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Purpose The cardiovascular mortality of the psychiatric patients is higher than the general population. The antipsychotics and their propriety of prolongation of the QT interval seems to be a possible track. We tried to analyze the epidemiological, clinical, biological, therapeutic and especially electrocardiographic (ECG) data in those patients, to determine the prevalence of the syndrome of prolongation of the QT interval and investigate its main risk factors. Methods We conducted a cross-sectional study, at the university psychiatric center Ibn Rochd of Casablanca, in collaboration with the cardiology department, over one year, concerning 134 patients receiving an antipsychotic treatment, we realized12 derivations ECG, and assessed clinical, biological and pharmacological data. Results The mean age was 32, 48±10,9 year,82,8% men/17,2% women, the first psychiatric disorder was the paranoid schizophrenia 56%, hyperkalemia was present in1 patient, hyermagnesaemia (1), calcemia was normal, polytherapy has been found in the majority of cases(2.8±0.9), neuroleptics were prescribed for all patients(45.5% for long term), in association with benzodiazepines (25%) and anticholinergics (23%), antidepressant (21%) and lithium (10%).The mean dose antipsychotic chlorpromazine equivalent (CPZ eq) is 617.8±534, 3mg/d, 88% of patients are under moderate doses and only 6% receive very high doses >2000mg/d CPZ eq. the mean heart rate was 82.7±16.5 BPM, one patient had a bradycardia to 44 bpm. The mean QTc is 386.22±30,9ms, the prevalence of long QT syndrome (>440ms) in our series is 4.5% so lower than the literature. The mean value of QTc increases with age, and it is higher in female gender, the risk of QT prolongation is associated with multiple co-prescribed drugs, and gets higher with the number of prescribed drugs and with strong dosage. The risk increases also at the beginning of the treatment and in patients with long term treatment >6 months. Conclusion However, despite the proven toxicity of these treatments, it must be remembered that the QT prolongation does not necessarily induce a negative risk-benefit balance. This is to be assessed on a case-by-case, and in cooperation between psychiatrists, cardiologists, pharmacists, for a better control of the risk of sudden cardiac death from a psychiatric medication origin.

During the lunar month of Ramadan, Muslims abstain from eating, drinking and smoking from sunrise to sunset. We reported previously that Ramadan provokes a shortening in nocturnal total sleep time by 40 min, an increase in sleep latency, and a decrease in slow-wave sleep (SWS) and rapid eye movement (REM) sleep duration during Ramadan. During the same study, the effects of Ramadan intermittent fasting on daytime sleepiness were also investigated in eight healthy young male subjects using a quantitative waking electroencephalograph (EEG) analysis following the multiple sleep latency test (MSLT) procedure. This procedure was combined with subjective alertness and mood ratings and was conducted during four successive experimental sessions: (1) baseline (BL) 15 days before Ramadan, (2) beginning of Ramadan (R11) on the 11th day of Ramadan, (3) end of Ramadan (R25) on the 25th day of Ramadan, (4) recovery 2 weeks after Ramadan (AR). During each session, four 20-min nap opportunities (MSLTs) were given at 10:00, 12:00, 14:00 and 16:00 h and were preceded by rectal temperature readings. Nocturnal sleep was recorded before each daytime session. Subjective daytime alertness did not change in R25 but decreased in R11 at 12:00 h, and subjective mood decreased at 16:00 h, both in R11 and R25. During the MSLT, mean sleep latency decreased by an average of 2 min in R11 (especially at 10:00 and 16:00 h) and 6 min in R25 (especially at 10:00 and 12:00 h) compared with BL. There was an increase in the daily mean of waking EEG absolute power in the theta (5.5-8.5 Hz) frequency band. Significant correlations were found between sleep latency during the MSLT and the waking EEG absolute power of the fast alpha (10.5-12.5 Hz), sigma (11.5-15.5 Hz) and beta (12.5-30 Hz) frequency bands. Sleep latency was also related to rectal temperature. In conclusion, Ramadan diurnal fasting induced an increase in subjective and objective daytime sleepiness associated with changes in diurnal rectal temperature.

During the month of Ramadan intermittent fasting, Muslims eat exclusively between sunset and sunrise, which may affect nocturnal sleep. The effects of Ramadan on sleep and rectal temperature (Tre) were examined in eight healthy young male subjects who reported at the laboratory on four occasions: (i) baseline 15 days before Ramadan (BL); (ii) on the eleventh day of Ramadan (beginning of Ramadan, BR); (iii) on the twenty-fifth day of Ramadan (end of Ramadan, ER); and (iv) 2 weeks after Ramadan (AR). Although each session was preceded by an adaptation night, data from the first night were discarded. Polysomnography was taken on ambulatory 8-channel Oxford Medilog MR-9000 II recorders. Standard electroencephalogram (EEG), electro-oculogram (EOG) and electromyogram (EMG) recordings were scored visually with the PhiTools ERA. The main finding of the study was that during Ramadan sleep latency is increased and sleep architecture modified. Sleep period time and total sleep time decreased in BR and ER. The proportion of non-rapid eye movement (NREM) sleep increased during Ramadan and its structure changed, with an increase in stage 2 proportion and a decrease in slow wave sleep (SWS) duration. Rapid eye movement (REM) sleep duration and proportion decreased during Ramadan. These changes in sleep parameters were associated with a delay in the occurrence of the acrophase of Tre and an increase in nocturnal Tre during Ramadan. However, the 24-h mean value (mesor) of Tre did not vary. The nocturnal elevation of Tre was related to a 2-3-h delay in the acrophase of the circadian rhythm. The amplitude of the circadian rhythm of Tre was decreased during Ramadan. The effects of Ramadan fasting on nocturnal sleep, with an increase in sleep latency and a decrease in SWS and REM sleep, and changes in Tre, were attributed to the inversion of drinking and meal schedule, rather than to an altered energy intake which was preserved in this study.

Introduction: Le medicament generique est souvent une origine de prejuges negatifs et de mefiance chez les professionnels de sante et les patients. Ceci pourrait etre du a plusieurs facteurs entre autre le manque des connaissances du patient sur ces medicaments. Le but de notre etude etait d'evaluer l'information du consommateur sur les medicaments generiques et apprecier leur utilisation de ces medicaments. Methodes : Il s'agit d'une etude transversale realisee de Janvier a Mars 2010 aupres de 251 sujets. Un questionnaire comprenant dix questions fermees a ete utilise. Les questions concernaient l'evaluation des connaissances sur les medicaments generiques, les sources d'information, le degre de confiance et d'information des patients sur ces medicaments. Une analyse descriptive simple des differentes variables a ete realisee. Resultats : Dans notre etude, 126 sujets (50,2%) ont repondu connaitre les medicaments generiques. Parmi eux, 52,3% les utilisaient et 67,4% estimaient qu'ils etaient insuffisamment informes sur ces medicaments. Les cadres superieurs et les etudiants ont represente la categorie qui utilisait le plus les medicaments generiques (respectivement dans 40,9% et 25,7%) et qui etait la mieux informee (respectivement dans 61,9% et 23,81%). Le faible cout a ete la principale motivation d'utilisation du medicament generique (93,9%). Les medias ont represente la premiere source d'information (59,5%). Apres sensibilisation, 88,8% des sujets qui ne connaissaient pas le medicament generique ont ete favorable a son utilisation. Conclusion : Une promotion efficace par une politique d'information soutenue aupres des consommateurs et par des mesures incitatrices a la prescription et a la delivrance du generique par les medecins et les pharmaciens, pourront ameliorer l'utilisation de ces medicaments dans notre pays. Key words : Medicament generique, consommateur, perception, Maroc

The Ramadan month represents a valuable opportunity to test the hypothesis that the course of the illness of bipolar patients can be disrupted by the change in social rhythm which usually occurs during this month. The objectives of this study were to follow up the mood state and blood lithium level of fasting Muslim bipolar patients who had been on lithium therapy for at least 3 months, and were clinically stable before being included in the study. Twenty bipolar patients were enrolled during the month of Ramadan in 1997. Diagnosis of bipolar disorder was according to ICD-10 criteria. Patients were assessed during the week before Ramadan, the second and the fourth weeks of the fasting month and the first week after its end, with the Hamilton Depression and Bech-Rafaelsen scales. The plasma concentration of lithium was also assessed. The main finding of the study was that 45% of the patients relapsed, 70% during the second week and the remaining patients at the end of Ramadan. These relapses were not related to plasma concentration of lithium. Most of the relapses were manic (71.4 %). Patients who did not relapse had insomnia and anxiety during the second and third weeks of the study. Side-effects of lithium increased and were observed in 48% of the sample, mostly dryness of the mouth with thirst and tremor. The result of this pilot study indicates that the Ramadan month may disrupt the mood state of bipolar patients. More studies are needed to confirm this observation and to evaluate the validity of the Ramadan model to study the impact of social rhythms on bipolar patients.