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This study aimed to explore medical students' attitudes, social perception, and knowledge towards mental illness and identify the associated factors.A cross-sectional study was conducted in the Medical Faculty of Fez. A representative sample of 420 Moroccan students from the first to the seventh years was selected randomly during the academic year (2018/2019). They completed the Mental Illness Clinicians Attitudes scale (MICA) and a self-questionnaire exploring sociodemographic data, the university course, social perception and knowledge towards mental illness, and the potential consideration of psychiatry as a career.The average age of participants was 21.73 years (SD ±2.60), and 72.4% (n=304) of respondents were female (M/F gender ratio=0.39). The participants held stigmatizing attitudes and negative social perceptions towards mental illness, as indicated by the high score of the MICA scale (mean=57.24; SD ±9.95). Females (p=0.02) and married students (p=0.02) showed significantly more tolerant attitudes. The attitudes of students (p=0.37) who completed the psychiatry clerkship were slightly more favorable (p=0.15). There was no significant difference in attitudes according to the level of study (p=0.06). Students with a lower socioeconomic level tended to be less stigmatizing (p=0.08). The assessment of knowledge about mental illness among students objectified major gaps. A total of 17.9% (n=75) considered psychiatry as a career.The attitudes of medical students in this study were stigmatizing, and this should without delay motivate Moroccan research, educational and health authorities to investigate further scientific research in this area to address these attitudes and remedies.

Resume Introduction Les crises psychogenes non epileptiques (CNEP) sont frequentes en clinique mais peu connues et peu etudiees par les psychiatres. Nous presentons ici une premiere etude Marocaine dont l’objectif est de decrire la clinique et le contexte psycho-pathologique de ce trouble. Methode Nous avons recrute sur une periode d’une annee des patients avec CNEP rencontres au niveau du service des urgences psychiatriques du CHU Hassan II de Fes. Les donnees recueillies portaient sur les elements sociodemographiques des patients, les criteres MINI des differents troubles psychiatriques, des troubles de la personnalite et de la suicidalite, l’echelle d’anxiete de Hamilton, l’echelle de depression de Beck et l’echelle de maltraitance a l’enfance CTQ (Childhood Trauma Questionnaire). Resultats L’echantillon est constitue de 32 patients avec une majorite de femmes d’un niveau economique modeste (89 %). La moyenne d’âge de debut de la maladie est de 23,97 ans. La forme generalisee est retrouvee chez la majorite des patients (71,9 %). Un facteur declenchant est present dans 46 %. Les crises duraient en moyenne 23,47 minutes et 37,5 % des patients avaient au moins une crise par jour. Parmi les patients, 68,8 % avaient en comorbidite un trouble psychiatrique avec dans 46 % une depression et dans 18,6 % un etat de stress post-traumatique (ESPT). Le risque suicidaire etait cote comme modere ou severe chez 12,5 % des patients et 40,62 % avaient deja fait une tentative de suicide. Un trouble de personnalite est present dans 18,8 % des cas. Enfin, une notion de maltraitance a l’enfance est presente chez 59,4 % de l’echantillon, et elle est correlee a l’âge de debut precoce de la maladie et a la presence de la depression. Conclusion Notre population est comparable aux populations etudiees dans la litterature de par les presentations cliniques, les comorbidites et le lien avec les evenements de vie ; cependant, notre echantillon est caracterise par des crises plus prolongees et plus frequentes avec une suicidalite plus elevee.

Resume Introduction Les automutilations non suicidaires ANS representent un veritable probleme de sante publique, etant donne leur frequence au sein d’une population jeune et les relations complexe qu’elle entretiennent avec autres troubles psychiatriques et comportements a risque. Pour mieux comprendre le phenomene, nous avons conduit une etude descriptive au sein de l’unite psychiatrique du CHU de Fes. Methodologie Il s’agit d’une etude d’observation transversale recrutant tous les patients avec automutilations ayant ete hospitalises en psychiatrie sur une periode d’une annee. Nous avons recueilli des donnees concernant les caracteristiques de l’echantillon, du comportement d’ANS, de son contexte et ses modalites, puis nous avons cherche les evenements traumatiques dans l’enfance et les diagnostics associes selon le DSM-IV. Enfin nous avons compare nos donnees a celles de la litterature preexistante. Resultats La prevalence des automutilations au sein des patients hospitalises est estimee a 6,91 %, avec une nette majorite d’hommes et un âge moyen de 27 ans. Vingt-deux pour cent des participants avaient deja presente un comportement suicidaire, 56 % sont usagers de substances et 30 % ont subi des traumatismes ou de la maltraitance. Trente-trois pour cent de l’echantillon repondent aux criteres DSM-IV de la personnalite borderline et 30 % des patients avaient une schizophrenie. L’intolerance a la frustration (73 %) et l’angoisse massive (37 %) accompagnait souvent l’acte d’ANS et les localisations la plus frequente etaient les avant-bras (90 %) et les bras (57 %). Conclusion Notre etude confirme le caractere frequent des automutilations au sein de la population psychiatrique et retrouve les memes caracteristiques rapportees par la litterature occidentale, notamment le lien avec la personnalite borderline et l’anxiete, sauf pour la predominance feminine.

Describe and compare the clinical profile of schizophrenic patients with and without obsessive-compulsive symptoms and obsessive-compulsive disorder (OCD) patients.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).The "schizo-obsessive" group differed from the "schizophrenia" group in: more severe psychotic symptoms (mean=64.16±17.049, P0.001), higher anxiety (mean=8.87±5,655, P0.001) and depression (mean=7.50±5.989, P0.001) 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 (P0.001) 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).A careful assessment of obsessive symptomatology is essential in schizophrenia for better patient management and prognosis.

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.

Resume Objectifs Les symptomes de la schizophrenie ne se manifestent pas generalement avant la fin de l’adolescence ou au debut de l’âge adulte. Plusieurs symptomes de differents types peuvent etre presents a l’adolescence et peut-etre meme a l’enfance. La presente etude a pour objectif principal d’etudier le comportement de nos patients schizophrenes durant leur enfance et leur adolescence. Methodes Il s’agit d’une etude retrospective menue au service universitaire de psychiatrie de Fes a propos de 100 patients atteints de la schizophrenie. Pour etudier le comportement de nos patients durant leur enfance et leur adolescence, nous avons utilise la version pour adolescents de la (Child Behavior Cheklist 4–18 [CBCL]). Resultats 100 patients atteints d’une schizophrenie et leurs parents ont participe a notre etude. L’âge moyen de nos patients etait de 25,36 ± −3,54 ans, avec des extremites d’âge de 18 et de 30 ans. Nous avions une predominance masculine avec seulement vingt femmes. La moyenne d’anciennete du trouble etait de 4,10 ± −2,74 ans. Le score moyen de CBCL etait de 41,69 ± 26,397 avec quarante-sept patients qui avaient un score superieur au seuil. Plusieurs facteurs etaient significativement lies a un score CBCL eleve : le genre, l’âge precoce de debut de la maladie, et la presence d’un evenement traumatique a l’enfance. Conclusion L’enfance et l’adolescence des schizophrenes sont caracterisees par la presence d’une multitude de symptomes et de troubles de comportement. Meme si ces symptomes sont peu specifiques, leur presence doit alerter le clinicien sur la probabilite non negligeable de developper une schizophrenie.

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

Background The prevalence of autism spectrum disorder is increasing worldwide, making screening and early intervention necessary. Several screening instruments have been developed in recent years. The Modified Checklist for Autism in Toddlers Revised with Follow-up (M-CHAT-R/F) is considered to be one of the specific measures designed to identify toddlers at risk for autistic spectrum disorder. Objective The aim of the study was to translate and adapt the original version of M-CHAT-R/F from the English to the Moroccan Arabic language. Study design Specialized translators and clinicians ensured forward and backward translation of the scale into Moroccan Arabic. Then, a two-stage screening of the M-CHAT-R/F-T was applied to a study sample comprised of 56 toddlers with autistic spectrum disorder (category I) and 96 toddlers with normal development (category II). "Kappa test", "Cronbach's alpha" test, the intra class correlation coefficient, and the area under the curve were determined. Result The average score results of M-CHAT-R/F were 13.12 for category I, while it was 2.24 for category II. The Cronbach's alpha coefficient of the checklist was 0.929. The kappa values ranged from k=0.78 to k=0.97 with a confidence interval of 95% indicating good convergence. The intra-class correlation coefficient ranged from 0.97 to 0.99, which is excellent. The area under the curve in our study was 0.988, an excellent result. Conclusion Efficiency of the Moroccan Arabic version of the MCHAT was demonstrated for screening in the general population.

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.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.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%).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.

Introduction : Les affections dermatologiques chez les patients schizophrenes sont frequentes, graves et sous-diagnostiquees. Objectifs : Le but de notre etude est de preciser la nature et la prevalence des affections dermatologiques observees chez les patients schizophrenes consultants ou hospitalises en service de psychiatrie. Methodes : Etude transversale prospective etalee sur une periode de 12 mois realisee en collaboration entre le service de dermatologie et le service de psychiatrie du CHU Hassan II de Fes. Resultats : Parmi 120 patients schizophrenes inclus, nous avons enregistre 98 cas de dermatoses, soit 82 % des patients, 56 % des cas en hospitalier et 44 % en consultation. L’âge moyen etait de 27ans avec un sex-ratio F-H a 2,07. Les diagnostics dermatologiques retenus dans notre etude etaient domines par les etats pelliculaires dans 16 % des cas, les automutilations dans 13 % des cas, la dermatophytie dans 10 % des cas, la dermite seborrheique dans 8,3 % des cas, la pediculose dans 5,8 % des cas et autres. Discussion : Les dermatoses liees a une hygiene defectueuse sont frequentes chez les patients schizophrenes hospitalises, ce qui pourrait etre explique par le desinteret de ces malades pour leur proprete et la grande promiscuite en milieu hospitalier. Conclusion : La collaboration entre le psychiatre et le dermatologue est primordiale pour ameliorer la prise en charge des pathologies dermatologiques chez les schizophrenes.[resume d’auteur]

Resume Les etudes sur l’usage de substances chez les patients hospitalises pour une schizophrenie sont nombreuses. Cependant, il n’existe pas d’etudes au Maroc. Objectifs Etudier la frequence de l’usage de substances chez les patients ayant une schizophrenie et determiner les facteurs de risque de cette association. Methodes Etude transversale faite au centre psychiatrique de Fes ciblant les patients hospitalises, chez qui le diagnostic de la schizophrenie a ete pose selon les criteres du DSM-IV. Un hetero-questionnaire a ete etabli pour rechercher les donnees sociodemographiques exactes, les antecedents medicaux et psychiatriques, les donnees cliniques et therapeutiques de la maladie schizophrenique ; l’âge et le mode de debut, le traitement et la qualite de l’observance. L’usage de substances a ete evalue selon les criteres du DSM-IV a la recherche d’une dependance ou d’un abus aux differents types de toxiques. Resultats L’echantillon comporte 108 patients ayant une schizophrenie diagnostiquee selon les criteres de DSM-IV. La prevalence de l’usage de substances est de 60,2 % ( n = 65). Le tabac et le cannabis sont les substances les plus utilisees. La plupart des patients (71,1 %) ont commence l’usage avant la maladie. Le sexe masculin (OR 13,95, p = 0,01) et la presence d’un antecedent judiciaire (OR 0,12, p = 0,05) se sont reveles des facteurs determinants de l’usage de substances chez les patients ayant une schizophrenie. Conclusion L’identification precoce des facteurs de risque de consommation de substances chez les patients souffrant de schizophrenie pourrait ameliorer le pronostic des patients en reduisant le nombre de rechutes et de promouvoir l’adhesion aux soins.

Resume Les affections somatiques chez les patients souffrant de troubles psychiatriques graves constituent aujourd’hui un enjeu important dans la prise en charge globale de ces patients. Elles rendent plus complexe la prise en charge therapeutique et retentissent sur le pronostic vital. Nous illustrons a travers ce travail l’experience du service de psychiatrie au CHU Hassan II de Fes (Maroc) dans le depistage et la prise en charge des comorbidites somatiques chez les patients atteints de pathologies psychiatriques graves. Objectifs Donner un apercu sur la nature de la pathologie organique observee en milieu psychiatrique, etudier les differentes interactions entre les pathologies psychiatriques et les affections somatiques et comparer ces dernieres entre les patients consultants et les patients hospitalises en service de psychiatrie. Methodes Nous avons realise une etude transversale aupres des patients consultant aux urgences psychiatriques ou hospitalises dans le service de psychiatrie presentant des signes cliniques en faveur d’une pathologie organique et transferes pour avis specialise dans les services medico-chirurgicaux du CHU de Fes, pendant une periode de 24 mois allant de janvier 2010 a decembre 2011. Le recueil des informations a ete effectue en se basant sur les observations cliniques psychiatriques et celles des medecins somaticiens. Resultats Sur une periode de 24 mois, 80 patients ont ete inclus dans notre etude. Les motifs les plus frequents de demandes d’avis aupres des services medico-chirurgicaux etaient la suspicion d’une cause organique de la symptomatologie psychiatrique dans 35 % des cas et la presence d’un signe d’appel organique dans 22 % des cas. Les services medico-chirurgicaux les plus sollicites etaient le service des urgences somatiques et le service de neurologie dans 30 % des cas chacun. L’interaction entre affection somatique et pathologie psychiatrique etait une comorbidite dans 32 % des cas, un effet iatrogene des psychotropes dans 24 % des cas et un trouble psychiatrique d’origine organique dans 13 % des cas. Les comorbidites somatiques etaient essentiellement infectieuses dans 45 % des cas et traumatiques dans 20 % des cas. Les effets iatrogenes des psychotropes etaient surtout d’ordre neurologique dans 32 % des cas. Conclusion Les affections somatiques chez les patients consultants ou hospitalises en psychiatrie sont tres frequentes, souvent meconnues et leur prise en charge n’est pas toujours aisee.

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. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3143-5) contains supplementary material, which is available to authorized users.

Usually Schizophrenia starts in late adolescence or early adulthood. However in childhood it is associated with significant impairment. The aim of this study is to investigate behavior disorders of schizophrenic patients in this particular period of life, and whether the presence of these disorders leads to predict a subsequent development of schizophrenia.Our study is retrospective, about a group of patients with schizophrenia, conducted in the university department of psychiatry of Fez. The study of the behavior of our patients during their childhood and adolescence is based on interviews with the parents of the subjects. We also used the teen version of the Child Behavior Cheklist 4-18 (CBCL).The sample included a total of 100 patients with a schizophrenia disorder, of which 80 were male, the average age was 25.36±-3.54 years. According to parents, 60 % of our patients were shy and too wise; a third of them had a preference for solitary games, and they were disobedient at home and school, frequently fighting, breaking the laws, taking drugs. Finally 20 % were very aggressive, attacking and hitting others - they even destroyed their personal possessions - and had run away from home. The average CBCL score was 41.69±-26,397, with 47 % above the threshold. Several factors were significantly related to a high CBCL score: gender, early age of onset of schizophrenia, and a traumatic event in childhood.Childhood and adolescence are characterized by the presence of many symptoms and behavior disorders. Although they are not very specific, their presence should alert the clinician to the significant probability of developing schizophrenia, especially in a risky population.

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.

Resume La therapie interpersonnelle (TIP) est une therapie breve et structuree qui a initialement ete developpee par G. Klerman dans le cadre de la recherche sur le traitement de la depression de l’adulte dans les annees 1970. Elle a ete ensuite codifiee dans un manuel en 1984. Cette therapie, qui se base sur la theorie de l’attachement, vise l’analyse et la correction des modes relationnels interpersonnels de la personne souffrant de depression et elle ne se concentre pas sur les aspects intrapsychiques ou cognitifs de ce trouble psychiatrique. La TIP se fonde sur l’hypothese selon laquelle la majorite des personnes souffrant de depression ont des relations interpersonnelles perturbees qui declenchent ou suivent l’apparition du trouble de l’humeur. Il en decoule que le travail visant a resoudre les difficultes marquant ces relations interpersonnelles favorisera l’amelioration des symptomes depressifs. Cette demarche therapeutique va s’appuyer sur l’exploration des quatre domaines problematiques qui sont fortement correles a la depression selon G. Klerman : le deuil, les conflits interpersonnels, les transitions de role et les deficits interpersonnels. En fonction de l’exploration, un (ou deux maximum) de ces domaines va etre alors le centre de la therapie. Des etudes cliniques controlees ont demontre l’efficacite de cette approche therapeutique dans le traitement non seulement de la depression, mais aussi d’autres troubles psychiatriques aussi bien en phase aigue qu’en phase de maintien et dans differents formats therapeutiques, individuel, de couple ou de groupe. Plusieurs guidelines recommandent la TIP comme l’un des traitements de choix pour les troubles depressifs unipolaires. Cet article passe en revue les principes fondamentaux et les objectifs de ce modele therapeutique. Les concepts theoriques et les preuves resultant de la recherche sont egalement evoques. L’approche est brievement decrite et les differentes phases therapeutiques sont discutees.

Resume L’ingestion recidivante et volontaire de matieres metalliques est un phenomene rare. Il a suscite un grand interet des professionnels en sante mentale au cours des deux dernieres decennies. Pourtant, ce sujet est rarement rapporte dans la litterature et l’exploration en profondeur des ses aspects cliniques et psychopathologiques specifiques demeure encore limitee. Nous rapportons le cas d’une patiente de 32 ans, qui a ete condamnee a 20 ans de prison pour homicide. L’acte avait ete perpetre a l’encontre de sa cousine, fille de son oncle paternel, par lequel elle avait elle-meme ete violee a l’âge de 14 ans, l’affaire ayant ete etouffee par la famille et la patiente subissant dans ce contexte divers comportements de maltraitance familiale. Apres son incarceration, la patiente a effectue des ingestions volontaires de matieres metalliques, qui ont necessite a plusieurs reprises des admissions dans des services de chirurgie pour des extractions endoscopiques ou des interventions chirurgicales. Elle a ingere plus d’une trentaine de fois divers objets metalliques (fil metallique, lame de rasoir, cuillere…) sous l’effet d’une impulsivite et d’une angoisse massive. Ces ingestions volontaires d’objets metalliques, associees a des conduites d’automutilation iteratives, s’inscrivaient dans le cadre de troubles de la personnalite de type borderline , l’incarceration et les conditions d’emprisonnement ayant joue un role important dans l’apparition et l’entretien de ce comportement. Nous examinons, a travers notre vignette clinique, les aspects psychiatriques specifiques de l’ingestion intentionnelle d’objets metalliques, en vue de parvenir a une meilleure comprehension de ce comportement.

Resume La psychiatrie de liaison s’occupe des troubles psychiatriques se manifestant chez les patients des autres disciplines medicales et comporte trois grands types d’activite : clinique, pedagogique et de recherche. L’etude concerne les patients hospitalises a temps plein dans les services medico-chirurgicaux et les patients admis en hopitaux de jour, en consultation externe et aux urgences a travers une etude transversale sur 24 mois faite au sein du centre hospitalier universitaire Hassan II a Fes. Nous avons evalue certaines dimensions de cette discipline qui est encore jeune dans notre pays. Objectifs Etudier la prevalence et la nature des troubles psychiatriques rencontres lors des activites de psychiatrie de liaison, identifier les services les plus demandeurs ainsi que les motifs les plus frequents. Methodes Il s’agit d’une etude transversale sur une periode de 24 mois allant de janvier 2010 a decembre 2011 et portant sur 180 demandes d’avis psychiatriques provenant des differents services medico-chirurgicaux du CHU de Fes. L’avis psychiatrique est realise en se basant sur un entretien psychiatrique. Les donnees sont recueillies a l’aide d’un hetero-questionnaire comprenant 24 items remplis par un psychiatre. Apres un examen psychiatrique initial, un suivi est propose au patient au sein du service de psychiatrie lorsqu’un trouble psychiatrique categorise a ete identifie. Resultats Durant la periode de l’etude, 22 services du CHU avaient demande un avis psychiatrique. Les services les plus demandeurs d’avis etaient la dermatologie (16 %) et la nephrologie (11 %). Les motifs les plus frequents des demandes etaient l’agitation psychomotrice et l’evaluation d’une tentative de suicide (17 % chacun). Les troubles depressifs (47 %) et les troubles psychotiques (11 %) etaient les diagnostics les plus frequemment portes. La prise en charge psychiatrique etait basee essentiellement sur un traitement pharmacologique dans 60 % des cas et l’evolution etait favorable dans 80 % des cas. Conclusion Notre etude a montre une prevalence importante de troubles psychiatriques parmi les patients hospitalises dans les differents services de medecine et de chirurgie de notre centre hospitalier universitaire, justifiant ainsi la creation d’une unite de psychiatrie pour pouvoir mieux repondre aux demandes de soins et de suivi des patients.

Resume Le trouble factice est la production ou feinte ou intentionnelle de signes ou de symptomes physiques ou psychologiques dans le but de jouer le role de malade, sans avantages apparents. Quelques donnees montrent souvent une comorbidite du trouble factice avec d’autres troubles psychiatriques, comme la toxicomanie, les troubles somatoformes, la dysthymie, le trouble de la personnalite borderline et les troubles sexuels. La dermatillomanie est une maladie invalidante caracterisee par la cueillette repetitive de la peau qui provoque des lesions tissulaires. Ce trouble a une incidence de 2 %, il est actuellement considere comme un trouble du controle des impulsions non specifie. Cependant, il est associe a un taux eleve de comorbidites psychiatriques comme le trouble de la personnalite limite. A travers le cas d’une patiente presentant une comorbidite pathomimie et dermatillomanie, nous aborderons les caracteristiques cliniques et psychopathologiques du trouble factice et les difficultes therapeutiques rencontrees devant cette comorbidite.

Resume Les troubles anxieux et depressifs iatrogenes aux corticoides sont frequents, sous estimes et ont des consequences graves pouvant mettre en jeu le pronostic vital du patient. Les etudes portant sur ces troubles sont rares et leur prise en charge n’est pas encore consensuelle. Objectifs L’objectif de notre travail est de determiner la prevalence des troubles anxieux et depressifs induits par les corticoides, evaluer leur imputabilite a la corticotherapie et rechercher les facteurs de risque associes. Methodes Nous avons mene une etude longitudinale prospective sur 12 mois evaluant la prevalence des troubles anxieux et depressifs chez des patients suivis pour une dermatose chronique et traites par une corticotherapie prolongee. Nos patients ont ete evalues a l’aide des instruments standardises : le Mini International Neuropsychiatric Interview (MINI) ; l’echelle d’anxiete de Hamilton (HAS : Hamilton Anxiety Scale) et l’inventaire de Beck de depression (BDI : Beck Depression Inventory). Resultats Parmi 54 patients inclus, notre etude a montre une prevalence elevee des troubles anxieux et depressifs estimee a 27 % ; ces troubles etaient repartis en trouble depressif dans 16 % des cas, et trouble anxieux dans 11 % des cas. On a constate l’installation precoce de ces troubles durant les premieres semaines du traitement. Les facteurs de risque statistiquement significatifs etaient les antecedents psychiatriques personnels du patient et la posologie de la corticotherapie. Par ailleurs, on note une prevalence elevee des troubles chez les patients dont l’âge est superieur a 40 ans, le sexe feminin, et les patients traites pour pemphigus profond. L’evolution apres traitement pharmacologique et psychotherapie de soutien etait favorable chez la majorite des patients. Conclusion L’evaluation psychiatrique avant la prescription des corticoides au long cours doit etre de pratique courante pour detecter les patients a risque, discuter les modalites therapeutiques et assurer une prise en charge globale.

Le syndrome d'Ekbom, ou délire d'infestation parasitaire, est une pathologie rare, caractérisée par la conviction inébranlable d'avoir une peau infestée d'insectes ou de parasites. Il s'agit d'un délire monothématique à mécanisme hallucinatoire qui touche typiquement les femmes d'âge avancé. Nous rapportons les cas de trois patients qui présentent un délire d'infestation parasitaire dans des contextes cliniques différents. Le premier patient souffre d'un délire d'infestation isolé correspondant à la forme décrite par Karl Ekbom. Le deuxième cas présente un délire d'infestation secondaire, s'inscrivant dans le cadre d'une leuco-encéphalopathie de type CADASIL. Enfin, le troisième patient se présente dans un tableau évocateur d'un épisode dépressif avec une caractéristique psychotique qui intègre le délire d'infestation. Ces trois vignettes cliniques illustrent parfaitement le caractère trans-nosographique de ce syndrome ainsi que les difficultés de prise en charge de ces patients, tant au niveau de l'alliance thérapeutique que sur le plan des choix en matière de traitement pharmacologiques.Pan African Medical Journal 2016; 24

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.

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.

English version of the questionnaire. (DOCX 27Â kb)

Resume De nombreuses etudes ont fait etat des effets negatifs d’un mauvais sommeil sur la qualite de la scolarite des adolescents dont les fonctions cognitives sont ainsi alterees. Objectifs L’objet de ce travail etait d’etudier la prevalence des troubles du sommeil dans une population d’adolescents et d’en rechercher le retentissement sur le deroulement de la scolarite. Patients et methodes Nous avons mene une etude transversale pendant un mois aupres de 1451 lyceens de Rabat et Sale (Maroc) a l’aide d’un autoquestionnaire qui recueillait des informations sur les donnees sociodemographiques, les habitudes du sommeil et les resultats scolaires durant les trois derniers mois. Resultats Vingt-deux pour cent des filles et 18,1 % des garcons se plaignaient de difficultes d’endormissement. La somnolence en classe a ete retrouvee chez 17,6 % des filles contre 12,8 % des garcons, dont respectivement 1,6 et 1,4 % prenaient des somniferes. Une difference significative a ete notee entre la duree du sommeil durant les jours de cours et les jours de vacances. Les filles avaient tendance a se lever plus tot mais sans que cela ne diminue la duree globale de leur sommeil. Comme les garcons, elles etaient satisfaites de leur sommeil dans la moitie des cas, alors qu’elles presentaient plus de reveils nocturnes et de cauchemars. Les difficultes d’endormissement, les reveils nocturnes repetes, les cauchemars et la prise de somniferes etaient significativement associes a un mauvais rendement scolaire chez les filles et les garcons. Conclusion Cette etude confirme l’importance de la qualite du sommeil des adolescents et ses repercussions sur la qualite des resultats scolaires. Elle amene a souligner l’interet d’un eventuel changement des strategies educatives, avec notamment une information des etudiants, une meilleure hygiene du sommeil et un examen medicopsychologique des etudiants qui presentent une somnolence elevee en classe.

La Presse Medicale - In Press.Proof corrected by the author Available online since mercredi 9 avril 2014

Introduction Violence, delinquency and psychiatric disorders are mostly connected. The relation between these three components is insignificantly evoked while the social authorities formulate continual demand. Objectives The goal of this study was to establish sociodemographic profile, delinquency and psychiatric evaluation of the minor delinquent girls. Methods This transverse study was realized in the center for child protection of Fez, Morocco (CCPF). Fifty minor girls between 12 to 18 years living in (CCPF) were studied. A heterogeneous questionnaire containing the sociodemographic data, the impact of violence and delinquency was used. The psychiatric scales of evaluation such the MINI, for diagnosing the existing psychiatric disorders, the Hamilton's scale for assessing the severity of anxiety, and Beck's depression inventory were all used. Results Most of the girls presented a generalized anxiety that has manifested as a major anxiety in 54 % of cases, with a score greater than 15 in the Hamilton scale. The depression scale found a severe depression in 40 % of cases. The post-traumatic stress disorder represented 38 %, and the panic disorder was recorded in 28 %. The drugs usage was found in 40 % of the investigated girls, while physical violence was practiced on 58 % of cases. Conclusion This descriptive study noticed an important occurrence of psychiatric disorders among minor delinquent girls of this sample. A consideration of the diagnostic and therapeutic modalities of psychiatric complications is critical for the responsible authorities. Language: fr

Resume L’infanticide est un acte criminel hautement traumatique avec des repercussions psychopathologiques et sociofamiliales graves, marque par la pluralite de ses formes, la diversite de ses aspects et la frequence des cas dissimules. Les actes d’infanticides qui ont ete rapportes dans la litterature se situent dans divers contextes. Nous avons choisi de rapporter le cas d’une jeune femme de 28 ans sans antecedents psychiatriques et qui a presente en post-partum un acces psychotique aigu avec un acte d’infanticide suivi par la suite d’une tentative de suicide. L’amelioration a eu lieu sous neuroleptiques au bout du quatrieme mois. Cela montre que le role des psychiatres dans la prevention des actes d’infanticide est primordial en depistant les populations a risque, en identifiant les complications psychiatriques du post-partum et en assurant une coordination adequate avec les equipes de maternite et les services sociaux.

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. Electronic supplementary material The online version of this article (doi:10.1186/s12888-015-0680-x) contains supplementary material, which is available to authorized users.

English version of the questionnaire. (DOCX 26Â kb)

STROBE checklist for cross sectional studies. (DOC 88Â kb)

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.

Le syndrome de Fahr est une entite anatomo-clinique rare, caracterisee par des calcifications intracerebrales bilaterales et symetriques, localisees dans les noyaux gris centraux, le plus souvent associees a des troubles du metabolisme phosphocalcique. L'hypoparathyroidie, primitive ou postoperatoire, est l'anomalie la plus classique. L'hyperparathyroidie est exceptionnellement rapportee comme cause du syndrome de Fahr. Nous rapportons le cas d'une fille de 17 ans suivie depuis l’âge de 12 ans pour une epilepsie avec la notion d'un retard mental depuis l'enfance, qui a presente un syndrome confusionnel revelant un syndrome de Fahr avec la particularite de l'existence d'une hyperparathyroidie.

Interpersonal therapy (IPT) is a brief, structured psychotherapy initially intended to treat adult depression that was developed in the 1970s and manualized in 1984 by G. Klerman and his team. Two main theories served as a basis for its design: Bowlby's attachment theory and communication theory. Klerman theorized that tensions and problems in interpersonal relationships (i.e. disputes) cause psychological distress in vulnerable individuals that may lead to a major depressive episode. Clinical and epidemiological studies have shown that an insecure attachment style is strongly associated with lifetime depression. Severe depressive episodes have been correlated with avoidant attachment in women.IPT is based on the hypothesis that recent or ongoing disturbances in interpersonal relationships either trigger or follow the onset of mood disorder. In practice, IPT assists patients in analysing their interpersonal relationship modes, correlating their relational states with their mood and in learning to use better communication. Resolving difficulties in interpersonal relationships through the use of better communication skills promotes the improvement of depressive symptoms. Klerman identified four interpersonal areas that seem to be highly correlated with depressive episodes: grief (a close and important personal relation who has died), interpersonal disputes (conflicts with significant people such as a spouse or another close family member), role transition (significant life changes such as retirement, parenthood or chronic and invalidating illness) and interpersonal deficits (patients who have limited social contacts and few interpersonal relations). Classically, IPT is planned around 12-16 weekly sessions. During the initial sessions, the therapist will explore all existing interpersonal relations and any significant dysfunctions, both recent and ongoing. Following this interview, the area the patient considers as driving the current depressive episode will be designated as the focus of therapy. Evaluation of depressive symptoms by a quantitative measure (i.e. Visual Analogue Scale) and qualitative measures (activity, pleasure, quality of life) reoccurs at each session. During the intermediate sessions, therapy uses current situations and events in the designated area that particularly affect the patient's mood. Coping, communication and decision-making skills are gradually improved through a number of techniques. These include non-directive and directive exploration, clarification, encouragement of affect, and communication analysis. The therapeutic relationship is empathetic and encouraging of all progress the patient makes. The final phases close the therapy and help the patient to plan future actions and improvements.Several controlled clinical trials in adult populations have demonstrated the efficacy of IPT in treating Major Depressive Disorder (initial and recurrent episodes). It has been recommended as an appropriate treatment option in several guidelines. It can be provided in individual, couple or group formats. There remains an ongoing discussion of the efficacy of monthly maintenance sessions in recurrent depression. Since its conception, clinical trials have explored its use in specific populations such as adolescents and the elderly. IPT has also been the object of trial in other disorders such as post-partum depression, bipolar disorder, social phobia and eating disorders.This article reviews the basic principles and objectives of this therapeutic model. Theoretical concepts and results from research are also discussed. The approach is briefly described and the various therapeutic phases are discussed. Clinical trials have shown that IPT is effective in treating major depressive disorder in a wide variety of populations. Further trials are necessary to determine its efficacy in other psychiatric disorders.

The prevalence of psychiatric disorders in epileptic patients remains unclear.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.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.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.

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

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.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.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.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.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.

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

To date, there is little data in the literature describing the anxiety and depressive disorders iatrogenic to corticosteroids. These disorders are common, underestimated, with potentially serious consequences that may jeopardize the patient's prognosis; their management is not consensual.The objective of our work is to determine the prevalence of anxiety and depressive disorders induced by corticosteroids, assessing their accountability to the corticosteroids and studying their risk factors.We conducted a prospective longitudinal study over 12months evaluating the prevalence of anxiety and depressive disorders in patients followed for chronic skin diseases treated with prolonged corticosteroid-therapy. Our patients were assessed using standardized instruments: the Mini International Neuropsychiatric Interview (MINI), the Hamilton Anxiety Scale (HAS) and the Beck Depression Inventory (BDI).Of 54 patients included, our study showed a high prevalence of anxiety and depressive disorders estimated at 27%. These disorders were divided into depressive disorder in 16% of cases, and anxiety disorder in 11% of cases. The early onset of these disorders was found during the first weeks of treatment. According to the Beck Depression Inventory (BDI), depression was moderate in 67% of cases; severe with suicide attempts in 22% of cases, and mild in 11% of cases. According to the Hamilton Anxiety Scale (HAS), anxiety was mild in 33% of cases and moderate in 67% of cases. The disorders observed were mainly distributed into: 33% deep pemphigus, 27% lupus, 13% bullous pemphigoid and 13% dermatomyositis. In this study the statistically significant risk factors are dose of corticosteroids and personal psychiatric history of the patient; in addition, there is a high prevalence of disorders in patients whose age exceeds 40 years, female gender, and patients treated for deep pemphigus. The evolution after pharmacological treatment and supportive psychotherapy was favorable in most patients.The psychiatric examination prior to prescription of long-term corticosteroid-therapy use should be standard practice to identify patients at risk, discuss the treatment modalities, and provide comprehensive care.