Biomedical subjects
Publications and source records attributed to D Moussaoui.
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.
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.
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.
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.
OBJECTIVES: We hypothesized that people in Morocco are more irritable during the month of Ramadan than during the rest of the year. Our objectives were to measure irritability in fasting Muslims during the month of Ramadan, to describe its various modes of expression, and to examine risk factors for this irritability. METHODS AND SUBJECTS: We studied 100 healthy volunteers during the month of Ramadan for two successive years (1994 and 1995). All subjects were male (mean age, 32+/-5.8 years), and 51% of them were smokers. Irritability was assessed over a 6-week period (before, four times during, and after the end of Ramadan). We assessed both subjective (visual analog scale) and objective irritability. We also recorded the consumption of psychostimulants, duration of sleep, and anxiety level as measured by the Hamilton Anxiety Scale. RESULTS: Irritability was significantly higher in smokers than in nonsmokers before the beginning of Ramadan. It was higher in both groups during the Ramadan month. Irritability increased continuously during Ramadan and reached its peak at the end of the month. Consumption of psychostimulants (coffee and tea) and anxiety level followed the same pattern. Smokers and nonsmokers had a similar pattern of irritability over time, but irritability increased more in smokers than in nonsmokers.
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.
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.
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.
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.
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.
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?
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