M. Maâlej

Sexualité de la femme tunisienne : entre le religieux et le culturel

INTRODUCTION Culture and religion carry several prohibitions and taboos, especially in the Arab-Muslim societies, and are therefore involved in the sexual behavior and its perception, particularly that of women. OBJECTIVES To assess the married populations knowledge and opinion about female sexuality, and to estimate the impacts of religious and cultural factors on womens life experience and sexual practice in the Tunisian society. SUBJECTS AND METHODS Our study is in an inquiry. We targeted 55 men and 55 women agreeing to participate in the study. They responded to an anonymous self-administered questionnaire comprising 18 items related to the influence of religion and culture on female sexuality. Among these items, some were binary responses (yes or no) assessing knowledge about female sexuality in the Tunisian religious and cultural context; 8 others explored the opinions of participants about female sexuality. Statistical analysis was performed using SPSS software (15th version). Pearsons chi-square test and Fishers exact association test were used for comparative study (P<0.05). RESULTS The rate of participants who did not manage to reach the threshold of 50% of responses compliant with religious precepts and morals in the Tunisian context was 48.19%. According to 61.8% of participants, the woman should consider sex as a religious duty, and according to 79.1%, she always ought to have sex with her husband even when she did not wish to. This assertion was more frequently reported by women (P<0.001). Among the participants, 35.5% did not approve of the idea that women had the right to reach sexual pleasure, like men. Men recognized this right less often than women did (P<0.001). With reference to social morals, 43.6% of participants thought that the woman should always remain passive when having sex. This opinion was more common to women (P<0.001). There were 71.8% who thought that premature ejaculation was not a limiting factor for female pleasure. Virginity was considered by 63.6% of respondents as a feminine virtue to preserve. This response was statistically more frequent among males (P<0.001). For 55.5%, in addition to sodomy, a man could not afford all the sexual practices with his wife. This response was significantly more frequent in males (P<0.001). Regarding the subjective perception of female sexuality, the percentage of those who thought that women might simulate orgasm was 70.9%. Women thought more frequently than men that such a behavior could be justified to avoid hurting the mans pride (P<0.001). CONCLUSION The experience of sexuality within the Tunisian population is hampered by the prohibitions related to religion and culture, at least in some of its aspects. The reasons for that may be the ignorance of religious texts or their misinterpretation and the biased cultural transmission not followed by questioning or seeking deeper knowledge. The introduction of sex education in school programs could play a crucial role in the fight against the obstacles surrounding sexuality, in order to promote the welfare of woman, and thereby, that of the couple and the family.

Détresse psychologique chez les personnes atteintes par le VIH

Introduction : l’infection par le virus de l’immunodeficience humaine (VIH) est devenue un sujet d’actualite en termes d’epidemiologie et d’impact psychologique. Les troubles psychiatriques sont de plus en plus frequents du fait du retentissement corporel et des representations sociales de cette pathologie. Notre objectif etait de depister l’anxiete et la depression chez les patients atteints par cette infection et de chercher les facteurs associes.

Factors Affecting the Management of Somatic Comorbidity in Tunisian Patients with Schizophrenia

Schizophrenia is often accompanied by somatic comorbidities, which make the management challenge of such patients more difficult. In this study, we proposed to identify the sociodemographic and clinical factors correlating with somatic comorbidities in patients with schizophrenia to facilitate screening and prevention. It was a retrospective descriptive study of 78 schizophrenia patients in clinical remission and followed in outpatient psychiatry. In addition to the acquired records, other data were provided by the clinical and biological examinations performed for each patient. The evaluation of the therapeutic adherence was carried out using the Drug Attitude Inventory (DAI).Seventy-six patients (97.4%) had somatic comorbidities with a mean of 3.83 (± 1.81). This number increased significantly in males, older patients, couples, urban patients, and those receiving a combination therapy. According to a multivariate study, the four predictors of an increased risk of comorbidities were age, use of psychoactive substances, waist size and therapeutic adherence.Our findings focus on somatic comorbidities risk in schizophrenia patients, requiring particular vigilance in their follow-up, and suggest some modifiable clinical factors that might be a preferred target for reducing or preventing the occurrence of such disorders.

Alcohol Use and Associated Environmental Factors Among Middle and High School Students in Sfax (Tunisia)

Our objective was to investigate the prevalence and the environmental determinants of alcohol use among students in the region of Sfax in Tunisia. We carried out a cross-sectional study among 315 middle and high school students. We used the Alcohol Use Disorders Identification Test (AUDIT) to identify risky alcohol consumption, and we used the Parenting Styles and Dimensions Questionnaire (PSDQ) to assess the students’ perceptions of their parents’ parenting styles. The results show that 19.7% reported drinking alcohol at least once in their lifetime. Among them, 21% scored as dependent alcohol users, according to the AUDIT. Those who drank alcohol at least once were more likely to have parents with a permissive parenting style ( p  < 0.001; Cramer’s V  = 0.287), and a father ( p  < 0.001; Cramer’s V  = 0.258), a mother ( p  = 0.025; Cramer’s V  = 0.158), or a friend ( p  < 0.001; Cramer’s V  = 0.341) who drinks. Students perceiving their parents’ parenting style as permissive had the highest AUDIT score ( p  = 0.005; partial η 2  = 0.132). The authoritarian style score was significantly higher for students who were current alcohol users ( p  = 0.028; Cohen’s d  = 0.57). Our study highlights the influence of peers, family drinking, and parenting styles on alcohol use among middle and high school students. Therefore, particular attention should be given to students that are at risk of having the abovementioned environmental determinants of alcohol use. And, prevention strategies should involve parents, as well as enhanced guidance and counseling for these students.

The Management of Depressed Patients by the Tunisian General Practitioners: A Critical Trans-sectional Study

Under-diagnosed and under-treated, depression has a pejorative prognosis. The general practitioners (GP) represent the most often consulted healthcare professionals by depressed patients. The aim was to describe how the Tunisian GPs manage the depressed patients and to note the difficulties they encounter in order to suggest corrective measures. A survey was conducted among 140 GPs in Sfax Governorate. The percentage of the GPs whose responses conformed to the scientific data in at least 67% of the items was 31.4%. Four factors were correlated to a good management of depression: age (p = 0.028), masculine gender (p = 0.016), long career (p = 0.034) and participation to continuous medical education sessions on depression (p = 0.01). Our study revealed inadequacies in the management of depression by the GPs. GPs were invited to sensitizing meetings. A training on depression was assured for the future internship supervisors by the commission of medicine of family in the Faculty of Medicine of Sfax.

EPA-1646 – Profile of suicidal attempters in psychiatric clinical population in tunisia

Introduction In Tunisia, the number of suicide attempts (SA) leading to a psychiatric follow-up seems to increase. Objectives To describe the clinical and environmental profile of suicidal patients addressed to the outpatient psychiatry department. Methods It was a retrospective and descriptive study. Data were collected from the files of 29 suicidal attempters referred in 2012 to the outpatient psychiatry department at the Hedi Chaker University Hospital of Sfax in Tunisia, after one or more SA. Results SA accounted for 2.4% of new patients referred to the outpatient unit during the year 2012. The sex ratio (M / F) was 0.7 and the mean age was 28.8 years. They were single in 51.7% of cases. Their school level didn’t exceed the primary education in 62% of cases and they didn’t have any occupation in 51.7% of cases. Some relational problems, especially family ones were identified in 69% of cases and the quality of family and / or social support was considered poor in 41.4% of cases. The SA was reactional in 24.1% of the cases; 34.5% of suicidal attempters presented a personality disorder and 17,2% presented a major depressive episode. Conclusion A young single person with no profession, a limited educational attainment and low social support, such is the profile most frequently encountered among suicidal attempters. The presence of underlying mental disorders and socio-familial dysfunction seems to be important risk factors for suicide and should be considered in the prevention of recurrence.

P-583 - Impact of January 2011 events in tunisia on psychiatric hospitalizations

In recent decades, several studies have examined the effects of both natural and man mad disasters, on a vulnerable population, the mentally ill. Objectives were to determine the impact of Tunisian revolution events on the psychiatric hospitalizations in January 2011 and to compare them with January of the last 2 years (2010 and 2009). It was a retrospective, descriptive and comparative study. All patients admitted in the psychiatric “C” department in Sfax teaching Hospital (Tunisia) between first and 31 January of 2009, 2010 and 2011 were identified through medical records. We collected for each patient the socio-demographic, clinical and therapeutic data. We compared the frequency, the reasons for hospitalization and the predominant delusion themes, for these three periods. The number of psychiatric hospitalizations in January 2009 and 2010 was 39, while in 2011it was 56 (almost one and a half). The three studied groups of patients (2009, 2010 and 2011) had no statistically significant socio-demographic difference. In January 2011, the psychomotor excitation (37.5%) and aggressive behavior (37.5%) were the main reasons for hospitalization. States of psychomotor excitations were also more frequent in January 2011 (37.5%) compared with January 2010 (7.7%) and January 2009 (25.6%). Delusion of politics was the most common in January 2011 (17.9% of themes) but non- existent in January of 2009 and 2010. These results show that the number of psychiatric hospitalizations has increased during January 2011. But, did the revolution events represent the determining factor behind this increase in psychiatric hospitalizations?

P03-567 - Teenagers’ perception of their sexuality

The objective of this work was to study the perception of teenagers for their own sexuality in the Tunisian socio-cultural context. One hundred teenagers participated in the study. They filled in an anonymous self-report questionnaire, consisting of 14 items relative to the aspects that seemed to us the most meaningful concerning teenage sexuality. Eighty-one percent of the participants did not manage to provide answers, in conformity with scientific data, to a minimum of 75% of the items. Fifty percent considered masturbation at adolescent age to be pathological. The possibility of a homosexual tendency during adolescence was rejected by 75%. Eighty-one percent perceived the subject of teenage sexuality as embarrassing. They were not permissive regarding the issue of sexual protected relations amongst adolescents in 44% of the cases, and regarding the interest that a female teenager could have in sexuality in 23% of the cases. Our study demonstrated a relatively high frequency of prejudice relating to teenage sexuality amongst the teenagers, reflecting the impact of the taboo on sexuality and particularly on the female teenager in the Tunisian socio-cultural context. The change in mentalities regarding teenagers’ sexuality should take place very smoothly.

P02-402 - Psycho-functional pain in depressed patients

Somatic symptoms are the main complaint of depressed patients in two thirds of cases. The objectives of this study were to assess the prevalence of psycho-functional pain in depressed patients consulting in psychiatry, and to identify factors associated with algic depression. We conducted a cross-sectional study, which involved depressed patients who consulted in psychiatry, in February 2010, at Hedi Chaker University hospital in Sfax, Tunisia. For each patient, we collected demographic, clinical and therapeutic data. We used the VAS to evaluate the intensity of pain, the HDRS to assess the severity of depression and the magnitude of improvement under treatment. The statistical analysis was performed by SPSS. The comparative study was based on the Chi2 test and Fischer test. We collected 36 cases of patients suffering from depression. Their average age was 48.2 years. Depression was minor in 33.3% and major in 50% of cases. The prevalence of psycho-functional pain was 80,6%. The pain was described as intolerable by 41.4% patients, agonizing by 17.2% patients and exhausting by 17.2% patients. The intensity and duration of pain were correlated to the severity of depression (p respectively: 0,006 and 0,008) Our study showed that the psycho-functional pain were very common in depressed patients, which is consistent with literature data. On the therapeutic level, it is important to take into account the algic symptomatology in the treatment of depressive episode. The emergence of new molecules mixing monoaminergic action would provide an effective response to the depressed patients with psycho-functional pain.

P01-186 - Perception of adolescents’ risk behaviours by the medical staff

The objective of this work was to study the perception of the adolescents’ risk behaviours, in the arabo-islamic context, by a hundred of medical and paramedic staff. Fifty doctors and fifty paramedics who have at least one adolescent child participated in the study. They have filled in an auto-questionnaire in an anonymous way, consisting of 6 items related to the general profile of the participants and another 10 relative to the aspects that seemed to us the most pertinent ones concerning adolescents’ risk behaviours. The answers of the participants enabled us to index the items in three groups: - Items with a high frequency of correct answers, independently of the educational level, referring to the unprotected sexual relations, the drug consumption, the dangerous moped driving, spending much time on internet and the excess of preoccupations to his weight. - Items with high frequency of incorrect answers independently of the educational level, referring to the fact that the teenager smokes and consumes alcoholic drinks or drug alone. - Items with a rate of correct answers significantly lower with paramedics than with doctors (p The answers of medical staff investigating were frequently in unconformity with scientific data, with many prejudiced ideas, reflecting the impact of the taboo related to the arabo-islamic culture what encourages us to suggest recommendations aiming to sensitize paramedical staff as well as the general public to the particularities of adolescence.