Epilepsy and traditional medicine in Bobo-Dioulasso (Burkina Faso).

OBJECTIVES: To contribute to a better knowledge of how epilepsy is perceived by traditional healers in Burkina Faso; what means they use to treat it, and how they think about modern treatment. MATERIAL AND METHODS: Individual interviews with 65 traditional healers chosen at random from members of the Reelwende Association. RESULTS: All traditional practitioners were of male gender. Most of them were above 50 years of age, and 75% had more than 10 years' experience. Epilepsy was considered to be contagious by 44% of the traditional practitioners, and hereditary according to 40% of them. Roughly, 15% of the healers think that the problem is localized in the head of a person and 7.8% think that they have worms in their head. Thirty-one per cent of them diagnose epilepsy if there is a combination of 'convulsions, sudden fall, dribbling and amnesia'. Another 15% require a combination of 'convulsions, amnesia and dribbling', the remaining 54% make the diagnosis based on one symptom or various combinations of two symptoms of 'grand mal' (generalized tonic clonic) seizures and most claim they have a treatment for it. For a quarter of them, therapeutic-means include concoctions of herbs or roots, baths and infusions. During the fit, 31% of the traditional practitioners think that nothing should be performed. According to 75% of them, traditional and modern treatments are complementary. CONCLUSION: Notwithstanding important differences in culture and religions (Muslim, Christian and Original), there is great similarity between the knowledge and beliefs about epilepsy reported from other parts of Africa and those presented by our study-group, suggesting an ancient origin of the concepts. Further study is needed to find out how other facets of epilepsy (e.g. complex partial seizures, absences) are perceived and how these are being treated. Ways need to be found to raise awareness about epilepsy without interfering with religious and cultural beliefs

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

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

Revisiting the 'Cotton Problem': A Comparative Analysis of Cotton Reforms in Sub-Saharan Africa

The cotton sector has been amongst the most regulated in Africa, and still is to a large extent in West and Central Africa (WCA), despite repeated refirm recommendations by international donors. On the other hand, orthodox refirms in East and Southern Africa (ESA) have not always yielded the expected results. This paper uses a stylised contracting model to investigate the link between market structure and equity and efficiency in sub-Saharan cotton sectors; explain the outcomes of refirms in ESA; and analyze the potential consequences of orthodox refirms in WCA. We argue that the level of the world price and of government intervention, the nature of pre-refirm institutional organisation, as well as the degree of parastatal inefficiency, all contribute to making refirms less attractive to firmers and governments in WCA today, as compared to ESA in the 1990s.We illustrate our arguments with empirical observations on the perfirmance of cotton sectors across sub-Saharan Africa

Senegal: Presidential elections 2019 - The shining example of democratic transition immersed in muddy power-politics

Whereas Senegal has long been sold as a showcase of democracy in Africa, including peaceful political alternance, things apparently changed fundamentally with the Senegalese presidentials of 2019 that brought new configurations. One of the major issues was political transhumance that has been elevated to the rank of religion in defiance of morality. It threatened political stability and peace. In response, social networks of predominantly young activists, created in 2011 in the aftermath of the Arab Spring focused on grass-roots advocacy with the electorate on good governance and democracy. They proposed a break with a political system that they consider as neo-colonialist. Moreover, Senegal’s justice is frequently accused to be biased, and the servility of the Constitutional Council which is in the first place an electoral court has often been denounced

Epidémiologie des cancers dans les troubles psychiatriques caractérisés

International audienceContexteLes patients atteints de cancers et de troubles psychiatriques caractérisés comme la schizophrénie, les dépressions unipolaires et les troubles bipolaires présentent un risque plus élevé de mortalité que ceux ne souffrant pas de ces pathologies de santé mentale en présence de cancers. Dans ce contexte, la file active du Centre hospitalier Esquirol de Limoges a été observée afin d'objectiver les liens entre troubles psychiatriques caractérisés et cancers notamment au travers de la temporalité d'apparition de chacune de ces deux pathologies ainsi que les comorbidités addictives leur étant associées.MéthodeUne étude rétrospective sur données incluant les patients dépressifs unipolaires, bipolaires et schizophrènes a été menée au sein de notre établissement comptant 2126 patients éligibles sur l'année 2022.RésultatsUne grande majorité de patients présente un trouble psychiatrique caractérisé suivi d'un diagnostic de cancer ce qui n'est pas identifié dans la littérature. En outre, deux diagnostics psychiatriques parmi ceux ciblés démontrent une prévalence du cancer plus importante. Il s'agit des patients dépressifs unipolaires et bipolaires dont environ 10 % des effectifs sont atteints d'une pathologie cancéreuse. La pathologie cancéreuse la plus retrouvée au sein de cette population est le cancer du sein. L'impact de l'alcool a également été étudié comme facteur potentiellement majorant.ConclusionCes éléments de précision en termes de temporalité de survenue de la maladie psychiatrique par rapport à celle de la pathologie cancéreuse, où la prévalence et le type d'organes atteints ont pu être caractérisés, mais aussi le rôle de l'alcoolisation dans le cadre de cette double affection, sont novateurs

Caractérisation du trouble de l'usage de l'alcool - Approche bio-psycho-sociale, ALCOTRANS

International audienceIntroductionL’étude ALCOTRANS vise à mieux comprendre le trouble de l'usage de l'alcool (TUA), en utilisant des approches variées et combinées. Son objectif est d'identifier chez des sujets présentant un TUA en France (Limoges), au Bénin et au Togo, des caractéristiques : socio-démographiques et cliniques, sensorielles, biologiques et sociales ainsi que l’étude du stigma et des représentations socio-culturelles.MéthodesDeux études ont été réalisées:en population générale au Togo et au Bénin pour identifier des cas de TUA et décrire les caractéristiques du trouble (comorbidités psychiatriques, craving, intensité dépressive, capacités cognitives), pour évaluer le profil sensoriel, et les indicateurs biologiques (S100 beta, NSE, BDNF) chez les sujets TUA identifiés ;en milieu hospitalier, chez les sujets avec un TUA, dans les trois pays pour comparaison des pays entre eux, avec les mêmes évaluations.RésultatsNous présentons ici les résultats de l’étude en population générale au Togo. La prévalence du TUA au Togo est de 12,4 %. Les comorbidités psychiatriques fréquemment associées au TUA ont été très peu retrouvées dans la population générale.ConclusionSi les analyses préliminaires suggèrent que la prévalence du TUA au Togo serait similaire aux estimations de l'OMS, et s'approcherait de celle des pays du Nord, cette étude épidémiologique à travers une approche biologique et environnementale a permis d’établir une typographie plus précise du TUA au Togo et de ses comorbidités. Cette caractérisation des sujets souffrant d'un TUA est indispensable pour optimiser les stratégies de prévention, de dépistage, et de soins adaptés