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Psych CASC / OSCEGeneral adult psychiatry

Psych CASC / OSCE · General adult psychiatry

The ataque in the emergency department — CASC cross-cultural assessment station

FRANZCP/MRCPsych-style station: assess a culturally patterned crisis presentation without dismissing it or over-medicalising it — elicit the idiom and explanatory model, screen medically, assess mood, trauma and suicide risk, work with an interpreter and family boundaries, and negotiate a safe plan. FRANZCP W11/W03.

communication3 min readVerification in progress

Target exams

FRANZCPMRCPsychABPNMD-DNB
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Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
A 31-year-old woman who migrated three years ago is brought to the emergency department by her sister after an episode at a family gathering: she screamed, wept, trembled, fell to the floor and was briefly unresponsive. She recovered within minutes and is now calm but tearful. She tells you it was 'un ataque de nervios', that it happens when things at home become unbearable, and that her mother had the same. She does not want to be admitted and does not want her husband told.
The station in one line

Take the idiom seriously as a communication, then assess it as a presentation: precipitant, medical screen, mood, trauma, risk — and negotiate a plan that respects her explanatory model and her refusal to involve her husband.[10][5][1]

Candidate instructions (7 minutes)

Take a focused history using cultural formulation principles, assess risk, and explain your plan. You may not order investigations during the station; state what you would request.[2][10]

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References20ShowHide
  1. [1]Lewis-Fernández R, Kirmayer LJ Cultural concepts of distress and psychiatric disorders: Understanding symptom experience and expression in context Transcult Psychiatry, 2019.PMID 31347476
  2. [2]Lewis-Fernández R, et al. Feasibility, acceptability and clinical utility of the Cultural Formulation Interview: mixed-methods results from the DSM-5 international field trial Br J Psychiatry, 2017.PMID 28104738
  3. [3]Aggarwal NK, et al. Barriers to implementing the DSM-5 cultural formulation interview: a qualitative study Cult Med Psychiatry, 2013.PMID 23836098
  4. [4]Kirmayer LJ Rethinking cultural competence Transcult Psychiatry, 2012.PMID 22508634
  5. [5]Nichter M Idioms of distress revisited Cult Med Psychiatry, 2010.PMID 20495999
  6. [6]Sumathipala A, Siribaddana SH, Bhugra D Culture-bound syndromes: the story of dhat syndrome Br J Psychiatry, 2004.PMID 14990517
  7. [7]Grover S, et al. Phenomenology and beliefs of patients with Dhat syndrome: A nationwide multicentric study Int J Soc Psychiatry, 2016.PMID 26142412
  8. [8]Chowdhury AN The definition and classification of Koro Cult Med Psychiatry, 1996.PMID 8740958
  9. [9]Saint Martin ML Running Amok: A Modern Perspective on a Culture-Bound Syndrome Prim Care Companion J Clin Psychiatry, 1999.PMID 15014687
  10. [10]Guarnaccia PJ, et al. The experiences of ataques de nervios: towards an anthropology of emotions in Puerto Rico Cult Med Psychiatry, 1996.PMID 8899285
  11. [11]Kirmayer LJ The place of culture in psychiatric nosology: Taijin kyofusho and DSM-III-R J Nerv Ment Dis, 1991.PMID 1985144
  12. [12]Simons RC The resolution of the Latah paradox J Nerv Ment Dis, 1980.PMID 7365478
  13. [13]Weller SC, et al. Susto and nervios: expressions for stress and depression Cult Med Psychiatry, 2008.PMID 18535889
  14. [14]Kato TA, Kanba S, Teo AR Hikikomori : Multidimensional understanding, assessment, and future international perspectives Psychiatry Clin Neurosci, 2019.PMID 31148350
  15. [15]Kleinman A Neurasthenia and depression: a study of somatization and culture in China Cult Med Psychiatry, 1982.PMID 7116909
  16. [16]Lee S Diagnosis postponed: shenjing shuairuo and the transformation of psychiatry in post-mao China Cult Med Psychiatry, 1999.PMID 10572739
  17. [17]Prince R The "brain fag" syndrome in Nigerian students J Ment Sci, 1960.PMID 14434928
  18. [18]Ola BA, Morakinyo O, Adewuya AO Brain Fag Syndrome - a myth or a reality Afr J Psychiatry (Johannesbg), 2009.PMID 19582315
  19. [19]Bourque F, van der Ven E, Malla A A meta-analysis of the risk for psychotic disorders among first- and second-generation immigrants Psychol Med, 2011.PMID 20663257
  20. [20]Bhugra D, Becker MA Migration, cultural bereavement and cultural identity World Psychiatry, 2005.PMID 16633496
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