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Background Monitoring and reducing restrictive practices in mental healthcare, including seclusion and restraint, is a global policy priority due to ethical concerns. However, research on these practices remains limited. This study aims to estimate the use of seclusion and mechanical restraint (MR) in mental healthcare at the national level in France, the variation in the use of these practices across hospitals, and associated factors considering a wide range of variables. Methods We used the French nationwide system for the routine collection of psychiatric hospital claims data, which includes a specific register on seclusion and MR, covering all hospitals providing involuntary psychiatric care for adults in France. Data from 204 hospitals were analyzed for the year 2022. Additional information on patient, hospital, and contextual characteristics was obtained by linking data from other national sources, including somatic hospital and community care claims, annual hospital surveys and census data. Using these combined datasets, we conducted multilevel logistic regressions to identify factors significantly associated with variations in the use of restrictive practices. Results In 2022, among 98,271 involuntary psychiatric inpatient admissions across 204 hospitals, seclusion was used in 31,679 admissions (32%) and MR in 8,551 admissions (9%). Large variations in the use of restrictive practices were observed across hospitals, with some reporting no use of MR. Multilevel models showed that patient characteristics, including primary diagnosis and prisoner status, were among the strongest predictors of seclusion and MR use. Admissions to public hospitals with teaching activities or multidisciplinary services were associated with lower odds of seclusion, while a higher nurse-to-patient ratio and proportion of involuntary admissions were associated with lower odds of MR use. No contextual factors related to hospitals’ catchment areas were significantly associated with the use of restrictive practices. Conclusions Significant variations were found in the use of seclusion and MR across hospitals in France, which cannot be explained solely by patient needs. While patient characteristics were strong predictors, several hospital-level factors were also associated with these practices. These findings highlight the need for closer monitoring and targeted interventions to reduce unwarranted variations and raise concerns about equity and ethics in mental healthcare. Clinical trial number Not applicable.

Monitoring and reducing restrictive practices in mental healthcare, including seclusion and restraint, is a global policy priority due to ethical concerns. However, research on these practices remains limited. This study aims to estimate the use of seclusion and mechanical restraint (MR) in mental healthcare at the national level in France, the variation in the use of these practices across hospitals, and associated factors considering a wide range of variables. We used the French nationwide system for the routine collection of psychiatric hospital claims data, which includes a specific register on seclusion and MR, covering all hospitals providing involuntary psychiatric care for adults in France. Data from 204 hospitals were analyzed for the year 2022. Additional information on patient, hospital, and contextual characteristics was obtained by linking data from other national sources, including somatic hospital and community care claims, annual hospital surveys and census data. Using these combined datasets, we conducted multilevel logistic regressions to identify factors significantly associated with variations in the use of restrictive practices. In 2022, among 98,271 involuntary psychiatric inpatient admissions across 204 hospitals, seclusion was used in 31,679 admissions (32%) and MR in 8,551 admissions (9%). Large variations in the use of restrictive practices were observed across hospitals, with some reporting no use of MR. Multilevel models showed that patient characteristics, including primary diagnosis and prisoner status, were among the strongest predictors of seclusion and MR use. Admissions to public hospitals with teaching activities or multidisciplinary services were associated with lower odds of seclusion, while a higher nurse-to-patient ratio and proportion of involuntary admissions were associated with lower odds of MR use. No contextual factors related to hospitals' catchment areas were significantly associated with the use of restrictive practices. Significant variations were found in the use of seclusion and MR across hospitals in France, which cannot be explained solely by patient needs. While patient characteristics were strong predictors, several hospital-level factors were also associated with these practices. These findings highlight the need for closer monitoring and targeted interventions to reduce unwarranted variations and raise concerns about equity and ethics in mental healthcare.

Infection of the dental pulp will result in inflammation and eventually tissue necrosis which is treated conventionally by pulpectomy and root canal treatment. Advances in regenerative medicine and tissue engineering along with the introduction of new sources of stem cells have led to the possibility of pulp tissue regeneration. This systematic review analyzes animal studies published since 2010 to determine the ability of stem cell therapy to regenerate the dentine-pulp complex (DPC) and the success of clinical protocols. In vitro and human clinical studies are excluded and only the experimental studies on animal models were included. Dental pulp stem cells constitute the most commonly used cell type. The majority of stem cells are incorporated into various types of scaffold and implanted into root canals. Some of the studies combine growth factors with stem cells in an attempt to improve the outcome. Studies of ectopic transplantation using small animal models are simple and non-systematic evaluation techniques. Stem cell concentrations have not been so far reported; therefore, the translational value of such animal studies remains questionable. Though all types of stem cells appear capable of regenerating a dentine-pulp complex, still several factors have been considered in selecting the cell type. Co-administrative factors are essential for inducing the systemic migration of stem cells, and their vascularization and differentiation into odontoblast-like cells. Scaffolds provide a biodegradable structure able to control the release of growth factors. To identify problems and reduce costs, novel strategies should be initially tested in subcutaneous or renal capsule implantation followed by root canal models to confirm results.

IntroductionG6PD is essential for the production of NADPH, which is a cofactor for many enzymes involved in antioxidant defense and neurotransmitter synthesis. A deficiency in this enzyme could lead to increased oxidative stress, impaired neurotransmitter and immune function. The latter have been implicated in the pathophysiology of schizophrenia.ObjectivesThe present case is presented to underscore the infrequent and uncharacteristic manifestation of this condition, in the context of clinical symptoms and the trajectory of evolution of schizophrenia when associated with G6PD Deficiency. Moreover, it sheds light on the challenges clinicians encounter in the management of such cases.MethodsA case report of a patient who was admitted to the Psychiatry Department (“Ibn Omrane”) of Razi Hospital”.ResultsMr. M.T is a 26 year-old unmarried man. He comes from a non-consanguineous marriage and has an educational level of a bachelor’s degree plus three additional years of study. He has a significant family medical history. His maternal uncle is under treatment for a chronic psychotic disorder. He has a personal history of G6PD deficiency and no specific habits to note. At the age of 24, he insidiously developed anxiety with incoherent statements of persecution accompanied by behavioral manifestations leading to mistrust and social isolation. He discontinued his studies for a year and began verbalizing suicidal thoughts accompanied by self-harm behaviors.The family sought help from a psychiatrist who prescribed 5 mg of olanzapine, which was covertly administered to the patient.At the age of 28, after a suicide attempt, he was involuntarily admitted to Razi Hospital. The clinical presentation was dominated by disorganization, with a partial response to treatment.ConclusionsMore research is needed to confirm the association between G6PD deficiency and schizophrenia and to determine the underlying mechanisms. Larger studies with well-defined populations and methodologies are needed. It is also important to study the interaction between G6PD deficiency and other genetic and environmental factors that contribute to schizophrenia.Disclosure of InterestNone Declared

IntroductionVitamin B12 deficiency gives rise to a wide spectrum of hematological, gastrointestinal, psychiatric, and neurological disorders. Notable among the neuropsychiatric symptoms are mood disturbances, cognitive decline, and psychotic manifestations.ObjectivesWe present a case of a woman with neuropsychiatric symptoms linked to vitamin B12 deficiency to highlight certain organic aetiologies with psychiatric symptoms in the foreground.MethodsWe discussed through a clinical case and a literature review, the relationship between neuropsychiatric symptoms and vitamine B12 deficiency in the context of biermer’s disease.ResultsWe presented a patient aged 51-years-old without neurological or psychiatric history, she was hospitalised in a psychiatry department for behavioral disturbances, hetero-aggression, and incoherent speech. The psychiatric examination revealed distant contact, inappropriate affects, disorganized speech with persecutory delusions, memory problems, and poor insight. Neurological et physical examinations were normal, and cerebral magnetic resonance imaging (MRI) showed no abnormalities. First, haloperidol 25mg was prescribed, however, there was only partial improvement. Complete blood counts revealed macrocytic anemia (Hemoglobin: 8 g/dL, mean corpuscular volume: 106 fL). Her serum B12 assay was 48.19 pmol/L.Given these results we proceed to a Fundic biopsy, performed by fibroscopy, that revealed fundic atrophy and intestinal metaplasia compatible with Biermer’s disease. Vitamin B12 replacement therapy began with hydroxocobalamin at 1000 μg/day intramuscularly for 15 days, followed by 1000 μg every 15 days for one month. Subsequently, there was a remarkable improvement in psychotic symptoms and cognitive function. Follow-up assessments demonstrated a return to baseline functioning.ConclusionsThis case, coupled with prior studies, emphasizes the importance of considering vitamin B12 deficiency in the differential diagnosis of neuropsychiatric symptoms. Therefore, prompt diagnosis and treatment of vitamin B12 deficiency are imperative in preventing potential irreversible neurological damage.Disclosure of InterestNone Declared

IntroductionCognitive Behavioral Therapy (CBT) provide a means of improving mental health among people with depression. However, few studies have explored its effectiveness with the presence of comorbid somatic disorders.ObjectivesWe aimed throug a case report to describe the cognitive and behavioral management of a patient with depression comorbid with systemic lupus erythematosus.MethodsWe present the case of a 47-year-old woman followed since 2012 for a systemic lupus erythematosus. In september 2013, she was diagnosed with depression. The cognitive behavioural therapy took place in 12 sessions of 45 minutes each, one session per week. Initial and final evaluations included Beck’s Depression Inventory and the « Questionnaire des pensées automatiques ».ResultsDuring the course of the therapy, we noticed an improvement of the patient’s mood, a decrease in anhedonia and somatic complains. We also observed a decrease in instinctual disorders. The final evaluation showed a significant improvement of the different scales. The objectives set with the patient were achieved.ConclusionsCognitive behavioral therapy is an interesting option for the management of cases of depression, including its comorbid form with a disabling disease such as systemic lupus erythematosus.Disclosure of InterestNone Declared

IntroductionThe social representations linked to bipolar disorder remain until today marked by unpredictability, danger and aggressiveness.ObjectivesThe objectives of this study were to identify clinical and socio-demographic characteristics of a group of patients with bipolar disorder who had committed a heteroaggressive act and to establish the relationship between these characteristics and the risk of recurrence of violenceMethodsWe conducted a descriptive and analytical study, including the files of 30 patients with bipolar disorder and hospitalized for heteroaggressive behavior.We collected the data related to the socio-demographic, anamnestic and clinical characteristics of the patients.ResultsThe average age of patients was 40.87 years, with extremes ranging from 25 to 62 years. The patients were mostly male (60%), living in urban areas (80%) and single (60%). 66,67% of patients in our sample were professionally active.Half of the patients in our study were consumers of alcohol or cannabis. The majority of patients were on sodium valproate (66.7%), a long-acting neuroleptic (60%) and a benzodiazepine (56.7%).Heteroaggressive behavior was in most cases physical (63.3%), having taken place in the patient’s home (66.67%) and directed towards a family member in an impulsive context (53.33%). 63.3% of patients reoffended their act of violence.We found statistically significant correlations between the recurrence of heteroaggressive behavior and advanced patient age (p=0.01), male sex (p=0.05), illiteracy (p=0 .04) and unemployment (p=0.04).Our study also showed that the recidivism of violence was significantly correlated with the criminal history of the patients (p=0.04) as well as the consumption of alcohol and cannabis (p=0.01). The number of recurrences was proportionally correlated to the duration of consumption.Recurrence of violence was also significantly higher in patients with psychiatric comorbidity (p=0.01) and poor treatment compliance (p=0.04).Finally, the number of recurrences of heteroaggressivity was proportionally correlated to the number of hospitalizations (p= ˂10¯³).ConclusionsHeteroagressive behavior in patients with bipolar disorder is not only attributable to mental illness but also to the intertwining of several risk factors. The prevention of violence requires the identification and management of these risk factors.Disclosure of InterestNone Declared

IntroductionAttitudes toward people with mental disorders in Arab countries have undergone huge transformations throughout history. Stigmatization of the mentally ill has been a long tradition in our communities. The public’s views have evolved since then, however, little is known about the current situation regarding mental illness stigma in our context.ObjectivesExplore attitudes towards mental illness and mental health knowledge in Arab countries.MethodsWe carried out a multinational cross-sectional study using online self-administered surveys in the Arabic language from June to November 2021 across 16 Arab countries.The Community Attitudes toward the Mentally Ill scale,the Mental Health Knowledge Schedule scale and the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form were administered to participants from the general public.ResultsThe study sample was predominantly female (77%), married (41%), educated (89% with tertiary education), living in urban areas (85%), with a mean age of 29.6 ± 10.8 years.Based on the CAMI, MAKS, and ATSPPH-SF total scores, 75th, 50th, and 25th percentile were considered as cut-off points for the high, medium, and low scores. We found that 26.5% exhibited stigmatizing attitudes towards people with mental illnesses, 31.7% had poor knowledge, and 28.0% hold negative attitudes toward help-seeking. Regarding attitudes toward mental illness, the highest mean score was on the social restrictiveness subscale (35.1 ± 5.6), reflecting the lowest amounts of stigma in this dimension; while the lowest mean score was on the Authoritarianism subscale (32.0 ± 4.6).We found a significant difference between countries regarding attitudes (F=194.8, p<.001) and knowledge (F=88.7, p<.001).ConclusionsAlthough much scientific progress has been made in the fields of diagnosing and treating mental illness, at a societal level the stigmatization of mental illness is still an important societal problem. The general population is largely ignorant about mental disorders, and fear of the mentally ill remains prevalent.Disclosure of InterestNone Declared

IntroductionCausal attributions of mental illness and help-seeking recommendations have multiple attitudinal and behavioral consequences; however, these factors have been subject of limited research in our Arab Muslim context.ObjectivesThis study examined causal attributions and help-seeking recommendations for mental illnesses among a large sample of the general population in Arab countries.MethodsWe carried out a multinational cross-sectional study using online self-administered surveys in the Arabic language from June to November 2021 across 16 Arab countries.The Community Attitudes toward the Mentally Ill scale,the Mental Health Knowledge Schedule scale and the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form were administered to participants from the general public.ResultsThe study sample was predominantly female (77%), married (41%), educated (89% with tertiary education), living in urban areas (85%), with a mean age of 29.6 ± 10.8 years.Psychosocial causes including lack of parental affection (88.0%) and childhood sexual abuse (85.5%) were the most common causal attributions of mental illnesses endorsed by our participants, with 95.7% of them agreeing with at least any one of the psychosocial causes.Palestinians were the most inclined to believe that mental illness is caused by Jinn possession and Magic/witchcraft (65.9% and 68.1%, respectively), followed by Algerians (56.2% and 68.6%, respectively), Kuwaitis (52.3%, and 62.7%, respectively), Yemenis (50.2%, and 61.4%, respectively) and Saudi participants (49.7%, and 61.2% respectively); whereas Tunisians were the least inclined to believe in these causes (18.6%, and 21.6%, respectively) (Table S3, supplemental material).Even though most of the study subjects tended to have a higher preference to seek help from formal sources than informal sources, they showed a high propensity to some informal sources such as family members (80.4%) and confidants (68.6%). Besides, Algerians were the most likely to ask help from a cleric or traditional healers (68.6% and 69.9%), followed by Palestinians (61.8% and 65.3%, respectively), Egyptians (58.4% and 48.8%), Jordanians (57.7% and 64.2%) and Kuwaitis (57.0% and 61.9%).ConclusionsInterventions aiming at improving help-seeking attitudes and behaviors and promoting early access to care are required to be culturally tailored, and congruent with public beliefs about mental illnesses and their causations.Disclosure of InterestNone Declared

IntroductionContagious disease outbreaks can have major repercussions on medical stuff. Doctors in Tunisia were requested to act as the first-line filter in managing active cases during the beginning of COVID19 pandemic.ObjectivesThis study aims to assess perceived stress in Tunisian doctors during COVID19 pandemic early stages and to identify factors associated to stress in order to guide prevention strategies.MethodsThis was a cross-sectional study conducted through an online survey, from April 18th 2020 to June 6th 2020. A 62-item semi-structured survey was created, consisting of 5 series of questions and scales. Linear regression models were performed to identify the associations between the study variables and the perceived stress score of the participants.ResultsWe included 203 physicians in this study. Stress levels were high among Tunisian doctors with a mean perceived stress score (PSS) of 28.6. One hundred fifteen participants (56.3%) scored for high PSS. This study identified vulnerable subgroups too stress. The female gender, working in the capital and working in critical medicine units were risk factors for high PSS. Managing COVID19 patients was not itself correlated to stress, however social isolation, stigma and luck of access to information were correlated to high stress levels.ConclusionsSeveral stressors can affect the well-being of doctors during the COVID-19 pandemic, which can lead to adverse psychosocial outcomes. The findings of this study may guide decision-makers to implement early mental health interventions for doctors.DisclosureNo significant relationships.