Koro-Like Symptoms in an Adolescent Female With Schizophrenia.

Koro is a disorder characterized by the fear of genitals shrinking and retracting into the body.1 While it is not included in the cultural concepts of distress in DSM-5, DSM-IV-TR described koro as "an episode of sudden and intense anxiety that the penis (or, in female patients, the vulva and nipples) will recede into the body and possibly cause death." The term koro originates from the Malay language, referring to the retracting motion of the head of turtles or tortoises into their shells. In the United States and Europe, the term genital retraction syndrome is commonly used instead of koro. In classical koro, cultural belief plays a role in its origin and spread, often in epidemics in Asian countries.2 On the other hand, Koro-like syndrome (KLS) has been reported worldwide secondary to medical and psychiatric disorders.2 Similar to koro, KLS is more prevalent in males, with only 3 documented cases in female patients worldwide (Table 1). We present the first case to our knowledge of KLS in an adolescent female patient with schizophrenia. The patient's parents gave consent for the publication of this case report.

[Koro syndrome : when culture interacts with psychopathology]. / Le syndrome de Koro : quand la culture interagit avec la psychopathologie.

Koro syndrome is a psychiatric disorder specific to certain Asian cultures. It is characterized by acute and intense anxiety with fear of a retraction of the penis into the body and resultant death. We report the case of a 43-year-old Moroccan male presenting with persistent anxiety associated with avoidance behaviors and a chronic belief that his genitalia may shrink or disappear and lead to his death. This impacted his professional and family functioning. The diagnosis of culture-bound syndrome was considered although the presenting syndrome was chronic and sporadic. The Moroccan culture, which attributes a great importance to the male sex, would explain this syndrome.

Le syndrome de Koro est un trouble psychiatrique spécifique à certaines cultures asiatiques. Il est caractérisé par la survenue brutale d'une anxiété intense associée à la peur d'une rétraction du pénis dans le corps qui peut mener à la mort. Nous rapportons le cas d'un patient marocain âgé de 43 ans, qui présente une anxiété persistante avec des conduites d'évitement associées à une chronique croyance que ses organes génitaux pourraient se rétrécir ou disparaître et conduire à sa mort, ce qui a impacté son fonctionnement professionnel et familial. Le diagnostic d'un trouble lié aux concepts culturels semble le plus probable, en se référant à la culture marocaine qui attribue une grande importance au sexe masculin, même s'il s'agit d'un cas chronique et sporadique.

Clinical course and treatment outcome of Koro: A follow up study from a Koro epidemic reported from West Bengal, India.

BACKGROUND: Koro, as a culture bound syndrome is predominantly reported from Asian countries. There is dearth of well-designed research focussing on course and outcome of Koro. METHOD: In the index study, 64 consecutive consenting patients with symptoms of Koro reported in different disciplines of a tertiary care Government Hospital of West Bengal were recruited over a period of 3 months. They were treated by standard treatment protocol and followed up for next 3 months. Data was collected on clinical course and treatment outcome by a pretested semi-structured proforma, specially developed for this study. RESULTS: A typical subject was a young single male, educated up to primary standard, agricultural worker by occupation and belonged to Hindu rural joint family. Among the whole sample 23% were female. Majority were referred from either private doctors or hospitals or government hospitals and reported first at non-psychiatric OPD. Dropout and recovery rates were 28% (male 33%, female 13%) and 89% (male 89%, female 92%) respectively. 20%, 75%, 9%, 31%, 19% of patients needed indoor admission, oral anxiolytics, injectable tranquilizers, specific pharmacological and psychosocial treatment, supportive medical treatment respectively. There was a subtle difference in course and treatment outcome noted between the genders. A new modality of psycho-sexual intervention 'sex education in vivo' was applied on patients of Koro with favourable result. CONCLUSION: Female counterpart represented a significant proportion. Overall improved trend of utilizing medical care facilities was observed. But sceptical attitude towards Psychiatric treatment is prevailing. An overall good treatment outcome was noted among the Koro victims.

Epidemic of Koro in North East India: an observational cross-sectional study.

OBJECTIVE: Koro is a culture bound syndrome, endemic in South-East Asia. The present study attempts to correlate the socio-cultural and demographic variables of the patients with the occurrence of the Koro and the differences in presentation between the classical features of the Koro and the actual presentation of the disease that has been observed in the present study. METHOD: A cross-sectional observational study was performed and data collected during the period was compared, analyzed and studied. A total number of 70 patients who presented to the Department of Psychiatry with symptoms of Koro over the period of 5 days were taken into the study. RESULTS: Most of the patients were, young, unmarried males belonging to a lower socioeconomic status. Most of these patients suffered the attacks in the evening mostly while at home. It was common in migrant and migrant lineage. Media had a major role to spread this epidemic. CONCLUSIONS: Koro epidemics are considered to be the result of panic that spread following the occurrence of symptoms in one or more individuals within the same geographical zone. While the issues concerning phenomenology, diagnosis and nosology of Koro are still being discussed, it is apparent that Koro which presents as an acute anxiety state is treatment responsive and has good prognosis.

[Mental illness in the former Dutch Indies--four psychiatric syndromes: amok, latah, koro and neurasthenia]. / Geestesziek in Nederlands-Indië--vier psychiatrische syndromen: amok, latah, koro en tropenneurasthenie.

--At the beginning of the 20th century Dutch psychiatrists in the former Dutch Indies encountered exotic psychiatric syndromes and variant expressions of psychopathological diseases that were also prevalent in Europe. --The amok and latah syndromes were reported relatively frequently and were considered typical endemic psychopathologies. Amok is an acute condition of insanity in which the affected individual, a man, attempts to kill others. Latah is a shock-like condition in which the affected individual, a woman, mimics the movements and sounds of those nearby against her will. --The koro syndrome is considered a typical but rare psychosis seen primarily among the Chinese population of the former Dutch Indies. Patients have a recurring fear of the penis retracting into the body. --A diagnosis of 'tropical neurasthenia' was frequently made in Europeans for what today would be referred to as dysthymic disorder or minor depressive disorder.

Chronic koro-like symptoms - two case reports.

BACKGROUND: Koro is a culture bound syndrome, which has been reported usually from Asian countries. It has been described as an acute, brief lasting illness, which often occurs in epidemics. There is no description in literature of a chronic form of this syndrome. CASE PRESENTATION: Two sporadic cases with koro-like symptoms from East India are presented where the illness had a chronic course with durations spanning more than ten years. In contrast to acute, good prognosis, psycho-education responsive form that is usually seen in epidemics; the chronic form, appeared to be associated with greater morbidity and poorer response to interventions. CONCLUSION: There is a possibility of a chronic form of koro syndrome.

[Koro-like symptoms in a recurrent depressive disorder]. / Koro-ähnliche Symptome bei rezidivierender depressiver Störung.

We report the case of a German male with a major depressive episode who also suffered from the terrifying perception that his penis was shrinking. These so-called koro-like symptoms (KLS) had also been present in earlier depressive episodes and subsided in the symptom-free interval of the recurrent depressive disorder. Under sufficient antidepressant medication with venlafaxine and lithium not only KLS but also the depressive symptoms remitted. The course of illness provides further evidence that KLS are not a distinct clinical entity in Western countries, but represent a concomitant syndrome that requires treatment of the underlying illness.

Koro-misidentification syndrome in schizophrenia? A plea for clinical psychopathology.

Although current diagnostic procedures favour the diagnosis of similar syndromes in different pathological processes, it cannot be overlooked that many psychiatric symptoms that share a similar 'surface grammar' differ in their 'deep grammar' or structure. In the case presented, we describe an acute psychosis where a Koro-misidentification syndrome might be diagnosed. In the discussion we point out how confusing this approach might be, as well as a feasible way to compensate for the shortcomings of contemporary descriptive psychopathology.

Research on culture-bound syndromes: new directions.

The unprecedented inclusion of culture-bound syndromes in DSM-IV provides the opportunity for highlighting the need to study such syndromes and the occasion for developing a research agenda to study them. The growing ethnic and cultural diversity of the U.S. population presents a challenge to the mental health field to develop truly cross-cultural approaches to mental health research and services. In this article, the authors provide a critique of previous analyses of the relationship between culture-bound syndromes and psychiatric diagnoses. They highlight the problems in previous classificatory exercises, which tend to focus on subsuming the culture-bound syndromes into psychiatric categories and fail to fully investigate these syndromes on their own terms. A detailed research program based on four key questions is presented both to understand culture-bound syndromes within their cultural context and to analyze the relationship between these syndromes and psychiatric disorders. Results of over a decade of research on ataques de nervios, a Latino-Caribbean cultural syndrome, are used to illustrate this research program. The four questions focus on the nature of the phenomenon, the social-cultural location of sufferers, the relationship of culture-bound syndromes to psychiatric disorders, and the social and psychiatric history of the syndrome in the life course of the sufferer.