Publications by authors named "R Rafrafi"

15 Publications

  • Page 1 of 1

[Sleep disorders and psycho-affective problems in paramedical personnel working an atypical schedule].

Rev Mal Respir 2021 Feb 3;38(2):147-156. Epub 2021 Feb 3.

Service de pneumologie et allergologie, université de Tunis El Manar, faculté de médecine de Tunis, CHU Mongi Slim La Marsa, Tunis, Tunisie.

Introduction: Shift work can cause health problems and sleep disorders and therefore affect mental health. These psycho-affective disorders can, in return, worsen sleep disorders and thus establish a vicious circle. The aims of our study were to assess the frequency of sleep and psycho-affective disorders among paramedical personnel doing shift work and to screen them for obstructive sleep apnoea-hypopnoea syndrome (OSA).

Methods: It was a cross-sectional study carried out among paramedical staff at the University Hospital Center Mongi Slim La Marsa in Tunis. Three questionnaires translated into Arabic (the Berlin questionnaire, the Spiegel questionnaire and the Hospital Anxiety and Depression Scale [HAD]) were presented by the same investigator during the survey.

Results: One hundred and fifty-eight paramedics were interviewed (46.2% were nurses, 23.4% were blue-collar workers, 19% were senior technicians and 11.4% were health care aides, midwives and physiotherapists). The average duration of shift work was 10.27 years, the average age was 36.48 years and there was a female prevalence of 70.9%. Sleep disorders were detected in 40.5% of the cases, OSA in 24%, anxiety in 53.2% and depression in 17.1%.

Conclusion: Sleep and psycho-affective disorders are frequent among paramedical personnel undertaking shift work in hospitals. Screening consultations in occupational medicine are necessary in order to detect these disorders at an early stage.
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February 2021

Tunisian Women's childbirth experience.

Tunis Med 2020 Jul;98(7):556-566

Background: The current international context considers birth experiences as a focal point for women's health. However, this subject is rarely discussed in Tunisian literature.

Aim: Analyze birth experience of a sample of Tunisian women.

Methods: Transverse descriptive study. All women who gave birth in the study unit during August 2018 were included. A direct interview was conducted during the first postpartum day. The questionnaire used was developed by a multidisciplinary team and included 55 questions, divided into 4 items. We compared the group of women who described their delivery as physically or psychologically traumatic to the group of women who reported a serene birth experience.    A multivariate analysis of variance was used to identify the variables that can influence childbirth experience.

Results: During the study period, 170 women were included with a response rate of 81%. Severe anxiety about delivery was reported by 74.5% (n = 127) of women. Delivery was experienced as a trauma in 48.2% (n = 82) of cases. In the group of women who expressed a negative experience, we found a significant association with the use of media and internet as a source of information (p=0.001) and repeated vaginal examinations (p=0.001). Pain significantly impacted women's experience (p = 0.02). Finally, main risk factors of a negative childbirth experience were: uterine revision: OR=7.04 95%CI [0.27-177.68]; Emergency caesarean section: OR=3.04 95%CI [0.94-9.85] and vaginal delivery: OR=2.13 95%CI [0.45-10.14].

Conclusion: We can intervene on modifiable factors with the introduction of a specific program preparing women for their childbirth and the improvement of the professional practices. However, the issue will benefit from being discussed and addressed at the national, cultural and societal levels.
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July 2020

Rights of people with mental disorders: Realities in healthcare facilities in Tunisia.

Int J Soc Psychiatry 2017 Aug 15;63(5):439-447. Epub 2017 Jun 15.

Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.

Background: Mental disorders have been associated worldwide with human rights' violations. Controversially, many occur in mental health facilities.

Aim: This work aimed to assess the rights of people with mental disorders in healthcare facilities in Tunisia.

Methods: A cross-sectional study, using the World Health Organization (WHO) quality-rights toolkit, assessed the human rights levels of achievement in Elrazi Hospital, the only psychiatric hospital in Tunisia, in comparison with the National Institute of Nutrition (NIN). The framework was the Convention on the Rights of Persons with Disabilities (CRPD). The assessment was carried through observation, documentation review, and interviews with service users, staff, and family members. The sample was composed of 113 interviewees.

Results: In Elrazi Hospital, three out of the five evaluated rights were assessed as only initiated: the right to an adequate standard of living, to exercise legal capacity and to be free from inhuman treatment. By comparison, these rights were partially achieved in the NIN. The right to enjoyment of the highest attainable standard of health was partially achieved and the right to live independently and to be included in the community was not even initiated. These last two rights were at the same level of achievement in the NIN.

Conclusion: Significant improvements are needed to adapt the practice in Elrazi Hospital to comply with human rights, especially since the achievement level of these rights is lower than in a non-psychiatric hospital. Our study emphasizes the importance of spreading the CRPD as a standardized framework.
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August 2017

[The name in schizophrenia: a study of 60 patients].

Tunis Med 2014 Mar;92(3):214-8

Background: Clinical aspects in schizophrenia suggest a unique relationship with the proper name. aim: Discuss the validity of the hypothesis that the non-transmission of the surname may be a vulnerability factor in schizophrenia.

Methods: Descriptive cross-sectional study conducted among 60 patients with schizophrenia and their families. Data were collected using a semi-structured interview. results: Seven patients carried a different surname from their father (11.6% of participants). The disparity has only concerned the child with schizophrenia. Family characteristics (birth rank, desired character of pregnancy, family history of schizophrenia) and evolutif profile of the disease were comparable between patients with a family name according to the father and those with a different surname.

Conclusions: It appears that patients with schizophrenia maintain a special relationship with the proper name, which could be involved in the genesis of schizophrenia. Our early hypothesis, supported by the psychoanalytic, transgenerational and behavioral theories, would be a plausible starting point for studies with a broader spectrum including witnesses of the general and psychiatric populations.
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March 2014

[Violence in schizophrenia: a study of 60 cases].

Tunis Med 2013 Dec;91(12):729-34

Background: Epidemiological studies suggest a positive but controversial correlation between the major mental disorders, particularly schizophrenia and delinquent or criminal acting out. aim : To study the occurrence of violence in patients with schizophrenia according to demographic, clinical and disease progression features.

Methods: 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.

Results: 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.

Conclusion: Violences committed by patients with schizophrenia are attributed to a particular group of patients and do not have necessarily a pejorative prognostic value.
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December 2013

[Bipolar disorder and criminality: a comparative study by gender].

Tunis Med 2013 Dec;91(12):693-9

Background: Unlike schizophrenia, the impact of gender on the criminality of patients with bipolar disorder has received little attention.

Aim: To estimate the sex ratio in relation to acts committed by forensic bipolar patients and evaluate the impact of gender on the characteristics of this crime.

Methods: A comparative study by gender, conducted at the psychiatric hospital Razi has included all patients with bipolar disorder hospitalized between 1990 and 2010 after being relaxed for mental illness, owing to the Tunisian penal code.

Results: The total number of patients was 36 and the sex ratio of 3.5.A suicide history was four times more common in women. Alcohol abuse was found only in men. Relapses were more frequent in women (3.06 I year against 1.14 I year, p = 0.02). Rapid cycling and comorbid anxiety were noted only in female patients. Filicide and prostitution were committed exclusively by women, economic crimes and sexual assaults were the preserve of men. The male offenses were more impulsive and unpremeditated (p = 0.04).

Conclusions: Although sex ratio is in favor of men, women's representation in the violence induced by bipolar disorder is significant, resulting, particularly during depressive phases, by serious and deadly acts. Preventive measures of acting out in bipolar patients must be supported and especially adapted to the genre
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December 2013

[Validity and reliability of the Tunisian version of section G of the Composite International Diagnostic Interview, relative to schizophrenia].

Tunis Med 2013 Nov;91(11):648-54

Background: Early diagnosis of schizophrenia can improve its outcome. Hence, screening policies should be held and suitable tools must be available for general practitioners.

Aim: To translate the section G (about schizophrenia) of the Composite International Diagnostic Interview to the Tunisian dialect and to check its validity and reliability.

Methods: 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.

Results: 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.

Conclusion: 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.
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November 2013

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

Tunis Med 2013 Oct;91(10):583-8

Background: 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.

Aim: 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.

Methods: 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.

Results: 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.

Conclusion: 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?
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October 2013

[Sleep in elderly].

Tunis Med 2013 Feb;91(2):123-8

Universite de Tunis, El Manar, Tunisie.

Background: Sleep disorders in the elderly are common. However, they are often under diagnosed and poorly supported.

Aim: To study the characteristics of sleep in the elderly consultant at the front line.

Methods: 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.

Results: 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.

Conclusion: 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.
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February 2013

Spectrum of autoantibodies in Tunisian psychiatric inpatients.

Immunol Invest 2012 22;41(5):538-49. Epub 2012 May 22.

Research unit 03/04 Schizophrenias, Department of Psychiatry F, Al Razi Mental Health Hospital, Mannouba, Tunisia.

One hundred and three psychiatric inpatients (74 men) were assessed for a wide spectrum of autoantibodies including antinuclear, antismooth muscle, antimitochondrial, antiDNA, anti-phospholipid, anti-cardiolipin IgG and IgM, antikeratin, rheumatoid factor, antithyroperoxydase, antigliadin IgA and IgG, antitransgutaminase, and antiendomysium antibodies. Four groups of patients were considered separately, including 47 with schizophrenia, 23 with schizoaffective disorder, 16 with bipolar disorder and 17 patients with other different psychiatric diagnosis. Forty one healthy, age- and sex-matched blood donors were used as a control group. There were no significant difference in the prevalence of the different autoantibodies between patients (N = 103) and controls except for antigliadin IgG (30.1 vs 9.8 respectively, p = 0.01). Presence of autoantibodies was influenced by age but not by sex or treatment. As for diagnosis categories, patients with bipolar disorder presented significantly more autoantibodies than the three other categories and controls. These results point out a possible autoimmune activation in at least a subgroup of psychiatric patients especially amongst those suffering from bipolar disorder.
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October 2012

Plasma homocysteine in schizophrenia: determinants and clinical correlations in Tunisian patients free from antipsychotics.

Psychiatry Res 2010 Aug 14;179(1):24-9. Epub 2010 May 14.

Research Unit 03/04 Schizophrenia and Department of Psychiatry F, Razi Hospital, Mannouba, Tunisia.

The existence of association between hyperhomocysteinaemia (HHC) and schizophrenia has been suggested by several recent studies. This study aimed to determine the prevalence of HHC and its main determinants, and sought a correlation with clinical features in Tunisian patients with schizophrenia. Plasma homocysteine (Hcy), folate, and vitamin B12, as well as the C677T methylene tetrahydrofolate reductase (MTHFR) polymorphism, were studied in 33 patients with schizophrenia, all free from antipsychotic treatment, and 35 age- and smoking-habit-matched healthy subjects as controls. Biochemical determinations and psychometric evaluations were carried out in patients before the administration of antipsychotics. The prevalence of HHC was higher and plasma B12 vitamin was significantly lower in patients. There was no significant difference in genotypic distribution and allelic frequency of the C677T MTHFR polymorphism between groups. Hcy was significantly correlated to the 'anhedonia-asociality' subscales of the Scale for the Assessment of Negative Symptoms (SANS). This study showed an association between HHC and schizophrenia, especially with the negative symptoms of the disease. In the Tunisian population, HHC in schizophrenia seems to be linked to vitamin B12 deficiency, likely caused by a lack of dietary animal proteins.
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August 2010

[Ulcerative colitis and schizophrenia: fortuitous association or etiopathogenic link?].

Tunis Med 2009 Aug;87(8):531-3

Service de Gastro-entirologie, Hôpital Charles Nicolle, Tunis, Tunisie.

Background: Ulcerative colitis is a chronic inflammatory bowel disease with multiple pathogenic factors. Psychiatric disorder have frequently been associated to ulcerative colitis, the most frequent being depression and anxiety, whereas schizophrenia is unusual.

Aim: Report a new case of ulcerative colitis associated topsychiatric disorder.

Case-report: We report the case of a 42-year-old woman with ulcerative colitis associated with schizophrenia. Although the two diagnoses were concomitant, on questioning, she revealed that digestive symptoms began before psychiatric disorders.

Conclusion: Few cases of schizophrenia associated with ulcerative colitis have been reported in the literature. We discuss epidemiological, etiopathogenic and therapeutic links between the two diseases.
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August 2009

[Social outcome of schizophrenics in Tunisia: a transversal study of 60 patients].

Encephale 2009 Jun 23;35(3):234-40. Epub 2008 Sep 23.

Service de psychiatrie F, hôpital Razi, 12, rue des Orangers, 2010 Manouba, Tunis, Tunisie.

Introduction: Transcultural studies suggest that the social outcome of schizophrenia might be better in developing countries than in industrialized ones. This study aims to check this hypothesis and attempted to identify prognostic indicators of schizophrenia among Tunisian patients.

Methods: This study included all the outpatients responding to DSM IV criteria of schizophrenia for at least five years, during the study period. The assessment tools were: an interview with the patients and their families, data from medical records and the Global Assessment of Functioning scale (GAF) applied for the premorbid period, at two years after onset, at five years, and during the interview (current assessment). The social outcome was assessed by marital and labour market status, social network, sexuality and the GAF score. The outcome was considered to be good, if the current GAF >60, intermediate if GAF was between 31 and 60 and severe if GAF
Results: Informed consent was obtained from 60 patients (85.7% of outpatients) and from 56 families. The sex-ratio was 4 (48 men/12 women), the mean age of patients was 39.3 years; the mean follow-up was 14.7 years ([5-45]). School level was six years primary school in the majority of cases, and the living conditions were poor in 48.3% of cases (n=29). During the interview, only 21.6% (n=13) of patients were married. The majority of patients, who were working before the first episode, had lost their job. 76.6% (n=46) did not have any social contacts and only 23.3% (n=14) had any sexual activity. Thus, the social outcome was good in 21% of patients, intermediate in 11.1% and severe in 67.9%. Most social indicators (GAF score, labour market status, social network) revealed a fairly similar progress: a significant decline between the premorbid period and two years after the onset. The course reached a plateau after two years. According to current GAF scores, outcome was good in 25% (n=15) of cases, intermediate in 55% (n=33) of them and severe in 20% (n=12). Some indicators were found to be correlated with this outcome: patient related factors; late language development (correlated with intermediate prognosis [p=0.03]); a comorbid axis II diagnosis (correlated with poorer outcome p=0.04); a poor premorbid global functioning (higher premorbid GAF scores were correlated with a better outcome [p<0.03]); family history related factors; consanguinity in parents (correlated with intermediate-severe prognosis [p=0.04]); elderly father at birth (correlated with severe prognosis [p=0.04]).

Conclusion: Even if these results are limited in their generalisation, this Tunisian sample argues that schizophrenia's prognosis is not better in such a developing country.
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June 2009

[The practice of traditional therapies in psychiatric environment: about 100 cases].

Tunis Med 2008 Jun;86(6):560-3

Hôpital Razi, rue des orangers, Manouba, Tunis.

Background: 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.

Aim: 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.

Methods: 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.

Results: 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.

Conclusion: 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.
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June 2008