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Chapter: Psychiatric Mental Health Nursing : Schizophrenia

Cultural Considerations - Schizophrenia

Awareness of cultural differences is important when assess-ing for symptoms of schizophrenia.



Awareness of cultural differences is important when assess-ing for symptoms of schizophrenia. Ideas that are consid-ered delusional in one culture, such as beliefs in sorcery or witchcraft, may be commonly accepted by other cultures. Also, auditory or visual hallucinations, such as seeing the Virgin Mary or hearing God’s voice, may be a normal part of religious experiences in some cultures. The assessment of affect requires sensitivity to differences in eye contact, body language, and acceptable emotional expression; these vary across cultures (APA, 2000).


Psychotic behavior observed in countries other than the United States or among particular ethnic groups has been identified as a “culture-bound” syndrome. Although these episodes exist primarily in certain countries, they may be seen in other places as people visit or immigrate to other countries or areas. Mojtabai (2005) summarized some of these psychotic behaviors:


·    Bouffée délirante, a syndrome found in West Africa and Haiti, involves a sudden outburst of agitated and ag-gressive behavior, marked confusion, and psychomotor excitement. It is sometimes accompanied by visual and auditory hallucinations or paranoid ideation.


·    Ghost sickness is preoccupation with death and the de-ceased frequently observed among members of some Na-tive American tribes. Symptoms include bad dreams, weakness, feelings of danger, loss of appetite, fainting, diz-ziness, fear, anxiety, hallucinations, loss of consciousness, confusion, feelings of futility, and a sense of suffocation.


·    Locura refers to a chronic psychosis experienced by Latinos in the United States and Latin America. Symp-toms include incoherence, agitation, visual and audi-tory hallucinations, inability to follow social rules, unpredictability, and, possibly, violent behavior.


·    Qi-gong psychotic reaction is an acute, time-limited epi-sode characterized by dissociative, paranoid, or other psychotic symptoms that occur after participating in the Chinese folk health-enhancing practice of qi-gong. Especially vulnerable are those who become overly in-volved in the practice.


·    Zar, an experience of spirits possessing a person, is seen in Ethiopia, Somalia, Egypt, Sudan, Iran, and other North African and Middle Eastern societies. The af-flicted person may laugh, shout, wail, bang her or his head on a wall, or be apathetic and withdrawn, refusing to eat or carry out daily tasks. Locally, such behavior is not considered pathologic.


Ethnicity also may be a factor in the way a person responds to psychotropic medications. This difference in response is probably the result of the person’s genetic makeup. Some people metabolize certain drugs more slowly, so the drug level in the bloodstream is higher than desired. African Americans, white Americans, and Hispanic Americans appear to require comparable therapeutic doses of antipsy-chotic medications. Asian clients, however, need lower doses of drugs such as haloperidol (Haldol) to obtain the same effects; therefore, they would be likely to experience more severe side effects if given the traditional or usual doses.


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