[Prevalence and characteristics of sexual dysfunction among Moroccan patients consulting for a first depressive episode]

Depression as such causes emotional and physical disturbances that affect biological functions such as sleep, appetite, decreased libido and lack of interest in sexual function. Indeed, there is a significant incidence of sexual dysfunction in depressed patients. In addition, depression and sexual dysfunction have a significant impact on the quality of life of couples which can be improved by managing these two conditions between which there seems to be a two-way causal link. Sexual dysfunction has long been neglected in the clinic of depression. In Morocco, depression affects more than a quarter of the population. However, to date, no study has focused on the assessment of sexual function in relation to depression among Moroccans.

OBJECTIVES

This work aimed to evaluate the prevalence and characteristics of sexual dysfunction in Moroccan patients consulting for a first depressive episode.

METHODS

This is a descriptive cross-sectional study. All subjects included in this study were consulting for a first major depressive episode according to DSM-5 criteria from June 1st to November 30th, 2017 at the psychiatric university department at Ibn Nafis hospital in Marrakech. The severity of depression was assessed using the Hamilton scale. The ASEX (Arizona Sexuel Experience) scale was used to define sexual dysfunction. Statistical analysis was performed using SPSS 22 software.

RESULTS

Fifty eight patients were recruited 34 of whom were female. They had an average age of 37 years. The majority were between 27 and 42 years old (59 %), married (81 %), with an average level of education (34.5 %). The average duration of the episode was 57 days. The major depressive episode was severe in 62 % of patients. According to the ASEX, 77.6 % of the depressed patients had a clinically significant sexual dysfunction. The majority of our patients (60.3 %) consulting for depression attach their sexual dysfunction to their depressed mood, either by reporting the onset of sexual dysfunction at the same time as depression (53.4 %), or worsening after the depression onset (6.9 %). The frequency of sexual intercourse with the pre-depressive state was decreased in the majority of our sample. Sexual desire was the most impaired phase of the sexual response (58.6 %) followed by excitation (53.4 %) and then orgasm (51.7 %). Of the 47 married patients, more than two thirds (32 patients) were dissatisfied with their life as a couple as well as with different aspects of their relationship life. The majority of patients reporting marital dissatisfaction attributed the cause to the quality of their sexual intercourses rather than to their frequency or other relational aspects. Sexual dysfunction was significantly correlated with the severity of depression (P=0.031), whereas it was not correlated with duration of depressive episode (P=0.412) or age or patient sex (P=0.114, P=0.202 respectively).

CONCLUSIONS

The prevalence of sexual dysfunction is high in depressed patients. It significantly impacts the couple's quality of life. Although our main limitation was the small sample size which prevented us from doing a multi-varied analysis, the robust nature of this study lies in documenting the initial prevalence and types of sexual dysfunctions in both sexes in the first major depressive episode unrelated to the dysfunctions induced by antidepressant drugs. The early identification of sexual disorders and the consideration of couple dynamics would be two important elements in the management of the depressed patient.

[Family violence]

INTRODUCTION

Family violence is a serious public health problem, the scale of which is seriously increasing in Morocco. Although it has existed for a long time, we ignore the real characteristics of this plague in our country; our work consisted in an epidemiological approach of family violence in Marrakech during 2006.

METHOD

After elaborating a questionnaire, which allows the study of the demographic and social profile of the families, the study of violence exercised in the family and the evaluation of the depression in the women, we led an inquiry amongst 265 women.

RESULTS

Analysis of the results obtained has allowed us to underline the following characteristics: 16.6% of the women in our sample had been physically beaten; the young age is a risk factor; the age range most affected by violence is in women between the ages of 30 and 40 and which represent 39% of the battered women; domestic violence touches all the social, economic and cultural classes: in our study, 63% of the women having undergone violence were housewives, 25% were managers and 3% senior executives; family problems were the most important cause of violence in our study, representing 32.32%. Requests for money was the cause in 11.3% of the cases, and imposed sexual relations were found in 6.8% of the cases; alcoholism is an aggravating factor of family violence; 27.3% of the spouses who assaulted their wives were drunk; 52% of the assaulted women were victims of violence in childhood and 36% had been witness to their father's violence; in 63.6% of the cases of violence, the children were witnesses, and in 25% of the cases the children were victims of violence at the same time as their mothers; 50% of the women victims of violence did not react, while 38.6% left home, and 9.1 filed for divorce. Thirty-two percent of the assaulted woman had been traumatised by the aggression; the association of depression and violence was very high, 343% of the battered women in our study suffered from severe depression.

CONCLUSION

This work underlines the necessity of an urgent intervention in order to limit the extension of this plague and its consequences.

[Depressive disorders in diabetic patients]

INTRODUCTION

Diabetes is a public health problem. Its global prevalence was 2.8% in 2000 and it will reach 4.4% in 2030 to be 366 million diabetics. In Morocco, this true "epidemic" affects 6.6% of the population. Many epidemiologic studies have shown that patients with diabetes are more susceptible to depression. Diabetes and depression align in a non-accidental way and complicate one another.

PATIENTS AND METHODS

We report a cross-sectional study conducted in association with the endocrinology department of the Mohammed VI university hospital during the period spread between April and September 2006. The aim was to evaluate the prevalence of depressive disorders in patients with diabetes and to describe their sociodemographic and clinical profile. The study included 187 patients. The scales used were the Mini International Neuropsychiatric Interview (MINI) and Hamilton's depression. Sociodemographics and diabetic characteristics were evaluated by self-questionnaire.

RESULTS

The average age of our patients was 53±14 years and the percentage of females was high: 71.2%. Diabetes type 2 was the most representative (85.6%), diabetes type 1 (11.8%) and gestational diabetes (2.7%). Half of diabetics were treated with an association of healthy dietary measures (MHD) and oral anti-diabetics; 31.6% were under MHD and insulin therapy; 33.2% of patients had acute complications and 43.5% had degenerative complications. Only 11 patients (5.9%) had antecedents of depression. The prevalence of major depressive episode was 41.2%; 27.8% of patients suffered from dysthymia and 21.9% from double depression. Hamilton's depression scale indicates that all depressed patients had mild depression (total of 17 items from 8 to 17). Major depressive episode and dysthymia were frequent in out patients. Dysthymia was predominant in diabetic patients in the 46 to 55 years age group, never been schooled and without any comorbidity. The vast majority of patients with EDM had type 2 diabetes with 89.6%, 7.8% type 1 diabetes and 2.6% gestational diabetes. Most of dysthymic patients had type 2 diabetes with 94.2% against 5.8% type 1 diabetes.

DISCUSSION

The association of depression and diabetes was noted in the literature for the first time more than 300 years ago by the English doctor Willis. Compared to the population of non-depressed subjects, patients with depression may be more likely to develop type 2 diabetes. There would be an increase in the release of hyperglycemic hormones in depression, as in the stress response. In addition, patients with depression have insulin resistance during testing tolerance to insulin, and during testing tolerance to glucose. Other hypotheses explain that the depression/diabetes link included biological and genetic resources.

CONCLUSION

Diabetes and depressive disorders are public health problems due to their prevalence and their cost. The prevalence of major depressive disorders found among our population of diabetics justifies their research by doctors. The literature promotes appropriate care that would improve the prognosis of diabetes, as well as depression-increased mortality among diabetics.

The management of depression in oncology: State of play

Introduction

Many authors insist on the psychiatric accompaniment of patients in oncology. Today in developed countries, the role of psychiatrists has become a necessity in the context of a multidisciplinary working (psychiatrists, oncologists, radiotherapists…) The work of psychiatrists became necessary because of the prevalence of cancer and because of the development of therapeutic methods and specificity of the disease itself.

The objective of this work

The authors of this work focus on the current state of accompaniment and the role of psychiatrists in the care of patients regarding the structures of Oncology Nursing.

Materials and methods

The study was conducted at the National Institute of Oncology (INO) People interviewed: 50 doctors practicing in the INO.

Information was collected prospectively from a self-administered questionnaire completed by physicians

Results

40% of psychiatric manifestations appear after the diagnosis of cancer, 61% of oncologists reassure patients considering the symptoms as normal, 11.1% prescribe psychotropic especially anxiolytics.

Conclusion

The specificity of cancer requires the presence of psychiatrists in the service of cancerology

Screening of bipolarity in a depressed population

Introduction

It's not always evident to diagnose a bipolar disorder.The difficulties of diagnosis have been demonstrated by several studies, some of which have shown that one out of two bipolars consulted at least three health professionals before receiving a proper diagnosis, with an average period of 10 years evolution prior to diagnosis. hypomania is often experienced by patients as a pleasant experience and not a pathological one, rarely have they reported this phenomenon spontaneously. Thus, the diagnosis of hypomania or BP-II disorder is not established in 50% of cases.

Aims

to find the prevalence of bipolar disorder type II in a population of depressed people in order to highlight the role of scales in the early identification of this disease often under-diagnosed.

Methods

a prospective study of screening for a history of hypomania in a population of patients hospitalized for consultants or major depressive episode or recurrent depressive disorder; over a period of three months

The diagnoses of MDE and RDD were prepared according to the DSM-IV.TR.

The screening tool is the Hypomania Checklist (HCL French version) which was completed by patients or by the psychiatrist of illiterate patients after its translation into Arabic dialect

Results:

Sample of 35 patients: 20 women and 15 men, average age: 34 years; Composed of 25 RDD and 10 MED

15 patients answered “yes” to 10 or more items of the HCL-20, hypomanic history was confirmed by a clinical interview in 13 of them

Autism and violence

Introduction

Autism is a disorder of the overall development and early onset before the age of 3 years, characterized by a deviant functioning and / or delayed in three areas: social interaction, verbal and nonverbal behavior.

The child may be aggressive, either to himself or to others. Communication difficulties hamper the social control of the aggression that is often disproportionate and can frighten the family.

In this work we are interested in the management of aggression for the autistic children.

Aims

identify ways of managing aggressive behavior for autistic children

Method

self-administered questionnaires provided to educators, psychologists, psychomotor therapists, working at Mohamed VI national center for handicapped people.

Results

43.3% of our sample exhibits behavioral problems which are « auto ou hétéroagressifs. We noted a male predominance. Precipitating factors were identified in 30% of cases and are mainly represented by the situations of failure and the changes in the environment of the autistic child. The management of aggressive behavior is based on several methods including the use of medications and behavioral approach.

Conclusion

The behavioral disorders are common among autistic children and are a major problem that families face. The aggressive management of the crisis is often difficult, and management remains uncodified.

[Schizotypal personality in academia]

INTRODUCTION

Schizotypal personality, otherwise known as "latent schizophrenia" is a personality disorder accepted in the spectrum of schizophrenia. Its prevalence is 3% of the general population. The schizotypal personality questionnaire (SPQ) developed by Raine is one of the most-widely used auto-evaluation instruments for the study of this personality disorder, it allows the rapid diagnosis of schizotypal personality, using 74 items divided into nine lower scales, evaluating the total DSM IV-R criteria of this disorder.

AIM OF THE STUDY

To explore the schizotypal personality among students in two Moroccan establishments, the medical school in Marrakech and the College of Technology in Safi (EST), through the Raine's SPQ, and to describe the sociodemographic profile of students with schizotypal traits.

METHODS

This is a retrospective study concerning a sample of the first round students in two university sites in Morocco (the medical school in Marrakech and the College of Technology in Safi). The investigation began on October 2004 and was spread over a period of 6 months. The questionnaire was anonymous, divided into two parts; the first part concerning sociodemographic characteristics and the second exploring the SPQ, developed by Raine, assessing nine schizotypal traits specified as such in the DSM IV-R.

RESULTS

The average score was 25.33 ± 11.77; with the upper and lower threshold values 44/74 and 10/74 respectively. Males were predominant among schizotypal students (7.24% versus 3.62% among females). Moreover, most of the schizotypal students (16.7%) were living with their parents, 1.4% living alone and only 0.7% with their friends. In the schizotypal students, 11.6% were pursuing their studies in the College of Technology in Safi, and 6.8% in the medical school of Marrakech. The average score for the SPQ was 25.33 ± 11.77 (minimal score 2/74 and maximal score 52/74). Excessive social anxiety total score was 518, the distrust total score was 496, and the lack of close friends total score was 449. Concerning scores for the sub scales: poverty affects, bizarre speech, reference ideas, perceptual experiences, unusual and bizarre beliefs, were respectively 434 (mean 2.94), 430 (mean 2.91); 422 (mean 2.88), 410 (mean 2.66), 337 (mean 2.30). Bizarre and eccentric behavior's total score was 309 (mean 1.97). Finally, our study could not find a relationship between the schizotypal disorder and the consumption of illicit drugs.

DISCUSSION

Schizotypal personality disorder is considered as a trouble-generator spectrum of schizophrenia; patients with this disorder are at high risk of developing schizophrenia, particularly when not detected earlier. The average SPQ questionnaire score in our sample was 25.33+11.77. Very similar scores are found in other studies concerning student populations. According to the method of Raine threshold, scores have been defined by the values corresponding to 10-degree and 90-degree percentile distribution of collected scores. In our study, these lower and upper threshold scores were 10/74 and 44/74 which appear similar to those calculated by Raine (12/74 and 41/74), Dumas et al. (9/74 and 40/74), Dumas et al. (7/74 and 40/74), and in the study of Gaha et al. who found upper and lower threshold score of respectively 9/74 and 42/74. Several epidemiological studies conducted since the early 1990s indicate that the lifetime prevalence of drug consumption (abuse or dependence) is nearly 50% in schizotypal personality before the outbreak of schizophrenic symptoms, schizotypal personalities tend to consume these substances to relieve their anhedonia, to socialize and to allay their anxiety, which explains the co-occurrence of schizophrenia and drug consumption.

[Cerebral hydatic cyst and psychiatric disorders. Two cases]

The hydatidosis is an endemic illness in regions of the Middle Orient, Mediterranean, south of America, north Africa and the Australia. The preferential localization of cyst hydatic is the liver (48%), the lung (36%) and in 6% of cases it localizes in unaccustomed place as the brain. Intracerebral localization is relatively rare, its impact is 1 to 5% of all cases of hydatidose. This localization is the child's appendage with a masculine predominance. The cyst hydatic intracranien is often lone, of localization usually supratentorielle, sometimes infratentorielle. Symptoms are especially the diffuse headache associated to various neurological signs in relation with sits of the tumor. The psychiatrics symptoms depends on its localization, sides, intracranial hypertension, and the previous personality. In 15 to 20% of cases these tumors can appear in the beginning of their evolution by the isolated psychiatric symptoms. We report the case of two patients that have been hospitalized first in the Academic Psychiatric Unit of Marrakech for isolates psychiatric disorders and whose scanning revealed the presence of cerebral hydatic cyst and that required a surgical intervention in neurosurgery. Case 1 - Patient 29 years old, bachelor, uneducated, leaving in country outside, fermar, in permanent contact with dogs. No particular medical history. The patient has been brought by his family to the psychiatric emergencies after behavior disorders. The beginning of his symptomatology was one year ago by behavior disorders: instability, violence, isolation, and a corporo-sartorial carelessness. His symptomatology worsened and the patient became very aggressive. In psychiatric unit, he was disregarded, sad, anguished, indifferent to his state, very dissonant, completely detached, depersonalized. He brought back some visual and auditory hallucinations with attitude of monitoring. He was raving with delirium of persecution, of ideas of reference and delirium of bewithment. He was unconscious of his disorders. The patient has first been put under classical neuroleptic 9 mg/day of Haloperidol and 200 mg/day of chlorpromazine. The diagnosis of schizophrenia has been kept according to criteria of DSM IV. The PANSS (Positive and Negative Syndrome Scale) was to 137 (score on a positive scale was to 34, score on a negative scale was to 35 and the general psychopathologie scale was to 58). One week after his hospitalization, he developed headache with subconfusion, a cerebral scanning has been made in emergency and showed a voluminous cyst in oval foramen compressing the mesencephalon strongly. The cyst was well limited, hypodense, not taking the contrast, and without intracerebral oedema, the diagnosis of cerebral hydatic cyst has been made. The complementary exploration didn't show any other localizations, and biologic exam results didn't show any particular anomalies. The patient has been operated in neurosurgery. The immediate evolution was favorable with disappearance of confusion and absence of complications. The patient was lost of view. Six months after, the patient has been readmitted to the psychiatric emergency. He dropped his neuroleptic treatment. He was aggressive, raving, hallucinated and depersonalized. The global score to the PANSS was 63. He has been put back under neuroleptics. Three weeks after improvement and passage of the PANSS to 30, the patient went out. We couldn't have a cerebral scanner of control because the patient had no medical assurance and no money for cerebral scanner. Case 2 - Patient aged of 53 years, father of four children, uneducated, native and resident of Marrakech, confectioner as profession. He is in contact with dogs since 12 years. He has been brought to the psychiatric emergencies by his family after an agitation. The history of his illness seemed to go back at eight months ago, by the progressive apparition of an instability, sleep disorders, hostility, associated with an emotional lability. To the interview he was agitated and had a delirium of persecution. He was convinced that his wife and his children plotted against him. He had sad mood. He was anguished and had auditory and visual hallucinations. The patient was not confused but it had a hypoproxie, an fixing amnesia, a disorders of judgment and a light left hemiparesia. Cerebral scanner revealed three cerebral cyst. The first measuring 42 x 40 mm, sitting at the level parietal right, to the contact of the occipital horn, dragging his/her/its amputation and an effect of mass on ventricle homolateral, the median line and ventricle controlateral. The two other, at the level of the center semi oval, behind the first, measuring 23 mm and 15 mm on the big axis. The patient has been addressed in neurosurgery. He had a completeray exploration to search other localizations. The thoracic x-ray showed 2 pulmonary cyts. The abdominal scan and imagery by magnetic resonance showed liver cyst, peri-heart cyst and mediastinal cyst. The patient has been operated for these three cysts with good recuperation on the psychiatric and neurological symptoms. He has been addressed in heart surgery for the heart localization. The hydatidose is an endemic illness in Morocco and constitute a public health problem. The cerebral localization is rare and appear by signs of cerebral hypertension and signs of focusing. The psychiatric demonstrations are rare but preserve a major interest, by the therapeutic measure specificity that they impose. Of course, the surgical ablation of the tumor can be sufficient to attenuate the psychiatric symptoms but the recourse to a specific treatment can prove to be necessary to act on the precise targets. We are conscious of the methodological difficulties that present these 2 cases but there are unfortunately due to the financial difficulties of our patients.

[Autosomal dominant Alzheimer's disease. Study of a Moroccan family]

The authors describe in this paper a Moroccan family presenting Alzheimer's disease with early onset and rapid course (6 members, of whom 3 died at 34 and 40 years old in a severe picture of dementia). Among these 6 members, Mr M.K., 36 years old, was admitted in the University Psychiatric Department for 4 years of depressive syndrome, -memory impairment and cognitive deficit. In the literature, the cases of Alzheimer's disease begining before 60 years have been reported since 1991; the transmission of this syndrome is autosomal dominant. The genetic studies showed a multifactorial determinism. For the familial cases with early onset, the mutation occurs on the amyloïd precursor protein and on the presenilin 1 and 2. In this case, the result of the familial investigations was compatible with Alzheimer's disease, a dominant autosomic disorder, with early onset between 32 and 40 years old. The clinical course evoked a mutation of presenilin 1. The identification of such mutation in one of his sisters living in France confirmed the genetic transmission. Despite progress made in understanding the pathogenesis, the development of a curative treatment in Alzheimer's disease remains difficult. Selective inhibitors of cholinesterase can improve patients with mild to moderate Alzheimer's disease forms. In Morocco, only donepezil is available, but it is inaccessible for patients who need this treatment because of its high price. For Mr M.K., who still has a professional activity, symptomatic treatment, cognitive and psychological supports may allow him to maintain an adequate life for years. The family support is essential.