Culture bound syndrome, culture related specific disorders, culture specific disorders/ syndromes, exotic psychiatric syndromes or Rare atypical unclassifiable disorders.
Culture bound syndrome, culture related specific disorders, culture specific disorders/ syndromes, exotic psychiatric syndromes or Rare atypical unclassifiable disorders.
This is seminar presented as part of academics in my department. Please comment on the content, so that i can improve myself. If the content is good, kindly like it.
World View of Disorders and Culture Bound SyndromesImran Waheed
A lecture by Dr Imran Waheed, Consultant Psychiatrist, delivered in Birmingham, UK on February 7th 2012. The audience was medical students in Birmingham.
The somatoform disorders are a group of psychological disorders in which a patient experiences physical symptoms that are inconsistent with or cannot be fully explained by any underlying general medical or neurologic condition. Medically unexplained physical symptoms account for as many as 50% of new medical outpatient visits. [1] Physical symptoms or painful complaints of unknown etiology are fairly common in pediatric populations. [2] Many healthy young children express emotional distress in terms of physical pain, such as stomachaches or headaches, but these complaints are usually transient and do not effect the child's overall functioning. The somatoform disorders represent the severe end of a continuum of somatic symptoms.
Somatization in children consists of the persistent experience and complaints of somatic distress that cannot be fully explained by a medical diagnosis. They can be represented by a wide spectrum of severity, ranging from mild self-limited symptoms, such as stomachache and headache, to chronic disabling symptoms, such as seizures and paralysis. These psychological disorders are often difficult to approach and complex to understand. It is important to note that these symptoms are not intentionally produced or under voluntary control.
In somatoform disorders, somatic symptoms become the focus of children and their families. They generally interfere with school, home life, and peer relationships. These youngsters are more likely to be considered sickly or health impaired by parents and caretakers, to be absent from school, and to perform poorly in academics. Somatization is often associated temporarily with psychosocial stress and can persist even after the acute stressor has resolved, resulting in the belief by the child and his or her family that the correct medical diagnosis has not yet been found. Thus, patients and families may continue to seek repeated medical treatment after being informed that no acute physical illness has been found and that the symptoms cannot be fully explained by a general medical condition. When somatization occurs in the context of a physical illness, it is identified by symptoms that go beyond the expected pathophysiology of the physical illness.
Recurrent complaints often present as diagnostic and treatment dilemmas to the primary care practitioner (PCP) who is trying to make sense of these symptoms. The PCP may feel poorly prepared and/or may have little time to assess or treat the somatic concerns. While the more disabling somatic complaints are more likely to be referred to a mental health professional, these youngsters presenting with these disabling physical symptoms bridge both medical and psychological domains and present a puzzling quandary for professionals from either field if working with them alone. [3] The nature of these symptoms requires an integrated medical and psychiatric treatment approach to successfully decrease the impairment caused by these disorders.
The DSM-5 organizes 10 personality disorders into 3 groups, or clusters, based on shared key features. Cluster C Personality disorders includes 3 disorders sharing anxious and fearful features. Avoidant, Dependent, and Obsessive-Compulsive.
This is seminar presented as part of academics in my department. Please comment on the content, so that i can improve myself. If the content is good, kindly like it.
World View of Disorders and Culture Bound SyndromesImran Waheed
A lecture by Dr Imran Waheed, Consultant Psychiatrist, delivered in Birmingham, UK on February 7th 2012. The audience was medical students in Birmingham.
The somatoform disorders are a group of psychological disorders in which a patient experiences physical symptoms that are inconsistent with or cannot be fully explained by any underlying general medical or neurologic condition. Medically unexplained physical symptoms account for as many as 50% of new medical outpatient visits. [1] Physical symptoms or painful complaints of unknown etiology are fairly common in pediatric populations. [2] Many healthy young children express emotional distress in terms of physical pain, such as stomachaches or headaches, but these complaints are usually transient and do not effect the child's overall functioning. The somatoform disorders represent the severe end of a continuum of somatic symptoms.
Somatization in children consists of the persistent experience and complaints of somatic distress that cannot be fully explained by a medical diagnosis. They can be represented by a wide spectrum of severity, ranging from mild self-limited symptoms, such as stomachache and headache, to chronic disabling symptoms, such as seizures and paralysis. These psychological disorders are often difficult to approach and complex to understand. It is important to note that these symptoms are not intentionally produced or under voluntary control.
In somatoform disorders, somatic symptoms become the focus of children and their families. They generally interfere with school, home life, and peer relationships. These youngsters are more likely to be considered sickly or health impaired by parents and caretakers, to be absent from school, and to perform poorly in academics. Somatization is often associated temporarily with psychosocial stress and can persist even after the acute stressor has resolved, resulting in the belief by the child and his or her family that the correct medical diagnosis has not yet been found. Thus, patients and families may continue to seek repeated medical treatment after being informed that no acute physical illness has been found and that the symptoms cannot be fully explained by a general medical condition. When somatization occurs in the context of a physical illness, it is identified by symptoms that go beyond the expected pathophysiology of the physical illness.
Recurrent complaints often present as diagnostic and treatment dilemmas to the primary care practitioner (PCP) who is trying to make sense of these symptoms. The PCP may feel poorly prepared and/or may have little time to assess or treat the somatic concerns. While the more disabling somatic complaints are more likely to be referred to a mental health professional, these youngsters presenting with these disabling physical symptoms bridge both medical and psychological domains and present a puzzling quandary for professionals from either field if working with them alone. [3] The nature of these symptoms requires an integrated medical and psychiatric treatment approach to successfully decrease the impairment caused by these disorders.
The DSM-5 organizes 10 personality disorders into 3 groups, or clusters, based on shared key features. Cluster C Personality disorders includes 3 disorders sharing anxious and fearful features. Avoidant, Dependent, and Obsessive-Compulsive.
Insight is one of the crucial components of a mental status examination in Psychiatry. Scarce data is available in the standard textbooks on this concept.
The following presentation was made after going through the myriad of articles and case studies i found online.
Arab Youth Identity Crises Or Mental Illnessburaikyx
Arab youth are facing particular challenges integrating societal norms, economic pressures and self-fulfillment needs in a global world. Their issues can result or be percieved as mental illness. What is our role as Mental health professionals dealing with this population?
A strategy for social stability in Tripoli, Lebanon (CARE International)Magnus Wolfe Murray
A summary slideshow of a strategy I worked on with CARE international in Lebanon colleagues. For Syrian refugees living in Tripoli but also for local people who face dwindling social services and few economic opportunities.
A seminar with Walid Ammar, MD, PhD, Director General, Ministry of Public Health of Lebanon; Professor, The Lebanese University; Senior Lecturer, American University of Beirut.
Topirol (Topiramate Tablets) is used for the treatment of various types of seizures (antiepilepsy) in adults and children, aged 2 years and greater. It can also be used for the prevention of migraines in adults.
Developing Mental Health Services for Refugee ChildrenYoung Lives Oxford
This presentation explores the challenges and opportunities of developing mental health services for refugee children, paticularly in school-based environments.
Presented by Mina Fazel, NIHR Post-Doctoral Research Fellow, Department of Psychiatry, University of Oxford and
Consultant in Child and Adolescent Psychiatry, Children’s Psychological Medicine, Oxford University Hospitals
A Critical Look at Clinical PsychologyThe .docxransayo
A Critical Look at Clinical Psychology
The DSM
“Patchwork of scientific data, cultural values, political compromises, and the material for making insurance claims”
The 1980 edition revision tried to mimic a biomedicine style
In Psychiatric diagnosis, etiology is rarely known
Reliability remains a big problem
The 1980 edition began to define conditions by listing symptoms. Revision was an effort to portray psychiatry as a branch of medicine which would boost credibility of the field and ensure financial viability. However in biomedicine, diagnosis are based on etiology > that is causes rather than symptoms. And they would then test for various causes of said symptoms. In psychiatric diagnosis, etiology, is rarely known. Ex. Schizophrenia (combination of things). Reliability remains a big problem with the DSM. Just because not every clinician may give the same individual the same diagnosis. -> could be due to cultural values, ethnicity or socioeconomic status.
Homosexuality
Multiple theories that classified homosexuality as a disease
Psychiatrist and psychoanalyst Edmund Bergler infamously wrote in a book for general audiences, “I have no bias against homosexuals; for me they are sick people requiring medical help... Still, though I have no bias, I would say: Homosexuals are essentially disagreeable people, regardless of their pleasant or unpleasant outward manner... [their] shell is a mixture of superciliousness, fake aggression, and whimpering. Like all psychic masochists, they are subservient when confronted with a stronger person, merciless when in power, unscrupulous about trampling on a weaker person”
On December 15, 1973, the Board of Directors of the APA declassified homosexuality per se as a mental disorder from the DSM-II
Judgements of Normality depend on social norms, cultural standards and local customs. Grief is another example. Talk about different cultures
Commercial for Cymbalta
Questions to ask after Video:
What are some things that you noticed within the video?
What are the explicit ideas expressed in this video?
What’s the overall message?
Political Economy of Clinical Psychology
1980’s revision involved “medicalization”
Adoption of the language of medicine. Including terms like: disease, symptoms, patient, syndrome, relapse, diagnosis and prognosis.
Introduction of managed care
Intrusion of pharmaceutical companies
Conflict of interest between pharmaceutical companies and psychiatrists
Drastic cuts in funds for mental health care
The 1980 revision of the DSM involved medicalization. Meaning they adopted the language of medicine to understand and describe psychological suffering. This language would include disease, symptoms, patient, syndrome, relapse, diagnosis and prognosis.So now that the field of psychiatry identified itself as a “medical” specialty, the research efforts concentrated on searching for biological bases of suffering and pharmaceutical treatments. Politica.
Discussing the cultural perspectives and Health related details using Biomedical model. This whole discussion will cover psychopathology, health related issues and cultural beliefs
An overview of dementia gives an introduction to epidemiology, causes, clinical features, investigations, diagnosis, and management of dementia. Also a short description of related topics like difference between cortical and sub cortical dementia, psuedo dementia, mild cognitive impairment and reversible causes of dementia is also included.
HIV and Psychiatry , Neuropsychiatric aspects of HIV , AIDS , Breaking bad news in HIV , Psychiatric intervention in HIV , Neuropsychiatric complications of HIV and AIDS
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
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- Prix Galien International Awards Ceremony
2. Also known as culture related specific disorders,
culture specific disorders/ syndromes.
In the American handbook of psychiatry,
Exotic psychiatric syndromes or Rare atypical
unclassifiable disorders.
They all refer to certain illnesses or disorders which
occur exclusively in certain cultures and not in
others.
3. The term culture-bound syndrome denotes a set of
behavioral and experiential phenomena that is present
in a particular socio cultural context and are readily
recognized as illness behavior by most participants in
that culture.
The syndromes are commonly assigned culturally
sanctioned explanations ,that, in turn, generate
culturally congruent remedies, usually in the form of
healing rituals.
Kaplan & Sadocks Synopsis of Psychiatry ; tenth edition Pg:521
4. Culture
Culture is a vast, complex concept. Culture consists of
shared symbols, artifacts, beliefs, values, and
attitudes. It is manifested in rituals, customs, and
laws.
Culture is learned through contact with family,
friends, classmates, teachers, significant persons,
and the media; the term for this process is
enculturation.
Kaplan & Sadocks Synopsis of Psychiatry ; tenth edition Pg:168
5. Acculturation and Assimilation
Adults, such as migrants or refugees, who only in part
adopt the culture of a host society are said to be
assimilated, whereas those who assume a new
cultural identity consonant with the host culture are
said to be acculturated.
Persons who abandon their native culture but fail to
be assimilated or acculturated usually lose their
sense of identity or purpose in life and are at high
risk for suicide, substance abuse, and alcoholism.
Kaplan & Sadocks Synopsis of Psychiatry ; tenth edition Pg:168
6. The concept of culture bound
syndromes.
The DSM & ICD are not universally applicable;
psychopathological syndromes exist, especially in
non-Western cultures that do not fit the scientific
nomenclature unless they are placed into the
atypical •category. These syndromes are perceived
to be more influenced by culture and, therefore,
have been labeled culture-bound. Some syndromes
are found in distinct cultural groups, whereas others
are found in large cultural regions.
7. History
Conditions now been referred to as CBS were first
described in Kraepelin textbook of psychiatry,
the 8th edition in 1909.
It was the Chinese psychiatrist Yap who first
introduced the term Culture Bound Syndrome in
1969.
CBS were first described outside the west and so were
thought to be only non-western conditions
Culture-bound syndromes:the story of dhat syndrome.D.Bhugra et alBJP(2004)
9. ICD 10
Neurotic, stress-related and somatoform disorders
F.48.8 - Other specified neurotic disorders
This category includes mixed disorders of behavior,
beliefs, and emotions which are of uncertain etiology
and nosological status and which occur with
particular frequency in certain cultures;
The strong association of these syndromes with locally
accepted cultural beliefs and patterns of behavior
indicates that they are probably best regarded as not
delusional.
ICD 10 by WHO , page 110
10. DSM 5
The DSM 5 includes them in the Appendix under
the heading “ Glossary of Cultural Concepts of
Distress”
12. Dhat
A folk diagnostic term used in India to refer to severe
anxiety and hypochondriacal concerns associated
with discharge of semen , whitish discoloration of
urine and feelings of weakness and exhaustion.
Also called Jiryan , Sukra prameha(Sri Lanka) and
Shen-K’uei(China).
13. The term Dhat is derived from the Sanskrit word
Dhatu which means elixir or metal.
It was first described in western psychiatric
literature and the term DHAT coined by Wig in
1960s , with vague psychosomatic symptoms of
fatigue, weakness, anxiety, loss of appetite, guilt
and sexual dysfunction, attributed by the patient
to loss of semen in nocturnal emission, through
urine or masturbation.
DHAT SYNDROME: A REAPPRAISAL ;Indian Journal of Dermatology
Wig NN. Problem of mental health in India. J Clin Social Psychiatry. 1960;17:48–53.
14. The symptoms of semen-loss anxiety are well known in Indian
historical writing. In Ayurvedic texts semen production is
described thus: food converts to blood, which converts to flesh,
which converts to marrow, and the marrow is eventually converted
into semen. It is said that it takes 40 days for 40 drops of food to
be converted to one drop of blood, 40 drops of blood to one drop
of flesh, and so on.
In the individual susceptible , semen starts to take on an
overwhelming importance. These notions frighten the individual
into developing a sense of doom if a single drop of semen is lost,
thereby producing a series of somatic symptoms .
15. A prototype patient is likely to be a married or recently
married male, of average socioeconomic status, coming
from a rural area and belonging to a family with a
conservative attitude towards sex
Patient's knowledge and attitude towards sexual
processes which is colored by information from friends,
colleagues or relatives and lay magazines is a major
etiological factor behind manifestation of this
syndrome.
(Bhatia & Malik,1991; Akhtar, 1988; Behera & Natraj, 1984).
16. These ideas of semen loss and consequent
anxiety are not confined to India; they
have been reported from Sri Lanka and other
parts of the subcontinent as well. Fear of semen
loss and resulting problems is so strong
that cures are advertised by vaids and hakims
everywhere – on walls, on television, in
newspapers and on roadside hoardings.
DHAT SYNDROME IN A FEMALE- A CASE REPORT ;Indian Journal of Psychiatry, 2001, 43(4),345-348
17. Semen-loss anxiety in China
A healthy exchange of
yin and yang in sexual intercourse maintains
a balance. Following masturbation,
nocturnal emission or homosexual intercourse,
yang would be lost but without corresponding
gain of yin and the resulting
imbalance leads to disease. This has been
associated with epidemics of koro
18. Semen-loss anxiety in Western cultures
From the times of Hippocrates and Aristotle,
semen has been considered extremely
important . Greeks in ancient times
saw masturbation as a natural outlet for
men lacking opportunity for sex.
In many Western European cultures masturbation
has been prohibited on religious
grounds.
19. Patients having Dhat syndrome can be further divided
into three categories.
Dhat alone - Patients attributed their symptoms to
semen loss; presenting symptoms -
hypochondriacal, depressive or anxiety symptoms
Dhat with comorbid depression and anxiety - Dhat
was seen as an accompanying symptom
Dhat with sexual dysfunction-
Prakash O. Lessons for postgraduate trainees about Dhat syndrome. Indian J Psychiatry 2007;49:208-10
20. Dhat syndrome in women.
• a 23 year old matriculate housewife from middle socio
economic, Sikh nuclear family of urban background
presented with complaints of weakness and vaginal
discharge for the last 3 years and "fear" of sex of 6
months duration.
• Before marriage, patient hailed from a conservative
joint family of rural background where open
discussions about sexual topics were discouraged. She
never masturbated and had no history of premarital
sexual contact. She regarded sexual intercourse as a
shameful and painful activity.
DHAT SYNDROME IN A FEMALE- A CASE REPORT ;Indian Journal of Psychiatry, 2001, 43(4),345-348
21. At about 20 years of age, she started feeling 'wetness' in
the vagina whenever she thought of the act of sexual
intercourse or on occasions spontaneously too. She did
not report any foul smelling discharge or local itching.
She started thinking that she was losing something
vital. She also complained of weakness and "swelling"
of the body, for 1-2 days after such experience. Within
the next 1-2 months, she developed aches and pains
throughout the body, headaches and poor
concentration. She would attribute these symptoms to
the 'wetness'. She started remaining constantly
preoccupied with these symptoms and hence anxious.
22. The different sources indicate the
universality of symptoms and global and global
prevalence of this condition, despite its
image as an exotic ‘neurosis of the Orient’ ,
challenging its diagnosis as a culture bound
syndrome.
Culture-bound syndromes:the story of dhat syndrome.D.Bhugra et alBJP(2004)
25. Management of Dhat syndrome
Understanding of Dhat syndrome by Modern Medicine fails to impress
most patients. Wig suggested emphatic listening, a
nonconfrontational approach, reassurance and correction of
erroneous beliefs, along with the use of placebo, anti-anxiety and
antidepressant drugs, wherever required. Other group advocated
psychoeducation and culturally informed cognitive behavioral
therapy. Good response was reported with anti-anxiety and
antidepressant drugs as compared to psychotherapy. Depressive
symptoms of this syndrome showed effective response to selective
serotonin reuptake inhibitors along with regular counseling.
The available intervention studies suggest that the management of
Dhat syndrome involves sex education, relaxation therapy and
medications.
Prakash O. Lessons for postgraduate trainees about Dhat syndrome. Indian J Psychiatry 2007;49:208-10
26. Sex education primarily focuses on anatomy and physiology of sexual
organs and their functioning with reference to masturbation,
semen, nocturnal emissions. It also involves functioning with
genitourinary system independent of gastrointestinal tract, etc.
Relaxation therapy mainly consists of Jacobson's Progressive
Muscular Relaxation Technique, which can be combined with
biofeedback (so as to facilitate objective evidence and mastering of
anxiety by the patient). Relaxation therapy should be practiced two
to three times per day regularly, especially after therapy sessions
are over.
Evaluation of the presence of associated anxiety or depressive
symptoms that may impede the process of therapy must be
performed. Anxiolytics or/and antidepressants can be added for the
least possible time and in the least possible doses.
Prakash O. Lessons for postgraduate trainees about Dhat syndrome. Indian J Psychiatry 2007;49:208-10
27. With industrialisation and urbanisation, the anxiety
about semen loss in the West diminished, and
the same is likely to happen in southernAsia as
well.
If we understand dhat as a culture-bound
syndrome, the historical evidence indicates that it
was prevalent in Europe, USA and Australia in the
19th century. In those countries it might have
disappeared in response to changes in social and
economic factors, whereas it is still prevalent in
southern Asia.
28. Amok
Indiscriminate , unprovoked episode of destructive or homicidal
activity followed by amnesia.
May be accompanied by persecutory idea , automatism ,
amnesia and exhaustion.
May culminate in suicide.It seems to occur only among males,
and is often precipitated by a perceived slight insult.
Common in Indonesia & Malaysia.
Malayan Men running Amok.
29. In 1634, the eldest son of the raja of Jodhpur ran
amok at the court of Shah Jahan, failing in his
attack on the emperor, but killing five of his
officials.
30. Koro
-Head of Turtle.
A term probably of Malaysian origin, that refers to an
episode of sudden and intense anxiety that the
penis (or, in women, the vulva and nipples) will
recede into the body and possibly cause death.The
diagnosis is included in the second edition of
Chinese Classification of Mental Disorders (CCMD-2)
31. Koro sometimes seems to be spread socially and
may be a kind of mass hysteria, causing
widespread panics and concern, as well as a
disorder of individuals. Afflicted persons may
resort to clamps, ties, pegs or hooks to keep
the genitals from fully receding, sometimes
resulting in damage to the organs
32. Brain fag
West African concept referring to a condition
experienced by university or high school
students in response to challenges of
schooling.
Difficulty in concentrating , remembering and
thinking. “ Brain fatigue” .
33. Latah
-Common in Malayan woman.
Response to frightening stimuli characterized by
- Increased sturtle response
- Echolalia and echopraxia
- Automatic obediance and trance states
34. Piblokto
An abrupt dissociative episode accompanied by
extreme excitement and frequently followed by
convulsive seizures and coma. The person may be
withdrawn or mildly irritable for a period of hours
or days before the attack and typically reports
complete amnesia for the attack. During the attack
persons may tear off their clothing, break furniture,
shout obscenities, eat feces, flee from protective
shelters, or perform other irrational or dangerous
acts.
35. Locura
A term used in the United States and Latin America to
refer to a severe form of chronic psychosis
Symptoms exhibited by persons with locura include
incoherence, agitation, auditory and visual
hallucinations, inability to follow rules of social
interaction, unpredictability, and possibly violence.
36. Boufée delirante
A sudden outburst of agitated and aggressive
behavior, marked confusion and psychomotor
excitement. It is an acute, nonaffective and
non-schizophrenic psychosis, accompanied by
visual and auditory hallucinations and/or
paranoid ideation. A distinctive feature is a
complete remission after an acute episode.
37. spell
A trance state in which persons communicate•
with deceased relatives or spirits. At times the
state is associated with brief periods of
personality change. The culture-specific
syndrome is seen among African-Americans
and European-Americans from the southern
United States.
38. Rootwork
The conviction that illnesses are brought about
by supernatural means, such as witchcraft,
voodoo, or evil influence. Symptoms include
anxiety, gastrointestinal complaints, and fear
of being poisoned or killed.
Southern US and the Caribbean's.
40. zar
A general term applied in Ethiopia, Somalia,
Egypt, Sudan, Iran, and other North African
and Middle Eastern societies to the
experience of spirits possessing a person.
Persons possessed by a spirit may experience
dissociative episodes that may include
shouting, laughing, hitting the head against a
wall, singing, or weeping.
41. Course and Prognosis
Limited data on the longitudinal course of
patients with culture-bound syndromes
suggest that some of them eventually develop
clinical features compatible with a diagnosis of
schizophrenia, bipolar disorder, cognitive
disorder, or other psychotic disorders
42. Treatment
Treatment of a culture-bound syndrome poses
several diagnostic challenges, the first of
which is determining whether the
symptomatology represents a culturally
appropriate adaptive response to a situation.
Acceptance of and respect for the patient's
cultural frame is important.
43. Cognitive and cognitive behavior therapies may
achieve some modicum of freedom from
cultural bias.
44. One promising avenue is collaboration with
indigenous healers.
Several researchers have reported their success
in the use of indigenous healers, especially
those whose psychotic conditions are
substantially connected to culture-specific
beliefs.
Kaplan & Sadocks Synopsis of Psychiatry ; tenth edition Pg:524