Clinical profile of schizophrenia comorbid with obsessive-compulsive symptoms: A comparative study

OBJECTIVE

Describe and compare the clinical profile of schizophrenic patients with and without obsessive-compulsive symptoms and obsessive-compulsive disorder (OCD) patients.

METHODS

A descriptive and analytical cross-sectional study was carried out at the psychiatry department of Hassan II University Hospital in Fez over 12 months to compare three groups of patients: "schizo-obsessive" (n=32), "schizophrenia" (n=34), and "OCD" (n=46). All participants (n=112) were assessed using the mini-international neuropsychiatric interview (MINI), the Yale-Brown obsessive-compulsive scale (Y-BOCS), the Brown assessment of beliefs scale (BABS), the Hamilton anxiety rating scale (HAM-A), the Beck's depression inventory (BDI-II), the positive and negative syndrome scale (PANSS), and the clinical global impressions-severity scale (CGI-S).

RESULTS

The "schizo-obsessive" group differed from the "schizophrenia" group in: more severe psychotic symptoms (mean=64.16±17.049, P<0.001), higher anxiety (mean=8.87±5,655, P<0.001) and depression (mean=7.50±5.989, P<0.001) scores, more prevalent suicide attempts (46.9%), higher illness severity score (mean=5.13±1.157, P=0.02), and more professional disinsertion (78.1%). The "schizo-obsessive" group (mean= 14.47±3.388) had significantly poor insight (P<0.001) compared to the "OCD" group (mean= 8.35±4.542). There were similarities in the obsessive and compulsive themes between the "schizo-obsessive" and the "OCD" groups, with no significant difference of severity (P=0.26).

CONCLUSION

A careful assessment of obsessive symptomatology is essential in schizophrenia for better patient management and prognosis.

Moroccan version of the short Tobacco Craving Questionnaire (MTCQ-12)

INTRODUCTION

Craving is a key clinical dimension in the assessment and management of substance use disorders. It is also a recognized predictor of relapse in addictology. To date, no scale for measuring tobacco craving is available to Moroccan clinicians. This work proposes a cross-cultural validation of the Tobacco Craving Questionnaire (TCQ) in its short version.

METHODS

This work consists of the creation of a translated version according to a rigorous methodology and the evaluation of its psychometric properties in a statistical study.

RESULTS

The validation study was done on a sample of 130 smokers with a majority of men (95%). It showed a high acceptability and homogeneity with a Cronbach's alpha coefficient of 0.82. The four scale factors showed a high discriminant validity. Finally, the scale showed high reproducibility with an inter-observer stability of 0.95 and 0.94 between tests and retests.

CONCLUSION

The Moroccan version of the TCQ-12 scale shows good validity indices for measuring craving in Moroccan smokers and also shows that it measures independently the four clinical dimensions of the scale.

Psychological stress and its related factors among Moroccan nursing students: A cross-sectional study

OBJECTIVE

This study was performed to evaluate the prevalence and related factors of perceived stress among nursing students at Fez High Institute of Nursing Professions and Health Technics in Morocco.

METHOD

A cross-sectional study was used to determine the perceived stress levels and stress-related factors among nursing students enrolled at Fez High Institute of Nursing Professions and Health Technics in Morocco. The Perceived Stress Scale 10, Pittsburgh Sleep Quality Index scale, and Academic Competence, Test Competence, Time Management, and Strategic Studying scale were used to collect data from 405 students enrolled in nursing courses. Univariate and bivariate analyses were conducted using SPSS version 20.

RESULTS

Of the 437 nursing students, 405 (105 men and 300 women) completed the survey. A low prevalence of perceived stress (17%; N = 69) was found, with a mean stress score of 17.17^4,15. The stress level of the students was significantly associated with the year of study of the students, the practice of professional extracurricular activities, the monthly income of the family, and the use of public transportation. In addition, the stress level was associated with the subjective quality of the sleep of the students, sleep latency, diurnal dysfunction, and usual sleep efficiency. In addition, a positive correlation was observed between "time management" scores and "test adaptation skills" scores. However, no significant association was observed between stress scores with the age and gender of the students.

CONCLUSION

Considering these results, national universities should employ preventive interventions by disclosing and controlling the associated factors of stress. Thus, the results of this investigation could be effective to determine stress-related factors to provide adequate intervention to this subset of the population.

Induced Depressive Disorder Following the First Dose of COVID-19 Vaccine

INTRODUCTION

Several COVID-19 vaccines have been implemented. However, some side effects of the vaccine have been reported, which are sometimes very harmful. Reported cases and data are still very limited regarding the psychiatric side effects of the COVID-19 vaccine. To our knowledge, only one case has been reported. In this paper, we report the case of a patient who presented an acute depressive episode 24 hours after receiving his first dose of the BNT162b2mRNA vaccine.

CASE REPORT

The case was a 26-year-old man with a history of Down syndrome with moderately good autonomy for daily routine tasks. The patient, who presented hypothyroidism at 10 years old and schizophrenia at 15 years old, was doing well before the vaccination and received his first dose of the BNT162b2mRNA vaccine. Twenty-four hours later, he presented depressive symptoms that resolved spontaneously after one week. Then, fifteen days later, the symptoms reappeared, and the episode lasted for 5 weeks. The patient received 10 mg/day of escitalopram besides his usual treatment. The depressive symptoms improved considerably by the second day of treatment.

DISCUSSION

The presented case illustrated significant diagnostic challenges, especially when taking into account the sequential relationship between the COVID-19 vaccine and the occurrence of depressive symptoms. A single case of depression has been reported after the administration of the COVID-19 vaccine. Scientific evidence suggests the important role of the immune system in the pathophysiology of various psychiatric disorders, including depression.

CONCLUSION

Health professionals must take into consideration the potential psychiatric side effects even being rare so far, especially in vulnerable subjects. Further studies are required to establish the causal effects of depressive symptoms occurring during the weeks following the COVID-19 vaccine bolus injection.

Les déterminants du climat émotionnel dans les familles de patients avec Schizophrénie: étude transversale sur 50 familles

Introduction

expressed emotion (EE) is a concept which dates back to the sixties and refers to the attitude that relatives have toward a family member with schizophrenia. It comprises three behavioral patterns: criticism, hostility, and emotional overinvolvement. An important body of literature has shown that high expressed emotion (EE) is a factor of relapse in schizophrenia. The purpose of our study was to measure expressed emotion in the families of a Moroccan sample of patients and then to investigate factors associated with high EE.

Methods

fifty (50) patients with stable schizophrenia, each with a relative involved in their care, were recruited during outpatients visits. Sociodemographic data were collected and the FAS scale was used by relatives. Data were also collected from the mental representations of relatives about the patient and disease. Statistical analysis was carried out using the SPSS software and was based on the Chi 2 tests as well as T tests for independent samples.

Results

forty-eight percent (48%) of relatives had a high EE. High EE was associated with a feeling of shame toward the patient. It was also associated with cannabis addiction. Low EE was associated with the fact that the patient financially took care of his family.

Conclusion

the knowledge of the determinants of high EE in our socio-cultural context is essential in order to direct any psycho-educational intervention aimed at reducing EE.

The prevalence and associated factors of depression, anxiety, and PTSD among Moroccan medical doctors in the COVID-19 pandemic: a national study

COVID-19 pandemic is facing healthcare professionals with unprecedented challenges, which might alter their mental health. We targeted assessing depression, generalized anxiety, and post-traumatic stress disorder (PTSD) of Moroccan medical doctors during the COVID-19 pandemic; this would allow identifying the associated factors. A cross-sectional national study was carried out on 1267 exposed and unexposed public health medical doctors to COVID-19 patients. The study was conducted between May 15 and 15 June 2020. An anonymous self-administered questionnaire was completed online voluntarily and randomly. We used the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder (GAD-7), and the PTSD Checklist for DSM‑5 (PCL-5) to assess depression, generalized anxiety, and PTSD, respectively. The respondents' rate was 63.3%. The mean age was 30.97 ± 6.65 years old, and 59.3% (N = 751) were females with a sex ratio M/F of 0.68. The sample included 43.0% (N = 545) of COVID-19 frontline doctors. Among all participants, 31.5% (N = 400) had depression, 29.2% (N = 370) had generalized anxiety, and 21.7% (N = 276) had PTSD. The average scores of the PHQ-9, the GAD-7, and the PCL-5 were 7.79 (± 5.54), 6.12 (±5.72), and 18.58 (±17.62), respectively. The multivariate logistic regression showed that working in primary and secondary hospitals, moderate and high-stress perceptions, a chronic physical illness, and a family history of psychiatric disorder were independently associated factors of depression, generalized anxiety, and PTSD. The females expressed significantly more anxiety. Doctors living in a family consisting of member with chronic disease showed a significantly higher risk of PTSD. The security sense of contamination risk and low threat perception of COVID-19 were significantly protective factors of depression, anxiety, and PTSD. Moroccan medical doctors are in psychological distress. It is essential to preserve medical doctors' mental well-being health for a better fight against the COVID-19 pandemic through effective and targeted health policies.

Religiosity, stress, and depressive symptoms among nursing and medical students during the middle stage of the COVID-19 pandemic: A cross-sectional study in Morocco

BACKGROUND

Recent studies on nursing and medical students showed a higher prevalence of depression and stress than the general population. Religiosity and spirituality are common in Muslim countries and are usually used as a means of coping strategy for psychological and mental disorders.

OBJECTIVE

Our objective was to evaluate the association between religious actions, depressive symptoms, and stress among students of nursing education lasting 3 years and students from the first 3 years of medical education lasting 7 years. The study was conducted at Ibn Zohr University of Agadir, Morocco.

METHOD

A sample of different stages of nursing and medical students was recruited. Religiosity was assessed by Muslim Belief into Action (M.BIAC) scale. The depressive symptoms and stress were, respectively, assessed by the Beck Depression Inventory (BDI-II) and Perceived Stress Scale (PSS).

RESULTS

Four hundred and thirteen students participated in this study. Our results showed a high prevalence of depressive symptoms (62.2%) and stress (66.8%). The depression scores were higher in the following subsample categories: students in the first 2 years of studies, female medical students, and nursing students with significant differences. The recorded religiosity was greater among students without depression compared to students with depression (p < 0.001). In the multivariate regression, the BIAC score demonstrated religiosity as neither a risk factor nor a protective factor of depression.

CONCLUSION

Religiosity constitutes a protective factor of depression and stress among nursing and medical students. This should improve the student's ability to cope with stressful situations during their training. Prospective studies are needed to further investigate this association and how religiosity improves mental health. This would contribute to improved academic performance and wellbeing among medical and nursing students.

Burnout among physicians and caregivers in oncology: the Moroccan experience

Purpose

Caregivers in radiation oncology are exposed to a high risk of burnout which sometimes causes serious consequences for their health, which can in turn affect patient care. In this study, we investigated the prevalence of burnout and its psychological impact on health professionals and determined the factors that predispose to the risk of burnout.

Methods and materials

A cross-sectional survey was conducted with descriptive and analytical purposes among the different teams within the oncology and radiotherapy departments in different hospitals (CHU and regional hospitals) in Morocco, through an online self-questionnaire composed of sociodemographic data, professional data, working conditions, an assessment of interfering factors, the Maslach Burnout Inventory (MBI), the Generalised Anxiety Disorder-7 (GAD-7) scale and the Patient Health Questionnaire-9 (PHQ-9) scale.

Results

One hundred and eighteen caregivers participated in this evaluation. 62.7% were physicians, 75.4% worked in university hospitals and 53.4% were in radiotherapy departments. Analysis of the three dimensions of the Maslach Burnout Inventory - Human Services Survey (MBI-HSS) score found high scores in the dimensions of emotional exhaustion (81.4%) and depersonalisation (79.7%), and low scores in decreased personal accomplishment (46.6%). The evaluation of the impacts of burnout in the latter found a mean of the Patient Health Questionnaire-9 (PHQ-9) at 12.45 + 7.84 and the mean of the GAD-7 at 9.73 + 5.98.

Conclusion

Our results are in line with those found in the literature, hence the need for screening and active prevention of burnout among radiation oncology caregivers.

Heavy and Chronic Cannabis Addiction does not Impact Motor Function: BOLD-fMRI Study

OBJECTIVE

The aim of this paper is to demonstrate the impact of heavy and chronic cannabis use on brain potential functional control, reorganization, and plasticity in the cortical area.

METHODS

23 cannabis users were convened in 3 user's groups. The first group included 11 volunteers with an average of 15 joins/day; the second group included 6 volunteers with an average of 1.5 joins/day; the third group included 6 volunteers with an average of 2.8 joins/week. Besides, a 6 healthy volunteers (control group). All healthy and cannabis users underwent identical brain BOLD-fMRI assessment of the motor function. Besides, neuropsychological and full biological assessments were achieved.

RESULTS

BOLD-fMRI maps of motor areas were obtained, including quantitative evaluation of the activations in the motor area. Besides, statistical analysis of various groups was achieved.

CONCLUSION

Chronic cannabis addiction of varying use strength by groups of heavy, moderate, low dose, and zero doses are shown to have systematically equivalent effects on the control of brain motor function. Indeed, the BOLD-fMRI shows a remarkable sensitivity to minimal brain plasticity and reorganization of the functional motor control of the studied cortical area, and such varionation was not shown. Specific elucidation of the cannabis effect mechanisms in this unique function should clarify further protective pharmacological effects. This might illuminate the use of neuronal resources to prepare processes for pharmacological use and pharmaceutical forms. This suggests exploring any potential cannabis pharmaceutical form in diseases involving motor impairments.

Prevalence of sexually transmitted infections in patients with schizophrenia in Morocco

OBJECTIVES

People with schizophrenia are likely to be overrepresented in high-risk categories for sexually transmitted infections (STIs). We aimed to determine the seroprevalence of HIV, HBV, HBC, and syphilis in these patients.

PATIENTS AND METHODS

Sociodemographic and clinical characteristics of 444 patients were collected, as well as risk factors for STIs. Serological tests were performed.

RESULTS

Lifetime seroprevalence rates were 0.0% for HIV, 1.6% for HBV, 0.9% for HBC, and 3.6% for syphilis. These figures are lower than those reported in the general population except for syphilis. Only 0.45% of patients were seropositive for both HBV and syphilis.

CONCLUSION

No higher rates of HBV, HBC, and HIV seroprevalence were observed compared with the general population, except for syphilis.

[Clinical presentation, co-occurrence and suicidality in psychiatric emergency patients with psychogenic non-epileptic seizures]

INTRODUCTION

Non-epileptic psychogenic seizures (PNES) are a common condition but little studied in psychiatry. Our study is the first Moroccan of this topic. Our aim was to describe their clinical presentation, comorbidities and suicidality.

METHOD

It was a one-year recruitment study conducted in the Department of Psychiatry at the University Hospital of Fez. We collected socio-demographic data. Psychometric evaluation used the MINI criteria for different psychiatric disorders, personality disorders and suicidality, the Hamilton anxiety scale, the Beck depression scale and the Childhood Trauma Questionnaire.

RESULTS

Thirty-two patients were included, the majority of whom were female with a low economic level (89 %). The average age of onset average was 23.97 years. The generalized form represented 71.9 % of cases with a triggering factor present in 46 %. The duration of the seizures average was 23.47minutes, and 37.5 % of the patients had at least one attack per day. Among patients, 68.8 % had comorbidity: major depressive disorder MDD (46 %) and post-traumatic stress disorder PTSD (18.6 %). Suicide risk was rated as moderate or severe in 12.5 % of patients, and 40.62 % had a previous suicide attempt. A personality disorder was present in 18.8 % of cases. Finally, a history of child abuse was found in 59.4 % of patients and was correlated to PNES age of onset and co-occurrence depression.

CONCLUSION

We found several similarities with previous studies in terms of clinical description and co-occurrences. However, our sample is characterized by more prolonged and more frequent seizures and a higher rate of suicidality.

Cultural Adaptation and Validation of the Moroccan Arabic Version of the Muslim Belief into Action (BIAC) Scale

Various approaches have been developed to comprehensively assess multiple dimensions of religiosity. The Belief into Action (BIAC) Scale was developed for this purpose and to evaluate the degree of translation of personal beliefs into real-life actions. The goal of the present study was to assess the validity and reliability of the Moroccan Arabic version of the Muslim BIAC, designed to assess the religiosity of Muslims. This study was conducted in two stages. First, the original version of Muslim BIAC was translated from English to Arabic using a standard forward-backward translation procedure. Second, the Moroccan Arabic version of the Muslim BIAC was administered to a sample of 132 students at Ibn Zohr University, Agadir, Morocco (mean age 22.2 years). The average score on the BIAC was 46.1 (SD = 17.2). The Cronbach's alpha for internal reliability was 0.81, with alphas for removed items ranging from 0.77 to 0.82. Test-retest reliability by intraclass correlation coefficient (ICC) was 0.87 (95% CI = 0.83-0.91). Discriminant validity indicated relatively weak correlations with depressive symptoms (r = - 0.06) and perceived stress (r = 0.08). The Moroccan Arabic version of the Muslim BIAC is a reliable and valid measure of religious involvement that can be used to assess the relationship between religiosity and health in Moroccan Arabic populations.

[The role of the general practitioner in management of psychiatric disorders]

AIM

Psychiatric disorders represent a huge burden of disease worldwide. Significant gaps in their diagnosis and treatment remain. In Morocco, an observed shortage of psychiatrists would logically call for their collaboration with family physicians. Our objectives were to analyse perceptions of general practitioners' capacity to manage psychiatric disorders, to study the difficulties encountered in their management of these pathologies, and to assess their degree of collaboration with existing mental health structures.

METHODS

A cross-sectional nationwide survey of family physicians practicing in urban and rural areas in the private and public sectors in the Kingdom of Morocco was organised. Carried out over a period of 10 months (April 2016 to January 2017), the study was based on an anonymised self-administered questionnaire comprising 23 items. Were excluded from the sample: physicians who had tested the questionnaire prior to its distribution, medical students, family physicians employed in administrative services, resident doctors in university hospitals, and questionnaires with incomplete answers.

RESULTS

All in all, five hundred and four questionnaires were distributed, with a participation rate of 79.8%, while 57.9% of the respondents were men. Their seniority as doctors ranged from 1 year to 60 years with average duration of 19.5±11 years. An overwhelming majority of the doctors had obtained their doctorates in Morocco, while 8.4% had been trained abroad. The majority of the doctors surveyed worked in private practice in urban areas (53.1%), and most of them (81.9%) agreed that the management of psychiatric disorders is a public health priority. The participating physicians stated that they received an average of five patients per day suffering from mental disorders, representing 17.3% of their medical consultations. According to their perceptions, the most frequent psychiatric pathologies were depression, somatoform disorders and sleep disturbances, which were cited by 92.9%, 78.8% and 78.5% of them respectively. Regarding the diagnosis of psychiatric pathologies, 60.2% of the doctors considered bipolar disorder as a difficult pathology to diagnose, followed by schizophrenia, autism and dementia, while the pathologies reported as the most difficult to treat were addictive behaviours, schizophrenia, bipolar disorder, autism and dementia. Physicians felt a need for training, primarily pertaining to anxiety disorders, schizophrenia and bipolar disorders (49.5%, 35% and 33.7%, respectively). Nearly a quarter of the respondents (22.4%) mentioned a need for training in management of all psychiatric illnesses. Regarding the reasons for their referral of patients to mental health care structures, 65.4% of the physicians justified their doing so by a need for hospitalisation, while in 43.7% of cases, the transfer was carried out at the request of the patient or his family. The difficulties mentioned by the respondents were firstly a lack of adapted means of care (77.5%), followed by their insufficient training in mental healthcare (52.4%) and absence of collaboration with mental health professionals (52.4%).

CONCLUSION

For the majority of the physicians surveyed, psychiatry represented a public health priority, and their prioritising provides a probable explanation for their positive perception of their role in the management of mental disorders. However, we went on to observe that a number of difficulties constituted obstacles to their role in management of mental disorders and induced them to refer their patients to psychiatrists. Our analysis highlighted the impact of continuing education on physicians' attitudes and the interest of collaboration between practitioners. Efforts in university teaching and continuous education should be encouraged in view of enabling family physicians to more effectively cope with the demands of daily practice and meet the expectations of the overall population.

[The perception of liaison psychiatry by the medico-chirurgical services]

INTRODUCTION

Research addressing the perception of liaison psychiatry by caregivers is still limited in Morocco. Collaboration between practitioners in liaison psychiatry is necessary, and the perception of physicians influences their implications in liaison psychiatry.

OBJECTIVES

To evaluate the perception of this activity among the various medical and surgical units, determine the involvement, level of collaboration and expectations of practitioners, as well as the difficulties and constraints encountered.

METHODOLOGY

A survey was carried out among medical personnel at the Hassan II University Hospital Centre in Fez in 2016, through a self-questionnaire determining the perception and position of carers with regard to liaison psychiatry. The data are collected using an anonymous self-administered questionnaire, consisting of 27 items. We included in this study a targeted population: interns, residents and professors.

RESULTS

The total population of caregivers participating in this survey was 615 physicians, including 111 professors, 436 residents, and 68 interns. The participation rate was 80.32%. The average age was 30.25 years, with 47.6% (236) women and 52.4% (258) men. The percentage of doctors who obtained their doctorates in medicine in Morocco was 89.3% (85.9% at the Faculty of Medicine in Fez) and 92.3% had received a unique internship in the psychiatry department during their university studies, while 98.7% never received any continuing training in the field of psychiatry. Half of responding physicians reported difficulties in managing psychiatric disorders diagnostically, and 59.5% (292) reported difficulties in treating patients with psychiatric disorders, while 90% (444) reported that they are unable to provide therapeutic follow-up. Only 35.6% of the doctors surveyed were informed about the establishment of liaison psychiatry, but only 10% of these doctors were informed about the procedure for requesting a psychiatric opinion. Faced with a psychiatric disorder, 98% of doctors managed the situation by seeking psychiatric advice, 87.1% considered this request urgent. The reasons for not soliciting q psychiatrist were divided between difficulties in identifying a psychiatric disorder (51%) and difficulties in requesting an opinion (49%).

CONCLUSION

Our study showed several difficulties perceived by practitioners, whether in the diagnosis, treatment or follow-up of patients with psychiatric manifestations. Collaboration between different practitioners is an indispensable element of patient management. Improving knowledge through awareness-raising and the organization of scientific days bringing together the different specialties will help to improve doctors' perceptions.

Eating disorders among Moroccan medical students: cognition and behavior

Introduction and aim

Eating disorders (EDs) are complex, multifactorial diseases linked to biological, developmental, psychological, and sociocultural factors. Medical students are among subjects at high risk of EDs. The aim of the present investigation was to evaluate EDs among 710 Moroccan medical students with a focus on cognition and behavior related to EDs.

Methods

Sociodemographic, economic, and clinical data were collected. Validated questionnaires, such as the SCOFF (Sick, Control, One Stone, Fat, Food) questionnaire and the Eating Disorder Inventory 2 (EDI2), were administered.

Results

The male:female ratio was 0.53, mean age was 21±2 years, 11.1% of participants were underweight, 13.4% were overweight, and 1.8% were obese. A middle socioeconomic level was found in 84.9% of cases. The prevalence of EDs in students was 32.8% (37.6% among females and 23.7% among males) and that of weight-control behaviors 18.5%. Increased body-mass index values were significantly associated with dieting (P<0.001), fasting (P=0.044), and the use of appetite suppressants (P=0.037).

Conclusion

It appears that the impact of EDs is high, affecting a third of medical students, with significant use of harmful weight-control behaviors. We also found that dimensions of bulimia, perfectionism, body dissatisfaction, and ineffectiveness, parts of the core of EDs, were found in future medical practitioners.

[Folie à deux, symptoms sharing us a relationship modality: a case report]

Shared Psychotic Disorder or Folie à deux is a rare and controversial entity that raises phenomenological, nosographic and psychopathological issues. It questions the nature of dilusion and its occurrence outside the psychotic structure and also the issue of symptoms contagion in psychiatry. We offer a semiological analysis of an intrafamilial case of Folie à deux, a case with the clinical specificity of sharing not only delusional symptoms but also non-delusional psychotic elements. We then dig back in the epidemiological characteristics and common factors to other reported cases in the literature of different cultures. Then we draw a history of the entity and its evolution over the classifications since its first description by Legrand to the DSM 5. From here, we emphasize the insufficiency of a purely descriptive approach and focus on the possible link with other more common clinical situations of mental symptoms transmission between two or more persons. Then, we propose a psychopathological reflection that essentially targets the sharing of the symptom rather than its nature while questioning the function of the delusion in a delusional couple.

Sleep disorders associated with interferon in chronic viral hepatitis C

Chronic infection with hepatitis C is a public health problem in Morocco and in the world. The objective of the work screens for sleep problems during the disease and its management to better guide the monitoring and psychiatric interventions.

Methodology

Sixty-eight patients followed for hepatitis C were recruited. The treatment was based on the combination of pegylated IFNa or standard IFNa and ribavirin for 6 to 12 months. The evaluation was done by a questionnaire containing demographic information, medical and psychiatric history, substance use. Sleep assessment was made by Pittsburgh Sleep Quality Index, and measuring the quality of life by SF36. The assessment before starting treatment and at 1 month and 4 months. Statistical analysis by SPSS 21 software read.

Results

Fifty-six patients were able to complete the monitoring. 36 women to 20 men. The average age is 59.1years old (standard deviation 9.88). A quarter of patients still gainfully employed. 64.3% of participants live in couple. Seventy-six point eight percent of patients live in the city. Seven percen consume tobacco and single patient use cannabis occasionally. Sleep disorders increased from 37.5% before the start of the treatment to 55.4% after its start. While 44.5% have kept a sleep disturbed to 4 months. At first, the quality of life had more impaired scores on psychological than physical scores. The overall score declined significantly way after initiation of treatment (0.04). A larger decline on the psychological component (0.000) while the physical score did not significantly decrease.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

[Acute psychosis secondary to dysthyroidism: about 2 cases]

Des anomalies fonctionnelles de la thyroïde sont fréquentes et touchent près de 5 % de la population générale, avec une prédominance pour les femmes. La survenue de troubles mentaux, en particulier de l'humeur, au cours des affections thyroïdiennes est connue depuis plus d'un siècle, alors que les troubles psychotiques associés aux dysthyroïdies sont rarement décrits. Nous rapportons les observations de 2 patientes présentant des troubles psychotiques dans deux situations différentes, la première suite à une hyperthyroïdie avec mauvaise observance thérapeutique et la deuxième secondaire à une hypothyroïdie après une thyroïdectomie. Ces observations suggèrent la responsabilité de l'équilibre hormonal thyroïdien dans l'installation des manifestations psychotiques et elles soulignent la nécessité d'éliminer une dysthyroïdie avant tout traitement psychotrope.

A case report of Lhermitte-Duclos disease revealed by psychiatric disturbances

BACKGROUND

Lhermitte-Duclos disease (LDD) is a rare cerebellar lesion characterized by a hamartomatous lesion in the posterior fossa. Mainly diagnosed by MRI, the clinical presentation is usually made of neurological symptoms.

CASE PRESENTATION

We present here a rare case of a woman who developed depressive symptoms that inaugurated the clinical presentation of LDD.

CONCLUSION

Psychiatric symptoms may occur in all brain lesions, delaying the diagnosis and causing therapeutic escalation. More attention should be given by practitioners to psychiatric aspects of LDD.

[Reversible catatonia after the abrupt discontinuation of clozapine: Case report]

In this paper, we report the case of a patient, aged 26, with schizophrenia who was admitted to psychiatric emergencies for catatonia, one week after abrupt discontinuation of clozapine. An improvement was seen after only two days of the reintroduction of clozapine alone. This catatonia is reversible and it responds magnificently to the reintroduction of clozapine. And we conclude that patients and their caregivers need to be educated about the effects of abrupt cessation of clozapine administration.

[Nosographic considerations on delusional parasitosis based on three clinical observations]

Ekbom syndrome or delusional parasitosis is a rare disease characterized by the unwavering conviction of having cutaneous infestation of insects or parasites. This is a monothematic delusion of hallucinatory origin that typically affects older women. We report the case of three patients with delusional parasitosis in different clinical settings. The first patient suffered from isolated delusional parasitosis corresponding to the condition described by Karl Ekbom. The second case suffered from secondary delusional parasitosis, occurring in the setting of leukoencephalopathy (CADASIL). Lastly, the third patient appeared in a state which was evocative of a depressive episode with psychotic symptom integrating delusional parasitosis. These three clinical vignettes perfectly illustrate the trans-nosographic dimension of this syndrome and the difficulties in treating these patients, both in terms of therapeutic alliance and of choice of pharmacological treatment.

Psychoactive substances use and associated factors among middle and high school students in the North Center of Morocco: a cross-sectional questionnaire survey

BACKGROUND

Data on psychoactive substance (PAS) consumption among adolescents in the North Center of Morocco are not at all available. Therefore, the current study aimed at investigating the prevalence and the determinants of psychoactive substances use among middle and high school students in this region.

METHODS

A cross-sectional study was conducted from April 2012 to November 2013 in public middle and high schools in the North Central Region of Morocco. An anonymous self-administered questionnaire was used to assess psychoactive substances use among a representative sample of school students from the 7th to the 12th grade, aged 11-23 years, selected by stratified cluster random sampling. Factors associated with psychoactive substance use were identified using multivariate stepwise logistic regression analyses.

RESULTS

A total of 3020 school students completed the questionnaires, 53.0 % of which were males. The overall lifetime smoking prevalence was 16.1 %. The lifetime, annual and past month rates of any psychoactive substance use among the study subjects were 9.3, 7.5, and 6.3 % respectively. Cannabis recorded the highest lifetime prevalence of 8.1 %, followed by alcohol 4.3 %, inhalants 1.7 %, psychotropic substances without medical prescription 1.0, cocaine 0.7, heroine 0.3, and amphetamine with only 0.2 %. Psychoactive substance use was associated with males more than females. The risk factors identified by multivariate stepwise logistic regression analyses were being male, studying in secondary school level, smoking tobacco, living with a family member who uses tobacco, and feeling insecure within the family.

CONCLUSIONS

The prevalence among all school students reported by the current study was comparable to the national prevalence. Efforts to initiate psychoactive substance prevention programs among school students should be made by designing such programs based on the significant factors associated with psychoactive substance use identified in this study.

Suicidal behaviors among Moroccan school students: prevalence and association with socio-demographic characteristics and psychoactive substances use: a cross-sectional study

BACKGROUND

Suicidal behavior is a major cause of injury and death worldwide, especially among adolescents and young adults. Few studies have tackled this issue in the Arab world. The present study investigated the prevalence and the risk factors of suicidal behaviors among Moroccan school students.

METHODS

From April 2012 to November 2013, a cross-sectional study was conducted in the North-Centre region of Morocco among students in public secondary schools selected using stratified cluster random sampling. The data were collected via anonymous self-administered questionnaires. The Mini International Neuropsychiatric Interview was used in its Moroccan Colloquial Arabic version to assess suicidality according to the DSM-IV criteria.

RESULTS

A total of 3020 students (53 % boys) aged 11-23 years (average age = 16 ± 2.1 years) were included in the study. The prevalence of suicide ideation, suicide planning and suicide attempts during the last month were 15.7, 6.3, and 6.5 % respectively. Univariate analyses demonstrated that suicidal behaviors followed different epidemiological patterns. According to the multivariate analyses, the risk factors for all suicidal behaviors among Moroccan school students were the female gender, middle school level, urban locations, low family income, parents' divorce, tobacco consumption and psychoactive substances (alcohol and cannabis) use.

CONCLUSIONS

The intervention of preventive programs has become an emergency to overcome the issue of suicidality in Morocco. Further researches on adolescents' suicidal behaviors are suggested to update temporal data and assess the effectiveness of potential interventions.

[Psychiatric disorders and associated factors in patients with epilepsy in Fez, Morocco]

BACKGROUND

The prevalence of psychiatric disorders in epileptic patients remains unclear.

OBJECTIVE

This study was conducted in order to determine the prevalence and nature of the psychiatric disorders and the associated factors in patients with idiopathic epilepsy.

METHODS

A cross-sectional study was conducted over a period of eighteen months in the psychiatric unit of the University Hospital Hassan II of Fez (Morocco). A questionnaire was completed by the included patients, which specified: the socio-demographic data, personal and family history, and the clinical features of epilepsy and its management. Psychiatric disorders were identified by the Mini International Neuropsychiatric Interview test (MINI). The severity of the depression and anxiety symptoms was investigated using the Beck Depression Inventory (BDI) and the Hamilton Rating Scale.

RESULTS

Eighty-nine patients met the inclusion criteria. The average age of patients was 29.7±10.8years. Mood disorders were the leading psychiatric comorbidity: 32.6% among which 25.8% of major depressive episodes, 15.7% of dysthymia and 2.2% of hypomanic episodes. Anxiety disorders came second: 28.1% (among which 19.1% panic disorder, 13.5% agoraphobia, 12.4% generalized anxiety disorder, 10.1% social phobia and 4.5% post-traumatic stress disorder). Female gender, unemployment and poor compliance to antiepileptic drugs are all risk factors for the occurrence of psychiatric disorders in this population.

[Risk factors for treatment adherence in patients with schizophrenia: case-control study]

Les progrès réalisés dans le traitement de la schizophrénie n'ont jusqu'ici pas modifié de manière radicale l'importance de l'adhésion des patients à leur médication. L'objectif de ce travail est d'identifier les facteurs de risque de l'abandon du traitement sur un échantillon marocain de malades schizophrènes. C'est une étude transversale menée au centre psychiatrique universitaire de Fès sur une période de 4 mois. Les malades inclus présentaient une schizophrénie ou un trouble schizo-affectif, sélectionnés en deux groupes observant et non observant. L’évaluation de l'observance a été faite par un hétéro-questionnaire comprenant une liste de causes d'abandon du traitement avec des réponses par oui ou non et à l'aide de l’échelle MARS (Medication Adherence Rating Scale). Le traitement statistique des résultats a été réalisé par le logiciel Epi Info version 3.5.1. On a recruté 164 participants, 112 étaient des malades non observants à leur traitement (cas) et 52 patients bien observants (témoins). L’âge moyen est 31 ans, avec une prédominance masculine. Les facteurs de risque d'inobservance thérapeutique sont: l’âge jeune, le sexe masculin, le célibat, les troubles addictifs. Les principales raisons d'abandon du traitement sont le changement fréquent du médecin, le manque d'informations sur la maladie, un mauvais insight et les effets secondaires des antipsychotiques. Le groupe de schizophrènes non adhérents à leur traitement pharmacologique avait un score élevé à l’échelle MARS dans 80% cas. Ces résultats doivent être pris en considération par le personnel soignant pour optimiser l'observance thérapeutique chez les patients souffrant de schizophrénie.

Clinical assessment of depression and type 2 diabetes in Morocco: Economical and social components

Background:

The global prevalence of diabetes is increasing worldwide. In Morocco, diabetes and depression are major public health problems, requiring improvement in their care. Diabetes and depression are associated with morbidity and early mortality. This association contributes to raising the risk of the complications that occur, while causing higher suffering to patients, as also an increased cost toward healthcare.

Aim:

This study aims to assess the prevalence of depression in patients with type 2 diabetes (T2D), and identify the main risk factors for depression in this category of diabetic patients.

Patients and Methods:

Type 2 diabetic patients and older than 18 years of age were recruited. The exclusion criteria included being type 1 diabetic, pregnant woman, hospitalized patients, a history of neurological disorders, such as, stroke, infectious episidodes, and history of psychiatric disorders. The individual patient data was collected through individual and confidential interviews lasting 30 minutes, at the end of the diabetology consultation, by the same diabetologist, trained to use the psychometric scales that were needed. The Moroccan–Arabic version of the Beck diagnostic scale of depression was used. Patients assessed with depressive disorders were reviewed in a specialized psychiatric consultation. The statistical analysis was achieved by using SPSS package (version 17). We retained a threshold P value of 0.05.

Settings and Design:

A cross-sectional study was conducted that included adults with type 2 diabetes. The depression diagnosis was performed using the Arabic version of the Beck Depression scale.

Statistical Analysis:

We included 142 patients with type 2 diabetes, with an average age of 56.26 years. The prevalence of depression was 33.1%. The risk factors recognized for depression were, lack of social security, hypertension, and a history of type 2 diabetes of more than five years.

Results and Conclusions:

In this study, we have focused on the frequent association of ‘Type 2 diabetes and depression’ and the risk of mutual aggravation of both pathologies that might require multidisciplinary healthcare, as well as, improvement in the risk factors of depression through improved access to healthcare, with the extension of social security. The stability of the healthcare personnel involved in the treatment of both chronic diseases, including diabetes and hypertension screening, should also be considered for better management of psychiatric complications.

Clinical assessment of depression and type 2 diabetes in Morocco: Economical and social components

Background: The global prevalence of diabetes is increasing worldwide. In Morocco, diabetes and depression are major public health problems, requiring improvement in their care. Diabetes and depression are associated with morbidity and early mortality. This association contributes to raising the risk of the complications that occur, while causing higher suffering to patients, as also an increased cost toward healthcare. Aim: This study aims to assess the prevalence of depression in patients with type 2 diabetes (T2D), and identify the main risk factors for depression in this category of diabetic patients. Patients and Methods: Type 2 diabetic patients and older than 18 years of age were recruited. The exclusion criteria included being type 1 diabetic, pregnant woman, hospitalized patients, a history of neurological disorders, such as, stroke, infectious episidodes, and history of psychiatric disorders. The individual patient data was collected through individual and confidential interviews lasting 30 minutes, at the end of the diabetology consultation, by the same diabetologist, trained to use the psychometric scales that were needed. The Moroccan–Arabic version of the Beck diagnostic scale of depression was used. Patients assessed with depressive disorders were reviewed in a specialized psychiatric consultation. The statistical analysis was achieved by using SPSS package (version 17). We retained a threshold P value of 0.05. Settings and Design: A cross-sectional study was conducted that included adults with type 2 diabetes. The depression diagnosis was performed using the Arabic version of the Beck Depression scale. Statistical Analysis: We included 142 patients with type 2 diabetes, with an average age of 56.26 years. The prevalence of depression was 33.1%. The risk factors recognized for depression were, lack of social security, hypertension, and a history of type 2 diabetes of more than five years. Results and Conclusions: In this study, we have focused on the frequent association of ‘Type 2 diabetes and depression’ and the risk of mutual aggravation of both pathologies that might require multidisciplinary healthcare, as well as, improvement in the risk factors of depression through improved access to healthcare, with the extension of social security. The stability of the healthcare personnel involved in the treatment of both chronic diseases, including diabetes and hypertension screening, should also be considered for better management of psychiatric complications.

Suivi prospectif sur 5 ans des tentatives de suicide en population clinique dans la région de Fès, Maroc

Au Maroc, les tentatives de suicide (TS) demeurent un sujet mal évalué à cause de considérations socioculturelles et l'absence d'approche longitudinale. L'objectif principal était d’évaluer le devenir des suicidants après 5ans au centre universitaire psychiatrique de Fès, les objectifs secondaires étaient l'estimation de la prévalence des TS, préciser les étiologies les plus fréquentes, et établir une corrélation entre les paramètres sociodémographiques, cliniques et évolutifs. Etude prospective à visée transversale et longitudinale, incluant les suicidants vus à l'hôpital psychiatrique de Fès, avec un suivi longitudinal sur 5ans. L’évaluation a été faite par un hétéro-questionnaire et le Mini International Neuropsychiatric Interview (MINI) cherchant le trouble psychiatrique sous jacent. On a recruté 105 patients suicidants, 62% des femmes, l’âge moyen est de 29,23ans. La prévalence des tentatives de suicide est de 3% sur l'ensemble des consultants à l’établissement. Les troubles de l'humeur, psychotiques et de personnalité ont occupé respectivement 37,6%, 27,7%, et 25,7% des cas. La récidive suicidaire a été notée chez 54% des patients, était significativement corrélée à la vie solitaire (P: 0,039) et à la présence d'antécédents familiaux de TS (P: 0,046). L'utilisation de moyens violents était significativement fréquente chez les patients psychotiques. Après 5ans, 32 patients ont répondu à notre appel. Le taux de récidive était de 15%. On a noté trois cas de décès dont deux suicides confirmés. Les résultats confirment les données de la littérature scientifique avec certaines particularités cliniques et évolutives.

[Recurrent voluntary ingestion of metallic objects in prison by a female patient]

INTRODUCTION

Recurrent and intentional ingestion of metallic objects is a rare but important phenomenon. It has attracted great interest among mental health professionals over the last decades. However, this issue is rarely reported in the literature. A deep exploration of its clinical and specific psychopathological aspects remains limited.

CASE REPORT

We report the case of a 32-year-old female patient, who was sentenced to 20 years in prison for homicide against her cousin, the daughter of an uncle who had raped her when she was 14. This affair was hushed by the patient's family and the patient was submitted to several acts of abuse by her family. Following her incarceration, she repeatedly ingested metallic objects requiring repeated admissions in a department of surgery for endoscopic extractions or surgical interventions. She impulsively ingested more than 30 times various metallic objects such as wire, razor blades, spoons, etc., under the pressure of impulsiveness and massive anxiety. Voluntary metal ingestions, associated with iterative self-mutilation behaviors, took place within the framework of a borderline personality disorder, the incarceration and the conditions of imprisonment playing a role in initiating and retaining the behavior.

CONCLUSION

Through this case report, we examine the specific psychiatric aspects of intentional ingestion of metallic objects in order to better understand this behavior.

[Experience of liaison psychiatry in Morocco: transversal study over 24 months]

INTRODUCTION

Liaison psychiatry is a discipline caring for psychiatric disorders in patients of general hospitals. It involves clinical, educational, and research aspects. The liaison psychiatry supports patients hospitalized for full-time in medical and surgical departments, patients admitted in day-hospital and patients treated in the emergency department. In this transversal study, we assessed the liaison psychiatry impact that is still in development stage in Morocco. This study lasted 24 months, and was conducted at the University Hospital in Fez, Morocco.

OBJECTIVES

The goal of this work was to evaluate the prevalence of psychiatric disorders managed by liaison psychiatry, identify those requiring medical and surgical departments of such psychiatric support, and classify the motivations involved in their needs.

METHODS

This transversal study was initiated in January 2010 and has lasted 24 months. The study recruited 180 patients requiring psychiatric consultation from different medical and surgical departments at the University Hospital in Fes, Morocco. The psychiatric assessment was based on a psychiatric interview using the MINI. The data were collected by a certified psychiatrist using a questionnaire containing 24 items. After initial psychiatric assessment, the follow-up was proposed to the patient in the psychiatric department.

RESULTS

During this study, 22 medical and surgical departments of our University Hospital had requested a psychiatric assessment for their patients. Most demands were respectively emitted by the Department of Dermatology (16%) and Nephrology (11%). The most common motivations for psychiatric consultations were respectively psychomotor agitation (17%) and an evaluation of suicide attempts (17%). Depressive and psychotic disorders were the most diagnosed disorders with 47% and 11% respectively. The psychiatric support was based on pharmacological treatment in 60% of cases. Finally, the outcome was favourable in 80% of followed cases.

CONCLUSION

Hospitalized patients in different medical and surgical departments of the University Hospital of Fez have demonstrated a high prevalence of psychiatric disorders. This constitutes a very strong motivation to setup a department of liaison psychiatry. This would allow a better psychiatric support and follow-up of patients.

["Factitious disorder and skin picking: Clinical approach". A case report]

OBJECTIVE

The number of patients requiring primary and secondary care for factitious disorder unexplained by any known medical condition is high. We report a case illustrating the clinical and psychopathological features of factitious disorder. The treatment difficulties encountered in the association of this disorder with dermatillomania are discussed.

CASE REPORT

The patient was a 22-year old girl with abrasions on the face and forearms with ingested epidermal layer of the skin. She also had multiple somatic complaints, the authenticity of which was difficult to confirm. The diagnosis of comorbid factitious disorder with dermatillomania was retained. In view of reducing self-harm acts, we prescribed a mood stabilizer associated with an anxiolytic for 6 months. The self-harming acts have regressed, while the hypochondriacal complaints remain with a tendency of overstatement.

DISCUSSION

Factitious disorder (FD) is a mental disorder occurring in patients acting intentionally similar to a physically or mentally sick person with no apparent benefits. The reported cases often show FD comorbidity with other psychiatric disorders such as substance abuse, somatoform disorders, dysthymia, borderline personality disorder and sexual disorders. Comorbidity of factitious disorder with neurotic excoriation is exceptional, and rarely described in the literature. Pathological skin picking (PSP) is a disabling disorder characterized by repetitive skin picking, which causes tissue damage. It was estimated to affect 2% of the population. PSP is currently listed as an impulse control disorder not otherwise specified, it is associated with a high rate of psychiatric comorbidity like borderline personality disorder.

CONCLUSION

The comorbidity of factitious disorder and dermatillomania makes diagnosis very difficult. The limit between the two disorders is sometimes unclear.

Genital self-mutilation in an attempt of suicide by a patient with a borderline personality

Self-mutilation acts are known to characterize the borderline personality disorders. However, voluntary cutting of the male genital organ remains extremely rare. The present paper reports a case of a 25-years-old young male with a borderline personality. The patient committed a genital self-mutilation (GSM) targeting suicide during incarceration stage in jail. In addition, a discussion of the epidemiological and psychopathological aspects of the self-mutilation of borderline patients was been conducted. A particular interest is attributed to the genital self-mutilation and a review of the literature is presented.