Delusions of witchcraft: a cross cultural study

Clinical symptoms of psychotic episodes and 25-hydroxy vitamin D serum levels in black first-generation immigrants

OBJECTIVE

Dark-skinned immigrants have a higher risk for schizophrenia and other psychoses than other immigrants. The first British studies reported that first-generation immigrants (FGIs) from the Caribbean presented atypical psychoses. This study examines the characteristics of psychotic episodes in black FGIs to Canada.

METHOD

The charts of 18 FGIs from Africa and Haiti, extracted from a series of 20 black patients consecutively admitted to Psychiatry, were retrospectively reviewed regarding clinical features, diagnoses and vitamin D levels.

RESULTS

Young FGIs presented acute psychotic episodes with abrupt onset, florid positive symptoms, few negative symptoms and good evolution. The onset was more insidious in older FGIs. Overall, catatonia was very frequent (28%), and mood symptoms still more frequent (44%). No cognitive decline was observed during follow-up. Serum levels of 25-hydroxy vitamin D were in the insufficiency range. Supplementation at 1000 IU/day did not restore normal levels.

CONCLUSION

The clinical features of psychotic episodes in black FGIs are similar to those reported in dark-skinned FGIs to other countries. They are also observed in other immigrants and in non-immigrants. These atypical psychoses are possibly related to a recent vitamin D deficit. This hypothesis should be tested by clinical trials of sufficient vitamin D supplementation.

Belief in supernatural causes of mental illness among Malay patients: impact on treatment

The concept of aetiology of mental illness in 134 Malay patients was investigated by means of a 20-item checklist. About 53% of the patients attributed their illnesses to supernatural agents. Witchcraft and possession by evil spirits were regarded as common causes of illness. The number of patients who believed in supernatural causes of their mental illness was significantly higher among those who had consulted bomohs (Malay traditional healers) than among those who had not consulted them. The belief that mental illness is caused by supernatural agents is firmly held by bomohs, who reinforce this notion in those who seek their advice. Belief in supernatural causes of mental illness was not significantly associated with age, gender, level of education or occupation of the patients. Patients who believed in supernatural causes of mental illness were also found to show poor drug compliance, and the number of such patients at 6 months follow-up was significantly lower than the corresponding figure for those who did not believe in supernatural causes. The importance of understanding the patients' cultural background when treating psychiatric patients is highlighted.

The interaction of popular and clinical diagnostic labeling: the case of embrujado

This paper explores the effect of a popular diagnosis of distress, "bewitchment," on diagnosis, treatment and outcomes of psychiatric illness in a small group of Hispanic patients in New Mexico. Two major approaches to such "culture-bound" illnesses in clinical settings are critiqued and synthesized in suggesting a practical way to understand how both folk and psychiatric explanations can affect experience with, and of psychiatric patients who present with their own culturally patterned diagnoses. Further study suggests that clinically focused ethnography can address the issue of change or persistence in both lay and clinical explanations of illness as they interact in a clinical setting.

Mental illness among immigrant minorities in the United Kingdom

Cross-cultural studies on immigrants from Pakistan and the New Commonwealth are reviewed, with emphasis on epidemiology and differences in clinical presentation. Their referral to the psychiatric service is also examined and deficiencies are noted. Awareness of transcultural issues among health professionals need to be increased in order to achieve diagnosis and improvements in health care.

The atypical psychoses

The psychiatric literature contains numerous accounts of psychoses found worldwide that do not fit classic definitions of schizophrenia, manic-depression, or organic brain syndrome. These vaguely defined 'atypical psychoses' are under scrutiny because of growing knowledge and more rigorous methodology in descriptive and cross-cultural psychiatry. The authors trace the history of atypical psychosis concepts from the contributions of Kraepelin, Jaspers, and Freud to contemporary European and Anglo-American viewpoints. Studies of the atypical psychoses are reviewed in the light of current validation methods in psychiatry. Several methodologic problems plague this area: inadequate definitions, etiologic prejudice, poor premorbid and follow-up assessment, as well as certain naive notions about psychopathology in different cultures. Consequently, knowledge of atypical psychosis is limited and largely impractical. The authors suggest several possibilities for interpreting present and future evidence about these disorders and certain strategies for future studies.

Origins of disease phobia

The literature on disease phobia is discussed and a controlled study of this variety of hypochondriasis is presented.

There were 30 disease phobic and 30 control subjects, in-patients of a general hospital psychiatric unit in Sydney. Controls were defined as lacking the symptoms ‘disease phobia’, ‘disease conviction’, ‘somatic preoccupation’ and ‘psychogenic pain’. Matching was one-for-one and concerned sex, age and occupational prestige.

In brief, the disease phobics were more anxious and self-pitying (current mental state). Before the illness they were more prone to inhibition of anger, bodily concern and low selfesteem (personality variables). As children they were more often weak, sickly and overprotected. Fifteen were youngest siblings versus only six of the controls. They gave a history of much family illness, substantiated by the findings of an excess of deaths among the mothers of disease phobics (life history characteristics). They reported an electrical current as a sensation at relatively low voltages and had low tolerance of pain (experimental measures).

A logical insight into the origins of disease phobia is provided by inter-relating the data from these four aspects of the investigations (Fig. 1). This matrix is interpreted in terms of the augmentation-reduction theory of Petrie.