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Introduction: Excessive use of social media can lead to addiction with adverse consequences for health. Through this work, we evaluated the prevalence of addiction to social media of college students from different fields and the associated factors., Methods: We conducted a survey of 115 students by means of a questionnaire posted online during two weeks in groups of students aged between 19 and 30years from different fields in Tunisia. The questionnaire consisted of an information sheet and three self-administered questionnaires: Bergen social media addiction scale, Hospital Anxiety and Depression scale, and UCLA 3-item loneliness scale., Results: Our population was 70% female. The average age was 25.1±3.5years. Regarding lifestyle habits, twenty-nine students (25.2%) were smokers, thirty-three students (28.7%) consumed alcohol, and nine students (7.8%) used cannabis. The average number of years of social media use was 11.77±3.28years. The average time on line per day was 3.8±1.81hours. The main social networks were Facebook (98.3%), Instagram (93%), Whatsapp (80.9%), Tiktok (28.7%), Snapchat (20%), and Twitter (19.1%). The use of social networks was the first action in the morning when waking up in 71.3% of the students and before sleeping in almost all students (94%). According to the results of the Bergen Social Media Addiction Scale, 31.3% of students had problematic social media use, defined by a score≥19/30. Thirty-three students (28.7%) had moderate to severe anxiety symptomatology and 41 students (35.7%) had moderate to severe depressive symptomatology. Sixty-two students (53.9%) were considered lonely according to the UCLA loneliness scale. Marital status was significantly associated with social media addiction score, with higher rates among single students. Smoking was also associated with higher social media addiction scores. Social media addiction scores were positively and significantly correlated with anxiety, depression, and loneliness scores. Frequency of going out with friends was negatively and significantly associated with social media addiction score, as well as depression and loneliness scores., Conclusions: This study shows that social media addiction is a major health problem. Therefore, it is important for college students to recognize a problematic social media use and take steps to use it in a healthy way., 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.)

Introduction: Telemedicine has become a fundamental pillar of the evolution of healthcare worldwide. In Tunisia, the challenges of the health system, amplified by the COVID-19 pandemic, have highlighted the urgency to adopt innovative solutions. In this regard, the publication of Presidential Decree No. 318/2022 on April 8 in the Official Journal of the Tunisian Republic represents a significant advance in the regulation of telemedicine., Aim: To assess the knowledge of Tunisian psychiatrists and child psychiatrists regarding telemedicine, its legal framework, and their perceptions of this new medical practice., Methods: A descriptive cross-sectional study was conducted 8 months after the issuance of the presidential decree. The survey was conducted online through an electronic questionnaire on Google Forms., Results: A total of 68 participants were included in this survey. The median number of professional years was 5±7 years. Among the participants, 82% worked in psychiatry and 18% worked in child psychiatry. The sector of practice was public in 69% and private in 31% of cases. Most of them (62%) did not know about the different telemedicine acts, and 57% of doctors were unaware of the existence of the presidential decree. The majority of doctors (84%) expressed a favorable opinion regarding the adoption of telepsychiatry, regardless of sex (p=0.69), professional status (p=0.512), specialty (p=1), years of experience (p=0.83), and practice sector (p=1)., Conclusion: Despite a low level of knowledge regarding telemedicine, the study highlights the interest of the participants in integrating telepsychiatry into their clinical practices.

Self-stigma of people with bipolar disorder is an underestimated problem, with serious consequences in terms of clinical severity and social and professional functioning., Objectives: This study aimed to evaluate self-stigma in patients with bipolar disorder, to identify socio-demographic and clinical factors associated with it and to analyze the links between self-stigma and functioning in this population., Methods: We conducted a cross-sectional, descriptive and analytic study including 61 patients with bipolar disorder meeting criteria of remission. We used the internalized stigma of mental illness (ISMI) to investigate self-stigma, and the functioning assessment short test (FAST) to assess functioning., Results: The mean age of patients was 43.4 years. The sex ratio was 2.4. Half of the patients were single or divorced (50 %). They had secondary or university education in 69 % of cases and were professionally inactive in 59 % of cases. The socioeconomic level was low or medium in 92 % of cases. A personal judicial record was found in 16 % of patients, a suicide attempt in 41 % of cases. Most patients in our series had bipolar I disorder (92 %). The mean age at onset of the disease was 23.5 years, with a mean duration of disease progression of 20 years. Patients were hospitalized an average of 5.9 times. Most patients (90 %) exhibited psychotic features during their mood relapses. The mean duration of the last remission was 27.9 months. Patients had regular follow-ups at our consultations in 87 % of cases. Among the patients included in the study, 8 % were on long-acting neuroleptics. The mean score on the internalized stigma of mental illness was 2.36±0.56. More than half of our patients (59 %) were self-stigmatized. Discrimination and alienation were found in 51 % of cases, followed by resistance to stigmatization (43 %) and assimilation of stereotypes (41 %). Regarding functioning, a global impairment was noted in more than two thirds of patients (71 %). An alteration in professional functioning was found in 82 % of cases and in cognitive functioning in 69 % of cases. Disruption of the financial sphere concerned 43 % of the patients, and the relational sphere 41 % of them. Autonomy was altered in 41 % of patients. Analysis of the relationships between self-stigma and characteristics of the study population revealed statistically significant associations between higher self-stigma scores and single or divorced status, low socio-economic level and judicial record. In terms of clinical parameters, the mean self-stigma score was significantly associated with a higher total number of thymic episodes and hospitalizations, a longer cumulative duration of hospitalizations and a shorter duration of the last remission. In addition, the mean self-stigma score was associated with significantly more impaired functioning., Conclusions: Our study underlines the need to work towards the implementation of management modalities aimed at combating the self-stigmatization of patients with bipolar disorder and mitigating its negative consequences during the course of the disease., (Copyright © 2022 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Background: In recent years there is a growing interest in public beliefs about mental disorders. Numerous representative population-based studies have been conducted around the globe, also in European countries bordering on the Mediterranean Sea. However, relatively little is known about public beliefs in countries in Northern Africa., Objective: To fill this gap by comparing public beliefs about mental disorders in Tunisia and Germany, focusing on causal beliefs, help-seeking recommendations and treatment preferences., Methods: Representative national population-based surveys have been conducted in Tunisia in 2012 (N = 811) and in Germany in 2011 (N = 1852), using the same interview mode and the same fully structured interview starting with a vignette depicting a person suffering from either schizophrenia or depression., Results: In Tunisia, the public was more likely to adopt psychosocial and to reject biogenetic explanations than in Germany. Correspondingly, psychological treatments were more frequently recommended and biological ones more frequently advised against. There was also a strong inclination to share religious beliefs and to recommend seeking religious advice. Tunisians tended much more than Germans to hold moralistic views and to blame the afflicted person for his or her illness. In Tunisia, the public tended less to differentiate between schizophrenia and depression than in Germany., Conclusion: Marked differences between Tunisia and Germany exist in public beliefs about the causes of mental disorders and their treatment, which correspond to differences in cultural orientations prevailing in these countries. Mental health professionals need to be sensitive to the particular cultural context in which they operate, in order to be able to reach those they intend to care for., (© 2020 Angermeyer et al.)

Aim: Methadone is a long-acting opioid receptor agonist. It is prescribed to patients with opioid-related use disorders. The OPRM1 gene encodes for methadone's main receptor. It appears that polymorphisms in OPRM1 may affect the efficacy of methadone maintenance treatment (MMT)., Objective: Our purpose was to identify all relevant published papers dealing with the impact ofOPRM1's SNPs  on MMT's efficacy and to summarize results in order to evaluate the relevance of conducting pretherapeutic genotyping in opioid addicts prior to the onset of MMT., Methods: MEDLINE, PsychINFO and Scopus databases were systematically searched up to 1 January  2018 with no year restrictions using the following keyword combination (MMT) AND (mu or OPRM or mu opioid receptors or SNP or polymorphism or gene). Endpoint of the included studies had to be the impact of OPRM1 gene polymorphisms on the efficacy of MMT and/or methadone required doses during MMT. All abstracts were reviewed to assess papers' relevance. Studies conducted on animals and duplicate papers were excluded., Results: Our literature search identified 438 articles. Eight of them were included in our systematic review. The total number of included participants was equal to 2170, of whom 1718 underwent MMT. One study reported results of a randomized controlled trial. Three were designed as case-control studies and four as cross-sectional studies. rs1799971 (A118G) was the most studied allele. Results were divergent. Other SNPs might affect MMT's efficacy, however they were scarcely studied., Conclusion: Genotyping patients with opioid-related use disorders is a promising way to reach a better outcome in patients willing to be on MMT. Focusing on OPRM1 solely should be balanced since polymorphisms in other genes implicated in methadone pharmacodynamics and/or pharmacokinetics may conjunctly affect the efficacy of MMT. Recommendations cannot be enunciated for the moment.

Background: Evidence of the presence of an inflammatory syndrome in depressive disorders has aroused great interest among researchers but results were heterogeneous and almost all previous studies involved patients from Europe or North America. The objectives of the current study were to determine the prevalence of biological inflammatory syndrome among patients with depression in a Middle-Eastern/North-African population and to examine the associated sociodemographic and clinical factors., Methods: We conducted a cross-sectional descriptive and comparative study including 65 patients and 30 healthy controls. The patients had an untreated major depressive episode and no inflammatory medical conditions; they were recruited in the psychiatry outpatient clinic in Razi hospital - Tunisia over an eight-month period ranging from May to December 2012. We examined sociodemographic and clinical characteristics and both groups had an inflammatory balance including: high sensitive C-reactive protein, interleukin 6, serum protein electrophoresis, haptoglobin and orosomucoid. A standardized inflammatory protein profile for age and sex was performed., Results: High sensitive C-reactive protein levels did not differ significantly between patients with depression and controls. The assay results of Interleukin 6 in our study showed higher values in patients with depression than in controls (p=0.024). Albumin was found to be increased in patients with depression (p<0.001). The dosage of the alpha-1-globulin including the orosomucoid and of the alpha-2-globulin including haptoglobin, showed that patients with depression had higher values than controls (p<0.001). The inflammatory protein profile (which consists of a synthesis of three inflammatory proteins: high sensitive C-reactive protein, haptoglobin and orosomucoϊd) showed a trend towards higher levels of inflammation among patients with depression than among controls., Limitations: The relatively small number of subjects decreased the statistical power and the cross-sectional setting does not allow us to draw any conclusions about cause-to-effect relationships. Although we tried to exclude people with current infections, a small percentage of subjects may have had subclinical infections. The Body Mass Index, a parameter that might affect the levels of the investigated inflammatory markers, was not measured., Conclusion: The existence of inflammation in depression has been proven by the results of four meta-analyses and over a hundred studies. However, the generalization of this finding is yet to be confirmed. It seems more likely that inflammation concerns a subgroup of patients with depression. Studies targeting this particular subgroup could provide new therapeutic approaches., (Copyright © 2016 Elsevier B.V. All rights reserved.)

The goal of this study is to report on the treatment of obsessive-compulsive disorder (OCD), a chronic disabling condition that often presents during childhood and adolescence. Reports on adults using clonazepam for the treatment of OCD are more numerous than on children. Clonazepam as an augmentative treatment in OCD is still controversial. Our aim is to illustrate in a case report the efficacy of clonazepam as an augmentative treatment for severe childhood onset OCD. We report on the case of a young teenage girl with an extremely severe form of obsessive-compulsive disorder (score of 32 on the Children's Yale-Brown Obsessive Compulsive Scale), who, after a mild improvement with a combination of serotonin recapture inhibitors and second generation antipsychotics at high doses, has responded to clonazepam (3mg/day) augmentation of sertraline (200mg/day) and olanzapine (15mg/day). Clonazepam was effective not only in reducing anxiety symptoms, but also in lowering compulsions and obsessions frequency within 6 weeks with a drop in the Children's Yale-Brown Obsessive Compulsive Scale of 16 points. It may be asserted that clonazepam could be useful in the initial stage for severe OCD in young patients.

Theoretical Background: Interpersonal therapy (IPT) is a brief, structured psychotherapy initially intended to treat adult depression that was developed in the 1970s and manualized in 1984 by G. Klerman and his team. Two main theories served as a basis for its design: Bowlby's attachment theory and communication theory. Klerman theorized that tensions and problems in interpersonal relationships (i.e. disputes) cause psychological distress in vulnerable individuals that may lead to a major depressive episode. Clinical and epidemiological studies have shown that an insecure attachment style is strongly associated with lifetime depression. Severe depressive episodes have been correlated with avoidant attachment in women., Therapy Structure and Techniques: IPT is based on the hypothesis that recent or ongoing disturbances in interpersonal relationships either trigger or follow the onset of mood disorder. In practice, IPT assists patients in analysing their interpersonal relationship modes, correlating their relational states with their mood and in learning to use better communication. Resolving difficulties in interpersonal relationships through the use of better communication skills promotes the improvement of depressive symptoms. Klerman identified four interpersonal areas that seem to be highly correlated with depressive episodes: grief (a close and important personal relation who has died), interpersonal disputes (conflicts with significant people such as a spouse or another close family member), role transition (significant life changes such as retirement, parenthood or chronic and invalidating illness) and interpersonal deficits (patients who have limited social contacts and few interpersonal relations). Classically, IPT is planned around 12-16 weekly sessions. During the initial sessions, the therapist will explore all existing interpersonal relations and any significant dysfunctions, both recent and ongoing. Following this interview, the area the patient considers as driving the current depressive episode will be designated as the focus of therapy. Evaluation of depressive symptoms by a quantitative measure (i.e. Visual Analogue Scale) and qualitative measures (activity, pleasure, quality of life) reoccurs at each session. During the intermediate sessions, therapy uses current situations and events in the designated area that particularly affect the patient's mood. Coping, communication and decision-making skills are gradually improved through a number of techniques. These include non-directive and directive exploration, clarification, encouragement of affect, and communication analysis. The therapeutic relationship is empathetic and encouraging of all progress the patient makes. The final phases close the therapy and help the patient to plan future actions and improvements., Clinical Trials of Ipt and Developments: Several controlled clinical trials in adult populations have demonstrated the efficacy of IPT in treating Major Depressive Disorder (initial and recurrent episodes). It has been recommended as an appropriate treatment option in several guidelines. It can be provided in individual, couple or group formats. There remains an ongoing discussion of the efficacy of monthly maintenance sessions in recurrent depression. Since its conception, clinical trials have explored its use in specific populations such as adolescents and the elderly. IPT has also been the object of trial in other disorders such as post-partum depression, bipolar disorder, social phobia and eating disorders., Conclusion: This article reviews the basic principles and objectives of this therapeutic model. Theoretical concepts and results from research are also discussed. The approach is briefly described and the various therapeutic phases are discussed. Clinical trials have shown that IPT is effective in treating major depressive disorder in a wide variety of populations. Further trials are necessary to determine its efficacy in other psychiatric disorders., (Copyright © 2014 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Background: During the Tunisian Revolution, the constant threat of death and the feeling of insecurity brought about psychological reactions that tended to be excessive in some individuals, thus leading to genuine psychiatric disorders., Objectives: This study aimed to outline the different psychiatric disorders which occurred following the Tunisian Revolution and to determine the social, demographic and clinical features associated with these disorders., Method: A cross-sectional study was undertaken. We included all patients who first presented at the outpatient clinic at Razi hospital with psychiatric symptoms attributed to the Tunisian Revolution between 15 January 2011 and 15 October 2011. We used a form detailing social, demographic and clinical characteristics. Diagnoses were made on the basis of the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision (DSM-IV-TR) criteria., Results: Our population consisted of 107 subjects: 28 women (26.2%) and 79 men (73.8%), with a mean age of 40 ± 12. The majority (66.4%) were married. Most (57.9%) patients had a secondary education level. Agents of order represented the largest occupational group accounting for 36.4% of the population. The most prevalent psychiatric disorders included major depressive disorder (30.8%), adjustment disorder (30.8%) and post-traumatic stress disorder (27.1%)., Conclusion: This study emphasizes the diversity of psychiatric disorders that can occur following a man-made disaster.

Background: Efavirenz is one of the most prescribed HIV drugs, it can have number of psychiatric adverse effects varying from sleeping disorders to psychotic symptoms., Aim: Through a case-report study we tried to evaluate the imputability of an acute psychosis to Efavirenz., Case: Mr. B is 25-year-old, he had hemophilia A, he has been infected by HIV and HVC during one of the transfusion sessions. He'd had Combined therapy, component of Epivir, Zerit and Efavirenz. Three months after Efavirenz's prescription he presented a schizophreniform disorder according to DSM IV criteria. The onset of psychotic manifestations, 3 months after prescription is not in favor of drug's etiology. Neuropsychiatric side effects generally appear rapidly after the first dose and usually decrease during the first four months. Psychotic disorders are generally rare. However those side effects have been reported 03 years after drug introduction., Conclusion: Such information has an impact on drug prescription. In fact, efavirenz had been stopped, although the improvement of CD4 and the difficulty to prove the imputability of psychotic syndrome to efavirenz.

Background: In all the communities, parallel forms of healing continue to be practised by the population in addition to the services offered by the "modern" psychiatry., Aim: The aim is to examine the current state of the traditional therapy in Tunisia and to try to deal with its scope, profile and determinants surveying the population of mentally ill patients., Methods: It is about a specific study carried out on 100 consecutive patients having consulted the service of psychiatry "C" of Hospital "RAZI" in Tunis. All the patients having an intellectual deficiency were excluded. We proceeded by a semi-open questionnaire in dialectical Arabic., Results: 90 patients, composed of 38 women (42.2%) and 52 men (57.8%) at the age of 37.8 years in average, were kept in our study. 50% of our patients had recourse to the traditional therapy, 70% of whom before consulting a psychiatrist. This behaviour was not influenced by the age, the profession and the educational level. In 75% of the cases, it was chosen under the effect of the opinion of a member of the family. 1/3 of the patients having had consulted a traditional therapist have improved after his intervention. These are the patients who were convinced of the diagnosis identified by the traditional therapist. The therapeutic observance and the adherence to the modern psychiatry were not influenced by the recourse to the traditional therapy., Conclusion: At the end of this research, we conclude that in Tunisia the recourse to the traditional therapy still persists and continues to perform its function. It makes us think about the necessity to accept its place in the devices for treatment of the mentally ill patients and why not to collaborate with it.

Purpose: The goal of the study was to assess the health-related quality of life (HRQOL) of persons with epilepsy (PWE) by using the short form survey 36 (SF-36), to compare it with that of a control group and to detect factors influencing it., Methods: We collected clinical and demographic data and information on health status by using the Arabic translation of the SF-36 questionnaire from two groups: (a) 120 PWE consulting our outpatient clinic during a period of 4 months, and (b) 110 Tunisian citizens, representative of the Tunisian general population, as a control group., Results: The mean age of PWE group was 32.74 years, and 45.5% were men. Idiopathic generalized epilepsies were observed in 44.5% of cases, and symptomatic partial epilepsies, in 30%. The most commonly prescribed drug was sodium valproate (VPA). For the SF-36, PWE had lower scores than the control group for only three subscales: general health perception, mental health, and social functioning. Seizure frequency, time since last seizure, and the antiepileptic drug (AED) side effects were the most important variables influencing the HRQOL among PWE. Seizure-free adults have HRQOL levels comparable to those of the control group. Sociodemographic variables had no influence on the SF-36 subscales., Conclusions: HRQOL is impaired in Tunisian PWE. The influencing factors identified in this study differ from the previously published data. Several possible reasons such as family support and cultural and religious beliefs are proposed to explain these cross-cultural differences. A larger study should be conducted to verify such findings., (Copyright 2004 International League Against Epilepsy)

In Arab and Islamic countries, domestic violence is not yet considered a major concern despite its increasing frequency and serious consequences. Surveys in Egypt, Palestine, Israel and Tunisia show that at least one out of three women is beaten by her husband. The indifference to this type of violence stems from attitudes that domestic violence is a private matter and, usually, a justifiable response to misbehaviour on the part of the wife. Selective excerpts from the Koran are used to prove that men who beat their wives are following God's commandments. These religious justifications, plus the importance of preserving the honour of the family, lead abusers, victims, police and health care professionals to join in a conspiracy of silence rather than disclosing these offences. However, a fair reading of the Koran shows that wife abuse, like genital mutilation and "honour killings" are a result of culture rather than religion.