German G A
Bull World Health Organ. 1979;57(3):359-71.
The nature of psychiatric disorders in tropical regions is affected much more by the effect on the patient of certain environmental and cultural factors than by any specific features of tropical diseases. In places where the standards of health care and health education are not yet fully developed, abnormalities of physical development, particularly those affecting the development of the cerebral cortex, are of great importance. For example, protein-energy malnutrition may result in deficits in cerebral maturation and efficiency that reduce the capacity of the brain to manage its behavioural functions and may give rise to impaired capacities for concentration, foresight, and judgement and impairment of inhibitory control over intensely experienced emotions. In addition, certain cultural attitudes that are widespread in pre-literate societies influence the type of secondary reaction to disease: for example, acute symptoms tend to be florid and uninhibited, and violently experienced and externalized emotions such as hilarity, terror, anger, and grief are the rule rather than the exception.Certain tropical diseases are, however, the direct cause of severe disturbance of cerebral functioning, while others affect only the finer cerebral controls so that normally controlled fears, anxieties, and other personality traits emerge. These specific brain syndromes may be acute or chronic and may be triggered by an apparently trivial physical cause. Acute brain syndromes appear to be more common in tropical countries perhaps because in the adult the cerebral cortical reserve is less than it ought to be because of the prevalence of earlier minimal brain damage. Formal psychiatric reactions are, of course, also seen in tropical countries, but the expression of, for example, schizophrenia, hypomanic and manic states, and depression is coloured by the underlying personality and the cultural background of the patient. Perhaps in no other setting is the intimate relationship between behaviour and the physical body seen more clearly than in populations living in the tropics and it is important that health workers in these regions should be aware of the role played by earlier or concurrent physical disease in behavioural disturbance.
与热带疾病的任何特定特征相比，热带地区精神疾病的性质更多地受到某些环境和文化因素对患者的影响。在医疗保健和健康教育标准尚未充分发展的地方，身体发育异常，尤其是那些影响大脑皮层发育的异常，具有重要意义。例如，蛋白质 - 能量营养不良可能导致大脑成熟和效率方面的缺陷，从而降低大脑管理其行为功能的能力，并可能导致注意力、远见和判断力受损，以及对强烈情感的抑制控制能力受损。此外，在未开化社会中普遍存在的某些文化态度会影响对疾病的继发反应类型：例如，急性症状往往表现得夸张且不受抑制，诸如欢乐、恐惧、愤怒和悲伤等强烈体验并外化的情绪是常态而非例外。然而，某些热带疾病是大脑功能严重紊乱的直接原因，而其他一些疾病仅影响更精细的大脑控制，从而使正常情况下受控制的恐惧、焦虑和其他人格特质显现出来。这些特定的脑综合征可能是急性的或慢性的，并且可能由看似微不足道的身体原因引发。急性脑综合征在热带国家似乎更为常见，这可能是因为在成年人中，由于早期轻度脑损伤的普遍存在，大脑皮层储备低于应有的水平。当然，在热带国家也会出现典型的精神反应，但例如精神分裂症、轻躁狂和躁狂状态以及抑郁症的表现会受到患者潜在人格和文化背景的影响。也许在其他任何情况下，行为与身体之间的密切关系都不如生活在热带地区的人群中看得那么清楚，这些地区的卫生工作者应意识到早期或并发的身体疾病在行为障碍中所起的作用，这一点很重要。
