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Introduction: Various therapeutic approaches for post-traumatic stress disorder have been the subject of numerous studies. Antidepressants are sometimes used in PTSD. They improve the symptoms of PTSD. But their effect is not clear on the sexual dysfunctions that accompany this disorder. Objectives: The aim of this study is to display the effect of antidepressants on sexual dysfunctions in men with PTSD. Methods: A total of 30 male patients with PTSD were included in this study. The International Erectile Function Index (IIEF15) was used to assess sexual dysfunction in participants before treatment and two months after starting antidepressant treatment. Results: Half of the patients (50%) used sertraline, 23% paroxetine, 20% fluoxetine and 7% escitalopram. The mean IIEF-15 score was 51.16 ± 6.82 in patients with PTSD before initiation of treatment. The average scores of the areas of sexuality studied by this scale were 3.93±0.52 for sexual desire; 18.80±5.68 for erectile function; 8.93 ± 8.97 for orgasmic function; 5.13 ± 1.10 for satisfaction with intercourse and 4.13 ± 1.16 for overall satisfaction. After 2 months of use of the antidepressant treatment, there was a statistically significant improvement in sexual functions: significant increase in the total score of the IIEF15 (p <0.001), and in the mean scores of the areas of sexuality. Conclusions: Antidepressant treatment could, by improving posttraumatic symptoms, improve sexual dysfunction. [ABSTRACT FROM AUTHOR]

Introduction: Post-traumatic stress disorder affects emotional, social and professional functioning. It can also affect physical and sexual health. Objectives: The aim of this study is to write down the prevalence of sexual dysfunction in men with PTSD and to economize on potential predictors of sexual dysfunction. Methods: A total of 30 male patients with PTSD were included in this study. We collected socio-demographic and clinical data and we used Post-Traumatic Stress Disorder (PCLS) and International Erectile Function Index (IIEF15) scales. Results: The mean PTSD severity score was 65.43±2.95. The mean score for revitalization, avoidance, cognitive and mood alteration, and hypervigilance were 15.80 ± 1.44, respectively; 8 ± 0; 24.07 ± 1.20 and 17.57 ± 2.95. The mean IIEF-15 score was 51.16 ± 6.82. The mean sub-scores were 3.93 ± 0.52 for sexual desire; 18.80 ± 5.68 for erectile function; 8.93 ± 8.97 for orgasmic function; 5.13 ± 1.10 for satisfaction with intercourses and 4.13 ± 1.16 for overall satisfaction. The IIEF15-EF score was negatively correlated with the presence of a personal medical history (p = 0.02) and the impairment cognitions and mood score (p = 0.023). The IIEF-OF score was significantly associated with reviviscence, hypervigilance, cognition and mood alterations (p = 0.015; 0.041; 0.045). The IIEF-15 SD score was negatively correlated with altered cognition and mood (p = 0.007). Conclusions: Our study focused on the importance of assessing sexual function in men followed for PTSD and helps to understand the association of PTSD with different types of sexual dysfunction. [ABSTRACT FROM AUTHOR]

Introduction: Exposure to extreme traumatic events can lead to post-traumatic stress disorder (PTSD). This disorder affects emotional, social and professional functioning. Recent studies suggest that it can lead to sexual dysfunction. Objectives: The aim of this study is to compare the level of sexual dysfunction between men with PTSD and control subjects. Methods: A total of 30 male PTSD patients and 30 controls were included in this study. We used the Post-Traumatic Stress Disorder Check Scale (PCLS) to assess the intensity of PTSD symptoms and the International Erectile Function Index (IIEF15) to assess sexual dysfunction of both patients and controls. Results:Themean IIEF-15scorewas51.16±6.82 in patients followed forPTSDversus 77.33±2.02 in healthy controlswith a non-significant difference (p = 0.26). Three patients (10%) had an alteration of desire while the control reported only dysfunction but there was no significant difference between themean scores of IIEF-SD (p = 0.22). No patient or control had erectile dysfunction and there was no significant difference between the IIEF-EF sub-scores in the 2 groups (p = 0.20). The mean sexual intercourse satisfaction (SD) score in the patients was 5.13 ± 1.10 versus 8.86 ± 0.40 with a non-significant difference (p = 0.09). Altered satisfaction with intercourse was noted in 15% (n = 5) of subjects with PTSD versus a single control. Conclusions: It is important that practitioners address the subject of sexuality in patients followed for PTSD and refer their patients, if necessary, to a sexology consultation. [ABSTRACT FROM AUTHOR]

Background/objectives: Schizophrenia (SZ) is a complex psychiatric disorder with increasing evidence pointing to an autoimmune component, including the presence of antiphospholipid antibodies (aPLs). This study aims to assess the prevalence of anticardiolipin (aCL) and anti-beta-2 glycoprotein I (aβ2GPI) antibodies, particularly the IgG, IgA, and IgM isotypes, in drug-free SZ patients compared to healthy controls, and explore their possible involvement in the disease's pathophysiology., Methods: Eighty SZ patients meeting DSM-IV criteria were recruited, along with 80 matched healthy controls. Serum samples were analyzed using enzyme-linked immunosorbent assays (ELISA) to quantify IgG, IgA, and IgM isotypes of aCL and aβ2GPI., Results: SZ patients exhibited significantly higher levels of aCL-IgM and aCL-IgA ( p < 0.05), as well as elevated aβ2GPI-IgA (22.5%, p < 0.001), compared to controls. No significant differences were observed in the aCL-IgG isotype. Interestingly, 72% of aPL-positive SZ patients were positive for aβ2GPI-IgA, with some also co-expressing multiple isotypes, suggesting a potential link between SZ and antiphospholipid syndrome (APS)., Conclusions: This study is the first to report a high prevalence of aCL-IgA and aβ2GPI-IgA in SZ patients, highlighting a possible autoimmune involvement in the disease. The presence of multiple aPL isotypes, particularly IgA, suggests a need for further investigation into their role in SZ pathogenesis and their potential association with APS.

Background: Temperamental dysregulation may constitute the link between predisposing genetic factors and affective disorders., Aims: Evaluate affective temperaments in bipolar patients, healthy siblings and controls, and address the relationship between affective temperaments and recent life events in these groups., Methods: Sixty bipolar patients, 60 patients' siblings and 60 controls were recruited. Assessment of life events in the last 6 months was performed using the Paykel's interview for recent life events. The Arabic version of Temperament Evaluation of Memphis, Pisa, Paris and San Diego - Auto-questionnaire was used to evaluate affective temperaments., Results: Bipolar patients and siblings showed higher scores in cyclothymic and hyperthymic temperaments compared to controls. There were no significant differences in scores of irritable and anxious temperaments between the three groups.There was a strong relationship between anxious/cyclothymic temperaments and the high number of recent life events in bipolar patients and siblings. Contrary to bipolar patients and siblings, the number of recent life events in controls was not related to any dimension of affective temperament., Conclusions: Cyclothymic and hyperthymic temperaments were associated with bipolarity in patients and they could be characteristic traits of healthy siblings. Anxious/cyclothymic temperament might at least partially explain the high number of recent life events in bipolar patients and in siblings.

Introduction: The birth of a child is a milestone in a woman's life. Sexual health concerns are common in postpartum as women face psychological and physical difficulties. However, studies about sexuality during postpartum are rare in Tunisia., Aim: To evaluate the sexual function of a population of women in postpartum, and identify possible particularities and associated factors of the studied population., Methods: This was a cross-sectional, descriptive study of women who gave birth in the six months preceding the study. A questionnaire was sent viaa social networking service., Results: Our population of 100 women had an average age of 31.4 years. Women lived in urban areas, were married, have gone to university, were mostly primiparous (73%), and had vaginal delivery (53%). The average time to have sex again after delivery was nine weeks. In postpartum, sexuality showed modifications such as a change in sexual practices and a decreased frequency of sexual intercourse (73% of cases). Some factors influenced the resumption of sexuality, such as instrumental vaginal delivery, breastfeeding, body image disturbances (37%), fatigue (24%) and lack of availability (60%). The major sexual dysfunctions reported during postpartum were: desire disorders (31%), altered vaginal lubrication (31%), painful intercourse (14%) and decreased sexual satisfaction (33%)., Conclusion: Our study highlights the importance of identifying the sexual disturbances faced by women during postpartum.

Background: Pregnancy is a period during which anatomical, physiological and psychological changes may affect couple sexuality., Aim: To determine the knowledge and practices in sexuality, and identify the particularities of the sexual function during pregnancy., Methods: A cross-sectional, descriptive and analytical study of pregnant women who responded to a questionnaire sent by Internet through a social network., Results: Ninety-one percent of the 100 enrolled women were aged 25 to 34 years; 97% had a university education, and 66% were in the third quarter. Ninety-four percent of women thought that sexual intercourse is possible during pregnancy. The main reason to continue having sex during pregnancy was to have pleasure for either partner (87%). The reasons not to have sex were mainly fatigue (63%) and discomfort (51%). The main sources of information were the Internet (82%) and physicians (70%). During pregnancy, 92% of women continued to have sex with, however, a reduced frequency compared to the period before pregnancy. Fifty-five percent of women had a decreased desire level, and sexual satisfaction was also decreased in 43% of women. Sexual desire and lubrication were present half the time or more in the second quarter in, respectively, 69% and 55% of pregnant women. The difference with pregnant women in the first and third quarters was statistically significant., Conclusion: Our study focused on women who had most often access to scientific information about pregnancy and sexuality. The pleasure was the main reason to continue having sexual activity. The second quarter was the most sexually "rich" period.

Background: Schizophrenia is a highly disabling chronic mental illness. It is considerded as a neurodeveloppemental illness resulting from the interaction of genetic and environmental factors. Growing evidence supports the major role of prenatal infections and inflammation in the genesis of schizophrenia. The hypothesis including viral infections has been the subject of several studies and the role of parvovirus B19 (PB19) in the onset of the disease has been suggested. However, there is, up till now, no seroepidemiological evidence of his involvement., Objective: To determine the prevalence of parvovirus B19 (PB19) in schizophrenic patients and in control subjects and to examine clinical associations between viral prevalence, risk factors of infectious disease and clinical features., Method: We carried out a case-control seroepidemiological study in the Psychiatry department of Farhat-Hached general hospital of Sousse (Tunisia). We recruited108 schizophrenic patients and 108 healthy controls free from any psychotic disorder and matched for age and sex. We collected sociodemographic data, medical history, axis I comorbid disorders and infectious risk factors. We assessed patients for psychopathology and severity of illness using respectively the Brief Psychiatric Rating Scale (BPRS), the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impressions (CGI). For each study participant, blood sample was collected and levels of IgG and IgM anti-PB19 were measured using the ELISA technique., Results: The prevalence of IgG antibodies to PB19 was significantly higher in schizophrenic patients than in controls (73.1% vs 60.2%; P=0.04). There were no statistical differences between the two groups regarding the prevalence of IgM antibodies to PB19. No association was found between viral prevalence and sociodemographic data, risk factors for infection or clinical characteristics. The presence of PB19 antibodies was associated with a lower score on the PANSS negative subscale (P=0.04). No other signficative association were found., Conclusions: In our study, prevalence of IgG antibodies to PB19 was significantly higher in schizophrenic patients than in controls. This finding supports the hypothesis of the involvement of PB19 in schizophrenia. Further studies including both virological and immunological aspects are needed to better clarify the etiopathogenic mechanisms of schizophrenia which would challenge the management of this disease., (Copyright © 2014 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Background: The prevalence related to alcohol use disorders in adults is 1.7%. It varies around the world. In Tunisia, as in most Arab and Muslim countries, alcohol consumption is still a taboo and little studied., Aims: To estimate the prevalence of alcohol abuse and dependence Band to assess associated socio-demographic factors in primary care patients in Sousse governorate., Method: It's a descriptive study carried out between June and November 2006. The sample included 30 primary care units in Sousse governorate, chosen by a stratified random method. We used the Composite International Diagnostic Interview (CIDI 2.1) translated and validated in Tunisian dialect., Results: Our sample included 2577 participants. The lifetime prevalence of alcohol abuse and during the last 12 months were 2.8% and 1%. Those of alcohol dependence were respectively 0.7% and 0.3%. Only one case of alcohol abuse was found among women and no cases of dependence have been noticed. For men's, the prevalence of alcohol abuse at the lifetime and during the last 12 months were 12.8 % and 4.5 %. For men's alcohol dependence, prevalence rates were 3% and 1.6 %. Associated factors with abuse or alcohol dependence were studied in men's sample (n=560). Alcohol abuse was more common after multivariate logistic regression in the age group betwen18 and 34 years and in those with a diploma. Alcohol dependence was associated with only high level of education., Conclusion: Our study provides further evidence that alcohol abuse and dependence in primary care remain low compared to other international studies and highlights the role of primary care physicians in the screening of these health problems especially among men.

Hypotheses regarding an immune-cytokine basis of schizophrenia have been postulated with controversial findings and a lack of data related to many cytokines. The aim of this study was to assess serum levels of Interferon-γ (IFN-γ), Interleukin-4 (IL-4), Transforming Growth Factor-β (TGF-β), Interleukin-17 (IL-17) and B-cell Activating Factor (BAFF) in schizophrenic patients and to determine correlations between cytokine levels and clinical parameters. Serum cytokine levels were measured with ELISA techniques in 60 neuroleptic-free patients on acute phase of the disease (BPRS≥40) and 28 healthy controls matched for age and sex. Current symptoms were assessed with Brief Psychiatric Rating Scale (BPRS), Positive and Negative Syndrome Scale (PANSS), Scale for the Assessment of Positive Symptoms (SAPS) and Scale for the Assessment of Negative Symptoms (SANS). No significant difference was found between patients and controls regarding IFN-γ serum levels. IL-4 was not detected in both groups. Patients exhibited significantly higher IL-17 and lower BAFF serum levels. IL-17 and BAFF levels were negatively correlated in schizophrenic patients. SANS global score was negatively correlated with IL-17 and positively correlated with IFN-γ serum levels. These results argue against the involvement of Th1 or Th2 population cells in schizophrenia. IL-17 and BAFF could be valuable markers for schizophrenia., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Background: Non-adherence to treatment in patients with schizophrenia is associated with increased hospitalization, higher health care costs, and poorer long-term outcomes in terms of relapse rates. It is established that a negative drug attitude was a risk factor for non-adherence in long-term schizophrenia. The scale "Drug Attitude Inventory" is one of the scales designed to assess this concept. It has been translated and validated in different languages. However, its psychometric properties have not yet been studied in our sociocultural context., Objectives: The aims of this study were to translate into Tunisian Arabic dialect the scale "Drug Attitude Inventory" with 30 dichotomous items (DAI-30) and validate it in Tunisian sociocultural context in patients with schizophrenia., Materials and Methods: This study was performed in 234 outpatients with schizophrenia, recruited through a random drawing. These patients are in remission and meet remission criteria proposed by "The Remission in schizophrenia Working Group". We recruited 30 patients for pretest and 204 patients for linguistic validation. Forward and backward translation of the DAI-30 was performed according to the protocol of the "MAPI Research Institute". This final version was submitted to 24 experts and followed by a pretest. Construct validity has been established by performing a principal component analysis factor on a sample of 204 patients. Internal consistency was assessed by Cronbach alpha coefficient and inter-rater reliability was assessed by the use of Intra-Class Correlation coefficient (ICC). For the test-retest reliability evaluation, the "r" Pearson's coefficient was used between the DAI scores obtained in the initial evaluation and those obtained at 15 days., Results: Regarding construct validity, factor analysis revealed seven factors that were responsible for 59.9% of the variance. The study of internal consistency between the 30 items was rated good (α=0.88). The test-retest reliability was satisfactory (r=0.99, p<10(-3)), as well as inter-rater reliability (ICC=0.99)., Conclusion: In the Tunisian cultural context, the DAI-30 presented seven factors with good consistency and an inter-rater reliability., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Panic and phobic disorders are the most common anxiety disorders in the general population. They can be a source of suffering, disability and are often complicated by other psychiatric disorders., Aims: To estimate the prevalence of panic disorder, agoraphobia, social phobia and specific phobia and to assess associated sociodemographic characteristics in primary care patients in Sousse governorate., Methods: A systematic sample of 1246 adults who presented to 30 different primary care units in Sousse for a medical appointment was recruited in a cross- section epidemiological study. The Composite International Diagnostic Interview (CIDI 2.1) was used to diagnose the concerned anxiety disorders., Results: The lifetime prevalence of panic disorder, agoraphobia, social phobia and specific phobia were respectively 1.3%, 2.5%, 6.2% and 24.6%. The female gender was significantly predominant in social and specific phobia. The young age was found significantly in subjects with social phobia. These anxiety disorders were significantly predominant in rural areas, except for social phobia. All of these disorders have a chronic course with an index of chronicity ranging from 71 to 80%., Conclusion: Our study provides further evidence of the high prevalence of anxiety disorders in primary care and highlights the particular need for general physicians to diagnose and treat correctly these disorders.

Background: If the severity of dermatitis artefacta (DA) is accepted by most authors, few published studies have sought to clarify its etiology and impact. It is in this context that this work aimed to compare Life Events (LE) and quality of life (QoL) scores in patients with DA, in their siblings and in control patients with other chronic dermatological diseases., Methods: This is a descriptive and comparative cross-sectional study carried out in the dermatology department of Farhat Hached hospital in Sousse, Tunisia. Thirty female patients diagnosed with DA according to DSM-IV criteria were retrospectively recruited. For each patient with DA, one of her sisters, the closest in age, was enrolled in the siblings group. The control group consisted of thirty female patients with other chronic dermatological diseases, matched with DA patients for age and duration of disease progression. Assessment was based on Paykel inventory for LE and on SF-36 for QoL., Results: Compared to both control groups, DA patients reported more LE with more objective negative impact of these events and had a lower score and more often impaired mean global score of QoL., Conclusions: LE would have a role in the pathogenesis of DA which seems to alter the QoL of patients. These results could help to improve the understanding of DA and incite clinicians to focus not only on the diagnosis and treatment of DA but also on the impact of this disease., (Copyright © 2014 Elsevier Inc. All rights reserved.)