B. Ben Hadj Ali

Intérêt des anticholinestérasiques dans les dépressions du sujet âgé

BACKGROUND Depression in the elderly is characterized by an atypical expression with delusion, major anxiety, behaviour disorders, somatic complains or cognitive impairment. These clinical aspects are suspected to be at the origin of the poor response to antidepressants observed in these cases. It is currently indicated to add sedative medicines to antidepressants, when a major anxiety is associated with depression, or an antipsychotic in the delusional forms of the depression. However, it is not consensually established that cholinesterase inhibitors can be helpful in depression with cognitive impairment. Cholinesterase inhibitors are efficient among patients with Alzheimer disease. They improve cognitive performances and slow down the degenerative process during the first years of treatment. Today, new findings on neurobiological mechanisms of depression involve a located degenerative process, with some similar anomalies in the brain in both depression and pre-Alzheimer states. New therapeutic trials have shown that cholinesterase inhibitors can be also efficient on depressed symptoms among patients with Alzheimer disease. These evidences support the hypothesis that the association of cholinesterase inhibitors to antidepressants can bring more benefits to depressed elderly patients. AIM Through a review of the literature and a case report, we tried to specify whether cholinesterase inhibitors can be useful in the treatment of depression among the elderly. CASE REPORT We report the case of a 68-year-old man who had presented, four years ago, a second episode of major depression with a cognitive impairment. Treated with an antidepressant (venlafaxine), the improvement was poor with major anxiety, slow thoughts, and an evidence of a persistent cognitive impairment. Despite normal cerebral scanning images, we decided to add a cholinesterase inhibitor (donepezil) to the same antidepressant. With this association, we rapidly obtained a total remission from depression with restitution of cognitive performances. This state is still maintained until today (four years after the last depressive episode) with no new mood relapses. Recent cerebral scanning images did not show any degenerative process. CONCLUSION The association of cholinesterase inhibitors and an antidepressant seems a good alternative, when the response to antidepressant is partial in depression with cognitive impairment in the elderly. However, further therapeutic trials are still needed, to prove the usefulness of cholinesterase inhibitors among depressed elderly patients.

P03-209 - Sexual Function in Untreated then Treated Schizophrenic Patients: a Prospective Study

Introduction High prevalence of impaired sexual function in patients with schizophrenia has been reported by several studies. Various factors were incriminated including the disease itself, the low level of social competence and treatmentside effects. Objective To compare sexual function in drug free schizophrenic patients and six months after initializing antipsychotic treatment. Methods A consecutive sample of 109 patients meeting DSM-IV criteria of schizophrenia was constituted in psychiatry department of Farhat Hached hospital (Sousse, Tunisia), during a twenty four months period. They were drug naive or drug free for at least three months. Assessment was performed at two time points: T0: During an acute phase of the disease as defined by a BPRS global score ≥ 40 T1: six months after antipsychotic treatment. Assessment of sexual function used the Arizona Sexual Experience Scale (ASEX). Results Sexual function was impaired under antipsychotic treatment. In fact, we noticed lower global score of asex (p = 0.03) and lower subscores of drive (p = 0.015), arousal (p = 0.006), erection or vaginal lubrication (p= 0.010), orgasm (p= 0.001) and satisfaction (p= 0.005). Conclusion Sexual function was impaired in patients under antipsychotic drugs, according to global score and to diffrent sexual dimensions subscores. This results seem to, prospectively, confirm the implication of treatment in sexual dysfunction occurence among schizophrenic patients.

Schizophrenia course: Correlates to symptomatic remission

S Center Rounds® are multidisciplinary meetings where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members, with the goal of advancing compassionate health care, supporting caregivers, and fostering the connection between clinician and patient. Rounds were initiated at the MGH Cancer Center in 1997 and have since grown to include in more than 320 healthcare facilities in 39 states, and most cancer centers nationwide. In a formal evaluation of the impact of rounds participants reported increased insight into psychosocial aspects of care; enhanced compassion; increased ability to respond to patients’ social and emotional issues; enhanced communication amongst caregivers; greater appreciation of colleagues’ roles and contributions. Attendees reported decreased feelings of stress and isolation and a greater sense of teamwork. Participants reported that Rounds discussions led to changes in institutional practices or policies. Patient centered care requires that we balance modern medicine with humanism, through the different phases of patients’ experience of life threatening illness. Schwartz Center Rounds provide a forum for discussion of challenging psychosocial, spiritual and emotional issues and promotes resilience.F five large scale studies among children, adolescents and mothers to young children on the consequences of exposure to political violence, we can begin asking questions about resilience: who does not develop PTSD or substance use despite mass exposure to political violence; what are external resources that promote resilience; what are the implications for measurement scales? Schiff ’s presentation will begin answering these and other questions based on her research studies. Methods: Results from five large-scale studies at different times will be presented. During the acts of political violenceA representative sample of 997 (10 and 11 graders) from all Jewish schools in Haifa; 600 students from six Jewish high schools. A year after the second Lebanon warA representative sample of 4733 students from Israeli Arab and Jewish high schools; 6700 elementary, junior high and high school Israeli Arab and Jewish students residing in north Israel; a representative sample of 904 Israeli Arab and Jewish mothers to young children. Results will point to the high exposure to political violence (self-report). Israeli Arab children, adolescents, and mothers report higher levels of exposure and greater negative consequences (PTSD, violence and substance use) than their Jewish counterparts. Thus, ethnicity, age, gender, social support, protective measures during war, acknowledging need for help, religiosity, traumatic events in childhood, and life satisfaction all play important roles in the individual’s level of resilience. Implications for the need for better conceptual framework and further research at the local and international level will be explored.Background: Each year world-wide, more than 14 million people receive a diagnosis of cancer. More than 32 million people have received a cancer diagnosis during the last five years, and this number will exponentially increase in the coming decade thanks to improved medical technologies. For an individual, a diagnosis of cancer includes many practical, physical, psychological and existential challenges. It seems understandable that approximately 12% of all cancer patients experience clinical levels of depression, and up to 70% report distress related to existential challenges, such as having to find new priorities and meaning in life, and being confronted with life’s hardships. More and more psychological studies show that these existential factors are at the heart of the cancer patients’ experience of stress. That is, difficulties in coping with cancer cannot only be attributed to having ‘unhelpful cognitions’ or ‘inadequate problem-solving skills’, but also to the inherent existential meaning of having cancer. For that reason, also more and more psychotherapeutic interventions are being developed to help cancer patients to cope with these existential topics. A systematic literature review will discuss the therapeutic techniques and effectiveness of these existential therapies.T presentation demonstrates visual art therapy as a unique integrative approach to the multidimensional treatment of PTSD. This model offers unique contribution in three major areas: 1. working on traumatic memories; 2. the process of symbolization and integration; 3. providing unique qualities for containment, transference and counter transference. The artistic medium encourages the pictorial expression of the client’s inner experience enabling communication with the traumatic memory in its own language – shape, color and sensations. The medium allows dissociated, repressed materials stored in memory as visual images to reach consciousness, to be expressed and encountered. The symbolic image spontaneously emerging in the client’s work is the core of the healing process and has the ability to contain and bear the dissociative character of the trauma. Thus symbols evoked in the artistic products of victims help recode the traumatic event and turn a dissociated and isolated instance into an integrated part of the individual’s personality, connected associatively to other thoughts, feelings and times. In this way, a coherent biographical continuum is formed and the healing process can occur.

Séroprévalence du Parvovirus B19 dans un groupe de patients schizophrènes

BACKGROUND Schizophrenia is a highly disabling chronic mental illness. It is considerded as a neurodeveloppemental illness resulting from the interaction of genetic and environmental factors. Growing evidence supports the major role of prenatal infections and inflammation in the genesis of schizophrenia. The hypothesis including viral infections has been the subject of several studies and the role of parvovirus B19 (PB19) in the onset of the disease has been suggested. However, there is, up till now, no seroepidemiological evidence of his involvement. OBJECTIVE To determine the prevalence of parvovirus B19 (PB19) in schizophrenic patients and in control subjects and to examine clinical associations between viral prevalence, risk factors of infectious disease and clinical features. METHOD We carried out a case-control seroepidemiological study in the Psychiatry department of Farhat-Hached general hospital of Sousse (Tunisia). We recruited108 schizophrenic patients and 108 healthy controls free from any psychotic disorder and matched for age and sex. We collected sociodemographic data, medical history, axis I comorbid disorders and infectious risk factors. We assessed patients for psychopathology and severity of illness using respectively the Brief Psychiatric Rating Scale (BPRS), the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impressions (CGI). For each study participant, blood sample was collected and levels of IgG and IgM anti-PB19 were measured using the ELISA technique. RESULTS The prevalence of IgG antibodies to PB19 was significantly higher in schizophrenic patients than in controls (73.1% vs 60.2%; P=0.04). There were no statistical differences between the two groups regarding the prevalence of IgM antibodies to PB19. No association was found between viral prevalence and sociodemographic data, risk factors for infection or clinical characteristics. The presence of PB19 antibodies was associated with a lower score on the PANSS negative subscale (P=0.04). No other signficative association were found. CONCLUSIONS In our study, prevalence of IgG antibodies to PB19 was significantly higher in schizophrenic patients than in controls. This finding supports the hypothesis of the involvement of PB19 in schizophrenia. Further studies including both virological and immunological aspects are needed to better clarify the etiopathogenic mechanisms of schizophrenia which would challenge the management of this disease.

P03-491 - Depression, anxiety and quality of life in female patients with dermatitis artefact: a comparative study

Introduction Psychological profile and quality of life of patients suffering from Dermatitis artefact (DA) have never been assessed in a standardized and comparative way. Objective To compare anxiety, depression and quality of life in patients with DA and in patients with other chronic skin illness Material and methods Thirty patients meeting DSM-IV criteria of Dermatitis artefact were recruited in dermatology department of Farhat Hached hospital (Sousse, Tunisia). Control group consisted of 30 patients with other chronic dermatitis, randomly selected and matched for age and disease duration. Anxiety and depression were assed using the Hospital Anxiety and Depression Scale (HAD-S). Quality of life was measured by the MOS 36-Item Short-Form Health Survey (SF-36). Results Compared with controls, patients with DA had an impaired quality of life (p Conclusion Compared to patients with other chronic dermatological conditions, patients suffering from DA had a more impaired quality of life, but they were no more depressed or anxious.

P02-89 Suicidal attempts in primary care: Prevalence and correlates in a Tunisian area

Aims This study aimed to determine prevalence and correlates of suicidal attempts in an adult primary care population in Sousse (Tunisia). Method Sampling followed a stratified multistage probability cluster design from witch a representative sample of adult primary care population of Sousse was obtained. The sample was composed of 1249 subjects aged 18 years or more. Subjects were interviewed by trained clinicians using the Tunisian version of Composite International Diagnostic Interview 2.1. General and clinical characteristics of subjects who had reported previous suicidal attempts were compared with those of the remainder using t test and Chi-2 test. Results Mean age in our sample was 43.4 ± 17.62 years, with female gender (70.9%) and urban residency (67.8%) predominance. 62.3% of participants were married, 27.3% celibates and 10.4% divorced or widowed. 68.4% of them had low educational level and 70% were out of work during the last 12 months. Suicidal attempts were found in 2.9% of participants. They were correlated to less than 40 years age (p=0.036) and to the diagnosis of major depressive episodes (p -3 ), recurrent major depressive disorder (p=0.005) and dysthymic disorder (p -3 ). Among major depressive episodes, only severe ones were associated to higher prevalence of suicidal attempts (p -3 ). Conclusion Prevalence of suicidal attempts in Sousse primary care population was 2.9%. It was correlated to low age and to depressive disorders.

P01-170 Suicidal attempts among bipolar patients: Correlation with affective temperaments and life events

Aims In this study, we focused on the correlations between life events, affective temperaments and suicidal attempts among patients with bipolar disorder. Methods Patients with DSM IV diagnosis of bipolar I or bipolar II disorders were recruited from psychiatric consultation of the Farhat Hached Hospital in Sousse. All bipolar patients were in remission for at least four weeks. Suicidal attempts were checked by interrogating patients and consulting medical observations. Affective temperament dimensions were determined by using the Arabic version of TEMPS-A. The assessment of life events was based on the Paykel scale. Results A total of 57 patients (47 with bipolar I disorder and 10 with bipolar II disorder) have participated in the study, with a mean age of 41,8 ± 11,3 years and a gender ratio of 2,29. Suicidal attempt number was positively correlated with depressive (p=0,021) and anxious (p=0,015) temperament, early orphanage (p=0,008) and the total number of life events (p=0,011). It was also correlated with the global negative impact of these events (p=0,036). Conclusion According to our findings, life events and their negative impact, early parental loss and anxious and depressive temperaments predispose to suicidal attempts among patients with bipolar disorder. Further prospective studies are required to confirm these results.

P01-17 Gender prevalences of alcohol abuse and dependence in primary care

Aims In Tunisia and in most Muslim countries, alcohol consumption has remained taboo. The aim of our study was to determine the prevalence of alcohol abuse and alcohol dependence in an adult primary care population and to compare gender prevalences and characteristics. Method This is a cross-sectional prevalence survey conducted in the district of Sousse from June to November 2006. Thirty primary care centers have been randomly selected. The sample was composed of 2576 subjects aged 18 years and more. Participants were interviewed by psychiatrists and medical trainers using the Composite International Diagnostic Interview, which was translated into the Tunisian dialect and validated. Results Females represented 78% of the whole sample. The lifetime prevalence rates of alcohol abuse and alcohol dependence were respectively 2,9% and 0,7%. The lifetime prevalences in the male subgroup were 12,9% for alcohol abuse and 3% for alcohol dependence. Only one case of alcohol abuse was found in the female subgroup. Conclusion The related alcohol disorders among the men of our study are as frequent as among occidental ones. The related alcohol disorders among women were unexpectedly very low. However, a similar result was reported in an other study conducted in the United Arabic Emirates. This gender alcohol use discrepancy, found in our study, led to two main interrogations. The first one concerning the usefulness of the alcohol disorder structured interviews among Arabic women and the second concerning the Arabic women beliefs about alcohol consumption (Is it a result of religious thoughts or a deny?).

P01-219 Suicidal attempts and life events among depressive adult outpatients

Aims Although a relationship between experience of problematic life events and suicidal behaviour has been recognized during last decades, few studies of life events have been realized among depressive adults. The aim of this study was to determine the correlations between life events and suicidal attempts among depressive adult patients. Methods Eighty adult outpatients were recruited from the psychiatric department of Farhat Hached hospital of sousse (in Tunisia). All patients were followed up for a Major Depressive Disorder (MDD) according to the DSM IV criteria. They also were in remission for at least four weeks. For life events we used the EVE scale of Ferreri which permitted to assess event nature, event number and patient strategies in front of stressful life events. Results The gender ratio of the sample was 1.35 and the mean age was 44.4 ± 12.9 years. Twenty five percent of the sample have committed at least one suicidal attempt. Suicidal attempts were positively correlated with the total number of life events (p = 0.001), the number of early life events (p = 0.024) and the number of stressful life events (p Conclusion To prevent suicide, psychotherapies focusing on stress coping could be a good therapeutic alternative among patients with MDD.