[Relationship between diabetes mellitus type 2 and depression]

Relation between diabetes and depression is bidirectional. Diabetics are at higher risk for developing depression, which is a risk factor for the onset of type 2 diabetes and its complications. We will illustrate these links through the cases of two patients. The first patient had a major depressive episode that has resisted treatment, and in whom the management of a discovered diabetes has improved the depressive symptoms. The second patient suffered from diabetic complications stabilized after treatment of a neglected depression. Several factors favor the occurrence of depression in diabetic patients: the low socioeconomic and education level, loneliness, stress, high levels of glycated hemoglobin and the presence of diabetic complications, especially neuropathic ones. Furthermore, depression can lead to eating disorders and sedentary lifestyle, favoring the development of obesity and type 2 diabetes; depression is also accompanied by biological changes that may increase vulnerability to diabetes. Therapeutic response to antidepressants is probably lower in diabetics

[Identification and evaluation of suicidal risk in general practice]

Suicide is a major public health problem in many countries. In morocco, and in the absence of official statistics, some indicators suggest that our country is not immune to this phenomenon. In current medical practice, any physician may be confronted with this problem, and therefore, must know how to detect and assess patients at risk. The presence of psychiatric disorders, especially depression, a history of suicide, impulsive behavior, severe somatic pathologies, and a context of solitude are proven vulnerabilities. The assessment of suicide risk requires well-conducted interview, to determine the risk, the urgency of the threat and the danger of suicide scenario, this assessment is preferably based on standardized tools, as the Mini International Neuropsychiatric Interview, which was translated and validated in Moroccan dialect. However, the problem of specificity and sensitivity of this evaluation still persists

[Depression in chronic hepatitis C: diagnosis and pharmacological treatment]

Interferon-alpha combined with Ribavirin is currently the standard treatment for chronic hepatitis C. although frequently effective, IFN-alpha induces has as series of psychiatric side effects responsible for the breakdown the treatment. Depression induced by IFN-alpha is the most common manifestation. It covers approximately one third of patients. Its symptoms are often overlooked during routine clinical interviews. For the diagnosis of this depression, it is recommended to use diagnostic tools such as the Mini-International Neuropsychiatric Interview for DSM-IV, translated and validated in Moroccan Arabic. The psychiatric evaluation before treatment, the initiation of antidepressant medication at the onset of the depressive episode and close monitoring of patients are needed to ensure safety and promote compliance to antiviral treatment. Although controversial, the preventive treatment with antidepressant medication might be beneficial for patients with significant depressive symptoms prior to antiviral therapy

[Prescription of psychotropic drugs in pregnant women]

Taking psychotropic drugs during pregnancy is now a common situation. It confronts the prescriber to the problem of risk-benefit balance. In pregnant women, there is a significant increase in the distribution and excretion of drugs; most of psychotropic medications pass easily the placenta, while the capacity of liver metabolism and renal excretion in the fetus are low. The use of those substances [antidepressants, anxiolytics, mood stabilizers and antipsychotics] is however possible during pregnancy, taking into account the precautions for each class. In the first trimester, the prescription is usually not recommended, especially for mood stabilizers belonging to the family of anticonvulsants. Using the lowest effective dose, of molecules having the more perspective, and reducing dosage, late in pregnancy, is recommended. Finally, parental involvement in decision-making is mandatory