[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.

epidemiologie des patients suicidants dans le service de Reanimation medicale du Centre Hospitalier Universitaire d'Antananarivo

Introduction. Decrire l'epidemiologie hospitaliere des patients suicidants; et connaitre les differents facteurs de risque sur un echantillon de population malgache. Methode. Il s'agit d'une etude prospective; allant du mois de Janvier 2009 au mois de Decembre 2009; des suicidants hospitalises dans le service de Reanimation medicale du CHU Antananarivo. Resultats. Cent soixante quatorze cas (14;83) sur les 1173 patients hospitalises ont ete retenus pour cette etude. L'age moyen etait de 26;20 ans et le sex ratio de 0;74. La majorite (52;29) de nos patients etait celibataire. Cinquante quatre patients (31;03) ont des antecedents medico-chirurgicaux; dont 8 avec des antecedents psychiatriques (4;60); et 26 patients (15) avec des antecedents de tentative de suicide. Le contexte de depression a ete retrouve dans 36;78; les troubles psychotiques dans 6;32et l'impulsivite dans 56;89. Le moyen le plus frequemment utilise etait l'intoxication aux organo-phosphores (55;17); et l'intoxication aux antipaludiques de synthese (16;67). Conclusion. La tentative de suicide est une realite et une actualite qu'il ne faut pas negliger a Madagascar. Les plus vulnerables sont ceux qui presentent des comorbidites psychiatriques; et ceux qui vivent dans un environnement pathologique. Il serait souhaitable que tous patients suicidants recoivent une evaluation psychiatrique approfondie pour eviter la recidive