Depression and anxiety among psychiatry residents

Introduction

Residency training has been reported as being stressful which may lead to different mental disorders.

Objectives

To study the prevalence and associated factors of anxiety and depression symptoms among psychiatry residents.

Methods

A cross-sectional study was conducted through an online survey among psychiatry residents. Participants completed an anonymous self-administered questionnaire and the HADS questionnaire for screening anxiety and depression.

Results

Forty responses were collected.The average age of the sample was 28.08 ± 2.43 and the sex-ratio (F/M) was 0.875. Eleven participants were married. Eight residents were smokers. The prevalence of alcohol use and cannabis use was 22.5 % and 5% respectively. Half of participants were first year residents and near three-quarter of them (72.5%) declared working in poor conditions. A considerable proportion of participants had symptoms of anxiety and depression. The prevalence of anxiety case and depression case was 52.5% and 47.5% respectively. The prevalence of Anxiety symptoms and depression symptoms was significantly higher in female participants (p = 0.017, p=0.034 respectively). Poor conditions of the workplace were significantly associated with depression symptoms (p=0.004).

Conclusions

Training residents in psychiatry showed high rates of anxiety and depression symptoms. Screening and early management of these psychiatric manifestations is necessary. In addition, improving working conditions would upgrade their training and quality of life.

Disclosure

No significant relationships.

Assessment of obsessive and compulsive symptoms in patients with schizophrenia

Introduction

Obsessive-Compulsive Symptoms (OCS) are common in patients with schizophrenia, with a prevalence of 3.5% to 25%.

Objectives

The aim of our study was to assess the frequency of OCS in patients with schizophrenia, and to study the clinical and evolutionary characteristics of schizophrenia and OCS comorbidity.

Methods

We conducted a cross-sectional, descriptive, and analytical study. Thirty schizophrenic patients were recruited in the department of psychiatry B of Hedi Chaker university hospital of Sfax. We used the Yale-Brown Obsession-Compulsion Scale (Y-BOCS) to assess obsessive and compulsive symptoms, at the end of hospitalization, after clinical remission of schizophrenic symptoms.

Results

The mean age of patients was 41.2, that of disease onset was 27.3. Most of patients were male (86.7%) and unemployed (81.3%). A personal history of suicide attempts was found in 16.6% of patients. The average number of hospitalizations was 8.83. OCS were noted in 36% of patients with a Y-BOCS mean score of 5.5. Patients with OCS had significantly more frequent alcohol use (p = 0,008), a higher number (p = 0.03) and longer duration of hospitalizations (P = 0,034) and are more frequently treated with atypical antipsychotics (p = 0.001).

Conclusions

Our results show that patients with schizophrenia frequently present OCS. This comorbidity has a negative impact on the evolution and the prognosis of the disease, as well as the functioning of patients. Therefore, it should be investigated in order to ensure better care and promote the socio-professional reintegration of these patients.

Disclosure

No significant relationships.

Burnout among psychiatry residents in tunisia

Introduction

Psychiatry residency training is a stressful transitional period for young doctors who are faced with challenging patients, increased clinical responsibility coupled with lack of clinical experience, and on-call obligations, leaving them at high risk of burnout.

Objectives

To assess the frequency of burnout among psychiatric trainees, and to identify factors associated with severe burnout.

Methods

A cross-sectional study was conducted through an online survey among psychiatry residents working in Tunisian hospitals. Participants completed an anonymous self-administered questionnaire and the Maslach Burnout Inventory (MBI) to assess burnout.

Results

Forty residents completed the survey. The average age was 28.08 ± 2.433. The majority of the participants (87.5%) were females, 27.5% were married and 17.5% had kids. One fifth of the residents were smokers, 22.5 % used alcohol and 5% used cannabis. History of psychiatric disorder was reported by 35% of the participants (depression 15%, anxiety 17.5%, bipolar disorder 2.5%). Half of participants were first year residents and 75% had psychiatry as their first-choice specialty. The majority (72.5%) declared working in poor conditions. Overall, 37.5% of the participants met the criteria for severe burnout. Female gender and poor conditions of the workplace were significantly associated with burnout symptoms (p=0.007 and p=0.014 respectively).

Conclusions

Attention to burnout during residency is important, given the potential to implement preventive and management strategies on time for physicians’ to promote wellness and avoid severe consequences.

Disclosure

No significant relationships.

Assessment of depressive symptoms in hospitalized patients with schizophrenia

Introduction

The prevalence of depressive disorders in patients with schizophrenia is estimated at 25%. Nevertheless, depressive symptoms occurring during the acute decompensation of schizophrenia have rarely been studied.

Objectives

The aim of our study was to assess depressive symptoms in hospitalized patients suffering from schizophrenia.

Methods

We conducted a cross-sectional, descriptive and analytical study, including 30 schizophrenic patients, hospitalized in the psychiatry B “department of the Hedi Chaker university hospital in Sfax. The assessment of clinical severity of schizophrenia was performed by the Positive and Negative Syndrome Scale (PANSS), that of depressive symptoms by the “Calgary Depression Scale for Schizophrenia” (CDSS).

Results

The mean age of patients was 41.2. Most of patients were male (86.7%) and unemployed (83.3%). Only 13.3% of them were married. Patients were hospitalized 8.83 times in average. A personal history of suicide attempts was found in 16.70% of cases. The mean score in the CDSS scale was 5.12. According to the CDSS score, a depressive state was diagnosed in 36.7% % of patients. Depression was associated with significantly more frequent history of suicide attempts (p=0.028), as well as significantly higher scores in the positive dimension of the PANSS (p=0.03).

Conclusions

Our results show that depressive symptoms are common during the acute decompensation phase of schizophrenia. They are associated with impaired functioning of patients, as well as a higher risk of suicide. Screening for depressive symptoms in patients hospitalized for schizophrenia is therefore essential in order to ensure better management.

Disclosure

No significant relationships.

Life-threatening subglottic hemangioma in an infant successfully treated with propranolol

Subglottic hemangioma is a rare benign tumor in children. It causes an obstruction of the upper airway and can be life-threatening. Several therapeutic options have been used in the literature, including surgery. Currently, the treatment is essentially based on propranolol. We report the case of a 2-month-old female infant hospitalized for severe obstructive dyspnea secondary to a subglottic hemangioma. Diagnosis was confirmed by laryngoscopy and magnetic resonance imaging. The child underwent a tracheotomy and was treated with propranolol. The progression was favorable with regression of the subglottic hemangioma and improvement of laryngotracheal airway obstruction.

Cervical unicentric Castleman's disease in children

INTRODUCTION

Unicentric Castleman's disease (CD) is a rare benign lymphoproliferative disorder. A cervical location has rarely been reported in the pediatric literature.

CASE REPORT

A 13-year-old boy presented with a mass in the right neck region of 3 months' evolution. Clinical examination revealed a smooth mobile 5 cm node deep in the sternocleidomastoid muscle. The diagnosis of hyaline vascular type CD was confirmed by complete surgical excision and histopathologic examination. Postoperative course was simple, without recurrence over 1 year's follow-up.

DISCUSSION AND CONCLUSION

Cervically located CD often shows few symptoms, and is rarely suggested by a cervical mass found in children. Definitive diagnosis is histopathological. The hyaline vascular type of unicentric CD has a good prognosis after complete resection of the lesion.

[Bronchoscopic findings in children with prolonged respiratory symptoms]

OBJECTIVE

This retrospective study aims to establish an algorithm indicating a bronchoscopy, based on clinical and radiological criteria predictive of the presence of a foreign body (FB), in children with prolonged respiratory symptoms and no history of foreign body aspiration (FBA); to establish a study of these criteria and to compare the clinical, radiological and broncoscopic findings in such cases.

METHODS

We chose to review the records of 73 children (age < or = 15 years) with prolonged respiratory symptoms (for at least 15 days) and no history of FBA who underwent bronchoscopy at our institution between 1996 and 2005.

RESULTS

The mean age was 3 years and 2 months, the majority of the patients were between 1 and 3 years of age (56%), 59% of the patients were boys and the mean of evolution of symptoms before the broncoscopy was 3 months and 3 weeks. We found a foreign body (FB) in 17 cases (23.2%). The FBs were in 88.2% of the cases of vegetable origin. A granulation tissue was associated in 47% of positive bronchoscopies. There were no complications related to bronchoscopy. The clinical and the radiological findings were no specific of FBs.

CONCLUSION

Bronchoscopy must be indicated in suspected cases of FBA to prevent delayed diagnosis and pulmonary sequelae. The clinical and radiological findings may help the clinician to indicate it.

[Mycobacterial cervical lymphadenitis: role of surgery]

OBJECTIVE

To discuss the place of surgery in the management of mycobacterial cervical lymphadenitis.

PATIENTS AND METHODS

It's a retrospective study (1982-2002) about 246 patients treated in the ENT department of Farhat Hached Sousse for cervical lymph node tuberculosis. Resolution was considered when neither symptoms nor lymphadenopathy in examination were noted.

RESULTS

The mean age of our patients was 28 years. A light female prevalence was noted. In 5 patients diagnosis was established by lymph node punction. A medical treatment of first intention was then managed with a failure in 3 cases, after deadlines from 3 to 4 months. All other patients were operated: cellulolymphadenectomy (47%), adenectomy (47%) or drainage of a cervical abscess (4%). Recurrence and antituberculosis treatment resistance were noted respectively in 6% and 3% of cases.

DISCUSSION

Two questions are still discussed in the management of mycobacterial cervical lymphadenitis: 1- Is surgery necessary for the diagnosis? 2- When is surgery indicated directly? Histological specimen established the diagnosis in all cases and excluded a mestastatic lymph node. In some situations surgery must be indicated at first: cold abscess, lymph node fistulation.

CONCLUSION

Surgery still has an important place in the treatment of tuberculosis lymphadenopathy.

[Diffuse pseudotumorous oncocytosis of the parotid gland. A case report]

Pseudotumorous oncocytosis of the parotid gland is very uncommon and frequently misdiagnosed since it generally presents as a true tumor. The clinical presentation and imaging features of a 6-cm diameter left parotid mass led to the diagnosis of a tumor in a 73-year-old man. At pathology examination of the partial parotidectomy specimen the "tumor" was found to be a metaplastic oncocytic lesion. We discuss the diagnostic criteria, differential diagnosis, and etiopathogeny of this lesion.

[Submandibular lithiasis. Report of 48 cases]

This retrospective study concerned 48 patients treated surgically for sub mandibular lithiasis. Results of medical imaging (plain films, sialography, ultrasonography) are confronted with operative findings. The surgical indications are analysed according to lithiasis localisation.

[Ear myiasis. Two case reports]

The authors report two cases of aural myiasis. This pathology rarity induced us to search after epidemiologic, clinic and therapeutic peculiarity of this parasitical disease.