[Stigma in psychiatry]. / Stigmatisation en psychiatrie.

Mental illness affects 48.9 % of the Moroccan population. Despite this significant figure, mental illness remains unrecognized. The patients suffering from mental disorders are therefore subject to stigma and social rejection. A descriptive study was conducted at the consultation service of the psychiatric Ibn Nafiss hospital of the CHU of Marrakech. We chose as a sample 100 stabilized patients, followed on an outpatient basis. The study included the three mental disorders: depressive disorder, bipolar disorder, and schizophrenia. The number of patients in each group had been fixed beforehand; and we tried to get a fairly even distribution between the two genders. The questionnaire had three main axes: (1) Sociodemographic data of the patient. (2) Knowledge of the disease. (3) Evaluation of the experience of stigma. The results of our sample were as follows: For both sexes the age extremes were 19 to 68 years with an average of 38.5 with a clear predominance of women. For the entire population, most patients were single with a percentage of 60 %. Two thirds of the patients, i.e. 59 %, did not exceed primary school. For personal medical history, endocrine pathologies were the most prevalent, at 18 % of cases, while depression was the most common family psychiatric history in our study. We noticed that our population suffered more discrimination and disclosure from those around them regardless of family, social and professional with less appreciation of the positive aspects.

[C-reactive protein and agitation in patients with schizophrenia: A cohort study with a control group]. / Protéine C-réactive et agitation chez des patients atteints de schizophrénie : suivi d'une cohorte avec groupe témoin.

BACKGROUND: Recent studies first reported the relevant role of the immune system in the pathophysiology of schizophrenia and then the association between inflammation and agitation. OBJECTIVES: In this study, we aim to explore the relationship between CRP (C-reactive protein) levels and agitation in patients with schizophrenia. METHODS: We conducted a cohort study with a comparison group of 60 patients with a DSM5 diagnosis of schizophrenia who were followed by the Department of Psychiatry of the University Hospital of Marrakech in Morocco. Patients were divided into two groups according to the state of agitation evaluated by the PANSS Excitement scale. These two groups have been matched according to age and gender. A comparison of CRP level, clinical and laboratory characteristics between the two groups and a monitoring of CRP level in the agitated group after 3 weeks of treatment were performed. RESULTS: Inpatients with agitation displayed a significantly high CRP (P<0.0001), a high score of PANSS total (P<0.0001), PANSS positive (P<0.0001) and general PANSS (P<0.0001). After treatment, there was a significant reduction in CRP (P<0.0001) and PANSS excitement (P<0.0001). CONCLUSION: These results confirm the role played by inflammation and immunity in agitation behavior in patients with schizophrenia and highlight the interest of the CRP assay at the time of admission of patients as a potential marker of agitation in hospitalized patients with schizophrenia.

[Prevalence and characteristics of sexual dysfunction among Moroccan patients consulting for a first depressive episode]. / Prévalence et caractéristiques de la dysfonction sexuelle chez des patients marocains consultant pour un premier épisode dépressif.

Depression as such causes emotional and physical disturbances that affect biological functions such as sleep, appetite, decreased libido and lack of interest in sexual function. Indeed, there is a significant incidence of sexual dysfunction in depressed patients. In addition, depression and sexual dysfunction have a significant impact on the quality of life of couples which can be improved by managing these two conditions between which there seems to be a two-way causal link. Sexual dysfunction has long been neglected in the clinic of depression. In Morocco, depression affects more than a quarter of the population. However, to date, no study has focused on the assessment of sexual function in relation to depression among Moroccans. OBJECTIVES: This work aimed to evaluate the prevalence and characteristics of sexual dysfunction in Moroccan patients consulting for a first depressive episode. METHODS: This is a descriptive cross-sectional study. All subjects included in this study were consulting for a first major depressive episode according to DSM-5 criteria from June 1st to November 30th, 2017 at the psychiatric university department at Ibn Nafis hospital in Marrakech. The severity of depression was assessed using the Hamilton scale. The ASEX (Arizona Sexuel Experience) scale was used to define sexual dysfunction. Statistical analysis was performed using SPSS 22 software. RESULTS: Fifty eight patients were recruited 34 of whom were female. They had an average age of 37 years. The majority were between 27 and 42 years old (59 %), married (81 %), with an average level of education (34.5 %). The average duration of the episode was 57 days. The major depressive episode was severe in 62 % of patients. According to the ASEX, 77.6 % of the depressed patients had a clinically significant sexual dysfunction. The majority of our patients (60.3 %) consulting for depression attach their sexual dysfunction to their depressed mood, either by reporting the onset of sexual dysfunction at the same time as depression (53.4 %), or worsening after the depression onset (6.9 %). The frequency of sexual intercourse with the pre-depressive state was decreased in the majority of our sample. Sexual desire was the most impaired phase of the sexual response (58.6 %) followed by excitation (53.4 %) and then orgasm (51.7 %). Of the 47 married patients, more than two thirds (32 patients) were dissatisfied with their life as a couple as well as with different aspects of their relationship life. The majority of patients reporting marital dissatisfaction attributed the cause to the quality of their sexual intercourses rather than to their frequency or other relational aspects. Sexual dysfunction was significantly correlated with the severity of depression (P=0.031), whereas it was not correlated with duration of depressive episode (P=0.412) or age or patient sex (P=0.114, P=0.202 respectively). CONCLUSIONS: The prevalence of sexual dysfunction is high in depressed patients. It significantly impacts the couple's quality of life. Although our main limitation was the small sample size which prevented us from doing a multi-varied analysis, the robust nature of this study lies in documenting the initial prevalence and types of sexual dysfunctions in both sexes in the first major depressive episode unrelated to the dysfunctions induced by antidepressant drugs. The early identification of sexual disorders and the consideration of couple dynamics would be two important elements in the management of the depressed patient.

[Risk factors related to homicide in Moroccan patients with schizophrenia]. / Facteurs de risque de passage à l'acte d'homicide chez des patients marocains atteints de schizophrénie.

BACKGROUND: Persons with schizophrenia are thought to be at increased risk of committing violent crime - 4 to 6 times the level of general population individuals without this disorder. The relationship between schizophrenia and homicide is complex and cannot be reduced to a simple causal link. OBJECTIVES: The objectives of this study were to describe the characteristics of homicide in Moroccan patients suffering from schizophrenia and to determine the correlated sociodemographic, clinical and toxic variables. METHODS: The study included two groups of patients with a DSM IV diagnosis of schizophrenia who attended the "Ibn Nafis" university psychiatric hospital of Marrakech in Morocco. The first group was composed of 30 patients hospitalized for homicide in the forensic unit between 1 January 2005 and 31 August 2015. The second group included 90 patients without any criminal record. These two groups have been matched according to age and gender. Demographic, clinical and therapeutic variables were analyzed and compared between the two groups. RESULTS: Data analysis has objectified the following results: the mean of age in the first group was 37.03 (±9.09) and in the second group was 31.4 (±8.76). No significant differences were found between the two groups regarding the different sociodemographic variables and the age of onset of disease. Significant differences were found between the two groups regarding: personal antecedents of attempt of homicide (P=0.003), personal antecedents of attempt of suicide (P<0.001), a history of previous violence (P=0.005), untreated psychosis before the act (P<0.001), poor medication compliance and a low familial support (P<0.001), antisocial behavior (P<0.001) and addictive behavior (P=0.005). DISCUSSION: Several studies identified some possible predictor factors for violent behavior: poor compliance, lack of insight impulsivity and paranoid-hallucinatory symptoms, systematized delusions and addictive behavior seem to considerably increase the risk of turning to violence. Demographic variables as suggested by other studies are less valuable predictors of homicide in patients with schizophrenia. CONCLUSION: Awareness of these factors will allow us to provide improved prevention of violence within schizophrenic subjects. Interventions for reducing such behavior should focus on clinical variables and integrate an early diagnosis of the disease and an improvement of medication compliance.

[Family violence]. / Violence familiale.

INTRODUCTION: Family violence is a serious public health problem, the scale of which is seriously increasing in Morocco. Although it has existed for a long time, we ignore the real characteristics of this plague in our country; our work consisted in an epidemiological approach of family violence in Marrakech during 2006. METHOD: After elaborating a questionnaire, which allows the study of the demographic and social profile of the families, the study of violence exercised in the family and the evaluation of the depression in the women, we led an inquiry amongst 265 women. RESULTS: Analysis of the results obtained has allowed us to underline the following characteristics: 16.6% of the women in our sample had been physically beaten; the young age is a risk factor; the age range most affected by violence is in women between the ages of 30 and 40 and which represent 39% of the battered women; domestic violence touches all the social, economic and cultural classes: in our study, 63% of the women having undergone violence were housewives, 25% were managers and 3% senior executives; family problems were the most important cause of violence in our study, representing 32.32%. Requests for money was the cause in 11.3% of the cases, and imposed sexual relations were found in 6.8% of the cases; alcoholism is an aggravating factor of family violence; 27.3% of the spouses who assaulted their wives were drunk; 52% of the assaulted women were victims of violence in childhood and 36% had been witness to their father's violence; in 63.6% of the cases of violence, the children were witnesses, and in 25% of the cases the children were victims of violence at the same time as their mothers; 50% of the women victims of violence did not react, while 38.6% left home, and 9.1 filed for divorce. Thirty-two percent of the assaulted woman had been traumatised by the aggression; the association of depression and violence was very high, 343% of the battered women in our study suffered from severe depression. CONCLUSION: This work underlines the necessity of an urgent intervention in order to limit the extension of this plague and its consequences.

[Depressive disorders in diabetic patients]. / Les troubles dépressifs chez les patients diabétiques du centre hospitalier universitaire Mohammed VI de Marrakech au Maroc.

INTRODUCTION: Diabetes is a public health problem. Its global prevalence was 2.8% in 2000 and it will reach 4.4% in 2030 to be 366 million diabetics. In Morocco, this true "epidemic" affects 6.6% of the population. Many epidemiologic studies have shown that patients with diabetes are more susceptible to depression. Diabetes and depression align in a non-accidental way and complicate one another. PATIENTS AND METHODS: We report a cross-sectional study conducted in association with the endocrinology department of the Mohammed VI university hospital during the period spread between April and September 2006. The aim was to evaluate the prevalence of depressive disorders in patients with diabetes and to describe their sociodemographic and clinical profile. The study included 187 patients. The scales used were the Mini International Neuropsychiatric Interview (MINI) and Hamilton's depression. Sociodemographics and diabetic characteristics were evaluated by self-questionnaire. RESULTS: The average age of our patients was 53±14 years and the percentage of females was high: 71.2%. Diabetes type 2 was the most representative (85.6%), diabetes type 1 (11.8%) and gestational diabetes (2.7%). Half of diabetics were treated with an association of healthy dietary measures (MHD) and oral anti-diabetics; 31.6% were under MHD and insulin therapy; 33.2% of patients had acute complications and 43.5% had degenerative complications. Only 11 patients (5.9%) had antecedents of depression. The prevalence of major depressive episode was 41.2%; 27.8% of patients suffered from dysthymia and 21.9% from double depression. Hamilton's depression scale indicates that all depressed patients had mild depression (total of 17 items from 8 to 17). Major depressive episode and dysthymia were frequent in out patients. Dysthymia was predominant in diabetic patients in the 46 to 55 years age group, never been schooled and without any comorbidity. The vast majority of patients with EDM had type 2 diabetes with 89.6%, 7.8% type 1 diabetes and 2.6% gestational diabetes. Most of dysthymic patients had type 2 diabetes with 94.2% against 5.8% type 1 diabetes. DISCUSSION: The association of depression and diabetes was noted in the literature for the first time more than 300 years ago by the English doctor Willis. Compared to the population of non-depressed subjects, patients with depression may be more likely to develop type 2 diabetes. There would be an increase in the release of hyperglycemic hormones in depression, as in the stress response. In addition, patients with depression have insulin resistance during testing tolerance to insulin, and during testing tolerance to glucose. Other hypotheses explain that the depression/diabetes link included biological and genetic resources. CONCLUSION: Diabetes and depressive disorders are public health problems due to their prevalence and their cost. The prevalence of major depressive disorders found among our population of diabetics justifies their research by doctors. The literature promotes appropriate care that would improve the prognosis of diabetes, as well as depression-increased mortality among diabetics.

[Schizotypal personality in academia]. / Personnalité schizotypique en milieu universitaire à Marrakech (Maroc).

INTRODUCTION: Schizotypal personality, otherwise known as "latent schizophrenia" is a personality disorder accepted in the spectrum of schizophrenia. Its prevalence is 3% of the general population. The schizotypal personality questionnaire (SPQ) developed by Raine is one of the most-widely used auto-evaluation instruments for the study of this personality disorder, it allows the rapid diagnosis of schizotypal personality, using 74 items divided into nine lower scales, evaluating the total DSM IV-R criteria of this disorder. AIM OF THE STUDY: To explore the schizotypal personality among students in two Moroccan establishments, the medical school in Marrakech and the College of Technology in Safi (EST), through the Raine's SPQ, and to describe the sociodemographic profile of students with schizotypal traits. METHODS: This is a retrospective study concerning a sample of the first round students in two university sites in Morocco (the medical school in Marrakech and the College of Technology in Safi). The investigation began on October 2004 and was spread over a period of 6 months. The questionnaire was anonymous, divided into two parts; the first part concerning sociodemographic characteristics and the second exploring the SPQ, developed by Raine, assessing nine schizotypal traits specified as such in the DSM IV-R. RESULTS: The average score was 25.33 ± 11.77; with the upper and lower threshold values 44/74 and 10/74 respectively. Males were predominant among schizotypal students (7.24% versus 3.62% among females). Moreover, most of the schizotypal students (16.7%) were living with their parents, 1.4% living alone and only 0.7% with their friends. In the schizotypal students, 11.6% were pursuing their studies in the College of Technology in Safi, and 6.8% in the medical school of Marrakech. The average score for the SPQ was 25.33 ± 11.77 (minimal score 2/74 and maximal score 52/74). Excessive social anxiety total score was 518, the distrust total score was 496, and the lack of close friends total score was 449. Concerning scores for the sub scales: poverty affects, bizarre speech, reference ideas, perceptual experiences, unusual and bizarre beliefs, were respectively 434 (mean 2.94), 430 (mean 2.91); 422 (mean 2.88), 410 (mean 2.66), 337 (mean 2.30). Bizarre and eccentric behavior's total score was 309 (mean 1.97). Finally, our study could not find a relationship between the schizotypal disorder and the consumption of illicit drugs. DISCUSSION: Schizotypal personality disorder is considered as a trouble-generator spectrum of schizophrenia; patients with this disorder are at high risk of developing schizophrenia, particularly when not detected earlier. The average SPQ questionnaire score in our sample was 25.33+11.77. Very similar scores are found in other studies concerning student populations. According to the method of Raine threshold, scores have been defined by the values corresponding to 10-degree and 90-degree percentile distribution of collected scores. In our study, these lower and upper threshold scores were 10/74 and 44/74 which appear similar to those calculated by Raine (12/74 and 41/74), Dumas et al. (9/74 and 40/74), Dumas et al. (7/74 and 40/74), and in the study of Gaha et al. who found upper and lower threshold score of respectively 9/74 and 42/74. Several epidemiological studies conducted since the early 1990s indicate that the lifetime prevalence of drug consumption (abuse or dependence) is nearly 50% in schizotypal personality before the outbreak of schizophrenic symptoms, schizotypal personalities tend to consume these substances to relieve their anhedonia, to socialize and to allay their anxiety, which explains the co-occurrence of schizophrenia and drug consumption.

Mental health of Moroccan women, a sexual perspective.

Sexuality is a complex process coordinated with neurological, vascular, and endocrine systems. It incorporates family, societal, and religious beliefs and interpersonal relationships. Sexuality in the Muslim world is further complexed by tradition and discrimination of women. Studies conducted in Ibn Rushd University Psychiatric Center, Casablanca, Morocco, explored various aspects of sexuality in a traditional Muslim society: sexual behaviour (representative sample of Casablanca population n=728), sexual dysfunction (n=644), prevalence of abuse during childhood, effect of breast removal on sexuality (prospective study on 100 patients), effect of menopause on sexuality (comparative study between Moroccan and Tunisian samples, n=200), pregnancy and sexuality (follow up study in primary health care, n=100), and Ramadan and sexuality among healthy fasting people.