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Samer El Hayek,1 Marwa Nofal,2 Doaa Abdelrahman,3 Ali Adra,4 Mansour Al Harthi,5 Siham Al Shamli,6 Nawaf AlNuaimi,7 Lynda Bensid,8 Mohamad Ali Cheaito,9 Alkhansa Mahdi Emberish,10 Amine Larnaout,11 Ahmed Radwan,12 Mohammad Slaih,13 Firas Kobeissy,14 Maya Bizri1 1Department of Psychiatry, American University of Beirut, Beirut, Lebanon; 2Helwan Mental Health Hospital, Cairo, Egypt; 3The Sudan Medical Specialization Board, Khartoum, Sudan; 4Department of Psychiatry, Damascus University, Damascus, Syria; 5Department of Psychiatry, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia; 6Oman Medical Specialty Board, Psychiatry Program, Muscat, Sultanet of Oman; 7Psychiatric Department, Al Ain Hospital, Abu Dhabi, United Arab Emirates; 8Department a, University of Algiers, Drid Hocine Hospital Specialized in Psychiatry, Algiers, Algeria; 9Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon; 10Alrazi Hospital for Mental Health, Tripoli, Libya; 11Psychiatry Department D, Razi Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia; 12Mental Health Service, Hamad Medical Corporation, Doha, Qatar; 13National Center for Mental Health, Ministry of Health, Amman, Jordan; 14Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, LebanonCorrespondence: Samer El HayekDepartment of Psychiatry, American University of Beirut, Bliss Street, PO Box: 11-0236, Riad El Solh, Beirut 1107 2020, LebanonTel +961 70941362Email samer.elhayek@gmail.comPurpose: Telepsychiatry, a subset of telemedicine, has been increasingly studied to meet the growing demands for psychiatric care. The utility of telepsychiatry is relevant now more than ever as the world endures the COVID-19 global pandemic. This paper describes the prior state and the changes that the COVID-19 outbreak brought to telepsychiatry in a selected group of Arab countries of the Middle East and North Africa (MENA) region.Patients and Methods: We invited twelve early-career psychiatrists from different Arab nations to share information related to telepsychiatry in their respective countries before and during the COVID-19 pandemic. The information was collected using a semi-structured guide. This was complemented by a search for relevant articles in five search engines using terms such as “COVID-19,” “telepsychiatry,” and “Arab world”.Results: Before the pandemic, digital mental health services were provided in several Arab countries, mainly through hotlines and messaging services. The COVID-19 pandemic has marked a major shift in digital psychiatric services in the Arab MENA world, through the transformation of many clinics and some hospitals into digital mental health systems. Many non-governmental organizations also started remote initiatives for psychological support and psychiatric counseling. Three main barriers of patient-related, healthcare-related, and system-related hurdles of using telepsychiatry emanated from the analysis.Conclusion: The use of digital mental health services varies between different Arab countries. Even though some nations have laws that regulate the provision of such services, most struggle with multifactorial barriers. As affordable and attainable solutions cannot only rely on training and recruiting more psychiatrists, telepsychiatry would help meet the exceeding demands in the Arab world, particularly after the COVID-19 outbreak.Keywords: telepsychiatry, mental health, Arab, COVID-19

Introduction One of the common symptoms of schizophrenia is sleep disturbances, which can have a significant impact on the quality of life of patients. Several studies suggest the existence of a complex link between sleep disorders and agressive behavior in patients with schizophrenia. Objectives to determine the impact of sleep disorders on aggressive behavior in patients with schizophrenia. Methods We conducted a cross-sectional, descriptive, and analytical study that took place over a period of one month (from 1st to 31nd March 2023) with patients consulting the post-cure of Psychiatry Service D at Razi Hospital, Tunisia. We included patients diagnosed with schizophrenia according to DSM5, and stabilized on a psychiatric plan. We used the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality over a period of one month. The Buss & Perry Aggression Questionnaire (QABP) was used to measure aspects of aggression. We used the Adult Social Relationships Scales (ASRS), part of the National Institute of Health (NIH) toolkit, assessing six domains of social relationships: perceived rejection, perceived hostility, loneliness, friendship, instrumental support and emotional support. Results We collected data from 40 male patients with a mean age of 42.5 ± 14.02. The mean global PSQI score was 9.23 ± 4.58. Ten patients were on typical antipsychotics, 25 patients were on atypical antipsychotics, and the remaining five patients were on a combination therapy (both atypical and typical antipsychotics). Regarding the use of benzodiazepines, 34 patients were taking lorazepam at a dose of 2.5 to 5 mg per day. he mean QABP global score was 45 ± 12.3 out of 72. For the subjective evaluation, all patients self-reported feeling “irritable,” “dysphoric,” “unable to communicate with others,” and “wanting to break objects” when they experienced insomnia. We found a statistically significant association between QABP and daytime dysfunction (p=0.003). The overall PSQI score was higher, and statistically significantly associated, in patients who reported low emotional support (p=0.018) and perceived social rejection (p=0.04). Conclusions An integrated approach that includes the evaluation of sleep disorders, as well as the prevention and management of violence, can play a key role in the overall improvement of the mental health of patients with schizophrenia. Disclosure of Interest None Declared

Introduction Traumatic life events (TLEs) have been associated with the entire spectrum of psychosis outcomes, including risk and severity of psychotic disorders and psychotic-like experiences (PLEs). In a non-clinical setting, understanding the relationship could help improve prevention services. Objectives The aim of this study is to establish the relationship between TLEs and PLEs. Methods A cross-sectional study was conducted in a Tunisan business and engineering school from March 2022 to June 2022. Participants completed the Tunisian dialect version of the Prodromal Questionnaire-Brief (PQ-B), a validated self-report instrument designed to evaluate prodromal symptoms. TLEs such as physical, sexual, and emotional abuse, as well as neglect experiences, lived or witnessed have been assessed along with bullying experiences. Results The final sample size consisted of 358 participants, with a median age of 22 ± 2.22 years, with a sex ratio (M/F) of 1.41. More than half of the participants (58.6%) reported having experienced TLEs (49% in the preceding 6 months) while 31% had experienced bullying or abuse in school (27.9% in the preceding 6 months). The mean total score of the PQ-B for the study population was 7.27 ± 4.387, 36.3% reached the threshold and were defined as PQ-B-positive subjects. Those with a lifetime history of major life events were more likely to screen positive on the total score PQ-B (p = 0.000), as were those with a lifetime history of bullying or abuse (p = 0.000). Conclusions Understanding the factors that interact in the significant association between PLEs and TLEs may provide useful information for prevention programs and the improvement of mental health. Disclosure of Interest None Declared

Introduction Sleep disorders are a significant concern for patients with schizophrenia, and they can have a profound impact on their quality of life. Studies have shown that sleep disturbances are prevalent in patients with schizophrenia, and they may be linked to the clinical characteristics of the disorder. Despite this, the exact nature of the relationship between sleep disorders and schizophrenia remains unclear. Understanding this relationship is critical as it may lead to better diagnosis and treatment of both conditions, ultimately improving the overall health and wellbeing of patients. Objectives To establish the link between sleep disorders and clinical characteristics in a clinical population being treated for schizophrenia. Methods We conducted a cross-sectional, descriptive, and analytical study that took place over a period of one month (from 1st to 31nd March 2023) among patients consulting the post-care service of Psychiatry Department D at Razi Hospital, Tunisia. We included patients aged between 18 and 65 years, diagnosed with schizophrenia according to DSM-5, and stabilized on psychiatric treatment. We used the Pittsburgh Sleep Quality Index (PSQI) to evaluate sleep quality over a period of one month. The evaluation of the clinical characteristics of schizophrenia was carried out using the Positive and Negative Syndrome Scale (PANSS). The interview was conducted by a single researcher, and when the questionnaire was distributed to the participants, we explained the framework and the principle of this study as well as the implications of participating in it and explained that the participant could stop participating at any time if he or she wished. Results We collected data from 30 male patients with a mean age of 42.5 ± 14.02. The mean overall PSQI score was 9.23 ± 4.58. The subscales evaluating the subjective quality of sleep obtained an average score of 1.42 ± 0.72, sleep latency was 1.61 ± 1.33, sleep duration was 1.01 ± 0.98, habitual sleep efficiency was 0.67 ± 0.75, sleep disturbances were 0.91 ± 0.52, sleep medication use was 1.36 ± 1.68, and daytime dysfunction was 1.12 ± 0.96. The mean scores of PANSS were: positive scale (28.26 ± 5.93), negative scale (18 ± 6.15), and general psychopathology scale (90.03 ± 16.21). We found a statistically significant association between the positive PANSS scale and sleep latency (p=0.002) and sleep medication use (p

Introduction Schizophrenia is a debilitating mental illness that can cause significant disruptions in a person’s life, leading to difficulty with thinking, emotions, and behaviors. While the symptoms of schizophrenia are well-known and extensively studied, comorbidities like eating disorders are often overlooked and undertreated, despite their prevalence in patients with schizophrenia. Objectives determine the different eating attitudes among schizophrenic patients and establish the link between eating attitudes, age, weight status, and psychotropic medication. Methods This is a cross-sectional and descriptive study that took place from September to November 2022 among patients who consulted the post-care consultations of Psychiatry D service at Razi Hospital, Tunisia. We included patients who had been followed for at least one year for schizophrenia according to the diagnostic criteria of DSM-V and who had not relapsed for at least 2 months. The collection of sociodemographic and clinical data was done retrospectively by referring to the patients’ clinical records. Anthropometric measurements (weight, height, waist circumference, etc.) were recorded for each participant at the end of the interview. The Three-Factor Eating Questionnaire (TFEQ) was used to analyze eating attitudes. Results According to our results among 30 patients followed for schizophrenia, 74% were men with a mean age of 45 years (3.8). Sixty percent of the participants had a BMI

Introduction Female sexuality is a complex and multifactorial domain that can be influenced by a variety of psychological, biological, relational, and sociocultural factors. However, sexual dysfunctions in women remain a taboo subject in many cultures and are often underestimated, underdiagnosed, and undertreated. In Tunisia, few studies have been conducted to assess the prevalence of sexual dysfunctions in women and their predictive factors. Objectives to determine the prevalence of sexual dysfunctions in a group of Tunisian women and to identify the predictive factors of these dysfunctions. Methods This is a cross-sectional, descriptive, and analytical study, over a period of three months, from September to December 2022, conducted online via a pre-established questionnaire to collect various sociodemographic data, personal history, psychoactive substance consumption, weight, and height. We used the Female Sexual Function Index (FSFI) scale to evaluate sexual functioning in participants. We recruited sexually active Tunisian women over 18 years of age who agreed to anonymously respond to the questionnaire. The form was disseminated on social networks, in groups that focus on women, with a rate of three publications per week. Results We collected data from 90 women with a mean age of 35 ± 12.84 years. More than half of our population (60%, n=54) had at least one sexual dysfunction. The most common sexual dysfunctions reported were arousal disorders (31.3%), followed by desire disorders (26.8%) orgasm disorders (12.4%). We found that several factors were significantly associated with sexual dysfunctions : Women over 45 years of âge (p

Introduction The use of cannabis is associated with developing psychotic disorders, especially for those with a pre-existing vulnerability and elevated familial risk for psychosis. Objectives To assess cannabis use during first episode psychosis and its relationship with patients’ clinical symptoms and functioning. Methods We assessed 50 patients hospitalized for first episode psychosis using three scales: CAST test (Cannabis Abuse Screening Test), Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Functioning (GAF). Results The sex ratio of our population was 4 men to 1 woman. The average age was 25.6±6.16 years. About 60% of the patients used cannabis. The average duration of untreated psychosis was 10 months, with extremes ranging from one week to 24 months. Forty-four patients were antipsychotic-naïve (88%). For patients who used cannabis, the mean score of CAST test was 11.3±4.16, with extremes between 4 and 18. The risk of dependence was high in 81% of cannabis users. The PANSS total scale showed a mean score of 58.29±12.90 with extremes between 35 and 91. The average score at GAF scale was 30 with extremes between 20 and 70. Duration of untreated psychosis was significantly correlated to negative scale of PANSS (p=0,012 ; r=0,420), PANSS total score (p=0,011 ; r=0,424) and GAF levels (p=0,012 ; r=-0,420). There was no association between age of onset of psychosis and cannabis use (p=0,181) nor CAST scores (p=0,747). There was no correlation between CAST and GAF scores (p=0,641). However, there was a significant and positive correlation between CAST scores and positive scale of PANSS (p=0,04 ; r=0,432). Conclusions Cannabis use is neither necessary nor sufficient to cause psychosis on its own. However, it has an influence on the prognosis. Early intervention programs should address cannabis and substance use problems early in the course of illness. Disclosure of Interest None Declared

BackgroundThe COVID-19 pandemic placed great strain on healthcare professionals, leading to a substantial impact and a redistribution of the workforce. Despite the active involvement of the Eastern Mediterranean Region Office (EMRO) and the World Health Organization in managing mental health crises, there is a knowledge gap concerning the working conditions and training opportunities available for early career psychiatrists (ECPs) during the pandemic period.ObjectivesThis study aims to investigate the impact of the COVID-19 pandemic on ECPs and how it affected their well-being, employment, and educational opportunities.MethodsA mixed methods study has been conducted in Iran, Egypt, and Tunisia, three EMRO member countries. It includes a cross-sectional survey with self-reported questions, and a qualitative study with individual in-depth interviews.DiscussionThe findings of this study will raise awareness to the working conditions of ECPs within the EMRO region and its member societies, both during the COVID-19 pandemic and beyond. The results will serve as a basis for encouraging supervisors and policymakers to mitigate the pandemic’s impact on psychiatric training, strengthen healthcare systems’ preparedness, and equip early career psychiatrists with the necessary skills to deal with the mental health consequences of the COVID-19 pandemic.

Introduction The covid 19 pandemic was a period of uncertainty. This uncertainty was sustained even after the advent of the vaccine against covid 19. Several concerns have emerged related to the vaccine and health care workers were at the centre of this uncertainty. Objectives Study intolerance of uncertainty and vaccine hesitancy among health care workers in relation to covid 19 vaccination Methods This is a descriptive study conducted by a questionnaire posted on social networks using Google Forms targeting groups of health professionals before the launch of the vaccination campaign in Tunisia from January 16, 2021 to March 6, 2021. We collected sociodemographic data and the attitudes of health care workers about COVID 19 vaccination. We used Intolerance of Uncertainty Scale short form (IUS 12) to evaluate the intolerance of uncertainty related to COVID 19 vaccine Results Our study included 168 health care workers represented mainly by medical personnel (81% of the respondents). The average age was 34 ±10 years and sex ratio was 0.22. Sixty percent (60%) of population were hesitant in front of the COVID 19 vaccine. This hesitancy was explained in 90% of cases by the insecurity of the new COVID19 vaccine. Thirty-seven percent (37%) doubted the efficacy of these vaccines and 22% trivialized COVID19 by expressing the worthlessness of preventing this disease. The mean score for intolerance of uncertainty was 26.57 ± 9.68 and a median of 26. The minimum score was 10 and the maximum score was 50. We found a significant association between intolerance of uncertainty and vaccine hesitancy (p=0.034). Subjects with higher uncertainty intolerance scores were less hesitant in front of COVID19 vaccination. Conclusions Intolerance of uncertainty is a consideration when introducing a new covid 19 vaccine to health care workers and in a pandemic context Disclosure of Interest None Declared

Introduction Cannabis use is frequent among patients with psychotic disorders. However, the relationship between cannabis consumption and transition to psychosis has not been fully elucidated. Objectives The aim of this study was to assess the prevalence of cannabis use in first episode psychosis and its correlation with transistion to psychosis and severity of symptoms. Methods A cross-sectional study was conducted at the psychiatric department D of Razi hospital including 50 patients hospitalized for first episode psychosis. The evaluation focused on sociodemographic and clinical characteristics of the patients. We used the cannabis abuse screening test (CAST) and positive and negative syndrome scale (PANSS). Results The sex ratio of our patients was 4 men per 1 woman. The mean age was 25.6±6.16 years. Two-thirds of the patients had secondary education (n=24). Half of them had no occupation (n=17). Twenty-five patients (71%) had no psychiatric history. The total PANSS score showed a mean of 58.29±12.90 with extremes between 35 and 91. About 60% of the patients used cannabis with high addiction risk in 81% of cases. The mean duration of cannabis use was 7,04 years, 3 times a week. Cannabis use was correlated to the gender. However, no correlation was found between cannabis use and duration of untreated psychosis niether the negative or positive symptoms. Conclusions Although cannabis use is knownto accelerate transition to psychosis, it does not affect the severity of symptoms. Further work is necessary to identify the factors that underlie individual vulnerability to cannabinoid-related psychosis and to elucidate the biological mechanisms underlying this risk. Disclosure of Interest None Declared

Introduction Psychotic disorders are associated with a degree of disability that is much more considerable if the duration of untreated psychosis is prolonged. This fact highlights the importance of early intervention strategies among individuals at ultra-high risk (UHR) for psychosis, often struggle with depressive symptoms. Objectives The objective of this work was to evaluate the effectiveness of cognitive-behavioral and emotional therapy on depressive symptoms in a patient at high risk of psychosis. Methods This is a detailed case report of a young adult at UHR for psychosis who was referred to psychiatry department “A” at Razi Hospital for treatment of depression symptoms. The patient had benefited from 15 sessions of cognitive-behavioral and emotional psychotherapy, over eight months, from July 2021 to February 2022, at the rate of one 45-minute session per two weeks. The main psychotherapeutic techniques used were: behavioral activation, cognitive restructuring and relaxation. An initial and final assessment was performed by the Hamilton Depression Scale and by the comprehensive assessment of mental states at risk. Results The clinical case illustrated concerns a 21-year-old female with a state of high risk of psychosis, suffering from depression symptoms that had been worsen since two years. As the therapy progressed, an improvement in depressive symptoms and functioning has been noticed, by a decrease in the score of the Hamilton scale, from 28 to 11, with a response estimated at 61% and a score for social functioning and professional, initially estimated between 21 and 30, to became between 41 and 50 after therapy. The active participation of the patient, and her assiduity were important factors in this success. Conclusions Cognitive-behavioral and emotional therapies for depressive symptoms could constitute an effective intervention approach for subjects at high risk of psychosis, allowing the improvement of the prognosis of psychotic disorders. Disclosure of Interest None Declared

Introduction The introduction of the covid 19 vaccine was a long-awaited event. However, many concerns accompanied this vaccine and the decision to be vaccinated was conflicting, especially among the most vulnerable population at that time, the health care workers. Objectives Evaluate the decisional conflict among health care workers concerning the launch of the covid19 vaccination campaign. Methods This is a descriptive study conducted by a questionnaire posted on social networks using Google Forms targeting groups of health professionals before the launch of the vaccination campaign in Tunisia from January 16, 2021 to March 6, 2021. We collected sociodemographic data and the attitudes of health care workers about COVID 19 vaccination. We used SURE score to screen the decisional conflict related to COVID 19 vaccine. Results Our study included 168 health care workers represented mainly by medical personnel (81% of the respondents). The average age was 34 ±10 years and sex ratio was 0.22. Sixty percent (60%) of population were hesitant about the COVID 19 vaccine. Scientific sources were consulted by 61% and non-scientific sources were referred to by 19%. Seven percent (7%) did not use any information source. The SURE decisional conflict score: the mean was 2.26 ± 1.35. The majority of our population (74.4%) had SURE scores in favour of a decisional conflict. We found that decisional conflict was significantly related to information sources. This conflict was highest amoung health care workers who did not use scientific information sources to inquire about the vaccine. Conclusions The announcement of the covid 19 vaccination campaigns raised a significant decisional conflict among the health care workers. Screening for decisional conflict among this population is important. Specific interventions to reduce this conflict are recommended by incorporating decision support tools (Decison Aids) and the shared decision making approach. Disclosure of Interest None Declared

Background: It is difficult to quantify the impact of the COVID-19 pandemic on mental health as many community surveys have limited quality, rely on screening tests to measure mental health conditions and distress, and often use convenience samples. Moreover, robust surveys come mainly from high-income countries. Aim: To measure the prevalence of depressive disorders with onset during the pandemic in a community of a Lower-Middle-income country (LMIC)-Tunisia. Methods: Clinical semi-structured face-to-face interviews were carried out during the pandemic (September–December 2021) by medical doctors among a representative sample of the general population in the governorate of La Manouba, Tunisia. Psychiatric diagnoses were established according to DSM-IV. Results: The prevalence of Major Depressive Disorder (MDD) started or recurred after the pandemic was 5.66%. The factors associated with MDD were loss of job and considerably diminished income due to the pandemic (OR = 2.1, 95% CI [1.5, 2.9]) and the perception of having the family's financial situation below the Tunisian average (OR = 2.3, 95% CI [1.7, 3.2]). Female sex, marital status as separated/divorced, and having a COVID-19 infection were associated with MDD only in the overall sample and urban areas, but not in rural areas. Age and having loved ones who passed away due to COVID-19 were not associated with MDD. Conclusion: In Tunisia, the pandemic seems to have increased the risk of depression in people experiencing a precarious financial situation, also due to the pre-existing economic crisis. Specific local level factors, such as not establishing a rigid lockdown for an extended period, may have protected young people and allowed for better mourning in families suffering the loss of a loved one. [ABSTRACT FROM AUTHOR]

Introduction Capgras syndrome is a disorder of personal identification characterized by the delusional belief that one or more persons close to the subject have been replaced by physically identical doubles. Objectives To deepen our knowledge of the Capgras syndrome Methods A case report about a Capgras syndrome. Results We report the case of a 46-year-old female patient who was admitted in February 2021 for incoherent speech and behavior disorder against her family members. Three years ago, she started to have hypochondriacal concerns. A week before her admission, she threatened her husband with a knife and she was convinced that her daughters were dead and that they had been replaced by clowns. She had a Capgras delusion with a hallucinatory and interpretative mechanism against her daughters, she reported olfactory and cenesthetic hallucinations. Biological explorations and brain CT were normal. The PANNS scale showed a positive scale of 36, a negative scale of 39, the general psychopathology scale of 53. She had a total score of 30/40 on The Penn emotion recognition test. The patient had difficulty in recognizing low intensity emotions (0 or 1) and 50% of the false responses were for the neutral emotion with responses tending towards anger first and then sadness. Conclusions Capgras syndrome remains poorly described in the literature and the hypotheses concerning its origin often oscillate between neuropsychological and psychodynamic. With the recent advances in neuroscience, it would be interesting to deepen its physiopathology in order to place it in a more modern nosological framework. Disclosure No significant relationships.

Introduction Despite improvement of mental health outcomes over the last years in Tunisia, there are still striking rural-urban mental health inequalities. Objectives The aim of this study is to evaluate the rural-urban differences in accessing mental health care among patients with psychiatric disorders Methods A cross sectional and descriptive survey was conducted between March and April 2021 in the department of psychiatry D of Razi Hospital including 70 patients admitted or treated as outpatients. The sex ratio was 1. Results The participants were aged between 17 and 68. About 11.42% came from rural areas. In these areas, 75% percent had low income versus 30.64% in urban areas. (p=0.047) The percentage of celibacy in urban areas was 68.85% versus 37.5% in rural areas (p=0.042) No significant difference was observed between the level of education and living in rural or urban areas. There was no association between rural or urban origin and number of admissions or treatment adherence or use of cannabis. The mean time between symptoms onset and consulting was 8.51 years in rural areas versus 2 years in urban areas. Moreover, time between symptoms onset and admission was significantly associated with rural or urban origin (p=0.045). The mean duration was 13,33 years (±10) in rural areas versus 3.12 years (±4.13). Conclusions Families living in urban areas had better income and would come to psychiatric hospital earlier. Therefore, we should help patients in rural areas access to mental health facilities for a better medical care. Disclosure No significant relationships.

Introduction Lithium is the oldest known treatment of bipolar disorders and remains the gold standard. Nevertheless, it remains difficult to handle, largely due to its narrow therapeutic index and its long-term side effects. Thus, it requires special initiation and monitoring measures. Objectives This study aims to assess nurses’ knowledge and attitudes regarding lithium. A protocol on Lithium initiation and monitoring will be established. Methods This is a descriptive study including 20 nurses in a psychiatry department conducted from January to May 2021 based on an self-assessment questionnaire that was established to assess nurses’ knowledge about Lithium, its side effects, initiation and monitoring. Results None of the recruited nurses had any training regarding the use of lithium. The vast majority of subject (85%) said that lithium’s dosage must be individualized and adaptable to each patient throughout a specific blood test. 90% recognized renal failure as the most common contraindication of lithium. Complete Blood Count (CBC), and renal check-up were the only tests recognized as necessary by all the sample subjects. 90% answered that lithium is toxic and 65% answered that it is fatal. In case of toxicity by lithium all subjects (100%) agreed to call the responsible doctor of the patient, 25% of them chose it as a unique measure and 75% thought it was necessary to stop the lithium immediately as well. Conclusions Lithium is considered as a double-edged sword largely due to its narrow therapeutic index. Nevertheless, nurses are undertrained when it comes to its use and manipulation. Disclosure No significant relationships.

Introduction Physical restraint is a therapeutic procedure allowing to immobilize an agitated patient.Although it is an effective method especially in the states of psychomotor instability, its practice is not devoid of risks which imposes a codified technique with particular monitoring. Objectives The aim of this work was to evaluate the knowledge of nurses and nursing assistants in the practice and monitoring of physical restraint and to establish a suitble protocol codifing it. Methods Our study was a descriptive cross-sectional study based on a questionnaire grouping together a set of questions on general and professional characteristics, the decision of physical restraint, its prescription, its means, its monitoring, informing the patient and his relatives, physical restraint’s risks, the patient’s experience, the caregiver’s experience as well as the relationship between caregiver and patient. Our target population was composed of nurses and orderlies of the psychiatry department <> of the Razi hospital in Manouba. Results We collected 30 professinals.90% of them were women. 30% of our sample had less than five years of experience. Only 23.30% of caregivers had mental health training at the beginning of their professional career. 50% of them received training focused on physical restraint.83.30% reported using physical restraint for psychomotor agitation.56.6% ignored the psychological effects of the physical straint on patients. 73.3% of caregivers informed patients before straint. Conclusions A physical restraint protocol, codifying the technique of implementation and monitoring parameters is needed in order to improve the relation patient-cargiver and ensure an optimal care . Disclosure No significant relationships.

Introduction The COVID-19 pandemic has several risks particularly in the elderly, such a high death rate and severe forms.The risk also involves significant psychological distress especially anxiety. Objectives Assessment of anxiety symptoms due to COVID 19 in elderly subjects in Tunisia. Methods A cross-sectional descriptive study on a sample of 50 people aged between 65 and over. Data was collected using a questionnaire and a COVID Anxiety Rating Scale “Fear of COVID-19 Scale”. Results We found that most subjects agreed or strongly agreed that they were afraid of Corona and that 54% agreed or strongly agreed that they felt uncomfortable thinking about the Corona. Physical symptoms like having sweaty hands, or having palpitations related to the fear of having the disease were reported by 24% of the subjects. Almost half of the respondents (46%) were afraid of losing their lives due to Corona. Most subjects (66%) reported that they became nervous or anxious when viewing information posted on social media on Corona. Insomnia related to worries about having COVID was reported in 12% of subjects. We were able to retain that most of the subjects (68%) had a mild level of anxiety and that 30% of the subjects had a moderate level. No subject had severe anxiety. Conclusions Low to moderate level of fear due to the COVID 19 pandemic was observed among Tunisian elderly according to this study. This leads us to conclude that assessment of anxiety particularly in seniors should be more systematic. Disclosure No significant relationships.

Introduction There are several case reports describing clozapine side effects such as agranulocytosis, constipation,tachycardia but rarely cases describing oesophagitis caused by clozapine were reported. Objectives To report the first case in our country about clozapine induced oesophagitis. Methods We describe a case in which a patient who has no gastrointestinal past history,has developed an oesophagitis stage 2 of Savary and Miller Classification without any gastroesophageal reflux disease, few weeks after introducing clozapine at therapeutic dose. Results A 25 years old male patient with resistant schizophrenia managed with clozapine,was admitted to reinitiate his treatment after weeks of stopping his medication.During hospitalization, our patient developed a sudden haematemesis in 10 days after commencement of clozapine. The patient had no history of gastrointestinal symptoms or disease. The clinical examination and blood tests did not find any signs of bleeding severity.A gastroscopy was performed, revealing esophagitis stage 2 of Savary and Miller classification and a cardiac polyp removed with biopsy forceps that showed no malignant lesions .The patient was treated with acid suppressant therapy.There was no further episode of haematemesis and our patient healed uneventfully within a week.As for clozapine, it wasn’t interrupted and we continued increasing doses very carefully with no further incident. Conclusions Although it is a rare side effect, oesophagitis may appear at therapeutic doses of clozapine, and this possibility should be taken into account when treating patients with resistant psychiatric disorders. Disclosure No significant relationships.

Introduction Tunisia is viewed as an advanced country in terms of women’s rights in the Arab world. However, women are more exposed than men to many specific risk factors which greatly contribute to threaten their mental health. Objectives The main objective of this study was to find out the sociodemographic and clinical profiles of women admitted in Razi psychiatric hospital and their access to mental health services. Methods A cross sectional and descriptive survey was conducted between March and April 2021 in the department of psychiatry D of Razi Hospital including 40 female inpatients. Results The majority of patients had low (37.1%) to moderate (61.9%) socio economic status, with primary education (40%), secondary education (20%) and higher education (28.6%). The majority was unemployed (68.8%). A significant difference was observed between adherence to treatment and family support (p=0.04). It was mainly the father or the husband who was taking care of the patient in 50% of cases. The first psychiatric consultation was 2.68 years after having symptoms. Hospitalization was about 4.94 years later. Twenty five percent of them have seen a tradipractioner before consulting. About 46.87% of patients had conflicts with a member of her family and 15.62% of them were victims of either domestic or family violence. The main diagnoses were mood disorders (31.4%) and schizophrenia (42.9%) Time between symptoms onset and hospitalisation was significantly associated with socioeconomic status (p=0.047) and cultural beliefs (p=0.026). Conclusions The protection of women’s mental health is not only a medical challenge but also a cultural and political one. Disclosure No significant relationships.

Introduction Arachnoid cyst is a neurological tumor. It’s rare and benign. Its association to psychosis has been described in literature. Objectives Through a case report and a review of the literature we hypothesize that arachnoid cyst is the cause of resistance in a patient with schizoaffective disorder. Methods Starting from a case report, we conducted a literature review on “PubMed”, using key words “arachnoid cyst”, “arachnoid cyst a psychiatry”, “arachnoid cyst and schizoaffective disorder”, “arachnoid cyst and schizophrenia” Results Mr. AA is 50 years old, has diabetes treated with metformin, hypercholesterolemia and celiac disease under gluten free diet. He has been diagnosed with schizoaffective disorder in 1992, initially put on haloperidol and carbamazepine. Since the patient wasn’t getting better, we suspected no-compliance so we switched haloperidol for fluphenazine decanoate. The patient still suffered from persecutory delusion and auditory hallucinations. We started him on clozapine still with no improvement. So, we concluded to the resistance of schizoaffective disorder considered electroconvulsive therapy (ECT). A cerebral MRI was conducted, prior to ECT, objectifying a left anterior frontal arachnoid cyst of 26 millimeters from the main axis producing a mass effect on the cerebral cortex. This neurological tumor didn’t require neurosurgery. Conclusions Our patient was resistant to all treatments including clozapine. The only anomaly discovered was the arachnoid cyst. Could this explain the resistance of this patient and others like him? Could this be an interesting research path to further elucidate the mystery of metal disorder? Disclosure No significant relationships.

Introduction Gender disparities exist regarding prevalence, symptomatology and risk factors of mental disorders. In Tunisia, there is only one hospital dedicated entirely to mental health which is Razi hospital. Objectives The aim of the present study was to assess gender based mental health disparities in a psychiatric department and its related factors. Methods A cross sectional and comparative survey was conducted between March and April 2021 in the department of psychiatry D of Razi Hospital including 70 patients with a sex ratio= 1. Results The participants were aged between 17 and 68. Men had higher rate of celibacy: 80% of men against 48.57% of women (p=0.009). A total of 11.42% of women were illiterate against 2.85% of men, 48% of men were unemployed against 62.85% of women. There was a significant difference between gender and use of cigarettes, cannabis and alcohol (p

Introduction The COVID-19 pandemic poses a threat particularly to the elderly. Although the current vaccination strategy is recognized as an adequate measure to reduce mortality, it still raises concerns about its efficacy and safety. Objectives Assessment of worries and attitudes among Tunisian elderly towards the pandemic. Methods A descriptive cross-sectional study on a sample of 50 consultants in a geriatric service, aged between 65 years and over. A questionnaire was formulated based on the recommendations of WHO and INEAS. Results The average age of our population is 74.6 years. The participants were mainly female, retired (76%) and with low educational attainment. Most of the elderly reported that they respected the wearing of the mask in public (90%) and washing their hands regularly (92%). Social distancing was respected by only 44% of the participants. Concerning the vaccine registration, we noted that 48% of the subjects expressed their willingness to register on the Evax.tn platform. On the other hand, 15 people expressed their refusal to receive the anti-Covid vaccine. We noted that only 22% had a dose of the Covid-19 vaccine. Only 4% of the respondents did not have concerns about new variants of the virus. About half (52%) of the subjects expressed significant concern about an increased risk of virulence and mortality due to the new variant. Vaccination was considered ineffective by most of the participants (70%). Conclusions Addressing worries about vaccine would be an important step to accept it among Tunisian elderly. Adequate information strategy is essential to change attitudes during the pandemic. Disclosure No significant relationships.

Background: This study aims to verify the accuracy of item 10 on the energy level of the Short-Form Health Survey (SF-12) in an item screening according to Mood Disorder Questionnaire (MDQ) results, providing a measure of hyper-energy. Methods: Regression techniques were employed in a dataset comprising 4093 records of respondents to test both linear and nonlinear relationships between predictor and outcome variables (energy level and symptoms considered in the MDQ). We examined the relationship of energy level with cases identified using MDQ with a cut-off of 7. Results: Levels of energy, as rated on item 10 of the SF-12, were related to the MDQ score with sensitivity = 0.72 and specificity = 0.70. In linear regression, the associations were stronger with MDQ items on excessive energy or activity, showing a medium effect size and an explained variance of 10% or higher. A greater association was observed for items on excessive energy and activity, as expected, as well as for items concerning self-confidence, sociability, and talkativeness. Conclusions: This result may have implications for the research on risk factors and the pathogenesis of the dysregulation of mood, energy, and social rhythms syndrome (DYMERS), a syndrome that is hypothesized to occur in stressful conditions like those shown under the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Introduction Lockdown due to coronavirus pandemic has been a stressful experience especially to mothers. Juggling work from home and childcare has led to maternal burn out and depression. Objectives The aim of the present study was to assess maternal burn-out rate during lockdown and its eventual relationship with depression and associated factors Methods 156 Tunisian mothers responded to online questionnaire posted on social network after 1 month of lockdown. The questionnaire evaluated burnout and depression as measured by the Maslach Burnout Inventory (MBI) and depression and anxiety symptoms (HADS) respectively. Results The participants were aged between 24 and 64 years and 61.5% had more than one child. Mean score on the BMS10 was 4.11 out of 7 maximum score with 71.8% of participants fulfilling criteria for maternal burn-out. Among them, 30.1% had high level of burn out and 9.6% extreme burn out. The main factors associated with maternal burn out were age of children, financial difficulties and lack of leisure activities. Mother’s age, perceived husband support, medical or psychiatric history haven’t been associated with maternal burn out. HADS questionnaire indicated that 38.5% of mothers had moderate to severe anxiety disorder and 35,9% had moderate to severe depressive disorder. A postive correlation was found between burnout and anxiety (r=0.634, p

Introduction Dissociative experiences have been studied in different circumstances. Objectives In this study we aim to analyze dissociative phenomena under a stress factor: lockdown. Methods We conducted a cross sectional-study, using an online survey, spread during lockdown period in Tunisia, between the 2nd and the 8th of April. It was comprised of sociodemographic, geographic, medical history, confinement status and DES-II questionnaire in its french version. Age superior than 18 was the only inclusion criteria and the no respect of lockdown was the exclusion criteria. Based on former studies on DES-II, 3 sub scores have been assessed; amnesia (measures memory loss), depersonalization (sense of unreality of the self ) and absorption (the absorption has to do with one’s traumatic experiences). Results We recruited 167 individuals; 100 women and 67 men. The most common age class was 20 to 30 years old (60.5% of the sample). The Mean total score was 11.06 which was higher than mentioned in earlier studies. The mean score was 15,11 for absorption; 5,28 for amnesia and 6,88 for depersonalization subscale. Significant differences in scores were found based on different variables. Women had higher absorption score (p=0.011). Besides people living in COVID-19 clusters had lower total score (p=0.038). Finally, people with somatic medical history showed higher total score (p=0.013), absorption score (p=0.003) and depersonalization score (p=0.012) compared to those with none. Conclusions During lockdown, dissociative experiences showed to be more frequent. But does this mean that a resurgence in PTSD (posttraumatic stress disorder) or ASD (acute stress disorder) in the months to come.

Background: With the uncertainties of COVID-19, people infected with coronavirus present with diverse psychiatric presentations. Some institutions have had to manage their patients with existing protocols, others have had to create them. In this article we aimed to report the challenges and good practices in the management of psychiatric conditions and delirium coexisting with COVID-19 across continents. Methods: Early Career Psychiatrists (ECPs) from across five continents were approached to share their experiences on the management of psychiatric conditions in patients with COVID-19 during the current pandemic. Results: We collected information about the experiences from sixteen countries. Commonalities were similar psychiatric presentations and poor preparedness across countries. Differences were varying adjustments made in the management of psychiatric conditions coexisting with COVID-19 and different innovations. Good practices which can be adopted by other countries are novel approaches such as telepsychiatry, proactive consultation-liaison units and enhanced community services targeted at circumventing challenges faced when providing mental health services. Conclusions: These findings highlight the need for global preparedness in the mental health sector during outbreaks of infectious diseases, and the need for concerted efforts targeted at global and locally sensitive adaptation of existing protocols and the development of new guidelines for the management of psychiatric conditions for the present pandemic and subsequent occurrences.