SOCIOCULTURAL PSYCHIATRY

Question 1

JARMAN INDEX

Answer 1

JARMAN INDEX
A scoring system developed by the British general practitioner Brian
Jarman for the level of social deprivation
in a community, using census data

Question 2

The sick role

Answer 2

American sociologist Talcott Parsons
4 characteristics:
1. freed of normal social roles
2. not responsible or blamed for disease
3. tries to get well- temporary
4. Seek help and cooperate with medical care

Question 3

Concept of disease
disease
illness
sickness
impairment
disability
handicap

Answer 3

Disease: refers to actual pathology (e.g. a process that results in illness)

Illness refers to personal experience (a set of symptoms suffered by a patient)

Sickness refers to social consequences (e.g. absence from work)

Impairment: interference with structural or psychological functions (that is, parts of the whole person e.g. loss of an arm’s function due to fracture).

Disability is interference with activities of the whole person in relation to the immediate environment (simply ‘activities of daily living’ e.g. not able to cook for oneself due to the
fracture)

Handicap is the social disadvantage resulting from disability (e.g. loss of work and inability to meet friends due to restricted driving secondary to fracture)

Question 4

The Transtheoretical Model (TTM)
- Prochaska and DiClemente (1982)

Answer 4

(1) Consciousness raising – helping the patient gather information about self and the problem

(2) Choosing – increasing awareness of healthy alternatives,

(3) Catharsis – emotional expression of the problem behaviour and the process of change,

(4) Conditional stimuli – includes stimulus control and counterconditioning,
a. Stimulus control: Avoidance of stimuli associated with the problem behaviour
and the operant extinction cueing effect of the stimulus on behaviour.
b. Counterconditioning: Training an alternative, healthier response to the cue
stimuli.

(5) Contingency control: Positive reinforcement from others and self-appraisal and improving self-efficacy by self-reinforcement.

Question 5

6 processes of change
- prochaska and diclemente

Answer 5

1- precomntemplation
2. contemplation
3. preparation
4. action
5. maintainance
6. relapse
- motivational interviewing (miller and rollnick) is often used together with TMM and changes of change

Question 6

Family instability - whats affected more

Answer 6

boy > girl
young > older
hyperactive affective >placid

Question 7

Lidz schizophrenogenic family patterns

schism
skew

Answer 7

Marital schism –> repeated threats of parental separation , disequalibibrism

Marital skew –> family is at an equilibrium that is skewed and achieved at an expense of the distorted parental relationship.

Question 8

Double blind relationship= (bateson)

Answer 8

• Superficial verbal communications
  contradict the behavioural and deeper communications among the members of a family.
• These mixed messages keep a growing child in a double bind (cannot be correct either way) that can later increase the risk of psychosis

Question 9

Expressed emotions concept

Answer 9

Developed by Brown & Rutter in 1966 as a part of the Camberwell Family Interview [CFI]

Ratings were based on content and prosodic aspects and emphasis of speech
- critical, positive remarks, emotional over involvement, hostility, emotional warmth

Question 10

Findings of studies of EE

Answer 10

• Worldwide the proportion of high EE in carers of patients with schizophrenia is 52%.
  Lowest rates are found in India and other developing nations.
• same relation in men and women
• A meta-analysis of EE data reveals that for patients living in situations rated as showing high expressed emotion, the relapse rate is 50%, whereas in the ‘low
  expressed emotion group’ the rate is 21%
• Pakistani families in the UK were more likely to be rated as high expressed emotion than White families, indicating that components such as emotional over-involvement may be cultural rather than pathogenic traits

Question 11

Holmes & Rahe (1967) Social Readjustment Rating Scale

Answer 11

43 life events in the last
2 years are rated using arbitrary ‘stress’ units

Question 12

Types of life events

Answer 12

Loss
Humiliation
Entrapment

Question 13

Genes and life events
Kendler 1997
Genetic vulnerability to depression and the risk of experiencing stressful life events.

Answer 13

• A reverse causality effect (i.e. vulnerability to depression itself could explain the occurrence of more
  frequent stressful life events) was demonstrated.
• 2000 female twins, genetic liability to depression was associated with a significantly increased risk of
  experiencing an assault, serious marital problems, divorce/break-up, job loss etc
• Genes can probably impact on the risk for psychiatric illness by causing
  individuals to select themselves into high-risk environments

Question 14

Rating scales for life events

Answer 14

Semi-structured interviews
- Life events & Difficulties Scale (Brown & Harris)
- Interview for Recent Life Events (Paykel)

Life events scales
- Social Readjustment Rating Scale (Holmes & Rahe)
- Adverse Childhood Events Scale
- Hassles & Uplifts Scale (Lazarus & Folkman

Question 15

Who created the biopsychosocial approach

Answer 15

Engel’s model

Question 16

Social drift or social selection theory
Faris & Dunham

Answer 16

An expected excess of social class 5 was noted but social class distribution of fathers of the patients was the
same as the general population suggesting that schizophrenia results in a downward drift of economic status rather than poverty being a cause for schizophrenia.

• Chicago study
• The least socially organized inner urban zones had the highest rates of schizophrenia

Question 17

Rutter landmark study
- 6 inter-related risk factors
- correlated significantly with childhood mental disturbances in general:

Answer 17

1. Severe marital discord
2. Low social class
3. Large family size
4. Maternal mental health disorder
5. Paternal criminality
6. Foster placement.

Question 18

Primary deviance
Secondary deviance
Formal
Informal

Answer 18

Primary deviance - may refer to minor rule
breaking in society such as over-speeding. when repeated– >

Secondary deviance - actions carried out by a person identified as a ‘deviant’ by institutions such as the society or the
justice system.

Formal deviance includes breaking a written law or code of constitution as in criminal act;

Informal deviance includes breaking unspoken social rules of living.

Question 19

Durkhein (father of sociology)
sociological model of suicide
Altruistic
Egoistic
Fatalistic
Anomic

Answer 19

Altruistic suicide - Individual is overly attached to social norms and dies for the sake of the society (i.e. for others in the society) e.g. self-molestation among Buddhist monks in Tibet

Egoistic suicide - Excessive individualism, but low social integration. No cohesive group
attachment

Fatalistic suicide - Society’s control on the individual is very strong such that it interferes with moral values and personal goals

Anomic suicide - Individual feels that he has no guidance or regulations from the societal
system; feels disillusioned

Question 20

Brown and Harris (1978)
4 vulnerability factors to depression

Answer 20

examined women in london

1. Absence of a close confiding relationship;
2. Loss of mother before age of 11;
3. Lack of employment outside home;
4. Having 3 or more children under 15 living at home

Question 21

Social defeat hypothesis

Answer 21

“long-term experiences of social disadvantage lead to sensitization of the… dopamine system and (or) to
increased baseline activity of this system, thereby, to an increased risk for schizophrenia.”

Question 22

social factors schizophrenia

Answer 22

• More of a minority you are, higher the risk
• More urban, higher the risk
• Immigration - higher risk
• 1st generation immigrants having higher rates of psychosis,
• the 2nd generation children of immigrants also have a very high rate of psychosis

Question 23

Social reactivity and schizophrenia:

Answer 23

Wing & Brown surveyed asylums including mapperley
social poverty and lack of stimulation were very much related to the severity of blunted affect, poverty of speech, and social withdrawa

Question 24

Transcultural psychiatry.
Emic perspective

Etic perspective

Answer 24

Emic perspective- The perspective of an individual from a specific cultural group about his own group. (own = MI )

Etic perspective - Refers to the perspective of an individual **outside a
specific **cultural group about the studied group. The etic approach, for instance, involves applying Western psychiatric concepts en bloc into a different culture and uses it for diagnosis. This approach assumes
1. Universality of illnesses
2. Invariance of core symptoms
3. Validity of diagnostic constructs

Question 25

Acculturation (barrys model)
integration
assimilation
separation
marginalisation

Answer 25

integration - high retention old culture, high adoption new
assimilation - low retention, low adoption new
separation - high retain old, low adopt new
marginalisation - low both

Question 26

Enculturation

Cultural diffusion or syncretism

Sojourning

Answer 26

Enculturation - refers to culture being learnt through contact with family, friends, teachers and the media. This happens to everyone irrespective of migration.

Cultural diffusion or syncretism refers to the spread of cultural traits (including psychiatric
syndromes, treatment methods) through contacts across societies

Sojourning refers to voluntary but brief exposure to different culture e.g. tourists, Peace Corps volunteer

Question 27

Culture bound syndromes

Amok ( F68 disorder of personality and behaviour)

Ataque de nervios (F45 somatoform)

Answer 27

Amok- Mostly dissociative not psychotic in nature. Starts with sullen period,
followed by outburst of violent, sometimes homicidal behaviour;
A return to premorbid state occurs after the episode - malaysia, phillipines

Ataque de nervios (F45 somatoform)- dissociative trance - attack of distress wherein sudden shouting, crying, beating oneself on chest with dissociation and panic attacks

Question 28

Berdache

Bouffee delirante

Brain fag

Dhat

Frigophobia

Answer 28

Berdache - North America, Term for a male who has assumed female gender role

Bouffee delirante- Seen in French-speaking nations where a sudden outburst of agitated and aggressive behaviour, confusion resembling an episode of brief psychotic
disorder. West Africa and Haiti commonly

brain fag- seen in students with difficulties in concentrating,
remembering, and thinking

Dhat - Refers to severe anxiety and hypochondriacal concerns associated with the. seminal discharge accompanied by feeling weak and tired

Frigophobia - A morbid fear of feeling cold / wind due to presumed yin-yang imbalance

Question 29

Anti-psychiatry movement

Answer 29

David Cooper coined the term ‘anti-psychiatry’ in 1960s.

Question 30

Karl Jasper

Answer 30

Karl Jaspers is widely considered a major figure in philosophy and psychiatry.
Jaspers method of philosophical enquiry into symptoms of psychiatry has laid the foundation for descriptive psychopathology that we use today.

Question 31

Adab al-Tabib (Conduct
of a Physician)

Hammurabi code

Chakra

Answer 31

The first written book on
medical ethics was authored by Ishaq bin Ali

Hammurabi code is the first attempt in history to codify medical competence and legal liability for negligence.

Charaka, an ancient Indian physician, proposed what seems to be the earliest of medical ethics relevant to modern medicine. - friendship, sympathy, interest in cases, no attachement after recovery

Question 32

Prima facie principles:
developed by?

Answer 32

autonomy—respecting patients’ wishes and freedom of choice

beneficence—acting in patients’ best interests

Non-maleficence—avoiding harm – primum non nocere.

Justice—treating problems equally, with equitable distribution of resources to the needy

ROSS

Question 33

Landmark publications relevant for critique on ethics
Nuremberg Code 1974:
Declaration of Geneva 1948:
Declaration of Helsinki 1964:

Answer 33

Nuremberg Code 1974: post ww2 doctor experimenting in concentration camps. - makes sure human experiments are safe

Declaration of Geneva 1948: Reaffirmation of humanitarian aims of medicine

Declaration of Helsinki 1964: specifically addresses clinical research, reflecting changes in medical practice from the term ‘Human Experimentation’ u

Question 34

Tuskegee Syphilis Study (1932-1972):

Willowbrook School Study (1963 - 1966):

Jewish Chronic Disease Hospital:

Tearoom Trade Study:

Answer 34

Tuskegee Syphilis Study (1932-1972): - (people not told or treated for syphulis and some died) belmont report highlighted that benefits must outweight harms and informed consent needed

Willowbrook School Study (1963 - 1966): Mentally handicapped children at Willowbrook State School were deliberately infected with hepatitis after parents gave consent for what they thought
to be vaccinations

Jewish- Chronically ill patients who did not have cancer where unknowingly injected with cancerous human liver cells

tearoom- followed up men who had sex in public places

Question 35

Double agentry
WHO is the case?

Answer 35

when a psychiatrist has a conflict of interests that interferes with their ability to act solely in the best interests of the patient.

This is illustrated by the Tarasoff case