Lewis-Fernández Roberto, Díaz Naelys
Columbia University, New York, NY, USA.
Psychiatr Q. 2002 Winter;73(4):271-95. doi: 10.1023/a:1020412000183.
The growing cultural pluralism of US society requires clinicians to examine the impact of cultural factors on psychiatric illness, including on symptom presentation and help-seeking behavior. In order to render an accurate diagnosis across cultural boundaries and formulate treatment plans acceptable to the patient, clinicians need a systematic method for eliciting and evaluating cultural information in the clinical encounter. This article describes one such method, the Cultural Formulation model, expanding on the guidelines published in DSM-IV. It consists of five components, assessing cultural identity, cultural explanations of the illness, cultural factors related to the psychosocial environment and levels of functioning, cultural elements of the clinician-patient relationship, and the overall impact of culture on diagnosis and care. We present a brief historical overview of the model and use a case scenario to illustrate each of its components and the substantial effect on illness course and treatment outcome of implementing the model in clinical practice.
美国社会日益增长的文化多元性要求临床医生审视文化因素对精神疾病的影响，包括对症状表现和求助行为的影响。为了跨越文化界限做出准确诊断并制定患者可接受的治疗方案，临床医生需要一种在临床诊疗过程中获取和评估文化信息的系统方法。本文介绍了一种这样的方法，即文化定式模型，它是在《精神疾病诊断与统计手册》第四版（DSM-IV）中发布的指南基础上进行扩展的。该模型由五个部分组成，评估文化身份、对疾病的文化解释、与心理社会环境及功能水平相关的文化因素、医患关系的文化要素，以及文化对诊断和治疗的总体影响。我们简要介绍该模型的历史概况，并通过一个案例场景来说明其每个组成部分，以及在临床实践中应用该模型对疾病进程和治疗结果的重大影响。
