Transcultural Psychiatry recent issues

Editorial: The Cultural Formulation

Lewis-Fernandez, R. — Fri, 16 Oct 2009 07:19:02 PDT

Cultural Formulation Guidelines

Mezzich, J. E., Caracci, G., Fabrega, H., Kirmayer, L. J. — Fri, 16 Oct 2009 07:19:02 PDT

The outline for the Cultural Formulation (CF) introduced in DSM-IV does not present any method for collecting the required cultural information. The absence of specific guidelines and illustrative cases has hampered its wider use. This article offers a practical approach to preparing a Cultural Formulation as a component of culturally competent clinical care. We summarize the rationale for the four sections of the CF, describe the process of conducting culturally focused clinical interviews, and present examples of questions or lines of inquiry that can be used to collect the information needed to construct the CF. An online supplement provides case examples of cultural formulations applied to patients seen in the US.

The Cultural Formulation: A Model to Combine Nosology and Patients' Life Context in Psychiatric Diagnostic Practice

Baarnhielm, S., Scarpinati Rosso, M. — Fri, 16 Oct 2009 07:19:02 PDT

This article discusses the experience of adapting and applying the Outline for a Cultural Formulation in DSM-IV to the Swedish context. Findings from a research project on the Cultural Formulation highlight the value of combining psychiatric nosological categorization with an understanding of patients’ cultural life context in order to increase the validity of categorization and to formulate individualized treatment plans. In clinical care practitioners need models and tools that help them take into account patients’ cultural backgrounds, needs, and resources in psychiatric diagnostic practice. We present a summary of a Swedish manual for conducting a Cultural Formulation interview. The need for further development of the Cultural Formulation is also discussed.

A Qualitative Study of Clinicians' Use of the Cultural Formulation Model in Assessing Posttraumatic Stress Disorder

Fortuna, L. R., Porche, M. V., Alegria, M. — Fri, 16 Oct 2009 07:19:02 PDT

The Cultural Formulation (CF) of the Diagnostic and Statistical Manual (DSM) provides a potential framework for improving the diagnostic assessment of Posttraumatic Stress Disorder (PTSD) in culturally diverse patients. We analyzed data from the Patient-Provider Encounter Study, a multi-site study that examines the process of diagnosis and clinical decision-making during an initial clinical intake session, in order to examine use of CF for PTSD diagnosis. We find that while the CF is generally used inconsistently or underutilized in routine community settings, when employed appropriately it may assist the formulation and interpretation of traumatic experiences. We discuss the implications for improving the assessment of PTSD in the time-limited setting of the clinical intake encounter and across race/ethnicity.

Recognizing Cultural Identity in Mental Health Care: Rethinking the Cultural Formulation of a Somali Patient

Groen, S. — Fri, 16 Oct 2009 07:19:02 PDT

Although there are many ways to produce a cultural formulation that facilitates a culturally sensitive diagnosis and treatment for asylum seekers and refugees in mental health care, it is essential to gain trust and ‘recognize’ the patient. One way to achieve this recognition is through a cultural interview, in which cultural references of the health care provider and the patient are exchanged. This paper presents an example of such a process with a Somali migrant to the Netherlands, whose passivity and inactivity puzzled the psychiatrist. Gaining his trust and recognizing his cultural roots as a member of a Somali ethnic group revealed more about his motives, concepts and attitude. This example suggests the importance of cultural identity as a way to explore the meanings of the illness and the interrelationship between the patient and health care provider. The cultural identity of the patient is a basis on which meanings can be exchanged in an ongoing way and starting points for effective treatment can be found.

Clinical Pitfalls in the Diagnosis of Ataque de Nervios: A Case Study

Lizardi, D., Oquendo, M. A., Graver, R. — Fri, 16 Oct 2009 07:19:02 PDT

Ataque de nervios (attack of nerves) is an idiom of distress generally thought of in relation to Caribbean Hispanics. The following case study discusses the presentation of ataque de nervios in a Colombian female. This case study provides insight into a different presentation of ataque de nervios in a new population that clinicians should be aware of in order to ensure accurate diagnosis. Ataque de nervios is a distinct syndrome that does not fully correspond with any single DSM-IV diagnosis. However, there is overlap between symptoms in this condition and those in conventional clinical diagnoses. Common problems in deriving an accurate differential diagnosis are discussed. Implications for treatment are also reviewed, with an emphasis on a comprehensive approach to treatment that supports the client’s norms and values.

Use of the Cultural Formulation with Refugees

Rohlof, H., Knipscheer, J. W., Kleber, R. J. — Fri, 16 Oct 2009 07:19:02 PDT

This article discusses the experiences of mental health professionals who applied the Cultural Formulation (CF) of the DSM-IV for assessment of psychopathology and treatment needs of refugees in the Netherlands. The CF approach proved to be a useful tool in the assessment and diagnostic phase of clinical treatment. However, patients reported problems with defining their own culture and providing explanations of illness and therapists had difficulty identifying culturally-based difficulties in the clinical relationship. Additional information was needed about working with interpreters, therapists’ attitudes towards the culture of the patient and towards their own culture, patients’ previous experiences with discrimination and inaccessibility of care, gender issues, and specific cultures and subcultures. A more structured approach to conducting the CF is recommended. We developed the "Cultural Formulation Interview" for this purpose. The adaptations are aimed at improving the CF for use with refugee populations, as well as for more general use in transcultural psychiatry.

DSM-IV-TR Cultural Formulation of Psychiatric Cases: Two Proposals for Clinicians

Caballero Martinez, L. — Fri, 16 Oct 2009 07:19:02 PDT

This article reviews some limitations of the current guideline for the DSM-IV-TR Cultural Formulation (CF) from the perspective of psychiatric practice that are based on the author’s experience conducting doctoral courses on cultural psychiatry from 1996 to 2007 in the Department of Psychiatry at the Universidad Autónoma de Madrid (Spain). Two proposals are presented for facilitating use of the CF by general clinicians. These proposals offer a procedure for embedding only the most relevant clinical information in a psychiatric history, followed by a brief cultural formulation. The approach is illustrated with a clinical case. Although the CF has considerable promise for revealing knowledge about patients, health practices, and health systems that is essential for clinical care, substantial research must be carried out to facilitate widespread use of the CF in clinical practice.

Book Review: Russell F. Lim (Ed.), Clinical Manual of Cultural Psychiatry. Washington, DC: American Psychiatric Publishers, 2006. 336 pp. Paper: $64.00 (US), ISBN 1585622567

Morrison, J. — Fri, 16 Oct 2009 07:19:02 PDT

Book Review: Nancy Waxler-Morrison, Joan M. Anderson, Elizabeth Richardson, & Natalie A. Chambers (Eds.), Cross-Cultural Caring (2nd ed): A Handbook for Health Professionals. Vancouver, BC: University of British Columbia Press, 2005. 365 pp. Cloth: $95.00 (CDN), ISBN: 0774812559

Carnevale, F. — Fri, 16 Oct 2009 07:19:02 PDT

Book Review: James B. Waldram, Revenge of the Windigo: The Construction of the Mind and Mental Health of North American Aboriginal Peoples. Toronto, ON: University of Toronto Press, 2004. 414 pp. Paper: $37.00 (US), ISBN 0802086004

BigFoot, D. S. — Fri, 16 Oct 2009 07:19:02 PDT

Letter to the Editor: What do we mean by "Asian"?

Babbar, J. — Fri, 16 Oct 2009 07:19:02 PDT

The Validity and Clinical Utility of Post-traumatic Stress Disorder in Afghanistan

Miller, K. E., Omidian, P., Kulkarni, M., Yaqubi, A., Daudzai, H., Rasmussen, A. — Thu, 18 Jun 2009 06:43:52 PDT

This study examined the validity and utility of PTSD among 320 adults in Afghanistan. Findings support the validity of PTSD in this cultural context: PTSD symptoms were highly prevalent, shared common variance, and correlated as expected with exposure to traumatic stress. However, only limited support was found for the clinical utility of PTSD. Other types of psychiatric symptomatology, including depression and a culturally specific measure of general distress, correlated more highly with traumatic stress than did PTSD; and PTSD accounted for limited variance in functioning beyond that explained by depression and general distress. Implications for research and intervention are considered.

A Qualitative Study of Mental Health Problems among Children Displaced by War in Northern Uganda

Betancourt, T. S., Speelman, L., Onyango, G., Bolton, P. — Thu, 18 Jun 2009 06:43:52 PDT

While multiple studies have found that children affected by war are at increased risk for a range of mental health problems, little research has investigated how mental health problems are perceived locally. In this study we used a previously developed rapid ethnographic assessment method to explore local perceptions of mental health problems among children and adults from the Acholi ethnic group displaced by the war in northern Uganda. We conducted 45 free list interviews and 57 key informant interviews. The rapid assessment approach appears to have worked well for interviewing caretakers and children aged 10—17 years. We describe several locally defined syndromes: two tam/par/kumu (depression and dysthymia-like syndromes), ma lwor (a mixed anxiety and depression-like syndrome), and a category of conduct problems referred to as kwo maraco/gin lugero. The descriptions of these local syndromes were similar to western mood, anxiety and conduct disorders, but included culturespecific elements.

Immigrants' Continuing Bonds with their Native Culture: Assimilation Analysis of Three Interviews

Thu, 18 Jun 2009 06:43:52 PDT

Three case studies of immigrants to the US from China, Iraq, and Mexico were used to build a theory of acculturation in immigrants by integrating the continuing bonds model, which describes mourning in bereavement with the assimilation model, which describes psychological change in psychotherapy. Participants were interviewed about the loss of their native culture and their life in the US. One participant had not fully assimilated the loss of her native culture, but used her continuing bonds with her culture as a source of solace. Another participant used his continuing bonds with his culture as a source of solace, but these bonds had become a source of conflict with the host culture. The third participant had largely assimilated the loss of his native culture such that the voices of this culture were linked via meaning bridges with the voices of the host culture, and the continuing bonds were resources that helped him in his land of immigration.

Problemas de Nervos: A Multivocal Symbol of Distress for Portuguese Immigrants

James, S., Fernandes, M., Navara, G. S., Harris, S., Foster, D. — Thu, 18 Jun 2009 06:43:52 PDT

This article outlines research on a previous unstudied form of suffering specific to the Portugese immigrant community: problemas de nervos. Thirty-two Portuguese immigrant women (in Waterloo, ON and Boston, MA) were interviewed and each completed a questionnaire. Cluster analysis demonstrated that problemas de nervos has many meanings. The study profiled symptoms, causes and therapies associated with four variations of this culture-specific form of distress: "mal da cabeca" meaning problems with/in the head (e.g., lack of control, visions); " aflição" meaning affliction (e.g., nervous attacks, heart problems); immigration stress (causing sleep disturbances); and, conflicts with others (resulting in pressure within the body). None of the symptom clusters reported matched criteria for a DSM-IV-TR diagnosis, suggesting that problemas de nervos represents an idiomatic rather than universal expression of distress.

What Research tells us about the Mental Health and Psychosocial Wellbeing of Sudanese Refugees: A Literature Review

Tempany, M. — Thu, 18 Jun 2009 06:43:52 PDT

Sudan has long been one of the world's chief refugee-producing nations. Many researchers and practitioners have developed considerable interest in culturally-specific information on the mental health and wellbeing of Sudanese refugees. In this selective review of studies with Sudanese refugees, on mental health and psychosocial wellbeing, coping strategies and interventions, most quantitative studies found high rates of psychopathology, particularly PTSD and depression. However, some studies using mixed methods cautioned that while many Sudanese refugees have symptoms of traumatic stress, their functioning was not necessarily reduced, and they themselves often reported more concern with current stressors such as family problems than with past trauma. Some qualitative studies suggest that many Sudanese refugees use coping strategies such as silence, stoicism, and suppression. Few studies were available regarding appropriate interventions for Sudanese refugees and it remains unclear which aspects of standard treatments used by western-trained mental health practitioners may be beneficial for members of this population.

Working Together for Public Health

Martelli, P. — Thu, 18 Jun 2009 06:43:52 PDT

Italy's recent economic growth and strategic position in the Mediterranean Sea have made it a prime destination for immigrants and asylum seekers in Europe. Despite its well-developed health care system, statistics on foreign citizens' health are worrisome. In 1998 public health services were extended to illegal immigrants, giving them the right to necessary urgent and non-urgent medical assistance, even for a prolonged period. This paper examines a two-year joint intervention project between Centre for the Study and Research of Public Health (Mental Health), Local Health Agency ROMA E (LHA RME) and the non-governmental organization Médecins Sans Frontières (MSF) in Rome.

The Role of Leisure in the Lives of Psychotic Patients: A Qualitative Study

Ponde, M. P., Peireira, C. T. M., Leal, B., Oliveira, S. C. — Thu, 18 Jun 2009 06:43:52 PDT

Quality of life is defined by indicators that measure the life patterns of a person or community in relation to an ideal model. Leisure is an important component of quality of life and a tool for rehabilitation for patients with chronic psychosis. This qualitative study evaluated the role of leisure in the life of patients living with psychosis. Interviews with patients and relatives indicate that sociability is an important value for both groups. Deeper analysis, however, indicates that sociability is a culturally learned concept for patients and does not relate to their real needs. Improvement of symptoms and respect of individuality are more central to their well-being.

Autism in Saudi Arabia: Presentation, Clinical Correlates and Comorbidity

Al-Salehi, S. M., Al-Hifthy, E. H., Ghaziuddin, M. — Thu, 18 Jun 2009 06:43:52 PDT

Although autism is a global disorder, relatively little is known about its presentation and occurrence in many developing countries, such as Saudi Arabia. This article describes the reasons for referral and clinical characteristics of a sample of 49 children (37 males and 12 females) diagnosed with an autistic spectrum disorder at a tertiary referral center in Saudi Arabia. The diagnosis of autism was based on DSM-IV criteria supplemented by information obtained from parent and child interviews, rating scales, and examination of school and hospital records. Females were older than males at the time of referral. Eleven patients had a history of seizure disorder and one patient had a chromosome abnormality. Twenty-five patients were taking psychotropic medications and 14 patients were the product of consanguineous marriages. Clinical and research implications of these findings are discussed.

Strange, Incredible and Impossible Things: The Early Anthropology of Reginald Scot

Littlewood, R. — Thu, 18 Jun 2009 06:43:52 PDT

Reginald Scot has been acclaimed as an early rationalist for his critical consideration of witchcraft in 1584. At the same time, the Discoverie of Witchcraft appears organized much as later classic anthropological monographs. This article considers whether his methods and writing might indeed correspond to what we recognise as the procedures of medical or psychiatric anthropology.

Book Review: Wen-Shing Tseng, Suk Choo Chang, & Masahisa Nishizono (Eds.), Asian Culture and Psychotherapy: Implications for East and West. Honolulu, HI: University of Hawai'i Press, 2005. 313 pp. Paper: $32.95 (US), ISBN 0824821335

Lo, H.-T. — Thu, 18 Jun 2009 06:43:52 PDT

Book Review: Mudita Rastogi & Elizabeth Wieling (Eds.), Voices of Color: First Person Accounts of Ethnic Minority Therapists. Thousand Oaks, CA: SAGE, 2005. 389 pp. Paper: $51.95 (US), ISBN 0761928901

Bell, C. C. — Thu, 18 Jun 2009 06:43:52 PDT

Book Review: Marie Connolly, Yvonne Crichton-Hill, & Tony Ward, Culture and Child Protection: Reflexive Responses. Ontario: UBC Press, 2006, 144pp. Paper: $27.95 (US), ISBN 1843102706

Hassan, G. — Thu, 18 Jun 2009 06:43:52 PDT

Mass Possession State in a Family Setting

Sethi, S., Bhargava, S. C. — Thu, 18 Jun 2009 06:43:52 PDT

The Cultural Myth of Koro Conceptualization: Time for a Rethink

Marlowe, K. — Thu, 18 Jun 2009 06:43:52 PDT

Editorial: From Amrita to Substance D: Psychopharmacology, Political Economy, and Technologies of the Self

Kirmayer, L. J., Raikhel, E. — Tue, 17 Mar 2009 07:51:23 PDT

Trussed in Evidence? Ambiguities at the Interface between Clinical Evidence and Clinical Practice

Healy, D. — Tue, 17 Mar 2009 07:51:23 PDT

This article considers the dominance that randomized controlled trials (RCTs) of psychotropic agents currently have in relation to the practice of psychiatry in mental health and primary care settings. In contemporary psychiatry, data of marginal significance based on rating scale measures are privileged as evidence that treatments are effective, while judgments of drug effects based on clinical practice are downgraded. The dominance of RCTs has also led to an increasing promotion of rating scales in clinical practice, described here as `rating scale mongering.' The logical consequence of current interpretations of RCT data is that clinicians should adhere to guidelines which are based on a systematic assembly of such data, but the selective publication of trial data and ghostwriting of publications, lays the basis for guideline capture, and a corresponding capture of evidence-based clinical practice by pharmaceutical companies.

From Descartes to Desipramine: Psychopharmacology and the Self

Gold, I., Olin, L. — Tue, 17 Mar 2009 07:51:23 PDT

Despite the remarkably widespread use of the new generation of antidepressants, almost everything we know about their effects comes from animal studies and clinical trials in which the sole parameter of interest is depressive symptomatology. Almost nothing is known about the effects that antidepressants have on cognition, affect, or motivation when used over a period of months or years. Nor do we understand what effects, if any, antidepressants have on what we think of as the self. In this article, we argue that neither psychiatry nor philosophy, in their current state, are well equipped to think about these issues. In order to explore this idea, we consider the neurobiology of romantic love and its relation to antidepressant neurochemistry. This case study, we suggest, supports the view that antidepressants are very likely to have significant effects on personhood as well as the suggestion that we are in need of new ways of thinking about the self and its pathologies.

Pills that Swallow Policy: Clinical Ethnography of a Community Mental Health Program in Northern India

Jain, S., Jadhav, S. — Tue, 17 Mar 2009 07:51:23 PDT

India's National Mental Health Program (NMHP) was initiated in 1982 with the objective of promoting community participation and accessible mental health services. A key component involves central government calculation and funding for psychotropic medication. Based on clinical ethnography of a community psychiatry program in north India, this article traces the biosocial journey of psychotropic pills from the centre to the periphery. As the pill journeys from the Ministry of Health to the clinic, its symbolic meaning transforms from an emphasis on accessibility and participation to the administration of a discrete `treatment.' Instead of embodying participation and access, the pill achieves the opposite: silencing community voices, re-enforcing existing barriers to care, and relying on pharmacological solutions for psychosocial problems. The symbolic inscription of NMHP policies on the pill fail because they are undercut by more powerful meanings generated from local cultural contexts. An understanding of this process is critical for the development of training and policy that can more effectively address local mental health concerns in rural India.

The Unlicensed Lives of Antidepressants in India: Generic Drugs, Unqualified Practitioners, and Floating Prescriptions

Ecks, S., Basu, S. — Tue, 17 Mar 2009 07:51:23 PDT

Antidepressant uses have been rising rapidly over the past decades. Two main theories have been advanced to explain this. One claims that socio-economic change causes a global rise of depressive illness. The other holds that European and North American corporations are aggressively marketing antidepressants to expand their global reach. Both theories assume that multinational capitalism drives rising depression rates. Based on ethnographic data from India, this article shows that antidepressants are increasingly used in this country as well, but for reasons than have been little explored yet. Taking fluoxetine (Prozac) as the main example, it is argued that the spread of antidepressants in India is `unlicensed' by Euro-American corporations in at least three ways: (i) drug marketing is driven by Indian generic producers; (ii) fluoxetine is given by practitioners who have no license to do so; and (iii) knowledge of fluoxetine is spread through unlicensed `floating' prescriptions that patients take from one prescriber to another.

`Consumers are Patients!' Shared Decision-making and Treatment Non-compliance as Business Opportunity

Applbaum, K. — Tue, 17 Mar 2009 07:51:23 PDT

This article describes an aspect of the progressive insertion of commercial interests into the relationship between patients and their clinicians, with particular reference to psychiatry. Treatment noncompliance, a long-standing problem for healthcare professionals, has lately drawn the attention of the pharmaceutical and allied industries as a site at which to improve return on investment (ROI). Newly founded corporate `compliance departments' and specialized consultancies that regard noncompliance as a form of marketing failure are seeking to rectify it with reinvigorated models and strategies. This intervention stands to impact patients' experience of illness as well as the participation of those formally (physicians, case managers, etc.) and informally (family, friends, etc.) involved in treatment. My analysis draws upon observation at compliance conferences to demonstrate the contrasting models of patient empowerment underlying the marketing vs. medical approaches. I propose a research agenda for measuring the effects of industry compliance programs.

Uncanny Scripts: Understanding Pharmaceutical Emplotment in the Aboriginal Context

Oldani, M. J. — Tue, 17 Mar 2009 07:51:23 PDT

This article outlines a new social reality of global psycho-pharmaceutical prescribing: the pharmaceutical family, or `phamily.' Ethnographic case studies from Manitoba, Canada (2002 to 2004) show how pharmaceutical emplotment, involving a synergy between cultural and drug scripts, can have uncanny consequences for vulnerable groups, such as Aboriginal children. Observations and interview transcripts of high prescribing doctors are analyzed to understand the prescribing logic of using psychoactive medication, such as methylphenidate, in young Aboriginal children diagnosed with FASD and/or ADHD. Pharmaceutical narratives are presented in order to show how non-compliance to psychotropic prescribing can further marginalize Aboriginal children and is related to the history of colonial practices in Canada.

Adolescent Experience of Psychotropic Treatment

Tue, 17 Mar 2009 07:51:23 PDT

Despite growing concern over the treatment of adolescents with psychiatric medications, little research has examined youth understandings and interpretations of mental illness and psychotropic treatment. This article reports the exploratory findings of semi-structured and open-ended interviews carried out with 20 adolescents diagnosed with one or more psychiatric disorders, and who were currently prescribed psychiatric medications. Grounded theory coding procedures were used to identify themes related to adolescent subjective experience with psychiatric medications. The categories identified are interpreted as different points of view through which adolescents understand and take action upon their illness concerns; their need for medication treatment; their perceptions of how medications work; their responses to parental and other influences upon medication treatment; and, their everyday management activities.

Tense Prescriptions? Alzheimer Medications and the Anthropology of Uncertainty

Leibing, A. — Tue, 17 Mar 2009 07:51:23 PDT

This article discusses the two major groups of Alzheimer medications, which are hotly debated in the specialized literature because of their doubtful efficacy. Examining this issue under the rubric of an `anthropology of uncertainty,' this article seeks to address the question: how do doctors prescribe medications given tensions created by uncertainty? A partial answer is drawn from research conducted in Brazil with local psychogeriatricians, which has documented a high degree of certainty regarding Alzheimer drugs and their benefits. I argue that one reason for this certainty is that `efficacy' has become increasingly non-specific in Alzheimer's disease through the broadening of outcome measures in clinical trials. While such measures previously focused on cognitive symptoms, they now encompass concepts such as functionality, quality of life and activities of daily living. The certainty of the Brazilian psychogeriatricians is further buttressed by three interacting elements: (i) the influence of the pharmaceutical industry; (ii) long-standing arguments for including non-cognitive symptoms in dementia care and research; and (iii) a specific discourse found in geriatrics and gerontology, which recognizes `the person beyond cognition.'

Book Review: Carl Elliott & Tod Chambers (Eds.), Prozac as a Way of Life. Chapel Hill, NC: The University of North Carolina Press, 2004. 224 pp. Paper: $19.95 (US), ISBN 0807855510; Cloth: $39.95 (US), ISBN 0807828807

Cohen, S. — Tue, 17 Mar 2009 07:51:23 PDT

Book Review: Wen-Shing Tseng & Jon Streltzer (Eds.), Cultural Competence in Clinical Psychiatry. American Psychiatric Publishing, 2004. 202 pp. Paper: $39.00 (US), ISBN 1585621250

Baarnhielm, S. — Tue, 17 Mar 2009 07:51:23 PDT

Book Review: Marleen S. Barr, (Ed.), Envisioning the Future: Science Fiction and the Next Millennium. Middletown, CT.: Wesleyan University Press, 2003. 214 pp. Paper: $22.95 (US), 0819566527; Cloth: $65.00 (US), 0819566519

Chambers, T. — Tue, 17 Mar 2009 07:51:23 PDT

Book Review: Janis Hunter Jenkins and Robert John Barrett (Eds.), Schizophrenia, Culture, and Subjectivity: The Edge of Experience. Cambridge: Cambridge University Press, 2004. 357 pp. Paper: $32.99 (US), ISBN 0521536413; Cloth: $85.00 (US), ISBN 05218829550

Stanghellini, G. — Tue, 17 Mar 2009 07:51:23 PDT

Call for Papers: Clinical Case Studies in Cultural Psychiatry

Tue, 17 Mar 2009 07:51:23 PDT

Ethical and Cultural Considerations in Delivering Psychiatric Diagnosis: Reconciling the Gap Using MDD Diagnosis Delivery in Less-Acculturated Chinese Patients

Yeung, A., Kam, R. — Wed, 17 Dec 2008 02:25:12 PST

Talking to patients from diverse cultural backgrounds about their psychiatric disorders requires knowledge of one's own culture, the patients' cultures, and the ways in which they might interact, both in positive and unexpectedly negative ways. In this paper, we discuss the issues raised by discussing psychiatric diagnoses with Chinese-Americans who hold traditional illness beliefs and are not familiar with Western conceptions of psychiatric disorders. We explore how cultural values influence this aspect of medical practice, and suggest practical approaches to communicating the diagnosis of major depressive disorder in a culturally sensitive manner. Our clinical approach is to develop co-constructed illness narratives with patients, and to aid this process by reframing different elements of the clinical process into more culturally resonant forms. The following steps are suggested: 1) elicit patient's illness beliefs; 2) understand and acknowledge multiple explanatory models; 3) contextualize depressive symptoms into patient's physical health and social system; 4) introduce Western psychiatric theories in ways that reflect assumptions shared by Traditional Chinese Medicine (TCM); 5) involve patients' families whenever possible; and 6) use terminology that avoids unintended stigma.

When Providers and Patients Come from Different Backgrounds: Perceived Value of Additional Training on Ethical Care Practices

Roberts, L. W., Johnson, M. E., Brems, C., Warner, T. D. — Wed, 17 Dec 2008 02:25:12 PST

Fostering the therapeutic alliance, safeguarding confidentiality, gaining informed consent, and enhancing treatment adherence are critical aspects of patient care. We examined whether multidisciplinary health care providers perceive additional training on these areas as helpful in their work with patients from different ethnic backgrounds than the provider. Data are drawn from a National Institute on Drug Abuse-funded survey of 1555 providers in 8 disciplines in New Mexico and Alaska. Clinicians viewed additional training as moderately helpful for ensuring treatment adherence, establishing the therapeutic alliance, safeguarding confidentiality, and engaging in informed consent processes, in that order. Women were more receptive than men to additional training. Modest differences were detected between behavioral and physical health providers and between minority and majority providers. Implications of providers' only modest interest in such training are discussed.

Adapting the SRQ for Ethiopian Populations: A Culturally-Sensitive Psychiatric Screening Instrument

Youngmann, R., Zilber, N., Workneh, F., Giel, R. — Wed, 17 Dec 2008 02:25:12 PST

The objective of the study was to develop a culturally sensitive psychiatric screening instrument valid for Ethiopians in Ethiopia and Israel. The study sample was composed of 356 Amharic-speaking Ethiopians from Ethiopia and Israel, aged 18—55, divided into three groups: i) general population; ii) people in non-psychiatric treatment; iii) people in psychiatric treatment. They were interviewed with the Self-Reporting Questionnaire (SRQ), modified to include 10 culturally specific items, and the Brief Psychiatric Research Scale (BPRS) as a criterion of psychopathology. Physicians also completed an encounter form about the presence of mental health symptoms in participants. To make the questions more culturespecific, the translation of 12 items on the SRQ was changed. The content, construct, and criterion validity of each question were also examined, leading to the deletion of five items. The validity of the revised instrument (SRQ-F) was superior to that of the original instrument (SRQ). This study demonstrates the need for psychiatric screening instruments to be adapted to different cultures by incorporating meaningful translations and adding culturally specific items.

The Quest for Recognition: Brazilian Immigrants in the United States

Zubaran, C. — Wed, 17 Dec 2008 02:25:12 PST

`Hispanic' and `Latino' are imprecise umbrella terms often used in the United States to designate nationals from Central and South America. The labelling of Brazilians in this manner generates inaccurate demographic information, including a significant undercount of the migrant population. Research data indicates that Brazilians object to being designated Hispanics, since Brazilians speak Portuguese and have no Spanish heritage. The labelling of ethnic groups has been criticized as a stereotypical and racist system, which primarily responds to non-scientific demands. This commentary appeals for reform in the way researchers and institutions refer to minority citizens as well as for continued research to investigate racism and ethnic prejudice. The development of new approaches and methodologies to examine social networks, migration and the geographic concentration of poverty is advocated.

Daily Stressors, War Experiences, and Mental Health in Afghanistan

Miller, K. E., Omidian, P., Rasmussen, A., Yaqubi, A., Daudzai, H. — Wed, 17 Dec 2008 02:25:12 PST

Working in Afghanistan's capital city of Kabul, the authors assessed the relative contribution of daily stressors and war-related experiences of violence and loss to levels of depression, PTSD, impaired functioning, and a culturally specific measure of general psychological distress. For women, daily stressors were a better predictor than war experiences of all mental health outcomes except for PTSD; for men, daily stressors were a better predictor of depression and functional impairment, while war experiences and daily stressors were similarly predictive of general distress. For men, daily stressors moderated the relationship between war experiences and PTSD, which was significant only under conditions of low daily stress. The study's implications for research and intervention in conflict and post-conflict settings are considered.

The Experience of `Mental Trauma' and its Transcultural Application

von Peter, S. — Wed, 17 Dec 2008 02:25:12 PST

Approaches to the mental health care of refugees and disaster survivors have recently been subject to sustained critique. This article critically examines the notion of `mental trauma' as it has been used by psychosocial intervention programmes addressing the aftermath of the 2004 Asian tsunami. The objective is to shed light on the guidelines' implicit and explicit assumptions about how people are expected to act and feel after a disaster, thereby implying a certain `metaphysic' of emotional experience. It will be argued that feelings can not be separated from intersubjective and public spheres, for they shape and motivate expression and experience. Instead, it is necessary to explore the particular ways in which cultural meaning and social structure relate to discourses and practices through which suffering is produced and represented. To conclude, a method is outlined to operationalize particular experiences of suffering and the institutionalized discourses and practices in which they obtain social meaning and force.

Cultural Factors in the Diagnosis and Treatment of Traumatised Migrant Patients from Turkey

Schouler-Ocak, M., Reiske, S.-L., Rapp, M. A., Heinz, A. — Wed, 17 Dec 2008 02:25:12 PST

The process of migration may be associated not only with great hope, but also with distressing experiences that can lead to trauma and posttraumatic stress disorders. Although some of the symptoms induced by trauma are common across cultures, the strategies used to deal with them are often culture-specific. In the following paper, we consider the unique aspects of trauma-focused psychotherapy in patients with a history of migration. We discuss a variety of culture-specific factors with the help of two case histories.

Arab Culture and Mental Health Care

Fakhr El-Islam, M. — Wed, 17 Dec 2008 02:25:12 PST

This selective review describes recent literature and the author's experience with mental illness and mental health care, and the impact of cultural transformation on mental health in some Arab Islamic cultures, particularly in Egypt, Qatar and Kuwait. Traditional extended Arab families provide a structure for their members that may sometimes prevent and or compensate for the effects of parental loss and mental disability. The role of traditional families in the care of members and in medical decision-making is discussed. The impact of cultural change on Arab culture is also examined, as is the effect of intergenerational conflict in traditional families.

Karo-Kari: A Form of Honour Killing in Pakistan

Patel, S., Gadit, A. M. — Wed, 17 Dec 2008 02:25:12 PST

Karo-Kari is a type of premeditated honour killing, which originated in rural and tribal areas of Sindh, Pakistan. The homicidal acts are primarily committed against women who are thought to have brought dishonour to their family by engaging in illicit pre-marital or extra-marital relations. In order to restore this honour, a male family member must kill the female in question. We conducted a systematic review of the published literature other sources on karo-kari and related forms of honour killing or violence against women. Media and non-governmental organization reports were utilized for case studies and analysis. Although legally proscribed, socio-cultural factors and gender role expectations have given legitimacy to karo-kari within some tribal communities. In addition to its persistence in areas of Pakistan, there is evidence that karo-kari may be increasing in incidence in other parts of the world in association with migration. Moreover, perpetrators of `honour killings' often have motives outside of female adultery. Analysis of the socio-cultural and psycho-pathological factors associated with the practice of karo-kari can guide the development of prevention strategies.

Ramadan Fasting Triggering Koro-like Symptoms during Acute Alcohol Withdrawal: A Case Report from Oman

Al-Sinawi, H., Al-Adawi, S., Al-Guenedi, A. — Wed, 17 Dec 2008 02:25:12 PST

This article describes a case of koro-like symptoms from Oman associated with alcohol withdrawal and illustrates how the socio-cultural practices of Ramadan-fasting affected the patterning and timing of presentation of severe alcohol withdrawal symptoms. The patient was severely distressed by the delusion that his penis had been amputated. The acute anxiety involving this delusion appears to be conceptually and phenomenologically similar to koro.

Book Review: Nadia Taysir Dabbagh, Suicide in Palestine: Narratives of Despair. Northampton, MA: Interlink, 2005. 280 pp. Paper: $17.95 (US), ISBN 1566566037

Moghadam, A. — Wed, 17 Dec 2008 02:25:12 PST

Book Review: Paul McHugh, The Mind Has Mountains: Reflections on Society and Psychiatry. Baltimore: Johns Hopkins Press, 2005. 252 pp. Cloth: $25.00 (US), ISBN 0801882494

Paris, J. — Wed, 17 Dec 2008 02:25:12 PST

Book Review: James Georgas, Lawrence G. Weiss, Fons J.R. van de Vijver, & Donald H. Saklofske (Eds.), Culture and Children's Intelligence: Cross-Cultural Analysis of the WISC-III. San Diego: Academic Press, 2003. 336 pp. Cloth: $89.95 (US), ISBN 0122800559

Thombs, B. D. — Wed, 17 Dec 2008 02:25:12 PST

Acknowledgement of Reviewers

Wed, 17 Dec 2008 02:25:12 PST