ABSTRACT
Context and objective. Autism spectrum disorders (ASD) in sub-Saharan African (SSA) countries are poorly studied. The aim of the present study was to describe the socio demographic and clinical characteristics of children with autism and to identify associated factors. Methods. This was a cross-sectional study of children with ASD attended at three specialized centers in Kinshasa. We confirmed a ASD diagnosis through clinical observation using Diagnostic and Statistical Manuel of Mental Disorders four Text Revision (DSM-VI-TR) criteria and standardized autism diagnostic tools. We analyzed socio-demographic and clinical characteristics and main comorbidities of ASD. The comparison of proportions was done using Pearson's chi-square test. One-way ANOVAs were calculated to test differences in averages. Results. A total of 120 children (72.5 % male) were examined. Their mean age at diagnosis was 7.83 ± 3.4 years, while parents were alerted at 1.8 ±0.78 years. Language delays were the main alert sign (54%) and the main symptom (62%). Social interaction disorders (11.7 %) were underreported by parents. The core signs of ASD were disorders of social interaction (90.5%), behavior (80%) and language (62.5%). The main ASD symptoms were associated with epilepsy(p=0.027), cerebral palsy (p=0.026) and hearing impairment (p=0.045). Conclusion. The diagnostic and language delay co-occurring with epilepsy and hearing impairment are the main clinical features of autism in the DRC. This study suggests that screening children for autism and its main comorbidities using a multidisciplinary approach should be a priority in Kinshasa.
Subject(s)
Autistic Disorder , Comorbidity , Cross-Sectional Studies , Autism Spectrum Disorder , Language Development DisordersABSTRACT
INTRODUCTION: Stroke is a major cause of burden which can lead to anxiety and depressive disorders in stroke patients and their caregivers. This study aimed to assess the burden of depression and anxiety and covariates as well as its association with functional disability level among stroke survivors and caregivers dyads. METHODS: This cross-sectional study assessed for anxiety and depressive symptoms, and perceived burden among survivors of stroke and their caregivers in the rehabilitation center of Kinshasa; using the Hospital Anxiety and Depression Scale to identify participants with anxiety and depression; the Zarit Burden Inventory to assess the burden of depression and anxiety; and the modified Rankin scale used to assess functional outcome or level of disability. RESULTS: Eight in ten caregivers of stroke survivors perceived the burden, which took more expression of depression than anxiety, whereas three in ten stroke survivors had a burden expressed by symptoms consistent with depressive and anxiety disorders. Being married increases the risk of perceiving the burden among stroke survivors. We found a positive association between high level of burden and depression and anxiety among caretakers of stroke survivors. Moreover, our findings did not reveal a statistical association between the burden and level of dependence evaluated based on the severity of disability. CONCLUSIONS: The psychological burden is higher among caregivers than stroke survivors. Specialized programs targeted the psychological distress, its association with anxiety and depressive symptoms; and the functional disability level of stroke survivors should be integrated into the rehabilitation center of patients with disabled illnesses. Our findings warrant further studies to test the impact of reducing psychological burden on functional disability.
Subject(s)
Stroke Rehabilitation , Stroke , Adaptation, Psychological , Caregivers/psychology , Cross-Sectional Studies , Democratic Republic of the Congo/epidemiology , Depression/diagnosis , Depression/epidemiology , Depression/psychology , Humans , Rehabilitation Centers , Stroke/complications , Stroke/diagnosis , Stroke/therapy , Survivors/psychologyABSTRACT
BACKGROUND: Post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD) are two conditions that co-occur frequently. The mechanistic explanations of this co-morbidity are still unclear. The goal of this study was twofold. First to investigate whether PTSD reduces the threshold for the acquisition of ethanol sensitization in an animal model of PTSD. Then to investigate whether ethanol sensitization modulates the expression of PTSD. METHODS: 152 female inbred DBA/2 J mice were submitted to an inescapable footshock paradigm to induce a PTSD-like condition (PTSDLC) and to a paradigm of locomotor sensitization to ethanol. In a first experiment, mice were submitted to the PTSDLC and then repeatedly injected with either saline, 1 g/kg ethanol or 2 g/kg ethanol. Their sensitization to the locomotor stimulant effects of ethanol was then tested in an open field. In a second experiment, mice were first sensitized to the locomotor stimulant effects of ethanol and then tested for their behavioral response to PTSDLC. RESULTS: In the first experiment, PTSDLC failed to induce a significant locomotor sensitization at the subthreshold dose of 1 g/kg ethanol. However, with 2 g/kg ethanol, a stronger ethanol sensitization was observed in mice submitted to the footshock relative to the control group. In the second experiment, ethanol sensitization increased only some of the behavioral clusters of PTSDLC, namely the fear generalization in a new context. CONCLUSION: PTSDLC did not reduce the dose threshold for the acquisition of ethanol sensitization but strengthened the development of ethanol sensitization with effective doses. This suggests that PTSD might interact with one of the mechanisms underlying the development of alcohol sensitization. When the relationship between ethanol sensitization and PTSDLC is tested in the reverse direction, the present study only shows a significant effect of ethanol administration on the "sensitized fear" PTSD cluster.
Subject(s)
Ethanol/metabolism , Locomotion/drug effects , Stress Disorders, Post-Traumatic/physiopathology , Animals , Behavior, Animal/drug effects , Comorbidity , Disease Models, Animal , Dose-Response Relationship, Drug , Ethanol/pharmacology , Female , Locomotion/physiology , Mice , Mice, Inbred DBA , Motor Activity/drug effects , Stress Disorders, Post-Traumatic/metabolism , Substance-Related Disorders/metabolism , Substance-Related Disorders/physiopathologyABSTRACT
The purpose of this study was to verify the hypothesis that there is an association between peritraumatic dissociation (PD) and post-traumatic stress disorder (PTSD) in individuals exposed to recurrent armed conflict. More specifically, we sought to evaluate whether PD differentially predicts PTSD according to the degree of exposure to the potentially traumatic event (PTE), the level of education, and gender. A total of 120 individuals between 17 and 75 years of age, including 51 women, completed the Traumatic Events List, the Peritraumatic Dissociative Experiences Questionnaire, and the French version of the Posttraumatic Stress Disorder Checklist Scale, as well as a questionnaire providing information regarding sociodemographic details. The group of participants with high scores for PD had significantly more PTSD. PD differentially predicts PTSD depending on the level of education and gender of the individual. Those who had been physically assaulted and raped, as well as the less educated, were more likely to be dissociated during PTE· exposure compared to witnesses and those with a higher level of education. The primary target population for prevention and early management should comprise individuals with high levels of PD, low levels of education, and women.
Subject(s)
Armed Conflicts , Dissociative Disorders/epidemiology , Stress Disorders, Post-Traumatic/epidemiology , Adolescent , Adult , Aged , Democratic Republic of the Congo/epidemiology , Female , Humans , Life Change Events , Male , Middle Aged , Psychiatric Status Rating ScalesABSTRACT
BACKGROUND: Epilepsy mostly affects children in sub-Saharan Africa. However, little is known about the therapeutic itinerary of these children living with epilepsy (CWE). This study aimed to describe the therapeutic itinerary of CWE in Kinshasa and to analyze its relationships with clinical features, behavioral problems, and cognitive impairment. METHODS: This hospital-based study has included 104 CWE aged 6 to 17â¯â¯years. The features of their therapeutic itinerary and their relationship with clinical features, behavioral problems, and cognitive impairment were analyzed. RESULTS: The vast majority of CWE (87%) has started their therapeutic itinerary by the Western medicine. The first source of information about epilepsy as well as the type of antiepileptic treatment varied with the socioeconomic status of families of CWE. The total duration of the therapeutic itinerary was shorter for the CWE who were living with both their parents (Pâ¯=â¯.038), who had generalized seizures (Pâ¯=â¯.0073) or who had no family history of epileptic seizures (Pâ¯=â¯.019). The CWE who had total behavioral problem, compared with the others, were putting more time (Pâ¯=â¯.021) to reach the Centre de Santé Mentale Telema (CSMT) after the suspicion or the diagnostic of epilepsy. The total duration of CWE who had cognitive impairment (Pâ¯=â¯.021) was longer than that of CWE who had not cognitive impairment. CONCLUSION: The therapeutic itinerary of CWE in Kinshasa began with Western medicine. The remainder of this therapeutic itinerary looks like what is described in sub-Saharan literature with the majority of CWE seeking the healing based on beliefs. This study also shows that the therapeutic itinerary of CWE was associated with socioeconomic conditions, clinical features, behavioral problems, and cognitive impairment.
Subject(s)
Anticonvulsants/therapeutic use , Child Behavior Disorders/drug therapy , Child Behavior Disorders/epidemiology , Cognitive Dysfunction/drug therapy , Cognitive Dysfunction/epidemiology , Epilepsy/drug therapy , Epilepsy/epidemiology , Adolescent , Child , Child Behavior Disorders/psychology , Cognitive Dysfunction/psychology , Cross-Sectional Studies , Democratic Republic of the Congo/epidemiology , Epilepsy/psychology , Female , Humans , Male , Parents/psychologyABSTRACT
BACKGROUND: Behavioral problems and cognitive impairment are common in children with epilepsy (CWE). In sub-Saharan Africa, little is known about these comorbidities particularly their relationships with socioeconomic features. The goal of this study was to identify clinical and socioeconomic factors associated with behavioral problems and cognitive impairment in CWE of Kinshasa (Democratic Republic of the Congo). METHODS: This cross-sectional hospital-based study had included 104 CWE aged 6 to 17years. Behavioral problems were assessed by the child behavior checklist. The Wechsler nonverbal scale of ability was used to assess cognitive impairment. RESULTS: At least one behavioral problem was found in 34.6% of CWE. Internalized problems were increasing with father's age (p=0.034). Externalized problems were increasing with the decreased of mother's age (p=0.009) and with a previous antiepileptic treatment (p=0.032). Total behavioral problems were increasing with a previous antiepileptic treatment (p=0.029). Cognitive impairment was present in 73.3% of CWE. It was more common in boys (p=0.013), and it was increasing with a low household daily expenses (p=0.034), with a previous antiepileptic treatment (p=0.041), with an early onset of epileptic seizures (p=0.042), and with a high frequency of epileptic seizures (p=0.011). CONCLUSION: Behavioral problems and cognitive impairment are common in CWE. Multivariate analysis has shown that behavioral problems were associated with socioeconomic features only. Contrariwise, cognitive impairment was associated with both socioeconomic factors and clinical features. There is a need of more studies to improve knowledge of these comorbidities in the sub-Saharan Africa context.
Subject(s)
Behavioral Symptoms/epidemiology , Child Behavior Disorders/epidemiology , Cognition Disorders/epidemiology , Epilepsy/epidemiology , Epilepsy/psychology , Adolescent , Anticonvulsants/therapeutic use , Behavioral Symptoms/etiology , Child , Cognition Disorders/etiology , Cognitive Dysfunction/drug therapy , Comorbidity , Cross-Sectional Studies , Democratic Republic of the Congo/epidemiology , Epilepsy/drug therapy , Female , Humans , Male , Problem Behavior/psychology , Seizures/drug therapy , Socioeconomic FactorsABSTRACT
Introduction: dans les zones de conflit en Afrique les récentes études rapportent des fréquences élevées des états de stress posttraumatiques (ESPT) notamment en milieu communautaire. L'objectif général de cette étude est de contribuer à une meilleure prise en charge des patients confrontés à la violence subséquente au conflit sociopolitique en cours en République centrafricaine.Méthodes: il s'agit d'une étude transversale portant sur les dossiers des patients reçus en consultation externe Trauma center de Médecins sans Frontières/France à Bangui.Résultats: l'ESPT était présent chez 33.33 % (n = 35) alors que l'état de stress aigu était présent chez 17.14 % (n = 18) des patients. Les états de stress (ES) étaient associés au sexe féminin, au viol, à l'anxiété et à la dépression. Le viol multipliait par 8 le risque de survenue d'un ES. L'âge médian observé était de 30 ans (P25: 22 ans; P75: 40 ans). La majorité des patients présentait un trouble de l'humeur (63.81 %; n = 67). L'insomnie était présente chez 62.83 % (n = 66). L'anxiété (HADS) était présente chez 44.76 % des patients (n = 47). La dépression a été retrouvée chez 40.95 % (n = 43). Conclusion: les résultats obtenus montrent à quel point, au-delà des membres de milices, la société est touchée par la violence du conflit que traverse le pays. Ces résultats pourraient nourrir la réflexion sur l'organisation des soins et la prise en charge de la population centrafricaine considérant l'impact à court, moyen et long terme des états de stress aigus en situation de conflit
