BackgroundAlthough communication skills towards breaking bad news are an important aspect of medi... more BackgroundAlthough communication skills towards breaking bad news are an important aspect of medical care [1], future Tunisian rheumatologists have no formal training in this area. The gaps in communication skills are significant to date in the field of rheumatology.ObjectivesThe aim of this study was to evaluate the impact of a training workshop on the disclosure of bad news in rheumatology.MethodsWe conducted a prospective, multicenter, interventional study over a six-month period during the academic year 2021-2022. 31 residents were recruited on a voluntary basis. Two groups were individualized: The training group A (N=16) and the control group B (N=15). The training session included interactive lectures, video-case studies, role-playing and peer-to-peer discussions. A self-administered survey was used to assess residents’ abilities to deliver bad news before and three months after the training.ResultsFollowing training (T3), group A residents showed a significant improvement in ...
Introduction Since the work of R.H. Rosenman and Meyer Friedman in 1959, a correlation has been e... more Introduction Since the work of R.H. Rosenman and Meyer Friedman in 1959, a correlation has been established between type A behavioral patterns and the occurrence of coronary heart disease. Type A personality has been found to be more of a coronary risk factor than a poor prognostic factor once coronary disease has set in. Subsequent studies have not supported such a relationship. Objectives The objective of our work was to investigate the association between type A personalities and coronary heart disease. Methods We conducted a retrospective study involving a sample of 200 patients recruited at the Mohamed Tahar Maâmouri Hospital in Nabeul. Our sample was composed of 100 coronary patients hospitalized or followed as outpatients in the cardiology department and 100 controls hospitalized or followed as outpatients in the general surgery or orthopedics department respectively. The study was conducted between April 15 and June 30, 2014. Personality type A was assessed according to the ...
BACKGROUND Sleep disorders in the elderly are common. However, they are often under diagnosed and... more BACKGROUND Sleep disorders in the elderly are common. However, they are often under diagnosed and poorly supported. AIM To study the characteristics of sleep in the elderly consultant at the front line. METHODS A cross-sectional survey was conducted on a random sample of fifty persons aged 65 years and over, consultant in the center of basic health of Ezzahra and in a private practice in the same delegation. RESULTS The sleep efficiency index was 0.85. Nighttime awakenings were present in 44 persons (88%). Unexplained late night awakening was reported by 19 subjects (38%). Among the respondents, 40 (80%) were considered to have at least one sleep disorder. The subjective complaint of insomnia was present in 70% of subjects. Excessive daytime sleepiness and/or hypersomnia were present in 70% of subjects. Nocturnal snoring was reported by 22 persons (44%). Nine subjects (18%) had respiratory pauses during sleep. Despite the high incidence of sleep disorder among the respondents, only 6 persons (15%) among them consulted their General Practitioner for this reason. Among patients with sleep disorder, 14 persons (40%) were taking hypnotics, from which 6 (43%) by self-medication. CONCLUSION Sleep disorders in the elderly as well as self-medication with hypnotics are common and under diagnosed. They should be sought systematically in front-line consultation.
IntroductionCovid-19 pandemic represents a sanitary crisis with social, economic and political ne... more IntroductionCovid-19 pandemic represents a sanitary crisis with social, economic and political negative impacts. Studies had well established the link between stress and the display or maintenance of addictive behaviour. Measures like social distancing and confinement imposed by governments during this pandemic, could explain an outbreak of internet addiction cases.ObjectivesAssess the prevalence of internet addiction in times of the covid-19 pandemic and to study its relationship with personal and family factors but also with the psychiatric comorbidities.MethodsWe conducted a cross sectional analytical study during the period of the covid-19 pandemic, using an internet survey exploring socio-demographic and clinical data: through Hamilton depression and anxiety rating scale and the Rosenberg self esteem scale. The assessment of internet addiction was carried out using Young’s Internet Addiction test.ResultsOur study included 150 users, the average age was 36 years, mainly made up ...
Introduction Tunisia is knowing a significant increase of the elderly population, this phenomenon... more Introduction Tunisia is knowing a significant increase of the elderly population, this phenomenon comes along with an increase of the incidence of degenerative pathologies "dependent on the age" as the Alzheimer's disease. The physical and psychic consequences of the disease and also the behavior of family members are an important determinant of quality of life and economic activities of both patients and informal caregivers. Objectives and methods Our aims are to establish characteristicsof60 informal cargivers of Alzheimer's patients followed in the department of neurology in Razi's Hospital and to estimate their socioeconomic burden through a descriptive study. Results Our sample of caregivers was predominantly female with a moderate socio-economic conditions in 36,66%. The support was provided in 2/3 of cases exclusively by the informal caregivers. 22,66% ( n =13) of them lost their profession since the beginning of assistance's relationship. Among care...
INTRODUCTION Shift work can cause health problems and sleep disorders and therefore affect mental... more INTRODUCTION Shift work can cause health problems and sleep disorders and therefore affect mental health. These psycho-affective disorders can, in return, worsen sleep disorders and thus establish a vicious circle. The aims of our study were to assess the frequency of sleep and psycho-affective disorders among paramedical personnel doing shift work and to screen them for obstructive sleep apnoea-hypopnoea syndrome (OSA). METHODS It was a cross-sectional study carried out among paramedical staff at the University Hospital Center Mongi Slim La Marsa in Tunis. Three questionnaires translated into Arabic (the Berlin questionnaire, the Spiegel questionnaire and the Hospital Anxiety and Depression Scale [HAD]) were presented by the same investigator during the survey. RESULTS One hundred and fifty-eight paramedics were interviewed (46.2% were nurses, 23.4% were blue-collar workers, 19% were senior technicians and 11.4% were health care aides, midwives and physiotherapists). The average du...
Pre-requis: La rectocolite hemorragique est une maladie inflammatoire chronique de l'intestin... more Pre-requis: La rectocolite hemorragique est une maladie inflammatoire chronique de l'intestin d'etiologie multifactorielle. Son association a des troubles psychiatriques a frequemment ete rapportee, essentiellement a type de troubles depressifs ou anxieux, cependant, son association avec la schizophrenie est exceptionnelle. But: Rapporter un nouveau cas d'observation associee a une schizophrenie. Observation: Ce travail rapporte le cas d'une patiente âgee de 42 ans, qui presente une rectocolite hemorragique associee a une schizophrenie indifferenciee. Bien que les deux maladies aient ete diagnostiquees a la meme periode, l'interrogatoire a permis de montrer que les signes digestifs ont precede les troubles psychiatriques. Conclusion: Peu de cas de schizophrenie associee a la rectocolite hemorragique ont ete rapportes dans la litterature. Les liens epidemiologiques, etiopathogeniques et therapeutiques de cette association sont discutes.
Introduction The studies on Alzheimer disease highlight the family caregivers burden and his cons... more Introduction The studies on Alzheimer disease highlight the family caregivers burden and his consequences on hostility. Few authors study the burden and the mental health of the caregivers of a demented relative. Aims This study aims at assessing the hostility and emotional load of caregivers of Alzheimer patients and determining the relation between the burden and the psychic health caregivers and its impact on the patient. Methods It is a descriptive cross-sectional study. Patients were recruited from the neurology department of Razi hospital Tunisia between January and June 2013. Consenting caregivers participating in the study were interviewed with a structured survey focused on their socio-demographic characteristics, the characteristics of the aid relationship and the emotional burden felt valued by the Family Attitude Scale (FAS). Results The caregiver was in nearly 60% a child. He lived under the same roof in 78.3% of cases. In 65% of cases, it passes between 12 and 24hours ...
INTRODUCTION Shift work can cause health problems and sleep disorders and therefore affect mental... more INTRODUCTION Shift work can cause health problems and sleep disorders and therefore affect mental health. These psycho-affective disorders can, in return, worsen sleep disorders and thus establish a vicious circle. The aims of our study were to assess the frequency of sleep and psycho-affective disorders among paramedical personnel doing shift work and to screen them for obstructive sleep apnoea-hypopnoea syndrome (OSA). METHODS It was a cross-sectional study carried out among paramedical staff at the University Hospital Center Mongi Slim La Marsa in Tunis. Three questionnaires translated into Arabic (the Berlin questionnaire, the Spiegel questionnaire and the Hospital Anxiety and Depression Scale [HAD]) were presented by the same investigator during the survey. RESULTS One hundred and fifty-eight paramedics were interviewed (46.2% were nurses, 23.4% were blue-collar workers, 19% were senior technicians and 11.4% were health care aides, midwives and physiotherapists). The average duration of shift work was 10.27 years, the average age was 36.48 years and there was a female prevalence of 70.9%. Sleep disorders were detected in 40.5% of the cases, OSA in 24%, anxiety in 53.2% and depression in 17.1%. CONCLUSION Sleep and psycho-affective disorders are frequent among paramedical personnel undertaking shift work in hospitals. Screening consultations in occupational medicine are necessary in order to detect these disorders at an early stage.
IntroductionThe Alzheimer's patient assistance relationship is a morally painful experience, ... more IntroductionThe Alzheimer's patient assistance relationship is a morally painful experience, most frequently discussed in terms of “burden” in the literature, especially as professionals and institutional intermediaries are underdeveloped in Tunisia.GoalIt is intended to assess the level of burden among caregivers of patients with Alzheimer's disease and to search factors associated with a high level of burden.MethodologyThis is a retrospective descriptive study. Patients were recruited from neurology department of Razi hospital, which were hospitalised between the months of December 2012 and March 2013. The burden was measured using the Zarit inventory.Results and discussionThirty patients were included. The majority female, most caregivers are descendants (60%), then, daughters in law (33%), and finally the spouses (23%). 80% of caregivers lived in the same home as patients. Caregivers were asked about all the items of the grid Zarit. The average burden in our sample is 59...
IntroductionViolence against elderly persons is an intricate social, legal and ethic issue. Alzhe... more IntroductionViolence against elderly persons is an intricate social, legal and ethic issue. Alzheimer's patients are the most vulnerable individuals to mistreatment and neglect. The aggressor can be even the main helper of the patient. We noticed a wide underestimation of this phenomenon, which remains taboo subject in our society.Objectives and methods– The aim of our study is to identify predictive factors of mistreatment of Alzheimer's patients through a prospective and descriptive study, within patients following in the department of neurology in Razi's hospital.– we evaluate cognitive function (MMSE) and the importance of behavioural disorders.– we explored helper's socio-demographic characteristics and the quality of aid relationship.– anger and hostility within relationship were estimated through family attitude scale.ResultsOur sample accounts 60 informal caregivers predominately female (91.7%) with an average age of 49.67 years, mostly are married (71.66%) a...
Epidemiological studies suggest a positive but controversial correlation between the major mental... more Epidemiological studies suggest a positive but controversial correlation between the major mental disorders, particularly schizophrenia and delinquent or criminal acting out. aim : To study the occurrence of violence in patients with schizophrenia according to demographic, clinical and disease progression features. This retrospective study included all out-patients, consulting during a period of one month, suffering from schizophrenia for at least five years. The clinical and forensic history was obtained owing to a semi-structured interview with patients and their families, medical records and the passing of different scales. Sixty patients were included. 46.7% (n=28) of patients had a violent behavior in the pre morbid period. Aggressiveness was noted as the first prodrome in 13.3% (n=8) of cases. 28 major acts of violence were committed by 30% (n=18) of patients regardless of the active period of disease. In 13.3% (n=8) of cases, these acts announced the disease. The majority of ...
Unlike schizophrenia, the impact of gender on the criminality of patients with bipolar disorder h... more Unlike schizophrenia, the impact of gender on the criminality of patients with bipolar disorder has received little attention. To estimate the sex ratio in relation to acts committed by forensic bipolar patients and evaluate the impact of gender on the characteristics of this crime. A comparative study by gender, conducted at the psychiatric hospital Razi has included all patients with bipolar disorder hospitalized between 1990 and 2010 after being relaxed for mental illness, owing to the Tunisian penal code. The total number of patients was 36 and the sex ratio of 3.5.A suicide history was four times more common in women. Alcohol abuse was found only in men. Relapses were more frequent in women (3.06 I year against 1.14 I year, p = 0.02). Rapid cycling and comorbid anxiety were noted only in female patients. Filicide and prostitution were committed exclusively by women, economic crimes and sexual assaults were the preserve of men. The male offenses were more impulsive and unpremedi...
Early diagnosis of schizophrenia can improve its outcome. Hence, screening policies should be hel... more Early diagnosis of schizophrenia can improve its outcome. Hence, screening policies should be held and suitable tools must be available for general practitioners. To translate the section G (about schizophrenia) of the Composite International Diagnostic Interview to the Tunisian dialect and to check its validity and reliability. The Arabic version of section G of the Composite International Diagnostic Interview has been translated to the Tunisian dialect by psychiatrists speaking fluently both languages. Metric features of the instrument (sensitivity, specificity and predictive values) were assessed by checking its results against those of the gold standard i.e. the expert's opinion owing to the criteria of the Diagnostical and Statistical Manual of mental disorders 3rd revised edition. Reliability has been measured by the index of observer agreement. The instrument showed a low sensitivity of 45% [32% - 58%] and a high specificity of 96% [93% - 99%]. It looked as a diagnostical...
The law 92-83, has established the rights of the mentally ill to respect for individual freedom a... more The law 92-83, has established the rights of the mentally ill to respect for individual freedom and to appropriate care. However some gaps in its implementation led to the revision by Act 2004-40. To study the evolution of the number of admissions with and without consent (hospitalizations at the request of a third party and compulsory hospitalizations), between 2000 and 2009. Retrospective study of the archives of the mental health unit of Razi hospital. The study population included inpatients under the mode of voluntary and involuntary admission either compulsory hospitalizations or at the request of a third party. An increase in the number of hospitalizations without the consent from 2000 to 2009 was noted. The number of compulsory hospitalizations and the one of hospitalizations at the request of a third party rose respectively from 1,048 to 1,443 and from 22 to 1,323. So the number of free hospitalizations has decreased while the number of involuntary hospitalizations has incr...
Ulcerative colitis is a chronic inflammatory bowel disease with multiple pathogenic factors. Psyc... more Ulcerative colitis is a chronic inflammatory bowel disease with multiple pathogenic factors. Psychiatric disorder have frequently been associated to ulcerative colitis, the most frequent being depression and anxiety, whereas schizophrenia is unusual. Report a new case of ulcerative colitis associated topsychiatric disorder. We report the case of a 42-year-old woman with ulcerative colitis associated with schizophrenia. Although the two diagnoses were concomitant, on questioning, she revealed that digestive symptoms began before psychiatric disorders. Few cases of schizophrenia associated with ulcerative colitis have been reported in the literature. We discuss epidemiological, etiopathogenic and therapeutic links between the two diseases.
Background & aims: Dementia is one of the most common neuropsychiatric disorders in nursing h... more Background & aims: Dementia is one of the most common neuropsychiatric disorders in nursing home residents. Despite a high prevalence and a major impact on daily activities, dementia remains largely underdiagnosed and therefore rarely treated in nursing homes throughout the world. This study aims to determine the prevalence of dementia among residents of Manouba nursing home (in Tunis) and to identify the proportion of recognised cases of dementia among this population. Methods: A cross-sectional study was performed from September to October 2012 among all consenting residents of Manouba nursing home. Sociodemographic data were collected by the means of a semi-structured questionnaire. Cognitive functions were assessed using the Montreal Cognitive Assessment (MoCA) test in its Arabic version. We excluded subjects who could not take the MoCA test because of a severe sensory deficit or a severe psychiatric condition. Results: At the time of the study, the population of Manouba nursing home residents consisted of 116 subjects. After applying the exclusion criteria, we retained 77 subjects: 48 males (62.3%) and 29 females (37.7%). The average age was 72.6 years. The average MoCA score was 14.4 +/− 6.5 (range: 3 to 29). The prevalence of dementia in our population was 58.4% (n=45). Among these 45 subjects with dementia, only three (or 6.7% of dementia cases) were already diagnosed as such. Of these three patients, only one was on anticholinesterase treatment. Conclusion: Dementia is largely underrecognised and hence undertreated in nursing homes in Tunisia as in other countries. Routine screening for cognitive deficits seems paramount in order to ensure early diagnosis and treatment of this debilitating condition.
BackgroundAlthough communication skills towards breaking bad news are an important aspect of medi... more BackgroundAlthough communication skills towards breaking bad news are an important aspect of medical care [1], future Tunisian rheumatologists have no formal training in this area. The gaps in communication skills are significant to date in the field of rheumatology.ObjectivesThe aim of this study was to evaluate the impact of a training workshop on the disclosure of bad news in rheumatology.MethodsWe conducted a prospective, multicenter, interventional study over a six-month period during the academic year 2021-2022. 31 residents were recruited on a voluntary basis. Two groups were individualized: The training group A (N=16) and the control group B (N=15). The training session included interactive lectures, video-case studies, role-playing and peer-to-peer discussions. A self-administered survey was used to assess residents’ abilities to deliver bad news before and three months after the training.ResultsFollowing training (T3), group A residents showed a significant improvement in ...
Introduction Since the work of R.H. Rosenman and Meyer Friedman in 1959, a correlation has been e... more Introduction Since the work of R.H. Rosenman and Meyer Friedman in 1959, a correlation has been established between type A behavioral patterns and the occurrence of coronary heart disease. Type A personality has been found to be more of a coronary risk factor than a poor prognostic factor once coronary disease has set in. Subsequent studies have not supported such a relationship. Objectives The objective of our work was to investigate the association between type A personalities and coronary heart disease. Methods We conducted a retrospective study involving a sample of 200 patients recruited at the Mohamed Tahar Maâmouri Hospital in Nabeul. Our sample was composed of 100 coronary patients hospitalized or followed as outpatients in the cardiology department and 100 controls hospitalized or followed as outpatients in the general surgery or orthopedics department respectively. The study was conducted between April 15 and June 30, 2014. Personality type A was assessed according to the ...
BACKGROUND Sleep disorders in the elderly are common. However, they are often under diagnosed and... more BACKGROUND Sleep disorders in the elderly are common. However, they are often under diagnosed and poorly supported. AIM To study the characteristics of sleep in the elderly consultant at the front line. METHODS A cross-sectional survey was conducted on a random sample of fifty persons aged 65 years and over, consultant in the center of basic health of Ezzahra and in a private practice in the same delegation. RESULTS The sleep efficiency index was 0.85. Nighttime awakenings were present in 44 persons (88%). Unexplained late night awakening was reported by 19 subjects (38%). Among the respondents, 40 (80%) were considered to have at least one sleep disorder. The subjective complaint of insomnia was present in 70% of subjects. Excessive daytime sleepiness and/or hypersomnia were present in 70% of subjects. Nocturnal snoring was reported by 22 persons (44%). Nine subjects (18%) had respiratory pauses during sleep. Despite the high incidence of sleep disorder among the respondents, only 6 persons (15%) among them consulted their General Practitioner for this reason. Among patients with sleep disorder, 14 persons (40%) were taking hypnotics, from which 6 (43%) by self-medication. CONCLUSION Sleep disorders in the elderly as well as self-medication with hypnotics are common and under diagnosed. They should be sought systematically in front-line consultation.
IntroductionCovid-19 pandemic represents a sanitary crisis with social, economic and political ne... more IntroductionCovid-19 pandemic represents a sanitary crisis with social, economic and political negative impacts. Studies had well established the link between stress and the display or maintenance of addictive behaviour. Measures like social distancing and confinement imposed by governments during this pandemic, could explain an outbreak of internet addiction cases.ObjectivesAssess the prevalence of internet addiction in times of the covid-19 pandemic and to study its relationship with personal and family factors but also with the psychiatric comorbidities.MethodsWe conducted a cross sectional analytical study during the period of the covid-19 pandemic, using an internet survey exploring socio-demographic and clinical data: through Hamilton depression and anxiety rating scale and the Rosenberg self esteem scale. The assessment of internet addiction was carried out using Young’s Internet Addiction test.ResultsOur study included 150 users, the average age was 36 years, mainly made up ...
Introduction Tunisia is knowing a significant increase of the elderly population, this phenomenon... more Introduction Tunisia is knowing a significant increase of the elderly population, this phenomenon comes along with an increase of the incidence of degenerative pathologies "dependent on the age" as the Alzheimer's disease. The physical and psychic consequences of the disease and also the behavior of family members are an important determinant of quality of life and economic activities of both patients and informal caregivers. Objectives and methods Our aims are to establish characteristicsof60 informal cargivers of Alzheimer's patients followed in the department of neurology in Razi's Hospital and to estimate their socioeconomic burden through a descriptive study. Results Our sample of caregivers was predominantly female with a moderate socio-economic conditions in 36,66%. The support was provided in 2/3 of cases exclusively by the informal caregivers. 22,66% ( n =13) of them lost their profession since the beginning of assistance's relationship. Among care...
INTRODUCTION Shift work can cause health problems and sleep disorders and therefore affect mental... more INTRODUCTION Shift work can cause health problems and sleep disorders and therefore affect mental health. These psycho-affective disorders can, in return, worsen sleep disorders and thus establish a vicious circle. The aims of our study were to assess the frequency of sleep and psycho-affective disorders among paramedical personnel doing shift work and to screen them for obstructive sleep apnoea-hypopnoea syndrome (OSA). METHODS It was a cross-sectional study carried out among paramedical staff at the University Hospital Center Mongi Slim La Marsa in Tunis. Three questionnaires translated into Arabic (the Berlin questionnaire, the Spiegel questionnaire and the Hospital Anxiety and Depression Scale [HAD]) were presented by the same investigator during the survey. RESULTS One hundred and fifty-eight paramedics were interviewed (46.2% were nurses, 23.4% were blue-collar workers, 19% were senior technicians and 11.4% were health care aides, midwives and physiotherapists). The average du...
Pre-requis: La rectocolite hemorragique est une maladie inflammatoire chronique de l'intestin... more Pre-requis: La rectocolite hemorragique est une maladie inflammatoire chronique de l'intestin d'etiologie multifactorielle. Son association a des troubles psychiatriques a frequemment ete rapportee, essentiellement a type de troubles depressifs ou anxieux, cependant, son association avec la schizophrenie est exceptionnelle. But: Rapporter un nouveau cas d'observation associee a une schizophrenie. Observation: Ce travail rapporte le cas d'une patiente âgee de 42 ans, qui presente une rectocolite hemorragique associee a une schizophrenie indifferenciee. Bien que les deux maladies aient ete diagnostiquees a la meme periode, l'interrogatoire a permis de montrer que les signes digestifs ont precede les troubles psychiatriques. Conclusion: Peu de cas de schizophrenie associee a la rectocolite hemorragique ont ete rapportes dans la litterature. Les liens epidemiologiques, etiopathogeniques et therapeutiques de cette association sont discutes.
Introduction The studies on Alzheimer disease highlight the family caregivers burden and his cons... more Introduction The studies on Alzheimer disease highlight the family caregivers burden and his consequences on hostility. Few authors study the burden and the mental health of the caregivers of a demented relative. Aims This study aims at assessing the hostility and emotional load of caregivers of Alzheimer patients and determining the relation between the burden and the psychic health caregivers and its impact on the patient. Methods It is a descriptive cross-sectional study. Patients were recruited from the neurology department of Razi hospital Tunisia between January and June 2013. Consenting caregivers participating in the study were interviewed with a structured survey focused on their socio-demographic characteristics, the characteristics of the aid relationship and the emotional burden felt valued by the Family Attitude Scale (FAS). Results The caregiver was in nearly 60% a child. He lived under the same roof in 78.3% of cases. In 65% of cases, it passes between 12 and 24hours ...
INTRODUCTION Shift work can cause health problems and sleep disorders and therefore affect mental... more INTRODUCTION Shift work can cause health problems and sleep disorders and therefore affect mental health. These psycho-affective disorders can, in return, worsen sleep disorders and thus establish a vicious circle. The aims of our study were to assess the frequency of sleep and psycho-affective disorders among paramedical personnel doing shift work and to screen them for obstructive sleep apnoea-hypopnoea syndrome (OSA). METHODS It was a cross-sectional study carried out among paramedical staff at the University Hospital Center Mongi Slim La Marsa in Tunis. Three questionnaires translated into Arabic (the Berlin questionnaire, the Spiegel questionnaire and the Hospital Anxiety and Depression Scale [HAD]) were presented by the same investigator during the survey. RESULTS One hundred and fifty-eight paramedics were interviewed (46.2% were nurses, 23.4% were blue-collar workers, 19% were senior technicians and 11.4% were health care aides, midwives and physiotherapists). The average duration of shift work was 10.27 years, the average age was 36.48 years and there was a female prevalence of 70.9%. Sleep disorders were detected in 40.5% of the cases, OSA in 24%, anxiety in 53.2% and depression in 17.1%. CONCLUSION Sleep and psycho-affective disorders are frequent among paramedical personnel undertaking shift work in hospitals. Screening consultations in occupational medicine are necessary in order to detect these disorders at an early stage.
IntroductionThe Alzheimer's patient assistance relationship is a morally painful experience, ... more IntroductionThe Alzheimer's patient assistance relationship is a morally painful experience, most frequently discussed in terms of “burden” in the literature, especially as professionals and institutional intermediaries are underdeveloped in Tunisia.GoalIt is intended to assess the level of burden among caregivers of patients with Alzheimer's disease and to search factors associated with a high level of burden.MethodologyThis is a retrospective descriptive study. Patients were recruited from neurology department of Razi hospital, which were hospitalised between the months of December 2012 and March 2013. The burden was measured using the Zarit inventory.Results and discussionThirty patients were included. The majority female, most caregivers are descendants (60%), then, daughters in law (33%), and finally the spouses (23%). 80% of caregivers lived in the same home as patients. Caregivers were asked about all the items of the grid Zarit. The average burden in our sample is 59...
IntroductionViolence against elderly persons is an intricate social, legal and ethic issue. Alzhe... more IntroductionViolence against elderly persons is an intricate social, legal and ethic issue. Alzheimer's patients are the most vulnerable individuals to mistreatment and neglect. The aggressor can be even the main helper of the patient. We noticed a wide underestimation of this phenomenon, which remains taboo subject in our society.Objectives and methods– The aim of our study is to identify predictive factors of mistreatment of Alzheimer's patients through a prospective and descriptive study, within patients following in the department of neurology in Razi's hospital.– we evaluate cognitive function (MMSE) and the importance of behavioural disorders.– we explored helper's socio-demographic characteristics and the quality of aid relationship.– anger and hostility within relationship were estimated through family attitude scale.ResultsOur sample accounts 60 informal caregivers predominately female (91.7%) with an average age of 49.67 years, mostly are married (71.66%) a...
Epidemiological studies suggest a positive but controversial correlation between the major mental... more Epidemiological studies suggest a positive but controversial correlation between the major mental disorders, particularly schizophrenia and delinquent or criminal acting out. aim : To study the occurrence of violence in patients with schizophrenia according to demographic, clinical and disease progression features. This retrospective study included all out-patients, consulting during a period of one month, suffering from schizophrenia for at least five years. The clinical and forensic history was obtained owing to a semi-structured interview with patients and their families, medical records and the passing of different scales. Sixty patients were included. 46.7% (n=28) of patients had a violent behavior in the pre morbid period. Aggressiveness was noted as the first prodrome in 13.3% (n=8) of cases. 28 major acts of violence were committed by 30% (n=18) of patients regardless of the active period of disease. In 13.3% (n=8) of cases, these acts announced the disease. The majority of ...
Unlike schizophrenia, the impact of gender on the criminality of patients with bipolar disorder h... more Unlike schizophrenia, the impact of gender on the criminality of patients with bipolar disorder has received little attention. To estimate the sex ratio in relation to acts committed by forensic bipolar patients and evaluate the impact of gender on the characteristics of this crime. A comparative study by gender, conducted at the psychiatric hospital Razi has included all patients with bipolar disorder hospitalized between 1990 and 2010 after being relaxed for mental illness, owing to the Tunisian penal code. The total number of patients was 36 and the sex ratio of 3.5.A suicide history was four times more common in women. Alcohol abuse was found only in men. Relapses were more frequent in women (3.06 I year against 1.14 I year, p = 0.02). Rapid cycling and comorbid anxiety were noted only in female patients. Filicide and prostitution were committed exclusively by women, economic crimes and sexual assaults were the preserve of men. The male offenses were more impulsive and unpremedi...
Early diagnosis of schizophrenia can improve its outcome. Hence, screening policies should be hel... more Early diagnosis of schizophrenia can improve its outcome. Hence, screening policies should be held and suitable tools must be available for general practitioners. To translate the section G (about schizophrenia) of the Composite International Diagnostic Interview to the Tunisian dialect and to check its validity and reliability. The Arabic version of section G of the Composite International Diagnostic Interview has been translated to the Tunisian dialect by psychiatrists speaking fluently both languages. Metric features of the instrument (sensitivity, specificity and predictive values) were assessed by checking its results against those of the gold standard i.e. the expert's opinion owing to the criteria of the Diagnostical and Statistical Manual of mental disorders 3rd revised edition. Reliability has been measured by the index of observer agreement. The instrument showed a low sensitivity of 45% [32% - 58%] and a high specificity of 96% [93% - 99%]. It looked as a diagnostical...
The law 92-83, has established the rights of the mentally ill to respect for individual freedom a... more The law 92-83, has established the rights of the mentally ill to respect for individual freedom and to appropriate care. However some gaps in its implementation led to the revision by Act 2004-40. To study the evolution of the number of admissions with and without consent (hospitalizations at the request of a third party and compulsory hospitalizations), between 2000 and 2009. Retrospective study of the archives of the mental health unit of Razi hospital. The study population included inpatients under the mode of voluntary and involuntary admission either compulsory hospitalizations or at the request of a third party. An increase in the number of hospitalizations without the consent from 2000 to 2009 was noted. The number of compulsory hospitalizations and the one of hospitalizations at the request of a third party rose respectively from 1,048 to 1,443 and from 22 to 1,323. So the number of free hospitalizations has decreased while the number of involuntary hospitalizations has incr...
Ulcerative colitis is a chronic inflammatory bowel disease with multiple pathogenic factors. Psyc... more Ulcerative colitis is a chronic inflammatory bowel disease with multiple pathogenic factors. Psychiatric disorder have frequently been associated to ulcerative colitis, the most frequent being depression and anxiety, whereas schizophrenia is unusual. Report a new case of ulcerative colitis associated topsychiatric disorder. We report the case of a 42-year-old woman with ulcerative colitis associated with schizophrenia. Although the two diagnoses were concomitant, on questioning, she revealed that digestive symptoms began before psychiatric disorders. Few cases of schizophrenia associated with ulcerative colitis have been reported in the literature. We discuss epidemiological, etiopathogenic and therapeutic links between the two diseases.
Background & aims: Dementia is one of the most common neuropsychiatric disorders in nursing h... more Background & aims: Dementia is one of the most common neuropsychiatric disorders in nursing home residents. Despite a high prevalence and a major impact on daily activities, dementia remains largely underdiagnosed and therefore rarely treated in nursing homes throughout the world. This study aims to determine the prevalence of dementia among residents of Manouba nursing home (in Tunis) and to identify the proportion of recognised cases of dementia among this population. Methods: A cross-sectional study was performed from September to October 2012 among all consenting residents of Manouba nursing home. Sociodemographic data were collected by the means of a semi-structured questionnaire. Cognitive functions were assessed using the Montreal Cognitive Assessment (MoCA) test in its Arabic version. We excluded subjects who could not take the MoCA test because of a severe sensory deficit or a severe psychiatric condition. Results: At the time of the study, the population of Manouba nursing home residents consisted of 116 subjects. After applying the exclusion criteria, we retained 77 subjects: 48 males (62.3%) and 29 females (37.7%). The average age was 72.6 years. The average MoCA score was 14.4 +/− 6.5 (range: 3 to 29). The prevalence of dementia in our population was 58.4% (n=45). Among these 45 subjects with dementia, only three (or 6.7% of dementia cases) were already diagnosed as such. Of these three patients, only one was on anticholinesterase treatment. Conclusion: Dementia is largely underrecognised and hence undertreated in nursing homes in Tunisia as in other countries. Routine screening for cognitive deficits seems paramount in order to ensure early diagnosis and treatment of this debilitating condition.
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Papers by R. Rafrafi