In this second part of the study, we propose an implementation of Karl Leonhard's phenotype of periodic catatonia for ICD-10/11-trained psychiatrists. If the goal is to identify the same subgroup of patients within the schizophrenia spectrum disorders (SSD), we will refer to it as "progressive periodic catatonia" or PPC to emphasize the difference with the classical diagnostic procedure which only makes sense in the context of systems neuropsychiatry. This attempt differs from the previous ones in that we use criteria accessible to practitioners trained in ICD-10/11 and by the replacement of the Boolean polythetic logic by a more integrative Bayesian logic. The principle is simple and consists of using the characteristics whose probability of occurrence is conditioned by the PPC vs non-PPC diagnosis (nPPC). If neither of them is discriminating in isolation, the combination of their likelihood ratios allows us, from a determined prevalence of PPC, to estimate an a posteriori probability of diagnosis. The procedure, named "Bayes-PPC", requires the evaluation of nine criteria: two concern the evolutionary course, six the residual syndrome (two psychomotor distortions, two negative symptoms, and the absence of two positive symptoms), and the family aggregation. A feasibility study was conducted on 38 PPC and 21 nPPC individuals. Starting from the SSD populations or restricting to SSD with deficit schizophrenia (80% of the population), Bayes-PPC allows for a correct classification of 69 and 67% of the patients respectively. For a posteriori probability higher than 95%, the sensitivity for PPC is 82 and 77% respectively, and the specificity is 100% in all cases. For a posteriori probability less than 5%, the sensitivity for nPPC is 48 and 47% respectively and the specificity is 100% in both cases. These results are encouraging and must now be confirmed in a study involving a larger population and by researchers not trained in the neuropsychiatric diagnostic procedure. They nevertheless suggest the possibility of allowing these same untrained psychiatrists to study the PPC phenotype. (C) 2023 Published by Elsevier Masson SAS.
While the correlation between the phenotype of periodic catatonia and two biomarkers, one genetic and the other brain imaging, has attracted the attention of international psychiatry, there has been little clinical or etiopathological research on this phenotype. The main reason is probably that this phenotype described by the Wernicke-Kleist-Leonhard (WKL) school has been defined in a paradigmatic framework so far removed from that of the ICD or DSM, and that even its name is problematic. Here, 'periodic catatonia' has nothing to do with a simple recurrence of relapsing-remitting ICD-catatonia. Hence, we will refer to it as 'periodic catatonia by progressive access' (PCPA) to distinguish it from remitting forms. In PCPA, catatonic manifestations are often inconspicuous, and more than half of the patients advance in a step-like progression towards a kind of disabling 'deficit schizophrenia'. Preliminary results indicate that this symptomatology, which is usually resistant to psychopharmacological treatments, could respond to a personalized neuromodulation treatment specific to PCPA. This is what a national study seeks to confirm in France. In this context, this two-part article aims to make those psychiatrists who have been trained in ICD/ DSM psychopathology aware of PCPA and to enable them to diagnose it correctly. The objective of this article is therefore twofold. In the first part, it seems essential to present the problem. PCPA is a product of systems neuropsychiatry, whose diagnostic approach is at odds with the atheoretical and polythetic approach of the international classifications. This first part is intended to present an idea of the diagnostic procedure and to stress the impossibility of diagnosing 'periodic catatonia' without reference to its conceptual framework. This is emphasized by changing the name: PCPA is not periodic catatonia, but an operationalization of the original concept. PCPA is intended to be sharable without recourse to a theoretical corpus which is not universally accepted. Therefore, we will describe PCPA using ICD-11 terminology to present an overall picture of the symptomatology and to introduce the elements on which it will be possible to rely when performing the probabilistic diagnosis that will be presented in part II. (c) 2023 Published by Elsevier Masson SAS.
Le tabagisme est la cause de décès la plus évitable dans le monde aujourd'hui. Chaque année, plus de 8 millions de personnes meurent à cause du tabagisme dont la plupart surviennent dans les pays à faibles et moyens revenus. Nous avons réalisé une étude prospective, descriptive allant de mai 2019 à juillet 2019 à l'hôpital Saint Jean de Dieu à Thiès, Sénégal. Nous avons interrogé 195 patients hospitalisés, l'âge moyen était de 52,64 ans, on notait 84 hommes et 111 femmes, soit un sex-ratio de 0,75. Nous avons retrouvé 13 fumeurs soit 6,7 % et de 21 ex-fumeurs soit 10,8 %. Nous ne retrouvions que 1 femme, soit 0,5 %. L'âge moyen des fumeurs actifs était de 49,23 ans, l'âge de début du tabagisme était en moyenne de 20,32 ans, la consommation de tabac sous forme de cigarette, était estimée en moyenne à 11,3 paquets année. La dépendance à la nicotine était moyenne chez 61,5 % selon le test de Fagerström. Les facteurs initiateurs au tabagisme étaient principalement par l'influence de l'entourage chez 46,15 % et le stress chez 30,7 %. L'âge moyen des ex-fumeurs était de 54,8 ans, Le sevrage tabagique était le plus souvent réussi grâce à la volonté personnelle (52,4 %). Le coût mensuel du tabagisme, il était estimé en moyenne à 0,7 % du SMIC, 38,2 % des fumeurs consommaient le tabac noir roulé traditionnel de façon concomitante, ainsi que 17,64 % consommaient du cannabis. La prévalence du tabagisme est faible en milieu rural au Sénégal. Toutefois, la sensibilisation de la population est primordiale pour diminuer ce fléau.
Better known in neurology by the expression paratonia coined by Ernest Duprein 1907, the term Gegenhalten has remained dominant in psychiatry. While the term was created by Karl Kleist in 1927 to define a form of hypertonia in order to distinguish it from negativism, many current references continue to conflate the two concepts. Gegenhalten is the most frequent kind of hypertonia, and if its differential diagnosis with spasticity is generally easy, it is more difficult to distinguish it from parkinsonian rigidity, especially in psychiatric settings where antipsychotic-induced (or revealed) parkinsonism is frequent. Problematically, the most used evaluation scale for it, i.e., the Simpson-Angus scale does not allow for the distinction of Gegenhalten from parkinsonism. This could explain some of what is currently referred to as "spontaneous parkinsonism", i.e., a hypertonia reported to occur in psychotic patients who are not taking any antipsychotic medication. Classical Gegenhalten is reactive, i.e., it occurs in the absence of an increase in resting tonus. It opposes an involuntary resistance during passive mobilization, the appearance of which is often delayed, or may only be perceptible after frequent repetitions. Thus, in the absence of a sensitization maneuver, minor forms of Gegenhalten may go undetected. Gegenhalten opposes a variable resistance. For instance, it depends on position (enhanced by gravitation) or emotional arousal. It can also be masked by a Mitmachen, a form of automatic assistance which is also of locomotor origin (like the Gegenhalten). While the French school of psychiatry saw Gegenhalten as a lack of voluntary control of muscle relaxation, Karl Kleist viewed it as an exacerbation of postural fixation reactions. For him, Gegenhalten could also occur "spontaneously" under the simple effect of gravity. Kleist hypothesized that spontaneous Gegenhalten was a kind of hypersensitive postural fixation reaction that could account for catatonic rigidity. These hypotheses were hotly debated at the beginning of the 20th century and stimulated considerable research. The growing interest in motor abnormalities in endogenous psychoses invites us to reconsider them. Unfortunately, they cannot be understood without a return to a refined semiology which has since been forgotten. This review is a first step in this direction. (C) 2022 Published by Elsevier Masson SAS.
Introduction: The aim of this study was to evaluate the anatomical and functional results of locked condylar plate osteosynthesis in distal femur fractures in elderly Togo patients.Patients and Method: It was a continuous prospective study with descriptive and analytical aims, conducted over a period of 4 years 6 months, from 1 January 2019 to July 2023. The AO/OTA classification was used for the radiological classification of fractures. The walk was measured by the Parker score. Functional outcome of the knee was evaluated using the MEGY functional score. The population of study was 32 cases. The mean age of the patients was 74.25 years, and the most affected group was 35-45 age. Both sexes were equally represented. Fall at home were responsible of 43.8% distal femoral fracture in patients aged over 60 years old. Fractures were open in 18.8%. In 15.6% cases, these lesions were associated to polyfractures and/or polytrauma and in 3 cases we found
