Biswas Jhilam, Gangadhar B N, Keshavan Matcheri
Bridgewater State Hospital, Massachusetts Partnership in Correctional Healthcare, Visiting Associate Psychiatrist at Brigham and Women's Hospital, USA.
Department of Psychiatry, Director, National Institute of Mental Health and Neuroscience (NIMHANS), USA.
Asian J Psychiatr. 2016 Oct;23:1-7. doi: 10.1016/j.ajp.2016.05.011. Epub 2016 Jun 29.
A frequent debate in psychiatry is to what extent major psychiatric diagnoses are universal versus unique across cultures. We sought to identify cultural variations between psychiatrists' diagnostic practices of mental illness in Boston Massachusetts and Bangalore, India. We surveyed psychiatrists to identify differences in how frequently symptoms appear in major mental illness in two culturally and geographically different cities. Indian psychiatrists found somatic symptoms like pain, sleep and appetite to be significantly more important in depression and violent and aggressive behavior to be significantly more common in mania than did American psychiatrists. American psychiatrists found pessimism about the future to be more significant in depression and pressured speech and marked distractibility to be more significant in mania than among Indian psychiatrists. Both groups agreed the top four symptoms of psychosis were paranoia, lack of insight, delusions and auditory hallucinations and both groups agreed that visual hallucinations and motor peculiarities to be least significant. Despite a different set of resources, both groups noted similar barriers to mental health care access. However, American psychiatrists found substance abuse to be a significant barrier to care whereas Indian psychiatrists found embarrassing the family was a significant barrier to accessing care. Because psychiatrists see a large volume of individuals across different cultures, their collective perception of most common symptoms in psychiatric illness is a tool in finding cultural patterns.
精神病学中经常争论的一个问题是，主要的精神疾病诊断在多大程度上具有跨文化的普遍性或独特性。我们试图确定马萨诸塞州波士顿市和印度班加罗尔市的精神科医生在精神疾病诊断实践中的文化差异。我们对精神科医生进行了调查，以确定在两个文化和地理上不同的城市中，主要精神疾病症状出现频率的差异。与美国精神科医生相比，印度精神科医生发现，疼痛、睡眠和食欲等躯体症状在抑郁症中更为重要，而暴力和攻击行为在躁狂症中更为常见。美国精神科医生发现，对未来的悲观情绪在抑郁症中更为显著，言语紧迫感和明显的注意力分散在躁狂症中比印度精神科医生所见更为显著。两组都认为精神病的四大症状是偏执、缺乏洞察力、妄想和幻听，两组都认为视幻觉和运动异常最不显著。尽管资源不同，但两组都指出了获得心理健康护理的类似障碍。然而，美国精神科医生发现药物滥用是获得护理的一个重大障碍，而印度精神科医生发现让家人难堪是获得护理的一个重大障碍。由于精神科医生接触过来自不同文化背景的大量个体，他们对精神疾病最常见症状的集体认知是发现文化模式的一种工具。
