Common language and local diversities of psychopathological concepts--alternatives or complements?

Beyond the blues: towards a cross-cultural phenomenology of depressed mood

BACKGROUND

There is a great cultural variety in the social phenomenology of depressed mood. The aim of this qualitative study was to compare English and Laotian Hmong semantic and pragmatic differences in depressed mood and to assess their relevance for cross-cultural psychiatric research and practice.

SAMPLING AND METHOD

The first author conducted long-term ethnographic fieldwork from 2000 to 2002 among the Hmong in Laos. Methods included participant observation, interviews and focus group interviews in the Hmong language. The semantic and pragmatic context of Hmong depressed mood tu siab, literally translated as 'broken liver', is compared to that of 'sadness' in Western contexts.

RESULTS

Hmong 'broken liver' and English 'sadness' are deeply shaped by culture-specific premises concerning notions of social interaction, morality, interiority, socialisation, and cosmology.

CONCLUSIONS

Critical attention has to be paid when assessing depressed mood cross-culturally. A social phenomenology combining qualitative and quantitative methods should be developed to analyse important semantic and pragmatic differences of depressed mood across cultural contexts.

Classification of functional psychoses and its implication for prognosis: comparison between ICD-10 and DSM-IV

BACKGROUND

The aim was to examine the agreement and differences between ICD-10 and DSM-IV in the classification of functional psychoses.

SAMPLING AND METHODS

In a sample of 218 first-hospitalised patients, ICD-10 diagnoses were compared with DSM-IV diagnoses. Functional psychoses of both diagnostic systems were classified into the four diagnostic groups schizophrenia, transient/episodic psychoses, delusional disorders and affective disorders. Based on information from a 15-year follow-up, it was examined which course is associated with each diagnostic group.

RESULTS

Although in ICD-10 there was a higher frequency of schizophrenia and a lower one of affective disorders, a high agreement between ICD-10 and DSM-IV (kappa value of 0.82) was found. In both diagnostic systems, transient/episodic psychoses and affective disorders were mainly associated with a non-chronic course and schizophrenia was mainly associated with a chronic one. Nevertheless, several patients with transient/episodic psychoses showed a chronic course (ICD-10: 10%, DSM-IV: 15%) and more than one third of patients with schizophrenia a non-chronic one (ICD-10: 40%, DSM-IV: 33%).

CONCLUSIONS

In the cross-sectional assessment, there is a high diagnostic agreement between ICD-10 and DSM-IV. With respect to the long-term course, the delimitation of transient/episodic psychoses from schizophrenia was neither completely achieved by ICD-10 nor by DSM-IV.