[Sleep in elderly consultants in the front line: about 50 cases]

Sleep disorders in the elderly are common. However, they are often under diagnosed and poorly supported. To study the characteristics of sleep in the elderly consultant at the front line. A cross-sectional survey was conducted on a random sample of fifty persons aged 65 years and over, consultant in the center of basic health of Ezzahra and in a private practice in the same delegation. The sleep efficiency index was 0.85. Nighttime awakenings were present in 44 persons [88%]. Unexplained late night awakening was reported by 19 subjects [38%]. Among the respondents, 40 [80%] were considered to have at least one sleep disorder. The subjective complaint of insomnia was present in 70% of subjects. Excessive daytime sleepiness and/or hypersomnia were present in 70% of subjects. Nocturnal snoring was reported by 22 persons [44%]. Nine subjects [18%] had respiratory pauses during sleep. Despite the high incidence of sleep disorder among the respondents, only 6 persons [15%] among them consulted their General Practitioner for this reason. Among patients with sleep disorder, 14 persons [40%] were taking hypnotics, from which 6 [43%] by self-medication. Sleep disorders in the elderly as well as self-medication with hypnotics are common and under diagnosed. They should be sought systematically in front-line consultation

[ descriptive study of the procedures of psychiatric admissions at Razi hospital]

The law 92-83, has established the rights of the mentally ill to respect for individual freedom and to appropriate care. However some gaps in its implementation led to the revision by Act 2004-40. To study the evolution of the number of admissions with and without consent [hospitalizations at the request of a third party and compulsory hospitalizations], between 2000 and 2009. Retrospective study of the archives of the mental health unit of Razi hospital. The study population included inpatients under the mode of voluntary and involuntary admission either compulsory hospitalizations or at the request of a third party. An increase in the number of hospitalizations without the consent from 2000 to 2009 was noted. The number of compulsory hospitalizations and the one of hospitalizations at the request of a third party rose respectively from 1,048 to 1,443 and from 22 to 1,323. So the number of free hospitalizations has decreased while the number of involuntary hospitalizations has increased, leading to a constant number of total hospitalizations. The sex ratio for compulsory hospitalizations has increased from 2.04 to 5.83 while it markedly decreased for hospitalizations at the request of a third party [from 10 to 1.7].Men, unlike women, were more likely to be hospitalized compulsorily than at the request of a third party. There is a larger use of hospital admissions under constraints than free ones; is it due to a concern for the respect of law or an abuse in the deprivation of freedom for some patients?

[Validity and reliability of the Tunisian version of section G of the composite international diagnostic interview, relative to Schizophrenia]

Early diagnosis of schizophrenia can improve its outcome. Hence, screening policies should be held and suitable tools must be available for general practitioners. To translate the section G [about schizophrenia] of the Composite International Diagnostic Interview to the Tunisian dialect and to check its validity and reliability. The Arabic version of section G of the Composite International Diagnostic Interview has been translated to the Tunisian dialect by psychiatrists speaking fluently both languages. Metric features of the instrument [sensitivity, specificity and predictive values] were assessed by checking its results against those of the gold standard i.e. the expert's opinion owing to the criteria of the Diagnostical and Statistical Manual of mental disorders 3rd revised edition. Reliability has been measured by the index of observer agreement. The instrument showed a low sensitivity of 45% [32% - 58%] and a high specificity of 96% [93% - 99%]. It looked as a diagnostical test that can avoid wrong diagnoses of such a serious and stigmatizing illness. These values are similar or even better than those of literature. The observer agreement index was 0.83 showing a very good reliability. The interviews mean duration was 20 minutes. The instrument showed no variability towards the sex, the age or the educational level of interviewees. Even though section G of the Composite International Diagnostic Interview failed to detect most cases with schizophrenia and showed a poor sensitivity, this instrument can be useful for screening strategies carried out by lay interviewers in the general population

[Violence in Schizophrenia: a study of 60 cases]

Epidemiological studies suggest a positive but controversial correlation between the major mental disorders, particularly schizophrenia and delinquent or criminal acting out. To study the occurrence of violence in patients with schizophrenia according to demographic, clinical and disease progression features. This retrospective study included all out-patients, consulting during a period of one month, suffering from schizophrenia for at least five years. The clinical and forensic history was obtained owing to a semi-structured interview with patients and their families, medical records and the passing of different scales. Sixty patients were included. 46.7% [n=28] of patients had a violent behavior in the pre morbid period. Aggressiveness was noted as the first prodrome in 13.3% [n=8] of cases. 28 major acts of violence were committed by 30% [n=18] of patients regardless of the active period of disease. In 13.3% [n=8] of cases, these acts announced the disease. The majority of acts have been committed against a non-foreign person. Recurrence was noted in 44.4% [n=8] of patients. Several risk factors of violent behavior were found. Only prodromal aggression was associated with a poor prognosis. Violences committed by patients with schizophrenia are attributed to a particular group of patients and do not have necessarily a pejorative prognostic value

practice of traditional therapies in psychiatric environment: study about 100 cases

In all the communities, parallel forms of healing continue to be practised by the population in addition to the services offered by the [modern] psychiatry. The aim is to examine the current state of the traditional therapy in Tunisia and to try to deal with its scope, profile and determinants surveying the population of mentally ill patients. It is about a specific study carried out on 100 consecutive patients having consulted the service of psychiatry [C] of Hospital [RAZI] in Tunis. All the patients having an intellectual deficiency were excluded. We proceeded by a semi-open questionnaire in dialectical Arabic. 90 patients, composed of 38 women [42.2%] and 52 men [57.8%] at the age of 37.8 years in average, were kept in our study. 50% of our patients had recourse to the traditional therapy, 70% of whom before consulting a psychiatrist. This behaviour was not influenced by the age, the profession and the educational level. In 75% of the cases, it was chosen under the effect of the opinion of a member of the family. 1/3 of the patients having had consulted a traditional therapist have improved after his intervention. These are the patients who were convinced of the diagnosis identified by the traditional therapist. The therapeutic observance and the adherence to the modern psychiatry were not influenced by the recourse to the traditional therapy. At the end of this research, we conclude that in Tunisia the recourse to the traditional therapy still persists and continues to perform its function. It makes us think about the necessity to accept its place in the devices for treatment of the mentally ill patients and why not to collaborate with it