Due to the convenient and easy access to the Internet, there is an increasing tendency to seek online health information instead of formal help-seeking. To date, there is a very little amount of research on online help-seeking behaviors for mental health problems, with no studies having been performed in Tunisia.

We aimed to explore mental health information-seeking behaviors and e-health literacy in a sample of Tunisian community adults.

We performed a cross-sectional descriptive study among adults from the general population. All participants were administered the Barriers to Access to Care Evaluation scale (BACE-30), the Columbia Suicide Severity Rating Scale (SIS-5), the Depression Anxiety Stress Scales (DASS-21), and the eHealth Competency Scale (eHEALS).

A total of 44.2% participants reported having searched the Internet for mental health-related information during the last 12 months. Google was the most used tool by participants when searching for mental health related information. The main topics searched were symptoms and management (n=49%), followed by finding a diagnosis (n=47%), researching for medications and physicians (n=41%). We conducted a multivariate analysis to identify factors related to participants’ e-health literacy. A higher depression score (p=0.037), lower levels of education (p=0.011), and perceived barriers to access to care (p=0.004) were substantially linked to worse e-health literacy.

While a high proportion of participants reported mental health information-seeking behaviors, those with higher depression and who perceived more barriers to care access exhibited lower e-health literacy. These findings may have practical clinical implications.

None Declared

Acute marital psychosis is an acute psychotic episode occurring in a particular context which is marriage. In fact, marriage represents an event with a very important emotional load especially in the Arab-Muslim culture. This event can, in some people, induce a relapse of certain psychiatric disorders, particularly psychotic ones. We propose in this work to report two clinical observations concerning two brothers who both presented, a few years apart, an acute nuptial psychosis with two different evolutions.

Studing the characteristics of nuptial psychotic episode in a one family and the different evolution of each one.

Reporting two clinical cases of two brothers who represented both acute psychotic episode in a nuptial context with different evolution.

The two patients are brothers with common psychiatric background which is their mother treated for chronic psychotic disorder. They were hospitalized in our psychiatric service for acute psychotic episode occuring in a nuptial context with chronic evolution for the first one and a partial recovery for the second one.

Marriage represents an event with a very important emotional load especially in the Arab-Muslim culture. In thiscontext, acute psychotic episode can occur with different evolution for patients predisposed. Studing socio-cultral circumstances related to psychotic episode can help mental health professional to improve the quality of health care service.

Les symptômes dépressifs subsyndromiques dans le trouble bipolaire sont fréquents, et semblent être présents indépendamment de la durée de la maladie et de la polarité du dernier épisode. D’après plusieurs auteurs, la persistance de symptômes dépressifs minimes pourrait expliquer l’écart entre la rémission syndromique et la rémission fonctionnelle.

Il s’agissait d’une étude transversale réalisée auprès des patients bipolaires type I euthymiques et suivis en ambulatoire. Le recueil des données s’est fait au moyen d’une fiche qui comportait les données sociodémographiques et cliniques, la mesure de la phase thymique à l’aide de l’échelle de dépression de Hamilton et l’échelle de manie de Young et le Functioning Assessment Short Test.

Plus de la moitié de la population (53,3 %) avait une déficience fonctionnelle globale. La majorité des domaines spécifiques du fonctionnement étaient touchés. Nous avons trouvé un score HDRS relativement élevé (2,03 ± 2,3) en comparaison avec le score YMRS (0,6 ± 1,2). Le fonctionnement global était associé à l’âge (p = 0,025), au niveau scolaire (p = 0,027), à l’activité professionnelle (p = 0,001), au nombre d’épisodes maniaques (p = 0,013) et dépressifs (p = 0,003), au nombre d’hospitalisations (p = 0,023) ainsi qu’à un score HDRS plus élevé.

Les symptômes subsyndromiques qui persistent en périodes intercritiques de la maladie bipolaire sont fréquents, et ont un mauvais pronostic fonctionnel. Ils mettent en évidence le profil chronique et sévère de la maladie bipolaire, et la nécessité d’introduire des interventions thérapeutiques axées sur les symptômes dépressifs résiduels dans le but d’améliorer le fonctionnement.

Les contagions psychiques induites par les liens, ou « folie à deux », a passionné des générations d’aliénistes. C’est une entité clinique considérée comme rare. Elle met en jeu, non pas un, mais deux ou plusieurs personnes qui ont une relation proche. Rarement tous les membres de la famille partagent les mêmes illusions et ceci est appelé folie à famille. Nous proposons à travers ce travail de présenter un cas de cette pathologie rare, et d’analyser le cas à travers une illustration des données de la littérature.

Les frères S et Y ainsi que la sœur S sont de mêmes parents biologiques, tous célibataires, orphelins de mère depuis quatre ans et vivant ensemble avec le père depuis longtemps dans un isolement social relatif, en milieu rural au Nord-Ouest de la Tunisie. Le frère « inducteur » a été atteint de schizophrénie paranoïde avec délire de persécution qui a été imposé et plus tard partagé par les autres membres de la famille. En effet, Monsieur S. a clairement exprimé un délire interprétatif et hallucinatoire, à thématique persécutive prédominante, selon lequel il existerait un complot à grande échelle à son encontre. Puis, tous les membres de la famille devenaient aussi visés : ils seraient poursuivis par des personnes inconnues ayant un pouvoir politique, voulant nuire à monsieur S à travers sa fratrie. Au fil du temps, tous les proches, les voisins, ainsi que les agents de l’ordre sont devenus « persécuteurs ».

Le cas que nous rapportons illustre la complexité de la folie à famille, la gravité de ses conséquences comportementales, ainsi que le dysfonctionnement psychosocial qui en résulte. Les délires partagés, notamment la folie à famille, offrent l’opportunité unique d’examiner les rôles respectifs des facteurs de risque génétiques et environnementaux dans le développement des troubles psychotiques.

Mixed states are characterized by the coexistence of manic and depressive symptoms in the same mood episode. In clinical practice, identification of such states is essential.

The study's purpose was to evaluate our clinical practice for the treatment of mixed access and compare with international recommendations.

This is a retrospective study of the records of patients with bipolar disorder, mixed access hospitalized in our department from August 2009 to January 2012.

The sex ratio was 0.52 (23 men / 22 women.). The average age was 39.4 years. In the majority of patients, treatment of mixed episode was based on a combination of drugs. Prescribed combinations were: Conventional neuroleptic (haloperidol) and antiepileptic (valoproique acid) in 44% of cases, haloperidol and antiepileptic (carbamazepine) in 24%, Atypical antipsychotic (Olanzapine) and antiepileptic (valoproique acid) in 16% of cases.- Atypical antipsychotic (risperidone) and valoproique acid in 8% - olanzapine was prescribed as monotherapy In 8% cases

Our therapeutic conduct is in compliance with the international recommendations.

The occurrence of mixed episodes is often associated with poor response to treatment, greater recurrence of episodes and a higher risk of suicide. The recognition of these conditions and the use of appropriate treatment are needed to improve the prognosis of the disease.

Liaison psychiatry specializes in the interface between physical and psychological health. This discipline to which a large literature was devoted, has developed in recent decades. In our country, because of economic and social factors, the implantation of this ‘sub-specialty’ is still difficult. Its location in general hospitals must go first by its acceptance by the health professionals.

Assess the perception of the management of somato-psychiatric comorbidities in somatic medicine and the practice of liaison psychiatry.

It is a transversal and descriptive study of 68 non-psychiatric physicians practicing in public institutions. They all received self-assessment questionnaires with 15 questions via internet.

The surveyed physicians were mostly medical residents (43%). The sex ratio (M / F) was 0.2. Among participants, 71% had sometimes suspected or diagnosed psychiatric illness among their patients. Depression was the most frequent diagnostic (27% of cases).

The majority of participants (60%) rarely search psychiatric complications of severe somatic diseases. Faced with psychiatric symptoms, 82% of practitioners consistently directed the patient to psychiatric consultation. Finally, 87% of physicians considered the existence of a psychiatric unit in the hospital as beneficial and 58% of them judged the presence of a psychiatrist in the team as crucial.

The results of this study emphasize the importance of collaboration between psychiatry and other medical specialties and the necessity to promote the liaison psychiatry in our country.

Schizoaffective disorder (SAD) is one of the most challenging concepts with unclear boundaries and remains difficult for clinicians due to its instability over time.

we aimed to set the socio demographic and clinical profile of patients treated for SAD and to identify factors influencing the change in the diagnosis from SAD to another mental illness.

we have analyzed 50 patients followed for at least 10 years and diagnosed as SAD on the basis of DSM-IV criteria.

The first SAD crisis was severe in 40,8% of cases. Almost half of the patients had a pre morbid personality (48%). At the first hospitalization, diagnoses were as follow: in 32% of cases: Schizophrenia, in 28% of cases: SAD, in 26% of cases: a mood disorder. The schizoaffective disorder diagnosis was rectified in 2 cases. More than 4 years are required to change the diagnosis. A complete remission was observed in 40% of cases during intervals, as the evolution of SAD is cyclical. The prognosis was considered good in the majority of cases. The change of the diagnosis is correlated to the age of the onset of the disorder (p = 0,046), the quality of intervals (p = 0,01), the quality of the professional insertion (p = 0,018) and the prognosis (p = 0,003).

The heterogeneity of patients with schizoaffective disorder and the absence of operational criteria in the definition of the pathology lead to the incapacity to set SAD clear diagnostic criteria.

Le terrorisme-suicide est la forme la plus meurtrière de terrorisme. C’est la seule forme de combat où l’attaquant envisage des actions extrêmes dans lesquelles il ne prévoit pas de survivre à la mission. Le mode opératoire adopté est difficilement explicable, car l’attaquant décide avec détermination de se suicider en même temps qu’il décide de tuer.

Notre travail propose une revue de la littérature théorique existante afin d’examiner le profil psychopathologique du terroriste suicidaire.

Peu d’études formelles ont été publiées sur la psychopathologie des terroristes suicidaires; avec des résultats mitigés. Différentes études sur le sujet ont conclu qu’il n’existe aucun attribut psychologique particulier pouvant décrire une « personnalité terroriste ». D’après certains auteurs, les terroristes suicidaires sont dotés d’une santé mentale solide et n’ont pas de passé criminel. En effet, les recruteurs de futures bombes humaines écarteraient d’emblée les personnes d’allure mentalement instables. Cependant, cela a été contredit par d’autres études montrant qu’un grand nombre de kamikazes que la police avait arrêté après échecs de leurs attentats-suicides étaient mentalement déséquilibrés ou cognitivement déficients. Plusieurs études ont affirmé que les terroristes suicidaires ne sont pas en réalité suicidaires. Mais, il n’y a aucune preuve probante étant donné l’absence d’utilisation d’outils d’évaluation structurés et systématiques.

La genèse du terroriste suicidaire semble être multifactorielle. L’étude du profil psychopathologique des terroristes suicidaires devrait avoir des implications cliniques et préventives.

Impulsivity is recognized as a predisposing factor for addictive and suicidal behavior in bipolar patients. We aim to study the impact of childhood traumatic experiences on the development of impulsive behavior in patients with bipolar disorder and the particularties of these patients

Case-control study during a period of six months. Euthymic patients with bipolar disorder were enrolled. The two groups were compared by the scores of the Barratt Impulsivity Scale (BIS-10) and the Childhood Trauma Questionnaire (CTQ).

The total impulsivity scores of motor and cognitive impulsivity in subjects with bipolar disorder were higher than in control subjects (with respectively p=0,001 ; p=0,005 ; p=0,002). There was a statistically significant difference between bipolar patients and controls regarding the CTQ total (p<10-3) and sub-scores for emotional abuse (p<10-3), physical neglect (p=0,01) and physical abuse (p=0,001) which were higher among patients. There was a correlation between the average total CTQ score and the average total score of impulsivity in the BIS-10 in patients with bipolar disorder (p=0,04). Impulsivity was associated with a childhood full of traumatic events, particularly in bipolar patients.

It is interesting to routinely use impulsivity scales (especially the BIS) and Childhood Trauma Questionnaire as indicators of high risk of addictive behavior in bipolar patients. This is paramount in order to develop appropriate therapeutic measures for this group of patients, often responding poorly to standard care.

The influence of parents’ psychiatric disorders on the mental health of their children, has grown considerably due to the development of epidemiology, genetics and notions of vulnerability or gene-environment interactions. Early interactions between the mother and her child have a direct impact on the psycho affective child development. Mental disorders in children are, at their turn, generator of a psychiatric disorder among parents, especially the mother. This’loop’ in which the mental health of the child and mother are constantly interacting needs a specialized and targeted intervention.

The aim of this work is to describe the profile of mothers of children with psychiatric disorder and to link the mental disorders diagnosed in children and their mothers who receive care in psychiatry.

We focused on the cases of the mothers whose children were followed in the consultation o child psychiatry in Razi hospital and who are themselves suffering from a psychiatric disorder. Data collection was made ??from the patient records.

We collected data in ten cases of patients suffering from psychiatric disorders. On our preliminary results, maternal depression is the disorder most frequently observed. We plan to expand the study population.

Regardless of the mental disorders of the child, the therapy is mainly based on parental guidance. The psychiatric disorders among parents and especially the mother is important to detect to guarantee a successful therapy. This work emphasize on the importance of the collaboration between psychiatrists and child psychiatrists.

A retrospective study was done on patients admitted to the department for Forensic Psychiatry at the Razi Hospital from 1996 to 2016, initially jailed for detention and drug consumption and judged irresponsible by reason of insanity. Data were collected by record review.

Thirty-two patients were included in the study. Mean age was 27.81 years. Thirty-six percent of the participants were illiterate and 45% were single. More than half of the subjects (54%) had personal psychiatric history and 27, 27% had family history of psychiatric problems. About one third (31.81%) of participants had judicial background: 33% were arrested for public drunkenness, 44% were arrested for violence, and 22% were arrested for theft. Concerning the diagnosis, 45% were suffering from schizophrenia, 22.77% were diagnosed with personality disorder and 27.27% of them would not have any mental trouble. About 50% of the patients did not follow up with treatment.

Addictive disorders are authentic psychopathological disorders. Effective treatment is hindered by the paucity of research on clinical application of treatment models for addictive disorders in this population.

The authors have not supplied their declaration of competing interest.

Several studies have analyzed the influence of bipolar disorder (BD) related to many kinds of functioning. Even if it is obvious that patients in relapse have poor quality of live (QoL), what's about it in interictal phases with subthreshold symptoms?

To study the potential relationship between QoL and subthreshold symptoms in bipolar I patients in remission.

To evaluate the above relationship, we hypothesized that subsyndromic BD phases can be related to worse subjectively QoL.

This was a cross-sectional study. Forty-four BD patients were enrolled. The subthreshold symptoms were evaluated by Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS). Patients with HDRS lower than 7 and YMSR lower than 6 were the successful applicants. Then, we run the Tunisian version of SF-36 to measure the QoL.

Twenty-seven men and seventeen women with an average age of 39.3 years were selected. Age of beginning of BD was 31.5 years and patients were in relapse since 1.56 years. The HDRS's average score was 2.73. Twenty patients (45.5%) have an HDRS upper than 4. The YMRS's average score was 2.25 and twenty-nine BD's patients have a score between 1 and 6. The overall average score at SF-36 scale were 64.2 and 25% of BD patient with subthreshold symptoms had a poor QoL.

Subsyndromic interictal phases affect the QoL of BD patients and it's necessary to introduce therapy adapted according to troubles in order to improve patient's quality of life and functioning.

The authors have not supplied their declaration of competing interest.

Zoophilia consists of sexual intercourse by a human being with a lower animal. There is a paucity of literature on this paraphilia.

In this paper, we report an uncommon case of homicide committed by a man with co-morbid borderline personality disorder and paraphilic disorder, and review the literature.

Mr SH was a single and unemployed 30-year-old male. He was hospitalized in our forensic psychiatric department following a dismissal for criminal responsibility for an act of attempted murder with premeditation. There was no history of any other psychiatric disorder, chronic physical illness or drug dependence. He complained that he had been suffering for the past ten years from sad mood, sleeplessness, loss of interest, and feelings of guilt worthlessness, and hopelessness. He had started sexual intercourse with animals eight years ago. He harbored feelings of guilt for his sexual experiences with animals. There was no formal thought disorder or perceptual abnormality. At the beginning of bestiality, he explained his unconventional behavior, by the fact that he had been bewitched, by his uncle's wife. Projective tests found borderline psychopathology. The crime occurred after a zoophilic sexual intercourse. Mr SH was obsessed with bewitchment thoughts, and got an uncontrollable urge to kill his uncle's wife. The crime was impulsive and violent. Psychiatric experts retained the diagnosis of co-morbid borderline personality disorder and other specified paraphilic disorder (DSM-5).

In this case, we discuss the clinical and therapeutic challenges of this complex case, and the legal liability of Mr SH.

The authors have not supplied their declaration of competing interest.

The bipolar disorder (BD) is a chronic and severe disease which diagnosis and treatment are still raising the issues.

To show a potential clinical and socio-demographic profile in BD patients.

We hypothesized that BD patients have a particular clinical and socio-demographic characteristics.

This was a descriptive and retrospective study which assesses 49 BD's outpatients. The diagnosis was accorded to DSM-IV criteria. The enrollment was conducted from January 2010 to August 2015. The socio-demographic and clinical data were collected by a preestablished railing.

The mean age was 39.7 years with a sex ratio of 1.33. Six patients (12.2%) lived in urban zones and 61% (n = 30) patients have a lowly socioeconomic conditions. Celibacy was the prevailing civil status in 57.1% (n = 28) among which 17 lived in family home. Thirty-four (69.4%) patients were unemployed.

A primary school level was found in 34.7% of the cases (n = 17). Nineteen patients (38.8%) were schooled until the secondary level and 9 patients (18.4%) followed a university program.

Addiction to smoking was found at 26 patients (53%) whose half of them had moreover an alcoholic poisoning. The mean age at the diagnosis was 35.6 years with an inaugural manic episode in 63.4% (n = 31) of the cases. The average number of relapse was 1.23 and the mean duration of follow-up was 3.2 years.

The knowledge of the profile of the consultants, their socio-demographic and clinical characteristics would allow to adapt the offer of care to the request.

The authors have not supplied their declaration of competing interest.

In some forms of sexual perversion, sexual satisfaction is achieved only by treating one's partner violently (sadism) or conversely, by suffering pain (masochism).

The objectives of our study were to understand the complex relationship between psychotic and perverse structures, and discuss the importance of some criminal risk factors for psychotics who have sexually perverse behaviors, through clinical observation and review literature.

Mr AB was 35-year-old, single and unemployed. He was hospitalized in our forensic psychiatric department following a dismissal for criminal responsibility for an act of emasculation on a child aged 5 years without sexual abuse. In his biography we have objectified cruelty to animals, charged judicial history (imprisonment for theft, murder and escape from prison, hetero aggressive acts) and substance use.

The patient explained with indifference that he heard voices making fun of his “sexual impotence and loss of his manhood”. The day of the forensic act, he got an uncontrollable urge to emasculate the first man he met on his way at the behest of this hearing hallucinatory activity. Psychiatric experts retained the diagnosis of psychosis with perverse arrangements. Under neuroleptic treatment, psychotic symptoms disappeared but the patient's sadistic problems remained present and active throughout his hospitalization.

The following case illustrates the issue of dangerousness and responsibility in a perverse psychotic author assault of a sexual nature. Given their clinical history, the path between perversion and psychosis shows that perverse manifestations are prior to the first psychotic symptoms and the perverse constitution is developed parallel to the psychotic illness.

The authors have not supplied their declaration of competing interest.

Incest may be defined as sexual relations between close blood relatives. Legally, incest and sexual aggression toward minors are classified as a criminal behaviour. Tunisia is among the countries from which incest cases are rarely reported.

The aim of this study is to investigate the relationship between the psychotic structure and incest, and to describe the individual, clinical, and criminal traits of the incestuous father through clinical observation.

Mr T.G is 46 years old. He is married and has six daughters. His wife appears to be passive, and largely dependent on her husband. Mr T.G has had incestuous relationships, initially, with his two eldest daughters. The acts were followed by the mother's complicit silence and the non-denunciation of the daughters. Two years later, he starts an incestuous behavior with his third daughter. Incest took place in the context of delusion. The patient was convinced that he is responsible of his daughters’ sexuality education. He develops an incoherent theory of purification with a tendency towards morbid rationalism. It is only after four years of insufferable paternal incestuous relationships that the third daughter filed a complaint to the police. A psychiatric expertise concluded that the accused is exempt from criminal responsibility.

Incest is a multi-faceted phenomenon, which makes its approach, comprehension, and treatment quite complex. For a psychotic patient incest is a means to deny alterity by crushing other. It also allows him to find, in this complete power, control over his annihilation anxiety.

The authors have not supplied their declaration of competing interest.

The digital boom and the media coverage of the sexuality urge the youngest to expose itself more and more via the social networks and other digital applications.

To explore the virtual sexuality of the Tunisian teenagers.

It's a cross-sectional study made in August 2015, including 104 Tunisian teenagers from different social backgrounds and living in Tunis, chosen aimlessly. An auto-railing drafted in Arabic, anonymous and carrying on various items was distributed.

We included 52 boys and 52 girls. Seven of them (6.1%) was not schooled and 68.3% (n = 71) were at high school. Ninety-one of the teenagers (87.5%) reported not have sexual education at school and 74% (n = 77) have already turned to web sites to inquire about sexuality. A regular practice of cybersex at the rate of at least once a week, was founded at 36.5% (n = 36) and 41 teenagers (39.4%) have reported to have already undressed in front of their webcam. The candidates have already consulted a pornographic site at least once in their life in 76.9% (n = 80) of the cases. The allocated time for these virtual activities is made to the detriment of the sleep in 75% of the cases (n = 27). The connection was accompanied with a masturbatory activity in 38.9% (n = 14).

Contrary to preconceived ideas, the computer screen does not protect from sexual risk behaviors. Therefore, a sexual education for the youngest is more than ever necessary to avoid such drift.

The authors have not supplied their declaration of competing interest.

Several studies have explored the vulnerability to mood disorders that constitute some personality traits.

To study the potential relationship between mood disorders and personality disorders.

We hypothesized that personality disorders can be related to severe mood disorders.

This was a retrospective study including the period from January 2000 till September 2015 and related to patients in whom the diagnosis of mood disorder and personality one were retained according to the criteria of the DSM-IV TR while the sociodemographic and clinical were collected by a pre-established railing.

We included 28 patients (15 ♂, 13 ♀). The average age was 38 years. Eighteen (64.3%) patients (7 ♂, 11 ♀) are unemployed. Fifteen patients (10 ♂, 5 ♀) were schooled until secondary level. Seventeen patients (60.7%) were married. The bipolar I disorder (BD I) was most frequently founded (50%), followed by the major depressive disorder in 25% (n = 7) then by the bipolar II disorder in 21.4% (n = 6). A case of dysthymia was also noted. Half of the personality disorders were the borderline type, followed by the histrionic type in 28.6% (n = 8) then by the antisocial in 17.9% (n = 5) and finally one patient presented a paranoiac personality. The antisocial personality was significantly associated with the BD I (P = 0.011) and half of the patients with a pathological personality, presented a depressive symptomatology.

The personality disruption is a factor of severity of the thymic disorders. Consequences on the management of patients and their response to treatments remain available.

The authors have not supplied their declaration of competing interest.