N. Zouari

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.

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.

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.

Quality of Life, Emotional Distress and Coping Strategies in Patients with Epilepsy

Introduction The epilepsy literature shows a high prevalence of psychological and social disorders which are considered more handicapping than seizures themselves. Objectives - To assess the quality of life (QOL) of patients with epilepsy. - Determine the relationship between QOL and level of anxiety, depression and coping strategies. Methods It was a cross-sectional study involving 50 subjects with epilepsy and followed in the outpatient psychiatry department. The state-trait anxiety inventory was used to assess the level of anxiety, whereas the Beck depression inventory was used to measure the severity of depression. The QOL was assessed using the quality of life in epilepsy inventory (QOLIE -31). The items of the Brief COPE were used to assess coping strategies. Results Coping strategies most frequently used were: emotional support (mean score = 5.52), acceptance (mean score = 5.22) and the emotional expression (mean score = 4.18), but none used the strategies of problem avoidance and self-blame. The average overall score of QOL of our patients was 71.66. It was significantly higher in patients with a minimum level of anxiety (p = 0.012) and those using active coping strategies (p Conclusion Our results emphasize the importance of reinforcing strategies of adjustment to illness and the role of the anxiety associated with the unpredictability of seizures; it seems to have an important impact on QOL of patients with epilepsy.

Correlates of Insight in Patients with Schizophrenia

Introduction Increasing evidence supports the important role of illness state and individual characteristics in insight among patients with schizophrenia (SCZ). Aim of the study To determine factors predicting the lack of insight among patients with SCZ. Methods It was a cross-sectional, descriptive and analytical study, involving 40 patients with DSM-IV diagnosis of SCZ followed in the outpatient psychiatry department at the Hedi Chaker University Hospital of Sfax inTunisia . The SAIQ (Self Appraisal of Illness Questionnaire) was used to measure 3 domains of insight (need for Treatment, Worry, and Presence/Outcome of Illness) and the PANSS (Positive and Negative Syndrome Scale) was used to measure the intensity of psychotic symptoms. Results The average age of our patients was 41 years (21-64 years). The mean duration of disease was 14 years and the number of hospitalization was 2.5. The scores of insight were independent from sociodemographic factors. The lack of insight in SAIQ was significantly correlated with a greater number of hospitalizations (p = 0.03). The worry subscale was associated with a longer duration of disease (p = 0.04) while the presence/outcome of illness subscale was associated with the intensity of negative symptoms (p = 0.03). There was no correlation between insight and positive syndrome. Conclusion Our results show that the lack of insight is closely related to negative symptoms and the duration of the illness in patients with SCZ. Therefore, interventions to better the insight should focus on early diagnosis and psychosocial therapy to improve negative symptoms.

Profile of Tunisian Population of Drug Addicts

Introduction In Tunisia, the number of drug addicts seems toincrease and this addiction is considered as a complex psychiatric disorderwith a chronic relapsing course. Objective to describe the socio-demographic and clinicalprofile of drug addict patients. Methods This consisted on a cross-sectional and descriptive study. Data were collected from the files of 30 men hospitalized at the drug abuse prevention center ‘ATUPRET ‘of Sfax in Tunisia, during the month of September and October 2014. Results The average age of patients was 33,6 years (19-59 years). They were single in 66.7%. Their school leveldidn’t exceed the secondary one in 80% of cases and they didn’t have any occupation in 30% ofcases. Theaverage age of onsetof drug use was21.3 years (14-52years) and the average duration of drug use was 11.9 years (1-43 years). Curiosity was the most commonly reported reasonfor initiating drug use (36, 7%). It was commonly a polytoxicomania (63%). The most widely used substances were cannabis (56, 7%) and subutex (46,7%). Nearly half of subutex addictsused to shoot it (42, 3%) and the average daily dose was 5, 28 mg. A comorbide affective disorder was found in16.7% of addict patients. Conclusion A young single men with no profession and a limitededucational attainment, such is the profile most frequently encountered amongdrug addicts in our study. Those social characteristics and the presence ofunderlying affective disorders should be considered in the management of suchpatients.

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.

2790 – Management of elderly patients consulting in psychiatry: critical thinking about the study of 159 cases

Introduction The prescription of psychotropic drugs in the elderly is more common. Doses are increasingly high, with frequent recourse to a combination therapy. Objective Our purpose was to describe treatment strategies in elderly patients consulting in psychiatry, in order to confront them with the latest recommendations. Methods Our study was retrospective and descriptive. It involved all elderly patients aged more than 60 years, who had consulted for the first time in psychiatry since January 2010 until December 2011. We collected, for each patient, the sociodemographic data, the diagnosis(es), the treatment(s), the side effects and the illness evolution under treatment. Results We collected 159 cases of elderly patients, representing 6.07% of all the consultants in psychiatry during the period of the study. Their average age was 73 with a sex-ratio (M/F) of 1.13. Dementia and mood disorders were the most common diagnoses (respectively 40.2% and 34.6%). As far as drug therapies are concerned, an antidepressant was prescribed to 95 patients (59.7%); an antipsychotic was prescribed to 55.3%. A tranquillizer was prescribed to 40.8%. A combination therapy made of at least two different families of psychotropic drugs was prescribed to 55.9% of the patients. None of the patients benefited from psychotherapy. Conclusion Our study showed that the treatment strategy of the elderly consulting in psychiatry in the area of the study was not in accordance with the latest recommendations.

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.