Lecture 4: Cultural factors

Question 1

Discuss Kraepelin Early studies of culture

Answer 1

Kraepelin:
Visited Java in 1904 and was interested in comparing disorders across-cultures
He, like many physicians of that time, attributed differences in psychiatric disorders to race (like some disorders were considered to be “female”)
Belief that “races” (which included people from other parts of Europe) differed in their “character” or psychological make-up

Seems obsolete, but
We continue to have biases and stereotypes about people from different backgrounds
“laidback” “emotional” “religious

Question 2

What are the three sources of effects that are hard to separate?

Answer 2

1) Cultural variation in presentation
2) Cultural dislocation and effects of migration
3) Ethnic or cultural variation in risk factors for SZ

Question 3

Explain the Cultural variation in presentation

Answer 3

1) Different expression of symptoms (Some cultures may express more physical symptoms, rather than “psychological” symptoms, e.g., tired vs depressed; restless vs anxious)
2) People may view and describe psychological experiences and distress differently (People may be reluctant to express distress, or may see distress as normal, e.g., “fate” or “god’s will”)
3) Poor understanding of cultural variations may result in under- or over diagnosis
4) This can affect estimates of prevalence, and assessment of outcomes

Question 4

Explain Cultural dislocation and SZ – effects of migration

Answer 4

• Immigrants more likely to be diagnosed with and to suffer from psychotic disorders
• This may be mis-diagnosis
• Or, the causes and/or consequences of migration may have negative effects on mental health

Question 5

Explain Ethnic or cultural variation in risk factors for SZ

Answer 5

Different genetic susceptibility (think cancer, diabetes)
Risk of exposure to infection in home or country of migration
Particular cultures may predispose to certain disorders (i.e Eating disorders in Westernized cultures)
Cultures or societies under stress (war, repression, disaster)

Question 6

Across all cultures, some people report psychotic-like symptoms. In fact, Isolated psychotic symptoms not uncommon across cultures. What is the lifetime prevalence?

Answer 6

5%

Question 7

People from cultural and ethnic minorities are ______ more likely to report psychotic-like symptoms

Answer 7

1.5%

Question 8

Psychotic-like symptoms are linked to ___________ in both Asians and Latinos in the US

Answer 8

acculturative stress

Question 9

Which ethnic group seen for any psychiatric problem more commonly report psychotic-like symptoms?

Answer 9

Latinos

Question 10

It is important to assess whether symptoms are ________________________

Answer 10

prodromal SZ or other psychological problems

Question 11

___________ and ________ can affect prevalence estimates

Answer 11

Reliability and appropriateness of diagnostic tools

Question 12

Immigrants are at higher risk. Give examples of risk factors.

Answer 12

• Particularly black immigrants to the UK, US, Netherlands and Canada
• Low SES to high SES
• Age at migration

Question 13

Higher risk persists for ____________

Answer 13

second generation

Question 14

What are the possible contributors?

Answer 14

Migration stress and biases in diagnosis

Question 15

Explain further the migration stress.

Answer 15

• Home country (war, poverty, disaster, discrimination)

- New country (stress related to loss of culture, employment, isolation, discrimination)

Question 16

Give examples for biases in diagnosis.

Answer 16

• Cultural and language barriers

- Racial and ethnic biases in assessment

Question 17

Symptoms express themselves differently. The content of hallucinations and delusions varies. Give examples for White people, Black people and Latinos.

Answer 17

White: more delusions, grandiosity.
Black: more paranoia, suspiciousness.
Latino: more somatic, religious and family content

Question 18

Is higher rate of SZ diagnosis in immigrants the result of clinician bias? If so, provide an explanation.

Answer 18

Yes. Longitudinal studies show more variable diagnosis, suggests contribution of bias of individual clinicians.

Question 19

Expression differences may also contribute to what?

Answer 19

More persecutory content in black people may lead to bias to diagnose psychosis

Question 20

Poorer access to health care may lead to ______________________________

Answer 20

longer untreated psychosis, leading to more severe symptoms

Question 21

In regard to genetic variation, SZ risk is related to a __________________

Answer 21

large number of genes

Question 22

Exposure to ___________ depending on country of origin or migration can increase risk of SZ

Answer 22

prenatal or early childhood infection

Question 23

The DSM-V Cultural formulation interview is designed to help clinicians address __________

Answer 23

cultural context in diagnostic interviews

Question 24

The DSM-V Cultural formulation interview encourages people to express ____________

Answer 24

culturally specific views of their issues and views of treatment

Question 25

What are examples of questions you would ask in a DSM-V Cultural formulation interview?

Answer 25

• Sometimes people have different ways of describing problems to family and friends. How would you describe your problem to them?
• Why do you think this is happening to you?
• What do your family, community think you should do?

Question 26

However, what is an important caution to remember in regard to the DSM-V Cultural formulation interview?

Answer 26

These are questions good clinicians should ask everyone! Be careful not to marginalize people