Can a brief training intervention on schizophrenia and depression improve knowledge, attitudes and practices of primary healthcare workers? The experience in Armenia.

BACKGROUND: Although the World Health Organization has called for mental health services to be integrated into primary care, mental health remains in most countries, and especially in low- and middle-income countries, one of the most neglected topics in the training curriculum of frontline health workers. As a result, primary healthcare professionals leave medical and nursing schools with insufficient knowledge, and often with negative attitudes towards mental disorders. AIM: We investigated the effect of a brief training intervention on schizophrenia and depression conducted among general practitioners and nurses in Armenia. METHODS: Training interventions were one-day, face-to-face, interactive workshops, including didactic presentations and discussions of case studies. We used a quasi-experimental design of the before/after type, to compare data on knowledge, attitudes and practices collected before and after the training sessions. RESULTS: Mean scores for knowledge, attitudes and practices increased significantly (p < 0.001) among both nurses and GPs for both schizophrenia (111 GPs and 167 nurses) and depression (459 GPs and 197 nurses). CONCLUSIONS: Our experience suggests that a brief training intervention can result in significant improvements in knowledge, attitudes and practices among primary healthcare workers and could help improve mental health services.

[Mirror syndrome: literature review based on a case]. / Le syndrome miroir: revue de la littérature illustrée par un cas.

Mirror syndrome or Ballantyne syndrome is a rare disease, characterized by the association between fetal anasarca and maternal generalized edema. This may be complicated by pre-eclampsia. The purpose of this study was to highlight the diagnostic and therapeutic features of this severe clinical entity, which, despite its rarity, should be suspected. We here report the clinical case of a 35-year-old parturient woman at 26 weeks of amenorrhea presenting to the Emergency Department with idiopathic mirror syndrome whose progression was rapidly marked by the occurrence of intrauterine fetal death and remission of maternal clinical-biological symptoms, once uterine vacuity was obtained. Indeed, a specific treatment in uterus is necessary, although in some severe idiopathic cases, only uterine vacuity can improve maternal and fetal prognosis.

[Delayed delivery in multiple pregnancy: about a case and literature review]. / Accouchement différé d´une grossesse multiple: à propos d´un cas et revue de la littérature.

Delayed delivery is designed to allow the remaining fetus(es) to develop after premature expulsion of the first twin in the second trimester of pregnancy. This decision is aimed to allow the remaining fetus(es) to reach full fetal growth. We here report a clinical case of delayed delivery in a patient with triple pregnancy in whom the time between the expulsion of the first twin and the birth of the third twin was 10 weeks. The purpose of this study was to highlight the benefit and indications for delayed delivery.

[Peripartum cardiomyopathy]. / Cardiomyopathie du péripartum.

Peripartum cardiomyopathy (PP-CMP) or Meadows' syndrom, is a dilated cardiomyopathy which occurs during or following pregnancy. It is characterized by heart failure with a systolic left ventricle ejection fraction of less than 45%. It is rare and its pathophysiologic mechanism is poorly elucidated. From a clinical point of view, it is characterized by unespected heart failure with rapid onset of symptoms, unpredictable evolution and risk of refractory cardiogenic shock, justifying patient's management in Cardiovascular Unit. PP-CMP requires no specific treatment compared to other causes of heart failure. We here report the case of a 29-year old primip at 32 weeks of amenorrhea presenting with congestive heart failure associated with peripartum cardiomyopathy. The aim of this study was to highlight the features of this heart disease which, despite its rarity, should not be disregarded by obstetricians.

Prevalence of anxiety disorders: a population-based epidemiological study in metropolitan area of Casablanca, Morocco.

BACKGROUND: In Morocco, no epidemiological study has been conducted to show the current prevalence of mental disorders in the general population. The aim of the present study was to assess the prevalence and comorbidity of anxiety disorders in Moroccan subjects. METHODS: We used cross-sectional study, with a representative sample of Casablanca city. Direct interviews used the Mini International Neuropsychiatric Interview in its validated Moroccan Arabic version RESULTS: Among 800 subjects, 25.5% met criteria of at least one current anxiety disorder: Panic Disorder (2%), Agoraphobia (7.6%) Social phobia (3.4), Obsessive Compulsive Disorder (6.1%), Post Traumatic Stress Disorder (3.4%), Generalized Anxiety Disorder (4.3%) CONCLUSION: The results are generally similar to those of Western countries. Future studies need to replicate these results and to concentrate on their impact on the quality of life and the cost of such conditions in the community.

[Psychiatry and mental health in Morocco]. / Psychiatrie et santé mentale au Maroc.

Morocco has a population of some thirty million inhabitants, a very large proportion of whom are young. Mental health and psychiatry are dealt with jointly by the university, public, private, and military sectors. Despite significant progress in the last twenty years, there are still no more than 350 psychiatrists in Morocco (thirty years ago there were fewer than ten...), plus about 60 clinical psychologists, about 400 nurses specializing in psychiatry, and social workers. There are about 1900 psychiatric beds in both specialized hospitals and general hospital psychiatry units located in the main cities. In the teaching sector there are currently four university psychiatry departments, with a total of five full professors, six associate professors and five assistant professors. The National Mental Health Program, launched in 1974 and revised in 1994, was not properly implemented. Several NGOs also work in psychiatry and mental health, including the League for Mental Health and five patient associations. A national survey of the prevalence of mental disorders, completed in 2003 but only made public in 2007, represented a watershed for psychiatry in Morocco: 48.9% of a sample of 5600 persons representative of the general population were found to have a mental disorder, and 26.5% of respondents were depressed. This survey is an invaluable reference for years to come, helping to match mental healthcare provision with real needs. Research activity has also progressed since the early 1980s, as reflected by the number and quality of publications in the different fields, including epidemiology, biological psychiatry, social psychiatry, psychopharmacology and clinical psychopathology. Cultural aspects are a special research focus (suicide and religion, cannabis use, traditional treatments, etc.). International university collaboration has been especially important for Moroccan research. However, despite major progress over the last three decades in the fields of psychiatry and mental health, much remains to be done, notably to bolster child and adolescent psychiatry, and to manage mental illness in small towns and villages, including in the remotest regions.

[Struma ovarii: a rare case of giant ovarian cyst]. / Struma ovarii: un cas rare de kyste ovarien géant.

Struma ovarii is a rare tumor, which accounts for 2.7% of ovarian teratomas and 0.01% of ovarian tumors. It usually affects women in the fifth decades of life and is most often detected incidentally during ultrasound and then confirmed histologically. The gold standard treatment is surgery and prognosis is excellent. We here report the particular case of a young female patient with giant struma ovarii whose radiological features were classified as unusual presentation. We match patient's data with those from the literature.

[Idiopathic intracranial hypertension: a rare case related to pregnancy]. / Hypertension intracrânienne idiopathique: à propos d'un cas rare associé à la grossesse.

We report the case of a 25-year old primipara whose pregnancy was complicated by idiopathic intracranial hypertension (ICHT) associated with visual impairment in the first quarter. She underwent lumboperitoneal shunt without obstetric consequences. This study aimed to determine the features of this rare pathological entity whose pathophysiological mechanism is poorly elucidated. It would be caused by poor absorption of cerebrospinal fluid (CSF) through the arachnoid granulations. Major risk factors are: obesity, polycystic ovary syndrome, thrombophilia and hyperfibrinolyse. Diagnosis is based on modified Dandy criteria after negative clinico-biological and radiological assessment. Visual prognosis is compromised, as in the case of « classical ¼ ICHT. However, there is no risk for cerebral involvements which could be life-threatening. In addition, this disease does not influence pregnancy outcome. This said, rapid and effective treatment should be implemented in order to preserve visual function in these patients.