[Psychiatric disorders in Madagascar: clinical study of 376 cases registered in 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.