While women victims of intimate partner violence (IPV) suffer the burden of mental health issues (MHI), they face many challenges accessing mental health services (MHS).

We draw on the socioecological model and explore different level barriers for accessing MHS among women experiencing IPV.

We conducted a qualitative study in 2020-2021 at three levels: policy, practice and women’s experience. This included in-depth interviews with 19 policymakers from the Ministry of Health (MoH) and the Ministry of Social Welfare (MSW); four directors of shelters for women victims of IPV; 35 women (26 Arabs, 9 Jewish) attending shelters for women victims of IPV (age 22-50), and six focus groups with 26 social workers. Participants were asked about the barriers for utilizing MHS.

We identified complex multifaced barriers regarding the accessibility and quality of MHS among women victims of IPV. At the policy level, we identified structural organizational barriers related to the division of responsibilities between the two offices (MoH and MSW). These included lack of collaboration, funding and information transmission and insufficient communication mechanisms. At the practice level, shelters’ directors and social workers raised barriers, most of which were related to divisions in knowledge, terminology, and treatment approaches among mental healthcare providers and social welfare therapists. The women themselves raised issues related to stigma, lack of family support and continuity of MHS.

To improve MHS access, it is crucial to overcome the multiple barriers (individual, family, therapeutic and organizational) that are faced by women who are experiencing IPV.

No significant relationships.

The COVID-19 pandemic brought unbearable psychological pressure to people worldwide, because of serious threats to one’s physical health and life. From early stages of this pandemic, concerns have been raised about its effect on mental health. However, we still know little whether pre-existing psychiatric disorder (PD) affects the susceptibility and evolution of this infection.

We aimed to assess the interactions between COVID-19 infection and PD.

We conducted a litterature review through pubmed database, using the keywords :«COVID 19», «psychiatry», «mental disorders», « schizophrenia », « anxiety », « depression », «insomnia».

On one hand, prior surveys suggested that the infection is associated with increased incidence of a first psychiatric symptom. Mental health disturbances mostly include anxiety, depression, sleep disturbances, cognitive impairment and post-traumatic stress disorder. On the other hand, recent studies showed that patients with pre-existing mental disorders were associated with high susceptibility to be infected, increased risk of intensive care unit admission and a high mortality. The susceptibility to contracting COVID-19 was associated with pre-existing mood disorders, anxiety, and attention-deficit hyperactivity disorder. Infection severity was associated with pre-existing or subsequent mood disorders and sleep disturbances; or a pre-extisting schizophrenia. Mortality is increased in patients diagnosed with schizophrenia.

The complicated interactions between COVID-19 infection and PD have several implications. Enhanced psychiatric follow-up should be considered for survivors of COVID-19. Besides, early detection and intervention for PD are needed to control morbidity and mortality induced by the COVID-19 infection.

No significant relationships.

Recent research showed that persons with mental disorders may represent a population at increased risk for coronavirus disease (COVID-19) infection with more adverse outcomes.

We aimed to analyze clinical profile of psychiatric inpatients during their infection with COVID-19, and to explore factors associated with the disease progression.

We analyzed retrospectively the medical records of 32 psychiatric inpatients, hospitalized in psychiatry “B” department at Hedi Chaker hospital (Sfax, Tunisia), and who contracted the COVID-19 infection. We used “Charlson Comorbidity Index Score” (CCIS), predicting 10-year survival in patients with multiple comorbidities.

Somatic history was reported in 50% of patients. The CCIS ranged between 0 and 4. Psychiatric diagnosis was schizophrenia in 81.3% and bipolar disorder in 18.7% of cases. The clinical symptoms reported were fever (50%), dry cough (75%); dyspnea (34.4%). Biological assessment showed a lymphopenia in 40.6% and a high C-Reactive Protein (CRP) in 53.1%. Among our patients, 37,5% needed oxygen, and 25% were transferred to the intensive care unit. The COVID-19 complications were mostly bacterial pulmonary superinfections (21.9%) and pulmonary embolism (9.4%). Only three (9.4%) patients died from the virus. Patients with medical history were more likely to need oxygen (p<0.001). Clinical and paraclinical parameters associated with oxygen need were: fever (p<0.001); dyspnea (p<0.001); lymphopenia (p<0.001); high CRP (p=0.001). Patients presenting pulmonary superinfection or embolism were more likely to require oxygen (p=0.006 and p=0.044 respectively).

This study highlighted factors that may worsen the COVID-19 infection evolution, and which require special attention, in order to improve the prognosis of this disease.

No significant relationships.

In recent years, advances in the areas of both bipolar disorder (BD) and borderline personality disorder (BPD) have generated considerable interest in the relationship between these two conditions, since that they are commonly comorbid.

We aimed to investigate the impact of BPD on course of illness in patients with BP.

We conducted a cross-sectional, descriptive and analytical study among 30 psychiatric outpatients diagnosed with BD in the Psychiatry « B » department, Hedi Chaker Hospital (Sfax, Tunisia). The McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) was used to screen for BPD. Clinical outcomes (hospital stays, comorbidities, suicidality…) were compared between BD- patients with or without BPD comorbidity.

The mean age was 41.63 years, with a sex ratio of ½. Among the patients, 2/3 were diagnosed with BD-I, while 1/3 presented a BD-II. Physical comorbidities, comorbid anxious and eating disorders were noted respectively in 36.7%; 16.7% and 43.3% of patients. Suicidal attempts were reported in 46.7% of cases. According to MSI-BPD, a comorbid BPD was noted in 30% of our sample. Patients with BD-II were significantly more likely to present BDP traits (50%) than those with BD-I (20%) (p<0.001). Patients with BPD were significantly more likely to attempt suicide (p=0.033), and to present physical comorbidities (p<0.001) and comorbid eating disorders (p<0.001).

Our study showed that BPD darkens the prognosis of BD, because of worse outcomes related to suicide, physical and psychiatric comorbidities. Thus, its co-occurrence complicates the management of BD.

No significant relationships.

Post-operative bleeding is one of the most common and severe complications of turbinate surgery. This study compared post-operative bleeding following partial turbinectomy, submucosal turbinate reduction and endoscopic turbinoplasty.

Post-operative bleeding was assessed in patients who underwent inferior turbinate intervention by partial turbinectomy, submucosal turbinate reduction or endoscopic turbinoplasty between January 2016 and November 2017 and had completed at least one month of follow up.

Of 1035 patients who underwent inferior turbinate surgery during the study period, 751 were included. Of these, 56 (7.5 per cent) presented to the emergency room with post-operative bleeding; 31 (8.4 per cent) had undergone partial turbinectomy, 19 (10.7 per cent) had undergone submucosal turbinate reduction and 6 (3.0 per cent) had undergone endoscopic turbinoplasty. The odds ratio of requiring an intervention to control bleeding was significantly lower in the endoscopic turbinoplasty group than in the submucosal turbinate reduction group (odds ratio = 3.26, 95 per cent confidence interval = 1.02–10.43).

Endoscopic turbinoplasty had the lowest rate of post-operative bleeding and the lowest rate of patients requiring intervention.

Interactions between infertility and sexuality are numerous and complex. Recently more attention is being paid to the impact of infertility on the marital sexuality.

The aim of this study was to determine the effects of infertility on sexual functions.

A cross-sectional descriptive study, the obstetric gynecology department Basic demographic information was collected. Respondents were surveyed regarding sexual impact and perception of their infertility etiology.

Our patients had an average age of 33.2. The average number of years of infertility was 3.9 years.. The most common cause of female infertility was an ovulat disorder (36%), that of male infertility was sperm production defect. The confrontation with a diagnosis of infertility marks a difference in the way couples organize their sexual life. In our study, sexual problems after this diagnosis were experienced by 38% of women. Sexual dysfunction was detected as a pain problem (24%), a desire problem (10%), an arousal problem (4%), and an orgasm problem in 6% and. Faced with this situation, women felt guilty (46%), angry (72%) and anxious (82%). Infertility was perceived as the worst experience of life by 78% of our patients.

Infertility can interfere negatively in women sexuality. The investigation of sexual difficulties in infertility consultations must be systematic.

Gaming is a source of addiction for adolescents. It is recognized as a behavioral and mental health condition, both by the American Psychiatric Association and by the World Health Organization.

To determine the prevalence of gaming addiction among secondary school students.

This cross-sectional study was conducted between September and October of 2020 among students enrolled in secondary school. The participants had filled the Game addiction scale and a data file regarding the socio-demographic information, physical and information about the internet access and use.

The initial sample was composed of 180 secondary school students. Among them 28 were excluded because they did not play video games. Final sample consisted of 152 students (90 males, 62 females) with a mean age of 13.14 ± 1.2 years. The average duration of connection among participants was 5.3 hours per day. Nearly one quarter of the participants (24,3%) played videogames more than 20 h per week. The prevalence of gaming addiction was 21,7%. The participants with gaming addiction were, on average, younger than those who were not addicted to gaming Game-addicted individuals were more likely to be male than female (13,8% vs 7,9%; p=0,036). There was, also, a significant relation between IA and having academic difficulties (p=0.042).

Based on our study findings, that gaming addiction is a challenging problem among Tunisian adolescents. We recommend authorities consider gaming addiction a serious problem for the young population and make this growing phenomenon an adolescent health priority.

No significant relationships.

Family caregivers of psychotic patients are exposed to violence and stress. However, associated psychological outcomes are poorly characterized in this population.

The aim of this study was to clarify the relationship between violence directed towards caregivers of patients with psychosis and developing post-traumatic stress disorder (PTSD).

Participants were family caregivers of psychotic patients (n=95). They completed a questionnaire assessing sociodemographic characteristics. Sociodemographic and clinical data of patients were collected from medical records. We used the perceptions of prevalence of aggression scale (POPAS) to measure the frequency and severity of aggression directed at the respondent in the past and the Impact of Event Scale-Revised (IES-R) to evaluate PTSD.

A rate of 75.8% of caregivers reported experiencing moderate to severe levels of aggression. Decreased contact with patient (p=0.00), male gender (p=0.00), older age (p=0.00) and parent relationship (p=0.01) of caregivers, diagnosis of schizophrenia or schizoaffective disorder (p=0,00) and poor adherence to treatment (p=0,00) in affected relatives were associated with experiences of moderate–severe aggression. More than a half of caregivers (54.7%) reported potentially significant levels of PTSD which correlated with the level of aggression (p=0.00).

Our findings suggest that a large proportion of family caregivers of patient-initiated violence in psychosis reported experiencing a great distress and a high level of PTSD symptomatology. So, more attention should be paid to the support needs of caregivers who are faced with potentially life threatening aggressive behaviour by psychotic family members.

Poorer metacognitive abilities are recognized as strong predictors of social functioning deficits in individuals with schizophrenia.

The aim of the current study is to examine metacognitive functioning in people with schizophrenia and to explore correlations between metacognition, symptoms and general functioning.

It was a cross-sectional study involving outpatients diagnosed with schizophrenia and followed in the psychiatry “C” department at Hedi Chaker university Hospital, in Sfax -Tunisia, between may and december 2018. Sociodemographic, clinical and therapeutic data were measured using self-reported questionnaires, and metacognition was assessed with the Metacognition Assessment Scale – Abbreviated version (MAS-A). The general functioning was measured with The Global Assessment of Functioning (GAF).

A total of 74 participants participated in the study. The average age was 34.1 ± 11.8 years and the sex-ratio was 1.6. The average score of global assessment of functioning was 49.39±10. Means and standard deviations on MAS scores were as follows: self-reflectivity 4.18 (1.46), understanding of others’ minds 3.20 (1.06), decentration 2.5 (1.8), mastery 2.54 (1.85), and the MAS total scores 12.42 (6.17). The results indicate that poor social functioning is associated with metacognitive difficulties (r=0.27, p<10-3). Greater metacognition was significantly correlated with fewer negative symptoms (r= -0.62, p<10-3), but metacognition was not significantly correlated with positive psychotic symptoms, cognitive disorganisation, excitement or emotional distress

These findings underscore the importance of interventions designed to enhance the patients’ metacognitive capacities, that is, the more proximal capacities linked to poorer social functioning.

The impact of intimate partner violence (IPV) can be devastating on women’s psychology. Moreover, IPV may destroy women’s self-esteem and self-identity.

To identify sociodemographic characteristics associated with IPV and to assess self-esteem among women victims of IPV.

It was a descriptive and analytical study over a period of 03 months from June 1st to August 31st, 2018 including all cases IPV female victims in forensic department at Habib BOURGUIBA University Hospital, Sfax. In addition to epidemiological data, Rosenberg scale were used to assess the victim’s self-esteem.

Among 142 female IPV victims, only 60 (22.3%) agreed to answer our questionnaire. Their median age was 33.5 years (27-41 years). Victims did not pass high school in 61.7% of cases and they were unemployed in 53.3% of cases. Most women got married at 23 years-old (20-26). The average length of marriage was 7 years (3-14 years). Bruises and abrasions were the most frequent lesions (58.3% and 56.7% of cases). Rosenberg Scale score’s mean was 28.3 ± 4.3. Self-esteem was low or very low among 70% of victims.

Female victims of IPV do not have a specific profile and low self-esteem is quite common among them. Additional research is needed to better understand the extent of the problem and to develop more effective reporting methods.

No significant relationships.

The relationship between epilepsy and depression has been recognized for a long time. In fact, the presence of depression could worsen the disease outcome.

we aimed to study the prevalence of depression in patients with epilepsy and to assess the determinant factors of its genesis.

54 patients with epilepsy, aged more than 18 years, attending the neurology department of Habib Bourguiba Hospital, Sfax, Tunisia, were enrolled for the study. All patients were administered Mini-International Neuropsychiatric Interview (MINI) for evalution of psychiatric comorbid disorders especially depression. Socio-demographic and clinical data were collected.

A total of 54 patients were included, of whom 63% (n =34) were men. Mean duration of epilepsy was 20.13 years. The most frequent type of seizure was generalized 72.7%. Depression was present in 7.3 % of patients. Alcoholism (p=0.027) was significantly associated with occurrence of depression. Drug resistence (p = 0.03) and longer duration of epilepsy (p = 0.046) were significantly associated with occurrence of depression. No significant association was found between type of seizure, seizure frequency, medication compliance and depression. Depression wasn’t associated with anti-epileptic drug. We didn’t find any association between depression and other psychiatric comorbidities.

Depression wasn’t frequent in our study contrary to literature. The possible explanations are the reduced simple size and the sensitivity of the used tool to assess depression in epilepsy. Pursuant to literature, we found significant association between Alcoholism, drug resistance and long duration of epilepsy.

Gayet Wernicke Encephalopathy (GWE) is a diagnostic and therapeutic neuropsychiatric emergency due to thiamin deficiency (vitamin B1).

The purpose of our work is to recall some clinical situations suspecting GWE, along with radiological and evolutionary profile.

We conducted a retrospective study concerning patients who were hospitalized in the neurology department of Habib Bourguiba Hospital between 2013 and 2020 for management of GWE.

The median age of 7 patients was 39.57 years with sex ratio (H/F):1.33. The most common risk factor found is incoercible vomiting (5 patients), followed by chronic alcoholism (3 patients). Confusional state was the most frequent symptom found in 4 patients. The characteristic clinical triad of confusion, oculomotor disorders and ataxia was only found in 2 patients. Neuroimaging showed a typical aspect in 3 patients. The serum levels of thiamine were low in five patients and normal in two patients. After receiving parental than oral thiamin supplementation, three patients were independent after one month with a mRS score <3.

GWE is an acute neuropsychiatric emergency. Chronic alcoholism is recognized as its most common cause. The clinical triad is not constantly present. MRI shows typically bilateral symmetrical hyperintensities in periaqueductal area, periventricular region, thalami and mammillary bodies. Thiamin level can be normal since it does not accurately represent body thiamine status or in case of mutations in a thiamine-transporter gene. Thiamine therapy is warranted if any component of the GWE triad is present in an appropriate clinical setting to prevent irreversible neurological sequelae.

Internet addiction (IA) is a significant public health issue among adolescents. There is considerable evidence that IA is associated with various psychosocial harms.

The aim of this study was to measure the prevalence of internet addiction among secondary school.

This cross-sectional study was conducted among 152 students enrolled in secondary school. The participants had filled the Internet Addiction Test of Young and a data file regarding the socio-demographic information, physical and information about the internet access and use.

The sample consisted of 90 males and 62 females with a mean age of 13.14 ± 1.2 years. The majority of participants had their own smartphone (83.6%). The average duration of connection among participants was 5.3 hours per day. The prevalence of IA was 14,5%. Results showed that 46,8% feel their internet use significantly hinders their family relationships. Twenty participants (13,2%) reported that they connected to the internet while they were in classroom. The prevalence of IA was higher among boys than girls (p= 0.018). There was, also, a significant relation between IA and having academic difficulties (p=0.037).

The prevalence of IA is elevated in Tunisia. Many negative consequences are identified. Urgent measures should be taken to counter the problem.

An association can be found between patient with psychosis and perpetrating acts of violence. So, the caregiving role can impact negatively on psychosis carer psychological health and wellbeing.

The aim of this study was to identify the factors associated with post-traumatic stress disorder (PTSD) in family caregivers of psychotic patients following exposure to aggression.

This cross-sectional study was carried out involving 95 family caregivers of psychotic patients followed in psychiatry. Data were gathered from caregivers about their experiences in providing care. Sociodemographic and clinical data of patients were collected from medical records.We used the perceptions of prevalence of aggression scale (POPAS) to measure the frequency and severity of aggression directed at the respondent in the past and the Impact of Event Scale-Revised (IES-R) to evaluate PTSD.

The caregivers were male in 51.6% and with low educational level in 46.3% of cases. A rate of 75.8% of caregivers reported experiencing moderate to severe levels of aggression. More than a half of caregivers (54.7%) reported potentially significant levels of PTSD. Decreased contact with patient (p=0.01), male gender (p=0.00), older age (p=0.00), living far from patient (p=0.00), parent relationship of caregivers (p=0.00), diagnosis of schizophrenia or schizoaffective disorder (p=0.00) and poor adherence to treatment (p=0.00) in affected relatives were associated with the presence of PTSD following exposure to moderate to severe aggression.

These findings highlight the need for interventions to promote family psychoeducation and to provide psychosocial support for caregivers of patients in order to prevent the traumatic impact of violence on them.

Epilepsy is a chronic disease defined as a brain disorder, characterized by a predisposition to present seizures, generating cognitive, psychological, and social consequences.

To determine the prevalence of psychiatric comorbid disorders in patients with epilepsy (PWEs) and its associated factors.

We conducted a cross-sectional study involving 30 PWEs who were treated in the neurology department of Habib Bourguiba Hospital in Sfax, Tunisia. We used the Mini International Neuropsychiatric Interview for the diagnosis of Axis I psychiatric disorders.

The half of patients had psychiatric comorbidities: 4 had major depressive disorder (MDD), 2 had MDD with generalized anxiety disorder, 4 had MDD with social phobia, 1 had bipolar disorder type I, 1 had panic disorder, 1 had agoraphobia and 2 had generalized anxiety disorder.

Twenty-five PWEs had seizure-onset below 30 years old and among them, 40% had psychiatric comorbidities. Among patients who had seizure-onset above 30 years old, none had psychiatric comorbidities. Psychiatric comorbidities were found in 71.5% of patients with seizure frequency >2 per year. Psychiatric comorbidities were more common in patients with generalized seizures compared to whom with partial seizures (53% versus 45%). It was also more common in patients treated with polytherapy compared to whom with monotherapy (64% versus 37.5%).

The prevalence of psychiatric comorbidities is relatively high among PWEs. The most frequent diagnoses found were mood and anxiety disorders. It is very important to identify them and treat them to enhance seizure control.

The authors have not supplied their declaration of competing interest.

This is a retrospective study to evaluate the efficacy and safety of routine use of electronic portal imaging device (EPID) in intensity-modulated radiation therapy for localised prostate cancer.

Data from 20 patients with localised prostate cancer treated by radical radiotherapy using intensity-modulated technique in Habib Bourguiba Hospital were analysed to define the action levels for pretreatment planer dose distribution of 100 treatment fields and the set-up errors of 418 portal imaging. Pretreatment planar dose distribution was measured with the EPID. The additional dose from repeated portal imaging was determined with treatment planning system.

For all 100 fields, the predicted and the measured planar dose distribution agrees well with mean±standard deviation value for γmax=2·31±0·57, γavg=0·36±0·07 and γ%≤1=98·94%±0·71%, respectively. For the evaluation of set-up errors, the mean total errors with 1 SD in the lateral, longitudinal and vertical directions were 0·11±0·44 cm; 0·02±0·37 cm and −0·02±0·21 cm, respectively. The imaging additional dose was evaluated as 1 cGy per monitor unit.

EPID is a useful tool to verify pretreatment dose distribution and to assess the correct field position without a significant increase in the absorbed dose due to the repetition of portal imaging.