Characteristics of Recurrent Visions of the Nonphysical World Among Cognitively Unimpaired Elders of the Ojibwe Tribal Nation.

Importance: Visual hallucinations are a core feature of dementia with Lewy bodies and primary psychiatric disease, yet identification of a hallucination vs normal spiritual experience depends on cultural context. Almost no information exists in the medical literature regarding normal spiritual experiences in American Indian participants in the context of a neurocognitive evaluation. Objective: To assess the characteristics of a normal spiritual experience in an Ojibwe Tribal Nation. Design, Setting, and Participants: This prospective, cross-sectional study was conducted between August 1, 2021, and August 31, 2022, among an Ojibwe Tribal Nation in northern Minnesota. Participants were evaluated at their tribal nation clinic. Cognitively unimpaired tribal Elders who were enrolled members of the tribal nation and aged 55 years or older were invited to participate via fliers, radio advertisements, and health fair presentations. Thirty-seven tribal Elders volunteered. Main Outcomes and Measures: Each participant was asked whether they experienced hallucinations or visions of people, animals, or objects that are not part of the physical world. This was an a priori formulated question and part of a comprehensive neurocognitive evaluation consisting of history and physical examination (including cognitive screening with a subspecialty-trained behavioral neurologist); blood tests for metabolic, nutritional, and thyroid conditions; and noncontrast magnetic resonance imaging brain scan. Four patients were excluded from the present analysis due to having mild cognitive impairment or dementia. Results: Thirty-three cognitively unimpaired tribal Elders (mean [SD] age, 66.0 [7.5] years; 22 women [67%]) were included. Sixteen (48%) answered affirmatively, reporting recurrent visions of the nonphysical world. Generally, these visions were well formed, benevolent in nature, and transient; started in preadolescence; involved spirits or ancestors; and were congruent with cultural and spiritual beliefs of the Ojibwe people. No patients had accompanying dream enactment behavior, dysautonomia, parkinsonism, sleep transition-related hallucinations, or moderate to severe depression to suggest a prodrome of an α-synucleinopathy, hypnopompic or hypnagogic hallucinations, or psychosis. Conclusions and Relevance: Although based on only 1 Ojibwe Tribal Nation, this study suggests that formed visions of the nonphysical world are common among cognitively healthy Ojibwe individuals and can represent normal spiritual experiences. Clinicians would benefit from careful consideration of cultural or spiritual context to avoid misdiagnosis of neuropsychiatric disease.

Understanding the mental health burden of COVID-19 in the United Kingdom.

This article outlines the mental health burden of COVID-19 in the United Kingdom population, and presents preliminary evidence of less common psychiatric issues, such as paranoia and hallucinations, to which vulnerable groups in the U.K. population may be more vulnerable. It is argued that cognitive-behavioral therapy, with components of mindfulness, should be part of the therapeutic response. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

He korowai o nga tipuna: Voice hearing and communication from ancestors.

OBJECTIVE: This article describes the voice hearing experiences of a young Maori man, and the joint Maori healing and psychiatry assessment he received, in which the Maori healer (WN) concluded that some of the young man's experiences could be accounted for by ancestral kaitiaki (spiritual guardians). CONCLUSIONS: Kaitiaki are commonly accepted in Te Ao Maori (the Maori world) as an explanation for some types of voice hearing experiences. Collaboration between a Maori healer and a psychiatrist can offer Maori whanau (individuals and families) more appropriate mental health assessment and intervention than conventional psychiatric assessment alone when Maori spiritual experiences are suspected.

Do they see dead people? Cultural factors and sensitivity in screening for schizophrenia spectrum disorders.

OBJECTIVE: Schizophrenia spectrum disorders (SSDs), are diagnosed more frequently among African-Americans (AAs) than Caucasians. It has been suggested that cultural differences in symptom presentation and endorsement (including reporting spiritual/religious experiences) may influence this disparity. The current study investigated the relationship between endorsement of spiritual auditory and visual hallucinations and subsequent diagnosis of SSD among AA patients. DESIGN: Participants (N = 471 AAs) completed the Mini International Neuropsychiatric Interview-Plus (MINI-Plus) Screening Interview as part of their intake to a HIV outpatient clinic. Endorsement of auditory or visual (A/V) hallucinations was explored with the MINI-Plus Psychotic Disorder Module and questions regarding the content of the unusual experience. RESULTS: Logistic regression indicated that endorsement of A/V hallucinations significantly predicted a SSD (OR = 41.6, 95% CI 13.7-126.0, p < .001). However, when hallucinations were spiritual in nature, odds of an SSD fell dramatically (OR = 0.22, 95% CI 0.07-0.64, p < .001). CONCLUSIONS: The current study indicates that not all visual and auditory hallucinations are symptomatic of a psychotic disorder in AA patients. Many of these experiences may be related to spirituality. Clinicians assessing AA patients need to query content of, meaning attributed to, and distress associated with A/V unusual experiences.

Dreams of the dead among Cambodian refugees: frequency, phenomenology, and relationship to complicated grief and posttraumatic stress disorder.

The authors investigated the importance of dreams of the deceased in the experiencing of prolonged grief (PG) and posttraumatic stress disorder (PTSD) among Cambodian refugees who survived the Pol Pot genocide (1975-1979). Such dreams were frequent in the last month (52% of those surveyed), and most often involved a relative who died in the Pol Pot period. Past month frequency was correlated with PG severity (r = .59) and PTSD severity (r = .52). The dreams were almost always deeply upsetting because the dreams indicated the deceased to be in a difficult spiritual state. Dreams of the deceased as a central component of PG and PTSD among Cambodian refugees is discussed.

Voice hearing and pseudoseizures in a Maori teenager: an example of mate Maori and Maori traditional healing.

OBJECTIVE: The aim of this paper is to describe a Maori traditional healing approach to assessment and treatment of distressing psychiatric symptoms in a young man. METHOD: We describe the case of a 17 year old Maori male with voice hearing and pseudoseizures and the assessment and intervention by one of the authors (WN). We report on the young man's and his family's experience of this treatment. We outline concepts from a Maori world view that illuminate an indigenous rationale for this approach. RESULTS: A single session traditional Maori healing intervention was associated with immediate resolution of this young man's psychiatric symptoms and restoration of his sense of wellbeing, despite cessation of antipsychotic treatment. He and his family felt satisfied with the cultural explanation about the origin of his distress, which was congruent with their world view. He remained well at follow-up one year later. CONCLUSIONS: Collaboration between psychiatrists and traditional Maori healing practitioners can enhance the mental health care of Maori whaiora (service users) and their families. Indigenous research is required to further evaluate the acceptability and effectiveness of such joint approaches.

Saudades at the edge of the self and the merits of 'portable families'.

The treatment of a Mexican American patient who was referred due to hallucinations reveals a world of 'magic realism' that is far from infrequent in elderly people with a small and dwindling social network--especially if they come from cultures where the boundaries between the inner and the outer world are fuzzy. Respecting these traits allows for the development of treatment approaches that can evolve satisfactorily without disrupting the patient's inscription in this dual world.

Insight, psychopathology and global functioning in schizophrenia in urban Malawi.

Insight, psychopathology and functioning are related in schizophrenia, but it is unclear whether insight relates independently to functioning after controlling for psychopathology. Equally, any such relationship may vary culturally. We investigated the relationship between insight, psychopathology and functioning in 60 patients with schizophrenia in Mzuzu, a town in Malawi. After controlling for psychopathology, functioning was associated with the ;symptom relabelling' dimension of insight (P=0.01). This preliminary finding suggests that symptom-focused psychoeducation might be appropriate for African patients with schizophrenia.

Self-care symptom management strategies for auditory hallucinations among patients with schizophrenia in Taiwan.

This descriptive study explored self-care management strategies for controlling auditory hallucinations (AH) among Taiwanese patients with schizophrenia. Patients with schizophrenia (N = 200) were recruited by convenience from 2 general hospitals. Self-report and semistructured questionnaires were used to identify 41 self-management strategies. Strategies were categorized into 3 groups: physiological, cognitive, and behavioral. Ignoring AH, a cognitive strategy, was the single most frequently used strategy. As a group, strategies in the behavioral category were used the most. The most common resource for strategies was self-learning. These results can help health care providers better understand self-care management strategies for coping with AH among outpatients with schizophrenia. We suggest the development of a manual of selected self-care strategies identified by these patients to empower other patients to use self-care for AH.

[Naawtal or the psychopathological aspects of a particular migration]. / Le Naawtal ou les aspects psychopathologiques d'une migration particulière.

This study deals with some psycopathological features of naawtal. Naawtal is a Wolof word designating a social practice based on black magic that consists in ostracizing someone to prevent him from competing for a common goal or approaching a loved one. This traditional practice leads to involuntary migration from one place to another in the country. The survival of this practice in the socio-economic context of modern Senegal and indeed its extension to social classes not previously involved, reflects individual suffering, collective malaise, and ongoing social adjustments. Analysis of the practice of naawtal not only distinguishes motives, author, means of casting the spell (involving birds and wind), and the way to break the spell but also underlies the essential place of sexual identity with the notion of greater female vulnerability. To illustrate this article, the case of a woman persecuted by auditory hallucinations is analyzed in the light of the syndrome of mental and motor automatism characteristic of the diagnosis of chronic hallucinatory psychosis. The basic notion of internal exile and drifting contained in this traditional representation of mental illness is called on to explain the psychopathologic features. The authors emphasize the value of the reference to naawtal in the therapeutic relationship in helping to achieve acceptance of psychiatry in Africa.