Introduction Depression and dementia with Lewy bodies (DLB) are two fairly common pathologies in the elderly which can have similar presentations or be associated and therefore pose a diagnostic challenge. Objectives We propose to illustrate, through our case, the diagnostic and therapeutic challenge of these two pathologies. Methods We present the case of Ms. S. BA aged 67, without organic or psychiatric history, admitted to the psychiatry department for massive anxiety and insomnia. The troubles date back to nineteen months when the patient isolated herself, remained bedridden, lost her appetite and no longer slept. The evolution quickly led to the appearance of an excessive agitation. The patient became distracted, talking and laughing to herself, and ran away from the house. She consulted several free-lance psychiatrists and received several antipsychotic medications without improvement. The admission interview revealed a very anxious patient with a difficult contact. Her speech was centred on well-detailed visual hallucinations with themes of death. The neurological examination was difficult at first. She was started on haloperidol and clonazepam. After 2 days, neurological examination showed a parkinsonian syndrome and a temporal disorientation. Other cognitive functions were difficult to assess. The two diagnoses evoked were DLB and a characterized depressive episode with psychotic features. Standard workup showed mild anaemia and thrombocytopenia. Brain MRI and electroencephalogram and immune tests were normal. However, PET imaging was not available in our hospital. Haloperidol was immediately stopped and the patient was treated with an anticholinergic corrector in combination with quetiapine at 200 mg. The evolution was characterized by a significant reduction in anxiety and visual hallucinations with a marked improvement of the parkinsonian syndrome. Depressive symptoms took the forefront of the clinical presentation; hence we associated sertraline with quetiapine. The subsequent evolution showed a clear improvement in the depressive symptoms with total resolution of the parkinsonian symptoms and a normal cognitive evaluation. Results In our case, the clinical evolution constituted a key element in the diagnostic orientation. So far, it is unlikely that our patient has DLB and the diagnosis retained was a characterized depressive episode with psychotic and melancholic features. Depression in the elderly can have atypical presentations, and raise the possibly of other differential diagnoses. Diagnostic uncertainty should not delay the implementation of treatment. Conclusions The choice of molecules must take into account the associated somatic symptoms for a better tolerance. In the absence of a biological or iconographic examination with good sensitivity and specificity, the therapeutic test remains the only way to decide. Disclosure of Interest None Declared

Introduction The internalized stigma associated with mental illness is considered as an additional burden faced by people with mental disease. Among mental illnesses, schizophrenia is considered as the most stigmatizing. Objectives To Assess the level of stigma in a sample of people with schizophrenia Methods This is a cross-sectional and descriptive study carried out on 72 stabilized patients followed at the post-cure psychiatry consultation ‘A’ at the CHU Hedi Chaker in Sfax diagnosed with schizophrenia according to the DSM 5 criteria. Socio-demographic and clinical data were collected using a pre-established sheet We used The Internalized Stigma of Mental Illness (ISMI) scale to assess internalized stigma Results The mean age of the patients in our study was 46.83 ± 11.6 years, with a sex ratio (M/F) of 2. They were single in 48.5%, unemployed in 69.4%. Their level of education did not exceed primary school in 44.4% and their socio-economic level was low in 63.9%. 2% of the patients had no somatic history and 36.1% had a history of attempted suicide. The median for the total ISMI score was 2.45, which corresponded to the absence of strong stigma. The median of the subscales was distributed as follows: 2 for the level of alienation, 2.28 for stereotype endorsement, 2.4 discrimination experience, 2.36 for social withdrawal and 2.60 for stigma resistance. In our study, 45.8% of patients reported experiencing high levels of self-stigma (total score>2,5). Conclusions Our study found levels of self-stigma in individuals with schizophrenia that align with previous research, suggesting that schizophrenia-related stigma is a global phenomenon unaffected by factors such as origin or ethnicity. Disclosure of Interest None Declared

Introduction During the COVID-19 pandemic confinement, the number of people shopping online has increased all over the word. To date, little is known about the online shopping behaviours of Tunisians consumers. Objectives Evaluate the characteristics of internet shopping among Tunisian consumers. Methods A cross-sectional, descriptive and analytical study was conducted among subjects who had already made at least one online purchase. Data was collected using a self-questionnaire published by GOOGLE FORMS. We used a survey form collecting socio-demographic data, personal history and characteristics of online shopping behaviour. Results A total of 137 participants aged 34.62 ± 9.82 years took part in this study. All participants had made at least one online purchase, with 43.8% (N=60) purchasing “More than once a year”. The products purchased were most often textiles and shoes (50.4%; N=69). The main reasons consumers gave for buying online were special offers (37.2%, N=51), reduced prices (25.5%, N=35) and free delivery (14.6%, N=20). Almost half of the participants (N=63; 46%) said that they had visited physical shops less since they started shopping online. Regarding the average online shopping budget, 44.5% of consumers (N=61) spent less than 50 dinars/month and 18.2% (N=16) did not use all the products they bought online. Almost half of participants (N=68, 49.6%) feared that their credit card information would be at risk. The majority of respondents (88.9%) thought they might receive a faulty product following online shopping. Conclusions Our study has enabled us to identify certain factors that may act as a blocker for online purchasing. So that, stablishing strategic actions for the continuous improvement of online shopping services with the reduction of subjectivity in customer perception will be helpful. Disclosure of Interest None Declared

Introduction Giving care to someone who is experiencing mental distress is a difficult and challenging task that could be detrimental to the caregiver’s overall quality of life. Stigma associated with mental illness is one of the most important mental health issues faced by these caregivers. Objectives Our aims were to assess perceived stigma among family caregivers of patients with severe mental disorders and to identify its associated factors. Methods We conducted a descriptive and analytical cross-sectional study among family caregivers of patients followed at the psychiatry outpatient clinic of the Hedi Chaker University Hospital in Sfax, during the period from February 2022 to July 2022. A structured interview questionnaire was designed to collect socio-demographic data of both patients and their caregivers. We used the Stigma Devaluation Scale (SDS) to assess stigma. Results A total of 90 family caregivers of severely mentally ill patients were included: 26 men and 64 women, with an average age of 50.68 ±11.67 years. Patients’ parents accounted for 40% of family caregivers. The majority of family caregivers (83.3%) had no more than secondary education. Married people represented 70% of cases. The median age of patients was 42 years. Schizophrenia was the diagnosis in 68.9% of cases. The mean duration of illness was 16.23 years. Daily assistance lasted from 4 to 8 hours in 30% of cases and more than 8 hours in 66.7% of cases. The mean score (SDS12) for family-focused stigma was 13.12 ± 2.34 with ranges from 8 to 18. Perceived stigma scores were significantly higher among caregivers caring for non-married patients (p=0.04), with an age <50 years (p=0.04), and with a higher level of education (p=0.02). Long duration of providing care (> 8 hours per day) (p=0.05) and insufficient information about the illness (p=0.02) were significantly associated with perceived stigma. Conclusions The clinicians managing patients with severe mental disorders must focus on stigma and psychological distress among the caregivers and plan intervention strategies to reduce stigma. Disclosure of Interest None Declared

Introduction Cannabis is the most widely consumed illegal drug in the world and one of the easiest to access. This drug provides a feeling of well-being and euphoria. However, frequent consumption is associated with several complications including increased impulsivity and an increased risk of suicidal behaviour. Objectives Our objective was to study the link between cannabis consumption, impulsivity and suicide intentionality. Methods We conducted a cross-sectional study, during the period from September 2020 to October 2021, among cannabis users consulting the Sfax Detoxification Center in Tunisia. Impulsivity was studied using the Barrat Impulsivity Scale (BIS 15) and suicide intentionality was assessed using the Suicide intent scale Beck; Pierce (SIS) in subjects with history of a suicide attempt. Results We included 38 consumers. The average age is 26 years old and the sex ratio was 8.5 with an over-representation of men. The average BIS15 score was 38.2 ranging between 19 and 45. We have demonstrated that the higher the level of cannabis dependence, the higher the level of impulsivity. A high level of impulsivity was found in younger subjects (p=0,04) and with a low socio-economic level and unemployment (p =0,021). Suicidal intentionality, assessed in 10 patients with a history of suicide attempt, was low and intermediate in 40% and 60% of users respectively, which means a low to intermediate risk of subsequent completed suicide. Conclusions Impulsivity is associated with aggressive behaviour, various accidents including motor vehicle accidents, more self-mutilation and a much greater risk of dying by suicide than the general population. Frequent cannabis use is also associated with increased risk of developing all types of suicidal behaviours independently of the existence of depressive symptomatology. Overall, it is important to take into account the issues of impulsivity and substance abuse in daily clinical work as they influence the level of dangerousness. Disclosure of Interest None Declared

Introduction The professional quality of life for psychiatry residents is a complex and multifaceted aspect of their careers. However, the demanding nature of their work can place significant stress on their own psychological well-being. Balancing the need to care for patients while also managing personal and professional responsibilities can be challenging. Nevertheless, psychiatry residents have the opportunity to make a profound impact on the lives of their patients and find fulfillment in their work. Objectives To assess the prevalence of burnout (BO) and secondary traumatic stress (STS) among psychiatry residents. Methods We conducted a descriptive online cross-sectional survey in January 2022 among psychiatry residents practicing at Hedi Chaker University Hospital in the Sfax region in Tunisia. Professional life quality was evaluated using The Professional Quality of Life Scale - 5 “ProQOL-5”. Results The total number of residents was 34, of which 91.2% were female. Their mean age was 27.94 years±2.43. They were single in 67.6%. They were residents in adult psychiatry in 61.8% and in child psychiatry in 39.2%. For 91.2% of them, the specialty of adult or pediatric psychiatry was their own choice. The individuals had been practicing psychiatry for an average of two years. They reported a personal medical or surgical history, a personal psychiatric history, and a family history of psychiatric disorders in 32.4%, 8.8%, and 50%, respectively. On the ProQOL-5 scale, we found that 88.2% of the residents had a moderate level of compassion satisfaction, 67.6% had a moderate level of burnout, and 52.9% had a moderate level of secondary traumatic stress. Conclusions Our study showed a moderate professional life quality among psychiatry residents, hence the importance of implementing intervention strategies. Disclosure of Interest None Declared

Introduction Schizophrenia is often considered as pathology of consciousness. Some authors have considered that patients’ self-perception of their cognitive difficulties expressed in the form of subjective complaints could represent a source of stress. These cognitive difficulties may then interfere with the interpretation of symptoms, leading to poor insight. Insight and cognitive complaints in stabilized outpatients with schizophrenia. Objectives Study the relationship between subjective cognitive complaints and clinical insight in a Tunisian population with schizophrenia. Methods This is a cross-sectional, descriptive and analytical study carried out on 72 stabilized patients followed at the post-cure psychiatry consultation ‘A’ at the CHU Hédi Chaker in Sfax diagnosed with schizophrenia according to the DSM 5 criteria. We used the schedule for the Assessment of Insight–Expanded Version(SAI-E) scale to assess Clinical Insight and the Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS) to determine subjective cognitive complaints Results The mean age of the patients was 46.83 ± 11.6 years, with a sex ratio (M/F) of 2. In our study, 48.5% were single and 69.4% were unemployed. The median total SSTICS score was 25. Using the SAI-E scale, an average score of 20.1 was objectified in our study. In our study, the better the insight, the greater the subjective cognitive complaints were in all cognitive domains (p=0.00). Awareness of illness was statistically associated with working memory (p=0.001), explicit memory (p=0.004), attention (p=0.001), language (p=0.01) and executive functions (p=0.001). Conclusions Our study highlights the relationship between awareness of illness and cognitive complaints. The clinician, faced with repetitive cognitive complaints, should assess the insight before incriminating another cause (effects of a drug, cognitive deficit, etc.). Disclosure of Interest None Declared

Introduction Cannabis consumption constitutes a public health problem both because of its serious repercussions and complications and the psychological and social problems it causes. Objectives Our objective was to assess the level of cannabis dependence in consumers receiving care at the Sfax detoxification center in Tunisia, to describe the sociodemographic profile of these consumers and the neuropsychological complications that may be caused. Methods We conducted a cross-sectional study, over a period of 13 months (September 2020 to October 2021), among cannabis users consulting the Sfax detoxification center in Tunisia. We used the Cannabis Abuse Screening Test (CAST) in order to detect a “problematic” cannabis use, along with a clinical information sheet to collect epidemiological and clinical data. All patients gave their free and informed oral consent to participate in the survey while ensuring anonymity. Results We included 38 patients. The average age was 26 years old with a median age of starting cannabis use at 17 years old. The sex ratio was 8.5 with an over-representation of men. Most of the subjects were single, lived with their family and had a secondary school education. Consumption was daily for the majority of patients (68.5%) with an average quantity of 4 joints/day. According to the CAST scale, 36 users (94.7%) had problematic cannabis use. The factors favouring cannabis consumption were stress and anxiety in 34 patients (89.5%) followed by depression and the festive atmosphere in 14 subjects (36.8%) each. Among the participants, 26.3% had a psychiatric history including depression (5.3%), a psychopathic personality disorder (10.5%) and cannabis-induced psychotic disorder (10.5%). History of psychiatric hospitalization and history of suicide attempt were found in 21.1% and 26.3% of the patients respectively. Concerning the complications caused by cannabis, 68.4% of the patients described a phenomenon of tolerance, while 63.2% reported the sensation of craving. Psychotic symptoms such as delirium and/or hallucinations were found in 6 patients (15.8%) and 8 subjects (21.1%) reported a history of overdose in the form of cannabis psychosis. Chronic complications were an amotivational syndrome (63.2%) and social disintegration (52.6%). Treatment of cannabis dependence was considered effective with total withdrawal in 31.6% of subjects. Weaning was partial in 42.1% of the patients. Conclusions Cannabis use is emerging as one among many interacting factors that can affect psychological and physical health, with an impact on various levels including mood, neurocognition and general health. Although studies have shown functional brain mechanisms underlying the effects of cannabis, the exact mechanisms remain unclear. Overall, treatment for substance use disorders generally prevents these complications and improves prognosis. Disclosure of Interest None Declared

Introduction Social networks (SN) addiction is a serious problem among young adults that requires increased attention. Objectives The aim of the study was to assess the relationships between internet addiction and selected psychological characteristics of university students. Methods This is a descriptive and analytical study, conducted over the period from November 2022 to January 2023, among students in various fields. SN addiction was measured using the Social Media Addiction Scale-Student Form (SMAS-SF). The Rosenberg scale was used to assess global self-esteem and the Social Self-Esteem Inventory was used to assess social self-esteem. The Big Five Personality-10 (BFI 10) scale was used to assess the 5 personality dimensions. Results A total of 116 students, with an average age of 25.49, took part in the study. Most students (91.4%) were over 20 years old. They were female in 78.4% of cases. They enrolled in postgraduate studies in 55.2% of cases. The majority of students (59,5%) studied medicine. According to the SMAS-SF scale, the average score was 75.87. The mean score for social self-esteem score was 122.03. Sixty-four participants (55.2%) had low and very low self-esteem. The dominant personality dimensions were extraversion and neuroticism in 15.5% each. Addiction to SN was significantly associated with very low global self-esteem (p=0.028) and a lower social self-esteem score (p=0.011). Low conscientiousness and neuroticism were significantly associated with increased SN use (p=0.007, p=0.004 respectively). Conclusions This study provides a better understanding of the phenomenon of addiction to SN, and enables us to tailor prevention and care more effectively. The psychological factors associated with this behavior need to be more explored in future research. Disclosure of Interest None Declared

Introduction In addition to the classic clinical symptoms, patients with schizophrenia suffer from cognitive difficulties, self-stigma and poor insight. Objectives This study aims to evaluate the impact of stigma, symptom severity, and insight on subjective cognitive complaints in patients with schizophrenia. Methods This is a cross-sectional, descriptive and analytical study carried out on 72 stabilized patients followed at the post-cure psychiatry consultation ‘A’ at the CHU Hédi Chaker in Sfax diagnosed with schizophrenia according to the DSM 5 criteria. We used the schedule for the Assessment of Insight–Expanded Version(SAI-E) to assess clinical insight, The Internalized Stigma of Mental Illness (ISMI) scale for the assessment of internalized stigma, the Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS) scale to determine subjective cognitive complaints and the Positive and Negtive Syndroms Scale (PANSS) to assess positive and negatives symptoms. Results The average age of the patients was 46.83 ± 11.6 years, with a sex ratio (M/F) of 2. In our study, 48.5% of the patients were single, 52.8years,% were smokers and 23 6% consumed alcohol. The level of education did not exceed the primary level for 44.4% of the patients. The average age of disease onset was 24.56 ± 5, 82. Our participants had an average score of 25 on the SSTICS total score and 20.1 on the SAI-E. The median ISMI total score and PANSS total score were 2.45 and 46respectively The predominant negative symptoms(p=0.003), stigma(p=0.009), and insight (p<10-3)were significant factors associated with increased cognitive complaints. Conclusions In schizophrenia, the combination of cognitive difficulties, self-stigma with a low insight makes the management of these patients more difficult. Disclosure of Interest None Declared

Introduction It’s a well-known fact that violence, particularly repetitive violence or violence lasting several years, as is often the case with intimate partner violence (IPV), has a severe psycho-traumatic impact. Although not all women are affected to the same degree or in the same way, post-traumatic stress disorder (PTSD) is the most common mental health consequence of IPV. Objectives To assess the psycho-traumatic impact of IPV on female victims. To study the factors associated with PTSD among these women. Methods We conducted a descriptive and analytical cross-sectional observational study, carried out over a 10-month period from March 2021 to December 2021, among female victims of IPV consulting psychiatric emergencies at UHC Hédi Chaker, Sfax, Tunisia for medical expertise at the request of the court. We studied the PTSD in these women using the Post Traumatic Stress Disorder Checklist Scale (PCLS). Results The total number of participants was 120 with an average age of 37.27 years. The majority had secondary education or less (62.5%), were professionally active (53.3%), and were financially dependent on their partners (26.7%). As for the women’s clinical characteristics, 19.2% were under psychiatric care, 15% had attempted suicide and 10% had a history of childhood abuse. Regarding the couple’s profile, marriage was arranged in 58.3% of cases, and the average duration of marriage was 12.34 years, exceeding 10 years in 44.2% of cases. The impact reported by our women was 100% psychological and 96.7% familial. As a result, 75.8% had sought help from family and friends, and 55.8% had decided to separate from their partners. According to the PCLS scale, 78.3% of female victims showed PTSD with a positive score > 44. It was associated with a higher number of suicide attempts (p=0.04), a marriage duration exceeding 10 years (p=0.02), help-seeking (p=0.001), and divorce (p=0.014). Conclusions PTSD is a particularly serious psychiatric condition. However, its impact remains insufficiently understood and taken into account in medical, psychological, social, and legal care. Knowing the psycho-traumatic consequences of violence is absolutely essential to better protect, support, and care for victims. Disclosure of Interest None Declared

Introduction The prevalence of psychosis in patients with epilepsy is estimated approximately 7.8%. However, postictal psychosis appears to be much less common, with a prevalence of 2% in epilepsy. Postictal psychosis is defined as psychotic episodes starting within less than one week after an epileptic seizure. Objectives Our aim was to study the clinical characteristics and the therapeutic options through a case report and a review of the literature. Methods Case report and unsystematic literature review were obtained by searching the Pubmed.gov database. Thirty-six articles were identified through searches of this database and thirty-five articles were included in the selection of in-text articles integral Results A 32-year-old men patient, without a personal or family history of psychiatric illness, was admitted to a psychiatric unit for a psychotic episode which has started three days before, mystical delusions, irritability, disorganized behavior, and aggressiveness, that had emerged shortly after a cluster of generalized tonic-clonic GTC seizures. Additionally, divided attention and memory deficits were noticed during psychiatric hospitalization. Past medical history was relevant for epilepsy since he was 20 years olds. He did not regularly attend follow-up neurology appointments and had poor adherence to antiepileptic treatment. Last tomography images, a day before the hospitalization in psychiatry, had documented hypodense lesions in the periventricular white matter and subcortical semi-oval center distributed bilaterally and symmetrically suggestive of leukopathy. During the hospitalization, biochemical screening, renal and thyroid function were normal, serologies for B and C hepatitis were negative. Psychotic symptoms subsided in the first 36 hours after admission upon treatment with Risperidone 4 mg/day, carbamazepine 600 mg/day, and 15O mg phenobarbital. Conclusions From our research, we can deduce that although these syndromes are widely recognized, standard diagnostic manuals fail to acknowledge them, resulting in a noticeable lack of attention in the literature. Therefore, it is crucial for physicians to carefully examine patients with known risk factors for the symptoms of postictal psychosis. Disclosure of Interest None Declared

Introduction Schizophrenia is a chronic condition that leads to major socio-professional disintegration and personal suffering. In addition to the classic clinical symptoms, these patients also suffer from poor insight. Objectives To assess insight in a population followed up for schizophrenia Methods We conducted a cross-sectional and descriptive which concerned the patients followed in the unit of outpatient post-cure consultations of psychiatry ‘A’ at the CHU Hedi Chaker of Sfax. We included 72 stabilized patients diagnosed with schizophrenia according to the DSM criteria 5. For the collection of sociodemographic and clinical data, we used a pre-established sheet. We used the schedule for the Assessment of Insight–Expanded Version(SAI-E) scale to assess clinical insight Results The mean age of the patients in our study was 46.83 ± 11.6 years, with a sex ratio (M/F) of 2. They were single in 48.5%, and unemployed in 69.4%. Their level of education did not exceed primary school at 44.4% and their socio-economic level was low at 63.9%. In our study, 72.2% of patients had no somatic history and 36.1% had a history of attempted suicide. Using the SAI-E scale, the mean score was 20.1 with a minimum of 5 and a maximum of 28. Conclusions At the end of this evaluation, it is important to emphasize that insight seems to be an important prognostic factor. Disclosure of Interest None Declared

Introduction Psychiatric pathologies are more common in people with epilepsy than in the general population and have a negative impact on the quality of life of these patients. Objectives The objective of this work is to illustrate, through a series of cases, the complex relationship between epilepsy and psychiatric pathologies. Methods We report the cases of four patients with different psychiatric pathologies associated with epilepsy admitted to the psychiatry department of Hedi Chaker Sfax. We collected the clinical characteristics of these patients based on their medical files. Results The patients were aged 64, 45, 38 and 26 respectively. The first patient had a late-onset vascular epilepsy following the psychiatric pathology onset by 20 years. In the remaining cases epilepsy onset preceded the psychiatric pathology by 6, 3 and 1 year respectively. The aetiology of epilepsy was juvenile myoclonic epilepsy, and idiopathic in 2 cases. The psychiatric pathologies were schizophrenia, obsessive compulsive disorder with schizoid personality, schizoaffective disorder in the bipolar type and mild intellectual disability with histrionic personality, respectively. Familial history of psychiatric disorders was found 2 patients and of epilepsy in one. Conclusions Epilepsy and psychosis have a complex and bidirectional relation. Not only are patients with epilepsy at a greater risk of developing a psychotic disorder, but patients with a primary psychotic disorder are also at greater risk of developing epilepsy. The fact that the association between these pathologies is more frequent than expected should prompt more in-depth studies concerning the underlying etiopathogenic mechanisms to improve their management. Disclosure of Interest None Declared

Introduction Since that the online commerce provides an important shopping environment, it has been argued that traditional buying-shopping disorder may migrate into the online market. Objectives The aims of the current study were to investigate the prevalence of online buying-shopping disorder, and to determine sociodemographic and psychological factors related to this addictive behavior. Methods A cross-sectional, descriptive and analytical study was conducted among subjects who had already made at least one online shopping. Data was collected using a self-questionnaire published by GOOGLE FORMS. Assessment included the short version of the Internet Addiction Test modified for online shopping sites (s-IATshop). The Hospital Anxiety and Depression Scale (HADS) has been used to assess anxiety and depression. Results A total of 137 participants aged 34.62 ± 9.82 years completed the online questionnaire. Only 4 (2.9%) participants had a probable compulsive buying shopping on line. The HADS-A score ranged from 0 to 14, with a mean of 6.85 +/- 3.49 and almost half of the participants (44.5%; N=61) had anxiety symptoms. A high s-IAT shopping score was correlated with secondary or university education (p=0.046). We also found that women, who were younger and had higher incomes, had the highest scores on the s-IAT-shopping scale, without however confirming statistical significance. Conclusions Our study has shown the potential vulnerability factors for compulsive online shopping disorder. Thus, this behaviour deserves to be taken into account in behavioural addictions. Disclosure of Interest None Declared

Introduction Family caregivers of patients suffering from severe psychiatric disorders may present with health problems, lower quality of life, and painful emotions, which can seriously compromise their well-being when they do not receive appropriate professional support. Objectives The aims of this study were to assess the level of burden and resilience in family caregivers of patients with severe mental disorders and to determine associated factors. Methods We conducted a descriptive and analytical cross-sectional study among family caregivers of patients followed at the psychiatry outpatient clinic of the Hedi Chaker University Hospital in Sfax, during the period from February 2022 to July 2022. We used the Connor–Davidson Resilience Scale (CD-RISC) to assess resilience and the Zarit Burden Inventory to assess the level of burden. Higher scores indicate higher resilience and greater burden. Results The sample included 90 family caregivers of patients with severe mental disorders. The average age was 50.68. They were the parents of patients in 40% of cases. Professionally active caregivers accounted for 57.8% of cases. Thirty family caregivers had a somatic disorder history (33.3%). The median age of patients was 42 years. Ten patients (11.1%) were financially independent. The diagnosis was schizophrenia in 68.9% of cases. The mean duration of illness was 16.23 years. Irregular follow-up was noted in 10 patients (11.1%). The mean scores of the Zarit Burden scale and the CD-RISC were 41.86± 10.33 and 58.46± 9.18 respectively. Unemployed caregivers and parents experienced a higher burden (p=0.001, p=0.03 respectively). The level of burden was higher in caregivers taking care of financially dependent patients (p=0.03), with a duration of the disease greater than 15 years (p=0.04), and with irregular follow-up (p=0.008). A low level of resilience in caregivers was correlated with spousal relationship (p=0.001), cohabitation with the patient (p=0.05), widowhood (p=0.01), low level of education (p=0.02), the presence of a somatic disorder history in the caregivers (p=0.04). A negative correlation was observed between CD-RISC and Zarit scores (p=0.04; r=-0.21). Conclusions Family caregivers of mentally ill patients experienced a significant level of caregiver burden, and it was lower in caregivers with higher levels of resilience. Psycho-educational programs directed toward family caregivers are highly recommended. Disclosure of Interest None Declared

Introduction A woman’s emotional dependence on a man refers to a marked need for care, protection, and support, even in situations where the woman is able to function autonomously. This dependence fosters a fusional bond that makes it difficult for the woman to leave the relationship, however unhealthy it may be. This puts the victim at greater risk of suffering and tolerating violence, in particular intimate partner violence (IPV). Objectives To study the emotional dependence of women who are victims of IPV, and to determine the factors associated with this dependence. Methods We conducted a descriptive and analytical cross-sectional observational study, carried out over a 10-month period from March 2021 to December 2021, among female victims of IPV consulting psychiatric emergencies at UHC Hedi Chaker, Sfax, Tunisia for medical expertise at the request of the court. Emotional dependence was assessed using the Emotional Dependence Questionnaire (EDQ) which contains 20 items. Responses are given on a seven-point Likert-type scale which is recoded so that a high score reflects a high level of emotional dependence in relationships. Results The total number of participants was 120 with an average age of 37.27 years. The majority had secondary education or less (62.5%), were professionally active (53.3%), and were financially dependent on their partners (26.7%). As for the women’s clinical characteristics, 19.2% were under psychiatric care, 15% had attempted suicide and 10% had a history of childhood abuse. Tobacco was the only psychoactive substance consumed by 12.5% of the women. The average length of marriage was 12.34 years, exceeding 10 years in 44.2% of cases. Marital conflicts had existed since the very beginning of the relationship in 91.7% of cases. The mean total score of the EDQ was 79.38, indicating a slight emotional dependence of these women on their spouses. It was correlated with childhood violence (p=0.028), smoking (p=0.049), early conflict (p<10-3), and personal psychiatric history (p=0.02). Conclusions A link, probably bidirectional, may occur between emotional dependence and IPV, particularly a link with maintaining the relationship in an IPV context. However, the slight emotional dependence of our victims may explain why they seek help from the police and report the violence. Disclosure of Interest None Declared

Introduction Neurological bladder is considered a functional disability that has a significant impact on the quality of life and psychological state of patients. Psychotropic drugs, in turn, can worsen the urinary dysfunction caused by this disease. Objectives Our objective is to illustrate, through the case of a patient suffering from a neurological bladder decompensated by the treatment of a characterized depressive episode, the link between these two pathologies. Methods We report the case of Ms. M.W., aged 51, with a history of high blood pressure stabilized under nebivolol and a neurological bladder diagnosed 10 years ago with episodic pollakiuria, admitted to the psychiatric department for repeated suicide attempts. She had never used psychoactive substances and had no family psychiatric history. The patient presented depressive symptoms evolving for 5 months. The diagnosis of a characterized depressive episode with melancholic features was made and the patient was treated with sertraline. From the first intake of the drug, the patient presented acute urinary retention (UR) requiring the placement of a permanent bladder catheter. The urinary symptoms improved upon stopping the treatment. Sertraline was changed to olanzapine and escitalopram. The patient stopped the treatment after one month because of the worsening of urinary symptoms requiring the installation of a suprapubic catheter. The urinary problem, together with the cessation of treatment, were responsible for a worsening of psychiatric symptoms leading to multiple suicide attempts. Given the advanced stage of the neurological bladder demonstrated by the urodynamic tests, our patient was treated with paroxetine, quetiapine and oxazepam along with psychotherapeutic education. The evolution was characterized by improvement in psychiatric symptoms and the urinary symptoms were stable. Results The lack of improvement after treatment discontinuation could be explained by an underlying neurological bladder manifesting with pollakiuria. The current literature on UR induced by psychotropic treatments is quite rare limited in case reports. This effect occurs especially when selective serotonin reuptake inhibitors (SSRIs) are prescribed in combination with other antipsychotics. Unlike first generation antipsychotics, atypical antipsychotics have muscarinic receptor antagonist properties which can induce UR. Among atypical antipsychotics, olanzapine has been shown to have the greatest antimuscarinic effects. Regarding SSRIs, they are associated with a lower risk of UR than other antidepressants and sertraline had the highest risk of UR. Conclusions SSRIs can induce UR particularly in combination with atypical antipsychotics. Coordination of care across multiple specialties and understanding the side effects of psychotropic medications can enable faster diagnoses and adequate management. Disclosure of Interest None Declared

Introduction Intimate partner violence (IPV) is a major source of perceived stress for the women who suffer from it. To cope, they tend to implement multiple coping strategies depending on a number of contextual factors including, among others, the severity and frequency of abuse, the duration of the relationship, and available resources such as social support and financial resources. Objectives To study the coping strategies used by women who are victims of IPV. To study the factors associated with coping strategies among these women. Methods We conducted a descriptive and analytical cross-sectional observational study, carried out over a 10-month period from March 2021 to December 2021, among female victims of IPV consulting psychiatric emergencies at UHC Hedi Chaker, Sfax, Tunisia for medical expertise at the request of the court. The Brief-COPE is a 28-item self-assessment questionnaire designed to measure coping with a stressful life event. It can be divided into 3 subscales: problem-focused, avoidance-focused, and emotion-focused. Results The total number of participants was 120 with an average age of 37.27 years. The majority had secondary education or less (62.5%), were professionally active (53.3%), and were financially dependent on their partners (26.7%). As for the women’s clinical characteristics, 19.2% were under psychiatric care and 15% had attempted suicide (SA). Almost all the women surveyed (99.2%) had reported at least one previous incident of IPV. These incidents were daily in 60.5% of cases. Emotional violence was severe in 75.8% of women. The emotion-focused strategy was the most widely used, with a mean score (29.68) on the Brief cope scale. It was correlated with the absence of a personal psychiatric history (p=0.02), the absence of SA (p=0.036), and the occasional frequency of IPV (p=0.037). The scores for problem-focused coping and avoidance-focused coping are 19.3 and 17.24 respectively. Avoidance-focused coping was negatively correlated with the presence of severe emotional abuse. Conclusions The most used strategy by our population was the emotion-focused strategy, with a relatively high average score compared to the other strategies. Indeed, it may be an extremely effective strategy for recovering from a traumatic event, through actions designed to help these women manage and relieve their psychological distress and reduce its negative impact. Disclosure of Interest None Declared

Introduction The nature of psychiatry as a specialty dealing with mental health and emotional well-being may contribute to the perceived stigma. These misconceptions and biases can impact the way psychiatry residents perceive their profession, their own self-esteem, job satisfaction, and overall well-being. Objectives Our goal was to evaluate the experience of stigma among psychiatry residents. Methods A descriptive cross-sectional online survey was conducted in January 2022 among psychiatry residents at Hedi Chaker University Hospital in Sfax, Tunisia. The Clinician Associative Stigma Scale (CASS) was used to assess stigmatization experiences. Results A total of 34 residents participated in this survey. Their average age was 27.94 years ± 2.43, with 91.2% being female. Of the participants, 61.8% were adult psychiatry residents, and 39.2% were child psychiatry residents. Additionally, the choice of adult psychiatry or child psychiatry specialty was self-determined in 91.2% of cases. The participants had an average of 2 years of experience in psychiatry. They reported a personal medical or surgical history, a personal psychiatric history, and a family history of psychiatric disorders in 32.4%, 8.8%, and 50%, respectively. The average CASS score was 47.09 ± 8.32. The mean scores for the “discomfort with disclosure” factor, the “stereotypes about mental health professionals” factor, the “negative stereotypes about individuals with serious mental illness” factor, and the “negative stereotypes about effectiveness” factor were respectively 8 ± 3, 9.44 ± 2.57, 15.62 ± 5.7, and 11.35 ± 3.33. Conclusions Our study highlighted that residents in psychiatry suffered stigma. Special attention should be given to reducing this phenomenon in this population. Disclosure of Interest None Declared