No abstract

Introduction: Psoriasis is a common chronic inflammatory dermatosis. Despite the fact that sex life can be severely affected in patients, it is often poorly assessed by clinicians. Purpose of the work: The aim of this work is to determine the impact of psoriasis on quality of life and sexuality, and the main associated factors. Materials and Methods: A prospective descriptive study with a data collection of psoriatic patients psoriatic patients followed at the Dermatology consultation at the Military Hospital of Instruction in Rabat,over a period of 07 months from October 2017 to May 2018. Results:Thirty-eight patients were included in our study, with an average age of 39.5 ± 12.5 years. Seventeen patients had a positive family history of psoriasis. This represents (44.7%) of the patients recruited. Twelve patients (31.5%) had other significant comorbidities (arterial hypertension, diabetes, dyslipidemia, obesity, benign prostatic hypertrophy). The average age of the psoriasis was 14.3 ± 12.4 years. The majority of patients (60.5%) had plaque psoriasis, 17 patients (44.7%) had scalp involvement, 11 patients had facial lesions (28.9%), palmar-plantar involvement was present in 21 patients (55.2%), trunk involvement in 32 patients (84.2%), while genital area involvement was present in 19 cases (50%) and lower limb involvement in 34 cases (89.4%) The mean PASI was 13.1 ± 11.2 points. 47.3% of the patients had psoriasis considered mild. The mean DLQI score was 10 points, psoriasis had a moderate effect on quality of life in 34.2% of patients. The majority of patients (55.1%) had erectile dysfunction. More than 34.2% of patients often felt that other people considered their skin problem to be a contagious disease, 47.3% of patients at least occasionally avoided social activities. 39.4% of patients reported feeling social rejection sometimes. The majority of the participants (55.2%) pointed out that their disease occasionally influenced their sexual life, 71% of the patients avoided sexual intercourse to a different extent. When being with their sexual partner, 44.7% of the patients felt embarrassed at least occasionally, and 42.1% of them felt stress before sex. Many patients felt at least some discomfort, if the lesions are present on the visible parts of the body (47.3%) and on the genitals (28.9%), genital involvement was one among the causes both personal and related to the spouse. Discussion: Currently, the evaluation of the severity of psoriasis takes into consideration its impact on the quality of life of the patient. The improvement of the quality of life remains the final objective in the management of psoriasis, the average score of DLQI in our study is 10. Thus, 44.7% of our patients had a score higher than 10, indicating a significant alteration in quality of life due to psoriasis. Comparing our results with the average DLQI scores found in other studies of psoriasis patients, we note that the average score of our patients is similar to that found in most studies. Recent studies have shown that this disease can affect psychosocial well-being and may be linked to an increased risk of depression. However, data on the impact of psoriasis on sex life are still limited, in part because erectile dysfunction is an embarrassing and neglected problem. The prevalence of this condition depends on the study population, in our study as many as 55.1% of patients suffer from erectile dysfunction. In addition to low self-esteem, stigma and decreased confidence, Avoidance of sexual contact due to the disease and feeling of rejection also significantly influenced the quality of life of our patients. Conclusion: In the patients included in our study, psoriasis had a moderate impact on quality of life. The assessment of sexual disorders by the IIEF-5, and the predefined questionnaire gave an idea about erectile dysfunction and emotional problems related to sexual life in psoriatic patients. Thus, it is understood that this is a complex disease that requires multidisciplinary management.

Les effets secondaires psychiatriques des corticoïdes sont décrits depuis longtemps. Certaines réactions sont sévères et concernent environ 5% des patients. Ces effets secondaires sont plus difficiles à évaluer lorsque le recours aux corticoïdes sort du cadre thérapeutique habituel et s'intègre dans une automédication en lien avec certaines influences culturelles. Nous rapportons le cas d'une jeune femme ayant présenté un épisode psychotique aigu dans les suites d'une auto-prise de corticoïdes dans un but de gain de poids. Nous discutons l'intérêt d'un diagnostique et d'une prise en charge précoce ainsi que l'importance du volet préventif multidisciplinaire, en particulier devant l'implication de l'aspect culturel dans l'observation présentée.

Fibromyalgia (FM), a chronic disabling disorder causing diffuse musculoskeletal pain, presents strong comorbidity with psychopathological disorders, including post-traumatic stress disorder (PTSD). We report the case of a 35-year old Syrian Refugee, diagnosed with both Fibromyalgia and PTSD related to traumatic events (killed husband, expulsion from home, rape with death threats, difficult socio-economic situation). An antidepressant treatment combined with psychotherapeutic and psycho-educational intervention led to satisfactory improvements. Considering the clinical case and other related studies, it seems that early management of the traumatic dimension is essential, in order to prevent the chronicity of the suffering and the emergence of psychiatric comorbidities.

Thyroid hormones are important for the development, maturation, and function of the central nervous system. While the association between the lack of thyroid hormones in congenital hypothyroidism and profound mental retardation is well documented (Dugbartey 1998), hypothyroidism acquired in adulthood can also manifest itself in a variety of symptoms not only somatic, but also psychiatric especially mood disorders, and anxiety. Psychotic symptoms are rare but are part of this psychic picture. We report the case of a 50-year-old female patient admitted to the psychiatric emergency department for psychomotor agitation of a psychotic appearance, revealing autoimmune hypothyroidism. This observation underlines the need not to underestimate the responsibility of the thyroid hormonal balance in the onset of psychotic manifestations, and to eliminate dysthyroidism before any psychotropic treatment.