Transient psychotic disorders in general are dealt with in C.h.apt§L4.:3.9. The following is a short summary of information indicating that acute transient psychotic and psychosis-like reactions occuring in African and African-Caribbean populations are disorders directly related to culture and culture change. These reactions appear to be encountered with increasing frequency in Africa, and are embedded in anxieties over sorcery and witchcraft that persist or even increase under rapid sociocultural changes.(3Z> Anglophone psychiatrists have described transient psychotic and psychosis-like reactions in Africans under various terms, while their francophone colleagues use the neutral diagnostic label bouffée délirante which was introduced into French psychiatry in the 1880s by Magnan and later redefined by French-speaking authors in Africa in accordance with their clinical data. (38> The bouffée délirante reactions are of sudden onset and brief duration and occur in Africans, as a rule, in connection with experiences that are charged with culturally validated fears of magic persecution. The clinical picture is characterized by unsystematized paranoid delusions, often also visual and auditory hallucinations, acute and extreme anxiety, and agitation with highly emotionalized, often demonstrative and sometimes dangerous acting-out behaviour in apparent confusion, followed by retrograde amnesia, or rather disavowal. The Nigerian psychiatrist Lambo reported such reactions as frequently shown by Africans under intense fear of bewitchment; he introduced the English term frenzied anxiety and equated it with bouffée délirante.(39) As repeatedly stated by Lambo and other researchers who have examined African patients after bouffée délirante reactions, the underlying causes for these are not of a toxic-organic nature but sociocultural factors. Among these factors, of paramount importance is the acculturative stress affecting many persons in many parts of contemporary Africa who have become marginalized in society through rapid culture change, as recently again confirmed by an extensive study in Swaziland.4.» Under modern situations of urbanization and Westernizing acculturative pressures the traditional communalistic society is disintegrating and the supportive kin network is breaking down. The individual experiences an increasing economic rivalry and social isolation that intensifies the old fears of witchcraft and sorcery, never obliterated by Christianity, while the traditional protective and remedial resources are no longer readily available. (ICD-10, F23; DSM-IV, 298.8)
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