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Tunisia is a lower-middle-income country located in North Africa with strengths and challenges to its mental health system. We present an overview of available services, facilities, and human resources to offer mental health care in Tunisia. We conducted a cross-sectional study, where data for the year 2017 was collected between May 2018 and May 2019 by consulting stakeholders involved in the health field in Tunisia. We compare this information with data published in the WHO-AIMS report (2008), which presents mental health data in Tunisia for the year 2004. Successes of the mental health system in Tunisia include an increase in the ratios of psychiatrists and psychologists, with these ratios being higher than those of other lower-middle-income countries; a flourishing child-psychiatry practice; and an increase in people being treated for mental health conditions. Challenges include psychiatrists being over-represented in large cities along the coastline and in the private sector, and most people receiving treatment in specialized mental health facilities. The further operationalization of the National Strategy for Mental Health Promotion is envisioned, through the training of non-specialists in mental health care and incentives offered to psychiatrists to work in the country's interior and the public sector. [ABSTRACT FROM AUTHOR]

Benzodiazepines may be prescribed to manage anxiety and insomnia in patients with depression. However, as noticed during our daily practice, a considerable proportion of patients treated for depression and receiving benzodiazepines developed a dependence to these medicines. Our aims were to estimate the proportion of patients with depression who develop a benzodiazepine dependence and to identify its correlates. We conducted a comparative study in Razi Hospital's outpatient psychiatry unit (Tunisia). We included patients aged 18 to 65 years who were diagnosed with depression during the first three quarters of 2014. Included patients were prescribed benzodiazepines. Follow-up period was of 2 years. A multivariate analysis was performed to identify dependence-associated factors. We included 54 patients, and 52% developed a benzodiazepine dependence during the follow-up period. Two associated factors were identified: a daily mean benzodiazepine dose of more than 9.5 milligrams of diazepam equivalents prior to taper off (p =.001) and a benzodiazepine taper-off initiated after the fifth week of benzodiazepine intake onset (p =.007). The proportion of patients who developed a benzodiazepine dependence was high. Low doses and time-limited benzodiazepine prescription should be taken into consideration when managing patients with depression in order to prevent dependence. [ABSTRACT FROM AUTHOR]

To address the rise in mental health conditions in Tunisia, a training based on the Mental Health Gap Action Programme (mhGAP) Intervention Guide (IG) was offered to primary care physicians (PCPs) working in the Greater Tunis area. Non-specialists (such as PCPs)' training is an internationally supported way to target untreated mental health symptoms. We aimed to evaluate the programme's impact on PCPs' mental health knowledge, attitudes, self-efficacy and self-reported practice, immediately following and 18 months after training. We conducted an exploratory trial with a combination of designs: a pretest-posttest control group design and a one-group pretest-posttest design were used to assess the training's short-term impact; and a repeated measures design was used to assess the training's long-term impact. The former relied on a delayed-intervention strategy: participants assigned to the control group (Group 2) received the training after the intervention group (Group 1). The intervention consisted of a weekly mhGAP-based training session (totalling 6 weeks), comprising lectures, discussions, role plays and a support session offered by trainers. Data were collected at baseline, following Group 1's training, following Group 2's training and 18 months after training. Descriptive, bivariate and ANOVA analyses were conducted. Overall, 112 PCPs were randomized to either Group 1 (n = 52) or Group 2 (n = 60). The training had a statistically significant short-term impact on mental health knowledge, attitudes and self-efficacy scores but not on self-reported practice. When comparing pre-training results and results 18 months after training, these changes were maintained. PCPs reported a decrease in referral rates to specialized services 18 months after training in comparison to pre-training. The mhGAP-based training might be useful to increase mental health knowledge and self-efficacy, and decrease reported referral rates and negative mental health attitudes among PCPs in Tunisia and other low- and middle-income countries. Future studies should examine relationships among these outcome variables. [ABSTRACT FROM AUTHOR]

Introduction: Tardive seizure refers to a spontaneous seizure, which occurs after electroconvulsive therapy (ECT). It is a rare and poorly understood phenomenon that can lead to other serious consequences such as status epilepticus. Risk factors may be associated, and its management is by no means consensual. However, tardive seizure remains little explored in the absence of feedback and data sharing. The purpose of this study was to report the prevalence of late-onset seizures following ECT during the acute phase of treatment at the stimulation unit of Razi Hospital during its seven years of activity and to identify variables associated with this adverse event., Methods: This is a descriptive and retrospective study that was carried out at the ECT unit of Razi Hospital, Tunisia, based on the medical records of patients treated with ECT between December 2015 and September 2023. Every recorded ECT session during the initial course of treatment with available EEG tracings was included in the study. Maintenance ECT sessions, undocumented sessions, those without clinical observations, and/or those without EEG tracings were all excluded. A tardive seizure was retained according to criteria that included both recorded motor manifestations such as "motor jerks" or "generalized tonic-clonic seizures" which began spontaneously after ECT and the resumption of a state of consciousness concurrent with an equivocal EEG tracing., Results: A total of 162 patients received at least one course of ECT during the research period. Ultimately, we included 1931 well documented sessions that were completed for 157 patients in all. Of the 157 patients, seven had experienced at least one late seizure after receiving ECT, accounting for 4.45% of patients. Among the 1931 sessions, 11 late seizures were noted. The prevalence of tardive seizures in our series was 0.57%. Several factors have been associated to the onset of a tardive seizure, including being a male, the presence of a neurological lesion, treatment that lowers the epileptogenic threshold, anesthesia with etomidate, stimulation charge near seizure threshold or maximum electrical load, prolonged induced seizure, and poor post-ictal suppression on the induced seizure tracing., Conclusion: Despite the dearth of information, tardive seizure following ECT is considered to be a rare event. Risk factor management would be the first action to be taken to prevent such an event., Competing Interests: Disclosure of interest The authors declare that they have no competing interest., (Copyright © 2024 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Background: Early diagnosis of schizophrenia can improve its outcome. Hence, screening policies should be held and suitable tools must be available for general practitioners., Aim: To translate the section G (about schizophrenia) of the Composite International Diagnostic Interview to the Tunisian dialect and to check its validity and reliability., Methods: The Arabic version of section G of the Composite International Diagnostic Interview has been translated to the Tunisian dialect by psychiatrists speaking fluently both languages. Metric features of the instrument (sensitivity, specificity and predictive values) were assessed by checking its results against those of the gold standard i.e. the expert's opinion owing to the criteria of the Diagnostical and Statistical Manual of mental disorders 3rd revised edition. Reliability has been measured by the index of observer agreement., Results: The instrument showed a low sensitivity of 45% [32% - 58%] and a high specificity of 96% [93% - 99%]. It looked as a diagnostical test that can avoid wrong diagnoses of such a serious and stigmatizing illness. These values are similar or even better than those of literature. The observer agreement index was 0.83 showing a very good reliability. The interviews mean duration was 20 minutes. The instrument showed no variability towards the sex, the age or the educational level of interviewees., Conclusion: Even though section G of the Composite International Diagnostic Interview failed to detect most cases with schizophrenia and showed a poor sensitivity, this instrument can be useful for screening strategies carried out by lay interviewers in the general population.

Background: The law 92-83, has established the rights of the mentally ill to respect for individual freedom and to appropriate care. However some gaps in its implementation led to the revision by Act 2004-40., Aim: To study the evolution of the number of admissions with and without consent (hospitalizations at the request of a third party and compulsory hospitalizations), between 2000 and 2009., Methods: Retrospective study of the archives of the mental health unit of Razi hospital. The study population included inpatients under the mode of voluntary and involuntary admission either compulsory hospitalizations or at the request of a third party., Results: An increase in the number of hospitalizations without the consent from 2000 to 2009 was noted. The number of compulsory hospitalizations and the one of hospitalizations at the request of a third party rose respectively from 1,048 to 1,443 and from 22 to 1,323. So the number of free hospitalizations has decreased while the number of involuntary hospitalizations has increased, leading to a constant number of total hospitalizations. The sex ratio for compulsory hospitalizations has increased from 2.04 to 5.83 while it markedly decreased for hospitalizations at the request of a third party (from 10 to 1.7).Men, unlike women, were more likely to be hospitalized compulsorily than at the request of a third party., Conclusion: There is a larger use of hospital admissions under constraints than free ones; is it due to a concern for the respect of law or an abuse in the deprivation of freedom for some patients?

Background: Acupuncture is one of the most popular types of complementary/alternative medicine in the world. It is sometimes used as a treatment for schizophrenia mainly in China., Aim: To assess the contribution of acupuncture in the treatment of patients treated for schizophrenia in Tunisian population., Methods: Our study is a clinical randomized trial about 31 hospitalized patients with schizophrenia or schizo-affectif disorder (DSM IV). They were evaluated by the Positive and Negative Syndrome Scale (PANSS), the Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS) the first and 23nd day of the study. Manual acupuncture was used for 10 sessions at the rate of three sessions per week. All patients were under drug therapy. Among them, 15 were treated by acupuncture and 16 by sham acupuncture., Results: Scores of the PANSS, SAPS and SANS were similar in the two groups at the end of the study., Conclusion: Our study did not provide any evidence for the effectiveness of acupuncture in treating schizophrenic symptoms.

Unlabelled: The aim was to develop and validate an addictive behaviors screening tool in school children., Methodology: A cross sectional study including a self administrated 223 item questionnaire developed in Arabic language. The questionnaire included identification of the student and seven life domains: school, family, addiction, relationships with peers, leisure and well being, risky behaviors and personality traits. N=854 high school children. of Monastir City., Results: the questionnaire Alpha Cronbach's Coefficient ranged between 0.3 and 0.8. Only items with a coefficient higher than 0.6 were maintained in the final version. The time reliability by using the Bland and Altman method 15 days after the first measure showed a Pearson's coefficient of 0.81. Validity evaluated by principal components analysis led to 3 independent factors consisting respectively in 20, 4 and 3 well correlated items: family, school and risky behaviors., Conclusion: validated version of the questionnaire consisted in 102 items, easy to read and understand. This version doesn't require much time to be filled in and takes into consideration cultural particularities of the school children of Monastir. It could be considered as an interesting tool for both the assessment and the prevention of addictive behaviors in school.