Factors associated with psychological burden of breast cancer in women in Morocco: cross­sectional study.

BACKGROUND: Depression and anxiety are among the psychological diagnoses impacting individuals diagnosed with breast cancer. This study aims to estimate the prevalence, as well as the predictors, of anxiety and depression in women with breast cancer. MATERIALS AND METHODS: This was a cross-sectional, multi-center study conducted over an eight-month period among women with breast cancer in oncology centers in southern Morocco. Anxiety and depression were assessed using the validated Moroccan dialectal version of the Hospital Anxiety and Depression Scale (HADs). To identify the predictors of anxiety and depression in the study population. Multiple linear regression analyses were performed, including variables for which univariate analyses were significant with a p < 0.05 value. Statistical analyses were performed using Jamovi software version 2.2.3. RESULTS: A total of 230 participant responses were collected. The prevalence of anxiety and depression was 77.4% and 62.6%, respectively. Multiple linear regression analysis revealed the following factors increased anxiety: being younger than 50 years old, not having studied beyond elementary school, having children aged between 10 and 18 and having TNM stage III and IV. The following factors decreased anxiety in patients with breast cancer: good physical functioning (Karnofsky score), satisfaction with social support and financial support. Regarding depression, the following factors decreased depression: good physical functioning (Karnofsky score), a minimum of 2.5 h per week of physical activity, active occupational status, satisfaction with social support and financial support. In contrast, the recurrence of breast cancer was an associated factor with increased depression. CONCLUSION: The prevalence of anxiety and depression in women with breast cancer is very high in our context. Therefore, routine screening tests for depression and anxiety as well as psychosocial management care are necessary for patients with breast cancer in Morocco.

[Acute psychotic episodes related to the COVID-19 pandemic]. / Les accès psychotiques aigus liés à la pandémie COVID-19.

The world is currently going through an extremely stressful time due to the COVID-19 pandemic. This exceptional and alarming situation could increase the incidence of mental health problems, including acute psychotic disorders. Our observation reports two cases of patients with an acute psychotic episode, with a delusional theme related to the coronavirus pandemic. The two patients, who did not have a previous history of psychiatric disorders, were hospitalized in our psychiatry department, after the start of mandatory sanitary confinement in our country. The clinical symptoms found were mainly a hallucinatory syndrome and a delusional syndrome with a religious theme, and delusional ideas centered on COVID-19. This case report suggests that intense psychosocial stress, caused by the current global crisis and confinement measures, may be a trigger for new-onset psychotic episodes, and impact the clinical and delusional expression of acute psychosis.

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

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

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

BACKGROUND: Lhermitte-Duclos disease (LDD) is a rare cerebellar lesion characterized by a hamartomatous lesion in the posterior fossa. Mainly diagnosed by MRI, the clinical presentation is usually made of neurological symptoms. CASE PRESENTATION: We present here a rare case of a woman who developed depressive symptoms that inaugurated the clinical presentation of LDD. CONCLUSION: Psychiatric symptoms may occur in all brain lesions, delaying the diagnosis and causing therapeutic escalation. More attention should be given by practitioners to psychiatric aspects of LDD.

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

INTRODUCTION: Several COVID-19 vaccines have been implemented. However, some side effects of the vaccine have been reported, which are sometimes very harmful. Reported cases and data are still very limited regarding the psychiatric side effects of the COVID-19 vaccine. To our knowledge, only one case has been reported. In this paper, we report the case of a patient who presented an acute depressive episode 24 hours after receiving his first dose of the BNT162b2mRNA vaccine. CASE REPORT: The case was a 26-year-old man with a history of Down syndrome with moderately good autonomy for daily routine tasks. The patient, who presented hypothyroidism at 10 years old and schizophrenia at 15 years old, was doing well before the vaccination and received his first dose of the BNT162b2mRNA vaccine. Twenty-four hours later, he presented depressive symptoms that resolved spontaneously after one week. Then, fifteen days later, the symptoms reappeared, and the episode lasted for 5 weeks. The patient received 10 mg/day of escitalopram besides his usual treatment. The depressive symptoms improved considerably by the second day of treatment. DISCUSSION: The presented case illustrated significant diagnostic challenges, especially when taking into account the sequential relationship between the COVID-19 vaccine and the occurrence of depressive symptoms. A single case of depression has been reported after the administration of the COVID-19 vaccine. Scientific evidence suggests the important role of the immune system in the pathophysiology of various psychiatric disorders, including depression. CONCLUSION: Health professionals must take into consideration the potential psychiatric side effects even being rare so far, especially in vulnerable subjects. Further studies are required to establish the causal effects of depressive symptoms occurring during the weeks following the COVID-19 vaccine bolus injection.

Prevalence of and Risk Factors for Suicide Attempts Among Patients With Severe Psychiatric Disorders in Eastern Morocco.

Background: Suicide attempts are common in patients with severe psychiatric disorders; however, they are rarely studied in this population. Aims: To investigate the prevalence and risk factors associated with suicide attempts among patients with severe psychiatric disorders. Method: This is a cross-sectional study of patients admitted to the Mohammed VI University Hospital of Psychiatry in Oujda, Morocco. Results: A total of 250 patients with a psychiatric disorder were recruited in this study. Among these, 78 cases (31.2%) had a personal history of suicide attempts. A personal history of suicide attempt was significantly higher among women compared to men (45.5% vs. 27.2%, p = .0099). The most common method of suicide attempts was jumping from heights (31%). Patients with a personal history of suicide attempts had a significantly higher prevalence of alcohol consumption (p = .0063), family history of psychiatric disorders (p = .002), family history of suicide attempt (p = .00004), and family history of suicide (p = .018) compared to those who had never made suicide attempts. Limitations: As suicidal behavior is highly stigmatized in Morocco, the number of patients who have made a suicide attempt may be underestimated. Conclusion: Our findings justify the need to provide specialized support to psychiatric patients with risk factors for suicide attempts.

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

Background: Recent studies on nursing and medical students showed a higher prevalence of depression and stress than the general population. Religiosity and spirituality are common in Muslim countries and are usually used as a means of coping strategy for psychological and mental disorders. Objective: Our objective was to evaluate the association between religious actions, depressive symptoms, and stress among students of nursing education lasting 3 years and students from the first 3 years of medical education lasting 7 years. The study was conducted at Ibn Zohr University of Agadir, Morocco. Method: A sample of different stages of nursing and medical students was recruited. Religiosity was assessed by Muslim Belief into Action (M.BIAC) scale. The depressive symptoms and stress were, respectively, assessed by the Beck Depression Inventory (BDI-II) and Perceived Stress Scale (PSS). Results: Four hundred and thirteen students participated in this study. Our results showed a high prevalence of depressive symptoms (62.2%) and stress (66.8%). The depression scores were higher in the following subsample categories: students in the first 2 years of studies, female medical students, and nursing students with significant differences. The recorded religiosity was greater among students without depression compared to students with depression (p < 0.001). In the multivariate regression, the BIAC score demonstrated religiosity as neither a risk factor nor a protective factor of depression. Conclusion: Religiosity constitutes a protective factor of depression and stress among nursing and medical students. This should improve the student's ability to cope with stressful situations during their training. Prospective studies are needed to further investigate this association and how religiosity improves mental health. This would contribute to improved academic performance and wellbeing among medical and nursing students.

Are Patients with Schizophrenia Reliably Reporting their Cannabis Use? An African Cross-sectional Study.

BACKGROUND: Most studies of the prevalence of cannabis use among patients with schizophrenia used a self-report as declared by the patient himself. We hypothesize that patients with schizophrenia did not tell the truth and might underreport their use for many reasons to be discussed later. Indeed, the under-report of cannabis use among these patients can affect the effectiveness of their treatment. AIMS: To assess the degree of agreement between the prevalence values obtained from patients' reports and the results of the toxicological tests. METHODS: A cross-sectional study was carried out on 403 patients with schizophrenia. A sociodemographic, psychiatric history and illicit drug use profile was performed for each patient. We assessed the patients with the Positive and Negative Syndrome Scale (PANSS), Calgary Depression score (CDSS), Barratt Impulsiveness Score (BIS-10) and Medication Adherence Rating Scale (MARS). The consumption of cannabis used was confirmed with MINI International Neuropsychiatric Interview (MINI-DSM IV) and using toxicological analysis. RESULTS: Among the 403 patients who consented to give their urine samples, 49.1% (198/403) tested positive for cannabis, and 41.41% (82/198) underreported their use. The sensitivity and specificity of the questionnaire were 0.58 and 0.74. Based on the comparison between sociodemographic and psychiatric history data of patients who self-report and underreport their cannabis use, no significant difference was observed except for the duration of cannabis use and the score on the medication adherence scale. Moreover, it was found that impulsivity, PANSS score, CDSS score, and the type of schizophrenia are not involved in predicting the underreporting of cannabis use. CONCLUSION: The rate of patients who under-report cannabis use is important. Therefore, toxicological analysis is becoming relevant for identifying drug use among schizophrenic patients and in the addictive comorbidity research field.

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

OBJECTIVE: The aim of this paper is to demonstrate the impact of heavy and chronic cannabis use on brain potential functional control, reorganization, and plasticity in the cortical area. METHODS: 23 cannabis users were convened in 3 user's groups. The first group included 11 volunteers with an average of 15 joins/day; the second group included 6 volunteers with an average of 1.5 joins/day; the third group included 6 volunteers with an average of 2.8 joins/week. Besides, a 6 healthy volunteers (control group). All healthy and cannabis users underwent identical brain BOLD-fMRI assessment of the motor function. Besides, neuropsychological and full biological assessments were achieved. RESULTS: BOLD-fMRI maps of motor areas were obtained, including quantitative evaluation of the activations in the motor area. Besides, statistical analysis of various groups was achieved. CONCLUSION: Chronic cannabis addiction of varying use strength by groups of heavy, moderate, low dose, and zero doses are shown to have systematically equivalent effects on the control of brain motor function. Indeed, the BOLD-fMRI shows a remarkable sensitivity to minimal brain plasticity and reorganization of the functional motor control of the studied cortical area, and such varionation was not shown. Specific elucidation of the cannabis effect mechanisms in this unique function should clarify further protective pharmacological effects. This might illuminate the use of neuronal resources to prepare processes for pharmacological use and pharmaceutical forms. This suggests exploring any potential cannabis pharmaceutical form in diseases involving motor impairments.

Determining factors of anxiety in patients at the preoperative stage.

OBJECTIVE: To estimate patient preoperative anxiety, and determine associated factors. METHODS: Fifty surgical patients were investigated prospectively at the University Hospital, Rabat, Morocco between January and June 2008. Ethical Committee approval was obtained prior to conducting this study. A short version of the Hamilton scale was used. Descriptive statistics, student`s t-test, and ANOVA were performed to probe the sociodemographic impact factors on Hamilton scores. We investigated scores superior to 14 indicating a pathologic anxiety situation. A logistic regression was carried out by including all variables; the significant threshold was 0.15 in single variable analysis, and we retained a significant threshold of 0.05 in the final model. RESULTS: A significant decrease in anxiety from the preoperative to the postoperative stage was observed in all patients of merged surgery groups. Females had higher preoperational anxiety compared with males. A longer hospitalization stay and lower knowledge of patients regarding their pathologies were the main factors that increased the anxiety scores towards a pathological anxiety state. This applied to all patients, including higher education and prosperous social classes. CONCLUSION: Patient sociodemographic, psychological history, and surgery type have to be considered for identifying patients at risk for developing anxiety before and after surgery. Psychological support has to be established to avoid additional suffering of the patient from anxiety.

Determining factors for Cannabis use among Moroccans Schizophrenic Patients: A cross sectional study.

OBJECTIVE: Cannabis use is considered a major clinical problem associated with a poorer outcome in patients with schizophrenia. The objective of the present study was to assess the prevalence of cannabis us among patients with schizophrenia. The assessment consists in comparing some factors related to substance use in a population of schizophrenic patients between cannabis users and non. MATERIALS AND METHODS: Four hundred and three participants who were examined prospectively during their hospitalization answered the PANNS scale of schizophrenia, GAF, BIS-10, CDSS, and MARS. The consumption of cannabis was investigated using urine toxicological analysis. Sociodemographic, clinical and therapeutic data were also recorded. RESULTS: The prevalence of cannabis use among schizophrenic inpatients was 49%. Patients with cannabis use were younger (31.7 vs 34.9 years old, p<0.001), more often male (52 vs 20% female, p<0.001), and they presented more often a history of imprisonment (68.8% vs 31.2%, p<0.001). Patients who were users of cannabis had a lower age at onset of the disease than non-users (23.6 vs 24.8 years, p=0.029), and more often with poor medication adherence (p=0.001). Logistic regression revealed that factors associated with cannabis use among schizophrenics were the age, gender, history of imprisonment and poor medication adherence. CONCLUSION: The study showed that a high prevalence of cannabis use among patients with schizophrenia which was associated with negative overall outcomes. Determining comorbid substance use disorders among schizophrenic patients is crucial as it may contribute to establish a better therapeutic strategy.

[Folie à deux, symptoms sharing us a relationship modality: a case report]. / Folie à deux ou le partage de symptômes comme modalité relationnelle: à propos d'un cas.

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

Eating disorders among Moroccan medical students: cognition and behavior.

INTRODUCTION AND AIM: Eating disorders (EDs) are complex, multifactorial diseases linked to biological, developmental, psychological, and sociocultural factors. Medical students are among subjects at high risk of EDs. The aim of the present investigation was to evaluate EDs among 710 Moroccan medical students with a focus on cognition and behavior related to EDs. METHODS: Sociodemographic, economic, and clinical data were collected. Validated questionnaires, such as the SCOFF (Sick, Control, One Stone, Fat, Food) questionnaire and the Eating Disorder Inventory 2 (EDI2), were administered. RESULTS: The male:female ratio was 0.53, mean age was 21±2 years, 11.1% of participants were underweight, 13.4% were overweight, and 1.8% were obese. A middle socioeconomic level was found in 84.9% of cases. The prevalence of EDs in students was 32.8% (37.6% among females and 23.7% among males) and that of weight-control behaviors 18.5%. Increased body-mass index values were significantly associated with dieting (P<0.001), fasting (P=0.044), and the use of appetite suppressants (P=0.037). CONCLUSION: It appears that the impact of EDs is high, affecting a third of medical students, with significant use of harmful weight-control behaviors. We also found that dimensions of bulimia, perfectionism, body dissatisfaction, and ineffectiveness, parts of the core of EDs, were found in future medical practitioners.

Emotion processing in Parkinson's disease: a blood oxygenation level-dependent functional magnetic resonance imaging study.

Parkinson's disease is a neurodegenerative disorder caused by loss of dopamine neurons in the substantia nigra pars compacta. Tremor, rigidity, and bradykinesia are the major symptoms of the disease. These motor impairments are often accompanied by affective and emotional dysfunctions which have been largely studied over the last decade. The aim of this study was to investigate emotional processing organization in the brain of patients with Parkinson's disease and to explore whether there are differences between recognition of different types of emotions in Parkinson's disease. We examined 18 patients with Parkinson's disease (8 men, 10 women) with no history of neurological or psychiatric comorbidities. All these patients underwent identical brain blood oxygenation level-dependent functional magnetic resonance imaging for emotion evaluation. Blood oxygenation level-dependent functional magnetic resonance imaging results revealed that the occipito-temporal cortices, insula, orbitofrontal cortex, basal ganglia, and parietal cortex which are involved in emotion processing, were activated during the functional control. Additionally, positive emotions activate larger volumes of the same anatomical entities than neutral and negative emotions. Results also revealed that Parkinson's disease associated with emotional disorders are increasingly recognized as disabling as classic motor symptoms. These findings help clinical physicians to recognize the emotional dysfunction of patients with Parkinson's disease.

[Acute psychosis secondary to dysthyroidism: about 2 cases]. / Psychose aigüe secondaire à une dysthyroïdie: à propos de 2 cas.

Thyroid function abnormalities are common and affect nearly 5% of the general population, with a female predominance. The occurrence of mental disorders, especially mood disorders, during thyroid diseases is known since a century, while psychotic disorders associated with dysthyroidisms are rarely described. We report 2 cases of patients with psychotic disorders showing two different situations: the first of which following hyperthyroidism with poor medication adherence and the second secondary to hypothyroidism after thyroidectomy. These cases highlight the role for thyroid hormonal balance in the onset of psychotic manifestations and emphasize the need to eliminate dysthyroidism before any psychotropic treatment.

[Nosographic considerations on delusional parasitosis based on three clinical observations]. / Considérations nosographiques sur le délire d'infestation parasitaire à travers trois observations cliniques.

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