The underreported challenge of disabling psychogenic neurological disorders in Sub-Saharan Africa: a case series of patients presenting to a regional hospital in Tanzania (P1.271)

Marissa Kellogg, William Howlett and Marieke C. J. Dekker
Publication year: 

Objective: To describe a case series of four patients admitted to a regional hospital in Tanzania with disabling functional, somatoform, or psychogenic neurological disorders.

Background: On review of the existing literature, there are no studies on the incidence, prevalence, or characteristics of psychogenic disorders in Sub-Saharan Africa (SSA). Several studies of African immigrant populations conducted in North America, Europe and Australia, report that psychogenic presentations are common. A handful of studies in SSA examine the clinical presentations of certain medical subpopulations: non-epileptic seizures (South Africa only), and psychological or coping strategies of patients with HIV or histories of abuse or trauma (South Africa, Kenya, Mozambique, Burundi); psychogenic presentations are frequently noted.

Design/Methods: Case series description of all adult patients admitted to Kilimanjaro Christian Medical Center in January 2015 who underwent neurology consultation and were subsequently diagnosed with psychogenic disorders.

Results: 28-year-old woman with sudden-onset inability to speak with preserved mouthing of words, paraplegia, and general weakness for 3 days that slowly improved; she had a history of 3 prior identical events all occurring on the same day in preceding years. 38-year-old woman with irregular upper extremity tremors, inability to walk, and fluctuating posturing of the bilateral lower extremities for 2 weeks. 27-year-old woman with sudden back pain and inability to walk for 2 months. 23-year-old nun with sudden onset full-body weakness and astasia-abasia for 3 weeks; CT normal. All patients had non-focal neurological exams and were unable to work.

Conclusions: Psychogenic disorders are a common presentation to healthcare providers around the world. Incidence in SSA is likely at least as frequent as in industrialized countries, and may be more frequent given stigma about psychiatric disease, lower education rates, and limited access to psychiatric services. A paucity of studies address the characteristics or burden of psychogenic disorders in SSA.