Under-diagnosed and under-treated, depression has a pejorative prognosis. The general practitioners (GP) represent the most often consulted healthcare professionals by depressed patients. The aim was to describe how the Tunisian GPs manage the depressed patients and to note the difficulties they encounter in order to suggest corrective measures. A survey was conducted among 140 GPs in Sfax Governorate. The percentage of the GPs whose responses conformed to the scientific data in at least 67% of the items was 31.4%. Four factors were correlated to a good management of depression: age (p = 0.028), masculine gender (p = 0.016), long career (p = 0.034) and participation to continuous medical education sessions on depression (p = 0.01). Our study revealed inadequacies in the management of depression by the GPs. GPs were invited to sensitizing meetings. A training on depression was assured for the future internship supervisors by the commission of medicine of family in the Faculty of Medicine of Sfax.

IntroductionThe COVID19 outbreak has disrupted the mental health of resident doctors who had to care for patients. Eating disorders were among these reported mental health problems.ObjectivesTo screen binge eating disorder among young Tunisian doctors and its associated factors.MethodsWe conducted a cross-sectional, descriptive and analytical online-based survey, from April 19, 2020, to May 5, 2020 on 180 medical residents in training. We sent the survey via a google form link. We used a self-administered anonymous questionnaire containing sociodemographic and clinical data of young doctors. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria were used to assess Binge-Eating Disorder.ResultsAmong 180 young doctors who enrolled the survey, 70,2% were female, 16% were married. The mean age was 29 years. 51,1% were frontline caregivers, working directly in diagnosing, treating or caring for patients with coronavirus disease. Among our participants, 5% presented anxiety disorder, another 5 % presented depression disorder and 1,7% had eating disorder. Binge eating disorder were present among 8,9 % of participants and it was associated to personal history of eating disorder (7,7% vs 1,1%, p<10-3), past history of depression disorder (7,2% vs 3,3%, p=0.008), exposure to media or news about coronavirus outbreak (0.5% vs 8,3%, p=0.04).ConclusionsOur study indicated the evolving proportion of binge eating disorder among young doctors. Screening eating disorder is important in order to prevent related physical health problems.

INTRODUCTION: Revealing a diagnosis of cancer generates various psychological responses such as anxiety and depression which deteriorate the quality of life (QOL) of this patient. OBJECTIVES: Assess the level of both anxiety and depression in patients with cancer; assess the impact of their disease on their physical and mental QOL. AIMS: Deduct the risk factors of anxiety, depression and bad QOL. METHODS: Our study is transversal. It is conducted on patients hospitalized in the department of Carcinology CHU Habib Bourguiba in Sfax (Tunisia). The screening tool for anxiety and depression was HADS scale and the assessment of QOL was performed using the SF-36 RESULTS: We identified 50 patients. Concerning their psychological state, the one-quarter (23.9%) had a doubtful anxious state and the one-third (32.6%) had a certain anxious state. The depression was doubtful in 13% of cases and certain in 39.1%. The deterioration of QOL was significant (84.8%). The averages of both the physical score (PCS) and the mental score (MCS) was respectively 41.61% and 33.67%. A bad QOL was correlated with locally-advanced to metastatic stage of cancer (p = 0.043), the time progression of the disease (>6months) (p?? = 0.01), moderate to severe pain (p ??= 0.028), radiotherapy treatment (p = 0.029) and the depression state (p = 0.023). CONCLUSION: Our study underlines the necessity of screening both depression and anxiety in patients with cancer, in order to improve their QOL.

The drug-induced lupus erythematosus (DILE) is an autoimmune disorder caused by chronic use of certain drugs, including chlorpromazine. Chlorpromazine-induced lupus associated to circulating anticoagulant antibodies (CAC) would be even less frequent. Our observation is an illustration of this association.We report the case of Mrs. H., 33-year-old, without medical or surgical history, who has been followed in psychiatry since the age of 20 for bipolar disorder type 1. This patient was initially stabilized by an association of fluphenazine, sodium valproate and levomepromazine. The introduction of chlorpromazine in June 2015 induced a leuconeutropenia, which was corrected after stopping this drug. During subsequent decompensations, rechallenge with chlorpromazine and administration of other phenothiazines (levomepromazine, fluphenazine) or atypical anti-psychotics (olanzapine, risperidone, aripiprazole) induced a leuconeutropenia reversible after drug withdrawal. Within the etiological investigation of this leuconeutropenia, physical examination was normal; inflammatory tests (erythrocyte sedimentation rate, serum protein electrophoresis) and serology for hepatitis B and C and HIV were negative; antinuclear antibodies (ANA) titre was positive (1: 160) with a negative antibodies screen; rheumatoid factor and complement levels were normal. Activated partial thromboplastin time (APTT) was prolonged (47/29 s) and not corrected by addition of normal plasma. Lupus anticoagulant antibodies were positive. ANA became negative six months after cessation of implicated drugs. Thus, the diagnosis of “chlorpromazine-induced lupus with CAC” was retained. The pathophysiological mechanism of this association remains a subject of discussion. This induced autoimmunity, involving several anti-psychotics, is a real therapeutic challenge in our patient's case.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionVaginismus is the most common reason for unconsummated marriages in Tunisia.ObjectivesTo describe the socio-demographic profile and to explore the clinical and cultural aspects of sexual functioning of women with vaginismus.MethodsIt was a cross-sectional study established over a period of 3 months from the November 1st, 2019 to January 31st, 2020. This study focused on a population of women with vaginismus recruited from outpatient consultations of the hospital’s gynecology and psychiatry departments at the regional hospital of Gabes. We used a pre-established sheet exploring socio-demographic data, medical and gyneco-obstetric history and informations concerning the partner, the marital relationship and the woman’s sexual activity.Results35 women were included. They had a mean age of 30 years, jobless (54.5%) and with a secondary or university education (91.1%). The mean duration of marriage was 2.4 years. Partner had mean age of 36 and suffering from sexual dysfunction (21.3%). Among women, 12.5% had been sexually abused, 51.6% had suffered “Tasfih”, 70% had attended discussions about painful defloration. Vaginismus was primary in 85.7% and total in 50% of the cases. About the received thoughts of the women, 40% thought that vaginismus requires medical treatment, 13 of them (40%) thought that the disorder could be resolved spontaneously and 20% believed in a story of witchcraft. 85% consulted a physician and 24.2% a traditional therapist.ConclusionsVaginismus seems to be influenced by psychological and sociocultural factors so that a good psychoeducation of brides could reduce the incidence of this sexual disorder.Conflict of interestNo significant relationships.