Psychotic experiences among ethnic majority and minority adolescents and the role of discrimination and ethnic identity.

PURPOSE: Research shows that the prevalence of psychiatric problems is higher in ethnic minority youth compared to native youth. This school-based screening study of early adolescents' mental health in the Netherlands examined differences in prevalence of psychotic experiences in ethnic minority youth compared to their Dutch peers. Moreover, we investigated the association between psychotic experiences, ethnic identity, and perceived discrimination. METHODS: A cohort of 1194 ethnic majority and minority adolescents (mean age 13.72, SD 0.63) filled-out questionnaires on psychotic experiences (including delusional and hallucinatory experiences), perceived group and personal discrimination, and ethnic identity. RESULTS: Apart from lower levels of hallucinatory experiences in Turkish-Dutch adolescents, prevalence of psychotic experiences did not differ between ethnic minority and majority adolescents. Perceived personal discrimination was associated with the presence of psychotic experiences (including delusional and hallucinatory experiences) (OR 2.30, 95% CI 1.22-4.34). This association was stronger for delusional experiences (OR 2.94, 95% CI 1.43-6.06) than for hallucinatory experiences (OR 1.65, 95% CI 0.73-3.72). No significant associations were found between perceived group discrimination and psychotic experiences. A weak ethnic identity was associated with higher risk for reporting psychotic experiences (OR 2.04, 95% CI 1.14-3.66), particularly hallucinatory experiences (OR 3.15, 95% CI 1.54-6.44). When looking at specific ethnic identity categories, marginalization, compared to separation, was associated with a threefold risk for reporting psychotic experiences (OR 3.26, 95% CI 1.33-8.03). Both marginalisation (OR 3.17, 95% CI 1.04-9.63) and assimilation (OR 3.25, 95% CI 1.30-8.13) were associated with a higher risk for hallucinatory experiences. CONCLUSIONS: These results underline the protective effect of ethnic identity against mental health problems. Future research should focus on interventions that focus on strengthen social identity.

'My husband is possessed by a jinn': a case study in transcultural mental health.

Objectives The objective of this study was to discuss jinn possession in Muslim culture, and the importance of understanding cultural differences in mental health. Conclusion It is important to understand cultural and religious differences in psychiatry, as it affects the way patients perceive and attribute symptoms. It also helps clinicians to reach an accurate diagnosis and provide appropriate treatments. Beliefs about jinn possession should not automatically be regarded as delusional. In alleged cases of jinn possession, clinicians should consider all the biopsychosocial, cultural and spiritual factors that are unique to the individual. Further research is still needed in this area.

Prevalence of psychotic symptoms among older adults in an Asian population.

BACKGROUND: Psychotic symptoms are common among older adults and are seen in a wide range of conditions. Most studies examining the prevalence and correlates of psychotic symptoms among older adults have been conducted in Western populations. To address this gap the current study was undertaken to establish the prevalence and correlates of psychotic symptoms and paranoid ideation within a community sample of older adults without dementia in an Asian population. METHODS: The Well-being of the Singapore Elderly (WiSE) study was a comprehensive single phase, cross-sectional survey. All respondents were assessed using the Geriatric Mental State examination (GMS). Specific questions of the GMS were then used to establish the prevalence of hallucinations and persecutory delusions. RESULTS: A total of 2,565 respondents completed the study giving a response rate of 65.6%. The prevalence of any psychotic symptoms in this population of older adults was 5.2%. The odds of hallucinations and any psychotic symptoms were significantly higher among those of Malay ethnicity, and those who had no formal education. Older adults aged 75-84 years were significantly associated with lower odds of having hallucinations (vs. older adult aged 60-74 years), while homemaker status was significantly associated with lower odds of having any psychotic symptoms. CONCLUSIONS: The prevalence of psychotic symptoms among older Asian adults without dementia was higher than that reported from Western countries. Psychotic symptoms were associated with Malay ethnicity, poor cognitive performance and fewer years of schooling, visual and hearing impairment as well as depression and irritability.

Symptoms of psychosis in schizophrenia, schizoaffective disorder, and bipolar disorder: A comparison of African Americans and Caucasians in the Genomic Psychiatry Cohort.

Several studies have reported differences between African Americans and Caucasians in relative proportion of psychotic symptoms and disorders, but whether this reflects racial bias in the assessment of psychosis is unclear. The purpose of this study was to examine the distribution of psychotic symptoms and potential bias in symptoms assessed via semi-structured interview using a cohort of 3,389 African American and 5,692 Caucasian participants who were diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder. In this cohort, the diagnosis of schizophrenia was relatively more common, and the diagnosis of bipolar disorder and schizoaffective disorder-bipolar type was less relatively common, among African Americans than Caucasians. With regard to symptoms, relatively more African Americans than Caucasians endorsed hallucinations and delusions symptoms, and this pattern was striking among cases diagnosed with bipolar disorder and schizoaffective-bipolar disorder. In contrast, the relative endorsement of psychotic symptoms was more similar among cases diagnosed with schizophrenia and schizoaffective disorder-depressed type. Differential item function analysis revealed that African Americans with mild psychosis over-endorsed "hallucinations in any modality" and under-endorsed "widespread delusions" relative to Caucasians. Other symptoms did not show evidence of racial bias. Thus, racial bias in assessment of psychotic symptoms does not appear to explain differences in the proportion of symptoms between Caucasians and African Americans. Rather, this may reflect ascertainment bias, perhaps indicative of a disparity in access to services, or differential exposure to risk factors for psychosis by race. © 2015 Wiley Periodicals, Inc.

Mild psychotic experiences among ethnic minority and majority adolescents and the role of ethnic density.

PURPOSE: Despite evidence of the increased risk of psychotic disorders among ethnic minority adults, little is known about the effect of ethnic minority status to mild psychotic experiences among adolescents. This study investigated mild psychotic experiences in ethnic minority and majority adolescents in a Dutch representative general population sample, and tested the ethnic density effect in the classroom. METHODS: The CAPE was used to assess mild psychotic experiences among Dutch (n = 3,606) and non-Western ethnic minority pupils (n = 769). RESULTS: Ethnic minority adolescents showed higher levels of grandiosity and delusions than their ethnic majority peers, whereas no differences were found for hallucinations, paranormal beliefs and paranoia between both groups of adolescents. The ethnic density effect was partly confirmed for the ethnic majority: a decrease of ethnic majority pupils in class increased their feelings of paranoia. CONCLUSIONS: Because only some dimensions of mild psychotic experiences were affected by ethnic minority status or the interaction between ethnic minority status and ethnic class composition, our findings emphasize that mild psychotic experiences are multifactorial in origin, with different underlying processes.

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.

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.

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.

Possession experiences in dissociative identity disorder: a preliminary study.

Dissociative trance disorder, which includes possession experiences, was introduced as a provisional diagnosis requiring further study in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Consideration is now being given to including possession experiences within dissociative identity disorder (DID) in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), which is due to be published in 2013. In order to provide empirical data relevant to the relationship between DID and possession states, I analyzed data on the prevalence of trance, possession states, sleepwalking, and paranormal experiences in 3 large samples: patients with DID from North America; psychiatric outpatients from Shanghai, China; and a general population sample from Winnipeg, Canada. Trance, sleepwalking, paranormal, and possession experiences were much more common in the DID patients than in the 2 comparison samples. The study is preliminary and exploratory in nature because the samples were not matched in any way.

[Mamadou or anxiety resulting from a departure for the European Eldorado]. / Mamadou ou l'angoisse d'un départ vers l'Eldorado européen.

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.

Association of trauma-related disorders and dissociation with four idioms of distress among Latino psychiatric outpatients.

Past research on idioms of distress among U.S. Latinos has revealed that ataque de nervios and altered perceptions, such as hearing and seeing things when alone, are independent markers of higher morbidity and mental health utilization despite having no one-to-one relationships with any single psychiatric diagnosis. It has been proposed that the idioms exert this effect because they are signs of distressing dissociative capacity associated with traumatic exposure. This study examines the relationships in an ethnically diverse Latino psychiatric outpatient sample (N = 230) among interpersonal trauma, posttraumatic stress disorder (PTSD), major depressive disorder, dissociative capacity and four cultural idioms of distress associated with the popular overall category of nervios. We particularly explore how these relationships change with varied measures of traumatic exposure, including trauma severity and timing or persistence of trauma. A series of adjusted bivariate regressions assessed the matrix of associations between the idioms and the clinical variables. In this highly traumatized population, we identified a strong 'nexus' of associations between dissociation and three of the idioms: currently being ill with nerves, ataque de nervios and altered perceptions. These idioms were largely independent from PTSD and depression and were associated with trauma persistence and severity. A fourth idiom, being nervous since childhood, was not associated with any other variable and may represent a personality trait rather than a diagnosable condition. Our results validate the clinical utility of the construct of nervios as a set of specific idioms associated with dissociation that are useful markers of mental health need among Latinos independently of their association with clinical diagnoses.

Trauma and humanitarian translation in Liberia: the tale of open mole.

The focus of this paper is the intercultural process through which Open Mole and trauma-related mental illnesses are brought together in the postconflict mental health encounter. In this paper, I explore the historical dimension of this process by reviewing the history of Open Mole, and the ways in which it has been interpreted, acted on, and objectified by external observers over the last half-century. Moving into Liberia's recent war and postconflict period, I examine the process by which Open Mole is transformed from a culture-bound disorder into a local idiom of trauma, and how it has become a gateway diagnosis of PTSD-related mental illnesses, and consider how it is produced as an objectified experience of psychiatric disorder in clinical humanitarian contexts. By studying how Open Mole is transformed in the humanitarian encounter, I address the structure and teleology of the humanitarian encounter and challenge some of the foundational assumptions about cultural sensitivity and community-based mental health care in postconflict settings that are prevalent in scholarship and practice today.

[Cultural aspects in depression masked by psychotic symptoms in Maghreb countries: three case reports]. / Aspects culturels dans la dépression masquée par des symptômes psychotiques.

CASE REPORTS: In this study, we will describe three observations of depression "masked" by persecution delirium and/or hallucinations, to illustrate the role that the cultural factor could play in the expression and care of depression. In the first two observations, the persecutor was a group that was apparently difficult to circumscribe: the persecution appeared more important than the persecutor. In these two cases, persecution also had a depreciating role for the patient. In the third observation, the hallucinatory manifestations cast a slur on self-esteem and caused narcissistic injury. DISCUSSION: Analysis of the cultural context allows us to understand the depressive significance of such psychotic symptoms. In the traditional societies, depression is strongly related to the cultural context, it is often expressed by the fear of being punished or denied by the group, and a feeling of treason towards the community. The punishment can be direct or indirect, carried out by imaginary beings, "the djinn", or by any disease. According to Freud, the guilt is expressed by the fear of the vengeance of a dead man's spirit, which is then going to persecute the culprit. This persecution, which has a value of punishment, is based on the mechanism of the projection. In the same sense, Freud explained that the death, as a sequel of the disease, is the vengeance of the dead man's spirit in the living. In all religions, the impulses, the thoughts disapproved by the community, are attributed to Satan who etymologically means "the enemy" or "the opponent". This latter plays an important role in relieving fears, the sense of guilt and the disapproved thoughts. There is also involvement of the projection mechanism. So, guilt could be expressed by delirious ideas such as the conviction of being the victim of a demonic possession, to be under a spell or to be persecuted. CONCLUSION: Thus, taking the cultural context into account would allow us to fundamentally understand the depressive meaning of the delirious symptomatology of persecution, which is taken from a popular theory of misfortune shared and validated by the familial and the social circle of acquaintances. Plantine postulates that the psychotic conflict takes the subject away from the standards of his own culture. In the case of our three patients, we should try to establish a form of communication, to prevent them from falling into alienation. Thus, we must think about our attitude facing a patient who is diagnosed as depressed or even psychotic, while the patient believes he/she is possessed by a "Djinn". The therapeutic attitude should be adapted to the cultural dimension of the case. Thus, in situations similar to the studied cases, the therapy should be essentially based on the development of a psychotherapeutic relationship, rather than a pharmacotherapy, one should be careful not to compromise the cultural means of restoring psychic disorders such as the traditional therapy.

An evaluation of intensity of delusional belief in patients with delusional infestation pre- and post-treatment in a specialist psychodermatology center.

INTRODUCTION: The majority of patients with delusional infestation (DI) seek help from dermatologists as they consider their condition to be of cutaneous origin and deny referral to psychiatrists, with the prevalence of the condition arising. The objectives of our study were: (i) to assess whether there is a fixed delusional ideation in patients with DI, (ii) to assess the efficacy of managing such patients with combined dermatological and psychiatric treatment and (iii) to test any correlation between BABS scores and other variables. METHODS: All consecutive newly diagnosed patients with DI, from January 2014 to January 2015, seen in our specialist psychodermatology clinic were enrolled in our prospective observational study. Brown Assessment of Beliefs Scale (BABS) was used to assess the intensity of delusion. Correlation between BABS and other variables was also assessed. RESULTS: Forty-three patients were enrolled. There was a range of BABS scores pre- and post-treatment, indicative of the presence of a range of delusional ideation. A significant reduction in the BABS scores was noted post-treatment from 16.10 ± 5.53 to 11.66 ± 8.26 (p < .002). CONCLUSION: This is the first study to objectively demonstrate that delusional belief in patients with DI is not a binary phenomenon and to demonstrate an efficacious response to a combined multidisciplinary psychodermatological approach.

Ethnicity, social disadvantage and psychotic-like experiences in a healthy population based sample.

OBJECTIVE: We sought to investigate the prevalence and social correlates of psychotic-like experiences in a general population sample of Black and White British subjects. METHOD: Data were collected from randomly selected community control subjects, recruited as part of the AESOP study, a three-centre population based study of first-episode psychosis. RESULTS: The proportion of subjects reporting one or more psychotic-like experience was 19% (n = 72/372). These were more common in Black Caribbean (OR 2.08) and Black African subjects (OR 4.59), compared with White British. In addition, a number of indicators of childhood and adult disadvantage were associated with psychotic-like experiences. When these variables were simultaneously entered into a regression model, Black African ethnicity, concentrated adult disadvantage, and separation from parents retained a significant effect. CONCLUSION: The higher prevalence of psychotic-like experiences in the Black Caribbean, but not Black African, group was explained by high levels of social disadvantage over the life course.

[Severe depression : cultural and social factors]. / Dépressions sévères : facteurs culturels et sociaux.

After first providing a theoretical framework including the contributions of social constructivist and biological approaches to the comprehension of mental diseases in general and depression in particular, the authors stress the small number of publications mentioning a direct link between sociocultural factors and the severity of depression. However, there are indirect arguments that are classified into two groups : modifications based on the cultures of clinical expression (somatisation, delirious ideas) on one hand and the weight of social and individual views of depression and of its consequences in terms of stigmatisation on the other. These transcultural variations modify the process of seeking care and, thus, the progression of the disease towards increased severity. The authors point out, in conclusion, that the initial proposition could be reversed as some have postulated that the central role occupied by the diagnosis of depression is a phenomenon of civilisation or even the symptom of the severity of the uneasiness of western society.

DSM-IV-TR cultural formulation of psychiatric cases: Two proposals for clinicians.

This article reviews some limitations of the current guideline for the DSM-IV-TR Cultural Formulation (CF) from the perspective of psychiatric practice that are based on the author's experience conducting doctoral courses on cultural psychiatry from 1996 to 2007 in the Department of Psychiatry at the Universidad Autónoma de Madrid (Spain). Two proposals are presented for facilitating use of the CF by general clinicians. These proposals offer a procedure for embedding only the most relevant clinical information in a psychiatric history, followed by a brief cultural formulation. The approach is illustrated with a clinical case. Although the CF has considerable promise for revealing knowledge about patients, health practices, and health systems that is essential for clinical care, substantial research must be carried out to facilitate widespread use of the CF in clinical practice.

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.

Cross-cultural study of conviction subtype Taijin Kyofu: proposal and reliability of Nagoya-Osaka diagnostic criteria for social anxiety disorder.

Conviction subtype Taijin-Kyofu (c-TK) is a subgroup of mental disorder characterized by conviction and strong fear of offending others in social situations. Although the concept of c-TK overlaps with that of social anxiety disorder (SAD), patients with c-TK often may not be diagnosed as such within the current Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria. We propose the Nagoya-Osaka criteria to amend this situation. This study examined the cross-cultural interrater reliability of the proposed criteria. Eighteen case vignettes of patients with a variety of complaints focused around social anxieties were collected from 6 different countries, and diagnosed by 13 independent raters from various nationalities according to the original DSM-IV and the expanded criteria. The average agreement ratio for the most frequent diagnostic category in each case was 61.5% with DSM-IV and 87.6% with the modified DSM-IV with Nagoya-Osaka criteria (p < 0.001). These findings indicate that the Nagoya-Osaka criteria for SAD can improve interrater reliability of SAD.