From peculiar psychiatric disorders through culture-bound syndromes to culture-related specific syndromes

Medical Returnees: Somali Canadians Seeking Psychosocial and Spiritual Care in East Africa

The refugee experience has been associated with increased rates of psychosocial challenges. At the same time, evidence suggests that those who resettled in Western countries including Canada underutilize the formal mental health services in these countries. The low uptake has been attributed to barriers such as language, complexity of the health systems, and differing explanatory models of illness. The same is true for Somali refugees in the West. Studies suggest that Somali refugees prefer spiritual healing for psychosocial illness and that some return to East Africa for such healing. However, little is known about Somali Canadian's experiences with the Canadian mental health services and transnational health seeking. The study aimed to understand psychosocial challenges faced by Somali Canadians, their health seeking behaviors, and service utilization. Because some sought psychosocial services outside the country, fieldwork was conducted in Kenya to provide new evidence on transnational healing services. Ethnographic fieldwork and in-depth interviews were utilized. Thirty-seven interviews of about an hour each were undertaken. Fieldwork in Nairobi focused on spiritual healing centers and medical clinic. The findings reveal important findings regarding psychosocial challenges experienced by participants. It discusses psychosocial illnesses as variedly experienced, challenges with accessing Canadian healthcare services, and seeking culturally appropriate services in East Africa. The study highlights participants and their families struggle with psychosocial distress, the challenges of accessing culturally appropriate services within Canada, the role of spiritual healers and the existence of transnational health seeking practices.

A Rare Presentation of Delusional Parasitosis With Koro-Like Syndrome

Delusional parasitosis (DP) with Koro-like syndrome poses a complex clinical challenge, demanding a comprehensive and empathetic approach from healthcare professionals. This exceptional combination of fixed beliefs about infestation and experiences of genital retraction can profoundly impact patients' well-being and daily functioning. The associated stigma and misconceptions further compound the difficulties faced by individuals struggling with these co-occurring conditions. Given the rarity of encountering both conditions simultaneously, navigating the diagnosis and treatment of delusional parasitosis with Koro-like syndrome requires a thorough understanding of its multifaceted nature. Embracing a holistic strategy encompassing psychoeducation, psychotherapy, and pharmacological interventions is essential for effectively addressing these dual conditions.

Koro Syndrome: Epidemiology, Psychiatric and Physical Risk Factors, Clinical Presentation, Diagnosis, and Treatment Options

Koro syndrome is a multi-tiered disease presenting as an overwhelming belief that one's sex organs are shrinking into their body. Moderate to severe anxiety attacks are associated with the condition, along with a fear of imminent death. Koro is often culturally related and is most seen as an epidemic form in East and Southeast Asia, although it can present anywhere worldwide in its sporadic form. The condition typically affects young males who believe in sex-related myths, and many individuals can co-present with anxiety, depression, or even psychosis. Although most presentations of Koro are self-limiting, the condition is harmful for one's self-esteem and quality of life, and some individuals may go through extreme, physically injurious measures to prevent genital retraction. Treatments include the use of psychotherapy that has a sex education component, especially if the patient believes in culturally rooted myths. In sporadic Koro, it is believed that if the primary psychiatric disorder is treated with anxiolytics, antidepressants, sedatives, or psychotics, the secondary Koro-like symptoms will also fade. Additional investigation on the prevalence, pathogenesis, factors that correlate with treatment efficacy are needed to fully understand Koro syndrome.

Managing Chineseness: neurasthenia and psychiatry in Taiwan in the second half of the twentieth century

The present study investigates the role of Taiwanese psychiatrists in turning neurasthenia into a culture-specific disease in the late twentieth century. It first delineates the shift in both explanatory models of psychoneuroses and patient population in post-World War II Taiwan. Neurasthenia became a focus of international attention in the 1970s and 1980s with the advance of cultural psychiatry, and, as China was closed to the outside world, Taiwanese psychiatrists were influential in framing the cultural meaning of neurasthenia. With the rise of post-socialist China, Taiwan lost its status as a key laboratory of Chinese studies. This paper argues that the history of neurasthenia during the period was closely associated with the professional development and national identity of Taiwanese psychiatrists.

Cardiovascular Disease and Health-Related Quality of Life Among Asian American, Native Hawaiian and Pacific Islander Older Adults

Objectives: Assess the relationship between cardiovascular disease (CVD) and health-related quality of life (HRQOL) among Asian American, Native Hawaiian, and Pacific Islander (NH/PI) compared to white older adults. Methods: Data were from the 2011-2015 Health Outcomes Survey. HRQOL was assessed using the Veterans RAND 12-Item Survey, composed of physical (PCS) and mental component scores (MCS). Lower scores represent worse health. Multivariate regression was conducted to estimate PCS and MCS mean score differences related to self-reported CVD (coronary artery disease, congestive heart failure, myocardial infarction, other heart conditions, stroke) and race/ethnicity. Results: There were marked differences in PCS and MCS scores by disaggregated Asian American and NH/PI subgroups. After adjustment, Asian American and NH/PI older adults had better PCS but worse MCS than white older adults. Race/ethnicity moderated the relationship between CVD and HRQOL. Discussion: Asian American and NH/PI older adults with CVD had poorer mental health compared to their white counterparts.

Does "Susto" Really Exist? Indigenous Knowledge and Fright Disorders Among Q'eqchi' Maya in Belize

Susto is one of the most common disorders referenced in the medical anthropological and cultural psychiatric literature. This article questions if "susto" as understood in cultural psychiatric terms, especially in the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM), is in fact a single "cultural concept of distress." There is extensive cross-cultural and intracultural variability regarding fright-related disorders in the ethnographic literature. What is often labeled "susto" may be in reality a variety of distinct disorders, or lacking in the two signature components found in the cultural psychiatric literature: the existence of a "fright," and subsequent soul loss. There has been significant polysemic and geographical drift in the idiom label, the result of colonialism in Mesoamerica, which has overlayed but not necessarily supplanted local knowledge. Using data from fifteen years of research with Q'eqchi' (Maya) healers and their patients, we demonstrate how important variability in signs, symptoms, diagnosis, treatment, and prognosis of fright-related disorders renders any simple declaration that this is a singular "susto" problematic. We argue for a careful consideration of the knowledge of Indigenous medical specialists charged with treating fright-related disorders and against the inclination to view variability as insignificant. Such consideration suggests that Indigenous forms of fright-related disorder are not susto as presented commonly in the DSM and cultural psychiatric literature.

Psychiatric, cognitive functioning and socio-cultural views of menstrual psychosis in Oman: an idiographic approach

BACKGROUND

Most documented cases of menstrual psychosis have been from Euro-American populations with reports from cross-cultural populations being only a few. A primary aim was to determine whether the cyclical/episodic nature of menstrual psychosis among case series observed at a tertiary care unit in Oman fulfills the diagnostic criteria of the International Classification of Diseases (ICD-10) and diverge into Brockington's sub-types (World Psychiatry. 2005;4(1):9-17). Related aims were to solicit measures of psychometric functioning of those with menstrual psychosis and associated idioms of distress.

METHODS

A series of consecutive patients seeking psychiatric consultation from January 2016 to December 2017 were screened via structured interview-Composite-International Diagnostic Interview (CIDI) and Brockington's sub-types. The identified patients (n = 4) also underwent psychometric evaluation including examination of affective functioning, intellectual capacity and neuropsychological functioning (i.e.attention and concentration, learning and remembering, executive function, processing speed and speech and language). The analysis of outcome measures was via an idiographic approach.

RESULTS

The spectrum of distress among people with menstrual psychosis does not fit existing psychiatric nosology. Evaluations revealed that a majority of the participants displayed something akin to morbid phenomena relating to manic and psychotic symptoms. In the parlance of traditional Omani society, this would be termed "spirit possession". In terms of classification by timing within the menstrual cycle as expounded by Brockington, the present case series in Oman fulfilled the definition of catamenial psychosis and paramenstrual psychosis. With regard to psychometric function, all participants performed adequately on indices of intellectual functioning but appeared to have impairments in neuropsychological functioning, including the dimensions of processing speed, episodic memory, and executive functioning. Within the given society, the periodicity of mind alteration has been attributed to spirit possession.

CONCLUSIONS

This is one of the first case series of its kind in the country elucidating whether the manifestation of menstrual psychosis among individuals in Oman fulfills the subtypes postulated by Brockington. The present case series suggests that menstrual psychosis is marked with neuropsychological impairments that were previously observed in other phasic manic episodes or brief psychotic disorders.

Fractures in the framework: limitations of classification systems in psychiatry

This article examines the limitations of existing classification systems from the historical, cultural, political, and legal perspectives. It covers the evolution of classification systems with particular emphasis on the DSM and ICD systems. While pointing out the inherent Western bias in these systems, it highlights the potential of misuse of these systems to subserve other agendas. It raises concerns about the reliability, validity, comorbidity, and heterogeneity within diagnostic categories of contemporary classification systems. Finally, it postulates future directions in alternative methods of diagnosis and classification factoring in advances in artificial intelligence, machine learning, genetic testing, and brain imaging. In conclusion, it emphasizes the need to go beyond the limitations inherent in classifications systems to provide more relevant diagnoses and effective treatments.


Racial and ethnic differences in mental health service utilization among the Hawaii medicaid population

Background: Racial/ethnic differences have not been adequately addressed in the utilization of mental health services among Medicaid populations. Aim: This study aimed to examine racial/ethnic differences in the utilization of health services for mental disorders in a Medicaid adult population aged between 21 and 64 years. Methods: Racial/ethnic differences in inpatient, outpatient and emergency department services utilization were assessed using 2010 Hawaii Medicaid data. Zero-inflated negative binomial regressions were employed adjusting for age, sex and residential area. Results: Among 73,200 beneficiaries, 29.7% were Whites, 28.5% Asians, 34.7% Native Hawaiians and Pacific Islanders (NHPIs); 60.2% were younger (21-44 years) and 58.6% were females. The patterns of utilization of health services differed across race/ethnicity. Compared to Whites, Asians and NHPIs were less likely to use outpatient services and had lower rates of inpatient visits. NHPIs were also estimated to have lower rates of outpatient and emergency department visits. Conclusion: Variation in the utilization of health services emphasizes the importance of race/ethnicity in mental health management. Various factors, such as language barriers and cultural differences, should be considered in developing clinical interventions or integrative health programs that aim to reduce racial/ethnic disparities among people with mental disorders.

Síndrome de koro associado a transtorno obsessivo-compulsivo: caso clínico e breve revisão

RESUMO A síndrome de koro é uma síndrome psiquiátrica ligada à cultura, que se caracteriza por um episódio de ansiedade súbito e intenso relacionado com a crença de que o pênis (nas mulheres, mamilos e grandes lábios) estar a retrair-se para o interior do organismo, podendo conduzir à impotência, esterilidade e, eventualmente, morte. É mais frequente nos países do Sudoeste Asiático e no sexo masculino. No Ocidente é rara, embora existam descrições de koro-like secundárias a perturbações neurológicas, psiquiátricas ou orgânicas. No Diagnostic and Statistical Manual of Mental Disorders-5 é classificada como um “Transtorno Obsessivo-Compulsivo e transtornos relacionados com outra especificação”. Este artigo descreve um caso raro de um doente com síndrome de koro secundária a um transtorno obsessivo-compulsivo. Neste artigo, apresenta-se a descrição de um caso clínico e revisão bibliográfica, com base na pesquisa de artigos publicados, desde 2000, no PubMed, com as palavras-chave: “koro syndrome”, “obsessive-compulsive disorder” e “koro-like symptoms”. Analisaram-se alguns artigos anteriores ao ano 2000 para contextualização histórica. Doente com síndrome de koro secundária a transtorno obsessivo-compulsivo, com boa resposta à terapia farmacológica associada à terapia cognitivo-comportamental. O conhecimento desse diagnóstico e da sua gestão clínica é importante para identificar as condições subjacentes e otimizar o tratamento.

Culture-Bound Syndromes of a Brazilian Amazon Riverine population: Tentative correspondence between traditional and conventional medicine terms and possible ethnopharmacological implications

ETHNOPHARMACOLOGICAL RELEVANCE

It is not always possible to correlate the "emic" terms to the "etic" ones during ethnopharmacological surveys, especially regarding those related to Culture-Bound Syndromes (CBS). Nevertheless, it is the role of ethnopharmacology to address these correlations, since they are the basis for the understanding of potential bioactives.

AIM AND OBJECTIVES

This study reports the clinical manifestations and therapeutic resources used for the treatment of CBS among some riverine inhabitants of Brazilian Amazonia. An effort was made to establish a correspondence between the local "emic" terms of traditional medicine and the symptoms or diseases known by conventional medicine ("etic" terms). The ultimate goal was to gain insights to suggest further pharmacological studies with the local resources.

MATERIAL AND METHODS

Fieldwork was guided by methods of anthropology, botany and zoology-with the assistance of a doctor-among the traditional healing experts in Jaú National Park (during 199 days in 1995) and Unini River Extractive Reserve (210 days from 2008 to 2012).

RESULTS

Fifty-nine healers of different kinds were interviewed: a prayer-maker, medium, natural resource expert, massage therapist, midwife and snakebite healer. The clinical manifestations and healing resources of the following CBS were collected: "mau olhado" (evil eye), "quebrante" (chipping); "espante" (fright or susto); "doença do ar" (air diseases); "vento caído" (fallen wind); "derrame" (leakage); "mãe do corpo" (mother of the body) and "panema" (unlucky). The first three seem to be local variations of other CBSs already described in Latin America. "doença do ar", "vento caído", "derrame" and "mãe do corpo" seem to be folk terms for known conventional medical disorders, while "panema" is a yet undescribed Brazilian CBS that is possibly related to dysthymic disorder or depression and deserves further investigation. Treatments included prayer rituals, fumigation, baths and oral remedies using 25 plants and 10 animals.

CONCLUSION

It was possible to establish hypothetical correlations between CBS as described by the riverine population studied and some "etic" terms. The main importance of this is to help the proposition of target-oriented pharmacological studies of the natural resources used by these communities. Accordingly, the following plants are suggested to be submitted to further studies for antidepressant and anxiolytic activities: Siparuna guianensis, Mansoa alliacea, Leucas martinicensis, Petiveria alliacea, Annona montana and Alpinia nutans; for anti-seizure activity: Protium amazonicum, Protium aracouchini and Protium heptaphyllum; finally for antispasmodic activity: Leucas martinicensis.

Psychometric properties of the Ndetei-Othieno-Kathuku (NOK) Scale: A mental health assessment tool for an African setting

BACKGROUND

Research suggests that psychiatric conditions in children and adolescents are highly debilitating, with sparse resources for assessment and treatment in low- and middle-income countries (LMICs).

OBJECTIVES

The primary aim of this study was to evaluate the reliability, validity, and latent factor structure of an ethnographically-grounded assessment instrument for detecting common mental health complaints among rural Kenyan children and adolescents.

METHODS

The Ndetei-Othieno-Kathuku Scale (NOK) was delivered to 2 282 children aged 10 to 18 years old. Exploratory factor analysis identified four latent factors. This structure was confirmed in subsequent confirmatory factor analyses. External validity was explored by investigating associations among NOK factors and Youth Self-Report DSM-oriented scales.

RESULTS

Findings suggest the NOK possesses good internal reliability and a four-factor latent structure corresponding to depression, anxiety, somatic complaints, and a mixed factor. Significant associations ranging from small to medium effect sizes were noted between NOK factors and YSR DSM-oriented scales.

CONCLUSIONS

Exploratory findings suggest that the NOK possesses adequate psychometric properties among this population. This ethnographically-grounded instrument may be uniquely suited to screening for mental health complaints among Kenyan children and adolescents.

Transcultural Factors in Hypnotizability Scales: Limits and Prospects

Hypnotic suggestibility--loosely termed hypnotizability--is difficult to assess across cultures. Investigators often use translated research instruments to guide their inquiry in disparate geographic locations. Present-day hypnosis researchers rely heavily on two primary scales that are more than half a century old: the Stanford Hypnotic Susceptibility Scale: Form C (SHSS:C) (Weitzenhoffer & Hilgard, 1959) and the Harvard Group Scale of Hypnotic Susceptibility: Form A (HGSHS:A) (Shor & Orne, 1962). Scholars typically translate these scales to measure hypnotizability transculturally. This approach, however, operates under the specious assumption that the concept of hypnotizability is largely monolithic or universal across cultures. Whereas translations likely conserve the linguistic content, they may arguably imply different cultural meanings and historical subtexts. Whereas social scientists acknowledge the importance of qualitative and phenomenological accounts in the study of altered consciousness, including suggestibility, researchers interested in hypnotizability consider the impact of findings from anthropology and ethnography too little. Clinicians and scholars of hypnosis would stand to benefit from incorporating the insights afforded by transcultural research in the overarching investigation of a concept as nuanced as hypnotizability.

Frigophobia: a case series from Sri Lanka

Frigophobia is a condition in which patients report coldness of extremities leading to a morbid fear of death. It has been reported as a rare culture-related psychiatric syndrome in Chinese populations. An extensive survey of the literature yielded only six case reports. The present paper describes a series of 109 patients with frigophobia in Sri Lanka. The common clinical presentation was of patients initially examining their extremities for cold sensations, and then, with the onset of fear, covering themselves in layers of clothing, applying emollients, and staying near an open fire in an effort to ward off the cold. They avoided foods considered to be "cooling" and bathed only in the heat of the noonday sun. When the severity of the symptoms reached a peak, or when they felt death was imminent, Western medical aid was sought. The fear of dying is seen as the single most important aspect that drives these individuals to seek help. There was a preponderance of female patients, and a few had specific phobias as comorbid conditions. Management comprised primarily illness education, reassurance, and desensitisation by exposure to cold stimuli, with short-term anxiolytic medication use when necessary.

The Manifestation of Anxiety among Sesotho Speakers

Mental health research in black communities in South Africa has been neglected to an alarming degree. Consequently the health system is in a precarious situation owing to a lack of accurate data to facilitate proper planning. This study investigates the way in which anxiety is clinically manifested among Sesotho speakers. For this exploratory descriptive study, the participants consisted of 101 Sesotho speakers diagnosed with anxiety disorders. They were drawn from the population of patients visiting various health establishments in the Mangaung area, South Africa. A semi-structured interview based on the Psychiatric Interview Questionnaire was used to evaluate the participants. It consisted of two types of data collection: the open-ended interview and clinical observation. The results show that there were marked differences in the presentation of anxiety symptoms among Sesotho speakers in comparison with what has been reported in western literature. Anxiety among Sesotho speakers is characterized by the prevalence of hallucinations, and there are also overlapping symptoms of anxiety and depression.

A contribuição dos estudos transculturais dos países latino-americanos e caribenhos para a revisão da CID-10: resultados preliminares

OBJETIVO: Esta revisão visa identificar as evidências dos estudos de países da América Latina e do Caribe para a inclusão das síndromes transculturais na versão da Classificação Internacional de Doenças para sua 11ª Edição. MÉTODO: Os estudos foram identificados nas bases do Medline, LILACS e EMBASE, no período de 1992 a 2008, e classificados segundo o tipo de estudo, tipo de transtorno, país e número de publicações por ano. RESULTADOS: Foram selecionadas e classificadas 163 publicações: 33 no Medline, 90 no EMBASE e 40 no LILACS. A percentagem das síndromes transculturais ("culture bound-syndrome") correspondeu a 9% no Medline, 12% no EMBASE e 2,5% no LILACS. Dos 15 estudos sobre síndromes transculturais, dois eram sobre "nervios e ataque de nervios", dois sobre "susto", quatro sobre a relação entre crenças religiosas, "feitiçaria", transe e apresentação dos transtornos mentais, um sobre proposta de uma nova categoria diagnóstica, três artigos teóricos e três sobre psicopatoplastia dos transtornos mentais. CONCLUSÃO: A escassez de estudos sobre síndromes transculturais pode ter ocorrido pela dificuldade em rastrear os estudos por problema de indexação das publicações, falta de interesse em publicar tais estudos em periódicos indexados e a dificuldade de acesso às publicações. Dentre os estudos identificados, não há uma evidência clara que aponte quais modificações são necessárias nas classificações diagnósticas atuais.

Jiko-shisen-kyofu (fear of one's own glance), but not taijin-kyofusho (fear of interpersonal relations), is an east Asian culture-related specific syndrome

OBJECTIVE

According to the DSM-IV-TR, the concept of taijin-kyofusho (fear of interpersonal relations) is both unique to East Asia and a culture-bound syndrome. In the indigenous diagnostic classification system in Japan, taijin-kyofusho consists of four subtypes, i.e. sekimen-kyofu (phobia of blushing), shubo-kyofu (phobia of a deformed face/body), jiko-shu-kyofu (phobia of one's own foul body odour), and jiko-shisen-kyofu (phobia of one's own glance). Each subtype except for phobia of one's own glance can be adequately assigned to a respective existing category in the DSM-IV-TR. The aim of the study was to introduce clinical features of phobia of one's own glance to western psychiatrists.

METHODS

Description of a series of cases with jiko-shisen-kyofu (phobia of one's own glance).

RESULTS

All of our cases shared the unique feature that they suffered from the preoccupation that their own glance was offensive to others, and as a result were socially withdrawn themselves.

CONCLUSIONS

To our best knowledge, no cases with a clear picture of phobia of one's own glance have been reported in the West to date. The controversial issue of the classification of phobia of one's own glance as an east Asian culture-related specific syndrome was addressed.

How Distinctive Are Indigenous Ways of Achieving Influence? A Comparative Study of Guanxi, Wasta, Jeitinho, and “Pulling Strings”

The purpose of the study was to investigate the cultural specificity of guanxi, wasta, and jeitinho, each of which has been identified as an indigenous process of informal influence. Students in Brazil, China, Lebanon, and the United Kingdom were presented with three scenarios derived from each of the nations sampled. They rated the extent to which each scenario was representative of the locally indigenous process, the typicality for their culture of the events portrayed in the scenarios, and the extent to which these interpersonal exchanges were perceived positively. While each type of scenario was perceived as representative and typical in its culture of origin, each was also perceived as somewhat typical by respondents in additional locations. Informal influence processes may vary between cultures more in frequency than in quality. Rated scenario positivity was significantly predicted by respondents’ values. The United Kingdom–based process of “pulling strings” was rated as typical in all locations and was more positively evaluated than the other influence processes by all respondents. It is concluded that in addition to the pragmatic value of these concepts locally, their comparative testing can contribute to the development of culture-general models of social influence processes.