[Metacognitive deficit in schizophrenia: Characteristics and links]. / Déficit métacognitif dans la schizophrénie : caractéristiques et liens.

OBJECTIVES: Research indicates that many patients with schizophrenia experience deficits in metacognitive capacity defined as the ability to form complex representations of themselves and others. The aim of the current study was to assess metacognitive deficit in patients with schizophrenia. These variables were collected together with many other sociodemographic, clinical and therapeutic data. METHODS: We conducted a descriptive and analytical cross-sectional study in the psychiatry department at the Hedi Chaker University Hospital in Sfax (Tunisia). Patients were in a non-acute phase, defined by the absence of any psychiatric symptoms during the last four weeks, also, no changes in medication during the previous month had been required. An informed written consent was obtained, following which patients completed questionnaires assessing sociodemographic and clinical data during structured interviews. Symptoms and severity of the illness were assessed using the Positive and Negative Symptoms Scale (PANSS). Insight was assessed using the Insight Scale (Q8). In addition, the Metacognition Assessment Scale-Abbreviated (MAS-A) was used to assess metacognitive capacities. The MAS-A contains four dimensions: self-reflectivity, awareness of the mind of others, decentration, and mastery. Higher scores reflect an ability to effectively respond to psychological challenges on the basis of psychological knowledge. RESULTS: We recruited 74 adults with schizophrenia disorder. The diagnosis was with DSM5. Their average age was 45 years (SD=9.84 years) with a sex ratio (M/F) of 1.552. Nineteen patients (25.5%) were married, and low educational level was present in 43% of cases. Forty patients (54%) were unemployed. Metacognitive deficit was detected in all the patients. They had low levels in all four dimensions of metacognition. The most affected dimension in our series was "Mastery". All patients had an overall insight score less than six (the average score was 2.73) with poor awareness in 62% of patients. The main factors correlated with metacognitive deficit were: occupational inactivity (P-0.015), Primary education level (P=0.045), tobacco consumption (P=0.002), low insight (P-0.001), negative symptomatology (P<10-3) and the use of first generation of antipsychotics (P=0.003). The multivariate analysis showed that three factors (occupational inactivity, low insight and the presence of negative symptomatology) were predictors of metacognitive deficits. CONCLUSION: Based on our results, occupational inactivity, negative symptomatology and low insight are predictors of metacognitive deficit in schizophrenia. Specific therapeutics should be proposed to act on these factors. A metacognitive training program, tailored to this vulnerable population, is a priority to improve their quality of life.

[Effects of continuous positive airway pressure on depression, anxiety and quality of life in obstructive sleep apnea hypopnea syndrome patients]. / Effets de la ventilation en pression positive continue sur la dépression, l'anxiété et la qualité de vie au cours du syndrome des apnées-hypopnées obstructives du sommeil.

INTRODUCTION: The obstructive sleep apnea hypopnea syndrome (OSAHS) is a chronic stressor that may alter the emotional state and quality of life (QOL) of patients suffering from it. In this work, we proposed to estimate the prevalence of depression and anxiety, to assess the QOL in a Tunisian population of apneic patients, and to assess their evolution under continuous positive airway pressure (CPAP). METHODS: We conducted a prospective study, involving 33 apneic patients followed for SAHOS with moderate or severe class disease in the pneumology department at Hedi Chaker university hospital in Sfax, Tunisia. They received CPAP treatment for three months. We used an epidemiological record. Two scales, the Hospital Anxiety and Depression Scale (HADS) and the 36-item Short-Form Health Survey (SF-36), were completed before and after treatment to evaluate the effect of three months of treatment with CPAP. RESULTS: The prevalence of depression in the study's patients, according to the HADS, was 45.5% and that of anxiety was 21.2%. After 3months of CPAP, the prevalence of depression and anxiety had become 18.2% and 6.1%, respectively. QOL was impaired in 81.8% of cases before treatment, according to the SF-36. This figure had decreased to 69.7% after 3months of treatment with CPAP. Apart from the third dimension (physical pain), all other dimensions were significantly improved after 3months of CPAP treatment. The treatment with CPAP induced a significant improvement in the average scores of depression (P<0.001), anxiety (P=0.002) and QOL (P<0.001). CONCLUSIONS: These results attest to the importance of the frequency of anxio-depressive disorders as well as an altered QOL in patients with OSAHS. CPAP treatment was shown to be effective in improving these parameters, but this efficacy was partial. Specialized care may be needed in cases of residual anxio-depressive symptoms.

[Post-traumatic stress disorder, depression and anxiety in parents of children with epilepsy]. / Trouble stress post traumatique, dépression et anxiété chez les parents d'enfant(s) atteint(s) d'épilepsie.

INTRODUCTION: Post-traumatic Stress Disorder (PTSD), depression and anxiety are the most common psychiatric consequences among parents of children with epilepsy. OBJECTIVES: We aimed to investigate the prevalence and predictors of PTSD, depression and anxiety in a sample of parents of children with epilepsy. METHODS: A survey of 135 parents of children with epilepsy, treated in the pediatric neurology department at the Sfax Teaching Hospital in Tunisia, was conducted in the last quarter of 2019. The PTSD Checklist for DSM-5 and the Hospital Anxiety and Depression Scale (HADS) were used to assess, respectively, PTSD, depression and anxiety in parents. Associations with clinical and demographic variables with PTSD, depression and anxiety were evaluated in a logistic regression model. RESULTS: Results revealed PTSD rates of 20.7%, depression rates of 28.9% and anxiety rates of 55.6%. The main factors associated with PTSD on multivariable analysis were female gender (P=0.026, ORa=13.1), insufficient involvement of partner in disease management (P<10-3, ORa=12.1) and duration of epilepsy less than 12 months (P=0.001; ORa=0.1). Female gender (P=0.006, ORa=18.1) and restriction of social life (P=0.006, ORa=4.1) were associated with depression. Factors associated with anxiety were insufficient involvement of partner in disease management (P=0.03, ORa=4.6) and PTSD (P=0.005, ORa=9.1). CONCLUSION: These findings suggest that clinicians should pay more attention to psychological health of parents of children with epilepsy and help healthcare providers to develop preventive and intervention strategies for parents of such children.

Occurrence of Hypopituitarism in Tunisian Turner Syndrome patients: familial versus sporadic cases.

OBJECTIVE: To explore unusual association between Turner Syndrome (TS) and Hypopituitarism in a Tunisian cohort. METHODS: We reported 6 patients with TS associated to Hypopituitarism, including three familial cases except the fourth sister who showed only a TS phenotype. Biochemical analysis, resonance magnetic imaging and cytogenetic analyses were performed. RESULTS: The average age of our patients was 17.2 years (11-31 years). They were all referred for short stature and pubertal delay, except for the fourth sister who presented spontaneous puberty with the integrity of the pituitary axis and the presence of an X ring chromosome. Karyotype analysis showed monosomy in 3 cases and a mosaic TS in the 3 remaining cases, including one patient with abnormal X chromosome structure. Somatotropic and corticotropic deficiencies were confirmed in 2 sporadic cases while the gonadotropic and thyrotropic axes were spared. In contrast; familial cases were consistently affected by the integrity of the corticotropic axis. MRI showed pituitary hypoplasia in all familial cases and pituitary stalk interruption syndrome in only one sporadic case. No correlation was found between the chromosome formula and the anterior pituitary involvement. CONCLUSION: Co-segregation of congenital Hypopituitarism with pituitary hypoplasia and X chromosome aberrations could imply a molecular anomaly of transcription factors responsible for the differentiation and development of pituitary cells such as PROP1, POUF1, Hesx1, Lhx3, Lhx4. The etiopathogenic link between X chromosome abnormalities and the occurrence of Hypopituitarism remains unclear; however, the progress of molecular biology may clarify the interrelation between transcription factors and sex chromosome segregation abnormalities.

[The handling of psychotropics in diseases of central nervous system]. / Le maniement des psychotropes dans les maladies du système nerveux central.

Psychiatric signs and symptoms occur frequently in individuals with central nervous system diseases. Inadequately treated, these comorbid conditions affect patient rehabilitation, compliance with treatment and quality of life. Their management poses a major challenge given the variable efficacy and safety profiles of available psychotropic drugs and increased risk of drug interaction. This review aims to summarize the existing literature on the prescription of psychotropic drugs for management of psychiatric disorders among persons with central nervous system's diseases.

[Factors associated with Internet addiction among Tunisian adolescents]. / Facteurs associés à la cyberaddiction chez les adolescents Tunisiens.

INTRODUCTION: Internet addiction, a relatively new phenomenon, is a field of recent research in mental health, particularly within young populations. It seems to interact with several individual and environmental factors. OBJECTIVES: We aim to spot internet addiction in a Tunisian adolescent population, and to study its relationship with personal and family factors, as well as with anxious and depressive comorbidities. METHODS: We conducted a cross-sectional study of 253 adolescents recruited in public places in the city of Sfax in the south of Tunisia. We collected biographical and personal data as well as data describing family dynamics. The internet addiction was assessed by Young's questionnaire. Depressive and anxious co-morbidities were assessed using the HADS scale. The comparative study was based on the chi-square test and the Student's test, with a significance level of 5 %. RESULTS: The prevalence of internet addiction was 43.9 %. The average age of internet-addicts was 16.34 years, the male sex was the most represented (54.1 %) and increased the risk of internet addiction (OR a=2.805). The average duration of connection among Internet addicts was 4.6hours per day and was significantly related to internet addiction; P<0.001). Socializing activities were found in the majority of the internet-addicted adolescents (86.5 %). The type of online activity was significantly associated with internet addiction (P=0.03 and OR a=3.256). Other behavioral addictions were frequently reported: 35.13% for excessive use of video games and 43.25 % for pathological purchases. These two behaviors were significantly associated with internet addiction (with respectively P=0.001 and P=0.002 with OR=3.283). The internet-addicted adolescents lived with both parents in 91.9 % of cases. The mother's regular professional activity was significantly associated with internet addiction risk (P=0.04) as was the use of the Internet by parents and siblings (with respectively P=0.002 and P<0.001 with OR=3.256). The restrictive attitude of the parents was significantly associated with internet addiction risk (P<0.001 OR=2.57). Family dynamics, particularly at the level of adolescent-parent interactions, were a determining factor in internet addiction. Anxiety was more frequently found than depression among our cyber-dependent adolescents with frequencies of 65.8 % and 18.9 %, respectively. Anxiety was significantly correlated with the risk of internet addiction (P=0.003, OR a=2.15). There was no significant correlation between depression and the risk of internet addiction. CONCLUSION: The Tunisian adolescent seems at great risk of internet addiction. Targeted action on modifiable factors, especially those affecting family interactions, would be very useful in prevention.

[Affective temperaments in drug addicts: A case-control study]. / Tempéraments affectifs des toxicomanes : étude cas-témoins.

INTRODUCTION: The study of affective temperaments is a dimensional approach to personality that would provide a better understanding of the emergence of psychopathological disorders including addictive behaviors. However, in the literature, there is a lack of studies focusing on the links between this type of disorder and affective temperaments. Our objectives were to study the distribution of the five known affective temperaments in a group of drug addicts compared to a control group, and to identify sociodemographic and clinical factors associated with emotional traits. METHODS: This was a case-control study carried out in the drug abuse prevention center "ATUPRET" of Sfax in Tunisia. It included 50 drug addicts, all male, and 50 healthy control subjects matched for age (P=0.22), marital status (P=0.28), socioeconomic level (P=0.36) and educational level (P=0.95). Sociodemographic data were collected through an interview for drug addicts hospitalized in this center while clinical data were collected from medical records. The TEMPS-A questionnaire, 110 questions validated Tunisian version, has been used to evaluate five affective temperaments. RESULTS: The average age of drug addicts was 32.98 years (19-59 years) and the average age at onset of drug use was 20.36 years (12-52 years). Among drug users, the highest mean scores were observed for hyperthymic temperament (13.68±4.20), followed by cyclothymic (13.14±4.89), anxious (11.32±6.00) and depressive (11.02±3.65) ones. The lowest mean score was for irritable temperament (10.14±3.95). All of these scores, except that of cyclothymic temperament, were significantly higher than in the control group (P<0.01). The age of drug addicts was negatively correlated with cyclothymic (P=0.023) and irritable (P=0.035) temperament scores. These two temperaments were more dominant in the group of drug addicts with post-secondary education (P respectively 0.035 and 0.002). The age of onset of psychoactive substance use was negatively correlated with irritable temperament (r=-0.355, P=0.012). Cyclothymic temperament was correlated with alcohol dependence (P=0.03) and psychiatric comorbidity (P=0.01) among drug addicts. CONCLUSION: The present study provides support for the existence of temperamental dysregulation in drug-addicted patients. This result leads us to suggest that affective temperaments are implicated as a potential endophenotype and may represent a marker for the identification of persons vulnerable to drug use. These affective temperaments also appear to influence clinical features of drug addiction.

[Alcohol use in adolescents and its association with sensation seeking and impulsivity: A survey in the city of Sfax, Tunisia]. / Enquête sur la consommation d'alcool et sa relation avec la recherche de sensations et l'impulsivité chez l'adolescent de la région de Sfax, Tunisie.

BACKGROUND: Although the increase of media interest for psychoactive substances use, especially alcohol, among young people, since the revolution, Tunisia has few epidemiological studies on this subject, which does not allow having a clear idea of the importance of the problem and its different determinants. AIMS: To assess the prevalence of alcohol consumption among adolescents in the region of Sfax (Tunisia) and to determine its relations to the two personality dimensions: sensation seeking and impulsivity. METHODS: This was a cross-sectional study involving 317 middle and high school students in Sfax (Tunisia). We used the Alcohol Use Disorders Identification Test (AUDIT) to assess risky alcohol-consumption, the Barratt Impulsiveness Scale (BIS-11) to assess the degree of impulsivity and the Sensation Seeking Scale (SSS-V) to assess the level of sensation seeking. RESULTS: The average age of students was 15.79±1.5 years with a sex-ratio of 1.07. The prevalence of experimenters (who had drunk alcohol at least once in their lifetime) was 19.6% while that of current consumers (who had drunk alcohol more than one time during the past 12 months before the survey) was 8.8%. Among those who reported alcohol use during the last year, 42.8% were alcohol-dependent, according to the AUDIT. The analysis of personality dimensions showed a significant association between current alcohol consumption and sensation seeking (P<0.001) in particular on the dimensions of disinhibition (DIS), experience seeking (ES) and boredom susceptibility (BS) (P respectively: <0.001; 0.002 and 0.001). Total impulsivity and motor and attention impulsivity were associated with current alcohol consumption (respective P: 0.001, 0.005 and 0.015). CONCLUSION: Our study of schooled Tunisian adolescents shows that sensation seeking and impulsivity are associated with the development of alcohol use. Such a behavior is worrisome because it appears to be quite frequent and often problematic.

[Pituitary hyperplasia due to primary hypothyroidism]. / Hyperplasie hypophysaire secondaire à une hypothyroïdie périphérique.

INTRODUCTION: Pituitary hyperplasia due to primary hypothyroidism is rare and underdiagnosed. CASE REPORT: We report an 18-year-old patient referred for a pituitary mass revealing primary hypothyroidism. Biological parameters confirmed severe primary hypothyroidism and hyperprolactinemia. Outcome was favorable with l-thyroxin supplementation resulting in TSH and prolactin levels normalization and pituitary mass resolution. CONCLUSION: Pituitary hyperplasia due to primary hypothyroidism, although rare, should be recognized to avoid unnecessary surgery leading to irreversible complications.

[Impact of physical disability and concomitant emotional disturbances on post-stroke quality of life]. / Impact du handicap physique et des troubles émotionnels concomitants sur la qualité de vie en post-AVC.

INTRODUCTION: The physical and/or psycho-cognitive changes after stroke may lead to a decline in the quality of life (QOL) of patients. The aims of our study were to evaluate the QOL of stroke survivors and to investigate its relationships with the physical disability degree and the emotional disorders (anxiety and depression). METHODS: We conducted a cross-sectional study, which included 147 patients, followed for stroke that had occurred over the past year, in the outpatient neurology department at the university hospital Habib Bourguiba of Sfax (Tunisia). For each patient, we collected socio-demographic characteristics and clinical and therapeutic data. The quality of life of our patients was assessed using the SF-36 scale. The HAD scale was used to screen for anxiety and depression, whereas the modified Rankin scale was used to measure the degree of disability. RESULTS: The average age of our patients was 60.58 years. The overall mean score of the SF-36 ranged from 20.81 to 89.81 with an average of 55.27. Impaired QOL was found in 68% of patients. The study of the dimensional average scores revealed that only two dimensions of the SF-36 were not altered: physical pain and life and relationship with others. The physical component was slightly more altered than the mental component (41.4 and 42.9 respectively). A minimal disability was found in 32% of patients, while a moderate and severe disability was found in 19% and 21.1% of patients. Anxiety was detected in 55.1% of patients and depression in 67.3% of them. Impaired mental component QOL was significantly correlated with the presence of anxiety (P=0.008) and depression (P<<0.05). The severe degree of disability had a significant negative impact on all areas of QOL except that of life and relationships with others. CONCLUSION: It appears from our study that among the important effects of stroke is the constant deterioration of QOL in its various dimensions. The occurrence of emotional disturbances such as anxiety and depression and the degree of physical disability seem to be predictors of QOL impairment. Therefore, special attention should be given to such patients at higher risk of decline in their QOL.

Unusual association of turner syndrome and hypopituitarism in a Tunisian family.

PURPOSE OF THE STUDY: Familial occurrence of either Turner syndrome or hypopituitarism is very rare. Particularly, their association is an uncommon finding. In this context, we describe for the first time 4 sisters with Turner syndrome, hypopituitarism was reported in three among them. PATIENTS AND METHODS: Our cohort consists of four Tunisian adult sisters belonging to a consanguineous family. Biochemical analysis, resonance magnetic imaging and cytogenetic analyses were performed. RESULTS: Turner syndrome was diagnosed at the ages of 14, 17, 31 and 43 years in cases 1, 2, 3 and 4 respectively. They suffered from short stature, dysmorphic syndrome and/or delayed puberty. Interestingly, 3 among them showed also hypopituitarism, hypogonadotrophic hypogonadism and central hypothyroidism. Somatotropic insufficiency was proven in one case. Pituitary MRI has shown an empty sella turcica with hypoplastic pituitary gland in three cases. Their karyotypes were compatible with 45X in one case, 45X/46XX in the second and 45X/46XX/47XXY with x label in two cases. CONCLUSION: Hence, the presence of these familial cases of TS must evoke new etiopathogenetic arguments. Coincidence of hypopituitarism in this family, might suggest common genetic background for the two diseases. This particular family would be a precious tool for an extensive molecular analysis. More attention should be given to other family's members mainly in the presence of delayed puberty and sterility in other members.

[Sexuality of Tunisian women: Involvement of religion and culture]. / Sexualité de la femme tunisienne : entre le religieux et le culturel.

INTRODUCTION: Culture and religion carry several prohibitions and taboos, especially in the Arab-Muslim societies, and are therefore involved in the sexual behavior and its perception, particularly that of women. OBJECTIVES: To assess the married population's knowledge and opinion about female sexuality, and to estimate the impacts of religious and cultural factors on women's life experience and sexual practice in the Tunisian society. SUBJECTS AND METHODS: Our study is in an inquiry. We targeted 55 men and 55 women agreeing to participate in the study. They responded to an anonymous self-administered questionnaire comprising 18 items related to the influence of religion and culture on female sexuality. Among these items, some were binary responses (yes or no) assessing knowledge about female sexuality in the Tunisian religious and cultural context; 8 others explored the opinions of participants about female sexuality. Statistical analysis was performed using SPSS software (15th version). Pearson's chi-square test and Fisher's exact association test were used for comparative study (P<0.05). RESULTS: The rate of participants who did not manage to reach the threshold of 50% of responses compliant with religious precepts and morals in the Tunisian context was 48.19%. According to 61.8% of participants, the woman should consider sex as a religious duty, and according to 79.1%, she always ought to have sex with her husband even when she did not wish to. This assertion was more frequently reported by women (P<0.001). Among the participants, 35.5% did not approve of the idea that women had the right to reach sexual pleasure, like men. Men recognized this right less often than women did (P<0.001). With reference to social morals, 43.6% of participants thought that the woman should always remain passive when having sex. This opinion was more common to women (P<0.001). There were 71.8% who thought that premature ejaculation was not a limiting factor for female pleasure. Virginity was considered by 63.6% of respondents as a feminine virtue to preserve. This response was statistically more frequent among males (P<0.001). For 55.5%, in addition to sodomy, a man could not afford all the sexual practices with his wife. This response was significantly more frequent in males (P<0.001). Regarding the subjective perception of female sexuality, the percentage of those who thought that women might simulate orgasm was 70.9%. Women thought more frequently than men that such a behavior could be justified to avoid hurting the man's pride (P<0.001). CONCLUSION: The experience of sexuality within the Tunisian population is hampered by the prohibitions related to religion and culture, at least in some of its aspects. The reasons for that may be the ignorance of religious texts or their misinterpretation and the biased cultural transmission not followed by questioning or seeking deeper knowledge. The introduction of sex education in school programs could play a crucial role in the fight against the obstacles surrounding sexuality, in order to promote the welfare of woman, and thereby, that of the couple and the family.

Descriptive analyses of Turner syndrome: 49 cases in Tunisia.

Turner syndrome is linked to the absence or abnormality of one of the X chromosome leading to haplo-insufficiency of genes involved in the development and maintenance of the ovarian stock in women. We report the results of a 21-year retrospective study, conducted in 49 patients with Turner syndrome. The purpose of this study was to establish the clinical, hormonal, cytogenetic and evolutive pattern of a Tunisian population with Turner syndrome and to search for correlations between genotype and phenotype. The average age of our patients at diagnosis was 14 years (1 day-42 years). Twenty-four percent of them were diagnosed in adulthood (greater than or equal to 20 years). Turner syndrome was diagnosed later in the case of mosaicism (P=0.001). Short stature was present in 85% of cases; it was more frequent among the youngest and monosomics. The dysmorphic syndrome was observed in 85% of cases; it was significantly more frequent in monosomics (P=0.003). Delayed puberty was present in 62.4% of cases, it was almost constant in monosomics (P=0.05). The loss of ovarian function was more severe in case of monosomia compared to other forms (P=0.04). Our results report a high frequency of autoimmune diseases (18/46 cases) including dysthyroidism (eight cases). Hepato biliary affections were more frequent in mosaicism compared to monosomy. The average final height was greater even in mosaicism estimated at 150.5 cm compared to 141 cm in monosomics and 138.8 cm in mosaics with abnormal structures.

[Binge eating disorder and obesity: Epidemiological, clinical and psychopathological aspects. A study of an obese population in Sfax (Tunisia)]. / Hyperphagie boulimique et obésité : aspects épidémiologiques, cliniques et psychopathologiques. Etude d'une population d'obèses à Sfax (Tunisie).

OBJECTIVES: To evaluate the prevalence of binge eating disorder (BED) in a population of obese patients, to appreciate the impact of obesity on BED through a comparison between the obese group and a control group, and to assess anxiety, depression and quality of life in obese patients with BED. PATIENTS AND METHODS: A cross-sectional study including 60 obese patients and 60 controls. BED was diagnosed using the Binge Eating Scale. Quality of life was assessed by the Quality Of Life, Obesity and Dietetics Scale, and depression and anxiety symptoms by the Hospital Anxiety and Depression Scale. RESULTS: The obese group had a higher prevalence of BED than the control group (40% versus 8.3%; p < 0.001; OR = 3.5). The average score of BES was also higher (p < 0.001). Obese patients with BED were younger (p = 0.034). BED was correlated with an early onset of obesity (p = 0.01; OR = 1.12), depression (p = 0.002), anxiety (p = 0.008) and a poorer quality of life. CONCLUSION: This study confirms the relationship between obesity and BED, which is correlated with a high prevalence of anxiety and depression and with a poorer quality of life.

[Predisposition to autoimmune thyroid diseases within a Tunisian multiplex family]. / Prédisposition aux maladies auto-immunes thyroïdiennes au sein d'une famille tunisienne multiplexe.

The autoimmune thyroid diseases (AITDs) are multifactorial diseases which result from interplays between predisposing genes and triggering environmental factors. In order to study the genetic susceptibility factors to AITDs, we have followed up 115 control members belonging to a large Tunisian family with a high prevalence of AITDs (Akr family) during 15 years between 1990 to 2005. The follow-up of these control members have showed that 13 subjects (11.3%) developed AITDs (G2). The Hashimoto thyroiditis was the most frequently seen in 77% of the cases, whereas the Graves's disease was present in 23% of the cases. One hundred and two members remained controls (G1). High female predominance was noted in the two groups. The mean age of the G1 subjects group was slightly higher than that of G2. The prevalence of positive antithyroglobulin antibody (TgAb) and antithyroperoxydase antibody (TPOAb) was more frequent in G2 group (P=0.27 and P=0.23) respectively. The HLA haplotypes was realized in 42% of control members. The most frequent HLA haplotypes that were found were B37, DRB11 and A1. HLA B37 and DRB11 were significantly more frequent for the patients of G2 (P=0.0001 and P=0.034) respectively. Our study confirms the contribution of the genetic factors in the development of AITDs in 'Akr' family and suggested that the members of this family share the same genetic inheritance.