CULTURAL CONSIDERATIONS
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his head on a wall, or be apathetic and withdrawn, refusing to eat or carry out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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