Search

Introduction There are several arguments supporting the inflammatory hypothesis in schizophrenia (SCZ). Among the inflammatory markers, beta-2- microglobulin (β2M) is associated with abnormalities in neurogenesis and cognitive impairment described in (SCZ). Objectives The objectives of our study were to evaluate the level of β2M in a group of patients compared with a control group and to investigate the sociodemographic, clinical, and environmental factors associated with elevated β2M levels Methods We conducted a cross-sectional in outpatients with SCZ. We collected patients sociodemographic, environmental, and clinical data. We assessed psychopathology with the PANSS. We measured serum β2M concentration. Results We included 30 patients with SCZ compared with 20 controls. Patients mean age was 40,23±10,66. The mean level of β2M was 1,98 ± 0.42 mg/L for patients and 1.65±0.56 mg/L for control group. The difference was significant between the patient group and the control group (p

Introduction Defined by the World Health Organization (WHO) as the inability to conceive after a year of unprotected sexual intercourse, infertility remains a current and compelling topic of interest for both scientists and the general public. Over the past few decades, the prevalence of infertility, regardless of its cause, has significantly increased. Furthermore, it affects approximatively 15% of tunisian couples. However, previous studies have primarily assessed the psychological impact on women, leaving a gap in understanding gender differences. Objectives Our study aims to compare the psychological impact of infertility between genders in a Tunisian sample. Methods We conducted a cross-sectional study in a public hospital specializing in Assisted Reproductive Technology (ART) from August 30th to December 1st, 2022, involving sexually active infertile couples who had been under observation for at least one year. The participants provided information related to socio-demographic data. Additionally, we used the Hospital Anxiety Depression Scale (HADS) to assess anxiety and depression, and the Fertility Quality of Life (FertiQol) questionnaire to evaluate the quality of life. These questionnaires were administered in the Tunisian dialect. Results A sample of 60 infertile couples were recruited to this study. Primary infertility was present in 97% of cases and male infertility was the most common cause, accounting for 35%. Our findings revealed that women experienced higher rates of depression (35%) and anxiety (52%) compared to men (15% and 28%), with a statistically significant difference (p ≤ 0.001). Furthermore, women reported a significantly compromised overall quality of life, particularly in the context of treatment-related aspects (p=0.03). Notably, anxiety was identified as a significant risk factor for reduced quality of life among women (B = -5.27). In contrast, lower socioeconomic status was associated with diminished overall quality of life in men (B = -7.09). Conclusions It is important to consider gender differences in the management of infertility in order to guide and target psychological interventions and to improve the quality of life of infertile couples. Disclosure of Interest None Declared

Introduction Self-esteem entails evaluating oneself positively and often involves the need to be special and above average without comparisons with others. It could play a role in many areas of the patient’s life. Objectives The aim of the present study was to find the prevalence of self-esteem and investigate the associations between self-esteem and treatment adherence in patients with schizophrenia spectrum disorders. Methods This study involved outpatients with schizophrenia spectrum disorders ,according to (DSM-V) diagnostic criteria, attending the Department of Psychiatry A, Razi hospital between august and September 30, 2023. The level of self-esteem was measured with Rosenberg’s Self-Esteem Rating scale (SERS) and treatment adherence with the Medical Adherence Rating Scale (MARS).Socio-demographic characteristics were also collected. Results Thirty stabilized outpatients with schizophrenia (n=18), schizoaffective disorder (n=11), brief psychotic disorder (n=1) were included in the study. The mean (SD) age of the respondents was 43.2years; the mean number of Hospital admissions was 4.7.Almost two thirds of this population (63.33% ) had low self-esteem and 36.67 % had high self-esteem. The level of self-esteem did not differ between diagnostic categories. Self-esteem also positively correlated with higher education and negatively with an increased number of hospitalizations. However, no significant association was found between socio-demographic variables and self-esteem. Adherence was further negatively correlated with age and age of onset of disorders. Patients suffering from schizophrenia had the lowest adherence to treatment.The results of the present preliminary study suggest a positive correlation between the SERS total scores and the MARS scores. It was found that higher levels of self- esteem are related with higher levels of treatment adherence and lower levels of self- esteem are associated with discontinuation of medications without a psychiatrist’s recommendation. This connection was present in all diagnostic groups. Conclusions This study shows positive relationship between self-esteem and treatment adherence. Further studies are needed to investigate whether self-esteem is a factor positively influencing adherence to treatment and show if self-esteem training programs like standard psychoeducation and cognitive behavioral therapy could be beneficial to improve treatment adherence among psychiatric patients. Disclosure of Interest None Declared

Introduction Given the recurrence of mood episodes, with their negative repercussions such as high suicidal risk, significant cognitive decline and the persistence of residual signs with a negative impact on the patient’s family, social and professional functioning, Bipolar Disorder is a mental disorder with a significant social stigma. Objectives Identify the socio-demographic and clinical factors that may influence the experience of stigma in bipolar disorder type I Methods We conducted a cross-sectional, comparative study over a six-month period at the aftercare unit of Razi Hospital’s psychiatric ward “A”, including patients treated for TB I according to DSM 5 criteria and stable on treatment. The study was conducted in two stages: first, sociodemographic and clinical characteristics were collected using a pre-established form. The DISCUS scale, validated in Arabic, was then administered. Results We included 100 patients (60 men and 40 women) with a mean age of 43.55 years. The median DISCUS stigma score was 6 (0-19). The mean value of the DISCUS scale was high for patients of urban origin (p=0.042), with a low socioeconomic level (p=0.001), and poor family dynamics (p

Introduction Lack of adherence to antipsychotic medication in patients with schizophrenia spectrum disorders is a major risk factor for relapse and rehospitalizations which contributes to major social and economic consequences. A high proportion of patients with schizophrenia are partially or completely unaware of their mental disorder. Objectives The aim of this study was to investigate the association between insight and medication adherence. Methods A total number of 30 outpatients with schizophrenia spectrum disorders ,according to (DSM-V) diagnostic criteria who were attending the department of psychiatry A Razi hospital between august and September 30, 2023 were included in this study. Patients’ insight was measured by the birchwood insight scale. The degree of medication adherence was measured by using Medication Adherence Rating Scale (MARS). Results Patients enrolled in the study had a mean (SD) age of 43.2 .There was no significant correlation between patients’ insight and patients’ ages, duration of illness and hospitalization times. In addition, there was no significant association between medication adherence and age, duration of illness, number of hospitalization or social level. Impaired insight was associated with poor antipsychotic medication adherence in patients with schizophrenia spectrum disorders .Higher insight was correlated to higher therapeutic adherence. Our results showed that the level of insight and compliance to treatment are positively correlated. Conclusions The results of this study support the hypothesis that insight and treatment adherence are closely related. Interventions to enhance insight may be helpful in improving medication adherence. Disclosure of Interest None Declared

Introduction Violence in psychiatric settings poses significant challenges for healthcare professionals, particularly nurses. This study examines psychiatric nurses’ perceptions of violence and its impact on the quality of care they provide. Objectives The primary objective is to assess the influence of violence on the quality of care in psychiatric settings, with a focus on the experiences and perspectives of nurses. Methods We employed a questionnaire-based survey administered to 30 psychiatric nurses working in both inpatient and outpatient psychiatric units of the Razi hospital Manouba. The survey gathered information on the prevalence of violence, types of violence encountered, and the impact on nursing practice. Results Of the 30 respondents, 75% identified as female and 25% identified as male. Most of them had more than five years of experience. The primary results revealed that all the psychiatric nurses reported experiencing at least one incident of violence during their psychiatric nursing careers. Regarding exposure to verbal violence, the results indicated that 52% encountered it sometimes, 22% often, 17% very often. Regarding physical violence, 30% experienced it rarely, 26% sometimes, 13% often, and 13% very often. For sexual violence, 56% reported never experiencing it, 8% rarely, 26% sometimes, and 8% very often. These incidents had varying effects on nurses’ emotional well-being, job satisfaction, and the quality of care they were able to provide. 53% of nurses reported experiencing emotional distress and feelings of anxiety as a result of violence, 13% felt anger and frustration. One nurse declared he was not affected emotionally. Most of the respondents (75%) indicated that their job satisfaction had been negatively affected by violent incidents. 40% of respondents stated that violence has a negative impact on their relationship with patients, but they make efforts to maintain care quality. Whereas, 20% found ways to strengthen connections despite challenging experiences.The most commonly endorsed strategies to cope with violence included attempting to master their emotions by remaining calm and patient (78% of respondents), seeking assistance or the presence of other healthcare team members (65%), and maintaining a safe distance from patients (69%). Fewer participants reported raising their voice and adopting a position of authority (30%), while a minority indicated engaging in additional training on the management of violent situations (20%). These results illustrate the diverse range of personal coping strategies. Conclusions Violence in psychiatric settings has a multifaceted impact on psychiatric nurses, affecting both their emotional well-being and the quality of care they provide. Strategies for managing and preventing violence, as well as supporting nurses in coping with these challenges, are essential for maintaining high-quality psychiatric care. Disclosure of Interest None Declared

Introduction Negative countertransference in psychiatry refers to the therapist’s unfavorable emotional reactions to the patient, such as anger and frustration, which can hinder the therapeutic relationship and the client’s progress. This is why it is imperative to study the causes of this negative counter-transference, such as cultural causes, to ensure effective treatment, appropriate care and better comfort for psychiatry residents during their professional practice. Objectives To study the cultural causes of negative countertransference among psychiatric residents in Tunisia and their coping behavior. Methods This cross-sectional study was carried out among Tunisian residents working in psychiatric departments, using a questionnaire deployed via Google Forms. Results The study involved 26 residents with 23 females. The average age was 27.57 years with extremes ranging from 26 to 32. The participants were family doctors practicing in psychiatric wards (26.9%), first year psychiatry residents (15.4%), second year psychiatry residents (23.1%), third year psychiatry residents (19.2%), fourth year psychiatry residents (11.5%) and child psychiatry residents (3.8%). The majority of residents admitted having had a negative transference towards a patient (88.5%). The level of frustration felt by residents during this counter-transference on a scale of 100 varied from 1 to 100 with an average of 61.9. Substance abuse was the primary cause in 52.17% of cases. The second cause was the patient’s ideology, with a percentage equal to 43.47%. The same percentage of 17.39% was for traditions, socio-economic level and membership of a particular political group. In 82.6% of cases, residents tried to analyze this counter-transference and 65.2% of them managed to deal with their frustration. The feeling of guilt was experienced by 56.52% of practitioners and the same number of residents tried to avoid the patient. Among the participants, 43.47% discussed this difficulty with their supervising physician and only 4 residents asked to change patients. Conclusions In conclusion, our study identified the cultural causes of negative countertransference in Tunisian psychiatry residents, including substance abuse, ideology, traditions, socio-economic level and politics. Understanding these causes is essential to resident training but also to the delivery of quality care in psychiatry. By integrating this knowledge into training, we can help residents recognize and manage negative countertransference, in order to improve the quality of care they provide to their patients. Disclosure of Interest None Declared

Introduction Hyperthyroidism, characterized by excessive production of thyroid hormones, is a common endocrine disorder that affects various body systems. While most commonly recognized for its classic symptoms such as weight loss, tremors, and palpitations, it is important to acknowledge that hyperthyroidism can also lead to a rare but significant complication: psychosis. Psychosis in the context of hyperthyroidism refers to the presence of delusions, hallucinations, and disordered thinking, which can significantly impact an individual’s mental health and overall well-being. Objectives This case report aims to describe a rare case of hyperthyroidism-related psychosis in a patient including the clinical presentation, diagnosis, and management. Additionally, we aim to increase awareness of and promote further research into this condition. Methods We present a comprehensive case report detailing the clinical course of a 29-year-old male patient with no previous medical or psychiatric history, who sought urgent psychiatric evaluation at the Razi Hospital La Manouba’s emergency department due to escalating symptoms of agitation and paranoia persisting for three days. The patient, identified as Mr. S.O., a Tunisian male, presented with severe agitation and paranoia necessitating the use of restraints upon admission to the psychiatric emergency department. The initial physical examination revealed no notable abnormalities, except for the presence of tachycardia, which was subsequently confirmed on an electrocardiogram, arousing suspicion of a primary psychiatric illness. Results While the standard blood workup yielded unremarkable findings, the endocrine workup revealed decreased levels of thyroid-stimulating hormone (TSH) and elevated free thyroxine (FT4). Further laboratory investigations demonstrated elevated anti-thyroid-stimulating hormone receptor antibodies, leading to the diagnosis of Graves’ disease. Collaborative consultation with an endocrinologist resulted in the initiation of a treatment regimen consisting of methimazole, propranolol, and risperidone. Notably, within three days of the initiated therapy, the patient exhibited significant improvement in terms of reduced agitation, coherent speech, and the development of self-reflection regarding the episode, ultimately leading to his discharge on the seventh day of hospitalization. This case report serves to highlight the complexity of psychiatric presentations associated with underlying endocrine disorders and underscores the importance of interdisciplinary collaboration in achieving optimal patient outcomes. Conclusions While mental health factors play a significant role in the development of psychosis, it is essential to recognize that underlying medical conditions may also contribute to its onset or exacerbation. Disclosure of Interest None Declared

Introduction Self-compassion is defined as the ability to be open to and touched by one’s suffering and to relate to it with kindness and non-judgmental awareness. Although identifying factors related to treatment adherence remains an important challenge in patients with schizophrenia spectrum disorders, self-compassion has rarely been investigated in this population. Further studies are needed to investigate whether self-compassion training can improve treatment adherence in this population. Objectives The objective of the present study was to investigate the relationship between self-compassion and treatment adherence in patients with schizophrenia spectrum disorders. Methods thirty stabilized adult outpatients with schizophrenia (n=18), schizoaffective disorder (n=11), brief psychotic disorder (n=1) per DSM-5 criteria were included. Self- compassion was assessed using the 26-item Self-Compassion Scale (SCS). Treatment adherence was assessed using the Medical Adherence Rating Scale (MARS). Socio- demographic characteristics, including age, gender, academic level, and mean daily antipsychotic dosages were collected. Results There was no significant difference in SCS scores and MARS scores as a function of gender, age, or academic level. The results of the present preliminary study suggest a positive correlation between the SCS total scores and the MARS scores. It was found that higher levels of self-compassion are related with higher levels of treatment adherence in patients with schizophrenia spectrum disorders and lower levels of self- compassion are associated with discontinuation of medications without a psychiatrist’s recommendation. This connection was present in all diagnostic groups. Conclusions The results of the present preliminary study suggest that self-compassion and treatment adherence are closely related. Improving self-compassion in patients with schizophrenia spectrum disorders may improve their level of treatment adherence. Further studies are needed to investigate whether self-compassion training programs could be useful as an extension of standard psychoeducation and cognitive behavioral therapy to improve treatment adherence in this population. Disclosure of Interest None Declared

Introduction Among all mental pathologies, bipolar disorder (BD) is the one in which addictive comorbidity is most frequent. Recent studies suggest that this comorbidity has harmful consequences, threatening patients’ quality of life. Objectives Describe addictive comorbidity and determine its prevalence in a population of patients with BD I. Study the impact of addictive comorbidity on the evolution of BD I. Methods A cross-sectional, comparative study was conducted over a six-month period in the after-care unit of psychiatric wards at Razi Hospital, including patients treated for BD I according to DSM 5 criteria and stable on treatment. The study included two phases: first, sociodemographic, clinical and therapeutic characteristics were collected using a pre-established form. The CAGE, DUDIT and MARS scales, validated in Arabic, were then administered. Results We included 100 patients (60 men and 40 women) with a mean age of 43.55 years. Substance use disorder (SUD) was reported in 31% of our population; 22 alcohol users with a mean CAGE score of 1.23 (0-3), while psychoactive substance use was reported in 19 patients with a mean DUDIT score of 13.37 (0-28). Forensic history was higher in the group of patients with comorbid SUD (p

Introduction There has been growing evidence to support the hypothesis that inflammation is involved in the pathogenesis of schizophrenia. Objectives The aim of the present literature review was to assess the efficacy of acetylsalicylic acid (ASA) as an adjuvant agent in the treatment of an acute exacerbation of schizophrenia. Methods We searched randomized clinical trials based on regular searches of MEDLINE, Embase, PubMed. Results We included four studies. The results were in favor of the efficacy of ASA in the study where authors targeted early psychosis. Illness duration seems to predict response to anti-inflammatory agents. Conclusions Further studies of early stages of schizophrenia are helpful. Disclosure of Interest None Declared

Introduction Tunisia marked a significant milestone in the fight against gender-based violence with the adoption of Organic Law No. 2017-58. This pioneering law in the region enhanced the protection of women and girls’ rights and introduced harsher penalties for perpetrators of sexist violence. However, the journey toward eradicating violence against women is complex and multifaceted. Objectives Our aim is to explore how tunisian women perceive gender-based violence and their attitudes towards it. Methods A cross sectional online survey designed using Google Forms and distributed on social media platforms (Facebook, Instagram) was conducted from August 30th to September 25th 2023. The questionnaire, presented in the tunisian dialect, included questions about personal experiences with violence, knowledge of gender-based violence laws as well as their perceptions and attitudes towards gender-based violence. The sample consisted of women from various regions of Tunisia. Results In our study, we analyzed a sample comprising 110 tunisian women, with 46.4% falling within the 20 to 30 age bracket and 36.4% belonging to the 30 to 40 age range. Half of the survey participants were unmarried, and the majority of them (97.3%) had attained a university-level education. Our research revealed that 45.5% of the surveyed women reported instances of gender-based violence in Tunisia. However, only a minority of these individuals (22.2%) initiated legal proceedings, primarily citing a lack of confidence in the judicial system and fear of potential reprisals as their reasons. A majority of the participating women expressed deep concern regarding the issue of violence against women in Tunisia. When asked about their perceptions of the most prevalent types of violence in Tunisia, 76.36% believed that psychological violence was the most common, followed by sexual violence (21.3%). Economic and physical violence were perceived as less frequent (9.9%; 12.6%). These women attributed the primary factors contributing to violence against women in Tunisia to cultural norms and laws that they considered inadequately stringent. Indeed, 83.3% of them believed that the current legislation was not stringent enough to deter potential perpetrators, and 37.3% indicated that they were unaware of the existing legal framework. Conclusions Despite legislative advancements, gender-based violence remains a pressing concern in Tunisia. These findings underscore the importance of increasing awareness about available resources for victims, educating individuals about women’s rights and mental health, and building trust in the judicial system. Disclosure of Interest None Declared

Introduction Antipsychotics are currently widely prescribed for various mental disorders. A presumption of a potential carcinogenic effect of antipsychotics was raised by certain studies. There are few data in the literature on this subject. Objectives Study the relationship between the use of antipsychotics and the risk of cancer. Methods A systematic literature review was carried out on PubMed looking for articles in English, published during the last decade (2013-2023), using the keywords “Antipsychotics” and “Cancer”. We included all articles studying the relationship between antipsychotics use and cancer risk. Results Nine articles were included in our study, the majority of which focused on breast cancer. The results regarding breast cancer were discordant: although three studies did not show an association between the administration of antipsychotics and breast cancer, more recent studies have proven the opposite. Indeed, chronic exposure to antipsychotics, particularly those raising prolactinemia, was significantly associated with an accumulated risk of breast cancer, especially with positive estrogen receptors, whereas prolactin-sparing antipsychotics were not associated with it. Regarding hematologic malignancies, unlike other antipsychotics, long-term use of clozapine was associated with a high risk of malignancy, and had a greater effect on mortality from lymphoma and leukemia than to agranulocytosis. On the other hand, it has been proven that the use of atypical antipsychotics is associated with a reduced risk of lung cancer. Conclusions Data from the literature regarding the carcinogenic potential of antipsychotics remain discordant and inconclusive. The most recent studies are worrying and highlight in particular an association between the use of antipsychotics and the increased risk of breast cancer. If these data are confirmed in future studies, this will undoubtedly impact the benefit-risk balance when making therapeutic decisions. Disclosure of Interest None Declared

Introduction With the rapid advancement of modern technology, many countries have adopted mental health care systems supplemented by digital means of communication. Are Tunisian patients “ready” for the “digital revolution”? Objectives The aim of our study was to assess perceptions of people living with mental illness on digital mental health. Methods We developed a cross-sectional study where we randomly included patients who were treated for a psychiatric disorder in a public or a private practice. Inclusion criteria were: subject 18 years old or older, clinical remission for at least three months. We developed a questionnaire on sociodemographic and clinical variables. We also included questions on patients’ level of interest in using digital mental health services such as teleconsultation and mental health smartphone apps. Perceived obstacles in using digital mental health by patients were also evaluated. Results Our sample size was 260 patients. The mean age of our population was 36,4 years old with. The mean distance from the household to the mental health care provider was 17,3 km. Two thirds of the sample had access to a wifi connection at home (172 patients). When asked about the content of internet searches, 66% have already looked for information on their mental health or mental disorders on web pages. Patients were very interested in video teleconsultation with their therapists (72%), psychoeducation apps (68%) and online mood journals (61%). They expressed little to no interest in online exchanges with other patients and medication reminder apps. The most reported obstacles in implementing digital mental health as noted by patients were : lack of perceived effectiveness, virtual communication with their therapist and confidentiality issues. Conclusions Mental health patients in Tunisia expressed a great interest in teleconsultations and online psychoeducation programs. Further research on the willingness of mental health professionals to adopt digital mental health services are needed. Disclosure of Interest None Declared

Introduction Despite the scientific requirements and restrictive recommendations, there is a significant disparity between theory and practice in the prescription of benzodiazepine(BZD). Long-term prescribing, defined by a duration exceeding six months has been commonly reported worldwide, some authors explained this by physician’s perceptions. Objectives This study aimed to evaluate the perception of general practitioners practicing in Tunis, in the private or public sector, concerning the prescription of BZDs. Methods A cross-sectional study was conducted among general practitioners in the private and public sectors practicing in Tunis during the study period (September and October 2021). It is based on the response to a questionnaire, which focused on the perception of prescribing BZD, via google forms distributed to members of the regional committee of the order of physicians. Results A total of 75 physicians participated in the study. The mean age was 47.75± 12,2 years, with 17,28 ± 11,8 years of clinical experience. Among the 75 participating physicians, 83% considered that patients on BZD patients had a better quality of sleep and 58% assert that patients on BZDs had restful sleep. 83% of participants agreed that BZDs were associated with fewer nocturnal awakenings 83% and 85% with a decrease in the feeling of irritability. 18% of the doctors think that the easiest way to manage a patient’s anxiety is to prescribe a BZD. 24 doctors believe that chronic use of BZDs is essential to control anxiety. patients’ anxiety. The number of years of practice is inversely correlated with the perception that the patient wakes up less at night (p= 0.059). Male gender correlates with the perception that it is acceptable to continue prescribing beyond the recommended duration as long as they are well tolerated (p=0.035). Conclusions BZD prescription decision in general medicine is complex. This study participates in increasing our level of understanding of the reasons behind the long-term prescription of this molecule. Disclosure of Interest None Declared

Introduction Psychotic disorders are associated with a degree of disability that is much more considerable if the duration of untreated psychosis is prolonged. This fact highlights the importance of early intervention strategies among individuals at ultra-high risk (UHR) for psychosis, often struggle with depressive symptoms. Objectives The objective of this work was to evaluate the effectiveness of cognitive-behavioral and emotional therapy on depressive symptoms in a patient at high risk of psychosis. Methods This is a detailed case report of a young adult at UHR for psychosis who was referred to psychiatry department “A” at Razi Hospital for treatment of depression symptoms. The patient had benefited from 15 sessions of cognitive-behavioral and emotional psychotherapy, over eight months, from July 2021 to February 2022, at the rate of one 45-minute session per two weeks. The main psychotherapeutic techniques used were: behavioral activation, cognitive restructuring and relaxation. An initial and final assessment was performed by the Hamilton Depression Scale and by the comprehensive assessment of mental states at risk. Results The clinical case illustrated concerns a 21-year-old female with a state of high risk of psychosis, suffering from depression symptoms that had been worsen since two years. As the therapy progressed, an improvement in depressive symptoms and functioning has been noticed, by a decrease in the score of the Hamilton scale, from 28 to 11, with a response estimated at 61% and a score for social functioning and professional, initially estimated between 21 and 30, to became between 41 and 50 after therapy. The active participation of the patient, and her assiduity were important factors in this success. Conclusions Cognitive-behavioral and emotional therapies for depressive symptoms could constitute an effective intervention approach for subjects at high risk of psychosis, allowing the improvement of the prognosis of psychotic disorders. Disclosure of Interest None Declared

Introduction Prophylactic treatment during bipolar disorder aims to prevent recurrences and to improve the functional level. Objectives Our aim was to compare the clinical effectiveness of lithium versus sodium valproate in the prophylactic treatment of bipolar disorder type 1 Methods Retrospective, longitudinal, comparative study conducted among 162 patients followed for bipolar disorder type 1 hospitalized at the Psychiatry A department of Razi Hospital. The Alda scale and time to recurrence were used to compare the clinical effectiveness of the mood stabilizers. Results A difference between the two groups of patients was noted for some variables. Lithium prescription was associated with educational level, number of depressive episodes, suicide attempts, previous prescription of other thymoregulators, depressive polarity of the index episode and use of atypical antipsychotics. The prescription of Valproate was associated with educational level, unipolar mania, manic predominant polarity, manic polarity of the index episode, presence of psychotic features, prescription of long acting antipsychotics and higher doses of antipsychotics. The study of response by Alda scale showed no significant difference in the mean score of the scale nor in the rate of responders. We noted a higher rate of recurrence in patients on Valproate considering the whole duration of the study. The recurrence rate after one year was higher in patients on Lithium, the recurrence rate after two years was comparable in both groups. Survival curves showed earlier recurrences in patients on Lithium. Conclusions The efficacy of the two mood stabilizers was comparable. The recurrences occured earlier under Lithium. Disclosure of Interest None Declared

Introduction Mental Health Knowledge specific to symptom recognition, treatment efficacy, help-seeking, and employment can facilitate understanding when communicating with clinicians and reduce personal stigma. Better knowledge of mental illness has also been shown to decrease fear and embarrassment when interacting with people with mental illnesses. Thus, knowledge can play a key role in influencing behaviors and attitudes associated with stigma. Objectives The objective of this study was to evaluate mental health knowledge among Tunisian students Methods This cross-sectional study was conducted on 2501 Tunisian students from different academic institutions. They anonymously filled in a questionnaire circulated online through social networks in pages and groups of each university. The validated Arabic version of the “Mental Health Knowledge Schedule” (MAKS) was used to assess the knowledge about mental illnesses. Results The median MAKS score was equal to 45 out of 60, ranging from 30 to 56. In our study, 60.2% of the participants answered “don’t know” or “neither agree nor disagree” to item 1 indicating that “Most people with mental health problems want to have paid employment.”. Exactly 83.7% of the participants thought they knew what advice to give a friend to get professional help and 90% thought that psychotherapy could be effective in treating a person with a mental illness. In addition, 57.1% of participants thought that medication could be effective and 68.8% thought that people with severe mental health problems could make a full recovery. People with mental health problems do not seek professional help according to 39% of participants. About 90% were considering depression, schizophrenia, and bipolar disorder as mental illnesses. Stress and drug addiction were considered mental illnesses according to 71% and 63% of participants respectively. Finally, 52.9% answered that grief was a mental illness. Conclusions In Tunisia, anti-stigma programs are almost nonexistent. Our results would allow us to take a baseline assessment of mental health knowledge and could be the starting point for anti-stigma interventions. We should combine these findings with a behavioral and attitudinal assessment to better address stigma. Disclosure of InterestNone Declared

Introduction Mental illnesses affect one in eight people in the world according to the WHO in 2019. They are a leading cause of morbidity and a major public health problem. Stigma harms the quality of life of people with mental illness. Objectives Our study aimed to evaluate the association of mental illness stigma with socio-demographic characteristics in Tunisian students. Methods This is a cross-sectional study conducted on Tunisian students who anonymously completed a form circulated online through the groups and social network pages related to each academic institution. The form was containing an Arabic validated version of the “Mental Health Knowledge Schedule” (MAKS) and the “Reported and Intended Behaviour Scale” (RIBS) along with a sociodemographic questionnaire. Results We have included 2501 Tunisian students with a sex-ratio Male/Female of 0.37. The mean age was 21.57 (±2.55) ranging from 17 to 42 years. Participants’ fields of study were: Science and Technology (58.7%), Literature (17,4%), Economics and management (15.8%), and Arts (4.8%). Among them, 17.1% had a history of family psychiatric disorders and 17.6% had a psychiatric disorder. Besides, 20.9% of the students were using tobacco and 75.6% of them were religious. We also found that 26.7% of participants had previously attended an awareness session. Several determinants had a statistically significant association with the stigma of mental illness in our study population. We noted that females had higher mental health knowledge scores (p=0.001), while males had higher behavior scores (p=0.002). Moreover, students in the scientific and literary fields had higher scores on both MAKS (p

Introduction Schizophrenia is a common chronic mental illness (1% of the general population) classified by the World Health Organization in the group of the 10 most disability causing diseases. Despite its impact on social and relational functioning and the alteration of the quality of life, the sexuality of these patients is not always explored. Objectives Evaluate the sexuality of patients with schizophrenia by comparing men and women followed in the "A" psychiatry department of Razi Hospital in Tunisia. Methods A descriptive cross-sectional study was conducted with 50 stabilized patients (25 men and 25 women) suffering from schizophrenia. The research for sexual dysfunctions was carried out with the ASEX scale (Arizone Sexual Experience Scale) and CSFQ-14 (Changes in sexual functioning questionnaire) in their French version. A correlation was used between these two scales in order to guarantee results’ conformity. Results The sexual activity rate was 64.0% at the time of the study and 88.0% over a life span. These sexual activity rates were comparable between the two sexes. The overall rate of sexual dysfunction was 68.7% of sexually active patients at the time of the study and concerned 72.2% of men and 64.3% of women, with no difference according to gender. The different sexual dysfunctions were equally present in men and women, except for the dimension disorder: desire/interest, desire/frequency and arousal, which were more frequent in women. Conclusions The sexual aspect in patients followed for schizophrenia remains neglected by clinicians. It deserves better attention in order to optimize the overall care of patients and improve their quality of life. Disclosure of Interest None Declared

Introduction Bipolar disorder is a common chronic illness with progressive intermittent. The new health policy, which advocates the deinstitutionalization of patient’s mental illnesses, caused, for a part, a transfer of the load of these patients from the specialized care services to natural caregivers, which can involve a great burden for family members as well as an altered quality of life, anxiety and depressive symptoms. Objectives The aim of the study was to evaluate the rate of anxiety, depression and the repercussions on life quality in natural caregivers of patients with bipolar disorder. Methods This is a descriptive cross-sectional study that involved a group of 50 caregivers of patients with bipolar disorder treated at psychiatry department ‘A’ at Razi Hospital. We applied a questionnaire recording the different socio-demographic data. To determine the impact on the caregivers mental health and life quality we used the WHOQOL-brief (World Health Organization Quality Of Life-abbreviated version) and the HAD (Hospital Anxiety and Depression) Scale. Results Our sample consisted of 32 women and 18 men. The mean age was 52.12 years with extremes ranging from 28 to 79 years. A majority were parents (60%), 18% spouses, 16% siblings and 6% descendants. The repercussions of management of patients with bipolar disorder on the life and health of the caregivers were significant. Indeed, more than half of the caregivers (52%) (n=26) had a definite anxiety symptomatology on the Hospital Anxiety and Depression Scale (HAD). Twenty-two percent (n=11) presented definite depressive symptomatology and thirty percent (n=15) doubtful depressive symptomatology on this same scale. The most impaired domains on the World Health Organization Quality of Life Scale-version abbreviated (WHOQOL) were first: the environment domain with an average of 25.9 and second: the physical health domain with an average of 23.9. Conclusions Being a caregiver for a patient with bipolar disorder is associated with a great burden that can be the cause of anxiety-depressive complications and an alteration in the caregiver’s quality of life. It is important to assess this burden and its repercussions in order to preserve good family dynamics and ensure the proper functioning of the helping relationship and consequently improve the prognosis. Disclosure of Interest None Declared

Introduction Over the years, several studies have shown the high rate of discrimination experienced in particular by mental health service users. Stigma is composed of three elements: knowledge, behaviors, and attitudes. Although behaviors are the core of discrimination, this element has often been overlooked or intertwined with the other components. Objectives Our study aimed to assess Tunisian students’ behavior toward people with mental illness Methods This was a cross-sectional study conducted on 2501 Tunisian students who anonymously completed a form circulated online through social network groups and pages related to each academic institution. We have used the validated Arabic version of the “Reported and Intended Behaviour Scale” (RIBS) which assesses self-reported mental health behaviors and future intentions. Results The median RIBS score was 15 out of 20, ranging from 4 to 20. Among the participants, 40% were living or have lived with someone with a mental health problem and 49.7% would be willing to live with someone with a mental health problem. Moreover, 24% were working or have worked with a person with a mental health problem and 53.4% would be willing to work with him or her. In addition, 34% were having or have had a neighbor with a mental illness and 58% would be willing to have a neighbor with a mental illness. Finally, 51% were having or have had a close friend with a mental health problem and 83.7% answered that they would be able to maintain a relationship with a friend who had developed a mental health problem. Conclusions The assessment of behavior toward people with mental illness is fundamental as it has the most impact on individuals. However, behavior may be mediated by knowledge. Thus, it would be interesting to evaluate mental health knowledge to study the relationships between these constructs and optimize anti-stigma interventions. Disclosure of Interest None Declared

Introduction Schizophrenia (SCZ) is a chronic mental illness characterized by a rich and diverse symptomatology. A generalized cognitive deficit has been widely recognized among the symptoms of this disease. Several authors have studied the relationship between peripheral markers of inflammation and cognitive dysfunctions in order to explain the etiopathogeny of these disorders. Objectives The aim of our study is to better comprehend the nature of the relation between peripheral markers of inflammation and cognitive dysfunctions. Methods A systematic review of the literature was conducted following the guidelines provided by the PRISMA method. We performed a systematic search focused on two automated bibliographic databases: Pubmed and Google Scholar including the following keywords: “inflammation”, “schizophrenia”, “cognition” Results A total of 17 articles were included. Significant relations with cognitive function were reported with IL-6, IL-18, IL-2, IL-8, tumor necrosis factor α (TNF-α ) and chemokines. Memory was the cognitive domain where the most significant relations with cytokines were objectified. BDNF levels were correlated with cognitive tests in 5 studies of SCZ populations. The domains concerned were inhibition, flexibility, verbal fluency, verbal memory, attention, and processing speed. Elevated CRP in patients with SCZ was reported by all studies and a significant relation with cognition in 3 studies. This relations is objectified in the areas of memory, executive functions and processing speed. The relations between CRP, BDNF, cytokines and cognitive functions was inconsistent across studies. Conclusions The majority of the results observed during the review were in favor of a significant relation between CRP, BDNF and cytokines. Nevertheless, these results were not constant and heterogeneous. It would be interesting to better explore the nature of this relation through prospective studies in order to establish therapeutic perspectives. Disclosure of Interest None Declared

Introduction Depression is a common pathology in the elderly, often unrecognized and mostly affiliated to the consequences of aging,especially in front-line services. It induces somatic and functional impact and even a suicidal risk. When unrecognized or neglected, depression can reduce life expectancy and increases the use of healthcare and the institutionalization. Objectives -Determine the point-prevalence of depression in the elderly in a front-line heath service in Tunis. - Identify risk factors of depression in the elderly. Methods A descriptive and evaluative cross-sectional study on a sample of patients aged 65 or more, in a tunisian front-line service of general health care regardless of the medical reason. Sociodemographic and clinical forms along with the PHQ-9 scale (Patient health questionnaire-9) - validated in tunisian dialect- were used. Results Thirty patients have participated in our study (21 men and 9 women). The average age was 73.23 years. Chronic pathologies were found in 96.66% of cases. The found risk factors are: female sex in 70% of cases, loneliness and isolation in 10% of cases, widowhood in 50% of cases, grieving in 6.6% of cases and somatic comorbidity in 96 .66% of cases. The overall prevalence of depressive symptoms was 53.33%. This is correlated with advanced age and female sex (57.14% in women vs 33.33% in men). The depressive symptomatology found, was mild in 18.5% of cases, average in 62.5% of cases and moderately severe in 18.5% of cases. Conclusions Depression is a frequent pathology in the elderly with multiple risk factors. The aging of the Tunisian population on one hand and the change of the social model (family nucleus) on the other, encourage the early detection of depression in the elderly and the training of the health professionals in order to limit its prevalence. Disclosure of Interest None Declared

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

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.

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.

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.

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.

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.

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.

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.

Introduction Bipolar disorder (BD) is a chronic and recurrent illness frequently associated with functional deterioration and treatment challenges. High rates of thyroid dysfunction have been found in patients with BD, compared to the general population. Objectives To illustrate through a case-report the therapeutic challenges of treatment-resistant bipolar disorder and its relationship with thyroid dysfunction. Methods Case report of a 41-year-old male patient with BD and comorbid anxiety disorders who has been diagnosed with thyroid cancer and underwent total thyroidectomy. Results Mr B is a 41 year old patient diagnosed with BD and comorbid anxiety disorders (panic disorder, social anxiety disorder and generalized anxiety disorder) at age 18. He has presented in total 17 relapses and was hospitalized 7 times between the ages of 18 and 24. He experienced predominantly major depressive episodes with mixed features and debilitating anxiety symptoms. He was put on several treatments including a combination of mood stabilizers, antidepressants and benzodiazepines. Due to unsatisfactory treatment response, he was put on clozapine 150mg to 175mg/d combined with valproic acid, clonazepam. In 2009, the patient developed a nodular goiter caused by papillary thyroid carcinoma and underwent total thyroidectomy and radioactive iodine therapy. Following the surgical operation and stabilization of thyroid functioning, a decrease in the number of relapses and the severity of mood and anxiety symptoms have been noted. Conclusions This case reports highlights the importance of thyroid function assessment in patients with bipolar disorder and the possible correlation to treatment resistance and symptom severity. Disclosure No significant relationships.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Introduction In Tunisia, the Ministry of Health launched an awareness campaign in television spots and different social media platforms and started the vaccination campaign on the 13 March 2021 aiming to have vaccinated half of the Tunisian population by the end of 2021. However, to date, on July 31, 2021, only 1,104,286 people are completely vaccinated Objectives The aim of the study was to identify Tunisians’ mental perceptions and attitudes towards COVID-19 vaccines to examine the predictors of the COVID-19 vaccine hesitancy in the Tunisian population. Methods A group of citizens, randomly selected were invited to participate in the study. Data were collected through a focus group using a piloted topic guide. The entire discussion was recorded in audio-visual mode with a total duration of 1 hour. We also collected data on participant gender, age, education, and profession. Results Seven women and four men participated in the study All participants reported having doubts about the efficacy of the vaccines. Two participants reported that their acquaintances died after being vaccinated. They suspected that expired vaccines have caused the reported deaths. “I think these vaccines can be extremely dangerous. They could contain chemicals that are carcinogens or that have a castrating effect”, an interlocutor stated, supported by the rest of the group. We found unanimously in our study, attesting to the relevance of religion in the lives of the Tunisian people, which is in agreement with literature Conclusions Construction of multi-component and systematic interventions are required by public health authorities. Disclosure No significant relationships.

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.

Introduction In the literature, some studies consider psychiatric patients to be vulnerable to COVID-19, in contrast to other studies that find them rather protected. Objectives To determine the impact of the COVID 19 pandemic on patients undergoing psychiatric care. Methods This is a descriptive and cross-sectional study that took place in the psychiatry department A at Razi hospital in Tunisia. We conducted a comparison of patient follow-up between the period of March 2018-2019 and March 2020-2021. For this we used a form including socio demographic data, data concerning the COVID-19 situation, clinical data while comparing the follow-up of patients (hospitalizations, mode of relapses, consultations in the emergency room…) Results 100 patients were included, 60% were men, mean age 44 years (+/- 11 years) [19-65 years]. Ninety-seven percent of patients had no personal history of COVID-19 infection. Comparing the pre-pandemic year (2018-2019) and the pandemic year (2020-2021), we note an increase in the rate of emergency room visits of (17.5%) as well as a relapse rate requiring hospitalization in our department in 48%, this figure was 30% in 2019. A statistically significant increase was noted for depressive and anxiety relapses (p=0.04; r=0.7). Fear of catching the virus while attending hospital facilities (17.6%), geographical isolation (17.6%), unavailability of treatment (17%) and poor insight (41.2%) were the primary causes of poor adherence. Conclusions The patients followed in our department have presented during this COVID-19 pandemic several relapses of their psychiatric pathologies compared to the previous year. Disclosure No significant relationships.