Culture and psychiatric classification Original Paper – Roberto Lewis-Fernández Culture shapes every aspect of patient care in psychiatry, influencing when, where, how, and to whom patients narrate their experiences of illness and distress, the patterning of symptoms, and the models clinicians use to interpret and understand symptoms in terms of psychiatric diagnoses. This article presents the rationale for the changes related to the role of culture in psychiatric diagnosis that were included in DSM-5 and describes examples of these changes. The DSM-5 Cross-Cultural Issues Subgroup took into account the recommendations of neurobiologists and anthropologists who have criticized the rigidity of DSM-IV diagnostic criteria, which exclude alternate illness presentations and do not account for the role of context in the emergence and characteristics of psychopathology. Revisions in DSM-5 include a Cultural Issues section in the introduction, the inclusion of culture in the definition of mental disorder, material related to culture that was incorporated into the criteria and description of selected disorders, a new chapter on Cultural Formulation that includes the Cultural Formulation Interview and a description of the revised construct of cultural concepts of distress, and a Glossary illustrating this revised construct. The intent of these revisions was to enhance the validity and reliability of psychiatric diagnosis across cultural groups in the United States and around the world.
Melancholy in Muslim cultures Original Paper – M. Fakhr El-Islam Depressive disorder in Muslims has cultural inputs that affect its genesis, prevention, symptomatology and management. Cousin marriage which is favoured in Muslim cultures is associated with greater family incidence. On the other hand early adequate substitution of parental care deprivation in childhood may have primary preventive effects on the development of depression in adulthood. Somatic symptoms form the front of many depressive disorders. Guilt feelings lay in the background of as many Muslim depressives as Christian depressives in an Egyptian study. However suicidal thoughts are considered blasphemous and severely depressed Muslims stop at the level of death wishes. Family contributes to the triangular family-patient-doctor relationship instead of the dyadic Western patient- doctor relationship. Community care of the depressed includes the family much more than any other welfare agency.
“Illnesses of the Mind” and “Illnesses of the Spirit” among the Ñu’u savi indigenous people that inhabit the Metropolitan Area of Guadalajara (MAG) City in Mexico Original Paper – Sergio J. Villaseñor-Bayardo, Martha Patricia Aceves Pulido, María Dolores Ruelas Rangel, Isaura M. García Hernández Ethnic diversity brings along problems derived from coexistence and different worldviews. It seems necessary to make an analysis of the Mental Health consequences from the point of view of those who face a forced process of Acculturation. With funding of Mexico’s National Council for Science and Technology (CONACYT), we are conducting research work aimed to generate knowledge in order to create a model for mental health care which focuses on the problems and the needs of the migrant indigenous population from different ethnic groups in the MAG. This paper shows the results of the research done with the Mixteca population. Mixteca (named so by the non-indigenous population) or, more properly, Ñu’u savi (People of the Rain) are one of the migrant indigenous groups with more population in the MAG. They arrived here in the 1980s. Nowadays there are 2001 speakers of their language. This article show the results of a qualitative research aimed to characterize the illnesses and therapeutic methods described by this population and related somehow to Mental Health. It has been made semi-structured and non-structured interviews to migrant Ñu’u savi indigenous people living in the MAG. There were identified cases that could be diagnosed by psychiatry and others that the community had an interpretation related to spiritual causes, as witchcraft and susto.It is essential to know the patients’ culture in order to be able to intervene with efficacy. Psychiatry and Western medicine should adapt to and understand the population studied.
Association of delirious mania with Jinn possession phenomenon- A study from Pakistan Original Paper – Qurat ul Ain Khan, Aisha Sanober, Mariam Opel, Mohammad Zaman Objectives To study association of delirious mania with Jinn Possession Phenomenon in Pakistan. Methods The study was conducted at the Aga Khan University Hospital, Karachi. A retrospective chart review was done on all patients, from both inpatient and outpatient settings who were diagnosed with bipolar I, manic or mixed episode, with or without psychosis according to DSM IV-TR from Nov 2013 until July 2014. For diagnosing Delirious Mania we included presence of 2 or more of the following features: disorientation, confusion, altered consciousness, severe cognitive dysfunction, and fluctuations in these states, in the presence of mood disorder. Catatonia was diagnosed by the presence of 2 or more catatonic signs in the last 24 hours according to DSM IV-TR. A semi-structured pro-forma was used to collect demographic and clinical details about the presence or absence of delirium, catatonic features, and Jinn Possession. Results Of the total 73 people diagnosed with bipolar I disorder, 17 had delirious mania, and 5 out of 17 had Jinn possession. Catatonic features were present in most of the patients who had Delirious Mania and Jinn Possession. All 5 cases with Jinn possession were females, had poor compliance with treatment, and continued religious treatment by faith healers. Conclusion Presentation of delirious mania may be associated with phenomenon of Jinn possession in Pakistan. Knowledge of possible association of psychopathology with Jinn possession phenomenon needs to be promoted among the general public and physicians to reduce associated morbidity and mortality. Collaborations with faith healers may be useful to improve compliance.
30 Years longitudinal follow-up study of mental health status in Jinuo Nationality in China: A case of the development and challenge of transcultural psychiatry in China Original Paper – Jianzhong Yang, ChuanYuan Kang and XuDong Zhao Since 1978 Chinese society has experienced rapid and dramatic socio-economic development, especially apparent in rapid technical modernization and urbanization. All Chinese people, those of the Han majority population as well as those of the 55 ethnic nationalities in China, have been directly and indirectly impacted by these changes. However, rapid development and social change have generated new problems of acculturative stress and social isolation in large cities to which many millions have migrated from rural communities. From the perspective of transcultural psychiatry, both the economic and the sociocultural changes of the past thirty years have caused large numbers of people to feel disconnected from their previous lives and norms of behavior; leading to an increased prevalence of psychiatric symptoms and disorders, including increased incidence of alcohol and drug-related disorders, major depressive disorder, anxiety disorders and rising rates of suicide in rural communities such as shown in Jinuo Nationality over the past 30 years longitudinal follow-up study, as well as in urban populations. The resilience of ethnic minority populations in coping with and adapting to these massive changes has not been subject to detailed study, and it is a new task for current transcultural psychiatry research in China to explore those psychosocial mechanisms that both help and hinder the adaptation of specific ethnic groups faced with the rapid and intense changes of the past three decades.
Observations and reflections on clinical and socio- psychological aspects of psychosomatic disorders in Russia and Kazakhstan Original Paper – Nikolay Bokhan, Valentina Lebedeva, Sagat Altynbekov The article gives an analysis of the role of various pathogenetic (ethnic, personality, personality-biological, social-economic, organizational) factors of somatic pathology associativity in formation of clinical dynamics of psychosomatic diseases in patients of the Kazakh and Russian nationality in primary care. Comparative data are given about indicators (prevalence, medical aid appealability, staffing with mental health professionals, motivational traits of patients of the Kazakh and Russian nationality) reflecting efficiency of the existing models of mental health services in Kazakhstan and Russia. The reliable importance of hysterical, asthenic, sensitive personality traits in formation of psychosomatic disorders in persons of both nationalities with prevalence of cenesthopathic disorders in Russians and anxiety disorders in Kazakhs is ascertained. Influence of ethnocultural factors on clinical dynamics, efficiency of therapy, and outcome of psychosomatic disorders is emphasized. The used rehabilitation programs and algorithm of medical care for patients of general somatic network are in detail described. Use of this algorithm allows reducing unreasonable medical aid appealability of patients with mental disorders to doctors-somatologists by 3.5 times, improving the quality of social functioning, reducing terms of the rehabilitation period. Need of use of ethnocultural features in the complex of medical activities as a possible aspect of efficiency of therapy is emphasized. The main perspective strategies of efficiency of medical care to patients with psychosomatic disorders are formulated.
The impact of international migration on the mental health of Honduran teenagers Original Paper – Américo Reyes Ticas, Farah Archaga, Jose Luis Cruz, Rolando López, Aaron Rodríguez, Manuel Sierra, Mario Aguilar The main causes of international migration in Honduras are poverty and personal insecurity. Approximately 800,000 Hondurans have left the country, out of which 80% are located on the United States. One of the largest economical incomes in Honduras are remittances, however there is no information on the impact that leads to the family disintegration caused by this social phenomenon. Objective. To determine the mental health of teenagers, at a secondary school in Tegucigalpa, coming from households with and without parental migration. Methods and Materials: The first screening phase is to determine the degree of functionality and select teenagers with migrant parents, establishing cases, assigning two controls one for separated parents and another for both parents present. Results: Out of 3608 students, 449 (12.4%) had migrant parents. 550 teenagers were interviewed in the second phase. The perception of communication is better in families with both parents present. “Mara” or Gang membership was 4.4% higher in families with migrants. The relationship of teenagers with parents was better in families with migration. The percentage of physical, psychological and sexual abuse found was higher (p.009) in families with migration. Households with both parents present were a protective factor in abuse. A statistical significance in depression and anxiety disorders was found in teenagers from families with migration when comparing the three groups. Conclusion: Parental migration is a risk factor for teenagers to become victims of abuse, suffer from depression and anxiety disorders, as well as for the initiation in dissocial groups.
An evidence-based framework for cultural adaptation of Cognitive Behaviour Therapy: Process, methodology and foci of adaptation Original Paper – Farooq Naeem, Peter Phiri, Amina Nasar, Ashley Gerada, Tariq Munshi, Muhammad Ayub, Shanaya Rathod Currently there is no evidence-based framework for culturally adapting CBT for clients from the Non- Western cultural background. We adapted CBT for black and ethnic minority communities in the UK and local population in Pakistan. This paper describes the framework that evolved from this work, with a focus on the process of adaptation, details of methods used and the areas that need to be focused in order to culturally adapt CBT in a given culture. As far as we are aware this is the first adaptation framework that is evidence based and has been tested through field testing. A series of mixed method studies were conducted in Pakistan and the UK. Adaptation process starts with (a) background information gathering (b) in-depth interviews and focus groups with the stake holders; i.e., patients, carers, community leaders and health professionals (c) development of guidelines (d) cultural adaptation of therapy material, and (e) field testing adapted therapy. Through an iterative process we developed semi structured interviews that can be used now in low resource settings. The cultural adaptation of CBT should focus on three fundamental areas; (1) awareness of relevant cultural issues and preparation for therapy, (2) assessment and engagement, and; (3) adjustments in therapy. The adapted CBT was found to be effective in RCTs. Recently; the above methodology was used to culturally adapt CBT in China, Middle East and Morocco.