[Depressive disorders in diabetic patients]. / Les troubles dépressifs chez les patients diabétiques du centre hospitalier universitaire Mohammed VI de Marrakech au Maroc.

INTRODUCTION: Diabetes is a public health problem. Its global prevalence was 2.8% in 2000 and it will reach 4.4% in 2030 to be 366 million diabetics. In Morocco, this true "epidemic" affects 6.6% of the population. Many epidemiologic studies have shown that patients with diabetes are more susceptible to depression. Diabetes and depression align in a non-accidental way and complicate one another. PATIENTS AND METHODS: We report a cross-sectional study conducted in association with the endocrinology department of the Mohammed VI university hospital during the period spread between April and September 2006. The aim was to evaluate the prevalence of depressive disorders in patients with diabetes and to describe their sociodemographic and clinical profile. The study included 187 patients. The scales used were the Mini International Neuropsychiatric Interview (MINI) and Hamilton's depression. Sociodemographics and diabetic characteristics were evaluated by self-questionnaire. RESULTS: The average age of our patients was 53±14 years and the percentage of females was high: 71.2%. Diabetes type 2 was the most representative (85.6%), diabetes type 1 (11.8%) and gestational diabetes (2.7%). Half of diabetics were treated with an association of healthy dietary measures (MHD) and oral anti-diabetics; 31.6% were under MHD and insulin therapy; 33.2% of patients had acute complications and 43.5% had degenerative complications. Only 11 patients (5.9%) had antecedents of depression. The prevalence of major depressive episode was 41.2%; 27.8% of patients suffered from dysthymia and 21.9% from double depression. Hamilton's depression scale indicates that all depressed patients had mild depression (total of 17 items from 8 to 17). Major depressive episode and dysthymia were frequent in out patients. Dysthymia was predominant in diabetic patients in the 46 to 55 years age group, never been schooled and without any comorbidity. The vast majority of patients with EDM had type 2 diabetes with 89.6%, 7.8% type 1 diabetes and 2.6% gestational diabetes. Most of dysthymic patients had type 2 diabetes with 94.2% against 5.8% type 1 diabetes. DISCUSSION: The association of depression and diabetes was noted in the literature for the first time more than 300 years ago by the English doctor Willis. Compared to the population of non-depressed subjects, patients with depression may be more likely to develop type 2 diabetes. There would be an increase in the release of hyperglycemic hormones in depression, as in the stress response. In addition, patients with depression have insulin resistance during testing tolerance to insulin, and during testing tolerance to glucose. Other hypotheses explain that the depression/diabetes link included biological and genetic resources. CONCLUSION: Diabetes and depressive disorders are public health problems due to their prevalence and their cost. The prevalence of major depressive disorders found among our population of diabetics justifies their research by doctors. The literature promotes appropriate care that would improve the prognosis of diabetes, as well as depression-increased mortality among diabetics.

[Neuropsychiatric symptoms revealing pseudohypoparathyroidism with Fahr's syndrome]. / Manifestations neuropsychiatriques révélant une pseudohypoparathyroïdie avec un syndrome de Fahr.

UNLABELLED: Fahr's syndrome is characterized by the presence of intracerebral, bilateral and symmetrical non-arteriosclerotic calcifications, located in the central grey nuclei. One of its main etiologies is pseudohypoparathyroidism (PHP), due to a resistance to the action of parathormone (PTH) with essentially hypocalcaemia and a normal or a high rate of PTH. CASE REPORT: Mr B.A. is a 36-year-old man, admitted to hospital because of refractory psychotic symptoms associated with alcohol abuse and fits of convulsion, for diagnostic and therapeutic update. Mr B.A. had presented convulsions since the age of 10, without regular medical treatment. He showed a decrease in his school performances and started using alcohol. Since the age of 17, he began expressing delusions of persecution and of enchantment fed by the persistence of the convulsions. He was administered phenobarbital, and classic antipsychotics (haloperidol and levomepromazine) and developed serious extrapyramidal side effects, treated with an anticholinergic (trihexyphenidyl). Evolution was rather disadvantageous: more epileptic fits, exaggeration of tremors; abuse of alcohol and persistence of psychotic symptoms. On admission, psychiatric examination objectified paranoid delusions of being possessed and persecuted by others. Neurological examination revealed the presence of limb tremors, with a positive Froment's sign on the right, and dysarthria. Other than this, the patient was shorter in comparison with his siblings and exhibited bad dentition. A CT brain scan found bilateral, symmetric basal ganglia calcifications, confirmed by MRI, in favour of Fahr's syndrome. Phosphocalcic investigations revealed a low concentration of serum calcium (65 mg/l) and a hyperphosphataemia (60.1mg/l). The blood level of parathyroid hormone was in the upper limit of normal (66 ng/l), and levels of thyroid hormones and thyroid-stimulating hormone were normal. The diagnosis of Fahr's syndrome, revealing a pseudohypoparathyroidism was posed, and the patient was orientated to endocrinology after readjustment in his therapy (sodium valproate and olanzapine). DISCUSSION: About 40% of the patients with Fahr's syndrome are seen with primarily cognitive and other psychiatric findings. For this patient, hypocalcaemia was at the origin of his convulsions, and the use of phenobarbital, known for its hypocalcemiant action, provoked the inverse result. Alcohol drinking also aggravated hypocalcaemia, and maintained the fits. The use of classic antipsychotics and anticholinergic agents, amplified the extrapyramidal signs caused by Fahr's syndrome. Recognizing the origin of the symptoms allowed rethinking the therapeutic strategy according to all these elements. CONCLUSION: Psychiatrists should consider Fahr's syndrome as a differential diagnosis in the evaluation of psychosis associated with convulsions. This case, along with others in the literature, further emphasizes the importance of the role of neuro-imaging and the search for disrupted phosphocalcic metabolism in patients with atypical or refractory psychotic symptoms.