Diabetes Distress and Illness Perceptions in Tunisian Type 2 Diabetes Patients.

Purpose: Diabetes distress (DD) refers to the negative emotions and burden of living with diabetes. Illness perceptions are among the factors that can influence self-management and psychological distress in diabetics. This study aimed to determine the prevalence and the associated factors of DD in Tunisian patients with type 2 diabetes mellitus. We also studied the relationship between DD and illness perceptions in diabetics. Patients and Methods: This was a cross-sectional study conducted among individuals with type 2 diabetes, followed up at the outpatient endocrinology unit at the Hedi Chaker University Hospital, Tunisia. DD was assessed using the Diabetes Distress Scale (DDS-17). The Brief Illness Perception Questionnaire (Brief-IPQ) was used to assess diabetes illness perceptions. Multivariate logistic regression was used to determine independent factors associated with the presence of DD. Results: A total of 103 patients were recruited. The mean age was 59.31 (±10.83) years; 54.4% were female. In total, 70.9% had DD. Using regression analysis, we demonstrated that the illness perceptions of personal control, HbA1C, absence of comorbidities, lower age at diabetes diagnosis, and socioeconomic status were significantly associated with DD. Conclusion: This study sheds light on the high prevalence of DD among patients with type 2 diabetes in Tunisia. Illness perception-focused psychological intervention would be efficacious in reducing diabetes distress in patients with type 2 diabetes mellitus.

[Knowledge, attitudes and practice of medical students concerning sexual matters]. / Connaissances, attitudes et pratiques des étudiants en médecine en matière de sexualité.

Sexuality is a central aspect of being human throughout life. People with sexual problems commonly turn to their doctor, because he is regarded as competent and well informed. The purpose of our study was to assess the knowledge, attitudes and practice of medical students concerning sexual matters and to identify the main determinants of the lack of basic knowledge on this subject. We conducted a descriptive and analytical study of students in the Faculty of Medicine of Sfax (Tunisia). The questionnaire, completed individually and anonymously by each student, collected sociodemographic data, knowledge about sexuality as well as sources, student's attitude towards sexuality and sexual practices. The overall average score of sexology related questions was 11,05/20. Factors correlated with a medium high score of sexology related questions were: male sex (p=0.003), married status (p=0.012), high socioeconomic status (p=0.02), books as a source of the information (p=0.041) and sexual practices (p<0.001). Sexual practices were significantly more frequent among male students (p<0.001). There are gaps in knowledge about sexuality among medical students, at least in some of its aspects. A complete and uniform educational program about human sexuality, especially in its physiological aspects, can significantly improve the ability of future physicians to provide optimal patient care.

Psychological crisis intervention response to the COVID 19 pandemic: A Tunisian centralised Protocol.

In order to manage the urgent psychological need for support in response to the anticipated reaction of the population to the COVID-19 pandemic, we developed a new psychological crisis intervention model by implementing a centralised psychological support system for all of Tunisia. We set up a helpline which is accessible throughout the country, including those without access to Internet. This model integrates medical students, child and adolescent psychiatrists, psychiatrists, psychologists and social services to provide psychological intervention to the general population and medical staff. It will make a sound basis for developing a more effective psychological crisis intervention response system.

Is there a Place for Prebiotics in the Management of Neonatal Inguinal Hernia? A Preliminary Study.

The objective of this study was to assess the place of prebiotics in the management of neonatal inguinal hernia. Boys with a diagnosis of unilateral non-complicated inguinal hernia, aged less than 40 days, were prospectively followed from January 2012 to December 2014. Clinical and psychiatric data and outcomes were collected before and after prebiotics (Primalac AC) administration. Ninety-eight patients were included. There were 75 inguinal hernias and 23 inguino-scrotal hernias. Before prebiotics administration 72.2% of infants had abdominal distention and 98% had colic. After prebiotics, abdominal distention and colic regressed in 85.2% and 73.2% of patients, respectively. Hernias disappeared clinically in 66.3% of cases. The factors associated with the disappearance of hernias were the type of the hernia (p<0.001), colic (p<0.001), and abdominal distention (p<0.001). Prebiotics would be a new adjunct in the management of neonatal inguinal hernia. They decrease colic and abdominal distention, which seems helpful to prevent strangulation and probably get spontaneous resolution of small hernias.

Valproic Acid and Hepatic Steatosis: A Possible Link? About a Case Report.

BACKGROUND: Valproic acid is a mood-stabilizing anticonvulsant. Hepatic injuries are among the occasionally observed adverse effects of this medication. CASE PRESENTATION: We present the case of a 47-year-old man who had bipolar disorder for ten years and treated with valproic acid. He demonstrated elevated serum aminotransferases and ultrasonography revealed that hepatomegaly was suggestive of hepatic steatosis. CONCLUSION: This case report stresses the importance of a complete drug history and the need for clinicians to be aware of the delayed onset of hepatic injuries.

Post-stroke emotional incontinence or bipolar disorder?

INTRODUCTION: Post-stroke emotional incontinence and bipolar disorder are two disorders that involve the dysfunction of brain structures responsible for emotional regulation. The objective of this work is to study the links between these disorders through a clinical case. CASE REPORT: We present the case of a 43-year-old man without previous psychiatric history who experienced emotional incontinence after cerebrovascular events. He reacted promptly to selective serotonin reuptake inhibitor treatment. However, he experienced his first episode of hypomania after 6 months of antidepressant therapy. Adjunctive therapy with valproic acid and low-dose paroxetine was eventually added, resulting in complete improvement of both emotional incontinence and hypomania after 4 additional months of treatment. CONCLUSION: The clinician should carefully explore any history of premorbid bipolar disorder, personality disorder characterized by mood instability, and family history of bipolar disorder.

The profile of drug users in Tunisia: Implications for prevention.

BACKGROUND: Despite cultural, religious, and legal constraints on Muslims against the consumption of drugs, usage and misuse do exist. Drug addiction in Tunisia is a wide-spread problem and is destroying the lives of many individuals and families. AIMS: To examine the socio-demographic characteristics of substance users and to identify the drugs commonly used. METHODS: In this cross-sectional study, all the patients admitted at the addiction treatment center ''Aide et Ecoute'' in the period from January 2014 to September 2014 formed the sample of the present study. RESULTS: Only two hundred males were found to get treatment in the addiction center for various addictions. Among them, 65.9% were not married and 59.5 % had involvement with criminal justice. The mean age was 33.32 years and the mean age for starting substance use was 17.30 years. Substance use was higher (90.6%) in less educated people (secondary or below) and in urban population (73.2%). The most common substance misused was Buprenorphine (34.8%). There was a significant relation between buprenorphine consumption and immigration p= 0.013. CONCLUSION: Our observations point towards the vulnerability of younger age and immigrated population towards substance use and hence, it is proposed preventive health policies in this regard.

[Athletic performance, self-esteem and temperamental profile : Which relationship?]. / Le rendement sportif, l'estime de soi et le profit temperamental: Queslles relations?

BACKGROUND: Several authors emphasize the close relationship between self-esteem and athletic performance; such a relationship may raise the following question: by saying "strong" or "without any physical condition", is it a fair presentation of the individual's abilities or he reveals the most fundamental aspects of his personality, such as emotional temperament? OBJECTIVES: To evaluate self-esteem, physical self and temperamental profile in a group of sportsmen, and to look for a relationship between these variables and athletic performance. METHODS: We performed a cross-sectional, descriptive and analytic study in 80 young handball players of the "senior" category. We assessed self-esteem using the Rosenberg Self Esteem Scale, physical self-using the Physical Self-Inventory (PSI), and temperamental profile using the Temperament Evaluation of Memphis, Paris and San Diego Auto-questionnaire (TEMPS-A). Athletic performance was evaluated by the team coach by means of a score ranging from 1 to 10. RESULTS: High self-esteem was correlated to female gender (p=0.03), to an early start of physical activity (p<0.01), and certain dimensions of the physical self: perceived physical value (p=0.02), appearance (p<0.01), and the global score (p=0.01). Athletic performance was correlated to high self-esteem (p<0.01) and to two dimensions of the physical self: the global score (p=0.01) and the perceived physical value (p<0.01). Hyperthymic temperament was associated with high self-esteem (p=0.001). Good athletic performance was associated with hyperthymic (p<0.01) and cyclothymic (p<0.01) temperament. Low athletic performance was associated with depressive (p=0.04) and irritable (p=0.01) temperament. CONCLUSION: Our study shows the close relationship between selfesteem, temperamental profile and athletic performance. We suggest that the intervention of a psychiatrist or a psychologist aimed at improving sportsmen's' self-esteem might help to achieve better athletic performance. In this intervention, the individual temperamental profile should be taken into account.

Schizophrenia and Leigh syndrome, a simple comorbidity or the same etiopathogeny: about a case.

Leigh syndrome is a mitochondrial encephalomyopathy that occurs due to "cytochrome c oxidase deficiency". Few psychiatric disorders have been defined that are associated with Leigh syndrome. The objective of this work is to study relations between mitochondrial dysfunction and psychiatric disorders. It was a 20 year old male patient, who received Modopar, for severe extra pyramidal symptoms caused by Leigh syndrome. He developed, four months ago, acute psychotic symptoms such as audio-visual hallucinations, persecution and mystic delirium. The cerebral MRI has shown signal abnormalities in central grey nucleus. The EEG recording and blood test were normal. The hypothesis of drug induced psychiatric disorders (Modopar) was possible. The evolution under atypical antipsychotic was only partial. In this case, the cerebrospinal fluid and lactate levels mean that mitochondria were not an overall explanation for these psychiatric disorders but may at least play a partial role. Psychiatric disorders may just be acomorbidity.

Sexual dysfunction in married women with Systemic Sclerosis.

INTRODUCTION: Sexuality is an often neglected area in patients with rheumatic disease. The aim of this study is to assess sexual functioning and quality of life in a group of married women with Systemic Sclerosis (SSc). METHODS: This is a horizontal study for descriptive and analytical purposes. Married women with SSc were interviewed about their sexual functioning and their quality of life. RESULTS: A total of ten patients who met the criteria have accepted to participate to the study. Their mean age was 52, 4± 8,2 years. Eight women thought that the disease had affected their sexual activity. All patients reported a decrease in the frequency of intercourse since the onset of their disease. Eight of the sample reported a diminished desire for a sexual relationship. The reasons were fatigue, altered body image and pain. The assessment of sexual functioning using the Female sexual function index (FSFI) showed a mean FSFI score at 14,2±7,8 with nine women scoring in the range associated with sexual dysfunction (SD) (<26). All the subscales were affected. Our patients reported a mean total score on WHOQOL-brief (World Health Quality of Life-Brief Version) of 60 out of 120 indicating a moderate altered quality of life. Depression has been identified as determinants of impaired sexual function. CONCLUSION: The prevalence of SD in women with SSc is high when a specific questionnaire is used to assess it. These results indicate that in daily practice, inquiring about sexuality and screening for depressive symptoms is indicated for every patient with SSc.

Alexithymia impact on type 1 and type 2 diabetes: a case-control study.

OBJECTIVES: This paper focus on studying the prevalence of alexithymia in diabetes type 1 and type 2 and its impact on diabetes's clinical and therapeutic characteristics. We also studied the relationship between alexithymia and emotional disorders in diabetics. MATERIALS AND METHODS: The study involved a sample of 125 diabetic patients, among whom 50 had type 1 and 75 had type 2 diabetes mellitus compared with respectively 70 and 52 control subjects matched for age and sex. Alexithymia was assessed using the Toronto Alexithymia Scale, while emotional disorders were evaluated using the Hospital Anxiety and Depression Scale. RESULTS: Type 1 diabetics were more alexithymic than controls while type 2 diabetics had higher cognitive component score than control subjects. Alexithymic type 1 diabetics had a higher average of fasting blood sugar than non-alexithymic patients did (P=0.021). Moreover, with type 1 diabetes, erectile dysfunction was associated with difficulties in identifying feelings (P=0.012). We found that the presence of depression was a predictor of alexithymia in type 1 diabetes (ß=1.78, P=0.04) and the presence of psychiatric history was indicative of the presence of alexithymia in type 2 diabetes (ß=2.09, P=0.042). CONCLUSION: Given the impact of alexithymia on diabetes types 1 and 2, the detection and treatment of alexithymic subjects are important for a better prognosis of diabetic disease.

[Postpartum depression: prevalence and risk factors. A prospective Study concerning 302 Tunisian parturients]. / La dépression du postpartum: prévalence et facteurs de risque Etude prospective concernant 302 parturientes tunisiens.

BACKGROUND: Depression is a common condition especially in the postpartum. It exposes mothers, newborns and couples for psychosocial complications. AIMS: They were to estimate the prevalence of the depression in postpartum in a population of 302 Tunisian parturients and to identify its associated factors. METHODS: Our study was prospective, in two stages: at the first week (T1), then between sixth and tenth week of the postpartum (T2). The study was conducted at CHU Hédi Chaker in Sfax, Tunisia. We used the Arabic version and validated the Edinburgh Postnatal Depression Scale (EPDS) for screening for postpartum depression. We used the scale MSSS. "Maternity Social Support Scale"to assess the social and family support and the Azrin scale to evaluate the satisfaction of the conjugal relationship. An epidemiologic questionnaire was used to collect the sociodemographic and clinical data. RESULTS: At T1, 302 women were examined. At T2, 139 were reexamined (46% of the initial population). In the first stage, the prevalence of the intense postpartum blues, according to EPDS, was 19,2%. In the second stage, the prevalence of the postnatal depression was 12, 9%. Factors associated with postpartum blues intense were the low socioeconomic status (p =0, 01), a lower educational level (p = 0,017), the poor marital relationship (p =0, 04), an insufficient social support (p 0,001), the difficulty to accept pregnancy (p =0,001), the presence of psychiatric the presence of psychiatric history (p =0,001), the prematurity (p =0,001) and an ill newborn birth (p =0,001). Factors associated with the post natal depression were the low socioeconomic status (p =0,01), the poor marital relationship (p =0,034), difficulty with pregnancy (p =0,001) and the presence of psychiatric history (p =0,001). CONCLUSION: Postpartum depressions are common. It seems to be the result of the interaction of several biological, psychological and social factors. This suggests the importance of screening for women having such risk factors to prevent the installation of this depression. This detection should be done early in postpartum or else in the later postnatal consultations. This allows an adequate treatment for the mothers, for the relationship mother-new born and later, for the psychological equilibrium of the child.

Quality of life in alopecia areata: a sample of tunisian patients.

Background. Alopecia areata (AA) has a significant impact on the quality of life and social interaction of those suffering from it. Our aim was to assess the impact of AA on the quality of life. Methods. Fifty patients diagnosed with AA seen in the Department of Dermatology of Hedi Chaker University Hospital, between March 2010 and July 2010, were included. Quality of life was measured by SF 36; severity of AA was measured by SALT. Results. Eighty percent had patchy alopecia with less than 50% involvement, 12% had patchy alopecia with 50-99% involvement, and 8% had alopecia totalis. Compared with the general population, AA patients presented a significantly altered quality of life, found in the global score and in five subscores of the SF-36: mental health, role emotional, social functioning, vitality, and general health. Gender, age, marital status, and severity of alopecia areata had a significant influence on patients' quality of life. Conclusions. This study indicates that patients with AA experience a poor quality of life, which impacts their overall health. We suggest screening for psychiatric distress. Studies of interventions such as counseling, psychoeducation, and psychotherapeutic interventions to reduce the impact of the disease may be warranted.

Prevalence and Impact of Anxiety and Depression on Type 2 Diabetes in Tunisian Patients over Sixty Years Old.

Objectives. To estimate the prevalence of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) in a population aged over sixty years with type 2 diabetes and to study the impact of anxiety and depression on glycemic balance and disease outcome. Results. The prevalence of anxiety and depression in the 62 subjects included in the study was, respectively, 40.3% and 22.6%. We found a relationship between these disorders and complicated diabetes. The subjects having an imperfectly balanced diabetes had a higher average anxiety score than those having a good glycemic control (9.1 ± 4.2 versus 6.5 ± 3.1; P = 0.017). No relationship was found between diabetes balance and depression. Conclusion. Association between anxiety and depressive disorders and diabetes is frequent and worsens patients' outcome, in terms of diabetes imbalance as well as in terms of diabetic complications. Our study shows that there is need for physicians to detect, confirm, and treat anxiety and depressive disorders in elderly diabetic patients.

[Sexual function in married women with rheumatoid arthritis]. / Dysfonction sexuelle chez dix femmes mariées atteintes de polyarthrite rhumatoïde.

OBJECTIVE: The aim of this study is to assess sexual functioning in a group of married women with rheumatoid arthritis using a self-questionnaire. METHODS: This is a horizontal study for descriptive and analytical purposes. (between October and November 2010). Married women with a confirmed diagnosis of rheumatoid arthritis (RA), with no co morbidities that may affect sexual activity, were interviewed about their sexual functioning and their quality of life by a self report questionnaire. RESULTS: A total of 10 patients who met the criteria have accepted to participate to the study. Their mean age was 42.5±5.8 years (32-50 years), their mean age at the marriage was 24.8±8.9 years (16-48 years). Six women thought that the disease had affected their sexual relationship and their sexual activity. Six patients reported a decrease in the frequency of intercourse since the onset of their disease. The reported mean age at the beginning of sexual (SD) dysfunction was 37.1±5.8 years (30-48 years). Six of the sample reported a diminished desire for a sexual relationship since the disease onset. The reasons were pain, physical disability and fatigue. The assessment of sexual functioning using the Female sexual function index (FSFI) showed a mean FSFI score at 19.2±9.8 (2-30) with seven women scoring in the range associated with clinical SD (<26). All the subscales were affected: desire, arousal, lubrication, orgasm and satisfaction. Our patients reported a mean total score on World Health Quality of Life-Brief Version (WHOQOL-brief) of 60 out of 120 indicating a moderate altered quality of life. CONCLUSION: The prevalence of sexual dysfunction in women with RA is high when a specific questionnaire is used to assess it. The reasons for disturbed sexual functioning are multifactorial: impaired function, chronic pain and important fatigue.

[Role of the psychosocial factors in blood pression balance; cross-sectional study including 100 ambulatory hypertensive patients]. / Rôle des facteurs psychosociaux dans l'equilibre tensionnel: etude transversale de 100 hypertendus ambulatoires.

INTRODUCTION: Hypertension is a real public health problem. His pathogenesis involves a combination of several factors including environmental and psychosocial factors. AIM: We focus on the links between the blood pressure imbalance and some psychosocial factors in a population of ambulatory patients with hypertension. METHOD: It was a cross-sectional study on 100 patients with hypertension followed up in Cardiology in Sfax (Tunisia). Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS). Behavioral pattern was evaluated by a clinical interview, referring to the model of Friedman and Rosenman. We also collected socio-environmental, clinical, therapeutic and prognostic data. RESULTS: The most predictive factors of an unbalanced blood pressure were independently: personality type "A" or unspecified (p = 0002), high fat diet (p = 0026), poor drug adherence (p = 0038) and depression (p = 0015). CONCLUSIONS: Several sociodemographic and lifestyle factors are interrelated and implicated in the blood pressure imbalance, suggesting the need of a hygienic behavior joining the international recommendations. We insist on the treatment of the anxious and depressive disease and the psychotherapeutic approach of some personality patterns in the management of hypertension.