Anxiety and depression among Tunisian women victims of domestic violence

Introduction

Violence against women is now widely recognized as an important public health problem with substantial consequences on mental health, that is why health professionals should be identifying, preventing, and responding to violence against women more effectively.

Objectives

To study the prevalence and predictors of anxiety and depression among women victim of domestic violence

Methods

Our study was descriptive and analytical cross-sectional, carried out with women examined in the context of medical expertise, from May until October 2021. An anonymous survey was asked to these ladies. The HADS was used to screen for anxiety and depression

Results

75 responses was collected The age group of 26-35 years represents the highest percentage 44%. 98.7%were victim of verbal violence,94.7% of physical violence, 97.3% of psychological violence and 54.7 % of sexual violence According to the HAD, anxiety was retained in 72% and depression in 56%. Women who filed for divorce developed more depression (p=0.01). Women with a history of infertility were more anxious than others (p=0.025). Anxiety and depression were significately correlated with : the husband alcohol (p=0.01) and cannabis consumption(p=0.015). The ladies victims of sexual violence such as an unusual type of relationship developed more anxiety (p=0.045). An history of aggression during pregnancy was a risk factor of anxiety (p=0.035)

Conclusions

Our work has shown the association between violence against women and anxiety-depressive symptoms. The results of our work inspire us to reflect on and develop actions on the scourge of violence against women in a conjugal environment and its psychological repercussions.

Disclosure

No significant relationships.

Clinical and psychopathological profile of Tunisian Women victims of domestic violence

Introduction

Partner violence is a serious public health problem.International studies have well-explored the psychological aspects of domestic violence, but few explored the clinical profile of women victims of violence

Objectives

To define the clinical and psychopathological profile of women victims of domestic violence

Methods

We contacted 75 women who consulted at the psychiatric emergency of ‘HediChaker hospital’Sfax -Tunisia whowhere consulting in the context of medical expertise for domestic violence, on the period between May until October 2021 An anonymous survey was asked to these ladies

Results

The age oscillates between 18 and 64 years 86.7% of the participants were married for the first time, and 24% had at least one child. In 48% of the cases, the victims and their partners had an average socio-economic level. 66.7% don’t have a job. 6.7 % had toxic habits: 5.3% were smoking 22.7% had psychiatric follow: 14.3% for depressive disorder, 7% for bipolar disorder and 1.4% for anxiety Following a physical assault by the spouse, 37.3% of women consulted medical emergency and 21.3% consulted psychiatric emergency. The prevalence of potentially traumatic life events was 29.3%:16% were victim of parental violence and 13.3% suffered from sexual abuse.

Conclusions

This study shows that the prevalenceof domestic violence is higher among young working women. This work underlines also the necessity of a systematic screening of different aspects of violence in emergency medical or psychiatric servicesin order to provide for these ladies the necessary psychological support

Disclosure

No significant relationships.

Post-ictal psychosis: A case report

Introduction

People suffering from chronic diseases, especially epilepsy, are more likely to suffer from neurobehavioral disorders, like psychotic states. Postictal psychosis (PIP) is one of these potentially serious complications, that classically follows exacerbations of seizures.

Objectives

The present paper aimed to study the clinical and therapeutic aspects of PIP.

Methods

We report a case of PIP, which involved a patient hospitalized in psychiatry department, and discuss it in light of the relevant literature.

Results

We report the case of a 27-year-old man, with medical history of generalized epilepsy which was well stabilized under treatment (carbamazepine 600 mg/day). The patient was hospitalized for dangerous behaviors after having experienced 2 episodes of seizure activity in context of poor therapeutic adherence. Psychiatric assessment revealed a psychomotor instability, a pressured speech and hallucinatory behavior. There were no delirium symptoms. Neurological examination showed no localization signs, and cerebral imaging was normal. The patient was treated with benzodiazepines (Diazepam), associated to antipsychotics (Haloperidol). His antiepileptic drug was quickly reintroduced. After 48 hours of treatment, psychiatric symptoms improved. The patient returned to its baseline condition after 7 days.

Conclusions

The short-term prognosis of PPI is often favorable, compared to other psychotic disorders. However, more severe psychiatric disorders can potentially develop in the long-term, raising diagnostic and therapeutic difficulties. Thus, a good collaboration between psychiatrists and neurologists is highly desirable in order to better adapt the treatment.

Disclosure

No significant relationships.

Wernicke encephalopathy complicating catatonic schizophrenia

Introduction

Wernicke’s encephalopathy is a potentially fatal neurological emergency caused by thiamine deficiency. Although it is often associated with chronic alcoholism, it can also occur in all situations that lead to a thiamine deficiency such as undernutrition and exclusive artificial feeding.

Objectives

In this work, we propose to study the clinical and treatment concerns of Wernicke’s encephalopathy complicating catatonic schizophrenia.

Methods

We retrospectively report the case of a patient who developed a Wernicke’s encephalopathy in the aftermath of catatonic schizophrenia.

Results

Mr H.L, a 47-year-old-male has been followed in psychiatric hospital since the age of 27 for catatonic schizophrenia. He has been hospitalized in July 2020 because of oral intake refusal, social isolation and lack of self-care with a poor compliance to treatment. Examination of the patient revealed catalepsy, mutism and negativism. He was treated with antipsychotics drugs, benzodiazepines and parenteral nutrition. About six weeks after his hospitalization, the patient developed horizontal nystagmus and ataxic gait. Magnetic resonance imaging was consistent with Wernicke encephalopathy. Vitamin B1 dosage was 32nmol/l. Parenteral thiamine replacement therapy was initiated with clinical improvement

Conclusions

Catatonic schizophrenia can be associated with severe malnutrition and thus with thiamine deficiency and Wernicke’s encephalopathy. An early intervention by supplying prophylactic thiamine given parenterally in high-risk patients is crucial to avoid Korsakoff syndrome, as well as cardiovascular and neuropsychiatric complications associated with thiamine deficiency.

Psychiatric referrals in general practice

Introduction

Over half of patients with mental disorders are seen by primary care physicians. However, as for patients with somatic problems, referral to psychiatrists seems to be sometimes necessary.

Objectives

The present study aimed to identify reasons and difficulties perceived by general practitioners (GP) in mental health referrals.

Methods

A cross-sectional web-based survey was conducted between August 22 and September 23, 2020, so that 47 responses of GP were included.

Results

The mean age of respondents was 37.3 years. Their seniority as doctors was 8 years on average. Among them, only 17% attended a post-university psychiatric training. The participants reported that they refer on average 32.5% of patients with mental disorders to psychiatrist: 85.1% to psychiatric hospital, 40.4% to liberal psychiatrists and 21.3% to clinical psychologists. Regarding the reasons for referral to mental healthcare structures, 70.2% of doctors justified their doing so by their insufficient training in mental healthcare; 66% by a need for hospitalization, 57.4% by the presence of delusions, while in 27.7 % of cases, the transfer was carried out at the request of the patient or his family. The difficulties mentioned by GP were patient refusal to consult a psychiatrist (70.2%) and difficulties related to the management delay (44.7%).

Conclusions

Patient and health system factors, as well as physicians experience seem to have important influences on mental health referral. Open communication and ease of consultation with psychiatrists can make the care of patients with mental health problems even more rewarding to the primary care physician.

Title: Haematological disorders revealing a raticide suicide attempt: A case report

Introduction

Suicide attempts are common in individuals with schizophrenia. These actions are marked by a greater lethality, due to the use of more violent means in particular the intentional ingestion of rodenticides.

Objectives

To describe the gravity of the heamatological disorders revealing suicide attempts by a rodenticides in patient with schizophrénia.

Methods

We repport the case of a patient who present a haematological disorders after an rodenticide intoxication.

Results

A 41-year-old man with schizophrénia since 2011 was brought to the department of psychiatry in july 2020 for behavioral disorders. On arrival, the patient was oriented but reticent and refuse to tell his full story. On examination, his vital signs were normals, and he did not show any externalized bleeding. Bilogical tests revealed the prothrombin time (PT) was <10% with an isolated and unexplained fall in vitamin K-factors. The etiological investigation was negative. Later,the patient admitted attempted suicide by taken 4 rodenticide packages orally three days prior admission to hospital. The initial treatment with intravenous vitamin K almost daily is effective. An improvement in PT (35%) and vitamin K-dependent factors was observed after one week of treatment. A Normalization of hemostasis disorders was obtained after two weeks of treatment.

Conclusions

It is imperative to suspect rodenticide intoxication in patient with scizophrenia with an isolated and an explained deficiency of vitamin K dependent factors. The particularity of this intoxication lies in the dangerous and prolonged side effects making the curative treatment difficult and long.

Disclosure

No significant relationships.

Mental disorders management in general practice

Introduction

Compared to specialized care, primary care is considered to be more accessible, less stigmatizing, and more comprehensive since it manages physical ailments along with mental disorders (MD). Thus, MD are mainly treated by general practitioners (GP), even though their ability to diagnose and treat these diseases is often considered unsatisfactory.

Objectives

This study aimed to analyze perceptions of GP capacity to manage MD, and to assess the difficulties encountered during this management.

Methods

A cross-sectional web-based survey design was adopted between August 22 and September 23, 2020, so that 47 responses of GP were included.

Results

The mean age of respondents was 37.3 years. Among them, only 17% attended a post-university psychiatric training. On average, 6.3% of GP visits were MD-related. Anxious disorders and depression were perceived as very frequent respectively in 82.9% and 40.4% of cases. Among GP, 17% considered bipolar disorder as a difficult pathology to diagnose, followed by schizophrenia (12.7%), while the pathologies perceived to be most difficult to treat were dementia (17%), acute agitations (14.9%) and schizophrenia (10.6%). Anxiolytics and antidepressants use was very frequent (40.4% and 27.7% respectively), and 34% needed training in antipsychotics prescription. Difficulties encountered during MD management were related to lack of psychiatric continuing education (19.4%) and lack of collaboration with mental health professionals (12.5%). Among participants, 93.6% requested a psychiatric training: theoretical 29.3%, practice exchange 24.7%.

Conclusions

Our study confirmed that MD related visits are common in primary care and highlighted several obstacles in their management. Further continuous education, training,and collaboration between practitioners is required.

Somatic disorders in psychiatric inpatients : Prevalence and associated factors

Introduction

Elevated prevalence of somatic disorders (SD) in patients with mental diseases is well recognized and studied since latest years. However, their detection remains too late, which darken the prognosis of both diseases, and complicate the therapeutic management.

Objectives

We aimed to determine the prevalence of SD in psychiatric inpatients, and to assess relationships between the two diseases.

Methods

We analyzed retrospectively the medical records of 94 male patients hospitalized for the first time in psychiatry “B” department, Hedi Chaker hospital (Sfax, Tunisia), in the period from January 1^st until December 31^st, 2019.

Results

The mean age of patients was 36.88 years. Among them, 22.3% used cannabis and 37.2% consumed alcohol. Schizophrenia (41,5%) and bipolar disorders (20.2%) were the most common psychiatric diagnoses. During their hospitalization, at list one SD was noted in 53.2%: cardiovascular diseases 21.3% (electrocardiographic anomalies 19,1%); infections 9.6% and hepatic pathologies 8.5 %. The SD was comorbid with psychiatric disease in 90%, and represented a side effect of psychotropics in 10% of patients with SD. Older Patients were more likely to present SD during hospitalization, without a significant association. Patients with schizophrenia were significantly more likely to present infections (p=0.031). Repolarization disorders are more common in patients with cannabis use (p = 0.006).

Conclusions

Our study pointed the high prevalence of SD in patients with mental illnesses, especially in those with schizophrenia and cannabis use. Thus, the somatic assessment should be a systematic practice to identify patients at risk for somatic complications and ensure timely their transfer to a specialized setting.

Title: Risk factors of prolonged corrected QT interval among patients with mental disorders

Introduction

There is an increased rate of sudden cardiac death in mental health patients. Studies provide consistent evidence that prolonged QT interval is associated with higher risk of all-cause and cardiovascular mortality.

Objectives

This study aimed to assess the prevalence of prolonged QTc interval (corrected QT>450 milliseconds) and to determine the possible factors in hospitalized psychiatric patients.

Methods

We reviewed records of all mental health inpatient admissions to the psychiatry “C” department at Hedi Chaker university hospital in Sfax, between 1 february and 30 april 2019. Electrocardiogram (ECG) availability was noted and QTc interval was manually measured. Sociodemographic, clinical, biological and therapeutic data were collected.

Results

Of 68 mental health inpatient admissions, 59 (86.6 %) presentations had an ECG. A total of seven (11.8 %) had a prolonged QTc interval. These seven patients were treated with typical antipsychotics. Of the 7 patients with a prolonged QTc, 4 patients (57.1%) suffered from schizophrenia. QTc prolongation was significantly correlated with the presence of a recent physical trauma (p = 0.021), dietary restriction (p = 0.026), and taking at least two antipsychotics (p = 0.008). Moreover, this prolongation of QTc was linked to a longer duration of disease and an older age, without significant associations.

Conclusions

Our study supports an association between a prolonged QTc interval and clinical situations at risk and antipsychotic polypharmacy. However, a larger study with routine ECG screening is required to better assess the significance of this problem.

[Study of correlation between radiological aspect of pulmonary hydatid cyst and postoperative course]

Pulmonary Hydatid Cyst (PHC) may represent a real therapeutic challenge. Surgery remains the treatment of choice and postoperative course may be complicated in some cases. Several factors can be involved like the cyst's size and location. We aimed to study the existence of correlation between the radiological aspect of the PHC and the postoperative course through a retrospective study including 267 patients. Different radiological aspect of PHC found on the X-ray and/or computed tomography of the chest were classified according to Zidi et al.

CLASSIFICATION

Analytical study showed that there is minor chance to have complications with simple cyst (P<0.05 and OR<1), while type VI cyst were more likely to cause complications (P=0.007 and OR=2.6). Considering these results, more attention should be paid to type VI of PHC to prevent postoperative complications. A multicentric study will be more precise to study correlation between different characteristics of the PHC and postoperative course.

[Embryonal paratesticular rhabdomyosarcoma: a case report and a literature review]

Paratesticular rhabdomyosarcoma is a rare tumor. Multimodality treatment should involve surgery, radiotherapy and chemotherapy, which are indicated according to risk groups. Risk group stratification depends on pretreatment staging and definitive histology. Patients older than 10years or those with suspected lymph nodes on imaging have higher incidence of lymph node involvement. Prognosis is excellent for localized tumors, survival rates exceed 90%. We report a case of embryonal paratesticular rhabdomyosarcoma treated in our institution.

[Pediatric mucoceles: clinical aspects and therapeutic approaches]

INTRODUCTION

Paranasal sinuses mucoceles are extremely rare in children and adolescents. The objective of this study was to assess their clinical presentations and the contribution of endoscopic surgery in their management.

MATERIAL AND METHODS

we retrospectively reviewed 11 children with paranasal sinus mucoceles who were managed during a period of 15 years (1995-2009).

RESULTS

The mean age was 11.8 years with a sex ratio of 2.66. One patient had a history of nasal polyposis surgery. The symptomatology was dominated by ophthalmological complains. The ethmoïd sinus was the main localization. Orbital extension was found in eight cases, pyomucocele in one case. The surgical management was endoscopic (nine cases), and by an external approach (two cases). Two cases of recurrence were assessed. The mean follow-up was 22.3 months.

DISCUSSION

Paranasal sinuses mucocele is exceptional in children. Cystic fibrosis is the main etiologic factor. The symptoms depend on the location and size of the mucocele. The treatment is surgical and most authors prefer the endoscopic approach.