Cultural variants

Other forms of acute psychoses have been observed in both traditional and developing countries, with high prevalence in Asia, Africa, and Latin America. These brief psychotic episodes are culture-bound syndromes, often with immediate precipitating stress or life events. (25> There is disorganized behaviour, delusions, thought disorders, confusion, and mood disorders, usually with full recovery and no relapse in a 1-year follow-up.

The culture-specific disorders'26) and their potentially related syndromes are often acute and transient. The status of these culture-reactive disorders is controversial and needs more clinical and epidemiological research. The mode of assignment to categories in ICD-10 does not suggest category F23.

Appendix I of DSM-IV (Outline for cultural formulation and glossary of culture-bound syndromes) lists 25 syndromes, with a glossary mostly using the local terms (seven in Hispanic languages, five in English, and one in French). Bouffée délirante, described only in West Africa and Haiti, is defined as episodes resembling brief psychotic disorder and classified in F23.0. Mezzisch and Lin (25) have suggested that the whole group of culture-bound syndromes should be classified as acute and transient psychotic disorders, although this is justified only for a very few such as amok (dissociative episode with persecutory ideas and aggressive behaviour from Malaysia), shin-byung (Korean dissociation and possession), and spell (trance state in southern United States).

ICD-10 includes the two Malaysian syndromes koro and latah as well as dhat (India) in F48.8, Other specified neurotic disorders.

International follow-up studies have shown that cultural factors can influence the course and prognosis of acute psychotic disorders. In 1979, the World Health Organization compared the course of schizophrenia (295), psychotic depression, mania, and other psychoses in different cultures, using the ICD-9 criteria for the diagnoses. The outcome for the schizophrenic group was better in emerging countries than in the industrialized world. These results probably explain the individualization of category F23 in ICD-10.

Some authors(27) have suggested that short-lived psychotic episodes are expressions of overcharged mechanisms of defence, or of individual psychological fragility. The brief psychosis is an understandable development of the psychic life of the subject and has a cathartic effect.

Culturally related syndromes are discussed further in ChapteLiJB.

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