[Burnout in Tunisian medical residents: About 149 cases]. / Burnout chez les résidents en médecine tunisiens : à propos de 149 cas.

BACKGROUND: Burnout is a professional psychological chronic stress-induced syndrome defined by three dimensions: emotional exhaustion, depersonalization, and low personal accomplishment. This syndrome concerns all professions but especially healthcare staff. Numerous studies have attempted to document the impact of work activities on the doctor's mental health. According to the literature, junior doctors are more vulnerable to develop this syndrome. AIMS: Are to determine the prevalence of severe burnout among residents of different specialties: anesthesiology, general surgery, emergency medicine, psychiatry, basic sciences. The secondary end points are to analyze risk factors, causes and consequences associated with burnout. METHODS: A cross-sectional study conducted among medical residents working in hospitals located in the governorates of Tunis. Three instruments were used: an anonymous self-administered questionnaire, Maslach Burnout Inventory (MBI) to assess burnout, and Abstract Beck Depression Inventory to evaluate the intensity of depression. Severe burnout was defined as a severely high level of both emotional exhaustion and depersonalization associated with a severely low level of personal accomplishment. RESULTS: A total of 149 participants (response rate=76.8%) participated in the survey. Among participants, 17.14% (n=26) had a severe burnout. The emergency medicine residents had the highest rate of emotional exhaustion and depersonalization and severe depression. Overall, resident respondents, 31% (n=46), had moderate to severe depression. Among stress factors, those significantly correlated to burnout were: lack of hobbies (P<0.001), bad job conditions (P=0.031), poor conditions of the workplace (P=0.046), relationship problems in workplace (P=0.01), work-family conflicts (P<0.001). The consequences of occupational stress associated with burnout were: Antecedents of specialty change (P=0.017) and desire for a specialty change (P<0.001). A significant correlation between depression and severe burnout was not found. CONCLUSION: Medical residents in all specialties are at risk of burnout. Nevertheless, this study revealed that some specialties are more exhausting, which is consistent with the results reported in the literature. Moreover, it is shown that several stress factors as well as many consequences are related to severe burnout, which is in agreement with numerous studies. However, results between different studies are disparate.

[Factitious disorders in dermatology: Value of the dissociative state concept]. / Troubles factices en dermatologie : intérêt du concept d'état dissociatif.

BACKGROUND: Factitious disorders in dermatology consist of intentionally self-inflicted skin lesions that vary in morphology and distribution and occur on surfaces readily accessible to the patient's hands. They tend to be a chronic condition that waxes and wanes according to the circumstances of the patient's life. Patient management poses a particular challenge to the clinician and the prognosis is considered poor. The aetiopathogenesis of factitious disorders in dermatology is not completely understood. We present a case in which we suggested the occurrence of factitious behaviour during a dissociative state, and we briefly describe our diagnostic and therapeutic approach. PATIENTS AND METHODS: A 48-year-old unemployed woman was referred to our department of psychiatry by her dermatologist for suspected factitious disorder. The patient was diagnosed with diabetes mellitus type 1 and had been hospitalized repeatedly for confirmed diabetic ketoacidosis. The onset of the disease was related to marital discord with her spouse. Numerous skin lesions had appeared on her face, arms, legs, neck and back. These lesions resulted in multiple hospital admissions and in amputation of her left leg. The condition had worsened considerably after her separation from her husband. During the initial conversation, the patient was unable to provide a clear history of the disease. She denied any knowledge of the circumstances in which these skin lesions appeared, and she did not admit self-infliction. Her mood was depressed and her speech was slow. We suspected that our patient was herself causing her skin lesions while in a dissociative state. Several arguments militate in favour of our hypothesis, particularly her history of childhood maltreatment and the association of traumatic life events with simultaneous deterioration of the skin. The explanation of the dissociative mechanism helped us to strengthen the therapeutic relationship. Within a few days, we noted a slow regression of the lesions, but the patient was still unable to explain how the lesions had occurred. DISCUSSION: The pathophysiology of factitious disorders in dermatology is poorly understood. It has strong ties with other psychiatric disorders, and according to several authors, skin lesions occur in dissociative states, after which patients do not remember how the skin change started. Management of this disease is challenging. An improved understanding of its mechanisms may enhance the prognosis for this particular group of patients.

[Quality of life of patient with schizophrenia treated by conventional and atypical neuroleptics]. / Qualité de vie chez les patients atteints de schizophrènie traités par neuroleptiques classiques et atypiques.

BACKGROUND: the quality of life of patients suffering from schizophrenia was extensively studied but it seems that impact on quality of life of neuroleptics, particularly atypical antipsychotic treatment was not clearly elucidated. AIMS: In this study we have compared the impact on quality of life of atypical antipsychotic versus classic neuroleptics. METHODS: We have enrolled, prospectively, all patients with schizophrenia as confirmed by DSM-IV TR. These patients intakes antipsychotics for unless 6 months. We excluded patients with acute schizophrenia, mental deficiency and severe organic disease. Evaluation of clinical features is based on the PANSS scale (Positive And Negative Syndrome Scale). The quality of life is evaluated using the MOS-SF36 scale (Medical Outcomes Study 36-item Short Form). Extra pyramidal symptoms were evaluated by the Chouinard scale. RESULTS: We have enrolled 65 patients; 35 under classic neuroleptics and 30 under atypical antipsychotics. Clinical features were similar in the two groups. Patients with atypical antipsychotics were less hospitalized (2.4 +/- 3.2 vs. 4.5 +/- 4.2; p = 0.02) and needing less anti cholinergic treatment (26.6% vs. 88.6%; p < 0.0001). Adverse effects were more common with classic neuroleptics (Pakinsonism score: 6.1 +/- 7 vs. 10.8 +/- 8.6; P = 0.01); global clinical dyskinesia 1.22 +/- 0.8 vs. 1.90 +/- 1.7; p = 0.04; global clinical judgement of parkinsonism (2.41 +/- 2.1 vs. 3.72 +/- 2.4; p = 0.02). Quality of life was better in patients with atypical antipsychotics on the basis of vitality (76.7 +/- 27.8 vs. 62 +/- 29.6; p = 0.04) and social function (53.3 +/- 33 vs. 36.9 +/- 27.5; p = 0.03) we found a negative correlation between adverse effects and quality of life in patients with classic neuroleptics. CONCLUSION: Quality of life of patients suffering from schizophrenia with atypical antipsychotics is better than in those with classic neuroleptics and this may be due to the frequency of adverse effects particularly extra pyramidal symptoms.