Introduction In Tunisia, the 2019 corona virus pandemic was a challenging health situation, with more than 28 000 confirmed deaths in May 2022. The pandemic was responsible for people losing their beloved ones in a sudden and brutal ways. Even though the numbers of bereaved people had been escalating, little attention was paid toward their mental health. Grief is a normal response to losing someone close. However, recent studies have shown that the covid-19 grief is more severe than other causes of grief. It not only causes a negative impact on the bereaved life aspects but also creates severe consequences in the society. Screening a possible dysfunctional grief is a major need to prevent serious outcomes. Objectives To identify the prevalence of covid-19 dysfunctional grief and find out the possible associated risk factors to it. Methods A cross sectional online survey designed using Google Forms and distributed on social media platforms (Facebook, Instagram, WhatsApp) was conducted from 16 February 2022 to 05 May 2022. The participants provided information related to socio-demographic data. Covid-19 grief scale was assessed using the pandemic grief scale, which was translated into Arabic but not validated. Results A sample of 106 participants were recruited to this study .The sample was composed of Approximately 72% female and 28 % males, most of them were aged between 26 and 35 years old (37.7% ) . Overall, individuals who lost a loved one more than 06 months period were more frequent (81%). 91.7 % of the sample scored above the cut score of 7 on the PGS. Covid-19 grief was higher among those who sought psychological help (p = 0.02). In this sample, there was no associated risk factors between different socio-demographic characteristics and dysfunctional grief, as well as no correlation were found between period of time since the loss and dysfunctional grief ( rho = 0.186, p = 0.56) . Conclusions Although our study did not find a significant high prevalence of dysfunctional grief giving the small number of participants. More studies and screening must be conducted to identify those at risk of developing dysfunctional grief to prevent the serious individual and general outcomes. Disclosure of Interest None Declared

Introduction Stigma towards mental health disorders is an issue standing in the way of healing and integrating the patient into the social life. Stigmatising does not only come from the general population but also from health care providers. Studies found out that lack of knowledge and skills among health care professionals is associated with stigmatization, which affects the attitudes and the patient’s treatment process. Objectives The main aims of this study were to evaluate the attitudes and knowledge about mental health among nurses and psychiatry residents working in psychiatric departments, to explore the relationship between knowledge and attitude toward mental health and to find out the possible link with sociodemographic and work characteristics Methods A cross-sectional questionnaire was conducted in two departments of psychiatry at RAZI hospital focusing on nurses and psychiatrist trainees. The sociodemographic informations, duration and choice of working in psychiatric field, personal experience with mental illness were collected . The Mental Health Knowledge Questionnaire (MHKQ) and the mental illness clinicians attitude scale (MICA-4 )were used to evaluate the participants mental health knowledge and attitude towards psychiatry and people with mental disorders . Results A total of 30 health care providers finished the questionnaire. Their median (± interquartile range) age was 29 (±9) years within a range of 25 to 60 years old. Our participants were predominantly female (N = 26; 86.7%). The overall median of MHKQ scale was 10 (±6) with a higher score in psychiatrist trainees than nurses but no significant difference was found (p= 0.066) However there was a significant difference between the two groups regarding the MICA scale (p=0.02) with a negative attitude found in the group of nurses . Participants with no personal experience with mental illness along with those who were obliged to work in psychiatric facilities tend to have higher score on the MICA scale with significant statistically relationships, respectively, p =0.18 and p=0.09 We didn’t find any statistically significant relationship between the total scores of the MICA and MHKQ scales ( rho = -0.206, p = 0.275) Conclusions In our study negative attitude toward mental disorders were found in the group of nurses. Education about mental health disorders as well as addressing the importance of mental health outcomes must be included in the first year training of every healthcare provider. New strategies Focusing on improving the knowledge and skills among healthcare professionals are important to make due to their positive effect on the recovery. Disclosure of Interest None Declared

Introduction Le lupus érythémateux systémique (LES) est une maladie auto-immune qui affecte non seulement la santé physique des patients, mais aussi leur bien-être psychologique. Les relations avec autrui jouent un rôle crucial dans la gestion de la maladie et peuvent influencer les résultats psychologiques. Cette étude vise à évaluer l’association entre l’interaction avec autrui et différents aspects des relations des patients atteints de LES en relation avec des facteurs psychologiques tels que la dépression et l’anxiété. Matériels et méthodes Une étude transversale a été réalisée au sein du service de médecine interne menée sur des patients ayant un LES durant une période de six mois du 1er février jusqu’au mai 2023. Les caractéristiques sociodémographiques ont été recueillies par le biais d’entretiens cliniques et de dossiers médicaux. Les relations ont été évaluées à l’aide des domaines de qualité de vie du lupus (Lupus QoL), notamment les relations intimes et la charge pour les autres. Le score moyen de chaque domaine varie entre 0 (Bas score) et 100 (score élevé) La dépression et l’anxiété ont été évaluées à l’aide de l’échelle Hospital anxiety and depression scale (HADS). Résultats Notre échantillon comprenait 100 patients atteints de LES, principalement des femmes (89 %) avec un âge moyen de 42±13 ans. Une anxiété confirmée était présente chez 33 % des patients, et une dépression confirmée chez 32 %. Une forte corrélation négative a été observée entre le domaine des relations intimes du Lupus QoL et la dépression, indiquant que des niveaux plus élevés de dépression sont associés à des valeurs plus faibles dans ce domaine. Le modèle de régression linéaire a montré que la dépression était négativement associée au domaine des relations intimes (R2=0,266, B=–2,385 [–3,478 ; –1,291], p<0,001). L’anxiété n’était pas associée aux relations intimes. Une corrélation négative modérée a également été observée entre la charge pour les autres, la dépression et l’anxiété, mais elle n’a pas persisté dans le modèle de régression. Conclusion Cette étude souligne l’impact significatif de la dépression sur les relations intimes chez les patients atteints de LES. Bien que l’anxiété n’ait pas montré d’association avec les relations intimes, la charge perçue pour les autres est un facteur pertinent à explorer davantage. Ces résultats mettent en évidence la nécessité d’aborder les aspects psychologiques dans la gestion du LES pour améliorer la qualité de vie des patients.

Introduction There are several arguments supporting the inflammatory hypothesis in schizophrenia (SCZ). Among the inflammatory markers, beta-2- microglobulin (β2M) is associated with abnormalities in neurogenesis and cognitive impairment described in (SCZ). Objectives The objectives of our study were to evaluate the level of β2M in a group of patients compared with a control group and to investigate the sociodemographic, clinical, and environmental factors associated with elevated β2M levels Methods We conducted a cross-sectional in outpatients with SCZ. We collected patients sociodemographic, environmental, and clinical data. We assessed psychopathology with the PANSS. We measured serum β2M concentration. Results We included 30 patients with SCZ compared with 20 controls. Patients mean age was 40,23±10,66. The mean level of β2M was 1,98 ± 0.42 mg/L for patients and 1.65±0.56 mg/L for control group. The difference was significant between the patient group and the control group (p<10-3). No environmental or clinical factors have been associated with β2M levels other than smoking status (p=0.046). Conclusions Further research with larger samples investigating the different stages of SCZ especially early psychosis would be needed to confirm the relevance of this biomarker in SCZ. Disclosure of Interest None Declared

Introduction La douleur est un symptôme courant chez les patients atteints de lupus érythémateux systémique (LES) et peut affecter de manière significative leur qualité de vie. Il est essentiel de comprendre comment la douleur interagit avec des facteurs psychologiques tels que l’anxiété et la dépression. Cette étude vise à évaluer l’association entre la douleur et les niveaux de dépression et d’anxiété chez les patients atteints de LES. Matériels et méthodes Une étude transversale a été réalisée dans le service de médecine interne de l’Hôpital Rabta en Tunisie. Les patients participant à des consultations mensuelles en ambulatoire ont donné leur consentement éclairé et ont complété un questionnaire sociodémographique basé sur des entretiens et des dossiers médicaux. La douleur a été évaluée à l’aide du questionnaire Lupus quality of life (Lupus QoL) qui comporte un domaine consacré à la douleur. Le score moyen de ce domaine varie entre 0 (bas score)et 100 (score élevé). La dépression et l’anxiété ont été évaluées à l’aide de l’échelle HADS. Résultats Notre échantillon comprenait 100 patients atteints de LES avec un âge moyen de 42±13 ans. Une prédominance féminine a été notée avec une proportion de 89 %. Une anxiété confirmée était présente chez 33 % des patients, et une dépression confirmée chez 32 %. La médiane de la douleur était de 87 selon le questionnaire Lupus QoL. Une corrélation négative modérée a été observée entre la douleur et la dépression. Dans le modèle de régression, la dépression était associée négativement à la douleur (R2=0,366, B=–2,919, [–4,123 ; –1,714], p<0,001). Aucune association significative n’a été trouvée entre l’anxiété et la douleur. Conclusion Cette étude met en lumière l’association significative entre la douleur et la dépression chez les patients atteints de LES. Bien qu’une corrélation ait été observée avec la dépression, aucune relation n’a été établie avec l’anxiété. Ces résultats soulignent l’importance de prendre en compte les aspects psychologiques dans la gestion de la douleur chez les patients lupiques, afin d’améliorer leur qualité de vie.

Introduction Many researchers have turned their attention to studying the relation between the gut microbiota to mood disorders. In fact, studies in the last 5 years have shown that the change in microbiota in animals can cause anxiety a depression –like behaviors. In humans, considering the fact that there was a difference between in human gut microbiota between depressed persons and healthy controls, many clinicians suggest different treatment ways to compensate the microbiome imbalance such as Fecal microbiota transplantation (FMT). FMT is an ancient tool that used to treat food poisoning and severe diarrhea. Recent studies have shown its efficacy in autism spectrum disorders but not enough studies have shown its contribution in treating mood disorders. Objectives The aim is to explore and understand the use of fecal microbiota transplantaion in the mood disorder treatment Methods We conducted a literature search for English articles on PubMed using the keywords : mood disorder, Fecal microbiota transplantation, treatment. Results 13 results were initially found on the pubmed database. we identified 4 eligible studies. 02 case studies reported that patients diagnosed with bipolar disorder type 2 improved after repetitive FMT treatment, 01 randomised controlled trial concluded good tolerability and feasibility of FMT in major depression disorder but was not designed to measure clinical outcomes. Finally, 01 study protocol is still conducting on the efficacy and safety of FMT n in a population with bipolar disorder during depressive episodes. Conclusions No results have shown the efficacy of FMT in treating mood disorders yet. However, it is considered well tolerated and safe. Further studies are needed to conclude its efficacy. Disclosure of Interest None Declared

Introduction Defined by the World Health Organization (WHO) as the inability to conceive after a year of unprotected sexual intercourse, infertility remains a current and compelling topic of interest for both scientists and the general public. Over the past few decades, the prevalence of infertility, regardless of its cause, has significantly increased. Furthermore, it affects approximatively 15% of tunisian couples. However, previous studies have primarily assessed the psychological impact on women, leaving a gap in understanding gender differences. Objectives Our study aims to compare the psychological impact of infertility between genders in a Tunisian sample. Methods We conducted a cross-sectional study in a public hospital specializing in Assisted Reproductive Technology (ART) from August 30th to December 1st, 2022, involving sexually active infertile couples who had been under observation for at least one year. The participants provided information related to socio-demographic data. Additionally, we used the Hospital Anxiety Depression Scale (HADS) to assess anxiety and depression, and the Fertility Quality of Life (FertiQol) questionnaire to evaluate the quality of life. These questionnaires were administered in the Tunisian dialect. Results A sample of 60 infertile couples were recruited to this study. Primary infertility was present in 97% of cases and male infertility was the most common cause, accounting for 35%. Our findings revealed that women experienced higher rates of depression (35%) and anxiety (52%) compared to men (15% and 28%), with a statistically significant difference (p ≤ 0.001). Furthermore, women reported a significantly compromised overall quality of life, particularly in the context of treatment-related aspects (p=0.03). Notably, anxiety was identified as a significant risk factor for reduced quality of life among women (B = -5.27). In contrast, lower socioeconomic status was associated with diminished overall quality of life in men (B = -7.09). Conclusions It is important to consider gender differences in the management of infertility in order to guide and target psychological interventions and to improve the quality of life of infertile couples. Disclosure of Interest None Declared

Introduction Schizophrenia is a common mental illness with a wide range of symptoms. Given the high metabolic comorbidity observed in schizophrenia and the metabolic side-effects induced by the antipsychotics used in practice, the detection of eating disorders is crucial. These disorders may occur at the same time as psychotic symptoms or independently of them. Objectives we aim to provide an overview of eating disorders in schizophrenia. Methods We conducted a systematic search using the 2 bibliographic databases PubMed and Google scholar including the following keywords: “Schizophrenia”, “Eating disorders”, “Reward mechanisms”. Results Eating disorders are a frequent comorbidity in schizophrenia. Authors have reported that some patients with schizophrenia have an increased appetite and craving for fatty foods, increased caloric intake and frequency of consumption, which may be associated with increased disinhibition. According to the literature, binge eating and night eating are frequently observed in patients with schizophrenia, with a prevalence of around 10%. Studies have shown that people suffering from psychosis and treated with antipsychotics have high rates of binge eating, ranging from 4.4% to 16% for binge eating and from 8.9% to 45% for binge eating symptoms (without reaching the diagnostic threshold for binge eating). Rates ranging from 16.1% to 64% for cravings were reported. Anorexia nervosa appears to affect between 1% and 4% of schizophrenic patients. Conclusions Despite their frequent association with schizophrenia, eating disorders remain little studied. However, it is important to detect these disorders and elucidate the underlying psychopathological and neurobiological mechanisms in order to better manage metabolic comorbidity and improve patients’ quality of life. Disclosure of Interest None Declared

Introduction There has been growing evidence to support the hypothesis that inflammation is involved in the pathogenesis of schizophrenia. Objectives The aim of the present literature review was to assess the efficacy of acetylsalicylic acid (ASA) as an adjuvant agent in the treatment of an acute exacerbation of schizophrenia. Methods We searched randomized clinical trials based on regular searches of MEDLINE, Embase, PubMed. Results We included four studies. The results were in favor of the efficacy of ASA in the study where authors targeted early psychosis. Illness duration seems to predict response to anti-inflammatory agents. Conclusions Further studies of early stages of schizophrenia are helpful. Disclosure of Interest None Declared

Introduction Clozapine is an effective Atypical antipsychotic used in the treatment of resistant schizophrenia .However it can induce liver dysfunction from a simple transient asymptomatic cytolisis (30 to50 %) toa serious fulminant liver failure (0.001 %). Objectives To show the heptotoxicity potential of Clozapine and adress the importance of monitoring the liver function tests in clozapine titration to prevent sever conditions Methods A case report of a fifty-year old Tunisian male patient diagnosed with resistant schizophrenia who developed a hepatototoxicity under a low dose of clozapine within five days of treatment . Results Mr F is a 50 year old patient diagnosed with schizophrenia in 2018 . He had received various antypical and typical antipsychotic treatments including ( Haloperidol , Risperidone , Amisulpride , Olanzapine ) at effective doses and minimal periods of six weeks . He had no history of systemic diseases or substance use disorder . He smokes 10 cigarettes a day . He had a history of hepatotoxicity on olanzapine. These medications have failed to resolve the persecutory delusion and auditory hallucinations , and the trial of clozapine was institued . Baseline examination and laboratory tests were normal . The previous antipsychotic medication was not continued and a dose of 25 mg clozapine was administred . A marking drowsiness was present in the fisrt days , so we decided to keep the same dose . Five days later , he had high levels of Liver function test (LFT) : Elevated aspartate ( 5 times above normal) and alanine aminotransferase levels (4 times above normal ) , white blood cell count and bilirubine levels were normal . He had no fever or jaundice . The abdominal examination showed a mild sensiblity in the right upper quadrant . Clozapine was immediatly discontinuated . 24 hours later LFT continued to escalate to 5 times greater then normal . Then it decreased continueosly Conclusions Clozapine has a potential of hepatotoxicity even at lower dose . Screening liver function tests must be integrated in survey recommendations of clozapine treatment . Further researches must be conducted to understand the mechanism of this side effect in order to avoid sever conditions . Disclosure of Interest None Declared

Introduction The evidence of an inflammatory status at onset of psychosis supports the adjunction of anti-inflammatory agent to antipsychotic (AP). Some negative results of these clinical trials lead us to wonder about the anti-inflammatory power of AP. Objectives Would the action of associated anti-inflammatory agents be negligible compared to the anti-inflammatory potential of AP? Methods We conducted a prospective study. We included patients hospitalized for acute relapse of schizophrenia. They were all treated with Risperidone. We measured High sensitive C Reactive Protein (Hs CRP) at baseline and 8 weeks after. Results We included 24 patients. Mean age was 34,5 +7,32 years with 75% of female. Mean age of onset of illness was 24,63 ±4,81 years and illness duration was 10,70 +6,42 years. After 8 weeks, PANSS scores decreased significantly from 79,13 +12,07 to 47,21 +8,41 and Hs CRP levels dropped by 1,55 +3,96 mg/l. Conclusions These results highlighted the anti-inflammatory action of Risperidone. Clinical trial should consider the proportion of anti-inflammatory agents action. Disclosure of Interest None Declared

Introduction A mature and fulfilling sexuality is based on appropriate sexual education. The message must be adapted to the level of knowledge and practices of young people. Old studies dating back more than 15 years have been published. Objectives The objective of this study is to assess adolescents’ knowledge and attitudes about sexuality. Methods This is a descriptive cross-sectional study conducted among 80 adolescents using an anonymous online questionnaire. Results The average age of the participants was 18 years old 45% had had at least one sexual intercourse, they are mostly male. Only 9% had used a method of contraception. Most of them had heard of contraceptive techniques. Young age, male gender, lack of dialogue with parents, low socio-economic status and lack of sex education were significantly associated with a low level of knowledge about sexuality. Conclusions The results show that adolescents had risky practices with a lack of information. More studies are needed to approve these results and improve sexual health of these teenagers thanks to targeted sensitization. Disclosure of Interest None Declared

Introduction Attention deficit hyperactivity disorder (ADHD) is a condition that is usually diagnosed in childhood . However studies have shown that there is a propotion of adults with ADHD that did not have the disorder in their early ages and have been diagnosed in adulthood . Symptoms of adult ADHD are often confused with other psychiatric conditions due to the similarities in clinical criteria . Diagnosing Adult ADHD is still challenging due to lack of gold standard instruments , which can interfere with the therapy . Objectives Identify the assessement measures that improve the early diagnosis of Adult ADHD Methods A systematic literature search was executed using the PUBMED and GOOGLEscholar databases from 2009 to 2022 exploring the different assessement tools of adult ADHD using the keywords : Adult ADHD – Diagnosis issues – Assessement . Results Results show diagnosing Adult ADHD can be by using three different assessement methods : clinical interview – ADHD behaviour rating and neuropsychological tests . Clinical interview has a high sensitivity but low speceficity in diagnosing ADHD in adults . Harrison and Al showed the CAARS scale appears to have adequate specificity in a young adult population giving it has validity to identify invalid symptom presentation. The TOVA and the Conners CPT are the two CPTs widely used in ADHD assessment. It is not clear whether the TOVA or Conners CPT has better diagnostic accuracy . Cognitive test batteries dont show specific results in identifying ADHD Conclusions To sum up , diagnosing adult ADHD is a challenging situation due to the lack of specifity in the assessemnt tools . This work highlights the necessity of further studies to improve the diagnostic process and the ability to create a universal guidelines . That way , early interventions and treatments can take place and avoid the confusion with other conditions . Disclosure of Interest None Declared

IntroductionAnxiety has become a topical issue since the arrival of the coronavirus pandemic, especially for frontline healthcare professionals as they deal with patients affected by the Covid-19.ObjectivesObjectify anxiety in frontline medical and paramedical staff and study its associated factors.MethodsWe conducted a national descriptive and analytical cross-sectional study via a survey over a 2-month period from September to October 2020. We used “Beck Anxiety Inventory” to screen anxiety as well as “Brief Cope Scale” to detect probable correlations between anxiety and coping mechanisms.ResultsWe collected 78 persons. The mean age was 29.86 years. 35.9% moved out of home. 39.7% worked in Covid units. 7.7% had personal psychiatric history. 76.9% provided direct care to patients with Coronavirus. The frontline staff reported that only 29.5% of patients were stables. Only 48.4% received adequate training of protection against Covid-19. 64.1% of professionals did PCR test and only 16.7% of them tested positive. We objectified an increase of 6.4% in the anxiolytics use. Stigma affected 57.7% of professionals. We highlighted a link between anxiety and social support strategy (p=0.048). 92.3 % of the staff suffered from anxiety according to Beck Anxiety Inventory.ConclusionsScreening anxiety among frontline medical and paramedical staff might enhance their productivty and thus provide patients with the best care.DisclosureNo significant relationships.