Psychiatric manifestations of measles encephalitis: About a case report

Introduction

Acute measles encephalitis is a pathology of the central nervous system. It is most frequent in children but can also be described in adults. Given the rarity of this pathology, we present the case of this patient.

Objectives

present a rare neuropsychiatric complication of measles

Methods

Présentation d’un cas clinique d’encéphalite rougeoleuse et revue de la littérature

Results

Mrs. HJ, 45 years old, without any somatic history, was followed for an antisocial personality with a substance use disorder. She consulted the emergency for psychomotor agitation, a fever of 39, and a rash on the face, thorax, and limbs. At the psychiatric interview, she was disoriented and very unstable. She seemed to be hallucinating.

The brain imaging and the lumbar puncture (CT scan and brain MRI) were without abnormality. The rapid test (HIV) was negative and the biological check-up showed a hyperleukocytosis at 12660 and a crp at 138. The patient was put on double antibiotic therapy.

The evolution was marked by the non-improvement of the symptomatology with the persistence of agitation. Her speech was almost absent with a refusal to answer and to execute orders. She maintained certain postures. The patient was put on 400 mg of amisulpride.

After recovery of the viral serology, the diagnosis of a measles encephalopathy was confirmed (IgM positive) and the patient improved after a few days of hospitalization and was addressed to the psychiatric outpatient clinic.

Conclusions

Measles encephalitis is a rare but serious complication that requires multidisciplinary management

Disclosure

No significant relationships.

Psychoactive substance use among medical residents in Tunisia

Introduction

Recent studies in the word found an increase of substance use among medical students.

Objectives

To determine the prevalence of substance use and associated factors among medical residents in Tunisia.

Methods

It was a descriptive and analytical cross-sectional study among medical residents from the 4 medical faculties of Tunisia. A questionnaire was created from Google Forms and was published on the social network Facebook. We asked about the current consumption of different psychoactive substances. We used the Patient Health Questionnaire (PHQ-9) to identify depressive symptoms.

Results

The sample included 241 residents. The female sex was predominant (83.4%, n = 201). The average age was 28.18 (± 2.13) years. Among these residents, 27.8% (n = 67) currently consume at least one psychoactive substance and 71% (n = 171) had depressive symptoms. The substances consumed by residents were: tobacco 18.7% (n = 45), alcohol 18.7% (n = 45), cannabis 6.2% (n = 15) , amphetamine 3.3% (n = 8), sleeping pills (without medical prescription) 2.9% (n = 7), hallucinogens 2.9% (n = 7), cocaine 2.1 % (n = 5) and inhaled solvents 0.4% (n = 1).

The use of at least one psychoactive substance was significantly associated with male sex (p = 0.01), the presence of financial problems (p = 0.08), lack of religiosity (p <0.001), feeling of life dissatisfaction (p = 0.01), uncertainty about life events (p = 0.05) and the presence of depression (p = 0.018).

Conclusions

Psychoactive substance use has become a growing problem among residents in Tunisia. The associated factors should attract attention to identify these subjects.

Disclosure

No significant relationships.

Individual factors associated with workaholism among Tunisian engineers

Introduction

Globalization and increased competition in the engineering profession induce to work longer and harder, which predisposes to workaholism or work addiction. Identifying individual factors associated with workaholism could help to maintain the mental health at work.

Objectives

The aim of this study was to assess the prevalence of workaholism and its associated socio-demographic and historic factors among Tunisian engineers.

Methods

A cross-sectional descriptive and analytical study conducted among Tunisian engineers during July 2021. The data were collected by an online questionnaire including the socio-demographic and historic information and the “the Work Addiction Risk Test” (WART) which was used to assess the workaholism.

Results

A total of 52 engineers participated in this study (40.4% female and 59.6% male). The average age was 30.75 years (SD=6.25 years). Concerning marital status, thirty-five engineers (67.3%) were single. Of the participants, 17.3% had a history of chronic somatic-disorders and 25 % of them had a history of a psychiatric disorder, such as depressive disorder in 11.5% of cases. The prevalence of workaholism in Tunisian engineers was 23.1%. Workaholism was associated to older age with no significant difference (p = 0.11). The analysis showed that workaholics had more history of depressive disorder (p = 0.02) compared to non-workaholics. However, no significant difference was found by the other socio-demographic factors according to workaholism.

Conclusions

Workaholism is a significant phenomenon among Tunisian engineers. It may depend of personal characteristics and induce negative consequences on mental health and lead to depression.

Disclosure

No significant relationships.

Quality of life in patients with chronic hand eczema

Introduction

Chronic hand eczema (CHE) , inflammatory dermatitis, can lead to physical and psychosocial disability altering the quality of life of these patients.

Objectives

The objective of this study was to examine the quality of life in patients with chronic hand eczema

Methods

Descriptive study collating patients who consulted for CHE, at the Dermatology Department of the CHU Hédi Chaker Sfax, during 3 years (2018-2020). A socio-demographic, clinic , and the Quality of life Questionnaire (DLQI) were administered in this study.

Results

Our study included 12 patients (8 men and 4 women). The mean age was 46.8±11.6 years. The patients were in professional activity in 86.8% of the cases. No patient was in early retirement or disability status. The average duration of the disease was 4.5 years (1- 9 years). All patients were in remission. The intensity of pruritus at the last attack was mild (25.77%), moderate (72.23%), and severe (2%). The impact of pruritus on sleep was noted in 100%. The mean total quality of life score (DLQI) was 6.8±5.5 which means a moderate impairment of quality of life

Conclusions

This work highlights the importance of the impact of this dermatitis on the quality of life of these patients. Therefore, multidisciplinary dermatological and psychiatric management is considered necessary

Disclosure

No significant relationships.

Dopaminergic dysregulation syndrome associated with Othello’s syndrome in a patient with Parkinson’s disease: about a clinical case

Introduction

Parkinson’s disease (PD) and its pharmacological treatment can be associated with a long list of neuropsychiatric complications.

Objectives

The aim of our case report is to investigate through a case analysis the possible association of dopaminergic dysregulation syndrome and Othello syndrome

Methods

we carried out a case analysis and a review of the literature by searching the PubMed database

Results

Case report We present the case of a 43-year-old man suffering from early PD since the age of 16, started on levodopa since the age of 19.

Since 2 years, the patient has resorted to a considerable increase in the doses of levodopa up to 2500 mg / day, the evolution was marked by the installation of disabling dyskinesias and by a change in his behavior and mood.

He was then hospitalized in psychiatry following aggressive behavior towards his wife. The admission examination found a patient who was motor unstable with an interpretative delirium of jealousy and persecution.

The diagnosis of Othello syndrome associated with SDD was retained.

Our therapeutic strategy has been to put the patient on quetiapine, reduce the doses of levodopa, add a dopamine agonist and involve psychoeducation of the patient and his family. Evolution has been marked by the reduction of delusions of jealousy.

Conclusions

This case reports a rare case of delirium of jealousy induced by the misuse of dopaminergic drugs in a patient with PD in its early form. These complications can have catastrophic consequences for the patient. Researching and recognizing these psychiatric manifestations should help avoid devastating consequences.

Disclosure

No significant relationships.

cognitive complaints in schizophrenia: characteristics and relationship with insight

Introduction

Patients with schizophrenia suffer from cognitive difficulties expressed in the form of complaints as well as poor insight. The interaction of these two factors makes the management of these patients more difficult.

Objectives

To assess subjective cognitive complaints in a population of schizophrenics and study its relationship to insight.

Methods

Our study was a cross-sectional, descriptive, and analytical study of 72 stabilized schizophrenics followed up at the outpatient clinic. Subjective cognitive complaints were assessed by the SSTICS, clinical symptoms by the PANSS, and insight by the SAI-E.

Results

The mean age of our population was 46.83± 11.6 years. The patients had a low socio-economic level in 70.1%. They were unemployed in 46.9% , consumed alcohol in 23.6%, and consumed tobacco in 58,6% of the cases. the total score on the PANSS scale was 46. They had an average score of 25 on the total SSTICS score and 20,1 on the SAI-E. Cognitive complaint scores were significantly correlated with improved insight (p=0,00),low socio-economic level (p=0.04),alcoholism (p=0.001) and smoking (p=0.01)

Conclusions

Cognitive complaints in schizophrenia could be influenced by the level of clinical insight and reflect a deep malaise, requiring a more targeted and optimized management

Disclosure

No significant relationships.

Professional factors supporting workaholism among Tunisian engineers

Introduction

Workaholism or work addiction is a growing public health that may induce negative consequences on professional life. Engineers are at risk given the globalization and increased competition in their jobs.

Objectives

The aim of the study was to assess the different professional factors that promote wokaholism among Tunisian engineers.

Methods

A cross-sectional descriptive and analytical study conducted among Tunisian engineers during July 2021. The data were collected by an online questionnaire including the socio-demographic and professional information and the “the Work Addiction Risk Test” (WART) which was used to assess the workaholism.

Results

Participants were 52 engineers (31 males and 21 females), and aged from 23 to 55 years old (average age 30.75 years). Thirty-five engineers (67.3%) were single. Concerning professional data, 30.8% of engineers worked in the public and 51.9% of them were computer engineers. Of the participants, 11.7% worked more than 12 hours, 61.5% worked overtime and 92.3% had weekly rest. The prevalence of workaholism in Tunisian engineers was 23.1%. Engineers working in the public sector and working more than 12 hours had significantly higher proportion of work addiction with p <0.001 and p = 0.01, respectively. However, no significant difference was found by specialty, working overtime and having weekly rest according to workaholism.

Conclusions

In our study, we found that the public work sector and extended working hours promote work addiction. Addressing supporting factors in the work environment and periodic examination of the engineers and responding accordingly is required.

Disclosure

No significant relationships.

Perfectionism in academic settings and relationship to depression and socio-demographic characteristics

Introduction

Acute measles encephalitis is a pathology of the central nervous system. It is most frequent in children but can also be described in adults. Given the rarity of this pathology, we present the case of this patient.

Objectives

To assess perfectionism and depression and to study the relationship between these two parameters in a population of medical students.

Methods

We conducted a descriptive and analytical cross-sectional study among students of the Faculty of Medicine of Sfax during the months of June, July, and August 2020. The data were collected through a self-questionnaire disseminated on the social network “Facebook”.This questionnaire included identification of socio-demographic characteristics as well as the personal history of students. Perfectionism was assessed by the Rheaume scale and depression by the Beck scale.

Results

A total of 206 students participated in the survey. The mean age was 21.49 ± 1.37 years. The majority of students were female (57.2%) with a sex ratio (F/H) of 1.34. Of the participants, 39.8% were enrolled as undergraduates and 60.19% as graduate students. According to their scores on the Rheaume scale, the students were non-perfectionists (NP) in 21.4% of cases; moderately perfectionists (MP) in 70.38% of cases, and highly perfectionists (HP) in 8.25% of cases. Severe depression was objectified in 7.3% of the cases. Students living alone were less perfectionist (p=0.01). Perfectionism score was higher in depressed students (35 ± 6.34) versus (31.428 ± 6.37) with a statistically significant correlation ( p ≤ 0.001).

Conclusions

It is true that perfectionism is an essential element for academic success. However, screening and prevention of depression are deemed necessary given its significant association with perfectionism.

Disclosure

No significant relationships.

Anxiety, depression and post-traumatic stress symptoms among COVID-19 survivors in Tunis

Introduction

In addition to physical problems, patients with COVID-19 suffer from considerable stress throughout the disease crisis and could present psychiatric consequences even after their remission.

Objectives

To assess anxiety, depression and post-traumatic stress symptoms among patients who had recovered from the acute COVID-19 infection in Tunisia.

Methods

A cross-sectional design included 50Tunisian adults who survived COVID-19 virus infection.Participants have been screened with a telephone interview 1 to 3 months after a diagnosis of COVID-19. We used a questionnaire including socio-psychological variables,presence of close relatives being infected, bereavement due to COVID-19 and post infection physical discomforts.The Impact of Event Scale-Revised (IES-R) was used to investigate post-traumatic stress disorder (PTSD). Depression and anxiety were measured using The Hospital Anxiety and Depression Scales (HADS).

Results

The age of the participants ranged from 19 to 86 years.38%were female. Twelve percent (12%) of patients required hospitalization during COVID-19 infection. After a mean of 86.60 days (SD = 23) following the diagnosis, 28 % of patients reported clinically significant PTSD. The rates of depression and anxiety disorders in our population are 20% and 30%, respectively. Seventy percent of patients (70%) reported one or more post infection physical discomforts that the most common symptoms included Difficulty breathing and anosmia. Patients with PTSD, depression or anxiety had a more frequent history of a relative diagnosed positive for corona virus, a longer duration of infection, and more frequently post-infection physical discomfort

Conclusions

Long-term psychological impact of COVID19 should not be ignored and mental health care could play an important role in rehabilitation.

Disclosure

No significant relationships.

Anxiety and depressive symptoms in patients with psoriasis

Introduction

Psoriasis is a chronic inflammatory skin disease that affects approximately 2% of the population. It seems to have a multifactorial aetiology and it can be considered as a psychosomatic disorder.

Objectives

To determine risk factors for anxiety and depression in psoriasis

Methods

Case-control study including 44 subjects with psoriasis and 50 controls without psoriasis. All participants answered the Hospital Anxiety and Depression Scale (HADS) to measure the severity of anxiety and depression

Results

Descriptive study: We solicited 44 patients and the average age was 45.8 years. The majority of patients were married (70.5%), unemployed (40.5%), without medical heredity (84,6%). Psoriasis was in plaque (65.9%), guttate (20.5%), pustular (13.6.5%).Its severity, assessed by BSA, was mild to moderate in 72.7% of cases and associated arthropathy was noted in 29.5% of patients.the prevalences of anxiety and depression estimated at 29.54% and 18.18% respectively. Analytical study: Subjects with psoriasis, as opposed to controls, showed higher levels of anxiety (29,54% vs 15,9%) and depression (18,18% vs 4,54%) but there was no significant difference (p=0,335, p=0,573) Depression was significantly more important for single (p=0.043), for patients with associated arthropathy (=0.005) and for guttate form (p=0.015) According to the severity of the disease: patients with mild disease are more anxious and patients with severe disease are more depressed

Conclusions

Higher scores in anxiety and depression is common in psoriasis. Dermatologists should give special attention to this subgroup of persons with psoriasis in order to prevent future psychopathology.

Quality of life in patients with schizophrenia

Introduction

Schizophrenia, with its high prevalence, chronic progression and social impact, is a major challenge for health professionals. For this reason it is important to assess the impact of this disease on these patients, mainly on their quality of life.

Objectives

To study the quality of life in patients with schizophrenia and determine the factors correlated with it.

Methods

A cross-sectional, descriptive and analytical study of 28 patients with schizophrenia followed up at the psychiatric consultation in Hédi Chaker University Hospital of Sfax. Data collection was performed using a sheet exploring socio-demographic and clinical data. We used the Quality of Life Scale (Q-LES-Q-SF).

Results

The average age of our patients was 40.61±6.27 years. The sex ratio (M/F) was1.15. The socioeconomic level was low in 71.4%. The average number of relapses was 3.04±1.4. Follow-up and compliance were good in 28.6% of cases. The average number of hospitalizations was 3.04±1.4. The average of quality of life in patients with schizophrenia was 21±5.74. The quality of life was affected with age (p=0.023), with the high number of relapses and with a higher number of hospitalizations in psychiatric hospital (p=0.008). Quality of life was improved with regular follow-up and good adherence to the treatment (p=0.000).

Conclusions

The quality of life in mental disorders was impaired mainly in schizophrenics, hence the need to evaluate in a codified way the quality of life of our patients in order to raise awareness among general practitioners as well as psychiatrists to improve the therapeutic and social care of patients.

Insight and self-esteem in patients with bipolar disorders

Introduction

The recurrence of bipolar disorder due to poor treatment adherence can be explained by different factors.The poor awareness of the disorder seems to be the major cause.

Objectives

To evaluate insight in patients followed for euthymic bipolar disorders and determine the factors correlated with it,mainly the self-esteem.

Methods

A cross-sectional descriptive and analytical study of 33 euthymic subjects with bipolar I and II disorders (DSM 5) and followed up at the psychiatric consultation in Hédi Chaker university Hospital of Sfax.Data collection was performed using a sheet exploring socio-demographic and clinical data. We used Birchwood insight scale to assess the quality of insight and Rosenberg’s Self-Esteem scale.

Results

The average age of our patients was 44,52±12,99 years old.The sex ratio =0.32.Patients were followed for bipolar I disorder(60.6%).The first episode of the disease was depressive in(51.5%) of cases.The average number of depressive episodes was1.97±1.87.The last episode was depressive in(57.6%) or manic in(42.4%).There were no psychotic characteristics in(42.4%) of cases.The patients had good insight in(54.5%).The average of self-esteem score was27±7.85and it was low in 51.5% of cases.Factors correlated with good insight were bipolar II disorder(p=0.001), high number of depressive episodes(p=0.013) and absence of psychotic characteristics(p=0.003) during the last episode.In addition,good insight was significantly associated with low self-esteem(p=0.023).

Conclusions

Our study shows that a poor insight depends mainly on the clinical characteristics of bipolar disorders. Moreover,low self-esteem seems to be linked to it. For this reason, our attention should be focused on psychoeducation to improve insight, especially during episodes, in order to facilitate integration and increase patients’ self-esteem.

The factors associated with subjective cognitive complaints in schizophrenia

Introduction

Schizophrenia (SKZ) is a chronic, disabling and incapacitating psychiatric disorder. In addition to the traditional symptomes of schizophrenia, the suffering of this patients can be expressed through a set of cognitive complaints

Objectives

To determe the factors associated with subjective cognitive complaints in schizophrenia

Methods

We conducted a cross-sectional descriptive and analytical study among a sample of of 72 patients followed in psychiatric outpatient of Hefi chaker university hospital in sfax. We used the SSTIC scale to determine subjectif complains ans the PANSS to evalue positif and negatif symptomes

Results

The mean age of our popularion was 46.83± 11.6 years. The patients had a low socio-economic level in 70.1%. They were unemployed in 46.9%, consumed alcohol in 23.6% and consumed tobacco in 58,6% of the cases. the total score on the PANSS scale was 46, distributed as follows: 9 for positive symptoms, 17 for negative symptoms and 22 for total psychopathological assessment. They had an average score of 25 on the total SSTICS score Factors significantly correlated with subjective cognitive complaints were: low socio-economic level (p=0.04), lack of occupation (p=0.001), alcoholism (p=0.001), smoking (p=0.01) and presence of negative symptoms (p=0.00).

Conclusions

This study demonstrates that socio-demographic characteristics and the predominance of negative signs may increase the subjectif cognitif complains in schizophrenia. The recognition of these associations by the psychiatrist can have an important implication in the therapeutic management.

Impact of postpartum depression on quality of life

Introduction

Women during the postpartum period experience many physiological, psychological, and social changes. Quality of life (QOL) is a sense of well-being and arises from satisfaction or dissatisfaction with various aspects of life including health, employment, socioeconomic state, psychological-emotional state, and family.

Objectives

The purpose of this study was to identify influence of childbirth experience and postpartum depression on QOL.

Methods

This is a descriptive cross-sectional study regarding 150 postpartum women receiving cares in the hospital of Sfax and examined during the first and the sixth week post-delivery. Data collection tools in this study were demographic questionnaire, Edinburgh Postnatal Depression Scale (EPDS), and world health organization quality of life-bref (WHOQOL-bref). Data were analyzed using SPSS.

Results

The mean age of our sample (n = 150) was 29.61 years. During the sixth week study period, 126 of 150 were examined.

A personal psychiatric history of depression was found in 9.3% of cases.

The current pregnancy was undesired in 15.3% of cases.

The prevalence of postpartum depression in the first week was 14.7% and 19.8% in the sixth week after delivery.

The mean score of quality of life was 81.62 ± 9.09.

Scores of quality of life and all its dimensions were significantly lower in depressive women.

Conclusion

Because enormous changes develop in postpartum women, we suggest supportive measures for mother by her mother-in-law family, and caregivers to improve the QOL and health status of the mother and her child and to prevent postpartum depression.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The psychological impact of melasma. A report of 30 Tunisian women

Introduction

Melasma is a common disorder of acquired hyperpigmentation characterized by tan or brown macules and patches localized to photo-exposed areas of the face.

Objective

To study the psychological impact of melasma on Tunisian women.

Methods

We conducted a cross-sectional study on thirty patients with melasma who attended the dermatology department of the University Hospital in Sfax (Tunisia).

The questionnaire included socio-demographic and clinical data. We used four measurement scales:

– MELASQOL questionnaire;

– Rosenberg Self-Esteem Scale;

– Hospital Anxiety and Depression Scale;

– Body Image Questionnaire.

Results

The mean age was 34.6 years. The majority was living in urban areas (90%), was married (56.7%) and had a profession (80%).

Sixty percent of patients were anxious and 16.7% were depressed. Both self-esteem and body image were respectively altered in 43.3% and 36.6%. The average score of MELASQOL was 31.77%. It was higher in single woman (36.8 vs. 28.4), younger than 40 years old (31.5 vs. 21.7), having a low socioeconomic status (45.2 vs. 29) and working in private sector (40 vs. 24).

The quality of life was more damaged in patients with disease duration less than five years (P = 0.024).

Anxious patients had higher MELASQOL scores than non-anxious (38.17 vs. 22.17; P = 0.008), as well as depressed patients (49 vs. 28.32; P = 0.009).

High MELASQOL scores were correlated with low self-esteem (P = 0.05) and altered body image (P = 0.04).

Conclusion

Although benign, melasma causes an important psychological impact such as anxiety, depression, low self-esteem and poor body image. These effects should be considered in the care plan.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Pain Assessment in People with Dementia

Introduction

Assessing and quantifying the experience of pain in elderly with cognitive impairment is particularly challenging and important.

Objectives

To describe the overall profile and to identify the prevalence and characteristics of pain among demented elderly.

Methods

A descriptive study including 60 institutionalised elderly aged 65 and older in the retirement home, Sfax, Tunisia. Data collection was conducted using questionnaire exploring socio-demographic and medical data. Mini-mental state examination (MMSE) and Katz index of independence in activities of daily living (ADL) were used to assess respectively mental status and dependence for ADL. Verbal Descriptor Scale (VDS) and elderly behavioural scale (ECPA) were used to evaluate pain. Thirty-two elderly were included and the inclusion criteria were: Age ≥ 65 and MMSE score ≤ 20.

Results

The average age of cognitively impaired residents was 74.2 years with a slight male predominance (57%). They were mostly illiterate (83%) and 56.3% of subjects were single. Almost two-thirds were admitted voluntarily and the average length of stay was 4.8 days. The ADL scale has shown that 65.6% were dependent. According to the VDS, the majority of demented subjects (93.8%) did not feel and express pain, 3% of residents with dementia had mild pain, 2.2% had moderate pain and 1.1% had severe pain. Whereas, the hetero evaluation (ECPA) concluded that 72% of demented elderly actually had pain with severe pain in 18.8% of cases.

Conclusion

Pain in elderly persons with dementia is a significant problem. This underlines high needs of research as well as excellent implementation concepts for assessment and treatment of pain.

Disclosure of interest.

The authors have not supplied their declaration of competing interest.

Eating Disorders in Schizophrenia

Background

Due to their frequency and negative impact on quality of life, eating disorders in schizophrenia need to be considered and highlighting.

Objective

To identify the risk of eating disorders (ED) and its correlates among mental patients.

Methods

It was a descriptive and analytic study. It included 53 inpatients with DSM-5 diagnoses of schizophrenia or schizoaffective disorder, followed in the department of Psychiatry at the Hedi Chaker University Hospital of Sfax in Tunisia, during the three months of August, September and October 2016. Data collections were conducted using questionnaire exploring sociodemographic and medical data. The SCOFF (sick, control, one, fat, food) Questionnaire was used to screen ED. A total score of ≥ 2 was used as a cutoff point to select persons at risk of ED.

Results

The average age of our patients was 30.47 ± 9.5 years old. The majority of our patients was male (71.7%) and single (71%). The mean of extra Body mass was 27.9. The mean duration of disease was 9.9 ± 8.1 years and patients were mostly (54%) in atypical neuroleptics. According to the SCOFF Questionnaire, 35.8% had a risk of ED. Female gender and treatment with atypical neuroleptics were significantly associated to ED risk with respectively P = 0.02 and P = 0.038.

Conclusion

Eating disorders remain underestimated among patients suffering from schizophrenia. Yet, its screening prevention and management are crucial and must be multidisciplinary for optimal care.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Quality of Life and Depression in Caregivers of Patients with Cancer

Background

Most elderly patients, with cancer are cared for, by a family member who may be affected by various stressors that can influence their health and quality of life (QOL).

Objectives

To explore depression, quality of life and its related factors among caregivers of elderly patients with cancer.

Methodology

This is a descriptive and analytical cross-sectional study including 40 primary caregivers of old patients aged 65 or older, with cancer in oncologic radiotherapy service in university hospital Habib Bourguibain Sfax, Tunisia. The short form health survey (SF-36) and Beck inventory (13 items) were used to assess respectively QOL and depression.

Results

The average age of caregivers was 44.62 years. The sex ratio (M/F) was 0.9. Most of caregivers (75%) had impaired QOL (score ˂ 66.7). The two main components of SF-36 were altered with a standard score of 45 for the physical component and 41.1 for mental component. According to Beck inventory, Depression was present in 67.6% of cases. Impaired QOL of life was significantly correlated with somatic illnesses in the caregiver (P = 0.016), advanced stage of cancer (P = 0.01), financial difficulties (P = 0.04), the non-cohabitation with the patient before the disease (P = 0.031) and depression (P = 0.00).

Conclusion

According to our study, caregiving can have a negative effect on the caregiver's mental and physical health. Assistance and information from healthcare professionals are the key to improving the ability of caregivers to cope with caring for older patients with cancer.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Burnout in Medical Residents: Prevalence and Risk Factors

Background

Burnout is a state of mental and physical exhaustion related to work. It is manifested in a variety of professions and is prevalent in contexts in which health professionals are required to interact directly with the public.

Objectives

To estimate the burnout syndrome (BOS) prevalence and to identify its associated factors among medical residents.

Methods

A descriptive and analytic study conducted during a period from 2012 until 2014, including 184 residents exerting at the two university hospitals of Sfax, Tunisia. Data collection was conducted using an anonymous self-questionnaire, including demographic items and working conditions items. Maslach Burn-out Inventory (MBI) was used to assess BOS.

Results

The average age was 25.14 ± 1.47 years. The sex-ratio was 0.65. The majority (154 residents) was single. Over than half (58.2%) of medical residents endure a high emotional exhaustion, 62.5% a high depersonalisation and 12.5% a low personal accomplishment. About eighty percent (79.3%) of them were in burn out with 37% at intermediate and 11.3% at a severe degree. No statistical association was found between the personal characteristics and BOS. Whereas, several factors related to employment status were correlated with the presence of BOS such us: number of working hours > 30 h/week, a number of free weekends < 2/month and a number of days off ≤ 30 days/year. In addition, we found that psychotropic and alcohol consumption were significantly associated to BOS with respectively P = 0.050 and P = 0.002.

Conclusion

Burnout is a worrying reality among young doctors. Individual as well as organizational interventions should be targeted to prevention.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Drug-induced tardive dyskinesia: A case report

Introduction

Tardive dyskinesia (TD) is a serious medical condition that affects a significant proportion of patients treated with antipsychotic agents.

Objective

To report a patient who developed tardive dyskinesia after initiation of antipsychotic and antidepressant treatment.

Case report

Miss H. is 24-year-old Tunisian woman who had been diagnosed with bipolar disorder 6 years ago. She received various drugs: olanzapine, haloperidol, amisulpride, sertraline, paroxetine, etc. On November 2013, she first complained of hand tremor and then developed severe dystonia of the trunk and chorea. A series of laboratory tests was performed after the onset of these involuntary movements. It included complete blood count, liver, renal, and thyroid function tests, blood prolactin level, blood glucose level, blood copper level and ceruloplasmin level. A brain MRI was also performed. These examinations showed no specific findings. The diagnosis of TD was presumed. The patient was first treated with amisulpride, lorazepam, avlocardyl and piracetam until May 2014. Then, amisulpride was substituted by olanzapine until August 2015. The luck of improvement led to her admission. We stopped antipsychotic treatments and prescribed her vitamin E (900 mg/day), clonazepam (6 mg/day) and vitamin B6. The follow-up led to the decline of the Abnormal Involuntary Movement Scale (AIMS) score of 7 points over 6 weeks.

Conclusion

TD remains a serious side effect that worsens the prognosis and affects the quality of life of patients. Cluster randomised trial should be done in order to develop practice recommendations for prevention and management of TD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

[Psycho-emotional impact of a child's disability on parents]

Care for a child with a disability is a stressful experience for parents. It triggers a range of emotions and feelings that require a set of behaviors and attitudes to manage daily life. To face this situation, parents use coping strategies. The purpose of this study was to assess the psychological reactions (depression and anxiety) of parents and the impact of a child's disability on their quality of life (QOL), and to determine their coping strategies. A survey of 50 parents of handicapped children, treated in the neurology department at the Sfax Teaching Hospital in Tunisia, was conducted in September 2010. The Beck Depression Inventory (BDI), the State Trait Anxiety Inventory (STAI), the SF-36, and the Brief COPE were used to assess, respectively, depression, anxiety, QOL, and coping strategies in parents. Among the group of parents studied, the anxiety and depression rates were, respectively, 68% and 52%. Depression was more frequent among mothers and was correlated with low educational and socioeconomic levels. Anxiety was found in 70.7% of mothers and 55.6% of fathers with no significant correlation. There was a correlation between anxiety and increased family burden related to the presence of a similar case in the family. The range of coping strategies used includes religion (16%), active coping (16%), planning (16%), acceptance (20%), focus and venting of feelings (10%), and seeking emotional social support (10%). Parents used emotion-focused coping in 68% of cases and problem-centered coping in 32% of cases. The coping strategy choice was significantly correlated with gender. Mothers preferentially used emotion-focused coping. Depressed or anxious parents more frequently used emotion-focused strategies. Religious faith was correlated with a strategy centered on religious coping. The length of follow-up (more than 2years) was correlated with a strategy focused on acceptance. Emotion-focused coping was also correlated with low levels of education and socioeconomic status. We found correlations between depression and different types of emotion-focused coping such as emotional support. Impaired QOL was higher among mothers (58.5% versus 33.3%). It was correlated with depression, anxiety, and the use of emotional coping. Also, it was correlated with low educational and socioeconomic levels and increased family burden related to the presence of a similar case in the family. The size most commonly impaired in mothers was limited due to mental health (56.9% versus 44.4% for fathers). Social functioning (D6) was significantly correlated with the presence of a mental disability, the functional dependence of the child, and increased family burden related to the presence of a similar case in the family. Impaired QOL was found in 66.8% of parents dissatisfied with the explanations given by the medical team. More problem-focused coping was found in parents satisfied with the information given by the medical team compared to those inadequately informed (42.1% versus 25.8%). The presence of a disabled child causes profound changes in the family. The impact of anxiety and depression on parents and on their QOL are considerable. This is a situation that involves an adaptation process. At first, parents may be tempted to use coping strategies focused on religion, a choice related to Arab-Muslim fatalism. Parents should be encouraged to use active coping strategies to support their disabled child better. In addition, adequate information given by the healthcare staff would help them to deal with the child's handicap and would contribute to improving their QOL.

[Surgery of thyroid pathologies in one-day surgery]

The surgery of the thyroid pathologies in Day and/or One-Day-Surgery requires a thorough choice former of the surgery of the patients and the availability of the team specialist that could guarantee an adequate nursing after surgery. The authors describe the advantages and the limits of the short confined to stay in hospital for the surgery of the thyroid pathologies. The selection criteria for patients undergoing thyroidectomy in One-Day-Surgery have been: euthyroid patients with benign pathologies concentrate only thyroid lobe and lack of associated pathologies as cardiopathy, broncopathy, nephropathy, hepatopaty, diabetes, etc. Were executed in general anaesthesia forty lobectomies for uninodular thyroid disease and three enucleoresections for a nodule of pyramidal lobe, and only two cases the histological definitive diagnosis of carcinoma has caused a second hospital stay. In all forty-three cases was used a drainage, removed after 24 hours.