Cultural Variations in Public Beliefs about Mental Disorders: A Comparison between Tunisia and Germany.

BACKGROUND: In recent years there is a growing interest in public beliefs about mental disorders. Numerous representative population-based studies have been conducted around the globe, also in European countries bordering on the Mediterranean Sea. However, relatively little is known about public beliefs in countries in Northern Africa. OBJECTIVE: To fill this gap by comparing public beliefs about mental disorders in Tunisia and Germany, focusing on causal beliefs, help-seeking recommendations and treatment preferences. METHODS: Representative national population-based surveys have been conducted in Tunisia in 2012 (N = 811) and in Germany in 2011 (N = 1852), using the same interview mode and the same fully structured interview starting with a vignette depicting a person suffering from either schizophrenia or depression. RESULTS: In Tunisia, the public was more likely to adopt psychosocial and to reject biogenetic explanations than in Germany. Correspondingly, psychological treatments were more frequently recommended and biological ones more frequently advised against. There was also a strong inclination to share religious beliefs and to recommend seeking religious advice. Tunisians tended much more than Germans to hold moralistic views and to blame the afflicted person for his or her illness. In Tunisia, the public tended less to differentiate between schizophrenia and depression than in Germany. CONCLUSION: Marked differences between Tunisia and Germany exist in public beliefs about the causes of mental disorders and their treatment, which correspond to differences in cultural orientations prevailing in these countries. Mental health professionals need to be sensitive to the particular cultural context in which they operate, in order to be able to reach those they intend to care for.

Psychiatric disorders following the Tunisian revolution.

BACKGROUND: During the Tunisian Revolution, the constant threat of death and the feeling of insecurity brought about psychological reactions that tended to be excessive in some individuals, thus leading to genuine psychiatric disorders. OBJECTIVES: This study aimed to outline the different psychiatric disorders which occurred following the Tunisian Revolution and to determine the social, demographic and clinical features associated with these disorders. METHOD: A cross-sectional study was undertaken. We included all patients who first presented at the outpatient clinic at Razi hospital with psychiatric symptoms attributed to the Tunisian Revolution between 15 January 2011 and 15 October 2011. We used a form detailing social, demographic and clinical characteristics. Diagnoses were made on the basis of the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision (DSM-IV-TR) criteria. RESULTS: Our population consisted of 107 subjects: 28 women (26.2%) and 79 men (73.8%), with a mean age of 40 ± 12. The majority (66.4%) were married. Most (57.9%) patients had a secondary education level. Agents of order represented the largest occupational group accounting for 36.4% of the population. The most prevalent psychiatric disorders included major depressive disorder (30.8%), adjustment disorder (30.8%) and post-traumatic stress disorder (27.1%). CONCLUSION: This study emphasizes the diversity of psychiatric disorders that can occur following a man-made disaster.

Assessment of knowledge and perceptions of Tunisian psychiatrists regarding telepsychiatry.

INTRODUCTION: Telemedicine has become a fundamental pillar of the evolution of healthcare worldwide. In Tunisia, the challenges of the health system, amplified by the COVID-19 pandemic, have highlighted the urgency to adopt innovative solutions. In this regard, the publication of Presidential Decree No. 318/2022 on April 8 in the Official Journal of the Tunisian Republic represents a significant advance in the regulation of telemedicine. AIM: To assess the knowledge of Tunisian psychiatrists and child psychiatrists regarding telemedicine, its legal framework, and their perceptions of this new medical practice. METHODS: A descriptive cross-sectional study was conducted 8 months after the issuance of the presidential decree. The survey was conducted online through an electronic questionnaire on Google Forms. RESULTS: A total of 68 participants were included in this survey. The median number of professional years was 5±7 years. Among the participants, 82% worked in psychiatry and 18% worked in child psychiatry. The sector of practice was public in 69% and private in 31% of cases. Most of them (62%) did not know about the different telemedicine acts, and 57% of doctors were unaware of the existence of the presidential decree. The majority of doctors (84%) expressed a favorable opinion regarding the adoption of telepsychiatry, regardless of sex (p=0.69), professional status (p=0.512), specialty (p=1), years of experience (p=0.83), and practice sector (p=1). CONCLUSION: Despite a low level of knowledge regarding telemedicine, the study highlights the interest of the participants in integrating telepsychiatry into their clinical practices.

[The practice of traditional therapies in psychiatric environment: about 100 cases]. / La pratique de la tradithérapie en milieu psychiatrique: etude à propos de 100 cas.

BACKGROUND: In all the communities, parallel forms of healing continue to be practised by the population in addition to the services offered by the "modern" psychiatry. AIM: The aim is to examine the current state of the traditional therapy in Tunisia and to try to deal with its scope, profile and determinants surveying the population of mentally ill patients. METHODS: It is about a specific study carried out on 100 consecutive patients having consulted the service of psychiatry "C" of Hospital "RAZI" in Tunis. All the patients having an intellectual deficiency were excluded. We proceeded by a semi-open questionnaire in dialectical Arabic. RESULTS: 90 patients, composed of 38 women (42.2%) and 52 men (57.8%) at the age of 37.8 years in average, were kept in our study. 50% of our patients had recourse to the traditional therapy, 70% of whom before consulting a psychiatrist. This behaviour was not influenced by the age, the profession and the educational level. In 75% of the cases, it was chosen under the effect of the opinion of a member of the family. 1/3 of the patients having had consulted a traditional therapist have improved after his intervention. These are the patients who were convinced of the diagnosis identified by the traditional therapist. The therapeutic observance and the adherence to the modern psychiatry were not influenced by the recourse to the traditional therapy. CONCLUSION: At the end of this research, we conclude that in Tunisia the recourse to the traditional therapy still persists and continues to perform its function. It makes us think about the necessity to accept its place in the devices for treatment of the mentally ill patients and why not to collaborate with it.

Inflammatory profile in depression and associated clinical and sociodemographic features in a Middle-Eastern North-African population.

BACKGROUND: Evidence of the presence of an inflammatory syndrome in depressive disorders has aroused great interest among researchers but results were heterogeneous and almost all previous studies involved patients from Europe or North America. The objectives of the current study were to determine the prevalence of biological inflammatory syndrome among patients with depression in a Middle-Eastern/North-African population and to examine the associated sociodemographic and clinical factors. METHODS: We conducted a cross-sectional descriptive and comparative study including 65 patients and 30 healthy controls. The patients had an untreated major depressive episode and no inflammatory medical conditions; they were recruited in the psychiatry outpatient clinic in Razi hospital - Tunisia over an eight-month period ranging from May to December 2012. We examined sociodemographic and clinical characteristics and both groups had an inflammatory balance including: high sensitive C-reactive protein, interleukin 6, serum protein electrophoresis, haptoglobin and orosomucoid. A standardized inflammatory protein profile for age and sex was performed. RESULTS: High sensitive C-reactive protein levels did not differ significantly between patients with depression and controls. The assay results of Interleukin 6 in our study showed higher values in patients with depression than in controls (p=0.024). Albumin was found to be increased in patients with depression (p<0.001). The dosage of the alpha-1-globulin including the orosomucoid and of the alpha-2-globulin including haptoglobin, showed that patients with depression had higher values than controls (p<0.001). The inflammatory protein profile (which consists of a synthesis of three inflammatory proteins: high sensitive C-reactive protein, haptoglobin and orosomucoϊd) showed a trend towards higher levels of inflammation among patients with depression than among controls. LIMITATIONS: The relatively small number of subjects decreased the statistical power and the cross-sectional setting does not allow us to draw any conclusions about cause-to-effect relationships. Although we tried to exclude people with current infections, a small percentage of subjects may have had subclinical infections. The Body Mass Index, a parameter that might affect the levels of the investigated inflammatory markers, was not measured. CONCLUSION: The existence of inflammation in depression has been proven by the results of four meta-analyses and over a hundred studies. However, the generalization of this finding is yet to be confirmed. It seems more likely that inflammation concerns a subgroup of patients with depression. Studies targeting this particular subgroup could provide new therapeutic approaches.

[The Usefulness of Clonazepam as an Augmentative Treatment in a Case of Severe Childhood Onset Obsessive-Compulsive Disorder]. / Siddetli Bir Çocukluk Çagi Baslangiçli Obsesif Kompulsif Bozukluk Olgusunda Güçlendirme Tedavisi Olarak Klonazepam.

The goal of this study is to report on the treatment of obsessive-compulsive disorder (OCD), a chronic disabling condition that often presents during childhood and adolescence. Reports on adults using clonazepam for the treatment of OCD are more numerous than on children. Clonazepam as an augmentative treatment in OCD is still controversial. Our aim is to illustrate in a case report the efficacy of clonazepam as an augmentative treatment for severe childhood onset OCD. We report on the case of a young teenage girl with an extremely severe form of obsessive-compulsive disorder (score of 32 on the Children's Yale-Brown Obsessive Compulsive Scale), who, after a mild improvement with a combination of serotonin recapture inhibitors and second generation antipsychotics at high doses, has responded to clonazepam (3mg/day) augmentation of sertraline (200mg/day) and olanzapine (15mg/day). Clonazepam was effective not only in reducing anxiety symptoms, but also in lowering compulsions and obsessions frequency within 6 weeks with a drop in the Children's Yale-Brown Obsessive Compulsive Scale of 16 points. It may be asserted that clonazepam could be useful in the initial stage for severe OCD in young patients.