Post-traumatic stress disorder in a veteran

Military, operational circumstances exposed to potentially traumatic situations involving life-threatening and complicated by both a state of post- traumatic stress events reflect the specific effects of psychological trauma. We report the case of a former 79-year-old fighter who has a state of post- traumatic stress disorder, whose symptoms were not suggestive. The patient reported having multiple events occurring after events threatening his life. He presented flashbacks of the event, with avoidance behavior and significant distress. The treatment was a basis of the associated Sertraline has adapted psychotherapy. The diagnostic identification of posttraumatic stress remains difficult. Support is a biological, psychological and social. Cells medico-psychological emergency is essential to prevent complications of victims of war, disasters, collective accidents, or accidents strong psychological impact. Posttraumatic stress is common with a chronic course, but sometimes it is difficult to recognize

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

[Neuropsychiatric disorder revealing carbon monoxide poisoning]

We report a unique and distinct clinical observation of a patient aged 52 years with acute reversible encephalopathy with late onset occurred 3 weeks after a mass poisoning of carbon monoxide [CO]. The clinical picture was dominated by cognitive associated with behavioral disorders, mood and judgment. Brain MRI [Magnetic resonance imaging] shows T2-weighted sequence Flair hyperintense extensive periventricular white matter and the centrum ovale and a bilateral hippocampal damage. The patient received hyperbaric oxygen therapy sessions. The evolution was marked by a dramatic improvement with complete disappearance of clinical and radiological signs. Finally, all isolated coma occurred in uncertain circumstances especially during winter and whose negative was etiology should encourage thinking about a toxic cause including carbon monoxide. Therefore, reflects a coma mass poisoning and should require very close clinical monitoring due to the subsequent development of a post-interval syndrome of neuropsychiatric order

[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

[Sexual assault and post-traumatic stress disorder]

Sexual assault is an assault on the physical and psychological integrity of the child. She is qualified when it is incest within the family. The posttraumatic stress disorder is a psychological reaction that can be substantial. Mr B. Nabil aged 25 was hospitalized for a psychiatric depressive syndrome. At the age of 6, his older brother was sexually assaulted. The child took refuge in silence and presented problems which regressed spontaneously rained a few weeks later. His adolescence was marked by relational instability, impulsivity and manifest a tendency to consumption of toxic substances. In adulthood, he enlisted in the army which he could difficultly adapted to the new situation until to the occurrence of an incident [sexual advances by a friend] who reactivated her painful memories. He presented a state of post-traumatic stress disorder complicated by depression and decided to break the silence wanting consultant in psychiatry. The posttraumatic stress disorder and depression are psychological consequences of sexual assault. The disclosure process is long, complex and painful. A multidisciplinary approach allowed the patient to overcome the shame, guilt and fear and to manage invasive and painful memories. The state of posttraumatic stress may persist for several years in the absence of treatment. An early care, sensitive and multidisciplinary improves prognosis

[ neuroleptic malignant syndrome]

This is one of the serious complications that can occur at any time during treatment with neuroleptics. Its prevalence is estimated at 0.01% - 0.02% in patients treated with neuroleptics. Patient aged 19 years hospitalized in psychiatry for schizophreniform disorder and put on haloperidol 15 mg / day chlorpromazine 200 mg / day. Fifteen days after admission, he shozed gradually: generalized muscle rigidity, difficulty walking and fatigability. All operating in a context of confusion and hyperthermia at 38.5[degree sign] C. determination of CPK was 2396 IU / l. Given this clinical picture, the diagnosis of neuroleptic malignant syndrome was made and the neuroleptic treatment was stopped and the patient put under massive diazepam with rehydration and strict clinical supervision. The clinical and biological evolution was favorable, and he was put under Olanzapine. The patient was young. Neuroleptic malignant syndrome occurred two weeks after the introduction of neuroleptic treatment with haloperidol [15 mg / day] and chlorpromazine [200 mg / day]. The clinical picture is limited to generalized muscle rigidity, confusion, hyperthermia at 38.5 and elevated CPK [2396 UI / l]. Stopping the treatment in question, correction of fluid and electrolyte disorders and prescription of a benzodiazepine conduct to a favorable evolution two weeks later. A practitioner should suspect a neuroleptic malignant syndrome before unexplained hyperthermia in a patient under neuroleptic. Immediate discontinuation of neuroleptic therapy and general measures of resuscitation is the mainstay of treatment

[Telemedicine: evolution of a concept]

Being a medical practice in distance, it can be defined as a form of cooperation in medical practice, linking them remotely, thanks to information technology and communication, a patient and a or more physicians and healthcare professional for medical diagnosis, decision-making, care and treatment in accordance with the rules of medical ethics. Currently, she is the right solution for access to health care in countries with large geographical and situations of isolation or technical skills. There are several forms such as teleconsultation, telemonitoring, telesurgery, the teleconference, distance learning and tele-expertise. Interests of telemedicine are many: high efficiency: speed of decision, a better organization of care, limiting patient transfers and travel medical teams; accessibility of care regardless of location, and a reduction the costs related to health. In practice, it is in the theater she found her first indications particularly telecare surgical field, the most advanced in the field of medicine forward. The example of satellite transmission between five buildings French Navy, Southern and military Teaching Hospital [HIA] Saint Anne in Toulon digitized radiographs using military means of communication is one example. The ultimate development of this hotline will teleoperation that consists of performing Remote surgery [also known as telesurgery] using a robot

[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

[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

[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