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Psych VivasGeneral adult psychiatry

Psych Vivas · General adult psychiatry

Culture-bound syndromes and cultural concepts of distress — structured viva

Fellowship viva on the retirement of the culture-bound syndrome category, the DSM-5-TR cultural concepts of distress, eponym mastery without othering, amok and forensic caution, migration and psychosis epidemiology, and practical use of the Cultural Formulation Interview. FRANZCP W11-primary.

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Prompt
At handover a colleague describes a man who brooded for days, then attacked several strangers and afterwards claimed no memory of it, as 'a classic amok'. In the same week your service is asked why psychosis appears more common in a local migrant community, and a registrar asks you to teach 'the culture-bound syndromes' for the fellowship examination. Discuss: the status of the term, the classic presentations and their discriminators, the forensic caution around amok, the epidemiology of migration and psychosis, and how you would use the Cultural Formulation Interview in a busy service.
The examiner's opening gambit

"Teach me the culture-bound syndromes." — the consultant answer opens by retiring the term, names the DSM-5-TR triad of syndrome, idiom and explanation, and only then produces the eponyms, each with a discriminator rather than an anecdote.[1][5][6]

Question 1 — Is "culture-bound syndrome" still a valid category?

Say this: the presentations are real; the category was flawed. It implied that syndromes are bounded by culture, that they are rare, and that Western categories are culture-free — and all three implications failed.[1][6][4]

Evidence to name. Sumathipala found semen-loss anxiety described historically in Britain, the USA and Australia. Chowdhury noted that koro's occurrence across the world and across varied morbidities had already diluted its identity as a culture-bound syndrome.[6][8]

Finish with nosology: DSM-5-TR uses cultural syndromes, idioms of distress and explanations; ICD-11 has no equivalent glossary.[1][8]

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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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