Objectif: Déterminer l’impact psychoaffectif de la pandémie Covid-19 sur la santé mentale des professionnels de santé en Tunisie et estimer les facteurs associés. Méthodes: Étude transversale, descriptive et analytique auprès des professionnels de santé en Tunisie. Les participants ont répondu à un questionnaire incluant deux échelles psychométriques, le GAD-7 ( General Anxiety Disorder-7 ) et le PHQ-9 ( Patient Health Questionnaire-9 ) pour évaluer la prévalence et l’intensité des symptômes anxieux et des symptômes dépressifs respectivement. Résultats: L'étude a inclus 203 participants. Un tiers (34,3 %) a travaillé dans les départements comportant des patients Covid-19. Parmi tous les participants, 52,2 % ont déclaré que leur santé mentale a été altérée avec la pandémie de Covid-19 et seulement 4,4 % ont déclaré que leur santé mentale était devenue gravement insupportable. Parmi tous les professionnels, 37,5 % avaient des symptômes anxieux d’intensité modérée à grave et 35,5 % avaient des symptômes dépressifs d’intensité modérée à grave. Selon l’analyse multivariée, le sexe féminin était un facteur de risque de symptômes anxieux modérés à graves. Avoir un antécédent de trouble dépressif ou de trouble anxieux était un facteur de risque de survenue de symptômes dépressifs modérés à graves. La profession d’infirmier était le facteur le plus associé au développement de symptômes psychiatriques. Le fait de travailler dans les départements Covid-19 augmente le risque de développer des symptômes anxieux d’intensité grave. Conclusion: Afin de garantir une meilleure prise en charge des patients, le dépistage précoce des troubles psychiatriques chez les professionnels de santé et la mise en œuvre de stratégies préventives sont des priorités au cours de la pandémie actuelle.

IntroductionBipolar depression is not strictly clinically identical to unipolar depression.ObjectivesTo describe the clinical characteristics of patients with bipolar depression and to identify factors linked to bipolar depression.MethodsThis is a cross-sectional, descriptive and comparative study carried out at the psychiatric department of the University Hospital of Mahdia. We have included 26 patients with bipolar depression and have compared them to 26 patients with unipolar depression. The data were collected from patients’ medical files. The analytical study has been made using Chi2 tests. The threshold of p<0.05 was considered as significant.Results The mean age was 45 years. The majority of patients were male (61.5%) and unemployed (69.2%). Half of the patients were married. Alcohol consumption was found in 30.8% of cases. Family history of bipolar disorder and attempted suicide were present in 27% and 11.5% of cases respectively. A hospitalization number greater than or equal to 4 was found in 54% of cases. Personal history of suicide attempts was found in 46.2% of cases. At the psychiatric examination, psychomotor retardation, anxiety and psychotic and atypical characteristics were present in 73%, 31%, 42.3% and 7.7% of cases respectively. 46.2% of patients were treated with antidepressants in combination with a mood stabilizer. Antipsychotic treatment was combined in 80.8% of cases. A significant difference was noted for the number of hospitalizations, anxiety and antipsychotic treatment.ConclusionsAn early distinction between bipolar and unipolar disorders is crucial for the treatment of both diseases.

IntroductionThe association of an addictive disorder (harmful use, abuse or dependence) with a schizophrenic disorder is the rule. Genetic vulnerability and social and economic factors are common to both disorders.Objectivesdetermine the impact of addictive behavior on patients suffering from schizophrenia.MethodsA descriptive and analytical retrospective study of 150 patients with schizophrenia hospitalized in the psychiatry department of Taher Sfar University Hospital in Mahdia from January 2017 to December 2021.ResultsThe average age of the patients was 39.8 ± 11.23 years with a predominance of the age group 36-45 years (38.4%). All of the patients were male. Three quarters of the patients (75.5%) were consumers of psychoactive substances (PSA): nearly three quarters (72.8%) were dependent on tobacco, more than a third (39.7%) were dependent on alcohol, more than a quarter (29.1%) dependent on cannabis and almost a quarter (26.5%) dependent on other SPAs. Criminal history, suicide attempts and hospitalization in psychiatry were significantly more frequent in patients who consumed SPA than those who did not consume (39.5% vs 8.1%; p=0.008, 17.5% vs 2.7%; p=0.02, 89.5 % vs 75.7%; p=0.03, respectively). Patients who consumed SPA had significantly more positive signs of schizophrenia (51.8% vs 10.8%; p=0.001) and were significantly less observant to treatment (55.3% vs 16.3%; p=0.001) than those who did not consume. Hetero-aggressiveness, self-aggressiveness and job change were significantly more frequent in patients with addictive behaviors than those without addiction (86.8% vs 48.7%; p=0.001, 23.7% vs 2.7%; p= 0.004, 14.9% vs 0%; p=0.015, respectively). Multivariate analysis revealed that criminal history, hetero-aggressiveness, predominant positive symptomatology and work stoppage were the factors independently associated with SPA consumption in patients with schizophrenia in our study (β=14.7 95% CI 3.23–67.01, p=0.001, β=0.099, 95% CI 0.03–0.31, p=0.001, β=7.18, 95% CI 2.09–24.67, p=0.002, β=5.24 95% CI 1.27–21.7; p=0.02, respectively).ConclusionsAccording to our study, addictive comorbidities concern three quarters of our patients. They expose them to a higher risk of legal problems, hetero-aggressiveness, predominance of positive signs and instability at work. These results encourage the development of methods for early diagnostic identification of addictive behavior comorbid with schizophrenia as well as integrated care combining psychiatric and addictological care.Disclosure of InterestNone Declared

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IntroductionAlthough one third of patients with Bipolar Disorder have an addiction to Cannabis or an abused consumption, the interaction between cannabis use and bipolar disorder remains controversial.ObjectivesTo evaluate the use of cannabis among patients with Bipolar Disorder and to compare the socio-demographic and clinical characteristics between patients who are consumers and non-consumers.MethodsThis is a retrospective, descriptive study including all patients treated for type I bipolar disorder in the psychiatric department of Tahar Sfar Hospital of Mahdia (Tunisia). In addition to socio-demographic and clinical characteristics, we collected data on cannabis use (age at first consumption and frequency of consumption).ResultsOur study population consisted of 84 male patients followed for bipolar I disorder. The mean age was 36.8 ± 11.3 years. Among these patients, 23 (27.8%) had regular cannabis use. The average age at first consumption was 21.6 ± 7.2 years. Bipolar patients with regular cannabis consumption had an earlier age of onset of the disorder (p = 0.02). They had higher numbers of manic episodes (p = 0.05), higher number of manic episodes with severe intensity (p = 0.04), higher number of manic episodes with mixed characteristics(p = 0.04), a higher number of hospitalizations (p = 0.01) with longer hospital stays (p = 0.02).ConclusionsCannabis use among patients with type 1 bipolar disorder is associated with an unfavorable course of the disorder. Early diagnosis and appropriate management of this comorbidity seem to be essential for improving the prognosis of bipolar disorder.