ATP-dependent conformational dynamics in a photoactivated adenylate cyclase revealed by fluorescence spectroscopy and small-angle X-ray scattering.

Structural insights into the photoactivated adenylate cyclases can be used to develop new ways of controlling cellular cyclic adenosine monophosphate (cAMP) levels for optogenetic and other applications. In this work, we use an integrative approach that combines biophysical and structural biology methods to provide insight on the interaction of adenosine triphosphate (ATP) with the dark-adapted state of the photoactivated adenylate cyclase from the cyanobacterium Oscillatoria acuminata (OaPAC). A moderate affinity of the nucleotide for the enzyme was calculated and the thermodynamic parameters of the interaction have been obtained. Stopped-flow fluorescence spectroscopy and small-angle solution scattering have revealed significant conformational changes in the enzyme, presumably in the adenylate cyclase (AC) domain during the allosteric mechanism of ATP binding to OaPAC with small and large-scale movements observed to the best of our knowledge for the first time in the enzyme in solution upon ATP binding. These results are in line with previously reported drastic conformational changes taking place in several class III AC domains upon nucleotide binding.

[Ramadan and bipolar disorder: Example of circadian rhythm disturbance and its impact on patients with bipolar disorders]. / Ramadan et trouble bipolaire : exemple de perturbation du rythme circadien et son impact sur la maladie.

INTRODUCTION: Fasting during the Ramadan month is a cornerstone of Islam. Several disorders of the chronobiological rhythms occur during this month and impact on mood. Through this paper the authors provide a literature review of the impact of fasting on patients with bipolar disorders. MATERIALS AND SUBJECTS: A literature review using Mesh keywords through Medline database. From 1970 to 2011, articles in French and English were selected. RESULTS: Circadian rhythm refers to the approximately 24-hour cycles that are generated by an organism. Most physiological systems demonstrate circadian variations. Many hormones and other metabolisms, such as gastric pH, insulin, glucose, calcium and plasmatic gastrine, have been shown to exhibit circadian oscillation. The role of social rhythm in behaviors and its influence on circadian rhythms in humans is now obvious. It has been shown that the lack of concentration and irritability increased continuously during Ramadan month and reached its peak at the end of the month. Mood and vigilance are significantly decreased during the fasting month. Several authors have stated that the course of bipolar illness may be affected by the changes in social rhythm that occur during Ramadan (fasting month). Studies which have been devoted to this topic are sparse. Kadri et al., in 2000, studied 20 bipolar patients during the fasting month of Ramadan of 1417 (Hegirian calendar, corresponding to January 1997). Diagnosis of bipolar disorder was made according to ICD-10 criteria. Patients were assessed during the week before Ramadan, the second and the fourth weeks of the fasting month and the first week after its end, with the Hamilton Depression and Bech-Rafaelsen scales. The plasma concentration of lithium was also assessed. The main finding of the study was that 45% of the patients relapsed, 70% during the second week, and the remaining patients at the end of Ramadan. These relapses were not related to plasma concentration of lithium. Most of the relapses were manic (71,4%). Patients who did not relapse had more insomnia and anxiety during the second and third weeks of the study. The side effects of lithium increased and were seen in 48% of the sample, mostly dryness of the mouth with thirst and tremor. However, Farooq et al. in 2006 studied 62 bipolar patients during the fasting month of Ramadan 1427 (from 25 September to 24 October 2006). Serum lithium, electrolytes, Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS) were assessed, one week before Ramadan, mid Ramadan and one week after Ramadan. The side effects and toxicity were measured by symptoms and signs checklist. There was no significant difference in mean serum lithium levels at three time points. The scores on HDRS and YMRS showed significant decrease during Ramadan (F=34,12, P=0,00, for HDRS and F=15,6, P=0,000 for YMRS). Also the side effects and toxicity did not differ significantly at the three point's assessment. CONCLUSION: All physiologic parameters are influenced by the circadian rhythm, which is influenced in its turn by the food rhythm. So far, the results of these two main studies, with opposite results, do not help us advise bipolar patients to fast or not to fast. Other studies in this field are badly needed.

Moroccan national study on prevalence of mental disorders: a community-based epidemiological study.

OBJECTIVE: The main objective of this study was to assess the prevalence of common mental disorders in the Moroccan general population. METHOD: On a systematic representative randomized sample, the Moroccan Arabic version of the Mini International Neuropsychiatric Interview (MINI) was used to assess the prevalence of mood, anxiety, substance, and alcohol abuse disorders. RESULTS: Among 5498 subjects interviewed, 40.1% had at least one current mental disorder. Current major depressive disorder was the most common (26.5%), and at least one anxiety disorder was found in 37% of the sample. Mental disorders were more frequent among female, urban, divorced, and unemployed subjects. CONCLUSION: Mental disorders are common in the Moroccan general population, particularly mood and anxiety disorders.

[A critical study of the screening practices of gestational diabetes of a service of gynecology and obstetrics]. / Etude critique des pratiques de dépistage du diabète gestationnel d'un service de gynécologie obstétrique.

Our study has for aim to describe the practices of screening of the gestational diabetes mellitus. Screening test was realised at 61% of the women included in the study. The HGPO in 50 g was prescribed in 47% of the cases, a single fasting blood glucose in 28% of the cases; 13,4% of the detected women had a glycaemia included between 1,30 and 2 g/L one hour after a load of 50 g of glucose. Among these patients, 52,63% did not realize test HGPO in 100 g. Gestational diabetes mellitus complicates about 7,7% of pregnancies in our study. In statistical analysis united varied, are considered as risk factors: the age, the family history of diabetes and the histories of macrocosmic during previous pregnancy.

[Frequency and risk factors for pathological gambling in a sample of gamblers in Casablanca, Morocco]. / Fréquence et facteurs de risque du jeu pathologique chez une population de joueurs à Casablanca.

INTRODUCTION: Pathological gambling is a major psychiatric disorder and a public health problem that has gained a lot of attention in the last few years. The problems caused by gambling are increasingly serious. The prevalence of pathological or compulsive gambling varies from 0.8 to 2% in Europe, Canada and the USA. AIM OF THE STUDY: A study has been conducted in different gambling spots in Casablanca to measure the frequency of pathological gambling in Morocco and to determine the risk factors and the socio-cultural factors associated with it. DESIGN OF THE STUDY: The collection of data was conducted in the most frequented gambling spots. The first part of the questionnaire permitted the gathering of the sociodemographic characteristics and drug addictions as well as the psychiatric and legal histories. The detection and diagnosis of pathological gambling was conducted using through the South Oaks Gambling Screen (SOCS) questionnaire, which has been translated to Arabic to suit the needs of the study. PARTICIPANTS IN THE STUDY: Two hundred men were retained out of the 243 interviewed, which represent a participation rate of 82%. The frequency of pathological gambling among a population of gamblers is 53%. The mean age of the sample was 42.3 more or less 10.70 years. Thirty-six percent of those interviewed had a monthly income of less than 2000 dirhams (200 euros). Horse and greyhound racing were the most popular forms of gambling among those interviewed, with rates of 91 and 60% respectively. Individuals with an educational level of no more than primary school, a monthly income of less than 5000 dirhams (500 euros), a personal psychiatric history, and a drug addiction, are most risky to be pathological gamblers. CONCLUSION: The topic pathological gambling has been studied very little in Arab and Islamic countries, and it is necessary to conduct larger epidemiological studies on the general population to inquire about its prevalence, risk factors as well as its psychiatric characteristics.

[Recurrent pseudocyesis with polydipsia: a case report]. / Grossesse délirante récurrente avec polydipsie: à propos d'un cas.

INTRODUCTION: Pseudocyesis is an imaginary pregnancy resulting from a strong desire or need for motherhood. Pseudocyesis has become increasingly rare in many parts of the world in which accurate pregnancy tests have become widely available. Cultures that place high value on pregnancy, or that make close associations between fertility and a person's worth, still have high rates of the disorder. A woman may believe in her pregnancy to the point of delusion and show acute depression when no baby is born. CASE-REPORT: This report describes a case of recurrent pseudocyesis and polydipsia in a 49-year-old woman. She was an illiterate housewife who had been married since she was 21 years old. Four years later, she divorced because of a problem of sterility. She got remarried, five years later, and the couple had no child. The patient was admitted into the Obstetric Unit thinking that she was about to give birth. She presented all the symptoms of true pregnancy. She had abdominal distension, amenorrhea, mammary tension, nausea and vomiting, and weight gain. She claimed to have felt foetal movements. Other than this, she exhibited a polydipsia syndrome. These symptoms had evolved over 20 months. The patient had previously presented six similar episodes. All these episodes were identical. The length of these episodes varied between three and five months, after which all the signs disappeared progressively. The patient had never consulted for these symptoms before the present episode. During her stay in the Obstetric Unit, she benefited from a complete gynaecological examination, including pelvic ultrasound examinations, and laboratory tests, notably hormone assays (FSH, LH, prolactin, ss-HCG) and serum electrolyte levels. A primary sterility and menopause were confirmed. Otherwise, the psychiatric assessment confirmed the delusion of pregnancy and the presence of a depressive syndrome. The patient reported that she was possessed. She explained the normality of the imagery and laboratory tests by the intervention of the demons that hid the foetus and modified the results. DISCUSSION: The contribution of psychological and physiological factors in the development of the delusion of pregnancy, possession and polydipsia, and the possible interactions between the two phenomena are discussed.

[Post-traumatic stress disorder in survivors of the Agadir earthquake (Morocco) in 1960]. / Syndrome de stress post-traumatique chez les survivants du séisme d'Agadir (Maroc) de 1960.

INTRODUCTION: Agadir City is geologically located on a seismic line. This city witnessed an earthquake in February 1960 with a magnitude of 6 degrees in Richter scale. During this disaster more than 17,000 people died and 60% of the town was destroyed. OBJECTIVES: Forty years later, the objective of this study was to assess post-traumatic stress disorders at the time of the disaster and currently among this population. METHODS: Two groups, matched by gender and age were included: 1) a group (G 1) of 80 earthquake survivors with an age varying from 45 to 70 years ; 2) a control group (G2) with 80 people who experienced accidental events other than the earthquake. The instruments used were: a questionnaire concerning socio-demographic data, and the Post-traumatic Stress Diagnosis Scale-Edna Foa-1995 for the diagnosis of PTSD which was translated in Moroccan Arabic language. The epidemiological survey was conducted in two steps during 13 months. The first step consisted in the inclusion of the first group: victims of the disaster. One hundred and two survivors were contacted and 80 accepted to participate in the study. The second step, concentrated on the inclusion of the other group, according to gender and age of the survivors group. All interviews were conducted in the homes of the participants. Data analysis was performed on a PC microcomputer using Epi info 6.04 French version (Center for disease control and prevention CDC, Atlanta, USA). The statistical analysis was based on the descriptive techniques of statistics. RESULTS: The main results were: 1) after the traumatic events and retrospectively, survivors from the earthquake had statistically more PTSD than G2: 38.8% vs 20%; 2) at the time of the study, the prevalence of PTSD between the two groups was not significantly different: 10% for the survivors of the earthquake vs 7.5% for G2 (victims of accidents) while the dates of trauma differed; 3) forty years later, the socio-professional life of the survivors was still perturbed. DISCUSSION: These results are in accordance with the literature, even if the methodological differences constitute a limiting factor for the comparison. Nevertheless, the persistence of symptoms of PTSD many years later might be explained by the severity of the trauma, the existence of external stimuli, such as the frequent tremors felt in Agadir, the noise, the storms, the earthquake happening in other cities...create a persistent state of hyper-vigilance which maintains and/or worsens the symptoms of PTSD. CONCLUSION: In conclusion, 40 years later, survivors are in need of care to overcome symptoms of PTSD. Preventive measures for victims of disasters should perhaps be developed.

Moroccan colloquial Arabic version of the Mini International Neuropsychiatric Interview (MINI): qualitative and quantitative validation.

The validation of mini international neuropsychiatric interview (MINI) into Moroccan Colloquial Arabic language demonstrated good psychometric properties. The concordance between translated MINI's and expert diagnoses was good with kappa values greater than 0.80. The reliability inter-rater and test-retest were excellent with kappa values above 0.80 and 0.90, respectively.

Movements in never-medicated schizophrenics: a preliminary study.

Descriptions of schizophrenia dating to the beginning of this century include mention of abnormal movements which are similar to tardive dyskinesia (TD), currently thought to be sequelae of neuroleptic medication. In order to examine the extent to which such movements might appear in the normal course of schizophrenia, we examined a sample of 22 never-medicated DSM-III-R schizophrenics who presented for treatment at a psychiatric center in Casablanca, Morocco. Duration of illness in this sample ranged from 1 to 10 years. Patients were assessed for choreoathetoid movements using the Abnormal Involuntary Movement Scale (AIMS). Videotaped and live examinations were rated by the investigators. Three patients (14%) met research diagnostic criteria for probable SD. Mild movements in one body part (AIMS = 2) were seen in an additional five (23%) patients. The movements were characteristic of TD, although their somatic distribution differed from previous studies. Total AIMS score increased with age and duration of illness (r = 0.64, P < 0.01). These findings suggest that choreoathetoid movements may appear spontaneously in patients with schizophrenia.

Stability of exploratory eye movements as a marker of schizophrenia--a WHO multi-center study. World Health Organization.

The exploratory eye movements of patients with schizophrenia reportedly differ from those of patients without schizophrenia and healthy controls. In an attempt to determine whether exploratory eye movements provide valid markers for schizophrenia, the present collaborative study was conducted in six countries to analyze the stability of and variation in the following parameters of exploratory eye movements: the number of eye fixations (NEFs) and mean eye scanning length (MESL) in a retention task; the cognitive search score (CSS) that indicates how frequently the eye focused on each important area of a figure in order to recognize it in a comparison task; and the responsive search score (RSS), which reflects the frequency of eye fixations on each section of a figure in response to questioning in a comparison task. In addition, we investigated the validity of the currently employed discriminant function to extract a common feature of schizophrenia by applying it to the findings of the present study. The exploratory eye movements of 145 patients with schizophrenia, 116 depressed patients and 124 healthy controls at seven WHO collaborative centers in six countries were measured using eye mark recorders during viewing of stationary S-shaped figures in two sequential tasks. The RSSs of patients with schizophrenia were found to be significantly lower than those of depressed patients or healthy controls irrespective of geographical location, with no significant difference existing between the RSSs for depressed patients and those for healthy controls. By inserting the RSS and NEF data for each subject into the formula used to calculate discriminant function, patients with schizophrenia could be discriminated from depressed patients and healthy controls with a sensitivity of 89.0% and a specificity of 86.7%. The RSS is an exploratory eye movement parameter that detected schizophrenia irrespective of culture, race and various other subject variables. Furthermore, it is indicative of the stable, significant difference that exists between subjects with and without schizophrenia. The results of discriminant analysis confirm the previously reported validity of discriminant function.

Post-traumatic stress disorder in burned patients.

UNLABELLED: The essential feature of post-traumatic stress disorder is the development of characteristic symptoms following exposure to a traumatic stressor involving direct personal experience of an event that involves threat of death oactual r serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (DSM IV). The aim of this work is to assess the prevalence of post-traumatic stress disorder (PTSD) among the burned victims and its predicting factors. METHODS: Patients were recruited at the Burns Department in the Ibn Rushd University Hospital during the period between 1 October 1998 and 1 October 1999. All patients were psychiatrically interviewed and answered a questionnaire. The diagnosis of PTSD was done according to DSM IV criteria. Results were analyzed on Epi info software. RESULTS: Sixty patients gave their consent to participate in this study. The 23.3% met criteria for PTSD and 55% for major depressive disorder. In short, PTSD was related to age, explosion of gas containers for cooking purposes, depression and low social functioning. Otherwise, no relationship was found between PTSD and gender, length of hospitalization or severity of burn. CONCLUSION: Post-traumatic stress disorder remains a poorly known entity by clinicians and under-diagnosed in burned patients. Considering the frequency of this pathology, an anti-depressant treatment and a psychotherapeutic relationship are necessary to improve the health and the quality of life of these patients.

Benzodiazepines and memory.

Many anecdotal cases have been reported in the literature of dramatic memory impairment after benzodiazepine intake, raising psychobiological, pharmacological and forensic issues. This paper reviews some methodological difficulties encountered in human studies assessing memory function after benzodiazepine intake and the main results of these studies. Subjects studied are seldom insomniacs and the memory tests generally utilized are far from real-life situations. All benzodiazepines at some doses produce decrement in memory performance (anterograde amnesia) with a retrograde facilitation of retrieval, for the tasks learned before benzodiazepine intake. The mechanism of benzodiazepine induced amnesia is far from clear, but it has been shown that long term memory deficit could be the result of failure of memory consolidation due to rapid sleep onset (less than 5 minutes) after memory test performance during the night awakening (Roth et al. 1984). Many questions remain partially or totally unanswered: Is amnesia a specific effect of benzodiazepines? What are their other effects on cognitive functions? Which attitude to have towards a patient when the physician should prescribe a benzodiazepine?

[Biochemistry of depression. Literature analysis]. / Biochimie de la dépression. Analyse de la littérature.

The author goes briefly over the metabolism of the main cerebral monoamines, the functioning of synapses, as well as the methods used in studying the biochemistry of depression. Beyond all existing contradictory results, a review of the main works in this field enables us to point out some leading ideas:--Depression would be due to and/or accompanied by a monoaminergic deficiency: some authors emphasize the serotonin one, others the noradrenaline one.--The regulation of mood most probably finds its origin in the monoaminergic balance, rather than in the gross rates of any particular monoamine.--Disturbances are to be found on all metabolic levels: monoaminergic, hydroelectrolytic, hormonal, glucidic, lipidic, lipidic... Close intrication exists between those different metabolisms.--The interaction between the different aminergic systems and the metabolic ways, as well as the dispersion of the acknowledged results, impose more and more the necessity of a biochemical typology of depression, which would lead to a predictive approach to the evolution and treatment of depressive illness.

[Respective position of antidepressants in therapeutics (author's transl)]. / Place respective des différents antidépresseurs en thérapeutique.

The author points out the heterogeneity of depressions and antidepressants. He stresses the need of finding predictive indicators of antidepressant activity. Genetic, "demographic", biological, biochemical and pharmacokinetic factors can help to guide antidepressant's prescription. Urinary MHPG dosage seems to be one of the most interesting in this field.

[Never treated schizophrenic patients have no abnormal movements such as tardive dyskinesia]. / Les schizophrènes jamais traités n'ont pas de mouvements anormaux type dyskinésie tardive.

UNLABELLED: Tardive dyskinesia, described for the first time in 1957, have increased in frequency since neuroleptics started to be widely used. Is that disorder drug induced, or related to the psychosis, or does it exist in the general population, caused by others factors? This study is a trial in the approach of the problem. METHODOLOGY: the occurrence of tardive dyskinesia was rated for three kinds of populations which are schizophrenics never treated by neuroleptics; schizophrenics under treatment by neuroleptics; general population non psychotic and never treated by neuroleptics. Diagnostic criteria of schizophrenia are DSM III ones. Abnormal Involuntary Movement Scales of NIMH have been used in this work. The percentage is 14% in schizophrenics already treated by neuroleptics, and no one in the other two groups had dyskinesia. The middle duration of the illness in the schizophrenics group was about 12 months. Those results allow us to eliminate possible spontaneous dyskinesia in the general population which is young; to suppose that there is probably no responsibility of the psychosis in this disorder, at least at the beginning of the illness; to confirm that neuroleptic medication, alone or associated with other factors, is responsible for the occurrence of tardive dyskinesia.

[Autosomal dominant Alzheimer's disease. Study of a Moroccan family]. / Maladie d'Alzheimer à transmission autosomique dominante. A propos d'une famille marocaine.

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.

[Two years follow-up of patients with acute psychotic access: evolutionary modes and prognosis]. / Etude de suivi sur deux ans de patients présentant un accès psychotique aigu: modalités évolutives et pronostic.

UNLABELLED: The aim of this work is to study the evolutionary modes of the acute psychotic access and predictor factors of evolution toward schizophrenia. METHOD: It is a prospective survey done at the University Psychiatric Center Ibn Rushd with 2 years of follow-up. The diagnosis was made according to DSM IV criteria by a trained psychiatrist using the Structured Clinical Interview for DSM IV (SCID). All patients answered a pre-established questionnaire inquiring about socio-demographic data and personal and familial antecedent and data about illness. The Positive And Negative Syndrome Scale (PANSS) was used to assess the intensity of symptoms. The social functioning has been evaluated by the Global Assessment of Functioning scale (GAF). Was included every patient with the first episode of acute psychotic access, age between 15 and 50 years old and without psychiatric history. Sixty-five patients were included in this study. Data were missing on 18 subjects, who were not considered further, leaving a sample of 47 patients (29 men, 18 women). The analysis of results was made on the Epi-info software 6.04 (French version). RESULTS: The mean age of the sample was 23.1 + 7.2 years. A low socio-economic level was found in 91.5% (<200 r). After 2 years of follow-up, a recovery has been recorded in 21.3% of patients and 31.9% developed schizophrenia. A bipolar disorder has been diagnosed in 38.3%. In short, 4 patients (8.5%) relapsed during the first 2 years, presenting another acute psychotic episode. The statistical analysis showed that the evolution toward schizophrenia was bound meaningfully to the male gender, to the young age and to the negative symptom intensity.

[Prevalence of bulimia among secondary school students in Casablanca]. / Prévalence de la boulimie dans une population de lycéens à Casablanca.

During the two last decades, several epidemiological studies have been conducted on bulimia nervosa. According to recent studies, prevalence rates were estimated to be 1%. There are a very few studies on eating behaviour conducted in Arab countries. The aims of the current study were to assess prospectively the prevalence of Bulimia Nervosa and its characteristics in a Moroccan context in a randomly selected and representative sample of students attending six secondary schools in Casablanca. A second group composed of the students of the French secondary school of Casablanca was included in the survey in order to verify the influence of socio-cultural factors. Subjects completed a sociodemographic questionnaire and the Bulimic Investigatory Test of Edinburgh (BITE), a 33-item self-report measure of both the symptoms and severity of bulimia nervosa. A score of 25 or higher suggests a bulimic syndrome; 2,044 subjects returned their questionnaires (participation rate = 75.8%). The group of Moroccan school included 1,887 subjects and the French school 157 subjects. Females were preponderant (59%). The mean age was 18.3 +/- 1.2 years (15-22 years). For the first group, at least one substance was taken by 290 (15.3%) students: 12.7% were addicted to tobacco and 5.7% consumed occasionally alcohol. 16.3% reported a familial history of disturbed eating behaviour. According to the BITE, the overall prevalence of bulimia was 0.8% (1.2% in female and 0.1 in male subjects). The mean age of bulimic subjects was 18.6 +/- 1.7 years (16-24 years). The only male case in our sample was aged 24 years, without personal nor familial psychiatric history, consumed regularly tobacco and alcohol. His BITE symptoms score was 20 and severity score was 17, the highest score in our sample. Analyses of correlates of bulimia nervosa in the Moroccan sample showed that the group of bulimic subjects did not differ from the non bulimic with regard to any sociodemographic characteristics except sex: the female sex was predominant (p < 0.005) with 14 cases, the prevalence of bulimic syndrome was 1.2% among girls. This prevalence was 0.1% among boys. The bulimic subjects have regularly used different compensatory behaviours to control their weight: 6 (33.3%) used appetite suppressants, 3 (16.6%) used diuretics and 4 (22.2%) were engaged in self-induced vomiting. In the group of the french school, the prevalence of bulimia was 1.9% in the whole sample (3.4% among girls and no case among boys). These results are comparable to those reported recently in occidental countries and in an Egyptian study. However, the prevalence of bulimic syndrome in our sample was lower to those reported in countries with similar culture. The elevated prevalence of 10% reported in a tunisian study could be explained by the composition of the sample (medical students, aged 22-28 years) and the cut-off point for the BITE was determined to be 20 without taking into account severity criteria. A South African survey, conducted on 1,435 college students representing South Africa's ethnically and culturally diverse population comparable to our sample regarding the age (17-25 years), found a prevalence of 5% with a cut-off of 25 in the BITE. The majority of epidemiological community-based studies estimated the prevalence of bulimia nervosa to be 1 to 3% according to the diagnostic instruments used (self-report questionnaires versus clinical interviews) and the diagnostic criterias operationalized (DSM III, III-R or IV). The rate of occurrence of this disorder in males usually one-tenth of that in females was more decreased among our sample. However, the prevalence among males was comparable to the data of literature. Except the sex, we did not find other risk factors identified in the previous papers. Although in the bulimic group, we noted a higher rate of substance abuse (26.6% versus 15.2%, p > 0.5), familial histories of disturbed eating behaviour (26.6% versus 16.2%, p > 0.3) and less regular practice of sportive activity (72.2% versus 92.3%, p > 0.1), these differences are not statistically significant. The review of the literature identified at least 5 domains associated to bulimic disorder: parental problems (lower parental contact or separation, disruptive events), vulnerability to obesity, parental psychiatric disorder (alcoholism, depression), sexual or physical abuse and a premorbid psychiatric disorder. With the enormous media coverage and the globalisation of the media, cultural differences are disappearing. In order to estimate the prevalence of bulimia nervosa in the Moroccan population and to identify the risk factors, further epidemiological community-based studies using structured psychiatric interviews are required.

[Depressive disorders among epileptic patients attending a specialised outpatient clinic]. / Troubles dépressifs chez les patients épileptiques suivis au sein d'une unité de consultation spécialisée.

The overall prevalence of psychiatric disorders in epileptic patients is estimated between 19 and 62%. Depressive disorders may be the most common psychiatric disorders and the main reason for psychiatric hospitalisation and taking psychotropic drugs. The underdiagnosis and undertreatment of depressive disorders among epileptic patients represent a problem of considerable magnitude. The aim of the present study was to evaluate the prevalence of depressive disorders among patients with primary epilepsy and to determine the risk factors of the occurrence of the depressive illness. The survey was conducted in a outpatient epilepsy clinic in the Ibn Rochd University Hospital Centre in Casablanca. All patients with idiopathic or cryptogenic epilepsy aged 15 Years and above, were eligible, except for patients with severe physical and mental disabilities. Neurologists diagnosed the epilepsy based on clinical criteria with electroencephalograms data. The depressive disorders met a psychiatrist's evaluation of an ICD-10 criterion. Ninety-two subjects participated in the survey, 57.6% were men and the mean age was 30.3 +/- 10.8 Years. The epilepsy age of onset was 16.3 +/- 11.4 Years with an average duration of 14.1 +/- 9.2 Years. The prevalence of depressive disorders among epileptic patients in our survey was 18.5%. According to sex, the prevalence was 23.1% in women and 15.1% in men. The depressed patients were compared with the remaining patients without depression with regard to seizure variables and sociodemographic characteristics. The epilepsy-depression and epilepsy-control groups did not differ significantly in the duration of epilepsy or in the type of anticonvulsant therapy (mono versus polytherapy). Three variables were significantly different between the two groups. The mean age in the epilepsy-depression group was significantly higher (34.4 +/- 9.6 Years versus 29.4 +/- 10.9, p<0.03), the mean age of epilepsy age of onset was also higher in the epilepsy-depression group than in the epilepsy-control group (21.8 +/- 11.9 Years versus 15.04 +/- 11.0, p<0.03) and the seizure frequency per week was more important among depressed epileptic patients (2.4 + 5.2 seizures versus 0.4 + 1.5, p<0.007). The present survey confirms the findings of previous studies that the prevalence of the comorbidity between epilepsy and depression is common in specialised outpatient units. The detection and the treatment of depressive disorders among the epileptic patients remains a very great challenge in the management of the epileptic illness. It will improve the quality of life of these patients. A closer involvement of psychiatric and psychological treatment in patient management is necessary.

[Assessment of premenstrual dysphoric disorder symptoms: population of women in Casablanca]. / Evaluation des symptômes dysphoriques prémenstruels dans une population de femmes à Casablanca.

Menstruation is a biological phenomenon that has been subject of myths and taboos within and among various cultures. These myths distort the reality surrounding menstruation and create ambivalent feelings about the value and usefulness of this function outside of its necessity as mean of reproduction. Thus studies concerning menstruation need to take into account cultural and psychosocial factors that define the meaning, values and behavior associated with this biological phenomenon. According to several studies, 70% of women experience psychological faintness during this menstrual phase, 40% of them have these symptoms at each menstruation and between 3 to 8% of them suffer severely reacquiring medical support. This entity called premenstrual dysphoric disorder is defined by the presence of several symptoms (distress, tension, irritability, moodiness.) with a significant impairment in work or social functioning beginning during the week before and ending within a few days after the onset of menses. Several studies conducted over the past few years suggested that selective serotonin reuptake inhibitors (SSRIs) and serotoninergic tricyclic drugs may be more effective than other types of antidepressants in treating PMS symptoms. Two protocols are proposed; a continuous treatment or intermittent use during few days during pre-menstrual and menstrual phase for several cycles. The objective of the current study was to evaluate the prevalence of a potential premenstrual dysphoric disorder (PMDD) during one menstrual cycle, in a representative sample of general population of Casablanca, according the DSM IV criteria. On the other hand, a questionnaire, available from the authors, was used to explore socio-demographic data. Among 618 women interviewed, 310 met the criteria of a potential PMDD (50.2%). The mean age of the population with PMDD was 32.2 8 years ranging from 20 to 50 years; 54.8% of them were married, 33.9% of them were single and 66.5% of them had between 1 to 4 children. Two third of them were without a professional activity. During this premenstrual phase the following symptoms were found among the whole sample: marked depressive mood, feeling of hopelessness, or self-depreciation thoughts (77.7%, n=241%); difficulty of concentration (65%, n=201); marked change in appetite, overeating or specific food craving (82.8%, n=256); marked affective lability, with sadness tearful and increased sensitivity to rejection (65.8%, n=204); hypersomnia or insomnia (59.7%, n=185); subjective sense of being overwhelmed or out of control (55.7%, n=172); lethargy, excessive fatigability (91.6%, n=283); physical symptoms including breast tenderness, swelling, headache, joint or muscular pain, and a sensation of bloating and weight gain (81.9%, n=253). The most severe symptoms were fatigue and irritability. On the other hand, 73.9% of the sample had a disturbance in their socio-professional lives as a consequence to the psychological disturbances. Half of these women consulted a physician, mostly a general practitioner. These data are in accordance with the literature, confirming that this disorder is common and has a bad impact on mental health and on quality of life of the women suffering from PMDD.