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Cultural Assessment in Clinical Psychiatry (Gap Report (Group for the Advancement of Psychiatry)) PDF

202 Pages·2002·0.91 MB·English
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Cultural Assessment in Clinical Psychiatry Committee on Cultural Psychiatry Ezra Griffith, M.D., Chairperson Renato D. Alarcón, M.D., M.P.H., Project Coordinator Irma Bland, M.D. Prakash Desai, M.D. Edward F. Foulks, M.D., Ph.D. Frederick Jacobsen, M.D., M.P.H. Roberto Lewis-Fernandez, M.D. Francis Lu, M.D. Maria Oquendo, M.D. Pedro Ruiz, M.D. J. Arturo Silva, M.D. Ronald Wintrob, M.D. Joe Yamamoto, M.D. Trevia F. Hayden, M.D. (Fellow) Robert L. Harvey, M.D. (Consultant) J. Charles Ndlela, M.D., M.P.H. (Consultant) Dora Wang, M.D. (Consultant) Cultural Assessment in Clinical Psychiatry Formulated by the Committee on Cultural Psychiatry Group for the Advancement of Psychiatry Report No. 145 Washington, DC London, England Note: The authors have worked to ensure that all information in this book concerning drug dosages, schedules, and routes of administration is accurate as of the time of publication and consistent with standards set by the U.S. Food and Drug Administration and the general medical community. As medical research and practice advance, however, therapeutic standards may change. For this reason and because human and mechanical errors sometimes occur, we recommend that readers follow the advice of a physician who is directly involved in their care or the care of a member of their family. A product’s current package insert should be consulted for full prescribing and safety information. Books published by American Psychiatric Publishing, Inc., represent the views and opinions of the individual authors and do not necessarily represent the policies and opinions of APPI or the American Psychiatric Association. Copyright © 2002 Group for the Advancement of Psychiatry ALL RIGHTS RESERVED Manufactured in the United States of America on acid-free paper 06 05 04 03 02 5 4 3 2 1 First Edition American Psychiatric Publishing, Inc. 1400 K Street, N.W. Washington, DC 20005 www.appi.org Library of Congress Cataloging-in-Publication Data Cultural assessment in clinical psychiatry / formulated by the Committee on Cultural Psychiatry, Group for the Advancement of Psychiatry. p. ; cm.—(Report ; no. 145) Includes bibliographical references and index. ISBN 0-87318-144-1 (alk. paper) 1. Cultural psychiatry—United States. 2. Psychiatry, Transcultural. I. Group for the Advancement of Psychiatry. Committee on Cultural Psychiatry. II. Report (Group for the Advancement of Psychiatry : 1984) ; no. 145. [DNLM: 1. Community Psychiatry. 2. Cross-Cultural Comparison. 3. Cultural Characteristics. 4. Cultural Diversity. WM 30.6 C9676 2001] RC455.4.E8 C788 2001 616.89—dc21 2001027936 British Library Cataloguing in Publication Data A CIP record is available from the British Library. Contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii 1 Culture in Clinical Psychiatry: History and Scope . . . . .1 2 Cultural Variables . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 3 Cultural Formulation: Description and Clinical Use. . . 53 4 DSM-IV-TR Cultural Formulation Applied to Six Clinical Cases . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 5 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 GAP Publications . . . . . . . . . . . . . . . . . . . . . . . . . . 171 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 This page intentionally left blank Introduction Human beings reflect, in a complex set of everyday behaviors, the fact that they are repositories of a myriad of biological, social, psychological, and cultural influences. In the medical field, the doctor–patient relationship follows cultural rules as much as does the patient’s attitude toward taking pills or undergoing procedures. The health care delivery system of the United States also faces the growth, as well as the economic and cultural needs, of ethnic minority groups in various parts of the country. Many professional organizations in mental health have acknowledged this reality and have provided practical tools for improving clinical services to these groups. Hence, in this volume is proposed a contemporary pragmatic understanding of how culture inter- twines with and relates to mental health and mental illness. We offer this by considering specific cultural variables and applying DSM-IV-TR (Amer- ican Psychiatric Association 2000) guidelines for use of the cultural formu- lation in a series of clinical case examples. The first chapter presents a brief historical perspective of cultural psychiatry over the last several decades and defines five essential dimen- sions of cultural psychiatry as a clinical endeavor. The second chapter includes a succinct but thorough description of the main cultural variables influencing clinical work. This list of variables, by no means exhaustive, emphasizes their conceptual connections and clinical relevance to the five essential dimensions of cultural psychiatry. The complexity of these variables—from gender, sexual orientation, and age to religious/spiritual beliefs, myths, traditions, folklore, and dietary habits and patterns—becomes greater as we move to consideration of so- cioeconomic status, cultural identity, country of origin, education, and vii viii Cultural Assessment in Clinical Psychiatry language. The final set of variables involves racial and ethnic factors that, when taken together with the other elements, highlight the unique per- sonal identity of each individual patient. The discussion of each variable centers on its roles and functions, both positive and negative, as they re- late to health and illness behavior, expression of symptoms, explanatory models, stress causation, and social systems. Ultimately, each variable af- fects diagnosis and treatment outcomes. The third chapter is a historical account and a detailed analysis of the cultural formulation presented in DSM-IV-TR (American Psychiatric Asso- ciation 2000, Appendix I), the newest instrument for the thorough clinical assessment of any patient who comes to the professional’s attention. Practical examples, as well as an analysis of the items included in each of the four specific areas of the cultural formulation, provide the reader with a useful tool for the cultural assessment of a variety of clinical events. Perhaps the most important aspect of the book is the presentation in the fourth chapter of five cases reflecting a wide variety of clinical situa- tions and the role of cultural factors in their causation, course, manage- ment, and outcome. These cases explore the previously mentioned cultural variables and follow the structure outlined by the American Psy- chiatric Association Practice Guidelines for Psychiatric Evaluation of Adults (American Psychiatric Association 1995). There is special emphasis on the application of the tenets of the cultural formulation appearing in DSM-IV (American Psychiatric Association 1994) and DSM-IV-TR. A per- tinent literature review, as well as comments by the authors based on their specific expertise and clinical interests, completes each clinical discussion. The fifth and final chapter summarizes the contributions made in pre- vious sections and outlines conclusions and suggestions regarding the various issues raised by a thorough cultural assessment process in clinical psychiatry. The Group for the Advancement of Psychiatry (GAP) Commit- tee on Cultural Psychiatry believes that this book meets a significant need of many psychiatrists and other mental health professionals committed to giving their patients the most comprehensive and qualitatively useful care possible. A solid cultural approach provides a valuable anchor for this process. Introduction ix ■ References American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Washington, DC, American Psychiatric Association, 1994 American Psychiatric Association: Practice Guidelines for Psychiatric Eval- uation of Adults. Washington, DC, American Psychiatric Association, 1995 American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC, Amer- ican Psychiatric Association, 2000

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