The Tunisian association for Research and Prevention of Psychosocial and Organizational Risks in Workplace

Organizes:

Africa and Middle East Congress on Addiction

List of partners:

Faculty of Medicine of Monastir

University of Monastir

International Brain Research Organization (IBRO)

Khat Research Program, University of Minnesota

University hospital of Monastir

Arabic Network for Behavioral Medicine

National Office of Family and Population

Order of the Physicians, the Regional Council of the center

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Welcome to AMECA 2016 Greetings to all attendees of AMECA 2016! It gives me a great pleasure to welcome you all on behalf of the Scientific Committee and the International Steering Committee to the 4th Africa and Middle East Congress on Addiction (AMECA). I am so proud to have this conference be held in the Tunisia and particularly here in the beautiful coastal city of Monastir. The goal for AMECA is to provide a venue to gather researchers and clinicians from multiple fields including medicine, psychology, public health, and related fields in these regions. We have particularly focused our efforts in reaching out to our colleagues throughout the continent of Africa and the Middle East to develop a scientifically and professional responsive and credible mission. There is growing recognition of the heavy toll addictive disorders and related mental heath problems have in Africa and the Middle East. The impact of these problems is particularly complicated by socioeconomic conditions and low access to health care. The 4th conference in Tunisia focuses on the impact of psychological trauma and life adversity on addictive behaviors and mental health problems. The program includes a rich agenda with multiple sessions and symposia in addition to multiple plenary presentations. These sessions cover a wide range of scientific and clinical issues related to trauma, life adversity, addiction and mental health problems in the region. Training workshops focusing on the conference theme will also be conducted every afternoon of starting on December 1st. Multiple instructors are involved in the workshop, which will also cover a wide range of issues related to the neuroscience of stress, assessment, and treatment. In addition, general training topics will include methods and strategies for conducting research in the region, opportunities for collaboration, and ethics in research. Attendants of the conference and workshop will be senior scientists from the region and other parts of the world. This provides junior attendees outstanding opportunities for networking and developing research and training collaborations. I would like to express my thanks to the Africa Regional Committee (ARC) and the International Brain Research Organization (IBRO) for their generous support. I would like to dedicate this event the original champion who invited the congress to Monastir, the late Prof. Mohamed Soltani, the head of the department of Community and Preventive Medicine, University of Monastir who is deeply missed. I also would like to thank all colleagues who have helped in preparing this conference including organizers in Tunisia for their outstanding efforts under the leadership of Dr. Sana El Mhamdi. We also thank the University of Monastir and The Monastir Medical School for providing infrastructure and resources needed for the conference. Welcome to Monastir! Mustafa al‟Absi Chair, AMECA Scientific Committee

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Welcome to Monastir!

I am delighted to welcome you all to the 4th Africa and Middle East Congress on Addiction (AMECA). This is an outstanding initiative that complements our ongoing research and capacity building efforts in neuroscience in Africa and the Middle East.

As the Chair of the AMECA 2016 Organizing Committee, I am so proud to see this conference coming together here in Monastir, Tunisia. The hard work of dedicated individuals has helped us in putting together this interesting program. It is a testimony to the dedication of all of you who actively engaged in preparing for the conference, submitted abstracts, and came to attend this conference. I am so proud of all of you! I see this conference as setting an important milestone for advancing addiction and mental health research in Africa and the Middle East, and I am so proud to be part of it. I hope that the conference will be a great opportunity for networking with your colleagues who are doing similar work in the region and for identifying future collaborations. I encourage you all to take advantage of this opportunity. I also welcome your comments and suggestions for future AMECA activities. I welcome you again, and I hope you have intellectually exciting experiences at AMECA 2016. I also hope you enjoy our beautiful Monastir!

Bienvenu chez nous ! Sana El Mhamdi Chair, AMECA 2016 Local Organizing Committee

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Local Organizing Committee

Dr. Sana El Mhamdi: Faculty of Medicine, University of Monastir Tunisia (Chair) Dr. Ines Bouanene: Faculty of Medicine, University of Monastir, Tunisia Dr. Arwa Ben Salah: Faculty of Medicine, University of Monastir, Tunisia Pr. Naoufel Gaddour: Faculty of Medicine, University of Monastir, Tunisia Dr. Jihen Maatoug: Faculty of Medicine, University of Sousse, Tunisia Dr. Lamia Bouzgarrou: Faculty of Medicine, University of Monastir, Tunisia Mr. Amara Tamboura: University Hospital of Monastir, Tunisia

International Organizing Committee

Pr. Mustafa al‟Absi, University of Minnesota, USA (Chair) Pr. Nouria Lakhdar-Ghazal, University Mohammed V-Agdal, Morocco Dr. Florence Baingana, University School of Public Health, Uganda Pr. Félicien Karege, College of Science and Technology, Rwanda Pr. M.K. Luabeya, Neuro-psychiatric hospital Saint-Martin Dr. Micheline Marie-José Essi, University of Yaoundé, Cameroun Pr. Abdul Mohammed, Karolinska Institute, Sweden

Scientific Committee

Pr. Mustafa al‟Absi, Chair, University of Minnesota Medical School Pr. Ali Chadly: Dean of the Faculty of Medicine, University of Monastir, Tunisia Pr. Hajer Aounallah-Skhiri, National Institute of Public Health, Tunisia Dr. Florence Baingana, Makerere University School of Public Health, Uganda Pr. Richard Hoffman, University of Minnesota, USA Pr. Félicien Karege, University of Rwanda, Rwanda Dr. Andrin Lemieux, University of Minnesota Medical School Pr. Abdul Mohammed, Linnaeus University, Sweden Dr. Motohiro Nakajima, University of Minnesota, USA Dr. Michael Odenwal, Konstanz University, Germany Dr. Khalid Saeed, WHO/EMRO office, Egypt

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We would like to dedicate AMECA 2016 to the soul of Pr. Mohamed Soltani, head of the department of Community and Preventive Medicine, University of Monastir (Tunisia)

Pr. Soltani was dedicated and optimistic leader in community medicine. He championed multiple national initiatives including the development of Community and Preventive Medicine in Tunisia. He paid special attention to young scientists. His office was always full of young scientists seeking advice, which he readily gave.

5 Thursday, December 1, 2016

Title: opening day activities

13:00-16:30 Registration desk open

14:00-16:00 Pre-congress training workshops: - Designing a Community-based research: (Facilitators: Pr. Kamel Ben Salem & Dr. Jihen Maatoug) - Ethical conduct of research (Facilitators: Pr. Mustafa al‟Absi & Pr. Ali Chadly)

16:00-16:30 Coffee and tea break

16:30-17:30 Congress Opening ceremony: Sana El Mhamdi, Chair, Organizing Committee, AMECA Mustafa al‟Absi, Chair, Scientific Committee, AMECA Pr. Ali Chadly, Dean of the Faculty of Medicine of Monastir Pr. Mahjoub Aouni, University President

17:30-19:00 Opening reception

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Friday, December 2, 2016

Theme: Addictive behaviors and related psychiatric disorders

8:00-18:00 Registration desk open

8:30-10:00 Oral sessions

Session 1: Tobacco use Chair: Andrine Lemieux, PhD - Exposure to Adverse childhood experiences and smoking behavior among Tunisian adults (Hela Abroug; University of Monastir, Tunisia) - Passive smoking and adverse fetal outcomes in non-smoking pregnant women in Tunisia (Amal Amara; University of Monastir, Tunisia) - Epidemiology of psychoactive substances use among university students in Morocco: a cross-sectional questionnaire survey (Btissame Zarrouq; Sidi Mohammed Ben Abdallah University Morocco) - Gender difference in tobacco, alcohol and substance use among Tunisian students in the region of Sousse (Jihen Sahli; University of Sousse, Tunisia) - Alcohol abuse during pregnancy: Somatosensory defects in adult mice exposed to pre-natal alcohol (Oladiran Olateju; Faculty of Health Sciences, Johannesburg)

Session 2: Psychostimulants use Chair: Kamel Ben Salem, MD - The combination of developmental stress and genetic predisposition influences the response to psychostimulants (Jacqueline Womersley; University of Cape Town, South Africa) - Injecting drug use and risk of HIV transmission (Hayet Hamdouni; Ministry of Health, Tunisia) - Khat and alcohol use is associated with enhanced subjective distress (Motohiro Nakajima; University of Minnesota, USA) - Outcome of management of Adult ADHD in drug dependent patients (Khaled Helmy; Alex Health Resort, Alexandria, Egypt) - Addiction to screens: a new threat for mental health? ( Asma Guedria; University of Monastir, Tunisia)

10:00-11:30 Coffee/Tea Break and Poster Session 1 (Poster session 1: Poster presenters should be available and standing by their posters to answer questions. Please see list in the program booklet.)

7 11:30-13:00 Plenary symposium: The “MIMOSA” Program: Updates on research on life adversity and substance abuse problems

Chair: Lamia Bouzgarrou, MD - Social violence and smoking: Sana El Mhamdi - Adversity, craving and smoking relapse: Andrine Lemieux - Adversity, gender and patterns of tobacco use: Motohiro Nakajima - Impact of social childhood adversities on pregnancy outcomes and early postpartum period: Arwa Ben Salah

13:00-14:30 Lunch break

14:30-15:30 Debate: Is addiction a disease or a crime? Facilitator: Pr. Mustafa al‟Absi

Side 1 Side 2 Dr. Nidhal Haj Salem Dr. Abir Aissaoui Pr. Hajer Aounallah-Skhiri Mr. Chadly Sayadi

15:30-16:30 Coffee/Tea Break and Poster Session 1 (Poster session 1: Poster presenters should be available and standing by their posters to answer questions. Please see list in the program booklet)

16:30:18:30 Training workshops: - The science of addiction (Dr. Nora Volkow; the National Institute of Drug Abuse (NIDA)) - Treating addiction with Acceptance and Commitment Therapy (ACT) (Facilitator Dr. Ghanem Amara)

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Saturday, December 3, 2016

Theme: Exposure to violence and related addictive behaviors and mental health disorders

8:00-18:00 Registration desk open

8:30-10:00 Oral sessions

Session 3: Trauma and mental health Chair: Arwa Ben Salah, MD - Adverse childhood experiences and mental disorders among young adults in Tunisia (Sana Bhiri, University of Monastir, Tunisia) - Experienced discrimination among substance-dependent individuals (Lamia Jouini, Razi Hospital, Tunisia) - Dealing with trauma, substance use and mental health problems in post disaster and post conflict areas: the case for a community approach (Shamil Wanigaratne, National Rehabilitation Centre, Abu Dhabi, UAE) - Correlates of substance abuse among victims of insurgency in Maiduguri, Borno state (Ibrahim Mshelia, Nigeria) - Psychopharmacological interventions for Co-morbid PTSD and SUD (Ahmed Elkashef, National Rehabilitation Centre, Abu Dhabi, UAE)

Session 4: Psychostimulants and mental health comorbidity

Chair: Naoufel Gaddour, MD - Cannabis use in adolescence and bipolar disorder: a case report and review of the literature (Mouna Attia University of Monastir, Tunisia) - Attention deficit / hyperactivity disorder and substance use behaviors: a Tunisian

pilot study (Takoua Brahim, University of Monastir, Tunisia) - Impact of alcohol use disorder on functioning in remitted bipolar patients (Kaouthar Hajbi, University hospital Hedi Chaker Sfax, Tunisia) - Psychosis and cannabis (Aymen Kachouchi, University hospital Mohamed VI Marrakech, Morocco)

10:00-11:30 Coffee/Tea Break and Poster session 2 (Poster session 2: Poster presenters should be available and standing by their posters to answer questions. Please see list in the program booklet)

11:30-13:00 Plenary symposium: Impact of domestic violence: A regional perspective Chair: Hajer Aounallah-Skhiri, MD, PhD - Domestic Violence against women as a part of the honour: Pr. Mete Gulmen - Violence: Medicolegal aspects: Dr. Abir Aissaoui - The experience of ONFP in fighting against gender based violence in Tunisia: Dr. Hela Ouennich / Dr. Ridha Gataa

13:00-14:30 Lunch Break

14:30-15:30: Plenary symposium: Women mental health and addiction concerns: Role of trauma, society, and biology Chairman: Karim Aouam MD, PhD - Drugs and the brain: what has sex got to do with it?: Jacqueline Womersley - Examining sex differences in sexual risk behaviors and sexual orientation after exposure to social violence: Manel Ben Fradj - Sex differences in glucocorticoid and opioid functions and nicotine addiction: Andrine Lemieux

9 15:30-16:30 Coffee/Tea Break and Poster session 2 (Poster session 2: Poster presenters should be available to presenters should be standing by their posters to answer questions)

16:30-18:00 Training workshops Impact of trauma and adverse life experiences on addictive behaviors and mental health Applications Lectures: Medical evaluation of traumatic events (Facilitator: Dr. Nidhal Haj Salem) Effects of trauma, and other forms of violence on brain functions and behaviors: Psychological assessment and treatment (Facilitators: Dr. Andrine Lemieux, Dr. Mustafa al’Absi)

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Sunday, December 4, 2016

Theme: Research on addiction and related mental disorders in the MENA region

8:00-18:00 Registration Open

8:30-10:00 Oral sessions Session 5: Prevention and treatment of addictions Chair: Lotfi Gaha, MD

- Addiction treatment from an attachment perspective (Zaineb El Moutassim, University hospital Mohamed VI Marrakech, Morocco) - Promotion in Mental Health: The Role of a Training Program on General Practitioners, Tunisian experience (Nesrine Bram, University of Tunis, Tunisia) - Mr. M and the dangerous ally: a case study about alcohol dependence and its cultural implications (Lamia Jouini, Razi Hospital, Tunisia) - Evaluation of mobile apps for addiction on virtual stores (Hayat Sedrati, University of Rabat and National School of Public Health Rabat, Morocco) - Substance misuse prevention and treatment interventions in conflict and post-conflict settings (M. Claire Greene, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA)

Session 6: Addiction and mental health comorbidity Chair: Motohiro Nakajima, PhD

- Teen dating violence and suicide risk in Morocco: Fez city as a case study (Soukaina El Kinany,Sidi Mohamed Ben Abdellah University, Fez, Morocco) - Work addiction: are academic physician at risk? Preliminary results of a Tunisian bicentric study (Irtyah Merchoui, University of Monastir, Tunisia) - Chronic stress exposure induces depression and sexual disorders: alternative treatment with Nymphaea lotus Linn (Kameni Poumeni Mireille, University of Yaounde, Cameron) - The gut microbiome as the next frontier in addiction research (Khawla Tadist, University Mohammed Premier, Oujda, Morocco) - Cross-validation of Center for Epidemiologic Studies Depression Scale (CES-D) in Moroccan adolescents (Btissame Zarrouq, Sidi Mohammed Ben Abdallah University, Fez, Morocco) - The correlation between teen dating violence and psychoactive substances use in Morocco: Fez city as a case study (Soukaina El Kinany, Sidi Mohamed Ben Abdellah University, Fez, Morocco)

10:00-11:30 Coffee/Tea Break and Poster session 3 (Poster session 3: Poster presenters should be available and standing by their posters to answer questions)

11:30-13:00 Training workshop Impact of trauma and adverse life experiences on addictive behaviors and mental health Applications Lectures: Initiation to structured assessment of child and adolescent mental health

11 (Facilitator: Pr. Naoufel Gaddour) Addiction and mental health research in Africa: Challenges and opportunities (Facilitators: Dr. Ridha Gataa / Dr. Sana Bhiri / Pr. Mustafa al’Absi)

13:00-14:30 Lunch break

14:30-15:30 Coffee/Tea & Poster session 3 (Poster session 3: Poster presenters should be available and standing by their posters to answer questions)

15:30-16:00 Award and closing ceremony Closing remarks

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Posters

Day 1: December 2; 2016

1. Tobacco product use among Moroccan university students Btissame Zarrouq Sidi Mohammed Ben Abdallah University of Morocco

2. Alcohol dependence and male sexual disorders Mireille Kameni Poumeni University of Yaounde I, P.O BOX 812, Yaounde, Cameroon

3. Knowledge, attitudes and smoking behaviors among Tunisian adults in 2014 Asma Ben Cheikh University of Sousse Tunisia

4. Substance use among college students in the region of Sousse Tunisia: prevalence and risk factors Nawel zommit University of Sousse Tunisia

5. What we know about electronic cigarettes Najla Bahloul University of Sfax, Tunisia

6. Addiction in Tunisian Anesthetists Meriem Maamar University of Tunis, Tunisia

7. A successful intervention program of tobacco cessation in a Tunisian factory Sana Bhiri University of Sousse Tunisia

8. Effects of caregivers addictions and family instability on child well-being in Sousse, Tunisia Mohamed Yassine Braham University of Sousse Tunisia

9. Tobacco oral addiction at Sidi Bouzid : Clinical characteristics Lotfi Omri Regional Health Direction, Sidi Bouzid, Tunisia

10. Neffa users and cardiovascular diseases: what relationship? Lotfi Omri Regional Health Direction, Sidi Bouzid, Tunisia

11. Clinic profile smoking to consultation of cessation aid smoking at Sidi Bouzid Lotfi Omri Regional Health Direction, Sidi Bouzid, Tunisia

13 12. The project of a new law on addictive drugs in Tunisia: what contribution? Dorra Oualha university of Monastir, Tunisia

13. Impact of alcohol on the quality of life Houda Ben Ayed University of Sfax, Tunisia

14. Smoking or good quality of life? Houda Ben Ayed University of Sfax, Tunisia

15. Evaluation of perceived stress and addictive behavior among students Fatma Guermazi University of Sfax, Tunisia

16. How Iranian female drug users, describe their sexual norms through drug journey: A gender-based study Fabria Yadolahi Iran University of Medical Sciences, Tehran, Iran

17. Addictive substance use among school children in Sousse Tunisia in 2014 Rim Ghammam University of Sousse Tunisia

18. Effectiveness of three years school-based intervention to prevent smoking in Sousse Tunisia 2009-2014 Rim Ghammam University of Sousse Tunisia

19. Addiction and care in prison Hela Rabhi General Directorate of prisons and rehabilitation Prison of Mornaguia, Tunisia

20. Injecting drug users; sociodemographic characteristics and aspect of married life Jihene Jendoubi University of Tunis, Tunisia.

21. Smoking cessation: Predicting factors of failure Asma Kheder University of Tunis, Tunisia

22. Assessment of smoking cessation interventions in the military community Asma Kheder University of Tunis, Tunisia

23. Dependence on Nefopam: About a case Hicham Lakbiri Mohamed V University, Morocco

24. Gender differences in tobacco use among patients attending the smoking cessation clinic of Monastir (Tunisia) Manel Ben Fredj University of Monastir, TUNISIA 14

25. Parenting style and its influence on alcohol use in adolescence Mariem Turki University of Sfax, TUNISIA

26. Why do adolescents drinks? The role of social context Mariem Turki University of Sfax, TUNISIA

27. Sociodemographic characteristics and motivations to quit buprenorphine use in an adult sample Meriam Moella University of Sfax, TUNISIA

28. Addictive behaviours of Adolescents Bellali Nadia Ar-razi Psychiatric University Hospital, Salé, Morocco

29. Substance use among male forensic patients Molka Mezghani University of Tunis, Tunisia

30. Prevalence and associated factors of benzodiazepine dependence in the elderly Najeh Smaoui University of Sfax, TUNISIA

31. Addictive behaviors among hospital nurses: prevalence survey in 65 workers of the university hospital of Tahar Sfar-Mahdia Awatef Mahfoudh University Hospital Tahar Sfar- Mahdia-Tunisia

32. Correlates of smoking habits among Tunisian university students Meriem Nouira National Institute of Public Health, Tunis, Tunisia

33. Substance use among university health sciences‟ students Meriem Nouira National Institute of Public Health, Tunis, Tunisia

34. Awareness of the consequences of alcohol consumption among university students Meriam Nouira National Institute of Public Health, Tunis, Tunisia

35. The draft reform of the law relating to narcotics in Tunisia Rihab Naoui University of Sfax, TUNISIA

36. Healthcare providers and addictive disorders Jammeli K. University of Sfax, TUNISIA

15 37. Prevalence of nicotine dependence among interns in medicine and resident doctors Sahar Ellouze, University of Sfax, TUNISIA.

38. Prevalence and risk factors of internet misuse among adolescents Salma Hentati University of Sfax, TUNISIA

39. Smoking and obstructive sleep apnea Samira Mhamdi University of Tunis, Tunisia

40. Perceived stress and screen addiction in adults Kaouthar Yaich University of Sfax, Tunisia

41. Study of the level of osteocalcin in tramadol addicts compared to heroin and normal controls Shaimaa Khirt Department of Psychiatry and Addiction, New Nozha Hospital, Alexandria, Egypt

42. Drinking and driving: statistics and forensic repression Nesrine Belkhedja University Hospital Annaba

43. Office Hospitalization: statistics and forensic analysis Nesrine Belkhedja University Hospital Annaba

44. Eating disorders: Real addiction? Mounia Bitar Razi hospital in Salé, Rabat, Morocco

45. Internet addiction and its association with Traumatic experiences among adolescents. Fatima Ezzahra El Yazidi Department Of Psychiatry, Marrakesh

46. An intervention for alcohol use disorders in people living with aids and its impact on drinking and HIV treatment outcomes-a pilot study in Harare Munyaradzi Madhombiro University of Zimbabwe

47. Addiction to the Internet and video games among students in the University of Sidi Bel Abbes in the year 2012/2013 (Algeria) Latifa Kerroucha University Sidi Bel Abbes, Algeria

48. Bipolar disorder and cannabis Ghaya Jmii University of Tunis, Tunisia

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49. The use of coffee, tobacco and energy drink by interns in medicine and resident doctors and addiction Izdihar Lajmi University of Tunis, Tunisia

50. Problematic use of the internet in Tunisian university students Meriam Nouira National Institute of Public Health, Tunis, Tunisia

51. Burnout physicians and addictive behaviors Najla Bahloul University of Sfax, Tunisia

52. Knowledge, attitudes and practices of sayada high school pupils towards the smoking Fahima Hassine Primary Health Care Center, Monastir, Tunisia

53. Cross-sectional study of sport practicing and tobacco dependence among resident doctors and interns in medicine Farah Cherif University of Sfax, Tunisia

54. Self-reported prevalence of risk behaviors among Tunisian college students in the region of Sousse Zedini Chekib University of Sousse, Tunisia

55. Problematic Internet Use and associated factors in young adults Guermazi Fatma University of Sfax, Tunisia

Day 2: December 3; 2016

56. Sociodemographic and drug use characteristics of cannabis users in a rehabilitation center Meriam Moalla University of Sfax, Tunisia

57. Risk awareness of health outcomes of tobacco smoking Meriam Nouira National Institute of Public Health, Tunis, Tunisia

58. Alcohol use among medical students Salma Hentati University of Sfax, Tunisia

59. User‟s satisfaction of the electronic medical record in the hospital information system, Oran – Algeria Amina Belghitri University of Oran, Algeria

60. The quality certification of causes of death in the Euh Oran, Algeria Amina Belghitri University of Oran, Algeria

17 61. Clients‟ subjective experience of therapist-disclosure: helpful and hindering factors and conditions Lorato Kenosi. Botswana 62. Alexithymia in patients with substances abuse Ahlem Hajri, University of Tunis, Tunisia

63. Screens and ADHD: Study on 447 Tunisian students Amjed Ben Haouala University of Monastir, Tunisia

64. Suicide and addictive behaviors Aymen Kachouchi. University of Marrakech, Morocco

65. Impact of smoking on the treatment of schizophrenia Maroua. Daoud Regional Hospital of Gabes-Tunisia, University of Sfax, Tunisia

66. Attitudes of Tunisian young psychiatrists towards mental health patients with substance and alcohol abuse Lamia Jouini. University of Tunis, Tunisia

67. Does clozapine treatment influence smoking behaviours among psychiatric patients? Lamia Jouini University of Tunis, Tunisia

68. Depression comorbidity with alcohol use disorder, epidemiology etiological factors and therapeutical management: a case report Lyazid Chanoune. Public Hospital of Proximity Sidi Aich Bejaia, Algeria

69. Profile of psychiatric inpatients with cannabis abuse Fatma Guermazi University of sfax, Tunisia

70. Pokémon Go: a new addiction? Feki Rim University of Tunis, Tunisia

71. Alexithymia in Alcohol Use Disorders Feriel Ghali University of Tunis, Tunisia

72. Smoking is it a risk factor for difficult asthma Feki Walid University of Sfax, Tunisia

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73. Comorbid substance use disorders among psychiatric outpatients I Hachaichi University of Sfax, Tunisia

74. Smoking among psychiatric outpatients I. Hachaichi. University of Sfax, Tunisia

75. Workaholism among interns in medicine and resident doctors Izdihar Lajmi University of Sfax, Tunisia

76. PTSD and major depression after Yemeni civil war: A case report of a refugee woman from Yemen Souad Kajam University of Mohammed V Souissi, Morocco

77. Ortho surgical treatment in improving sleep apnea patients Ines Dallel University of Monastir, Tunisia

78. Impact of cannabis use disorder on the course of bipolar disorder Hajbi Kaouthar University of Sfax, Tunisia

79. Acute psychotic episode after a single ingestion of „ecstasy‟ Mariem Moalla University of Sfax, Tunisia

80. Prevalence and correlates of depression and anxiety among addicts Mariem Moalla University of Sfax, Tunisia

81. Prevalence of psychiatric comorbidity in Tunisian children and adolescent with addiction Mouna Attia University of Sfax, Tunisia

82. Assessment of the relationship between affective temperament and alcohol consumption Nada Charf University of Sfax, Tunisia

83. Cross-sectional study of sport practicing and tobacco dependence among resident doctors and interns in medicine Nada Cherif University of Sfax, Tunisia

84. Addictive behavior and borderline personality Nadia Bellal Ar-razi Psychiatric University Hospital, Salé, Morocco

19 85. Wedded life and alcohol addiction Nadia Bellali Ar-razi Psychiatric University Hospital, Salé, Morocco

86. Nicotine dependence and psychiatric comorbidities among elderly patients Najeh Smaoui University of Sfax, Tunisia.

87. Tobacco use among elderly psychiatric patients Najeh Smaoui University of Sfax, Tunisia

88. Prevalence of internet addiction among university students in the region of Sousse Tunisia Zammit Nawel University of Sousse, Tunisia

89. Gambling and its correlates among Tunisian university students Meriam Nouira National Institute of Public Health, Tunis, Tunisia

90. Substance abuse and psychiatric comorbidities in Tunisian substance dependent individuals (SDI) Rania Zaouche University of Tunis, Tunisia

91. Misuse of trihexyphénidyl among psychiatric patients Jammeli. K University of Sfax, Tunisia

92. Attachment style and cyber addiction among Tunisian students Rim Masmoudi University of Monastir, Tunisia

93. Dependence on cigarettes and smoking cessation motivation among bipolar patients Sahar Ellouze University of Sfax, Tunisia

94. Problematic video game use among adolescents Salma Hentati University of Sfax, Tunisia

95. Socio-demographic and clinical profile of smoking schizophrenic patient Samah Elleuch Regional Hospital of Gabes, Tunisia

96. Nicotine dependence, anxiety and depression in smoking adolescent Samah Elleuch Regional Hospital of Gabes, Tunisia

97. Role of alcoholism on levels of depression and anxiety in smokers of smoking cessation consultation of Sahloul hospital: A cross-sectional study. Sihem Ben Fredj University of Sousse Tunisia

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98. Cyber addiction and anxiety among students. Kaouthar Yaich University of Sfax, Tunisia

99. Relationship between tobacco dependence and anxiety and depression disorders among smokers of smoking cessation consultation of Sahloul hospital Héla Ghali University of Sousse Tunisia

100. Chronic khat chewing and its effect on mental health, in Hosanna Town, Ethiopia Fikirte Getachew Abate Black Lion Specialized Hospital, Ethiopia

101. Cybersex addiction among medical students Wafa Abbes University of Sfax, Tunisia

102. Prevalence of mental disorder and malnutrition among secondary school-going adolescents in Freetown, Sierra Leone Abubakarr Bah University college hospital, Sierra Leone

103. Prenatal stress induces vulnerability to nicotine addiction and alters DRD2 expression in the nucleus accumbens of adult rats Nadia Said Hassan II University, Casablanca, Morocco

104. Profile of intimate partner violence in Tunisia Saloua Shimi. university of Monastir, Tunisia

105. Violent death of a newborn, autopsy case report Lilia Saker Ibn Rochd university hospital - Annaba-Algeria

106. Traumatic experiences among users of alcohol Nadia Bellali Mohamed V University, Morocco

107. Influences of stigma and discrimination on default of HIV positive adolescents on HAART in Gaborone Aobakwe Bacos Malejane University of Botswana, Gaborone, Botswana

108. Quality of life of permanent night workers: The case of healthcare staff Aouatef Mahfoudh University of Monastir, Tunisia

21 109. Mental health of nurses: A cross sectional study conducted in the regional hospitals of the governorate of Mahdia in Tunisia Aouatef Mahfoud University of Monastir, Tunisia

110. Ethical issues of weaning addicted prisoners Meriem Beji University of Monastir, Tunisia

Day 3: December 4; 2016

111. Psychological counseling to former Senegalese hostages in the context of the Casamance conflict El Hadji Makhtar BA Fann Teaching Hospital, Senegal

112. Suicide by hanging of children: autopsy case report Lilia Saker Ibn Rochd university hospital - Annaba-Algeria

113. The effect of alcohol abuse on post-traumatic stress disorder in mice: Severity, extinction and psychotraumatic relapse Asmae Lguensat Cadi Ayyad University, Marrakech, Maroc.

114. Aggressions in pre-hospital emergency medicine: A cross sectional study among 51 health care workers Aouatef Mahfoudh University of Monastir, Tunisia.

115. Violence in health care settings: A study conducted in three hospitals in Tunisia Aouatef Mahfoudh University of Monastir, Tunisia.

116. The Influence of Individual lifestyle factors on the quality of life Alila Samar University of Sfax, Tunisia

117. Adverse childhood experiences and sleep disturbances among Tunisian pregnant women Amel Amara University of Monastir, Tunisia.

118. Social interactions, traumatic life event and ADHD: About 447 Tunisian students Amjed Ben Haouala University of Monastir, Tunisia.

119. Cases of suicide by self-immolation in Kairouan (west central Tunisia) during the period from 2011 to 2015 Meriem Beji Kairouan’s Hospital-Tunisia

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120. Ethical Consideration of using physical restraint Meriem Beji Kairouan’s Hospital-Tunisia

121. Can we predict the risk of institutional violence? Interest of the actuarial approach Ines Bouanene University of Monastir, Tunisia.

122. Factors associated with suicide attempts among patients attending a Tunisian emergency department Ines Bouanene University of Monastir, Tunisia.

123. Predictor factors of mental health disorders in victims of child maltreatment: a study of 317 case of child abuse in Sousse, Tunisia Mohamed Yassine Braham University of Sousse, Tunisia

124. Risk factors of child abuse and neglect and its effects on school performance in a Tunisian population sample Mohamed Yassine Braham, University of Sousse, Tunisia

125. Violence against children in Tunisian schools and institutions: study in the region of Sousse Mohamed Yassine Braham University of Sousse, Tunisia

126. Addictive behaviors among Tunisian women victims of sexual assault Mohamed Yassine Braham University of Sousse, Tunisia

127. Evaluation of an innovative action in awareness of teenagers against drug abuse in the community of Akouda Chiraz-Dorsaf Makni CSB Jawhara Groupement de santé Sousse1.

128. Suicide in women: Medico legal aspects in a Tunisian population Dorra Oualha University of Monastir, Tunisia.

129. Children‟s rights in Tunisia: legal and ethical issues Dorra Oualha University of Monastir, Tunisia.

130. Comparing assessments durations of temporary total disability (TTD) attributed by forensic doctor and general practioner Marwa Boussaid University Hospital of Mahdia-Tunisia.

23 131. Role of doctors in protection of the incompetent adults Marwa Boussaid University Hospital of Mahdia-Tunisia.

132. Rules of redaction of the primary medical certificate and medico-legal implications Marwa Boussaid University Hospital of Mahdia-Tunisia.

133. Epidemiological profile of old social insured individuals with depression at the regional Monastir Center of the National Health Insurance Office Hazar Bhouri The regional Monastir center of the National Health Insurance Office.

134. Exposure to social violence during childhood and the Risk of depression and anxiety among Tunisian adults Hela Abroug University of Monastir, Tunisia.

135. Self-harm in prison Hela Rebhi General Directorate of prisons and rehabilitation Prison of Mornaguia.

136. Female homicide victims: Autopsy study of 66 cases Imen Hmila University of Monastir,Tunisia

137. Health-related quality of life determinants during Tunisian medical internship Irtyah Merchaoui University of Monastir, Tunisia

138. Residents‟ Experiences of workplace Harassment in Tunisian medical sector Irtyah Merchaoui University of Monastir, Tunisia

139. Anxiety and depression during internship and residency: A cross sectional study in two Tunisian university hospitals Irtyah Merchaoui University of Monastir, Tunisia

140. The influence of attachment style on internet usage Hend MAATOUK University of Monastir, Tunisia

141. Sexual assaults: legal aspects comparison between Tunisia and other European countries Wael Majdoub Ibn El jazzar Hospital, kairouan, Tunisia.

142. Child sexual assault: An analysis of 134 cases Wael Majdoub Ibn El jazzar Hospital, kairouan, Tunisia.

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143. Determinants of stress at work: Data from the center of Tunisia Mohamed Bouhlel University of Monastir, Tunisia

144. Influence of occupation on the quality of life in different occupational sectors Mohamed Bouhlel University of Monastir, Tunisia

145. Cognitive behaviour therapy for children‟s posttraumatic stress disorder: a case report Mouna Attia University of Monastir, Tunisia

146. Assessment of the relationship between affective temperament and alcohol consumption Nada Charfi University of Sfax, Tunisia.

147. Intimate partner violence in relation with addictive behaviors and mental health outcomes

Meriam Nouira National Institute of Public Health, Tunis, Tunisia.

148. Adverse childhood experiences, addictive behaviors and mental health outcomes: Results of a study in university settings Meriam Nouira University of Tunis, Tunisia.

149. Links between violence, addiction and severe mental disorders: An updated literature review Amira Belkhiria University of Tunis, Tunisia.

150. Types of life experiences enhancing addictive behaviors Rania Zaouche University of Tunis, Tunisia.

151. Child sexual abuse: An analysis of 262 cases Sami Ben Jomaa, University of Monastir, Tunisia

152. Video games addiction in children with Autism spectrum disorders and Attention deficit hyperactivity disorder Ons Souid University of hospital Monastir, Tunisia University of Monastir, Tunisia

153. Epidemiological status of suicide in Tunisia Data from the first national suicide surveillance report 2015 Afef Skhiri National Institute of Public Health University of Tunis, Tunisia

25 154. The consequences of domestic violence: a prospective study on a sample of 100 people examined the forensic unit of the University Hospital of Annaba Youcef Mellouki University Hospital Annaba, Algeria

155. The lethal violence against women in the region of Annaba: Retrospective study of two years Youcef Mellouki University Hospital Annaba, Algeria

156. Quality of life among substance addicts: a case-control study Mariem Moalla University of Sfax, Tunisia

157. Illicit drug use and associated factors among youth Meriam Nouira National Institute of Public Health, Tunisia

158. How to treat the onychophagia Malek Ghorbel University of Monastir, Tunisia

159. Problematic Facebook use and social anxiety: Results of a cross-sectional study Sourour Trabelsi university of Sfax, Tunisia

160. Occurrence of stereotyped behaviors by clobazam: A case report Olfa Harzallah Primary Health Care Center, Monastir, Tunisia

161. Relationship between Epworth score and severity of sleep apnea syndrome: Validation in homogeneous group Mounira Sahtout. Primary Health Care Center, Monastir, Tunisia

162. Obstructive sleep apnea syndrome and high blood pressure Mounira Sahtout. Primary Health Care Center, Monastir, Tunisia

163. Identifying addictive behaviors among adolescents: A school based survey Maroua Daoud Psychiatry Department, Regional Hospital of Gabes

164. Epidemiological profile of injecting drug users in Tunisia Houyem Khiari Salah Azeiz Institute, Tunis, Tunisia

165. Detoxification attempts among injecting drug users in Tunisia Houyem Khiari Salah Azeiz Institute, Tunis, Tunisia

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E-Posters Abstracts

27

P-1 : Tobacco product use among P-2 : Alcohol dependence and male Moroccan university students. sexual disorders. Btissame Zarrouq, Asmae Chaib, Kameni Poumeni Mireille, Dzeufiet Mohammed El Amine Ragala, Karima Djomeni Paul Desire, Mengue Sandrine, Halim, Hamid Slali, Badiaa Lyoussi, and K. Mballa Marguerite, Tchoupou Huguette, El Rhazi Dimo Theophile, Kamtchouing Pierre. Sidi Mohammed Ben Abdallah University University of Yaounde I, P.O BOX 812, of Morocco Yaounde, Cameroon

Abstract : Abstract : Background and aims: The use of different Background and aim: Alcohol consumption forms of tobacco among university in Cameroon is estimated to be 2.6 liters of students in Morocco is not well described. pure alcohol per capita for men and Aim:The aim of this study was to estimate women older than 15 years. About 41.4% the prevalence and determinants of the of men consume alcohol regularly in use of all forms of tobacco among students Cameroon. The usual diet in Cameroon is of the Sidi Mohamed Ben Abdellah rich in alcohol content and excessive University at Fez city. alcohol intake is a common finding. This Methods: A cross sectional survey was study is aimed to establish the link conducted in 2015 in the Sidi Mohamed between alcohol consumption and related Ben Abdellah University. A self- male sexual problems. administered anonymous questionnaire Methods: NIAAA (National Institute on was distributed to a sample of students. Alcohol Abuse and Alcoholism) and Data entry was made on MS-Excel and relevant review and trials were searched. analysis of results on SPSS V20. Results: Chronic alcohol use is known to Results: A total of 550 students (62% induce male sexual disorders, which leads male) with a mean age of 22 ± 4 years to marked distress and interpersonal participated in this study. The cigarette difficulty. Previous research showed that was the most common tobacco product ethanol inhibits normal erectile function used with a last month prevalence of and reduces sperm count with an 49.4%, followed by chewing tobacco irreversible prostate atrophy. Episodic (34%), sniffing tobacco (24.3%) and erectile failure in alcoholic men is fairly hookah (12, 8%), which was turn away routine, found to be significantly higher in from its basic use. Among hookah users, men consuming more than three standard 35.5% reported mixed tobacco and units of alcohol (12 g ethanol) daily. Van molasses with benzodiazepines, while Thiel and Lester reported that 61% of 12.3% have put alcohol instead of water in patients dependent on alcohol reported the hookah vases. Multivariate analysis sexual dysfunction. showed that the use of tobacco in its Conclusion: Sexual dysfunction is common various forms was highly associated with in patients with alcohol dependence. the male gender (OR range from 11.6 for Heavy drinking proportionately increases tobacco sniffer to 37 for chewing tobacco, the risk. While much has been discovered p <0.0001), the study in the limited access over the past 30 years about the nature institutions (OR range from 1.08 to 2.7, p and extent of alcohol use disorders and <0.0001) and high monthly income (OR = their treatment, there is still much more to 9.4; CI-95% [3.1 to 28.1]). be learned. Multidisciplinary and Conclusion: Efforts are needed to be made transdisciplinary approaches may increase to slow the increase in new tobacco understanding in many areas: normal and products that are attractive to young abnormal biology and behavior related to students and that pose many of the same alcohol use; improved diagnosis, health risks as those related to cigarettes. prevention, treatment, and finally, enhanced quality healthcare for all. 28

P-3 : KNOWLEDGE, ATTITUDES AND P-4 : SUBSTANCE USE AMONG SMOKING BEHAVIORS AMONG COLLEGE STUDENTS IN THE REGION TUNISIAN ADULTS IN 2014. OF SOUSSE TUNISIA: PREVALENCE Asma Ben Cheikh, Jihène Maatoug, Rim AND RISK FACTORS. Ghammam, Sana Bhiri, Nawel Zammit, Zedini Chekib, Zammit Nawel, El Imed Harrabi, Hassen Ghannem Ghardallou Mariem, Mellouli Menel, Sahli University of Sousse Tunisia Jihen, Limem Menel, Mtiraoui Ali, Ajmi Thouraya, University of Sousse Tunisia Abstract : Background and aims: Smoking in adults Abstract : is a major public health in Tunisia. The aim Background: Substance use among of this study was to determine knowledge, college students represents one of the attitudes and smoking behaviors among most complicated social problems. Tunisian adults in 3 districts of the region Studying its socio-demographic predictors of Sousse in 2014. and the associated risk behaviors could Methods: We conducted a cross-sectional help deal with this problem more survey in 2014 among adults randomly efficiently. selected from 3 districts of the region of Aims: To determine the prevalence of Sousse. This study included 1977 adults substance use and related factors among aged from 18 to 65 years old. We used a Tunisian college students. questionnaire administered by interviewers Methods: Cross sectional study was to collect knowledge, attitudes and conducted in the university setting of the smoking behaviors among Tunisian adults. region of Sousse-Tunisia in 2012-2013 Results: Of the 1977 study participants, school-year. A sample of 556 college 67% (n=1200) were women. The current students responded to a self-administrated smoking prevalence was 20.8% (n=410) questionnaire. Collected data concerned [47.7% of men and 3.3% of women]. The socio-demographic characteristics and mean age of onset of tobacco use was substance use. 18.7ans ± 5.9. Concerning Knowledge of Results: The mean age of students was smoking's harmful effects: Current 21.8±2.2 years. Girls represented 51.8%. smokers were significantly less likely than Among participants: 31(5.6%) had nonsmokers to believe smoking is related consumed illicit substance. Cannabis was to lung cancer (90.7% vs 95.2%, p<0.002), the main substance used by 26(4.7%) cataract (40.6% vs 45.9%, p=0.036), students. Strong addiction was found abortion of pregnant women (66% vs among 9(31%) consumers. The average 72.9%,p<0.007)and decreased fetus age of the beginning of substance use was weight at birth(67.9% vs 75.9%,p<0.000). 19(±2.5) years. Illicit substance use was However,, they know that passive smoking significantly greater among boys, students was significantly associated to sudden with low socioeconomic level, smokers, child death (77.2% vs 71.3%, p<0.048). drinkers and those who had problematic Almost one third of smokers thought that internet use than respectively: girls, they could not stop smoking during the students with medium to high next six months. In fact, the most socioeconomic level, non smokers, non obstacles of smoking cessation reported drinkers and who controlled their internet were difficulty (34.4%) and no courage use. Binary logistic regression showed that (47%) of smoking cessation, respectively. alcohol consumption, tobacco use and low Conclusions: Intensive effort must be done socioeconomic level were the most to improve knowledge of smoking's influential predictive factors on substance harmful effects and to promote smoking use. cessation. Conclusion: This study highlights the socio-demographic predictors and the other risk behaviors associated to 29

substance use among college students in P-6 : Addiction in Tunisian Anesthetists the region of Sousse. Future interventions Meriem Maamar, Uta Ouali, Lamia Jouini, should take in consideration these risk Rabaa Jomli, Yosra Zgueb, Fethi Nacef factors. University of Tunis, Tunisia

P-5 : What we know about electronic Abstract : cigarettes. Background : Anesthetists are exposed to Bahloul N, Mkaouar N, Fki W, Baati I, a number of risks, including the risk of Ayadi H, Masmoudi J, Kammoun addictive behavior. This risk seems to be University of Sfax, Tunisia particularly elevated in this group of Abstract : physicians given the often stressful Background: The electronic cigarette or E- working conditions and the accessibility of cigarette is the new alternative to tobacco. psychoactive substances in emergency It produces a visually smoke like the settings and intensive care units. smoke produced by burning tobacco. It Method:We conducted a cross-sectional was controversial in the scientific literature study amongst residents in anesthesia and until today. intensive care who have completed an Aim:Our objective was to evaluate the anonymous self-administered knowledge of health professionals on the questionnaire and responded to the electronic cigarette. Perceived Stress Scale. Methods:Our survey was conducted within Results:Our sample consists of 32 the Hedi Chaker hospital. We interviewed residents. The majority were women 50 health professionals on their knowledge (78.1%). The mean age was 29.66 years. about the electronic cigarette by filling out The average number of night-shifts was an information sheet. 2.16 per week. Nearly half of the residents Results:The health professionals included (49.6%) worked more than 60 hours per in our study had an average age of 29 week. Five residents reported a psychiatric years, 69% were female, 70% were history of anxiety and depressive physicians and 26% nurses. The majority disorders. 12.5% of our population were (80%) wasn't smoking against 13% were smokers. One third of our sample (31.3%) current smokers. 74% of surveyed regularly used alcohol. Two residents subjects wanted to have information about occasionally used cannabis. 68.8% of the electronic cigarette. The adverse residents reported, that access to effects of electronic cigarette were the psychoactive substances required no response in more than half the cases. 36 control. Only one resident consumed persons thought that the electronic psychoactive substances, and this in an cigarette is not an effective way to quit experimental purpose. However, 68.8% of smoking and 60% thought it was rather a our sample knew colleagues who used means of initiation to smoking. Among the these substances, residents in 40.1% of 7 smokers, only 3 have tried the electronic cases, but also interns, specialists, and cigarette and rated it as ineffective. 89% of paramedical staff. The average score of health professionals were not advised to the Perceived Stress Scale was 29.94 with buy the electronic cigarette. 36% don‟t a standard deviation of 5.47. In 78.1% of know where sells electronic cigarettes cases, life was perceived as a perpetual against 35% who responded by sales threat, which corresponds to an important office. 56% had no idea about the price of stress. this cigarette. Conclusions:Residents in anesthesia and intensive care are exposed to significant stress. Their access to psychoactive substances being generally easy, addictive behavior in this environment is frequently reported. 30

P-7 : A SUCCESSFUL INTERVENTION Conclusions: The success of the PROGRAM OF TOBACCO CESSATION intervention might incite employers to IN A TUNISIAN FACTORY. involve a sustained tobacco cessation Sana Bhiri, Jihene Maatoug, Rim policy within their companies in the Ghammem, Asma Bechikh, Sihem Ben perspective of improving workers fredj, Nawel Zammit, Mustafa al'Absi, performance and mental health. Harry Lando, Hassen Ghannem University of Sousse Tunisia P-8 : EFFECTS OF CAREGIVERS ADDICTIONS AND FAMILY Abstract : INSTABILITY ON CHILD WELL-BEINGIN Background: Occupational environment SOUSSE, TUNISIA. influences heavily the workers physical Braham MY, and mental health. University of Sousse Tunisia Aim: To test the feasibility of a tobacco cessation program in Tunisian Workplace Abstract : setting. Background: Addictive behaviors of Methods: We conducted an interventional caregivers and family instability are well- pre-experimental study among 100 known risk factors of child abuse and smoking worker men in a pasta products neglect. industry. Participants administered a Aim: To describe their impact on child well- questionnaire by interview at the pre and being in the region of Sousse. post assessment. Three months Methods: From 2006 until 2015, we intervention consisted in an open retrospectively examined the files of all the sensitization day on tobacco cessation, a case of child abuse and neglect collective motivational interview with investigated at the child protection office in smokers insufficiently motivated for Sousse (Tunisia). cessation and consultations of tobacco Results: 317 cases of child abuse and cessation within the company. neglect were collected. Alcohol abuse was Results: The average age of participants found among 21 (6.62%) caregivers. The was 36.9 years ± 9.7. They consumed type of maltreatment that prevailed was Cigarette in 93% of cases, in addition to emotional abuse with a significant hookah in 15% and exclusive hookah in association, followed by neglect and 7%. The reason for smoking was largely physical abuse. Violence was most often to relieve anxiety (49%). According to perpetrated by the father. We noted family Fagerström score, 18.3% were very instability in 59.5% (n=153) of cases; dependent. However, 41.9% were very divorce in 24.1% (n= 62), separation in motivated to quit smoking. Among 21.8% (n= 56), families with a single cigarette smokers, 25% quitted smoking, mother were noted in 13.6% (n= 35). and 5% became hookah smokers after the Absence of one of the parents or both was intervention. Smokers who stopped common (43% ; n=117). Incarceration and smoking were younger (p = 0.01), single (p death of one of the parents were collected = 0.005), had a lesser number of respectively in 31 and 8 cases. Marital cigarettes smoked per day (p = 0.008), a conflict was noted in 33,8% of families shorter average seniority of smoking (p = (n=87). A significant association was found 0.006), a lower level of exhaled CO (p = between the absence of parents and the 0.005) and a lower anxiety score (p = child's exposure to neglect. However, 0.08). However those who continue children living with their parents were more smoking have lowered their Fagerström likely to suffer from emotional and sexual score (p <0.001), the level of exhaled CO abuse. (p = 0.001) and the number of cigarettes Conclusions: Caregivers addiction and smoked per day (p <0.001). family instability poses a threat to the child with a risk of abuse and neglect. Protection 31

measures must be taken inside families in Abstract : order to prevent dangerous outcomes. Background: Smoking is currently a major problem of public health. It‟s responsible for an important morbidity and mortality. It P-9 : TOBACCO ORAL ADDICTION AT should be the most preventable cause SIDI BOUZID : CLINICAL because the dangers are now known to CHARACTERISTICS. the majority of the population, including Lotfi OMRI, Raoudha SAKHRI ; Fatma smokers. DERBALI; Sana EL MHAMDI Materials and methods:Through our study Regional Health Direction, Sidi Bouzid, in the Sidi Bouzid region, we are interested Tunisia in the study of cardiovascular risk factors Abstract : in a particular population who consume Background: In Tunisia, as everywhere Neffa. else in the world, the form of the most Results:We noted that they are a men, not common smoking is smoking tobacco obese (mean BMI = 24.7), cardio- (cigarettes).Another form has attracted our metabolic history were observed in 11% of attention is snuff, commonly called the cases (5.6% have hypertension and 5.6% “NEFFA”. have a diabetes).Blood pressure in this Materials and methods:We conducted an population is as follows: (a) PA systolic epidemiological study in the region of Sidi average : 121.8 ± 17.49 mmHg (min: 100 Bouzid (middle of Tunisia) on 150 max: 170); (b) PA diastolic mean : 76.5 ± auctioneers of Neffa . 8.5 mmHg (min: 60 max: 95); (c) 1/3 are Results:It is clear from this work, that: (a) a either strongly or very strongly dependent clear male prominence, in fact less than on the Fargeström index.As against these 10% of Neffa users are female; (b) 60 % of people consume on average 5 kg of the respondents perform a job, and two tobacco and a half year or 15 grams on thirds have an education level not average daily basis. exceeding the primary; (c) more than half Conclusion:Our study confirms the low of Neffa uses in their lip with an average of dangerousness of oral tobacco, but may 15 grams daily since 5 to 6 kg of tobacco well serve as a basis for strengthening our annually; (d) 25 % strongly or very strongly region‟s application of the minimum anti- dependent. smoking advice. Conclusion:From the results of our study, we are forced to conclude that smoking is P-11 : CLINIC PROFILE SMOKING TO a real scourge in our society and it is CONSULTATION OF CESSATION AID urgent that a program be developed and SMOKING AT SIDI BOUZID implemented very quickly to curb the Lotfi OMRI, Fethi BEYAOUI ; Mahmoud current trend towards the increase of this SLIMANI smoking phenomenon. Regional Health Direction, Sidi Bouzid, The results of the KAP (Knowledge, Tunisia Attitude and Practices) should guide aims to take into account such a program. It Abstract : should also move towards the target to hit. Background : Tobacco control is one of public health priorities for action in Tunisia. P-10 : NEFFA USERS AND This struggle was marked by the CARDIOVASCULAR DISEASES: WHAT establishment in December 2009 to aid RELATIONSHIP ? smoking cessation units. As part of an Lotfi OMRI, Raoudha SAKHRI ; Fatma initial assessment of these centers, we DERBALI; Sana EL MHAMDI investigated the clinical profile of smokers Regional Health Direction, Sidi Bouzid, seeking the consultation of smoking Tunisia cessation in primary health care group of Sidi Bouzid. 32

Methods:A descriptive cross-sectional treatment. However, these laws are study was conducted among smokers is deemed very repressive. They introduced being presented at the consultation of the sanction of attending consumption smoking cessation during 2014. Data areas and prohibits“attenuating collection was made from consultants circumstances”. A new bill of 8 chapters records. and more than 40 articles is underway. It Results:The study population was considers drug addicts as sicks. The new exclusively masculine men with a mean law is about the establishment of a age of 41 ± 11 years. framework for the prevention and the Anxiety was found in 51% of establishment of rehabilitation centers, the consultants.More than half (61.2%) were adoption of a new sanctions regime. In heavy smokers and strongly addicted to fact, the new law is moving towards cigarettes (75%). Among the consultants replacing sentences by community service. 55% were motivated to stop smoking and It also try to reduce the sentences, to drop 40 % have tried at least once to quit the charges against any addict who feels smoking. the need to follow a cure of detoxification, Conclusions:Smokers are being presented and that before or after the discovery of at the consultation aid cessation of Sidi the offense for the first two times. Bouzid group were characterized by Conclusion: Despite these changes, the anxious and depressive tendencies and new law is far from unanimity. In fact, had a high level of physical many articles are still controversial. dependence.This analysis confirms that the request for aid in smoking cessation P-13 : Impact of alcohol on the quality specialist comes smokers having a of life. particular profile and having great difficulty Ben Ayed Houda, Jedidi Jihène. Alila quitting. Samar. Mejdoub yosra. Kammoun Sourour. Feki Habib. Kassis Modher. P-12 : THE PROJECT OF A NEW LAW Karray Raouf. Dammak Jamel ON ADDICTIVE DRUGS IN TUNISIA: University of Sfax, Tunisia WHAT CONTRIBUTION? Dorra Oualha, Nidhal Haj Salem, Mariem Abstract : Belhadj, Sami Ben jomaa, Imen Hmila, Backgrounds: We aimed to assess the Amal Mosbahi, Ali Chadly, impact of alcohol the quality of life (QOL). university of Monastir, Tunisia Methods: We conducted a comparative study including some visitors contacted in Abstract : the 2 university hospitals of Sfax. We used Background: Since the application of the the questionnaire of QOL (SF 36) to Law 92-52 on narcotics, the number of compare QOL between alcoholics (G1) persons brought to court has continued to and no alcoholics (G2). It was a validated increase which results in job loss or questionnaire with 2 summary scores: the interruption of studies. physical composite score (PCS) for Aim:Our aim is to assess the present laws physical health and mental composite in addictive substances, their weakness score (MCS) for mental Health. The and discuss the project of the new law. threshold of each score was set at 66.7%. Materiel and methods: a review of legal Results: We included 26 subjects in G1 aspects in Tunisia about the project of a and 44 subjects in G2. We verified the new law on addictive drugs. comparability between the two groups in Results: The actual laws allow addicted terms of socio-economic status, medical person before the discovery of the facts, to history and sport. Men were more frequent make a request, but only for one time, to in G1 (80.8% vs 50.3%; p= 0.017), as well track a cure for detoxification. It allows also as smoking (80.8% VS 38.6%; p=0.01). the court to order a detoxification We counted 9 daily alcoholics (34.6%). 33

The mean SF36 was 69.7±29.3. We found was significantly lower in G1 (p <0.001). It 27 cases with altered QOL (38.6%). SF36, included general health (p <0.001), PCS and SCM were significantly better in physical function (p <0.001), physical G2 (78±19 VS 55±23 ; p<0.001), limitation (p <0.001) and physical pain ( p (80.8±20.7 VS 56±27 ; p<0.001), <0.001). SCM was significantly lower in G1 (75.2±18.6 VS 55±22 ; p<0.001) (p<0.001). It included mental health respectively. PCS included general health (p<0.001), emotional limitation (p<0.001), (73.3±22 VS 51.6±18.4; p <0.001), social functioning (p<0.001) and vitality physical function (83±24 VS 60±34; (p<0.001). The number of cigarettes and p<0.001), physical limitation (86±26 VS the SF-36 were significantly correlated (r=- 50±39; p <0.001) and physical pain 0.4 ; p=0.025). Comparison between the (80.4±24 VS 61±33, p=0.013). MCS groups after adjustment for alcoholism, sex included mental health (68±19 VS 54.±22; and ages showed the persistence of the p=0.01), emotional limitation (88.7±23 VS association between smoking and bad 57.7±38.6; p=0.001), social functioning QOL (p=0.01; ORa=18). (77.9±24 VS 60.3±27; p=0.009) and vitality Conclusion: Tobacco is a risk factor of (66.4±21 VS 50.7±20.4; p=0.003). impaired QOL. This could be an additional Conclusion: Alcohol is a risk factor of an argument to encourage peoples to quit altered QOL either in mental or physical smoking. function. Prevention of addictive behaviors is highly recommended. P-15 : Evaluation of perceived stress and addictive behavior among P-14 : SMOKING OR GOOD QUALITY students. OF LIFE? Guermazi Fatma, Halouani Najla, Yaich Ben Ayed Houda, Jedidi Jihène. Alila Kaouthar, Ennaoui Rihab, Chouayakh Samar. Kammoun Sourour. Mejdoub Sameh, Aloulou Jihen, Amami Othman yosra. Feki Habib. Kassis Modher. Karray University of Sfax, Tunisia Raouf. Dammak Jamel University of Sfax Abstract : Aim :To assess perceived stress among Abstract : students and identify addictive behavior Backgrounds Our aim was to assess the associated with such State impact of tobacco on QOL. Methods :A transversal survey was carried Methods: We conducted a comparative out during the first half of September 2016. study including some visitors contacted in A sample composed by 35 students was the 2 university hospitals of Sfax. We used randomly selected from the Sfax medical the questionnaire of QOL (SF 36) to university. Students were asked to compare QOL between smokers(G1) and complete a self-anonymous questionnaire no smokers (G2). It was a validated collecting socio demographic and addictive questionnaire with 2 summary scores: the behavior's data. The questionnaire physical composite score (PCS) for included: The Perceived Stress Scale, physical health and mental composite Internet Addiction Test, Facebook score (MCS) for mental Health. The addiction scale, Videogame Test (Tejeiro threshold of each score was set at 66.7%. criteria), and online network game scale Results: We included 30 persons in each (DSM IV criteria). Addictions to substances group. We checked the comparability of (caffeine, tobacco, shisha, alcohol) were the groups in terms of socio-economic measured according to the criteria of status, medical history and sport. The DSM5. percentage of men was greater in G1 (p= Results : In our sample, 57.1% of students 0.01), as well as alcoholism (p<0.001). were female and 42.9% were male. The SF36 was significantly lower in G1than G2 average age was 23.71years. Thirty six (59.9±12.9 VS 88.6±8.3; p<0.001). SCP percent of students have a safe state of 34

stress for health. Perceived stress was behavioral reactions to internalized stigma significantly associated with a severe included avoiding or delaying seeking addiction to smoking (p = 0.042), the risk treatment. In addition, the stigma process of addiction to online games network (p = is conceived to occur within three 0.019), the consequences of the use of categories: feeling worthless, violence, and video games (p = 0.032), and internet experiencing moral distress. problematic use with serious Participants described how they traveled repercussions for life (p = 0.004). Having an unplanned journey, to sex work and an addiction to caffeine, chicha, alcohol violence which they experience. and problematic use of Facebook were not Conclusions :Social forces such as gender significantly associated with stress. role reinforcing violence and stigmatizing Conclusion: Stress is a well-known risk conditions that predispose these female factor for addiction. Students seem to use drug users to sex work and engaging in preferentially some addictions according to unsafe sex practices. In our point of view, their state of stress. A better community-based health services and understanding of stress triggers in the providing protective health care in women- students would be necessary to limit this only centers are recommended. way to cope. P-17 : ADDICTIVE SUBSTANCE USE P-16 : How Iranian Female Drug Users, AMONG SCHOOL CHILDREN IN describe their Sexual norms through SOUSSE TUNISIA IN 2014 Drug journey:A gender-based study. Rim Ghammam, , Jihene Maatoug, Asma Yadolahi F, Ben Cheikh, Sana Bhiri ,Nawel Zammit, Iran University of Medical Sciences, Imed Harrabi, Hassen Ghannem Tehran, Iran University of Sousse,Tunisia

Abstract : Abstract : Background :Female drug users are seen Aim: Identify the prevalence of addictive as extremely vulnerable group in Iran. The substance use, among schoolchildren in lack of gender specific research studies Sousse Tunisia 2014. and treatment services provides little Methods: We conducted a cross-sectional information impact of substance abuse on study during 2013-2014 school years. It female drug users. Exploring sexual risks concerned children of 15 colleges of and violence in these women during their Sousse aged from 11 to 16 years old in 7th drug journey may help health providers to and 9th grade. It was a random, understand their needs, and conducting proportional and stratified sample. We efficient interventions. used a self-administrated questionnaire in Methods:Five focus groups and 24 Arabic filled in presence of trained individual in-depth interviews were investigators to collect socio-demographic conducted with 17 female drug users. characteristic and drug use habits. In this Women were interviewed in the women- study we have excluded tobacco and only drop-in center in the south of Tehran. alcohol use. Chi-square test to compare Thematic and narrative analysis was used percentages, with 0.05 level of to analyze the data. significance, was used. Results :The key themes to emerge from Results: The study included 4275 the data were gender, stigma, sex work. schoolchildren, 48.2% of them were boys. Female drug users are doubly stigmatized The mean age of our sample was as being a woman and substance user. 13.27±1.21 years. The prevalence of drug High levels of internal stigma were found in use was 1.7%. The most frequently used our study. They believed that sex work and drugs were: Inhaled drugs 55.6%, substance use downgraded a woman Cannabis 18.1%, Artane 8.3% and Other more and more socially and morally. Their drugs in 18.1% of cases. The average age 35

of first time drug use was 9.75±4.76 years. intervention group, there was a non The proportion of schoolchildren who used significant decrease in tobacco use from one kind of drug more than twice was 5.7% at baseline to 4.8% at post 13.5%. In this study, 9.3% of participant intervention (p= 0.2). Whereas, in the reported that at least one person from the control group tobacco use increased people around used drugs.There was a significantly from 7.5% to 9.2% (p=0.04). significant difference between boys (2.1%) After adjusting for sex, there was a non and girls (1.3%) who used drugs significant decline in tobacco use among (p=0.034). the prevalence of children both boys and girls. While, in control group younger than 14-years-old who used a we observed a significant increase of kind of drugs was 0.8% against 2.8% of tobacco use among girls 1.1% to 5.2% children elder then 14-years-old (p<10-3). (p<10-3). We observed also a significant Conclusion: Drugs use among youth is a increase in tobacco use from 3.3% to 5.9% worrying problem in Tunisia. Further among those under 14 years old in the studies are needed to understand its same group (p=0.006). determinants. Conclusion: Integrated and sustainable interventions against tobacco use are P-18 : EFFECTIVENESS OF THREE needed to prevent this unhealthy behavior YEARS SCHOOL-BASED early in childhood. INTERVENTION TO PREVENT SMOKING IN SOUSSE TUNISIA 2009- P-19 : Addiction and care in prison. 2014 Rabhi Hela, Rim Ghammam, Jihene Maatoug, Asma General Directorate of prisons and Ben Cheikh, Sana Bhiri, Nawel Zammit, rehabilitation Prison of Mornaguia, Tunisia Imed Harrabi, Hassen Ghannem, University of Sousse,Tunisia Abstract : Aim: The aim of this work is to highlight the Abstract : various aspects of the medico-psycho- Aim: to evaluate the effectiveness of three social care of drug addicts in prisons. years school-based intervention on Method: this study is based on a collection smoking rates of adolescents in Sousse, given from a questionnaire including Tunisia 2009-2014. epidemiology,drug consumption profile and Methods: We conducted a quasi- support in prison. The questionnaire was experimental school-based intervention filled by 86 male prisonniers incarcered for with intervention group (in Sousse Jawhra, drug use offenses.Theses inmates are Sousse Erriadh) and control group (in randomly selected from a population of Sousse M‟saken). The study concerned 1779 inmates including 443(24.9%)are children of colleges of Sousse aged from consumer misdemeanor defendants 11 to 16 years old in 7th and 9th grade. whose age range between 18 and 26 The intervention lasted 3 years years. (intervention), with data collection at pre- Results: The age way of our patients was intervention during 2009-2010 school 22.29 years. 81.38% have a hight school years and at post-intervention during 2013- education. 56.97% are repeat 2014 school years. We used a self- offenders(46.69% readmitted for drug administrated questionnaire in Arabic filled use). 90.69% are derived from an urban. in presence of trained investigators in pre 28% have a family history of drug use. and post-intervention. 53.48% are cannabis smokers and 46.51 Results: At baseline, we included 1929 are polydrug. 93% of our patient have schoolchildren in the intervention group psychosomatic complaints like and 2074 in the control group. After the headache,nervousness,insomnia,memory intervention, 2170 and 2105 schoolchildren inpairement, and anorexia in connection were included in each group. In the with the abrupt withdrawal of drugs. Only 36

2.32% received a psychiatric consultation. the patients declared that they were None has followed withdrawal or unsatisfied with their sex lives, and half of substitution protocol. 37% have changed them attributed it to a lack of physical their habits manifested by excessive capacities. 89 % reported the installation of smoking and other illegal alternatives. their disorders after BHD consumption Conclusion: In the absence of adequately beginning. taken into medical and psychosocial care Conclusion : It is now established that the in place of detention we are faced dry BHD addiction goes with heavy somatic weaning which brings the patient to and psychiatric comorbidity , affecting alternative behaviors.To remedy this it is directly life quality. The emotional necessary to install protocols followed from dimension, which involves the married life, the first day of incarceration to avoid is often obscured or underrated, hence the withdrawal syndromes and substitution need for greater exploration and support of lines and even after his release to reduce the couple. the reduce the risk of recurrence. P-21 : Smoking cessation: Predicting P-20 : Injecting drug users; factors of failure. sociodemographic characteristics and Chiraz Aichaouia, Asma Kheder, Selsabil aspect of married life. Daboussi, Samira Mhamdi, Zied Jendoubi Jihene, Maamri Amira, Ben Moatemri,Cheikh Rezaieg, Hassouna Ahmed, Charradi Salma, University of Tunis, Tunisia Meziou Olfa, Bouasker Anissa, Zalila Haifa University of Tunis, Tunisia. Abstract : BACKGROUND: Smoking is the leading Abstract : preventable cause of death worldwide, and Background: Addiction to high doses of quitting smoking significantly reduces the buprenorphine (BHD) or Subutex risk of dying from tobacco-related administrated by injection, is a true diseases. Smoking cessation counseling is scourge in Tunisia by its increasing spread an effective way to fight against tobacco and its disastrous social and individual addiction. Whichever method used during implications. the intervention, relapsing is always a risk. Aims: The aim of this study is to AIM: Identify predictors of failure of determinate the socio-demographic profile smoking cessation. of injectable BHD users and to assess the METHODS: We conducted a retrospective use consequences on couples‟ study over a 4-year period, including 100 relationship. patients undergoing smoking cessation Methods: We conducted a descriptive interventions in the Pneumology and study among 27 injectable BHD men users Allergology department of the Military selected from our patients in the outpatient Hospital of Tunis. department of psychiatry in the RAZI RESULTS: Our results showed that 80% Hospital and who were in a relationship. of smokers relapsed and 20% achieved Results: The average age in our study was long-term abstinence. Relapsers were 35.6 years. Socioeconomic conditions mostly men (91,25%). The mean age of were difficult or acceptable in 96 % of the smoking onset was 18,82 years. 51% of cases. The average relationship length our patients were heavy smokers (> 20 was 7 years. Female partners average age cigarettes per day). The Fagerström Test was 37,7 years. Dating circumstances of Nicotine Dependence showed that were romantic in 93% of the cases. 27% of 57,5% of relapsers had a strong urge to the selected patients affirmed they were smoke. Nicotine replacement therapy was faithful to their partners. Regarding the prescribed for 81% of the consultants, and partners, 15% had a psychiatric history 16% used varenicline. Six patients and 19% had a history of addiction. 75% of received psychotropic drugs and none of 37

them succeeded quitting smoking. 28% of cases. Only 2,9% of patients had a regular our patients had past medical history of follow-up. Nicotine patches were the most depression. According to the statistical used treatment method (86,8%). The analysis, only medical history of overall success rate at 3 months, 6 months depression was significantly associated and 1 year were respectively 32,4%, 30,4 with the risk of relapse (p = 0,045). The and 25,5%. Successful weaning was results obtained were in good agreement significantly associated with medical with the data from the literature. history of mental illness, the HAD test, the CONCLUSION: A better understanding of Fagerström test of Nicotine Dependence, the predictors of failure is the key to a previous attempts of quitting and a successful smoking cessation intervention. thorough follow-up. A consistent analysis of the determinants CONCLUSION: Our study showed the of relapse would increase the chances of a essential role of the smoking cessation successful weaning in a future counseling in military environment. intervention. However, the results seem insufficient thus reflecting the complexity of this particular P-22 : ASSESSMENT OF SMOKING population. CESSATION INTERVENTIONS IN THE MILITARY COMMUNITY. P-23 : DEPENDENCE ON NEFOPAM: Asma Kheder, Chiraz Aichaouia, Gaiet El ABOUT A CASE. Fida Noubbigh, Samira Mhamdi, Selsabil Lakbiri Hicham, Ait Ouahaqi Zakaria, Daboussi, Zied Moatemri, Cheikh Rezaieg Achour Loubna, Ouanass Abderrazzak University of Tunis, Tunisia Mohamed V University, Morocco

Abstract : Abstract : Background: Tobacco is a major Background : Nefopam (Acupan) is a healthcare issue in Tunisia. The bearing analgesic 1 (OMS). It is indicated uniqueness of the military environment in the "symptomatic treatment of painful makes it conducive to the spread of this conditions." However, it is not like other addiction. analgesics, its chemical structure and its Methods: We conducted a retrospective mode of action are differents. He holds of study over a 12-year period including 204 atropine and dopaminergic effects. There military patients of the Pneumology and by, nefopam is related to amineptine and Allergology department of the Military tianeptine. Nefopam seems not to be Hospital of Tunis, aiming the assessment sought for its hallucinogenic effects, but for of smoking cessation counseling program, its effects on mood and psychostimulants: smokers‟ characteristics and predictors of amphetamine like. Dependence appears a successful weaning. within 3 months. And withdrawal syndrome Results: Patients were mostly men with a resulting in is ananxiodepressive state. mean age of 46,8. 51% were officers and Methods :We go into this work and through non-commissioned officers. A history of the case of Mr R. 54, followed psychiatric illness was reported in 10,3% schizophrenia for several years, of consultations. The HAD test (Hospital hospitalized for the treatment of a nefopam anxiety and depression scale) revealed problematic use, following a fracture of the 28,9% of depression and anxiety right tibial tray, we will highlight the disorders. The mean age of the onset of particularity and difficulty in charge of this smoking was 18,82 years. Previous case management. attempts to quit were found with 35,3% of Results : In the literature, many withdrawal the patients. The consultation was tests by psychostimulant were proposed, motivated in 76% of the cases by a but without satisfactory results. A case of medical condition. The Fagerström score withdrawal by clomipramine has been was strong or extremely strong in 77% of 38

reported and been successful, as our comparable. Women reported less daily case. cigarette consumption (p<0.018) and less Conclusion : The mechanism of action of alcohol consumption than males nefopam is not well understood. The (p<0.038). The mean Fagerstrom scores inhibition of serotonin, dopamine and and CO levels were similar in both groups. noradrenaline are probably linked to the Conclusions: The results of this study psychostimulant-like effects and the highlighted potential gender differences ananxiodepressive state of withdrawal. regarding smoking behavior and psychological symptoms. Further P-24 : Gender differences in tobacco investigations of hormonal response, use among patients attending the including the measurement of cortisol are smoking cessation clinic of Monastir needed to support these findings. (Tunisia) Manel Ben Fredj, Ines Bouanene, Asma P-25 : PARENTING STYLE AND ITS Sriha, Arwa Ben Salah, Hela Abroug, INFLUENCE ON ALCOHOL USE IN Kamel Ben Salem, Sana El Mhamdi ADOLESCENCE. University of Monastir, TUNISIA Mariem Turki, Nada Charfi , Najeh Smaoui, Manel Mâalej Bouali, Lobna Abstract : Zouari, Nasreddine Zouari , Jihene Ben Background and aims: Tobacco use Thabet , Mohamed Maâlej remains a major public health problem in University of Sfax, TUNISIA Tunisia with increased prevalence among adolescents and women. Gender Abstract : differences in smoking patterns have Background: Many researchers suggest consistently been reported. The current that parenting can have a large impact on study aimed at examining the effect of whether children become drinkers in gender on smoking behavior among adolescence. patients attending the smoking cessation Aim: We aimed to evaluate the parenting clinic (SCC) at the university hospital of style and its association with the alcohol Monastir (Tunisia). consumption among adolescents. Methods: We performed a cross-sectional Methods: It was a cross-sectional study comparison between all women (n=80) conducted in May and June 2016. The who attended the SCC from 2009 and sample consisted of 300 pupils from 4 2014 and a randomly selected 80 male colleges and schools in Sfax (Tunisia). The smokers during the prequit visit. A participants were asked to answer a self- questionnaire was used to explore the administered questionnaire, after their sociodemographic characteristics, smoking consent. Parenting styles were evaluated history, nicotine dependence (Fagerstrom with The “Parenting Styles and test) and anxiety/depression (Hospital Dimensions Questionnaires” (PSQD). Anxiety and Depression Scale). All Results: The mean age was 16 years with participants provided a sample of expired a sex-ratio of 1.06. The prevalence of carbon monoxide (CO). fathers‟ alcohol consumption was 8% while Results: Female smokers were that of friends was 37.7%. Among the significantly younger than males participants, 19.7% reported having drunk (p<0.024). Gender did not interact with alcohol at least once and 42.37% of them educational level nor the professional still consume. They estimated that alcohol status. Smoking initiation and regular initiation was influenced by their parents in tobacco use were later in women than in 6.7% of cases. Parents‟ attitude toward men (p<10-3). Motivations behind smoking alcohol use was favorable in 27.11% of behavior were similar in both groups. cases. According to PSQD, the Females were more anxious than males frequencies of democratic, authoritarian (p<0.007) whereas depression levels were and permissive parental styles were 39

respectively 87%, 11% and 0.7%. Alcohol alcohol misuse and 22% presented experimentation was correlated to the age dependence. Risk factors for drinking were of adolescents (p<0.001) and their fathers the age (p<0.001), masculine gender „drinking (p<0.001). Permissive parenting (p<0.001), grade level (p=0.026), somatic style was associated to alcohol use psychiatric and arrest histories (p=0.037, (p=0.038). However, the authoritarian style 0.041, <0.001 respectively), physical protect from continuing consumption (p= abuse (p=0.012), moral harassment 0.026). (p=0.007), non-supportive environment Conclusion: The results indicate that the (p=0.034) and peer‟s drinking (<0.001). parental style can have an influence on Conclusion: This study highlights the alcohol consumption among adolescents. existence of individual and environmental Thus, systemic family interventions can be risk factors for alcohol consumption in helpful to reduce alcohol consumption. adolescents. Understanding them is necessary to limit premature and P-26 : Why do adolescents drink? The excessive drinking among adolescents and role of social context. to set up alcohol consumption prevention Mariem Turki, Nada Charfi , Najeh plans. Smaoui, Jihene Ben Thabet, Manel Mâalej Bouali, Nasreddine Zouari , Lobna Zouari, P-27 : SOCIODEMOGRAPHIC Mohamed Maâlej CHARACTERISTICS AND University of Sfax, TUNISIA MOTIVATIONS TO QUIT BUPRENORPHINE USE IN AN ADULT Abstract : SAMPLE. Background: Underage drinking is Mariem Moalla, Rim Sellami, Ines Feki1, becoming a public health problem that Salma Hentati1, Albelmajid Zahaf, continues to be widespread among Jaweher Masmoudi adolescents. University of Sfax, TUNISIA Aim:This Study aims to identify the social determinants of alcohol use in teens. Abstract : Methods: We conducted a cross-sectional Background and aims: Buprenorphine is a study including 300 pupils from 4 colleges mixed opioid agonist/antagonist. It is and schools in Sfax (Tunisia). These widely used in opioid substitution therapy. adolescents were asked to answer a self- In Tunisia, there have been increasing administered questionnaire, after their concerns about its diversion, misuse and consent. Alcohol Use Disorders Test related harms. (AUDIT) was used to evaluate alcohol Aim :The objective of this work is to dependence. describe the sociodemographic and drug Results: The mean age was 16 years, with use profile of buprenorphine users who a sex-ratio of 1.06. Participants were from visit a rehabilitation center in Sfax for colleges in 38% and schools in 62% of cessation. cases. Among the participants, 16.3% Methods: A retrospective study was have suffered in the past from physical conducted over a period of 5 months for abuse, 35.7% from moral harassment and buprenorphine-dependent subjects who 45.3% considered their family as non- attempted to quit buprenorphine in a rehab supportive. They reported having drunk center '' Help and Listen”. The subjects alcohol at least once in 19.7% of cases completed a form investigating and 42.37% of them still consume. sociodemographic and substance use Seeking new experiences (78%), peers characteristics. The motivation to quit was influence (59.3%) and curiosity (49.1%) subjectively evaluated: low, medium or were the more important reasons given for strong. alcohol initiation. According to AUDIT, Results: We collected 62 subjects. They 1.7% of alcohol users presented an were all men. The mean age of 34.7 ±8.6 40

years. They were single in 45% of cases. questionnaire which took into The age of initiation buprenorphine use consideration sociodemographic and was 16.88 ±5.64 years. They all use the clinicalvariables, in addition to an intravenous route. The misuse of another evaluation of addictive behaviors by the psychoactive substance was reported by use of open and closed ended questions. 15.87% of subjects. Judicial antecedents Results:Our sample consisted of 50 were found in 51.16% of consumers. Half adolescents, 70% were male. The mean of them were immigrants. A family history age was 14,7ans. 95% had a high school of psychoactive substances use was level and 80% of them had a decline in reported in 24,59% of cases. A strong their academic performance. motivation to quit buprénorphine use was Tobacco, cannabis and alcohol use were reported by 20% subjects, while 30% had found in respectively 100%, 80% and 10% a low motivation. The reasons of of the cases. 2% had occasional use of buprenorphine cessation: health problems benzodiazepines. In our sample, the concerns (60%), saving family ties (30%) youngsters whose friends use and saving money (10%). psychoactive substances have a high Conclusion: This study allows us to levels of drug use. Traumatic life events describe the characteristics of patients were associated with substance use hospitalized in the only rehab center in disorders. Tunisia. Therefore buprenorphine misuse Conclusion: Knowledge of these prevention strategies and psychosocial vulnerabilities is an important key for care must be taken. planning and developing preventive mesures. P-28 : Addictive Behaviours of Adolescents. P-29 : SUBSTANCE USE AMONG MALE Nadia Bellali, Hind Nafiaa; Fz Yacoubi; FORENSIC PATIENTS Abderrazzak Ouanass, Mezghani M, Fekih-Romdhane F, Ghali F, Ar-razi Psychiatric University Hospital, Zghal M, Jmii G, Ghazeli I, Ridha R, Salé, Morocco University of Tunis, Tunisia

Abstract : Abstract : Introduction:Adolescence is a phase of Introduction: While addiction is considered curiosity, risk taking and challenges. Some a trivial problem in the field of forensic of these risks include the use of drugs, psychiatry, it remains a public concern in which is becoming more common. healthcare. There is a widespread use of For adolescents, addictive behaviors can substances abuse which might cause influence their development. In a key violence, suicide, interpersonal conflicts, period of academic learning, taking lawsuits, psychiatric commitment, and psychoactive substances can hamper their even crimes. Thus, psychiatrists are under life course and can be a handicap or a increasing pressure to develop strategies "loss of opportunity" for their future. to address the problem of coexisting The aim of this study is to identify the criminal behavior, addiction, and mental characteristics of adolescents‟ addictive illness. behaviors and to highlight contributing Aim:The aim of this study was to examine factors. the association between demographic Methodology:This is a descriptive cross- profile, psychiatric symptomatology and sectional study, conducted with 50 substance use in forensic psychiatric adolescents who were treated in the inpatients, and to consider the treatment outpatient as well as the inpatient setting needs and opportunities for intervention at the addiction department of the Ar-razi among the same sample. Psychiatric Hospital of Salé. The study Methodology: A retrospective study was was carried out with the help of a hetero- done on patients admitted to the 41

Department for Forensic Psychiatry at the Methods: This was a cross-sectional, Razi Hospital from 1996 to 2016, initially descriptive and quanti¬tative study. jailed for detention and drug consumption Benzodiazepine users, followed in and judged irresponsible by reason of outpatient psychiatric departments of Hedi insanity. Data were collected by record Chaker hospital in Sfax in Tunisiafor a review. The survey included items period of six months, were selected. Data assessing history of substance and collection was conducted with the aid of a demographic profile of each patient. semi-structured questionnaire Results: Thirty-two patients were included (socioeconomic characteristics, clinical in the study. Mean age was 27.81 data and BZD use). Levels of BZD years.36% of the participants were illiterate dependency were assessed with and 45% were single.More than half of the theFrench scale measuring addiction (the subjects (54,54%)had personal psychiatric “Echelle Cognitive d‟Attachement aux history , and 27,27% family history of Benzodiazepines” or ECAB). psychiatric problems. About one Results: The sample comprised 40 BDZ third(31.81 %) of participants had judicial users, 62.5% of whom were female. background: 33% were arrested for public Duration of benzodiazepine use was drunkenness,44% were arrested for greater than 1 year for all respondents. violence, and 22% were arrested for The most common psychiatric disorder theft.Concerning the diagnosis, 45% were among BZD consumers were depressive suffering from schizophrenia, 22.77 % disorders (57.5%). The dependence were diagnosed with personality disorder assessment indicated that 80% of users and 27.27 % of them would not have any were dependent on taking mental trouble.About 50% of the patients benzodiazepines. BZD dependence was did not follow up with treatment. correlated with female gender (p=0.022) Conclusion: Addictive disorders are and depressive disorders (p=0.006). authentic psychopathological disorders. Conclusion: The results of this study The treatment of addiction is in a care suggest that the use of benzodiazepines is setting long-term. It's a long and complex far from being optimal among seniors in procedure. Effective treatment is hindered Tunisia. The proportion of seniors who by the paucity of research on clinical develop dependence is important among application of treatment models for women and those with depressive addictive disorders in this population. disorders. The results illustrate the need to develop and implement programs to P-30 : PREVALENCE AND improve the quality of benzodiazepine use ASSOCIATED FACTORS OF among this population. BENZODIAZEPINE DEPENDENCE IN THE ELDERLY P-31 : ADDICTIVE BEHAVIORS AMONG Najeh Smaoui, Lobna Zouari, Kaouthar HOSPITAL NURSES: PREVALENCE Hajbi, Nada Charfi, Manel Maâlej-Bouali, SURVEY IN 65 WORKERS OF THE Nasser Zouari, Jihene Ben Thabet, UNIVERSITY HOSPITAL OF TAHAR Mohamed Maâlej SFAR-MAHDIA. University of Sfax, TUNISIA Nesrine Mars, Awatef Mahfoudh, Lamia Bouzgarrou, Tawfik Khalfallah Abstract : University Hospital Tahar Sfar- Mahdia- Background and aims: Benzodiazepines Tunisia (BZD) are the most frequently implicated in drug addiction in the aged. The objective Abstract : of our study was to assess levels of Background: The consumption of dependence, as well as factors associated psychoactive substances, including with this dependence among users of BZD tobacco, alcohol and cannabis, is aged 65 years and over. increasing in the general population and 42

particularly among people in the age of factors among youth and promote smoking professional exercise. cessation since this early stage of Aim:The purpose of our study is to smoking. evaluate the prevalence of use of these Aim:We performed our study to describe substances in a sample of nurses from the and analyze the risk factors of this University Hospital Tahar Sfar-Mahdia. phenomenon. Methods: A cross-sectional survey was Methods: Our study, conducted in 2013, conducted by anonymous self- investigated smoking behavior among questionnaires, given to the departments university students using a cross-sectional of the hospital, containing the Fagerstrom sample of 1002 students in university test for tobacco, Deta-cage questionnaire “Tunis El Manar”, who self-filled an for alcohol and an evaluation test of abuse anonymous questionnaire. Logistic or addiction for cannabis. regression was performed with current Results:The studied sample included 65 tobacco use. Socio-demographic workers, 8,12% of the hospital nurses . characteristics as well as social support The participation rate for the and religiousness were taken as questionnaires was 72,2% (65/90). The independent variables and p<0.005 was mean age was 39 years (24–59). Women considered significant. constituted 61,5% of the studied sample, Results: Investigated students had a mean which reflected a high female population of age of 21years (ranging from 17 to 28). the hospital . 53.8% of nurses were Around 24.5%of the students reported working at night .The rate of hospital being current tobacco users (54% of men nurses who declared to be smoker of vs. 9% of women). tobacco was 33,8%, with only 7,5% of Multivariate logistic regression found that women were smoking. Among these there was no significant difference smokers, 45,4% had low dependence and between medical sciences students and 13,6% had high dependence. 3,1% of the those from other fields. However, being a studied nurses declared to have consumed man, with decreased religious beliefs and some alcohol, without any risk of practice, and high scores of social support dependence. None of them declared the were associated with greater odds of consumption of cannabis. smoking. Conclusions:We noted that the prevalence Conclusion: Our results are alarming of use of cannabis and alcohol is clearly regarding the high frequency of tobacco lower than that of the general population, smoking for both sexes. Interventions like This may be explained partly by the fact preventive stress management are needed that the nurses are informed of the risks of to combat smoking behavior especially these substances. among youth.

P-32 : Correlates of smoking habits P-33 : Substance use among university among Tunisian university students. health sciences‟ students. Meriam Nouira, Nadia Ben Mansour, Meriam Nouira, Nadia Ben Mansour, Sophie Dziri, Sina Haj Amor, Fatma Sophie Dziri, Sina Haj Amor, Fatma Lassoued, Habiba Triki, Hajer Aounallah Lassoued, Habiba Triki, Hajer Aounallah Skhiri Skhiri University of Tunis, Tunisia University of Tunis, Tunisia

Abstract : Abstract : Background: Smoking frequency is Background: The use of tobacco, alcohol dramatically increasing especially among and illicit drugs threatens the health of young people. In order to take effective many young people. Health care givers action it is necessary to know the exact have a major influence on other people‟s magnitude of the problem and its related 43

health behaviors and they represent a awareness of our Tunisian university model for them. students about the negative health Aim:This investigation was performed in consequences and related diseases of order to describe substance use behaviors alcohol drinking. among students majoring in health Methods: A descriptive cross-sectional sciences studies. study was carried out in 2013 on 1002 Methods: A total of 1002 students who students at university “Tunis El Manar”. A belong to the university “Tunis El Manar” questionnaire was administrated to them were randomly enrolled in a cross- containing a section regarding their sectional study in 2013. A self- awareness about alcohol consumption administered questionnaire investigating hazards. substance use behaviours was applied. Results: Investigated students had a mean Chi-square test was performed for the age of 21 years (ranging from 17 to 28). statistical analyses using Stata11.2. Knowledge of alcohol miss-use‟s hazards Results: Investigated health students had was higher among non-smokers students a mean age of 21 years (ranging from 18 and the non-drinkers. We found that 37%of to 28).The study shows that about one students knew about the influence of quarter of health sciences students were drinking on heart disease. Only 27%and active smokers (54.35% of men vs.13.05% 35%of them were aware, respectively, of women ), 10.49% of them were drinkers about the association between alcohol and (total prevalence about 16%) and4.76% high blood pressure and mental illness. have tried illicit drugs at least once during We didn‟t find any significant difference last year. We didn‟t find any significant between medical sciences students and difference between senior and juniors other fields of study concerning their students concerning their substance use degree of conviction on the harms of behaviors. non/adequate alcohol use. Conclusion: Our results showed that Conclusion: High rate of students ignored substance use is quite high among the the health hazards of drinking alcohol future health care professionals. This was including future health professionals who surprising and unexpected in regards to will have a key role both as advisers and their academic knowledge. Awareness behavioral models. Our results highlight should be raised among this young the importance of implementing well generation of health students who are designed educational programs to going to play key roles regarding increase student awareness of the risks community health in the future. associated with alcohol drinking and focusing attention on cessation trainings. P-34 : Awareness of the consequences of alcohol consumption among P-35 : The draft reform of the law university students. relating to narcotics in Tunisia. Meriam Nouira, Nadia Ben Mansour, JAMMELI K, ENNAOUI R, BEN AMAR W, Sophie Dziri, Sina Haj Amor, Fatma BARDAA S, ZRIBI M, HAMMAMI Z, Lassoued, Habiba Triki, Hajer Aounallah MAATOUG S Skhiri University of Sfax, TUNISIA University of Tunis, Tunisia Abstract : Abstract : Background: Tunisian criminal legislation, Background and aims: Drinking alcohol at reserve to detention offenses, use and early ages causes increased risk of a host trade of addictive substances, specific of adverse social, psychological and health treatment; which derogates from the effects which are of immediate concern to accepted rules for all criminal offenses. our entire society. In this context, this The evaluation of the preventive aspect of study aims to evaluate the degree of this legal instrument, considered too rigid, 44

has highlighted its shortcomings in risk for the development of chemical incentive weaning and rehabilitation. dependence. The consequences of these That‟s why; a draft law against drugs was addictions are serious for medical staff as reviewed by the Council of Ministers at the well as patients. end of 2015. The project in question Aim: We propose to study the importance provides for the repeal of law N° 92- 52 of this professional risk, the predisposing relating to narcotics and its replacement by factors, the modalities of screening and a new law. prevention. Aim:In this work, we propose to introduce Methods: We report two cases of deaths this law project. We will discuss to clear his among anesthesiology professionals contributions over the old law and its presenting at autopsy signs of addiction to shortcomings. psychoactive substances. We also expose Discussion:The draft reform of the law a review of the literature about this subject. provides a set of preventive and curative Results: The case reports concern measures mainly for the benefit of respectively an anesthesia resident and a consumers. It also modified the sanctions nurse at the emergency unit. Both of the regime, favoring the incentive to victims were found in the toilet of the rehabilitation over punishment. Among hospital during a night watch; a syringe other things, the implementation of relief next to the corpse. The external measures provided penalties and examination of these two victims found substitution of physical punishment by the suggestive signs of addiction by work of public utility became possible. intravenous injection. Autopsy and Thus, the judge has recovered its flexibility toxicology samples were not concluding as in terms of classification of the offense. to the toxic origin of the death. Similarly, new phenomena related to the Conclusion: No Tunisian publication was possession and consumption of drugs interested before in drug abuse among became criminalized.This law anesthesiology professionals. However, hasalsoplanned the regulation of this problem exists in our country. investigation‟smethods and protection of International statistics estimate its all actorsinvolved in the fight against prevalence at 10.9% .The Product narcotics business. Thus, this project aims availability, stress and work overload are to harmonize Tunisian legislation with risk factors. The intended effects are ratified international conventions and the improving capacity and recreational dispositions of the new constitution. effects. The risk of excess mortality by However, it is necessary that the state can suicide or overdose has been proven. shape the measures of prevention and Reducing this risk requires prevention rehabilitation for this law to achieve its through improved working conditions and goals of reducing drug abuse the early detection of cases to ensure appropriate care. P-36 : Healthcare providers and addictive disorders P-37 : PREVALENCE OF NICOTINE JAMMELI K, ENNAOUI R, BEN AMAR W, DEPENDENCE AMONG INTERNS IN BARDAA S, ZRIBI M, HAMMAMI Z, MEDICINE AND RESIDENT DOCTORS MAATOUG S Sahar Ellouze, Fadwa Charfeddine, Izdihar University of Sfax, TUNISIA Lajmi, Farah Cherif, Jihen Aloulou, Lobna Aribi, Othmen Amami. Abstract : University of Sfax, TUNISIA Background: The use of psychoactive substances among healthcare Abstract : professionals has been well documented. Background : Despite their important role Anesthesiology is recognized among in tobacco cessation counselling, smoking medical specialty groups as having a high 45

prevalence has reached high rates among risky or problematic internet use and its physicians. risk factors among adolescents. Aim :In this work we propose to determine Methods: A descriptive and analytical the tobacco consumption patterns among cross-sectional study, conducted among interns in medicine and resident doctors 60 high school students, during the month and assess their dependence on nicotine. of January 2016. Data collection was Methods :A cross-sectional, self- conducted via a questionnaire exploring administered, anonymous survey of interns socio-demographics, Internet and video in medicine and resident doctors in Sfax, games use. We used the Young Tunisia was conducted during August- cyberaddiction scale to seek for September 2016. We used the Fagerstrom cyberdependency. A score ≥ 5 defines a Test for Nicotine Dependence (FTND) to problematic Internet use. assess the level of nicotine dependence. Results: The average age was 17, 17 Results : Sixty-two physicians were years. The sex ratio was 1.14. Grade included. Their average age was 27.76 repetition and an average academic (ranging from 24 to 32). More than half of performance were noted in respectively physicians were resident doctors (58.1%), 30% and 78,7% of cases. The relationship female (66.1%) and single (56.5%). The with parents was unsatisfactory for 30% of majority were of urban origin (95.2%), lived students and an addictive behavior was with the family (82.26%) and had an reported by 31.7% of them. Almost of the average socioeconomic level (64.5%). students (98.3%) had access to the The prevalence of current smokers was Internet at home and over a third (36.7%) 32.3%. It was significantly higher in men of them surfed the Internet more than 20 (P=0,003). Almost one quarter of hours per week. physicians smoke cigarettes (24.2%), The risky or problematic use of Internet 1.6% of them use e-cigarettes and 17.7% concerned 56.7% of students. Factors use narghile. The average number of related to the Internet misuse were: Male cigarettes per day was 10.33. The mean gender (p = 0.04), grade repetition (p = FTND score was 2.32. Dependence on 0.025), poor relationship with parents (p = nicotine was very low in 68.43% of cases, 0.031), a long period of Internet low in 15.79% of cases and moderate, connection(p = 0.003), and Video game high or very high among 5.26% of addiction (p = 0.003). physicians, each one. Conclusion: Problematic Internet use is Conclusion : Compared with previous widespread phenomenon among youth studies, our results showed a marked population. decrease in the prevalence of smoking Our study has highlighted some individual among physicians and their level of and environmental characteristics that can nicotine dependence. These results reflect be associated with this behavior. the greater awareness among physicians of the risk of tobacco on health and their P-39 : Smoking and obstructive sleep vital role in the fight against this scourge. apnea. S.Mhamdi, S.Daboussi, Z.Moetemri, P-38 : Prevalence and risk factors of C.Aichaouia, M.Khadhraoui, R.Cheikh. internet misuse among adolescents University of Tunis, Tunisia Hentati S, Ben thabet J, Turki M , Charfi N, Maâlej-Bouali M, Zouari N, Zouari L, Abstract : Maâlej M. Introduction: Obstructive sleep apnea University of Sfax, TUNISIA (OSA) syndrome is a common disorder; The effect of tobacco on obstructive sleep Abstract : apnea hypopnea syndrome is well- Objective: To estimate the prevalence of documented but the effect on the severity

46

of this syndrome has not been completely addiction Test (Young), video game test established. (Tejeiro criteria), online network game Aim: evaluate the impact of smoking on scale (DSM IV), Bergen Facebook the severity of OSA based on AHI. Addiction Scale). The collected data were Methods: During 4 years 200 patients were analyzed by SPSS referred to our department for a suspicion Results: The sample was composed by of obstructive sleep apnea hypopnea 58% boys (n = 40) and 42% girls (n = 29). syndrome. The diagnosis of an obstructive The mean age was 27.5 years. More than sleep apnea syndrome was confirmed by half were unmarried (69.6%). All of them nocturnal polygraph. Smoking status, had a high education level. This study clinical and spirometric data were showed that 95.7% of adult were very determined in these patients.Our patients concerned by the uses of internet and were divided into 2 groups according to facebook. A total of 34.8% of adult had a smoking status (G1: smoking; G2: non- cyberdependency, and only 4.3% were smoking) addicted to facebook.The risk of becoming Results: Among these 200 patients, 47% addicted to online video games included were non-smokers and 53% current 10.1% of adult. Problematic uses of video smokers. The apnea and hypopnea index games included 15.9% of participants. (AHI) were higher among current smokers Stress was perceived in 39% of than non-smokers. The percent of patients participant. Perceived stress was who had a not severe obstructive sleep correlated to facebook problematic use (p= apnea syndrome were higher among non- 0.031), to online video games addiction smokers than current smokers patients (P (p= 0.012) and to cyberaddiction with = 0.03). There was no significant severe repercussion (p=0.031). difference between the two groupes for Conclusion :This study showed that the snoring (95.74% vs 96.23%) and perceived stress was causing some excessive daytime sleepiness (mean addictive behaviors. So a better knowledge Epworth score: 12, 08 vs 11.3). of the factors causing stress would be Conclusion: Smoking habits seems to be necessary in order to limit some associated with the severity of obstructive addictions. sleep apnea syndrome that's why smoking cessation is very important in the treatment P-41 : STUDY OF THE LEVEL OF of obstructive sleep apnea hypopnea OSTEOCALCIN IN TRAMADOL syndrome. ADDICTS COMPAREDTO HEROIN AND NORMAL CONTROLS. P-40 : Perceived stress and screen shaimaa khirt, addiction in adults. Yaich.K, Halouani.N, Guermazi.F, Background: Tramadol is an opioid pain Naoui.R, Aloulou.J, Amami.O. medication which is used to treat moderate University of Sfax, TUNISIA to moderately severe pain. When taken as an immediate-release oral formulation, the Abstract : onset of pain relief usually occurs within Aim: To determine the association about an hour Opioids intervene in bone between screen addiction and perceived metabolism through three basic opioid stress among a sample of adult. receptors, that is, μ, κ, and δ receptors. Methods:A cross-sectional survey was Osteocalcin is a noncollagenous, 49 amino conducted among a sample composed by acid glutamate-rich polypeptide bone 69 young adults. The data has been matrix protein with a molecular weight of collected on a predetermined about 5800 kDa found in bone and dentin. questionnaire with items related to socio- One predictor of fracture is demographic aspects, and some scales undercarboxylated osteocalcin. (Perceived Stress Scale, the internet Osteocalcin is rapidly cleared by the 47

kidneys and, to a lesser extent, the liver; Abstract : Osteocalcin increases during high bone No war, known to date in the world, has turnover (such as with claimed more victims than road and the hyperparathyroidism, acromegaly, and main cause lies in the human factor in Paget disease). Measurement of which alcohol intake takes a sizeable osteocalcin can be used to monitor therapy share.Our goal is to make a descriptive with antiresorptive agents. The reference analysis of blood alcohol made by our intervals for osteocalcin are about 1.1–11 service as part of the implementation of ng/mL (adult male) and 0.7–6.5 ng/mL the new law on road organization (adult female). published in 2009 (BAC> 0.20 g / l). Aim: to compare the levels of osteocalcin This is a retrospective study over a period in tramadol addicts compared to heroin of 4 years (2012 to 2015), covering all addicts. blood alcohol requested by the Subjects: The study was conducted on 45 judiciary.3117 we recorded blood alcohol cases of drug use disorders patients, who demands mainly by the national were divided into 3 groups, group A 15 gendarmerie.17.80% of the analyzes we used tramadol, group B 15 patients used note have revealed a BAC ≥ 0.20 g / l. heroin from outpatient‟s clinics and In this study, we also noted that 12.62% of inpatient private hospital in Alexandria, traffic accidents had occurred because of Egypt and group c 15 healthy subjects as drivers driving under the influence of a control who were matched for age and alcohol and 63.40% of the samples taken gender. Patients with major psychiatric to check driving under ' drunkenness were disorders or on addictive drugs other than positive. the tested ones, patients with endocrine or bone diseases were excluded P-43 : Office Hospitalization: statistics Methods: All patients were subjected to and forensic analysis. (Anonymous questionnaire to assess the N.Belkhedja, Y.Mellouki, F. Kaious, socio-demographic state,Mini International F.Gehria, L.Sellami, Y.Zrairia, L.Saker, Neuropsychiatric Interview (MINI-plus) to M.Boudef, A. Mira. diagnose major depressive disorder and University Hospital Annaba exclude other psychiatric illnesses, Urine test to proof or exclude use of illicit Abstract : substances. Blood sample to show Hospitalization in a psychiatric setting is osteocalcin level. very special that is why the Algerian Results Tramadol abusers in the study legislature has regulated to avoid abusive showed significantly increased osteocalcin internments. level32.27 ± 15.38 compared to heroin Our goal is to make an analysis of the abusers 24.93 ± 3.10 and control group administrative procedure for involuntary 20.28 ± 5.47,p 0.005* hospitalization of mental patients in all Conclusions tramadol addicts have these stages and according to data from higher serum ostoecalcin levels when the health law. compared to heroin addicts and normal This is a prospective study of descriptive controls. nature which covers a population made of Key words: tramadol, heroin and 40 cases of mental patients hospitalized Osteocalcin. involuntarily to the various units of the ER- Razi EHS for a period of 06 months P-42 : Drinking and driving: statistics ranging from July until December 2015. and forensic repression. We found that 82.5% of hospitalization N.Belkhedja, Y.Mellouki, F. Kaious, decisions emanated from the wali on the F.Gehria, L.Sellami, Y.Zrairia, L.Saker, basis of medical evidence established R.Djafer, A. Mira. psychiatric disorder by a psychiatrist in University Hospital Annaba (75%) of cases. The patients were 48

schizophrenic decompensation in 77.5% of The survey award highlights the presence cases with an average hospital stay of 35 of all dependence symptoms in patients in days and whose evolution has been the first group as the craving and pleasure favorable to the stabilization of symptoms to control food restriction with the anorexic and an output EGF estimated between as well as pleasure and relief when [31-40 %]. ingesting large amounts of food in the So it should be noted that the results of our bulimic and in the same way that in study show the correlation between the patients in the second group in the regulations and their implementation on consumption of substances. the ground. P-45 : Internet addiction and its P-44 : Eating disorders: Real addiction? association with Traumatic experiences Bitar Mounia, among adolescents. El Yazidi F, Kachouchi A, Adali I, Manoudi Abstract : F, Asri F. Introduction:The eating disorders are real Department Of Psychiatry, Marrakesh addictive behaviors: the person finds himself dependent on his illnessas others Abstract : are of a substance.The person with this Abstract: Internet brings lots of disorder lose control of his normal convenience to modern life, however, the behavior and find himself in denial over the growth in internet use has also make many severity ofhis illness and in constant persons, especially adolescents, depend search of thrills.This addictive behavior too much on internet which may be termed causes real suffering for both the patient as internet addiction (IA). The association and his family that is found in dismayat this between traumatic experiences and loss of control. substance abuse is well established. Less Objectif:Our job is to highlight the main is known about the role of traumatic features and behaviors that evoke a true experiences in the onset and maintenance addiction in the various eating behavior of Internet related disorders. disorders and in the same way as in other Methods: Review of the available addictions. literature. The following issues will be Methodology: A Prospective study reviewed: the prevalence of IA, the conducted among teenage girls suffering association between IA and traumatic from eating behavior disorder followed in experiences, and the interactions of psychiatric consultation or hospitalized in stressful life events and psychological Ar-razi hospital.We use a survey on socio- symptoms on IA. demographic parameters, history and a Results: This review shows that several survey assessing their disorder while studies have examined the prevalence of emphasizing the addictive IA during the past few years. For example, component.Comparison of symptoms a study conducted in the USA reported a identified with addictive symptoms found in prevalence of 1.0% (Aboujaoude, Koran, patients with an addiction to drug use. Gamel, Large, & Serpe, 2006), a study Results: Our sample consists of two conducted in Europe reported a groups of patients. The first group includes prevalence of 9.0% (Villella et al., 2011), 12 patients with disorder of eating behavior and studies conducted in Asia reported and the second group includes 12 patients prevalence ranging from 2.0% to 18.0% with problematic substance use.The (Ko, Yen, Yen, Lin, & Yang, 2007; Wang, average age for both groups was 17 years. Wang, & Fu, 2008). , it is no doubt that IA An age ranging between 14 and 20 years. is a serious public health problem around All our patients are single.In the first group the world, especially among adolescents. are 6 patients with anorexia nervosa and 6 However only a few studies have focused patients with bulimia. on the relationship between traumatic 49

experiences and Internet addiction Methods. The study participants were symptoms (Dalbudak, Evren, Aldemir, & treatment-seeking adults who are HIV Evren, 2014; Dalbudak et al., 2013; positive and have been on HAART for Schimmenti, Passanisi, Gervasi, Manzella, three months or more recruited in January & Famà, 2014; Yates, Gregor, & Haviland, 2106.Registered general nurse carried out 2012). Schimmenti et al. (2014) found that the interventions. Participants needed to child sexual abuse increased the odds of score 6 and above on the AUDIT to be suffering from significant Internet addiction included in the study. The participants symptoms in a sample of 310 students were block randomized to intervention and aged 18–19 years old by over 7 times. control. However, despite the emerging evidences Results. The sample size was 40 with 17 in this field, studies on the relationship males and 23 females. The mean age was between exposure to traumatic 39(sd 9.35) years. Eight five percent had experiences and Internet addiction undetectable viral load mean CD4 was symptoms are still lacking. Further 460. The mean number of years on research is needed, as a huge literature HAART was 4years. Fifteen percent of the suggests that many types of trauma, not participants were on second line of only child abuse, can increase the risk of HAART. The mean AUDIT score was 15. addictive behaviors (da Silva, Diehl, At the end of the study, there was a Cherpitel, & Figlie, 2015; Keyser-Marcus et reduction in the AUDIT score for both the al., 2015; Mason et al., 2014; Ullman, intervention and control from 15 to 9 and Relyea, Peter-Hagene, & Vasquez, 2013). 17 to 11 respectively. There was also Conclusion:Therefore, the results of this some change in other outcome measures review suggest that trauma memories may that include the CD4. increase the risk of problematic Internet Conclusion/recommendations. An use during adolescence. intervention for alcohol use disorders is feasible in this setting. P-46 : AN INTERVENTION FOR ALCOHOL USE DISORDERS IN P-47 : Addiction to the Internet and PEOPLE LIVING WITH AIDS AND ITS video games among students in the IMPACT ON DRINKING AND HIV University of Sidi Bel Abbes in the year TREATMENT OUTCOMES-A PILOT 2012/2013 (Algeria). STUDY IN HARARE. Kerroucha Latifa, Soulimane A.K Munyaradzi Madhombiro, Soraya Seedat,Simbarashe Rusakaniko, David Abstract : Stewart,Dixon Chibanda, Bazondlile Introduction: The internet has become a Marimbe, Michelle Dube powerful and complex phenomenon, giving University of Zimbabwe free rein to expression and information without boundaries. For some, it will Abstract : become more than just a mode of Background. Interventions for alcohol use communication, work and entertainment. It disorders in HIV infected individuals have will be the main focus of their lives. The been primarily targeted at HIV infection conclusions are the same as regards the risk reduction and improved adherence. use of video games. However, alcohol use reduction is an Aim: The aim of our research is to provide important outcome. Alcohol use affects answers to questions facing a growing other factors that influence treatment emerging phenomenon of addiction to outcome. This was a feasibility study of an games and Internet by assessing the alcohol use disorders intervention based prevalence of addiction to internet and on motivational interviewing and CBT, video games among students at the compared with an equal attention WHO University of Sidi Bel Abbes. MH GAP treatment at Harare Hospital. 50

Methods: Survey by self-administered determine the consequences of cannabis questionnaire was offered to university on the expression of bipolar illness and students without obligation of participation. prognosis. Results: 633 students participated in the Methods: This is a comparative cross- study with an average age of 21 years sectional study which included patients (21.26 ± 0.07). In our sample, 167 followed in the psychiatry department of students have an Internet problematic use the G Razi hospital for bipolar disorder (5 or more criteria Young positive), or 27% type I and for substance dependence of the surveyed students. The at-risk use according to DSM IV diagnostic criteria *. Internet (4 criteria of positive Young) Hetero questionnaire on sociodemographic relates to 133 students, or 21.6% of them. variables, clinical and treatment of disease 168 students have challenging use of and comprising 10 items was completed video games (4 or more positive criteria), after obtaining the patient's consent. 26% of all students and 36% of video Results : The average age was 41 years. gamers. The average hospital stay was 9.18. Conclusion: This study showed the 33.33% of patients were monitored importance to continue to better know this regularly. Most patients were single and emerging phenomenon in the field of worked as a day laborer. Cannabis was addictions without substance; and offer the most consumed substance. Cannabis information and awareness among all use was prior to the expression of students of the University to promote psychiatric illness in 55% of cases. The awareness of the potential risk of misuse average number of hospitalization in of the Internet and video games. patients with a cannabis addiction was significantly greater than that observed in P-48 : BIPOLAR DISORDER AND the non-addicted group. Similarly, the CANNABIS average number of suicide attempts Jmii G,, Zghal M,Robbana L, Karoui M, among patients with cannabis addiction Ellouze F, Mrad F. was significantly higher than the group University of Tunis, Tunisia without cannabis addiction. Conclusions : Aggressive drug abuse Abstract : treatment immediately after a first Introduction: People with bipolar disorder psychiatric hospitalization might decrease frequently struggle with substance abuse rates of recurrence and new cases of and dependence. Typically, cannabis is cannabis use disorder in the course of the most commonly abused drug in bipolar disorder. individuals with bipolar disorder. In some studies of bipolar disorder, particularly P-49 : The use of coffee, tobacco and those with younger patients, the rates of energy drink by interns in medicine and cannabis use disorders equal or exceed resident doctors and addiction. those of alcohol abuse or dependence. I.Lajmi, F.Charfeddine, F.cherif; S.Ellouze, The effects of cannabis have been much J.Aloulou, L.Aribi, O.Amami. less studied. Some investigators have University of Sfax, Tunisia implied that cannabis may actually be mood stabilizing in patients with bipolar Abstract : disorder, although this suggestion lacks Aims: To assess the prevalence and the research support. However, the intensity of coffee, tobacco and energy relationships between cannabis use and drink use among interns in medicine and bipolar disorders are complex and remain resident doctors and to determine factors incompletely described. correlated with this consumption. Objective: The aim of this study was to Methods:This was a cross-sectional, identify the characteristics of addiction to descriptive and analytic study, concerned cannabis in bipolar patients type I and 62 interns in medicine and resident doctors 51

conducted in tow hospitals in Sfax (Hedi excessive internet use and the threat of its Chaker and Habib Bourguiba) or via rapid expansion. internet. A structured questionnaire Methods: A descriptive cross-sectional designed for the study was used to collect study was carried out on a sample of socio-demographic characteristics and 1002students at university “Tunis El addictive behavior data. We used the Manar” in2013. A questionnaire was Addictive Intensity Evaluation administrated to them containing a section Questionnaire (AIEQ) to evaluate those regarding their use of internet. Data addictive behaviors. analysis was performed using Stata11.2. Results:The mean age of our population Results: Investigated students had a was 28 years. Sex-ratio (H/F) was 0.5. mean age of 21years (ranging from 17 More than half of this population were to28).Overall, the average time spent resident doctors (58%) and online is about 3.56hours per day. Around single(56.5%).They consume coffee in 70%of students spent more than 21 hours 87% of cases, tobacco in 32% of cases per week surfing on internet. Almost one and energy drink in 16% of cases.The hour [0.72; 1.47] per week is conserved for majority of them (82%) have a coffee sex online with a significant gender addiction. 21% of tobacco consumers were difference (2.27 h for men vs. 0.18 h for addict. Coffee addiction was moderate in women).The multinomial analysis indicated 50% of cases, high in 13% of cases and that studying in medical sciences fields intense in 37% of cases according to and living with parents are significantly AIEQ. The analytical study releaved a related with higher time spent online. significant correlation between intense Conclusion: Our data shows a high coffee addiction and tobacco use frequency of excessive internet use (> 20 (p=0.004). hours per week) among students. Conclusion: It emerges from this work that Accessing the internet via one‟s own home the coffee addiction among interns in portal would expose to a daily excessive medicine and resident doctors is frequent use which may eventually lead to a misuse and associated with tobacco use.Interns and even addiction. Control strategies in medicine and resident doctors still have should focus on parental mediation of a low awareness about the consequence children‟s internet use like supervision and of coffee addiction. conversational strategies.

P-50 : Problematic use of the internet in P-51 : Burnout physicians and addictive Tunisian university students. behaviors. Meriam Nouira, Nadia Ben Mansour, Bahloul N, Fki I, Fki W, Baati I, Ayadi H, Sophie Dziri, Sina Haj Amor, Fatma Ketata W , Masmoudi J, Kammoun . Lassoued, Habiba Triki, Hajer Aounallah University of Sfax, Tunisia Skhiri. University of Tunis, Tunisia Abstract : Background: Faced with the daily suffering Abstract : of the patients, their distress and danger of Background: The internet was originally death, our young doctors may be able to designed as a tool to have rapid and better collapse and burn from the inside and information and to facilitate communication sinking into burnout. and research activities. However, use of Aim : To search a relationship between the internet in society and especially burnout and the use of tobacco, alcohol or among youth is growing at an exponential psychotropic medicine. rate which may have various negative Method : We conducted a cross-sectional effects. There is an urgent need to study on a population of 184 young recognize and respond to the reality of doctors after five years of studies and one year of training for two consecutive 52

academic years. We identified girls accounted 40.4 % of the study sociodemographic and professional population. The prevalence of smoking characteristics, their lifestyle and their was 15.2%, it was 26 % for boys and 8% health. To determine the risk of burnout, for girls. The nicotine dependence was we used the Maslach Burnout Inventory present in 35% of smokers and 53.2% of (MBI) scale with its three dimensions them reported having previously attempted (exhaustion, depersonalization and to quit at least once. More than half of personal achievement). respondents (58.8%) were unaware of the Results :Our population was predominantly effect of nicotine, 43.3 % of students did female (sex ratio = 0.65) with an average not know the origins of addiction and age of 25 years. Our doctors were rather 11.7% of smokers reported smoking in the single, married interns were almost female. school. All smokers, had not reported any Nearly 20% of them said they were obstacle to the purchase of cigarettes. The smokers. The majority had never exhibition of smoke in public places was consumed alcohol. 17.4% had used described by 66.5 % of students. psychotropic drugs during the internship. Conclusion: The results of this study Those who had consulted a psychiatrist for support the need to develop a complete reasons relating to the internship period program that integrates education for were 11.4%. 36.4% regretted not students but also for teachers which consulting a psychiatrist; A highly affects ample smoking behavior of statistically significant correlation was students found between burnout and consumption of alcohol for the first time during the P-53 : Cross-sectional study of sport internship period (p = 0.002) and between practicing and tobacco dependence BOS and consumption of psychotropic among resident doctors and interns in drugs for the first time (p = 0.050). medicine. Cherif F, Charfeddine F, Ellouze S, Lajmi I, P-52 : Knowledge, attitudes and Alulou J, Aribi L, Amami O. practices of sayada high school pupils University of Sfax, Tunisia towards the smoking. Fahima Hassine, Asma Sriha , Afifa Koba , Abstract : Mounira Sahtout, Riadh Fekih, Salwa Background and aims: Regular physical Hedhri activity plays a crucial role in health University of Monastir, Tunisia maintenance and disease prevention. However, excessive exercise has the Abstract : potential to have adverse effects. Background: tobacco Is the first cause of The purpose is to examinate the preventable death, the prevalence of it‟s relationship between tobacco dependence consumption in adolescents varies and sport practice among resident doctors between 10 and 30%. Initiation is the and interns on medecine. cause of psychological then physical Methods: This study enrolled a sample of dependence. resident doctors and interns in medecin. Aim: study the prevalence of smoking They were assessed by self reported among high school students, assess their questionnaire adiminestred in the hospital knowledge on the subject of smoking and via internet. Demographic informations addiction and attitudes and practice were obtained. We used the Addictive towards tobacco. Intensity Evaluation Questionnary (AIEQ) Method: This is a descriptive study, to assess intensity of addictive behaviors. transversal, using a self-administered Results: Data for the study were recolted anonymous questionnaire during 2013. from 62 participants, resident doctors Results: The response rate was 70 % (n = (n=36) and interns in medecin (n=26) 505). The average age was 16.7 years, composed of 41 females (66,1%) and 21 53

males (33,9%). The age of participant analysis was carried out using the SPSS ranged from 24 to 32 years (mean age= 18.0 software. 28). About two-third of participant (64,5%) Results: The prevalence of smoking during present a low/middle socioeconomic statut. the last twelve months among the students Nineteen participant use tobacco: 79% was 22.1% (n=123, 95%CI [18.7-25.5]) revealed a low dependence on tobacoo, and 18.70% during the last 30 days 10% revealed a moderate dependence (n=104, 95%CI [15.5-21.9]). Among the and 10% revealed a high dependence. participants, 15.1% have consumed More than one third (38,70%) of them alcohol at least once in their lives (n=80, practice sport: 75% present a low 95% CI [12.2-18.3]). During the last 30 dependence on sport and and 25% shows days this prevalence was 7.6% (n=42), a moderate dependence on sport. Soccer (95% CI [5.5-10.0]). The drug use was was the sport most frequently mentioned. reported by 5.6% of the participants (n=31) The relationship of tobbaco dependence at least once in life (95%CI [3.7-7.5]) and and sport practice fell short of significance by 1.4% during the last 30 days (n=8, (p>0,05). 95%CI [0.4-2.4]). Conclusion: The study revealed that there Conclusions: Risk behaviors could be is no statistically significant relation preventable and only a community between sport practice and tobacco participatory approach involving both dependence. This result reinforces that individual and institutional level can ensure sport parcticing could be associated with the effectiveness of actions to be taken to healthy behaviour. prevent this risky behavior with the student population. The introduction of health P-54 : SELF-REPORTED PREVALENCE policy and the definition of monitoring OF RISK BEHAVIORS AMONG indicators for addiction should therefore be TUNISIAN COLLEGE STUDENTS IN THE a priority in Tunisia. REGION OF SOUSSE. Zedini Chekib, Sahli Jihene, Mellouli P-55 : Problematic Internet Use and Manel, El Ghardallou Meriam, Makni associated factors in young adults. Chiraz, Limam Manel, Mtiraoui Ali, Ajmi Guermazi Fatma, Halouani Najla, Yaich Thouraya. Kaouthar, Ennaoui Rihab, Chouayakh University of Sousse, Tunisia Sameh, Aloulou Jihen, Amami Othman. University of Sfax, Tunisia Abstract : Background and aim: College traditionally Abstract : occurs during the transition from Aims : This study aims to evaluate the adolescence to adulthood and may be problematic Internet use and search the associated with changes in behavior, factors associated with this behavioral including risk behaviors. Risk behaviors, addiction. such as alcohol and drug use, can have Methods : A cross-sectional study was long term negative impact on public health. carried out during the first half of In this context, we conducted this study to September 2016.A sample of 69 young determine the prevalence of risk behaviors adults with a high education‟s level was among Tunisian students in the region of randomly selected from the general Sousse. population. In addition to basic Methods: A cross sectional study was demographic information, the survey conducted in the academic year 2012- comprised a number of different 2013 among 556 students enrolled in the psychometric tools: the Young Internet universities of the region of Sousse in Addiction Test, Videogame Test (Tejeiro Tunisia. A self-administered questionnaire criteria), online network game scale, the was used to collect data. Statistical Hospital Anxiety and Depression scale and

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addictions to substances according to the cannabis-dependent subjects who criteria of DSM5. attempted to quit cannabis in a rehab Results :The mean age was 27.54 years center '' Aide et Ecoute”. The subjects (SD = 5.31), with a range from 22 to 40 completed a form investigating years. In terms of gender distribution, sociodemographic and drug use approximately two-thirds of the sample characteristics. The motivation to quit was was male. Results indicated that 34.8 % of subjectively evaluated: low, medium or our population were classified as being strong. addicted to the Internet including 26.1% Results: All subjects were male with mean with possible consequences and 8.7% with age of 26.55 ±6.2years. They were single severe repercussions. The concerned in 23.21% of cases. Socioeconomic level subjects had used the Internet for an was low or middle for 82.85% of cannabis average of 9.3 years. The correlation users. We found that 21.42% of patients coefficients showed that Internet addiction were involved in criminal justice. The age was positively associated with the male of initiation cannabis use was 16.15 gender (p=0.019), single state (p=0.001) ±4.05years. A family history of and being a student (p=0.015). Moreover, psychoactive substances use was reported this study found that the Internet in 17.14% of cases. Motivation to quit problematic use was correlated to cannabis use was strong in 90% and dependence on online games network (p = moderate in 10% of cases. The reasons of 0.008) and the problematic use of the cannabis cessation were: becoming facebook (p = 0.001). Unlike depression, more involved in work, studies or activities anxiety were correlated to a cyberaddiction (60%) and cognitive impairment (10%). (p=0.005). Conclusion: Through this study, the Conclusion: Our results shows the characteristics of this population and the alarming prevalence of Internet cannabis use problematic use among young adults. have been identified. Future researchs are Identification of related factors will lead to needed to confirm and extend these effective prevention and earlier findings, with the hope that more relevant management strategies. demographic targeting of prevention and treatment programs might improve P-56 : SOCIODEMOGRAPHIC AND treatment adherence and effectiveness. DRUG USE CHARACTERISTICS OF CANNABIS USERS IN A P-57 : Risk awareness of health REHABILITATION CENTER. outcomes of tobacco smoking. Mariem Moalla1, Rim Sellami1, Ines Feki1, Meriam Nouira 1, Nadia Ben Mansour 1,5; Salma Hentati1, Albelmajid Zahaf2, Sophie Dziri 2; Sina Haj Amor 1; Fatma Jaweher Masmoudi1 Lassoued 1; Habiba Triki 3; Hajer University of Sfax, Tunisia. Aounallah Skhiri 1,4 University of Tunis, Tunisia Abstract : Background: Cannabis is the most widely Abstract : used illicit drug in the world. In spite of Background and aims: Tobacco smoking is religious, social and legal sanctions in a global epidemic which is considered as a Tunisia, its use remain increasing major health hazard. Assessing the especially in recent years. knowledge and the degree of awareness Aim:The aim of this work was to describe about the dangerous effects of tobacco the sociodemographic and drug use profile consumption among young people is a of cannabis users visiting a rehabilitation very important step to well target the gaps. center in Sfax for withdrawal. Methods: A cross-sectional study was Methods: A retrospective study was conducted in2013 on a representative conducted over a period of 5 months for 40 sample of 1002 students of the university 55

“Tunis El Manar”. Data were collected Sfax, Tunisia, during the academic year using a self-administered questionnaire 2015-2016. Data collection was conducted including a section about their knowledge via a questionnaire exploring socio- of some diseases related to tobacco demographics characteristics and drinking smoking. behavior. Problem drinking was measured Results: Investigated students had a by the CAGE test and defined as a CAGE mean age of 21years(ranging from17 to28) score of two or more. .Beliefs in the degree of importance of not Results: The average age was 19,76 ± smoking were higher on average among 0,68 years with a slight female the non-smokers comparing to the current predominance (51.7%). The smokers, with score means of 7.37 socioeconomic level was judged to be and4.96, respectively. About 66%of good in 62 % of cases. Alcohol respondents were aware of the association experimentation had concerned 26,4 % of between smoking and lung cancer with a students and it was mostly with peers higher percentage among senior students. (73%). Curiosity (44%) was the main Only 21%and 55%of them were aware reason for initiation of alcohol use. The about the association between tobacco prevalence of alcohol consumption was and, respectively, high blood pressure and 20,1%. Drunkenness was reported by heart diseases. Unexpectedly, we didn‟t 71,9% of students. According to the CAGE find any significant variation between test, 40,6% of subjects had problem students majoring in medical sciences and drinking. students of other study fields, concerning Conclusion: Alcohol use is a widespread their beliefs and awareness. phenomenon amongst addictive behaviors Conclusion: This data indicate large gaps in young people. Because of its in knowledge concerning the health impact prevalence, costs and adverse health of smoking not only among students of all risks, alcoholism prevention is essential fields of study but also, and surprisingly, through a health education. among future health professionals who are supposed to fulfill the exemplary role of P-59 : User‟s satisfaction of the non-smoking behavior.Starting health electronic medical record in the education activities at an early age, since hospital information system, oran – the level of primary school studies is algeria. urgently needed to better control tobacco Amina BELGHITRI, Fatima DAMOUCHE use. 1, Khadidja REGUIEG 1, Ramzi TEDJANI1, Nori MIDOUN P-58 : Alcohol use among medical University of Oran, Algeria students. Hentati S, Ben thabet J, Turki M ,Maâlej- Abstract : Bouali M, Charfi N, Zouari N, Zouari L, Keywords : satisfaction, evaluation, EMR, Maâlej M. hospital information system University of Sfax, Tunisia Background: The electronic medical record (EMR) is the major project of the Abstract : information system of the institution that Objectives: Alcohol use is one of the main plays a strategic role in the project taking health and social problems among today's into account the human, organizational youth. The study objectives were to and information technology. describe alcohol behavior and to assess Methods: Having reached halfway through the prevalence of problem drinking among the full deployment of electronic medical university students. record, we thought it was important to Methods: We conducted a descriptive make an inventory of the hospital cross-sectional study carried on 159 information system through an assessment students enrolled in medical faculty in of user‟s satisfaction and an impact study 56

on EMR organization of the hospital and its Epidemiology and Preventive Medicine of consequences. All features of the EMR the EUH Oran on death certificates issued were discussed namely the medical between 01.01.2010 and 6.30.2015. The collection, prescriptions, care plan, the Consolidation of the data, performed results of laboratory and imaging. manually, is to bring to ICD-10 according Results: With 76% response rate (101 to rules specified diseases reported on the responders) different profiles of trades, certificate. After analyzing the content of ergonomics EMR wins 60% positive the attestation of death certificates, we opinion against 32% of negative opinions. code the underlying cause of death: Upon For its use, the exchange of information request, a meeting to finalize and validate between professionals were considered if problematic; Frequent contact with easy by nearly all users or 89.5% of doctors to complete the missing responses and 70.7% want to continue to information; Validation of forms for data use the EMR to not return to the paper entry on Epi data and registration as a system. database. Users say they are satisfied in their use of Results: 2280 death certificates were EMR experience in 82.2% of responses by evaluated with a sex ratio = 1.66; Tumors bringing time savings in obtaining are the leading cause of death (33.2%) laboratory results, the research records followed by diseases of the circulatory and access to records. system in the second position (21.3%); Conclusions: The realization of a hospital 44.1% of death certificates have been information system requires proper validated, while the rest was returned to consideration of the expectations of users service issuers for possible corrections and better coordination among and completeness; 9.9% failed the initial stakeholders (doctors, nurses, liaison with cause, while 18.2% contain no technical platforms). intermediate causes.

P-60 : THE QUALITY CERTIFICATION P-61 : Clients‟ subjective experience of OF CAUSES OF DEATH IN THE EUH therapist-disclosure: helpful and ORAN, ALGERIA hindering factors and conditions. BELGHITRI A, zemour lakhdar LORATO KENOSI, DUNCAN University of Oran, Algeria CARTWRIGHT

Abstract : Abstract : Background: The quality of mortality Background: In psychotherapy, the norm statistics is highly dependent on the quality and expectation is for clients to self- and reliability of information on the causes disclose thus disregarding and of death that gives interest to indicators discouraging self-disclosure by therapists. that will be measured and used for Consequently, therapist disclosures are planning, assessment and management of often unguided subsequently defying the public health actions. noble motive of disclosure by causing The evaluation of the quality of information harm to the client. Furthermore, how on the causes of death was a central clients experience therapist disclosure has methodological concern of the health been given little attention and the scarce information unity SEMEP EUHO. research on client experiences of therapist Objective: To evaluate the quality of the disclosure rely on assumptions made from information contained in death certificates information given by pseudo clients, written by doctors of EUHO between 2010- observers and therapist perspectives. 2015 Aim: To investigate clients‟ subjective Methods: This is a prospective descriptive experience of therapist disclosure, study conducted to gather at the Unity particularly, how clients feel about, Health Information Service of interpret, appraise and react to therapist 57

disclosure in order to understand it‟s alexithymia in patients with substances helpful and hindering factors, and abuse. underlying conditions. Given that therapist Methods: Thirty patients with substances disclosure has a huge impact on the use disorders were recruited in external therapeutic relationship and consequently consultation of Razi hospital. We passed a the outcome of therapy, Edward S. questionnaire designed to record Bordin‟s therapeutic working alliance sociodemographic data and evaluate theory was utilized to conceptualize this psychoactive substance use. Alexithymia study. was evaluated with the Toronto Methods: The study was qualitative and Alexithymia Scale, 20 items version (TAS- used semi-structured interviews to collect 20), data from eight people who had been in Results: The mean age of patients was psychotherapy. Data was then analysed 28.74+-8.4 years. All patients were men using Interpretative Phenomenological and 63.33% of patients had no Analysis (IPA) which helped in professional occupation. Our results understanding therapist disclosure from showed levels of alexithymia generally the clients‟ experiential perspectives. important.The frequence of alexithymia in Results: Data revealed three basic patients with addictive behaviors was themes: perceived underlying conditions of 66,66% with a mean score to this scale of disclosure event, disclosure type and 64,1 ±11,5 disclosure impacts. Results indicated that Conclusion: Levels of alexithymia were disclosure underlying conditions are the important in patients with addictive determinant factor in how clients behaviours, showing in these patients experienced therapist disclosure, difficulties to identify and distinguish regardless of the disclosure type, and the between feelings and bodily sensations, to impact of the disclosure on clients‟ lives. describe feelings and presenting an Conclusion: The study has revealed that externally-oriented thinking. two similar disclosures may be experienced differently due to underlying P-63 : Screens and ADHD: Study on 447 factors and conditions. Tunisian students. Ben Haouala A, A, Mhalla A, Guedria A, P-62 : ALEXITHYMIA IN PATIENTS Amamou B, Bouslah S, Gaddour N, WITH SUBSTANCES ABUSE. Zaafrane F, Gaha L. Ahlem Hajri, Olfa Meziou, Souha Ben University of Monastir, Tunisia Alaya, Yosra Abid, Amira Maâmri, Anissa Bouasker, Haifa Zalila Abstract : University of Tunis, Tunisia Introduction: Attention-deficit/hyperactivity disorder (ADHD) isa multifactorial Abstract : disease.The aim of our study was to Background and aims: Researches on explore the relationship between screen troubles of emotional control in addictions use and ADHD in a population of high have mainly focused their attention on school students in Monastir (Tunisia). alexithymia concept, defined by Sifneos in Methods: It was a cross-sectional study 1972. Alexithymia is considered to be a concerning a representative sample of 447 deficit in emotion processing. More third year high school students of the specifically,characteristics include difficulty governorate of Monastir during November in identifying and describing feelings as 2015; we had proceeded to a cluster well as discriminating between feelings sampling.The diagnosis of ADHD was and physical sensations. Many studies made by the Adult ADHD Self-Report have shown there was a high level of Scale (ASRS-v1.1) validated in Arabic alexithymia in patients with addictive language.The sociodemographic and behaviours. Our purpose was to evaluate clinical characteristics were evaluated by a 58

pre-established questionnaire. The attempts, major depression, bipolar threshold of 5 hours daily was selected for disorder, borderline personality disorder the excessive consumption of TV, Internet and posttraumatic stress disorder are and video games. especially associated with suicidal Results: The mean age of our population behavior in people with addictive was 17.15±0.7 year-old.The study of the disorders. use of screensshowed that 93.5% of the Conclusion : The more we understand the students have used the internet daily with complex link between these factors of an average of 4 hours; 89.7% have suicidality and substance use disorders, watched television (TV) each day with an the more successful we will be in making average of 2.8 hours, and only 44.7% have preventive models to improve outcomes played video games with an average of for treatment. one hour; 25.1% have consumed excessively the Internet, 7.6% have had an P-65 : Impact of smoking on the excessive television consumption and treatment of schizophrenia. 5.4% have used excessively video games. M. Daoud, L. Ghanmi*, S. Elleuch*, Kh. The diagnosis of ADHD was associated to Zitoun*, S. Ben Mahmoud, L. Zouari**, M. excessive TV, to excessive video games Maalej** use and to excessive internet use (42% for University of Sfax, Tunisia adolescents with ADHD vs. 21.3% for adolescents without ADHD; p<0.001). The Abstract : multivariate analysis showed an Aim: To determine the impact of smoking association between the diagnosis of on the treatment of schizophrenia in a ADHD and internet excessive use population of patients followed in the (p=0.014). Gabes psychiatric consultation. Conclusion: The screen misuse have an Methods: This is a cross-sectional study impact on adolescents with ADHD. including patients with schizophrenia aged over 18 years, under antipsychotics (AP). P-64 : Suicide and addictive behaviors. Data collection was done through a semi- A.Kachouchi, S. Salim,, I. Adali, F. structured interview with the patient and a Manoudi, F. Asri family member + review of medical University of Marrakech, Morroco records. We assessed the movement disorders by AIMS scale (scale of Abstract : measurement of abnormal involuntary Background: Suicide is a serious sanitary movements) and akathisia by the rating and social problem and up to 40% of scale akathisia caused by a drug Thomas patients seeking treatment for substance Barnes. 175 patients were enrolled. They dependence report a history of suicide were divided into 2 groups: smokers (n = attempt. It is important to describe the risk 85) and non-smokers (n = 90). A factor for suicide in persons with addictive comparaison between groups was made. behaviors to elaborate a preventive Results: The mean number of cigarettes strategies including the management of was 15 cig / day. In our sample, smoking addictive behaviors. was significantly associated with more Method: A systematic review of literature. frequent prescription of conventional Results: Suicidal behavior is a significant neuroleptics (98.8 vs 92%, p = 0.03) and problem for people with co-occurring poorer adherence to treatment (77 vs disorders and addictive behaviors. Several 62.2%, p = 0.02). There were no risk factors are objectived such as marital significant differences between the 2 and interpersonal relationship disruption, groups regarding the average doses of occupational and financial stressors, neuroleptics, the presence of recent heavy substance use and extrapyramidal signs, scores on the AIMS intoxication a history of previous suicide score and akathisia. 59

Conclusion: In this study, smoking is had more negative attitudes than younger correlated with the prescription of classical and less experienced ones regarding neuroleptics. It seems to negatively question 1 (p=0,006/p=0,038). influence adherence. Conclusion: Healthcare professionals‟ attitudes regarding PWASUD may P-66 : ATTITUDES OF TUNISIAN negatively influence the care that this YOUNG PSYCHIATRISTS TOWARDS people receive.Further studies should MENTAL HEALTH PATIENTS WITH evaluate the consequences of those SUBSTANCE AND ALCOHOL ABUSE. negative attitudes on the adherence to Lamia Jouini, Uta Ouali, Rabaa Jomli, treatment and the patient‟s recovery. Yosra Zgueb, Fethi Nacef University of Tunis, Tunisia P-67 : DOES CLOZAPINE TREATMENT INFLUENCE SMOKING BEHAVIOURS Abstract : AMONG PSYCHIATRIC PATIENTS? Background: Problematic alcohol and Lamia Jouini, Uta Ouali ; Jomli Rabaa ; substance use has been identified as a Sami Ouanes ;Yosra Zgueb ; Fethi Nacef major social issue in Tunisia. Healthcare University of Tunis, Tunisia professionals are crucial in the identification and accessibility to treatment Abstract : forpeople withAlcohol and substance use Background: Worldwide, severe disorders (PWASUD). psychiatric diseases are associated with a Aim:Our objective was to assessyoung higher prevalence of smoking when psychiatrists attitudes towards PWASUD in compared with other illnesses. The Tunisia. literature provides some suggestions that METHODS: This is a cross-sectional study clozapine treatment(CT) may be amongst 103 Tunisian young psychiatrists. associated with decreased smoking. We administered an auto-questionnaire Aim:The goal of our study was to explore containing: socio-demographic data; data this association within a Tunisian cohort of related to the professional experience and mentally ill patients. the work place; and two questions from the Methods: This is a retrospectiveand cross- Attitudes Towards Mental Health Scale sectional study amongst 21 patients under (ATAMHS) related to PWASUD: 1) CT in Razi Hospital. We administered a «Alcohol abusers have no self control », questionnaire containing: Socio- and 2) « Patients who abuse substances demographic data; data related tothe should not be admitted to acute wards », treatment characteristics; smoking each of which was assessed with a 5-point behavior before and after the onset of CT. Likert scale (“1”, meaning: “Completely RESULTS: The average age of CT onset agree”, “7” meaning: “Completely within our patients was 33,75 years and disagree” and “4” representing the neutral the average dose of Clozapine was 480, midpoint). An obvious positive or negative 95 mg.The average number of cigarettes attitude was demonstrated in issues that lowered significantly from 26, 86 before CT had more than 70% approval in one start to 18, 67 (p= 0,035).The decrease in direction. the number of cigarettes concerned rather Results: The average age of the residents the patients who didn‟t reach university in psychiatry was 29,35 years and the levels (p=0, 08). There was no relation average professionalexperience was 27,43 between the change of smoking behavior months. Negative attitudes were seen in and the socio demographic data (Sex, the participants' responses to question 1 profession, marital status, diagnosis) with 72,8% (n=75) who thought that neither the treatment characteristics (Age Alcohol abusers have no self control while of treatment onset, dose, adherence and divided opinions were evident in question EGF before and after CT). 2. Older and more experienced residents 60

CONCLUSION: Although the cause is still Abstract : unknown, these results are consistent with Aim:This study aimed to characterize the reports that clozapine reduces profile of cannabis users hospitalized for smoking.However, larger samples are psychiatric disorders and determine the needed to increase power and provide clinical and therapeutic impact. more confidence in the results Methods: This is a retrospective and descriptive study conducted among 33 P-68 : DEPRESSION COMORBIDITY patients with cannabis abuse who had WITH ALCOHOL USE DISORDER, been admitted to Psychiatry B department EPIDEMIOLOGY ETIOLOGICAL at the University Hospital Hedi Chaker of FACTORS AND THERAPEUTICAL Sfax from1 January 2012 to 31 December MANAGEMENT: A CASE REPORT. 2014. Data collection was performed using Lyazid Chanoune, a preset plug exploring the socio- Public Hospital of Proximity Sidi Aich demographic characteristics, history, Bejaia, Algeria addictive behaviors, clinical and evolutionary data of the disorders. Abstract : Results: The mean age was 27.48 years. Background: Symptoms of depressive The majority of the studied subjects were disorder associated to alcohol misuse are single (75.6%). Approximately, two-thirds more likely to be tough. There are many of the users (62.4%) were unemployed. difficulties: establishing diagnosis and The main substances used over lifetime, in therapeutic management. The evolution is addition of cannabis, were tobacco marked with recurrent hospitalizations, (100%); alcohol (93.3%); drug abuse relapse and resistance to treatment. (48.5%), cocaine and heroin (12.12%).Half Prognosis is poor related to high suicidal of the patients had criminal record. Sixty likelihood. percent of the subjects had previous Case presentation: This clinical case show psychiatric history. The psychiatric an alcohol addiction in a patient suffering diagnosis at the outlet were substance- from a depressive disorder about for years. induced disorder (48.5%), schizophrenia Our patient is using to consume alcohol as (18.2%) and bipolar disorder (30.3%). medication to cope with anxiety. With During the evolution: 6.1% of patients did harmful consequences, the patient had an not recidivate, 6.1% recurred the same accident while alcoolised: 3g/l. He also lost disorder, 27.3%developed a permanent his father who was suffering from cancer psychosis and 45.5% had one or many which become as an additional factor to relapse of their disease. exacerbate depression disorder and The diagnosis changed to schizophrenia relapse. He is hospitalized and beneficied among 21.2% of patients. Most of patients of psychiatric and addictlogical (71%) had poor treatment adherence. management. Conclusion:Cannabis use is a public health Conclusions: The comorbidity between problem for the most vulnerable alcohol use and depression disorder is populations. frequent and it‟s important to know the Coexisting cannabis use disorders and difficulties to ameliorate the management psychiatric disorders are mutually injurious of this dual diagnosis. and complicate treatment outcomes and P-69 : Profile of psychiatric inpatients prognosis. with cannabis abuse. Guermazi Fatma, Ennaoui Rihab, P-70 : Pokémon Go: a new addiction? Bouattour Wiem, Halouani Najla, Feki Rim, Uta Ouali, Maamer Meriem, Chouayakh Sameh, Aloulou Jihen, Amami Aloui Sarra, Fethi Nacef Othman University of Tunis, Tunisia University of sfax, Tunisia

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Abstract : Sifneos (1973) as difficulty identifying and Introduction: Pokemon Go (PG) is a communicating feelings, differentiating location-based augmented reality feelings and somatic sensations of game.The game's extended launch began emotional arousal, a diminution of fantasy on July 6, 2016, and within one week it and imagination and an externally oriented attracted over 65 million users and has cognitive style. Between 45-67% of alcohol become one of the most used mobile dependent individuals have been identified applications. The aim of this study is to as alexithymic. There is a limited amount asses the prevalence and the socio- of empirical evidence exploring the demographic features of PG users and to relationship between alexithymia and determine if PG is responsible for more alcohol use, which is surprising as video game addiction than other video alexithymia has been hypothesized to be a games . risk factor in the genesis of alcohol use Method : We conducted a cross sectional disorders. comparative study from 15 to 30 August, Aims & Methodology: The aim of this study 2016. The participants were asked to is to review the published research on complete self-report measures using an alexithymia and alcohol use, to present a online response method. Questionnaire critical update on the relationship between included demographic informations, game alexithymia and alcohol use disorders. use-related characteristics and the game Results: Research studies have shown addiction scale (GAS). high prevalence rates of alexithymia in Results: The questionnaire was visited by alcohol dependent populations, yet there is 150 viewers, the participation rate reached only preliminary evidence to indicate 26 %. relationships between alexithymia, alcohol 59 % of participants were female. The consumption and severity of alcohol mean age of the sample was 28,3 years. problems, and limited evidence examining 67,6 % of participants worked, 59 % were the different dimensions of alexithymia in single. 43.8 % claimed to be not relation to alcohol dependence. Thus, the interested in any video games.16,2 % notion that alexithymia is a vulnerability were playing PG ,half of them appreciate factor in the development and PG because it mixes reality and virtual maintenance of alcohol use disorders is life.The average time spent on PG was 1,6 premature. Despite limited support for a hours a day. People who played PG were relationship between alexithymia and significantly younger ( p=0,02) ; they spent alcohol dependence, several studies have more time on the internet (p=0,043),were examined alexithymia in association with more addict to video games (p=0,027), other risk factors for alcohol use including and scored higher on the GAS attachment, depression, personality (p=0,002).Playing Pokémon Go was not disorder traits, emotional and perceptual significantly correlated with gender, dependency and suicidal ideation. occupation or marital status. Conclusion: A number of key issues need Conclusion: Pokémon Go seems to reach to be addressed in examining the veracity a young public with a higher risk to of the link between alexithymia and alcohol generate video game addiction. dependence. Although alexithymia is often considered a risk factor for the P-71 : Alexithymia in Alcohol Use development of alcohol use disorders, Disorders. there is little evidence to support this Ghali.F, notion. Given that alexithymia may have University of Tunis, Tunisia the potential to interfere with treatment outcomes, a better understanding of the Abstract : role of alexithymia in alcohol use is Introduction: Alexithymia is a multifaceted needed. construct that was first described by 62

P-72 : Smoking is it a risk factor for P-73 : Comorbid substance use difficult asthma. disorders among psychiatric Feki Walid, Bahloul Najla(1), Kallel outpatients Nessrine(1), Feki Ines(2), Ketata Wajdi(1), I. Hachaichi, L. Ghanmi*, Kh. Zitoun*, S. Kammoun Samy(1) Hamrouni*, S. Elleuch*, M. Daoud*, L. University of Sfax, Tunisia Zouari**, M. Maalej** University of Sfax, Tunisia Abstract : Abstract : Introduction : The difficult asthma is a Background: Little is known about the significant problem by running the risk of epidemiology of substance use disorders severe exacerbations, therapeutic climbing (SUD) among psychiatric oupatients in and iatrogenic complications. Tunisia. Aim :The goal of our study was to Aim: To examine the prevalence of SUD determine the epidemiological, clinical and among adult psychiatric outpatients at the therapeutic characteristics of difficult regional Hospital of Gabes. asthma and identify its aggravating factors Method: A cross-sectional study was especially smoking. undertaken for a month period. During this Methods :Retrospective study including period, data was collected on outpatients patients followed for difficult asthma in (n=120), with different psychiatric pulmonology department at CHU Hédi diagnoses (DSM-V), aged over 18 years, chaker Sfax during the period from 1 following the psychiatric department of the January 2012 to 30 June 2013. regional hospital of Gabes, who agreed to Results :40 patients was included. The accept to the study. Data collection was average age was 50.6 years with extremes done through a semi-structured interview ranging from 27 to 74 years. There were with the patient and a family member + 26 women and 14 men. The origin was review of medical records. SUD was urban in the majority of cases (70%). defined as an abuse or dependence to 52.5% of patients in our series were alcohol or drug. exposed to tobacco abuse among which 6 Results: In our sample, the alcohol use were smokers with an average of 14.6 PA. was noted in 6% of patients and cannabis Passive smoking was noted in 15 patients. in 4%. Patients with a SUD had Among these smoking patients actively or significantly more the diagnosis of passively, of acute asthma history were schizophrenia (100% vs 36.2%, p=0.05), a noted in 7 patients, or 33.3% of cases. All higher rate of smoking (100% vs 27.7%, our patients were on inhaled p=0.02). Financial situation, education, corticosteroids at high doses in 2 cases marital status and age of onset of the associated with corticosteroids orally disease were not associated with SUD. continuously. 28 patients had more than 3 Conclusion: SUD are prevalent among exacerbations per year that required oral psychiatric outpatients and contribute to corticosteroid therapy. Blood gas analysis their morbidity. was normal in 12 patients. Hypoxemia with hypocapnia were noted in 14 patients. P-74 : Smoking among psychiatric Conclusion :Our study shows that smoking outpatients may be a risk factor for difficult asthma I. Hachaichi, L. Ghanmi*, Kh. Zitoun*, S. since it decreases the efficacy of Hamrouni*, M. Daoud*, S. Elleuch*, L. corticosteroids and impairs lung defense Zouari**, M. Maalej** mechanisms University of Sfax, Tunisia

Abstract : Introduction: In general, patients with psychiatric disorders have an increased

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incidence of smoking when compared to structured questionnaire designed for the the general population. study was used to collect socio- Aim: The present study examined the demographic characteristics and addictive prevalence and determinants of smoking behavior data. We used the Addictive among outpatients receiving different Intensity Evaluation Questionnaire (AIEQ) psychiatric diagnoses (DSM-V). to evaluate the addictive behavior Methods: It was a cross-sectional study (workaholism) and co-addictions (coffee undertaken for a one month period, addiction). including outpatients with different Results:Our population was consisted of psychiatric diagnoses (DSM-V), aged over 62 interns in medicine and resident 18 years, following the psychiatric doctors. The mean age was 28 years. Sex- department of the regional hospital of ratio (H/F) was 0.5. More than half of this Gabes. Data collection was done through population were resident doctors (58%) a semi-structured interview with the patient and single(56.5%).They consume coffee in and a family member + review of medical 87% of cases and energy drink in 16% of records. We assessed patient cases.The majority of them (62%) have a demography, psychiatric and smoking workaholism. This behavior addiction was history. moderate in 63% of cases, high in 13% of Results: In our sample, smokers account cases and intense in 24% of cases for 34% of the patients and were according to AIEQ. The analytical study exclusively men. The prevalence of releaved a significant correlation between smoking was significantly higher in male workaholism and coffee addiction patients. Smokers had significantly more (p=0.021), intense coffee addiction the diagnosis of schizophrenia (62.5% vs according to AIEQ (p=0,047), energy drink 29.4%, p=0.02), a higher number of consumption (p=0.047), relapses (3.9 vs 1.8, p=0.03) and a higher Conclusion:It emerges from this work that rate of substance use disorders (18.8% vs the workaholism among interns in 0%, p=0.02). Financial situation, medicine and resident doctors is frequently education, marital status and age of onset associated with coffee addiction and of the disease were not associated with energy drink cosumption. smoking. Conclusion: Because psychiatric patients P-76 : PTSD AND MAJOR DEPRESSION smoke so much, prevention approaches AFTER YEMENI CIVIL WAR: A CASE are clearly indicated. REPORT OF A REFUGEE WOMAN FROM YEMEN. P-75 : Workaholism among interns in Souad Kajam, MD., Maria Sabir, MD., and medicine and resident doctors. Abderrazzak Ouanass, MD I.Lajmi, F.Charfeddine; F.cherif; S.Ellouze; University of Mohammed V Souissi, J.Aloulou; L.Aribi; O.Amami Morocco University of Sfax, Tunisia Abstract : Abstract : Background: Among the consequences of Aims: The objective of our study is to war, the impact on the mental health of the assess the prevalence and the intensity of civilian population is one of the most workaholism among interns in medicine significant. Empirical research has only in and resident doctors and to determine the past years begun to investigate the factors correlated with this addiction effects of war-related stressors among behavior. civilians. Mostly we are aware of the fact Methods: This was a cross-sectional, that soldiers can suffer from significant descriptive and analytic study concerned psychological problems as a result of war, 62 interns in medicine and resident doctors including Post traumatic Stress Disorder conducted in hospitals in Tunisia. A (PTSD). However civilian populations are 64

also exposed to PTSD, especially those treatment for OSA needs to be who flee the war zone and become individualized in order to address all refugees. It is found that war, causes anatomical areas of obstruction. The most serious mental health problems to adults, frequently utilized surgery treatment is the elderly population and children. It‟s also uvulopalatopharyngoplasty. found that women are more prone to the Maxillomandibular advancement (MMA) is war affects as compared to the men. Thus, another type of surgery that has been used this case report describes a case of PTSD to treat OSA. with Major Depression in a refugee woman However, on many occasions, the after war in Yemen. parameters of the upper airways are not Methods: In-depth interview was used to taken into account when the aims of gain data and insight into the personal conventional treatment are fulfilled. experiences of a Yemeni woman refugee. Good aesthetics should never be achieved Results: The case reported here was for some of our patients at the expense of manifested by nightmares and periods of diminishing the capacity of their upper unreality associated to problems in airways. concentration. Suffering from professional harassment while civilian war in Yemen P-78 : IMPACT OF CANNABIS USE and losing her mother who had dementia. DISORDER ON THE COURSE OF Therefore, she opened up to us about her BIPOLAR DISORDER. life‟s details in Yemen and her experiences Hajbi Kaouthar, Zouari Lobna*, Smaoui of trauma as a result of war and we Najeh*, Yaich Sourour**, Maâlej-Bouali learned about her feelings after her. In this Manel*, Charfi Nada*, Zouari Nacer*, Ben case study we found criteria of major Thabet Jihene*, Dammak Jamel**, Maâlej depression associated to PTSD‟s criteria. Mohamed Conclusions: PTSD often follows war University of Sfax, Tunisia events and awareness of the possibility of dual diagnosis with major depressive Abstract : disorder is recommended. Background: There is a considerable debate about the effect of cannabis abuse P-77 : Ortho surgical treatment in on the prognosis and expression of bipolar improving sleep apnea patients. disorder. Ines Dallel, Wiem Marwène, Med Ali Jerbi, Aims: (1) To investigate the prevalence of Samir Tobji, Adel Ben Amor, Faten Ben cannabis use disorder (CUD) in a group of Amor remitted bipolar patients. (2) Explore the University of Monastir, Tunisia relationship between this addictive comorbidity and clinical features of bipolar Abstract : disorder in order to unveil its impact on One of the general aims of orthodontic illness course. treatment and of the combination of Methods : orthodontics and orthognathic surgery is to We realized a transversal, descriptive and achieve good occlusion and aesthetic analytical study during the period from 1 improvement, especially in cases of severe September 2014 to 30 September 2015. It obstructive sleep apnea (OSA). involved 155 stable outpatients with bipolar The management of patients with severe disorder in reference to the classification of obstructive sleep apnea (OSA) syndrome the DSM-5, followed in the department of refusing or not tolerating continuous psychiatry “C” in the Hedi Chaker positive (CPAP) pressure ventilation University Hospital, in Sfax (Tunisia). remains problematic. Oral appliance The instruments used in this study were: devices include mandibular repositioning (a) A semi-structured designed appliances (MRAs) and tongue questionnaire inquiring about socio- retaining/stabilizing devices. Surgical demographic data of the subjects and 65

illness-related variables; (b) DSM 5 criteria hearing voices and behaving aggressively. for CUD; and (c) The Hamilton depression The exam show disorientation to place, rating scale (HDRS) and the Young mania and time; marked loosening of rating scale (YMRS) to check for euthymia. associations, delusional ideation and Results: The prevalence of CUD among agitated behavior. Vital signs were normal; our patients was 19.4%. CUD correlated physical examination was unremarkable. to younger age of onset of bipolar disorder Results of extensive blood work were (p=0.00), mixed (p=0.00) and psychotic normal. Urine toxicology, done after the features (p=0.04) as well as to third day, was negative. The diagnosis of subsyndromal mood symptoms (0.03), MDMA-induced psychotic disorder seemed history of suicide attempts (p=0.01) and most appropriate given the absence of any maniac polarity (0.04). Higher dose of sustained mood disturbance and the lack antipsychotics (p=0.04), side effects of evidence of any prodromal symptoms, (p=0.02) and poor compliance (p=0.00) as typically seen in first-episode psychosis. were also associated with CUD. In addition, there was no family history of Conclusion: While possible mood disorders or psychosis among first- pharmacological effect of cannabis on or second-degree relatives. mood disorders is still controversial and Conclusion: MDMA can cause serious needs further experiencing to be proved, feelings of dissociation resulting in extreme our study confirmed literature data anxiety and psychosis. Currently, use of showing that CUD has a great weight on MDMA in Tunisia is limited, but ecstasy bipolar disorder prognosis. intoxication should be considered in patients with these symptoms. P-79 : ACUTE PSYCHOTIC EPISODE AFTER A SINGLE INGESTION OF P-80 : PREVALENCE AND „ECSTASY‟ CORRELATES OF DEPRESSION AND Mariem Moalla, Rim Sellami, Ines Feki, ANXIETY AMONG ADDICTS. Salma Hentati, Jaweher Masmoudi Mariem Moalla1, Rim Sellami1, Leila University of Sfax, Tunisia Mnif2, Ines Feki1, Albelmajid Zahaf3, Jaweher Masmoudi1 Abstract : University of Sfax, Tunisia Background and aims: The recreational drug “ecstasy” (MDMA), a synthetic Abstract : amphetamine that has both stimulant and Background: Today, addiction is so hallucinogenic properties, has become widespread in the world that it has turned increasingly popular within the youth into a chronic and social disease and has culture. MDMA use has become threatened social security. extremely prevalent among young people Aim:The goal of this study was to evaluate at all-night dances or “raves.” There is a the prevalence and correlates of widely held belief that MDMA is a “safe” depression and anxiety among drug drug, but a growing body of literature has addicts. documented both medical and psychiatric Methods: The current study is a case- adverse reactions to MDMA. In this work, control, which assessed 40 addicts and 40 we describe an individual who developed non-addicts. The addicts group consisted an acute psychosis after a single of patients admitted to the addiction recreational use of MDMA. treatment center ''Aide et Ecoute''. The Case report: A 19-year-old man without non- addicts were selected with respect to remarkable psychiatric or medical history the demographic characteristics. The obtained Ecstasy from his friends and subjects were assessed through the ingested the tablet. He report subjective Hospital Anxiety and Depression Scale effects of euphoria, enhanced sense of (HAD). well-being and closeness. Then, he began 66

Results: The mean age was 30.86 ±8.07 records.Psychiatric comorbidities were years. Subjects were single in 74% of screened at their first consultation through cases. Socioeconomic level was middle in the Mini International Neuropsychiatric 58% and low in 22% of cases. The most Interview for Children and Adolescents common substance misused was (MINI-KID) translated into Arabic and Buprenorphine(52%), followed by cannabis adapted to the Tunisian context (30%) and heroine (18%). Poly drug use Results: Two types of addictions were was reported by 42% of subjects. The age been found in our sample: 67% of patients of initiation psychoactive substance use had a substance abuse and 29% had a was 22,42 ±6,91years. In the addicts behavioural addiction (to internet and group, the average score was 9.06 ±2.25 video game). Only one patient had both of for anxiety and 7.9 ±3.1 for depression. them. We also noticed that the majority of 46% of patients had anxiety and 38% had patients had an addiction to volatile depression. Anxiety and depression scores substances, which are more available in were significantly higher in the addicts our country. For psychiatric comorbidities, group than the controls group (p≤ 10-3). 70% of our patients had another Depression was significantly correlated to psychiatric disorder in addition to his age upper 35 years (p=0,049), earlier age addiction. Depression, conduct disorders of initiation consumption (r=-0,260;p=0,05), and Attention deficit hyperactivity disorder Poly drug use (p=0,02), single state and (ADHD) was the most common psychiatric low to middle socioeconomic state comorbidities. (p=0,016). Anxiety was significantly Conclusion: There is increasing evidence correlated to single state and low to middle for high rates of psychiatric comorbidity in socioeconomic state (p=0,011). children and adolescent with addictions. Conclusions: The present results indicate elevated prevalence of anxiety and P-82 : ASSESSMENT OF THE depression within addicts. Those RELATHIONSHIP BETWEEN comorbidities must be taken into account AFFECTIVE TEMPERAMENT AND in developing treatment programs of ALCOHOL CONSUMPTION. withdrawal. Nada Charfi, Neila Messedi 2, Mariem Turki1, Lobna Zouari 1, Manel Mâalej P-81 : Prevalence of psychiatric Bouali 1, Nasreddine Zouari 1, Jihene Ben comorbidity in Tunisian children and Thabet 1, Mohamed Maâlej1 adolescent with addiction. University of Sfax, Tunisia. Attia M, Boussaid N, Slama H, Gaddour N, Gaha L Abstract : University of Monastir,Tunisia Background: It is unclear how temperament is linked to alcohol-related Abstract : behavior. Aim: To describe the prevalence of Aim:To assess the prevalence of affective psychiatric comorbidity in a sample of child temperament (AT) among alcohol users and adolescent with addiction. and to determine the factors related to Method: A retrospective study of alcoholism. outpatients meeting the DSM-V criteria of Methods : It was a cross-sectional and “Substance-Related and Addictive comparative study among a sample of 50 Disorders” and regularly consulting in Child drug addicted men. They were hospitalized and Adolescent psychiatry department of in the drug abuse prevention center of Monastir and Mahdia was performed. Our Sfax in Tunisia. The TEMPS-A sample consisted of 31 children (3 girls, 28 questionnaire, 110 questions version, has boys) with a mean age of 13, 87 years. been used, evaluating five AT in alcohol Patients were identified through a users and non-users groups. systematic review of medical 67

Results: The average age of patients was were obtained. We used the Addictive 32.98 years [19-59 years]. They were Intensity Evaluation Questionnary (AIEQ) single in 64% of cases and unemployed in to assess intensity of addictive behaviors. 34% of cases. A psychiatric comorbidity Results: Data for the study were recolted was present among 24% of them. In the from 62 participants, resident doctors alcohol abuse and dependence group, (n=36) and interns in medecin (n=26) cyclothymic (54.05%) and hyperthymic composed of 41 females (66,1%) and 21 (27.02%) were the most common AT. The males (33,9%). The age of participant average scores of cyclothymic, ranged from 24 to 32 years (mean age= hyperthymic, depressive, irritable and 28). About two-third of participant (64,5%) anxious AT were respectively 14.27/21, present a low/middle socioeconomic statut. 13.22/21, 11.46/21, 10.78/20 and Nineteen participant use tobacco: 79% 11.59/26. The TEMPS scores of revealed a low dependence on tobacoo, cyclothymic and irritable AT were 10% revealed a moderate dependence significantly higher among the users than and 10% revealed a high dependence. non-users of alcohol (p respectively: More than one third (38,70%) of them <<0.00, 0.02). The alcohol abuse and practice sport: 75% present a low dependance was related to the young age dependence on sport and and 25% shows of patient (p=0.01), polytoxicomania a moderate dependence on sport. Soccer (p=0.02) and the duration of drug use was the sport most frequently mentioned. (p=0.04). However, it wasn‟t correlated The relationship of tobbaco dependence with psychiatric comorbidity (p=0.14). and sport practice fell short of significance Conclusions : In accordance with previous (p>0,05). findings in the field of AT in alcohol users, Conclusion: The study revealed that there our study highlights the predominance of is no statistically significant relation cyclothymic and irritable AT among alcohol between sport practice and tobacco users. Prevention and treatment dependence. This result reinforces that strategies may be more developed if this sport parcticing could be associated with effect is taken into account. healthy behaviour.

P-83 : Cross-sectional study of sport P-84 : Addictive behavior and practicing and tobacco dependence borderline personality. among resident doctors and interns in NADIA Bellali, AMAL Sedrati; FZ Yacoubi; medicine. ABDERRAZZAK Ouanass Mariem Turki,Cherif F, Ar-razi Psychiatric University Hospital, University of Sfax, Tunisia Salé, Morocco.

Abstract : Abstract : Background and aims: Regular physical Introduction:In a literature review, the activity plays a crucial role in health incidence of addictions in the life of maintenance and disease prevention. borderline patients ranged from 14 to However, excessive exercise has the 56%.Addictive behaviors in borderline potential to have adverse effects. patients,who are usually compulsive, are The purpose is to examinate the characterized by the search of rapid relationship between tobacco dependence psychotropic effects with alcohol and and sport practice among resident doctors "stoned" effects with drugs. and interns on medecine. Crisis situations are frequent, marked by Methods: This study enrolled a sample of massive intake of drugs that facilitate self- resident doctors and interns in medecin. destructive behaviors. They were assessed by self reported The aim of our study was to evaluate the questionnaire adiminestred in the hospital prevalence of the comorbiditiesaddiction and via internet. Demographic informations and borderline personality disorder and to 68

highlight the specificities of addictive and patient in the family‟s environment as well therapeutic behaviors in this population. as a psychological support for the spouse. Methodology :This is a descriptive cross- Methodology:Our work focuses on patients sectional study, conducted with 50 patients with problematic alcohol usage according with borderline personality disorders to diagnostic criteria DSM 5. This is a diagnosed according to the DSM 5 criteria. cross type of case-control study evaluating The patients were followed on the inpatient the quality of life of the patient‟s spouse, and outpatient settings of the Ar-razi using the quality of life scale SF-36 psychiatric Hospital of Sale using a hetero translated and validated in dialectal Arabic. questionnaire containing demographic and Results:90% of our 40 patients were male, clinical variables with evaluation of their mean age is 43.6 years. The addictive behaviors by open and closed spouse‟s mean age is 36.7 years. Their ended questions. educational level and their socioeconomic results:Our sample consisted of 50 status varies; and they all live in urban patients with borderline personality areas. 94% of our patients have children, disorder, 68% were female. The mean age with an average of 2.8 children per couple. was 25.2 years and 84% had a high school The disease‟s mean duration was 15.8 level. 76% were single. 45% suffered from years. a depressive disorder. Regardless of the elements evaluated, the Tobacco, cannabis, alcohol, cocaine and results obtained from our sample are heroin use were respectively 100%, significantly lower than those obtained in 87.5%, 37.5%, 20% and 2.5%. the general population, indicating that the The role of drugs was to reduce anxiety in spouses of patients with alcohol use 20%of the patients and for their pleasant disorder have a poorer quality of life. effects in 70%. Conclusion: Psychological support of the 55% of our sample were on spouse and children remains essential in antidepressants, 32% on mood stabilizers any therapeutic strategy. and 30% on antipsychotic. Conclusion: The management of P-86 : NICOTINE DEPENDENCE AND addictions and borderline personality PSYCHIATRIC COMORBIDITIES disorders must be simultaneous. AMONG ELDERLY PATIENTS. Najeh Smaoui, Lobna Zouari, Kaouthar P-85 : Wedded life and alcohol Hajbi, Nada Charfi, Manel Maâlej-Bouali, addiction. Nasser Zouari, Jihene Ben Thabet, NADIA Bellali, AMAL Sedrati;FZ Yacoubi; Mohamed Maâlej. ABDERRAZZAK Ouanass University of Sfax, Tunisia. Ar-razi Psychiatric University Hospital, Salé, Morocco Abstract : Background and aims: Tobacco Abstract : dependence is the most common Introduction:Alcohol dependence is one of substance use disorder in adults with the most common addictive behaviors. It psychiatric conditions. The objective of our has always been a disease that many study was to determine the comorbidity of families suffer from in silence, which nicotine dependence and psychiatric greatly affects spouses and children who disorders in elderly. are dealing with the addiction of a loved Methods: This was a cross-sectional, one. descriptive and quantitative study which The aim of our study is to shed light on the included patients over the age of 65 years repercussion of family alcoholism by and followed in outpatient psychiatric evaluating the life quality of the alcoholic‟s departments of Hedi Chaker hospital in spouse, in order to offer some suggestions Sfax -Tunisia, for a period of six months and thus facilitate the reintegration of the (from January to June 2016). Data 69

collection was conducted with the aid of a period of six months (from January to June semi-structured questionnaire, containing 2016). Data collection was conducted with questions related to socioeconomic the aid of a semi-structured questionnaire characteristics, tobacco use and clinical containing questions related to data, and the Fagerström Test for Nicotine socioeconomic characteristics and tobacco Dependence (FTND). Diagnoses were use, and the following instruments; The selected according to the DSM-5 criteria. Hospital Anxiety and Depression scale Results: Thirty four patients, aged over 65 (HAD), and TheFagerström Test for years were current daily smokers. They Nicotine Dependence (FTND). were 79.4% male and had an average age Results : One hundred patients aged over of 69.40 years. Eighteen (52.9%) smokers 65 years participated in this study, 51% of presented with either high or very high whom were female. Seventy-two percent degree of nicotine dependence, at the of patients were married. Sixty one percent FTND. Psychiatric diagnoses among of participants lived in an urban elderly nicotine-dependent smokers were environment. The level of education did as follows: Schizophrenia and related not extend the primary level in 82% of disorders (38.8%), depressive disorders cases. The prevalence of current daily (27.7%), bipolar disorders (22.3%), anxiety smokers in older patients was 34%. The disorders (5.6%) and Posttraumatic Stress results of the HAD indicated higher levels Disorder (5.6%). Elderly smokers were of depressive symptoms (58.8%). Eighteen treated with antipsychotic drugs in 67.6% (52.9%) smokers presented with either of cases. Among tobacco users, 38.2% high or very high degree of nicotine were benzodiazepines users. Tobacco dependence, at the FTND. The degree of dependence was correlated with nicotine dependence was found to be antipsychotic drug use (p= 0.035) and BZD significantly associated with male gender, use (p = 0.028). low level of education, low income and Conclusion : In the present study, the level depressive symptoms. of tobacco dependence seems to be more Conclusion: In our sample, the frequency severe in schizophrenia, BZD addiction or of tobacco use and nicotine dependence depressive disorders. The major impact of among elderly psychiatric patients was tobacco dependence is on the metabolism high. The results of this study highlight the of psychotropic treatments. importance of focusing smoking cessation efforts specifically on people with mental P-87 : Tobacco use among elderly illness. psychiatric patients. Najeh Smaoui, Lobna Zouari, Kaouthar P-88 : PREVALENCE OF INTERNET Hajbi, Nada Charfi, Manel Maâlej-Bouali, ADDICTION AMONG UNIVERSITY Nasser Zouari, Jihene Ben Thabet, STUDENTS IN THE REGION OF Mohamed Maâlej SOUSSE TUNISIA. University of Sfax, Tunisia Zammit Nawel, Zedini Chekib, Mellouli Menel, El Ghardallou Mariem, Limem Abstract : Manel, Sahli Jihen, Mtiraoui Ali, Ajmi Aim:The aim of this study was to Thouraya determine the prevalence of tobacco use University of Sousse, Tunisia among the elderly psychiatric patients and to determine possible factors related to the Abstract : degree of nicotine dependence. Background: Internet addiction is an Methods: This was a cross-sectional, upcoming health problem in low and descriptive and quantitative study, which middle income countries. In university included elderly patients followed in setting, many studies have identified high outpatient psychiatric departments of Hedi rates and severe consequences of internet Chaker hospital in Sfax in Tunisia, for a addiction. In Tunisia, little is known about 70

the extent of this problem and its stimulating and considered as a major predictors among university students. stream of revenue. In Tunisia, limited Aims: To detect both the prevalence of attention has been paid specifically to Internet addiction among university student‟s gambling. students and the possible Aim:We conducted this survey to evaluate sociodemographic predictors. risky behaviors among youth including the Methods: Cross sectional study was degree of gambling involvement and its conducted in the university setting of the implicated factors. region of Sousse-Tunisia in 2012-2013 Methods: Investigation was performed school-year. A sample of 556 university using a cross-sectional study conducted in students from the 5 university specialties 2013 on a sample of 1002students of the region responded to a self- belonging to university “Tunis El Manar”, administrated questionnaire. Collected who were asked about types of gambling data concerned sociodemographic activities in which they engage and the characteristics and internet addiction using frequency of involvement. Logistic the « Young test ». regression was performed to analyze Results: The mean age of students was multivariate associations between 21.8±2.2 years. Girls represented 51.8%. gambling and socio-demographic Among participants: 230 (45.9%) were characteristics. using internet for long periods but they Results: Investigated students had a controlled their usage, 262 (50.6%) were mean age of 21years (ranging from 17to experiencing occasional or frequent 28).One quarter of the total sample problems related to the Internet use and reported having tried any type of gambling 18 (3.2%) were addicted to internet. during their life with significant higher Internet addiction among students under frequency among male students(46%of the third study level (4.8%) was men vs.9%of women). Around a half of significantly greater than among those at these students, reported being involved on superior study levels (1.5%) (p=0.02). a gambling game at least once per However, no significant differences were week.Multivariate logistic regression found observed according gender, origin, that being a man, poorer family socioeconomic level, social situation or the background, decreased religious beliefs studied specialty. and practice are associated with greater Conclusion: The findings of the current odds of gambling. study suggest that other factors could Conclusion: The concomitant cost of determine the internet addiction among gambling activities to society is staggering. university students. Psychological The youth with low family income are more approaches and early detection systems involved in gambling which is generally are required in order to develop leading to vicious circle of financial appropriate interventions for these problems, in contrast to their beliefs that it students. will be an important source of earning money. Our results are alarming, indicating P-89 : Gambling and its correlates the need to immediately develop and among Tunisian university students. implement strategic gambling education Meriam Nouira, Nadia Ben Mansour 1,5; and harm reduction in our universities. Sophie Dziri 2; Sina Haj Amor 1; Fatma Lassoued 1; Habiba Triki 3; Hajer P-90 : SUBSTANCE ABUSE AND Aounallah Skhiri 1,4 PSYCHIATRIC COMORBIDITIES IN University of Tunis, Tunisia TUNISIAN SUBSTANCE DEPENDENT INDIVIDUALS (SDI). Abstract : Rania Zaouche, Jouini, Amira Mâamri, Background: Engaging in gambling games Jihed Mrizak, Olfa Meziou, Haifa Zalila. is appealing for youth because it‟s University of Tunis, Tunisia 71

Abstract : conducted among 90 patients followed at Background and aims: Substance use the outpatient psychiatry B at the disorders (SUDs) constitute a major health University Hospital HediChaker of Sfax, in problem and are associated with an which the doctor has prescribed extensive psychiatric comorbidity. trihexyphenidyl and that during the period Personality disorders (PDs) and SUDs from January to March 2013. Data commonly co-occur. The present study collection was done by a pre-established investigated the prevalence of PDs and record that featured,in addition of socio- common Axis I disorders in a sample of demographic data, clinical features of each Tunisian SDI. patient (diagnosis according to DSM IV, Methods: This is a descriptive cross- occurrence of side effects, number of sectional study amongst 32 Tunisian SDI previous hospitalizations ...) and monitored in the outpatient unit of Razi prescribing rules (manner of first Hospital from July to August 2016. We prescription, duration and medium doses, administered a questionnaire containing previous attempts degression ...). A factor data related to socio-demographic analysis was conducted among a characteristics, substance use behaviors subgroup of patients followed for and common Axis I and II disorders. personality disorder and the rest of the Results: The average age of our patients population.Data analysis was performed was 38.5 years and the average age of using SPSS 13 software. substance use onset was 26.8 years. Results: The average age was 34 years, Unemployment was reported in 31,1% of half of the patients had a primary school our patients and 50% were single. The level, a slight male predominance was average number of relapses was 7.47. noted and 93.33% were without Hepatitis was diagnosed in 44% of our profession.Twenty five percent of the patients and 6.3% of them were HIV studied subjects had criminal record and positive. 19.8% and 6% respectively 6.66% were poly-drug users.The average suffered from depressive disorder and duration of trihexyphénidyl prescription adjustment disorder on Axis I. On Axis II, was 10.37 years. The diagnoses Borderline and Antisocial personality foundwere schizophrenia (61%), bipolar disorders were estimated up to 25% each. disorder (30%), antisocial personality Conclusion: Our results may have disorder (15%) and two cases of mental implications for establishing risk factors for retardation. Only 17.7% of patients know addictive behaviors and related psychiatric the remedial effect of the neuroleptic‟s disorders, leading forward to the adverse effects. The euphoric effect was development of prevention strategies found in 22.22% of cases.Misuse of derived from these factors. trihexyphenidyl was significantly correlated to the male, psychopathic personality type, P-91 : Misuse of trihexyphénidylamong poly-drug abuse and a higher average psychiatric patients. daily dose. Jammeli. K, Ennaoui. R, Belkaroui. M, Conclusion:Misuse of anticholinergic is a Halouni. N, Aloulou. J, Ammami. O common public health problem. Our work University of Sfax, Tunisia has tried to identify some risk factors.

Abstract : P-92 : Attachment style and Background: Recent observations suggest cyberaddiction among Tunisian the existence of trihexyphenidyl abuse students. linked to its hallucinogenic and euphoric Rim Masmoudi, Ahmed Mhalla, Badii effects. Data concerning the incidence and Amamou, Wafa Chebbi, Lotfi Gaha characteristics of the abusers are scarce. Ahmed Mhalla, Badii Amamou, Wafa Methods: This is a descriptive and Chebbi, Lotfi Gaha comparative cross-sectional study 72

Abstract : Jawaher Masmoudi1 Background:Insecure early attachment University of Sfax, Tunisia experiences have been reported to play an Abstract : important role in the manifestation of drug Background:Dependence on cigarettes is addiction. highly prevalent among patients with Aim: To find the cyberaddiction prevalence bipolar disorder (BD) in comparison to the among students and to examine the general population. relation between attachment style and Aim: To assess dependence on cigarettes Internet addiction. among BD patients and evaluating their Methods:Our study included 85 students motivation to stop smoking. from the faculty of medicine at Monastir. Methods:Our cross-sectional and For data collection, we used: A data sheet descriptive study included 30 oupatients containing demographic data, reasons for with BD, who presented to the psychiatry Internet connection; The Young department at the Hedi Chaker University cyberaddiction scale; The Relationships- Hospital of Sfax in Tunisia. For each style-questionnaire-RSQ to assess patient, we collected sociodemographic attachment style. data and clinical parameters of BD. We Results:The sample was composed by used the Cigarette Dependence Scale 85.9% girls and 14.1% boys. Mean age (CDS-12) and the Smoking cessation was 20.02 years ± 0.2. A total of 20% (n = motivation questionnaire (Q-MAT). 17) of the students were addicted to Results:The thirty patients included were Internet. The students were connecting on all male. Their mean age was 42.34 years. the internet to access the social network The majority of patients were married Facebook in all the cases, communicate (56.7%), had an urban origin (76.7%), a with friends in 95.3% of cases, to deepen high school education (53.3%), a knowledge in 76.5% of cases. In cyber professional activity (63.3%) and an addicted students, only 23.5% of subjects average socioeconomic level (56.7%). had a secure attachment style. Insecure Clinically, patients had BD type 1 in 76.7% attachment styles could be distinguished of cases. Regarding smoking, the mean into 35.3% dismissive, 29.4% preoccupied age of initiation was 17.53 years and the and 11.8% fearful. Forty percent of mean age of onset of daily smoking was students with insecure fearful attachment 20.85 years. The average number of connect to Internet to communicate with cigarettes per day was 31.34. Dependence friends on Facebook (p= 0.01). Finding on cigarettes was average (56.7%) or high new friends on Facebook was significantly (43.3%). The motivation to quit was correlated with insecure preoccupied insufficient in 63.3% of cases, average in attachment type (p= 0.03) 30% of cases and good in 6.7% of cases. Conclusion: The cyberaddiction was Conclusion:Our results show that BD frequent among students. Attachment style patients are highly dependent on played an important role in Internet cigarettes and poorly motivated to stop addiction. More attention must be paid on smoking. To improve the quality of life of the development of child in particular his these patients, long-term smoking interactions with family environment. cessation should be considered as an integral part of the overall care in this P-93 : DEPENDENCE ON CIGARETTES population. AND SMOKING CESSATION MOTIVATION AMONG BIPOLAR P-94 : Problematic video game use PATIENTS. among adolescents. Sahar Ellouze1, Imen Baati1, Wafa Hentati S, Ben thabet J, Turki M ,Maâlej- Abbes1, Jihen Jedidi2, Najla Bahloul3, Bouali M, Charfi N, Zouari N, Zouari L, Jamel Damak2, Samy Kammoun3, Maâlej M. University of Sfax, Tunisia 73

Abstract : appears to be related to self-medication for Objectives: The study objective was to some psychotic symptoms. estimate among high school students, the Aim: To identify the socio-demographic prevalence of problematic video game and clinical features of smoking (VG) use and its risk factors. schizophrenic patient versus non-smoking. Methods: A descriptive and analytical Methods: This is a cross-sectional study cross-sectional study, conducted among including patients with schizophrenia (skz) 60 high school students, during the month aged over 18 years, under antipsychotics of January 2016. Data collection was (AP).Data collection was done through a conducted via a questionnaire exploring semi-structured interview with the patient socio-demographics, Internet and VG use. and a family member + review of medical We used the Young cyberaddiction scale records. We assessed: psychopathological to seek for cyberdependency and the symptoms by the PANSS scale (Positive problem video game playing questionnaire And Negative Syndrome Scale), the global (Tejeiro) to assess problem video game functioning by the GAF scale (Global playing. Assessment of Functioning). 175 patients Results: The average age was 17, 17 were included. They were divided into 2 years. The majority (83.3%) of students groups: smokers (n=85) and non-smokers plays VG. (n = 90) and compared. Problematic VG use had concerned 44% Results: The average number of cigarettes of players while risky or problematic was 15 cig per day. In our sample, Internet use had concerned 66% of them. smokers account for half of the patients Nearly a third of teens (34%) were playing and were exclusively men. The group of more than 10 hours per week. Problematic smokers consisted significantly more VG use was related to the male gender (p single patients (76.5 vs 58.9, p = = 0.001), grade repetition (p = 0.015), lack 0.01).There were no significant differences of communication with parents (p = 0.034) between the 2 groups regarding clinical and parental conflicts (p = 0.03). variables, including age of onset of the A cannabis use, a long period of VG disease, the duration of the disease, the practice and Internet misuse were severity of positive and negative significantly associated with problematic symptoms, and GAF scores. GV use with respectively p = 0.04; 0.00 Conclusion: Tobacco use is common in and 0.005. patients suffering from schizophrenia. Conclusion: Adolescents are particularly Clinically, tobacco does not seem to affect vulnerable to risky behaviors such Internet the positive or negative symptomatology of and VG disorders. Identifying risk factors schizophrenia. can help in the prevention of this phenomenon through a targeted action. P-96 : Nicotine dependence, anxiety and depression in smoking adolescent. P-95 : Socio-demographic and clinical S. Elleuch, L. Ghanmi*, M. Daoud *, Kh. profile of smoking schizophrenic Zitoun*, L. Zouari**, M. Maalej patient. Regional Hospital of Gabes, Tunisia S. Elleuch, L. Ghanmi, M. Daoud, Kh. Zitoun, S. Ben Mahmoud Abstract : Regional Hospital of Gabes, Tunisia Aim: To assess nicotine dependence, anxiety, and depression among smoking Abstract : adolescents. Introduction: In the general population, Methods: It‟s a cross-sectional study smoking is the leading cause of death. included teenagers from 2 colleges located Although the number of smokers is 20 to in Gabes and used a self-administered 30%, the percentage of smoking among anonymous questionnaire. This schizophrenics is 60 to 90%. This smoking questionnaire was drawn up on these 74

adolescents. The loss of autonomy over consultation in university hospital Sahloul. tobacco use was evaluated with the They were given the Fagerstrom Test for Hooked on Nicotine Checklist. The anxiety Nicotine Dependence, HAD test (Hospital and depressive disorders were identified Anxiety Depression scale) for depression using the Hospital Anxiety and Depression and anxiety. scale. Results: The mean age of the sample was Results: Still now, 30 teenagers were 42.1±13.8 and the majority (93.6%) was included. The prevalence of smoking was male gender. Of the 534 patients, 270 80%, it was 92% for boys and 8% for girls. (50.6%) were nicotine dependent. The The vast majority of Tobacco users were prevalence of alcohol intake was 19.1%. using several modes of consumption. The mean score of anxiety was 93.8% of daily smokers had already lost significantly higher in smokers with control of their smoking. Their average alcoholism compared to those without score the Honc was 5.5 (gap deviation alcoholism, respectively 11.79±4.03 vs. 2.4). Of these, 61.3% had a score greater 10.53±4.71, p=0,026. In the other hand, than or equal to 5. The results of the HAD there was no significant difference test for students according to their smoking between the nicotine dependent and status reports a significant difference in the nondependent groups in the severity of scores that were higher in smoking anxiety (respectively 12.08±4.49 vs. students. Depression scores increased 11.41±4.08, p=0.47) and depression with Tabaco consumption frequency. The (6.52±3.42 vs. 6.08±3.79, p=0.56). anxiety scores increased with the Conclusion: Some studies have reported frequency of consumption tobacco. that alcohol dependent patients who Conclusion: Smoking is frequent among smoke have lower depression and anxiety teenagers in Gabes. The vast majority of levels and that their levels of anxiety and daily tobacco users lost control of their depression increase following nicotine smoking. withdrawal. Therefore, alcoholism exert a strong detrimental effect on the ability to P-97 : Role of alcoholism on levels of stop smoking implies a role for adjunctive Depression and Anxiety in smokers of therapy in smoking cessation treatment for smoking cessation consultation of recovering alcoholics with a history of Sahloul hospital: A cross-sectional depression or anxiety. study. Sihem Ben Fredj, Héla Ghali, Salwa P-98 : Cyberaddiction and anxiety Khéfacha, Mohamed Ben Rejeb, Nesrine among students. Mohamed Salah, Fethia Dallel, Kalthoum Yaich.K, Halouani.N, Guermazi.F, Ben Alaya, Lamine Dhidah, Houyem Said Naoui.R, Aloulou.J, Amami.O University of Sousse Tunisia University of Sfax, Tunisia

Abstract : Abstract : Background: It was established that Aim: To evaluate the problematic use of alcoholism is strongly associated with internet, anxiety and depression among cigarette smoking. Moreover, alcohol users student‟s sample of Sfax medical could add the tobacco to alcohol to face up university, and to compare them with some to depression and anxiety. literature data. Aim: We aimed to evaluate the association Methods:A cross-sectional survey was of alcoholism with the severity of anxiety conducted among a sample composed by and depression among a group of Tunisian 35 students who completed a smokers. questionnaire composed by 3 parts : the Method: A cross-sectional survey was first part involve the students' socio- carried out. It comprised 534 smokers who demographic characteristics, personnel have been followed in our anti-smoking and familiar data, the second part 75

included the Hospital Anxiety and cessation consultation of Sahloul hospital Depression scale(HAD scale) and the third since October 2014 to May 2015. Data part included the internet addiction Test were analyzed using the SPSS software (Young) to seek for cyberdependency. 19. Results:The sample was composed by Results: 534 smokers were collected. 57.1% girls (n = 20) and 42.9% boys (n = Based on the scores of the Hospital 15). The mean age was 23.7 years. Anxiety Depression scale, there are 9.2% Majority were unmarried. All students used with anxiety disorder, 13.7%, with internet, with an average time per day 6.53 depressive disorder and 10.1% with hours. A total of 48.6% (n = 17) of anxiodepressif disorder.The score of students were addicted to Internet. While, physical dependence was significantly meanly 43 % of students had anxiety higher among smokers with anxiodepressif symptoms (HAD scale), only 17% had disorder (p<0.05). The rate of quitting at a depressive symptoms. In this study, month was the lowest among the anxious anxiety were correlated to the smokers. In the other hand, the rate of cyberdependency (p= 0.011), however quitting at 3 months, 6 months and 1 year there was no relation between depression were lower among depressed subjects. and cyberaddiction (p= 0.33). The follow-up to the consultation has made Conclusion:This study showed that clear that the frequency of the cessation problematic internet use was frequent in was higher among subjects with a score of the student population. Anxiety symptoms motivation ≥ 12, those where the number were also important in case of net of cigarettes consumed per day is < 20 addiction. So it is important to detect and and who were faithful to the consultation. prevent this cyberaddiction and those In multivariate analysis, the attendance to psychiatric comorbidities in order to limit the consultation was the strongest factor of the extension of this problem. success of cessation. Conclusion: The prevalence of anxiety and P-99 : Relationship between tobacco depression among smokers is frequent. dependence and anxiety and The knowledge of this disorder will help to depression disorders among smokers improve the control of smoking cessation. of smoking cessation consultation of Sahloul hospital. P-100 : Chronic Khat Chewing and Its Héla Ghali, Sihem Ben Fredj, Salwa effect on Mental Health, In Hosanna Khéfacha, Mohamed Ben Rejeb, Nesrine Town, Ethiopia Mohamed Salah, Fethia Dallel, Kalthoum Getachew Abate F,, Ben Alaya, Lamine Dhidah, Houyem Said Black Lion Specialized Hospital, Ethiopia University of Sousse Abstract : Abstract : Background: The Research was Background: The relationship of smoking conducted to assess the effect of chronic and nicotine dependence with depression consumption of Cath edulis on Mental and anxiety disorders has been well- Health in Hosanna Town, Ethiopia. established. Those disorders are a factor Methods :In this study data was collected of failure during the smoking cessation randomly from a total of 384 khat chewers. process. In Tunisia, a systematic tracking Community based cross sectional study of such disorders in a smoking cessation using systematic random sampling consultation has a great interest. technique was employed to select samples Aims: Analyze the relationship between of khat sellers and cluster sampling tobacco dependence and anxiety and technique will be used to select study depression disorders. participants. World Health Organization Methods: A cross-sectional study was substance abuse questionnaire was conducted among smokers of smoking adapted and modified to make it relevant 76

to the objectives of the study. The degree Internet for sexual purposes involved two- of khat chewing and other thirds of our respondents. The modalities factors were addressed through this of the use of Internet for sexual purposes questionnaire. In addition, World Health were in order of frequency: surfing on Organization Self Reporting Questionnaire sexual sites (54.8%), visiting sexology (SRQ) format which has been translated in websites (49.6%) and chatting about sex to Amharic and validated in Ethiopia was (22.6%). Regarding the frequency of used to measure mental distress. cybersex addiction, ten students (8.7%) Results : The result shows that there was were classified "at risk". Some factors statistically significant mental distress were correlated with the risk of cybersex mean score difference between Khat addiction: male gender (p <0.001), earlier chewer and non-Khat chewer group. In age of onset of sexual interest (p <0.001), addition there was a statistically significant preference for a society allowing sexual association between chewing khat and liberty (p <0.001), presence of sexual mental distress .Independent sample t-test fantasies (p= 0.001), practice of indicated that there was a statistically masturbation (p= 0.002) and practice of significant mean score difference between superficial sexual intercourses (p= 0.003) Khat chewer and non-Khat chewer group or penetrative ones (p <0.001). on dependent variable Mental Distress. Conclusions:Cybersex was a frequent Conclusion : The result showed that the activity among students at the Faculty of Mental Distress mean score of Khat Medicine of Sfax, but its use was rarely chewer group was greater than the Mental problematic. Further large-scale studies Distress mean score of non-Khat chewer would be required, especially to explore group (p<0.005). Finally, the major the motivations of cybersex users and the implication of the study was indicated and consequences of their behaviour on their possible recommendations were sexuality off-line. forwarded. P-102 : Prevalence of mental disorder P-101 : CYBERSEX ADDICTION AMONG and malnutrition among secondary MEDICAL STUDENTS. school- going adolescents in Freetown, Wafa Abbes1, Imen Baati1, Leila Mnif2, Sierra Leone. Sahar Ellouze1, Jihen Jedidi3, Jamel Abubakarr Bah, Damak3, Jawaher Masmoudi1 university college hospital, Sierra Leone University of Sfax, Tunisia Abstract : Abstract : Background: Across the life cycle, Aims:This study aimed to describe the use adolescence marks a critical transition of Internet for sexual purposes by medical period for physical, psychological and students and to determine the frequency of social growth and development. cybersex addicts and their profile among Adolescents are vulnerable to mental these students. challenges, which can adversely impact on Methods:It was a cross-sectional, their successful navigation into adulthood. descriptive and analytical study including This study aimed to assess the 220 students at the Faculty of Medicine of relationship between mental disorders and Sfax. Each student had to complete a malnutrition among adolescents in questionnaire with socio-demographic Freetown. data, details about sexuality, accessibility Methodology: A cross-sectional descriptive of Internet and its use for sexual purposes. study carried out among 471 school-going We also used the "Internet Sex Screening adolescents. A combination of Socio- Test". demographic questionnaire, Global School Results:One hundred and fifteen single Health questionnaire (GSHQ), DISC students were selected. The use of Predictive Scales (DPS) and the Becks 77

Depression Inventory (BDI) was In this study, we investigated the effect of administered to the selected students, prenatal stress on the reinforcing followed by a brief clinical examination and properties of nicotine in the CPP paradigm. BMI measurement. Then, we examined the mRNA expression Results: Their ages ranged from 15 to 19 of the D2 dopaminergic receptors using years. Majority, (68%) were from a the quantitative real-time PCR technique in monogamous family setting. The the nucleus accumbens (NAcc). We found prevalence of depression using the DPS that prenatally stressed rats exhibited a and BDI was 24% and 28% respectively. greater place preference for the nicotine- Approximately 14% and 10% of students paired compartment than the control rats. reported suicidal ideation and suicidal Moreover, we observed an overexpression attempt respectively, 12.7% and 10% had of the DRD2 gene in adult offspring use alcohol and psychoactive substances stressed in utero and a downregulation in respectively. About 18.3% were stunting the PS NIC group (PS rats treated with and 2.5% obese. nicotine) compared with their control Family dysfunction, occupation of parents, counterparts (C NIC). parental smoking, poor academic These data suggest that maternal stress performance, frequent hunger, drinking can permanently alter the offspring‟s alcohol, cigarette smoking and having addictive behavior and D2 receptors‟ experience traumatic event were expression. significantly liked with mental disorders. Drinking alcohol, poor academic P-104 : Profile of intimate partner performance, involvement in a fight, poor violence in Tunisia. parental monitoring and parental smoking Shimi S, Haj Amor R, Rouissi R, Mouloud were independently predictive of B, Frigui R, El Mhamdi S depression. Being underweight was university of Monastir, Tunisia significantly associated with suicidal attempt but did not independently predict Abstract : suicidal attempt. The situation of violence against women Conclusion: Mental health problems and refers to a woman victim and an malnutrition are prevalent among aggressor, since these are in large part the adolescents and this buttresses the situations accompanied by professionals. urgent need for policy makers to prioritize Nor should the situation of children adolescent mental and physical health. witnessing such violence be ignored. In this context, we carried out this study, P-103 : Prenatal stress induces which aims to determine the impact of vulnerability to nicotine addiction and spousal violence on the behavior of the alters DRD2 expression in the Nucleus child. Accumbens of adult rats. We performed a quantitative, analytical, N. SAID, Lakehayli; M. EL Khachibi; M. El longitudinal and retrospective study. The Ouahli; S. Nadifi; F. Hakkou; A. Tazi study was conducted at the Monastir Hassan II University, Casablanca, Reproductive Health Clinic for one month Morocco from August 1 to August 31, 2013. In our series, 85 out of 150 women Were Abstract : victims of intimate partner violence at least Prenatal stress (PS) can induce several one time in their lives (56.7%). Forms of long-lasting behavioral and molecular intimate partner violence were associated abnormalities in rats. It can also be in most cases: one third of women had two considered as a risk factor for many forms, one third had three associated psychiatric diseases like schizophrenia, forms. depression or PTSD and predispose to Violence against women is an international addiction. priority and requires a multicomponent 78

response. These data provide evidence P-106 : Traumatic experiences among that strategies should include major public users of alcohol. education programs to change attitudes Nadia Bellali, Abderrazzak Ouanass about the acceptability of intimate partner Mohamed V University, Morocco violence against women, and that these should be addressed to women and girls. Abstract : Introduction:Single or repeated traumatic P-105 : Violent death of a newborn, events, whether they are old or new are Autopsy case report. often found in the biography of addicted Saker L, Guehria F., Sellami L., Zerairia patients. Furthermore, post-traumatic Y., Belkhadja N., Mellouki Y., Kaouis F., stress disorder leads in many cases to the Mira A development of addictive behavior with or Ibn Rochd university hospital - Annaba- without substance. Algeria The post- traumatic stress disorder (PTSD) is a major public health issue with a Abstract : prevalence ranging from 1 to 9% in the Background: Violent death can occur general population, and senior figures in because of injuries, poisonings or other certain high risk populations (war veterans, external causes. In newborns, it is refugees, vulnerable professions to essentially criminal.Neonaticide is the traumatic events, ... ) . Important and deliberate act of murdering a child during complex relationship between alcohol and the first 24 hours of life which is usually psychological trauma has been done by a young girl who wants to hide her demonstrated by studies conducted mostly delivery for social reasons. on the victims of aggression, or exaction, Case: We report the case of a 13-year-old collective disasters, or among veterans. teenager who gave birth to an alive full- Methods:This is a descriptive cross- term male infant inside the hospital where sectional study on a sample of patients she consulted for abdominal pain. After who have suffered from a psychological delivery, she threw her baby out of the trauma in a moment of their life (from window. The day after, the newborn was childhood to adulthood), and the alcohol found alive behind the hospital and then addiction began after this life event. The transferred to the emergency department objective is to study the where he underwent the necessary psychopathological profile of these management but died overnight.An subjects, to improve their management autopsy of the newborn was ordered by which should be early and appropriate for the public prosecutor, performed at the a better prognosis.We used the Post- Forensic Medicine Department, Ibn Rochd traumatic stress disorder Checklist scale. university hospital in Annaba-Algeria. The Results :90% of the alcohol users had mission was to determine the cause of experienced an adverse life event death. 20% were women, whereas men were Results:The external examination has 80% of the sample found external violence lesions.The The traumatic events were: rape and child autopsy has found internal violence abuse (40%), car accident causing injuries in the chest and the head. The damage (30%), loss of a family member diagnosis is: violent death due to (10%), terrorist attack (1%), other polytrauma. traumatic events (9%) Conclusion:Infanticide is a crime known Conclusion:The results of the present since ancient times.Preventing infanticide study suggest that post traumatic stress is found in all care strategies. disorder is deeply connected to adverse life events, and the toughest is the traumatic event the more severe the alcohol abuse is. 79

P-107 : INFLUENCES OF STIGMA AND Conclusions: There is need to address DISCRIMINATION ON DEFAULT OF HIV issues of stigma and discrimination as part POSITIVE ADOLESCENTS ON HAART of prevention of the further spread of HIV IN GABORONE. and AIDS in Botswana. As part of the Aobakwe Bacos Malejane, Refilwe study the theory of Planned Behaviour will Precious Sinkamba be used to intervene in addressing this University of Botswana, Gaborone, issue as a way to find behavioural Botswana influences to these adolescents.

Abstract : P-108 : Quality of life of permanent Background: On-set HIV and AIDS night workers: the case of healthcare epidemic was mainly found among groups staff. who were already socially marginalized Mahfoudh A, and discriminated against. People living University of Monastir, Tunisia with HIV and AIDS become implicitly associated with stigmatized behaviours, Abstract : regardless of how they actually became Aim: To study the impact of fixed night shift infected. They find themselves not on the quality of life among healthcare accepted, rejected, and shunned and may staff. experience sanctions, harassment, and Methods: The present study is an violence based on their infection or exhaustive cross-sectional survey which association with HIV and AIDS (Goldsmith, has been conducted at the University 2004). Discrimination often includes public Hospital of Monastir, and it is about 92 restrictions and some forms of punishment care agents working permanently at night. (Busza, 1999). The study of quality of life is based on the Methods : In this study, social attitudes‟ questionnaire SF-12 variables are used to investigate HIV and Results: The average age was equal to AIDS related stigma and discrimination 42.53 ±9.45 years with a sex ratio of 1.72. among adolescents in Botswana in relation Nurses represented 72% of study to default of HIV positive adolescents on population. The average global score of HAART in Gaborone. The paper adopts a the quality of life (GSQL) was 49.7±11 and framework in studying factors influencing 55.4 % of them had a GSQL < 50. The stigmatization and discrimination against average score of the mental health (SMH) APLWA in Botswana. Variables that reflect was 46.72 ±12.9. A SMH < 25 was noted knowledge and misconceptions about HIV in 5.4 % of hospital night workers. The transmission and those that show the average score of physical health (SPH) socio-economic and demographic profile of was 52.71± 18.04. A SPH 50 < was found individuals are used as predictors of in 54.3 % of the questioned staffs. This stigma and discrimination. score depended significantly on the Results: Results from secondary data consumption of tobacco (p=0.004), alcohol sources show that many of the (p=0.03) and the frequency of family adolescents experience negative attitudes meetings (p=0.007). leading them to refrain from disclosing Conclusion: More detailed studies will be their statuses to anyone. Individuals with needed to identify factors involved in the HIV and AIDS are stigmatized because deterioration of the quality of life of their illness is: (a) associated with deviant permanent night workers among behaviour; (b) viewed as the responsibility healthcare staff to improve their physical of the individual; (c) not well understood by and mental well-being and ensure good the lay community and viewed negatively quality care. by health care providers (Alonzo and Reynolds, 1995).

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P-109 : Mental health of nurses: a cross P-110 : Ethical issues of weaning sectional study conducted in the addicted prisoners. regional hospitals of the governorate of Meriem BEJI, Wael MAJDOUB, Amal Mahdia in Tunisia. MOSBAHI,Ahmed MHALLLA, Ilyes TURKI Aouatef Mahfoud, Aouatef Mahfoud Kairouan’s Hospital-Tunisia, University of University of Monastir, Tunisia Monastir, Tunisia Abstract : Abstract : Background: Addiction to illicit substances Aim: To evaluate the mental health status is a complex medical condition affecting of nursing staff assigned to regional neurocognitive and physical functioning. hospitals in the governorate of Mahdia in An abrupt illicit substances withdrawal may Tunisia. cause profound physical and psychological Methods: It‟s a cross-sectional study over suffering. Addicted individuals are three months, conducted in the especially vulnerable at the time of arrest Department of Occupational Medicine at or initial detention and may be driven to the University Hospital of Mahdia in engage in risky behavior. Tunisia. Data collection was realized with a Aim: To analyze the ethical issues of predefined simple questionnaire, with weaning drug addicts in prison. specific parts for sociodemographic and Methods:We made a review of literature professional characteristics. The concerning the ethical issues of weaning assessment of mental health was addicted prisoners. conducted with the General Health Results:The lack of addicted prisoners' Questionnaire (GHQ). treatment threatens fundamental human Results: A total of 130 health care workers rights to be protected against cruel, have contributed to the study. The mean inhuman or degrading treatment and rights age was 41.9 ± 10 years. The average job to health and life. It also poses serious tenure was 17 ± 11 years. The study of ethical problems for health care providers Mental Health found that 73% of since this violates the basic principles of participants had at least a minor mental beneficence and non-maleficence. disorder. Twenty four percent of the Indeed, the trauma of imprisonment, population had concentration disorders coupled with severe illicit substance and 35% had difficulty of sleeping. More withdrawal, can also increase the risk of than a third of participants had difficulty in suicide among drug addicts. That‟s why making decisions and felt constantly international principles of medical ethics depressed. After logistic regression, a poor require that prison medical staff have to relationship within the health care team provide “the best possible health care for (p=0,05, OR= 1,2; IC= ( 0,9-1,5) and a those who are incarcerated in prisons for highest job tenure (p=0,02 OR=2,26 IC= whatever reasons”. Therefore, all (1,08-4,7)) are correlated to impaired detainees must be able to have access, at mental health of nurses. any time, to health-care personnel. Conclusion: The nursing staff is particularly Conclusions:The health care of prisoners exposed to the risk of mental disorders, should be a public health priority. An which can significantly hinder not only his access to addiction treatment for prisoners health but also the quality of care is primordial to guarantee the fulfillment of delivered. ethical and human rights obligations. Keywords: Nurses, work conditions, mental health P-111 : Psychological counseling to former Senegalese hostages in the context of the Casamance conflict. El Hadji Makhtar BA., Fann Teaching Hospital, Senegal

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Abstract : family history of suicidal hanging a 16years Southern Senegal is facing an armed old cousin a year earlier. conflict that began in the 1980s and Results: An autopsy on his body was following the secessionist ambitions of an allowed to find any trace of violence on the armed movement: the movement of entire body surface outside the groove Democratic Forces of Casamance found in the neck with the characteristics (MFDC). The Senegalese soldiers of a normal life hanging groove. Violence including elite corps namely paratroopers injuries related to the constriction of the and commandos are constantly deployed neck by hanging. The diagnosis is: there. In 2010, 08 Senegalese soldiers and Voluntary violent death by hanging a policeman were taken hostage by Conclusion: Suicide is inherent to family elements of the MFDC. They stayed for a factors where the child plays the role of a year in the positions of the movement. witness ( family conflict , suicide in the After lengthy negotiations, they were family etc.) or factors related to the child released. itself ( weakened personality). In return, they had trouble sleeping. They saw the scenes of the attack and their P-113 : The effect of alcohol abuse on fallen comrades at the time of the attack. post-traumatic stress disorder in mice: They had great difficulty in returning to severity, extinction and their body. When they managed to return psychotraumatic relapse. to their peers, they are marginalized. They Lguensat A, Bentefour Yassine, Bennis felt useless and wondered if they would Mohamed, Garcia René, Ba-M'hamed not have been better that they die at the Saadia time of the attack. The monitoring allowed Laboratoire de to return to the errors of command in the Pharmacologie,Neurobiologie et initial management of these former Comportement, CNRST, URAC37, Cadi hostages... Ayyad Université, Marrakech, Maroc.

P-112 : Suicide by hanging of children: Abstract : autopsy case report. Background : Post-traumatic Stress Saker L, Guehria F., Sellami L., Zerairia Disorder (PTSD) is a sever disorder that Y., Belkhadja N., Mellouki Y., Kaious F., affects approximately 5 to 10% of the Mira A entire population. A startling trend of co- Ibn Rochd university hospital - Annaba- occurring PTSD with alcohol use disorder Algeria. (AUD) has surfaced among humans who express this condition. Yet the Abstract : neurobiological basis for this comorbidity Background: The hanging is due to its remains unclear. ease of implementation and its almost Aim:To investigate the PTSD-AUD radical nature, a major cause of voluntary interaction in mice. We managed first, to death. When it is an adult hanging is establish a reliable alcohol induced usually connected with a suicide. When it conditioned place preference (CPP) in interests the child, it becomes problematic. adult mice. Then, we have investigated the Indeed the discovery of a hanged child interaction between PTSD and AUD puts the coroner and investigator in combining an animal model of PTSD trouble. Is it a crime, suicide or an (based on avoidance training) with the accident? CPP paradigm. Case: We present a case of violent death Results:Our main findings were that by hanging of 14-year-old teenager , who alcohol induces a reliable CPP using was found dead, hanging from a tree 0,8g/kg and 1,6g/kg of alcohol. Following branch with a rope in the family garden, the combination of CPP with PTSD we found that ethanol induced CPP using 82

1,6g/kg had no significant effect was demotivation (17.6%). Main concerning avoidance symptom, whereas preventive measures proposed by study it reduces anxiety-like behavior evaluated population were a systematic use of forces by the elevated plus maze test. In the in areas at risk (45.1%). Specific training in sensitization test, an increased freezing the management of violence can also be response was observed for the group co- an effective preventive measure for 17.6 % expressing CPP and PTSD. After of participants. avoidance extinction, relapse was Conclusion: The risk of aggressions on observed for the group combining PTSD health workers, in particular in pre-hospital and CPP using very low intensity chocs area is considerable. Public awareness, (0,15mA). training staff in managing stressful Conclusion:We have thus managed to situations and improvement of care quality investigate the effect of CPP on PTSD‟s are the main axes to prevent violence at main symptoms and we have found that pre-hospital emergency medicine. CPP facilitates avoidance relapse. P-115 : Violence in health care settings: P-114 : Aggressions in pre-hospital a study conducted in three hospitals in emergency medicine: a cross sectional Tunisia. study among 51 health care workers. Mahfoudh A., Mahfoudh A, Nesrine Mars, Amira Faculty of Medicine of Monastir, University Omrane, Lamia Bouzgarrou, Imen Kacem, of Monastir, Tunisia Taoufik Khalfallah. Faculty of Medicine of Monastir, University Abstract : of Monastir, Tunisia. Aim: Aggressions represent a potential conflict to heath care workers. To assess Abstract : this risk, describe the profiles of victims Aim: To evaluate the frequency of and aggressors and to analyze the aggressions in pre-hospital emergency circumstances of abuse, we conducted a medicine, analyze its circumstances and study of 106 attacks. its consequences to propose means of Methods: This is a retrospective study of prevention. 87 cases of occupational accidents that Methods: A questionnaire was given to a have involved victims of aggression in 3 sample of pre-hospital care providers. The university hospitals in central and southern participants were asked about their socio- of Tunisia, over a period of 10 years. demographic and professional Results: A male predominance was noted characteristics, aggression during their in the victim / aggressor couple with a careers (typology, frequency, causes and respective frequency of 53.8% and 71.6%. consequence) and the possible means of The staff of psychiatric is more exposed to prevention. attacks (48.1%) and the category of nurses Results: Fifty one agents have taken part is most concerned with an average rate of in this study. Physical assaults and 48.1%. The abuser is frequently a patient psychological abuse was reported (56.6%), less often a family member of the respectively by 39.2 % (n=20) and 84.3 % patient (15.1%). The attacks were (n=43) of participants. Concomitant voluntary in 78.1% of cases and due to exposition to both types of aggression was agitated patients in 14.2% of cases. They reported by 32.8 % agents (n=16). Injuries occurred often during the daytime (83.1%) were mild in all cases: bruises 15.6 % and in 27.3% of cases over the weekend. (n=8), ecchymosis 5.8 % (n=3) and Natural arms (punch, crush, bite ...) are the skinners 17.6% (n=9). The main most frequently means used (86.8%). The circumstance of violence was delayed attacks have led to a work stoppage in coming, noted in 31.4 % of cases. The 87.7% of cases and a cumulative period of principal consequence of these injuries absence of 1033 days. 83

Conclusion: Aggressions in health care 0.049, OR = 9.8, respectively) while the settings have multiple causal factors. This physical exercise was a protective factor phenomenon became a frequent daily (p= 0.001, OR= 0.009). reality that generates significant indirect Conclusion: Our results highlight the need human cost on individual and collective for a regular physical activity as well as functioning. That is why we must smoking and alcohol cessation to improve denounce violence and integrate people quality of life. prevention programs into work organization, particularly in hospital facility. P-117 : Adverse childhood experiences and sleep disturbances among Tunisian P-116 : The Influence of Individual pregnant women. lifestyle factors on the quality of life. Sana El Mhamdi,, Amel Amara, Ines Alila Samar, Jedidi Jihen ,Ben Ayed Bouanene, Arwa Ben Salah, Mohamed Houda, Kamoun Sourour, Mejdoub Yosra , Soltani, Mustafa al‟Absi Feki Hbib , Kassis Mondher ,Karray Raouf, Faculty of Medicine, University of Monastir Dammak Jamel (Tunisia) Department of Community Medecine and Epidemiologie CHU Hedi Chaker Sfax. Abstract : Background: Adverse Childhood Abstract : Experiences (ACEs) are associated with Backgrounds: The aim of this study was to an increased risk of several negative assess the influence of individual lifestyle health outcomes throughout the life factors on the quality of life. course. Studies suggest that sleep Methods: We conducted a comparative disorders may be one such outcome. study between two groups. The first group Aim: To extend this literature by examining (G1) included subjects with a altered the link between ACEs and sleep quality of life (QOL) and the second (G2) disturbances during pregnancy in Tunisian subjects with a normal QOL. The study pregnant women. included some visitors contacted at the two Methods: We conducted a prospective University Hospitals in Sfax. A self- study among pregnant women in five administrated questionnaire assessed both primary health care centers in Tunisia. individual lifestyle factors (physical activity, Women were followed during the second, tobacco and alcohol use) and quality of life third trimesters and during the postnatal using the generic SF-36 scale. QOL was period. ACEs included intra-familial considered altered if the overall score of adversities (maltreatment, neglect, the SF-36 is less than 66.7%. physical and sexual abuse) and social Results: Our study included 70 subjects adversities (peer violence, exposure to divided in two groups (G1 = 27 subjects; community and collective violence). Self- 38.6%) (G2 = 43 subjects; 61.4%). Mean reported sleep disturbances were age was 35.7 ± 13.43 years with a assessed using the Arabic version of the predominance of male subjects (62.9%). Pittsburgh Sleep Quality Index (PSQI). The percentage of smoking was Results: Overall, 500 pregnant women significantly higher (96.3% vs 30.2%, p were followed during the study period with <0.001) altered QOL group. The same 54% reported at least one ACE. Sleep applied to the percentage of alcohol use disturbance was reported by 37.2% and (63% vs 20.9%, p= 0.04) .However, the 42.9% during the third trimester and during percentage of subjects practicing physical the postpartum period respectively. After activity in this group was significantly lower adjustment to postpartum depression and (18.5% vs. 65.1%, p <0.001). The post-traumatic stress disorders, ACEs multivariate analysis showed that tobacco were significantly and positively associated and alcohol were independent risk factors to sleep disturbance during the postpartum for altered QOL (p <0.001, OR= 500; p = period. 84

Conclusion: Adverse childhood and 30.4% have had bad relationships with experiences were associated with self- peers. The multivariate analysis showed reported sleep disturbances in pregnant an association between the diagnosis of women. ACEs could be considered as ADHD and the bad relationships with potential risk factor for sleep disturbances. parents and antecedents of maltreatment. Conclusion The ADHD was associated to P-118 : Social interactions, traumatic several sociodemographic characteristics life event and ADHD: about 447 and traumatic life event. Tunisian students. Ben Haouala A, Mhalla A, Guedria A, P-119 : Cases of suicide by self- Amamou B, Bouslah S, Gaddour N, immolation in Kairouan (west central Zaafrane F, Gaha L. Tunisia) during the period from 2011 to Monastir University Hospital, Monastir. 2015. Meriem BEJI, Wael MAJDOUB, Amal Abstract : MOSBAHI,Jihene Mannai, Ilyes TURKI Introduction: Attention-deficit/hyperactivity Kairouan’s Hospital-Tunisia, Department of disorder (ADHD) is considered as a Psychiatry –Kairouan neurodevelopmental disorder . Aim:The aims of our study were to Abstract : determine the prevalence of ADHD in a Background:There are different methods of population of high school students in committing suicide. Some of these Monastir and to study the association methods have a high fatality rate such as between ADHD and relationship with hanging or shooting. In Tunisia, since parents and with peers. 2011, we have noticed an increase in self Methods: It was a cross-sectional study immolation suicides. This method is concerning a representative sample of 447 considered as one of the most lethal third year high school students of the methods. governorate of Monastir during November Aim:The aim of our study was to analyze 2015.The diagnosis of ADHD was made the trends of suicide by self-immolation by the Adult ADHD Self-Report Scale. The over a period of five years (2011–2015). sociodemographic and clinical Methods:We investigated retrospectively characteristics were evaluated by a pre- the forensic autopsy cases of suicide by established questionnaire. self-immolation in Kairouan (west central Results: The prevalence of ADHD in our Tunisia) from 2011 until 2015. population was 18.1%. The study of the Results:There were 24 cases (15 men, five family status showed that the majority of them were married and 9 women), (93.5%) lived in two-parent families. The corresponding to 23% of all known relationship between the adolescent and suicides committed in Kairouan during this his parents was described as very good in period. The most common reasons for self- 47.7%, and disturbed in 23.7% of the immolation were family conflict or financial cases. A history of maltreatment was problems. Five individuals were depressed reported by 18.8%. 91% of students for health reasons. There was a history of reported having friends; the relationship mental disturbances in 17 % of these was described as very good for 42.3% and suicide cases. The location of the self- moderately disturbed for 13.2%. The immolation was home in 94 %. In one case diagnosis of ADHD was associated to the the suicide was committed in front of the single parent family status, 18.5% of police station. In nearly 78 % of cases, the adolescents with ADHD had a single individuals had spilled on themselves an parent ADHD, it was also associated to inflammable fluid mainly petrol. The body bad relationships with parents and with surface area burnt was from 28% to 99 %. peers, 74.1% of adolescents with ADHD Suicide by self-immolation was committed have had bad relationships with parents under the influence of alcohol in 3 cases. 85

Conclusion :In Tunisia the number of governed by clear protocols, which are still suicides by self immolation has increased absent, that ensure its appropriate since 2011. Close cooperation with the application to protect the rights of mentally criminal investigation department is ill person. imperative for determining whether the death by fire was accidental, suicidal or P-121 : CAN WE PREDICT THE RISK OF homicidal. INSTITUTIONAL VIOLENCE? INTEREST OF THE ACTUARIAL APPROACh. P-120 : Ethical Consideration of using Ines Bouanene, Sana El Mhamdi, Ilyes physical restraint. Bouanene Meriem BEJI, Wael MAJDOUB, Amal Facultéde Médecine de Monastir, MOSBAHI,Ahmed MHALLLA, Ilyes TURKI. MONASTIR, TUNISIE. Kairouan’s Hospital-Tunisia, Department of Psychiatry –Monastir Abstract : Introduction: Risk assessment of Abstract : institutional abuse is a major concern of Background: Physical restraint is one of professionals in mental health. Many the most controversial practices in instruments have been developed to psychiatry department. It involves one or increase the prediction accuracy of this more members of staff to hold the person, risk, the Violence Risk Apraisal Guide move him, or block his movements to stop (VRAG) which is the most used instrument him from leaving. It is a real dilemma for for assessing the risk of violence on an medical and nursing staff, shared between actuarial approach based on algorithmic the bond to protect the patient and the duty decision-making process that reflects a to respect his personal freedom. statistical combination to estimate the Aim: Our aim is to analyze the ethical probability of future violence. frameworks relevant to physical restraint. Aim:The aim of our study was to examine Methods: We made a review of literature the predictive validity of the Violence Risk concerning the ethical dilemma of using Appraisal Guide. physical restraint in psychiatry department Methods: We performed a prospective Results:Decisions about the use of study during four months with all patients physical restraints are complex and admitted in the psychiatric department of ethically laden; the complexity of physical the University Hospital of Mahdia in restraint depends on patient characteristics Tunisia under the regular compulsory and nurse-related factors including nurse's hospitalization. The main outcome perception of patient behavior, their measure was the "institutional violence" willingness to take risks, and their own was defined as the occurrence of at least comfort. It is useful to prevent injury and one physical assault against a patient or reduce agitation but it is a highly caregiver and / or behavior that required controversial and potentially dangerous the use of physical restraint during the practice. Indeed, it can produce physical hospital stay. The evaluation of the and psychological effects on both patients predictive validity of the VRAG was made and staff. It should be considered as a last by ROC curve analysis "Receiver resort because it may represent a Operating Characterisic" with calculation of significant threat to human rights, dignity the area under the curve AUC (Area Under and autonomy. However, there are the Curve). A value AUC> 0.70 reflects situations where nurses have to use good predictability. physical restraint to prevent patients from Results: In a cohort of 55 patients admitted self-harming. in compulsory way and followed Conclusions:The use of restraint is always prospectively for a mean duration of 27 an emotive issue, involving challenges and days, the occurrence of "institutional difficult decisions. That‟s why it must be violence" was noted in 30.9% of cases. 86

VRAG score varied between - 19 and 8 95.6% of cases. Self-induced intoxication with an average of - 8.9 ± 6.9. When was the most widely used method (93.4%). applying the ROC curve analysis, VRAG Reactional suicidal attempts as well as has proved predictive for this violence with depression and anxiety disorders an AUC = 0.73 (95% CI [0.59 to 0.87]; p accounted for 60% and 33.3% <0.006). To a cut-off score of - 12.5 respectively. Many factors were corresponding to the inflection point of the significantly associated with suicide curve, VRAG had a sensitivity of 0.82 and attempts: young age, female gender, specificity of 0.50. secondary level of education, liberal Conclusion: These results allowed us to profession or students, presence of trigger identify the predictive capability of this factor, family and personal history of instrument for the actuarial evaluation in mental disorders, the provenance of the the short term risk of violence in Tunisian examination request from a physician. psychiatric environment. Conclusion: This study highlighted a particular profile of patients at high risk of P-122 : FACTORS ASSOCIATED WITH suicide. Special attention must be paid to SUICIDE ATTEMPTS AMONG PATIENTS them with regard to prevention and ATTENDING A TUNISIAN EMERGENCY research programs. DEPARTMENT Ines Bouanene, Ilyes Marrag, Kilani Hajji, P-123 : PREDICTOR FACTORS OF Sana El Mhamdi, Mohamed Nasr MENTAL HEALTH DISORDERS IN Department of Preventive Medicine and VICTIMS OF CHILD MALTREATMENT: A Epidemiology,University Hospital of STUDY OF 317 CASE OF CHILD ABUSE Monastir, Monastir,TUNISIA. IN SOUSSE, TUNISIA. Braham Mohamed Yassine, Jedidi Maher, Abstract : Sahnoun Maha , Masmoudi Tasnim, Elkhal Background: Understanding patterns and Mohamed Cherif, Ben Dhiab Mohamed, potential risk factors of suicidal behaviors Souguir Mohamed Kamel is crucial for healthcare professionals to Farhat Hached University Hospital Sousse, implement selective interventions. Tunisia Aim:The current study aimed at examining the factors associated with suicide Abstract : attempts among patients attending a Background: Research into the Tunisian emergency department. consequences of child maltreatment has Methods: We conducted a cross-sectional uncovered many deleterious study among patients who attended the developmental outcomes. emergency department of Mahdia Aim: To identify risk factors and University Hospital (Tunisia) from April characteristics of Tunisians victims who 2013 to March 2014. Data were collected suffered from psychological consequences from medical records and questionnaires. of child abuse and neglect. Socio-demographic, contextual, Methods: Retrospective cohort study. Data anamnestic and clinical variables were was collected from the reports of the child assessed. protection services agency of Sousse, Results: A total of 90 suicide attempts Tunisia, from 2006 to 2015. Only screened made by 77 individuals were recorded in referrals of child abuse and neglect were during the study period, representing analyzed. prevalence rates of 2.2% of medical Results: 317 reports of child abuse and emergencies and 17.5% of psychiatric neglect were collected and 113 (35.6 %) ones. The patients‟ mean age was 26 suffered from mental health problems years with a female predominance (sex which appeared through the psychiatric ratio = 0.3). More than 1/3 of them were follow-up; conduct disorders (n=63; unemployed. A trigger factor was found in 55.26%), anxiety disorders (n=29; 87

25.43%), depressive symptoms (n=14; (n=115) of the mothers were housewives. 12.3%). Addictive behaviors were found A significant association was found among 2 boys. The most common types of between parental absence and exposure maltreatment were neglect and to neglect as well as between poverty and psychological abuse. Male gender, neglect. In this study, 49.8% (n=126) recurrence of maltreatment, and alcohol school-aged children were not attending abuse among caregivers had significant schools. Early school dropout was association with mental disorders. significantly higher among boys.52.2 Furthermore, children in large families %(n=35) of those who could access were more vulnerable. education had poor school performance, Conclusions: Considering the short and this was significantly related to the child's long term mental sequelae on the mental exposure to neglect. health of victim of child maltreatment, Conclusion: Child maltreatment is a prevention and early identification of cases multifactorial public health issue. is necessary and more effort should be Identifying risk factors helps prevent all provided. forms of maltreatment particularly with support of families through home visits and P-124 : RISK FACTORS OF CHILD educating programs. ABUSE AND NEGLECT AND ITS EFFECTS ON SCHOOL PERFORMANCE P-125 : VIOLENCE AGAINST CHILDREN IN A TUNISIAN POPULATION SAMPLE. IN TUNISIAN SCHOOLS AND Braham Mohamed Yassine, Jedidi INSTITUTIONS: STUDY IN THE REGION Maher1, Sahnoun Maha1, Mlayeh Souhail OF SOUSSE. 2, Masmoudi Tasnim1 , Chkirbène Braham Mohamed Yassine, Jedidi Maher, Youssef1, Ben Dhiab Mohamed 1, Souguir Masmoudi Tasnim,Sahnoun Maha ,Elkhal Mohamed Kamel1. Mohamed Cherif, Ben Dhiab Mohamed, Farhat Hached University Hospital Sousse, Souguir Mohamed Kamel. Tunisia. Farhat Hached University Hospital Sousse, Tunisia. Abstract : Aims: To identify risk factors of violence Abstract : against children and to assess the impact Background: Violence against children on children's access to education and their occurs in homes, schools and streets, in school performances. places of entertainment, and in care Methods: Retrospective, descriptive study centres. Perpetrators include parents, based on reports of the Child Protection teachers, caretakers and other children. Services of Sousse, Tunisia collected from Aim:Our study examines maltreatment in 2006 to 2015. care centers and victimization of children Results:317 cases of maltreatment were by peers and teachers. identified. Children aged from 7 to 10 Methods: A ten-year retrospective and years were more exposed (n=96; 31%). descriptive study (2006 - 2015) of Neglect was predominant in all ages, screened in referrals of the Child followed by psychological violence except Protection Services of Sousse, Tunisia. for children over 14 years-old where it was Results: 317 children were victims of child followed by sexual abuse. Physical abuse abuse and neglect. Through the years, and neglect were significantly associated violence in schools raised gradually. In our to male gender whereas sexual abuse was study, 7% (n = 22) of child maltreatment significantly associated to female gender. cases were perpetrated by teachers and Among siblings, the youngest were classmates. Teachers were more likely to significantly more likely to be victims of commit physical abuse whereas peers sexual abuse. 13.14% (n=16) of fathers were more likely to commit physical abuse victims were unemployed, and 78.2% 88

and emotional abuse with significant mental which is dominated by addictive associations. behavior. Victim‟s access to psychological Furthermore, we collected 5 cases (1.5%) support means should be possible and of sexual abuse while the child was in easy, so that all women who experience foster care. The child himself reported the sexual trauma may follow a path of abuse which consisted in sexual touching recovery and empowering. and sexual harassment. Conclusion: Child abuse represents a real P-127 : Evaluation of an innovative risk for children's ability to learn and grow action in awareness of teenagers into adults who can create sound families against drug abuse in the community of and communities. Prevention programs Akouda. must take place especially in schools Chiraz-Dorsaf Makni, Dr Manel Mallouli*, where children must feel safe and should Dr Chekib Zedini* ,Dr Ajmi Thouraya* be able to thrive. CSB Jawhara Groupement de santé Sousse1. P-126 : ADDICTIVE BEHAVIORS AMONG TUNISIAN WOMEN VICTIMS OF Abstract : SEXUAL ASSAULT. Background : Effective awareness Braham M-Y, Jedidi Maher, Elkhal teenagers against drugs bump into a social Mohamed Cherif, Masmoudi Tasnim, taboo. Replacing the traditional teaching Sahnoun Maha, Ben Dhiab Mohamed, methods, art and peer education are the Souguir Mohamed Kamel. best approaches to raise teenager. Farhat Hached University Hospital Sousse, Aim : The aim of our study was to evaluate Tunisia. this educational approach in the short term. Abstract : Methods : 500 students of primary and Background: Sexual assault is a major secondary school in Akouda were chosen public health problem facing our society. It by science teachers to .attend the has immediate and long-term outreach session. 20% were drawn to consequences that can be devastating complete an evaluation of their knowledge for the physical, emotional and relational pre-forming. A show was made through a health of the victim. partnership between doctors, teachers and Aim: To identify the consequences of life skills peer educators expressing drug sexual assault on Tunisian women abuse problem through plays, poems, addictive behaviors. songs, dances and painting. Same Methods: A descriptive phenomenological questionnaire was distributed at the end of study on 8 Tunisian womenwho were training to half of the initial number victims of a sexual assault on the Sousse (randomly). region between 2013 and 2015 and who Results : 71 students participated with were examined at the Forensic Medicine 67.6% females (n=48), average age Department CHU Farhat Hached Sousse. 13.2years (+/-1.4), Results: In our sample, the main age of 7% have never heard of drug addiction women was 28.25 years. The assailant (n=5). 72% reported that substance abuse was known in 75% of cases in which the is a common problem (n=51), 45% are husband was the perpetrator in one case. convinced that this issue does not affect We founded some new addiction teenagers but the adult males (95%,n=68). behaviors in victims; alcoholic addiction in After training, the majority considers that 33%, drugs addiction in 20% and cannabis the problem affects both sexes, all ages addiction in 46%. combined. If 93% (n=68) of students Conclusion: The impact of sexual trauma consider drug addiction as an abnormal mental health is clearly important and behavior they neither see it as a crime constitutes a serious problem for health penalized nor as having a fatal outcome 89

(30% to 40% of cases).These rates mentioned in 32% of cases, represented increased respectively by 20%/30% post- by depression (12.5%) and schizophrenia training. Girls are more exposed, 38% (5%). Fifteen cases (12 %) had a previous don‟t consider addiction as serious acts, suicide attempt.The most common method (boys 26% p=0.01). This difference of suicide was hanging (39.2%). The most persisted after training despite its reduction reported reason in our study was family (6%). conflict (17.6%). Conclusion : The short-term increase in Conclusion: Although individuals commit awareness of teenager against drug abuse suicide for various reasons, communities is demonstrated, but requires a long-term are often not willing to discuss the issue. evaluation focused primarily on female Suicide prevention programs are urgent students to judge its impact. and should incorporate woman specific strategies. P-128 : SUICIDE IN WOMEN: MEDICO LEGAL ASPECTS IN A TUNISIAN P-129 : CHILDREN‟S RIGHTS IN POPULATION. TUNISIA: LEGAL AND ETHICAL Dorra Oualha, Nidhal Haj Salem, Mariem ISSUES. Belhadj, Sami Ben jomaa, Imen Hmila Dorra Oualha, Mariem Belhadj, Nidhal Haj Amal Mosbahi, Ali Chadly Salem, Imen Hmila, Sami Ben jomaa, Fattouma Bourguiba Hospital, Monastir, Amal Mosbahi, Ali Chadly Tunisia. Fattouma Bourguiba Hospital, Monastir, Tunisia. Abstract : Background: Suicide is an important and Abstract : preventable public health problem, which Background: Children are vulnerable and is associated with high economic burden. need special attention and care by Increased Tunisian suicide rates are governments. Tunisia was a pioneer reported especially after revolution. country in childhood protection by taking Despite women's greater vulnerability to many measures. suicidal behavior, completed suicide is Aim:Our aims is to describe the country‟s more frequent among males than females. advancement in the legal field Aim:The goal of this study is to describe Results: Tunisia is party to a large number characteristics of female suicide, including of international conventions promoting the means and social parameters. children‟s Methods: We conducted a retrospective rights. The most relevant measure is the and descriptive study over a period of 25 promulgation in 1995 of a Code for the years. We included all cases of suicide Protection of among females autopsied in the Forensic the Child (CPE). The 4 article specify that Medicine Department of Monastir. Data the best interest of the child must be the were gathered from the medical hospital aim in all records, the commemorative reported by actions and decisions taken. Parents have parents of the casualties, the minutes of the primary responsibility and active the judicial police and the autopsies involvement in reports. all phases of intervention appointed by the Results: One hundred and twenty-five Code. The Respect of children's female suicide cases were recorded during views and 1991–2015. The mean age of the cases participation in all social or judicial was 32 years (SD = 15.96), and the age measures taken in its favor. The first range was 11–87. Twenty-one of the chapter of this code cases (16.8 %) were under the age of 18. is specially made for child in danger and The majority of the suicide deaths the second chapter for the child in conflict occurred in spring. Psychiatric history was with laws. 90

It also favors measures promoting traffic accidents. The TTD were preventive and educational reintegration. determined on over 3 months in 15.38 Furthermore, the %.The average of days attribued was code creates a “delegate for the protection 45.62 with extremes 04-120 days. The of childhood” who enforces measures of other 22 certicates were delivred for prevention victims of violence. The TTDwere and protection. It also protects them determined on over 10 days in 68.18%. against all forms of exploitation, violence, The average of days was 19.31 with prejudice or extremes 06-45 days. The certificates physical, psychological or sexual assault were revaluated by a forensic doctor and or abandonment or neglect. Many others the TTD were determined on over 3 legal texts months in only one certificate of victim of protect the right to vaccination, to traffic accidents and on over 10 days for education, to give consent and to avoid the certificates of victims of violence in only conflict in 36.36 %. interest between child and legal guardian Conclusion :This study highlited the Conclusion: Despite of these numerous inhomgeneity in the assements of the TTD measures, there is a significant gap attributed by general practioner and between legal provisions and their weak or forensic doctor, which can be explained by inexistent application in practice. the absence of the official scale and the lack of knwoledge of its medico-legal P-130 : COMPARING ASSESSMENTS consequences. DURATIONS OF TEMPORARY TOTAL DISABILITY (TTD) ATTRIBUTED BY P-131 : ROLE OF DOCTORS IN FORENSIC DOCTOR AND GENERAL PROTECTION OF THE INCOMPETENT PRACTIONER. ADULTS. Marwa Boussaid, Mohamed Amine Marwa Boussaid, Mohamed Amine Mesrati, Abir Aissaoui, Ali Chadly Mesrati, Abir Aissaoui, Ali Chadly Taher Sfar University Hospital of Mahdia- Taher Sfar University Hospital of Mahdia- Tunisia. Tunisia.

Abstract : Abstract : Background: The duration of the temporay Background :An incompetent person is total disability (TTD) is the period of time anyone of full age without legal capacity during which the victim is unable to do the and unable to manage their own basic activities. The evaluation of this affairs.That‟s why , it‟s necessary to duration is an act that could have serious protect these people from abuse and implications. Every doctor doctor must be exploitation. able to assess the TTD. Aim:The aim of this work is to determine Aim:The aim of this work is to compare the measures to protect these incompetent assessments durations of temporary total adults in Tunisia and the role of docters in disability attributed by forensic doctor and this situation. general practioner. Methods : A revue of literature and an Methods : A retrospective study was analysis of tunisian legislation promoting conducted in the Department of Forensic the protection of the incompetent adults. Medicine of .he University Hospital of Analysis : Doctors are required to do fine- Mahdia. One hundred primary medical grained cognitive and functional evaluation certificates were studied. Then, the TTD that balances promoting autonomy while initialy established was masqued and protecting a vulnerable adult from harm. revaluated by a forensic doctor. The writing of such certificates involves the RESULTS : Among the studied certicates, practitioner's full responsibility. In Tunisia, 78 certificates were delivred for victims of the guardianship is the only tool for 91

protection comparing to other contries Keywords: Primary medical certificate, such as France (gurdianship, Structure, Medicolegal implications trusteeship…).Thus, the guardian can be authorized to make legal, financial, and P-133 : Epidemiological profile of old health care decisions for the ward. social insured individuals with Conclusion : Doctors have an important depression at the regional Monastir role in definding incompetent adults‟rights Center of the National Health Insurance and protecting these people from abuse Office. and their mission will be harder in the Hazar Bhouri, Raja Bouslama, Adel absence of these protective measures . Gaalich, Amira Saadallah The regional Monastir center of the P-132 : RULES OF REDACTION OF THE National Health Insurance Office. PRIMARY MEDICAL CERTIFICATE AND MEDICO-LEGAL IMPLICATIONS Abstract : Marwa Boussaid, Mohamed Amine Introduction:Depression in the elderly is Mesrati, Abir Aissaoui, Ali Chadly often inadequately diagnosed and Taher Sfar University Hospital of Mahdia- insufficiently treated. Regardless of the Tunisia. nature of the depression, the influence and the impact of the biological, situational, Abstract : social and psychological factors would be Background and aim: Doctors are more important in old subject than in frequentely requested by their patients or young ones when the discorder occurs. by judicial requisition to redact a primary Aim: the aim of our survey is to determine medical certificate. the prevalence of depression in old people. The aim of this work is to analyse critically Methods: our study is a transverse, a primary medical certificate of victim of descriptive and analytical survey carried violence written by a general practitioner out on 20 old people and to discuss its medico-legal Results: the examined population was implications composed of 20 people aged from 65 to 93 Methods: An analysis of a primary medical with a sex ratio of 1.05. Depression was certificate of victim of violence written by a more frequent in:female subjects(58.8% of general practitioner and a revue of women compared to 44.4% of men). literature. Conclusion: Depression in the elderly is Analysis: The primary medical certificate is related to several depressive factors. This a descriptive observation of the injuries situation needs very importants adaptive found. It involves the practioner's full capacities. responsibility (legal, civil, disciplinary).Thus, every doctor should be P-134 : Exposure to social violence able to perform these certificates. The during childhood and the Risk of document can then be used for judicial depression and anxiety among Tunisian purposes and can direct action against adults. alleged violence perpetrators. It allows the Hela Abroug, Sana El Mhamdi, Ines patient who has suffred damage to get fair Bouanene, Arwa Ben Salah, Manel Ben compensation according to the conditions Fredj, Mohamed Soltani, Mustafa al‟Absi and procedures prescribed by law. Faculty of Medicine, University of Monastir Conclusion: The primary medical (Tunisia). certificate records the facts that the physician has personally found and Abstract : noticed. The writing of such certificates Background: Previous evidence suggests commits the practitioner's legal, civil and that experiencing intra-familial adversities disciplinary responsibilities. during childhood may be linked to problematic health behaviors such as 92

smoking. However, the impact of social to highlight the frequency of this adversities such as peer, community and phenomenon in prison ,the causes and collective violence on risk for tobacco various psychological and behavioral dependence has received much less problems associated with this attention. The Current study examines the phenomenon and support in prison. relationships between social childhood Methods: This work included 100 inmates adversities and smoking behavior inflicted injuries selected randomly on all Methods: We performed a cross-sectional cases of self-mutilation by skin breakdown study among 2010 Tunisian adults using occured in 2015. the Arabic version of the World Health Results: Among the cases studied several Organization Adverse Childhood prisoniers suffering from psychitric Experiences – International questionnaire disorders.Several types of addictions are (WHO ACE-IQ). Data about smoking frequently observed.No taking psychiatric history and nicotine dependence among or psychological treatement was current smokers were also collected. mentioned in the monitoring of self- Results: Males were more likely to have mutilation. experienced all types of social ACEs than Conclusion: Self-injury by dermal females. The overall rate of ever smoking degradation is a phenomenon widespread was 41% with significant sex differences in prison .In general, We find that the (74.7% for males and 12.7% for females; reasons are unclear or p<.0001). Compared to the group with no unknown.However,mental disorders ACEs, students exposed to intra-familial (depression,anxiety....)was described as ACEs reported significantly higher rates of well as drug and alcohol addiction. tobacco use. Likewise, the rates of There is great uncertainly about the type of tobacco use observed for the social ACEs psychiatric treatement for self-mutilation. are significantly higher (80.7% among The therapeutic methods mainly focus on males and 14.4% among females) the causes rather than the behavior itself. compared to the referent group (no ACEs) (p<.001) and the intra-familial ACE P-136 : FEMALE HOMICIDE VICTIMS: exposed group (p <.001). AUTOPSY STUDY OF 66 CASES. The group of current smokers are more Imen Hmila, Nidhal Haj salem, Mariem likely to experience a large number of Belhadj, Amal Mosbahi, Sami Ben Jomaa, ACEs than the group of former smokers. Dorra Oualha, Ali Chadly Conclusion: The findings from this study Teatching hospital Fattouma Bourguiba of underscore the need of multi-sectoral and Monastir, Tunisia. population-based strategies to minimize the occurrence of ACEs in general and Abstract : particularly social ACEs following a Background: Homicide as an extreme stressful transition period in Tunisia. violence against women is an important medico-legal issue worldwide. Its P-135 : Self-harm in prison. characteristics are highly influenced by Rebhi Hela., victim‟s gender specificity. By elucidating General Directorate of prisons and relevant features we aim to enhance rehabilitation Prison of Mornaguia. forensic case profiling through describing the epidemiological characteristics of Abstract : female homicide victims. Background: The self-aggressive behavior Methods: A retrospective analysis of is particularly common in prison,but they forensic autopsy records of female are little studied even thought they homicide victims in forensic medicine represent the majority of attacks on department of Monastir during a 25-year itself.The most common form of self-harm period was carried out. The age, victim- is skin damage.The purpose of this work is 93

offender relationship, modes of homicide standardized questionnaire assessing the and motivation of murder were analyzed. mental and physical quality of life, we Results : During the study period, 66 collected demographic, occupational and female homicide cases were collected. health data. Offender has been identified in 59.1%, it Results: Determinants of the interns‟ was an acquaintance of the victim in physical quality of life were smoking (0.07), 48.5%. Victims were killed by intimate suicidal thoughts (p=0.07), psychosomatic partners in 21.2% and by one of their complaints (p=0.001) and satisfaction in parents in 18.2%. The average age of relation to occupational expectations in the killed victims was 32-year-old varying from department (p=0.001) .Mental quality of life 1-day to 85-year-old. Corps were found was statically influenced by psychosomatic dead most often in the victim‟s domicile in complaints (p=0.002) , suicidal ideation ( 51.1%. The most common causes of death p=0.005) and professional expectations ( were blunt force injury 31.8%, p=0.001). After removal of all the variables strangulation and smothering in 28.8%. that were not independently associated to Combined impacts were revealed in mental and physical quality of life, factors 25.8%. The homicides were associated to accounting for 8.7% of the variance in rape in 9.1% The main motives were physical quality of life were: psychosomatic mostly undetermined; the determined ones complaints (p=0.001) and satisfaction in included interpersonal conflict in 15.2%, relation to occupational expectations in the pregnancy out of wedlock in 9.1% and department (p=0.02) and those accounting robbery in 3%. for 6.5 % of the variance of interns mental Conclusion : Homicide in women is a quality of life were suicidal thoughts phenomenon with several distinctive (p=0.009) and occupational expectations victim, offender, and event characteristics. in the department (p=0.002). Provided data could be helpful for corpus Conclusion: Medical internship is a inspection in forensic casework and for transition from the student training to a real strategic planning of prevention. medical exercise mostly depending on the organizational occupational aspects and P-137 : Health-related quality of life technical resources. Further management determinants during Tunisian medical efforts should be planified to enhance internship interns‟ quality of life on both mental and Irtyah Merchaoui, Noura Belhadj, Wiem physical sides. Bouhoula, faten M'henni, Ines Rassas, Adnène Henchi, Néila Chaari, Mohamed P-138 : Residents‟ Experiences of Akrout,Charfeddine Amri. workplace Harassment in Tunisian University hospital of Monastir, Tunisia medical sector. Irtyah Merchaoui, Tensim Slim*, Feten Abstract : Mhenni*, Ines Rassas*, Neila Chaari*, Background: Medical internship has been Adnène Henchi* , Mohamed Akrout*, Ferid considered the best form of professional Zaafrane**, Charfeddine Amri.*. training for doctors thus various University hospital of Monastir, Tunisia determinants impact mental and physical quality of life of medical interns. Abstract : Aims: To assess the quality of life of Background: Moral harassment has been medical interns and to identify associations a longstanding problem in medical sector, with socio demographic and occupational especially in residency training. This factors. common problem can affect the ability and Method: A cross-sectional anonymous, satisfaction of residents. survey involving 331 interns has been Aim:Our study aims to evaluate the extent conducted in 2 university hospitals. of moral harassment at workplace in Besides the short form of Health survey 94

medical residents and to determine the continues and increases especially with associated factors. medical training. Methodology: A cross-sectional survey Aim: To point out the determinants of was conducted during two months in all depression and anxiety in interns and the cohort of residents practicing in two residents trainees and to assess impact on university hospitals of the faculty of quality of life. Medicine of Monastir in Tunisia. It was Methods:An exhaustive cross-sectional based on the self-administered «Negative survey was carried out during 2 months in Acts Questionnaire». 547 medical interns and residents working Results: A total of 113 questionnaires were in two university hospitals. Anxio- completed. Fifty-eight percent of the Depressive symptoms have been explored residents were victims of moral by the Hospital Anxiety and Depression harassment according to the NAQ. The scale and the quality of life by the Short most frequent harassment acts were the Form 8 Health Survey. quite unmanageable workload (64%), the Results:About 71% of respondents had attribution of tasks much lower than their anxio-depressive symptoms which were competences or tasks with unachievable significantly influenced by serious family objectives or with hard to meet deadlines problems (p = 0.012), number of (31%) and the excessive monitoring dependents (p=0.005), increase in (29.2% ).Workplace moral harassment smoking and alcohol consumption (p = was statistically associated with serious 0.011), satisfaction regarding the quality of family problems (p=0.005), disappointment services provided to patients (<10-3) and with the tasks they were assigned which satisfaction by the department or the fall well below their expectations (p=0.006) chosen specialty. No significant relation to and the failure to rest for psychosomatic or the occupational status of intern or anxio-depressive symptoms (p=0.047). resident (p =0.051) was found. The The final model of logistic binary multivariate model of correlates of anxio- regression showed that dissatisfaction with depressive symptoms was made of the working conditions in the selected satisfaction regarding the quality of department or specialty (p= 0.008) and services provided to patients (p=0.001) anxio-depressive symptoms (p≤0.001) and serious family problems (0.044). were responsible in 19.4 % of the Quality of life, has been significantly variability of residents‟ moral harassment. impaired by the anxio-depressive Conclusion: Being abused during symptoms on the mental ( p< 10-3) and residency is a universal problem. physical sides ( p< 10-3). Educational programs and effective Conclusion:Mental health seems to be preventive measures against this impairing quality of life of interns and mistreatment are urgently required. residents in our university hospitals. Serious measures based on prevention P-139 : Anxiety and depression during programs and aiming to improve work internship and residency: a cross conditions, as well as trainee‟s well-being sectional study in two Tunisian are required to be implemented. university hospitals. Irtyah Merchaoui, Asma Chouchane, Feten P-140 : THE INFLUENCE OF Mhenni,Neila Chaari, Adnène Henchi , ATTACHMENT STYLE ON INTERNET Mohamed Akrout, Ferid Zaafrane, USAGE. Charfeddine Amri. MAATOUK.H, SOUID.O, GUEDRIA.A, University hospital of Monastir, Tunisia. GADDOUR.N, GAHA.L. University Hospital of Monastir, University Abstract : of Monastir, Monastir, Tunisia. Background:Stress in medical career begins since medical studies, and 95

Abstract : CONCLUSION: Attachment theory notes INTRODUCTION: The number of internet that children‟s attachments to their users has increased spectacularly the last caregivers in their early formative years decades. In fact with the global extent of shape their thoughts, feelings and the net, concerns about the over-use of motivations in adulthood. Results of this this technology has been raised. Internet study suggest that dysfunctional addiction is strongly related to attachment style had a great influence on psychological motivations. Indeed adolescents and young adult‟s likelihood of attachment theory has been advanced to becoming addicted to Internet. In fact explain the addictive internet usage. addictive behavior could be a consequent PURPOSE: The aim of this study is to need to escape the emotional distress that examine the impact of the attachment style results from insecure attachment. on Internet addiction risk. Reducing addiction risk to the net could be METHOD: It‟s a cross-sectional study with handled by providing secure foundation for a purposive sampling of 70 adolescents adolescent development. and young adults. Data were collected using a French version of Internet P-141 : SEXUAL ASSAULTS: LEGAL addiction test (IAT) and the Adult ASPECTS COMPARISON BETWEEN attachment scale (AAS). All statistical TUNISIA AND OTHER EUROPEAN analyses were performed using the COUNTRIES. software Statistical Package for Social Wael Majdoub, Amal Mosbahi, Mariem Sciences (SPSS) Version 21. This study Beji, Elyes Turki. was conducted from June 2016 to August Ibn El jazzar Hospital, kairouan, Tunisia. 2016. Abstract : RESULTS: Our sample was comprised of Background: Sexual assaults and rapes 70 participants, of which 40 were girls are considered as psychological and (57.1% of the sample) and 30 boys (42.9 medico-legal emergencies. Their %), ages ranging from 14 to 29 years management necessitates a good (M=24.46). There were 74.3% Medical knowledge of the specific legislation, students, 14.3% were school students, circumstances, physical and psychological 5.7% were commerce students, were 4.3% effects, and of the procedures that follow design students, and 1.4% were sport the lodging of complaint. students. 100% of users reported having Aim: To analyze Tunisian legislative Facebook account, 31.4% had Instagram approach to sexual violence in comparison account, 7.1% uses Twitter network and with other European countries. only 1.9% communicate with Viber. The Methods:It is an overview of legislation main motives of internet use were: concerning sexual assaults in Tunisia and Chatting with friends, spending time, some European countries. studying, playing and purchasing. 32.9% of Results:Tunisian legislation criminalizing users were not addicted to Internet. 41.1% sexual assault is restrictive, gender had mild addiction, 21.4% had moderate specific and fails to define rape in a addiction and 8.6% were severely addicted manner consistent with international laws. to the net. Results had shown that Rape is defined, by a Tunisian insecure attachment style was significally jurisprudence, as the non-consensual related to Internet addiction. In fact, penetration of the vagina by the penis. insecure attachment style was related to France has a broad definition of rape, mild addiction (p=0.024), to moderate including fellatio, anal intercourse and addiction (p=0.000) and to severe penetration by an object other than the addiction (p=0.02). However, secure style penis. Under Tunisian Penal Code, of attachment was not related to addictive “anyone who engages in sexual relations behavior (p=0.015). with a female without her consent through the use or threat of violence is punishable 96

by death”. This definition, unlike French the use or threat of violence is punishable law, excludes the possibility of rape of men by death”. This definition, unlike French and boys and rape within a marital law, excludes the possibility of rape of men relationship. Penalties vary according to and boys and rape within a marital victim‟s age. Any sexual relation with a relationship. Penalties vary according to female aged less than twenty years, victim‟s age. Any sexual relation with a married couple excluded, is punishable by female aged less than twenty years, Tunisian law. However, in France, sexual married couple excluded, is punishable by majority age is 15 years. “Indecent assault” Tunisian law. However, in France, sexual is not clearly defined by Tunisian law, but it majority age is 15 years. “Indecent assault” is generally applied to criminalize non- is not clearly defined by Tunisian law, but it consensual sexual conduct which does not is generally applied to criminalize non- meet the definition of rape. consensual sexual conduct which does not Conclusion:Sexual assaults are crimes meet the definition of rape. repulsed and condemned by all societies Conclusion: Sexual assaults are crimes and laws. However, its definitions and repulsed and condemned by all societies penalties vary from one country to another. and laws. However, its definitions and penalties vary from one country to another. P-142 : CHILD SEXUAL ASSAULT: AN ANALYSIS OF 134 CASES. P-143 : DETERMINANTS OF STRESS AT Wael Majdoub, Amal Mosbahi, Mariem WORK: DATA FROM THE CENTER OF Beji, Elyes Turki, Tasnim Masmoudi, TUNISIA. Mohamed Ben Dhiab. Mohamed Bouhlel, Irtyah Merchaoui, Ines Ibn El jazzar Hospital, kairouan, Tunisia. Rassas, Aymen Melki, Charfeddine Amri, Adnène Henchi, Mohamed Akrout, Neila Background: Sexual assaults and rapes Chaari. are considered as psychological and University hospital of Monastir, Tunisia medico-legal emergencies. Their management necessitates a good Abstract : knowledge of the specific legislation, Aim: To assess determinants of stress at circumstances, physical and psychological work according to professional and socio- effects, and of the procedures that follow demographic characteristics the lodging of complaint. Methods: We conducted a cross - sectional Aim: To analyze Tunisian legislative study during 6 months in 300 participants approach to sexual violence in comparison from 5 different occupational sectors of the with other European countries. region of Monastir. We collected socio- Methods: It is an overview of legislation demographics data, professional concerning sexual assaults in Tunisia and characteristics and used the Job Content some European countries. Questionnaire (JCQ) to evaluate workers Results: Tunisian legislation criminalizing perceived stress. sexual assault is restrictive, gender Results: According to the Karasek model, specific and fails to define rape in a job demand was insignificantly associated manner consistent with international laws. to age and gender. However, in men it was Rape is defined, by a Tunisian associated to the nature of work. The jurisprudence, as the non-consensual mean job demand score was the highest penetration of the vagina by the penis. among brickyard workers and the poorest France has a broad definition of rape, among teachers (p<0.001). In women, it including fellatio, anal intercourse and was the highest among textile workers and penetration by an object other than the the poorest among nurses (p<0.001). As penis. Under Tunisian Penal Code, for decision latitude, there was no “anyone who engages in sexual relations significant difference according to gender; with a female without her consent through nevertheless it was significantly associated 97

to age in men: young men had better among men, p<0.05 among women). decision latitude than older ones (p<0.05). Otherwise, Quality of life was significantly On another hand, decision latitude was influenced by Occupational Sector in the associated to the occupation type: it was mental dimension both in men and women. better when no manual labor was Best score was noticed in men teachers requested independently of gender (p<10- and the poorest one in brickyard workers 3). Finally, the global score of Karasek (p<0.001). As for women, the best score showed that women were more stressed was recorded in teachers and the poorest than men (p<0.05). The age increased one in textile industry (p<0.05). significantly the perceived stress among Conclusion: Mental Quality of life seems to women (p<0.001) while the nature of work be better in men and women teachers and had no significant influence. worse in manual workers. Conclusion: Stress at work seems to be related to gender, age and to type of P-145 : Cognitive behaviour therapy for occupation children‟s posttraumatic stress disorder: a case report. P-144 : INFLUENCE OF OCCUPATION Attia M, Boussaid N, Bannour S, Slama H, ON THE QUALITY OF LIFE IN Gaddour N, Gaha L. DIFFERENT OCCUPATIONAL University of Monastir. SECTORS. Mohamed Bouhlel, Irtyah Merchaoui, Abstract : Aymen Melki, Ines Rassas, Adnène Background: Children and adolescents can Henchi, Charfeddine Amri, Mohamed develop posttraumatic stress disorder Akrout, Neila Chaari, (PTSD) after exposure to traumatic events. University hospital of Monastir, Tunisia. PTSD is associated with substantial impairments in social and academic Abstract : functioning, and if left untreated, may run a Background: In the occupational field, it is chronic course. A substantial body of work more and more important to provide the provides support for the efficacy of best working conditions to insure the best cognitive-behavioral therapy (CBT) for quality of life and the best performance at children with PTSD. work. Aim: To show the different steps of Aim:Our study aims to assess the impact cognitive behavioral therapy in the of the occupational setting on the Quality treatment of posttraumatic stress disorder. of life among workers. Method: This study presents the case of a Methods: A cross-sectional study was 12-year-old girl diagnosed with PTSD conducted between January and June according to the American classification of 2009. A sample of 300 workers from 5 mental disorders (DSM 5). Initial different sectors was enrolled (education, assessment and at the end of therapy was textile industry, brick industry, weaving carried out using the Children Post industry, healthcare sector). They were Traumatic Stress Reaction Index (CPTS- equally distributed into two groups: Group RI ). 1 included younger workers aged 25 to 35 Cognitive behavioural therapy was based years and group 2 included older ones on the model of PTSD of Ehlers and Clark aged 45 to 55 years. Quality of life was with suitable adaptations for use with assessed Through “SF12 –Health survey” children. Treatment was manual based, consisting of a 12-item- evaluation on piloted before the start of the trial, and then physical and mental dimensions. delivered in 12 weekly sessions. Results: Quality of life was better among Treatment components included younger workers as well as in men and psychoeducation, imaginal reliving women on physical (p<0.001 in the two (including writing and drawing genders) and mental sides (p<0.001 techniques), cognitive restructuring 98

followed by integration of restructuring into non-users of alcohol (p respectively: reliving, revisiting the site of the trauma, <<0.00, 0.02). The alcohol abuse and seeking alternative thoughts, relaxation dependance was related to the young age training and work with parents at all of patient (p=0.01), polytoxicomania stages. (p=0.02) and the duration of drug use Conclusion:Our results showed clinical and (p=0.04). However, it wasn‟t correlated psychometric improvement of symptoms with psychiatric comorbidity (p=0.14). with a decreased level of anxiety to half Conclusions : In accordance with previous and a good social and school findings in the field of AT in alcohol users, rehabilitation. our study highlights the predominance of cyclothymic and irritable AT among alcohol P-146 : ASSESSMENT OF THE users. Prevention and treatment RELATHIONSHIP BETWEEN strategies may be more developed if this AFFECTIVE TEMPERAMENT AND effect is taken into account. ALCOHOL CONSUMPTION. Nada Charfi, Neila Messedi 2, Mariem P-147 : Intimate partner violence in Turki1, Lobna Zouari 1, Manel Mâalej relation with addictive behaviors and Bouali 1, Nasreddine Zouari 1, Jihene Ben mental health outcomes. Thabet 1, Mohamed Maâlej Meriam Nouira, Nadia Ben Mansour 1,5; Hedi Chaker UH Sfax ,Tunisia. Sophie Dziri 2; Sina Haj Amor 1; Fatma Lassoued 1; Habiba Triki 3; Hajer Abstract : Aounallah Skhiri. Background: It is unclear how National Institute of Public Health, Tunisia. temperament is linked to alcohol-related behavior. Abstract : Aim:To assess the prevalence of affective Background: Many researches directed temperament (AT) among alcohol users attention toward identifying the role of and to determine the factors related to substance use in partner violence. alcoholism. However, progress in establishing a causal Methods : It was a cross-sectional and or even a temporal link between exposure comparative study among a sample of 50 to violence and subsequent engaging in drug addicted men. They were hospitalized addictive behaviors has been difficult. This in the drug abuse prevention center of investigation was performed to determine Sfax in Tunisia. The TEMPS-A the association between exposure to questionnaire, 110 questions version, has physical and sexual partner violence, post- been used, evaluating five AT in alcohol traumatic stress disorder(PTSD), and users and non-users groups. addictive behaviors like tobacco smoking, Results: The average age of patients was alcohol and other illicit drug use. 32.98 years [19-59 years]. They were Methods: We used a data from a survey single in 64% of cases and unemployed in conducted in 2013in the university “Tunis 34% of cases. A psychiatric comorbidity El Manar” on a sample of 1002students was present among 24% of them. In the who self-field an anonymous questionnaire alcohol abuse and dependence group, about their experiences with intimate cyclothymic (54.05%) and hyperthymic partner violence. PTSD symptoms were (27.02%) were the most common AT. The identified by asking whether they had average scores of cyclothymic, experienced difficulties related to a hyperthymic, depressive, irritable and traumatic experience. anxious AT were respectively 14.27/21, Results: Investigated students had a mean 13.22/21, 11.46/21, 10.78/20 and age of 21years (ranging from 17to 11.59/26. The TEMPS scores of 28).Obtained prevalence rates included: cyclothymic and irritable AT were 5%for intimate partner violence in general, significantly higher among the users than 2.9%for sexual assault and 2.7%for 99

physical assault.Men were found logistic regression were performed for the significantly more exposed to violence (for statistical analyses using Stata 11.2. both physical and sexual) than women(~ Results: Investigated students had a 8.0% of male students vs.3.5%of mean age of 21 years (ranging from 17 to female).Victims had 2.7times greater 28). Overall, 49 students (7% of men vs. likelihood of smoking tobacco than non- ~6% of women) reported being exposed to victims.We didn‟t find any significant sexual or/and physical childhood violence. association between alcohol and other Compared to students who had not been drug use, and sexual traumatic exposed to violence, they were almost 2 experiences.The prevalence of post- times more likely to report using tobacco traumatic stress disorders among victims products, and almost 3 times to use of intimate partner violence was found psychotropic drugs. We found a significant about 43%. association between violence exposure Conclusion: Violence against women during childhood and poor mental health attracts a significant attention in our outcomes in victims. society. However, our results about partner Conclusion: Violence-exposed youth are at violence against men are surprisingly increased risk of multiple adverse health unexpected. Therefore, violence behaviors such as substance use and preventing programs should focus not only adverse psychosocial outcomes. Life skills in women but also include violence against training programs should actively screen men in their priorities. this high-risk group since early childhood.

P-148 : Adverse childhood experiences, P-149 : LINKS BETWEEN VIOLENCE, addictive behaviors and mental health ADDICTION AND SEVERE MENTAL outcomes: results of a study in DISORDERS: AN UPDATED university settings. LITERATURE REVIEW Meriam Nouira, Nadia Ben Mansour 1,5; Amira Belkhiria, Feten Fekih Romdhane, Sophie Dziri 2; Sina Haj Amor 1; Fatma Ines Khemiri, Rym Ridha. Lassoued 1; Habiba Triki 3; Hajer Razi Hospital Tunis TUNISIA Aounallah Skhiri National Institute of Public Health, Tunisia. Abstract : Introduction: Violence has important Abstract : relevance for the criminal justice and Background: Childhood maltreatment like health care systems especially forensic sexual, physical, and domestic violence psychiatry. Although previous studies may result in significant and long-lasting reported the relation between violence and deleterious outcomes ranging from mental illness, the mechanisms underlying emotional and behavioral difficulties to this complex relation is still fragmentary, diverse complex psychopathology effects. especially when it concerns comorbid Aim:to examine the relationship between substance abuse. exposure to violence during childhood and Aim:We purpose to investigate the related addictive behaviors, and mental association between addiction and health consequences. violence among people with severe mental Methods: During a sectional-cross survey illness through a review of literature. conducted in the university “Tunis El Method: we conducted a MEDLINE and Manar” in 2013, 1002 students were asked PUBMED literature search of studies specific questions about childhood published between “2000 and 2015”, exposure to sexual and physical violence. combining the MeSH terms “psychotic We assessed mental health outcomes disorders” , “addiction” “substance use using 10-items about several depressive disorder “. symptoms. Chi-square test and bivariate Results: The synthesis of the results of studies published showed that much of the 100

excessive violence observed in patients individuals (SDI) may find it harder to with severe psychiatric disorders is due to withdraw when facing these SLEs. comorbid substance use disorder (level of Aim: This study examines the hypothetical evidence 1) more than mental disorder per relationship between SLEs and addictive se. Increasing violence associated with behaviors. substance use disorders in patients with Method: A descriptive cross-sectional severe psychiatric disorders had however study amongst 32 Tunisian outpatients same level than that observed among was carried out. A questionnaire subjects without severe psychiatric containing socio-demographic data, data disorders. Moreover, increasing violence in related to substance use behaviors and subjects with substance use disorder but associated life experiences was without severe mental disorders was administered to the participants. higher than in patients with only severe Results: The average age of our patients mental disorders. In fact, mental disorders was 38.5 years and the average age of could increase the risk of installing on substance use onset was 26.8 years. alcohol and drug use disorders, and Dependence was reported in 87.5% and therefore increase the risk of partner abuse in only 12.5% of the cases. violence, and/or be an expression of Amongst our patients, 31, 1% were vulnerability shared for addictive disorders, unemployed. The average number of and violence. Among the substances used, relapses was 7.47. SLEs associated to if alcohol is frequently identified as a addictive behaviors were: Sense of Consumer risk for the emergence of frustration in 50% (Loneliness, money violence among subjects with severe shortage, precarious social conditions…), psychiatric disorders, stimulants when hanging with wrong crowd in 43.8%, consumed could be causing more violence imprisonment in 33,3%, family conflicts in than alcohol (level of evidence 4). 25% and emotional trauma in 18.8% of the Conclusions: Severe mental illness are cases. associated with violence and violent Conclusions: These findings should be offending. However, most of the excess integrated into prevention/intervention risk appears to be mediated by substance programs in hopes of quelling the duration abuse comorbidity. The risk of violence in and severity of substance use behaviors these patients with comorbidity is similar to among Tunisian adults. that for substance abuse without psychosis. This findings improves the need P-151 : CHILD SEXUAL ABUSE: AN of prevention of substance use disorders ANALYSIS OF 262 CASES. and emphasize the fact that patients with Sami Ben Jomaa, Meriem Belhadj, Nidhal severe mental disorders are more often Haj Salem, Dorra Oualha, Imen Hmila, victims than perpetrators of violence Amal Mosbahi, Ali Chadly University Hospital Fattouma Bourguiba P-150 : TYPES OF LIFE EXPERIENCES Monastir (Tunisia). ENHANCING ADDICTIVE BEHAVIORS Rania Zaouche, Lamia Jouini, Amira Abstract : Mâamri, Jihed Mrizak, Olfa Meziou, Haifa Background: Sexual abuse is a serious, Zalila insidious, and persistent form of child Razi Hospital, La Manouba, Tunisia. abuse that is difficult to identify. It is often not reported because many cases remains Abstract : hidden. It is difficult to come by realistic Background: Adults who experience data regarding the prevalence of sexual stressful life events (SLEs) may engage in abuse. substance misuse as a maladaptive coping Aim:We aim in this work to describe the strategy, and substance dependent epidemiological characteristics of sexual assault through the analysis of 262 cases. 101

Methods: This is a retrospective, Aim:The objective of this study was to descriptive study of medico-legal cases of evaluate the use of video games in sexual assault that were examined in children diagnosed with autism spectrum Forensic Medicine Department of disorders (ASD) and attention deficit Monastir. The data analysis is including hyperactivity disorder (ADHD) and to commemorative, judicial report and compare these children to those having forensic investigations. typical development. Results: In the 20 years period of activity Methods: This is a descriptive and we collected 262 cases of sexual assault. comparative study, conducted at the Child There is a male predominance (58%). Psychiatry Out-patient Unit of the Socioeconomic level was low in 59% of University Hospital of Monastir. The cases. The average age was 12 years [2 sample was composed of 15 children years- 17 years]. The average age of the diagnosed with high functioning autism, a attackers was 24 years. In 28 cases, a subgroup of ASD, 15 children with ADHD family relationship between victim and and 15 children with typical development, aggressor was noted. A history of sexual attending primary school. The mean age assault was reported in 23% of cases. The the sample was 8.7 years (6 – 12 years- consultation period was less than 7 days in old) with a masculine predominance (sex 62% of cases. In 10%, rape was ratio=7). The evaluation of video games complicated by pregnancy. Physical consumption and its related problems was violence were reported in 31% of cases recorded using the „‟ Problem Video Game and toxic submission in 10%. The anal Playing Questionnaire‟‟ (PVP, Tejeiro examination showed the presence of 2002) which contains 9 yes/no questions recent anal signs of penetration in 5%. The based on the DSM criteria of addiction. gynecological examination showed Results:The mean value of affirmative laceration of the hymen in 47% cases. answers on PVP was higher in the ASD Conclusion: The analysis of cases of group: 5.33/9, compared to a 4.53/9 in the sexual assault shows a male ADHD group. According to the PVP, the predominance among victims. However ASD group had more problems related to anal examination is normal in the majority video games use than the ADHD group: of cases which explains the difficulty in loss of control (p=0.025), withdrawal (p< diagnosing sexual assault on the basis of 0.001), escape (p=0.033), disregard for the clinical examination. physical or psychological consequences (p=0.010) and family/schooling disruption P-152 : Video games addiction in (p=0.030). There was no difference children with Autism spectrum between the two groups (ASD and ADHD) disorders and Attention deficit regarding to preoccupation (p=0.125) and hyperactivity disorder. tolerance (p=0.346). Regarding the item 7: SOUID O, GUEDRIA A., MAATOUK H., ”Lies and deception”, the ADHD group BRAHIM T., BEN RHAIEM R. GADDOUR responded “Yes” in 80% comparing to only N., GAHA L. 26% in the ASD group (p=0.005). University of Monastir, Tunisia. Comparing to the control group, both the ASD and ADHD groups had more Abstract : problems related to video games Background:Nowadays children use more consumption (p<0.001). and more Smart phones and games Conclusion: Our results showed a more consoles and this due to technological problematic use of video games by ASD revolution. Therefore, they are more children than ADHD. Both groups had a exposed to the risk of video games more related problems compared to typical addiction, particularly those who are developed children. More research is diagnosed with emotional and behavioral required to investigate the mechanism disorders. underling such findings. 102

P-153 : Epidemiological status of Youcef Mellouki, suicide in Tunisia Data from the first Abstract : national suicide surveillance report Violent death is defined as death 2015. "unnatural", it is caused by a deliberate Afef Skhiri, action (or of others: homicide, self-: suicide) or by a sudden external cause, Background and aims called the accident. After the spring revolution in Tunisia, we The purpose of our job is to bring out the observed an increase of suicide frequency epidemiological characteristics and especially among youth. A national forensic violent deaths affecting women in strategy for suicide prevention was the region of Annaba; established and a suicide surveillance This is a retrospective study, from the system was implemented. The aim of this death for which a medico-judicial autopsy work is to present national statistics on was ordered and practiced during the suicide. period 1èr January 2009 until 31 Methods December 2010, on a population of The data gathered by doctors from all women with age equal to or greater than forensic departments was analyzed at the 18 years, in the embalming unit of the National Health institute with the forensic unit of the University Hospital of coordination of the national suicide Annaba.The ethical implications have been prevention committee. scrupulously observed. We included all cases defined as a high During the two-year period, 503 autopsies presumption suicide case according to were performed, among these, we autopsy results. Calculation of suicide identified 35 cases of violent deaths incidence were carried out based on involving women. population estimates from the National The frequency is noted on the order of Statistics Institute (INS) i for 2015 .The 5.82%. suicide means were dived on medical and A third of cases is represented by victims non medical means . in an age between 30 to 40 years. Results Représentaient71 married women, 42% of A total of 372 cases of suicide were all deaths, 88.87% of the victims were reported during 2015; the national suicide decided inactivity. 51.42% of violent incidence rate was 3.27/100.000. The deaths occurred at the family home. incidence was higher among men with a 51.42% of violent deaths are criminal sex ratio of 2.61. The average age of violent deaths, 31.43% of deaths had suicide was 37.9 ± 17.6 years with lesions similar to those observed in extremes ranging from nine to 88 years. suicide. Hanging and immolation were the major it seems that the violent deaths involving suicide means with respectively (58.3% women have little impact, it represents 6% and 15.9%) rates. of all forensic dead. Conclusion The homicide is the first forensic form of The suicide is a national issue with high death, followed by suicide and accidental social impact. Surveillance system is death. essential and provides relevant data for As for etiologies are burns on accidental policy makers that guide strategy death, injury by firearms in homicide and prevention, to monitor activities. hanging in suicide; The autopsy operations and possibly the P-154 : The consequences of domestic toxicological reviews have highlighted the violence: a prospective study on a violent cause of death in the overwhelming sample of 100 people examined the majority of cases forensic unit of the University Hospital of Annaba. 103

P-155 : The lethal violence against Department of Psychiatry A, Hédi Chaker women in the region of Annaba: University hospital, Sfax, Tunisia. Retrospective study of two years. Youcef Mellouki, Abstract : Background: Drug abuse is one of the Abstract : most dangerous phenomena in human The aim of our work is to identify the key societies in the present era. Studies have forensic aspects of this form of abuse. indicated that physical and psychological It is an analytical cross-sectional study consequences of addiction result in a including women aged 18 and older, who decrease in quality of life of the addicts. underwent physical assault by a spouse Aim:This study was conducted to compare during the period between 13 January and quality of life dimensions among drug 20 April 2013. A total sample of 200 addicts and non-addicts consultants was established. Methods: The current study is a case- Data have been collected through a control, which assessed 40 addicts and 40 personal interview and semi-directive, they non-addicts. The addicts group consisted were captured and processed by the Epi- of patients admitted to the addiction info6 software. The frequencies are treatment center ''Aide et Ecoute''. The compared using the chi 2 test and non- addicts were selected with respect to averages are compared using student test the demographic characteristics. The with a 5% significance level. instrument used was Quality of Life (SF- A frequency of 9.35% of the victims who 36) scales. viewed during the study period are victims Results: The mean age of 30.86 of domestic violence. ±8.07years. They were single in 74% of Over sixty six percent of the victims were cases. Socioeconomic level was middle in age less than or equal to 40 years; 58% and low in 22% of cases. All The distribution of repeated violence and participants smoked tobacco. The most frequency of acts of violence is significant common substance misused was (P = 0.00002) Buprenorphine (52%), followed by The distribution of victims of repeated cannabis (30%) and heroine (18%). Poly violence and the use of tobacco is drug use was reported by 42% of subjects. significant (P = 0.0386). Average duration of consumption was 8.24 The distribution of victims of attempted ±5.32years. The study revealed that 92% suicide and sexual violence was significant of addicts have a poor quality of life. (Chi 2 = 9.104, P = 0.0026). Addicts have a quality of life lower than The distribution of victims of suicide non-addicts (P < 0.05). Low and middle attempt and forced sex was significant (Chi socioeconomic level significantly alter the 2 = 4.399- p = 0.0360). physical component (p=0,04). The long We note the crucial role of the pathologist consumption duration was negatively in the management chain. Its mission is to correlated to quality of life (r=-0,327; respond to both legal requirements that p=0,021) and physical component (r=- health. 0,437; p=0,002). Poly drug use Keywords : women, consequences, mental significantly alter general health (p=0,05) health physical health and physical component (p=0,013). Conclusions: Regarding the study findings, P-156 : QUALITY OF LIFE AMONG there was a significant difference between SUBSTANCE ADDICTS: A CASE- quality of life among addicts and non- CONTROL STUDY. addicts. Mariem Moalla, Rim Sellami1, Leila Mnif2, Ines Feki1, Albelmajid Zahaf3, Jaweher Masmoudi1

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P-157 : Illicit drug use and associated P-158 : How to treat the onychophagia. factors among youth. O.Marouane, A.Necibi, M.Nahdi M.Ghorbel Meriam Nouira, Nadia Ben Mansour 1,5; N.Douki. Sophie Dziri 2; Sina Haj Amor 1; Fatma Faculty of dentistry, Monstir Tunisia. Lassoued 1; Habiba Triki 3; Hajer Aounallah Skhiri Abstract : Institut National de Santé Publique, Onychophagia is defined as a chronic Tunisie habit of biting nails, commonly observed in both children and young adults. Abstract : This oral habit may lead to various medical Background: Use of illicit drugs by young and dental problems. To date, people is widespread and its related harm onychopahgia is considered, even in our has risen in the past decade including days, an unsolved problems in medicine several types of psychological and social and dentistry. effects like mental disorders, road-traffic In this work, we describe a nonpunitive accidents, suicides, and violence. fixed appliance bonded in the mandibular Aim:We conducted this study to evaluate arch, as a treatment of onychophagia. It the prevalence of addictive behaviors was used successfully in a group of 15 including illicit drug use and its related young adult patients and maintained factors among youth in Tunisia during a month. Methods: A cross-sectional survey was With 6 months follow up, clinical results performed in 2013 among a sample of has satisfied the patients entirely, that 1002 students at university “Tunis El could be a promising treatment in similar Manar”. Data were collected by an situations. anonymous self-administered questionnaire which was administered to P-159 : PROBLEMATIC FACEBOOK the students usually at the end of a lecture USE AND SOCIAL ANXIETY: RESULTS or seminar. We studied the relationship OF A CROSS-SECTIONAL STUDY between the use of illicit drugs and many Sourour Trabelsi, Nada Charfi, Mariem sociodemographic variables, the degree of Turki, Manel Mâalej Bouali, Jihèn Ben social integration and religiousness, using Thabet, Nasreddine Zouari, Lobna Zouari, the logistic regression with Stata11.2 Mohamed Mâalej . software. Hedi Chaker university hospital, Sfax – Results: About 6%of students (52 persons Tunisia. with mean age of 20.7 years) have tried illicit drugs at least once during the last Abstract : year; 80%of them were men. Nearly half of Aim: To explore whether there is an these students have tried drugs more than association between the presence of social 3 times during the last twelve months. In anxiety and problematic use of Facebook multivariate regression, more elevated (FB). frequency of using illicit drugs was found Methods: A total of 200 FB users took part among non-medical students with in the cross-sectional study. We included significant higher rates among men. subjects whose age is greater than or Conclusion: Our results are worrying equal to 11 years with at least one account because the real prevalence of illicit drug on FB. The FB addiction scale (FAS) and use is surely more elevated regarding to the Liebowitz Social Anxiety Scale were the underestimation of this behavior which used. is considered as illicit and therefore it is Results: The average age of the often hidden. Therefore, urgent policy participants was 24.4 years. The Sex ratio responses to drug problems are needed. was 0.57. On average, they were on FB since 72 months. The average number of their FB friends was 700 and they 105

interacted with only 15% of them in the Methods:This was a prospective study real life. The average daily FB use time in including patients consecutively admitted hours was 2.8. The main purposes and between 1st January 2010 and 31st motivations for using FB were to establish December 2013 with suspicion of SAS and and maintain online and offline an AHI ≥ 5. Were excluded patients with relationships with their friends (66.7%). other sleep disorders and patients with The average FAS score was 34.21 / 100. chronic respiratory failure and chronic According to FAS scores, 19 participants bronchitis. (9,5%) were considered addicts to FB. Results:During the study period 330 Liebowitz social anxiety scale indicated patients were included and divided into 2 that 37.5% of participants had a simple groups: severe SAS group with an AHI ≥30 social anxiety and 17.5% had a / h (n = 234), and a non-severe SAS group generalized social anxiety. FB addiction with AHI between 5 and 30 / h (n = 96). was positively correlated with Social Middle age was 56 ± 12 years with 60% anxiety (p = 0.027). There was statistically female. In both groups, snoring is the most significant correlation with gender (p = common reason for consultation (91%). 0.042) and not with the account seniority Morbidities associated with the diagnosis (p=0,164). The social anxiety was of SAS are dominated by overweight and correlated with the daily time of connection severe hypertension. Severe OSA group (p=0,005) but not with the number of FB had a higher frequency of respiratory friends (p=0,050). arrest (116 vs 19, p <0.01, OR = 2.2), Conclusion: Problematic FB use seems to nocturne awakenings (158 vs 37, p <0.01, be associated with social anxiety. This OR = 2, 17) and sexual problems (98 vs finding may serve for prevention purposes. 34, p <0.01, OR = 2.3). The performance of Epworth score in the diagnosis of P-160 : Occurrence ofstereotyped severity of SAS has been explored by the behaviors by clobazam: A case report area under the ROC curve. The area OlfaHarzallah, under the curve was 0.77. The average of Abstract : Epworth score was 14 ± 5 in the P-161 : Relationship between Epworth population of SAS obstructive and 13 ± 6 score and severity of sleep apnea in the central SAS. The Epworth score was syndrome: validation in homogeneous significantly higher in the group of severe group. OSA (15 VS 10 p = 0.0001). Sahtout M,, Ben Braiek D, Hammouda Z, Conclusion:The Epworth score was found Adhieb A, Nakaa S, Hraiech K, Ousji A, to have a poor ability to identify or Mghirbi A, Ben Abdallah S, Ouanes I, eliminate the severity of OSA. It would be Dachraoui F, Ouanes-Besbes L, Abroug F more interesting in the central type of University of Monastir. sleep apnea syndrome.

Abstract : P-162 : Obstructive sleep apnea Introduction:The sleep apnea syndrome syndrome and high blood pressure. (SAS) is a chronic condition affecting 3-7% Sahtout M,, Hraiech K, Ben Abdallah S, of the general population, aged between Nakaa S, Ben Braiek D, Adhieb A, Mghirbi 30 and 70 years, but still unknown by most A, Ousji A, Hammouda Z, Ouanes I, physician and so often discovered at the Dachraoui F, Ouanes-Besbes L, Abroug F stage of complications. The aim of this University of Monastir. study was to describe the circumstances of discovery of SAS, the clinical Abstract : characteristics of patients and to evaluate Introduction:Obstructive sleep apnea the performance of Epworth score in syndrome (OSA) is a chronic condition that diagnosis of severity of SAS. is frequently under-diagnosed due to its non-specific clinical symptoms. It is a real 106

health issue because of its cardiovascular P-164 : Epidemiological profile of complications. High blood pressure (HBP) injecting drug users in Tunisia is one of these complications. OSA is an Houyem Khiari, independent factor in its own development Salah Azeiz Institute, Tunis, Tunisia with a "dose-response" relation between Background and aims the severity of OSA and the risk of Injecting drug use is a real public health occurrence of HBP. Looking for OSA in the problem. According to estimations of last medical check-up of resistant HBP is surveys in 2009 and 2011, injecting drug endorsed by the HAS and ESH-ESC. The users (IDU) account around 7000 in the aim of this study was to describe the District of Tunis, Sousse and Bizerte. The prevalence of HBP in patients with OSA. aim of this study was to describe the Methods:This was a prospective study epidemiological profile of IDU in 2014. including patients consecutively admitted Methods between 1st January 2010 and 31st March This survey concerned two regions of 2013, having HBP with suspicion of SAS Tunisia (the District of Tunis and the and an AHI ≥ 5. governorate of Bizerte) where drug use is Results: During the study period 300 most prevalent. The sampling method patients were admitted to the ICU, 268 of used was the Respondent Driven them have an AHI ≥ 5. 190 patients (70%) Sampling: RDS. Investigators were trained have a HBP. The middle age was 58 ± 12 in all aspects of the survey protocol. The years with 67% female. In our study, the data were entered using the Epi-data majority of patients have been referred to software and analyzed using the RDS us by a cardiologist for poorly controlled software. hypertension despite a well conducted Results treatment. The group of patients with A total of 802 injecting drug users were severe hypertension was significantly included. The mean age of IDU was 35.9 ± older. Patients with hypertension had 10.5 years; 14.6% were under 25 years old usually a severe OSA. We noticed that and 35.9% were between the ages of 25 daytime and nocturnal symptoms and 34. About two-thirds (65.1%) were not suggestive of OSA were more pronounced married. The majority (96.0%) were in in the group of patients with severe school, but more than the half (53.2%) did hypertension, and with a higher Epworth not exceed the primary school cycle and sleepiness score. 22.1% did not exceed the first cycle of Conclusion:In our cohort patients with secondary education. In about two thirds of hypertension had a severe OSA and cases (62.4%), initiation to injection drug symptoms of OSA were more pronounced were between the age of 15 and 19 years in patients with HBP. Further studies are and in one fifth (19.1%) it was before 14 required to confirm the relation between years. In terms of employment, only 38.7% OSA and hypertension as well as the were active workers. The majority of IDUs evolution of hypertension after OSA were sexually active; Among the total IDU treatment. investigated, four fifths (80.7%) of them have stayed in prison. P-163 : Identifying addictive behaviors conclusion among adolescents: A school based This study have shown that IDU were survey mostly a young population, unmarried and Maroua Daoud, of precarious socio-economic status, Psychiatry Department, Regional Hospital having stayed for the majority in prison. of Gabes The initiation to injection drug use occurred Abstract : most often at a very young age.

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P-165 : Detoxification attempts among accessible because of fears of criminal injecting drug users in Tunisia prosecution. Houyem Khiari, Salah Azeiz Institute, Tunis, Tunisia Background and aims Substance abuse treatment reduces not only drug use but also associated HIV/HCV risk behaviors among drug dependent individuals. In Tunisia, detoxification programs and centers are insufficient. The aim of this study was to describe detoxification attempts among injecting drug users in Tunisia. Methods This survey concerned two regions of Tunisia (the District of Tunis and the governorate of Bizerte) where drug use is most prevalent. The sampling method used was the Respondent Driven Sampling: RDS. Investigators were trained in all aspects of the survey protocol. The data were entered using the Epi-data software and analyzed using the RDS software. Results Slightly less than one-third (31.2%) of the IDU underwent detoxification, including 46.0% at the Tyna center in Sfax, 13.9% at the Jebel El West center, and 13.0% at a psychiatric hospital. Whereas only 4.5% in the Chams center (a low threshold center for IDUs). Detoxification attempts were relatively more frequent among IDU residing in Tunis (31.8% in Tunis against 19.5% in Bizerte) and those who were aged over 25 (33.5% in the 25 years and above vs. 5.4% in the less Of 25 years). The average number of detoxification attempts among those who tried at least once varies from 1 to 20, with an average number of 1.9 ± 1.5 and a median number of 1. conclusion Support for detoxification is essential by helping IDU to acquire professional qualifications, supporting them in their economic reintegration and providing help and needed care to fight against the pressures of their entourage (peer group, dealer ...). As a result, many local communication efforts have to be deployed for this population, which still not very 108