Erectile dysfunction with antipsychotics: prevalence and associated factors

The presence of associated or antipsychotics induced sexual disorders complicates the management of schizophrenia. These disorders are not well diagnosed and studied. Evaluate the prevalence of erectile dysfunction in a population of schizophrenic patients taking antipsychotics, and search for associated risk factors. This is a cross-sectional study on 52 schizophrenic patients stabilized on antispychotic. We used the [International Index of Erectile Dysfunction] scale, and the data analyzed by statical software. The prevalence of this disorders is 63.5%. Univariate logistic regression shows that it is related to the type of schizophrenia [paranoid] and antipsychotics association. Related studies show that antipsychotics improve desire and frequency of sexual thoughts, but cause erectile and orgasm dysfunction and decreased sexual satisfaction. Drug combinations are generally not recommended. Sexual disorders induced by antipsychotics in schizophrenics patients are very harmful. These sexual dysfunction must be diagnosed, explained and treated quickly

Somatoform disorders and depression: comorbidity and problems of management

Somatoform disorders are characterized by the presence of physical symptoms without organic lesion or pathophysiological mechanism. The use of antidepressants is quite common, even in the absence of associated depressive disorder. We will assess the prevalence of depression in a population of patients with somatoform disorders, and discuss the difficulties of management of these disorders. This is an observational cross-sectional study, about 152 patients. Diagnoses were made according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders in its fourth revised version. Data evaluation was performed using statistical software. This population is represented mostly by women [116[76.3%]], with low socioeconomic status [114[75%]] above 40 years age [43.5 +/- 14.6]. Prevalence of depression is 34%, with a predominance for somatization disorder [47.9%]. Comorbidity of these two disorders is common. The difficulties encountered in the management of these patients are especially of sociocultural nature, necessitating the adoption of appropriate psychotherapeutic measures. Clinicians should redouble their efforts to adapt the management of these disorders in our context

[Münchhausen syndrome by proxy]

Munchausen syndrome is a rare and little known disturbance, which corresponds to the current definition of "factitious disorder". In its "proxy" type, there is a child maltreatment by a person who is in charge. Its complexity is that it is part of a triangular relationship [parent-child-doctor]. We report the case of a 3 years old girl, who was subject of maltreatment by her mother, with repeated injections of salt spirit, which caused deep wounds with important mutilations. The unexplained injuries and their recurrence has raised the questions of the medical staff. The separation between mother and her child confirmed the diagnosis and has protected the patient. The clinical presentations of this syndrome are diverse, but with some common characteristics. The mother is often blamed and suffers rarely from psychiatric disorders. The observed improvement after her removal away from the child remains the most important element to confirm this diagnosis. This disorder must be suspected in presence of symptoms with clinically discordant evolution. When Munchausen syndrome by proxy is suspected, a specific course of action is needed, and child protection is required in the shortest possible time

[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

[Psycho-socio-pathological aspects of ulcerative colitis]

Ulcerative colitis is a chronic, severe and disabling disease whose etiology remains unclear. Studies are controversial regarding the role of psychopathological factors in its onset and evolution. psychiatrists have studied this disease for a long time. First, through the psychosomatic and psychoanalytic approaches, and then, with the development of neuro-physiology and the concept of stress. Thus, authors have described a number of characteristics in those patients, including the alexithymic dimension of personality; others have emphasized the role of stress and psycho-neuro-endocrine regulation mechanisms. Ulcerative colitis has also been linked with a higher incidence of psychiatric disorders, including anxiety and depression. But only the findings on the psychosocial impact of this disease are universally accepted. The development of psychosocial interventions aiming at ameliorating the quality of life of patients has also improved the prognosis of this disease

[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

[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