problem that concerns the health care system and the country’s judicial authorities alike. Objectives The aims of our study were to estimate the incidence of sexual assault encountered in the context of forensic psychiatric assessment and to assess the criminological profile of sexual assault perpetrators. Methods We conducted a retrospective study of a series of sexual assault perpetrators examined in a forensic psychiatric assessment in the psychiatry C department at Hedi Chaker university Hospital in Sfax, from January 2010 to December 2021. Results Over the period of 11 years (2010 to 2021), we collected 374 forensic psychiatric assessment files. Among them, 49 were those of sexual assaults (13.10%). It was a rape assault in 54.4% of cases. Aggravating circumstances have been noted in 87% of cases. These were mainly assaults on minors (54.3%) and assaults associated with physical violence (38.4%). The victim gender was female in 63% of cases, with an average age of 21 years 9 months. and was among the relatives of the sexual assault perpetrator in 28.3% of cases. Conclusions Rape seems to represent a non-negligible proportion of the offenses motivating a forensic psychiatric assessment in Tunisia. Sexual assaults against minors are frequent, despite undeniable under-reporting. Disclosure of Interest None Declared

Introduction The female criminal phenomenon will gradually become a reality and the participation of women in criminogenic currents is clearly increasing .Tunisian society, like all other societies, has not escaped this phenomenon. Objectives Our objective is to describe the criminological and forensic characteristics of the expertized women. Methods This study was retrospective and descriptive. It focused on the files of criminal psychiatric expertise carried out in the psychiatry department "C" at the Hedi Chaker hospital in Sfax and involved female accused subjects. We have collected all the criminal expert reports carried out over a period of 24 years (from January 1, 1998 to December 31, 2021). Results Out of a total of 864 criminal psychiatric expert opinions carried out over a period of 24 years, we collected 56 expert opinions in which the accused was a woman (6.48%). Among the offenses committed, we identified 31 offenses against persons (55.4%) and 25 offenses against property (44.6%). Homicides represent 37.5% of offenses (N=21) and in second place are thefts (23.2%). Twenty-seven offenses took place at the victim’s home (48.2%) and 13 (23.2%) at the accused’s home. The offense was committed under the influence of a psychic disturbance (disorganization, delusional syndrome, psychic excitation, hallucinatory injunctions, cognitive deficit) in 30.4% of cases. Dementia in the legal sense was retained in 30.4% of cases. Conclusions Given the frequency of mental illness among accused women, it would be interesting to optimize their psychiatric care in order to fight against violent acts. Disclosure of Interest None Declared

Introduction Sexual violence is a worldwide public health concern. Nevertheless, the psychopathology of perpetrators of sexual assault still nowadays poorly documented. Objectives The aim of this study was to assess the characteristics of sexual aggressors with mental disorders. Methods It was a retrospective study that included a series of sexual aggressors examined in forensic psychiatric assessment in the psychiatry C department at Hedi Chaker university Hospital in Sfax, from January 2010 to December 2021. Data were collected from psychiatric expert reports. Results The sample was exclusively composed of men with an average age of 37 years and 07 months (± 12.75 years). 54.4% of sexual aggressors suffered from mental disorder. Personality disorder was the most prevalent psychiatric disorder and the antisocial type was noted in 23.9% of cases. Sexual aggressors suffering from mental disorder were more likely to commit rape followed by murder (p=0.05). They used physical violence far more than the others did (p=0.007) and they were more apt to threaten their victims with weapon during the assault (p=0.038). They were also more likely to abuse the power given by their professional roles (15,2 % versus 5,6 %; p=0.07). They more frequently attacked unknown victims (p=0.019). Conclusions More than half of sexual aggressors suffered from psychiatric disorder. Therefore, the detection and treatment of psychiatric morbidity among sexual aggressors may minimize the risk of recidivism. Disclosure of Interest None Declared

Introduction In addition to psychological distress in patients with COVID 19, neurological and neurocognitive manifestations, such as memory impairment, are increasingly reported. Screening for cognitive impairment is therefore crucial. Objectives Identify cognitive impairment inpost COVID19. Methods This is a descriptive and analytical cross-sectional study that took place during the period from 1 st March 15 th May 2021 with 154 patients who were hospitalized at the COVID19 unit at Hedi Chaker Hospital Sfax. The psychometric evaluation, done by telephone, was performed using the "Hospital Anxiety and Depression Scale" for the screening of anxiety-depressive disorders, the "Impact of Event Scale-Revised" for the screening of post-traumatic stress disorder, the Insomnia Severity Index for the evaluation of sleep, the "The Prospective and Retrospective Memory Questionnaire" scale and the Mac Nair questionnaire for the evaluation of subjective memory. Results The mean age was 66.62 ± 13.34 years. Male patients represented 60.4% of the population. The prevalence of anxiety, depression and post-traumatic stress disorder was 24.7%, 11% and 13.6% respectively. For the assessment of subjective memory, the mean total score of the PRMQ was 27.72 ± 7.71, with that of prospective and retrospective memory 15.41 ± 4.44 and 12.16 ± 3.73 respectively. According to the Mac Nair scale, 18.8% of patients had memory impairment (Mac Nair score >15). Anxious patients showed more memory impairment. Depressed patients had the most impaired scores for total memory (p= 0.03) and retrospective memory (p= 0.022). Patients with post-traumatic stress disorder had more memory impairment (p=0.021). Conclusions Psychological distress is multifactorial in its etiology. The medium and long term management of COVID+ patients must therefore be multidisciplinary. Disclosure of Interest None Declared

Introduction Homicide is the most serious, radical and irreversible criminal act. It arouses a multitude of questions and fears. Committed by women, the homicide seems more unusual and weird. Objectives Our objective is to describe the circumstances of the homicide committed by Tunisian women Methods This study was retrospective and descriptive. It focused on the files of criminal psychiatric expertise and involved female accused subjects.We have collected all the criminal expert reports carried out over a period of 24 years (from January 1, 1998 to December 31, 2021) Results This study included 21 women who committed homicide.The majority of victims of homicide or attempted homicide (85.6%) belonged to the family circle of the accused.Five women (23.8% ) committed this act against their children and four women (19.1%) committed this act against their husbands.The means most used in homicide and its attempt were immolation (23.8%), strangulation (23.8%) and blows (23.8%). Among those charged with homicide or its attempt, seven (33.3%) presented a personality disorder, 14.3% a depressive disorder, 14.3% a moderate intellectual disability, 4.8% a schizophrenia and 4. 8% mild intellectual disability. Conclusions This female criminality, in particular homicide, would find their explanations in different factors and the existence of a mental disorder at the origin of deviant behavior in women seems to be a significant factor in the determinism of such behavior. Much effort remains to be made to apply preventive measures. Disclosure of Interest None Declared

Introduction Elderly people have always presented physiological changes and suffered from many diseases. There are few studies focused on this growing particular population, especially with mental pathologies. Thus, psychiatric hospitalization of the elderly population is more frequent nowadays. Objectives The aim of this study is to establish the socio-demographic characteristics of elderly patients hospitalized in psychiatry. Methods Retrospective and descriptive study over a period of 20 years and 6 months on patients aged over 65 years old hospitalized in the psychiatry “B” department of the Hedi Chaker University hospital in Sfax, Tunisia, for a psychiatric disorder, selected according to the DSM 5 diagnosis criteria. Results The number of records identified was 62, out of 4019 patients (15.4%). The mean age of patients was 71.1 years old and the sex ratio (Male / Female) = 0.67. Patients were originally from Sfax in 58.1% and from rural areas in 58.1% of cases. Most of patients (78.4%) were living at least with one member of their family. They were married in 53.2% of cases. The average number of children was 5.21. The majority of patients were illiterate (61.3%) and never had a professional activity in 45.2% of cases. Social coverage concerned 96.8% of our sample. Conclusions Elderly patients hospitalized in our department were mainly illiterate, females and living with their family. Despite everything, family involvement in care is still necessary for this category of patients. Disclosure No significant relationships.

Introduction The rapid spread of coronavirus has forced the healthcare systems in Tunisia to reorganize its structures, thus mobilizing all caregivers. Their professional and emotional burden was put to the test. Objectives To evaluate the level of anxiety and to study coping strategies among caregivers during this pandemic. Methods A cross-sectional descriptive and analytical study among150 caregivers in two hospitals in Sfax in Tunisia; during April 2020. We used anonymous questionnaire, the Spielberger State Anxiety Scale(STAI) to assess tension felt at anxiety-producing situations; and the Coping Inventory Scale for Stressful Situations (CISS): to assess coping strategies. Results The average age was 30.33± 6,93 years and the sex-ratio M/W = 0,29. Caregivers followed the news of this pandemic with these means of communication: 96% Facebook, 80%TV. The increase of the time spent in front of media:84% Sleep disorders were present in 64.7%: insomnia (36%), chopped sleep(34%). Caregivers used sleeping pills in 12% of case. STAI: The mean ascore =48.85 and a high anxiety level was noted in72% of case. CISS: Task-oriented coping strategies : a mean score= 47.90 and Emotion-centered coping : a mean score = 40,49 High anxiety was correlated with: age>40 years old (p=0.042). The increase of the time spent in front of media, chopped sleep and use of sleeping pills are correlated respectively (p= 0,043, p=0,003, p=0,003) with an emotionally focused coping strategy. Conclusions Health professionals had a painful psychological experience with significant anxiety. Strengthening prevention strategies, management of health crises should be a priority of our health-system.

Introduction Since COVID19 pandemic emergence, containment measure have been taken by the Tunisian government imposing a new lifestyle resulting in psychological repercussions and a change in behavior. Objectives Highlighting changes of behavior and lifestyle of the general public secondary to the COVID19 pandemic and to confinement and to assess their levels of psychological. Methods This is a qualitative, descriptive and analytical cross-sectional study realized between April and May 2020 with the general public using an anonymous online questionnaire covering: socio-demographic data; behavior during confinement; epidemic psychological impact; Mental health status was measured using Depression, Anxiety and Stress Scale(DASS-21). Anger level was assessed by STAXI-10 items. Results 132 responses were received: 68.2% were women; the average age 32.01(±11.10); half were single; 77.3% were at higher education level; 41.7% were healthcare professionnels. Consumption increased by 26.5% in coffee, 8.3% tobacco and 1.5% alcohol. 33.3% of participants increased their religious practice. 56.1% experienced sleep disorder mostly women(p

Introduction In Tunisia, traditions of marriage are still preserved by certain regions of the country : the taboo of sexuality and the requirement of the preservation of virginity until marriage mark the Tunisian mentality till this day. Objectives To discuss the impact of the Tunisian culture related to marriage on the precipitation of psychotic disorders in the bride. Methods A case report and a review of litterature via PubMed using the terms : « nuptial, psychosis, bride». Results A 31-year-old woman With no personal desease, developped a mutism, refusal of food and heteroagressiveness since the day after the wedding. The wedding party went well and it was consumed on the first night without any real incidents, yet, Ms. H was very anxious about the loss of her virginity and especially because of the low bleeding she had. The day after the wedding day, the bride was especially worried because of the presence of her family waiting in front of the bedroom to see the the blood-stained sheet : proof of the virginity of their daughter and the virility of the husband. In fact, incertain of the reaction of the family, the patient left her house early without informing her husband and was found by the police. Later, she developped an incoherent speech, audio-visual hallucinations and delusions against those around her. Conclusions In Tunisia, despite the progress made in terms of equality betwen men and women, women’s sexuality still suffer from certain taboos. Sexual education needs to be improved among young people to avoid subsequent sexual problems. Disclosure No significant relationships.

Introduction Rarely, thyroid cancer can lead to hyperthyroidism. The link between dysthyroidism and psychiatric symptoms is well established, but cases of psychosis associated with hyperthyroidism are rarely reported in the literature. Objectives Identifying psychosis secondary to hyperthyroidism caused by a secreting tumor through a case and literature review. Methods We report the case of a patient with thyroid suspect tumor and chronic psychosis. We performed a literature review based on a PubMed search with the following keywords: “dysthyroidism psychosis”. Results Mr. S,32, with a personal psychiatric history of chronic psychosis evolving since 4 years, without notable pathological history, was hospitalized in psychiatry for psychomotor instability, verbal hetero-aggressiveness, subtotal insomnia and refusal of treatment. The psychiatric examination revealed the presence of a chronic delusional syndrome with a theme of persecution, mysticism,and an interpretive, intuitive and hallucinatory mechanism, without dissociative syndrome. The somatic examination objectified a cachectic patient with a bilateral symmetrical non-impulsive exophthalmos, a goiter with a thrill on palpation, dysphonia and sinus tachycardia.A laboratory workup revealed inflammatory syndrome, collapsed TSH (

Introduction Medical studies have always been considered as very stressful. Although these students are generally among the most academically successful students, they are not spared from developing both substance and behavioral addictions, particularly pornography cyberaddiction. Objectives To evaluate the pornography cyberaddiction in a group of tunisian students, to study their impulsivity and determinate the link between these two entities. Methods A descriptive and analytical cross-sectional study including 155 medical students. We used the S-IAT sex : to evaluate pornography cyberaddiction and Barrat bis 10 : to evaluate impulsivity. Results The average age of students was 25.8 ±3.5 years old. The sex ratio (M/W) was 0,72. This medical students were single in 76.8%, had a high socio-economic status in 99.4% of case. They had a personal psychiatric history in 15.0%. They are smokers in 20%, consume alcohol in 30.3% and cannabis in 9% of case. The mean score of : the BIS 10 was 63.3 and the S-IAT was 15.6. The viewing of pornographic movies started around the age of 15 years old. Pornographic sites are the most frequently used tool (58.2%). The factors correlated with this addiction are: male sex (p=0.014), tobacco consumption (p=0.012), alcohol consumption (p=0.02) and impulsivity (p=0.03). Conclusions It resort from our study that medical students may suffer from pornography cyberaddiction. This increased use may be associated with impulsivity and substance use. Psychological support aimed specifically should be used to protect medical students.

Introduction A signifiant proportion of adolescents and young adults suffer from mental disorders that interfere with their development and influence their academic and professional succes. Objectives To describe the soscio-demographic and clinical profile of tunisian students who have consulted in the psycho-pedagogy unit. Methods A retrospective descriptive study, data were collected from the files of 359 pupils and students having consulted in the psycho-pedagogy unit of the psychiatry (B) department of the Hedi Chaker university hospital of Sfax in Tunisia, from 2014 to 2018. Results The average age of students was 20.38 ±2.38 years old. The Sex ratio = 0.95 (175 M / 184 W). Students were undergraduates in 55.4 of the cases. THey are smokers in 19% and consume alcohol in 7% of case. A family psychiatric history was present in 34% of students and personal history in 25%. A difficult childhood was found in77.5% of patients and their academic results were low (< 10/20) in 54%. Adjustement disorders were the most frequent disorders in psycho-educationel counseling (47% of case). The most prescribed psychotropic drugs were antidepressants (31.8%) followed by anxiolytics (23.7%) and the withdrawel syndrome was found in 18% of patients. Conclusions A students with a difficult childhood, low academic results and adjustement disorders such is the profile most frequently encountered among patients consulting the psychopedagogy unit. In this way,the promotion and protection of adolescent’s health particulary pupils and students benefits not only for their own health, but also for the economic and the society.

Introduction: Galectin-3 plays critical roles in the adhesion, proliferation, and differentiation of tumor cells. Recent data have suggested that galectin-3 plays a role in the development of hepatocellular carcinoma (HCC); however, its prognostic value has not been validated. The aim of our study was to evaluate the clinical and prognostic value of galectin-3 in patients with HCC. Methods: We prospectively enrolled and collected clinicopathologic data and serum samples from 767 patients with HCC between 2001 and 2014 at The University of Texas MD Anderson Cancer Center. Two hundred patients without HCC were also enrolled and had data collected. The Kaplan-Meier method was used to estimate overall survival (OS) distributions. Results: The median OS in this cohort was 14.2 months (95% CI, 12–16.1). At the time of analysis, the 1-year OS rate was 45% (95% CI, 0.4–0.51) among patients with high galectin-3 levels and 59% (95% CI, 0.54–0.63) among patients with low galectin-3 levels. OS was significantly inferior in patients with high galectin-3 levels than in patients with lower galectin-3 levels (median OS: 10.12 vs. 16.49 months; p = 0.0022). Additionally, the multivariate model showed a significant association between high galectin-3 level and poor OS (hazard ratio [HR] = 1.249; 95% CI, 1.005–1.554). Comparison between low (n = 464 patients) and high (n = 302 patients) galectin-3 levels showed that mean serum galectin-3 levels were significantly higher in patients with HCC who had hepatitis C virus (HCV) infection (p = 0.0001), higher Child-Pugh score (CPS) (p = 0.0009), and higher Cancer of the Liver Italian Program (CLIP) score (p = 0.0015). Conclusion: Our study shows that serum galectin-3 level is a valid prognostic biomarker candidate.