As the elderly population increases the domain of geriatric psychiatry is developing. Senior patients have unique clinical presentations and coexisting medical conditions necessitating a thorough assessment and treatment plan. We aimed to investigate how residents at the Ibn Nafis University Psychiatric Center in Marrakech (Morocco) prescribe psychotropic drugs to elderly patients. We also explored the recommendations offered by research for the treatment of psychiatric disorders in this citizenry. A cross-sectional descriptive design was employed. Seventeen psychiatry residents at the Ibn Nafis University Psychiatric Hospital made up the research population. A survey in French was provided to every resident for completion. The collected data was processed using Microsoft Excel 2019. We found that 38% of the residents used typical antipsychotics, 81% used atypical antipsychotics and 94% used benzodiazepines in the event of agitation. For Major Depressive Disorder MDD 72% prescribed Sertraline. For anxiety disorders sertraline was prescribed by 56% of the sample. Of the medications prescribed by the residents risperidone was selected the most frequently by 77%. Alprazolam was found to be prescribed by 56% in cases of insomnia. The study emphasizes the need of a tailored therapeutic approach for elderly patients. Selective serotonin reuptake inhibitors (SSRIs) especially sertraline, atypical antipsychotics especially risperidone, anxiolytics especially hydroxyzine and alprazolam are preferred by residents at Ibn Nafis University Psychiatric Center over other psychotropics in the context of older adults. This work also highlights the value of weighing each medications benefit-risk ratio. Prescription of psychotropic medications to elderly patients ought to be tailored to their particular requirements and present health status. Etiologic treatment, the minimum effective dose and monotherapy ought to take precedence over symptomatic treatment. Additionally ............
La neurofibromatose du type 1 (NF1) estsouventassociee aux troubles psychiatriques.Ilssont plus frequents chez les patients atteints de NF1 quedans la population generale (33% des patients).La dysthymieest le diagnostic le plus frequent (21% des patients).Unefrequenceimportante de trouble de lhumeur de type depressif (7% des patients), de troubles anxieux (1 a 6% des patients) et de troubles de la personnalite (3% des patients) estobservee. Le risquesuicidaireestegalementaccru (4 fois plus quedans la population generale).Les troubles de lhumeurbipolaires et la schizophreniesontrares. Lalteration de la qualite de vie observeedans la NF1 sembleêtreunfacteur important danslapparition deces troubles psychiatriques. Levaluation de celle-ci permettrait de definirune population a risque. [1].
Introduction: moral harassment in the workplace is a growing phenomenon worldwide. Leymann defined it as a form of psychological terrorism that manifests itself over a relatively long period of hostile words or actions expressed or manifested by one or more people towards a third person (target) at work. It causes damaging consequences on the mental and physical workers health, with negative economic impacts on the company. Objectives: our objective was to study the epidemiological characteristics, the clinical aspects, and the consequences of moral harassment among the medical and paramedical staff of the Mohammed VI university hospital in Marrakech. Methods: We carried out a descriptive transversal study over six months covering 329 caregivers working at the Mohammed VI university hospital in Marrakech. The support of the investigation was an individual, and a strictly anonymous questionnaire containing the French version validated by the questionnaire of Leymann entitled Leymann Inventory of Psychological Terror; sociodemographic, mental health, and professional data were also collected. Results: In our study, the prevalence of moral harassment was 27.5%, according to Leymann's criteria (exposure to at least one situation, at least once a week for at least six months). Moral violence targets were between 25 to 35 years old (76%) and less than five years seniority (55%). The victims were represented mainly by residents (65.5%) and interns (33%). There was no correlation between sex and exposure to psychological violence (p=0,36). The supervisor was the main harasser (80%). Anxiety, depression, and symptoms of post-traumatic stress disorder had been the most observed consequences on the mental health of victims. Conclusion: Moral harassment at work seems, by its prevalence, to invade the hospital environment, and young doctors constitute a particular target. Exposure to this phenomenon has a negative impact on an individual's mental health. Our results are alarming enough to prompt us to continue investigating and put in place recommendations to limit and prevent the consequences.
The association between autoimmune thyroiditis and encephalopathy is rare and well known. A case report of a patient with bordeline disoder (BLD) with fluctuanting mood and psychotic symptoms using double blind method shows a significant relationship between psychotic symptoms and fluctuanting antithyroid anto immnune antibody titers [1]. We report here a case of patient with BLD and autoimmune thyroiditis. Improvement of BLD traits is obtained after adding thyroid hormones replacement therapy to psychotropic medication.
Prescribing psychotropics for pregnant women is a delicate issue as most drugs cross the placenta. There are concerns about possible hazards to the growing fetus and balancing the risk of malformation against the risk of a psychiatric condition relapsing is a common dilemma. To minimize the risks associated with polypharmacy monotherapy is typically the preferred approach. This study aimed to explore the prescription habits of psychotropic medications to pregnant women by residents at IBN NAFIS University Psychiatric Center and review it in the light of literature. 25 residents took part. We found that for agitation, 93% of residents prescribed classic antipsychotics. For major depressive disorder, 81% of residents prescribed selective serotonin reuptake inhibitors (SSRIs). For anxiety disorders, 68% of the sample prescribed SSRIs. For manic episodes, 50% of residents prescribed lamotrigine, 12% prescribed olanzapine, 6% preferred sodium valproate, 6% prescribed classic antipsychotics. For psychotic disorders, the vast majority of residents prescribed classic antipsychotics (88%), while 6% of them prescribed Risperidone and the remaining 6% preferred the use of Olanzapine. For insomnia, the majority of residents in the sample preferred prescribing hydroxyzine (69%). Oxazepam is considered a first-line anxiolytic because it doesn't create active metabolites. Classic antipsychotics like haloperidol and chlorpromazine are commonly prescribed during pregnancy due to their proven efficacy and safety. Atypical antipsychotics like olanzapine risperidone quetiapine and clozapine are used, with olanzapine being a first-line treatment due to reassuring data on fetal side effects. Thymoregulators like lamotrigine can be used but caution is advised due to potential risks. Antidepressants like tricyclics and SSRIs are commonly prescribed with SSRIs being preferred for pregnant women. The study emphasizes the importance of taking into account the particulars of the drugs such ...
Introduction:Ethics is an integral part of medical practice; medical ethics are based on the following principles: respect for the person, the principle of beneficence, the principle of non-maleficence and the principle of justice.We conducted a study that the objective is to study the perception of the notion of medical ethics, to assess the level of training and knowledge, to evaluate attitudes and practices in the exercise of the medical profession.Materials and methods: 100 doctors at the Marrakech University Hospital were recruited for a study about "Ethics in the medical practice of non-psychiatrist doctors", throughout 6-month and we completed a pre-designed, structured, anonymous questionnaire that describes the sociodemographic characteristics of the doctor and assesses and provides information on his knowledge, attitudes and practices in medical ethics.Results: The majority of physicians were aware of medical ethics and the majority had acquired knowledge in this area at the faculty level, It was also found that more than half of doctors were unaware of the existence of a code of ethics in Morocco and that most of the opinions were in favor of the establishment of a unit of information, education and communication in ethics of care and medical ethics; on the other hand, the majority of our doctors have deemed that the consent of patients is necessary during surgical treatments in the first place, followed by medical treatments.35% of physicians still always shared information with their patients in daily practice.Conclusion: These attitudes and practices are statically independent of the physician"s medical or surgical specialty.Rather, they relate to the education of physicians in clinical ethics.
With new treatments targeting features of schizophrenia associated with functional disability, there is a need to evaluate the validity of ratings of everyday outcomes. It is unknown whether patients can validly self-report on aspects of their functional status, which would be a potentially economical method for obtaining outcome data. In this study, 67 older schizophrenia outpatients provided self-ratings of everyday real-world functioning using the specific levels of functioning scale (SLOF). They were also administered assessments of neuropsychological performance, performance-based measures of functional capacity and social skills, clinical symptoms, and quality of life. Case managers, unaware of other ratings, also generated SLOF ratings. Based on discrepancy scores, participants were categorized as accurate raters (n = 24), underestimators (n = 16), or overestimators (n = 27) of their functional status as compared to case managers' ratings. Patients' self-rated functional status was correlated with their subjective quality of life, but remarkably unassociated with case manager ratings of functional status or their own performance on functional capacity or social skills measures. Case manager ratings, however, were highly correlated with performance on functional capacity and social skills measures. Patients who underestimated their real world performance had better cognitive skills and greater self-rated depression than those who overestimated. Accurate raters demonstrated greater social skills than both overestimators and underestimators, while overestimators were most cognitively and functionally impaired. Accurate ratings of everyday outcomes in schizophrenia may require systematic observation of real world outcomes or performance-based measures, as self-reports were inconsistent with objective information.
First, to explore whether in Morocco, a non-Western country, family members of patients with schizophrenia suffer from stigma and, if they do, which areas of their lives are most affected; and second, to explore family members' knowledge about the illness and their attitudes toward the patients.The study was conducted among 100 family members accompanying patients with schizophrenia. We used a heteroquestionnaire that inquired about family members' and patients' sociodemographic data, family members' knowledge of the patients' illness, their attitudes and behaviours toward the patient, and their perception of stigma.Family members' mean age was 47.44 years, SD 12.83; 69% were women; 38% had no education; and 77% had no professional activity. Most families (76%) reported having no knowledge about the illness. However, the illness was considered to be incurable (39%), severe (37%), chronic (80%), and handicapping (48%) and was believed to be caused by drug use (25%), stressing life events (such as conflict or bereavement; 46%), sorcery (25%), organic disturbance (30%), or heredity (23%). We found that most of the families suffer from stigma and discrimination. A total of 86.7% reported they have hard lives because of the illness, and 72% reported psychological suffering caused by sleep and relationship disturbances and a poor quality of life.In this study, we found that Moroccan families of patients with schizophrenia suffer from stigma. We found the same results in European, In North American, and in some Arab and Islam countries. Despite the belief that traditional societies are more supportive of the weak and the sick, stigma is a major burden in addition to that of the illness.
Physical restraint is used very often in psychiatry, as a means to control agitated and violent patients, in order to provide protection for the patient and others, after failure of alternative measures. Our cross-sectional descriptive study of 30 patients hospitalized in the psychiatry department of the university hospital MOHAMED VI in Marrakech, who have undergone physical restraint, over a period of 6 months; intended to describe the feelings and experiences of these patients in relation to physical restraint, and to determine the symptoms related to it. The analysis of the results revealed the following: a male predominance at 80%, the most frequent age group was between 31 and 40 years old. 57% of patients were diagnosed with schizophrenia, and the most common reason for restraint was agitation at 60%.We found that patients had mainly negative feelings during the period of restraint, with helplessness at 90%, loneliness at 73%, sadness at 60%, fear at 40%, anxiety at 36.6%, anger at 36.6%, humiliation at 16, 6% and injustice at16.6%.We also found unpleasant physical perceptions during restraint, with pain at 63.3%, sleep difficulties at 23.3%, cold at 16.6%, and thirst at 16.6%. On the other hand, the analysis of the traumatic experience of patients after the physical restraint, through the PCLS scale, revealed a low percentage (7%) of patients with a score compatible with PTSD. This indicates a less traumatic effect of restraint in our population compared to the Western world.
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