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Despite advances in medicine and technology, when facing epidemics people continue to turn to religion to deal with such unpredictable life-threatening events. We aimed to assess psychological distress in the general population of Tunisia during the COVID-19 pandemic and to examine the contribution of religious coping (RC) in the reports of anxiety and depression at the time of the survey. We carried out and online cross-sectional study using a non-probability snowball sampling technique. A total of 603 responses were recorded. The “Depression Anxiety Stress Scales,” the “Brief religious coping scale\" and the “Arabic religiosity scale” were used. We found that 28.3%, 24.4% and 19.4% of the participants reported severe or extremely severe levels of depression, anxiety and stress, respectively. The mean score for positive RC was 22.8 ± 5.3, while that for negative RC was 14 ± 5.8. After controlling for confounders, multivariate analysis showed that negative RC significantly and positively contributed to depression and anxiety scores in our respondents, indicating that greater use of negative RC was associated with higher levels of psychological distress. No significant relationship was found between overall religiosity or positive religious coping and either depression or anxiety symptoms. Religious beliefs may have an impact on how people cope with emerging infectious disease outbreaks. Religion should be considered by professionals as an important variable to consider in therapy for individuals who engage in RC or perceive religious needs.

Introduction. The management of neuropathic pain remains complex, generally because of the psychiatric comorbidity that is often underdiagnosed. The objectives of our work were to determine the link between depression and the characteristics of NP on the one hand and quality of life on the other hand, in a sample of subjects consulting for neuropathic pain (NP) regardless of etiology. Methods. We conducted a cross-sectional study involving 61 neuropathic pain consulting patients in whom we assessed five parameters, namely, neuropathic pain based on DN4, pain intensity using EVA, anxiety, and depression according to the HADS and quality of life. Results. The study population mean age was 52.71 ± 14.29 years while the sex ratio (m/f) was 0.52. The neuropathic pain’s most common etiologies were postherpetic pain, carpal tunnel syndrome, and diabetic neuropathy. Depression and anxiety prevailed by 65.6% and 73.7%, respectively. The quality of life was impaired with average SF-12 physical and mental scores of 33.76 ± 8.03 and 37.78 ± 11.52, respectively. The overall mean BPI score was 5.53 ± 1.76. Patients with high DN4 scores were significantly more depressed (p=0.025). A significantly positive association was found between the depression score and the pain intensity (p=0.001, r = 0.41). Depressed subjects had a poor quality of life according to SF-12 and BPI. Conclusion. Given the depressive comorbidity impact on the neuropathic pain components as well as the quality of life, screening for this comorbidity should be part of the baseline ND assessment.

Background The nature of the relationship between Internet Gaming Disorder (IGD) and psychosis is unclear so far. There is evidence that greater time spent in playing video games may expose players to both insomnia and a toxic online environment with widespread cyberbullying. These two possible consequences of IGD may, in turn, be associated with greater psychotic experiences (PE). Based on this theoretical framework, the present study proposed to contribute the body of the knowledge in this area, by testing the possible indirect effects of insomnia severity, cyber-victimization and cyberbullying in the cross-sectional association between IGD and PE in a sample of Tunisian university students. Method We conducted a cross-sectional study over 4 months (February-May 2022). The Arabic versions of the Brief Symptom Inventory, the Internet Gaming disorder-20 Test, the Insomnia Severity Index, and the Revised Cyber Bullying Inventory–II were administered to a total of 851 students (mean age = 21.26 ± 1.68 years, 53.7% females). Results We found that 25% of students were at risk of IGD, and 1.8% had an IGD. The results of the mediation analysis showed that insomnia severity fully mediated the association between IGD and paranoid ideation. Higher IGD was significantly associated with more insomnia severity, which was, in turn, significantly associated with more paranoid ideation. Cyberbullying partly mediated the association between IGD and psychoticism. Higher IGD scores were significantly associated with more cyberbullying, which was, in turn, significantly associated with more psychoticism. Finally, greater IGD was significantly and directly associated with higher psychoticism. Conclusion Our findings suggest that insomnia and cyberbullying may be regarded as potential targets for youth mental health promotion, as well as community-focused prevention and early intervention in psychosis. More particular attention should be devoted to the huge potential for engaging in cyberbullying among online gamers. Sleep deprivation should be prevented, assessed and treated in heavy gamers.

Family caregivers represent an integral part of the mental health care system in Tunisia, as well as in most of the low-to-middle-income countries and collectivist cultural backgrounds (i.e., communities that prioritizes the group over the individual). However, their task is burdensome, often associated with both experienced and perpetrated violence toward the patient. We aimed to shed light on the caregiver-patient relationship by investigating the prevalence and correlates of both violence victimization and violence perpetration in a Tunisian sample of caregivers of patients with schizophrenia. A paper-and-pencil self-administered questionnaire was used to collect data from participants. Caregivers (N = 110, aged 39.7 ± 12.5 years, 63.6% females) were asked questions about their experience of violence perpetration and victimization involving their relative with schizophrenia in the past 12 months. The Depression Anxiety and Stress Scales (DASS-21) and the abridged version of the Zarit Burden Interview (ZBI) were administered to all participants. Verbal violence was the most reported type of violence victimization (35.5%), followed by threat (25.5%), and physical violence (25.5%). In addition, 54.5% of caregivers disclosed having perpetrated verbal violence at least once against their ill relative. The most endorsed causes of violence victimization were symptoms of illness (57.3%) and refusal to adhere to treatment (49.1%). Multivariable analysis (logistic regression) revealed that caregivers' levels of burden remained significantly associated with violence victimization occurrence (OR = 1.48; 95% CI 1.05; 2.09; p = .026), while having another person in charge of caring represented a significant factor associated with perpetration of any form of violence against patients (OR = .17; 95% CI.05;.62; p = .007). Although preliminary and based on cross-sectional data and a relatively small sample size, our findings draw attention to the high prevalence of both violence perpetration and victimization within the caregiver-patient relationship in schizophrenia. Findings also identified caregivers' burden and having another person in charge of caring as factors significantly associated with occurrence of any violence victimization and violence perpetration, respectively. These factors are potentially malleable, and may be helpful in targeting an at-risk population and developing appropriate prevention strategies.

Background Rare cases of COVID-19 infection- and vaccine-triggered autoimmune diseases have been separately reported in the literature. In this paper, we report the first and unique case of new onset acute psychosis as a manifestation of lupus cerebritis following concomitant COVID-19 infection and vaccination in a previously healthy 26-year-old Tunisian female. Case presentation A 26-years old female with a family history of a mother diagnosed with schizophrenia, and no personal medical or psychiatric history, was diagnosed with mild COVID-19 infection four days after receiving the second dose of Pfizer-BioNTech COVID-19 vaccine. One month after receiving the vaccine, she presented to the psychiatric emergency department with acute psychomotor agitation, incoherent speech and total insomnia evolving for five days. She was firstly diagnosed with a brief psychotic disorder according to the DSM-5, and was prescribed risperidone (2 mg/day). On the seventh day of admission, she reported the onset of severe asthenia with dysphagia. Physical examination found fever, tachycardia, and multiple mouth ulcers. Neurological evaluation revealed a dysarthria with left hemiparesis. On laboratory tests, she had severe acute kidney failure, proteinuria, high CRP values, and pancytopenia. Immune tests identified the presence of antinuclear antibodies. Brain magnetic resonance imaging (MRI) revealed hyperintense signals in the left fronto-parietal lobes and the cerebellum. The patient was diagnosed with systemic lupus erythematosus (SLE) and put on anti-SLE drugs and antipsychotics, with a favorable evolution. Conclusions The chronological relationship between COVID-19 infection, vaccination and the first lupus cerebritis manifestations is highly suggestive, albeit with no certainty, of the potential causal link. We suggest that precautionary measures should be taken to decrease the risk of SLE onset or exacerbation after COVID-19 vaccination, including a systematic COVID-19 testing before vaccination in individuals with specific predisposition.

Background In the context of persistent wars and conflicts worldwide, the impact of acute, excessive and constant exposure to media coverage of such events on mental health outcomes becomes a serious problem for public health, and requires therefore urgent investigation to inform an effective prevention and management response. The objective of the present study was to test the hypothesis that war-related media exposure is directly and indirectly associated with insomnia through depression and perceived stress among adults from the general population of different Arab countries. Methods A cross-sectional study was carried-out two weeks after the beginning of Israel-Gaza war on the 7th of October 2023. An anonymous online survey and a snowball sampling method were adopted to collect data. A sample of 2635 general population adults (mean age of 23.98 ± 7.55 years, 73.1% females) took part of this study. Results The results of the mediation analysis showed that, after adjusting over potential confounders, depression and perceived stress fully mediated the association between war media exposure and insomnia; higher war media exposure was significantly associated with higher depression (Beta = 0.13; p  < .001) and perceived stress (Beta = 0.07; p  < .001), whereas higher depression (Beta = 0.43; p  < .001) and perceived stress (Beta = 0.31; p  < .001) were significantly associated with higher insomnia. It is of note that war media exposure was not significantly and directly associated with insomnia (Beta = − 0.01; p  = .178 and Beta = 0.02; p  = .098 respectively). Conclusion The present study is the first to provide evidence that more time spent viewing the horrors of war is significantly associated with insomnia. In addition, symptoms of stress and depression were present as early as two weeks following the beginning of the war, and played a significant role in mediating the association between war media coverage and insomnia. These findings suggest that timely screening for, and management of depression and stress symptoms in clinical and preventive programs might be beneficial for community adults who have been heavily and indirectly exposed to war through media, and present with insomnia.

Background Even though not all cyber bullies or victims think of (or consider) suicide, they clearly appear to be at an increased risk. One possible strategy to reduce suicide risk is to decrease cyberbullying occurrence; but this approach has its limitations, as it is certainly an illusion to believe that cyberbullying could be controlled or eliminated in a digitalized world. Another alternative and interesting strategy is to consider mediating factors that may indirectly affect suicidality. To this end, our purpose was to test the hypothesis that positive and negative psychotic experiences (PEs) mediate the relationship from cyberbullying perpetration/victimization to suicidal ideation (SI). Method The study followed a cross-sectional design, and was conducted during the period from June to September 2022. A total of 3103 healthy community participants from Lebanon were included (mean age 21.73 ± 3.80 years, 63.6% females). Results After adjusting over potential confounders, mediation analysis models showed that both positive and negative PEs partially mediated the associations between cyberbullying victimization/perpetration and SI. Higher cyberbullying perpetration and victimization were significantly associated with greater positive and negative PEs; more severe positive and negative PEs were significantly associated with higher levels of SI. Higher cyberbullying victimization and perpetration were significantly and directly associated with higher levels of SI. Conclusion In light of our preliminary findings, there appears to be an urgent need for a new focus on carefully assessing and addressing attenuated psychotic symptoms in healthy individuals engaged in cyberbullying either as victims or bullies and who present with SI. It is important that school counselors and decision-makers consider a holistic approach taking into account both external/environmental (bullying) and internal/individual (PEs) factors in their suicide prevention programs. Future longitudinal research in larger samples are still required to confirm our findings and further elucidate the mechanisms underlying the relationship between cyberbullying and suicide.

Background The way how technology addiction relates to psychosis remains inconclusive and uncertain. The present study aimed to test the hypothesis of a mediating role of depression, anxiety and stress in the association between three technology (behavioral) addictions (i.e., Addiction to the Internet, smartphones and Facebook) and psychosis proneness as estimated through schizotypal traits in emerging adults. Methods A cross-sectional study was performed among non-clinical Tunisian university students (67.6% females, mean age of 21.5 ± 2.5 years) using a paper-and-pencil self-administered questionnaire. Results Results for the Pearson correlation revealed that higher smartphone, Internet, and Facebook addictions’ scores were significantly and positively correlated with each of the depression, anxiety and stress subscores; whereas depression (r = 0.474), anxiety (r = 0.499) and stress (r = 0.461) scores were positively correlated with higher schizotypal traits. The results of the mediation analysis found a significant mediating effect for depressive, anxiety and stress symptoms on the cross-sectional relationship between each facet of the TA and schizotypal traits. Conclusion Our findings preliminarily suggest that an addictive use of smartphones, Internet and Facebook may act as a stressor that exacerbates psychosis proneness directly or indirectly through distress. Although future longitudinal research is needed to determine causality, we draw attention to the possibility that treating psychological distress may constitute an effective target of interventions to prevent psychosis in adolescents with technology addictions.

Background While expansive research has accumulated concerning the association between traditional, face-to-face peer victimization and psychosis, a paucity of empirical research has been undertaken so far to investigate these associations with experiences of new and evolving ways of victimization through the digital world. Exploring these associations is highly relevant and timely, given that emerging adults are heavy users of digital technologies, highly exposed to online risks, and are at the peak age of onset of psychosis. This study aimed to test the hypothesis that psychological distress and insomnia symptoms have a significant indirect mediating effect on the association between cyber-victimization and self-reported positive psychotic experiences (SRPEs) in a binational sample of Tunisian and Lebanese community adults. Method The total sample was composed of 3766 participants; 3103 were from Lebanon (Mean age: 21.73 ± 3.80 years, 63.6% females) and 663 from Tunisia (Mean age: 26.32 ± 4.86 years, 59.9% females). Online anonymous self-report questionnaires were administered to all participants. Results Higher SRPEs were found in Lebanese participants compared to Tunisians, in single participants compared to married ones, in those with a university level of education compared to secondary or less, in those who live in rural areas compared to urban, in those who do not smoke, do not drink alcohol and do not use marijuana or any other illegal drug. Furthermore, more cyber-victimization, a higher insomnia severity and psychological distress were significantly associated with higher SRPEs. After adjusting for potential confounders, mediation analysis demonstrated that higher cyber-victimization was significantly associated with more insomnia severity/psychological distress; which were, in turn, significantly associated with greater SRPEs. Finally, more cyber-victimization was significantly and directly associated with more positive dimension. Conclusion Identifying insomnia and distress as mediators could provide novel insight for psychosis prevention efforts and intervention targets for cyber-victimized individuals prone to experience subclinical psychotic symptoms.

Background Growing research indicated that it is highly valuable and clinically beneficial to quantitatively measure and detect the potential presence of paranoid thinking. Among the various existing self‐report instruments to measure paranoia, the Green et al. Paranoid Thoughts Scale (GPTS) was recommended as having the most well‐defined, clearly articulated construct underlying its items, and the strongest psychometric qualities in general and clinical population samples. Yet, the psychometric performance of the GPTS remains unknown in the Arab language and culture. To address this gap, our study aimed to explore the psychometric properties of an Arabic translation of the shortest version of the scale (i.e., the GPTS‐8). Methods A cross‐sectional study was conducted. Data were collected during the period September 1st 2024 to January 31th 2025. A total of 552 Arabic‐speaking general population adults from Tunisia aged 25.81 ± 4.86 years participated. Results Analyses provided support for a bidimensional model, with a first dimension referring to ideas of persecution and a second one corresponding to ideas of reference. The internal consistency reliability coefficients were high, with both Cronbach's alpha and McDonald's ω reported to be 0.83 for ideas of persecution and 0.83 for ideas of reference. Measurement invariance was established for both subscales, implying that the Arabic GPTS‐8 measures the same underlying construct of paranoia in the same way across male and female respondents. Finally, paranoia scores correlated positively with psychotic experiences scores, indicating convergent validity, as well as with depression, anxiety and insomnia scores, supporting the concurrent validity of the scale. Conclusion By translating and validating GPTS‐8 for the first time in Arabic, this study contributes to rendering the tool available to a broader array of clinicians and researchers who work with Arabic‐speaking people. We believe the new Arabic version of the GPTS‐8 will provide further encouragement to research and development in this yet‐unexplored field among Arabic‐speakers.