Clinical relevance of contemporary cultural psychiatry

Thematic analysis of the raters' experiences administering scales to assess depression and suicide in Arab schizophrenia patients

BACKGROUND

This study aimed to enhance the cultural adaptation and training on administering the Arabic versions of the Calgary Depression Scale in Schizophrenia (CDSS) and The International Scale for Suicidal Thinking (ISST) to Arab schizophrenia patients in Doha, Qatar.

METHODS

We applied the qualitative thematic analysis of the focus group discussions with clinical research coordinators (CRCs). Five CRCs met with the principal investigator for two sessions; we transcribed the conversations and analyzed the content.

RESULTS

This study revealed one set of themes related to the scales themselves, like the role of the clinician-patient relationship during administration, the semantic variations in Arabic dialects, and the design of scales to assess suicide and differentiate between negative symptoms and depression. The other set of themes is relevant to the sociocultural domains of Muslim Arabs, covering religion, families' roles, and stigma. It also covered the approaches to culturally sensitive issues like suicide, taboos in Islam, and the gender roles in Arab countries and their impact on the patients' reports of their symptoms.

CONCLUSIONS

Our results highlight several cultural and religious aspects to tackle when approaching schizophrenia patients through in-depth discussions and training to improve the validity of the assessment tools and treatment services.

When Cotard's syndrome fits the sociocultural context: The singular case of Per "Dead" Ohlin and the Norwegian black metal music scene

The sociocultural context of psychiatric patients shapes symptoms experience and expression, as well as how patients deal with a disorder and how society appraises its symptoms. Specifically, the context may influence the social appraisal of a behavior as normal or pathological. Therefore, markedly pathological symptoms may not be accordingly recognized by peers when they are in consonance with the sociocultural context. Per "Dead" Ohlin was a Swedish musician who was a member of the Norwegian black metal band Mayhem from 1988 until his suicide in 1991, at age 22. Black metal is a musical movement characterized by death worshiping and anti-Christianism, and is also associated with church arsons and murders during the 1990s. Even among peculiar personalities such as black metal musicians, Ohlin was considered the personification of the movement ideals due to his eccentric and unparalleled beliefs and behaviors, claiming, for instance, that he was already dead. In this article, we propose that Ohlin's eccentric beliefs and behaviors were symptoms of an unrecognized psychiatric condition, Cotard's syndrome, and discuss the diagnostic dilemma presented by Ohlin's artistic persona and singular context. The compatibility between his symptoms and the sociocultural context of black metal may have obscured his mental disorder. If so, Ohlin's unique case may shed light upon one of the effects of context in a psychopathological process: concealing a psychiatric disorder and reinforcing symptoms that fit a particular environment.

Prevalence of mental disorders in refugees and asylum seekers: a systematic review and meta-analysis

BACKGROUND

Studies have identified high rates of mental disorders in refugees, but most used self-report measures of psychiatric symptoms. In this study, we examined the percentages of adult refugees and asylum seekers meeting diagnostic criteria for major depressive disorder (MDD), post-traumatic stress disorder, bipolar disorder (BPD), and psychosis.

METHODS

A systematic literature search in three databases was conducted. We included studies examining the prevalence of MDD, post-traumatic stress disorder, BPD, and psychosis in adult refugees according to a clinical diagnosis. To estimate the pooled prevalence rates, we performed a meta-analysis using the Meta-prop package in Stata (PROSPERO: CRD42018111778).

RESULTS

We identified 7048 records and 40 studies (11 053 participants) were included. The estimated pooled prevalence rates were 32% (95% CI 26-39%; I ² = 99%) for MDD, 31% (95% CI 25-38%; I ² = 99.5%) for post-traumatic stress disorder, 5% (95% CI 2-9%; I ² = 97.7%) for BPD, and 1% (95% CI 1-2%; I ² = 0.00%) for psychosis. Subgroup analyses showed significantly higher prevalence rates of MDD in studies conducted in low-middle income countries (47%; 95% CI 38-57%, p = 0.001) than high-income countries studies (28%; 95% CI 22-33%), and in studies which used the Mini-International Neuropsychiatric Interview (37%; 95% CI 28-46% p = 0.05) compared to other diagnostic interviews (26%; 95% CI 20-33%). Studies among convenience samples reported significant (p = 0.001) higher prevalence rates of MDD (35%; 95% CI 23-46%) and PTSD (34%; 95% CI 22-47%) than studies among probability-based samples (MDD: 30%; 95% CI 21-39%; PTSD: 28%; 95% 19-37%).

CONCLUSIONS

This meta-analysis has shown a markedly high prevalence of mental disorders among refugees. Our results underline the devastating effects of war and violence, and the necessity to provide mental health intervention to address mental disorders among refugees. The results should be cautiously interpreted due to the high heterogeneity.

Methodological guidelines to investigate altered states of consciousness and anomalous experiences

Anomalous experiences (AE) (uncommon experiences or one that is believed to deviate from the usually accepted explanations of reality: hallucinations, synesthesia, experiences interpreted as telepathic…) and altered states of consciousness (ASC) have been described in all societies of all ages. Even so, scientists have long neglected the studies on this theme. To study AE and ASC is not necessary to share the beliefs we explore, they can be investigated as subjective experiences and correlated with other data, like any other human experience. This article presents some methodological guidelines to investigate these experiences, among them: to avoid dogmatic prejudice and to 'pathologize' the unusual; the value of a theory and a comprehensive literature review; to utilize a variety of criteria for pathology and normality; the investigation of clinical and non-clinical populations; development of new appropriate research instruments; to be careful to choose the wording to describe the AE; to distinguished the lived experience from its interpretations; to take into account the role of culture; to evaluate the validity and reliability of reports and, last but not least, creativity and diversity in choosing methods.

Measurement Issues: Is standardised diagnostic assessment feasible as an adjunct to clinical practice? A systematic review

BACKGROUND

A standardised diagnostic assessment (SDA) is a comprehensive assessment of psychiatric disorder that provides a label according to established diagnostic criteria. While standardised assessments are considered essential in child and adolescent mental health research, they are rarely applied systematically in routine clinical practice.

METHOD

A systematic review of studies that assessed the utility, feasibility and acceptability of SDAs in the assessment of psychopathology among children and young people in routine clinical practice.

RESULTS

Eight papers were identified that applied mixed research methods. Overall, attitudes towards SDAs were positive, with lack of training in administration and interpretation of SDAs and a concern for the validity of diagnostic categories being key barriers. Two randomised control trials and a case series suggest that SDAs might aid the detection of emotional disorders in particular.

CONCLUSION

The current evidence is not yet sufficient to recommend that SDAs should be universally adopted as an adjunct to clinical practice, but our findings suggest that can they be used if applied cautiously and mindfully pending further evaluation.

The Implementation of a Telephone-Delivered Intervention for Asian American Disordered Gamblers: A Pilot Study

This report will discuss the implementation and preliminary results of a community-based telephone-delivered gambling treatment program specifically designed for Asian Americans. The intervention was implemented by the NICOS Chinese Health Coalition, a nonprofit community organization based in Northern California, overseen by the UCLA (University of California, Los Angeles) Gambling Studies Program and the California Office of Problem Gambling, and launched in December 2010. It consisted of six 1-hr long telephone-delivered sessions conducted by a mental health provider using a translated version of the Freedom from Problem Gambling Self-Help Workbook. In the current study, 6 providers completed a 30-hr training program for gambling related disorders. One-hundred and 40 callers inquired about the intervention within the first 6 months of its launch, 19 clients expressed interest in participating, and 8 enrolled into the program. The results show that the majority of clients who enrolled into the program did not report any gambling behavior after baseline and improved on self-reported measures of overall life satisfaction, gambling urges, and self-control. This study suggests that the implementation of this type of intervention is feasible at a small community-based organization and may be effective in treating gambling-related disorders for Asian American populations. The low rate of clientele enrollment is addressed and potential remedies are discussed.

'Missing persons': technical terminology as a barrier in psychiatry

Several fields contributing to psychiatric advances, such as psychology, biology, and the humanities, have not yet met to produce a cohesive and integrated picture of human function and dysfunction, strength and vulnerability, etc., despite advances in their own areas. The failure may have its roots in a disagreement on what we mean by the human person and his or her relationship with the world, for which the incommensurate language of these disciplines may be partly to blame. Turns taken by western philosophy over the past 400 years may help to explain this. Language is such an important tool for psychiatrists, that examination of it may afford an insight into the reasons for divisions in the field. This paper aims to examine and compare psychologies (and hence psychiatries) derived from modern western philosophy, with similar concepts in other cultures, through the study of developments in terminology, in terms of the simplest facts about what it means to be human. Terminology used in mental health in western cultures is examined, with particular consideration of the term "self" as it has come to be used in a technical sense. Analogous terms from non-English speaking European languages, and some non-western cultures are studied. Western philosophy and psychology have evolved a meaning for the term "self" which is quite different from equivalent terms in non-western cultures. It is a moot point whether or not the development in western psychiatry of what are now technical terms to describe normal human experience has become needlessly obscure and ambiguous. It is not evident that this "new" language represents a genuine advance in understanding; it distances mental health professionals from those who are not familiar with it; and it makes transcultural dialogue difficult.

Differential diagnosis between non-pathological psychotic and spiritual experiences and mental disorders: a contribution from Latin American studies to the ICD-11

OBJECTIVE

To review research articles in psychiatry and psychology involving Latin American populations and/or produced by Latin American scholars to investigate the differential diagnosis between spiritual/anomalous experiences and mental disorders in order to contribute to the validity of the International Classification of Diseases towards its 11th edition in this area.

METHOD

We searched electronic databases (PubMed, PsycINFO, Scopus, and SciELO) using relevant keywords (possession, trance, religious experience, spiritual experience, latin, Brazil) for articles with original psychiatric and psychological data on spiritual experiences. We also analyzed the references of the articles found and contacted authors for additional references and data.

RESULTS

There is strong evidence that psychotic and anomalous experiences are frequent in the general population and that most of them are not related to psychotic disorders. Often, spiritual experiences involve non-pathological dissociative and psychotic experiences. Although spiritual experiences are not usually related to mental disorders, they may cause transient distress and are commonly reported by psychotic patients.

CONCLUSION

We propose some features that suggest the non-pathological nature of a spiritual experience: lack of suffering, lack of social or functional impairment, compatibility with the patient's cultural background and recognition by others, absence of psychiatric comorbidities, control over the experience, and personal growth over time.

A look at cultural psychiatry in the 21st century

Cultural psychiatry, as a subspecialty of psychiatry and thus medicine, has grown steadily and extensively in the 20th century, especially during the second part of this century. In this article, we look at the origins of cultural psychiatry; at its history through the centuries; at its role in the clinical, educational, and research domains; at its significance in today's conceptualization of the fields of psychiatry and mental health; and at its future perspectives within the realms of both medicine and psychiatry.

Equivalência semântica da versão em português da Escala de Experiência de Quase-Morte

Na literatura internacional, a experiência de quase-morte (EQM) é avaliada principalmente por meio do instrumento The Near-Death Experience Scale (NDE), elaborado por Bruce Greyson, em 1983. O objetivo do presente estudo é verificar a existência de equivalência semântica entre a versão original da escala (em inglês) e a versão traduzida ao português do Brasil, avaliando os significados geral e referencial. Após as diversas etapas de avaliação da equivalência semântica, a escala foi pré-testada em seis pacientes internados após alta de um Centro de Tratamento Intensivo (CTI) de um Hospital Universitário. Na avaliação realizada por dois psicólogos e dois psiquiatras, constatou-se existir equivalência semântica entre a versão final em português e o original. Na aplicação da escala na população-alvo, verificou-se boa compreensão dos itens. Portanto, a escala está adequada à cultura brasileira, podendo ser utilizada para pesquisas sobre Experiências de Quase-Morte neste contexto.

Cognitive-behavioral therapy for pathological gambling: cultural considerations

Pathological gambling is a common disorder with severe consequences for patients and their families. This case study describes cognitive-behavioral therapy (CBT) for pathological gambling and its general principles and provides an example of a modification of CBT techniques in the treatment of a 51-year-old immigrant Afro-Caribbean woman. The case depicts the contribution of beliefs, especially those that are part of a cultural system, to the perpetuation of a patient's disorder; the influence of family members' attitudes, moved by their cultural beliefs and values, in shaping the patient's behavior; and the consideration of these issues in guiding specific interventions, such as challenging irrational thoughts or helping patients devise strategies to change their behavior in a culturally congruent manner.

Culture, cultural factors and psychiatric diagnosis: review and projections

This paper aims to provide conceptual justifications for the inclusion of culture and cultural factors in psychiatric diagnosis, and logistic suggestions as to the content and use of this approach. A discussion of the scope and limitations of current diagnostic practice, criticisms from different quarters, and the role and relevance of culture in the diagnostic encounter, precede the examination of advantages and disadvantages of the approach. The cultural content of psychiatric diagnosis should include the main, well-recognized cultural variables, adequate family data, explanatory models, and strengths and weaknesses of every individual patient. The practical aspects include the acceptance of "cultural discordances" as a component of an updated definition of mental disorder, and the use of a refurbished cultural formulation. Clinical "telescoping" strategies to obtain relevant cultural data during the diagnostic interview, and areas of future research (including field trials on the cultural formulation and on "culture bound syndromes"), are outlined.

Culturally-sensitive complaints of depressions and anxieties in women

BACKGROUND

Current classifications of Mental Disorders are centered on Westernized concepts and constructs. "Cross-cultural sensitivity" emphasizes culturally-appropriate translations of symptoms and questions, assuming that concepts and constructs are applicable.

METHODS

Groups and individual psychiatrists from various cultures from Asia, Latin America, North Africa and Eastern Europe prepared descriptions of main symptoms and complaints of treatment-seeking women in their cultures, which are interpreted by clinicians as a manifestation of a clinically-relevant dysphoric disorder. They also transliterated the expressions of DSM IV criteria of main dysphoric disorders in their cultures.

RESULTS

In many non-western cultures the symptoms and constructs that are interpreted and treated as dysphoric disorders are mostly somatic and are different from the Western-centered DSM or ICD systems. In many cases the DSM and ICD criteria of depression and anxieties are not even acknowledged by patients.

LIMITATIONS

The descriptive approach reported here is a preliminary step which involved local but Westernized clinicians-investigators following a biomedical thinking. It should be followed by a more systematic-comprehensive surveys in each culture.

CONCLUSIONS

Westernized concepts and constructs of mental order and disorders are not necessarily universally applicable. Culturally-sensitive phenomena, treatments and treatment responses may be diversified. Attempts at their cross-cultural harmonization should take into consideration complex interactional multi-dimensional processes.

Biological, life course, and cross-cultural studies all point toward the value of dimensional and developmental ratings in the classification of psychosis

The diagnostic criteria for schizophrenia in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) are based on the premise that it is a discrete illness entity, in particular, distinct from the affective psychoses. This assumption has persisted for more than a century, even though patients with a diagnosis of schizophrenia show a wide diversity of symptoms and outcomes, and no biological or psychological feature has been found to be pathognomonic of the disorder. However, there has been sustained, and indeed growing, criticism of the concept. For example, writing about the diagnosis of schizophrenia more than a decade ago,2 one of Britain's most sophisticated nosological experts, Ian Brockington, enjoined "It is important to loosen the grip which the concept of 'schizophrenia' has on the minds of psychiatrists. Schizophrenia is an idea whose very essence is equivocal, a nosological category without natural boundaries, a barren hypothesis. Such a blurred concept is 'not a valid object of scientific enquiry'."3 Should Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition(DSM-V), persist with the neo-Kraepelinian concept of schizophrenia with all its defects, or should it deconstruct psychosis into its component dimensions? In this article, we will address the question by considering 2 main themes, firstly, the role of culture and ethnicity in the diagnosis of psychosis, and secondly, a life course approach to understanding psychosis. We will then discuss whether more progress would be achieved in DSM-V by abandoning the familiar categorical system and instead moving to a dimensional system which rates both developmental impairment and symptom factor scores. However, we will begin by briefly reviewing the recent history of the classification of the psychoses.

Diagnostic stability 2 years after treatment initiation in the early psychosis intervention programme in Singapore

OBJECTIVE

To evaluate the diagnostic stability of psychotic disorders over a 2 year period in patients presenting with first-episode psychosis.

METHODS

One hundred and fifty-four patients were recruited from an early psychosis intervention programme (EPIP). They were diagnosed by the attending psychiatrist using the Structured Clinical Interview for DSM-IV Axis I at first contact (baseline) and after 24 months. The diagnoses were classified into the following categories: schizophrenia spectrum disorders (schizophrenia, schizophreniform disorder and schizoaffective disorder), affective psychosis (bipolar and major depressive disorders with psychotic symptoms), and other non-affective psychosis (delusional disorder, psychosis not otherwise specified and brief psychotic disorder). Two measures of stability, the prospective and the retrospective consistency were determined for each diagnosis.

RESULTS

The diagnoses with the best prospective consistency were schizophrenia (87.0%) and affective psychosis (54.5%). The shift into schizophrenia spectrum disorder was the most frequent diagnostic change. Duration of untreated psychosis was found to be the only significant predictor of shift.

CONCLUSION

It is difficult to make a definitive diagnosis at first contact. The clinical need to review the diagnosis throughout the period of follow up is emphasized.

Fine motor skills in South African children with symptoms of ADHD: influence of subtype, gender, age, and hand dominance

BACKGROUND

Motor problems, often characterised as clumsiness or poor motor coordination, have been associated with ADHD in addition to the main symptom groups of inattention, impulsiveness, and overactivity. The problems addressed in this study were: (1) Are motor problems associated with ADHD symptoms, also in African cultures? (2) Are there differences in motor skills among the subtypes with ADHD symptoms? (3) Are there gender differences? (4) Is there an effect of age? (5) Are there differences in performance between the dominant and non-dominant hand?

METHOD

A total of 528 children (264 classified as having symptoms of ADHD and 264 matched comparisons) of both genders and from seven different South African ethnic groups participated in the study. They were assessed with three simple, easy to administer instruments which measure various functions of motor speed and eye-hand coordination: The Grooved Pegboard, the Maze Coordination Task, and the Finger Tapping Test. The results were analysed as a function of subtype, gender, age, and hand dominance.

RESULTS

The findings indicate that children with symptoms of ADHD performed significantly poorer on the Grooved Pegboard and Motor Coordination Task, but not on the Finger Tapping Test than their comparisons without ADHD symptoms. The impairment was most severe for the subtype with symptoms of ADHD-C (combined) and less severe for the subtypes with symptoms of ADHD-PI (predominantly inattentive) and ADHD-HI (predominantly hyperactive/impulsive). With few exceptions, both genders were equally affected while there were only slight differences in performance between the dominant and non-dominant hand. The deficiencies in motor control were mainly confined to the younger age group (6-9 yr).

CONCLUSION

An association between the symptoms of ADHD and motor problems was demonstrated in terms of accuracy and speed in fairly complex tasks, but not in simple motor tests of speed. This deficiency is found mainly in the children with ADHD-C symptoms, but also to a lesser degree in the children with symptoms of ADHD-PI and ADHD-HI.

Diagnostic stability in patients with first-episode psychosis

OBJECTIVE

To examine the short-term stability of Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) and International Classification of Diseases (10th revision; ICD-10) diagnoses in a group of patients with first-episode psychosis.

METHOD

Sixty patients with first-episode psychosis admitted consecutively to Roozbeh Hospital, Tehran, were sampled; their illnesses could not be attributed to any medical or substance-induced conditions. Patients were assessed at the time of discharge from the hospital, and at 3, 6 and 12 month intervals following admission. At each visit, two psychiatrists made consensus DSM-IV and ICD-10 diagnoses, based on all available information. Stability was discerned as the consistency between diagnoses at the time of discharge and at 12 month follow up.

RESULTS

Forty-eight patients completed follow up. Affective psychotic disorders and schizophrenia in both classification systems were highly stable. In addition, all patients with DSM-IV brief psychotic disorder and ICD-10 acute and transient psychotic disorders remained the same at follow up.

CONCLUSIONS

Affective psychoses and schizophrenia, in line with previous findings, remained stable. Diagnoses of brief psychoses were highly stable as well; this could reflect a non-relapsing course of acute brief psychoses, especially in developing countries.

Race, culture and psychiatry: a history of transcultural psychiatry

The term 'transcultural psychiatry' has encompassed changing notions of race, culture and psychiatry and, as a result, it is a difficult concept to define. For a long time psychiatrists and social scientists have been commenting on how the psyches and psychiatric illnesses differ in non-White populations. However, transcultural psychiatry was not created as a distinct discipline until after World War II. This article will attempt to tell the story of transcultural psychiatry, charting its genesis in the aftermath of World War II, and then go on to describe how it has taken different forms in response to developments within psychiatry and wider sociocultural changes.

A Confirmatory Model for Depression Among Japanese American and Part-Japanese American Adolescents

A confirmatory model integrating Japanese ethnicity, cultural identity, and depression was developed (N = 140). The model incorporated the Center for Epidemiologic Studies-Depression Scale (CES-D), Major Life Events Scale, and Japanese Cultural Scale. Japanese American adolescents scored higher on the Japanese Cultural Scale and reported fewer depressive symptoms on the CES-D total and on 2 of the 3 CES-D factors than part-Japanese American adolescents. Predictors for depression were being Japanese American vs. part-Japanese American, female gender, and culturally intensified events. A significant interaction of behavior by self-identification was noted. The model had good overall fit and suggested that the formation of cultural identity may contribute to depressive symptoms experienced by adolescents, particularly adolescents of mixed heritage.

Association of Rorschach and MMPI Psychosis Indicators and Schizophrenia Spectrum Diagnoses in a Russian Clinical Sample

In this study, I investigated the relationships among psychological test variables and schizophrenia spectrum diagnoses in a Russian sample of 180 psychiatric patients. Schizophrenia is understood somewhat differently in Russia than in the West. Analyses compared Rorschach (SCZI, PTI; Exner, 2001) and MMPI (Berezin, Mitroshinkov, & Sokolova, 1994) psychosis indicators (Sc, Sc3, Sc6, and BIZ) and 3 diagnostic systems: (a) Russian traditional, (b) the Russian-modified International Classification of Diseases (9th ed. [ICD-9]; Ministerstvo Zdravokhraneniya SSSR, 1982), and (c) the nonmodified ICD-10 (World Health Organization, 1992; comparable to the Diagnostic and Statistical Manual of Mental Disorders [4th ed.], American Psychiatric Association, 1994). Results showed modest support for the SCZI and PTI but not the MMPI indicators. While the field awaits further evidence, psychologists should proceed with caution when using the Rorschach and MMPI to assess for psychosis among Russians.

Australian and New Zealand clinical practice guidelines for the treatment of panic disorder and agoraphobia

BACKGROUND

The Royal Australian and New Zealand College of Psychiatrists is co-ordinating the development of clinical practice guidelines (CPGs) in psychiatry, funded under the National Mental Health Strategy (Australia) and the New Zealand Health Funding Authority.

METHOD

For these guidelines, the CPG team reviewed the treatment outcome literature, consulted with practitioners and patients and conducted a meta-analysis of recent outcome research.

TREATMENT RECOMMENDATIONS

Education for the patient and significant others covering: (i) the nature and course of panic disorder and agoraphobia; (ii) an explanation of the psychopathology of anxiety, panic and agoraphobia; (iii) rationale for the treatment, likelihood of a positive response, and expected time frame. Cognitive behaviour therapy (CBT) is more effective and more cost-effective than medication. Tricyclic antidepressants (TCAs) and serotonin selective reuptake inhibitors are equal in efficacy and both are to be preferred to benzodiazepines. Treatment choice depends on the skill of the clinician and the patient's circumstances. Drug treatment should be complemented by behaviour therapy. If the response to an adequate trial of a first-line treatment is poor, another evidence-based treatment should be used. A second opinion can be useful. The presence of severe agoraphobia is a negative prognostic indicator, whereas comorbid depression, if properly treated, has no consistent effect on outcome.

Masculinity-femininity as a national characteristic and its relationship with national agoraphobic fear levels: Fodor's sex role hypothesis revitalized

Hofstede's dimension of national culture termed Masculinity-Femininity [. Cultures and organizations: software of the mind. London: McGraw-Hill] is proposed to be of relevance for understanding national-level differences in self-assessed agoraphobic fears. This prediction is based on the classical work of Fodor [. In: V. Franks & V. Burtle (Eds.), Women in therapy: new psychotherapies for a changing society. New York: Brunner/Mazel]. A unique data set comprising 11 countries (total N=5491 students) provided the opportunity of scrutinizing this issue. It was hypothesized and found that national Masculinity (the degree to which cultures delineate sex roles, with masculine or tough societies making clearer differentiations between the sexes than feminine or modest societies do) would correlate positively with national agoraphobic fear levels (as assessed with the Fear Survey Schedule-III). Following the correction for sex and age differences across national samples, a significant and large effect-sized national-level (ecological) r=+0.67 (P=0.01) was found. A highly feminine society such as Sweden had the lowest, whereas the champion among the masculine societies, Japan, had the highest national Agoraphobic fear score.

Quality of life in patients with schizophrenia in five European countries: the EPSILON study

OBJECTIVE

To compare subjective quality of life (QOL) and objective QOL indicators in patients with schizophrenia from five European sites: Amsterdam, Copenhagen, London, Santander and Verona.

METHOD

A representative sample of 404 patients with schizophrenia, in contact with mental health services, was randomly selected and evaluated with the Lancashire Quality of Life Profile (EU).

RESULTS

The level of satisfaction in certain domains, religion, family and social relations appears to be associated with local style of living and culture while work, finances, and safety were more independent from local variations. In addition to the severity of symptoms, frequency of contacts with family, friendship and age appear as predictors of QOL, all of them influenced by the characteristics of the surroundings.

CONCLUSION

The centres participating in the study presented differences in subjective measures of QOL, objective indicators and also in service provision and styles of living.

Inpatient psychiatry incident review management: Part I. Special issues

Incident review (IR) is a process for achieving a better understanding of problems related to the health and safety of clients and the integrity of healthcare facilities. The purpose of IR is to identify and document adverse incidents through fact-finding. Incidents may vary in both type and levels of seriousness. Through careful documentation, investigation, and committee review, patterns of healthcare delivery can be discerned. The goal of IR is the development of systemic performance improvements in healthcare delivery, which may serve to anticipate and deter the recurrence of similar incidents. IR ensures that the quality and performance of healthcare delivery in the facility continue to be improved by both administrative and clinical staff members. This article examines IR in the context of the inpatient psychiatry unit.

Multiethnic comparison of adolescent major depression based on the DSM-IV criteria in a U.S.-Japan study

OBJECTIVES

To compare the prevalence rates of major depression based on the DSM-IVcriteria with data from a multiethnic sample of adolescents drawn from the same U.S.-Japan study and to investigate the relation of adolescent major depression to ethnicity.

METHOD

Adolescents aged 12-15 years (N= 2,046; 539 Anglo-American, 636 African-American, 409 Mexican-American, and 462 Japanese adolescents) were studied in 1994 (response rates: 85.3% for U.S. students and 95.5% for Japanese students). The DSM Scale for Depression, a self-administered checklist developed from the Diagnostic Interview Schedule for Children questions on major depression, was used to estimate the prevalence of DSM-IV major depression.

RESULTS

The overall prevalence rates of major depression without/with impairment were 9.6% and 4.3% for Anglo-American, 13.4% and 6.1 % for African-American, 16.9% and 9.0% for Mexican-American, and 5.6% and 1.3% for Japanese adolescents. The significant association between adolescent major depression and ethnicity disappeared after sociodemographic adjustments. Only fathers' educational attainment and family financial status remained significant (odds ratios: 3.28-5.30 for grade school for fathers and 2.62-2.78 for being worse off economically).

CONCLUSION

These findings imply ethnicity does not have a significant impact on the risk of adolescent major depression after sociodemographic adjustments.

The Chinese version of the Davidson Trauma Scale: a practice test for validation

The Chinese version of the Davidson Trauma Scale (DTS-C) was developed to respond to the need of Chinese-speaking individuals. The DTS is a validated self-rating scale used in the diagnosis of posttraumatic stress disorder (PTSD). The DTS-C is translated from DTS through a two-stage translation. Subjects were drawn from a sample of 210 survivors of the 21 September 1999, Chi-Chi Earthquake. The scale showed good internal consistency (Cronbach's alpha = 0.97) and test-retest reliability (r = 0.88). Concurrent validity was obtained against the clinical diagnostic interview, with a diagnostic accuracy of 0.85 at DTS-C score of 44. It showed that the sensitivity was 0.9, specificity 0.81, positive likelihood ratio 4.74, and negative likelihood ratio 0.12. The recommended stratum-specific likelihood ratios were 0.10 (95% CI: 0.05-0.20) for the score range 0-39, 4 (2.22-7.23) for the score range of 40-59, and 6.14 (3.42-11.02) for the scores above 60. In PTSD diagnosed subjects, the factor structures closely resembled the DSM-IV grouping of PTSD symptoms. The psychometric strength of DTS-C is reliable for its future use, particularly for screening for subjects with possible diagnosis of PTSD.