A replication study of sHLA-E influence on schizophrenia and bipolar disorder.

OBJECTIVES: Schizophrenia (SZ) and bipolar disorders (BP) are chronic and severe neuropsychiatric diseases. These disorders are tightly related to immune deregulations. In the current study, we intended to replicate the previously reported involvement of the soluble HLA-E isoforms (sHLA-E) in the risk of developing the two conditions along with disease severity in a Tunisian population group. PATIENTS AND METHODS: One hundred and twenty-four patients with schizophrenia and 121 with bipolar disorder meeting the DSM-IV criteria along 111 healthy controls were included in this present case-control study. The soluble HLA-E isoforms circulating levels were measured using the ELISA method. The statistical analyses were performed using Kruskal-Wallis and Wilcoxon rank sum tests by R software and GraphPad prism 9. RESULTS: We found that the sHLA-E circulating levels were significantly higher in BP patients as compared to healthy controls (P<0.0001) and that such increases were mainly observed in patients during an acute phase of their disease (P<0.0001). In SZ patients, while we failed to observe an association with the levels of sHLA-E in the entire SZ sample, we found that high sHLA-E levels characterized stabilized patients in comparison with those during an acute episode (P=0.022). Finally, we did not observe any association between sHLA-E circulating levels and symptoms assessed by the classical clinical scales either in BP or SZ patients. CONCLUSION: Overall, the present findings replicate in a Tunisian population group the previously demonstrated implication of sHLA-E circulating levels in the risk of developing BP or SZ in a French patient cohort. Such replication allows to consider HLA-E as a potent and true inflammatory marker in the context of the two disorders.

CSMD1 rs10503253 increases schizophrenia risk in a Tunisian population-group.

OBJECTIVES: Schizophrenia is a complex and chronic neuropsychiatric disorder. Recent genome-wide association studies have identified several at risk genetic variants, including two single nucleotide polymorphisms, namely the rs10503253 and the rs1270942 respectively located in the CSMD1 and the CFB loci. The present case-control study was designed to assess potential associations between the two variants and the risk of developing schizophrenia and disease severity. Further we demonstrate the relationship between these variants and clinical characteristics in a population-group from Tunisia. PATIENTS AND METHODS: In total, 216 patients diagnosed with schizophrenia along with176 healthy controls were included in this case-control study. The molecular analysis of the two polymorphisms was performed using tetra the Primer Amplification Refractory Mutation System-Polymerase Chain method. The statistical analysis was done using Compare V2.1 software, and correlations between genetic results and clinical characteristics were examined by Kruskal-Wallis testing. RESULTS: The frequency of the rs10503253A allele was found significantly higher among patients with schizophrenia as compared to healthy controls and associated with high negative PANSS scores. While no association was found concerning the implication of the rs1270942 variant in schizophrenia risk, a positive correlation with high positive PANSS scores was further observed. CONCLUSION: The present finding confirms the previously reported association between the Cub and Sushi multiple Domain 1 rs10503253A allele and the risk to develop schizophrenia and identified the rs1270942 variant as a potential disease risk modifier. Such observations may be important for the definition of the susceptible immunogenetic background in North African individuals at risk to develop mental disorders.

Mental health status of healthcare workers at a third line Tunisian hospital during COVID-19 pandemic.

INTRODUCTION: During the COVID-19(coronavirus-19 disease) pandemic, health care workers (HCWs) faced the risk of infection and distressing work to meet health requirements. The aim of the present stud ywas to evaluate perceptions of HCWs of their security at work in COVID-19 units and their coping strategies, at the military hospital of Tunis, during the second wave of COVID-19. METHODS: A cross-sectional study was conducted via an auto-questionnaire on February 2021.HCWs of the military hospital of Tunis were included. Participants were asked about their perceived security at work in COVID-19 units and their coping behaviors. Mental disorders were assessed, via qualitative questionnaires. RESULTS: A total of 110 HCWs' responses were collected. Fifty-eight participants (52.7%) were females. The mean age was 33.7 years (SD 9.3). They were doctors at 45.5% and nurses at 39.1%. HCWs declared having worked in COVID-19 units in 81.8% of cases. The participants reported their fears about being infected in 58.2% and infecting family members in 85.5% of cases. Protective factors included information about the disease (80%), availability of personal protective equipment (PPE) (80.9%), support from colleagues(72.7%)or superiors at work (50.9%), and ability to communicate with others (63.6%). Depression, anxiety, and insomnia were found in respectively 25.5%, 30%, and 41.8% of HCWs. In multivariate analysis, suffering from a traumatic distress was significantly associated with anxiety and depression (p (p<0.01 and, p<0.05 respectively). In addition, insomnia severity was linked to age (p=0.05) and having colleagues infected with COVID-19 (p<0.05). CONCLUSION: In the present study, HCWs of the military hospital of Tunis stated having high levels of insomnia, anxiety, and depression since the early outbreak of the COVID-19 pandemic. These mental disorders may have a negative impact on the quality of life of HCWs and should be enhanced by psychological support and preventive measures.

[Validation in literary Arabic among Tunisian soldiers of the Post-Traumatic Stress Disorder checklist for DSM-5]. / Validation en arabe littéraire chez les militaires tunisiens de la Post-Traumatic Stress Disorder checklist for DSM-5.

Introduction: post-traumatic stress disorder (PTSD) is a topical issue due to the increase in armed conflicts and terrorist attacks in recent decades. The PCL-5 scale is used to screen and monitor patients with PTSD. The aim of our work was to validate a literary Arabic version of this scale on a population of Tunisian soldiers. Methods: the translation of the PCL-5 scale into Tunisian literary Arabic was performed according to the back-translation technique described by Werner and Campbell and recommended by Brislin. Cross-cultural validation was conducted in 7 steps according to Vallerand's method. Data collection was conducted at the psychiatry department of the Military Hospital of Tunis from February 2019 to December 2020. Results: we recruited 300 military personnel, 150 of whom were followed for PTSD. Cronbach's alpha was 0.98 indicating good internal consistency. The study of inter-item correlations revealed a total Spearman index of 0.75. This index indicates a good homogeneity of the translated scale items. Construct validity was checked using the Kaiser-Meyer-Olkin index (K-M-O) and Bartlett's test of sphericity. The latter was significant (p<0.000), and the K-M-O index was 0.969, indicating that the correlations between the items were of good quality. Conclusion: our study showed that the Arabic version of the PCL-5 scale has satisfactory psychometric properties comparable to those of the original version.

Immediate Psychological Responses, Stress Factors, and Coping Behaviors in Military Health-Care Professionals During the COVID-19 Pandemic in Tunisia.

Objective: The COVID-19 epidemic began in Tunisia in March 2020; health-care workers (HCWs) were suddenly confronted with a particularly stressful situation. The aim of this study was to assess the psychological responses of HCWs during the epidemic, determine the stressors and identify ways to cope. Methods: This cross-sectional study used an online questionnaire that included 62 questions. ANOVAs and t-tests were used to compare the responses between professional groups, age groups, and genders. Results: Questionnaires were completed by 368 HCWs. HCWs believed they had a social and professional obligation to continue working long hours (95.3%). They were anxious regarding their safety (93.7%) and the safety of their families (97.8%). Youthful age (p = 0.044) and female gender (ps <0.046) were identified as stressors. The availability of personal protective equipment (PPE; 99.7%) and good communication between colleagues (98.1%) and managers (91.6%) were important protective factors. Family and friend support (95.9%), following strict protective measures (99.4%), knowing more about COVID-19 (94.8%), adopting a positive attitude (89.6%), and engaging in leisure activities (96.1%) helped in dealing with this epidemic. Conclusion: This study highlights the importance of providing HCWs with infection control guidelines and adequate PPE. Communication and support within the team and maintaining family support help in coping with this stressful situation.

Affective temperament profile in psoriasis patients in Tunisia using TEMPS-A.

BACKGROUND: Psoriasis may be considered as falling within the category of psychosomatic disorders. The aim of this study was to investigate the temperament profile in psoriasis patients in Tunisia. METHOD: We performed a prospective and comparative study investigating affective temperament in Tunisian psoriasis patients. Sixty five psoriasis patients and 67 age and sex matched healthy controls were enrolled, aged from 18 to 60 years. The diagnosis was made clinically; if necessary, lesional biopsy was obtained for histopathological examination. Temperament Evaluation of Memphis, Paris and San Diego Auto-questionnaire (TEMPS-A) in its 110-items version was used. Both statistical and descriptive analyses were performed. RESULTS: We found significant gender differences, with women scoring higher in depressive and anxious temperaments. There was no significant difference between temperament scores in psoriasis patients and healthy controls. Irritable temperament scores tend to decrease with disease duration. Stressful event was more frequently associated with anxious and depressive temperaments in women. LIMITATION: This survey has a single-time cross-sectional design. CONCLUSIONS: This study broadens our understanding of the relationship between temperament and psoriasis. Some aggravating factors of the disease seem to be associated with particular temperament traits. Understanding the temperaments would be essential in establishing a cooperative relationship between patients and doctors during the management of this chronic skin disorder.