Arabic validation of a cyberbullying assessment instrument.

INTRODUCTION: Cyberbullying is a new form of peer violence that has become a widespread problem in the world. The prevalence of this phenomenon is not known in Tunisia due to the absence of validated assessment instruments. The aim of this study was to translate and validate the questionnaire "Second Revision of the Revised Cyberbullying Inventory". METHODS: We translated this questionnaire into dialectal Tunisian Arabic using the back-translation method. To study the construct validity and the reliability, we conducted a cross-sectional study involving 962 Tunisian adolescents. Confirmatory factor analysis was performed to study construct validity for the two dimensions of the scale: cyber-victimization and cyber-aggression. To test reliability, the global internal consistency was computed for the two sections of the scale. RESULTS: The translated version was considered satisfactory. The adjustment indices of the confirmatory factor analysis were satisfactory for both sections confirming the two-dimensional nature of the scale. The values of the cyber-aggression section were as follows: Comparative Fit Index=0.92; Tucker-Lewis Index=0.9; Root Mean Square Error of Approximation=0.04; Standardized Root Mean Square Residual=0.01. As for the cyber-victimization section, fit indices were as follows: Comparative Fit Index=0.92; Tucker-Lewis Index=0.9; Root Mean Square Error of Approximation=0.01; Standardized Root Mean Square Residual=0.07. Both sections showed good reliability. The internal consistency of each section was optimal. In fact, the Cronbach alpha was respectively 0.79 for cyber-aggression and 0.73 for cyber-victimization. CONCLUSION: The Arabic version of the "Second Revision of the Revised Cyberbullying Inventory" is a psychometrically valid assessment. This scale could be useful to conduct further research and allow us to better understand the phenomenon of cyberbullying.

[Initial impact of the COVID-19 pandemic on Tunisian parents and children]. / Impact initial de la pandémie COVID-19 sur les parents et les enfants tunisiens.

INTRODUCTION: The infection with SARS-CoV-2 Coronavirus started in the city of Wuhan in China in 2019 and has not stopped spreading around the world since then. From March 11, 2020 The World Health Organization (WHO) has declared this COVID-19 infection a global pandemic. As a result, the Tunisian government has taken several measures in order to prevent the progression of the pandemic. These different changes can have different psychological consequences for both adults and children. OBJECTIVES: We proposed to study the initial impact of the spread of the COVID-19 pandemic on Tunisian parents and children. MATERIAL AND METHODS: We conducted a prospective descriptive study two weeks after the proclamation of the curfew and one week after the proclamation of sanitary lockdown in Tunisia. Parents of Tunisian children were invited to voluntarily answer an anonymous questionnaire posted on social media. The questionnaire included questions on socio-demographic characteristics and the degree of impact of the spread of the COVID-19 pandemic on family habits and activities. The stress level of the parent responding to the questionnaire was measured by the Impact Event Scale Revised (IES-R). RESULTS: One hundred and thirty-eight parents answered this questionnaire of which 88% were mothers. Fathers had to operate changes in their working arrangements in 87.2% of the cases and mothers had to do so in 79.8%. One of the parents chose to live far from the family in 13% of the cases. Only 1% of parents did not teach or talk to their children about hygiene rules. The parents of our study reported that they had a child aged 12 or less in 91% of cases with an average age of six years and a sex ratio of 1.13. Parents sought to keep them occupied in 58.6% of the cases. Children did different activities during this period: watching television in 41%, playing games in 27% and studying in 38% of the cases. In 41.4% of the cases, parents had a child aged over 12 years with an average age around 15 years and a sex ratio of 0.9. Teenagers often spent their time on tablets/computers in 80%, 52% watched movies or series, 31.25% participated in house cleaning activities, 27% spent time cooking for their family, 14.5% read books and 4.16% did social work. Parents reported that their children's behaviour changed in 60% of the cases when the children were 12 or younger and in 20% of the cases when the children were older than 12. The IES-R scores for the parents interviewed ranged from 2 to 79 with an average of 28.9 ± 18. In 48 cases, the score was greater than 32. The severity of the impact was associated with the female sex of the parent responding to the questionnaire (P = 0.04). We found a positive correlation between the IES score and the symptomatology of children with P < 0.001 and r = 0.52 when the age was 12 years or less and P = 0.001 and r = 0.518 when the age was strictly superior to 12. CONCLUSIONS: Both parents and children were affected when the COVID-19 pandemic began to spread in Tunisia. Psychological intervention is essential in order to help them get through this crisis with as few consequences as possible.

[Profile of the victims of sexual violence in child psychiatry consultation]. / Enfants victimes de violences sexuelles en consultation de pédopsychiatrie.

INTRODUCTION: Child sexual abuse is a major health problem that remains under-declared and under-reported worldwide. In this paper we have taken an interest in establishing the profile of the victims in a clinical population of children consulting for sexual abuse. METHOD: We conducted a descriptive retrospective study in the child and teenager psychiatry department of the Mongi-Slim hospital (Tunis, Tunisia). We included all patients referred for treatment or medical expertise during the period from January 2013 to June 2019 and recorded sociodemographic data and clinical characteristics on pre-established charts from patient files. RESULTS: The total number of consultants was 150 patients with 61,33 % of female subjects (n=92). The average age was 9,9 years old with extremes ranging from 2 to 18 years old. The assault was unique in 62,7 % and happened in a place known by the victim in 47,33 %. Sexual abuse with non-penetrating contact was the most frequent (48 %). The average age at which the first sexual abuse happened was 9 years old. In the vast majority of cases, the abuser was a male. Concerning the identity of the abuser, he was someone of the family in 37,3 % of the cases and in half of these cases, he was the father. In the other cases where the abuser wasn't a family member, the identity was known by the child and/or his family in 48,66 %. A psychiatric diagnosis was made in 58 % of the cases with a percentage of 52,1 % among girls and 60,3 % among boys. Main diagnoses were acute stress disorder in 10,6 %, post trauma stress disorder in 19,3 %, adjustment disorder in14,6 % and a major depressive disorder in 8 %. CONCLUSION: Knowing the profile of victims of child sexual abuse and taking into consideration the social and psychiatric impact can help in adapting the means to intervene properly in order to take care of the victims and prevent such abuse.

[The Eyes Movement Desensitization and Reprocessing for children with traumatic traumatic stress disorder: A Tunisian experience]. / L'Eyes Movement Desensitization and Reprocessing auprès des enfants avec Trouble Stress Post-Traumatique : une expérience tunisienne.

OBJECTIVES: Evaluate the effectiveness of the Eyes Movement Desensitization and Reprocessing psychotherapy for children with Post-Traumatic Stress Disorder. METHODS: A retrospective study was conducted in the Child Psychiatry Department of CHU Mongi Slim, Marsa (Tunis, Tunisia). All Outpatients with a Post-Traumatic Stress Disorder diagnosis and who had Eyes Movement Desensitization and Reprocessing psychotherapy during the period from July 2016 to May 2018 were included. They were evaluated according to DSM 5 criteria in pre and post therapy. RESULTS: The sample consisted of sixteen children with a sex-ratio of 1.6. Their age ranged from 3 to 17 years old with a mean age of 9.5±4.6 years. Five patients were less than six years old. Our patients were exposed to a sexual assault (4 cases), a death of a family member (3 cases), a road accident (3 cases), a physical assault (4 cases), an arrest of the father (1 case) and burglary of the house (1 case). In 15 cases, the traumatic event was unique while it was repeated in one sexual assault case. The total number of follow-up sessions ranged from one to seven sessions with an average of 3±2.4 sessions. The average number of sessions for preschool children was 2.6±0.5 sessions. Bilateral tactile stimulations were used with thirteen children in our population, including the five children younger than six years old. At the end of the therapy all patients no longer met the criteria for Post-Traumatic Stress Disorder diagnosis. All the preschool patients and eight children older than 6 years did not respond to any of the four Post-Traumatic Stress Disorder criteria. The difference between the scores of the DSM 5 criteria in pre and post EMDR was statistically significant. We found P=10-3 for children over six years and P<0.05 for children under six years old. CONCLUSION: Eyes Movement Desensitization and Reprocessing is a therapy that has several advantages. First, it is effective in Post Traumatic Stress Disorder in children. Second, its protocol is flexible and adaptable to all ages and developmental level of the child. Third, the number of sessions is usually reduced, which is a great advantage over other trauma-focused psychotherapies.

[Epigenetics' implication in autism spectrum disorders: A review]. / Implication de l'épigénétique dans les troubles du spectre autistique : revue de la littérature.

BACKGROUND: The etiology of autism spectrum disorders (ASD) is complex and multifactorial, and the roles of genetic and environmental factors in its emergence have been well documented. Current research tends to indicate that these two factors act in a synergistic manner. The processes underlying this interaction are still poorly known, but epigenetic modifications could be the mediator in the gene/environment interface. The epigenetic mechanisms have been implicated in susceptibility to stress and also in the pathogenesis of psychiatric disorders including depression and schizophrenia. Currently, several studies focus on the consideration of the etiological role of epigenetic regulation in ASD. OBJECT: The object of this review is to present a summary of current knowledge of an epigenetic hypothesis in ASD, outlining the recent findings in this field. METHODS: Using Pubmed, we did a systematic review of the literature researching words such as: autism spectrum disorders, epigenetics, DNA methylation and histone modification. RESULTS: Epigenetic refers to the molecular process modulating gene expression without changes in the DNA sequence. The most studied epigenetic mechanisms are those that alter the chromatin structure including DNA methylation of cytosine residues in CpG dinucleotides and post-translational histone modifications. In ASD several arguments support the epigenetic hypothesis. In fact, there is a frequent association between ASD and genetic diseases whose epigenetic etiologies are recognized. A disturbance in the expression of genes involved in the epigenetic regulation has also been described in this disorder. Some studies have demonstrated changes in the DNA methylation of several autism candidate genes including the gene encoding the oxytocin receptor (OXTR), the RELN and the SHANK3 genes. Beyond the analysis of candidate genes, recent epigenome-wide association studies have investigated the methylation level of several other genes and showed hypomethylation of the whole DNA in brain and blood samples of autistic patients. The changes in epigenetic marks following exposure to environmental factors known as autism risk factors are also discussed in many reports. They include nutritional (vitamin D and folate) and toxic (sodium valproate, bisphenol A) factors. Despite a considerable contribution to understanding the complexity of ASD etiology, the epigenetic studies suffer from numerous methodological biases that limit the scope of their results and make their interpretation difficult. The cell samples used in the psychiatric studies are mostly from the post-mortem tissue of the central nervous system, and factors that might change the epigenome (age, gender, treatments received…) are not taken into account. The use of blood and buccal epithelium samples raises in turn the question as to whether the epigenome of these cells reflects that of the nerve cells. DNA methylation can also be influenced by cell subcomposition variability, transcriptional variability and by DNA sequence variants. CONCLUSION: These recent discoveries in epigenetics are the beginnings of an etiopathogenic research revolution in neurodevelopmental disorders. The conceptualization of epigenetic processes is in its early stages and despite its limited means will help integrate disparate data factors previously involved in autism. It could also be the target for the development of new therapeutic modalities.

[Tunisian mothers' beliefs about their child's first psychotic episode]. / Opinion des mères tunisiennes concernant le premier épisode psychotique de leur enfant.

INTRODUCTION: Initiating psychiatric treatment depends on several factors including clinical, personal, familial and economic factors. In the case of a first psychotic episode in an adolescent, parents, especially mothers, have a critical role in initiating psychiatric treatment for their child. OBJECTIVE: In this study, we investigated mothers' beliefs about their child's first psychotic episode. METHODS: Participants were adolescents consulting the department of Child and Adolescent Psychiatry of the Razi hospital in Tunisia. They were aged from 12 to 19 years at the onset of their medical follow-up. Their diagnoses were schizophrenia, schizoaffective disorder and schizophreniform disorder according to DSM-IV. A questionnaire was submitted to patients' mothers after their approval. It was divided into two parts. The first part was used to collect information on socio-demographic and clinical characteristics of the mothers and their children. The second part was composed of the following four questions in Tunisian dialect: (1) what did you think was the matter when you first noticed psychotic symptoms in your child? (2) what was the main reason for which you thought psychiatric treatment was necessary? (3) what obstacles did you perceive in initiating psychiatric treatment? (4) do you have any advice or suggestions for caregivers on how they could facilitate an early start of treatment? RESULTS: Twenty-two mothers were included. The mean age of the mothers at onset of the follow-up of their child was 42 years (SD: 4.81). Ten mothers had never been schooled, five had primary school level, four had secondary school level, three had bachelor's degree and two had a diploma of doctorate; 63.6% of the mothers were housewives. The mean age of patients was 13.77 years at the start of their medical follow-up (SD= ± 2.14). Most of the patients were male (14 males for eight girls). Most patients were diagnosed as having schizophrenia (91%); 4.5% were diagnosed with schizoaffective disorder and 4.5% with schizophreniform disorder. The duration of untreated psychosis (DUP) was 11.5 months. Longer duration of untreated psychosis was associated with male gender (P=0.008). A significant relationship was also found between long DUP and stigmatization of mental hospital and psychiatry (respectively P=0.04 and P=0.05). Most of the mothers did not think that their child initially suffered from a psychotic disorder. In 63.3%, the cause of the child's symptomatology was attributed to spirit possession. The others reasons for seeking psychiatric treatment were: behavioral disorder in 77.3%, inefficacity of traditional practices in 54.5%, and patient refusal (40.9%). Stigmatization of the Razi hospital, the unique psychiatric hospital in the country, and of psychiatry in general were evoked by mothers as the main obstacles in initiating psychiatric treatment in more than half of the cases (70%). Others obstacles were: fear of side effects of psychiatric treatment (50%), patient refusal (40.9%), inaccessibility to psychiatric services (31.8%) and fear of an addiction to psychotropic agents (31.8%). Thirty-six percent of mothers underlined the need to consult in the occurrence of school difficulties or any change in the child's behavior; 27% proposed educational and anti-stigmatizing campaigns about the signs of early psychosis through radio, newspapers, cinema, and TV media advertisements. Making teachers and educators sensitive to psychosis was proposed by 13.6% of mothers; 9.1% thought that diagnostic skills should be improved in general practitioners. CONCLUSION: Knowledge of attitudes of mothers towards the illness of their child prior to psychiatric treatment and towards the start of treatment is essential for the development of interventions for reducing duration of untreated psychosis.