Religiosity and religious delusions in schizophrenia - An observational study in a Hindu population

BACKGROUND

Religion exerts a significant effect on the lives of many individuals including people with mental illness. As evidences keep accumulating, role of religion in mental illness is gaining importance.

OBJECTIVES

The study was designed to study the effects of religiosity on religious delusions, its presentation, acute course and outcome in schizophrenia.

METHOD

The study was a naturalistic observational study. Subjects with schizophrenia were grouped into those with religious (RG) and with non-religious delusions (NG). Their premorbid religiosity was assessed with Brief Multi-dimensional measurement of Religiosity/spirituality (BMMRS) and were rated on Scale for Assessment of Positive Symptoms (SAPS), Brown's Assessment of Belief Scale (BABS) and Positive and Negative Symptom Scale (PANSS) at baseline and 4 weeks.

RESULTS

Scores on private religious practices, baseline scores of SAPS, BABS & PANSS and duration of untreated psychosis (DUP) were significantly higher for RG in comparison to NG. On component analysis, higher scores were seen on private praying, watching religious programs on TV, reading religious books and prayers at meals. But no significant correlation was found between the private religious practices and the baseline scores of (DUP), SAPS, BABS, PANSS and outcome measure. Also no significant difference was noted in measures of improvement between groups.

CONCLUSION

Private religious practices are more prominent in patients of schizophrenia with religious delusions and this group of patient seems to present with a more severe illness, and a longer duration of untreated psychosis in comparison to those with non-religious delusions.

Major discriminatory events and risk for psychotic experiences among Black Americans

Racism is a multidimensional construct that impacts risk for psychosis through various complex pathways. Previous research has yet to fully explore how major racial discriminatory events contribute to risk for psychotic experiences in the general population. We examined the National Survey of American Life to analyze the effects of 9 major racial discriminatory events on lifetime psychotic experiences among Black Americans. By examining each event separately, we found that police discrimination was associated with increased risk for lifetime psychotic experiences after adjusting for demographic variables, socioeconomic status, and co-occurring psychological or social problems. Being denied a promotion, being a victim of police abuse, and being discouraged from pursuing education were associated with lifetime visual hallucinations, and being discouraged from pursuing education was also associated with lifetime delusional ideation. None of the events were associated with lifetime auditory hallucinations. As a count of events, experiencing a greater range of major racial discriminatory events was associated with higher risk, particularly for lifetime visual hallucinations. Our findings point to the need for early detection and intervention efforts in community settings and multilevel efforts to eliminate racial discrimination. (PsycINFO Database Record

Comparing schizophrenia symptoms in the Iban of Sarawak with other populations to elucidate clinical heterogeneity

INTRODUCTION

The symptom profile of schizophrenia can vary between ethnic groups. We explored selected symptom variables previously reported to be characteristic of schizophrenia in the Iban of Sarawak in transethnic populations from Australia, India, and Sarawak, Malaysia. We tested site differences to confirm previous research, and to explore implications of differences across populations for future investigations.

METHODS

We recruited schizophrenia samples in Australia (n = 609), India (n = 310) and Sarawak (n = 205) primarily for the purposes of genetic studies. We analyzed seven identified variables and their relationship to site using logistic regression, including: global delusions, bizarre delusions, thought broadcast/insertion/withdrawal delusions, global hallucinations, auditory hallucinations, disorganized behavior, and prodromal duration.

RESULTS

We identified a distinct symptom profile in our Sarawak sample. Specifically, the Iban exhibit: low frequency of thought broadcast/insertion/withdrawal delusions, high frequency of auditory hallucinations and disorganized behavior, with a comparatively short prodrome when compared with Australian and Indian populations.

DISCUSSION

Understanding between-site variation in symptom profile may complement future transethnic genetic studies, and provide important clues as to the nature of differing schizophrenia expression across ethnically distinct groups. A comprehensive approach to subtyping schizophrenia is warranted, utilizing comprehensively ascertained transethnic samples to inform both schizophrenia genetics and nosology.

History of religious delusions and psychosocial functioning among Mexican patients with paranoid schizophrenia

The association between global functionality and religiosity among patients from developing and predominantly Catholic countries warrants attention. To compare religiosity and psychosocial functioning in Mexican schizophrenia patients with and without a history of religious delusions, seventy-four patients with paranoid schizophrenia were recruited. Patients with a history of religious delusions had more psychiatric hospitalizations and poorer psychosocial functioning compared with those without a history of religious delusions. No differences emerged between groups in the total scores of religiosity scales. A history of religious delusions rather than religiosity itself may have an influence on psychosocial functioning among Mexican patients with schizophrenia.

DSM-IV "criterion A" schizophrenia symptoms across ethnically different populations: evidence for differing psychotic symptom content or structural organization?

There is significant variation in the expression of schizophrenia across ethnically different populations, and the optimal structural and diagnostic representation of schizophrenia are contested. We contrasted both lifetime frequencies of DSM-IV criterion A (the core symptom criterion of the internationally recognized DSM classification system) symptoms and types/content of delusions and hallucinations in transethnic schizophrenia populations from Australia (n = 776), India (n = 504) and Sarawak, Malaysia (n = 259), to elucidate clinical heterogeneity. Differences in both criterion A symptom composition and symptom content were apparent. Indian individuals with schizophrenia reported negative symptoms more frequently than other sites, whereas individuals from Sarawak reported disorganized symptoms more frequently. Delusions of control and thought broadcast, insertion, or withdrawal were less frequent in Sarawak than Australia. Curiously, a subgroup of 20 Indian individuals with schizophrenia reported no lifetime delusions or hallucinations. These findings potentially challenge the long-held view in psychiatry that schizophrenia is fundamentally similar across cultural groups, with differences in only the content of psychotic symptoms, but equivalence in structural form.

A survey of psychosis risk symptoms in Kenya

Defining the prepsychotic state in an effort to prevent illness progression and the development of disorders such as schizophrenia is a rapidly growing area of psychiatry. The presentation of psychotic symptoms can be influenced by culture; however, there has not been any previous assessment of psychosis risk symptoms in the continent of Africa. Our study aimed to measure the prevalence of psychosis risk in a community sample in Nairobi, Kenya, and to evaluate the effects of key demographic variables. A culturally modified version of the 12-item PRIME-Screen (mPRIME) was self-administered by 2758 youth (aged 14-29 years) recruited through house-to-house visits in Nairobi, Kenya. The prevalence and severity of psychosis risk items from the mPRIME and the effects of sex and age on symptoms were evaluated. k-Means cluster analysis was used to identify symptom groups. Depending on the mPRIME item, 1.8% to 19.5% of participants reported certainty of having had a psychosis risk symptom. Overall, 45.5% reported having had any psychosis risk symptom. Females had a significantly higher mean severity score on items evaluating persecutory ideation and auditory hallucinations. Symptom severity on 5 items showed a modest (R = 0.09-0.13) but significant correlation with age. Cluster analysis identified 4 groups of participants: normative (55%), high symptom (11%), intermediate symptom (19%), and grandiose symptom (15%). Psychosis risk symptoms appear to be highly prevalent in Kenyan youth. Longitudinal studies are needed to determine the correlation of identified symptoms with transition to psychotic illness, as well as the associated functionality and distress, to develop appropriate intervention strategies.

[Mamadou or anxiety resulting from a departure for the European Eldorado]

Candidates for emigration are susceptible to a psychotic breakdown accompanied by feelings of guilt arising from abandoning their community of origin. The elimination of this guilt involves, essentially, a denial of identity with a touch of megalomania which makes treatment difficult.

Idiom of distress or delusional state? Cultural clash as the cause of misdiagnosis: a case report

The Beta Israel (House of Israel) represent a total number of more than 100,000 individuals. Ethiopian Jewish culture is based on a tribal cultural model. With their arrival in Israel, many difficulties surfaced. Ethiopian Jews had to deal with cultural choices that challenged their traditions. It has been suggested that the trauma of their journey coupled to the difficulties of the adaptation process to Israeli society, ( the culture shock), was directly responsible for psychopathology found among this population. It also appeared that culture plays a central role in the construction of the clinical picture, blurring at times the boundary between expressions of distress and pathology. It became increasingly difficult to draw the line between culturally normative behavior and psychopathology. The following case report underlines the importance of socio cultural considerations in both staff and patients, and illustrates the dangers of misdiagnosis due to patient therapeutic team cultural clash. A 41 year old woman of Ethiopian origin was hospitalized for suspected schizophrenia. Because of the striking contrast between the patients behavior, responses and so called psychotic content, possible misunderstanding based on cultural differences was considered by the clinical management team. This case underlines the dangers of the psychiatric diagnostic process, emphasizes the important role of sociocultural backgrounds of both staff and patients in patient management and encourages the consideration of cultural factors in all patient evaluations.

Symptoms of offensive type Taijin-Kyofusho among Australian social phobics

This study investigated the culture specificity of Taijin-Kyofusho (TK) offensive type by examining whether symptoms of the disorder covary with social phobia and determining the proportion of those who meet criteria for a diagnosis of TK offensive type among Australian socially phobic individuals. The study included a total of 94 participants who met the DSM-IV criteria for social phobia and 39 normal controls who did not meet criteria for any mental disorder. All participants were born in Western countries and resided in Australia. Results showed that levels of offensive worry were significantly elevated in socially phobic individuals and decreased after treatment of their social phobia, pointing to a close relationship between symptoms of TK offensive type and social anxiety. Correlational analysis indicated that TK offensive type and social phobia appear to represent distinct constructs, although the two constructs were clearly strongly related. However, diagnostic examination revealed that the prevalence of reported offensive symptoms (eight out of 94; 8.5%) was extremely low among participants with social phobia in Australia and none of them met the full criteria for TK offensive type. The mixed findings relevant to the existence of TK offensive type among an Australian sample with social phobia are discussed in relation to cultural influences on life interference, referral behaviors, and diagnostic customs.

Behavioral and psychological symptoms in Taiwanese patients with Alzheimer's disease

OBJECTIVE

To investigate the prevalence of and risk factors for behavioral and psychological symptoms in Taiwanese Alzheimer's disease (AD) patients.

METHOD

Consecutive AD patients from the Memory Clinic of the Taipei Veterans General Hospital were studied. Cognitive function was evaluated using the Chinese version of the Cognitive Abilities Screening Instrument. Primary caregivers were interviewed for the Clinical Dementia Rating scale, the Barthel Index, and the Alzheimer's Deficit Scale. Behavioral and psychological symptoms were assessed using the Behavioral Pathology in Alzheimer's Disease Rating Scale.

RESULTS

Of the 142 participants, 73 (50.7%) had at least one delusion. The most frequent delusion was delusion of theft (N=43, 30.3%). Thirty-five patients (24.6%) experienced hallucination. Fifty-seven patients (40.1%) had activity disturbances and 39 (27.5%) had aggression. Patients were divided into two subgroups according to the presence or absence of each cluster of symptoms, namely, delusions, hallucinations, activity disturbance, aggression, diurnal rhythm change, affective symptoms, and anxiety. There was no significant correlation between age, age at onset of dementia, number of years of education, and duration of illness and each cluster of symptoms. Correlation between severity of behavioral and psychological symptoms of dementia and cognitive decline was noted.

CONCLUSIONS

This study revealed a high prevalence of behavioral and psychological symptoms of dementia in Taiwanese patients with AD and suggests that these symptoms are associated with cognitive deficit.

Delusional ideation and manic symptoms in potential future emigrants in Uganda

BACKGROUND

The cause of increased schizophrenia rates among immigrants in Europe is unknown. This study explores psychotic features in persons aspiring and actively planning to emigrate, prior to their potential emigration.

METHOD

Potential future emigrants and controls in Kampala (Uganda) were screened for delusional ideation and manic symptoms, using the Peters et al. Delusions Inventory (PDI) and mania items from the Composite International Diagnostic Interview (CIDI).

RESULTS

Aspirations regarding emigration were associated with increased delusional ideation compared with controls (p=0.01), whereas active plans regarding emigration were not. Neither aspiring nor actively planning to emigrate was associated with increased manic symptoms. Subjects with increased delusional ideation also had increased manic symptoms (p<0.001).

CONCLUSIONS

Although some aspects of delusional ideation might include thoughts concerning emigration, practical circumstances (e.g. visa requirements, travel costs) probably prevent emigration of the psychosis-prone in many settings.

Correlates of lifetime suicide attempts among individuals with affective disorders in a Chinese rural community

The aim of this study was to compare the demographic and clinical characteristics of individuals with affective disorders who had attempted suicide at some time in their lives and those who had not made a suicide attempt. In a Chinese rural community, individuals with suicide attempt (N = 30) and those without suicide attempt (N = 166) were assessed with Present State Examination (PSE). Attempters had a significantly higher level of family economic status, higher rate of lifetime depressed mood and hopelessness, and delusions than nonattempters. The logistic regression models also indicated that depressed mood and hopelessness were the most important predictors of suicide attempts. No significant difference in treatment condition was found between attempters and non-attempters. Early identification and interventions focusing on reducing depressed mood, hopelessness, and controlling psychotic symptoms may be helpful in reducing the risk of suicide attempts among individuals with affective disorders residing in the community.

Irrational beliefs in major depression and generalized anxiety disorders in an Iranian sample: a preliminary study

Previous research on Rational Emotive Theory using western samples has shown that irrational belief systems are associated with emotional disorders such as anxiety and depression. In a replication of this work the present study was conducted to compare the scores of 29 clinically depressed, 31 clinically anxious, and 34 normal controls on the Irrational Beliefs Test in an Iranian sample. Consistent with Ellis's theory, depressed and anxious patients scored higher than the controls on scores for the full scale and all 10 subscales of the Irrational Beliefs Test. Also, the two patient groups differed significantly in their endorsement of 2 out of 10 irrational belief subscales but not in overall score on irrational beliefs. Results were interpreted in light of previous literature.

Prevalence of delusional ideation in a district in southwestern Uganda

BACKGROUND

Population-based prevalence studies suggest that psychosis is a continuum distributed in the general population.

AIM

To assess the prevalence of delusional ideation in young healthy individuals in a low-income country setting (Uganda) and to investigate possible relevant background factors.

METHOD

Interviews were conducted in a district capital and in three rural villages, using the Peters et al. Delusions Inventory (PDI-21).

RESULTS

Levels of delusional ideation and associated levels of distress, preoccupation, and conviction were higher than in studies conducted in Europe. Higher PDI-21 scores were associated with younger age and with urban residence. The urban effect was stronger in persons with a higher level of education.

CONCLUSIONS

Although the factors that contribute to population differences in levels of delusional ideation are currently unknown, the results suggest that urban residence may be an important influence.

Making psychiatric sense of sand: a case of delusional disorder in Saudi Arabia

Somatic delusional disorder is an uncommon psychiatric disorder that has been typically reported in elderly women. This article reviews the literature and describes a Saudi female patient who presented with novel somatic delusion of turabosis--the conviction that she was continually being covered by sand from sandstorms. Although the systematized delusional convictions remained unshakable, her anxiety and mood symptoms responded to a regimen of tricyclic antidepressants and her delusional beliefs resolved within eight weeks of treatment with risperidone. Sociocultural themes and therapeutic approaches to somatic delusional disorder are discussed.

Phenomenology of delusions in Pakistani patients: effect of gender and social class

The present study aimed to assess the actual content of delusions of Pakistani schizophrenic patients by gender and social class. A total of 98 schizophrenic patients (48 men and 50 women) from the two psychiatric units in Lahore, Pakistan, were interviewed using the Present State Examination categories. When the sample was analysed as a whole, the delusion of persecution was found to be the most common one followed by the delusion of grandiose identity. When the sample was divided according to gender and social class, two subgroups with surprisingly similar themes of delusions emerged from the analysis, one male and wealthy and the other female and poor. The themes of having special powers and being a star were more frequently found among the former, whereas the themes of black magic, persecution, being controlled and erotomania appeared to be more conspicuous among the latter. The results indicated that the phenomenology of delusions differs in subgroups of the population depending on their socio-cultural roles and specific vulnerabilities.

Puppy pregnancy in humans: a culture-bound disorder in rural West Bengal, India

BACKGROUND

Delusion of pregnancy in males, though uncommon, has been reported in the literature. Delusion of animal pregnancy in humans is unreported until now, and we are reporting here cases of puppy pregnancy in human beings from a part of rural West Bengal, India.

MATERIAL

Studies of six male cases and one female case of delusion of puppy pregnancy after an alleged touch or bite of a dog are presented.

DISCUSSION

Detailed phenomenological analysis revealed that there exists a strong cultural belief that dog bite may evolve into a puppy pregnancy even in the human male. Psychiatric status showed that there was a clear association of obsessive-compulsive disorder in two cases, anxiety-phobic locus in one and three showed no other mental symptom except this solitary false belief and preoccupation about the puppy pregnancy. All the cases were from rural areas and their communities endorse this pathogenic event of puppy pregnancy in humans. One case (11-year-old child) exemplified how the social imposition of this cultural belief made him a case that allegedly vomited out an embryo of a dog foetus.

CONCLUSION

Although the belief in puppy pregnancy is culturally shared, the cases presented a mix of somatic and psychological complaints and their help-seeking behaviour was marked. These features prompted us to identify this phenomena as a culture-bound disorder which needs proper cultural understanding for its effective management.

A comparison study of early non-psychotic deviant behavior in Afrikaner and US patients with schizophrenia or schizoaffective disorder

In a previous study early non-psychotic deviant behaviors in US adult schizophrenic patients recruited for a large-scale genetic study were examined (Psychiatry Research, 101, 101). Early deviance characterized a distinct subgroup of patients at rates that were consistent with earlier reports. In addition, specific early non-psychotic deviant behaviors were meaningfully associated with later disease outcomes. In the present study, we examined the demographic, syndrome course, symptom and early deviant behavior history of 109 Afrikaner probands who met criteria for DSM schizophrenia or schizoaffective disorder, and compared them to 109 age- and gender-matched US probands. Consistent with past findings, 68% of Afrikaner probands, as compared to 67% of age- and gender-matched US probands, reported one or more forms of early non-psychotic deviance, including poor socialization, extreme fears/chronic sadness, and/or attention/learning impairment. The remaining 32 and 33% of probands, respectively, were without behavioral deviance until the onset of schizophrenia or schizoaffective disorder. The frequency and distribution of individual deviant behaviors were strikingly consistent between the samples. However, logistic regression analyses revealed different patterns of associations between the early deviant behaviors manifested and disease outcome. Afrikaner participants with early fears/chronic sadness were 3 times more likely to attempt suicide, while among US participants, this form of early deviance conferred 3.5 times more risk for later schizoaffective disorder, and 3 times greater likelihood of later sensory (tactile and/or olfactory) hallucinations. Afrikaner participants with attention/learning impairment were 2.5 times more likely to experience later auditory hallucinations, while US participants with these early difficulties were 3 times more likely to experience thought disorder. We concluded that early non-psychotic childhood deviance in this independently collected Afrikaner population distinguished a distinct subtype of patients and that the forms of early deviance manifested were meaningfully linked to later disease outcome. Possible reasons for the association pattern differences in these two populations are considered.

Death, neurosis, and normalcy: on the ubiquity of personal and social delusions

In this article Freudian theory is invoked to illustrate the connections among repression, the fear of death, and delusional phantasies. Civilization is a structure invented to protect individuals from death, but the sacrifices imposed by that social structure are psychologically injurious and terrifying because society threatens individuals with punishment and death for having illicit desires. Annihilation anxiety may be abated by social structures, but the psychological sacrifice and threat amplify annihilation anxiety. I further argue that immersion in personal or social phantasies quells the conscious fear of death. Individuals vary in terms of reactions to death anxiety and how the complex matrix of fear and terror is nourished or abated in the developmental process. A Freudian reading of the developmental process implicates the inherently traumatic nature of nurture and the necessity of self-deceptive illusions. These phantasies do subdue conscious fear, but conscious feelings of security do not dispel unconscious tremors. Underneath these phantasies, dread and terror impel rigid adherence to whatever phantasy system provides subjective feelings of safety and salvation.

Discrimination and delusional ideation

BACKGROUND

In the UK and The Netherlands, people with high rates of psychosis are chronically exposed to discrimination.

AIMS

To test whether perceived discrimination is associated longitudinally with onset of psychosis.

METHOD

A 3-year prospective study of cohorts with no history of psychosis and differential rates of reported discrimination on the basis of age, gender, disability, appearance, skin colour or ethnicity and sexual orientation was conducted in the Dutch general population (n=4076). The main outcome was onset of psychotic symptoms (delusions and hallucinations).

RESULTS

The rate of delusional ideation was 0.5% (n=19) in those who did not report discrimination, 0.9% (n=4) in those who reported discrimination in one domain, and 2.7% (n=3) in those who reported discrimination in more than one domain (exact P=0.027). This association remained after adjustment for possible confounders. No association was found between baseline discrimination and onset of hallucinatory experiences.

CONCLUSIONS

Perceived discrimination may induce delusional ideation and thus contribute to the high observed rates of psychotic disorder in exposed minority populations.

Ethnicity, class and schizotypy

BACKGROUND

This study investigated whether, similarly to schizophrenia, there is an increased rate of schizotypy among African-Caribbeans in the general population compared with white people in the UK. Since social adversity has been associated with schizophrenia in a number of studies, social class as well as ethnicity was explored. In addition, any differences between the groups in neurotic pathology were investigated.

METHODS

Four groups of 12 participants (African-Caribbean, working-class; African-Caribbean, middle-class; white, middle-class; white, working-class) were interviewed using The Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE), The Peters et al. Delusions Inventory (PDI), The Delusions-Symptoms-State-Inventory (DSSI) and The Hospital Anxiety and Depression Scale (HADS).

RESULTS

As predicted, African-Caribbean participants scored higher than the white participants on the PDI. There was a significant interaction between ethnicity and class, with African-Caribbean, working-class participants scoring higher than the other three groups on the PDI as well as on the DSSI. There was an unexpected effect of class, with the middle-classes scoring higher than the working-classes on the O-LIFE category of 'impulsive non-conformity'.

CONCLUSIONS

These findings suggest that it is delusional ideation specifically, rather than general schizotypy, that is higher in the African-Caribbean population. However, whether this is a reflection of their social reality or their psychosis proneness is unclear. Furthermore, the results suggest that class is a significant factor in the expression of delusional ideation in African-Caribbeans.

Comparison of delusions among schizophrenics in Austria and in Pakistan

One of the central purposes of cross-cultural psychiatry is to scrutinize the sociocultural influences on the phenomenology of psychiatric diseases. On the other hand it is possible to lay bare a nucleus of symptoms, common to all cultures, which, independently of all influences, occupies a central position for an understanding of the disease considered. In this study an attempt was made to approach this problem by means of investigating the contents of delusion of schizophrenic patients in Austria and Pakistan. The contents of delusion among 126 Austrian and 108 Pakistani patients diagnosed as having schizophrenia according to DSM-III-R (art. 295) were compared following the classification of Huber and Gross. Additionally the kind of persecution and the type of the persecutor were registered. However it appeared that only a few contents of delusion are frequent in both countries. In both countries persecution was the most frequently mentioned content of delusion. The comparison of the contents of delusion revealed significantly higher frequencies of delusions of grandeur, guilt and religious delusions in Austrian patients. Significant differences could also be found with the kind of persecution and the persecutor's type. Cultural factors seem to have a decisive influence on shaping the contents of delusion.

Erotomania in Thai patients: a study of 20 cases

The study presented included 20 Thai erotomanic patients, 16 women and 4 men. The age at the onset of delusion ranged from 15 to 45 years with a median age of 23 years. The majority of the patients suffered from secondary erotomania, whereas, primary erotomania was diagnosed in three cases. Bipolar affective disorder represents the most common diagnosis associated with this delusion, followed by schizoaffective disorders. Two patients were sisters. The occurrence of intrafamilial cases is unusual and has not been reported previously. Most love objects are of the opposite gender. Only in one instance, was erotomania found in a lesbian context. Teachers and medical doctors are at increased risk for attracting individuals prone to erotomania.

The uses of culture in the making of AIDS neurosis in Japan

OBJECTIVE

AIDS Neurosis is an illness phenomenon in which the person suffering is convinced that he or she is HIV positive, despite negative test results, and a range of nonspecific physical symptoms and phobic and neurotic tendencies, are manifested. To explore the relationship between culture and mental illness, this study examines a) the emergence of AIDS Neurosis as a socially recognized clinical entity in contemporary Japan, and b) the claims by activists, psychiatrists, health officials, and others that AIDS Neurosis is a culturally unique illness phenomenon specific to Japan.

METHODS

The data was collected during 12 months of ethnographic fieldwork in Japan, supplemented by readings in popular and clinical literature.

RESULTS

The cultural explanations proferred for AIDS Neurosis clearly inform the meanings and practices surrounding this phenomenon, but such cultural stereotypes are too simplistic and are not sufficient for understanding the development of AIDS Neurosis nor the complex attitudes and practices relating to AIDS in Japan.

CONCLUSIONS

This study argues for a more critical perspective on culture, which attends to the local contests and practices involved in making an illness category such as AIDS Neurosis.

A polydiagnostic approach to the differences in the symptoms of schizophrenia in different cultural and ethnic populations

This study evaluates the pathoplastic influences of ethnicity and culture on the symptoms of schizophrenia. A sample of 113 schizophrenics was evaluated using the Present State Examination (PSE) and Landmark's Manual for the Assessment of Schizophrenia. The subjects were 57 coloured and 56 black individuals. Six different tribes of Bantu, Negroid and Khoisan origin and with different language and cultural backgrounds were represented among the black subjects. Core symptoms remained basically the same in two groups, but the content of positive symptoms was found to be influenced by culture. However, no statistically significant differences in the presentation of negative symptoms were found in terms of quantity, but there were qualitative differences between the ethnic groups.

Transcultural study of schizophrenic delusions. Tokyo versus Vienna and Tübingen (Germany)

Schizophrenic delusions of 324 inpatients in Tokyo, 101 in Vienna, and 150 in Tübingen (Germany) were compared according to the same classifications. Among the three areas, about 80% of the patients had equally 'negative' delusions (injury and/or belittlement), and about one-fourth had 'positive' delusions of grandeur. Transcultural influences were found in the detailed contents of the 'negative' delusions; specific and direct themes of persecutory delusion, i.e., delusions of poisoning, and religious themes of guilt/sin were conspicuous in Europe, while amorphous delusions of reference such as 'being slandered' were predominant in Japan. The latter may derive from the group-oriented self in Japanese 'shame culture'.

Erotomanic symptoms in 42 Chinese schizophrenic patients

BACKGROUND

Reports on erotomania frequently include schizophrenic patients with secondary erotomania, but there are no reports on the prevalence and characteristics of erotomanic symptoms in schizophrenic patients.

METHOD

A structured item on erotomanic delusions was added to the Chinese version of the Scale for Assessment of Positive Symptoms and administered to 448 randomly selected schizophrenic patients on admission to four psychiatric hospitals in China.

RESULTS

Erotomanic symptoms were identified in 9.4% of the patients (42/448; 95% CI 6.9-12.4%) 4.5% (20/448; CI 2.8-6.8%) had erotomanic ideation and 4.9% (22/448; CI 3.1-7.4%) had fixed erotomanic delusions. Compared with patients without erotomanic symptoms, erotomanic patients were more likely to be male and unmarried, and they had a higher level of education, more severe grandiose delusions, more prominent hostility, and less severe negative symptoms.

CONCLUSION

The relatively common occurence of erotomanic symptoms in Chinese schizophrenic patients may be related to the indirect manner of expressing sexual interest in Chinese culture and, thus, be an example of the cultural moulding of psychiatric symptoms.

Querulous paranoia in Chinese patients: a cultural paradox

OBJECTIVE

There has been no reported case of querulous paranoia from the Asian population. A prospective study was undertaken to identify patients with querulous paranoia in an outpatient clinic.

METHOD

One thousand, five hundred and fifty-one new referrals to a university-affiliated psychiatric outpatient clinic in Hong Kong were screened for querulous paranoia during routine clinical work.

RESULTS

Three patients with querulous paranoia (0.19%) were identified during 1 year. The case histories of these three patients are reported.

CONCLUSION

Possible reasons for the low reporting rate are discussed and the importance of sociocultural traditions in the development and recognition of querulous paranoia is emphasised.

Racial influence on diagnosis in psychotic mania

In a sample of 100 patients with psychotic mania, we examined whether African-Americans were more likely than Caucasians to present with Schneiderian first-rank symptoms, potentially contributing to a misdiagnosis of schizophrenia. In this sample, African-American patients were significantly more likely than Caucasian patients to have received a clinical diagnosis other than bipolar or schizoaffective disorder. There were no racial differences in affective symptoms, but there were differences in psychotic symptom profiles, primarily due to increased hallucinations in African-Americans and increased persecutory delusions in Caucasians. Racial differences in the clinical diagnosis of patients with mania were not due to differences in symptomatic expression, however.

Phenomenological differences of delusions between schizophrenic patients of two cultures of Malaysia

Two hundred and seventy schizophrenia patients were interviewed using the Present State Examination to elicit the phenomenological symptoms of the illness. Cultural factors and ethnicity were found to be significant variables associated with the symptoms. Higher prevalence of religious and other subculturally related delusions were common in Kelantan patients. Our general belief that Malaysian culture influences symptomatology of mental illness seems to be proven.

Culture-specific delusions. Sense and nonsense in cultural context

It can be said that a definition of delusions requires the invocation of cultural understandings, standards of acceptability, as well as conceptions of reality and the forces that animate it. For these reasons, the determination of delusional or normative ideation can only be effected properly within particular cultural contexts. The cross-cultural record suggests that it is difficult to separate the delusional from the cultural; a belief that is patterened and culturally specific is, by definition a cultural, not a delusional belief. One must rely upon particular, relevant local cultural understandings to ascertain when the bounds of culture have been transgressed and meaning has given way to unshareable nonsense.

Obsessional harassment and erotomania in a criminal court population

The criminal behaviors of harassment and menacing are difficult to control, and of increasing concern to the general public and local law enforcement officials. In 1992, the New York State Legislature modified the Penal Law, responding to public fears and concerns that stalking behavior may become violent. Some persons charged with these types of offenses are suffering from psychiatric disorders. Among these disorders are those classified as Delusional Disorders. According to both DSM-III-R (1987-1993) and DSM-IV (1994), there are five specific types of Delusional Disorder: erotomanic, grandiose, jealous, persecutory and somatic. This type of disorder tends to be chronic. Forty eight cases of persons charged with harassment and menacing in the New York County Criminal and Supreme Court and referred for evaluation to the Forensic Psychiatry Clinic between January 1987 and January 1994 are reviewed. When cases of erotomania and other affectionate/amorous complaints were compared with persecutory/angry forms of harassing behavior, there was a great deal of similarity. When all harassers were compared to the Clinic population as a whole, major differences in ethnicity, age, educational level and sex were noted. Findings are presented regarding incidence, other demographic data, recidivism, violence and clinical diagnosis. The researchers conclude that erotomania does exist, however, there are other psychiatric disorders which can also be diagnosed in individuals accused of harassing and menacing behavior. From the point of view of the victim and the criminal justice system, the similarities in behavior patterns are more important than the different diagnoses.

The illusion of reality or the reality of illusion. Hallucinations and culture

BACKGROUND

The aim of this review is to integrate research findings on the role of sociocultural factors in hallucinations and to relate these factors to current psychological theory and research.

METHOD

The literature was surveyed by manual search, and the more reliable studies selected for the review.

RESULTS

One hundred and thirteen publications were scrutinised and 30 of them were included in this review.

CONCLUSIONS

Cross-cultural concepts of reality are related to the development and the threshold of hallucinations. Attitudes toward hallucinations tend to affect the emotional reaction to, and the degree of control of, these experiences. Awareness of these attitudes may help the diagnostician to distinguish between pathological and culturally sanctioned hallucinations. It is important that therapists consider the functional significance and meaning of hallucinations as well as the social context and the stimuli associated with them.

Comparative study of diagnostic systems: Chinese Classification of Mental Disorders-Second Edition versus DSM-III-R

We report on the diagnostic comparative study of the Chinese Classification of Mental Disorders-Second Edition (CCMD-2) and the DSM-III-R in a field trial in China. The Adult Diagnostic Interview Schedule-Second Edition (ADIS-2), a modified diagnostic interview schedule that can generate both CCMD-2 and DSM-III-R diagnoses, was used to test 254 psychiatric patients in China. It was found that the reliability and validity of the CCMD-2 and DSM-III-R are compatible in most diagnostic categories such as schizophrenia, delusional disorder, bipolar disorders, and depressive disorders. The discrepancies between Chinese and American diagnostic systems were found mainly in neurasthenia and hysterical neuroses. Such discrepancies may have resulted from frequent changes of the diagnostic terms in the West, such as the phenomenon of neurasthenia, or from creating a new disorder entity in CCMD-2, such as "Eastern gymnastic exercises-induced mental disorder. "Further cross-cultural studies focusing on these discrepant disorders are urgently needed to understand the cultural influences on diagnosis, as well as to improve the professional classification of mental disorders in different diagnostic systems.

Interethnic variations in the presence of Schneiderian first rank symptoms

Differences in the presence of Schneiderian First Rank Symptoms in first admission schizophrenic patients were examined in five subcultural groupings treated in the same facilities. Examination of the case notes of 212 patients revealed that first rank symptoms were most prevalent in the UK immigrant group and least frequently present in the Greek immigrant group. First rank symptoms were more prevalent in patients admitted recently, admitted voluntarily, and amongst those who had at least some command of English.

Transcultural aspects of schizophrenia: a comparative study in South Africa and in Namibia. A preliminary report

Thirty six Coloured and Black patients with a clinical diagnosis of schizophrenia were evaluated by means of Present State Examination. The two groups were concordant by means of the 12 systems for the diagnosis of schizophrenia. This preliminary report has shown the difference in symptomatology of schizophrenia among the Coloureds of South Africa and the Blacks from Namibia. The differences are influenced by cultural and ethnical factors. The authors discuss the validity of methods employed in the study, especially language and intellectual capability as bias factors that may have influenced the final results.

[Sinistrosis in the Northwest African migrant]

The author begins by briefly retracing the causes and the evolution of sinistrosis. He defines the concept and point out its ambiguities. The clinical aspect affect on the north african migrant is then discussed. The body is appeared the converging point for the different psychological social and cultural dimension involved. The conclusion is that the complexity of the transferential and counter transferential phenomena leads to a continue reflexion about the therapeutic models to be used.