H. Ben Ammar

1823 – Addiction to high dose buprenorphine and sexually transmitted diseases in tunisia

Introduction High dosage buprenorphine (Subutex) is actually the principal treatment for substitution medication. Some misappropriations and wrong uses have been seen; the most frequent and sever being using tablets for injections. Since the introduction in different countries, the high dose buprenorphine as a substitition treatment for opioid drug dependence, the number of overdose deaths and heroin users are significantly declined. But the existence of non-use replacement of this processing, mainly intravenously, was born a new scourge of addiction, especially in Tunisia. Besides the risk of overdose, there is a risk of viral contamination. Objectives To study the sexually transmitted diseases among patients addicted to high dose buprenorphine in Tunisia and followed in the outpatient hospital Razi. Materials and methods It is a retrospective study of twenty-three (23) patients (23 men), injection of high dose buprenorphine, having consulted the outpatient clinic of Razi Hospital between January and July of 2012. Results 8 patients had a communicable disease: 1HIV, 5 Hepatitis C, 1Hepatitis B, 1 syphilis. 4 patients had infectious complications: 3 cases of skin infections and 1 case of endocarditis. 9 had never been screened. 8 recognized using a used needle. Conclusion The addiction to high dose buprenorphine is a widespread phenomenon in Tunisia. Lack of information and awareness of companion in Tunisia is at the origin of serious infectious complications. Health professionals have to play an important role in drug addict patients’ education and supervision, to prevent addiction to buprenorphine and related infectious complications.

Burnout of caregivers in geriatric Institution: “Coping” strategies

Introduction The health sector has long been recognized to be a very stressful work environment for teams that can lead to “burnout”. Geriatric institutions are no exception to this observation; this state has deleterious effects on health care as on the quality of care. Objectives Measure the burnout rate among caregivers in geriatric institutions and identify associated factors and coping strategies specific to this population in order to provide the necessary preventive measures. Subjects and method A cross-sectional study, conducted among caregivers exercising at the shelter for aged subjects of Manouba, Tunisia. We used a pre-survey exploring the socio-demographic data associated with two validated scales: the Maslach Burnout Inventory assessing the level of burnout and the Brief COPE assessing coping strategies. Results Thirty-one subjects were recruited. The prevalence of burnout was 45.16%. Respectively 32.26%, 25.80% and 45.16% of the respondents had high scores in dimensions emotional exhaustion, depersonalization and personal accomplishment at work. The analytical study revealed that seniority in work increased the risk of burnout. The coping strategies of caregivers in geriatric institution facing burnout were mainly centered on emotion. The number of years of experience has been associated with burnout in our study. Conclusion This work reaffirms that the population of caregivers in geriatric institution is at risk of burnout and allows to identify predictors. The establishment of individual and collective measures is essential for appropriate treatment references (In the body text, a publication should be referred to by a consecutive number between bracket)

Travellers to the psychiatric hospital in Tunisia

Resume Objective A growing number of travellers in Tunisia are being hospitalized for a psychiatric condition. This study aimed at characterizing pathological travellers, a population seldom studied in psychiatry. Methods This is a retrospective and descriptive study on patients with nationalities other than Tunisian that were admitted to the only psychiatric hospital in Tunisia from January 2000 to January 2015. Patients were identified on the basis of administrative data. Their medical records were then analyzed and pathological travellers were identified. Results A total number of 157 hospitalizations of patients with foreign nationalities were recorded during the last fifteen years. Among those hospital admissions, 80 patient files were examined. 28.7% of patients ( n =23) were hospitalized for a pathological journey. Fifteen out of these 23 patients were diagnosed with bipolar disorder, five with schizophrenia and three with schizoaffective disorder. Pathological travellers came from European and African countries. The majority of patients were male and single. Average age was 41 years with extremes going from 23 to 73 years. Most of them travelled alone. Conclusion In the context of globalization, international travel is on the increase, which may lead to a rise in pathological journeys. In our study, the majority of pathological travellers were diagnosed with bipolar disorder. Their choice to travel to Tunisia could be explained by the relatively easy accessibility from Europe or Africa, by the nature of the climate, as well as by cultural and religious specificities of the country.

Medical repatriation from Razi Hospital in Tunisia

Introduction Travel might represent a stressful adventure that can influence mental state to a considerable extent. Some of the travellers experience psychiatric emergencies that require medical attention, during the course of their travel, leading to admission to psychiatric hospital and then repatriation. Aims Identify the number and clinical characteristics of foreign patients needing medical repatriation due to psychiatric disorders. Methods This is a retrospective and descriptive study on patients with nationalities other than Tunisian that were admitted to Razi Psychiatric Hospital in Tunis/Tunisia for a psychiatric condition from January 2000 to January 2015. Medical records were analyzed and patients requiring medical repatriation were identified. Results A total number of 157 hospitalizations of patients with foreign nationalities were recorded during the last fifteen years. Among those hospital admissions, 100 patient files were examined. Twenty-nine percent of patients were repatriated to their home countries, most of them to Europe (72.4%, n =21). The majority of patients were female and single. Fifteen out of these 29 patients (51.7%) were diagnosed with bipolar disorder, 34.4% with chronic psychotic disorders, and 6.8% with acute transient psychotic disorders. The majority of patients were visiting Tunisia as part of a pathological journey (55.1%, n =16), 24.1% of patients ( n =7) were tourists and 13.7% ( n =4) were resident in Tunisia. Conclusion The majority of repatriated patients was diagnosed with bipolar disorder and was visiting Tunisia in the context of a pathological journey. Other patients could have been repatriated without being hospitalized. Further studies must be conducted to refine results.

EPA-1008 - Personality traits and major depressive disorder

Introduction The association between major depressive disorders and personality disorders is an important factor to consider due to its clinical, therapeutic and prognostic consequences. The aims of the present study were to determine the prevalence of comorbid personality disorders in patients with major depression, and to evaluate the relationship between some personality traits and outcome of depression. Methods A descriptive and comparative study was carried in the unit ‘E’ at the Razi Hospital. Only men were included. We collected the records of thirty six patients in whom the diagnosis of major depressive disorder was retained in axe I and personality disorder in axe II (as the diagnostic criteria of DSM IV). Assessment was based on demographic characteristics, medical history, clinical aspects of the index episode and outcome characteristics. Results 17 patients (47.22%) had personality disorder (which 23, 5% histrionic, 35,3% antisocial, 17,7% passive-dependent, 23,5% borderline). The patients with comorbid personality disorder had an earlier age at onset of their depression and more previous suicide attempts. Comorbid personality disorders were correlated to an impaired outcome, with more recurrences and more persistent symptoms. Conclusion The impact of personality disorder in the outcome of depression is evident. A taking into consideration of this comorbidity as well as a medicinal and psychotherapeutic care are necessary.

1768 – Sick-leave due to psychiatric disorder among women

Introduction Women take sick-leave more often than men, in general and especially because of psychiatric disorders. Objective The aim of the present study was to describe and analyse sick-leave due to psychiatric morbidity and its relation to age and occupation, with a special focus on sex differences. Method We conducted a retrospective and descriptive study in external consultation of the psychiatric hospital Razi. We collected the records of patients seen between 01/07/2011 and 30/09/2012 and who received sick leave for psychiatric illness. Results 92 patients were included (78 female, 14 male) with mean age of 43,6 years. Sick-leave duration was longer for women. The greatest gender differences were found in the youngest and oldest age-groups. Women had higher incidence also in the longest spells (86% vs 14%). Depressive disorders were found among 73% of cases. Highest incidence of sick-leave was found among those with a combination of psychiatric and physical morbidity. Conclusion Psychiatric disorder is an important factor in sick-leave among women, especially regarding length of absence. Further studies on the influence of sex integration on sickness absence need to be done.

1833 – Incest: a traumatic experience: a case report

Introduction Incest may be defined as sexual relations between close blood relatives. It is found in all walks of life and all cultures. Incest is a taboo in all populations. This “secret” lived in childhood raises questions about the future of such a psychological trauma. Father-daughter incest is the most common. It has psychological, social, medical, and legal ramifications. Recently, it was reported that being the victim of paternal incest during childhood might be a significant predictor of a borderline personality disorder and complex posttraumatic stress in adults. Tunisia is among the countries from which incest cases are rarely reported. Objectives Browse the impact of this early trauma on victims to become adult and difficulties the therapeutic approach. Clinical case We propose from a clinical case of a family, in which five girls were victims of father-daughter incest. Conclusion This would suggest that father-daughter incest is the most traumatic experiences which deserves attention and that we cannot afford to ignore. In-depth knowledge of the dynamics and effects of father-daughter incest suggest specific treatment strategies are indeed necessary.

1808 – The use of antipsychotic drugs in elderly patients with dementia

Introduction Delusions, hallucinations, aggression, and agitation affect more than half of patients with dementia. Antipsychotic drugs are used to treat these behaviors and symptoms. They are among the most frequently used psychotropic drugs in this disease, but their benefits are uncertain and concerns about safety have emerged. We assessed the current practice in use of antipsychotics medication in outpatients with dementia. Method We conducted a retrospective cohort study involving patients older than 65 years who began outpatient treatment with antipsychotic drugs following a dementia diagnosis. Results 22 patients were included (16 female, 6 male) with mean age of 78.6 years. All patients consulted for behavioral problems. Most received typical aantipsychotic drugs (72,8%), while 36,4% received atypical antipsychotic drugs. 13 patients (59,1%) were receiving haloperidol. Improvement was observed in 54,5% of patients. The comparisons of haloperidol with risperidone suggest no difference in efficacy for the treatment of global behaviour disturbance. On the other hand, use of haloperidol is, however, associated with a higher incidence of extrapyramidal and other side effects. Conclusion The treatment of elderly patients requires daily careful management and monitoring because of their polypathology, polymedication and of their greater sensitivity to the toxic effects of drugs. Overall, the study findings suggest that there is a need to monitor antipsychotic drug use by elderly patients in light of recent efficacy and safety data on atypical agents.

P01-136 - Panic disorder and quality of life: a tunisian study

Introduction Panic disorder with or without agoraphobia is one of the most disabling anxiety disorders. It has severe consequences on psychosocial functioning and quality of life of patients. The aim of our study was to evaluate the quality of life in a population of patients treated for panic disorder. Methods Thirty patients were evaluated using a standardized questionnaire exploring socio-demographic parameters, clinical parameters and evolutionary parameters. It also explore the the disorder impact on social life, family and work. Assessing the quality of life was performed using the (SF-36). This scale includes 36 questions divided into eight dimensions. Statistical analysis was performed by SPSS in its 18th version. Results The average age of our population was 42.07 years with extremes ranging from 22 to 71years. The sex ratio was 1. The socioeconomic level was low in 56.7% of cases, medium in 40% of cases and high in 3.3% of cases. Half of the patients reported having marital conflicts; these conflicts had led to divorce in 3.3% of cases. Regarding the professional impact of panic disorder, 33.3% of patients were off work, and 20% used sick leave. The overall average scores of the SF-36 of all patients ranged from 0 to 76 with an average of 37, 98 and a standard deviation of 18.46. Ninety percent had impaired quality of life (overall mean score of less than 66, 7) All dimensions are altered in 100% of the cases except D1 (physical dimension) that is altered in 63.7% of cases.