According to the World Health Organization (WHO), there is a chronic shortage of psychiatrists on a global scale. In Tunisia, we only have 287 psychiatric specialists, the equivalent of 0,23 per 10 000 habitants in 2017. There is a strong and urgent need to increase the recruitment and retention of doctors in psychiatry, starting from their young years.

We aimed to study medical students’ attitudes and views of psychiatry, and their career choices in psychiatry.

A systematic random sample of medical from two medical schools anonymously completed a questionnaire, distributed via the internet, covering the mental illness: clinicians’ attitudes (MICA) scale, their choice of psychiatry as a career, and the possible associated factors.

A total of 118 medical students participated in the study, with 50% in the second and first years of medical school. The mean age was 21.00 ± 12.2 years. The sex ratio (M/F) was 0.24. We found a personal history of mental health problems in 33.1% of the students.

The mean score of the attitude of health care professionals towards mental illness was 43.61 ± 8.22 out of 96. The results were moderately positive (lowest possible score 25, highest possible score 67) and the female student’s attitude was slightly –but not significantly more positive than male students (male 46.4, female 42.4).

Negative attitudes were reported about the interactions with people with mental health problems, fear of disclosure to colleagues or friends about mental health problems, and confidence in the capabilities of assessing mental health problems in general medicine. No correlation was observed between the immersion clerkship of psychiatry and the MICA scores.

Of the 118 respondents to this question, 35 (29.8%) were most interested in surgical specialties, 35 (29.8%) in medical specialties, and 10 participants (8.5%) were most keen on psychiatry.

Stigma against psychiatry is widespread among medical students. The negative attitudes about mental health and mental diseases may be addressed through educational programs.

None Declared

When medical professionals are obliged to adhere to lege artis and evidence-based decision-making, they need to interpret available evidence. As a complex cognitive process, however, such interpretation may be affected by socio-cognitive biases and predispositions. For instance, the conspiracy mentality (the general readiness to believe in conspiracy theories) or biological determinism (the belief that human lives are determined biologically) affect attitudes to antidepressant medication and vaccination in the public. Little is known about the effects of these variables on the decision-making of clinicians or students of medicine.

The study examines the effects of conspiracy mentality (CM), covid-related conspiracy beliefs (CCBs), and biological determinism (BD) on the doubts students of medicine have about antidepressants and on their uptake of the booster dose of COVID-19 vaccine.

CM, CCBs and BD were measured in May 2022 in a sample of 179 students of medicine (115 females), using the Conspiracy Mentality Questionnaire by Bruder et al. (2013), set of items measuring CCBs developed by Imhoff and Laberty (2021), and the Biological Basis scale by Bastian and Haslam (2006), respectively. The doubts about antidepressants were measured by the Antidepressant Conspiracy Scale by Natoli et al. (2021) tapping participants’ beliefs that drugs and antidepressants specifically are ineffective and promoted and prescribed for financial gains. Logistic and linear regression models were used to predict respondents’ vaccine uptake and doubts about antidepressants.

Booster vaccine uptake was predicted by BD (OR = 1.45; p < .05) and CCBs (OR = .73; p < .05), together explaining 7% of the variance. Booster vaccine uptake was not predicted by CM.

Doubts about antidepressant medication were predicted by CM (b = .17, p < .001) but not BD (p = .89), together explaining 10% of the variance.

The doubts students of medicine have about antidepressants and their vaccination behavior was predicted by their biological determinism, belief in conspiracy theories and general conspiracy mentality. Although the relationships were weak, they support claims that health-related beliefs and behaviors of students of medicine are related to their implicit beliefs and socio-cognitive predispositions. These personal factors may therefore affect their professional decision-making and should be addressed in medical education.

None Declared

Women with schizophrenia require health interventions and safe spaces sufficiently different from those of men.

To describe units in two mental health outpatient services specialized in the treatment of women with schizophrenia and related disorders.

Two units in Spain projected to treat women with schizophrenia and related disorders - Community Mental Health Programs (CMHU Rambla, CMHU Sant Cugat) will be described. Recruitment, assessment, intervention, and evaluation and satisfaction measures will be characterized, and the need to build-in safety precautions (policy/structural).

Demographics:(Preliminary 2021 data on the two services).

Patients attending (CMHU): 3,393. Forty-five per cent diagnosed with severe mental illness. Schizophrenia and related disorders: 873 patients. 58% women.

Staffing projected: 2 psychiatrists, 2 nurses, 1 clinical psychologist, 2 social workers.

Physical structure: Safe spaces for women/children.

Programs (offered currently and in planning stages): 1)Therapeutic Drug Monitoring/Adherence, 2)Individual/group patient/family sessions, 3)Perinatal Mental Health (preconception, pregnancy, lactation, postpartum, parent training/support), 4)Collaborative programs (primary care, medical specialties especially obstetrics/gynecology and endocrinology, trauma specialists, addiction experts), 5)prevention/intervention of suicide risk, 6)social services (single mothers, family issues, domestic abuse, sexual exploitation) 7)home-based services, 8)peer support, 9)physical activity, 10)psychoeducation for patients and families.

Planned quality evaluation measures: diagnostic assessment (reliability, long-term validity);regular treatment effectiveness evaluation (individualization of treatment plans, assessment of adverse effects of drugs, screening for metabolic syndrome/ physical health, family intervention, psychoeducation (individual/group) assessment of suicidal ideation and global functioning.

Specific services for women with schizophrenia and related disorders represent an important resource to improve patient well-being and offer clinical care leading to individual recovery.

None Declared

Childbirth can be experienced as distressing or even traumatic for some women and her partners, which could cause psychological distress, intense fear or helplessness and increases the risk of anxiety, depression and even post-traumatic stress disorder (PTSD). The reported prevalence of post-traumatic stress disorder after childbirth ranges from 1.5% to 6%.

The current study aimed to elaborate a narrative literature review to identify predictors associated development of PTSD in women and the partners.

PubMed database searched using the terms “post-traumatic stress disorder” and “childbirth” and “trauma”. Only research conducted in the past 20 years was considered for inclusion.

Several variables were associated with risk to development PTSD after childbirth, including negative experiences and severe fear of childbirth, subjetive distress, previous abortion, psychological difficulties in pregnancy, previous psychiatric problems, history of PTSD and trauma. Futhermore, obstretic and birth-related factors such as pregnancy complications, type of birth could also contribute to PTSD in women and her partners. Additionally, diferent environmental factors like poor interaction between provider and mother, low social support during labour and birth are associated with development of PTSD.

Clinicians should be aware that many women and her parterns have a risk to development PTSD following childbirth. We need to research risk factors in routine clinical practice and carefully monitored the patients with high risk.

None Declared

Mother-child relationship has a major role in a child’s cognitive, emotional and behavior shaping. Unfortunately, in the context of domestic violence, this relationship can be negatively impacted becoming strained or distant.

To assess the quality of Mother-Child Relationship in the context of domestic violence or intimate partner violence. And to investigate the factors influencing negatively the Mother-Child Relationship.

This is a descriptive and analytical cross-sectional study, conducted among abused women and their children, recruited from associations combatting violence against women, from Moulay abdellah hospital of Salé, and from consultation at the university psychiatric hospital Arrazi of Salé, through a hetero-questionnaire that includes socio-demographic characteristics and scales measuring the quality of mother-child relationship (IPA, CAM) and psychological distress of the mother and the child (EMMDP).

From the results observed in women and children recruited in our study, we retain that various elements are impacting the mother-child relationship, such as psychological maternal functioning, child’s behavior functioning, parenting qualities, insecurity of child’s attachment, unhealthy internalized representations…

A better understanding of the factors influencing mother-child relationship, can allow us to offer more tailored supports and could enable interventions promoting recovery and women’s and children’s well-being in the context of domestic violence.

None Declared

Mental pathology is relatively prevalent in the women, and there is often a need for treatment with psychotropic drugs, with an impact on women’s reproductive health. The use of contraception is widely spread among this population and the choice between these methods must be considered carefully.

This review aims to present the main interactions between contraceptive methods and psychotropic therapy and its impact on psychiatric disorders, in addition to the precautions to be taken in their choice.

Literature review of relevant articles on Pubmed. Query: Contraceptive+(psychiatric disorder, depression, anxiety, schizophrenia, bipolar disorder, psychotropic drugs).

Based on current evidence, no statistically significant differences regarding unplanned pregnancy rates or the psychotropic treatment outcomes were found when using combined oral contraceptives and antidepressants, benzodiazepines or atypical antipsychotics (being clozapine the exception). The impact of contraceptive methods on mood was unclear, as some articles showed an association between contraceptive use and a higher risk of beginning antidepressants and others showing no differences or even as a protective factor. Although the interactions of the aforementioned drugs are infrequent, there are cases where important interactions occur, such as clozapine, valproic acid, lamotrigine and carbamazepine, as some herbal products as the St.John’s wort. With clozapine, there is an increased serum concentrations, while the opposite occurs in the case of valproate and lamotrigine with a decrease of 32.6% and 23.4%, respectively. Treatment with valproic acid in women of childbearing age has been discouraged because of its association with polycystic ovary syndrome, elevated testosterone concentrations and menstrual irregularities, in addition to the risk of fetal malformations. In cases where this drug is prescribed, it is recommended to use highly effective methods such as subcutaneous implants or intrauterine devices. Lamotrigine and carbamazepine reduce the effectiveness of some contraceptive methods, such as oral contraceptives, transdermal patch and vaginal ring, in which case the placement of a subcutaneous implant or intrauterine device is indicated.

The magnitude of the impact between contraceptives, regarding depressive disorders, is unclear. The evidence shows that some women report the appearance and recrudescence of depressive symptoms, evidencing the need of further studies to identify the risk factors in these cases. The importance of clear and simple information and a shared decision on which contraception to choose is crucial, as clarification about their interactions with psychiatric treatment. The clinician must also be aware of the implications for reproductive health, in order to reduce the risks and side effects associated with some drugs.

None Declared

The effects of antidepressant and antipsychotic medications in the perinatal period in both mothers and children have been a subject of interest for many decades. Risks and benefits should be considered according to the illness stage, trimester of pregnancy/ postpartum period, and neonatal outcomes.

Our goal was to summarize the knowledge about the use of antidepressants and antipsychotics in the perinatal period. To illustrate the complexity of treatment decisions with clinical reports.

Review: A narrative review was carried out using the PubMed database including papers published in 2022. Evidence about the risks and benefits of using antidepressants and antipsychotics in the perinatal period is presented. Search terms: antidepressants OR antipsychotics AND (perinatal OR pregnancy OR postpartum).

Case reports (5 clinical scenarios): (1) pre-pregnancy counselling, (2-4) first-, second- and third-trimester of pregnancy, and (5)postpartum/breastfeeding.

Review: (1)Depression/antidepressants. Treating maternal depressive symptoms is associated with a lower risk of pregnancy complications. Although placental passage of sertraline is low, drug monitoring is recommended. Antidepressant use in pregnancy is associated with preterm delivery and low weight at birth. (2)Psychosis/Antipsychotics. Antipsychotic intrauterine exposure is not significantly associated with increased risk of major congenital malformations. Minimum effective doses are recommended.

Case reports. (1)Pre-pregnancy counselling. Schizoaffective disorder receiving perphenazine, quetiapine and lithium. (2)First-trimester pregnancy. Discontinuation of treatment in major depressive disorder. (3-4)Second/third trimester. Occurrence of anxiety symptoms in posttraumatic stress disorder. (5)Postpartum/Breastfeeding. Discontinuation of antidepressants.

Shared decision-making models for antidepressants and antipsychotics prescription represent patient-centered approaches to be recommended in perinatal period.

None Declared

Women experience some physiological, cognitive and emotional symptoms due to changes during menopause, which is a critical period in their lives. Every woman experience differences in symptoms and severity of them. Women’s individual perceptions and attitudes towards menopause affect their quality of life.

The aim of this study is to describe women’s perceptions and feelings about menopausal process and symptoms experienced and their behaviours to cope with these symptoms within framework of Cognitive Behavioral Model.

Phenomenology design was used in this study.Three focus group interviews were held June-September 2022, using Zoom platform.Purposive sampling was used as the sampling method of study.A total of 13 women in a menopausal period of 1-15 years, 5-6 people in each group, were included in the study.Focus group interviews were held for 1-1.5 hours and once with each group. In the focus group interviews, a ‘Semi-Structured Interview Form’ consisting of 4 questions was used to evaluate perceptions, changes and behaviors of postmenopausal women regarding menopause process.Zoom recordings were taken during the interviews and data were written down.The data were evaluated by thematic analysis method within framework of Cognitive Behavioral Model.

In this study, 11 themes were defined as women’s perception of menopause at individual and social level.These themes are negative automatic beliefs about female identity such as menopause reduces woman and loses her femininity, woman is not understood and struggles alone, woman has been stigmatized, women need support, hidden and spoken in a low voice, long and difficult process, also beliefs that physiological changes occur in the body associated with the fact that it’is a natural process and that it’is necessary to use new coping strategies to effectively manage these changes, onset of diseases, changing relationships, and high self-observation process.Emotions such as irritability, tension, sadness, and hypersensitivity are negative automatic beliefs that decrease woman and loss of femininity, accompanied by emotions such as irritability, sadness, and behaviors such as crying crises, social withdrawal, that woman is not understood and is a process that she struggles alone, avoidance and social withdrawal behaviors such as reading books, listening music, walking alone.

In this study, it was observed that women had difficulties with gender identity along with physiological and psychological changes during menopause, and there was an increase in self-observation.It was determined that they used some new behavioral and psychological strategies to cope with this new situation.It was evaluated that these changes in emotions, thoughts and behaviors could be well formulated within the cognitive behavioral model and this model would be useful in supporting women.

None Declared

Human trafficking is the trade of humans for the purpose of forced labor, sexual slavery, or commercial sexual exploitation for the trafficker or others. This may encompass providing a spouse in the context of forced marriage or the extraction of organs.

Research into the mental health impact of trafficking has consistently found high rates of mental health problems, most commonly depression, anxiety, and posttraumatic stress disorder (PTSD).

While there is some evidence that these factors can contribute the diagnosis of PTSD, exposure to trauma is the most important feature in the development of PTSD.

Other Mental Health Problems in victims of

Trafficking:

1. 1. Dissociative disorders

2. 2. Substance-related disorders

3. 3. Complex trauma

Although mental health problems among victims of trafficking have been shown to be high, recovery without treatment is rare, particularly in those who have developed PTSD.

Where there is comorbidity, recovery often does not occur even when rehabilitation has been attempted. This is unsurprising given the multiplicity of trauma that victims of trafficking have experienced, which often includes trauma prior to the trafficking situation.

Evidence-Based Therapeutic Treatment Options for PTSD:

Some evidence suggests that selective serotonin reuptakeinhibitors can effectively complement the psychotherapeutictreatment of PTSD as well as other anxiety and mooddisorders.

Cognitive-behavioral therapy

Exposure therapy

Eye movement desensitization and reprocessing

Narrative Exposure Therapy (NET)

In the absence of research pertaining to the mental health treatment of victims of human trafficking, mental health professionals working with this population must educate themselves on the evidence based research related to the treatment of common diagnoses and similarly marginalized populations to ensure proper provision of the best mental health care possible.

Among the most devastating mental health consequences for victims of any crime can be the destruction of basic life assumptions; that one is safe from harm, one is a good and decent person, and the world is meaningful and just. For victims of human trafficking, mental health problems can be compounded by the misconceptions about and limited understanding of the issue of human trafficking.

Additionally, lack of social support and stigmatization by friends, family, and social institutions can exacerbate victims mental health conditions.

Psychologically process the trauma they have experienced. However, until these studies are conducted and their results made available, mental health practitioners can base treatment options for this population on existing research findings and interventions found to be successful with other similarly victimized populations.

None Declared

Menopause is a special period for women which can have both physical and psychological consequences.

The aim of our study was to assess the impact of menopause on women’s quality of life.

A cross-sectional descriptive study conducted on menopausal women consulting at the basic health center in réjiche over a period from 12 september to 12 october 2022. The impact of menopause on the mental health of women was assessed by the menopause rating scale (MRS).

A total of 83 women were incluted in our study. The mean age was 61.89±11.03 years. The median age of menopause was 45 years (50-43). The majority of women (90.4%) were married and five women (6%) lived alone. Twenty-six women were professionally active and more than half were sedentary (54.2%). The comorbidities were dominated by arterial hypertension (50.6%). The mean BMI was 30.6±4.75 Kg/m². All the women had a variable psychological impact (from minor to very strong). The median score of the psychological scale was 10 (13-7): median scores for depressed mood, anxiety and physical and intellectual fatigue equal to 3 (4-1), each and median score for irritability equal to 2 (4-1). Physical and mental fatigue was the most common psychological symptom in 88% of cases followed by irritability in 86.7% of patients. Depressive and anxious symptoms were noted in 85.5% and 84.3% of cases, respectively. Psychological impact was severe in 33.7% of patients (strong or very strong symptoms).

Focusing on a small sample of menopausal patients, our study revealed a high prevalence of psychological distress during menopause which requires early adequate assessment and treatment.

None Declared

Despite the general awareness of necessity for implementing development of competences in working with LGBTIQ+ people as the obligatory course within the education of mental health professionals, it is still not the educational standard in Croatia.

Within the perspective of the past 20 years, the development of educational programs aiming to develop LGBTIQ+ affimrative and informed practice in the field of mental health care, togeather with the review of the most crucial research results in the field of LGBTIQ+ mental health will be given.

The results obtained from several research on national samples of LGBTIQ+ people, psychology students and psychologists are analysed using mainly qualitative methodology and to the small extent quantitative methodology.

Psychologists are perceived as a profession that respects diversity and actively reduces stereotypes and prejudice but there are still some obstacles to overcome within the profession. In traditional cultures appreciation of human rights of LGBT people is unfortunately not a guiding principle. Research on Croatian university students showed that slightly positive attitudes toward LGBT people were stable and remained unchanged from the 2005 till 2013. Specific attitudes toward human rights of lesbians and gays are ranging from moderately negative to moderately positive. The most frequent forms of discrimination and/or violating human rights of LGBT people are: usage of offensive, humiliating, pejorative and oppressive language, ignoring of LGBT people, attentional exclusion of LGBT people, threatening with physical violence. Stress resilience, social support, and inclusion in the LGBT society are key determinants of different indicators of mental health in this population. Although 64.4 % of transgender participants are highly informed about the new legalization, only 24.5 % are very satisfied with it. Trans-women, in comparison to trans-men, have significantly lower levels of quality of life and experience significantly higher levels of sexual violence. Based on the online research among the professionals from the Croatian national list of experts in thefield of health care of trans people the percieved level of transphobia in sociaty is abowe the average, as well as percieved impact of the COVID- 19 pandemic on acessibility and slowing down of standard diagnostic procedures.

Significant political and social change for sexual and gender minority people in Croatia in the last several years have contributed to a greater public visibility of LGBTIQ+ people. As allies of LGBTIQ+ people and even as belonging to the LGBTIQ+ population, psychologists, psychiatrists and other mental health professionals have the leading role in ensuring that the results of their scientific findings and professional corpus of knowledge have ethical and practical implementation and beneficial impact on society.

None Declared

Pregnancy and childbirth are moments of great vulnerability in a woman’s life, which can predispose her to the development of psychopathology, ranging from transient depressive symptoms (“baby blues”) to psychotic symptoms. Postpartum delirium is the psychiatric syndrome that some authors refer to as puerperal psychosis par excellence. It was first described in the 18th century and were thought to be associated with painful delivery, then became rare after the introduction of effective analgesia.

The objective of this work is to contribute to a better understanding of this condition, through a literature review.

Bibliographic research using Pubmed® and the keywords: postpartum delirium.

Clinical presentation of postpartum delirium includes: constantly varying degrees of consciousness; perplexity; hallucinations or pseudo-hallucinations of one or more organs of sense; delusions or delusive-type thoughts; great motoric unrest and considerable motoric and verbal abandon; and acute aggressive discharges can also occur. It is thought to be due to organic complications, such as infectious disease, abnormal loss of blood, thrombosis, neurological disease, obstetric disease, vitamin deficiencies, hormonal changes. An article from 1975 mentions how difficult was to treat postpartum delirium despite the development of psychopharmaceutical therapy. The patients remained psychotic for long periods and had many relapses. They mention a comparative study that found that the symptomatic treatment of this syndrome with a combination of perfenazine and lithium carbonate produced relatively favorable results. For that reason, at that time, it was the medication of choice. Nowadays the psychopharmacological treatment of puerperal psychosis, in general, still consists of the combination of lithium and an antipsychotic, such as haloperidol, and possibly a benzodiazepine, such as lorazepam.

Postpartum delirium is rarely mentioned in the literature and just a few cases have been described. It is considered a rare postpartum psychotic condition but would perhaps be less rare if its existence were recognized. On this note, it is important for clinical practice to research on the psychoses of pregnancy and not just the most common.

None Declared

Tunisia, a pioneer in the Arab world in terms of promoting the status of women, has adopted a strategy to combat violence against women and now has a legal arsenal to protect women’s rights.

To study the contribution of the Tunisian jurisdiction in terms of protection of women victims of violence.

A review of the different legal texts, using the key words: “Women”, “Violence”, “Jurisdiction” and “Protection”.

*The National Survey on Violence against Women in Tunisia is a long process that involved the efforts of several stakeholders.

*In 2011, Tunisia was the first country in the region to have ratified and lifted all specific reservations to CEDAW (Committee on the Elimination of Discrimination Against Women). Violence against women is considered a threat to peace and security.

*Secondly, the adoption of Article 46 of the new Constitution of 2014 obligated the State to combat violence against women and make it its priority.

*The adoption of Organic Law 58/17 of 11 August 2017 finally gave the status of victim to the abused Woman. This law came into force in 2018.

*A number of mechanisms have been put in place, including the establishment of the National Observatory to Combat Violence against Women.

*Most magistrates still resist the application of Law 58/17, which contributes to the resurgence of violence against women, especially during periods of slackening of the justice system, such as the COVID lockdown period.

Despite the revolutionary legal arsenal acquired for the protection of women in Tunisia, there is still a gap between legislation and practice, and the rate of violence against women continues to increase. Nationwide awareness-raising campaigns aiming to spread awareness among women of their rights are necessary.

None Declared

Denial of pregnancy is the lack of awareness of being pregnant. It associates with increased morbidity and mortality of mother and child and can be classified as non-psychotic or psychotic. There is few literature regarding the latter, making it difficult to recognize, let alone to treat, since we do not have robust data on the incidence nor approved interventions.

To get a better understanding on the standard of care for patients with psychotic denial of pregnancy.

We present a case report alongside a narrative literature review on the topic.

We report the case of a 39-year-old caucasian woman, foreign, undomiciled, who was admitted to a Psychiatry unit due to psychotic symptoms. Her birthplace and prior medical records were unknown. She did not recognize being pregnant and showed great irritability when asked; her responses ranged from delusional attributions of symptoms related to the pregnancy to partially acknowledging her state but refusing to answer questions. Obstetric ultrasound revealed a low risk 35 weeks pregnancy. Treatment included quetiapine up to 700mg daily and psychological approach. A multidisciplinary team managed the case and arranged a plan for delivery. Eventually, delusional symptoms remitted and she accepted the gestation. She showed full collaboration during delivery, giving birth to a healthy female and presented transient recovery. After being separated from her daughter, her clinical situation worsened.

Psychotic denial of pregnancy is rather uncommon. It is usually seen in patients with prior history of major mental illness, most frequently schizophrenia, and important psychosocial vulnerability. It associates with several negative outcomes for mother and baby, including neonaticide. Most studies agree on the need of a multidisciplinary intervention including obstetrics, psychiatry, and others (social agents, ethical consultants…) to generate a plan for mother and baby. Biopsychosocial aspects should always be considered and each case individually formulated. Pregnant women must be given clear and concise information about the process. For some, seeing obstetric ultrasound might help them accept the pregnancy. Some authors propose labour induction prior to 39 weeks and performing a C-section, especially in cases of uncontrolled psychosis or risk of noncompliance. Most studies also recommend antipsychotic treatment. In cases of persistent denial or acute crisis, especially during the third trimester, patients should be admitted to a psychiatry unit with easy access to obstetric care. Supportive psychotherapy and psychosocial intervention should try to identify precipitating stressors for denial, such as prior or anticipated custody loss, which has been linked to psychotic denial.

Psychotic denial is a serious illness which requires a multidisciplinary treatment including biopsychosocial and obstetrical aspects.

None Declared

Denial of pregnancy is the phenomenon where a woman fails to recognize or accept her pregnancy at >20 weeks gestational age. It associates with increased morbidity and mortality of mother and child, and can be classified as non-psychotic or psychotic. There is fewer medical literature regarding the latter, making it difficult to recognize, let alone to treat, since we do not have robust data regarding incidence nor approved interventions or treatment.

To describe this unfamiliar entity in order to be able to perform a proper diagnosis and thus prevent possible negative outcomes.

We present a case report alongside a narrative literature review on the topic.

We report the case of a 39-year-old caucasian woman, foreign, undomiciled, with an advanced pregnancy, who was admitted to a Psychiatry in-patient unit due to psychotic symptoms such as mistrust and delusions. She showed scarce collaboration during assessment and did not give any plausible information about her identity. Her birthplace and prior medical records were therefore unknown. Apparently, she had no family nor social support network. Despite the obvious signs, she did not recognize being pregnant and showed great irritability when asked; her responses ranged from claiming she was suffering from a gastric tumor and making delusional attributions of symptoms clearly related to the pregnancy to partially acknowledging her state but refusing to answer any questions on the matter. Blood work showed no significant abnormalities and obstetric ultrasound revealed a low risk 35 weeks pregnancy.

With an estimated prevalence of 1:475 in general population, denial of pregnancy is not as rare as it may seem. The psychotic variant, however, is rather uncommon. Typically, women with psychotic pregnancy denial have prior history of major mental illness, most frequently schizophrenia, and suffer from extreme psychosocial vulnerability. They usually present previous or anticipated child custody loss, which hampers the process of developing antenatal attachment behaviours. Psychotic denial does not associate with concealing, since these women are mentally detached from the gestation and tend to create delusional explanations to their pregnancy symptoms. Not all of them show complete denial, some being able to acknowledge it, though mostly in an inconsistent way. These patients often fail to seek prenatal care or are noncompliant, they are at greater risk of drug exposure, and some are unable to recognize symptoms of labour, all of which increases the rate of negative outcomes for mother and baby, including neonaticide.

Psychotic denial is a rare diagnosis which should be properly assessed due to its clinical implications and the need to prevent potential negative outcomes for mother and baby.

None Declared

Perinatal grief is the process that occurs after the loss of a baby, either during pregnancy or during the period immediately before or after childbirth (up to a year). In recent years, the increase in specific training and development of programs focused on perinatal mental health has facilitated the creation of specific action protocols. The case of a 38-year-old woman who suffers a gestational loss during the third month of pregnancy is explored. The presence of personal and family antecedents that suppose risk factors for the adequate elaboration of the duel, raise doubts about the handling of the case.

This work has several objectives, including reviewing the published literature on perinatal bereavement in an emergency situation and, on the other hand, presenting a case.

A bibliographic search has been carried out in the main sources of medical information such as pubmed, uptodate as well as in national and international journals. Likewise, the knowledge and clinical experience of the team has been reviewed in order to expose its own experience in this field, defining specific interventions as well as results.

On evaluation, the patient was conscious and oriented to person, time, and space. Approachable and cooperative. Overall calm, although with intermittent crying. Low mood reactive to vital situation, without apathy, apathy, or anhedonia. No previous episodes of hypomania or mania. Not another major affective clinic. Fluid and coherent speech, formally well constructed without glimpse alterations in the course or content of thought. She denied sensory-perceptual alterations, without showing a listening attitude, or suspicion or any other psychotic or dissociative symptoms. He denied ideas of self-harm, death or self-harm, presenting an adequate request for help and coherent and realistic future plans. Altered biological rhythms with insomnia of three days of mixed pattern evolution. preserved appetite. Judgment of reality preserved.

The grief reaction is an experience that must be normalized after the loss of a loved one. However, given the risk factors presented by the patient, preventive management is established in the face of possible complicated perinatal grief. A new appointment is established in less than 10 days to reassess the case with the perinatal mental health team.

Perinatal mental health is an area of knowledge that could provide assistance to mothers, fathers and family systems plunged into a crisis of perinatal grief.

Prevention in situations of possible complicated perinatal mourning is no less important than treatment when the disorder is already established.

None Declared

Intimate partner violence is an under recognized problem in our society that is misjudged and often overlooked.

Violence in women has been linked to chronic health, emotional complications, one of which includes low self-esteem

To study the prevalence and predictors of low self-esteem among women victims of domestic violence.

Our study was descriptive and analytical cross-sectional, carried out with women examined in the context of medical expertise, from May until January 2022.

An anonymous survey was asked to these ladies.

The Rosenberg questionnaire was used to assess the self esteem

122 responses was collected.The average age of the assaulted women in our study was 35.66 years(from18 to 64 years) 98.4%were victims of verbal violence, 95,1% of physical violence, 97,5% of psychological violence and 54.7 %of sexual violence.

Self esteem was very low among 43,4% of women ,low among 18,9%,average among 15,6%,high among 15,6% and very high among 6,6%.

Women with children had lower self-esteem (p=0.02).

Low self-esteem were significantly correlated with: the husband cannabis consumption (p=0.01).

The ladies victims of sexual violence such as an unusual type of relationship had lower self-esteem (p=0.01).

Women who were threatened by their spouses had lower self-esteem (0,01).

An history of aggression during pregnancy was a risk factor for low self-esteem (p=0, 01).

Results suggest domestic violence has on women, not only physically effect but mentally and emotionally, this is why an urgent reaction must be taken by the state to reduce this scourge and hs repercussions on the mental health of the victims.

None Declared

The violence against women massively committed by their spouses is a scourge that transcends countries, ethnicities, cultures, classes social and age groups.

This violence is traumatic and represents a serious attack on the physical integrity and mental health of the women who are victims

To study the prevalence and predictors of peritraumatic distress among women victims of domestic violence

We contacted 122 women who consulted at the psychiatric emergency of ‘Hedi Chaker hospital’,Sfax examined in the context of medical expertise on the period between May 2021 until January 2022

A questionnaire regarding the violence was asked to responders .It included demographic and violence exposure questions and a scale applied during violence ‘Peritraumatic distress inventory’

The average age of women assaulted in our study was 35.6 ± 9.94 years (min=18,max=64).

78.7% (n=96) of ladies were of urban origin.

The majority of them(44,3%) had secondary level education.

The half of the population (51.6%) had an average socio-economic level. (86.1%) had children.

98.7%were victim of verbal violence,94.7% of physical violence, 97.3% of psychological violence and 54.7 %of sexual violence.

72.1% of women (N=88) developed peritraumatic distress related to the assault with a risk of developing post-traumatic stress disorder.

Women who were threatened by their spouses were more in distress than others (0,04).

Physically abused women using a knife developed more peritraumatic distress (p=0,02).

Domestic violence is a global public health problem, that calls for urgent actions.Peritraumatic distress linked to violence may lead to psychotraumatic disordersthat are the source for traumatized victims of great suffering mental health and a possible vital risk (suicide, risky behavior).

None Declared

The phenomenon of domestic violence poses, long been a problem at the social and family. The magnitude of the consequences, associated with this issue justifies the importance placed on the quality of marital satisfaction among abused women.

To study the quality of marital satisfaction among women victims of domestic violence and to determine predictors of bad marital satisfaction

Our study was descriptive and analytical cross-sectional, carried out with women examined in the context of medical expertise at ‘Hedi Chaker hospital’,Sfax , from May 2021 until January 2022.

An anonymous survey was asked to these ladies.

The AZRIN questionnaire was used to study the quality of marital satisfaction

The age oscillates between 18 and 64 years.

The half of the population (51.6%) had an average socio-economic level.

43.4% (n=53) lived in rented houses, 41% (n=50) owned the houses, 14.8% (n=18) lived with the husband’s family and 0.8% (n=1) was homeless.

All the women of our population were married: it was the first marriage in (89.3%).

The majority (86.1%) had children.

The average duration of marriage in our study was 11.16 years ± 9.12 years (min=1,max=40).

66.4% (n=81) were abused by their spouses during the first year of marriage.

Forty-seven women (38.5%) lived this ordeal daily.

98.7%were victim of verbal violence,94.7% of physical violence, 97.3% of psychological violence and 54.7 %of sexual violence.

Marital satisfaction was poor among 71,3% of ladies , average among 9% and good among 19,7%.

Bad marital satisfaction was significantly correlated with verbal violence (p=0,02),physical violence (p=0,01),psychological violence (p= 0,003)and sexual violence (p=0,04).

As our results have shown, we do not expect assaulted women to be satisfied in their couple relationships.

Urgent help must be provided to these women to save them from this burden.

None Declared

Childbirth is a period of transition for women, which can have several physiological and psychological repercussions on their lives.

To estimate the prevalence of postpartum post-traumatic stress disorder in a sample group of Tunisian women.

This is a longitudinal prospective descriptive study carried out among women who were hospitalized for childbirth in the obstetrics gynecology department and those who consulted the outpatient perinatal consultation of the Tahar Sfar Mahdia hospital during a period of 7 months from March 15, 2020 to September 15, 2020. Data collection was based on a pre-established questionnaire determining the different socio-demographic and clinical characteristics.

The women’s psychometric assessment was conducted using a PCLS psychiatric scale for screening for post-traumatic stress disorder.

We collected 120 women with an average age of 28.3 ±5.3 years. Among our sample, two women had a history of depression (1.6%) and three participants had a history of an anxiety disorder (2.5%).Thirty-five patients (29.1%) had a pathological obstetric history. However, fifteen patients (12.5%) were hospitalized during their pregnancies. Eighty-seven patients (72.5%) expressed their anticipated fear of childbirth and one hundred two patients (85%) had a good marital relationship with good social support. 48.3% of deliveries were vaginal and 27.5% were by emergency cesarean section. Level three pain was expressed in 73.3% of deliveries. Psychometric assessment revealed a prevalence of PTSD at 5.8% with PTSD symptomatology in 18.4% of women.

Postpartum post-traumatic stress disorder is a major public health problem that affects the healthy development of the newborn and the mental and physical recovery.

None Declared