Sociocultural Psychiatry Flashcards
1
Q
What is the social classification in Britain?
A
Class 1: Professional, managerial Class 2: Intermediate Class 3: Skilled, manual, clerical Class 4: semi-skilled Class 5: unskilled Class 6: unemployed
2
Q
Which psychiatric disorders are not as common in lower social classes?
A
Anorexia
Alcohol abuse
Bipolar
3
Q
What is the Jarman Index?
A
Scoring system for level of social deprivation in a community.
4
Q
Who created the concept ‘sick role’?
A
Talcott Parsons
5
Q
What makes up the sick role?
A
Sick person is exempt from normal social roles.
Sick people are not responsible for their disease.
Sick person must try and get well.
Sick person must seek help and cooperate with care.
6
Q
What is the difference between illness and sickness?
A
Illness: personal experience
Sickness: social consequences
7
Q
Define impairment
A
Interference with structural or psychological functions
8
Q
Define disability
A
Interference with activities of the whole person in relation of immediate environment.
9
Q
Define handicap
A
Social disadvantage resulting from disability
10
Q
What does the Transtheoretical Model (Prochaska and DiClemente) state?
A
How individuals can change illness-related behaviour:
- Consciousness raising (help them gather info)
- Choosing - increase awareness of alternatives
- Catharsis - emotional expression of problem behaviour
- Conditional stimuli
- Contingency control - positive reinforcement + self-appraisal
11
Q
What is conditional stimuli in the Transtheoretical Model?
A
Stimulus control - avoidance of stimuli associated with problem behaviour
Counterconditioning - training a healthier response to stimuli.
12
Q
What are the six stages of change under the Transtheoretical Model?
A
- Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance
- Relapse
13
Q
Who created Motivational Interviewing?
A
Miller & Rollnick, 1991
14
Q
What is the libertarian principle in resource allocation?
A
Resources distributed according to market principle - patient as consumer, if they can pay then resources are available to them.
15
Q
What does utilitarian principle suggest towards resource allocation?
A
Resources distributed according to maximum benefit to all
16
Q
Which principle suggests resources should be distributed according to need?
A
Egalitarian
17
Q
What does restorative principle suggest in terms of resource allocation?
A
Resources distributed with positive discrimination towards disadvantaged.
18
Q
What are the schizophrenogenic family patterns according to Lidz?
A
Marital schism
Marital skew
19
Q
What is marital schism?
A
Family is in disequilibrium due to repeated threats of parental separation. Parents downgrade roles of each other.
20
Q
What is the double-bind relationship?
A
Bateson: superficial verbal communication contradicts behavioral and deeper communication amongst family. These mixed messages keep child in a double bind that increases risk of psychosis.
21
Q
Who coined the term schizophenogenic mother?
A
Freida Fromm-Reichmann
22
Q
What is the schizophenogenic mother?
A
Rejecting, impervious to feelings of others, rigid in moralism re sex and fear of intimacy.
23
Q
Who created the concept of expressed emotions?
A
Brown & Rutter (1966)
24
Q
What are the measures for expressed emotion concept?
A
Critical comments Positive remarks Emotional over involvement Hostility Emotional warmth
25
What is the Camberwell Family Interview?
Individuals of family interviewed + patient.
| If one relative is classified as high expressed emotion, then whole family could be classified as such.
26
Who created the Life events and difficulties schedule?
Brown and Harris
27
What is the Life events and difficulties schedule?
Life events are graded according to their meaning for the individual.
28
What are some life event scales?
Social readjustment rating scale (Holmes and Rahe)
Adverse childhood events scale
Hassles & uplifts scale (Lazarus and Folkman)
29
Who suggest the social drift/social selection theory for MH problems?
Faris and Dunham
30
According to Rutter, which risk factors in family environment correlate with childhood MH problems?
```
Severe marital discord
Low social class
Large family size
Maternal MH disorder
Paternal criminality
Foster placement
```
31
What is primary deviance?
General aberration from normality before person is identified as deviant.
32
What are the types of suicide according to Durkheim?
Altruistic
Egoistic
Fatalistic
Anomic
33
What is altruistic suicide?
Individual is overly attached to social norms and dies for society
34
What is egoistic suicide?
Excessive individualism but low social integration.
35
What is fatalistic suicide?
Society's control on the individual is so strong that it interferes with moral values and personal goals.
36
What is anomic suicide?
Individual feels he has no guidance or regulations from society.
37
What are the vulnerability factors for depression according to Brown and Harris (1978)
Absence of close confiding relationship
Loss of mother before 11 years of age
Lack of employment outside home
3 or more children under 15 living at home.
38
What does the social defeat hypothesis state?
Long-term experiences of social disadvantage lead to sensitization of the dopamine system and increased baseline activity of this system. This increases the risk of schizophrenia.
39
What does the notion of prepsychotic segregation state?
Individuals who are psychosis prone find it hard to survive in countries of birth and therefore immigrate.
40
What are the stages of Goffman's 'moral career'
Betrayal funnel
Role stripping
Mortification
Privilege system
41
What is mortification in the moral career?
Series of assaults on the persons self-image. E.g. private activities are on public display, person must ask permission. Also called civil death
42
What are secondary adjustments according to Goffman?
Habitual arrangements used by patients who act as if their concern is to escape the institution
43
Who used the term institutional neurosis?
Russel Barton - 1976
44
What is institutional neurosis?
Characterized by apathy, lack of initiative and interest and submissiveness.
45
What is clinical poverty?
When social poverty and lack of stimulation are related to the severity of blunted affect, poverty of speech and social withdrawal in schizophrenia.
46
What is enacted stigma?
Patients actual experience of discrimination
47
What is courtesy stigma?
Stigmatization of someone related to an individual with that problem (e.g. MH)
48
What are the themes of stigma according to Hayward and Bright?
Dangerousness
Attribution of responsibility
Poor prognosis
Disruption of social interaction
49
What was Hagighat's theory of stigma?
```
Stigma serves the self-interest of stigmatisers in four ways:
Constitutional
Psychological
Economic
Evolutionary
```
50
What is the constitutional aspect of Hagighat's theory of stigma?
Quick and easy stereotypes at the expensive of depth.
51
What is the psychological aspect of Hagighat's theory of stigma?
Human tendency uses the example of the unfortunate other to feel happier towards themselves.
52
What is the economic aspect of Hagighat's theory of stigma?
To increase ones access to resources, stigmatization is used as a weapon for competition.
53
What is the evolutionary aspect of Hagighat's theory of stigma?
Stigma provides an evolutionary advance - e.g. avoiding such discriminated population from being chosen as sexual mates.
54
What is Corrigan's theory of stigma?
Three components:
Stereotypes
Prejudice
Social discrimination
55
What is Liz Sayce's model for addressing stigma?
Brain disease model
Individual growth model
Libertarian model
Disability inclusion model
56
What is the individual growth model in stigma?
MH as a spectrum, including good MH.
57
What is the Libertarian model in stigma?
Advocates for equal rights for MH patients.
58
What is the disability inclusion model for stigma?
Promotes concept of social inclusion on civil rights grounds.
59
Who created social role valorization?
Wolf Wolfensberger - 1983
60
What is social role valorization?
Creating social roles for devalued people to enhance their competencies.
61
What is the emic perspective?
The perspective of an individual about their own cultural group.
62
What does the etic perspective assume?
Universality of illness
Invariance of core symptoms
Validity of diagnostic constructs
63
What are the types of acculturation according to Berry?
Integration
Separation
Assimilation
Marginalization
64
What does assimilation mean in Berry's model of acculturation?
High degree of adoption of new culture
| Low degree of retention of culture of origin
65
What does separation mean in Berry's model of acculturation?
when someone has a high degree of retention of their cultural origin but low degree of adoption of the new culture?
66
What type of acculturation leads to a risk of MH problems?
When someone loses their culture of origin voluntarily but does not assimilate or integrate
67
What is enculturation?
Culture being learnt through contact with family, friends, media etc.
68
What is segregation according to Berry
Low degree of relationship among various cultures in society
| High degree of retention of individual culture identities
69
What is cultural diffusion/syncretism?
Spread of cultural traits through contacts across society.
70
What is sojourning?
Voluntary but brief exposure to different cultures.
71
What are Goffman's 5 types of segregation?
```
Incapable harmless - orphanages
Ill but threat to society - MH hospitals
Not ill, threat to society
Occupation related - boarding schools
Retreat from world - monasteries
```
72
How can psychiatry see culture?
Explanatory
Pathoplastic
Diagnostic
Service instrument
73
What is culture as a pathoplastic agent?
Description of psychopathology that results from cultural practices.
74
What is culture as a service instrument?
Allows utilization of cultural knowledge in service delivery
75
What are idioms of distress in Psychiatry?
Somatic symptoms that serve as a code for expressing ones mental distress in some cultures.
76
What is a hedge-your-bets approach in cultural psychiatry?
Both prescribed medication and ethnic, spiritual therapy may be best hope for securing adherence.
77
What type of illness is amok?
Dissociative
78
Where is amok common?
Malaysia, Laos, Philippines, Papua New Guinea, Puerto Rico
79
What is ataque de nervios?
Attack of distress - sudden shouting, crying, dissociation - leading to sense of being out of control. May have LOC/amnesia afterwards.
Related to acute stress.
Sense of heat arising from chest into head.
80
Where is berdache common?
North America
81
What is berdache?
Male who has assumed female gender role
82
What is Bouffee delirante?
Sudden outburst of agitated and aggressive behavior, confusion
.West Africa
Haiti
83
What is brain fag?
Difficulty concentrating, thinking, remembering.
West Africa
84
What is dhat?
Anxiety and hypochondria relating to seminal discharge accompanied by feeling weak and exhausted.
85
What is another name for dhat?
Shenkui in China
86
What is Frigophobia?
Fear of feeling cold/wind due to yin-yang imbalance.
87
What is Koro?
Episode of sudden, intense anxiety that penis/vuvla/nipples will recede into body and possibly cause death.
88
Where is Koro common?
Malaysia
| SE Asia
89
Where is Latah common?
Malaysia
| SE Asia
90
What is Latah?
Hypersensitivity to sudden fright, with echopraxia, echolalia, command obedience and dissociative behavior in middle-aged women
91
What is mal de ojo?
Mediterranean concept of evil eye affecting children with physical symptoms
92
Where is Nerfiza/nevra common?
Egypt
Greece
Central America
93
What happens in Nerfiza?
Chronic episodes of extreme sorrow/anxiety, inducing somatic complaints.
94
What happens in Piblokto?
Eskimos
Dissociative episode with excitement followed by seizure/coma lasting up to 12 hours.
May be withdrawn/amnesia afterwards.
95
What is shinkeishitsu
'Nervous traits' in Japanese.
| Syndrome of obsessions, perfectionism
96
What is susto?
Attributed to a frightening event that causes soul to leave body resulting in unhappiness
97
What is Tajin-kyofu-shou?
Fear of losing good will of others due to imagined shortcomings of oneself.
98
What is Windigo?
Intense craving for human flesh
Algonquian Indian cultures
99
What are Tseng's different effects of culture on psychopathology?
```
Pathogenic
Pathoselective
Pathoplastic
Pathoelaborating
Pathofacilitative
Pathoreactive
```
100
What is pathoplastic?
Culture influences manifestations of MH illnesses such as delusions.
101
What is pathoelaborating?
Universal behavioral reactions that are selectively reinforced by a culture.
102
What is pathofacilitative?
Cultural beliefs affect frequency of onset by facilitating risk factors.
103
What is pathoreactive?
Culture affects treatment, stigma and outcome.
104
Who coined the term anti-psychiatry and when?
David Cooper
| 1960s
105
Who proposed that mental disorders are learned abnormalities of behavior?
Eysenck, 1968
106
What is the first attempt in coding ethics in medicine?
Chakara
107
What is Chakara's principle of ethics?
Friendship
Sympathy towards the sick
Interest in cases according to ones capabilities
No attachment to patient after recovery
108
Name some higher order principles in ethics
Deontology
| Teleology
109
What is Deontology?
Centrality of rules in governing medical practice.
| Rights and duties determine action - thus this is absolutism.
110
What is Teleology?
Based on peoples interests, such as needs and desires. i.e. benefit vs harm.
The right action is the one that has the best foreseeable consequences
111
What are the forms of utilitarianism?
Act utilitarianism - deals with a specific act
| Rule utilitarianism - deals with general practices
112
What does the Nuremberg code state?
Human experimentation can only be carried out if:
there is voluntary consent
research is for common good of society
avoidance of unnecessary pain/suffering is guaranteed
subject has liberty to withdraw at any point
qualified researchers undertake research
scientists must terminate study if more harm is being caused than expected to subjects
113
What is the Declaration of Geneva 1948?
Reaffirmation of humanitarian aims of medicine by World Medical Association. Modification of Hippocratic oath.
114
What is the Declaration of Helsinki 1964?
Addresses clinical research, reflecting changes in medical practice from the term human experimentation used in Nuremberg code.
115
What was the Tuskegee Syphilis study (1932-1972)
US public health service following up 600 low-income african american males, 400 of whom were infected with syphilis but were not informed. Furthermore, some were not offered the treatment of penicillin.
116
What was the Willowbrook School study (1963-1966)
Mentally handicapped children were deliberately infected with hepatitis after parents gave consent for what they thought were vaccinations.
117
What was the Jewish Chronic disease hospital study?
Studies to develop information about the nature of human transplant rejection; chronically ill patients w/o cancer were injected unknowingly with cancerous human liver cells.
