Schizophrenia: An Overview

Culture and classification: the cross-cultural application of the DSM-IV

Changes incorporated into the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) include a number of features designed to enhance its cross-cultural applicability. However, the overt move toward a culture-sensitive nosology is undermined by an implicit assumption of the universality of its primary syndromes. In this review we argue that the DSM-IV's underlying thesis of universality based on Western-delineated mental disorders is problematic and has limited cross-cultural applicability. Research on the cross-cultural manifestation of schizophrenia and depression shows that presentation of these disorders varies significantly across cultures. We conclude by discussing the research and clinical implications of these findings.

Patient interactions in four psychiatric wards

This article describes the interactions between patients and between patients and staff in 4 psychiatric wards. Two of the wards are acute admission units and 2 are for long-stay chronic patients. The hospital is diagnostically streamed so that not only does the average length of stay vary between wards but so, for one ward, does the predominant diagnostic group. Patient interactions were analysed in terms of 5 major interactional categories: individual verbal, individual nonverbal, group verbal, group nonverbal and physical. The results show that, although there was little change in the overall level of verbal interaction as a function of chronicity, there were large shifts in patient-patient and staff-patient interaction rates. Variations between the 4 wards on the 4 other interactional categories are explained in terms of the known diagnostic characteristics of the patients.