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Introduction The direct and indirect effects of the COVID-19 pandemic on the mental health of the population have become a concern in the field of research in psychiatry. First psychotic episodes following infection with SARS cov2 have been reported. Objectives Through a clinical case, we will illustrate the association of psychiatric symptoms with SARS cov2 infection. Methods We discussed , through a clinical case, the association of psychiatric symptoms with infection by the coronavirus 19. Results L.R, Tunisian 52-year-old, diabetic (type 2) women, with no personal or family psychiatric history and no toxic habits. she did not receive receive covid 19 vaccination. Twenty days before her admission to the psychiatry departement, she had fever, cough, myalgia, and anosmia .The diagnosis of a SARS COv2 infection was retained by her general practitioner. Two weeks later she suddenly presented a persecutory delirium, distressing auditory hallucinations, and attempted rat poison suicide. On admission, The patient had a delirium of persecution towards her entourage and an auditory hallucinatory syndrome with distressing content. She was put on 1 mg of Risperidone with restitution ad integrum after 7 days. COVID-19 serology test detected IgM antibodies which allowed us to conclude that the symptomatology was related to the infection by this virus. For the etiological research, we performed a serology that confirmed the recent exposure to SARS COV2 and. The diagnosis retained is a brief psychotic disorder post-Sars Cov2. Conclusions The advanced hypothesis that infection with SARS CoV-2 could be the cause of the psychiatric manifestations remains unclear to this day. Disclosure No significant relationships. more...

Introduction Patients treated for chronic mental disorders and who receive atypical antipsychotics are in most cases at risk of gaining weight, the excess of which is complicated in the long term by metabolic syndrome (MS). The management of these patients is effective if it includes Therapeutic Education. Objectives Describe the therapeutic education program developed for patients on antipsychotics who have metabolic syndrome Methods In this work, we present the educational program that we have developed for patients undergoing psychiatric treatment with atypical antipsychotics, who have been stabilized for at least 3 months and who suffer from SM. Results It is a program that starts with the inclusion consultation and educational diagnosis with the first step of clinical (weight, abdominal perimeter and BMI), biological (blood sugar, HbA1C, cholesterol, HDL, triglycerides) and psychometric (SF12, MAQR, food and physical activity diary) assessments. Our initial program includes 6 sessions and 2 maintenance sessions at 1 month and 3 months after the 6th session. The objectives were divided between information about DM, motivation to eat a balanced diet, physical activity and improvement of quality of life. We also included stress management and positive psychology activities. Assessments are repeated at the end of the initial program and at the last maintenance session. Conclusions Our program was developed according to the Geneva therapeutic education recommendations. We plan to apply it to groups of patients in our department Disclosure No significant relationships. more...

Introduction Clozapine is widely known as the drug of choice in treating refractory schizophrenia. However, clozapine prescription requires close clinical and biological monitoring to prevent harmful side effects like agranulocytosis, neutropenia and myocarditis. Objectives To show the benefits of lithium carbonate in the clozapine rechallenge of a patient with neutropenia under clozapine. Methods We present the clinical case of a patient who developed neutropenia under clozapine, we rechallenged with clozapine after lithium treatment to stimulate hematopoietic functions. Results A 42-year-old man diagnosed with refractory schizophrenia, under clozapine for 11 years with a good clinical response at a dosage of 500mg per day (clozapine serum level 328ng/ml), developed a neutropenia (BCC at 840/mm3) within an interval of 2 months. Clozapine treatment was suspended and the patient presented a severe psychotic relapse requiring hospitalization. During hospitalization the patient remained symptomatic under haloperidol 15mg daily. At week 3 of clozapine cessation, neutrophil count reached 1510/mm3. After week 4 we introduced lithium carbonate and while reaching 500mg per day we observed an increase in the neutrophil count to 4850/mm3. We rechallenged with clozapine at week 12 after a poor clinical response, with incremental dosage to 150mg per day in 17 weeks. The blood cell count did not show any abnormalities and the patient had a good clinical response up to 11 months after the clozapine rechallenge. Conclusions Despite the lack of guidelines assessing clozapine rechallenge after neutropenia, the use of lithium carbonate may be considered to stimulate hematopoietic functions. Disclosure No significant relationships. more...

Introduction The covid-19 pandemic is a difficult global phenomenon that causes a lot of anxiety and uncertainty. This situation has involved reactions of fear. Healthcare professionals are necessarily in contact with patients, but may find themselves torn between the duty to care and the duty to protect themselves and their relatives. Objectives To assess perceived stress among medical residents in Tunisia Methods We conducted a descriptive study among a representative sample of residents working at a teaching hospital in Tunis during the first half of 2021 in different departments. We prepared a questionnaire for the study divided in two parts: socio-demographic data; professional data (function, practice setting); data related to contact with covid-19 patients ; questions on fear of covid-19 contamination and the Perceived stress scale (10items) Results Our sample consists of 100 residents in 10 different specialties, including 70 in services with direct contact with Covid-19 patients. Stress management is rated good for 30 residents, average for 40 residents and poor for 30 residents. This management depends on the number of guards, the number of patients examined, the technical platform available and especially the period of the pandemic. Conclusions Medical residents are in the front line in university hospitals in tunisia. The stress to which they are subjected depends on the working conditions and coping skills of each of them. Disclosure No significant relationships. more...

Introduction Suicide is a dramatic suicidality complication and a significant worldwild public health problem. Sixty percent of suicidal deaths are preceded by at least one suicide attempt. Objectives to search and estimate the factors predicting a suicidal recidivism Methods We conducted a retrospective descriptive survey, achieved in psychiatric departement A of Razi hospital on 60 patients hospitalized during a period of 10 years (from January 2010 to December 2019) and have committed at least a suicide attempt. Data collected from medical folders in order to explore sociodemographic and clinical characteristics of the patients. Results The mean age of the sample was 30 years. A high prevalence of female was objectified. There were a low level of education for 53%, most of patients (55%) were unemployed and came from urban area. Among our patients, 39% attempted suicide for a one time. 61% of patients attempted suicide for several times. The main risk factors related to recidivism of suicidal behavior were unemployment, family history of psychiatric disorders and family instability. Conclusions The analysis of these results justifies preventive actions in order to face the increase of suicidal recidivism by searching for these associated factors. Therefore, a multidisciplinary intervention approach is required. Disclosure No significant relationships. more...

Introduction Much has been learned about SARS-CoV-2. However, the mechanism of short or long-term neuropsychiatric symptoms remains unclear. several hypotheses, including lack of oxygen caused by lung damage, inflammation affecting brain cells, or Lack of blood flow caused by swelling of the small blood vessels in the brain, have been advanced to explain these symptoms. Objectives Herein, we presented a case of cognitive impairment diagnosed after infection with COVID 19. Methods We discussed, through a clinical case, the possible mechanisms and risk factors of cognitive impairment following COVID 19 infection. Results This case concerned a 28 –year-old patient. He had no personal or family psychiatric. In August 2021, he presented a SARS-CoV-2 infection without hypoxemia or respiratory failure. On day 10 the patient recovered. Two days after, he consulted our psychiatric department as he experienced impairment in memory. He had impairment in attention and executive function, and in particular verbal fluency. He said that his thinking was sluggish, fuzzy, and not sharp. He denied any alcohol or drug abuse. He was euthymic and he had no depressive symptoms. Arterial blood gas, laboratory, and clinical findings were normal. A brain CT scan with contrast was performed and did not show any abnormality. Conclusions This case highlighted the possible cognitive consequences of COVID-19 during the recovery phase. Further work is required to identify risk factors of psychiatric symptoms following COVID-19 infection and their management. Disclosure No significant relationships. more...

Introduction The complexity of the feeling of satisfaction makes its measurement complex, in this context our work aims to develop a simple and practical measurement tool to identify problems within the processes of psychiatric care in order to provide corrective interventions. Objectives to validate the psychometric properties of a scale designed for us to assess patients’ satisfaction with the quality of psychiatric care received. Methods This is a validation study conducted on a sample of 200 patients followed at RAZI Hospital in Tunisia, outside any period of hospitalization. The questionnaire consisted of 28 items and was structured around eight dimensions (the patient’s perception of his or her own mental disorder, the quality of the doctor-patient relationship, the quality of the nursing team-patient relationship, the organisational aspect and conditions of the hospital ward, the therapeutic discharge planning, the respect of human rights, and the quality of the patient’s health, The organisational aspect and conditions of the hospital ward, Therapeutic discharge planning, Respect for patients’ human rights, Satisfaction with overall care and Loyalty. Results Both face validity and content validity were satisfactory. Internal consistency was sufficient with a Cronbach’s alpha of 0.913. The inter-dimensional correlation reflected statistically significant and logical correlations within our scale. Temporal stability was satisfactory. An exploratory factor analysis revealed seven factors with a Kaiser-Meyer-Olkin score of 0.852. Conclusions Our scale has demonstrated good psychometric properties. It can be reliably used as a measure of the satisfaction of Tunisian patients with the psychiatric care received. Disclosure No significant relationships. more...

Introduction A delusion of pregnancy is defined as a fixed false belief that one is pregnant in the absence of any evidence to support the pregnant state. Different mechanisms have been advanced to explain this phenomenon. Objectives Herein, we present a case of hyperprolactinemia with delusion of pregnancy during the use of Amisulpride. Methods Herein, we present a case of hyperprolactinemia with delusion of pregnancy during the use of Amisulpride. Results This case concerns a 39-year-old, divorced Tunisian woman with the diagnosis of schizoaffective disorder,She has never been pregnant. She was taking Amisulpride at the dose of 400 mg per day with 100mg of Haldol Decanoate. In June 2021, she was admitted to our department as she expressed the thought that she was pregnant. No other psychotic symptoms were reported. There was no history of alcohol or illicit drug use. The physical examination was normal. The blood pregnancy test was negative. A measure of serum prolactin was performed and revealed a high prolactin level at 700 ng/ml. Amisulpride was discontinued. We then recorded the serum prolactin level at one month and then at three months after we stopped Amisulpride. We found that as her prolactin levels decreased her complaint of pregnancy also diminished. Actually, the patient has a normal level of prolactin and has no pregnancy delusion. Conclusions Clinicians should be aware that delusion of pregnancy in psychotic patients may be caused by side effects of the treatment. Monitoring of serum prolactin levels in patients under Amisulpride may help to improve the management of these patients. Disclosure No significant relationships. more...

Introduction The era of the paternalisation of the patient is over, gradually giving way to new models, in particular that of “shared medical decision making”, with the aim of responding to the growing desires of the patient and giving priority to his autonomy. Objectives to establish the influence of the new active position of the patient in the therapeutic process on the satisfaction of the psychiatric patient. Methods This is a descriptive cross-sectional study that took place over a period of 5 months from April 2019 to August 2019 in two university hospital psychiatry departments of Razi Hospital in Tunisia . The questionnaire was administered outside any period of hospitalisation, in order to increase the reliability of responses. We used a pre-established form including socio-demographic data, clinical data concerning the patient’s mental disorder followed by a patient satisfaction questionnaire regarding the quality of care received in a psychiatric setting. Results The patients interviewed in our study reported a good level of satisfaction (67.5%) with their involvement in the therapeutic process. However, 45.5% of the patients expressed dissatisfaction with the information provided to them by their doctor about their mental health status. The majority of the subjects surveyed expressed satisfaction with the quality of the interviews conducted during hospitalisation (71%) and with the time spent with the doctor (67%). Conclusions Despite the fact that providing information to patients with mental health problems is a key element of patient satisfaction, not enough doctors actually include it in their daily practice. Disclosure No significant relationships. more...

Introduction Approximately 30% of individuals diagnosed with schizophrenia suffer from treatment-resistant or refractory schizophrenia. The gold standard for treatment is clozapine. However, a significant number of patients discontinue clozapine treatment and this carries a poor prognosis. Objectives This study explores patients’ motives for cessation of clozapine therapy and its prevalence. Methods A longitudinal, retrospective and descriptive study on a period of 20 years, at the psychiatry department A of the Razi hospital in Tunisia. Data was collected from the medical files of patients trated by clozapine using a pre-established sheet. Results The studied sample included 64 patient records. Treatment with clozapine was stopped spontaneously or following a medical decision in 37 patients (57.8%). The total number of clozapine stops in these 37 patients was 70. Indeed, each one of these patients had stopped treatment at least once. Clozapine was discontinued by some patients in the study sample for poor compliance(45.9%), for adverse side effects of treatment (16.2%) and by treating physicians for poor response treatment (8.1%). Clozapine was discontinued by 11 patients for hematological adverse reactions, representing 27.9% of the total number of clozapine discontinuations. Withdrawal of clozapine was indicated in 2 cases of agranulocytosis(18.2%), in 2 cases of moderate neutropenia(18.2%), in 3 cases of eosinophilia (27.2%), in 3 cases of thrombocytopenia (27.2%) and in 1 case of severe anemia (9.2%). Conclusions Clozapine discontinuation was essentially caused by poor patients’ observation and hematological adverse reactions appearance.Future research should seek to further investigate clozapine cessation factors in order to better benefit from the medical virtues of this molecule. Disclosure No significant relationships. more...

Introduction COVID19 pandemic had an important emotional and psychological impact due to the higher rates of boredom, fear, stress, anxiety, depression, etc. (Brooks et al., 2020). Cases of suicide during the COVID-19 pandemic are increasingly reported. According to an Indian study, the main cause of suicide was fear or anticipation of COVID-19 infection. Objectives To illustrate a case of suicide attempt after COVID-19 infection. Methods We report the case of a Tunisian man who did a suicide attempt after his infection with the coronavirus. Results A 35-year-old Tunisian man, married, an official, with no medical or psychiatric history who was admitted in the Oto-rhino-laryngology department, after a suicide attempt by strangulation, five days after the diagnosis of COVID-19 infection. In fact, the patient was very stressed about his infection and feared transmitting the virus to his family. During his quarantine, he became anxious, had insomnia and suicidal thoughts. He was isolated in his room, and prohibit his family to approach his room. He told us that he could not support this anxiety and he decided to suicide to end this situation and save his family. Conclusions The COVID-19 pandemic may increase suicide rates. Psychological consequences of this pandemic including suicide may continue to incur later than this actual worldwide crisis. Mental health promotion is the key to prevent and mitigate such mental health consequences. Disclosure No significant relationships. more...

Introduction Clozapine use is not deprived of serious complications that can condition treatment strategies, particularly hematological. Recognizing the time it takes for these effects to set, can therefore help to better screen their appearance, improving healthcare. Objectives To study the time of onset of hematological adverse reactions in patients treated with Clozapine. Methods A longitudinal, retrospective and descriptive study on a period of 20 years starting from the first of January 2000, at the psychiatry department A of the Razi hospital in Tunisia. This study was conducted on patients treated by Clozapine. The data was collected from patients’ medical files using a pre-established sheet. Results The studied sample included 64 patient. Hematological disorders were found in 21 patients (32.8%). The mean time of onset of hematological adverse reactions was 119.71±126.56 days. Indeed, some patients had presented more than one hematological disorder and this at different times. Mild to moderate neutropenia had a mean time of onset of 502.57±908.32 days. The time of onset of eosinophilia was 937.75±1725.87 days, 297.67 ± 444.93 days for thrombocytopenia, 741±1268.85 days for leukopenia, 69.25 ± 48.19 days for hyperleukocytosis and 183. 33±231.80 days for anemia. Two cases of agranulocytosis were noted: one case occurred 10 years and three months from treatment beginning and the second case occurred after 7 months of treatment onset. Conclusions The time of onset of hematological side effects with clozapine varies widely and cannot be predicted with precision. Early, more frequent and regular surveillance is therefore necessary in this population. Disclosure No significant relationships. more...

Introduction Mixed states in mood disorders present significant clinical and prognostic challenges. Although the DSM-5 has broadened diagnostic criteria for mixed states with the development of the ‘mixed features’ specifier and its application to unipolar depressive disorders, some mixed episodes might still be overlooked. Objectives to evaluate the frequency and the factors associated with mixed depression according to the broader Koukopoulos criteria in a sample of patients with a major depressive episode Methods We included 99 consecutive patients presenting for a major depressive episode of bipolar (n=10) or unipolar major depressive (n=89) disorder at our outpatient clinic. Major depression was ascertained using SCID- IV criteria, and mixed features were determined using Koukopoulos’ diagnostic criteria Results Mean age of the sample was 35.5 years [14-58]. Women accounted for 63.6% of patients. Mixed features were found in 19.5% (n=19) of the sample, 80% (n=8) among patients with bipolar disorders (BD) and 12.3% (n=11) among those with major depressive disorder (MDD). Individuals with mixed features had more substance abuse (p=0.005) and more suicide attempts (p=0.01). Individuals receiving antipsychotics had a lower risk of mixed features (p=0.000) while antidepressant treatment did not have any affect. A family history of BD, psychosis, suicide and substance abuse were found in these patients. Mixed features in depression were more frequent in patients with BD than in MDD. Conclusions Our study showed a high frequency of mixed features in depression, especially bipolar depression when Koukopoulos criteria are applied. Special attention should be given to these patients given the association with substance use and suicidality Disclosure No significant relationships. more...

Introduction Clozapine is highly effective in patients with treatment-resistant schizophrenia but, to ensure optimal clinical response it is important to optimize its use and this depends on adequate pharmacological monitoring. Objectives Evaluate the therapeutic response rate according to clozapine plasma concentration. Methods It was a cross-sectional, retrospective and analytical study, carried out over a period of six months, in the F and A psychiatry departments of the Razi hospital in Tunis, including patients followed for treatment-resistant schizophrenia and receiving clozapine. We evaluated the response to clozapine using the Brief Psychiatric Rating Scale (BPRS). Results The average age was 37.7 ± 9.4. The mean age of introduction of clozapine was 31 years and the mean time to its introduction was 9.3 years. Clozapine was administered as a single drug in 85% of cases. The mean dose of clozapine was 373 mg/day. The mean of clozapine plasma concentration was 386.5 ng/ml with a minimum of 89 ng/ml and a maximum of 913 ng/ml. The clinical response rate to clozapine was 25% with a BPRS good response threshold value of less than 35. Patients with clozapine levels above the conventional cut-off of 350 ng/ml (n=34) had a response rate of 34.6%. A response rate of 37% was observed in the group of patients with a clozapine plasma concentration interval of 200-350 ng/ml. There was no statistically significant difference in therapeutic response (p=0186) Conclusions Our study revealed a therapeutic response variation according to plasma clozapine concentration and showed the existence of a non-negligible and effective response rate. Disclosure No significant relationships. more...

Introduction Schizophrenia (SCZ) is a severe mental disorder that is among the leading causes of disability worldwide. Multiple sclerosis (MS) is a chronic inflammatory neurological disease with a major impact on the quality of life of young adults. Despite the distinct nature of these two disorders, research studies have identified similarities in underlying pathological mechanisms and risk factors. Objectives To illustrate, through a case report, the central role of inflammation in schizophrenia and its relationship with multiple sclerosis. Methods Case Report of a 31-year-old male patient with schizophrenia who has been diagnosed with multiple sclerosis. Results Mr M. is a 31 year old patient who was diagnosed with schizophrenia at age 17. Between the ages of 25 and 27, the patient had two severe psychotic relapses each one requiring inpatient treatment. At that time, he experienced predominantly severe positive symptoms and persistent suicidality. He was initially prescribed amisulpride up to 600mg, followed by haloperidol up to 45mg daily. Due to poor clinical response, the patient was put on clozapine 400mg/d and has been stabilized since 2017, with outpatient checkups. The patient has reported vertigo and trouble walking in August 2021. He has been referred to the Neurology Department. Clinical, biological and imaging findings were highly suggestive of Multiple sclerosis and the patient has received short courses of intravenous corticosteroids. Conclusions This case report highlights the possible association between Multiple Sclerosis and schizophrenia. Further research is needed to clarify the role of inflammation in the central nervous system in schizophrenia and the overlap with Multiple Sclerosis. Disclosure No significant relationships. more...

Introduction Somnambulism or sleepwalking could be explained by dysfunction in the regulation of slow-wave sleep. It may be caused by drugs; in the literature, cases of somnambulism that occurred by olanzapine and lithium have been reported. Objectives Discuss the association between somnambulism and Hydroxyzine. Methods We will discuss the case of a patient with bipolar disorder treated with olanzapine and lithium who experienced episodes of somnambulism after adding Hydroxyzine. Results A 42-year-old woman, with no history of somnambulism, followed in our department for a bipolar disorder type 1, treated with 750 mg of lithium and 20 mg of olanzapine. During her usual control, she reported insomnia Hydroxyzine was added at the dose of 50 mg. At the next medical appointment, she said that her husband had noticed that she waked up at night and she eats, she ambulates and searches things. Episodes that the patient did not remember. She was tranferd to the neurolgic departement. She did a neurological exam, an electroencephalogram, and a brain scan, witch were normal. The polysomnography confirmed the diagnosis. The neurologist retained the diagnosis of somnambulism induced by Hdroxizine regarding the chronology of the symptoms. The somnambulism ceased after stopping Hydroxyzine. Conclusions Lithium and olanzapine were associated with the occur of somnambulism, but hydroxyzine had never been reported as a somnambulism drug inducing. Drug interaction may explain this phenomenon. Disclosure No significant relationships. more...

Introduction Suicidal behavior remains an important clinical problem and a major cause of death in youth. Objectives The purpose of this study was to describe the epidemiological and clinical profile of adolescents with suicide attempts. Methods This is a retrospective descriptive study that focused on a population of Tunisian adolescents aged between 10 and 19 years old and who were hospitalized after a suicide attempt between between January, 1st 2010 and November,15th 2018, in Razi Hospital. We used a pre-established questionnaire that explored the sociodemographic and clinical data of patients. Results Sixty adolescents were included in this study. The average age of the respondents was 14.3±2 years. The sex-ratio (m/f ) was 0, 36. The suicidal adolescent was a female (73%), single (98%), enrolled in school (66%) with school failure history (52%). Family history of suicide was reported in 8%. Fifty adolescents (83%) lived with their parents and the relationship with them was described as disturbed in 60% of them. A history of physical and sexual abuse was reported in 25% during first adolescence and 15% during second adolescence. The most frequent diagnoses were adjustment disorder with depressed mood (45%) and depression (28%). Drug ingestion was the most common mean of suicide (63%), in an impulsive way in 82% of cases. Conclusions Development of repeated epidemiological surveys makes it possible to better understand the prevalence of suicide attempts in adolescents and to implement suicide prevention programs. Disclosure No significant relationships. more...

Introduction Clozapine is commonly associated with hematological side effects. However, little research is available on the impact of adding other psychotropic medication on inducing blood dyscrasias. Objectives The aim of the study was to explore the impact of associating psychotropic medication to clozapine in producing hematological abnormalities. Methods Our study was a longitudinal, retrospective chart review of adult psychiatric patients receiving clozapine treatment at our clozapine consultation between January 2000 and September 2020. Results Our sample consisted of 15 women (23.5%) and 49 men (76.5%), mean age was 41.34 ±9.32 years. Polypharmacy was found in 70.3% of the cases. Association of clozapine to other psychotropic agents was found in 67.2% of the cases. Most prescribed add-on medication was valproic acid in 27 cases, benzodiazepines in 21 cases, promethazine and hydroxyzine in 16 cases, lithium in 8 cases and haloperidol in 6 cases. We found blood dyscrasias in 21 patients (32.8%). Hematological abnormalities were as follow: 2 cases of agranulocytosis, 8 cases of neutropenia, 13 cases of thrombocytopenia, 5 cases of leukocytosis, 5 cases of eosinophilia and 3 cases of anemia. In our sample we did not find a significant association between psychotropic polypharmacy and blood dyscrasias. Conclusions Many psychiatric patients on clozapine require polypharmacy to better stabilize their condition. Such co prescriptions may carry the risk of inducing more side effects especially blood dyscrasias. In our study, we did not find a significant association between psychotropic medication added to clozapine and hematological abnormalities. But further research is warranted to better explore this association. Disclosure No significant relationships. more...

Introduction Treatment adherence, is defined as “the extent to which a person’s behavior — taking medication, following a diet, and/or executing lifestyle changes — corresponds with the agreed recommendations from a healthcare provider.” The course of patients with mental health is habitually chronic and based on an indefinite continuation of treatment to sustain remission and prevent relapses. Treatment adherence issues are the main obstacles in the management of these patients Objectives The aim of the present study was to evaluate treatment adherence in patients with mental health and the demogrphic and clinical factors associated with it. Methods It was a cross-sectional study conduced at the department of Psychiatry A at Razi Hospital.The validated arabic version of Morisky-Green test was used to assess medication adherence. The patients were considered as adherent if they answered ‘No ’ to all questions Results 60 patients were included, with a sex ratio M / F of 0.47. Patients were treated for bipolar disorder type1 in 45% of cases, schizophrenia in 28.3% of cases, schizoaffective disorder in 10% of cases and depressive disorder in 6.7% of cases. 50% of included patients had Moderate level of adherence, 35% were considered as non- adherent and only 13.3% had high adherence. The reported reasons for treatment discontinuation were insight (50%), financial problems (26.9%), side effects (15.4%) and unavailability of drugs (7.7%). The Morisky-Green test score were not correlated neither to the nature of the psychiatric disorder nor to multiple medication. Conclusions We found a high proportion of nonadherence in patients with mental illness. Disclosure No significant relationships. more...

Introduction Suicide attempts in late adolescence deserves special attention. Identifying particularities of suicidal behavior in this age group seems important in order to detect suicidal ideations. Objectives Describe the characteristics of suicide attempts in late adolescence among hospitalized patients. Methods This is a retrospective descriptive study that was conducted in our psychiatry department in Razi Hospital, Tunisia. It focused on a population of Tunisian adolescents aged between 15 and 19 years old and who were hospitalized after a suicide attempt between January, 1st 2010 and November,15th 2018.We used a pre-established questionnaire that explored the sociodemographic and clinical data of patients. Results Thirty adolescents were included. Twenty-three of them (77%) were female. Mean age of suicidal adolescents was 16.5 years. They were mostly living with their families (80%). Intentional drug ingestion was reported in 56% of cases. Half of the adolescents were indifferent regard the suicide attempt. Conflictual family environment was reported to be a triggering factor of the suicidal thoughts in 60% of cases, and romantic breakup in 20% of cases. In fact, these adolescents were diagnosed with adjustment disorder with depressed mood in 47% of them and depression (28%).Adolescent suicide attempts were correlated with a conflictual family environment (p=0.04) and the presence of academic difficulties (p Conclusions Family dysfunction and conflictual environment are predictors of suicide risk in the late adolescence. Prevention strategies should be reviewed and focus more on these factors. Disclosure No significant relationships. more...