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Questions and Answers
Published in David Browne, Brenda Wright, Guy Molyneux, Mohamed Ahmed, Ijaz Hussain, Bangaru Raju, Michael Reilly, MRCPsych Paper I One-Best-Item MCQs, 2017
David Browne, Brenda Wright, Guy Molyneux, Mohamed Ahmed, Ijaz Hussain, Bangaru Raju, Michael Reilly
Answer: A. The term cultural fallacy is used to describe the difficulty that arises when a Western psychiatric diagnostic category is improperly used in a culture in which the category has no relevance. Ecological fallacy is a statistical term used to describe the fallacy that assumes that phenomena described at a macro (i.e. national) level will hold true at a micro (i.e. individual) level. Koro is a specific culture-bound syndrome. D and E are distracters. [E. p. 464; A. p. 189]
Sexual Emergencies: A Psychiatrist's Perspective
Published in R. Thara, Lakshmi Vijayakumar, Emergencies in Psychiatry in Low- and Middle-Income Countries, 2017
T.S. Sathyanarayana Rao, Gurvinder Kalra
Patients with koro, which has been described as a culture-bound syndrome, experience sudden and intense anxiety due to the fear that the penis or even the entire male genitalia (vulva and nipples or breast in females) will recede into the body and possibly cause death. Koro may either be the primary disorder or secondary to other psychiatric disorders (schizophrenia, anxiety disorder, depression), diseases of the central nervous system (epilepsy, brain tumors), or withdrawal from drugs. Although the acute type of koro is more common, a less common chronic form has also been reported (Westermeyer 1989; Bernstein and Gaw 1990; Earleywine 2001; Kar 2005).
Cotard and Capgras delusions in a patient with bipolar disorder: “I’ll prove, I’m dead!”
Published in Psychiatry and Clinical Psychopharmacology, 2018
Mehmet Hamdi Örüm, Aysun Kalenderoğlu
Cotard is a syndrome that is characterized by nihilistic and immortality delusions, depersonalization, derealization, and suicidal thoughts. It was first described by Jules Cotard (1840–1889) in 1880, a French neurologist [1]. Reports confirm that it is seen in several psychiatric conditions, but it is strongest association has been seen to be with severe depression from the start [2]. The syndrome is encountered in middle age and older people, especially in women. When it is seen in patients who are less than 25 years of age, a bipolar disorder is often the underlying pathology [3]. It has been described in organic brain diseases and in functional psychiatric disorders such as bipolar disorder, schizophrenia, catatonia, postpartum depression, and is association with other syndromes: Fregoli syndrome, Koro syndrome, and Capgras syndrome [4,5].
The future of psychiatric education
Published in International Review of Psychiatry, 2020
Keith Hariman, José Eduardo López Urquizú, Mariana Pinto da Costa
Rising global migration means that clinicians will likely encounter patients of a different ethnic and cultural background in their practice. With a shortage of psychiatrists in many countries, many positions may be filled by international medical graduates (Pinto da Costa, Giurgiuca, et al., 2019; Pinto da Costa et al., 2017). It is therefore important that future psychiatrists are aware of the nuanced fine details in different cultures. This not only applies to the culture-bound psychiatric morbidities such as koro in Asian culture or bouffée délirante in French, but also an understanding of the different terminologies and descriptive psychopathology experienced by people from different backgrounds. In Asian culture, for example, many patients are not well versed in describing mood symptoms, but instead experience multiple somatic symptoms, rendering the standard ICD-10 diagnostic criteria not applicable. However, consideration must be given on the method of instruction. In one study conducted in a major teaching hospital in the northeast US, the researchers noted that the ethnic background of the clinician, personal inclination, and the previous exposure or learning affect the degree of receptiveness towards teachings in cultural sensitivity (Willen, Bullon, & Good, 2010). Previous attempts at instructing cultural awareness were met with resistance from the trainees, possibly due to the time constraints and perceived time away from clinical duties. The authors also noted that the method of instruction was important as well, as didactic lectures may ‘alienate trainees or disseminate cultural caricatures that many trainees, as nuanced thinkers, will feel obligated to reject’ (Willen et al., 2010). Grounded dialogues, case-based discussions, or even experiential learning, along with communication with co-workers from different cultures, may be a more acceptable and effective way of instruction (Hansen, Braslow, & Rohrbaugh, 2018).
‘I am dead’: Cotard syndrome and dementia
Published in International Journal of Psychiatry in Clinical Practice, 2019
Gabriele Cipriani, Angelo Nuti, Sabrina Danti, Lucia Picchi, Mario Di Fiorino
Cotard delusions were reported in patients across a relatively wide spectrum of organic brain diseases and functional psychiatric disorders (Berrios & Luque, 1995). The syndrome often occurs in association with psychotic states and other mental disorders. Predominantly described in the context of major depression with psychotic symptoms (Machado, Peregrino, Azoubel, Cerqueira, & de Lima Filho, 2013; Machado et al., 2016), the syndrome is associated with schizophrenia (Ghaffari-Nejad, Kerdegari, & Reihani-Kermani, 2007; Huber & Agorastos, 2012), bipolar disorder (Soultanian et al., 2005; Consoli et al., 2007), and depersonalisation disorder (Ramirez-Bermudez et al., 2010). It was observed in the course of migraine (Bhatia, Agrawal, & Malik, 1993), cluster headaches (Sahoo & Josephs, 2018), subdural heamorrhage (Perez, Fuchs, & Epstein, 2014), ischemic stroke (Sottile et al., 2015), cerebral arterio-venous malformation (Gardner-Thorpe & Pearn, 2004), multiple sclerosis (Gardner-Thorpe & Pearn, 2004), cerebral infarction, superior sagittal sinus thrombosis (Hu, Diesing, & Meissner, 2006), temporal lobe epilepsy (Drake, 1988), brain tumour ( Reich, Comet, Rhun, & Ramirez, 2012), arachnoid cyst (Grover, Aneja, Singh, & Singla, 2013) Parkinson’s disease (Factor & Molho, 2004), supranuclear palsy (Sahoo & Josephs, 2018), brain injury (Young, Robertson, Hellawell, De Pauw, & Pentland, 1992), delirium (Oberndorfer, Schönauer, Eichbauer, Klaushofer, & Friedrich, 2017), mental retardation (Kearns, 1987; Sottile, De Luca, Bonanno, Finzi, Casella, & Calabrò, 2018) herpetic or nonherpetic encephalitis (Debruyne et al., 2009), Laurence-Moon-Bardet-Biedl syndrome (Lerner, Bergman, Greenberg, & Bar-El, 1995), noninfectious complication of heart transplantation (Muñoz et al., 2010), typhoid fever (Campbell, Volow, & Cavenar, 1981), HIV infection (Freudenreich, Basgoz, Fernandez-Robles, Larvie, & Misdraji, 2012). It was described during the use of psychoactive substances (Nicolato et al., 2007), as an adverse drug reaction to aciclovir and its prodrug valaciclovir (Helldén, Odar-Cederlöf, Larsson, Fehrman-Ekholm, & Lindén, 2007; Kassam & Cunningham, 2018), and in the course of malignant neuroleptic syndrome (Weiss, Santander, & Torres, 2013), dehydration, steroid psychosis and amantadine psychosis (Sahoo & Josephs 2018). De Berardis et al. (2015) described a patient who never suffered from psychiatric disorder and developed a secondary CS after a surgical intervention (breast surgery for a benign fibroadenoma). A variety of other delusions may accompany the central delusion of being dead. In terms of association with other monothematic and/or bizarre delusions, case reports have also described the occurrence of CS with hydrophobia (Nejad, 2002), lycanthropy (Nejad & Toofani, 2005), folie a deux, Capgras delusion (Joseph, 1986), Capgras and Fregoli delusion (Yalin, Taş, & Güvenir, 2008), voluntary starvation (Silva, Leong, Weinstock, & Gonzales, 2000), and Koro-like syndrome (Alvarez et al., 2012) (the belief that one’s own genitalia are shrinking or disappearing).