Descriptive study of cases of schizophrenia in the Malian population.

BACKGROUND: Schizophrenia is a relatively common disease worldwide with a point prevalence of around 5/1000 in the population. The aim of this present work was to assess the demographic, clinical, familial, and environmental factors associated with schizophrenia in Mali. METHODS: This was a prospective descriptive study on a series of 164 patients aged at least 12 years who came for a follow-up consultation at the psychiatry department of the University Hospital Center (CHU) Point G in Mali between February 2019 and January 2020 for schizophrenia spectrum disorder as defined by DSM-5 diagnostic criteria. RESULTS: Our results revealed that the male sex was predominant (80.5%). The 25-34 age group was more represented with 44.5%. The place of birth for the majority of our patients was the urban area (52.4%), which also represented the place of the first year of life for the majority of our patients (56.1%). We noted that the unemployed and single people accounted for 56.1 and 61% respectively. More than half of our patients 58.5% reported having reached secondary school level. With the exception of education level, there was a statistically significant difference in the distribution of demographic parameters. Familial schizophrenia cases accounted for 51.7% versus 49.3% for non-familial cases. The different clinical forms were represented by the paranoid form, followed by the undifferentiated form, and the hebephrenic form with respectively 34, 28 and 17.1%. We noted that almost half (48.8%) of patients were born during the cold season. Cannabis use history was not observed in 68.7% of the patients. The proportions of patients with an out-of-school father or an out-of-school mother were 51.2 and 64.2%, respectively. CONCLUSION: The onset of schizophrenia in the Malian population has been associated with socio-demographic, clinical, genetic and environmental characteristics.

Assessing traditional medicine in the treatment of neurological disorders in Mali: prelude to efficient collaboration.

INTRODUCTION: Neurological disorders (ND) have a high incidence in sub-Saharan Africa (SSA). In this region, systemic challenges of conventional medicine (CM) and cultural beliefs have contributed to a large utilization of traditional medicine (TM). Yet, data on TM and those who use it in the treatment of ND in SSA are scarce. Here, we systematically analyze its role as a therapy modality for ND in Mali, the socio-demographic characteristics of its users, and propose next steps to optimize the dual usages of TM and CM for patients with ND. METHODS: We conducted a questionnaire study in two phases. In phase one, patients with ND answered questions on their usage of and attitudes towards TM. In phase two, the TM therapists who provided care to the patients in phase one answered questions regarding their own practices for treating ND. Patients were recruited from the country's two university neurology departments. RESULTS: 3,534 of the 4,532 patients seen in the Departments of Neurology in 2019 met the inclusion criteria. Among these 3,534 patients, 2,430 (68.8%) had previously consulted TM for their present ND. Patients over 60 years of age most often used TM (83.1%). By education, illiterate patients utilized TM the most (85.5%) while those with more than a secondary education used TM the least (48.6%). An income greater than the minimum guaranteed salary was associated with decreased use of traditional medicine (OR 0.29, CI 0.25-0.35, p < 0.001). Among those using TM, it was overwhelmingly thought to be more effective than CM (84.6%). Linking illness to supernatural causes and believing TM therapists had a better understanding of illnesses were the most common reasons patients used traditional medicine (82.3% and 80.5%, respectively). We then interviewed 171 TM therapists who had provided care to the patients in phase one. These providers most commonly "sometimes" (62.6%) referred patients to CM and 4.1% never had. A majority of TM providers (62.6%) believed collaboration with CM could be improved by having doctor "take into account" our existence. CONCLUSION: Our work shows that TM plays a central role in the provision of care for patients with ND in SSA with certain cohorts using it at higher rates. Future development of treatment of ND in SSA will require optimizing TM with CM and needs buy-in from all stakeholders including conventional medicine clinicians, traditional medicine therapists, researchers, politicians, and most importantly, patients.

Human Immunodeficiency Virus (HIV) Treatment With Antiretroviral Therapy Mitigates the High Risk of Mental Health Disorders Associated With HIV Infection in the US Population.

Background: Whether treatment of human immunodeficiency virus (HIV) with antiretroviral therapy (ART) is associated with lower risk of mental health disorders (MHDs) among people with HIV (PWH) remains unknown. We aim to determine the association between HIV and MHDs and whether ART alters the risk of MHDs among PWH in the US adult population. Methods: We conducted a real-world study using the Merative MarketScan claims database (2016-2020), identifying individuals with HIV (diagnosed using International Classification of Diseases, Tenth Revision, Clinical Modification codes) and those without HIV. A multivariable stratified Cox proportional hazard regression model was conducted to examine the association of HIV treatment status with MHDs, adjusting for potential confounders. Additionally, we sought to determine the effect modification of ART on the relationship between living with HIV and MHDs. Results: A total of 313 539 individuals, with a mean age of 44.2 (standard deviation, 11.4) years, predominantly males (81.2%), residing in the South region of the US (50.9%) were included in the present analysis. During 671 880 person-years of follow-up, 46 235 incident MHD cases occurred. In the multivariable Cox proportional hazard model, living with HIV was associated with higher risk of incident MHDs. Relative to those without HIV, the adjusted hazard ratio was 1.85 (95% confidence interval [CI], 1.79-1.92; P < .001) for those with HIV on treatment, and 2.70 (95% CI, 2.59-2.82; P < .001) for those with HIV without any treatment. Stronger associations between HIV and MHDs were observed in men relative to women, among those aged 18-34 years relative to those aged 55-63 years, and among those with no overweight/obesity relative to obese individuals (Pinteraction < .001 for all). Conclusions: HIV was associated with an increased risk of developing MHDs. However, HIV treatment mitigated the risk.

Clinical and Genetic Aspects of Huntington's Disease in the Malian Population.

BACKGROUND: Huntington's disease (HD) is an autosomal dominant neurodegenerative disorder caused by mutation in the HTT gene and characterized by involuntary movements as well as cognitive and behavioral impairment. Since its first description 150 years ago, studies have been reported worldwide. However, genetically confirmed cases have been scarce in Africa. OBJECTIVE: To describe the clinical and genetic aspects of HD in the Malian population. METHODS: Patients with HD phenotype and their relatives were enrolled after obtaining consent. Symptoms were assessed using the Total Motor Scale (TMS) of the United Huntington's Disease Rating Scale (UHDRS) and the Mini-Mental State Examination (MMSE). Brain imaging and blood tests were performed to exclude other causes. DNA was extracted for HTT sequencing. RESULTS: Eighteen patients (13 families) with a HD phenotype were evaluated. A familial history of the disease was found in 84.6% with 55.5% of maternal transmission. The average length of the HTT CAG repeat was 43.6±11.5 (39-56) CAGs. The mean age at onset was 43.1±9.7years. Choreic movements were the predominant symptoms (100% of the cases) with an average TMS of 49.4±30.8, followed by cognitive impairment (average MMSE score: 23.0±12.0) and psychiatric symptoms with 22.2% and 44.4%, respectively. CONCLUSION: This is one of the largest HD cohorts reported in Africa. Increasing access to genetic testing could uncover many other HD cases and disease-modifying genetic variants. Future haplotype and psychosocial studies may inform the origin of the Malian mutation and the impact of the disease on patients and their relatives.

Neuropathic pain in Mali: The current situation, comprehensive hypothesis, which therapeutic strategy for Africa?

INTRODUCTION: According to the taxonomy of the International Association for the Study of Pain (IASP 2011), neuropathic pain (NeuP) is defined as "pain caused by a lesion or disease of the somatosensory nervous system". NeuP is currently well-defined clinically, despite a high degree of etiological variation, and it has become a significant public health problem. This work aimed to study the situation regarding NeuP in current practice in Mali, as well as to analyze the therapeutic environment of the patients. METHODOLOGY: This was a retrospective and cross-sectional study, carried out in two phases: (1) compilation of the files of patients according to the ICD-11, over a period of 24 months (2) a second prospective phase regarding the Knowledge, Attitudes, and Practices (KAP) of general practitioners and neurologists in regard to NeuP. The focus of the first phase of the study was the files of the patients who had undergone a consultation at the Gabriel Touré UHC. The second phase of the study focused on the general practitioners (Community Health Centers (comHC) of Bamako) and neurologists (Malian or not). RESULTS: Over the period of the study, 7840 patients were seen in consultation in the Department of Neurology, of whom 903 for NeuP, thus amounting to a NeuP frequency of 11.5%. Women accounted for 58.9% (532/903), with a sex ratio of 1.4. Using a comparative normal law, the difference in frequency was statistically significant between males and females (p < 10-7) and between two age groups (p ã€ˆ10-3). The 49-58 years of age group was represented the most. Diabetic NeuP (21%), lumbar radiculopathies (14%), HIV/AIDS NeuP (13%), and post-stroke NeuP (11%) were the most represented. The survey among the carers revealed: a need for training, a low level of compliance with the therapeutic guidelines, and the use of traditional medicine by the patients. DISCUSSION/CONCLUSION: This work confirms that NeuP is encountered frequently in current practice, and its optimal management will involve specific training of carers and improvement of access to the medications recommended in this indication. In light of this issue, we revisit the debate regarding the concept of essential medications and the relevance of taking into account effective medications for the treatment of NeuP.

Place et vécu psychosocial des proches de schizophrènes suivis au service d'addictologie et d'hygiène mentale d'Abidjan (SAHM) / Psychosocial place and experience of relatives of schizophrenics followed at the addiction and mental hygiene service of Abidjan (SAHM)

La survenue de la schizophrénie chez un membre de la famille n'affecte pas que le malade, elle a une répercussion sur l'ensemble de la sphère familiale. À la vue de cette réalité, nous avons mené une étude transversale à visée descriptive ayant portée sur un échantillon sur 132 proches de patients schizophrènes à Abidjan. Les résultats de cette étude ont montré que : - Dans la majorité des cas (87,13%), les aidants familiaux des patients schizophrènes étaient des membres de la famille nucléaire. Ces aidants familiaux qui assuraient l'essentiel de la prise en charge, exerçaient pour plus de la moitié (57,58%) d'entre eux dans le secteur informel, avaient à 72.22% un revenu mensuel inférieur à 100.000 F.CFA (152,7 euro). Tous nos participants à l'enquête ont affirmé ne recevoir aucune aide extérieure ; - En termes de degré d'implication des proches il ressort que les parents géniteurs et la fratrie étaient les plus impliqués à 78,29%dans frais des médicaments, à 73,49% dans le suivi de l'observance thérapeutique et à 61,36% dans l'apport d'assistance dans les besoins quotidiens de leur proche atteint de schizophrénie ; - Parmi les difficultés rencontrées par les proches dans la prise en charge des schizophrènes, celles qui ont les fréquences les plus élevées sont celles de la stigmatisation (77,78%), l'épuisement financier (73,33%), la fragilité de la santé (62,22%), des difficultés liées à la couchette et à l'alimentation (53,33%) et du manque de temps pour soi-même (46,67%) ; - Les principales réactions psychologiques enregistrées à l'annonce du diagnostic de schizophrénie chez nos enquêtés étaient : tristesse (88,89%) ; découragement (86,67%) et stress (77,78%). Il a été cependant noté qu'au décours du suivi des patients, les principales attitudes enregistrées chez nos participants face à cette situation étaient : renforcement de l'affection (52,67%) et le soutien moral (35,11%).

The occurrence of schizophrenia in a family member does not only affect the patient, it has an impact on the entire family sphere. In view of this reality, we conducted a descriptive cross-sectional study involving a sample of 132 relatives of schizophrenic patients in Abidjan. The results of this study showed that: -In the majority of cases (87.13%), family caregivers of schizophrenic patients were members of the nuclear family. These family carers who provided most of the care, worked for more than half (57.58%) of them in the informal sector, had at 72.22% a monthly income of less than 100,000 CFA francs (152,7 euro). All of our survey participants said they receive no outside help; - In terms of degree of involvement of relatives, it appears that parents and siblings were the most involved at 78.29% in drug costs, at 73.49% in monitoring therapeutic compliance and at 61, 36% in providing assistance with the daily needs of their loved one with schizophrenia. - Among the difficulties encountered by relatives in the care of schizophrenics, those with the highest frequencies are those of stigmatization (77.78%), financial exhaustion (73.33%), the fragility of health (62.22%), difficulties related to bed and food (53.33%) and lack of time for oneself (46.67%). - The main psychological reactions recorded at the announcement of the diagnosis of schizophrenia among our respondents were: sadness (88.89%); discouragement (86.67%) and stress (77.78%). It was however noted that during the follow-up of the patients, the main attitudes recorded by our participants in the face of this situation were: reinforcement of affection (52.67%) and moral support (35.11%)