Risk factors for suicidal behavior in patients hospitalized for adjustment disorders.

INTRODUCTION: Adjustment disorder (AD) is a common psychiatric diagnosis, but it is often considered less severe than other diagnoses. However, it is strongly associated with suicidal behavior. AIM: To identify the factors linked to suicidal behavior in patients hospitalized for AD. METHODS: This is a retrospective, descriptive, and analytical study conducted in the psychiatric department of Mahdia's hospital over a period of nine years. The study included patients who were hospitalized for the first time due to adjustment disorder, according to DSM-5 diagnostic criteria. RESULTS: The study population included 129 patients. AD was prevalent among young (median age 29 years) and female patients (75.2%). Almost half of the cases were single (48.1%) and having a history of suicidal behavior (48.3%). Sixty patients (46.5%) were hospitalized following a suicidal attempt (SA) and drugs were used as a way in half of the cases (50%). Conflicts were the dominant factor precipitating the SA in 88.3% of cases. Factors linked to suicidal behavior in patients with AD were being in an intimate relationship and the presence of family conflicts. Indeed, the risk of suicidal behavior was found to be increased by 3.15 times in patients with AD who experienced family conflicts. Besides, being in an intimate relationship in patients with AD multiplies the risk of suicidal behavior by 5.863. CONCLUSIONS: Given the high risk of suicide associated with AD, it is essential to have a more in-depth understanding of the suicidal process and AD through new studies.

Thiamine Deficiency Neuropathy in a Patient with Malnutrition due to Melancholic Depression.

Introduction: Melancholic depression is a daily clinical reality in psychiatry. It is a therapeutic emergency that can jeopardize life if not promptly and adequately treated. Apart from its high suicidal risk, complications related to the under-nourishment state are to be feared. Case Presentation. A 36-year-old woman was admitted with depressive symptoms, significant weight loss, and total functional impotence. Laboratory investigations revealed severe thiamine (vitamin B1) deficiency. An electromyography confirmed a sensory axonal neuropathy involving all four extremities suggesting a deficiency origin. Discussion. Vitamin and mineral deficiencies have been described in patients with malnutrition resulting from psychiatric illness (anorexia nervosa, eating disorders, severe depression, etc.). Thiamine is an essential cofactor in several biochemical pathways. Its deficiency can lead to neuropsychiatric morbidity. Conclusion: In our case, the rapid weight loss facilitated a cascade of complications related to nutritional deficiencies. Based on our clinical observations and the literature, thiamine deficiency should be considered in the presence of malnutrition and vulnerability, both on an organic and psychiatric level.

Developing learning objectives in postgraduate medical education for family medicine (Tunisia).

Introduction-Aim: The third cycle of medical studies (TCMS) lasts 3 years for the specialty of family medicine (FM) in Tunisia. The members of the FM committee of the Faculty of Medicine of Monastir (FMM) aimed to detail the learning objectives (LO) of residents in FM. METHOD: We used the Delphi method in 2 rounds including a group of experts called FM Learning Objectives Writing Group (FMLOWG) at the FMM. The FMLOWG included 74 university hospital physicians and FM internship supervisors. These members actively participated in the 10 meetings held during the month of March 2022. Three points were discussed: the identification of LOs; the development of training titles and the proposal of the teaching methods to be adopted. The writing was subdivided into 5 domains of LO: transversal, public health, typical population and by system. RESULTS: We identified 1359 LOs for FM residency, for which 552 were LOs per system (40.5%). The learning included 618 training session titles. Residents will have an academic training day every 3 weeks during 9 months for each TCMS year. CONCLUSION: A detailed, MF-specific consensus has been developed by majority of medical specialties. It will be a learning base for learners, a reference for supervisors and TCMS teachers.

[Antipsychotic prescription amongst the elderly].

INTRODUCTION: The treatment of certain psychotic, behavioural and delusional symptoms in the elderly frequently involves the prescription of antipsychotics. Prescribing such drugs to elderly patients has recently been called into question, leaving physicians with little or nothing to treat a range of symptoms that are often complex and difficult to treat. AIMS: The study aimed to evaluate the prescription of antipsychotics amongst elderly and to compare it with data in the literature. METHODS: This retrospective cohort study included patients aged 65 and older admitted to the psychiatric ward of Mahdia University Hospital over the period from 2014 to 2018 who received antipsychotic treatment during their hospitalization. RESULTS: The sample consisted of 44 elderly patients, with 31.8% patients using atypical agents, 34.1% using typical agents, 27.3% received both of them and 6.8% received a long-acting injectable antipsychotic. A majority of the elderly study sample were men (75 %). The mean (SD) age of the study sample was 69.8 years. 61.3% had at least somatic comorbidity. The most common diagnosis was schizophrenia with 31.8%, followed by dementia (27.3%). 34.1% reported adverse effects due to antipsychotic treatment. CONCLUSION: The study findings suggest that there is a need to be cautious when prescribing antipsychotic in the elderly population. Patient education and regular follow-up of patients can be instrumental in minimizing the adverse outcomes associated with the use of antipsychotics in the the aging population.

Eating disorders among women in primary care (Monastir, Tunisia).

INTRODUCTION: Eating disorders (ED) are relatively frequent, but convey a high mortality and morbidity. More than half of individuals with ED remain undetected in primary care. The general practitioners (GP) are in a strategic position to detect patients with ED. AIMS: To determine the prevalence of ED in Tunisian women visiting their GP using the SCOFF-F score and to determinate the associated socioeconomic, clinical, and lifestyle factors. METHODS: This is a cross-sectional study of women who consulted two primary health care in the city of Monastir, during 4 months of the year 2020. The SCOFF-F was performed. RESULTS: We included 445 women; the mean age of our patients was 36 ± 12 years. SCOFF-F was positive in 48% of cases CI95% [43-52%], 14% presented with bulimia nervosa and 12% with binge eating disorder. Patients with ED were overweight in 33% of cases, 40% perform a physical activity and 53% eat three meals per day. A family history of ED was 35%. 20% of the patients have a history of psychiatric disorder. In multivariate analysis, performing physical activity to control weight, eating three meals a day, maintaining the current diet without trying to change into a different one, non continous occupation and anxiety increase the risk of ED with respective ORs of 2.34, 4.26, 3.69, 2.09 and 2.09 respectively. Ages between 35 and 60 years, and a history of ED in siblings increases the risk of ED by 1.6. CONCLUSION: Our study concluded that ED was associated with common family behavior, especially among siblings, and with a particular psychological state which are interesting to screen by GP and to focus on targeting family care.

Hunger strike in prison: medical, ethical and legal aspects.

BACKGROUND: A hunger strike is a common form of protest in prison and is a potential cause of many types of problems, both for facility administrators and health care staff. Issues of conflict of rights and obligations involved, and how to treat people who are subject, have created major controversies. OBJECTIVES: To identify and review published studies that discuss the medical, ethical and legal considerations of managing a hunger strike in a prison setting from a physician's perspective. METHODS: A database search using "Medline" "Ovid" and "Science Direct was conducted to identify relevant publications. We included case series, guidelines and, review articles. RESULTS: The physician must clearly inform the striker of the risks and provide clinical assessment and regular monitoring of the concerned. The role of the psychiatrist is to detect an initial mental pathology underlying or secondary to fasting and assess the capacity of the striker's judgment. Thus, the clinician is faced with two paradoxical obligations: to assist and respect the striker's will. In addition, medical intervention is possible if the prognosis is life-threatening even without the patient's consent. CONCLUSION: The current practice of non-consensual attitude among hunger-striking seeking in detention needs a closer inquiry. Medical practitioners should be aware of their ethical and legal responsibilities, and that they should act independently of government or institutional interests.

[Epidemioclinical and legal aspects of sexual abuse among minors in Monastir, Tunisia]. / Aspects épidémiocliniques et suites judiciaires des abus sexuels chez les mineurs à Monastir, Tunisie.

INTRODUCTION: Child sexual abuse is a disturbing reality and a major public health problem. Indeed, it is a subject that has long been treated as taboo, with dramatic consequences on physical and mental health as well as on social wellbeing of the victims. The purpose of this study was to highlight the epidemiological and clinical features as well as the legal aspects of child sexual abuse. METHODS: we conducted a retrospective descriptive study at the psychiatric outpatient service of the University Hospital of Monastir over a period of 12 years and 6 months. All children younger than 18 years diagnosed with suspected or confirmed sexual assault were included. RESULTS: a total of 93 children, victims of sexual abuse were enrolled. The average age of patients was 10 years, with a standard deviation of 3.9 years. Sex-ratio M/F was 0.9. The most common sexual contact was touching (47,3% of cases). The majority of abusers were male (93,5%). In more than half of the cases (53,8%) they were relatives of the child and in 28% of cases intra-familial abuse was reported. Initial psychiatric assessment showed mental disorders in 70% of cases. CONCLUSION: sexual abuse is a very broad field of violence which varies widely in nature and intensity. Although, in some types of sexual abuse occasionally there is a lack of physical traces, the emotional and psychological impact is ubiquitous and characterized by numerous clinical manifestations.

Psychiatric emergencies : Factors associated with suicide attempts.

BACKGROUND: Among psychiatric emergencies, suicide attempt is a frequent reason for consultation. The magnitude of this phenomenon is not only related to its increasing frequency or life-threatening, but also to the psychosocial consequences of suicidal gesture both on the patient and his entourage. OBJECTIVES: To determine the prevalence of suicide attempts in psychiatric emergency department patients and to identify associated factors. METHODS: This is a cross-sectional study carried out in the emergency department of Mahdia University Hospital during a three months period, including consultants for whom a psychiatric opinion was solicited. Regarding statistical analyzes, we studied associations between suicide attempt and sociodemographic, contextual, anamnestic and clinical variables. RESULTS: Forty-four suicidal patients were included, with a prevalence of 0.5% of all emergencies. The patients mean age was 26.6 years with a female predominance (sex ratio = 0.29). Self-induced intoxication was the most widely used method (93.2%). Reactional suicidal attempts accounted for 75%. Many factors were significantly associated with suicide attempts: young age, female gender, secondar y level of education, students, presence of trigger factor, family and personal history of suicide attempt and the provenance of the examination request from a physician. CONCLUSION: This  study highlights  a particular  profile  of patients at  high  risk  of suicide,   a codified action is to begin, including all health care providers to prevent  its  occurrence. This primary prevention is only possible through  the  identification of  risk  factors  associated with it.

Psychiatric disorders in the acoustic neuroma: about a case.

Neurofibromatosis type 2 (NF2) is a rare autosomal dominant disorder characterized by formation of central nervous system tumors. They are associated to significant morbidity due to multiple problems such as hearing loss that can lead to many psychiatric disorders.