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IN SCHIZOPHRENIA
by,
Chithra U
Chaired by
Dr.Donae George
Introduction
Human behaviour, both normal and pathologic, is
essentially a product of physical, culture-
environmental, biologic, and psychologic factors
Emphasis on
objective (external) – artefacts, roles, and institutions,
subjective (internal) -shared beliefs, attitudes, values,
and norms
Culture – influence on illness
Pathogenic effects –as a direct causative factor in
generating illness
http://www.psychiatrictimes.com/schizophrenia/emil-kraepelin-cultural-and-ethnic-factors-mental-illness
Culture and Schizophrenia
Identify cultural differences in patient populations
Focus on finding risk factors
Impact on the treatments offered and taken up, and
on prognosis.
Ethnic inequalities in care experience and outcome
of psychoses
Argue for policies and practice that minimize health
inequalities
Culture and schizophrenia-Kamaldeep Bhui & Natasha Tsangarides
COMPARITIVE STUDY IN
SCHIZOPHRENIA
CULTURE AND SCHIZOPHRENIAAND OTHER PSYCHOTIC DISORDERSParmanand Kulhara, MD, FRCPsych, FAMS,
and Subho Chakrabarti, MD, MRCPsych
PREVALENCE
Prevalence rates - 1 to 2 per 1000 population.
Rates do not vary greatly between developing and
developed countries
Studies from different parts of India have also
yielded similar rates of 2 to 3/1000.
Studies from Taiwan and India-the rates stable over
15 to 20yrs despite dramatic changes in social and
physical environment
INCIDENCE
DOSMeD study is perhaps the largest of this kind,
which has used standardized criteria and uniform
methdology
The annual incidence of broadly defined
schizophrenia was in the range of 1.5 to 4.2 per
10,000
The incidence of more narrowly defined (CATEGO S
+ ) schizophrenia ranged from 0.7 to 1.4 per ten
thousand
The differences in rates of the broad category have
been variously interpreted to:
Suggest that it comprised of a large number of
cases of other psychotic disorders, mainly acute
psychoses, which are far more frequent in
developing countries
Point to the influence of physical environmental
Cultural Aspects of Major Mental Disorders: A Critical Review from an Indian Perspective Biju Viswanath and Santosh K. Chaturvedi
Other symptoms
First rank symptoms (FRS):
Indian studies have found FRS to be generally culture
free. However, there is a lower occurrence of FRS in
non-Western countries.
Negative symptoms and neuropsychological deficits
are common in most cultures.
There are differences in the frequency of types of
negative symptoms between patients in India and
the United States
Subtypes
Acute and catatonic Schizophrenia – developing
countries
Similarities in subsyndromes
Cultural differences in psychopathology
AIMS
Does schizophrenia exist in different parts of the world
Developing Developed
Highest proportion of asymptomatic Symptomatic patients (Moscow &
patients Aarhus)
<5% time spent in psychotic episode Aarhus worst outcome 40% pt psychotic
AIMS
Incidence rates of schizophrenia in different cultures
pattern of course
2. pattern of course
3. Occupational outcome
4. Social outcome
Conclusions
The outcome of schizophrenia is good in India compared to
developed countries (comparable to results of IPSS study)
The research of EE
Difficultiesinreliability and transfer of ratings,
confounding effects of social class and treatment,
Jenkins JH, Kamo M: The meaning of expressed emotion: theoretical issues raised by cross-cultural research
Industrialisation and urbanisation
Alteration in family and social structure
Environmental factors
Effect of immigration
Influence on Psychotherapy
Cultural values are important to determine
psychotherapeutic needs and interventions.
There are cross-cultural differences in personality
configurations which have to be taken into account.
The Western-model psychotherapy in its usual form may
not be suited for a diverse culture like India.
In addition to these modifications in Western
psychotherapy, indigenous models of psychotherapy
may be needed. For example, the guru–chela
relationship might be a particularly useful paradigm in
India.
Modifications
Use of religion or spirituality
Family involvement – Unlike in the West, many Indian
subjects might want active family involvement
Lower emphasis on individual responsibility and
autonomy
Superior class of the therapist and paternalistic
approach
Greater active participation by the therapist
Single session therapy may be useful for the poor and
underprivileged
Limitations of cross cultural studies
The central conflict in comparative psychiatry across
cultures seems to be between its two goals: to
demonstrate worldwide equivalence and cultural
differences
Influence by western concepts of normality
Emphasis on biological aspects
Impossibility of “representativeness”
Problems in application of scales
Conclusions
Cross-cultural psychiatry aspires to investigate both
dimensions -worldwide equivalence and culturally
determined variability
Accessibility
Coping
Social defeat hypothesis- John Paul
Experience of failure in a social encounter predisposing to
risk of Schizophrenia
Research- cross cultural validity, heterogenous nature of
culture, dynamic nature of culture
Sartorius – better prognosis with traditional healers
Oscillation between services
Phenomenological vs etiological presentation
Diagnostic stability
Categorical vs dimensional diagnosis
Decreased incidence of catatonics- ?organic
better rx of organic conditions