[A manner of voicing, the mass hysteria]. / Une manière de s'exprimer, l;hystérie collective.

INTRODUCTION: Mass hysteria is defined as the epidemic occurrence of a succession of physical symptoms without organic disorder or identifiable illness agents. The hysteria epidemic has been described since the Middle Ages, reported in different cultures and religions and affects different populations throughout the world. Few studies on the subject have been under takenin Madagascar. We aim at describing in this study the clinical and therapeutic aspects of a mass hysteria that has occurred in the South of Madagascar. METHODOLOGY: The study is retrospective and prospective at the same time. It concerns the victims of a mass hysteria that had occurred in a village (Ikalahazo) in the South of Madagascar,from the 6th of April 2009 to the 7th of May 2009. Patients exhibiting clinical symptoms ofconversive behavior and having undergone an assessment in hospital surroundings represent the object of this study. During the study period, 27 cases of young women were reported, 22 ofthem were sent to the University Hospital Center of Fianarantsoa (UHCF), a referring center o fthe region, for a thorough clinical examination. Demographic data, the clinical aspects and thecare and treatment provided are the studied parameters. RESULT: During a land ownership dissension that drags on endlessly in Ikalahazo village, exclusively 27 young women, between 8 and 21 years old, presented atypical symptoms, strangedisorders. A first case appeared on the 6th of April 2009, that is to say a month before alarge manifestation of the crisis. A similar case was observed two years ago, but it was an isolated case. The symptoms, primarily with motive manifestation, extended rapidly but remainedhowever limited, susceptible to the "Mpiandry" (literally "shepherds") advice. As the villagers believed that spiteful spirits were at the origin of the deeds, they appealed to the latter. Facing the symptoms persistence, the Neuropsychiatry Unit employees of the CHUF were sent to the village on the 6th of May 2009. The intense adhesion of villagers to a belief in satanic misdeedscomplicated their somatic assessment, the results of which showed no distinctive features. At the end of the land dissension proceedings that was resolved in favor of the villagers, and after the isolation of the "madwomen" in the Mpiandry's camp, no more pathological cases related to the above occurrence were reported. CONCLUSION: A mass hysteria diagnosis is retained. It is favored and kept up by local dissensions,by the villagers' belief and its large media casting, thanks to the shepherds' presence. It mingles culture, tradition and modern psychiatry. Therefore, care and treatment of the disorder to be appropriate and optimal require the cooperation between these three spheres.

[Psychiatric disorders in Madagascar: clinical study of 376 cases registered in Mahajanga]. / Les troubles psychiatriques à Madagascar: étude clinique de 376 cas répertoriés à Mahajanga.

Epidemiological and clinical data on psychiatric disorders from Madagascar are rare, particularly those issued from the coastal provinces. This retrospective study of cases, registered in the hospital of Mahajanga, from January 1st 1998 to December 31st 2000, gives a general scope on their frequency, their distribution and their features in this North Western littoral of the island. Concurrent resorts (traditional and religious healers) may reduce hospitalisation rate, by filtering minor and brief mental disorders at their level, but they delay the accurate management of severe or complicated cases, and enhance their frequency. The features of depression, the first cause of referrals (136/376), are characterized by the predominance of somatic complaints (89/136) over psychic symptoms (47/136), by that of persecutory ideas on self culpabilization and loss of self esteem, which accounts for the rarity of suicide (only 4/136 cases). Patients are sensitive to lower dose of antidepressant drugs, compared with patients from occidental countries. Psychosis, the second cause of medical resort (95/376), are essentially represented by schizophrenia (57/95), which involves males more than females (sex ratio 2), and displays more hebephrenic symptoms (31/57) than paranoid's (24/57). In spite of serious economical constraints, family dismissal is rare. Implementation of an accurate drug policy (long acting neuroleptics supply), along with this family support, may enhance patients' reintegration. Addictive (drugs, alcohol) and anxiety disorders seem to be underrepresented. In conclusion, the same pathologies reported in western literatures are encountered, but their features are sometimes modified by cultural particularities. A recent general population survey has brought complementary data, but this clinical study needs reproduction in other provinces, to be representative of the whole island.