Anxiety and Depression Symptoms in At-Risk Pregnancy: Influence on Maternal-Fetal Attachment in Tunisia.

OBJECTIVES: To investigate maternal prenatal anxiety and depression in high-risk pregnancies and examine their influence on maternal-fetal attachment. METHODS: We included 95 hospitalized high-risk pregnant women. The Hospital Anxiety and Depression Scale (HADS) and the Prenatal Attachment Inventory (PAI) were used to assess the primary objective. Internal consistency and construct validity of the PAI were investigated. RESULTS: The average age was 31 years and gestational age ranged from 26 to 41 weeks. Prevalence of depressive symptoms was 20% and anxiety symptoms 39%. Cronbach alpha coefficient of the PAI Tunisian version was 0.8 and the construct validity in favour of one factor model. PAI scores correlated negatively and significatively with the HADS total score (r = - 0.218, p = 0.034) and was attributed to the depression dimension only (r = - 0.205, p = 0.046). CONCLUSIONS FOR PRACTICE: Emotional wellbeing of pregnant women especially in high-risk pregnancies should be explored in order to prevent consequences on women, their growing fetus, and prenatal attachment.

What is already known? Maternal prenatal emotional well-being influences maternal­fetal attachment which has important implications on postnatal bonding. Anxiety and depression disorders during pregnancy could affect women's attachment to their unborn child in a negative way. Research has largely been conducted with the general pregnant population with little focus on at-risk pregnancies, which are associated with increased levels of mood disorders. What this paper adds? This study highlights the impact of depression but not situational anxiety on maternal­fetal attachment in women with high-risk pregnancies, highlighting the importance of assessing and managing psychological disorders during pregnancy to enhance the quality of prenatal bonding.

Covid-19 and mental disorders in children and adolescents: Experience of the child and adolescent psychiatry department of the Mongi Slim Hospital of Tunis.

The Covid-19 pandemic had a major psychosocial impact on the mental health of children and adolescents, especially when the childhas mental health problems. During containment, the healthcare structures were subject to a significant restriction of their activities. The child and adolescent psychiatry department of the Mongi Slim Hospital in Tunis has set up telephone follow-up for patients deemed to be at risk. This follow-up involved 166 cases, the majority of them were suffering from neurodevelopmental disorders, followed by depressive disorders and adjustment disorders. A third of the patients had reported a worsening of the symptoms during the containment and a third had reported clinical improvement. During this follow-up, recommendations were made to parents to limit the negative impact of Covid-19 pandemic. Maintaining follow-up of patients with mental disorders by telemedicine is a major challenge in order to prevent the repercussions of this pandemic in the long term.

Epigenetics and ADHD: Toward an Integrative Approach of the Disorder Pathogenesis.

OBJECTIVE: Epigenetic hypothesis is one of the research pathways used to explain the complex etiology of neurodevelopmental disorders. This review highlights the findings of recent studies in the field of epigenetics in ADHD. METHODS: An electronic literature search using Medline. RESULTS: In the Gene × Environment interaction model, several clinical, genetic and molecular arguments support the epigenetic hypothesis in ADHD etiology. Environmental ADHD risk factors including toxic, nutritional factors and stressful life events lead to changes in DNA methylation and in histone modification levels. One critical CpG site located in the promoter of the DRD4 gene exhibited a specific pattern in ADHD children. A methylome wide exploration of DNA showed decreased methylation in vasoactive intestinal peptide receptor 2 gene, which was not replicated by further research. CONCLUSION: Current data require consolidation and could lead to the identification of biomarkers and the introduction of new modalities of treatment.

[Tunisia: nursing practice of cognitive remediation in child psychiatry]. / Tunisie : pratique infirmière de la remédiation cognitive en pédopsychiatrie.

Cognitive remediation is today afforded a significant place in the treatment of neurodevelopmental disorders. A hospital team, comprising in particular a nurse offering consultations in a child psychiatry unit in a public hospital in Tunis, shares its experience with regard to this technique which aims to restore impaired cognitive functions in order to improve the efficiency and quality of life of young patients.

The Cognitive Remediation Therapy Program Among Children with ADHD: Tunisian experience.

BACKGROUND: Attention-Deficit Hyperactivity Disorder (ADHD) is associated with neuropsychological deficits including executive and attentional impairments. The cognitive remediation therapy is a new promising technique designed to improve the neurocognitive abilities damaged in ADHD. AIM: Adapt and apply the cognitive remediation program CRT (Cognitive Remediation Therapy) for children and adolescents with ADHD and to evaluate its effectiveness on attentional and executive abilities. METHODS: Children and adolescents with ADHD, diagnosed using the K-SADS-PL questionnaire was involved in the study. The CRT program was administered for an average period of fourteen weeks with a rate of one session per week of 40 minutes each. The Attentional Network Test was administered prior to the intervention and one week after. RESULTS: Of the 30 patients included, 14 had reached the end of the program. Among them, nine patients passed the attentional test post CRT, thus constituting our final sample. Their average age was 9 years. The mean number of sessions performed was 14.5. Post CRT, the mean of patient's response time was found to be shorter (p=0,004) and the frequency of omissions errors was also lesser than that found at the initial assessment. Patients also committed fewer errors in incongruent situations in post program, with a significant improvement of the conflict effect (p= 0.009) signing a better executive control. CONCLUSIONS: Cognitive remediation is a promising new modality in the treatment of ADHD. Further research is needed to better document its effects and the optimal conditions required for setting it up.

[Somatic manifestations among depressed children: the case of complains and conversion symptoms]. / Manifestations d'allure somatique chez l'enfant déprimé: le cas des plaintes somatiques et des conversions.

BACKGROUND: If all authors agree on the presence of fundamental changes in mood, as the basis of the diagnosis of depression, little importance is accorded to other symptoms that can mislead the diagnosis: in particular, age and cultural influence on depressive symptoms. AIM: Our work aims to describe and assess the frequency of somatic complaints and symptoms of conversion in Tunisian children and adolescents followed for depressive disorders, and to compare, through a study of literature to populations from different cultures. METHODS: This work consisted in a retrospective review of children who consulted the Department of Child Psychiatry between 2008 and 2011 and in whom the diagnosis of depressive disorders was retained according to DSM IV criteria. Were searched all the conversion symptoms corresponding to the DSM IV diagnoses of conversion and dissociative disorders, as well as all the somatic complaints reported. Children with organic were excluded in order not to confuse the pain secondary to these disorders from those associated with depression. Also, children with mental retardation, moderate, severe or profound were not included because their difficulties of expression can alter the semiological assessment. RESULTS: 119 children and adolescents aged 6 to19 years were included in the study. The mean age of the population was 11.6 years. Somatic complains were present in 37% of cases. Headaches were mostly represented (27.7%), followed by abdominal pain (14.3%). The presence of somatic complaints was significantly correlated with the presence of a comorbid anxiety (p=0.035). Conversion symptoms were present in 22.7% of cases. They were significantly more frequent among girls (p=0.006) and in children whose father had a low level of education (p=0,013). Among the conversions, fainting were more common in girls (p=0.004), when the father's educational level was low (p=0.001), and when the geographical origin was rural (p=0.016). CONCLUSION: Conversion symptoms and somatic complaints are frequent in depressed children.