Transcultural Psychiatry

Antropologia applicata all'invervento psicoterapeutico. L'esperienza del Centre Georges Dévereux

by Stefano Portelli

Published in (con)textos. revista d’antropologia i investigació social, Número 3. Juny de 2009. Pàgines 84-98. ISSN: 2013-0864
http://www.con-textos.net

Si descrivono qui alcuni dei presupposti teorici e dei dispositivi pratici attraverso i quali si sviluppa l'attività... more Si descrivono qui alcuni dei presupposti teorici e dei dispositivi pratici attraverso i quali si sviluppa l'attività del Centre Georges Dévereux, fondato a Parigi dallo psichiatra Tobie Nathan e orientato alla prise en charge di pazienti migranti. La necessità di evitare le semplificazioni nella traduzione tra le culture ha portato Nathan e il gruppo di professionisti del Centro a elaborare una teoria critica della modernità e del paradigma psichiatrico corrente, a partire dagli insegnamenti dell'antropologia contemporanea e dalla necessità di aiutare la disciplina psicanalitica ad affrontare le sfide della contemporaneità. Per l'antropologia, l'etnopsichiatria rappresenta una possibilità concreta di contribuire alla costruzione di un sapere pratico.

EOI Schiz Bulletin

by Swaran Singh

Service Use by Asian Americans

by Brett Sevilla

Update: Schizophrenia across Cultures

by Neely Laurenzo Myers

The incidence of schizophrenia, as well as the
symptoms, course, and outcomes for people so diagnosed
seem... more The incidence of schizophrenia, as well as the
symptoms, course, and outcomes for people so diagnosed
seem to vary across some cultural contexts. The mechanisms
by which cultural variations may protect one from or
increase one’s risk of developing schizophrenia remain
unclear. Recent findings from transdisciplinary crosscultural
research, indicate ways that we may better understand how socioenvironmental and cultural variables interact with physiologic pathways relating psychosocial stress and psychotic symptoms, epigenetic changes, and people’s use of culturally available tools to mitigate stress, in ways that may inform relevant, effective interventions for people diagnosed with psychotic disorders worldwide.

Modeling mania: Further validation for black swiss mice as model animals.

by Haim Einat

Hannah-Poquette C, Anderson GW, Flaisher-Grinberg S, Wang J, Meinerding TM, Einat H.

Behav Brain Res. 2011 May 6. [Epub ahead of print]

The paucity of appropriate animal models for bipolar disorder hinders the research of the disorder and its treatments.... more The paucity of appropriate animal models for bipolar disorder hinders the research of the disorder and its treatments. Previous work suggests that black swiss (BS) mice may be a suitable model animal for behavioral domains of mania including reward-seeking, risk-taking, vigor, aggression and sensitivity to psychostimulants. These behaviors are high in BS mice compared with other strains and are responsive to the mood stabilizers lithium and valproate but not to the antidepressant imipramine. The current study evaluated the etiological validity of this model by assessing brain expression of two proteins implicated in affective disorders, β-catenin and BDNF, in BS mice versus C57bl/6, A/J and CBA/J mice. Additionally, pharmacological validity was further tested by assessing the effects of risperidone in a behavioral battery of tests. β-catenin and BDNF expression were evaluated in the frontal cortex and hippocampus of untreated BS, CBA/J, A/J and C57bl/6 mice by western blot. Subchronic 0.1 and 0.3mg/kg doses of risperidone were tested in a battery of behavioral tests for domains of mania. Expression of β-catenin was found to be lower in the hippocampus of BS mice compared with the other strains. Reduced β-catenin expression was not observed in the frontal cortex. BDNF expression levels were similar between strains in both the hippocampus and frontal cortex. In the behavioral tests, risperidone ameliorated amphetamine-induced hyperactivity without affecting other tests in the battery. These results offer additional pharmacological and possible etiological validity supporting the utilization of black swiss mice as a model for domains of mania.

Rethinking Historical Trauma: Narratives of Resilience

by Aaron Denham

(2008) Transcultural Psychiatry, 45(3):391-414.

Moving Towards Healing - Nunavut Case Study

by Aaron Denham

with Chris Fletcher (2008). In Aboriginal Healing in Canada: Studies in Therapeutic Meaning and Practice, (pp. 93-129). Waldram, J., ed. Ottawa: The Aboriginal Healing Foundation.

Ethnicity and Detention Under the Mental Health Act: Systematic Review

by Swaran Singh

Background
Black and minority ethnic (BME) patients are disproportionately detained under the Mental Health Act... more Background
Black and minority ethnic (BME) patients are disproportionately detained under the Mental Health Act 1983. There has been no systematic exploration of differences within and between ethnic groups, nor of the explanations put forward for this excess.
Aims To systematically review detention and ethnicity, with meta-analyses of detention rates for BME groups, and to explore the explanations offered for ethnic differences in detention rates.

Method
Literature search and meta-analysis. Explanations offered were categorised, supporting literature was accessed and the strength of the evidence evaluated.

Results
In all, 49 studies met inclusion criteria; of these, 19 were included in the meta-analyses. Compared with White patients, Black patients were 3.83 times, BME patients 3.35 times and Asian patients 2.06 times more likely to be detained. The most common explanations related to misdiagnosis and discrimination against BME patients, higher incidence of psychosis and differences in illness expression. Many explanations, including that of racism within mental health services, were not supported by clear evidence.

Conclusions
Although BME status predicts psychiatric detention in the UK, most explanations offered for the excess detention of BME patients are largely unsupported.

Institutional Racism In Psychiatry: Author's Response

by Swaran Singh

Applying Systems Approach to Military Families

by Kelli Rodriguez

Rodriguez, K. Final Paper submitted for Social Systems Graduate Course, Capella, September 2007.

The social systems approach views all social systems as interconnected and interdependent.  In this paper, the... more The social systems approach views all social systems as interconnected and interdependent.  In this paper, the systems approach is further examined and applied to military families.    The systems that military families are involved in are identified and their interactions analyzed.  Recommendations for creating a more family-oriented military organization are offered.

Lookism and Weight-Discrimination: Ethnic & Cultural Awareness

by Kelli Rodriguez

Rodriguez, K. Final Paper written for Ethnic & Cultural Awareness Graduate Course, Capella University, June 2007.

American society ascribes power and privilege differently to various groups in society based on an individual’s... more American society ascribes power and privilege differently to various groups in society based on an individual’s cultural or racial background, gender, age, sexual preference, choice of religion, physical abilities, outward appearance, and socioeconomic class.  Most of the literature on discrimination focuses on racism, sexism, ageism, and classism.  Lookism, which is discrimination based on physical appearance, and weight-discrimination are possibly more common, but given less attention.  Multiculturalism has to do with being aware of the discrimination in society, knowledgeable about different cultures, and possessing the skills necessary to practice in a culturally-sensitive manner.  This paper discusses the history of lookism and weight-discrimination, examines the ways over-weight individuals are discriminated against, reviews the theories that attempt to explain why weight discrimination is common, and offers solutions for reducing weight discrimination.  The paper also includes an assessment of this learner’s personal competence and an action plan for increasing cultural competency.

The Common Factors Approach to Family Therapy

by Kelli Rodriguez

Rodriguez, K., Final paper completed for Family Therapy and Methods Graduate Course, August 2007.

This paper gives an overview of the Common Factors approach to Family Therapy.  The history and theoretical... more This paper gives an overview of the Common Factors approach to Family Therapy.  The history and theoretical formulations of the approach are discussed.  The Common Factors approach is applied to a case example.  The outcomes of the therapy are explained.  The merits and limitations of the approach are also discussed.

Addressing Developmental Needs and Cultural Issues of Asian American Adolescents

by Kelli Rodriguez

Rodriguez, K., Final Paper written for Survey of Research in Human Development and Behavior, Capella University, March 2004.

Examines how well the developmental needs and cultural issues of Asian American adolescents are being addressed by... more Examines how well the developmental needs and cultural issues of Asian American adolescents are being addressed by APCTC (Asain Pacific Counseling and Treatment Centers), a community based human service organization in Los Angeles. Summarizes an interview with APCTC on the work of the agency.  Reviews literature from various peer-reviewed academic and professional journals on adolescent development and multicultural counseling.  Evaluates APCTC services based on the information from the literature review.  Offers recommendations and resources for improving APCTC's services to better meet the developmental and cultural needs of the clients they serve.

(2009) Qu'est-ce que l'ethnopsychiatrie ?, nonfiction.fr

by Samuel Lézé

review in french

Institutional Racism In Psychiatry: Lessons From Inquiries

by Swaran Singh

The President of the Royal College of Psychiatrists recently reiterated the College’s determination to tackle... more The President of the Royal College of Psychiatrists recently reiterated the College’s determination to tackle institutional racism in psychiatry, as defined in the MacPherson Report (MacPherson, 1999). This reaction was prompted by a paper suggesting that racism was perhaps not the only explanation for ethnic differences in rates of psychosis and detention under the Mental Health Act 1983 (Singh & Burns, 2006). Although not providing a scientific criticism of the BMJ paper or any evidence to the contrary, the President stated that the paper risked setting ‘psychiatry back by 20 years’ (Hollins & Moodley 2006).

The MacPherson Report defines institutional racism as ‘the collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture or ethnic origin. It can be seen or detected in processes, attitudes and behaviour which amount to discrimination through unwitting prejudice, ignorance, thoughtlessness, and racist stereotyping which disadvantage minority ethnic people’. The report found institutional racism in many aspects of the Stephen Lawrence case, including the conduct of the investigation, the family’s treatment, the failure to recognise the murder as racially motivated, and the lack of urgency and commitment in the investigation.

Ethnicity In Psychiatric Epidemiology: Need for Precision

by Swaran Singh

Ethnicity and the Mental Health Act 1983

by Swaran Singh

Background
Black and minority ethnic (BME) patients are disproportionately detained under the Mental Health Act... more Background
Black and minority ethnic (BME) patients are disproportionately detained under the Mental Health Act 1983. There has been no systematic exploration of differences within and between ethnic groups, nor of the explanations put forward for this excess.

Aims
To systematically review detention and ethnicity, with meta-analyses of detention rates for BME groups, and to explore the explanations offered for ethnic differences in detention rates.

Method
Literature search and meta-analysis. Explanations offered were categorised, supporting literature was accessed and the strength of the evidence evaluated.

Results
In all, 49 studies met inclusion criteria; of these, 19 were included in the meta-analyses. Compared with White patients, Black patients were 3.83 times, BME patients 3.35 times and Asian patients 2.06 times more likely to be detained. The most common explanations related to misdiagnosis and discrimination against BME patients, higher incidence of psychosis and differences in illness expression. Many explanations, including that of racism within mental health services, were not supported by clear evidence.

Conclusions
Although BME status predicts psychiatric detention in the UK, most explanations offered for the excess detention of BME patients are largely unsupported.

Measuring Pathways to Care In First-Episode Psychosis: a Systematic Review

by Swaran Singh

Background
Adequately understanding and measuring pathways to care is a prerequisite for early detection and... more Background
Adequately understanding and measuring pathways to care is a prerequisite for early detection and effective treatment of first-episode psychosis.

Method
We conducted a systematic review of studies on pathways to care in first-episode psychosis to establish what measures currently exist to assess pathways in first-episode psychosis and to compare these measures.

Results
We identified 15 studies which had used six different measures of pathways to care. Differences in aims, methodology and lack of psychometric data did not allow a direct comparison of pathways measures but certain common themes emerged.

Discussion
Pathways to care in first-episode psychosis are diverse and varied. There is no measure with established psychometric properties that has been devised on a well-developed theoretical or conceptual framework and had its psychometric properties established. The conflict between exploring the patient's narrative and journey through the healthcare system and developing an empirical measure of pathways with optimal outcomes has hindered the development of such a measure.

Keywords:
Pathways to care; First-episode psychosis; Schizophrenia; Duration of untreated psychosis; Early intervention in psychosis

Race and Mental Health: There is More to Race Than Racism

by Swaran Singh

Some minority ethnic groups in England and Wales have higher rates of admission for mental illness and more adverse... more Some minority ethnic groups in England and Wales have higher rates of admission for mental illness and more adverse pathways to care. Are the resulting accusations of institutional racism within psychiatry justified?

Acute and Transient Psychotic Disorders: Precursors, Epidemiology, Course and Outcome

by Swaran Singh

Background
ICD–10 has introduced the diagnostic group acute and transient psychotic disorders (ATPDs; F23).more Background
ICD–10 has introduced the diagnostic group acute and transient psychotic disorders (ATPDs; F23).

Aims
To validate the nosological distinctiveness of ICD–10 ATPDs by following up an inception cohort with first-episode psychosis.

Method
All patients with first-episode psychosis identified in Nottingham between 1992 and 1994 and diagnosed using ICD–10 criteria were reassessed 3 years later. ATPD outcomes were compared with schizophrenia and affective psychosis. Multivariate analyses were conducted to determine whether acute onset and early remission predicted favourable 3-year outcome in first-episode psychosis.

Results
Of 168 cases of first-episode psychosis, 32 (19%) received an intake diagnosis of ATPD. The diagnosis of ATPD was stable in women over 3 years, but not in men. Outcomes in ATPD were better than in schizophrenia and similar to affective psychosis. In non-affective psychoses, favourable outcomes were a function of gender and premorbid functioning rather than acute onset and early remission.

Conclusions
The ICD–10 criteria for ATPDs identify a diagnostically unstable group of disorders. Acute onset and early remission do not independently predict favourable outcome over 3 years in first-episode psychosis.