[Schizophrenia concepts in Soviet and Russian psychiatry]

"Early Psychosis" as a mirror of biologist controversies in post-war German, Anglo-Saxon, and Soviet Psychiatry

The English term "early psychosis" was coined in the 1930s to refer to feelings of irritability, loss of concentration, hypochondriac ideas, moodiness, and lassitude that were seen to precede the onset of clear-cut hallucinations and delusions. The history of thinking about "early psychosis" under names such as "latent," "masked," "mild," "simple" or "sluggish" schizophrenia before World War II and afterwards on the different sides of the Wall and the Iron Curtain reveals "early psychosis" as a mirror of quite aged international biologist controversies that are still alive today and to the same extent as they are misunderstood, are influential in their implications in today's psychiatry.

Uzbekistan: psychiatry in transition

The center of a national medical identity in Uzbekistan is Abu Ali Ibn Sina born in 980 AD representing Islamic medicine and scientific universalism. Psychiatric institutions were founded under Russian influence starting in the late 19th century. Today, the great challenge in psychiatry is the development of a post-Soviet identity integrating Russian and Islamic traditions.

The association of schizophrenia with split personality is not an ubiquitous phenomenon: results from population studies in Russia and Germany

A widely prevalent stereotype connected with schizophrenia is its misperception as split personality. We examine whether the popular meaning of the term schizophrenia differs in countries of different cultural imprint by conducting an international cross-cultural comparison of public associations with the word schizophrenia in a Western and a Non-Western industrialized country. We analyze data from two representative population surveys in Novosibirsk, Russia (n = 745), and large German cities (n = 952) that used identical questions and sampling procedures. Unprompted associations with schizophrenia are compared by assigning them to a differentiated categorical system. 31.6% of respondents in Germany associated split personality with schizophrenia, compared to 2.0% in Novosibirsk. Logistic regression analysis controlling for age, gender and educational achievement demonstrated that country differences were independent of socio-demographic variables. Mention of split personality increased significantly with higher education. In Novosibirsk, associations with abnormality and unpredictability prevailed. We hypothesize on those cultural particularities in both countries that have shaped the different public understanding of the term and discuss implications for anti-stigma interventions.

A comparative study of diagnostic practice in psychiatry in Northern Norway and Northwest Russia

BACKGROUND

The co-operation between psychiatrists in Norway and Russia is increasing. The object of this study was to find out whether there were differences in diagnostic practice of psychiatrists in both countries, to look at the nature of the differences and to examine whether these differences affected diagnostic quality.

METHOD

Thirty medical doctors working at psychiatric hospitals in both countries diagnosed 12 clinical case vignettes selected from a wide spectre of psychiatric disorders.

RESULTS

The Russian clinicians used a larger range of diagnoses than the Norwegians. The Russians tended to diagnose schizophrenia and schizophrenia-like disorders in cases that presented psychotic syndromes, and somatoform disorders in cases that presented agoraphobia. The Norwegians tended to evaluate affective aspects in preference to psychotic symptoms in the case of schizoaffective disorder and overestimate the degree of depression. In general, the Russians had lower total score of correct answers than the Norwegians.

CONCLUSION

In spite of the limitations due to minor differences in the data collection phase in the two countries, the study clearly demonstrates differences in diagnostic practice between the countries.

Cultural adaptations of current psychiatric classifications: are they the solution?

Despite the limitations of modern nosological systems the development of cultural adaptations is a step backward, leading to unavoidable pitfalls in spite of the fact that cultural diversity is imposing new attitudes and demands on psychiatrists. Cultural adaptations challenge the principles of the universality of science and of ethics. ICD-10 and DSM-IV rely on the symptoms present to classify psychiatric diseases. This kind of classification has many advantages: it is a theoretical, close to clinical reality, easy to grasp and less prone to untested hypotheses. But they have some drawbacks: they do not say what diseases are, since the concept of symptom is not totally clear in psychiatry. The greatest disadvantage of this approach is the dispersion of disorders that may be related or even unique. Furthermore, when too many symptoms are present, this method requires a hierarchical structure (as in DSM-III)--unless one is willing to live with multiple diagnoses, the so-called co-morbidities (as in DSM-IV). But at other times, too few symptoms are present, leading to atypical, waste-basket and subsyndromal categories. Another problem is that symptoms may not be consistent across cultures, leading to the need of cultural adaptations. In the case of diseases diagnosed according to symptomatic criteria, cultural adaptations of internationally accepted classifications are often sought because symptoms are deemed to be inconsistent across cultures. But at a closer look, very often the symptoms are not so different and it is only the cultural halo which makes them attractive; even when they are particular to a given culture they can easily be interpreted (e.g., the penis invagination of latah). Indeed, they represent a way of experiencing common feelings such as anxiety (e.g., the susto of Latin America, which is a typical panic disorder) and depression. To put too much emphasis on local symptoms bears the risk of yielding to social and cultural pressure.