The vaccination of children and adolescents against covid 19 is an ongoing debate. While in some countries the program of vaccination of children under 12 years old is already implemented, in others the balance of risk and benefits is a dilemma. Parents’ perception and decision about covid vaccination is an important parameter to consider.

The ain of this study is to evaluate the parents’ attitude about childhood vaccination against Covid 19 in Tunisia.

The “vaccine hesitancy scale (VHS) adopted from WHO’s Strategic Advisory Group of Immunization” with 8 items translated in tunisian dialect and an additional ten survey idem about the Characteristics of parents and their vaccination status against Covid 19. The survey is distributed on social media groups of parents of tunisian children and adolescents.

Thirty parents have answered the survey.More than 80% of the participants were female with an average age of 38 years old.Among 30 participants 24 were vaccinated against covid 19 at least for once, but only one of them 10% decided to vaccinate their children against covid 19,while 3% are indecisive about the subject.Although 97 % of the children and adolescents have already been vaccinated completely according to the national vaccination program. The most common reasons for the refusal were.Parents consider that routine childhood vaccines are safe, necessary and useful more than covid vaccine. Some parents reported that their children have been infected by the virus so they have doubts about the usefulness of the vaccination.

A year after the pandemic, covid 19 contamination and vaccination against the virus are still an issue. With the emergence of new variants, the decline in protective measures, vaccination against covid is in the process of integrating routine programs. But the lack of information on the effectiveness of the vaccine and the adverse effects are a source of hesitation and refusal for parents. a large-scale national study is necessary before.

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The COVID-19 pandemic was originally of a magnitude exceeding that of previous epidemics, placing a heavy burden on healthcare systems in general and healthcare professionals in particular.

To assess the prevalence of depressive and anxiety symptoms among healthcare professionals at Farhat Hached Hospital in Sousse during the COVID-19 pandemic and to identify associated risk factors.

This is a descriptive cross-sectional study conducted among healthcare professionals practicing in the Farhat Hached Hospital of Sousse, which took place during the period extending between August and November 2021. The 9-item Patient Health Questionnaire (PHQ-9), the 7-item Generalized Anxiety Disorder (GAD-7), were used to assess depression and anxiety respectively.

Our study included 326 healthcare professionals from the Farhat Hached University Hospital. The mean age of our population was 36.38 ±10.19 years, with a clear female predominance of 81.3%. The prevalences of depression and anxiety were 46% and 35.3% respectively. Female gender and being a paramedical staff were risk factors for depressive and anxiety symptoms. On the other hand, professional seniority of over 5 years was statistically significantly associated with anxiety. Sporting activity was inversely associated with depressive and anxiety symptoms.

The multi-variate analytical study revealed that the practice of leisure activities other than sport was a protective factor against the occurrence of depressive symptomatology in healthcare professionals, while current smoking and the practice of a sporting activity were inversely associated with the occurrence of anxious symptomatology.

These findings underline the need for specific prevention strategies to reduce these symptoms and help healthcare professionals maintain their mental health. This will help to guarantee the quality and efficiency of work in the medical environment, to better control the pandemic.

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Clozapine is an atypical antipsychotic that is primarily prescribed for treatment-resistant schizophrenia. Despite its proven efficacy, the prescription of clozapine is sometimes limited by its hematologic side effects, including agranulocytosis. During the SARS-CoV-2 pandemic, schizophrenia is recognized as a risk factor for developing severe forms of the infection. Early and complete vaccination of patients has been recommended. However, there is limited data on the effect of the vaccine on the risk of hematologic abnormalities in patients treated with clozapine.

To study the hematologic effect of the mRNA vaccine against COVID-19 in a population of patients with treatment-resistant schizophrenia treated with clozapine.

Twenty-five patients hospitalized for schizophrenia at the forensic psychiatry department of Razi Hospital in Manouba, Tunisia, were included. Eighteen patients were treated with clozapine, and seven patients were treated with other antipsychotics. Consent from patients and/or their relatives was obtained before vaccination. The results of complete blood counts performed as part of the therapeutic protocol were compared between the two groups before and after administration of the vaccine.

No patient experienced agranulocytosis induced by clozapine after vaccination against COVID-19.Blood cells counts,red blood cells counts,and platelets were within the normal ranges.However,a decrease in the number of WBCs,neutrophils,and lymphocytes was observed in patients treated with clozapine without significant difference compared to the patients treated with other neuroleptics, but there was no severe neutropenia or need to stop treatment.

The prescription of clozapine, the introduction protocol, and treatment administration have been greatly influenced by the COVID-19 pandemic due to the hepatotoxic risk of the drug. Vaccination is essential to prevent severe forms of the infection, especially in at-risk populations such as patients treated for schizophrenia.The potentiation of hematologic side effects induced by clozapine by the vaccine is not documented.The COVID-19 mRNA vaccine is safe even with clozapine

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Patients with mental illness, particularly those with treatment-resistant schizophrenia, are at increased risk of severe COVID-19. The protective effect of vaccination against severe disease has been demonstrated, and vaccination of vulnerable individuals was a priority during the vaccination campaign. However, the effect of vaccination on the psychiatric symptoms of the disease is not well understood.

To investigate the impact of COVID-19 vaccination on psychiatric symptoms and somatic symptoms in patients hospitalized for treatment-resistant schizophrenia.

Thirty patients hospitalized for treatment-resistant schizophrenia with a history of medico-legal acts were admitted to the forensic psychiatry department at Razi Hospital in Manouba, Tunisia. The consent of patients and/or their relatives was obtained before vaccination, and potential side effects were explained to patients and their families. A neuropsychiatric assessment and clinical examination of patients were performed by their referring psychiatrist before vaccination and one month after.

The patients were all male, with a mean age of 42.3 years.No patient had an allergic reaction to the vaccine. No patient was infected with the virus one month after vaccination. On the clinical level, 30% of patients had general symptoms such as fatigue and myalgia, which improved spontaneously within a few days. On the psychiatric level, exacerbation of positive symptoms such as hallucinations and delusions was found in 26% of patients. No increase in the frequency of agitation episodes or risk of hetero-aggressive behavior was reported. Sleep disturbances such as difficulty falling asleep and fragmented sleep were reported. The most common functional complaints reported by patients were palpitations, which were a source of somatic concern.

Several side effects of the vaccine have been documented and are taken into account in the daily practice of practitioners, but psychiatric effects are poorly reported and are sometimes attributed to the underlying disease. A complete examination, objective assessment, and regular follow-up are necessary to identify symptoms early and prevent relapses.Because of the small size of the sample;results could not be generelized.Further studies on a larger scale should be conducted.

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The coronavirus infection emerging in 2019 caused a plethora of physical and mental health problems around the world. Recent studies showed a persistent psychological distress even after few months of the infection.

To determine the prevalence of depressive symptoms, insomnia and dyspnea among covid-19 survivors.

We conducted a prospective cohort study including 121 Tunisian COVID-19 inpatients who had been discharged alive from hospital. Each enrolled patient was asked about the period before the hospital stay, and the 6-9 month-period after hospital discharge. Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms. We assessed insomnia via the insomnia severity index (ISI) and dyspnea through the mMRC (modified British Medical Research Council).

The median age of participants was 59 years. The prevalence of depressive symptoms and insomnia increased significantly after the pandemic (5.7% vs 57.9%, p=0.038, r=0.189; and 4.9% vs 26.4%; p<0.0001, r=0.349 respectively). Younger patients presented more depressive symptoms (p<0.0001). females were more likely to suffer from depressive symptoms (p<0.0001). Dyspnea was more prevalent among survivors with depressive symptoms (p=0.001). Patients with depressive symptoms exhibited more insomnia (p<0.0001).

The pandemic of covid19 emerged a wide range of physical and mental health problems with complex physiopathology. The early detection of these disorders improves the quality of life of these patients.

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The global COVID-19 pandemic and subsequent lockdowns have significantly impacted global wellbeing and highlighted the close link between mental and physical health. Social isolation and quarantine have proven to be major stressors, leading to emotional distress and unpredictable psychological consequences.

We explored the pandemic’s impact on individuals’ physical and mental health and social relationships.

We conducted a cross-sectional study using a questionnaire which included among other socio-democratic questions, the Fear of COVID-19 Scale, the World Health Organization Quality-of-Life Scale (WHOQOL-BREF) and the Toronto Empathy Questionnaire (TEQ).

A total of 511 adults (55.1% males) participated in this study. Participants reported increased social media use (more than 4-5 times/week) during the lockdown, which was associated with increased fear of COVID-19 and negative effects on mental and physical health, and social relationships (p<0.01). Conversely, non-work-related outings (once a week) were associated with lower fear (p<0.01) and better well-being (p<0.05). Higher fear, particularly for loved ones, was associated with negative effects. The level of physical health was moderate to high, with varying levels of satisfaction in different areas. Empathy correlated with increased fear (p<0.01) and reduced mobility (p<0.05).

The COVID-19 pandemic and lockdowns significantly affected physical and mental health, highlighting the importance of tailoring interventions for vulnerable populations and promoting adaptive coping strategies in times of crisis.

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Children, who are particularly vulnerable in emergency situations, need tailored mental health strategies.

We investigated the impact of the COVID-19 pandemic on anger and life satisfaction in children.

September 2021, we conducted a cross-sectional study in Preveza, Greece, interviewing 91 students aged 10-12 years from four elementary schools. The survey included socio-demographic questions, the Anger Expression Scale for Children (AESC), and the Satisfaction with Life Scale (SWLS). AESC scores range from 6 to 30 indicating anger severity, while SWLS scores between 5-9 signify extreme dissatisfaction and 31-35 extreme satisfaction.

Significant correlations were found between the number of siblings (p 0.004), duration of electronic play (p 0.005), and duration of sleep (p 0.014) with life satisfaction. Children without siblings, with limited play consumption, and early bedtimes had lower life satisfaction. The presence of a television in their room (p 0.027) and daily use of television and social media (p 0.007) correlated with anger management and behavior. Social media/TV use was associated with better anger management.

Despite the pandemic lasting almost two years, children’s anger levels in Preveza remained stable, possibly due to outdoor activities and online interactions. These findings provide insights for policy makers, healthcare professionals, and parents seeking to improve anger management of children.

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Only a few cases of primary anterograde amnesia with confabulation after severe complex brain damage have been described in the literature.

To describe a case of anterograde amnesia with confabulation in a patient with severe and extensive brain damage.

case report

Case presentation: A 48-year-old male patient with a medical history of diabetes mellitus type II, hypertension, presented to a psychiatric clinic for the first time. He was admitted to the hospital due to the manifestation of disruptive aggressive behaviour, aimless wandering, and excessive, impulsive expenditure of financial resources. At the time of hospitalization and during the hospital stay, the patient exhibited a state of elevated mood and anterograde amnesia compounded by the presence of prominent confabulation, easily irritable mood with a tendency to conflict. No physical limitations.

Background: The patient is an active long-distance driver for 15 years. A year before hospitalization in psychiatric clinic, he was travelling to Moscow, he had episode of headache and unconsciousness after which hospitalization. Diagnosed with multiple infarcts of embolic origin in the right frontal lobes, both cortical and subcortical, on the right side at the level of the uncus, in the medial anterior parts of the right occipital lobe, on the left side in the insula and at the level of the capsula externa, in the anterior basal part of the left temporal lobe. After hemodynamic stabilization, he was repatriated to Latvia. Stationary positive SARS-CoV-2 PCR, O2 support therapy required.

The patient develops auditory and visual hallucinations, which do not correct on antipsychotic therapy. Lumbar puncture was performed, which showed positive anti-NMDA antibodies, magnetic resonance - autoimmune limbic encephalitis with damage to the gyrus cinguli of the insula cortex of both temporal lobes and the right subfrontal part with spread throughout the right temporal lobe, bilaterally in the mediobasal structures of the temporal lobes and the right thalamus with progressive changes. The patient receives immunomodulatory therapy, plasma exchange and immune globulin. Hallucinations decrease on the background of therapy. At discharge - moderate ataxia in the legs, disorientation in time, severe short-term memory disorders.

The patient in his mind lives like nothing has happened and the same life continues.

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The long-term prognosis for the patient remains uncertain, given the multifaceted nature of the condition and the extent of brain damage. Continuous monitoring, rehabilitation, and ongoing support will be essential to assess cognitive recovery and improve the patient’s quality of life.

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COVID-19 affected humankind worldwide in different aspects of life. Survivors still report the effects of the pandemic on daily life, physical health, and mental health.

To assess effects of the pandemic on the mood and the quality of life of the survivors.

We conducted a prospective cohort study including 121 Tunisian COVID-19 inpatients who had been discharged alive from hospital. Each enrolled patient was asked about the period before the hospital stay, and the 6-9 month-period after hospital discharge, using several scales: the validated Arabic version of “Patient Health Questionnaire” (PHQ-9) to screen for depressive symptoms, and “EuroQol five-dimension three-level” (EQ-5D-3L) to assess the quality of life.

The median age of participants was 59 years, with extreme values ranging from 18 to 80. Among them, 51.2% were females. As compared with baseline statue of patients, the depressive dimension assessed through PHQ was significantly impaired (7.05 vs 1.12; p<0.001). The different dimensions of the EQ-5D-3L showed significant deterioration in mean scores (mobility:1.09 vs 1.31, p<0.001;  selfcare:1 vs 1.11, p=0.001; daily activities:1.09 vs 1.49, p<0.001; pain and disturbance: 1.17 vs1.49, p<0.0005 and anxiety and depression: 1.07 vs 1.57, p<0.001). Depressive symptoms were 10 times more frequent in post-COVID (57.9% vs 5.7%). The post-COVID PHQ-9 score was correlated with the post-COVID EQ-5D-3L score (p=0.033).

This study points out the long-term impact of the COVID infection. Therefore, the clinician should screen for possible psychological distress even after resolution of the disease, in order to guarantee a better quality of life.

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Sleep quality depends on several factors such as smoking, physical activity, diet, and certain pathologies, namely obstructive sleep apnoea syndrome. Indeed, following their vaccination against COVID19, several medical trainees complained about a deterioration of their sleep quality.

To evaluate the quality of sleep of medical trainees who work at Charles Nicolle Hospital and who were vaccinated against SARS-COV2.

We conducted a descriptive cross-sectional study among medical trainees at Charles Nicolle Hospital who were vaccinated against COVID-19 during the period from March 2020 to August 2022. Sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Trainees were contacted during the period August 2022 to September 2022.

Sixty-nine medical trainees, vaccinated against Covid19 joined our study. Forty-nine of them had a significant sleep disturbance: Pittsburgh Sleep Quality Index (PSQI) greater than five. The average age was 29.39±3.04 years with a female majority (73.5%). No psychiatric history was found. The most affected category of trainees were residents (71.4%). Forty-three of them were inoculated with the messenger RNA vaccine and 4 with inactivated vaccine. Twenty-one patients vaccinated with the messenger RNA vaccine received two doses, seventeen received three doses and only one received a single dose. Sleep latency was high in 20,4% of cases. A sleep duration of less than five hours per night was found in 18,4% of the cases. Six participants reported using a sleep aid three to four times a week.

Our study revealed a significant sleep disturbance in medical trainees at Charles Nicolle Hospital. This could be due to the SARS-COV2 vaccination but can also be explained by the night shifts and the stress to which they are exposed, especially during this pandemic period.

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The world community is only at the beginning of awareness of the peculiarities of the formation, course and outcome of the psychopathological consequences of the impact of the SARS-CoV-2 pandemic.

To investigate the clinical and anamnestic features and their influence on the formation of psychopathological consequences in patients with first diagnosed mental disorders who have experienced COVID-19 and were exposed to the stressors of the SARS-CoV-2 pandemic.

97 patients with first diagnosed mental disorders who have experienced COVID-19 and were exposed to the stressors of the SARS-CoV-2 pandemic were examined (F 32.0-32.2 – 34 patients, F 40-45 – 32 patients, F 06.3-06.6 – 31 patients). Clinical-psychopathological, clinical-amnestic methods, including information about the experienced coronavirus disease COVID-19, the impact of the stressors of the SARS-COV-2 pandemic, and methods of statistical analysis were applied.

The conducted research made it possible to identify the phenomenological structure of mental disorders that develop after the coronavirus disease COVID-19. This structure includes depressive disorders (35.05%), neurotic, stress-related and somatoform disorders (32.99%), as well as mental disorders of organic genesis (31.96%). An important result of the study was the determination of the heterogeneity of mental pathology in the context of the influence of stressogenic factors of the pandemic and other psychogenies. In this aspect, all mental and behavioral disorders must be divided into 3 variants of pathology, which differ in the mechanisms of formation: caused by the pathoplastic factors of COVID-19 and the patient’s personal reactions to the disease; related to the psychogenic effects of the stressors of the SARS-COV-2 pandemic; with a combined mechanism of influence of pathoplastic and psychogenic factors. Certain diagnostic and phenomenological regularities characteristic of each of the options are defined. The influence of pathoplastic factors and personal reactions to the disease is associated with the formation of depressive disorders. Pandemic stressors most often cause the development of neurotic, stress-related and somatoform disorders. Under the influence of combined factors, disorders of organic genesis are formed to a greater extent. The initial manifestations of pathology also differ with different formation mechanisms: when pathoplastic factors predominate, asthenia, depression and sleep disturbances prevail; with leading psychogenic influences – anxiety and tension; when the above factors are combined - asthenia, stress and cognitive disorders.

The significance of the obtained data lies in the possibility of studying the role of the psychopathological consequences of COVID-19 in the genesis of mental disorders.

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This is a descriptive cross-sectional clinical study with professionals from the Nursing Team (Nursing Assistant, Nursing Technician and Nurse).

To assess the psychological impact of the Covid-19 pandemic on nursing staff professionals.

A descriptive, quantitative, cross-sectional study will be applied to a structured interview aimed at collecting sociodemographic and occupational data, Mental Health Scales evaluating professional exhaustion - Oldenburg Burnout Inventory and Beck’s Anxiety Rating Scale to assess the state of anxiety.

About 13,587 nursing professionals were interviewed, including nurses, technicians and nursing assistants. They were evidenced through the behavior indexes related to insomnia, the desire to cry and appetite variation may be related to the long working hours, the fear of contamination and the consequent absence from work, as well as the fear of getting sick may be related to the fact that the professional stops being a caregiver and starts to be cared for.

the study denotes the importance and need for interventions to promote and prevent mental well-being in health professionals exposed to COVID-19, these need to be implemented immediately, for nursing professionals, as they are on the front line, demanding attention Special. In this sense, the Nursing Council of the State of São Paulo created and implemented some bills such as the Obligation of Rest Rooms in Health Units, the Cuidando de Quem Cuida Program and the Yellow September Campaign in Allusion to actions for Nursing professionals for the prevention and promotion in mental health category.

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In studies of the socio-psychological consequences of the COVID-19 pandemic, models focused on the negative aspects of stressors, dysfunctions,  anxiety We present the attempt to expand the context and include in the field positive personal resources for psychological well-being and even post traumatic personality growth after disasters. Sometimes separation from family and friends, lack of medicines and medical resources, loss of income, social isolation to humanity, do not automatically assume that a person is capable and responsible for effectively coping with life difficulties.

397 (students and patients of clinic average age 26, 2/3 are female

Peritraumatic Distress Index (CPDI) (Feng, 2020); Impact of Event Scale (Horowitz, 1979), Coping Self-efficacy Scale (Chespeu et al, 2006); Posttraumatic Growth Inventory (Tedeschi& Calhoun, 1996), MMI (Nuttin, 1986) – adapted by M. Magomed-Eminov.

Significant negative correlation between coping self-efficacy and intensity of the impact of stressful events (IES) (rS = - 0,140, p < 0,05) was predictable.

CPDI and PTG showed significant correlation (Pearson’s r= 0.23, p<0.01) between Peritraumatic Distress Index and Post-Traumatic Growth indicators only in the group of respondents who have had  COVID-19. The data is confirmed by the content analysis of incomplete sentences of the subjects of COVID group. The correlation between these indicators in the Non-Covid group was insignificant.

Moreover additional information we got from narratives of infected patients: the data has been split into 3 groups of narratives in the context of cultural-historical activity theory which shows the triadic outcome of survivor after trauma : a) suffering, b) adaptation, coping, resilience, c) personal growth.

To interpret the data the authors propose the meaning-activity approach and personality work with negative life experience (Magomed-Eminov, 1998, 2007, 2009, 2021). Authors suggest that further research on the positive consequences of stressful events beside coping styles and mechanisms that would expand the repertoire of tools predicted the ability of a modern person to cope with adversity and use experience for deeper involvement of human resources with the help of personality work with personal experience.

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The Depression, Anxiety and Stress Scale (DASS-21) is recognized as being a widely used measure for the assessment of negative emotional states. While the DASS-21 has been widely used for assessing mental health in Pakistan, limited research has been done regarding its factor structure and measurement invariance.

To assess the factor structure and measurement invariance of the DASS-21 among young adults in Pakistan.

A large sample of 1361 Pakistani young adults had completed the scale during the current study comprising 666 males and 695 females with a mean age of 24.51 years.

Excellent internal consistency reliability was found for the overall DASS-21 and its three subscales (depression, anxiety and stress) ranging from r = .86 to .71 (Cronbach alpha). Moreover, the three subscales were strongly and significantly associated with one another. Additionally, the results showed a good fit of the three-factor model and the one-factor model of the DASS-21 aimed at assessing gender psychological distress. Strong measurement invariance was found regarding gender therefore showing that the DASS-21 is understood and interpreted similarly by males and females. However, little evidence was found regarding the three subscales (depression, anxiety and stress) for the measurement of three distinct constructs.

These findings confirm the utility of the DASS-21 for measuring mental health in Pakistan among young adults.

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The somatization problem has been one of the most acute in mental health for half a century (Kirmayer, L., 2000). Patients with somatic complaints turn to specialists in various fields but rarely to psychologists and psychiatrists, although the connection between bodily suffering and psychological difficulties sometimes lies on the surface (Molchanova E., 2016). In the last twenty years, the mechanisms of somatization have been considered by several disciplines, one of which is cultural psychiatry, which has become relevant.

Unfortunately, most of the research focuses on the cultural characteristics of migrants living in the United States (Groleau, D. and Kirmayer, L. 2004). There needs to be more research on the cultural features of somatization in Kyrgyz culture.

The goal of the study is to discover the distinctive features of the process of somatization in Kyrgyz culture

The objectives are:

To create a vocabulary of somatic phrases and idioms used to represent somatic problems to find the most commonly used somatic idioms for emotional complaints by native speakers of the Kyrgyz language.

To describe the mechanism of transformation of the emotional symptom into a specifically located and presented somatic complaint.

The research used a mixed, qualitative, and quantitative design.

The first stage is qualitative, including ten semi-structured interviews with linguists, culturologists, historians, and specialists in folk art.

The second stage included four focus groups (12 people in each group) with a follow-up analysis. The recruitment of respondents was carried out through social networks, announcements, and the snowball method.

The third stage was quantitative. With the help of the dictionary compiled at the first stage, 250 participants ranked the frequency of somatic idioms, which were used to express the emotional problems

There have been found more than 200 somatic idioms, which are used to present emotional problems. The most frequent ones describe the heart, liver, and joints. Heart metaphors are associated with despair and anxiety, joints - with depression, and liver metaphors - with some personality characteristics, such as conformity and kindness. The created map of somatic representation of emotional problems shows the most frequent localization of somatic symptoms in disorders featuring somatic symptoms in native Kyrgyz speakers.

There is a culturally shaped specifics of somatic representations of emotional problems among native Kyrgyz speakers. More research needs to be conducted to interpret the nature of people’s emotional problems represented by somatic symptoms.

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Art therapy, occupational and play therapy support the idea that man becomes what he is through activity. We accept man in his totality, we oppose the rigid boundaries between “sick” and “healthy”, there is no contradiction between these states, but only an unbroken chain of neighboring nuances, of gradual differences of human life.

Therapies based on the visual arts are also used in the discharge of repressed experiences, called in psychoanalytic terms “catharsis”, with the aim of preventing or remedying dysfunctions, facilitating maximum adaptability of the beneficiary, regardless of the degree of handicap. The activities of occupational therapy and ergotherapy has and productive objectives, in accordance with the outstanding, hidden skills, correlated with the current demands on the labor market. Art forms called: “Raw Art” can be practiced.

Traditional crafts and visual arts are reinvented as therapeutic methods. We use pottery and sculptural artistic ceramics with elements from the history of archaic arts connected with contemporary visual arts (pictures, sculpture, graphics, mixed arts and multimedia)

The creative process and symbolic communication, associated with narration and imitation, develop new ways of communication, new ways of self-expression, new ways of seeing things. Throughout this process, people are more productive, more efficient, focused, calm and self-satisfied. (2014- Emilia Chirilă The role of art therapy in self-knowledge, self-esteem and interpersonal relationships in children with emotional disorders”- THE SECOND WORLD CONGRESS ON RESILIENCE: FROM PERSON TO SOCIETY may 8-10 Timisoara Romania 1139-1145editors: M Tomita, S.Cace – MEDIUMOND- INTERNATIONAL PROCEEDINGS copyright 2014 by MEDIMOND srl 40065 Piamond (Bologna) Italy -Printed May 2014 by Editografica.Bologna Italy - ISBN 978-88-7587)

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People who do not have a sufficiently developed vocabulary to be able to express themselves feel very good practicing art as a natural means of communication. Discovering the skills of the beneficiary, through the artistic product and the awareness of emotions and feelings open up ways to a more effective non-verbal communication.

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In today’s world of global migration and cultural diversity, mental health care grapples with persistent challenges. Despite efforts to promote cultural competency and person-centred approaches, it’s vital to delve into the issues surrounding cultural differences and linguistic diversity in mental health care. This exploration highlights the complexities where culture, language, and healthcare intersect (Brisset et al., 2014; Desai et al., 2021).

Our aim is to analyse cultural and linguistic barriers in mental health care for migrants and assess their impact on access and quality of care.

Literature review, drawing from sources such as PubMed, ResearchGate, and Google Scholar. This review will be framed around the case of a 34-year-old man from Bangladesh, who has been residing in Lisbon for a year. His clinical presentation includes depressive symptoms, disorganized behaviour, and psychotic manifestations, such as persecutory delusions. He does not speak Portuguese or English, thereby limiting his access to essential mental health treatment services. Through this review, we intend to elucidate the intricate dynamics surrounding cultural and linguistic barriers in mental health care.

Migrants from diverse backgrounds face many challenges, including the loss of homes, livelihoods, and family, often leading to mental health issues like depression, anxiety, and post-traumatic stress disorder. Two primary challenges include adapting to a new life and experiencing discrimination and marginalization (Amri et al., 2013; Satinsky et al., 2019). Social stigma and mistrust hinder access to mental health services. Limited culturally competent services widen the gap between mental health needs and help-seeking attitudes. Language barriers significantly contribute to disparities in access to services (Amri et al., 2013). Additionally, mental health care providers’ organizational culture often prioritizes ‘ideal’ patients who are native speakers, favouring individual-oriented treatment over community-focused care (Desai et al., 2021).

To address these barriers effectively, it is crucial to employ specific strategies. The Multi-Phase Model of Psychotherapy, Social Justice, and Human Rights (MPM) equips mental health counsellors to better serve immigrant communities while addressing social stigma. This comprehensive framework comprises five phases of intervention: psychoeducation, culturally responsive service delivery, cultural orientation, collaboration with local healers, and connecting patients to essential resources (Amri et al., 2013). Additionally, practitioners should receive training in effective collaboration with interpreters to provide multilingual healthcare (Brisset et al., 2014).

Addressing cultural and linguistic barriers in mental health care is vital. The Multi-Phase Model of Psychotherapy offers a promising approach, while collaboration with interpreters remains essential.

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Dissociative Identity Disorder (DID) is the presence of two or more distinct personality states within an individual. It is a rare dissociative disorder where usually self-non-integration arises as a response to significant stress. As is the case for many other psychiatric disorders, the diagnosis and management of DID is highly dependent on cultural variables and contexts.

To present a case of DID in Palestine in which the diagnosis was dependent on noticing minor changes in the patient’s dialect at different times. To highlight the importance of understanding each patient’s environment, values, and culture when assessing DID to avoid under- or over-diagnoses.

A case report in which we present a case of a 17-year-old Palestinian girl who suffered from three months of general fatigue, restlessness, poor coordination, and peripheral numbness. She was seen by several doctors who excluded organic causes and several spiritual healers without benefit. This caused severe deterioration of social and academic functioning. The family noticed a change in her articulation and memory issues, so they presented her to a psychiatrist. Data was collected by interviewing the patient and her family weekly for a month. The psychiatrist noted that the patient has subtle differences in accent, and directed the family to record any change in tone of voice or articulation. The patient was found to have three different accents on top of her native one, representing a total of four personalities with no memory integrity among them. She was started on Escitalopram (gradually increased) and Alprazolam (gradually decreased).

The psychiatrist detected the theme of being “stuck” throughout the personalities, each in its own way, according to the context of their roots. It was revealed that the patient is engaged to a man she doesn’t approve of and has “no way out” due to the social and familial significance of this relationship. Family counseling and trauma-informed psychoeducation were done, where the patient’s choice was reaffirmed. This led to significant improvement in terms of mood, identity integration, and social functioning with complete resolution of split personalities in just short of one-and-a-half months.

This case report asserts the importance of cultural understanding and sensitivity when assessing psychiatric patients. Symptoms, triggers, psychotherapy, and psychoeducation have a universal baseline, yet are highly culturally-dependent. Through this case study, we emphasize the importance of translating universal criteria into context-specific practices.

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Melancholia is a concept deeply intertwined with the history of mood disorders in psychiatry. Isháq Ibn Imrân, a prominent Arab-Muslim physician of the 12th century, contributed significantly to the understanding of melancholia in his era, its. His treatise is the oldest surviving work entirely dedicated to melancholia, making it a pivotal milestone in the history of psychiatry. It is noteworthy that Ibn Imrân’s work has often been overlooked in Western psychiatry. This oversight highlights the enduring relevance of his insights within the context of modern psychiatry.

The objective of this study is to assess the clinical and therapeutic aspects delineated by Ibn Imrân in his treatise on melancholia for their contemporary accuracy and relevance within the field of modern psychiatry.

The review method for the Isháq Ibn Imrân treatise involves a detailed analysis of the original Arabic text and its French translation by Adel Omrani and Radhi Jazi from the Tunisian Academy of Sciences, Letters, and Arts Beit el Hekma. This includes studying the content, structure, and historical context, as well as comparing the Arabic and French versions for accuracy.

The treatise is divided into two parts to clinical examination and treatment. While some of the terminology may differ from contemporary classifications, the core observations resonate with modern psychiatric knowledge. The clinical form is described as sadness, loss of pleasure, social withdrawal, dark thoughts, and loss of interest, along with somatic manifestations: sleep disturbances such as onset insomnia or hypersomnia, as well as weight loss. Additionally, perceptual disturbances, including elementary visual hallucinations (black silhouettes), are mentioned. Regarding etiologies, perinatal factors are mentioned in the treatise (“mood of the uterus”), along with six postnatal acquired causes that must be balanced in an individual: movement and rest, sleep and wakefulness, food and drink, depletion and retention, ambient air and location and psychological torment. A seasonal pattern is described, with an association between melancholia and autumn. Several clinical forms are described, with the most prominent being catatonia compared to epilepsy, in its two agitated and inhibited forms. The second part of his treatise is dedicated to treatment, focusing on individualized approaches such as talk therapy, music therapy, and dietary interventions. Ibn Imrân also describes mental strategies to correct false beliefs. For the pharmacological treatment, specific herbs has been used via oral, nasal, or intra-rectal.

In conclusion, Isháq Ibn Imrân’s treatise on melancholia represents a timeless cornerstone in the history of psychiatry. This historical treasure serves as a reminder of the enduring quest to understand and alleviate the complexities of mental health.

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The recent addition to both ICD-11 and DSM-V of “Prolonged Grief Disorder” “PGD” raises questions regarding the complexity of the clinical manifestations and the nuances of “normal/abnormal” grief. The lack of consensus in diagnosing emphasizes grief as a non-homogeneous process highly dependent on cultural nuances and the proportion of losses.

Provide an open discourse on (PGD) emphasizing its multicultural aspects in the diagnosis, and debate whether it reinforces mental health stigma by “pathologizing” grief in today’s multicultural society.

Non-systematic review of literature using key words “Grief”, “Prolonged Grief Disorder”, “Multicultural aspects of Grief”, “Major Depressive Disorder” and “Disenfranchised Grief”, on the platforms PubMed, Medline, Google Scholar, “European Commission”, “International Migration Outlook 2022” and “Pordata”.

Literature has not clearly provided a universal definition of grief, grief processes or the threshold of abnormality. Grief lasting longer than expected is often equated to Major Depressive Episodes, given symptomatic similarities. Migration, war and the pandemic have played a significant role in how people currently grieve. Evidence showed that in 2021 alone there was a 22% increase in the permanent immigrant population. Moreover, the top five nationalities applying for first time asylum in the EU (2022) were: Syrian, Afghan, Venezuelan, Turkish, Columbian, and as of September 2022, 5 million Ukrainian refugees were registered. These figures are not neglectable and show the multiculturality of todays EU population. However, the development of transcultural psychometric tools accessing grief has not been uniform, lacking consistency in validating various transcultural factors. On the other hand, actively diagnosing “Prolonged Grief Disorder” has shown helpful to clinicians in recognizing the debilitating effects of some pernicious grief responses and quickly providing the necessary help.

Diagnosing “PGD” might lead to “psychiatrization” and “medicalization” of normative emotional processes, given different cultural backgrounds, especially due to the absence of universally applicable tools validating transcultural factors. Consequently, an inadequate consideration of context leaves patients feeling invalidated, non-supported and disenfranchised. A culturally sensitive approach is crucial, focusing on individual differences for effective grief intervention and support.

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