[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.

Combined thalamic ptosis and astasia.

Isolated cases of astasia or ptosis have each been reported in ischemic or hemorrhagic strokes involving the thalamus. We report a 70-year-old man with a medical history of hypertension who presented with left ptosis and gait disturbance despite intact motor strength in the legs and normal sensory function. MRI of the brain showed an evolving subacute infarction confined to the anteromedial-medial part of the left thalamus with no other areas of recent infarction identified. To our knowledge, combined ptosis and astasia in thalamic infarction has not been reported in the English literature. We identified 11 patients with thalamic ptosis and 21 with thalamic astasia in the literature. Patients who had ptosis, or gait abnormality which would not be related to thalamic stroke, were excluded; for example, evidence of infarction in the hypothalamus, midbrain, pons, cerebellum, or cingulate gyrus.

Conversion locked-in syndrome after implantation of a spinal cord stimulator.

BACKGROUND: The locked-in syndrome is defined as quadriplegia and anarthria (loss of articulate speech) with the preservation of consciousness. It is typically caused by a lesion to the ventral pons. Conversion disorder is the deficit of voluntary motor or sensory function requiring an extensive work-up to exclude any organic cause. METHODS AND RESULTS: After surgery for an implantation of a spinal cord stimulator, a 42-year-old woman presented with quadriplegia and lower facial diplegia, but was able to open and blink her eyes. We found no organic causes to explain her condition after appropriate radiological studies looking for intracranial or intraspinal causes, and reversal drugs were administered with no immediate effect. Over the course of several hours, the patient gradually recovered and was discharged the following day. A psychology consultation was obtained during her stay and she was found to meet the criteria for a conversion disorder to explain her condition. CONCLUSIONS: Before considering a psychological cause, all organic factors should be excluded with proper tests and consultations, as conversion disorder is a diagnosis of exclusion. We report a patient who, after implantation of a spinal cord stimulator, manifested locked-in syndrome resulting from a conversion disorder.

Conversion disorder after implant of a spinal cord stimulator in a patient with a complex regional pain syndrome.

IMPLICATIONS: This case history describes the treatment of a patient suffering with persistent pain. He was treated surgically with implantation of a spinal cord stimulator. After surgery, a partial paralysis that could not be explained medically and that was probably related to emotional factors occurred, and cognitive behavioral treatment was begun. This paper discusses the importance of considering social and psychological factors when medical treatment options are considered.

Dolor abdominal recurrente: un trastorno somatomorfo / Recurrent abdominal pain: a somatomorf disorder

El dolor abdominal recurrente es un problema común en pediatría. La etiología es desconocida, aunque se relaciona con un origen psicosomático. En este trabajo analizamos el dolor abdominal recurrente como trastorno somatomorfo indiferenciado, según los criterios del DSM-IV, y estudiamos los factores psicológicos asociados a la etiología, fisiopatología, diagnóstico y tratamiento (AU)

[Coexistence of mass hysteria, konzo and HTLV-1 virus in the Democratic Republic of the Congo]. / Coexistence hystérie collective, konzo et virus HTLV-1 en République Démocratique du Congo.

A cross-sectional study was carried out in Pindi located 115 kilometers from Kikwit, Democratic Republic of the Congo to characterize a local school epidemic involving paralysis of the lower extremities, identify risk factors, and establish differential diagnosis with konzo and spastic paralysis related to human T-lymphotropic virus type 1 (HTLV-1). Data was obtained using a qualitative approach based on records, interviews, focus group technique, and neurological examination. Blood tests using the ELISA and western blot tests were performed to detect HTLV-1 and HIV 1 and 2. A total of 41 cases of paralysis were observed between 1994 and 1998. All patients were female and most (n = 28) were between the ages of 16 and 20 at the time of the study. The majority of cases were recorded in 1998 (31 prevalent cases and 16 incidents). Epidemiological data, clinical findings, and laboratory tests suggested that the etiology was mass hysteria with somatic conversion rather than toxic or viral causes in most cases. The psychosocial environment played an important role in the spread of the epidemic. These findings demonstrate the crucial role of the psychosocial environment in the occurrence of mass hysteria and support use of integrated health programs in developing countries.

Interrogative suggestibility in patients with conversion disorders.

We tested the hypothesis that increased interrogative suggestibility may contribute to the shaping and maintaining of conversions symptoms. Interrogative suggestibility was measured in 12 patients with conversion disorder and 10 control patients with confirmed neurological disease matched for age, premorbid intelligence, and as closely as possible in terms of their neurological symptoms to the patients with conversion disorder. Our observations do not support the contention that individual differences in interrogative suggestibility are of importance in the etiology of conversion disorders.

[Pediatric psychosomatic medicine. Liminal proposals]. / La clinique psychosomatique chez l'enfant. Propositions liminaires.

Psychosomatic disorders are part of the pediatrician's everyday practice. However, they have only lately become a field for systematic investigations, based on diverse methods and concepts. The viewpoints supported by the authors originate in studies carried out in the pediatric department of a hospital which deals only with psychosomatics. The following points are considered successively: 1) definition and peculiarities of psychosomatic disorders in children; 2) susceptible emotional organizations, which carry a high risk of psychosomatic disease; 3) depression, which is a key mental mechanism in psychosomatic disruption. One of the main purposes of research is description of a specific semiology of childhood psychosomatic disease. Its ambition is to be both open to medical practice and acknowledged in its specificity, so as to be used in psychological disciplines, i.e., sufficiently clear but without oversimplification. Further developments can be found in "L'enfant du désordre psychosomatique" (Privat 1981) and "La psychosomatique de l'enfant" (PUF 1983).

Dysesthesia, witchcraft, and conversion reaction. A case successfully treated with psychotherapy.

An intelligent, well-educated black woman from the rural South, through an interaction of psychopathology and cultural background, experienced dysesthesia as a conversion reaction and came to believe that she was the victim of witchcraft. After neurological evaluation showed no abnormalities, she was successfully treated with conventional psychotherapy. Belief in hexing or root work is still alive today and should be inquired about in patients with unusual symptoms and an appropriate cultural background.