Packages of Care for Epilepsy in Low- and Middle-Income Countries

In the second in a series of six articles on packages of care for mental health disorders in low- and middle-income countries, Caroline Mbuba and Charles Newton discuss treatment for epilepsy

Dissecting the determinants of depressive disorders outcome: an in depth analysis of two clinical cases

Clinicians face everyday the complexity of depression. Available pharmacotherapies and psychotherapies improve patients suffering in a large part of subjects, however up to half of patients do not respond to treatment. Clinicians may forecast to a good extent if a given patient will respond or not, based on a number of data and sensations that emerge from face to face assessment. Conversely, clinical predictors of non response emerging from literature are largely unsatisfactory. Here we try to fill this gap, suggesting a comprehensive assessment of patients that may overcome the limitation of standardized assessments and detecting the factors that plausibly contribute to so marked differences in depressive disorders outcome. For this aim we present and discuss two clinical cases. Mr. A was an industrial manager who came to psychiatric evaluation with a severe depressive episode. His employment was demanding and the depressive episode undermined his capacity to manage it. Based on standardized assessment, Mr. A condition appeared severe and potentially dramatic. Mrs. B was a housewife who came to psychiatric evaluation with a moderate depressive episode. Literature predictors would suggest Mrs. B state as associated with a more favourable outcome. However the clinician impression was not converging with the standardized assessment and in fact the outcome will reverse the prediction based on the initial formal standard evaluation. Although the present report is based on two clinical cases and no generalizability is possible, a more detailed analysis of personality, temperament, defense mechanisms, self esteem, intelligence and social adjustment may allow to formalize the clinical impressions used by clinicians for biologic and pharmacologic studies

Alcohol use disorder (AUD) and health consequence in Subsaharan Africa (SSA); What about the situation in Togo?

International audienc

Dé-stigmatiser-fournir des données épidémiologiques en Santé Mentale en populations générales au Togo "Dé-Stigma Epi SM Togo"

International audienc

Epidemiology of alcohol use in the general population of Togo

Alcohol use is responsible for a high level of mortality and morbidity throughout the world. The WHO global strategy recommends that the detrimental effects of alcohol use be reduced. The objective of this paper was to investigate, using data from the 2010 Togo STEPS survey, alcohol use and other health-related factors in the general population of Togo. This epidemiological investigation using the STEPwise approach was undertaken from December 1st, 2010, to January 23rd, 2011, throughout the five regions of Togo. Togo is a low-income country (World Bank) located in West Africa. The study involved 4800 people aged 15 to 64 who were representative of the population of Togo and who were selected using the one-stage cluster sampling method. The sample was young and predominantly male. Approximately one-third of the respondents were alcohol abstainers, with the majority of these being women. Approximately the same proportion of current drinkers (daily consumption) by gender was observed. The reported daily average consumption of alcohol was 13 g of pure alcohol for men and 9 g for women. The mean number of heavy drinking days over the previous 30 days was higher for men (3 days), and this included 37.5% of the men who drink. We suggest a comparative analysis of the prevalence of harmful alcohol use in Togo and the WHO African region

A fatal case of probable neurobehcet

Behçet's disease (BD) is a systemic vasculitis characterized by recurrent oral and genital ulcers, with a frequent ocular and skin involvement. Neurological involvement in BD has been reported in 4–49% of cases and determines functional and vital prognosis of the disease. Based on clinical and imaging evidence, two major forms can be identified: a parenchymal or an extra parenchymal involvement essentially represented by cerebral vein thrombosis. Awareness disorders are rarely reported as tell-tale signs of neurological involvement in BD. We hereby report the peculiar case of a young patient, 39 years old, admitted to the emergency department for an acute onset of altered mental status in a non-traumatic setting where investigations led to the diagnosis of neurobehçet disease. Patient was placed on high doses corticosteroids with unfavorable outcome; patient passed away after 01 week

[Epilepsy and personality study among the Tamberma of Togo based on a general population survey using the Cloninger's Temperament and Character Inventory]

INTRODUCTION: There are many studies focusing on personality disorders of the patients with epilepsy in developed countries, using different methods. Such investigations with standardised tools like personality questionnaires lack in African populations in general and among the number of epileptic patients who have important psychosocial problems. In Togo, epilepsy still remains a shameful and contagious disease that leads often unfortunately to a "social death". The number of epileptic patients in this country is estimated around 45,000 and 90,000 and the situation is worst in some areas of the country like in Nadoba, chef-lieu of the Tamberma region where lives an homogenous and stable population that has kept its tradition. DESIGN OF THE STUDY: This study was aimed to show the probable existence of specific personality disorder among the epileptics in Nadoba; 34 epileptics and 34 controls chosen among the closest relatives (parents or co-tenants) matched by age (more or less than ten years old) and sex have been interviewed using the Temperament and Character Inventory (TCI) of Cloninger et al., in its French version validated by P?ssolo and L?ne. The TCI is a self addressed questionnaire that has 226 items with dichotomous and forced answer (true or false) that explores 7 dimensions of personality, 4 concerning temperament and 3 concerning character. Regarding psychometric aspects, the TCI has the particularity to gather together, in a unique tool, the exploration of two complementary dimensions: temperament rather conditional and character that has been acquired. The scores of character allow to differentiate the subjects having a good level of adaptation (high scores, about 100%), from those who, because of an individual fragility, adapt themselves less well (low scores). The temperament profile is used on a second approach to locate the personality disorders, taking into account probable deviations. People participating in this study were also interviewed with the Goldberg anxiety and depression scale. For the statistical analysis, the comparison of means was achieved through bilateral Student't-test. A significance threshold of 0.05 has been used for the analysis. RESULTS: Concerning the results, 67 questionnaires have been selected from 33 epileptics (3 men and 30 women), mean age 29.3 years+/-8.1 and 34 controls (4 men and 30 women), mean age 30.6 years+/-5.6. The average scores obtained from the different items of the TCI scale are summarised in chart 1. The comparison of average scores obtained at each item, sub-dimension and dimension of the TCI, did not show any significant difference between cases and controls. However cases were significantly different from controls (P<0.001) on average Goldberg's anxiety scores (4.6+/-1.5 and 2.6+/-1.3) and depression (4.4+/-2.2 and 0.8+/-0.8). DISCUSSION: The average scores obtained in France in the course of the normative study in general population were rather different. The validation study of the French version of TCI showed differences with the population of North America, suggesting inter cultural differences while evaluating the personality and the necessity of using specific norms during each new translation of the instrument. However, the valued in the French-speaking populations (Belgium, Swiss, Lebanon) are in general very close to the French values. The character and behavioural disorders among are of interest and the difficulty in evaluating the part of hysteria in the manifestation of exhibiting pseudo-seizure of epilepsy is also underlined. This question is raised in Nadoba in women, called "Odueri" or "the women that fall", a particular form of tonico-clonic fits observed in that cultural setting. Is it a question of real epileptic seizure or are these phenomena a kind of trance? This investigation of the Tamberma in Togo urges to set up psychometric studies to define local norms. It also suggests the possible existence of personality traits specific to the "women that fall" but these aspects require further developments

Epidemiology of alcohol use in the general population of Togo

International audienceIntroductionAlcohol use is responsible for a high level of mortality and morbidity throughout the world. The WHO global strategy recommends that the detrimental effects of alcohol use be reduced.AimsThe objective of this paper was to investigate, using data from the 2010 Togo STEPS survey, alcohol use and other health-related factors in the general population of Togo.MethodsThis epidemiological investigation using the STEPwise approach was undertaken from December 1st, 2010, to January 23rd, 2011, throughout the five regions of Togo. Togo is a low-income country (World Bank) located in West Africa. The study involved 4800 people aged 15 to 64 who were representative of the population of Togo and who were selected using the one-stage cluster sampling method.ResultsThe sample was young and predominantly male. Approximately one-third of the respondents were alcohol abstainers, with the majority of these being women. Approximately the same proportion of current drinkers (daily consumption) by gender was observed. The reported daily average consumption of alcohol was 13 g of pure alcohol for men and 9 g for women. The mean number of heavy drinking days over the previous 30 days was higher for men (3 days), and this included 37.5% of the men who drink.ConclusionWe suggest a comparative analysis of the prevalence of harmful alcohol use in Togo and the WHO African region