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Rim Masmoudi,1 Faten Hadj Kacem,2 Maroua Bouattour,3 Fatma Guermazi,1 Rim Sellami,1 Ines Feki,1 Mouna Mnif,2 Jawaher Masmoudi,1 Imen Baati,1 Mohamed Abid2 1Psychiatry “A” Department, Hedi Chaker University Hospital, Sfax, Tunisia; 2Department of Endocrinology, Hedi Chaker University Hospital, Sfax, Tunisia; 3Department of Family Medicine, Faculty of Medicine of Sfax, University of Sfax, Sfax, TunisiaCorrespondence: Rim Masmoudi, Psychiatry “A” Department, Hedi Chaker University Hospital, Sfax, 3029, Tunisia, Tel +216 74 244 511, Email rim19masmoudi@gmail.comPurpose: Diabetes distress (DD) refers to the negative emotions and burden of living with diabetes. Illness perceptions are among the factors that can influence self-management and psychological distress in diabetics. This study aimed to determine the prevalence and the associated factors of DD in Tunisian patients with type 2 diabetes mellitus. We also studied the relationship between DD and illness perceptions in diabetics.Patients and Methods: This was a cross-sectional study conducted among individuals with type 2 diabetes, followed up at the outpatient endocrinology unit at the Hedi Chaker University Hospital, Tunisia. DD was assessed using the Diabetes Distress Scale (DDS-17). The Brief Illness Perception Questionnaire (Brief-IPQ) was used to assess diabetes illness perceptions. Multivariate logistic regression was used to determine independent factors associated with the presence of DD.Results: A total of 103 patients were recruited. The mean age was 59.31 (± 10.83) years; 54.4% were female. In total, 70.9% had DD. Using regression analysis, we demonstrated that the illness perceptions of personal control, HbA1C, absence of comorbidities, lower age at diabetes diagnosis, and socioeconomic status were significantly associated with DD.Conclusion: This study sheds light on the high prevalence of DD among patients with type 2 diabetes in Tunisia. Illness perception-focused psychological intervention would be efficacious in reducing diabetes distress in patients with type 2 diabetes mellitus.Keywords: diabetes mellitus, type 2, distress, illness perception, Tunisian patients

Christian Lucas,1 Samia Aly,2 Chantal Touboul,3 Rahma Sellami,3 Xavier Guillaume,3 Gilles Garcia4 1Centre d’Evaluation et de Traitement de la Douleur, Service de Neurochirurgie, Hôpital Salengro, CHRU de Lille, Lille, France; 2Novartis Pharma, Rueil-Malmaison, France; 3Kantar, Montrouge, France; 4Service de Pneumologie, Hôpital Bicêtre, CHU Paris Sud, Kremlin-Bicetre, FranceCorrespondence: Christian LucasCentre d’Evaluation et de Traitement de la Douleur, Service de Neurochirurgie, Hôpital Salengro, CHRU de Lille, Lille, FranceTel +33 3 20 44 60 76Email christian.lucas@chru-lille.frIntroduction: Migraine and asthma are two frequent, disabling, chronic disorders with a major impact on patient well-being. The objectives of this study were to compare subjective well-being between patients with severe forms of migraine or asthma using a panel of PROs.Methods: Adult patients were recruited during routine consultations with chest physicians or neurologists. Patients with severe migraine (reporting headaches on ≥ 8 days/month and having failed ≥ 2 prophylactic treatments) and patients with severe asthma (according to the 2017 GINA definition: requiring Step 4 or 5 treatment or presenting uncontrolled symptoms) were eligible. Each patient completed the EuroQol Questionnaire (EQ-5D-5L), the Work Productivity and Activity Impairment Questionnaire (WPAI) and the Hospital Anxiety and Depression scale (HAD). Patients with severe migraine the 6-item Headache Impact Test (HIT-6) and those with severe asthma completed the Asthma Control Test (ACT).Results: 249 patients with severe migraine and 96 with severe asthma were enrolled. Mean EQ-5D-5L utility scores were significantly higher in the severe migraine group than in the severe asthma group (0.75± 0.25 vs 0.68± 0.26; p< 0.01). Low EQ-5D-5L utility scores were associated with frequent (≥ 15 headache days/month) or disabling (HIT-6 score ≥ 60) headaches and with poor asthma control. Patients with severe migraine more frequently presented a HAD depression score ≥ 11 (23.0% in severe migraine; 7.5% in severe asthma; p< 0.01), whereas those with severe asthma more frequently reported problems with mobility, self-care and usual activities. Absenteeism (percent worktime missed) was similar in both groups (severe migraine: 9.0%± 19.1%; severe asthma: 13.8%± 22.9%) but work impairment was higher in the severe migraine group (44.3% vs 28.4%; p< 0.01).Conclusion: Quality of life, work activity and psychological distress are all deteriorated in both severe migraine and severe asthma. Different aspects are affected in the two diseases: a greater impact on psychological aspects in severe migraine and a greater impact on physical aspects in severe asthma.Keywords: quality of life, work performance, psychological distress, asthma, migraine

Leila Mnif,1 Rim Sellami,2 Jawaher Masmoudi2 1Department of Psychiatry “D”, Razi University hospital, Tunis, 2Department of Psychiatry “A”, Hédi Chaker University Hospital, Sfax, Tunisia Introduction: Post-stroke emotional incontinence and bipolar disorder are two disorders that involve the dysfunction of brain structures responsible for emotional regulation. The objective of this work is to study the links between these disorders through a clinical case. Case report: We present the case of a 43-year-old man without previous psychiatric history who experienced emotional incontinence after cerebrovascular events. He reacted promptly to selective serotonin reuptake inhibitor treatment. However, he experienced his first episode of hypomania after 6 months of antidepressant therapy. Adjunctive therapy with valproic acid and low-dose paroxetine was eventually added, resulting in complete improvement of both emotional incontinence and hypomania after 4 additional months of treatment. Conclusion: The clinician should carefully explore any history of premorbid bipolar disorder, personality disorder characterized by mood instability, and family history of bipolar disorder. Keywords: stroke, emotional incontinence, bipolar disorder

Introduction: Cannabis is the most widely consumed illegal drug in the world and one of the easiest to access. This drug provides a feeling of well-being and euphoria. However, frequent consumption is associated with several complications including increased impulsivity and an increased risk of suicidal behaviour. Objectives: Our objective was to study the link between cannabis consumption, impulsivity and suicide intentionality. Methods: We conducted a cross-sectional study, during the period from September 2020 to October 2021, among cannabis users consulting the Sfax Detoxification Center in Tunisia. Impulsivity was studied using the Barrat Impulsivity Scale (BIS 15) and suicide intentionality was assessed using the Suicide intent scale Beck; Pierce (SIS) in subjects with history of a suicide attempt. Results: We included 38 consumers. The average age is 26 years old and the sex ratio was 8.5 with an over-representation of men. The average BIS15 score was 38.2 ranging between 19 and 45. We have demonstrated that the higher the level of cannabis dependence, the higher the level of impulsivity. A high level of impulsivity was found in younger subjects (p=0,04) and with a low socio-economic level and unemployment (p =0,021). Suicidal intentionality, assessed in 10 patients with a history of suicide attempt, was low and intermediate in 40% and 60% of users respectively, which means a low to intermediate risk of subsequent completed suicide. Conclusions: Impulsivity is associated with aggressive behaviour, various accidents including motor vehicle accidents, more self-mutilation and a much greater risk of dying by suicide than the general population. Frequent cannabis use is also associated with increased risk of developing all types of suicidal behaviours independently of the existence of depressive symptomatology. Overall, it is important to take into account the issues of impulsivity and substance abuse in daily clinical work as they influence the level of dangerousness. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]