[Sexual violence against minors in a Tunisian population: study of 53 psychiatric expert reports]. / Violence sexuelle sur mineurs dans une population tunisienne: étude de 53 expertises psychiatriques.

In Tunis, the reported cases of children who are victims of sexual abuse have increased in recent years. Child psychiatrists are asked to perform a psychiatric evaluation and treat patients. The purpose of this study was to describe the socio-familial and clinical profile of children who were victims of sexual violence and to describe data concerning the circumstances and nature of sexual abuse. We conducted a descriptive and analytic, retrospective study of children examined by child psychiatrists practising at the Hédi CHAKER hospital in Sfax following sexual violence. The study covered the period from January 2011 to October 2017. Child psychiatrists evaluated 53 child sexual abuse cases during the study period. The victims were girls in 64.2% of cases, with an average age of 10 years and primary school students in 46.2% of cases. Intra-family conflict was reported in 16.6% of cases. Intra-familial abuse was reported in 25% of cases, touching and anal penetration were the most frequent types of violence observed (63.5% of cases and 26.9% of cases respectively). More than half of children who were victims had a psychiatric disorder (post-traumatic stress in 32.7% of cases). This study shows that child sexual abuse is a complex problem with serious consequences. Measures must be taken to ensure children have adequate treatment.

Impulsivity in adolescents with major depressive disorder: A comparative tunisian study.

BACKGROUND: The association between impulsivity and depressive disorders in adolescence has been little studied at the literature and in our country, yet impulsivity is a major risk factor for suicide. Thus we aimed on this study to evaluate impulsivity in 25 adolescents with Major Depressive Disorder MDD compared to a control sample and to analyze the correlations between impulsivity and clinical features of MDD. METHODS: Employing a matched case-control design, participants included 25 adolescents with MDD and 75 controls. We have administered the Barratt Impulsivity Scale BIS-11 for the two groups to evaluate impulsivity. Semi structured interviews according DSM 5 criteria were conducted for adolescents with MDD. The Child Depressive Inventory CDI was used to measure depressive symptoms in the control sample. RESULTS: Adolescents with MDD were more impulsive compared to controls according to the BIS-11 in its three domains: motor (24.96±6.26 against 20.6±4.84; p=0.000), attentional (20.88±5.03 against 16.64±3.2; p=0.000) and non planning (28.2±7.26 against 24.44±4.32; p=0.02). Impulsivity was not correlated with clinical features of MDD (suicide attempts, psychiatric comorbidities, antidepressant medication …). CONCLUSION: Adolescents with MDD seem to be more impulsive than control subjects regardless their clinical features. Whether it is a specific characteristic or a symptom among others of MDD, impulsivity predicts health-related behaviors and associated damage that need to be detected and prevented in time.

Prenatal, perinatal and postnatal factors associated with autism spectrum disorder / Fatores pré-natais, perinatais e pós-natais associados ao transtorno do espectrodo autismo

Abstract Objective: To identify prenatal, perinatal and postnatal risk factors in children with autism spectrum disorder (ASD) by comparing them to their siblings without autistic disorders. Method: The present study is cross sectional and comparative. It was conducted over a period of three months (July-September 2014). It included 101 children: 50 ASD's children diagnosed according to DSM-5 criteria and 51 unaffected siblings. The severity of ASD was assessed by the CARS. Results: Our study revealed a higher prevalence of prenatal, perinatal and postnatal factors in children with ASD in comparison with unaffected siblings. It showed also a significant association between perinatal and postnatal factors and ASD (respectively p = 0.03 and p = 0.042). In this group, perinatal factors were mainly as type of suffering acute fetal (26% of cases), long duration of delivery and prematurity (18% of cases for each factor), while postnatal factors were represented principally by respiratory infections (24%). As for parental factors, no correlation was found between advanced age of parents at the moment of the conception and ASD. Likewise, no correlation was observed between the severity of ASD and different factors. After logistic regression, the risk factors retained for autism in the final model were: male gender, prenatal urinary tract infection, acute fetal distress, difficult labor and respiratory infection. Conclusions: The present survey confirms the high prevalence of prenatal, perinatal and postnatal factors in children with ASD and suggests the intervention of some of these factors (acute fetal distress and difficult labor, among others), as determinant variables for the genesis of ASD.

Resumo Objetivo: Identificar fatores de risco pré-natal, perinatal e pós-natal em crianças com transtorno do espectro do autismo (TEA) ao compará-las com irmãos sem transtornos de autismo. Método: Estudo é transversal e comparativo. Foi conduzido em três meses (julho a setembro de 2014). Incluiu 101 crianças: 50 com TEA diagnosticadas de acordo com os critérios do DSM-5 e 51 irmãos não afetados. A gravidade do TEA foi avaliada pela Escala de Avaliação do Autismo na Infância (CARS). Resultados: Nosso estudo revelou uma prevalência maior de fatores pré-natais, perinatais e pós-natais em crianças com TEA em comparação com irmãos não afetados. Também mostrou uma associação significativa entre fatores perinatais e pós-natais e TEA (respectivamente p = 0,03 e p = 0,042). Nesse grupo, os fatores perinatais foram principalmente do tipo sofrimento fetal agudo (26% dos casos), longa duração do parto e prematuridade (18% dos casos em cada fator), ao passo que fatores pós-natais foram representados principalmente por infecções respiratórias (24%). No que diz respeito a fatores dos pais, nenhuma correlação foi encontrada entre a idade avançada dos pais no momento da concepção e o TEA. Da mesma forma, nenhuma correlação foi estabelecida entre a gravidade do TEA e fatores diferentes.Após regressão logística, os fatores de risco de autismo encontrados no modelo final foram: sexo masculino, infecção pré-natal do trato urinário, sofrimento fetal agudo, parto difícil e infecção respiratória. Conclusões: Esta pesquisa confirma a alta prevalência de fatores pré-natais, perinatais e pós-natais em crianças com TEA e sugere a intervenção de alguns desses fatores (sofrimento fetal agudo, parto difícil) como variáveis determinantes para a gênese do TEA.

Prenatal, perinatal and postnatal factors associated with autism spectrum disorder.

OBJECTIVE: To identify prenatal, perinatal and postnatal risk factors in children with autism spectrum disorder (ASD) by comparing them to their siblings without autistic disorders. METHOD: The present study is cross sectional and comparative. It was conducted over a period of three months (July-September 2014). It included 101 children: 50 ASD's children diagnosed according to DSM-5 criteria and 51 unaffected siblings. The severity of ASD was assessed by the CARS. RESULTS: Our study revealed a higher prevalence of prenatal, perinatal and postnatal factors in children with ASD in comparison with unaffected siblings. It showed also a significant association between perinatal and postnatal factors and ASD (respectively p=0.03 and p=0.042). In this group, perinatal factors were mainly as type of suffering acute fetal (26% of cases), long duration of delivery and prematurity (18% of cases for each factor), while postnatal factors were represented principally by respiratory infections (24%). As for parental factors, no correlation was found between advanced age of parents at the moment of the conception and ASD. Likewise, no correlation was observed between the severity of ASD and different factors. After logistic regression, the risk factors retained for autism in the final model were: male gender, prenatal urinary tract infection, acute fetal distress, difficult labor and respiratory infection. CONCLUSIONS: The present survey confirms the high prevalence of prenatal, perinatal and postnatal factors in children with ASD and suggests the intervention of some of these factors (acute fetal distress and difficult labor, among others), as determinant variables for the genesis of ASD.

[Attention Deficit Hyperactivity disorder at schools in Sfax-Tunisia]. / Caractéristiques épidémiologiques du trouble deficit de l'attention/hyperactivité en population scolaire dans la region de Sfax-Tunisie : Etude transversale.

BACKGROUND: Frequency, social impact, the negative effects of ADHD on personal development, make it a public health problem. Tunisian existing data confirm its frequency and severity in clinical population. The absence of data in student population has led us to develop this work.The objectives of our study were to study epidemiological profile of ADHD in school population. METHODS: The analysis involved a cross-sectional descriptive study conducted from April 2008 to October 2008 using a representative randomized multistage sample of schoolchildren between 6 and 12 years old. Measurement was performed in two stages first the parents and teachers of each children filled Conners questionnaire separately then students with the score in subscales inattention, hyperactivity with impulsivity higher than 70 were selected for psychiatric interview. Psychiatric interview was intended to confirm or refute the diagnosis of ADHD. The diagnoses were made according to DSM IV-TR. To study the possible associated factors with the disorder they were compared in children with ADHD and children without the disorder taken as controls. RESULTS: A total of 51 students out of 513 had ADHD. Prevalence was found to be 9,94%. For the study of factors associated with ADHD were found in males, neonatal hospitalization, psychiatric and family history of ADHD and the existence of a family dysfunctionment. CONCLUSION: Our prevalence is similar to the majority of those reported by studies conducted through the same methodology as ours. The etiology of ADHD is not unequivocal. The disorder appears to be multifactorial.

[Evolution of bipolar disorders in adolescents: 30 cases]. / Evolution des troubles bipolaires à l'adolescence : a propos de 30 cas.

BACKGROUND: Bipolar disorders in adolescence are of a great importance, partly because of the relapsing character of this disorder and its impact in terms of psychosocial adjustment. aim: To study the evolution of bipolar disorders in adolescents. METHODS: We conducted a descriptive and retrospective survey on 30 adolescents followed in the child and adolescent psychiatry department of Sfax for bipolar disorders diagnosed according to the DSM-IV TR criteria. RESULTS: The average number of the thymic episodes /year was 1.36±0.75. The average duration of the maniac episodes was 39. 75 day±24.79 and that of the depressive episodes was 78.75 days ± 43.73. The average duration of the inter critical intervals was 13.78 months ±11. 29. The complete remission was noted in 42.8% of the cases whereas the passage to chronicity was noticed in 3.6% of the cases. The family adaptation was satisfactory in 63.3% of the cases whereas the repercussion of the disorder on the school level was obvious. The social adaptation was non satisfactory in 53.3% of the cases. The suicide attempts were found in 10% of the cases. CONCLUSION: The findings of the present study justify an early identification of bipolar disorders in adolescents as well as the initiation of appropriate therapy. The early intervention will permit to reduce the duration and the severity of the episodes. It will also limit the deleterious impact on the life of the subject and decrease the risk of suicide, which seems to be raised when the subject is not or is badly treated.

[Disclosing birth defects to parents]. / Les modalités et circonstances de l'annonce du handicap à révélation néonatale.

A descriptive transversal study was carried out by the child psychiatry and neonatology team of Hedi-Chaker General Hospital in Sfax, Tunisia. Its aim was to study the methods and circumstances of the announcement of a disability confirmed during the infant's first days of life. The results of the study show that when the announcement is made by an experienced, trained team, and in favourable conditions, it leads to better acceptance of the disability by the parents.

[The psychological aspects of enuresis in children and teenagers]. / Les aspects psychologiques de l'enurésie chez l'enfant et l'adolescent.

A retrospective study over seven years shows a high frequency of underlying psychological dimensions to enuresis, mainly regressive and passive, but also aggressive and erotic. It is therefore important to understand the meaning of this symptom and to take into account, in the treatment, underlying affective disorders.

[The persistent crying of newborns and its treatment]. / Les cris persistants du nourrisson et leur prise en charge.

The persistent and unexplained crying of newborns, attributed to colic, is a frequent problem in paediatrics. Usually considered harmless, it can however have consequences on the baby's behaviour and emotional regulation. Moreover, mothers often misinterpret the crying. Faced with the maternal anxiety which is often associated, treatment must be multifocal.