Adeponle Ademola B, Groleau Danielle, Kirmayer Laurence J
Division of Social & Transcultural Psychiatry, Department of Psychiatry, McGill University, Montreal, QC, Canada,
Cult Med Psychiatry. 2015 Mar;39(1):16-42. doi: 10.1007/s11013-014-9408-5.
We examined how the process of cultural formulation contributes to diagnostic assessment of patients with psychotic disorders at a specialized Cultural Consultation Service (CCS). Specifically, we investigated the reasoning process used to resolve uncertainty of psychotic disorder diagnosis in African immigrant patients referred to the CCS for assessment of possible psychotic disorder. Qualitative thematic analysis of 23 clinical case conference transcripts was used to identify clinicians' reasoning styles. Use of the CF appears to facilitate the emergence of a rule-governed reasoning process that involved three steps: (i) problematize the diagnosis of the intake 'psychosis' symptoms or behavior; (ii) elaborate explanations as to why the symptoms or behavior may or may not be psychosis; and (iii) confirm the diagnosis of psychosis or re-interpret as non-psychosis. Prototypes and exemplars drawn from previous experience in intercultural work featured prominently in clinicians' reasoning. Prototypes were crucial in diagnostic decision-making and appear to be important sources of both clinician expertise and bias, and may need to be targeted specifically in cultural competence training.
我们研究了文化定式过程如何在一家专业文化咨询服务机构（CCS）中辅助对精神障碍患者的诊断评估。具体而言，我们调查了在被转介至CCS以评估可能的精神障碍的非洲移民患者中，用于解决精神障碍诊断不确定性的推理过程。我们采用定性主题分析法，对23份临床病例讨论会记录进行分析，以确定临床医生的推理风格。文化定式的运用似乎有助于形成一个遵循规则的推理过程，该过程包含三个步骤：（i）对初诊时的“精神病性”症状或行为的诊断提出质疑；（ii）详细阐释这些症状或行为可能是或可能不是精神病性症状的原因；（iii）确认精神病性诊断或重新解释为非精神病性情况。临床医生的推理过程中，源自以往跨文化工作经验的原型和范例占据显著地位。原型在诊断决策中至关重要，似乎是临床医生专业知识和偏见的重要来源，可能需要在文化能力培训中专门针对这一点进行培训。
