Poster Session (Posters are listed alphabetically by authors’ last name)
Outcome of Treatment of Severe Mental Illnesses by Traditional Healers in Jinja and Iganga Districts, Eastern Uganda C. Abbo (Sweden/Uganda), S. Musisi (Uganda), P. Waako (Uganda), E. Okello (Uganda), S. Ekblad (Sweden)
Introduction healers in Jinja and Iganga districts of Eastern The use of Complementary and Alternative Uganda. Medicine (CAM), of which traditional healing is but a part, is widely acknowledged and growing Method both in developed and developing countries such A cohort of patients with psychosis was as Uganda. In North America, Western Europe recruited from traditional healers’ shrines between and other developed regions, an increasing January and March 2008 and followed up at three number of patients are seeking out CAM and six months. The Mini International practitioners for mental health care (1). The use of Neuropsychiatry Interview (MINI Plus) was used CAM approaches among individuals who meet for making specific diagnosis at the point of DSM-IV criteria for any psychiatric disorder is contact. For specific symptoms, Positive and significantly greater than in the general population Negative Symptom Scale (PANSS), Young Mania (2). In Africa, the commonest form of CAM is Rating Scale (YMRS) and Montgomery Asberg traditional healing practices, which are deeply Depression Rating Scale (MADRS) were used to embedded in African traditional beliefs (3, 4). measure severity of schizophrenia, mania and Because of what the community culturally psychotic depression, respectively. To measure perceives as the causation of severe mental illness, outcome by noting general severity, the Clinical people there have close relationships with Global Impression (CGI) and Global Assessment traditional healers, who often share the same of Functioning were used for assessments. The community and culture. In addition, it has been Compass Mental Health Index measured found that patients with psychosis do not often go wellbeing. Mean scores of the scales were to primary health care facilities, preferring computed using one-way ANOVA for traditional healing practices (4). independent samples. Associations between outcome and categorical variables were examined. Objective To determine the outcome and associated Results factors of treatment of psychosis by traditional The differences between the mean scores of 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION the scales were all significant (P<0.0001). The symptoms and those who combine biomedical Turkey HSD tests were also all significant at services and traditional healing. Further research P<0.01 except for MADRS, where there was no is needed in the area of traditional healing significant difference between 3 and 6 months for outcomes. depression severity. Over 80% of the participants used biomedical services for same symptoms in the References study period. Patients with mania made up a Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van majority. Schizophrenia negative symptoms Rompay M, Kessler RC: Trends in Alternative Medicine Use in the United States, 1990-1997: Results of a Follow- improved better than positive symptoms. up National Survey. JAMA 280:1569-1575, 1998 Significant associated factors were low Unutzer J, Klap R, Sturm R, Young AS, Marmon T, Shatkin socioeconomic status, early age of onset, longer J, Wells KB: Mental Disorders and the Use of Alternative duration of symptoms, positive family history, co- Medicine: Results From a National Survey. American morbidity and severity of symptoms. Journal of Psychiatry 157: 1851-1857, 2000 Patel V: Explanatory models of mental illness in Sub-Saharan Africa. Social Science and Medicine 40: 1291-1298, 1995 Conclusion Okello E, Musisi S: Depression as a clan illness (eByekika): An This study suggests that visiting traditional Indigenous Model of Psychotic Depression Among the healers may be of some benefit for patients with Baganda of Uganda. World Cultural Psychiatry Research Review 2: 60-73 2006 psychosis, particularly those with negative
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Self–Harm in South Asian Women. A literature Review Informed Approach to assessment and Formulation K. Ahmed (UK), Rajesh Mohan (UK), Dinesh Bhugra (UK)
Introduction We conjectured that the findings from this The rates of self–harm among South Asian literature review could be used to inform a more women in the United Kingdom are higher than in culturally competent assessment of such women, other ethnic groups (Raleigh et al., 1990). Among thus enabling us to provide culturally appropriate younger South Asian women, the attempted interventions. suicide rates are 2.5 times those of White women and 7 times those of South Asian men (Bhugra et Methods al., 1999a). Using literature review, we identified factors The reasons for this are far from clear and the associated with self–harm in South Asian women. factors involved need elucidating. However, there These findings were used to guide the clinical is evidence that socio–cultural factors may assessment of an South Asian woman who had contribute more than psychiatric factors to self– self–harmed using a personal narrative approach. harm among this patient group (Bhugra et al., Three independent clinicians analysed the 1999b). This highlights the need for assessing narrative using qualitative techniques and these factors to gain a better understanding of the identified important themes that gave an insight patient’s distress. Routine assessments of self– into the problems associated with the incident, harm have been criticised for inadequately arriving at a cultural formulation. identifying cultural and social factors in ethnic Literature review minority patients (Hunt et al., 2003). Searched the databases MEDLINE®, Furthermore, there is still a need for improved Ovid, and Embase to identify articles on cultural competence in healthcare professionals factors associated with self–harm in South who may be ill-equipped to deal with such Asian women using the search terms: presentations comprehensively and sensitively. self–harm, attempted suicide, South Asian, women, and female Aims Identified articles including published case In this study, we aimed to use literature review reports highlighting cultural & to gain a better understanding of the explanatory psychosocial factors associated with self– models behind self harm in South Asian women. harm in South Asian women World Cultural Psychatry Research Review 2009, S1: 191-237
192 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION Hand searched for cross-referenced assessment and to achieve a greater understanding articles of issues important to the patient. Two researchers reviewed the articles and generated a list of factors linked to self– Table 1: Factors associated with self-harm harm in South Asian women amoung South Asian women* Factors were grouped into broad areas CATEGORY FACTORS IN THIS CASE Personal • Low self-esteem (Thompson ! and Bhugra, 2000) • Social isolation (Rao, 1992; ! Interview Kingsbury, 1994). • Psychiatric diagnosis (Bhugra, 1999b) " Identified a patient of South Asian • Personality disorders (Rao, 1992) " ethnicity who had self-harmed following a • Interpersonal difficulties ! (Ponnudurai, 1986) review of the case register of a large inner Familial • Family conflicts (Gehlot and Nathawat, ! 1983; Bhugra & Desai, 2002) city teaching hospital • Conflict with spouses (Gehlot " and Nathawat, 1983) Conducted a recorded interview using our • Issues relating to children ! ‘literature-review informed’ approach (Chew-Graham et al, 2002) • Arranged marriages, rejection of " The interview consisted of: arranged marriages and related marital problems (Merrill and - Open ended questions to explore Owen, 1986) • Forced marriages (Chew- " the domains identified in the Graham et al, 2002) • Problems in inter-racial and inter- " literature review caste relationships (Mahy, 1993; Bhugra, 1999b). - A standard psychiatric history • Conflicts with in-laws Bannerjee, " 1990; Ponnudurai 1986) - Questions from the Asian • Problems with mothers-in-law " Cultural Identity Schedule (Khan and Reza, 1998) • Domestic violence and alcohol " (Bhugra et al., 1999c) to explore abuse in the family by males (Bhugra and Desai, 2002) aspects of acculturation • Illness of family members A thematic analysis of the interview • Gambling by male family transcript was performed by three members Cultural • Cultural conflict and poor acculturation ! independent psychiatrists to identify (Bhugra,1999b; Merrill and Owens, 1986). • Gender-role expectations (Bhugra and " themes pertinent to the self–harm episode Desai, 2002) • Inferior social standing of women " in this patient (Bhugra and Desai, 2002) Themes that emerged were used to • Inability to speak English (Chew- ! Graham et al, 2002) construct a cultural formulation of the • Misuse of religion to control women " (Chew-Graham et al, 2002) self–harm episode • Izzat, (personal or family honour) can " be misused to force women to behave in a certain way. (Chew- Graham et al, 2002) Asian Cultural Identity Schedule (Bhugra et al., 1999c) Socioeconomic • Poverty and financial problems (Chew- ! domains Graham et al, 2002) • Unemployment (Bhugra, 1999b) ! Religion • Migration leading to socio-economic ! and political disadvantages (Bhugra Language and Desai, 2002) • Discrimination (racism and sexism) " Marriage & family (Chew-Graham et al, 2002) *Although these factors could apply to women of any cultural background, the familial and Employment & housing cultural factorsl are particularly pertinent to women of South Asian origin. References for the above can be obtained on request. Leisure activities KEY: ! = YES/ FOUND IN THIS CASE " = NO/ NOT FOUND IN THIS CASE. Food and shopping Aspiration Case formulation Self-attitudes Mrs. A., a 30-year-old woman of Bangladeshi origin living in London with her husband and three young children, was seen in the A&E Results department following an incident of self–harm. Our literature review showed that various She had taken an overdose of her husband’s anti- factors were associated with distress and resilience epileptic medication. The immediate precipitant in this patient group. These can be divided into of the self–harm episode was an argument with four categories: personal, familial, cultural and her brother after she discovered he stole money socioeconomic factors. Cultural factors included from their parents to finance his gambling habit. level of acculturation, forced marriages, the At the time, Mrs A was struggling with concept of izzat (family honour) and the social multiple stressors; she was socially isolated and standing of women in Asian culture. was struggling to cope with looking after her We used the factors identified from our children. The poor health of her husband, who literature review to guide the interview. This has epilepsy and psoriasis, and her mother, who allowed us to conduct a more culturally informed has severe diabetes were further stressors. She was World Cultural Psychatry Research Review 2009, S1: 191-237
193 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION very concerned about mounting debts, the identify these issues, enable formulation of the possibility that her husband might not be able to problems within the cultural context, and inform continue working due to his ill health and on- culturally appropriate interventions. The findings going difficulties with her neighbours. of this case study may not be generalisable to While in her late teens Mrs. A entered into an other incidents of self–harm, but demonstrate arranged marriage. She described her husband how available evidence can be utilized to enhance and in-laws as very supportive. The major conflict the cultural competence of self–harm assessments in her parental family was between her brother in clinical settings. and the other family members due to his Some of the areas identified in this paper will gambling. be useful to clinicians and researchers dealing with Mrs. A. is a practising Muslim and wears the this patient group. Exploring these areas should hijab (headscarf). She described religion as an allow clinicians to perform a more comprehensive important aspect of her life. She speaks in Bengali assessment of self–harm in South Asian women. most of the time and felt her English was poor. She disapproved of her brother’s Westernised References habits and practices and was distressed by the Raleigh S, Buusu L, Balarajan R. Suicide among immigrants inability of the family to influence his behaviour. from the Indian subcontinent. British Journal of Psychiatry, 156: 46-50, 1990 Although Mrs. A. had lived in the U.K. for a Bhugra D, Desai M, Baldwin DS. Attempted suicide in west number of years, her level of acculturation was London, I. Rates across ethnic communities. Psychological not high, which may explain the dissonance in Medicine 29: 1125-1130, 1999a cultural values and the distress of dealing with her Bhugra D, Baldwin DS, Desai M, Jacob KS. Attempted brother’s gambling addiction. suicide in west London, II. Inter-group comparisons. Psychological Medicine 29: 1131-1139, 1999b Hunt IM, Robinson J, Bickley H, Meehan J, Parsons R, Conclusions McCann K, Flynn S, Burns J, Shaw J, Kapur N, Appleby It is important for caregivers interviewing L. Suicides in ethnic minorities within 12 months of South Asian women who have self–harmed to contact with mental health services. National clinical survey. British Journal of Psychiatry 183: 155-160, 2003 possess cultural knowledge and sensitivity. For Bhugra D, Bhui K, Desai M, Singh J. Asian Cultural Identity example, an interviewer should be familiar with Schedule: An investigation of culture and deliberate self– concepts such as izzat and be able to appreciate harm. International Journal of Methods In Psychiatric research the impact of a gambling habit for a Muslim 8: 212-218, 1999c family. Culturally competent assessments will help
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Discrete-Ethnic Characteristics of Prevalence of Neuro-Mental Pathology among Population of Tuva I.A. Artemyev (Russia)
Accepted definitions of ethnopsychiatry differ interesting phenomenon within some “nation” not very considerably and are reduced to the while taxonomic compound what tribal groups following: ethnopsychiatry studies peculiarities of maybe remains out of sight due to small definition prevalence, clinic, course and outcome of mental of these taxons in historically formed to present diseases and disorders in this ethnos. This typical time ethnos. On the territory of Siberian Federal definition idem per idem means that this or that Okrug simultaneously different – in ethnic and neuro-mental disorder may be understood taking cultural regard –peoples little drawn together live into account ethnocultural aspect. Investigations and Russian-language population represents the are carried out as a rule within an ethnos that is overwhelming majority. Within the largest understood as “historically have come into aboriginal peoples Buryats and Tuvinians are existence kind of stable social grouping of people distinguished. represented by tribe, nationality, and nation” Republic Tuva, a national-state formation in (Soviet Encyclopedia, 1984, p. 1555). Most often composition of Russian Federation, one comes to nothing more than study of geographically is situated in the center of Asia World Cultural Psychatry Research Review 2009, S1: 191-237
194 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION with high specific weight of aboriginal population separately drawn tribal groups as ethnic taxons up to 66% and almost absolute compactness: on there is not “tropism” to disorders of psyche of its its ethnic territory 97% of Tuvinians live. Data members hence risk of mental disorders at about tribal composition of Tuvinians are of great population level does not depend on tribal interest from the point of view of formation of belonging. Tuvinian ethnos. In spite of that at present time in Identification of incidence rate parameters Tuva – center of Asia – there is not exactly (number of men with mental disorders per 100) in defined tribal structure; tribal ethnonyms have various groups has shown that in spite of been continued in the contemporary Tuvinian considerable variability statistically significant surnames derived from names of tribal groups differences of this index has not been found. what is used by contemporary investigators. Vast Consequently, tribal belonging does not reflect data have been obtained about character of itself on the incidence rate of mental pathology of settlement of bearers of Tuvinian ethnonyms at its representatives. We have identified the value of present time (Weinstein, 1972). this index in tribal groups compactly settled in The most prevalent tribal groups covering some districts (kozhuunakh) of Tuva. So, in Bai- more than 95% of population are as follows: Taiginskaya population total incidence rate of soyan, mady, oorzhak, kuzhuget, todgi, choodu, three prevalent surnames (tribal groups) – irgit, irkit, mongush, salchak, tongak, tumat, kyrgys, salchak, khertek – has constituted respectively 14, uigur, tulush, telek, khertek, saryg, karzal, khuular, 20, 22% or 54, 66 and 83% of total number of khomushku, khovalyg, sat, ondar, todot, derbet, this group of surnames, documented on the olet, olp. The most ancient ethnonyms are telek, territory of the entire republic. In many respects telengut, tolan, uigur, which origin is associated similar picture is observed in Barun-Khemchensky with period of Turk kaganats. Composition of rayon (kozhuget, oorzhak, saaya, saryglar, contemporary Tuvinians has been entered by khomushku), Dzun-Khemchensky (kara-sal, offspring of ancient Uigurs (ethnonym uigur) and kuular, mongush, ondar, sat), in Ulug-Khemsky, Kyrgyz (ethnonym kyrgyz); ethnonyms mongush Tandinsky, Todginsky rayons. In Bai-Taiginsky tongak, tumat, salchak, todgi indicate the role of rayon incidence rate of mental disorders in above medieval Turk and Mongolian tribes. However listed groups has constituted 0,61-1,1 (р>0,05); in there are many disputable questions about origin Barun-Khemchensky – 0,56-0,75 (р>0,05); in of that or another tribal group as a whole authors Dzun-Khemchensky – 0,33-1,33 (р>0,05); in notice that tribal composition of Tuvinians is Tandinsky – 0,33; in Todginsky – 1,1. Differences characterized by mixture of compounding it of indices in groups dislocated in places of their ethnic components (Potapov, 1969). compact living as well s living in other rayons We have carried out analysis of dispensary appeared to be insignificant. contingent of mentally ill in Tuvinian population Consequently, incidence rate of mental of some rayons of Tuva, where as a source of diseases in Tuvinians belonging to various tribal information data of dispensary account served groups in formed system of specialized assistance and namely surnames that were used as a rendering appeared to be equal both under “marker” of tribal belonging. Because surnames conditions of their compact living on the in Tuvinians as well as tribal belonging are traced preferred for this group territory and to equal according to male line development involved only extent it is fair for other territories of Tuva which males under dispensary account. We have drawn this tribal group is settled on. information of N. A. Serdobova (1971) about We have studied prevalence and clinical incidence rate of indicated families among structure of non-psychotic mental disorders in Tuvinian population also we took into Russian and Tuvinian population living in consideration influence of Russian language on Republic Tuva. During consideration of formation of contemporary Tuvinian surnames syndromal spectrum of borderline pathology and names (Bavuu-Syuryu, 2000). As a total we (neuroses and psychopathies) in studied have distinguished 27 tribal groups which populations it appears to be that neurasthenic representatives were under dynamic dispensary disorders were revealed in 1/3 both among observation for mental disorders. Russians and Tuvinians living on indigenous As rating of significance of differences of territory. Compulsive states were revealed only in distribution of patients and healthy persons in Russians (14 ± 4,6%). Hysteric neuroses in Tuva tribal groups we used criterion chi-square that in were not documented by local psychiatrists (this our interpretation indicates that mental disorders phenomenon we leave without comments). in tribal groups are of occasional character, i.e. in Concerning depressive (24 ± 9,3% и 20 ± 5,3% World Cultural Psychatry Research Review 2009, S1: 191-237
195 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION Р>0,05) and hypochondriac symptomatology (10 search for psychiatric assistance has achieved the ± 6,5% и 11 ± 4,2%, Р>0,05), here they were index 66,4 per 1000 of the adult population. found equally in persons of both nationalities. In However, this pathology was identified basically in personality disorders we have not revealed also Russian-language population. For subpopulation any substantial prevalence of those or other of indigenous population screening-methods of stigmata in patients of Russian and Tuvinian recognition of borderline disorders and “risk nationalities. However, for justice’ sake, it is groups” appeared to be ineffective as a necessary to mention that paranoiac psychopathy consequence of ethnocultural features, in in Russians was found twice as often than in particular, in aboriginal population of rural areas Tuvinians. The greatest specific weight in both there is not self-recognition of neurotic symptoms compared groups is occupied by psychopathies of and characterological personality disorders as well excitable range (43 ± 9,0% and 38 ± 6,1%, as fixation on complaints at neurotic level. Р>0,05, respectively). Investigations carried out in various ethnic For total identification of differences of groups of urban population have shown that syndromal structure inherent in neurotic character of search by mentally ill for psychiatric personality disorders revealed based on clinical assistance correlates with ethnic belonging. During picture in two considered ethnoses we regarded as study of clinical-demographic structure of group appropriate an application of criterion л (Medik, of non-psychotic disorders according to data of 2003) as a rating of differences in distribution of dispensary account it has been identified that at signs (syndromes). It appeared to be that there are low total level of recognition of persons with not sufficient grounds to think that syndromal borderline disorders in urban population patients distribution both in neurotic disorders and in of Tuvinian nationality addressed in single cases. psychopathies in studied Russian and Tuvinian During correlation in population of Russians and populations differ reliably. It may be supposed that Tuvinians 3 : 1 specific weight of ill with neuroses both ethnic populations according to set of Tuvinians has constituted 10% of all under distinguished syndromes do not differ between account. Hence during study of dynamic of each other. mental diseases and interrelationship of it with The above considered interrelationships of various social-economic factors it is necessary to borderline disorders in representatives of two take into account ethnocultural features of studied ethnoses in Tuva cover only contingents of population. patients under dispensary observation. For Thus, existing organizing structure of correction associated with specific national ways psychiatric assistance does not take into account of behavioral response we have analyzed ethnic peculiarities of aboriginal population. In prevalence of neuro-mental diseases among adult addition, cohorts selected as a result of selective inhabitants of one of rural human settlements of function of system of prophylactic medical Tuva. Investigation carried out with census has examination, - are not appropriate object for study covered 855 persons what has constituted 51% of of ethnopsychiatric problems. This is why, new the total adult population what has allowed methodological approaches to study of concerned identifying prevalence of non-psychotic disorders topic are necessary. in population approximating to the real one. According to data of official dispensary account, Bibliography non-psychotic mental disorders constituted 5,2 per Bavuu-Syurun MV. Influence of Russian language on formation of the contemporary Tuvinian surnames and names In: Popkov YV 1000 of adult population. Additionally, during (Ed). Ethno-social processes in Siberia: thematic collection. personal “household” examination we have Novosibirsk, Publishing House of SB RAS, 2000, p 204- actively revealed 3,5 per 1000 of the population 205 patients with non-psychotic disorders needing Medik VA. Sickness rate of population: history, state-of-the-art and psychiatric assistance. Persons suffering from methodology of study. - M.: Medicina, 2003, p. 512 Potapov LP. Sketches of folk way of life of Tuvinians. – M., Nauka, borderline disorders but needing other than 1969, p. 402 conventional dispensary observation forms of Serdobov NA. History of formation of Tuvinian nation. Kyzyl, specialized psychiatric assistance have constituted Tuvinian Publishing House, 1971, p. 482 12,7 per 1000; organic central nervous system Sociological characteristics of urban population of Tuvinian republic (materials of research).- Novosibirsk, Nauka, 240 impairments — 45,0 per 1000. Thus, total index p. 1982 of prevalence of non-psychotic mental disorders Weinstein SI. Historical ethnography of Tuvinians. M., Nauka, for rural rayon of Tuva summarized both during 1972, p. 314 active revealing the patients and independent
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196 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION
Home Violence and its Influence on Mental and Physical Health, Psychocorrective Assistance L.N. Avdeyenok (Russia), E.V. Gutkevich (Russia)
The violence always was a part of existence of the husband. The information is required, first of the human society. Its diversified manifestations all, for the description of consequences of can be seen in all corners of the world. Annually violence, understanding of what factors increase on Earth more than one million people perishes, risk of violence over a victim, definition of and the even greater number receives physical efficiency of psychotherapeutic programs of injuries without a lethal outcome. There are many prevention of violence. Sources of the information variants of definition of violence. WHO defines on matrimonial violence can be the separate violence as: deliberate application of physical persons indirectly concerning home violence strength, valid or as the threat, directed against (children, neighbors, grandfathers, grandmothers), itself or other person, which result are (or there is medical workers, and also the information from a high degree of probability of it) physical injuries, law enforcement bodies and other significant a psychological trauma, deviations in development persons for family (the girlfriend, the teacher). or various sort of damage. Use of physical Even when the information is present, its quality strength should be understood, in particular, as can not satisfy to the purposes of research and absence of care, any kinds of cruel treatment development of psychocorrective programs, first (physical, verbal, sexual or psychological). The big of all long work with a victim of home violence share of violence is made at home, in family. therefore is required. Any factor separately is not Cruel treatment concerns this group of violence capable to explain, why one person behaves with children, violence over the intimate partner aggressively, and another is not present. The home and cruel treatment with elderly. The majority of violence is a result of complex interaction of victims of such violence are too small (small individual, group, social, cultural factors and children and teenagers), are weak or sick to factors of environment. One of significant factors protect itself. Others owing to the pressure is the personal factor which plays a determining rendered on them or influences of customs and role in behavior of the person. The psychologist traditions are compelled to keep silence and to analyzes the personal biography, relations in speak nobody about the sufferings. Since the parental family, attitudes toward the child, violence has appeared, there are also various personal characteristics of parents, style of systems: religious, philosophical, legal, social, education, the attitude toward the senior medical and psychological, called to prevent or generation. Besides such factors as impulsiveness, limit home violence. Any of them was not a low educational level, abusing alcohol, and also successful, but all have contributed to struggle marked in the person in past aggressive behavior against violence. Consequences of home violence and cruelty are taken into account. In other can be reduced by means of educational programs words, at this level the basic attention is paid to for population, carrying out of preventive actions, such features which increase probability that carrying out of psychological lessons. The personality becomes either a victim of violence, or psychologists engaged in problems of home its originator. Numerous investigations show, that violence, experience difficulties with gathering the two models of violence are found: severe this is information on available violence. Frequently the characterized by several forms of aggressive fear of estimated judgment prevents clearing of behavior simultaneously and growing and the available problem situation connected to supervising behavior on the part of the offender; violence. Patients frequently do not wish to more moderate form when all members of family pronounce a similar situation, being afraid of constantly feel frustration and irritation which consequences and being ashamed of behavior of from time to time are poured out in physical World Cultural Psychatry Research Review 2009, S1: 191-237
197 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION aggression. Our investigations have shown, that diseases, irritable bowel syndrome is formed, etc. women with who most severely address, usually Influence of cruel treatment can be kept for a long not are passive victims, but apply active strategy to time after its termination. The heavier is cruel safety of children. A part of women show treatment, the more is its influence on physical resistance, others seek safety in flight, the third try and mental health of the woman. We have to keep the peace, conceding to requirements of surveyed and consulted 352 women who have the husbands. All these methods of avoiding of undergone to domestic violence. From them in violence result in decrease of quality of life and 78% surveyed social and family adaptation is deterioration of mental health. In the sharply reduced. They constantly are in a psychological plan in women the self-estimation is condition of stress, very much is frequently reduced, ability to take part in a social life of a hospitalized in various medical institutions, society is broken, they frequently do not have frequently call the ambulance. In conversation access to the information, cannot receive the help speak more often about suppressed mood and bad from close and other significant persons. They are physical condition; cry much, in them decreases in not capable, as follows, to take care of themselves feeling of self-esteem is frequently marked, low and children or to find work and to be engaged in self-estimation, inability independently to make a the career. The violence entails set of negative decision. Frequently in them interpersonal consequences for the health, shown as at once, relations with girlfriends, with fellow workers, with and through long time. In victims of violence the parents, with own children are broken. Search for risk also raises to have in the future bad physical psychological assistance demands from patients and psychological health. To be a victim of certain courage. Sometimes from the moment of violence is the same risk factor for of illnesses and fulfillment of violence over the moment of search unhealthy conditions, as smoking and abusing for help a lot of time passes. The competent help alcohol. The data of our investigations show, that of an expert will help to go through structurally women who have experienced physical and sexual happened and to turn from a victim of violence cruel treatment in childhood or in mature years over the person survived violence. All forms and have bad health more often, than other women methods and techniques of work of psychologist who have not experienced violence. In them are under construction so that to enable a victim psychological adaptation worsens, they get of violence to understand that nobody tries to harmful habits which further raise risk of various underestimate values of her difficulties and diseases even more, including smoking, abusing problems, but in them, these difficulties and alcohol and frequently drugs. Experienced problems it is possible and necessary to seek and violence puts women in group of the increased find means for improvement of position. Thus, the risk concerning depression, anxiety, phobias and patient is induced to seek her own resources of panic disorders. In them physical apathy, a low change as which acts both her past, and future, self-estimation, passive suicide ideas, sleep both memoirs and imagination, assisting to search disorders, the nightmares, repeating negative for answers to problems in personal experience. memoirs, sensation of the hostile attitude of the Alongside with rendering for patients society, chronic painful syndromes, psychosomatic psychocorrective assistance, they need long diseases, physical traumas, gastrointestinal emotional support, and also legal consultation.
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The Role of “Folk Psychiatry” in Clinical Practice L. Ban (Canada), N. Haslam (Canada), Y. Kashima (Canada)
Understanding the way lay people think about (2005) offers a four dimensional schema of the mental disorder is important to effective way information about mental disorder is psychotherapy. In view of the fact that it is lay processed by lay people. According to the Folk conceptions of mental disorder that determine Psychiatry model, people first demarcate normal whether professional help is sought, and that from abnormal behavior through the process of discrepancies in conceptions held by therapist and pathologizing. This involves judging that the client have negative implications for treatment, behavior to be rare (infrequent in the general research into lay conceptions is of crucial practical population), incomprehensible (difficult to importance. Haslam’s model of Folk Psychiatry understand), and discrete (qualitatively different World Cultural Psychatry Research Review 2009, S1: 191-237
198 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION from normal behavior). Once pathologised, moral” system of beliefs that may be somewhat Haslam contends that the behaviour is submitted unique to this cultural context (Hamilton, 1992; to one of three explanatory frameworks. These Kirmayer, 1989; Miller & Bersoff, 1992). are medicalizing, where illness is seen as Finally the results indicate that people from biologically based; moralizing, were illness is Western backgrounds may normalize behaviour to attributed to the sufferer’s poor character and the extent they find it psychologically conscious decision-making; and psychologizing, understandable. While a similar effect was found where unconscious processes are seen to underlie in research conducted by Meehl (1973) and Ahn, the behavioral abnormality. While offered as a Novick and Kim (2003) – who label it a universally applicable cognitive grid there is “reasoning fallacy” – this research indicates that evidence for cross-cultural differences in the use of the effect may be unique to the Western cultural these frameworks. The current research examined context, and that it does not occur among East whether different aspects of Haslam’s model are Asians. While the clinical implications of this culturally salient for people from Western (i.e., finding are unclear, “normalizing” mental Australian) and East Asian (i.e., Chinese, Korean disorder may reduce patients’ motivation to seek and Singaporean) culturally backgrounds. The help and actively participate in the recovery results indicate that not only are certain process. Overall, the findings of this research frameworks differentially emphasized across demonstrate that lay conceptions of mental cultural groups but the frameworks can have disorder can differ significantly across cultural different meanings depending on the cultural groups. In light of this, clinicians must be mindful belief system within which they are expressed. of the various belief systems that clients from Three studies explored the differential salience of different backgrounds bring to psychotherapy. Folk Psychiatry dimensions across cultural groups. First, the results indicate that the three References pathologizing criteria were differentially Ahn, W., Novick, L., & Kim, N. Understanding behavior emphasised as markers of abnormality. makes it normal. Psychonomic Bulletin and Review, 10, 746-752. 2003 Specifically people with East Asian backgrounds Hamilton, V. Everyday justice: Responsibility and the perceived abnormal behaviour to be more rare individual in Japan and the United Sates. New Haven & and discrete while people from Western London: Yale University Press. 1992 backgrounds perceived abnormal behavior to be Haslam, N. Dimensions of folk psychiatry. Review of General more incomprehensible. These findings provide Psychology, 9, 35-47. 2005 Kirmayer, L. Cultural variations in the response to psychiatric insight into help-seeking behaviour and how it disorders and emotional distress. Social Science and may differ for people from these cultural Medicine, 29, 327-339. 1989 backgrounds. Second, the results indicate that Meehl, P. Why I do not attend case conferences. In people with East Asian backgrounds moralize Psychodiagnosis: Selected papers (pp. 225-302). Minneapolis, MN: University of Minnesota Press. 1973 mental disorder to a greater extent. However there Miller, J., & Bersoff, D. Culture and moral judgment: How is evidence to suggest that moralizing in this are conflicts between justice and interpersonal context does not entirely conform to Haslam’s responsibilities resolved? Journal of Personality and Social moralizing framework. Instead this way of Psychology, 62, 541-554. 1992 explaining mental disorder may refer to a “socio-
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New Approaches within Medical Anthropology Applied to the Field of Migration R. Bennegadi (France), C. Paris (France), U.A. Kalil (France)
Minkowska Centre has acquired a long and forward the notions of Clinical Cultural rich experience, over the past 50 years, in migrant Competence and Social Cultural Competence to and refugee mental healthcare. define the most adaptive therapeutic frame in We propose, thanks to the contributions of psychotherapeutic situations. Medical Anthropology and Psychoanalysis, to put
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199 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION
Stress and Stress Resistance as Ethnocultural-Historic Phenomena T.G. Bokhan (Russia) & N.A. Bokhan (Russia)
This article presents understanding of stress and stress the world reflected in consciousness of an resistance from positions of cultural-historic approach, individual and image of his/her life that needs a introduces results of phenomenological investigation of correction because it cancels corresponding to a difficult situations in representatives of youth of peoples of new image of the world; 3) as an inner state of the Siberia (Altayts, Buryats, Shorts, Khakases, Tatars, and person who overcomes formed behavioral ideas Russians). and stereotypes already not purposeful under new conditions of life and who identifies him/herself Key words in his/her new meanings and values of being. stress, stress resistance, cultural-historic conditionality, self- development, self-realization, difficult situation, meaning content, heterostereotypes, identification, distress prevention. Relying on methodology of cultural-historic approach cross-cultural investigation of stress and Problem of stress is a poly-disciplinary stress resistance has been carried out. The problem. For psychiatry that considers stress as investigation was entered by respondents at the one of factors conditioning formation of neuro- age of 16-22 years – schoolchildren and students mental disorders of special significance is a task of (representatives of nationalities living in Siberian understanding of stress as a psychological region: Buryats, Russians, Tatars, Altayts, phenomenon. Its resolution in contemporary Khakases, Shorts, Yakuts); total number of psychology is seen in considering the stress in respondents, teenagers, has constituted 970 cultural-historic context. This allows questioning persons. As a result we have presented the what culture is transformed into human life world, phenomenology of stress in teenagers of ethnic what specifically does it change in an individual, in groups of Siberia (Altayts, Buryats, Khakases, his/her mental resources and abilities Shorts, Yakuts, Tatars, and Russians) in the guaranteeing stability in dynamic of life world, context of formation of the personality in various what difficulties of self-development are cultures and poly-cultural world. We have shown experienced by the individual, what traditional cultural-historic determinants of stresses meeting means of coping with stress are acquired by stages of formation of human consciousness as a him/her. Cultural-historic approach allows culturally conditioned phenomenon. considering the stress and stress resistance as With content-analysis of statements of phenomena accompanying the process of human respondents it has been identified that for majority self-development, self-formation. They are of teenagers, appearance of difficult situations is signaling about degree of success of real, well conscious evidence in their life – they transformation of culture into human life world. were able to give definition of difficult situation, to Stress is manifested ambivalently; it may be present their own examples as well as to name experienced as self-diagnosis of the person difficult, in their opinion, situations of peers of detecting new possibility of his/her development other nationalities. Stressful, difficult situations for and possessing readiness for self-development teenagers are real-characteristic problem (model of “eustress) and a an assessment of situations of everyday life but not extreme, crisis beginning destruction of the person who is not situations or catastrophic events, the latter have able to maintain his/her integrity in dynamic of been indicated singularly (earthquake, fire, life changes what is manifested in experiencing catastrophe). impossibility of self-realization (model of Meaning categories of difficult situations have “distress”). Stress may act: 1) as a signal about been represented by two types: the first type is disturbance of the process of life self- associated with impossibility of realization of accomplishment, about state of the process of strives typical for level of value consciousness: a) to personality self-realization; 2) as reflection of be able to cope independently with difficulties, to appearing contradiction between actual images of influence and determine by him/herself the World Cultural Psychatry Research Review 2009, S1: 191-237
200 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION outcome of events, to make independently complete identification without specification of decisions; b) to strive for communication of content of difficult situations; 2) identification with quality at the level of understanding what testifies his/her own specific problems in some areas of to growth of possibilities of self-reflection and vital activity; 3) identification with his/her own strive for self-expression in interpersonal experiences associated with difficulties of self- communication; c) to be guided by idea about realization; 4) negative identification – national inevitability of difficult situations on the life way discrimination, difficulties in communication of the person and about necessity of their rising because of belonging to another nation; overcoming for realization of his/her aims and fights, quarrels between each other, with peers; plans; d) to lay claim to personal appreciation in drinking, drugs, smoking. Account for these types new acquaintances, in the society. The second of identification in trainings of intercultural type of meanings of difficult situations is tolerance will allow forming in youth the readiness associated with impossibility of realization of to effective transformation of difficult situations needs of levels of object and meaning rising in poly-cultural environment. consciousness: in dependence, in social support, in Content-analysis of statements completing not inner peace and absence of tension, in successes in complete sentences has distinguished meaning learning activity, in comfort relations with parents categories of attitude of respondents toward and peers, in material security. Identified types difficult situations: “experience of incidence rate”, show that stresses have dynamic of quality “possibilities-limitations of self-development”, corresponding to levels of formation of the “feelings and states”, “difficulties of interpersonal human consciousness in ontogenesis. relations”. Stress tension, thus, is conditioned by In the same time, in meaning content of not only blocking of homeostatic but also stresses a trend is traced reflecting their cultural heterostasic strives of respondents. These data conditionality. So, in Russians as, to certain extent, allow speaking about cultural-historic changes in representatives of West culture most frequently understanding of nature of stress. In this stressful situations are associated with difficulties association, difficult situations may be considered of decision making and choice. While in teenagers not only as stressors provoking states of tension of traditional cultures of Siberia (Altayts, Buryats, but also as integral fragments of human life Khakases, and Shorts), representatives of East associated with his/her self-development, self- culture, the foreground is entered by problems in perfection. school, quarrels with friends, in family. Probably, Most students in all national groups refer to for many representatives of youth of traditional incidence “rate” of difficult situations what may cultures of no relevance are problems of choice, testify to experience of presence of difficult their own decision making because they are built situations in everyday life of youth of peoples of and fastened traditionally in consciousness and Siberia. These respondents do not open for behavior of youth. In this association one could themselves their meaning content. Without suppose that if fastened in traditional culture thinking of meanings of difficult situations they values and ways of behavior will not be conscious can experience difficulties in coping with them independently and accepted by youth so in and experience rate of their rise. resolution of difficult situations under conditions The second place according to incidence rate of both traditional and poly-cultural space they in Russians, Khakases and Shorts is occupied by can be used unconsciously and inflexibly thereby meaning category “possibilities-obstacles for resulting in impossibility of self-realization and personal formation”. Respondents associate coping with problems. Indirectly, it is confirmed difficult situations with possibilities of self- by incidence rate in respondents of traditional development, self-realization, self-understanding, cultures of Siberia of such meaning category of self-respect, self-assertion, cognition of world, difficult situation as “helplessness, absence of way meaning of life, sensation of its completeness, and out”, while in respondents of Russian sample the acceptance of life with its existential variability. second place according to incidence rate is Such meaning content has a cultural occupied by categories “feeling, state”, “barrier for conditionality. It is manifested in that for sample overcoming” what testifies to some readiness to of Russian respondents significance of such idea realization of appearing in stressful situations toward difficult situations may be associated with feelings and states, to their overcoming. trends in Russian society associated with departure The investigation has distinguished from dominance of collectively oriented values to heterostereotypes of difficult situations forming in values of uniquity of the individual, his/her youth through mechanism of identification: 1) activity and responsibility for building his/her own World Cultural Psychatry Research Review 2009, S1: 191-237
201 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION life. For Khakases and Shorts as representatives of of self-reflection and efforts in self-change under scanty nationalities assimilated in poly-cultural new conditions of socio-cultural development may space of Siberian region of Russia, strengthening result in growth of stress tension both in and growth of national self-consciousness is a traditional and poly-cultural environment, its condition of maintenance of traditional culture. negative consequences for personality and health. In this association understanding of difficult Difficult situations as problems of situations as “possibilities-obstacles for self- “interpersonal relations” associated with conflicts, development” is conditioned by relevant for them misunderstanding, quarrels, ill-disposed attitude in tasks of self-assertion, self-respect and self- family, with surrounding people, peers are not understanding under new cultural-historic indicated by Khakases and Shorts, are of small conditions. representation in Russians, occupy the third The second place according to incidence rate position according to incidence rate of categories in Yakuts, Buryats, and Altayts is occupied by in groups of Yakuts, Buryats, Altayts. category of “feelings and states”. It reflects Phenomenology of difficult situations of youth experiences of difficult situations as loss of of peoples of Siberia studied from positions of control; rise of negative emotional and physical cultural-historic approach allows considering the states; sensation of deadlock and hopelessness, stress as a cultural-historic phenomenon. Results isolation; loss of balance, harmony. Values of of the investigation give orientations for harmony are attributed by investigators to ones of organizing the distress prevention and correction values of traditional culture. Probably, among youth with account for revealed ethno- representatives of these aboriginal cultures, more cultural and cultural-historic conditions of multiple and living on the united territory are development; may be used by teachers, troubled by tension of personal experiences and psychologists, psychotherapists in optimization of states. Their fixation and acuteness may reflect study process, interethnic communication, difficulties of self-formation under conditions of trainings of intercultural tolerance in poly-cultural dominance of traditional values. Thereby, absence environment of universities.
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Effect of Spirituality Well-Being on the End of Life in Terminal Cancer Patients A. Bovero (Italy), D. Palmisano (Italy), F. Aitoro (Italy), R.Torta (Italy)
Package for Social Sciences (SPSS 17.0; SPSS Objective Inc., Chicago Ill.). This study examined the impact of spirituality on quality of life in a sample of terminally ill Results patients with cancer in hospice. Significant correlations were seen between spiritual well-being and depression and anxiety Methods (p<0.05, p<0.01), positive correlations between It was carried out by S.C.D.U. Psychoncology pain and faith (p<0.05) and between some coping in hospice “Valletta“ in Turin. Fifty patients were styles (religion, acceptance) and faith (p<0.01). recruited with a life expectancy <3 months The Independent Samples t-Test highlighted (Karnosky Performance Status<50). Patients were significant differences between the two groups evaluated with the following Rating Scales: the (who prays/who doesn’t pray) for anxiety Hospital Anxiety and Depression Scale (HADS), (p=0.05), negation (p<0.01) and spiritual well- the Visual Analogue Scale (VAS), the McGill Pain being (p=0.05). Additionally significant differences Questionnaire (MPQ), the Brief Cope and the were shown between the two groups (participants Functional Assessment of Cancer Therapy with low spiritual well-being/participants with Spiritual Well-Being Scale (FACIT-Sp). Religiosity high spiritual well-being) for anxiety, depression was measured with the following two questions: (p<0.01), for the research of meaning and peace ‘‘Do you consider yourself a religious person’’ (p<0.01) and for some positive coping styles (yes/no) and ‘‘How often do you pray”. All data (religion, acceptance) (p<0.01). analysis were performed using the Statistical World Cultural Psychatry Research Review 2009, S1: 191-237
202 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION Conclusion spirituality may play an important role at These results showed the importance of improving quality of life among the dying. culture at the end of life and suggested that
Suicide Prevention. The Point of View of Italian Gays, Lesbians and Bisexuals A. Buffoli (Italy/Australia), E. Colucci (Italy/Australia)
Introduction gay or bisexual answered to an on-line survey International epidemiologica studies hosted on an internet website. demonstrate that gay and bisexual people are more likely to attempt suicide than the Results heterosexual counterpars. This study reflects the Data collected through the semi-structured paucity of reserch about self-harm and suicidel questionnaire are compared for gender, behaviour in Italian homosexuals. geographical provenience and sexual orientation. More than 80% of the sample reported to have Method thought about suicide and 18.5% reported one or 590 Italian partecipants (498 M and 92 F) , 25- more suicide attempts. Participants living in rural 65 years old, who identified themselves as lesbian, areas in South Italy were at greater risk of suicide.
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Self-Harm and Suicidal Behaviour among Adult Italian Lesbians, Gays and Bisexuals A. Buffoli (Italy/Australia), E. Colucci (Italy/Australia)
Introduction line survey hosted on an internet website. The study of the meanings of suicide is generally an unexplored area and it is particularly Results so for homosexuals or bisexuals. A deeper Data collected through a semi-structured understanding of the cultural representation of questionnaire are compared based on gender and suicide can give a substantial contribution to the sexual orientation. Participants attitudes towards development of adequate suicide suicide and its prevention, their beliefs on the prevention/intervention strategies. differences between males and females suicide, and reasons for suicide in homo/bisexual people Method will be explored. The paper will also indicate the 590 Italian participants (498 males and 92 main prevention strategies suggested by the females), 25-65 years old, who identified as participants. lesbian, gay or bisexual (LGB) answered to an on-
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“Sexting” and the American Teenager L.Chen (USA)
“Sexting” is the digital transmission of sexually primarily because of the unforeseen legal charged text messages, pictures, and videos, consequences that have resulted when adolescents usually by cell phone. Sexting is receiving engage in this behavior. A typical example: a 15 widespread media attention in the United States, year-old girl uses her cell phone to take a nude World Cultural Psychatry Research Review 2009, S1: 191-237
203 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION picture of herself. She sends this photograph to PsychInfo and PubMed yielded no results. The her 17 year-old boyfriend. The boyfriend topic merits attention from psychiatrists as well. forwards the picture to several of his buddies. The phenomenon of sexting raises many Several laws have been broken, and everyone questions from a cultural and adolescent involved is facing legal charges. The girl is psychiatry perspective. charged with production, possession and Is sexting among adolescents within the distribution of child pornography. The boyfriend realm of normal adolescent sexual exploration is charged with possession and distribution of and sexual identity formation? child pornography. The friends are also charged Given that sexting if fairly common among with possession of child pornography, even though American teenagers, can we think of it as a they did not seek out or solicit the nude picture of behavior that teens use to increase affiliation the girl, and did not know what they were opening and affirmation with peers? when the message appeared on their phones The majority of adolescents seem to be aware saying that their friend had sent them a picture. of the possibility of adverse, unintended Depending on which state they are in, the consequences of sexting, yet still engage in it. teenagers can be charged as minors or as adults, Could sexting be considered an example of their charges may be considered misdemeanors or adolescent risk tasking? Does it represent an felonies, and they may have to register as sex example of what Elkind (1967) described as the offenders. “personal fable” of adolescence, i.e., the belief A recent online survey (The National that one is unique, special, and invulnerable to Campaign to Prevent Teen and Unplanned the consequences of risky behavior? Pregnancy, 2008) of 653 teenagers ages 13-19, In a country that frequently glamorizes the and 627 young adults ages 20-26, explored the sexuality of teenagers, e.g., sexually provocative prevalence of and attitudes about sexting among photo spread of 16 year-old teen idol Miley teenagers and young adults in the United States. Cyrus in Vanity Fair magazine, does American 75% of teenagers and 71% of young adults culture promote the sexualization of minors, said that sending sexually suggestive material and thus sexting? can have serious negative consequences, yet Although there have been media reports in 20% of teenagers and 33% of young adults other countries, including Australia and the have sent or posed on websites nude or semi- United Kingdom, there is relatively little known nude pictures or videos of themselves. about sexing around the world. How prevalent 36% of teenage girls and 39% of teenage is sexting in other countries and cultures, and boys said it was common for nude or semi-nude how do adults view it? photos to be shared with people other than the Explicit photographs are yet another weapon intended recipient. some adolescents use to bully a peer. In 2008, 22% of teenagers said that they are an 18 year-old girl in Ohio committed suicide personally more forward and aggressive using after the nude picture she sent to a boyfriend sexually suggestive words and images than they was distributed around school. She had been are in “real life.” harassed by fellow students, and called a whore. 51% of teenage girls say pressure from a boy What is the relationship between sexting, is a reason girls send sexual messages or images, bullying, and school mobbing? whereas only 18% of teenage boys cited In what contexts would it be appropriate to pressure from a girl as a reason for sexting. consider sexting a crime? Widespread distribution of the images? If coercion were involved? If the recipient of the image was a 37 The term “sexting” is quickly becoming part of year-old instead of a 17 year-old? the American vernacular. One barometer of What is the psychological impact of sexting sexting’s relevance is the fact that a recent episode on adolescents? What is the psychological of the popular American television series, “Law impact of criminal prosecution and being and Order,” featured a story about teenage labeled as “sex offenders”? sexting. Major media outlets e.g., The Wall Street Journal and CNN, discuss sexting; the American A discussion of sexting among adolescents Civil Liberties Union has filed sexting-related requires consideration of developmental, legal, lawsuits; and U.S. lawmakers are scrambling to social, and cultural issues. The poster introduce new legislature specifically addressing presentation will present information on the sexting. However, a search for “sexting” in prevalence of sexting in the United States, the World Cultural Psychatry Research Review 2009, S1: 191-237
204 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION myriad legal consequences of sexting and http://www.brisbanetimes.com.au/technology/parents- measures being taken by U.S. lawmakers to get-sext-message-20090503-aqzu.html Accessed May 16, 2009. address sexting. The presentation will touch on Elkind D. Egocentrism in adolescence. Child Development. key elements of adolescent development, 1967;38:1025-34. including sexual identity formation, risk taking, Feyerick D, Steffen S. ‘Sexting’ lands teen on sex offender list. and body image issues. Finally, the presentation CNN.com April 8, 2009. Available at: will examine the role of mainstream American http://www.cnn.com/2009/CRIME/04/07/sexting.bust s/index.html Accessed May 16, 2009 culture on the prevalence of and attitudes toward Gavin P. Congress takes on ‘sexting’. Politico.com. May 13, sexting, and question how prevalence and 2009. Available at: attitudes would vary in other http://www.politico.com/news/stories/0509/22487.html countries/regions/cultures. Accessed May 16, 2009 Handy B. Miley knows best. Vanity Fair. June 2008. Available at: References http://www.vanityfair.com/culture/features/2008/06/m ACLU Sues Wyoming County D.A. For Threatening Teenage iley200806 Girls With Child Pornography Charges Over Photos Of Kazdin C, Ibanga I. The truth about teens sexting. ABC Themselves. Press release. ACLU.org March 25, 2009. News. April 15, 2009. Available at: Available at: http://abcnews.go.com/GMA/story?id=7337547&page http://www.aclu.org/privacy/youth/39151prs20090325. =1 Accessed May 16, 2009 html Accessed May 16, 2009 The National Campaign to Prevent Teen and Unplanned Bialik C. Which Is Epidemic -- Sexting or Worrying About Pregnancy, and Cosmogirl.com. Sex and tech: results It? The Wall Street Journal. April 8, 2009. Available at: from a survey of teens and young adults. 2008. Available http://online.wsj.com/article/SB123913888769898347. at html Accessed May 16, 2009. http://www.thenationalcampaign.org/sextech/PDF/Sex Carty L. Parents get sext message. Brisbane Times. May 3, Tech_Summary.pdf Accessed April 24, 2009 2009. Available at:
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Intrahospital Adaptation of Persons of Gipsy Nationality Suffering from Comorbid Mental Disorders D.V. Chetverikov (Russia), N.A. Bokhan (Russia)
In scientific investigations of last years various consumers - sellers from ethnic communities from approaches to problem of a combination of which are most appreciable the gipsy, Caucasians various psychopathological and addictive and also Tadjiks and Afghans are frequently phenomena, including ethnocultural approach are occupied. Criminal activity of gipsy drug groups is realized. Substantially ethnocultural specificity expressed in illegal purchase, transportation, determines both clinical features of comorbid storage and subsequent selling of drugs. The gipsy disorders, and opportunity of treatment and in manufacturing and processing of drugs rehabilitation of patients. From numerous basically are not engaged, they package drugs for ethnoses living in Russia, the only migrating one is retail, is frequent for increase in volume of sold the gipsy which uniqueness as object of "goods" adding in a drug various substances or ethnographic researches it is caused by a number medical products. Gipsy women are more active, of reasons - absence of geographical frameworks than men; participate in drug traffic which in many respects, genetic, social and psychological frequently is the important source of the income closeness of population of the gipsy, endogamy of family. The gipsy, however, are appreciable (marriages inside social group), common language mainly in retail drug traffic and, despite of and culture, aversion of assimilation, "gipsy" laws presence of gipsy communities in the majority of which traditionally are higher than other legal the Russian regions, are poorly represented at the frameworks etc. In these specific conditions level of inter-regional wholesale trade. The given psychopathological disorders are formed rather circumstance facilitates access to drugs and, originally, in particular – addictive disorders. accordingly, is the reason of high level mental Criminological investigations of last years have disorders. shown, that in regional and inter-regional systems For the purpose of study of intrahospital of illegal circulation of drugs sellers and adaptation we investigated 56 gipsy, the gipsy World Cultural Psychatry Research Review 2009, S1: 191-237
205 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION nationality, suffering from psychiatric disorders manipulative reactions where threats of physical associated with chemical addictions and taking violence, offers of money inconsistently sounded, place treatment in specialized structures of Omsk simulation of physical diseases and etc. Psychiatric Hospital. Nosological spectrum of comorbid pathology is 3. Adaptation in the hospital environment represented by syndrome of dependence on in the gipsy is the lowest. Practically in some hours alcohol and mental disorders from schizophrenia after hospitalization all patients irrespective of (8 supervision), recurrent depressive disorder (10 mental and somatic condition became the supervision), organic disorders (3 supervision), and extremely suspicious, and later - motor and somatoform disorders (5 supervision). Syndrome verbally active, made chaotic movements of of dependence on heroin in sample is comorbid enclosed character, entered causeless into conflicts with schizophrenia (6 supervision), with bipolar with other patients and medical staff, substandard affective disorder (3 supervision), recurrent quarreled, threatened, demanded an immediate depressive disorder (4 supervision), and organic discharge, showing thus surprising persistence and disorder (1 supervision); most frequently there uncompromising stand. The given phenomena were personality disorders - 16 supervision. were strengthened with presence of numerous Despite of so wide representation of various relatives which practically did not depart from the mental diseases we have estimated para-hospital patient, moreover were initiators intrahospital features of patients. consumption of narcotic substances.
1. Attitude toward mental disease. 4. Compliance in persons of gipsy nationality is In the given context we shall note, that the lowest. If in other situations non-compliance is practically all mentally sick persons of gipsy usually connected with let and frequently insolvent nationality differed by noncritical attitude toward attempts to rationalize refusal of reception of disease what is connected mainly with external psychopharmacological agents in this ethnic group factors - fatigue, excessive substance use or their we have faced unmotivated refusal. Patients combination. Explanations of irrational character categorically refused to accept quite often sounded. It is necessary to note, that in psychopharmacological preparations, and similar described ethnocultural group attitude of relatives refusal we met also in relatives of patients. of the patient toward anyone with disease, even to somatic or infectious (the HIV-infection, hepatites) 5. Reactance in the attitude toward was rather original - after rather expressive psychopharmacological treatment. reactions with verbal and motor excitation, We shall note, that expected effects of lamentations, superfluous aspiration to psychopharmacological preparations at mentally performance of medical purposes, the behavioral patients the gipsy met less often, as, however, in component was very poor and was limited to the representatives of other east ethnoses (Armenians, formal consent to treatment. the Turkmen, Tadjiks). By-effects and complications were found more often, especially 2. Cultural manifestation of mental during administration of traditional antipsychotics pathology. and tricycle antidepressants that also essentially Mental disorders in cultural environment of reduced compliance of patients. persons of gipsy nationality were interpreted Specified paraclinical features of mental ill unequivocally negatively; moreover, presence of persons of gipsy nationality, in our opinion, will mentally ill relative long time disappeared from promote construction of effective clinical tactics in associates, as stigmatized a sort of search for treatment of the given comorbid disorders. As specialized psychiatric help in gipsy environment it possible alternative to traditional hospital has been connected more often with urgent approach in the attitude of mentally patients of conditions. Other reason of search for psychiatric gipsy nationality can be considered assertive help was presence in the anamnesis of recently methods of the organization of psychiatric help perfect socially dangerous actions and threat of when patients receive necessary treatment directly criminal prosecution. In general the aspiration to in the camp which periodically visit psychiatrists manipulativeness in given ethnocultural groups is and experts in addictology of specialized poly- extremely expressed. During the slightest attempts professional team. Also, taking into account the of the medical personnel to limit the behavior of above-stated features, work with leaders of camp the patient directed on search and reception of (“gipsy barons”), unique persons who can really substances, were observed poly-modal raise compliance of patients. Besides described World Cultural Psychatry Research Review 2009, S1: 191-237
206 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION features allow expanding anthropological ethnos what are the gipsy. representations about closed enough migrating
Advertising God F. Cieri (Italy)
At the end of october 2008, the British the advertising agency that subsequently cancelled Humanist Association, has proposed an the campaign. advertising campaign in the United Kindom, Let us just reflect, and allow reflection, on announcing their point of view on the religion some of the issues that in our country are still question: “There’s probably no God. Now stop warring taboo: the unjustified privileges of the Catholic and enjoy your life”. The idea was resumed in the Church, the existence of a "secular ethics" that is United States with the slogan: “Why believe in God. not derived from the ten commandments, the Be good for the sake of goodness”. The advertising has heavy influence of the clergy in matters as found even in catholic Spain, but has been less scientific research, euthanasia and abortion, that successful in Italy, where it was promoted by the should not be decided by bishops appointed by the Italian Union of Rationalists Atheists and Pope. Here, as in the rest of Europe, society is Agnostics (UAAR), with the slogan: “The bad news becoming increasingly secularized, but the church is that God doesn’t exist. The good one, is that you don’t remains very strong politically, holding parties need one”. The italian Catholic Bishops Conference hostage and influencing much of what happens in President, Cardinal Angelo Bagnasco found out Italy. about the advertising and he immediatly wrote to
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Psychopharmacology, Genetic and Culture F. Cieri (Italy)
One of the most interesting developments of response to drug therapy, increasing knowledge on cross-cultural studies concerns the genetic- functions and neural structures culturally sensitive. investigation aim to the study of genotypic The study of the different psychopharmacological differentiation factors between different cultural treatment response by different ethnic groups groups, which results in variations on the (etnopsycopharmacology) represents an example phenotypic expression of proteins involved in of “good clinical practice” within those psycho- interaction with drugs. social intervention models that aim to reflect the Thus, pharmacogenetics would find a cultural diversity of society in which developed. prominent place within the study of ethnic variation (Ethnopharmacology) and cultural
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Anthropological Research of Post Traumatic Stress Disorder in the City of São Paulo J.D. da Silva (Brazil), D. Martin (Brazil)
Introduction Disorder (PTSD) in a context of the patients daily This text discusses the Post Traumatic Stress- life and his relation with the society, in an urban
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207 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION environment marked by a vast social inequality incomplete. Although all patients accept the and a high index of violence. The investigation is diagnosis of PTSD, during the interviews they carried out in the city of São Paulo with victims predominately talk about their condition of being of urban violence involving a shotgun. The victims of violence than to recognise their participants are PTSD diagnosed patients, treated disorder. Despite the missing comprehension of in a specialized psychiatric outpatient service. the nature of their disorder they all accept their São Paulo is Brazil's biggest city. It counts up to diagnosis and medication. 18 million people (SEADE, 2009) and is one of The elaboration of PTSD is experienced by the countries most violent cities. The rate of many of the patients only in the perception of homicides shows a drastic increase. Between1993 their symptoms. The intense fear is perceived as and 2003 the coefficient of homicides on every tachycardia, sweating, vertigo or panic attacks in 100.000 grew from 38,92 to 47,95 (DATASUS, habitual situations. Some of the patients 2007), which shows an increase of more than 23% interviewed needed to pass lots of physical in ten years. examinations before they would understand their The aim of this study is to understand how this problems being of a psychological origin. These “mental suffering” is dealt with, by PTSD patients only sought psychological help after diagnosed patients considering the social cultural having consulted various specialists such as context. PTSD is a violence related mental health cardiologists, neurologists or general practitioner. disorder being the principal mental health Like the ethnographic observation and the diagnosis of external cause. The relation between interviews reveal was the violence not only PTSD and urban violence is proved by a high experienced during the traumatic event which index of PTSD in areas of dense population initially caused their disorder, but is constantly (Breslau et al. 1992). In the face of phenomenons present in the patients perception. They identifies of urban violence, violence against women and the violence in her/his daily routine and feels violence against children, the estimate of PTSD more vulnerable coping with the urban violence victims in Brazil is high (Kapczinnski, 2003). The now, than before suffering her/his traumatic rate of shotgun caused homicides in Brazil is one event. Many patients point out to always having of the highest world wide (Waiselfisz, 2006). been aware of the existence of violence in the city There are only few international studies on and to already having got used to it. The PTSD and Culture, and in Brazil this one is the causation of the traumatic event is presented in an first. A qualitative study, based on the ambivalent discourse, being explained by the anthropology, was performed, including dense patient either on a social problematic or on a ethnographic observation, in-depth semi- individual-religious basis (been predestined to the structured interviews and the use of photography event). as a research technique (Martins, 2008). All patients interviewed report a frequent and Eight interviews with PTSD diagnosed patients close contact with conflict areas i.e. live or work (F43.1, ICD-10 – World Health Organization, close to a “favela”, where generally exists intense 1997) were carried out within a period of 6 month drug traffic, an often violent activity which makes (December 2008 – May 2009). The patients, five many of the PTSD diagnosed feel threatened or men and three women between 25 and 47 years uncomfortably. All of them report crime related old (average 34.7 years) with the majority of them fear when going out at night, or being confronted having secondary school level and professions such with the noise of ambulance or police sirens to the as office assistant, bus driver, caretaker, police point of feeling extremely suspicious of passing officer, journalist and physiotherapist, were motor cycles, associating them with a potential contacted through the PROVE (Programa de danger. Atendimento e Pesquisa em Violência). An An other important aspect is the prejudice outpatient service, connected to the research those patients' social life suffer due to their department of the Federal University of Sao traumatic experience. The interviews reveal that Paulo (UNIFESP). All patients interviewed lived the patients social relations both in private - through traumatic situations with a shot-gun (family, neighbours, friend) and in their involved (either robbery or kidnapping), and are professional life (work) undergo huge restrictions. being treated by the above service for at least 3 Some of the patients interviewed still don't moths. manage to carry on working as they identify various risk factors at their work, e.g. errands, Results bank visits, driving in traffic or interference with The research results at this moment are still the poorer population. World Cultural Psychatry Research Review 2009, S1: 191-237
208 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION The interviews also revealed a difference in the collective insecurity, is promoting a disorganisation society's comprehension between the terms in the traditional forms of sociability inside the “victim of violence” or “PTSD sufferer”. While urban lower class and stimulates more and more patients were paid attention to when telling about fear inside the middle and upper class (Adorno, their suffered violent experience, they were little 2002). In the populations point of view, the public understood when explaining their symptoms of authority's capacity to apply law and order has disorder. All interviewed patients complain about weakened. the society's misunderstanding that the mere fact In this context, for PTSD patients it is difficult of having survived the incident gives already to understand their disorder because the suffering sufficient motivation to cure the trauma, and get of intense fear and panic is not purely a symptom back to normal live. of their disorder. It is widely spread already in the sociability of the in habitants of São Paulo, not as Conclusion exaggerated as for PTSD patients, but existent. The discussion of the relation between PTSD The patients comprehension of their disorder and urban violence is more of collective character differs from the medical comprehension of PTSD. than individual. Since violence has entered the They express their disorder more in the sense of society in all parts and for all times, the patient’s victimisation than by the narration of the actual concern is more about his coexistence with the symptoms. violence, which is omnipresent and of whose existence he already knew before, than about the References treatment he's receiving or a possible cure of his Adorno S, Cardia N. Temas e Tendências: Violência. Revista disorder. Ciência e Cultura. SBPC, Ano 54, n. 1, julho/agosto de 2002. Brazil has no tradition of studies on violence. Breslau N, Davis GC, Andreski P, Peterson E. Traumatic The existent literature obtains its most important events ande posttraumatic stress disorder im am urbam contribution from areas like the Social Sciences, populatiom of young adults. Archives of General Psychiatry , Psychology and Law. In the medical field, the 48, 216-22, 1992. studies on violence are principally based on Datasus Departamento de Informática do SUS / Ministério da Saúde (2007). Avaiable mortality rates and injury rates. Although those from:http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sim/cn categories give information on the magnitude of v/extsp.def the phenomenon, they can't explain the problem Kapczinnski F, Margis R. Transtorno de estresse pós- of violence in its profundity. traumático. Rev. Brás. Psiquiatr. (supl. I): 12-6, 2003. Martins JS. Sociologia da Fotografia e da Imagem. São Paulo: In Brazil the diffuse and focused violence is Contexto, 2008. generally known by its tragic and cruel effects, but Organização Mundial da Saúde. Classificação de transtornos its missing a satisfactory comprehension which mentais e de comportamento da CID-10: referência rápida. Trad. explains the phenomenon. The country Gabriela Baldisserotto. Porto Alegre, Artes Médicas. experiences a conflict situation difficult to classify. 1997. Seade. Sistema Estadual de Análise de Dados Estatísticos. Informações With a shotgun caused mortality rate comparable dos Municípios Paulistas. Available from: www.seade.gov.br/ to countries in a warlike conflict, the country's produtos/ perfil/ index.php 2009 classification escapes the definitions of common Waiselfisz JJ. Mapa da Violência 2006: Jovens do Brasil. patterns of civil or international war. Organização dos Estados Ibero-Americanos para a Educação, a ciência E a cultura (OEI). Brasília, 2006. Especially the emergency of the drug traffic, being largely responsible for the construction of a
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A Psycho-Educational Intervention Applied to the East- European Patients with Various Mental Disorders and to their Families F. Dingo (Italy), E. Dall'Ara (Italy), G. Guerrini (Italy)
Scientific trials have pointed out the effectiveness disorders. The practical experience also suggests of the psycho-educational intervention on the its use for dealing with the patients' and their clinical and social outcome of the serious mental families' needs. On this ground the Mental Health World Cultural Psychatry Research Review 2009, S1: 191-237
209 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION Department (DSM) of La Spezia has put in action to the evaluation and the preparing of the persons a FPI (Family Psycho-educational Intervention) to train. They have been followed by informative program which has been financed by the group meetings devoted to the explanation of European Social Fund (ESF). mental disorders, their aetiology and treatment. It The particular aim of the program FPI is to has been explained in terms of a diathesis stress concur to the development of transversal skills vulnerability and bio-psycho-social model. The according to the guidelines of the European psycho-educational training of the immigrant Recommendation for the skills and competences patients has been adjusted for cultural reasons. of the active citizenship. Therefore the patients are getting trained into the In this contribution will be illustrated the comprehension of the environment differences methodology and the preliminary results of this and intercultural skills in addition to the health particular intervention. literacy, the development of personal and social The Family Psycho-educational Intervention (FPI) skills, the monitoring of proper emotions, the has a cognitive-behavioural ground and considers determination of the life goals and the use of knowledge and information to be central. problem solving. Therefore the fundamental element of the The group consists of six patients of age ranged intervention is that of giving information about from 23 to 40 (with an average age of 34). Five of the characteristics of the pathologies, the relative them come from East Europe and suffer from available treatment and the learning of the various psychiatric pathologies as schizophrenia, effective and functional modes for coping depression and borderline. The fundamental potentially stressful situations, focusing the problem with this kind of group is the risk of attention of the operators to the cultural and drop-out. In addition to other reasons the social communication abilities and problem economic, domestic, political and geographical solving. precariousness causes the absence of their families The training began in the spring of 2009 and it in the training meetings. will last 44 hours (22 meeting weekly or every two weeks). The first three meetings has been devoted
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Psychiatric Consultation Activities in the General Hospital to Migrant Patients S. Ferrari (Italy, C. Giubbarelli (Italy, M. Rigatelli (Italy)
Psychiatric consultations to patients who and colleagues). Psychiatric consultations at the experienced migration from non-western Accident&Emergency (A&E) were also counted countries are challenging, due to specific and available clinical data collected and analyzed. problems: intertwining of social and psychic distress; problems in communication (differences Results in symbolism and cultural meanings); limited Psychiatric consultations for migrants at MPCS training of health professionals. The aim of this have increased from 2.75% of total consultations study was to describe systematically the activities in 2006 to 6.25% in 2008. Countries of origin are of psychiatric consultation for migrant patients in mostly Maghreb and East Europe. Females are a general hospital. slightly prevalent (55.4%), mean age is 39 yo. Reasons for referral were most commonly Methods suspected depression, alcohol-substance abuse The database of the Modena Psychiatric related problems and attempted suicide. 17% of Consultation Service (MPCS) was searched for total accesses to the A&E were from migrants: patients of non Italian origin that were dealt with psychiatric consultation was asked for 1.1% of in the years 2006-2008. Socio-demographic and these (vs. 0.8% for Italian patients) and no clinical data were collected by means of a differences as to the outcome of the consultations structured culturally-oriented form (by Tarricone I were found between migrants and Italians. World Cultural Psychatry Research Review 2009, S1: 191-237
210 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION in the MPCS clinical experience. A systematic Conclusions and culturally-oriented data collection may The increasing relevance of migration as a improve knowledge and management of migrant social phenomenon in northern Italy is reflected patients with psychic distress.
Exorcisme, Perversion or Infanticide? A cultural Approach to the Forensis Psychiatry M. Ferretti (Italy), F. Padalino (Italy), A. D’Onghia (Italy), E. Tricarico (Italy), F. Dotoli (Italy), A. Bellomo (Italy), M. Nardini (Italy)
A case of “pseudo-exorcism” of a child is Each single considered approach showed different analyzed from two perspectives, the psychiatric- dynamics, meanings and situations, underlighting forensis one and the ethnoantrhopological one, in that only the interaction among several but order to get a cultural intepretation of the complementary points of view can give a instance. complete undestending of the case.
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The Ulysses Syndrome of Asylum Seekings in Puglia. New Results from a Survey M. Ferretti (Italy), I. Grattagliano (Italy)
Introduction The circumstances in which many immigrants Setting arrive today on the coast of Italy are characterised SPDC and other Departments of OO.RR.of by their extreme conditions. Because of that, In Foggia requering psychiatric consultations for touch with Achotegui we think that for millions of migrant guests. individuals, contemporary migration presents so severe stress levels that “...they exceed the human Results capacity of adaptation...” (Achotegui, 2005). As we postulate a direct relationship exists between the stress the immigrants are under and Objective their symptomatology. The interwies conducted in To check the possible interconnection among Foggia showed that in our country immigrants use the stress limits experienced, the integration to face a particular combination of symptoms process and a series of symptoms from several then, according to our hypothesis, the real context areas of psychopathology known as Uliysses of life changes the phenomenology of this Syndrome; to explore if, changing context of syndrome. recipient country, the Ulisses Syndrome’ symptoms can change too ; to find the prevalence, Conclusions types and predictors of this syndrome. It is obvious that with the situations of stress which these immigrants have to face, a greater risk Methods of alcoholism, psychosis, etc. is foreseeable. The A survey with structured interview. objective of intervention would be avoiding the worsening condition of those who suffer from this Participants manifestation so that they do not suffer a standard Multicultural adult immigrants/ asylum mental disorder. seeking at the first migration with symptoms of Ulysses Syndrome.
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211 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION
Primary Care and Mental Health Centres. What Care for What Migrants? C. Giubbarelli (Italy), S. Ferrari (Italy), I. Tarricone (Italy), M. Rigatelli (Italy)
Backgrounds and aims: Migration is a stressful patients are married. 41.3% doesn’t work for pay process that can be associated with higher and 28.4% lives with other people. 43.1% of occurrence of mental illness. The correct subjects were migrated to find a work. There are identification and treatment of mental disorders linguistic difficulties in 12.9% of patients. The are often difficult for general practitioners (GP) most frequent diagnosis are Psychotic disorders and also for psychiatrists. Additionally there are (33.6%), Mood disorders (31%) and Adjustment concerns regarding underutilisation of mental disorders (14.7%). Drop-out in the first 6 months services and drop-out from treatment among of treatment: 16.4%. migrants. 36 patients were referred to GPs. F/M: Methods: We have studied the migrant population 59.5%/40.5%. Mean age: 41.3 years. 66.7% of attended to 2 Mental Health Centres (MHC), in patients are married. 38.3% are unemplyed and the year 2007, and to 6 GP, during one month, in 27.8% lives with non familiar people. 50% of Modena. Socio-demographic and clinical data subjects were migrated to find a work. Linguistic were collected by means of a structured culturally- difficulties in 11.1% of patients. Out of 36 oriented form. patients, 6 (25%) reported a psychiatric reason for Results: Countries of origin, in both MHC and the visit (often common mental disorders – CMD) GP samples, are mostly East Europe and but only in one case file is reported a psychiatric Maghreb. 116 patients were referred to the MHC. diagnosis. 11.1% of patients had almost a previous The large majority are women (F/M: contact with a MHC 77.8%/22.2%). Mean age: 38.76 years. 43.1% of
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Ethnocultural Peculiarities of Patients on Example of Patients with Cardiovascular Pathology T. Glushko (Russia), I. E. Kupriyanova (Russia), G. V. Semke (Russia), A. Repin (Russia)
Contemporary system of healthcare functions account of interests of races, ethnoses, in an instable, steadily changing world making nationalities and care of quality of their life and increasingly growing demands to it. Policy of health care. health care under contemporary conditions should One of priority directions of scientific take into account democratic and social-economic investigations of recent decades determining changes in the society as well as related processes development of world psychiatry is of migration activation and revival of interdisciplinary study of interrelationship of ethnocultural traditions. ethnocultural phenomena and basic indices of Ethnopsychology studies facts, regularities and mental health of the population. Psychotherapy as mechanisms of manifestation of mental typology, an important not biological approach in treatment value orientations and behavior of that or another of mental disorders is closely connected with ethnic community, describes and explains ethnocultural factors including occupying the peculiarities of behavior and its motives inside of main stream ethnic identity, self-perception, the community and between ethnoses living in one system of value orientations, images of mental geohistoric space. health (Sayed M.A.//Soc. Behav. Person. – 2003. Main principles of ethnopsychology are – Vol. 31, N4. – P. 333-342, Seeley K.M.// – World Cultural Psychatry Research Review 2009, S1: 191-237
212 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION 2004. – Shimoji A. et. al.) diseases and thereby promotion of maintenance Currently the fact is without doubt that and strengthening of health of present cardiovascular pathology is one of the most generations as well as guarantee heath of future prevalent diseases of adult population in the generations. world. Association between psychoemotional Problems of social, cultural and psychological factors and CVD was recognized during hundred adaptation for patients of clinics of CRI become years. Strong emotions, especially fear, anger and not only priority but also vitally important. grief were since olden times associated with Everybody of them since the first days of “angina pectoris” and “cardiac rupture”. Already hospitalization is confronted by multiple problems in early papers, both depression and anxiety of adaptation to new conditions of the associated with development of IHD and AH environment (acclimatization, language, and (Both-Kewley S, Fridman HS. 1987). Clinics of culture, psychological and social adaptation). Cardiology Research Institute of SB RAMSci In our investigation we selected patients with have a powerful modern therapeutic-diagnostic affective spectrum disorders under therapy base and are an organizing-methodical center in associated with various forms of cardiovascular control of cardiovascular diseases on the territory system. Group of the investigation was entered by of Siberia and Far East. 70 persons. The CRI according to its national structure is a Using clinical-psychopathological methods we poly-ethnic institution. Cardiologists increasingly have examined two groups of patients: 34 persons often are interesting in detection and treatment of of Kazakh nationality and 36 of Russian one. depressive disorders in their patients (Organov R. According to results of hospital scale of anxiety G., Olbinskaya L. I., Smulevich A. B. et al., and depression (HADS) in Russians anxious Hemingway H, Marmot M. 1999; Rozanski A, symptoms from sub-clinical to clinically severe Blumenthal JA, Kaplan J. 1999). Addressing anxiety were revealed more frequently, in Kazakhs specialists, patients with somatic symptoms of depressive manifestations predominated. affective disorders usually receive the therapy Russian patients are open, single-hearted, directed at correction of physiologic functions and natural, and simple in behavior (up to simplicity), symptoms of the illness. However, without carefree, light-minded, insistent, not disciplined; appropriate treatment of anxious-depressive more sensitive, curious, initiative and exacting. pathology therapy is insufficiently effective. They more often doubt regarding correctness of Knowledge of clinic and principles of administered to them treatment. Along this, they treatment of anxious-depressive disorders in more willingly agree to take in psychotropic cardiology is necessary in association with its high preparations. They are careless, inaccurate and prevalence, differential-diagnostic value, influence negligent during filling in the test methodologies. on cardiovascular diseases and probable negative They manifest quite often helplessness and influence on prognosis of cardiological patient. submissiveness to destiny. They enough often do In section of ethnocultural evaluation of not observe recommended treatment, more interrelations of a doctor and a patient we seldom adhere to healthy life style. Thereby, they indicate differences in ethnocultural and social are less satisfied with results of their treatment. status of the therapist and patient as well related Consequences of such situation are repeated problems in diagnosis and treatment. We regard addresses of patients to medical institutions, that tension in relations may be provoked by repeated consultations of physicians of various difficulties or inability to communicate in native specialties. They prefer hiding from the relatives for patient language, difficulty of removal or the presence of diseases. misunderstanding of ethnocultural value of Mentality of one of the most ancient ethnoses symptoms, impossibility of definition of behavior of Central Asia – Kazakhs – was formed during of the patient both normative or pathological one. millennia on the base of nomadic life style and Regional approach in resolution of the general cultural spiritual complex. Every Kazakh problem of mental health care of the population knows 7 generations of his/her ancestors. Since becomes one of the leading ones in investigations childhood respect to familial structures is brought of Siberian scientists (Lotosh . . et al., 1981; up, young generation is expected to by respectful Balashov P, P, et al., 1998; Semke V. Ya., 2002; and obedient. Goldobina O. A., 2003). Namely ethnocultural In Kazakhs relative relations are closer and approach allows evaluating impact on the more multiple. Kazakhs are very sincere and organism of the man of many factors of the trustful, devoted in friendship. environment, prognosis on this basis of onset of Islam having come on the territory of World Cultural Psychatry Research Review 2009, S1: 191-237
213 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION Kazakhstan in the 9-10th centuries was not able reduced to negative attitude of the nearest and completely remove shamanism, heathen beliefs fear of stigmatization. In most cases they perceive associated with cult of fire, animals, plants, the illness as something available. mountains etc. On holy trees Kazakhs up to In the process of diagnostic search, present tie cloths in order to recover from illnesses formulation of diagnosis, definition of tactics of and protect themselves from various troubles. treatment and care we propose to take into Kazakh patients are religious, constrained, and account several levels of ethnocultural punctual, avoid confrontation. For Kazakhs of characteristics of a specific patient. During work importance is professional trust in doctor. Self- with the patient we recommend distinguishing the opening to the doctor is perceived as most probable for the patient social stressors, demonstration of their own weakness and failure. sources of social support, success of his/her Planned treatment they prefer concord with functioning. Of important value are stresses in the relatives, without willingness agree nearest of the patient as well as role of religion, recommendations to take in psychotropic family and the nearest in providing the subject and preparations. Search for psychiatric assistance is emotional support.
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AGE Pathomorphosis of Depressive Disturbances T.I. Ivanova (Russia), S.S. Odarchenko (Russia)
Problems of investigations of depressions in attention is accented on biological changes of this many respects are complicated by phenomenon of period of life, contributing to pathological age pathomorphosis, i.e. changes of clinically reaction (Zhislin S. G., 1956; Galenko V. E., 1959; outlined forms of psychopathological conditions Averbukh E. S., 1974; Helmhen H., 1986). The with the years. At children's age the clinical formed increased sensitivity caused by biological picture seldom happens steady and forms a factors of ageing, as though is united with increase picture of the outlined depressive attack. For the of characteristic for this age psychogenic majority of children variability of semiology, a situations. saturation plural rudimentary fluctuating For purpose of study of ontogenesis of symptoms, developing in complex and mosaic depressive syndrome influence and clinical- picture (Iovchuk N.M., 1989; Antropov Yu. F., dynamic structure of depression in children at the 2001). Complexities of diagnostics of depressive age 6 - 14 years (n=229) have been investigated disorders at children's age, is connected with that psychotraumatizing and persons older than 60 mental and physical development of personality years (n=181) taking place during treatment in of the child at the specified age is exposed to child-adolescent and geriatric units of Omsk substantial changes, is more often for him/her Clinical Psychiatric Hospital. typical is original disharmony and non-uniformity, In genesis of children's depressive disorders the disturbance of the physiological and psychological greatest value factors were mood disorders: balance achieved at the previous stage of perinatal pathology which have been not realized ontogenesis (Guryev . ., Dmitriyeva T. B., of increased social activity of the child, material Makushkin E. V., etc., 2007, Shevchenko Yu. S., trouble of family, absence of early socialization of Venger A. L., 2006). the child, family – deprivation, disharmonious With special frequency at late age act atypical social relations of the environment of dialogue of depressions possessing long course which the child, absence of the qualified medical aid at according to pathogenesis and semiology cannot early stages of development of children, obstetric- be attributed with definiteness neither to only jet, gynecologic complications of mothers and nor to only endogenous forms (Zhislin S. G., 1964, pathological family education. Shternberg E. J., Lauter H., Zimmer R., 1984). In genesis of depressive disorders in old men During analysis of reason of occurrence of long the following factors are allocated: an organic depressions special additional factors, inconsistency of brain, sharp change of social uncharacteristic for young age have been status, retirement, absence of the nearest (family) compelled to note the majority of authors. The environment, experience of situation of loss, World Cultural Psychatry Research Review 2009, S1: 191-237
214 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION absence of the qualified medical aid, adverse threat to existence. The increased uneasiness of family relations, alcoholization, premorbid the child was accompanied by episodes of properties of person and material trouble. psychomotor anxiety. The vector of disturbing Among nurseries of depression the following fears has been directed on habitual vital sphere of clinical types are revealed. the child and accompanied by refusal of visiting Simple clinical type. It was characterized by school. In the evening occurred amplification of mainly ideator disorders. The decreased mood disturbing component with the advent of was characterized by prevalence of long grief, elementary hallucinations. Periodically these sadness and divergence with aspiration to self- conditions alternated with affect of melancholy isolation, isolation. Children stated ideas about with complaints on “heavy feelings, a stone on own inconsistency and unattractiveness. Decrease soul”, motor overexcitation with stereotyped in school progress to full refusal of visiting school movements. The moods of the child reduced a was marked. Manifestation of vegetative background have been submitted by grief and component of depression was characterized by resentment. Children were languid, sluggish, disturbance of mode “sleep-wakefulness”, eating constantly complained of weariness and disorders were marked, arose senestopathic drowsiness. complaints. Incidentally arose dysphoria-like Autoaggressive clinical type. In the given disorders provoked by remarks of parents, with variant of depressive disorders we qualified impellent anxiety, shout, cry, ridiculous threats and symptom complex, with prevalence of suicide acts. tendencies. Distinguishing the given clinical Dysphoric clinical type. In the given clinical variant from dysphoric type is connected with that variant it was observed sensitivity, irritability and aggressive behavior of the child is directed at atypical spiteful affect with discontent, irascibility him/herself. Autoagressive behavior was shown by on a background of ideator block and complaints self-damages and / either the individual or on "bad", "malicious" mood. The affective numerous suicide actions, carrying elaborate background was gloomy and gloomy with absence character. Children cried, blaming an of pleasure from any kind of activity. Actively environment in the condition, stated ideas of own stated ideas of unattractiveness. Children made unattractiveness. The gloomy mood was illegal aggressive actions. The reason of accompanied by isolation, intensity, discontent hospitalization usually was suicide activity. The with self and associates, disturbance of mode of behavior had oppositional character. Children sleep-wakefulness and eating behavior. started to smoke, take alcoholic drinks and Regressive clinical type. In the given variant inhalants , were grouped with antisocial teenagers, pseudo-regressive symptoms which were expressed refused visiting school. They ceased to watch in a time suspension of development with the themselves, escaped from a house, on the tramp. termination of updating of lexicon, purchases of Hypochondriac clinical type was characterized new impellent functions, skills of self-service, more by massive somatoalgical manifestations - complex forms of game prevailed. Occurrence of headaches, dizziness, unconscious conditions, enuresis or encopresis in children with already weakness, slackness, pains in stomach, nausea, generated skills of self-service and disappearance vomiting, absence of appetite or selectivity in meal of these disorders is marked, during and so forth. These indispositions were disactualization of affective semiology. Arose polymorphic, unstable, or, on the contrary, puerile shade of behavior, children constantly monotonous. Sleep disorders are often. Episodes demanded presence of mother or the tutor beside, of an indisposition interrupted flashes of moved, holding him/her for a hand, refused to go irritability with ideas of death. Manifestations of independently to school, afraid of dialogue with asthenic symptom complex were staticized in first surrounding adults and children. School progress half of day, by the evening tearfulness, impellent was decreased; they could not apply the acquired anxiety, irritability accrued. The decreased mood knowledge and frequently refused visiting school. was little differentiated and masked the common Among children of elder children's age, there was uneasiness of the child. demonstrativeness, sensitivity, excessive aspiration Anxious-phobic clinical type united cases with to cleanliness or refusal of hygienic procedures. substantial manifestations of anxious-phobic The background of mood was characterized by semiology, masking depressive disorder. Condition adynamia, passivity, sluggishness, timidity, arose was characterized not only by amplification of fears of the infantile maintenance, in conformity "physiological" children's fears, but also with which the behavior changed. Positive occurrence of the fears connected to sensation of emotional events did not cause in them the World Cultural Psychatry Research Review 2009, S1: 191-237
215 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION adequate emotional response. second palpitation, cardialgias, faults in work of The clinical characteristic revealed depressive heart. Thus, the given experiences carried clear symptom complex in patients at age more senior senestopathic character. than 60 years was determined by the following Hypohedonic type was characterized by easing variants. of pleasant feelings, decrease in pleasure from Dissomnic type included all spectrum of sleep usual comfortable activity, events and disorders: shortening or lengthening of sleep, environments, feebly marked reactions to pleasant difficulty falling asleep, night and early stimulus, blunting vital sensations. awakenings, dreadful dreams, disturbing, Carrying out of comparison of factors of superficial sleep, absence of feeling of rest after formation of depressive disorders at child- sleep, decrease in quality of life after awakening, adolescent and senile age, the certain similarity is reduction of satisfaction by sleep, drowsiness revealed. So for both age groups great value in during day. genesis formations of depression organic Dyspeptic type. They are widely represented inconsistency of CNS, disharmony of family by functional gastrointestinal disorders - to pain in environment or has absence of it, social stresses stomach, a heartburn, meteorism, heavy feeling in determined by age surveyed, but having similar stomach, constipation or diarrheas, changes of psychogenic value and material trouble. Clinical appetite as reduction or increases, change of taste outline of depressive symptom during specified habits (excessive passion to sweet, sour, salty, etc.), age periods, it is determined by variability of change of viscosity of a saliva, dryness in mouth semiology, a saturation plural rudimentary or salvation. fluctuating symptoms developing in complex and Anergic type; in the given type prevailing mosaic picture. Thus, being based on a principle complaints were lack of will, slackness, laziness, of a psychological determinism according to apathy, chronic sensation of weariness. Usual which external behavioral manifestations are activity has been complicated, it demanded determined mainly by internal mental processes constant volition . which, in turn, are determined by features and Algical type. In this type dominating character of course of neurophysiologic processes complaints were painful sensations of various in the central nervous system, during comparison localization, and also general indisposition, of depressive syndrome at stages of early and late weakness, weakness, dizziness, heavy feelings in ontogenesis it is possible to reveal symmetry head, receptor disorders, first of all - paresthesias. between them, once again, emphasizing necessity Initial period was accompanied by numerous of multi-plan study of mental phenomena not complaints of somatic character, fixed first of all only from position of static clinical phenomena, in the field of head and heart. To the first, but also from position of mental development of persistent headaches of holding apart, the person – ontogenesis. compressing, pulling character concern to the
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Clinical Characteristics and Colour Models of Neurotic Disorders in Slavs I.S. Karaush (Russia), I.E. Kupriyanova (Russia)
Despite of diversity of viewpoints on There are many investigations where study of etiopathogenesis of neurotic disorders currently color preferences (more often with test of Luscher) basic ones are recognition of leading role of as a single method or in the composition of a kit intrapsychic conflict, consideration of the neurosis of tests testifies to a certain relevant state or as a process in which mechanisms of development peculiarities of personality traits – investigation of biological and mental, neurodynamic and patients with HIV-infection (Sultanov & Khalilov, personality, inappropriateness of cultural 2002), dementia (Rogers et al., 2007), peculiarities and peculiarities of upbringing of the schizophrenia (Henik & Salo, 2002; Kurylo et al., contemporary reality interact constantly. 2007), Alzheimer’s disease (Yoshihama et al., World Cultural Psychatry Research Review 2009, S1: 191-237
216 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION 2002) etc. However, parallels with other “suppression of emotions” (use of this strategy is characteristics of mental health are not identified more typical for men what is associated with sex- and color does not find its place in rehabilitation role and cultural peculiarities of upbringing and therapy. because in Russian society manifestation of Aim of investigation – to study parallels emotions by men is interpreted as a weakness) and between coming-to-be and unfolding of clinical by men “embarrassment” (as a non-constructive picture of a neurosis, dynamics of indices of strategy of coping) along with “active avoidance” tension of psychological defenses, level of and deprivation of adaptive strategy “optimism” anxiousness, behavioral preferences and dynamic testify to trend toward replacement of traditional of attitude toward the color. sex-role position. Object of the investigation were 70 patients of One of reason for high level of anxiety the Interdepartmental Mental Health Center at characterizing patients with neurotic disorders is the age from 25 to 60 years (average age presence of existential fears. Their essence always 40,5±0,5), predominantly of Slavic nationality. bears cross-cultural character; especially exactly Investigated group of patients was characterized their irrationality is manifested in ethnocultural by proportional distribution according to sex, age specific of Slavic mentality for which prevailing of periods, the group predominated with high emotional perception of reality with relevant need education (83%), basic part of patients (72,6% of for immediate affective response to psychogenic women and 43% of men) were married. The impact is typical. basic criterion of selection into the group of Summing results of clinical methods of patients was presence of neurotic syndrome as a investigation, psychological scales, study of color leading one in clinical picture. preferences and color perception we have revealed As methods of investigation we used clinical- some regularities typical for patients with neurotic dynamic, clinical catamnestic clinical scales (scale disorders. Taking the object for study namely early of quality of life, the Hamilton Anxiety Scale, forms of neurotic disorders, forming pathology we scale “Life style index”) – study of psychological have recognized absence of significant differences defenses, questionnaire of strategies of coping- in various forms of neurosis, however, reliable behavior, test of Luscher, method of computerized differences have been fixed during comparison of color-bio-modeling, statistical method. sexes. Increased interest in various diagnostic systems We have identified color models of formation requires work with models that encompass all the of neurotic disorders – totality of color necessary fields of significant information and preferences, clinical and social-psychological formulate many-level schemes of diagnosis characteristics. (Mezzich & Bergansa, 2005; Kazanovich & In women from color preferences we have Borisyuk, 2006; Smith & Conrey, 2007). Of distinguished predominant choice of violet in test relevance is approach with account for gender and of Luscher and predominance of negative cultural peculiarities, for example, taking into spectrum of emotions, high level of indices account social, cultural role of a woman in (computerized color-bio-modeling) revealed with correlation with characteristics of mental health account for analysis of perception of color. and coping-behavior (Walters & Simoni, 2002). Clinical picture is characterized by symptoms of Investigations appear developing psychobiological basic forms of neurotic disorders. We have model with use of computer methods allowing revealed reliable (p < 0,01 during t = 5,03) providing the individualization of obtained results predominance in women of pathology of neurotic (Kock, 2004). spectrum in relation to pre-nosological forms. For a patient with neurosis characteristic is From psychological; characteristics – high or existence of broad spectrum of intrapersonal middle level of anxiety, high level of tension of conflicts, one of which as a rule is sex-role conflict. psychological defenses – “denial”, “reactive Experience of sex-role inappropriateness is formation”, “repression”, “regression”, use of induced by inefficacy of behavior on reaching of non-adaptive coping-strategies in emotional that or other aims confronting the personality. domain. Traditionally Slavic mentality means a major role For men typical is predominant choice of of a man in the family, normative stereotypes of brown, black in test of Luscher, broadening the behavior of a Russian woman may be range of negative spectrum of emotions, high submissiveness, inconsistency, dependence, and level of indices (computerized color-bio- emotionality. Such accents in behavioral strategies modeling). Clinical characteristics are of patients with neuroses as a choice by women characterized by symptoms of basic forms of World Cultural Psychatry Research Review 2009, S1: 191-237
217 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION neurotic disorders. From psychological finding individual approaches in therapy and characteristics – high or middle level of anxiety, prevention of indicated states for able-bodied high level of tension of psychological defenses population, various social groups. Presence in “intellectualization”, “substitution”, “projection”, complex of methods of computerized color “denial”, “reactive formation”, “repression”, technology allows visibly characterizing basic or “regression”, use of non-adaptive coping- situative state of the patient, broadening the strategies predominantly in behavioral domain. approaches of complex non-medication of early Color models served as a basis for creation of forms of neurotic disorders. We are planning programs of color-correction and color-therapy. dynamic investigations characterizing formation Complex characteristic of patients with early and dynamic of neurotic process in patients of forms of neurotic disorders including clinical various nationalities living on the territory of picture, psycho- and sociometric scales allows Siberia.
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A Qualitative Study to Inform the Design of a Culturally Tailored Intervention for Persistent Postnatal Depression in British Women of Pakistani Origin S. Khan (UK), K. Lovell (UK), N. Husain (UK)
Introduction who develop a mental disorder during pregnancy Postnatal depression/Maternal depression is a or the postnatal period, should be given culturally treatable disorder (Cooper & Murray, 1998), with sensitive information at each stage of assessment, the majority of depressive episodes after childbirth diagnosis, course and treatment about the impact resolving spontaneously within 3-6 months of the disorder and its treatment on their health (Cooper et al., 1991). However, a subset of women and the health of their foetus or child. remain depressed beyond the first postnatal years, According to demographic data from the and research has linked depression during the Census in 2001 (National statistics online), the child-bearing years to chronic depression (Cooper Pakistani population comprising 747,285 (1.3%) and Murray, 1995). Depression in the child out of the 59 million, is one of the largest ethnic bearing years contributes to relationship groups living in the UK. Studies on depression in disharmony, domestic violence, neglect, Pakistani women date back to two decades. There separation, divorce, and may interfere with the are many barriers to accessing healthcare services positive environment needed for the successful for Pakistani women, whether is a reluctance to transition to parenthood (Nettelbladt, Uddenberg acknowledge mental illness due to perceptions et al. 1985; O'Hara 1986; Gruen 1990; Boyce such as “madness is incurable” Qureshi (1988), or 1994; Webster, Thompson et al. 1994; Fatoye and the effect of cultural differences in the expression Fasubaa 2002; Leung, Kung et al. 2002). Based on of depression, or language barriers (Fenton and current research, the strongest predictors of Sadiq., 1990),. persistent postnatal depression are experience of A considerable number of studies have been depression during pregnancy, a previous history of conducted on depression in Pakistani women in depressive illness, recent experience of a stressful general. However, to date, only a single study has life event and those who perceive they have low looked into the effects of postnatal depression in social support (Robertson et al, 2004). Mild to Pakistani women living in the UK, and no study moderate depression can be treated with talking has looked at persistent postnatal depression. therapies, such as Interpersonal psychotherapy Previous research in to both depression and (Spinelli et al, 2003) and cognitive behaviour persistent postnatal depression has almost therapy (CBT) (Appleby et al, 1997), and more exclusively considered Caucasian females and severe depression can be treated with their experiences. The experiences of other ethnic antidepressants (Wisner et al, 1997). groups, in particular South Asian depressed According to the National Institute of Clinical women (specifically Pakistani women) within the Excellence (NICE) guidelines (April 2007) women UK has not been thoroughly researched. These World Cultural Psychatry Research Review 2009, S1: 191-237
218 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION women have different illness perceptions and British women of Pakistani origin, and over the therefore may have a poorer response to current age of 18, who meet the criteria for mild to treatments. Few studies have attempted to moderate depression, following 2-3 years after examine the role of eastern cures for depression birth. Exclusions will be women with diagnosed (Wood, 2007), or to treat depression in Pakistani physical or learning disability or post-partum or women living in Pakistan (Rahman, 2008). The other psychosis. SITARA study is one of the first of its kind to use a psychosocial intervention for the treatment of Ethical Approval depression in Pakistani women living in the UK Ethical approval was granted by the local NHS (Gater et al in preparation). research ethics committee. Written, informed There is a clear need for treatments that are consent was obtained from all the participants. culturally tailored. The experience of immigrant womens need to be considered, as their Qualitative Interview Format interactions with, and access to, health care The interviewer (SK) conducted the one-to- services, and opportunities for social networks and one semi-structured interviews, and the qualitative support may differ significantly from other groups. research was supervised by KL. The interviews It is important to develop and evaluate treatments were conducted in the homes of the participants, that can prevent the persistence of depression. lasting approximately between 40-90 minutes. Many women receiving antidepressants are Following interviews, new questions were added to unaware of psychosocial interventions. Previous the topic guide which emerged as a result of the studies have largely neglected the treatment themes raised by the participants. All interviews received by Pakistani women living in the UK, were recorded using a Dictaphone and transcribed whereas this study will examine the treatment of verbatim. persistent postnatal depression of these participants. Results This study intends to collect qualitative data Preliminary results from the qualitative from patients on their experiences of previous interviews treatment for depression in the childbearing years. The participants were asked about the causes In order to further investigate this area qualitative of their depression. The following themes were interviews and questionnaires were used. Previous identified: qualitative interviews with Pakistani women have Marital problems (being one of the main provided some information for the persistence of causes) depression, however further information was Social isolation collected in the qualitative interviews and during Loss of hope and future aspirations the intervention. Poor physical health Lack of social support Objective Past traumatic events (bereavement/ The primary aim of this qualitative study was abortion/ previous marriages/ rape). to undertake qualitative interviews to develop a knowledge base for the design of an intervention. When further probed about the maintaining Information from participants regarding factors of depression, low self esteem was found to underlying themes relating to their depression, be the most prominent factor. Other causes were past experiences of treatment of their depression, lack of self confidence and motivation and living and their thoughts on a design for future in fear of past events and their punishment from intervention in the treatment of depression in the God, and persistent guilt. The guilt was due to child bearing years was collected. This first phase neglecting elderly parents and other family would be used to develop a knowledge base for the members, neglecting wifely duties, suffering in design of an intervention to be delivered later. silence, having gone through an abortion, rebelling against parents and not being a good Methods mother. Design The main symptoms of depression were 15 British women of Pakistani origin with overeating, persistent guilt, poor standard of persistent postnatal depression (up to 3 years) were concentration, constant crying and agitation. recruited to take part in the study Overall, help was not sought by a majority of the participants. When sought, the only source of Inclusion/Exclusion Criteria help contacted was the GP. All of the fifteen World Cultural Psychatry Research Review 2009, S1: 191-237
219 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION participants were given anti depressants. should incorporate a holistic approach with the However, antidepressants were not generally mind body connection and the name of the complied with. The general opinion towards intervention should reflect this. Lack of childcare antidepressants was that they are addictive, cause is also seen as a barrier and attention should be drowsiness, not seen as the solution as the causes paid to the practicalities regarding time remain; “they just numb the pain, and transform restrictions. Therefore the sessions should take people into robots”. place in the mornings, with crèche facilities for babies and toddlers. It was emphasised that the Participant Expectations person providing the intervention should have Psychological help was welcomed by most of some knowledge of the Pakistani culture. the participants. The general consensus was for group treatment. Most of the women felt it Summary of preliminary data would help reduce social isolation and allow them The qualitative interviews in this 1st Phase were to form new friendships with women who are in a conducted to in order to find out the type of similar situation. However, some women were intervention which would be feasible and hesitant to talk about their private affairs in front culturally appropriate for persistently depressed of unknown women and so preferred to be seen British mothers of Pakistani origin. We tried to individually. gauge the most suitable ways of delivering the The type of help that was asked for was centred intervention in terms of the setting, the name, the on confidence building, improving self esteem, content, the duration, and the approach. emotional support, learning ways of relaxing, Therefore the persistently depressed women managing thoughts in a more positive and showed an interest towards a more holistic productive way. Women who were going through approach to the treatment of depression. An marital problems wanted marital therapy, however intervention would need to be based on the all were in agreement that the husbands would not principles of Cognitive Behaviour Therapy. The welcome the idea and dismiss any kind of qualitative interviews showed a lack of psychosocial help. Talking about problems was empowerment in these women, both very low self- also seen as a cure in itself. It was identified as a esteem and self confidence. way of ‘lowering the burden of your chest’. The barriers identified to attending any kind of Currently the pilot intervention, a CBT based treatment sessions were stigma attached with intervention for persistent postnatal depression in mental health; therefore suggestions made to British women of Pakistani origin is being lower the stigma were regarding the approach to delivered. the treatment. It was suggested the treatment
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Aspects of Psychotherapy of Patients with Comorbid Borderline Mental and Gastrointestinal Disorders in Siberian Region A.K. Kostin (Russia), V. Semke (Russia)
Psychotherapy is an integral part of complex examined 150 patients (53 men, 97 women), treatment of psychosomatic disorders of digestive middle age 40,4±4,5 years with peptic ulcer system. We use individual intensive integrative or/and irritable bowel syndrome. We found approach that always includes utilization of abnormal patterns of upbringing in 92,7% ethnocultural features of the patient, religious and patients with psychosomatic pathology of cultural beliefs, and traits of the nuclear family. As gastrointestinal tract: the predominant types for it is well known, family factors are a main origin the patients with hysterical personal traits were for development of patient’s personality. In our «idol of family» and «Cinderella» (39%, 15,9%; investigation we examine structure of patient’s р<0,05), in patients with the other personal family, abnormal patterns of upbringing, structure most common were types hypocustody interrelationships between its members. We (37,8 %) and combinations of abnormal patterns World Cultural Psychatry Research Review 2009, S1: 191-237
220 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION of upbringing (18,9 %), (р<0,01). Most patients - systematic scandals, in 10,7% ”serene, but cold”. (62,0%) lived in a family with both parents, in This factors help us to develop therapeutic process 25,3% of cases parents were divorced, in 10,0% in a way of cooperation and mutual patients were brought up by one parent, in 2,7% understanding, allows us reaching a complete of cases patient was brought up by another recovery in 74,0% of cases and preventing re- relative. Family with changed structure was hospitalization. identified in 6,0% cases – mother became a leader of the family that was characterized by traditions, hierarchy. Relationship between parents in 58,0% of cases was “serene and kind”, in 28,0% children grew in atmosphere of frequent conflicts, in 3,3 %
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Depression among women living on the outskirts of urban centers in Brazil D. Martin (Brazil)
This paper aims to discuss depression among characterized by crafts fair and the presence of women living in poor urban communities on the artists who live and work in town, being also outskirts of Brazil. Depression seems to become known as Embu das Artes. Except for this specific especially important for Brazilian women living in place, the surrounding neighborhoods are very urban areas once they are properly diagnosed as poor. In 2004, Embu had a total population of having this mental health problem or they simply 232,165 inhabitants and a rate of urbanization of acknowledge having this disorder based on vulgar 100%. Most of the houses in the city are small information, regardless of whether there is a with concrete facing and were built by the owners correlation between signs and symptoms. One themselves; there is also a great number of approach to understanding female vulnerability to clandestine buildings and favelas. In 2003, the depression is to analyze the issue within its cultural local homicide rate per 100,000 inhabitants was context. twice as high as that of the State of São Paulo as a The experience of depression may be whole (71 and 36, respectively) (SEADE, 2005). understood with relation to the cultural A qualitative study was performed, including a environment in which people are immersed dense ethnographic observation and in-depth (Manson, 1995). In Brazil, the study of depression semi-structured interviews (Oliveira, 1996). focusing on the cultural context of women who Sixteen interviews were conducted with women suffer from the disorder is still relatively recent. diagnosed with depression (F32 and F33, ICD-10 The present text aims to show the living - World Health Organization, 1997) seen at a conditions of women with a diagnosis of primary health care facility in Embu. The data depression, focusing on the understanding of the collection was performed between August 2002 disease in relation to local morality. The study was and January 2003 at the primary health care set up on the urban outskirts of Brazil’s largest facility located in Jardim Santo Eduardo (the city, where poverty, social exclusion and violence poorest area of the town), which provides coexist. This particular study setting resembles psychiatric outpatient services. All women closely the outskirts of other big cities in Brazil interviewed lived in Embu, were referred to a with the same aforementioned conditions. psychiatrist, were receiving treatment for The study was conducted in Embu, a town depression (dually diagnosed), and were prescribed located in the city of São Paulo metropolitan area antidepressant medication. The interviewees aged (which has a total population of 19,058,889 between 20 and 57 years (mean age, 26.5 years). inhabitants), 27 km from São Paulo’s downtown All of them had children and a low schooling (Martin, Mari & Quirino, 2007; Martin, Quirino & Mari, 2007a).1 Embu is a tourist town Dr. Denise Martin has received grant/research support from the State of Sao Paulo Research 1 This study was conducted by the Department of Foundation (FAPESP - Protocol number: Psychiatry of Universidade Federal de São Paulo. 00/03329-3). World Cultural Psychatry Research Review 2009, S1: 191-237
221 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION level. was theirs. The interviewees complained about Although all patients accepted the diagnosis of alcoholic husbands, about having to take care of depression, they had not apprehended the real everything by themselves (house, work and meaning of the disorder. They were usually children), about the partner’s aggression to them unaware of the development of the disorder, as or their children, and lack of dialogue. Domestic well as of a probability of cure. Some had already violence is much cited in the literature (Giffin, been diagnosed with depression by a health 1994), and some studies have already associated professional (cardiologist, gynecologist) in a domestic violence with mental disorders previous occasion and were started on sedatives. (Fischbach & Herbert, 1997). Despite the lack of accuracy, all patients accepted Thus, when these women talked about the this medical diagnosis as if, because the causes of depression, they were actually talking psychiatrist “named” their suffering, the disease about daily suffering of poor people, gender would be legitimated. inequality, domestic violence, poverty, unemployment, as well as close contact with drug The causes of depression traffickers and users. We can observe a The interviewees had several explanations for displacement of understanding on the disease: its causes. The onset of depression is related to from a biomedical conception, based on stressful life events, most of them due to external symptoms, toward a local conception, strongly causes related to the environment in which they rooted in experiences from the context in which live, such as: unemployment, financial difficulties, the sufferers live. victimization or witnessing murders, arrested relatives, and presence of drug traffickers and True and false depression users. Other causes are related to their private life, Close family members, relatives and neighbors such as: death of relatives, aggressions, partner’s also reported their justifications for these women’s cheating, and alcoholism. experience with depression. The expression The term depression seems to be suitable for “depressed woman”, in this place, had two most of the life events described by these women, meanings: and may play a role in shaping their suffering True depression: when the woman suffered a experience. They are not to blame for their loss (for example, a murdered child), this suffering suffering. They are victims of a violent and was recognized as true by the community. In these increasingly unequal society. cases, the family and the community cared for and supported the woman in her suffering. Violence on daily life and gender relations The children of the women interviewed died Ethnographic observation and interviews of different causes: drowning, murder, accident, revealed that there are a small number of places etc... The fact that the mothers were ill was then available for leisure activities. Besides, since there understood and even justifiable from a community is no urban planning, the few activities carried out viewpoint: they were victims of a violent and in this area are often focused on the unjust society. The disease was a consequence of neighborhoods; however, neighborhood friendship the suffering they have undergone, thus they were ties are rare. supported by friends, relatives and neighbors. All interviewees reported a frequent and close Some situations yielded only a partial support, contact with drug trafficking and, consequently, since only a few people could understand these with the violence resulting from this activity. All women’s suffering. participants reported the fear of having their For some people, being depressed depended on children involved with crime, of walking in the these women’s personal will; therefore, their streets late at night and of their neighbors in attitude was morally reprehensible. This latter general, who might be criminals. The defensive perception of the disorder leads to another routine of these women involves, basically, staying concept of depression, considering it as an within their homes. Within this context, the scarce illegitimate suffering or leading to wrong sociability of these women becomes evident. conceptions of madness. It was considered as a Another important aspect was the inequality of “false depression”. gender relations. The interviews showed that the Our interviewees revealed remarkably difficult relationships of these women with their partners life experiences, such as relationship issues with were marked by submission. Most women were their partners, who showed a particularly violent economically dependent on their husbands, behavior, and problems with the local drug though the responsibility for raising the children trafficking, also marked by extreme violence and World Cultural Psychatry Research Review 2009, S1: 191-237
222 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION cruelty. Despite all the reasons above mentioned, this term, both by the women, who attributed these women’s psychological suffering was not their suffering to their difficult life, and by the always acknowledged as a disease by the community, which morally judged these women neighbors. Their condition was often described as who reported themselves as depressed. laziness, madness or excuse. They did not receive The epidemiological data show an increase in support from relatives and acquaintances and local and international levels of depression. In were often lonely sufferers. In this case, depression Brazil, women from urban outskirts are likely to was considered a moral issue, not a disease. live in conditions very similar to those described in Kirmayer (1989) showed that a persistent this study, if not in worse ones. disease is evidence of a failure in the control of In the present study, depression justified all the emotions. If this is an involuntary failure, the misfortunes endured by the women interviewed, person may be morally judged as not guilty, but redefining a whole experience marked by mentally weak. Women whose “true depression” suffering. Thus, it seems possible that in other was acknowledged were not condemned by their settings, with a similar population and living behavior. As for women with “false depression”, conditions, depression may also occupy this they were not mentally weak, since their failure in significant place, the expression of a social drama. the control of emotions was considered voluntary, i.e., they were considered to have sought the References problem they were experiencing, thus they Fischbach R, Herbert B. Domestic violence and mental deserved to be in such condition. health: correlates and conundrums within and across cultures. Social Science and Medicine, vol.45, n. 8: 1161- 1176. 1997 Conclusion Giffin K. Violência de Gênero, Sexualidade e Saúde. Cad. Depression goes beyond the pathological Saúde Pública, Rio de Janeiro. 10 (supl. 1): 146-155. 1994 notion defined by biomedicine and allows Kirmayer LJ. Cultural variations in the response to psychiatric comprising all the negative events of daily life. In disorders and emotional distress. Social Science and Medicine 29: 327-339, 1989 the present case, these negative life events are Martin D, Mari J, Quirino J. Views on depression among expressed through the contact with criminality patients diagnosed as depressed in a poor town in the and drug trafficking, domestic violence and outskirts of São Paulo, Brazil. Transcultural Psychiatry 44: unequal gender relations. Effects are far-reaching, 637-658, 2007 but a perspective on improvement is lacking. In Martin D, Quirino J, Mari J. Depressão entre mulheres na periferia de São Paulo. Revista de Saúde Pública / Journal face of that, daily suffering is hidden by a of Public Health 41: 591-597, 2007 legitimate practitioner (the psychiatrist) who ends Oliveira RCO. O trabalho do antropólogo: olhar, ouvir, up justifying such suffering. escrever. Revista de Antropologia, São Paulo, USP, (39), The focus moves from the undesirable life 1: 13-37. 1996 Organização Mundial da Saúde. Classificação de transtornos toward the disease explained by the psychiatrist, mentais e de comportamento da CID-10: referência allowing a new experience by taking medication to rápida. Trad. Gabriela Baldisserotto. Porto Alegre, Artes soften suffering, since drug therapy appears as an Médicas. 1997 objective approach to these women’s suffering. SEADE (Sistema Estadual de Análise de Dados Estatísticos). When they simply talk about the disease, the Informações dos Municípios Paulistas.. Available from: www.seade.gov.br/produtos/perfil/index.pHp. 2005 objectivity of the treatment seems quite abstract, since they feel they are trying to find explanations which might justify, although without changing, their daily suffering. The idea of depression embedded in common sense reveals the plasticity underlying the use of
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Study of Motivational Levels in Relation to the Use of Psychoactive Substances and Spirituality A. Martins de Souza Gonçalves (Brasil), S.C. Pillon (Brasil)
There are evidences of the relationship between spirituality and health and also that the World Cultural Psychatry Research Review 2009, S1: 191-237
223 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION exercise of spiritual dimension has potential to psychoactive substances for over 10 years, all or stimulate positive changes among users of alcohol almost all day 90 (60,2%). The SSRS scale or other drugs, in the rehabilitation process. This showed good index of reliability, with overall study aimed to evaluate the relationship between alpha of chronbach 0.8333, ranging from 0.7028 spirituality and motivational levels (Transtheorical to 0.8878. There was no statistically significant Model) among individuals who make harmful use relationship between spirituality and religious or are dependent on psychoactive substances, in aspects. Most 84 (60.8%) considers spirituality treatment or members of a group of mutual-help, different from religiosity. The motivational stages and evaluate the performance of translated and that showed association with spirituality were pre- adapted version of Spirituality Self Rating Scale contemplation, action and maintenance, through (SSRS). The methodological design of the study is linear multiple regression analysis. The results made on transversal type. A questionnaire was make us reflect that the exercise of spiritual drawn up, containing sociodemographic dimension in each stage can be considered to information and motivation and spirituality scales stimulate the individual to succeed in the process - URICA and SSRS, respectively. The sample of behavior changing, in relation to the use of consisted of 138 (69%) males. Participating users substance and rehabilitation in various contexts. were linked to a group of AA, a service of CAPS- The scale SSRS can be recommended for use, ad and three Therapeutic Communities despite its limitations. We conclude that there is a (evangelical, catholic and without religious ties). need of successive assessments of the processes Amidst the results, it was found that the involving the aspects of spirituality, in context of respondents had an average age of 39 years, treatment and motivation in the behavior catholics 71 (51.4%) and practitioners 83 (60.1%). changing, in relation to abuse and dependence of The majority answered that the consumed psychoactive substances. psycoative substance for the last time was alcohol 65 (47.1%) and 49 (35.5%) use or used
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State of Mental Health and Personality Features of Women at Reproductive Age with Gynecological Pathology in Slavic Population R.F. Nasyrova (Russia), I.E. Kupriyanova (Russia), L.S. Sotnikova (Russia)
Relevance extremality the most typical mental state of Nowadays interaction of social and natural women is stress. As a result of stress-induced factors, powerful man-made pressing on reforms of nervous, endocrinal and immune functional systems of the organism create systems a generalized influence of substantial preconditions for worsening the health psychopathological symptoms on physiological of the nation. The most threatening homeostasis of the entire organism of a woman manifestations of crisis of demographic situation and especially her reproductive system emerges. It in Russia is depopulation reflecting in exceeding is very essential that at present major mortality above birth rate, in substantial reduction predisposition of women to depressive and anxiety of quantity of able-bodied population and finely disorders has been proved; in addition, neurotic in weakening spiritual-moral potential (Semke, disorders flow in them heavier and end with 1999, 2003). From these positions health of disability more often than in men. Along with this women is a significant compound of societal social-economic factors appear to be very relevant health. against the background of biologically It is very relevant that under contemporary conditioned pattern of decrease of resistance to conditions of intense burdens, intense rhythm of stressor factors, increased sensitivity to minimal life, broadening the spheres of professional activity psychotraumatic impacts conditioned by social- in association with continuous growth of social, everyday adaptation of women (Shevchik et al., economic, ecological, man-made and personality 2002; Davydov & Lavrova, 2004; Sport, 2007). World Cultural Psychatry Research Review 2009, S1: 191-237
224 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION Stratification of emotional stressful states in clusters: neurotic, stress-related and somatoform totality with genetic predisposition evokes disorders (F40-48) have been revealed in 51% of psychosomatic disorder in reproductive system. In examined women; affective, predominantly of this association, it is important to note that among depressive spectrum (F32-34.1) – in 39%; somatic diseases accompanied by mental personality disorders and behavioral disorders at disturbances gynecological pathology occupies mature age (F60-61) – in 6% and behavioral significant positions (Mendelevich & Mendelevich, syndromes associated with physiological and 1993; Semke, 1999; 2003; Bitzer, 2003). At physical factors (F50-52) – in 4%. present there is a concept of psychosomatic nature Distribution according to Nosology within of gynecological diseases (Chandra & Ranjan, every register was as follows. In cluster of 2007; Neises, 2001). The basis of psychosomatic “neurotic, stress-related and somatoform pathology is disturbance of mental adaptation and disorders” there were agoraphobia (F40.0) in 2%, first of all interrelationship of somatic and mental social phobias (F40.1) in 2%, generalized anxiety state. disorder (F41.1) – in 2%, mixed anxiety and depressive disorder (F41.2) – in 15%, adjustment Aim of research disorder (F43.2) – in 10%, hypochondriac disorder Study of psychopathological and personality (F45.2) – in 5%, somatoform dysfunction (F45.3) - features as well as quality of life in women at in 2%, neurasthenia (F48.0) – in 12%. The group reproductive age with gynecological pathology of with affective disorders was entered by patients Slavic population. with depressive episode of mild degree (F32.0; 15%), depressive episode of middle degree (F32.1; Materials and methods 12%), depressive episode of severe degree without Object of research were 500 women at psychotic symptoms (F32.2; 4%) and recurrent reproductive age (from 18 to 45 years) with affective disorder of mild degree (F33.0; 8%). The gynecological pathology from Slavic population, third group included patients with personality average age has constituted 32,33±1,38 years. disorders and behavioral disorders at mature age: Distribution of gynecological pathology was as hysteric (F60.4; 2%), anxiety (F60.6; 2%) and follows: N 70 inflammatory illnesses of ovaries - mixed (F61.0; 2%). In group of women with 140 (28,0%) women; D 25 leiomyoma of uterus – behavioral syndromes associated with 110 (11,2%); N 80 endometriosis – 90 (18,0%); N physiological disturbances and physical factors, in 91 – absence of menses, scanty and rear menses 2% of cases we observed orgasmic dysfunction 56 (11,9%); N 92 – excessive, frequent and (F52.3), in 2% - dyspareunia of non-organic origin irregular menses - 104 (20,8%). (F52.6). The investigation used clinical-dynamic and Contemporary economic-political, social- clinical-catamnestic methods as well as the psychological and ecological factors form stressful following psychological methodical tools: scale of impact on the woman (Semke, 2003; Simalenkova, level of reactive and personality anxiousness of 2008). In women from Slavic population with Spielberg-Hanin, scale of alexythymia (TAS-26), pathology of reproductive system degree of Hamilton Anxiety Scale (HAS), scale of diagnosis stressful burden has constituted 261,11±11,87 of aggression of Bass-Darky (BDHI), scale “Rose scores according to scale of T.H. Holmes and of quality of life” (Gundarov, 1995), Social corresponds critical level of resistance to stress. Adaptation Scale (Holmes & Rahe, 1967). Results Analysis of sources of stress has demonstrated of the investigation have been processed with dominating position (62%) of familial stressors standard kit of programs Statistica for Windows (divorce or separation of spouses without official (2000, version 6.0). registration of the divorce, reinforcement of proneness to conflict of relations with the spouse, Results and discussion problems with relatives of the husband, problems Analysis of level of mental health of women at with children). Less significant role was played by reproductive age with pathology of reproductive problems at work and non-satisfactory housing system in Slavic population has allowed to conditions (45% and 28%, respectively). In one distinguishing great percent (72%) of comorbid third of examined we have detected combination borderline mental pathology. In these female of various psychotraumatic factors prolonged in patients in clinical structure of mental time. Evaluation of degree of severity of disturbances symptoms of neurotic register psychotraumatic events has revealed that severe dominated. According to diagnostic criteria of stressful situations have constituted 21%, in other ICD-10 revealed mental disturbances included 4 cases there was mental trauma of middle degree World Cultural Psychatry Research Review 2009, S1: 191-237
225 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION of severity that also on opinion of the women feeling guilty (74,35±3,91% according to scale “reflected” on state of her health. This fact BDHI) and insult (68,57±3,25%), what demonstrates conditionality of mental disorders demonstrates presence of restrained aggression including environmental factors (predominantly and suppression in herself of reaction to psychogenias). frustrating outer impact. High index of hostility Stress is always associated with experience of (12,08±0,43) during comparatively low index of potential threat in totality with cognitive aggressiveness (16,10±0,97) positions hostility as assessment of relevant personality resources as socially accepted way out thanks to mechanism of insufficient for its overcoming. In this association somatization. In indicated aspect of interest are dominating and obligate element of stress is data of correlation analysis that has shown anxiety that acts as one of the important links of positive associations of index of hostility with pathogenesis of somatic disorders. Average group severity of vegetative disturbances (r=0,47 during index testified to predominance of moderate level р<0,0001), level of alexythymia (r=0,43 during of anxiousness in these female patients and р<0,005), anxiety (r=0,38 during <0,05), and in reached in average 18,95±1,03 scores according particular, its mental compound (r=0,37 during to Hamilton scale (HAS). The greatest incidence р<0,05), personality (r=0,46 during р<0,0001) and severity in structure of mental disturbances and reactive (r=0,35 during р<0,05) anxiousness, were reached by mental anxiety (in average in as well as negative associations with subjective group – 11,34±0,56 scores). Among symptoms of evaluation of satisfaction with health (r=-0,52 mental anxiety the highest indices have been during р<0,0001) and spiritual needs (r=-0,39 documented according to parameters: “anxious during p<0,05). mood” (2,34±0,23 scores), “depressive mood” Mental and physical health is interrelated with (1,89±0,18 scores) and “tension” (1,93±0,16 quality of life. Quality of life is a sociometric scores). Neurovegetative cluster of anxiety was characteristic and possesses quantitative indicators also high and has constituted 2,96±0,18 scores. characterizing degree of adaptation of the Somatic manifestations of anxiety were significant personality. Of greatest vulnerability in these and have constituted 7,23±0,52 scores. women were criteria “health” (1,59±0,08 scores), Personality features of examined women were “inner peace” (1,72±0,09 scores), “rest” characterized by presence of severe anxious (2,03±0,14 scores) and “sexual life” (2,21±0,09 radical (in average in group - 48,76±1,35 scores). scores). Enough logical in our opinion are revealed High induces of personality anxiousness correlation associations between criterion “inner demonstrate presence of a neurotic conflict. In peace” and subjective evaluation of parameters addition, we have registered high indices of “work” (r=-0,37 during р<0,0001), “sexual life” reactive anxiety (43,51±1,29 scores) in examined (r=0,36 during р<0,05), “rest” (r=0,38 during female patients. Obtained data demonstrate р<0,05), “material position” (r=0,36 during selective sensitivity and predisposition to stressor р<0,05), as well as correlations between criteria impact in examined women. “sexual life” and “work” (r=-0,34 during р<0,05). Alexythymia contributes substantially to Interpreting this fact it should be mentioned that manifestation of psychosomatic disease due to notion of mental and physical health as an pathogenetic relation with adaptive possibilities of indicator of adaptation depends not only on the organism against the background of stress. peculiarities of stressing situation and personality Investigation of alexythymia as a personality trend characteristics of an individual but also on able to determine exhaustion of means of self- appropriateness of used model of coping with regulation and rigidity of adaptive-regulator frustration. Presented data demonstrate priorities mechanisms has documented “intermediate” of social success in examined women to the values of this index in this contingent (68,12±1,38 prejudice of stability in somatic sphere. scores according to scale TAS). In examined alexythymia bears secondary character and is Conclusions conditioned by fear against emotions and strive to Comorbidity of borderline mental disorders their blocking. and gynecological pathology complicating severity Aggression and hostility are psychological; of state of women from Slavic population factors that are associated with state of somatic decreasing adaptive abilities substantially worsen health. Study of level of aggression in women quality of life and efficacy of therapy. Obtained with diseases of reproductive systems from Slavic data ground necessity of creation of highly population has documented the following effective therapeutic and preventive strategies, predominating forms of aggressive behavior: used in these disorders inn psychiatric and World Cultural Psychatry Research Review 2009, S1: 191-237
226 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION gynecological practice. Developed differentiated of rendered medical assistance. preventive, therapeutic, rehabilitative Investigation has been performed within Grant psychopharmacological and psychotherapeutic of President of Russian Federation for state programs of correction of mental disturbances in support of young Russian scientists (№ of Grant women with reproductive system pathology from MK-3743.2008.7). Slavic population will allow improving social and clinical prognosis substantially heightening quality
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Clinical Peculiarities of Late Depressions Comorbid with Dementia in Persons of Slavic Nationalities S.S. Odarchenko (Russia)
Problem of depressive disorders in later life is patients (3,9%). one of the most relevant problems of the 6. Vascular dementia, not specified (F01.9.) – 6 contemporary psychiatry. In multiple scientific patients (11,8%). investigations of recent years, high level of 7. Dementia in Pick’s disease (F02.0.) – 2 associated forms of affective pathology of later life patients (3,9%). has been shown. During significant number of 8. Commotion syndrome F07.2.) – 14 patients investigations concerning various sides of the (27,5%) problem of affective disturbances, issues of age Introduced data show that mostly often in pathomorphosis have drawn comparatively little depressions of later life comorbid with dementia attention. Comorbid correlations in late commotion syndrome is found. This, in our depressions have been studied insufficiently. Role opinion, confirms accepted viewpoint about of age, personality and ethnocultural factor in presence of remote consequences of formation of pathology is considered unilaterally, craniocerebral injuries in the kind of little without account for significance of biological and progressing atrophic process. The second in social-psychological influences in this period. frequency cause of formation of similar states is Variety of factors determining course of Alzheimer’s disease, with its frequency in women depressions of later life actualize problem of their being higher than in men – 12 (23,5 %) and 2 (3,9 not only psychiatric, but also somatic and %) patients, respectively what corresponds to neurological comorbidity. During increase of age earlier obtained data about prevalence of against the background of forming intellectual- Alzheimer’s disease. The rest cases of dementia mnestic decrease as we as dementias of are associated with various variants of Alzheimer and non-Alzheimer type, affective disturbances of brain circulation of atherosclerotic disorders are found more frequently, and above genesis. Only in two cases we could diagnose mentioned processes of mental retardation Pick’s disease. substantially change the dynamic of these Despite of sufficiently broad spectrum of disturbances. diagnostic rubrics comorbid with depressions of In order to study clinical peculiarities of late late life both dementia and affective disorders had depressions comorbid with dementia we have a certain clinical similarity in all patients of this examined 51 patients of Slavic nationality group. Here affective symptoms were determined suffering from depressive disorders. Nosological by predominantly depressions of apathic and distribution is as follows: abulic character with intellectual-mnestic decrease 1. Dementia in Alzheimer’s disease with yearly and possible Dysphoric inclusions. onset (F00.0.) – 5 patients (9,8%). A peculiarity of depressive disorders in 2. Dementia in Alzheimer’s disease with late dementia was absence of depressive complaints of onset (F00.1.) – 9 patients (17,6%). patients, this is why, signs of depression were 3. Vascular dementia with acute onset identified based on objective rating – presence of (F01.0.) – 7 patients (13,7%). lowered mood, loss of interests, decrease of 4. Multi-infarction dementia (F01.1.) – 6 activity, heightened fatigue, low self-esteem, patients (11,8%). pessimistic vision of the future. In two cases of 5. Subcortical vascular dementia (F01.2.) – 2 depressions comorbid with dementia of World Cultural Psychatry Research Review 2009, S1: 191-237
227 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION Alzheimer’s type we have revealed suicidal actions. some fluctuations) mood with submergence in to Inherent in depressive disorders lowered ability to the circle of their own experiences, strive for concentration and attention is so typical fro seclusion, refusing of contacts. Grumbling degenerative process proper that it is impossible to affective background, non-satisfaction with the regard it as manifestation of only depression. surrounding and malevolent toward them attitude Affective background in this group was were accompanied by not persistent complaints characterized by prolonged (up to several weeks or toward the nearest, recalling insults, ideas of months) decrease of mood. Patients noticed references with reproaching of the acquaintances almost constant fatigue and depression, presence in insufficient attention, undeserved insults, of hard thoughts, feeling of lack of any prospect forgiveness of their past merits and of existence, difficulties in decision making, underestimation of their significance in resolution absence of feeling of joy, feeling of discomfort. of family problems. During constantly lowered affective background Gloomy mood periodically was interrupted by separate episodes of getting deeper the depression episodes of negativism and hostility and in some were observed, that sometimes alternated with cases was accompanied by ideas of detriment periods of relatively plain mood. and robbing. In some cases dysphoric affect Severity of depressive syndrome in this group reached the significant degree of severity and was has been distributed as follows: mild depressive accompanied by episodes of aggressive behavior episode – 12 persons (23,5 %), moderate with brutality. Dysphoric disorders carried a depressive episode – 34 persons (66,6 %), severe halftone of irritability and proneness to conflict: depressive episode – 5 persons (9,8 %). Depressive constant readiness to initiate conflicts resulted in episodes of mild and moderate severity according quarrels with neighbors or with not acquainted to ICD-10 differed in degree of lowering of the people, and loud reproaching the surrounding was mood and severity of other manifestations – accompanied by swinging with arms, assault with heightened fatigue, loss of interests and ability to fists, “insisting on their rights”. All that could be experience feeling of joy, low self-esteem, and accompanied by tears of hostile or helpless insult absence of self-confidence; in moderate degree of little systematized ideas of robbing and demands depression we revealed ideas of guilt and self- to return they say robbed things. However, we did humiliation, thoughts of death, sleep and appetite not observed deep, prolonged psychotic disorders disorders. In clinical picture of severe depressive in this group. During development of dysphoric episodes in addition to described manifestations reactions in patients, senestopathic and phobic there were symptoms of motional restlessness disorders, insult regarding insufficiency of reaching sometimes the degree of agitation attention and rendered assistance were actualized. however these symptoms carried short-term In three cases we have noticed dysmorphophobic character. disorders in the kind of constant preoccupation Other symptoms of depression such as about state of skin of the face, non-satisfaction difficulty in fulfillment of social functions, with his/her face, fixed examination of it in the household, professional difficulties may not be mirror, palpation of skin, frequent counseling and taken into account during identification of depth treatment. of depressive syndrome comorbid with dementia In the other group of patients (25 patients) because cognitive disorders being obligate adynamic symptoms in the kind of apathy or manifestations of dementia proper result in social- asthenia prevailed. Apathic depressions (9 household disadaptation. Despite of that observations) were characterized by nasty mood, depressions in patients with dementia have not poverty of affective experiences, vacant stare, enough distinctive syndromal appearance, hypo- or amimia, hypodynamia, hypoabulia, distinguishing various types of syndrome proved absence of incentives, absence of initiative, to be possible. As a whole, structure of depressive absence or extremely difficultly revealed feeling of syndrome in the course of disease changed little, incapacity. In depressions with asthenic although representation of those or other manifestations (16 persons) we noticed heightened depressive symptoms could fluctuate. fatigue, general weakness; patients lie in bed too We shall mark that in a half of patients (26 long. Experiences had altruistic trend, in persons – 50,9 %) we have revealed dysphoric statements apologies for troubling, requests not to inclusions in structure of affective disorders. take care about the patient sounded, strive to Similar depressions had various halftones of attract attention to her/him was absent. emotional-behavioral manifestations. They were In parallel with depressive disorders in this characterized by gloomy (monotonous or with group in 18 patients we observed confabulator World Cultural Psychatry Research Review 2009, S1: 191-237
228 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION disturbances. They did not influence the state of hours. Sometimes, episodically repeated affective background but sometimes confabulator depressive and anxiety disorders flew against the ideas of robbing were accompanied by anxiety background of not purposeful motional agitation. that was explained by imaginary disappearance of In other cases, behavior reflected strives to hide things or products of nutrition. In 16 cases against and run from the surrounding people or attempts the background of depressed mood and anxiety, to defend against imaginary threat, we noticed states of amnesiac confusion with disorientation in aggressive reactions and brutal actions. Such states surrounding persons, place and time, insecure could be accompanied by feeling of fear or horror. orientation in place and situation, motional Rough disturbances of memory and intellect restlessness, fussiness, search for relatives or lost made impossible any productive contact with the they say things occurred. States of amnesiac patient what complicated revealing of depressive confusion were usually preceded by change of symptoms proper and assessment of their role in stereotype of life, for example, during admission structure of syndrome. As a whole, depressive in hospital, move to new place of living, in cases disorders at this stage were determined by not of addition of somatic diseases. deep apathoabulic symptoms without circadian In more that a half of patients (32 persons – fluctuations and by motor retardation. Against the 62,7 %) in the course of disease we noticed also background of leveling the personality features deeper depressive disorders, however, their length stereotypization and fade of affectivity as a whole did not exceed 2-3 days, and more often occurred. fluctuated from several minutes up to several
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Trends of the Contemporary Family Development in Russia V.P. Pirogova (Russia), N.D. Bukreyeva (Russia)
Regular and occasional shifts in development family of an unemployed there are their own of the society undermine foundations of problems: abrupt falling of the authority of the traditional family, characterize directedness of father in eyes of children, because he can not familial life. Modern family differs from traditional support the family and does not mean a strong one by social-demographic characteristics, socio- man anymore. In the child feeling of security is cultural problems, and psychological features. destructing. In the family insecurity, fear for future New quantitative and qualitative parameters of fell. Of great interest are families of farmers the family condition also specific of performed by where children earlier than in other family are the family functions, especially reproductive and involved into labor activity. Every new type of the educational ones. family gives rise to their own specific problems. Economic reforms, freedom of the individual In its development the family impetuously goes activity change the society. There have been from many children to few children. After 1987 appeared the rich, the poor, the beggary, the birth rate became to fall abruptly, death rate of unemployed. And if for former society types of the population became to heighten. Many family were typical such as family of a worker, childless families have appeared. Currently in family of a collective farmer, family of an Russia one-child family predominates. Family with intellectual, so in the contemporary society one few children, especially one-child one is unique. It can distinguish many new types: family of a has many difficulties and, first of all, associated millionaire, businessman, street sellers, an with upbringing of a single child. Unigeniture unemployed, where with traditional familial negatively influences on the character of the child, problems (upbringing of children, domination in on child-parental relations. the family) new problems of sociocultural, From the beginning of the 70-th distinctive psychological plan appear. trend of increase of number of children born Children in the family of businessmen have a beyond the registered marriage is observed. In sufficient material provision, much pocket money 1970 every tenth newborn appeared beyond the but often remain without care of adults, are marriage. In women up to 20 years every fifth deprived of spiritual-moral communication with birth – beyond the marriage. In the country parents due to absence in them of time. In the number of extramarriage relationships has World Cultural Psychatry Research Review 2009, S1: 191-237
229 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION increased, families of single mothers where one of moments: first, appearing in the society rich men the most important factors of upbringing is absent can support their families and the wife becomes – father. High portion of extramarriage births is only housewife, second, reduction of the typical for Siberia, Chechen-Ingushetia. production first of all has an impact on women, New structure of the family is conditioned by having left them without work. Having closed exactly manifested processes of its nuclearization. everywhere children’s preschool institutions are From 50 to 70% of young spouses want to live replaced fully by maternal care, area of service separately from parents. On one side, this affects destructing is compensated by increasingly favorably the young family because in it broadening home duties in women connecting adaptation to new roles, conditions of life goes them to family and taking away the entire free quickly, dependence on parents is lesser, and this time. promotes formation of responsibility. But on the Heightening of the general level of well-being other side, such a family loses systematic help of of the society, adjusting all branches of the parents especially in period of birth of the child industry of consumption, perfection of children’s when it is especially needed. preschool institutions and etc. will allow not going Nuclearization is typical for development of toward de-emancipation of the woman, forced the family in the entire world. For example, traditionalism of the family. Thereby family must English, American families are neolocal, i.e. adult have all the conditions for free choice of form of children almost always are separate from parents. its vital activity. In the family process of egalitarianism of the Analyzing vital activity of the family in the family and democratization of intrafamilial contemporary situation it is necessary to mention relations between spouses, parents and children is some formalization if family relations when family observed. life is built on performance of duties without Also other (alternative) families appeared. This special mental expenses, when in family material is a family where a man having wife and children problems are accentuated, when in and supporting them at the same time has a communication of the family there is not mistress and also supports her. Both families know warmness, care, attention. Formalization of about existence of each other. Such a form of the relations is accompanied by emotional rejection of family has obtained the name “family – parents from children that manifests as moral- concubinage”. Families became often so where psychological opposition of fathers and children. husband and wife live in separate flats. This is so Family in Siberia reflects cultural style of life called Goodwin-marriage. of that ort another scanty people. Although in the modern family relations According census of All-Russian center of between husband and wife are built according to study of public opinion, 65% of asked have principle of interchangeability where rigid mentioned that basic role in their family is played attribution of duties is absent, in it trend of by their family. 26% have called this role of the traditionalism of family roles in their patriarchal family sufficiently significant. meaning takes shape: attribution to woman of the Family in life of the person is one of major role of only keeper of home, mother and father – values. role of breadwinner. This is associated with two
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Regional and Ethnic Features of Non-Psychotic Mental Disorders in Patients Exposed to Minor Doses of Radiation V.A. Rudnitsky (Russia), V.Ya. Semke (Russia)
In group of participants in liquidation of the Climatic and geographic conditions of Siberia, accident on Chernobyl atomic power station we regional man-made and environmental troubles, have identified organic non-psychotic mental adverse social and psychological situation in this disorders overlapping with somatic diseases and group of patients worsened course of mental immunologic disturbances. In that cohort of disorders. In patients from Caucasian and Asian patients we revealed prominent level of social ethnic groups we revealed more stabile structure disadaptation, decreased life duration and quality. of social interrelationships, as a sanogenic World Cultural Psychatry Research Review 2009, S1: 191-237
230 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION resource (stable families, professional means of grouping patients with the same clinical, environment), that result in higher level of social constitutional, biological and social and adaptation and more favorable clinical dynamic of psychological traits, with assessment of pathogenic mental disorders. In patients from other ethnic and sanogenic resources. Social activities in this groups in case of stable social connections course group of patients were very important. Activities of disorders was more favorable. We developed of medical and social care will promote more programs of rehabilitation, consisting of effective rehabilitation and allow increasing psychopharmacological, psychotherapeutic, quality of health care to patients exposed to minor physiotherapeutic and immunorehabilitative doses of radiation. complex. We used individualized approach by
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Benefits of Religious Coping Differ by Genes and Culture. An Analysis of Serotonin Receptor Polymorphism 5-HTR1A in European Americans and Koreans J. Sasaki (USA), K. Heejung (USA)
The way people use and benefit from religion may analysis. Results showed that Koreans were more be impacted by both genetic and socio-cultural religious and also lower in overall life satisfaction factors, as well as the interaction of genes and than European Americans. Although religiosity culture. Specifically, research suggests that the use did not predict life satisfaction or health symptoms and benefit of religious coping may vary for European Americans, religiosity predicted depending on group membership (Sasaki & Kim, greater life satisfaction and less negative health 2009), and recent contributions in gene- symptoms for Koreans, and particularly for those environment research suggest that genetic who were genetically predisposed to be stress predispositions to stress reactivity (e.g., having two reactive (i.e., those with two G alleles in 5- G alleles in a serotonin receptor polymorphism HTR1A). The results of this study have called 5-HTR1A; Huang et al., 2004) may also implications for how religion may impact physical play a role in how religion helps people to cope. health and psychological well-being in different For example, research has shown that African cultures. Americans have higher levels of religiousness than European Americans (Pargament, 1997), and References religious involvement also seems to be related to Ferraro KF, Koch JR. Religion and health among Black and well-being for African Americans more strongly White adults: Examining social support and consolation. Journal for the Scientific Study of Religion, 33, 362-375. 1994 than for European Americans (Ferraro & Koch, Huang Y, Battistuzzi C, Oquendo MA, Harkavy-Friedman J, 1994; St. George & McNamara, 1984). One Greenhill L, et al. Human 5-HT1A receptor C (-1019)G proposed explanation for this finding is that polymorphism and psychopathology. International Journal religion is especially helpful to those who have of Neuropsychopharmacology, 7: 441-451, 2004. been socially oppressed or face particularly Pargament KI. The psychology of religion and coping: Theory, research, practice. New York, Guilford,1997 difficult circumstances (Pargament, 2002). An Pargament KI. The bitter and the sweet: An evaluation of additional and yet untested possibility is that the costs and benefits of religiousness. Psychological Inquiry religion is most helpful to those who are 13: 168-181, 2002. genetically predisposed to be sensitive to stressors Sasaki J, Kim H. At the intersection of culture and religion: A cultural analysis of the effect of religion on control. in the environment. In the present investigation, Manuscript in preparation. 118 European Americans and 137 Koreans St. George A, McNamara PH. Religion, race and completed a questionnaire on coping and well- psychological well-being. Journal for the Scientific Study of being and also gave saliva samples for DNA Religion 23: 351-363, 1984
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231 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION
Depressive Disorders among Elderly in Nurse Care Department in Siberian Region (Russia) N.I. Shakhurova (Russia)
Background being in the hospital in association with necessity Investigations of recent years describing of assistance rendering or validation of medical possible ways of assistance rendering to an documents into nursing home. Investigation was individual in late life confirm necessity of taking entered by patients older than 60 years able to into account of complete clinical picture including understand the text of proposed psychodiagnostic its biological, mental and social aspects. questionnaires and willingly to answer them. Principle of palliativeness in the contemporary Criteria of exclusion were severe cognitive understanding is not reduced to oncological disorders (less than 20 scores according to Mini- pathology and is distributed on the other diseases Mental State Examination, MMSE); disorders of in which recovery is impossible. Observed consciousness, aphasia, neuro-sensory poor demographic trends of present time allow validly hearing, psychotic forms of organic impairment admitting that death from chronic noninfectious of CNS, severe diseases of inner organs at the disease including cancer already is not considered stage of exacerbation and decompensation, as unnatural and not justified interruption of progression of chronic heart failure. human life in the period of its prime but rather as In order to conduct screening of depressive one of usual and inevitable outcomes of biological disorders we have used HADS (Hospital Anxiety life of an individual in declining years. and Depression Scale) and GDS-15 (Geriatric Because nowadays style of familial life with Depression Scale-15). joint living of several generations practically disappears what facilitated in the past the final Results stage of life of incurable patients and old From total number of patients under treatment members of the family so providing the worthy for at the nurse care department women in 76,8% of an individual departure heightens significance of cases were admitted predominantly for conducting palliative direction in structure of the entire the treatment activities and 41,2% of men – for modern medicine. validation into a nursing-home (p=0,09289). According to Venice Declaration (2006), Study of structure of diseases of inner organs as a adopted by European Association of Palliative basic diagnosis has been presented in scheme 1. Care (EAPC) on advancement of global initiative Patients of nurse care department on scientific investigations in the field of palliative (n = 101; 19 men and 82 women) care as an important fact not only development of clinical services but also scientific-investigative and educative aspects of palliative medicine are recognized.
Objective of investigation To study typology and incidence rate of affective disorders as well as possibilities of use of Circulatory system Locomotive Chronic illnesses system illnesses of psychodiagnostic scales for rating of degree of illnesses respiratory organs severity of depression and efficacy of psychopharmacotherapy in elder patients with combined somatic pathology at nurse care department. Cardio- Consequ Fracture Bronchia and ences of of l asthma Material and methods of investigation. cerebrov experien femoral ascular ced neck, (n=2; Under observation group of patients of the stroke cotyloid 1,98%, nurse care department was (101 persons, of them diseases cavity (n=30; 0 male, 19 male and 82 female, average age 75,21±8,2 (n=54; 29,70%, (n=15; years), with complex combined somatic pathology, 53,47%, 14,85%, 2 female) 5 11 male, World Cultural Psychatry Research19 Review 2009,3 male, S1: 191-237 male, 12 68 female) female) 232 female) 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION qualified by psychoorganic syndrome with The largest group of 84 cases (83,17%) was appearing intellectual and physical asthenia, constituted by 16 men (15,84%) and 68 women decrease of cognitive functions not reaching (67,33%), with cardio- and cerebrovascular degree of dementia. pathology with high and very high risk of Revealed depressive disorders were qualified cardiovascular complications. according to following nosological rubrics: From total number of patients with cardio- and (F06.36) organic affective (non-psychotic cerebrovascular pathology we have distinguished a depressive) disorder - 35 cases (34,65%); (F 3) subgroup of patients – 3- persons (35,7%), current depressive episode - 10 (9,9%), recurrent attributed to rubric “Consequences of depressive episode of MDD - 11 (10,9 %), cerebrovascular illnesses” as consequences of dysthymia - 10 (9,9 %) cases of the total number experienced acute disturbance of brain of examined patients. circulation. Analysis of interrelationship and comparative It should be mentioned that cerebrovascular characteristic of incidence rate of affective diseases as consequences of experienced brain disorders in geriatric patients indicates statistically impairments (acute disturbance of brain significant differences between groups depending circulation in anamnesis), confirmed by objective on basic somatic pathology (p=0,03529). Major data significantly more frequently were observed part of cases of affective pathology (53,03%) has in men needing permanent care who have been presented by OAD. Maximal incidence of constituted 11 cases (57,89%) in group of men OAD (66,67%) was observed in patients with and 19 cases (23,17%) – in group of women consequences of cerebrovascular illnesses in the (p<0,05), what is an important medico-social kind of residual phenomena of stroke. In patients factor for selection of patients and performance of with cardio- and cerebrovascular diseases (IHD, organizing activities of palliative care. HI), locomotive system diseases of traumatic Analysis of medical documents and study of genesis and conditioned by pathological fractures, conditions and level of social support of patients OAD was revealed in 48,57% and in 44,44% of has shown that namely men after experienced cases, respectively. strokes (in presence of pareses, paralyzed Recurrent episode of MDD in total group was extremities) were potential candidates for found in 16,67% and was the most significant in transition into a nursing-home. patients with pathology of locomotive system Locomotive system diseases were found in 15 (44,45%) and diseases of CVS (20%). Dysthymia (14,8%) patients (in 3 men and in 12 women). and current depressive episode were observed in As a basic diagnosis in two women (1,98%) we equal portions in the total group. Dysthymia was revealed bronchial asthma of mixed form, high revealed in 28,57% of patients with consequences degree of severity with frequent relapses and of stroke in 11,43% with pathology of CVS. severe disturbances of function of outer Current depressive episode – in 20% of patients respiratory system. with diseases of CVS, in 11,11% - with pathology High risk of development of vascular of locomotive system, in 4,76% - with complications was determined by presence of the consequences of cerebrovascular complications. other significant risk factors and associated In clinical structure of affective disorders we diseases. As associated pathology in 29,7% of have distinguished five leading psychopathological studied cohort of patients (n=30) diabetes mellitus syndromes qualifying mental status of patients: (DM) of type 2 was diagnosed, thereby incidence depressive, anxious-depressive, subdepressive, and rate of DM in men (n=4) constituted 21,05%, in depressive-hypochondriac, dysphoric. women (n=26) 31,71%. Depressive syndrome was observed in 44 All 101 patients has an accompanying (42,57%) patients and was characterized by background cerebrovascular pathology in the kind decreased background of mood, inability to of discirculatory encephalopathy of stage II-III distract from burdensome experiences, absence of стадии, being adverse risk factor for development interest in the surrounding, tearfulness, sleep of vascular complications. disturbances, fixation on psychotraumatic According to data of clinical- circumstances during their presence, pessimistic psychopathological examination associated with evaluation of their past and future. Insight toward somatic diseases disorders of depressive spectrum perception of their state was present partially, were diagnosed in 66 patients (65,3% of cases). basic part of patients believed that in their In 35 (34,7%) patients we revealed organic position there is nothing “pleasurable”, at the non-psychotic disorders whose mental status was same time hoped for antidepressant therapy. World Cultural Psychatry Research Review 2009, S1: 191-237
233 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION Anxious-depressive, depressive-hypochondriac was qualified by psychoorganic syndrome with and dysphoric syndromes were found in 5 (7,92%) appearances of intellectual and physical asthenia, cases, in 7 (5,94%), in 10 (8,92%) cases, decrease of cognitive functions not reaching respectively and had additional phenomenological degree of dementia. clinical manifestations what has allowed As a result of clinical-psychopathological distinguishing them into indicated groups. investigation and rating the mental state of In the case of anxious-depressive syndrome the patients with somatic diseases we administered structural component of depression were psychopharmacotherapy with antidepressants of symptoms of anxiety in the kind of inner the first choice. Comparative analysis of efficacy restlessness, tension, inability to relax, constant of antidepressants with various mechanism of expectation of bad news. Nevertheless, during action has shown statistically significant decrease evaluation of clinical picture in these patients as a of level of severity of depression up to sub-clinical whole we have not revealed isolated forms of its manifestations irrespective from class of the anxiety disorders. preparation. Depressive-hypochondriac syndrome additionally was characterized by such features as Conclusions preoccupation with state of their own health, Thus, among patients of nursing carte heightened attention to details of examination, department the most multiple group of 84 cases changes of treatment, strive to elucidate in the (83,17%) was constituted by patients with doctor details about his/her disease that are circulation system pathology with high and very probably hidden from the patient. Circle of high risk for development of vascular interests of such patients is entered by reading of complications. Performed investigation has shown medical and scientific-popular literature, his/her a high (65,3%) incidence of disorders of own interpretation of the information with depressive spectrum in elder patients of geriatric account for individual biological peculiarities of hospital. Screening revealing of depressive the organism that was well studied by the patient. disorders with the help of Psychodiagnostic According to attitude toward other patients being questionnaires reaches important aims such as in room these patients not seldom occupy objectification of clinical diagnosis of mental protecting position explaining peculiarities of status and efficacy of psychopharmacotherapy, course of illnesses, causes of its appearance, attention of doctors-internists to non-psychotic sharing information about methods of treatment psychiatric pathology of elder patients, promotes with folk and other agents. more empathic response of secondary staff to Dysphoric syndrome has been distinguished by emotional needs of incurable patient. us in association with presence in mental status of Among reached clinical effects of patients of such manifestations as irritability, antidepressant therapy of greatest significance are aggressiveness, anger, heightened sensitivity to getting milder of depressive and anxious every outer irritant. Patients expressed multitude symptoms, improvement of somatovegetative of resentments according to various occasions, functions (normalization of sleep, heightening of sometimes provoked conflict situations in the room the appetite, reduction of alalgical manifestations), involving other patients. Emotional background maintenance of balanced mental and somatic was characterized by dreary-malign mood with state of patients influencing on their quality of captiousness, querulousness, inclination to threats. life. In the group of patients with non-diagnosed affective disorders (35 cases; 34,65%) mental status
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Problems in Treating Roma Diagnosed with Psychosis (SCH) Z. Stevanovic (Russia)
The first reference to the Roma people in the Monastery of Prizren. Serbia is found in a 1348 document, by which Today, however, most Roma speak the Stefan Uroš IV Dušan of Serbia, Emperor of dominant language of their region of residence. Serbs and Greeks donated some Gypsy slaves to Most Roma refer to themselves as Rom. In the World Cultural Psychatry Research Review 2009, S1: 191-237
234 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION Romani language, Rom (man) derives from the actually forced, as most communities do not Sanskrit dom (man). Wherever they arrived in accept Roma settlements. They usually remain on Europe, curiosity was soon followed by hostility the margins of society, living in isolated ghetto-like and xenophobia. Like the Jews, they were settlements. Only a small fraction of Roma sentenced to forced labor and imprisonment in children graduate from secondary schools, concentration camps. In Communist Eastern although during the Communist regime, former Europe, Roma experienced assimilation schemes Yugoslavia forssed all children to attend school, and restrictions of cultural freedom. The Romani and provided them, like other citizens, with all language and Roma music were banned from required basics such as textbooks and the public performance in Bulgaria. Worldwide, there compulsory uniform. The reasons include that are an estimated 8 to 10 million Roma, most of Roma avoid non-Roma because they traditionally whom reside in Europe. Although the largest consider them "mahrime" (spiritually unclean), Roma populations are found in the Balkan avoid them out of fear of persecution, still live in peninsula.. Most Roma speak Romani, an Indo- shacks (usually built ad hoc, near railways) and Aryan language likely derived from Sanskrit. The beg on the streets. In Kosovo, the Roma are seen traditional Roma place a high value on the by many Albanians as being allied with Serbian extended family. Both men and women often national interests. During the Yugoslav wars, marry young; there has been controversy in Roma were often victim to discrimination . Their several countries over the Roma practice of child low status on the job market and higher marriage. Roma social behaviour is strictly unemployment rates cause poverty, widespread regulated by purity laws ("marime" or social problems and crime. "marhime"), still respected by most Roma and Up until now, experience of the Clinic for among Sinti groups by the older generations. This Mental Protection in Nis indicate that Roma regulation affects many aspects of life, and is rarely ask psychiatrists for help. They have high applied to actions, people and things. Roma have tolerance for psychotic symptoms of their usually adopted the dominant religion of the host diseased. They come to a psychiatrist only when country. In the southern Balkans, the Roma are the diseased manifests with extreme anxiety and split into Christian and Muslim populations. aggressive behavior. Sometimes up to ten years pas Roma religion has a highly developed sense of until the diseased asks for psychiatric help. They morality, taboos, and the supernatural, though it is accept alternative forms of treatment (mages, often denigrated by organized religions. In the fortune-tellers) more often, which is in correlation Balkans, the Roma of Macedonia, Kosovo with ‘magical’ ways of thinking present in their (Southern province of Serbia) and Albania have culture. When they begin the treatment, they been particularly active in Islamic mystical irregularly come for controls. Medicamentous brotherhoods (Sufism). Roma in European compliance is low, which often results in worsening population centers are often associated with petty of the disease. They think that having a crime such as pickpocketing, utilizing a variety of psychiatric disease is a shame, so they often deceptions and tactic.In Serbia Roma often live in concede families although their partner is unaware depressed squatter communities with very high of their disorder. Their educational level and bad unemployment, while only some are fully economic status make cooperation in the process integrated in the society. Although some Roma of treating a lot harder. still embrace a nomadic lifestyle, most migration is
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Socio Epidemiological Characteristics of Roma People Admitted for Treatment in Psychiatric Hospital in Gornja Toponica Z. Stevanovic (Russia)
The Romani people are an ethnic group with The official number of Roma people is disputed origins in South Asia (India). Worldwide there is in many countries, because many Roma often an estimated population at least 15 million Roma. refuse to register their ethnic identity in official World Cultural Psychatry Research Review 2009, S1: 191-237
235 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION census for fear of discrimination. been admitted to the hospital. From these 19961, When the Roma people arrived in Europe, 578 were Roma, which make 2,89% of curiosity was soon followed by hostility and admissions. Most of the Roma are admitted with xenophobia. They were subject to ethnic diagnose of Schizophrenia and other similar cleansing, forced labor, and in Eastern Europe disorders (F20- F29) - 42,01%, while in the second Roma experienced assimilation schemes and place come disorders caused by the usage of restrictions of cultural freedom. Many Roma have psychoactive substances (F10- F19) - 33,7%. Like faced discrimination and prejudice from both with other nationalities admissions of men private groups and national Governments. (68,51%) are more common then admissions of In this poster socio epidemiological women (31,49%). Percentage of unemployed characteristics of patients admitted in Special Roma people, and Roma without any income is Psychiatric Hospital in Gornja Toponica in the much higher (74,55%) than of other nationalities period between 1995 and 2008 have been (25,29%). There are also differences in marriage observed. Patients with serious psychiatric status. Most of the treated Roma were married conditions from southern and eastern Serbia (47,41%) while most of the other patients were (approximately 2,5 million people) are admitted in not married (44,41%). this hospital. Percentage of Roma people in this The Roma are suffering the worst health area is about 1,96% (by the census from 2002.). conditions of the industrialized world together Majority of the population are Serbs, but there with some of the worse health problems associated are other national minorities (Albanians, with the third world. The proportion of Roma Bulgarians, Romanians, Bosnians, etc.). living in poverty exceeds 75% in countries Between 1995 and 2008, 19961 patients have throughout the region.
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Trauma and Vulnerability to Trauma in Asylum Seekers and Refugees in Italy: the experience of Padova L. Zaninotto (Italy), C. Cremonese (Italy), N. Campagnola (Italy), P. Zanibon, (Italy) A. Ferrandino (Italy)
Introduction Subjects and Methods The Italian Protection System for Asylum Participants were recruited among refugees Seekers, Refugees and Humanitarian Protection and asylum seekers from the local Protection Beneficiaries is coordinated by a Central Service System. All subjects were interviewed using in Rome, and managed by Local Authorities. In standard diagnostic interviews: HTQ [Harvard Padua a joint effort was activated between local Trauma Questionnaire], HSCL-25 [Hopkins authorities and the Psychiatric Service of the symptom checklist-25], WHOQOL-bref version University Hospital, in which psychiatric [World Health Organization Quality of Life] and consultants regularly supervise social workers TPQ [Tridimensional Personality Questionnaire] operating in the Protection System, and provide Participants also underwent a specific interview psychiatric assistance for the asylum seekers. The (DSM-IV-appendix IX) for the cultural high prevalence of psychiatric morbidity in formulation of the diagnosis. traumatized refugees and civilian populations is well established1. However only few studies have Results focused on the possible role of cultural and In the 2006-2008 period, 48 Asylum Seekers psychological factors in the development of PTSD (85% males) were received in Padua; 59% of them or other psychiatric conditions in these immigrated from West Africa, 23% from the Horn populations2,3. Our purpose is to determine the of Africa region. prevalence of a clinically evident psychiatric In the same period, Psychiatric Services were condition among refugees and asylum seekers, and activated for 13 asylum seekers. The main to define the role of cultural and psychological symptoms referred by patients and social workers factors on the development of trauma symptoms. were somatoform and behavioural disorders (particularly aggressiveness). After psychiatric World Cultural Psychatry Research Review 2009, S1: 191-237
236 2ND WORLD CONGRESS OF CULTURAL PSYCHIATRY NORCIA, ITALY – 27/30 SEPTEMBER 2009 POSTER SESSION evaluation, 38% of them received a PTSD diagnosis, while the other 62% received MDD, and Adjustment or Somatoform Disorder diagnosis.
Conclusion While almost every asylum seeker has lived through stressful or traumatic life events, the prevalence of PTSD in this population is quite low. From our clinical practice, psycho-social (as family situations) and personality factors may have a strong influence on the psychopathological outcome and the quality of life of these patients.
References Mollica RF. Waging a new kind of war: invisible wounds. Scientific American 282: 54-57, 2000 Elklit A, Christiansen DM. Predictive factors for somatization in a trauma sample. Clinical practice and epidemiology in mental health 5: 1; 2009 Roberts B, Ocaka KF, Browne J, Oyok T, Sondorp E. Factors associated with post-traumatic stress disorder and depression amongst internally displaced persons in northern Uganda. BMC Psychiatry 8: 38, 2008
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