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Introduction Cyber victimization is a form of violence that is perpetrated through social media, and its victims are primarily adolescents and young adults. This can have a negative impact on their psychosocial well-being. Objectives To investigate the relationship between cyber victimization, depression, and suicide, identifying risk factors, prevention and intervention strategies through an case report. Methods We report the clinical case of a 16-year-old Tunisian man who developed a depressive disorder after being cyber-victimized. We also conducted a literature review in PubMed database keywords: depression, suicide, cybervictimisation, adolescents to identify risk factors, prevention and intervention strategies. Results The adolescent was a member of a youth group called The Gung, which organized climbing challenges that were then broadcast on Facebook. He was the victim of cyberbullying after failing a challenge that was broadcast live. As a result, he was rejected by his group of friends and subjected to death threats and bullying. A clinical examination revealed major depressive disorder, low self-esteem, and low self-assertion. The patient was treated with a combination of medication and psychotherapy, and he had a good outcome with social and educational reintegration. Several studies have found that cyber victimization is associated with depressive disorders, anxiety disorders, and suicidal behavior among youth. Several risk factors have been identified, including low socioeconomic status, disrupted family dynamics, low self-esteem, and psychiatric disorders. Prevention and intervention strategies involve families, educational institutions, civil society, and health professionals. Conclusions The seriousness of cyber victimization among youth is undeniable. Early and personalized intervention is necessary to prevent suicidal behavior and restore the well-being of adolescents. Disclosure of Interest None Declared

Introduction Sleep disorders in youth are associated to psychiatric disorders and may lead to significant negative effects on cognitive skills, emotional regulation and behavior such as self harm. Objectives The aim of our study is to highlight the melatonin effects on reducing self harm behaviors in the youth. Methods Our work is a literature review based on the PubMed interface and adapted for 2 databases: Science Direct and Google Scholar using the following combination ( self harm [MeSH terms]) AND ( melatonin [MeSH terms]) AND ( youth [MeSH terms]) . Results We initially reviewed 6 articles published between 2012 and 2022. We retained 3 articles which corresponded to the aim of our study. Self harm behaviors were mainly described in youth during adolescenthood. In fact, self injurious release may be considered as way to release emotional tension and physical discomfort. Melatonin prescribed in youth for the treatment of sleep disorders not only improved sleep ,but also mood disorders and impulsivity. Melatonin restores indirectly serotonin levels through a continuous bidirectional connexion . Therefore it is efficient on psychiatric comorbidites, especially anxiety and depression which are associated with intentional self-harm. Conclusions Melatonin is the most prescribed drug for sleep disturbances in children and adolescents, its impact covers a large spectrum of disturbances including the self harm behaviors. Disclosure of Interest None Declared

Introduction According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), post concussive syndrome (PCS) is given a diagnosis of either major or mild neurocognitive disorder (NCD) due to traumatic brain injury TBI. However Persistent post-concussion symptoms (PPCS) are more complex, and typically involve multidisciplinary assessment and management. The symptoms are varied, non-specific and the therapeutic process is defiant for psychiatrist. Objectives To investigate the semiology of persistent post-concussion syndrome (PPCS) and the therapeutic challenges it poses. Methods A literature review was made on Pubmed, Google Scholar and Cochrane library using keywords: “post-concussive syndrome”,”psychiatric disorder”, “depression”,”post-traumatic stress disorder”,”treatment”, “physiopathology”. Results The physiopathology of persistent PCS is controversy.The Symptoms are due to the Concept of “Symptom Generators” which results from the alterations in neurophysiology and neuropathology secondary to the injury, and pre- or post-injury psychological factors physiological concussion. The Global cerebral metabolic disturbance, the autonomic nervous system dysfunction and the cerebral blood flow dysregulation induce biochemical cascade,excitotoxic reaction and immunotoxicity. Clinical diagnoses associated with PPCS are:Major depressive disorder,Post traumatic stress disorder,Anxiety disorder,Substance abuse disorder,Psychotic disorder and Antisocial personality disorder. For the non pharmacological management: A systematically early information and a graded physical exercise in addition to other treatment are essential. Antidepressant, benzodiazepine and mood-stabilizer are the most recommended treatments for psychiatric symptoms. Atypical neuroleptics are indicated in delirant disorder, behavior disorder and antisocial personality disorder.Some studies suggest the methylphenidate and biperiden to treat several cognitive impairment and severe behavior disorder. Conclusions (PPCS) is far from being a subjective complaint by patients. It is a complex clinical entity that groups symptoms that overlap with other psychiatric diagnoses, such as depression, post-traumatic stress disorder, and mood disorders. Early neuropsychiatric assessment and personalized pharmacological and psychotherapeutic treatment are essential factors in the prognosis of the disease. Disclosure of Interest None Declared

Introduction The European Border and Coast Guard Agency (Frontex) detected 330,000 irregular border crossings last year.Tunisian nationals are among the top three nationalities reported.While there are many reasons for illegal immigration,the social driver is one of the most important to study. Objectives To highlight the role of the social environment in promoting illegal immigration and its impact on the psychosocial well-being of individuals in Tunisia through a clinical case study. Methods we reported the clinical case of a 32 years old tunisian patient who was diagnosed with severe major depressive disorder and post traumatic stress disorder after an illigale immigration to Europe. Results A 32-year-old Tunisian man from Tataouine,a region in southern Tunisia,was the subject of this case study.He was the youngest of four siblings,had a secondary education,and worked as a shepherd.His socio-economic status was moderate,unstable and seasonal.He had already attempted to immigrate to Italy twice illegally,by sea,but had been deported both times.The patient sought consultation for depressive symptoms.In January 2023,he made a third attempt to immigrate to Europe,this time by plane.He traveled with two of his cousins,aged 18 and 20,and paid 22,000 Tunisian dinars for the trip.Both cousins died during the journey,one from hypothermia and the other from police pursuit.The patient was deported again and was diagnosed with post-traumatic stress disorder (PTSD) and a major depressive episode. Hamilton Depression scale PTSD checklist scale Rosemberg self esteem scale 22 severe depression 66 sup 44 Poor self esteem 21 Tataouine is konwn as “little Paris” a region in the south-east which,according to the National Institute of Statistics,had 71 emigrants/1000 inhabitants or 7.1% of the population.Where the society promotes youth immigration through societal values. Conclusions The social environment in Tataouine,which has a high rate of emigration,promotes the idea that immigration is a way to achieve social status and economic security. This can lead to young people feeling pressured to immigrate, even if they are not prepared for the risks involved. Disclosure of Interest None Declared

Introduction Sleep disorders vary widely and its treatment are based on a combination of life style changes and pharmacological therapy adapted to the primer health issue. Ketogenic diet has shown not only its efficacy in different health conditions, but it is also becoming a popular health trend. Could the therapeutic spectrum of ketogenic diet cover sleep disturbances ? Objectives The aim of our study is to evaluate the effect of ketogenic diet on sleep disorders Methods To identify relevant studies ,our literature review was based on the Pubmed interface and adapted for 2 databases : science direct and google scholar. We used the following key words ( ketogenic diet [meSH terms]) and (sleep disorders [meSH terms]). Results Our research revealed 14 articles published between 2012 and 2022. We selected 8 which corresponded to the purpose of our review. The ketogenic diet affects sleep hemostasis indirectly. In fact, this diet is associated with weight loss and therefore reduction of metabolic and cardiovascular complications disturbing sleep quality. From a neurobiological perspective, this regimen based on limited carbohydrates is associated with a low Tryptophan intake which is the precursor of melatonin. But on the other hand, Ketone bodies trigger adenosine activity which promotes melatonin liberation, the sleep inducing hormone. Conclusions Ketogenic diet modulates melatonin activity therefore affects sleep architecture. Meanwhile, Its impact on sleep disorders is still controversed due to the variation of its pathophysiological mechanisms. Disclosure of Interest None Declared

Introduction Obsessive compulsive symptoms may occur at any age. It was studied extensively in the youth contratry to the elderly that usually suffer for other health issues leading to misdiagnosis. Objectives We aim through this study to discover the particularities of OCD in elderly . Methods Our literature review was based on the PubMed interface and adapted for 2 databases: Science Direct and Google Scholar using the following combination ( obsessive compulsive disorder [MeSH terms]) OR (OCD [MeSH terms]) AND (elderly [MeSH terms]) OR (dementia [MeSH terms]). Results Our review revealed 39 articles from which we selected 4 articles. We found that in aged adults over than 50 years experience mostly somatic symptoms, religiosity, and moral scrupulosity as obsessive thoughts. We also found that OCD can occur as a primary disorder in older women, whereas in men it either persists from, younger years or arises in the context of another psychiatric or medical disorder The relationship between Obsessional illness, brain mechanisms and Cognitive disorders are not fully understood. Indeed, we noted a relative Impairment in executive function in older adults with OCD stressing the link with cognitive impairment. Moreover, Obessive compulsive symptoms may worsen cognitive functioning . Conclusions Obsessive compulsive disorder presence in the elderly may be described as a primary health condition or be related to organic mental health issues in particular dementia. The physiopathology remains unclear therefore further studies are needed for better understanding and management. Disclosure of Interest None Declared

Introduction Suicide is a major health problem, mostly related to mental health disorders. However psychological autopsies have revealed the presence of unexpected suicide factors such as dietary patterns particularly folate intake. Which is a naturally occurring form of B9 essential for neurogenesis, nucleotide synthesis and methylation of homocysteine. Objectives The aim of our study is to identify the link between folate intake and suicidality. Methods Our literature review was based on the PubMed interface and adapted for 2 databases: Science Direct and Google Scholar using the following combination ( suicide [MeSH terms]) AND (folate [MeSH terms]) AND (prevention [MeSH terms]). Results Stress-induced neuronal dysfunctions interact with genetic and environmental factors, including diet, to precipitate mental health disorders in vulnerable or predisposed individuals especially mood disorders. In one hand, studies showed delayed onset of clinical improvement even treatment resistance in depressive patients treated with fluoxetine associated with low folate levels. In the other hand Folate depletion has been linked to serotoninergic metabolism disturb. Moreover, co-administration of methylfolate, a highly absorbable form of folic acid, has been found to augment the effects of SSRIs .A duration-response analysis (1-mg dosage) revealed a 5% decrease in suicidal events per month of additional treatment. Conclusions Accumulating data have shown that these nutrients can enhance neurocognitive function, and may have therapeutic benefits for depression and suicidal behaviors . But the pathological mechanism remains unclear that’s why further studies are needed for a better comprehension and efficiency. Disclosure of Interest None Declared

Introduction Ramadan is a holly month for Muslims. Able-bodied adults fast and abstain from sexual activities from dawn to sunset. These hasty lifestyle changes have a major impact on the sexual life of the Muslim community. Objectives To assess the impact of Ramadan on sexual activity in a Tunisian community. Methods A cross-sectional study was conducted among married Muslim volunteers in Tunisia. The data was collected with an anonymous self-completed questionnaire, one week before Ramadan (W-1) and the fourth week of Ramadan (W4). Results We included 100 person in this study. The sample consisted of 59 females and 41 males. The average age was 40.3 years. During Ramadan, sexual intercourse happened more often on weekends (p=0.009) and mostly during the second part of the night (p ˂0.001). Data suggest a disturbed sex life with less satisfaction about sexual life compared to W-1 (p

Introduction General Lockdown was first declared in Tunisia from March 20th to May 4th 2020 to contain the spread of COVID19 pandemic, the last sanitary lockdown period was declared from July 12th to august 1st in 2021. Psychiatric emergency access and consultation has been affected by the confinement. RAZI Hospital Emergency Department (RHED) is the only emergency department in Tunisia specialized in psychiatry. Thus making it the most representative psychiatric emergency health care service in Tunisia. Objectives To assess changes in patients flow and admission rates in RHED in the context of the COVID-19 lockdown Methods We examined emergency room records and the hospital’s computer admission database during the first and the last COVID19 lockdowns and compared it to the same period of the previous year. Results The number of consultations was significantly lower in 2020 lockdown (N = 577) compared the same period in 2019 (N = 1525) (p

Introduction Previous studies have shown that the month of Ramadan has a negative impact on the sexual life of fasters. Sexuality during Ramadan seems monotonous, rather poor, leaving little room for foreplay, sensuality and diversification of the sexual repertoire. Objectives To examine the socio-demographic and religious factors associated with the change in the sexual lives of fasters Methods A cross-sectional study was conducted among married Muslim volunteers in Tunisia. The data was collected with an anonymous self-completed questionnaire, one week before Ramadan (W-1) and the fourth week of Ramadan (W4). Results We included 100 participants in this survey.The analytical study found a negative correlation between age and the frequency of coitus during Ramadan (r= -0.2, p= 0.04). The lenth of the marriage was associated with less communication about sexual satisfaction during Ramadan (P=0.01). Rural origin was associated with less tenderness (p=0.03) and shorter foreplay (p=0.03). Wearing the veil was associated with sexual abstinence in women during Ramadan (p=0.038) and not wearing it was associated with the cessation of oral sex (p=0.04). The practice of prayer was correlated to a lesser diversification of sexual positions (p=0.01) and to the withdrawal of certain sexual positions: posterior vaginal (p=0.01), lateral (p=0.02), Andromache (p=0.004). Conclusions Changes in the expression of sexuality during Ramadan are not consistent with religious dictates. These findings suggest that the perception of sexuality and its practices are motivated by tradition and culture much more than religion. Disclosure No significant relationships.

Introduction Epilepsy is a neurological disease that interferes negatively with many areas of the patient’s life. Sexual dysfunction is a frequent comorbidity in epileptic patients. Quality of life is particularly affected in women, who are also culturally stigmatized because of their illness. Objectives To assess the sexual function of women with epilepsy compared to healthy women. Methods This was a case-control study of female patients with generalized epilepsy, carried out at the national institute of neurology in Tunisia in 2018. The controls were the patients’ companions in the department. They were matched by age with the cases. Sexual function was assessed by the female sexual function index (FSFI). Results We included 40 cases and 40 controls.Their averge age was 30.45years. In comparison to the controls,the women with epilepsy had less kids ( p=0.04) and more miscarriages (p=0.032). On the other hand, women with epilepsy presented more sexual dysfunctions (p=0. 03) and had a lower total score on the FSFI (p=0.015) as well as significantly lower scores in the domains “desire” (p=0.009), “orgasm” (p=0.026), “satisfaction” (p=0.001) and pain (p=0.015). Conclusions The findings of this study are consisting with the literature, the women with epilepsy in this survey had impaired sexual function. More attention should be paid to these sexual disorders, previously considered secondary or even neglected. Disclosure No significant relationships.

Introduction Pregnancy and delivery are considered to be an important transition stage in a woman’s life. Although this experience is emotionally rich, it varies from one person to another and each woman goes through it in her own way. Objectives discuss the psychiatric outcomes after a childbirth with somatic complications. Methods case report Results Mrs X is a 32 years old woman, she has no particular history of illness until she gave birth to her son. He is now three and a half years old and he is an outpatient at the child and teen psychiatry department in a Tunisian hospital. After her delivery, Mrs X had several physical and psychological complications. She was hospitalized in the cardiology department for cardiomyopathy of Meadows for three weeks among it one week in the medical reanimation ward because she needed respiratory assistance. Furthermore, she suffered of left femoral head’s necrosis for which she was operated, and a total hip prosthesis replacement was done. Psychologically, Mrs X. presented a postpartum depression which resolved in its own after 9 months. Ever Since the childbirth, the patient presents symptoms concording with post-traumatic stress disorder and symptoms that may be linked to a specific phobia (fear of birthchild or tokophobia). Conclusions In addition to the usual health care provided to women during pregnancy and after childbirth, looking for mental health disturbances and eventually referring them for psychiatric assessment is important specially for women who have experienced traumatic events during the pregnancy or the delivery Conflict of interest No significant relationships.

Introduction The confinement did begot a recrudescence in the rate of stress within populations. Meanwhile, research targeting the mental health of the psychiatric patients’ accompanyings are scarce. Objectives Detect and evaluate anxiety levels of patients’ entourage during confinement. Methods It is a retrospective, descriptive and analytical study based on a random sample of People accompanying psychiatric patients from externals consultations service in the only Psychiatric Hospital in Tunisia. Data were been collected during the month of June 2020 via a 20 items questionnaire and a score HAD issued in Arabic. Results One hundred thirty five accompanyings were surveyed. The age group was predominantly between 51 and 60 with a sex ratio of 0.31. Near half was the parents. eighty seven were unemployed, 38 stopped working due to confinement and 10 have been worked normally. A pathological anxiety HAD score (>7) was found in 36 accompanyings (26, 67 %). Amongst them, 19 had manifested symptoms. Anxiety levels are significantly much higher in accompanyings of patients with personality disorders (p=0.053). Otherwise, 52, 6% of accompanyings who stopped working felt more under pressure than before lockdown. In contrary to those who did not worked before at all (29.9 %) and those who continued working (10%). Conclusions It seems that the entourage of mentally ill patients experience a continuous psychological distress, which was uncovered and marked in confinement period. Thus, it is necessary to establish screening programs, psychological education and early care to ensure their well-being. Disclosure No significant relationships.

Introduction General lockdown due to the outbreak of Corona virus is a major change in people’s lives. Some mental health professionals consider it as a traumatic event with potentially serious psychiatric repercussions, especially on married couples. Objectives Determine the consequences of the lockdown on married couples. Methods An online survey conducted on social media during Mai 2020. Results A total of 223 married persons filled our survey with 86,1% females. Marriage was traditional in 17%, through mutual friends and acquaintances in 0,4% and after a love story in 84,3%. Families were not consenting to the marriage in 5,4% and 28,7% of participants did not consider that they knew their partner enough prior to marriage. The mean duration of marriage was 2 years and 10 months. Having children was reported in 77,1%. Before the general lockdown, 1,79% described their relationship as “bad” compared to 5,82% during; sharing house chores raised from 56,44% to 68,44%. And taking care of children by both parents during the lockdown raised also from 55% to 67,22%. Frequency of sexual intercourse was the same in 57,4% and lower in 23,8%. The lockdown was an opportunity to discover new things in their partner for 28,4% and 19,7% did not consider the lockdown as a chance to spend more time with their partner. Conclusions The lockdown gave us a chance to study the impact of the absence of social life on married couples. Disclosure No significant relationships.

Introduction Actinomycosis is an uncommon inflammatory bacterial disease caused by Actinomyces species, especially Actinomyces Israeli. Abdominopelvic forms are relatively rare and may involve the colon as a solid mass, mimicking a malignant tumor. Case presentation A 68-year-old Tunisian man, with a history of diabetes, hypertension, penicillin allergy, and renal failure, presented to the emergency department with abdominal pain, vomiting, and bowel obstruction. CT scan showed an acute intestinal obstruction upstream with obstructive tissular mass at the sigmoid colon. Emergency surgery revealed a sigmoid mass and a pre-perforative cecum. Subtotal colectomy was performed, with ileostomy and distal end closure. Histological examination confirmed Actinomyces infection. The patient was then placed on long-term doxycycline and Bactrim, with no recurrence over a 9-month follow-up period. Conclusion Abdominal actinomycosis, though rare, presents diagnostic challenges. It can be mistaken for malignancy, leading to unnecessary surgery in non-complicated cases, since it is effectively treated by antibiotics. In complicated cases, a combined approach involving both surgery and antibiotic therapy is necessary until the infection is completely eradicated.