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Videnscenter for Transkulturel Psykiatri
Information om Transkulturel Psykiatri, juli 2003
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Indhold
Nyheder
generelt
Forord til artikelserien »Indvandrermedicin«
Psykosocial bistand - En effektiv afklaring/udredning af flygtninge med psykosociale vanskeligheder
om transkulturel psykiatri
Følger efter traumatiske oplevelser
Nydanskere fylder i retspsykiatrien
Tyrkiske sindslidende
generelt om psykiatri
Ansøgningsskemaer til psykiatripuljen
Litteratur
anmeldelser
Handbook of cultural psychiatry
Origins of psychopathology: The phylogenetic and cultural basis of mental illness
artikler
Attachment and traumatic stress in female holocaust child survivors and their daughters
Child war trauma: A comparison of clinician, parent and child assessments
Cognitive abilities related to post-traumatic symptoms among refugees from the former Yugoslavia in psychiatric treatment
Cultural Adaptations of Current Psychiatric Classifications: Are They the Solution?
Eating disorders in white and black women
Mental health of refugee children: comparative study
Mental Health, Social Functioning, and Feelings of Hatred and Revenge of Kosovar Albanians One Year After the War in
Kosovo
Reformulation of Diagnosis with Attention to Cultural Dynamics: Case of a Japanese Woman Hospitalized in Melbourne,
Australia
Refugee families during asylum seeking
Review of the Costs of Telepsychiatry
Screening for post-traumatic stress disorder among refugees in Stockholm
Treating Depression in Predominantly Low-Income Young Minority Women A Randomized Controlled Trial
Kalender
Nyheder
generelt
Forord til artikelserien »Indvandrermedicin«
Lise Dyhr & Benny Ehrenreich & Lene Løgstrup Poulsen
Månedsskriftet starter i dette nummer en serie om de mangeartede udfordringer den praktiserende læge møder hos
patienter af fremmed herkomst. Problemstillingerne strækker sig fra sociale og psykologiske over administrative til rent
sygdomsrelaterede.
Månedsskrift for praktisk lægegerning, 949 pp., juli 2003,
læs hele artiklen her : http://www.mpl.dk/show.asp?Id=218&nr=6972&show=article&from=nr
Psykosocial bistand - En effektiv afklaring/udredning af flygtninge med psykosociale
vanskeligheder
juni-nyt fra Dansk Flygtningehjælp
En del flygtninge såvel nyankomne som flygtninge, der har været i Danmark i en årrække har vanskeligheder i forhold til
uddannelse og arbejde. Uanset årsagen til vanskelighederne er det vigtigt at fokusere på de ressourcer, der er til stede og
at give et eventuelt behandlingsforløb plads, uden at det kommer til at fylde hele flygtningens liv.
Integrations og psykosociale tiltag, samt evt. behandling, bør være sideløbende processer og det er vigtigt at skaffe sig
overblik over, hvori problemerne egentlig består, hvilke ressourcer der er tilstede, hvilke ressourcer der er gemt, samt at
skelne mellem følger af kulturelle barrierer, sociale problemer, traumatiseringsgrad, torturskader og den enkeltes
personlighed.
Dansk Flygtningehjælpa integrationsnetværk (FIN) har særlig ekspertise i flygtningespecifikke problemstillinger. FIN har et
godt overblik over handle- og behandlingsmuligheder indenfor dette område.
FIN tilbyder bistand til afklaring af flygtninges behov, ressourcer og problemer med henblik på vurdering af eventuelle
relevante handlemuligheder eller behandlingsbehov.
Afklaringen kan indeholde følgende elementer :
Aktuelle problemstillinger/situation
Psykosocial tilstand
Selvopfattelse, motivation, ressourcer, barrierer
Ønsker og forventninger
Traumatiseringsgrad (PTSD-symptomer)
Egne mestringsstrategier
Kognitivt funktionsniveau/terapiegnethed (eks.: Kontaktevne, reflektionsevne, omstillingsevne)
Afklaringsforløbet sker i tæt samarbejde med sagsbehandler for at sikre konsensus mellem sagsbehandler, flygtning og
FIN og for at sikre koordinering i indsatsen. Afslutningen kan, efter ønske og behov, ske ved et statusmøde og/eller skriftlig
statusbeskrivelse med anbefaling af fremtidige tiltag i processen. Der vil således være mulighed for at få lagt en
fremadrettet realistisk handleplan. yderligere oplysninger fås hos:
FIN - Jylland
Birte Bøgh Hansen [email protected]
Marianne Badstue [email protected]
FIN – Sjælland og Fyn
Anne-Dorte Larsen [email protected]
FIN – Hovedstaden
Michael Rasmussen [email protected]
om transkulturel psykiatri
Nydanskere fylder i retspsykiatrien
Psykisk syge med anden etnisk baggrund end dansk bliver ofte først opdaget, når de begår
kriminalitet
Politiken 28. juli 2003, af Lene Vaaben Vennekilde
Udadtil levede den pakistanskfødte taxachauffør et normalt liv. Men han hørte stemmer. Han modtog skjulte beskeder fra
fjernsynet og mente, at han havde indflydelse på verdensordenen. Hans kone mente, han var besat af en ond ånd.
Først da han blev fængslet for vold, fik han diagnosen skizofren og blev indlagt til behandling på en retspsykiatrisk afdeling.
læs hele artiklen her : http://politiken.dk/VisArtikel.iasp?PageID=279027
Tyrkiske sindslidende
DEBAT
Firdevs Tamer, reservelæge, Viborg Sygehus, E-mail: [email protected]
Kommentar til debatindlægget »Rammer for behandling. Tyrkiske sindslidende her og der« af antropolog Lotte Bøggild
Mortensen (Ugeskr Læger 2003; 165: 2675-6 :http://www.dadlnet.dk/ufl/2003/0326/LS-html/LS42546.htm).
”Jeg mener, at jeg udtrykkelig gjorde opmærksom på, at vi er multikulturelle som tyrker. Og det er en selvfølge at hver
patient er unik, og at man i behandlingen selvfølgelig tager udgangspunkt i den enkelte patiens situation og baggrund,
uanset hvor patienten kommer fra og hvem patienten er!”
Ugeskrift for læger 165(29), 2900-2901
læs hele indlægget her : http://www.dadlnet.dk/ufl/2003/0329/LS-html/LS42829.htm
Følger efter traumatiske oplevelser
Marianne Kastrup
En betydelig del af de asylansøgere og flygtninge, der kommer til Danmark, har været udsat for forhold og oplevelser, der
er traumatiserende i større eller mindre omfang. Konsekvensen er en række fysiske og psykiske helbredsklager. Disse
klager påvirkes bl.a. af kulturelle forhold.
Fokus 10(2), s. 18-19
http://www.vfhj.dk/fokus/arkiv/artikler/pdf/fokus_2_2003.pdf
Dette nummer af Fokus – der udgives af Videnscenter for Hjerneskade – har ”Hjerneskade og etnicitet” som tema
generelt om psykiatri
Ansøgningsskemaer til psykiatripuljen
Kommunernes Landsforenings hjemmeside, juni 2003
Socialministeriet har nu udarbejdet ansøgningsskemaet til psykiatripuljen i forbindelse med psykiatriaftalen 2003 - 2006
samt en vejledning til ansøgningen. Du kan finde ansøgningsskemaet og vejledningen ved enten at gå ind på
Socialministeriets hjemmeside eller ved at klikke på linket på hjemmesiden.
KL’s hjemmeside : http://www.kl.dk/254179
Litteratur
anmeldelser
Origins of psychopathology: the phylogenetic and cultural basis of mental illness
By Horacio Fábrega, Jr., M.D. New Brunswick, N.J.
Rutgers University Press, 2002, 411 pp., $60.00.
anmeldt af WILLIAM R. FLYNN, M.D. Napa, Calif.
Slutningen af anmeldelsen :
The foregoing is but a sample of the content of this volume, which is a masterful piece of erudition and scholarship. Dr.
Fábrega analyzes an astonishing number of combinations of circumstances in which our ancestors lived in prehistoric
times. He traces the parallel lines of physical, cultural, cognitive, and language development and speculates on the
expression of psychopathology by individuals and their society’s responses to it. This work is valuable for its meticulous
exposition of what anthropologists, cultural anthropologists, paleoanthropologists, archeologists, ecologists, biologists,
evolutionary biologists, comparative and evolutionary psychologists, and cognitive scientists have to say about evolution
even without regard to psychopathology. My only cavil is that Dr. Fábrega uses anthropological terms freely but is a bit
parsimonious about explaining them. I would have welcomed a glossary.
American journal of psychiatry 160 : 1364, 2003
Handbook of cultural psychiatry
Edited by Wen-Shing Tseng. San Diego, Calif.
Academic Press, 2001, 855 pp., $149.95.
anmeldt af RENATO D. ALARCÓN, M.D., M.P.H.
Slutningen af anmeldelsen
As already noted, this book is one of encyclopedic proportions. At times a big, solid catalog of topics, at times a rich source
of an unusually unique knowledge, it is always imbued with a genuinely compassionate sense for the suffering of many. If
only for its wealth of data from so many countries and cultures, it is an exceptional contribution to the literature. It is a shame
it was published before the U.S. Surgeon General’s Report on culture and mental health and the World Health
Organization’s most recent documents about the realities of mental health in the world; these publications could have given
even more authority to its main message. The fact that the Handbook of Cultural Psychiatry is with us (and will be for years
to come, with desirable new editions) is reason enough for the enjoyment of learning so much from it.
American journal of psychiatry 160 : 1362-1364, 2003
artikler
Eating disorders in white and black women
Ruth H. Striegel-Moore, Ph.D., Faith A. Dohm, Ph.D., Helena C. Kraemer, Ph.D., C. Barr Taylor, Ph.D., Stephen Daniels,
M.D., Patricia B. Crawford, D.P.H., and George B. Schreiber, D.Sc.
OBJECTIVE: Epidemiological studies of eating disorders in the United States have focused on white women and girls, and
the prevalence of eating disorders in ethnic minority groups is unknown. This study examined the prevalence of anorexia
nervosa, bulimia nervosa, and binge eating disorder in a geographically and economically diverse community sample of
young white and black women who previously participated in the 10-year National Heart, Lung, and Blood Institute (NHLBI)
Growth and Health Study. METHOD: All NHLBI Growth and Health Study participants were recruited for this study. A
two-stage case finding method was used, consisting of a telephone screening (sensitivity=0.90, specificity=0.98) and an
in-person confirmatory diagnostic interview. RESULTS: A total of 86.0% of the original NHLBI Growth and Health Study
cohort participated, including 985 white women (mean age=21.3) and 1,061 black women (mean age=21.5). Fifteen white
(1.5%) and no black women met lifetime criteria for anorexia nervosa; more white women (N=23, 2.3%) than black women
(N=4, 0.4%) met criteria for bulimia nervosa; binge eating disorder also was more common among white women (N=27,
2.7%) than black women (N=15, 1.4%). Few women (white: N=16, 28.1%; black: N=1, 5.3%) ever had received treatment
for an eating disorder. CONCLUSIONS: Results suggest that eating disorders, especially anorexia nervosa and bulimia
nervosa, are more common among white women than among black women. The low treatment rates in both groups
suggest that health professionals need to be more alert to the possibility of eating disorders in women.
American journal of psychiatry 160 : 1326-1331, 2003
Attachment and traumatic stress in female holocaust child survivors and their daughters
Abraham Sagi-Schwartz, Ph.D., Marinus H. van IJzendoorn, Ph.D., Klaus E. Grossmann, Ph.D., Tirtsa Joels, Ph.D., Karin
Grossmann, Ph.D., Miri Scharf, Ph.D., Nina Koren-Karie, Ph.D., and Sarit Alkalay, M.A.
OBJECTIVE: During the Holocaust, extreme trauma was inflicted on children who experienced it. Two questions were
central to the current investigation. First, do survivors of the Holocaust still show marks of their traumatic experiences, even
after more than 50 years? Second, was the trauma passed on to the next generation? METHOD: Careful matching of
Holocaust survivors and comparison subjects was employed to form a research study design with three generations,
including 98 families with a grandmother, a mother, and an infant, who engaged in attachment- and trauma-related
interviews, questionnaires, and observational procedures. RESULTS: Holocaust survivors (now grandmothers) showed
more signs of traumatic stress and more often lack of resolution of trauma than comparison subjects, but they were not
impaired in general adaptation. Also, the traumatic effects did not appear to transmit across generations. CONCLUSIONS:
Holocaust survivors may have been able to protect their daughters from their war experiences, although they themselves
still suffer from the effects of the Holocaust.
American journal of psychiatry 160 : 1086-1092, 2003
Mental health of refugee children: comparative study
Mina Fazel, clinical lecturer, Alan Stein, professor
Section of Child and Adolescent Psychiatry, University Department of Psychiatry, Warneford Hospital, Oxford
Introduction
In 2002, over 110 000 people entered Britain to seek asylum—a 250% increase in five years. Children, who comprise at
least a quarter of asylum seekers, are exposed to numerous risk factors for psychological disturbance, including exposure
to violence, forced displacement, and multiple losses. The rates of mental health problems in refugee children are
uncertain, but the few studies that have been done suggest that refugee children incur significant morbidity.
We examined the rates of psychological disturbance in a sample of UK children who were refugees and compared them
with a group of children who were from an ethnic minority but were not refugees and a group of indigenous white children.
British medical journal, 327, p. 134, 19. juli, 2003
A review of the costs of telepsychiatry
Steven E. Hyler, M.D. and Dinu P. Gangure, M.D.
OBJECTIVES: The issue of whether telepsychiatry is worth the cost or whether it pays for itself is controversial. This study
investigated this question by reviewing telepsychiatry literature that focused on cost. METHODS: Approximately 380
studies on telepsychiatry published from 1956 through 2002 were identified through MEDLINE, PsycINFO, and
cross-referenced bibliographies. Of these, 12 studies with samples of more than ten persons or programs focused
specifically on the cost of telepsychiatry. RESULTS: The methods of examining cost used in the 12 studies were
cost-feasibility, cost surveys, direct comparison of costs of telepsychiatry and in-person psychiatry, and cost analysis. It
was concluded that in seven of the studies reported, telepsychiatry was worth the cost. One study reported that
telepsychiatry was not financially viable. Three studies of cost-effectiveness reported the break-even number of
consultations, the number that make telepsychiatry comparable in cost to in-person psychiatry. One review concluded that
the lack of a clear business plan contributed to the difficulty of determining whether any of the programs was cost-effective.
CONCLUSIONS: Telepsychiatry can be cost-effective in selected settings and can be financially viable if used beyond the
break-even point in relation to the cost of providing in-person psychiatric services. Whether governmental or private health
agencies value telepsychiatry enough to assume its cost is a question that remains to be answered.
Psychiatric Services 54:976-980, 2003
http://psychservices.psychiatryonline.org/cgi/content/abstract/54/7/976
Reformulation of diagnosis with attention to cultural dynamics: case of a Japanese woman
hospitalized in Melbourne, Australia
Peg LeVine, Department of Psychological Medicine, Monash Medical Centre, Monash University, 246 Clayton Road,
Clayton, Victoria 3168, Australia, Yoshimi Matsuda, Department of Psychological Medicine, Monash Medical Centre,
Monash University, 246 Clayton Road, Clayton, Victoria 3168, Australia
Fra starten af artiklen
CLINICAL HISTORY
Patient identification. M is a 28-year-old heterosexual Japanese woman who identifies herself as agnostic. She has a
diploma from a Japanese junior college and a certificate as a kindergarten teacher.Mmigrated to Australia three years ago
to join her Australian fianc´e, whom she had met in Japan one year prior. Since then she has worked at several temporary
waitress jobs to help support her life with her fianc´e. She has no physical disabilities, has conversational English ability,
and has been living in urban Australia (with a temporary Australian visa).Mreturns to her family and community near Osaka,
Japan, where she grew up, for extended visits each year. History of present illness.Mwas first brought to the attention of the
first author by a doctoral student who was on placement at an urban public hospital in Melbourne, Australia, whereMhad
been admitted voluntarily to the psychiatric unit as a public patient (a patient not covered by private insurance). The student
convinced the unit staff of the need to interview M in her first language before finalizing diagnosis and treatment. An
interpreter had not been used earlier because M’s English was considered to be “good enough.” Following
recommendation by the staff, the two authors were invited as consultants to interview M at the hospital.
Culture, Medicine and Psychiatry 27 (2): 221-243, 2003
Refugee families during asylum seeking
Andre Sourander
Abstract
The mental health of refugee families with children during the asylum period is a neglected research area in psychiatry. The
present paper describes the situation of 10 refugee families residing at an asylum centre in Finland. Case vignettes are
presented to illustrate the situations of these families. The study shows a high rate of depressive and post-traumatic stress
disorder-related symptoms among adult refugees. The case vignettes suggest that during the asylum period, many
children and adult members of the family are not in a post-traumatic situation, but they live constantly in a distressing
situation. The foremost distress amongst the asylum seekers appeared to be fear of deportation and separation from family
members. Most of the adults and all children had not received any psychiatric or psychotherapeutic assessment or
treatment. It is likely that current procedures for dealing with the asylum seekers contributes to the level of stress, family
confusion and psychiatric problems in already traumatized refugee families.
Nordic journal of psychiatry 57(3) 191-198, 2003
Cognitive abilities related to post-traumatic symptoms among refugees from the former
Yugoslavia in psychiatric treatment
Gunilla Kivling-bodén ; Elisabet Sundbom
Abstract
The overall aim was to study the relationship between post-traumatic symptoms and cognitive abilities among traumatized
refugees from the former Yugoslavia, in psychiatric treatment. The results showed that a diagnosis of post-traumatic stress
disorder (PTSD), as well as a higher level of post-traumatic symptoms, was significantly associated with poorer average
cognitive performance. Three of four tests of fluid intelligence, and the Benton Visual Retention Test, assessing episodic
memory, were the most discriminating. A specific constellation of PTSD symptoms, dominated by arousal and intrusive
symptoms, had a significant overall correlation with intellectual performance. One implication of the study is that
assessment of cognitive abilities might be advisable in this patient group, in particular when arousal and re-experiencing
symptoms are frequent
Nordic journal of psychiatry 57(3) 191-198, 2003
Screening for post-traumatic stress disorder among refugees in Stockholm
Hans Peter Söndergaard ; Solvig Ekblad ; Töres Theorell
Abstract
A screening procedure (The Health Leaflet; HL) to assist social workers in finding subjects with possible post-traumatic
stress disorder (PTSD) in recently resettled refugees is presented. It is compared with two established self-rating
instruments, the Harvard Trauma Questionnaire (HTQ) and Impact of Event Scale-22 (IES-22), as well as structured
clinical interview. Aim: To validate the screening interview and the rating scales in comparison to a clinical assessment for
PTSD, and examine the feasibility of lay screening for PTSD. Findings: The Health Screening Interview with a cut-off value
of 10 points identified cases with fully developed PTSD with both sensitivity and specificity about 0.7. Only two
items--difficulties concentrating and having been exposed to torture--contributed to the discriminatory performance of the
HL interview. In the HTQ symptom subscale, emotional detachment and a feeling of going mad contributed to the
discriminatory performance. In the IES-22, recurring strong affects about the events, as well as intrusive memories, were
the items with the highest canonical correlation coefficients. In the HL, the single screening question about difficulties
concentrating identified 31/32 individuals diagnosed with PTSD in this group, with a relative risk of 24. Conclusions: A
mental health screening procedure during refugee reception performed by lay persons is clearly feasible and can assist in
identifying subjects with trauma-related healthcare needs, thus leading to more realistic demands in refugee reception
Nordic journal of psychiatry 57(3), 185-189, 2003
Child war trauma: a comparison of clinician, parent and child assessments
Stephen Goldin ; Lilian Levin ; Lars Åke Persson ; Bruno Hägglöf
Abstract
This paper focuses on the difficulty of capturing child war trauma: the appropriateness of a standardized trauma
questionnaire and the value of recruiting multiple reports. Three independent assessments of the war exposure of 75
Bosnian refugee children and teenage youths (aged 1-20), resettled in Sweden, are compared: clinician assessment based
upon a semi-structured interview with the family, child self-report on the Harvard Trauma Questionnaire (HTQ) and parent
report on the same questionnaire. Parent and clinician reports show marked group similarities but differ often with regard to
the individual child. Clinician score reveals a social class gradient not visible on the HTQ. Parent and teenager
assessments correlate strongly on total exposure but diverge markedly on specific events. Discrepancy derives as
frequently from events affirmed by teenager alone as by parent alone. Primary school children, on the other hand,
systematically offer a less-detailed account of their own war exposure. In summary, original HTQ functions "quite well" as a
standardized questionnaire, but a Bosnian-specific version would expectedly afford greater validity and capture social
class differences in child exposure. For teenagers, the value of multiple informants appears evident; for primary school
children, a more adequately age-adjusted procedure remains the first priority.
Nordic journal of psychiatry 57(3), 173-183, 2003
Cultural adaptations of current psychiatric classifications: are they the solution?
Juan J. López-Ibor Jr.
Abstract
Despite the limitations of modern nosological systems the development of cultural adaptations is a step backward, leading
to unavoidable pitfalls in spite of the fact that cultural diversity is imposing new attitudes and demands on psychiatrists.
Cultural adaptations challenge the principles of the universality of science and of ethics. ICD-10 and DSM-IV rely on the
symptoms present to classify psychiatric diseases. This kind of classification has many advantages: it is a theoretical, close
to clinical reality, easy to grasp and less prone to untested hypotheses. But they have some drawbacks: they do not say
what diseases are, since the concept of symptom is not totally clear in psychiatry. The greatest disadvantage of this
approach is the dispersion of disorders that may be related or even unique. Furthermore, when too many symptoms are
present, this method requires a hierarchical structure (as in DSM-III) - unless one is willing to live with multiple diagnoses,
the so-called co-morbidities (as in DSM-IV). But at other times, too few symptoms are present, leading to atypical,
waste-basket and subsyndromal categories. Another problem is that symptoms may not be consistent across cultures,
leading to the need of cultural adaptations. In the case of diseases diagnosed according to symptomatic criteria, cultural
adaptations of internationally accepted classifications are often sought because symptoms are deemed to be inconsistent
across cultures. But at a closer look, very often the symptoms are not so different and it is only the cultural halo which
makes them attractive; even when they are particular to a given culture they can easily be interpreted (e.g., the penis
invagination of latah). Indeed, they represent a way of experiencing common feelings such as anxiety (e.g., the susto of
Latin America, which is a typical panic disorder) and depression. To put too much emphasis on local symptoms bears the
risk of yielding to social and cultural pressure.
Psychopathology 36(3), 114-119, 2003
Mental health, social functioning, and feelings of hatred and revenge of Kosovar Albanians
one year after the war in Kosovo
Barbara Lopes Cardozo, Centers for Disease Control and Prevention, National Center for Environmental Health,
International Emergency and Refugee Health Branch, Atlanta, Georgia;
Reinhard Kaiser, Centers for Disease Control and Prevention, National Center for Environmental Health, International
Emergency and Refugee Health Branch, Atlanta, Georgia
Carol A. Gotway, Centers for Disease Control and Prevention, National Center for Environmental Health, Division of
Environmental Hazards and Health Effects, Atlanta, Georgia
Ferid Agani, Department of Psychiatry, University of Pristina, Pristina, Kosovo
Abstract
A cross-sectional cluster sample survey was conducted in June 2000 in Kosovo to assess the prevalence of mental health
problems associated with traumatic experiences, feelings of hatred and revenge, and the level of social functioning among
Kosovar Albanians approximately 1 year after the end of the war. Findings of the second cross-sectional survey were
compared with those from our 1999 mental health survey in Kosovo. Included in the survey were 1399 Kosovar Albanians
aged 15 years or older living in 593 randomly selected households across Kosovo. Twenty-five percent of respondents
reported PTSD symptoms, compared with 17.1% in 1999. The MOS-20 social functioning score improved to 69.8 from 29.5
in 1999. In the 2000 survey 54% of men felt hatred toward the Serbs, compared with 88.7% in 1999.
Keywords
mental health, Kosovo, PTSD, hatred, social functioning
Journal of Traumatic Stress, 16(4): 351-360, 2003
Treating depression in predominantly low-income young minority women : a randomized
controlled trial
Jeanne Miranda, PhD; Joyce Y. Chung, MD; Bonnie L. Green, PhD; Janice Krupnick, PhD; Juned Siddique, MS; Dennis A.
Revicki, PhD; Tom Belin, PhD
Context Impoverished minority women experience a higher burden from depression than do white women because they
are less likely to receive appropriate care. Little is known about the effectiveness of guideline-based care for depression
with impoverished minority women, most of whom do not seek care.
Objective To determine the impact of an intervention to deliver guideline-based care for depression compared with referral
to community care with low-income and minority women.
Design, Setting, and Participants A randomized controlled trial conducted in the Washington, DC, suburban area from
March 1997 through May 2002 of 267 women with current major depression, who attended county-run Women, Infants, and
Children food subsidy programs and Title X family planning clinics.
Outcomes Hamilton Depression Rating Scale measured monthly from baseline through 6 months; instrumental role
functioning (Social Adjustment Scale) and social functioning (Short Form 36-Item Health Survey) measured at baseline and
3 and 6 months.
Interventions Participants were randomly assigned to an antidepressant medication intervention (trial of paroxetine
switched to buproprion, if lack of response) (n = 88), a psychotherapy intervention (8 weeks of manual-guided cognitive
behavior therapy) (n = 90), or referral to community mental health services (n = 89).
Results Both the medication intervention (P<.001) and the psychotherapy intervention (P = .006) reduced depressive
symptoms more than the community referral did. The medication intervention also resulted in improved instrumental role (P
= .006) and social (P = .001) functioning. The psychotherapy intervention resulted in improved social functioning (P = .02).
Women randomly assigned to receive medications were twice as likely (odds ratio, 2.04; 95% confidence interval,
0.98-4.27; P = .057) to achieve a Hamilton Depression Rating Scale score of 7 or less by month 6 as were those referred to
community care.
Conclusions
Guideline-concordant care for major depression is effective for these ethnically diverse and impoverished patients. More
women engaged in a sufficient duration of treatment with medications compared with psychotherapy, and outcome gains
were more extensive and robust for medications.
Journal of the American Medical Association, 290(1), 57-65, 2003
Kalender
13. – 16. august 2003, Reykjavík
Promoting psychiatric care
Congress of the Nordic Psychiatric Associations
Key issues of the congress include:
1. Aetiology of schizophrenia and related disorders
2. Prodromal symptoms of schizophrenia
3. Genetics of psychiatric disorders
4. Neuropsychiatry-neuropsychology
5. Child and adolescent psychiatry
6. Mood disorders
7. Anxiety disorders
8. Personality disorders
9. Substance abuse
10. Alcoholism and common comorbid disorders
11. Suicides and deliberate self harm
12. Psychiatric disorders in the elderly
13. Eating disorders
14. Psychodynamic psychotherapy
15. Psychological treatments
16. Community psychiatry
17. Psychiatric hospital care
18. Mental health, work and disability
19. Service users and mental health promotion
20. Social inclusion and mental disorders
21. Forensic psychiatry and forensic psychology
22. History of Nordic psychiatry and future perspectives
læs mere på hjemmesiden : http://www.icemed.is/npc2003/
16. september 2003 , Stockholm
Etik, människosyn & människovärde : Bemötande & förhållningssätt
Transkulturellt Centrum
Med etiken som grund. Ett heldagsseminarium om tillämpning i den kliniska vårdsituationen i mötet med asylsökande och
flyktingar.
Pris : Landstingsanställda 750:- / övriga 950:- exkl moms
Kontakt : Ingrid Edéus tel 08-672 29 11, [email protected]
http://www.sll.se/transkulturelltcentrum
20. – 21. september 2003, Essen
Ethnicity & Mental Health in Europe
Satellite Conference (following the Annual Meeting of the DTGPP) Organized by the Section on
Transcultural Psychiatry of the German Association of Psychiatry & Psychotherapy (DGPPN),
Supported by the German Association of Psychiatry & Psychotherapy (DGPPN) and the World
Psychiatric Association (WPA)
The change in Europe towards multicultural societies has lead to a growing demand for an adaptation of health care
services to the necessities of migrants. Despite increased psychosocial stressors for this population, there is no evidence
of an increased rate of mental disorders, but there are several difficulties that arise in the care of persons suffering from
these disorders. These problems start with difficulties in the access to care for the migrant population, but also in
diagnosing and treating the disorders. The gap on cultural awareness can lead to misdiagnosis as other mental disorders
or as somatic disorders, mainly due to differences in syndromal presentation, delaying or impeding the necessary
treatment of these disorders.
Due to the demands that arise within the European unification process, it is necessary to bring together the different
experiences of ethnicity and mental health research from all European countries, in order to develop a network for future
research activities in the field. It will also be necessary to incorporate experiences of ethnicity and mental health research
from other continents.
Saturday, Sept. 20th, 2003
Opening Remarks, 10:30-10:45
Wielant Machleidt, Chairman,
Section of Transcultural Psychiatry, DGPPN
Juan Mezzich, President-Elect, WPA
Session 1, 10:45-12:15 Chair: Wielant Machleidt
(Germany)
Christian Haasen (Germany) Barriers in the access to mental health care
Joop de Jong (Netherlands) Special situation of refugees
Marianne Kastrup (Denmark) Special situation of migrant women
Session 2, 13:00-14:30 Chair: Joan Obiols
(Andorra)
Juan Mezzich (USA) Cultural considerations in diagnosing specific mental disorders
Wielant Machleidt (Germany) Psychosocial issues in the treatment of migrants
Oktay Yagdiran &Anja Baumann (Germany) Stigma and discrimination: possibilities of a specialized program
Session 3, 14:45-16:45 Chair: Miguel Casas
(Spain)
Luis Caballero (Spain) Addiction disorders among migrants
Thomas Stompe (Austria) Schizophrenia disorders among migrants
Sofie Baarnhielm (Sweden) Depression and somatization among migrants
Kathy Aitchison (United Kingdom) Ethnic factors in pharmacology and pharmacogenetics
Closing Session, 17:00-18:00
Panel Discussion with experts from several countries on interventions to improve mental health care for migrants in Europe
Sunday, Sept. 21st 2003
Closed expert discussions (limited participation, please contact Scientific Committee)
contact : Dr. Christian Haasen : [email protected]
23. september 2003 Stockholm
Self and Family in Flux
Transkulturellt Centrum
Immigration innebär utmaningar för familjer och individer. De flesta av de motsättningar som invandrarfamiljen utsätts för
kan vi avläsa i den svenska historien i vår moderniseringsprocess. Men det är också en nutida världsomspännande
företeelse. Det vi ser som ”invandrarfamiljens strategier och svårigheter” i Sverige idag är en liten rännil av detta historiska
och globala fenomen. Seminariet kommer att belysa förändringar av familjestruktur och könsroller i samband med
immigration. Exempel såväl på strategier som är funktionella som dysfunktionella kommer att ges. Seminariet handlar
också om problem som det kan leda till för familj och individ och vilka konsekvenser det får för möten i vården.
Plats Föreläsningssalen, S:t Görans psykiatriska klinik, 1 tr ned
08.30 Registrering, kaffe
09.00 Inledning, välkomsthälsning
09.15 Self and family in flux: Opportunities and risks engendered by change. Att möta familjer i förändring, immigration och
könsroller. (Föredraget kommer att hållas på engelska) Güler Okman Fisek, professor i psykologi, Istanbul
11.15 Fruktpaus
11.30 Förändrade maktrelationer i (iranska) familjer i Sverige intensifierar familjekonflikter. Mehrdad Darvishpour,
sociolog, Stockholms universitet
12.30 Lunch
14.00 Kulturinslag
14.15 Att arbeta med flickor som är utsatta för hedersrelaterat våld i familjen. Sevil Bremer, psykoterapeut, Rädda
Barnen
15.00 Paneldiskussion
16.00 Avslutning
Kostnad Landstingsanställda 750:-, övriga 950:Ansvariga Sofie Bäärnhielm tel 08-672 29 05, [email protected]
Bengt-Erik Ginsburg tel 08-672 29 07, [email protected]
Anmälan via post/fax eller e-post med uppgift om att anmälan avser ”Self and Family in Flux” samt namn på
deltagare/yrke/telefon & fax nr eller e-post adress samt faktureringsadress. Skriftlig och bindande anmälan skall vara
Transkulturellt centrum tillhanda senast 2003-08-25.
Deltagarantalet är begränsat.
Plats ges i turordning och bekräftas.
Transkulturellt Centrum
Besöksadress: Stadshagsgården, St Göransg 126, plan 13
St Görans Sjukhus, plan 13 112 81 STOCKHOLM
Fax 08-672 19 14
Tel 08-672 29 10 E-post:
mailto:[email protected]
http://www.sll.se/transkulturelltcentrum
26. – 27. september 2003, København
Scandinavian Conference on Transcultural Nursing
Dr. PhD Madeleine Leininger, founder of the American Transcultural Nursing Society is Keynote Speaker of the
Conference.
We are pleased to invite you to attend the first Scandinavian Conference on Transcultural Nursing.
This will focus on the issues of cultural diversity facing nurses and other health care professionals in the current global
health care climate. Working as a nurse provides many challenges stemming from ethnic and cultural diversity. Today
nurses do not have to travel far to encounter cultural differences, such as ethnic customs, traditions and taboos.
Transcultural nursing is of great relevance as nurses learn to function in a multicultural world.
The main source of problems in caring for patients from diverse cultural backgrounds is a lack of understanding and
tolerance, when often neither the nurse nor the patient understands the other’s perspective. Nurses and health care
providers need to learn to ask questions sensitively and to show respect for different cultural beliefs.
Nurses need to be culturally competent to provide appropriate medical care, respecting and understanding the cultural
values and ways of life of all patients. It means understanding culturally influenced behaviours, and being flexible in
adapting medical care to suit the patient while avoiding stereotyping and misapplication of scientific knowledge.
The perception of illness and disease and their causes varies from culture to culture. Individual cultural preferences
influence the way people seek health care and how they behave toward health care providers. The question of
communication is a complicated issue, covering everything from the need for interpreters, fine nuances of words in different
languages to the reluctance to talk about intimate problems. Western medicine does not have all the answers.
Respect for the beliefs of others, and the effects of those beliefs on their well-being, are critically important to competent
care. Many ethnic patients mistrust people in authority, having witnessed or themselves been victims of atrocities at the
hands of the authorities in their homeland. Many people are as wary of the caregivers themselves as they are of care.
This conference offers an opportunity to identify issues and suggest strategies and approaches to enhance the quality of
cultural health care for all peoples.
AFLYST
hjemmeside : http://www.congress-consult.com/TCN2003/
30. september 2003
Ayurvedisk medicin en introduktion
Dansk Etnomedicinsk selskab
Flere oplysninger ved at maile til : mailto:[email protected]
hjemmeside : http://www.etnomed.dk/
september – november 2003, København
Antropologisk metode
Dansk Etnomedicinsk Selskab
3 kursusaftner i København :
26. september: Antropologiens historie,
3. oktober: Fagets metode
14. november: Medicinsk Antropologi
Underviser: Antropolog Hanne Mogensen
Sted: Novartis, Lyngbyvej 172 2100 København Ø
Alle gange fra kl. 1400 - 1700.
Pris for hele kurset: Medlemmer af DEMS kr. 500,- ikke medlemmer kr. 800,-.
Tilmelding til sekretærer på tlf. 46 32 05 32 eller per
mail: [email protected]
hjemmeside : http://www.etnomed.dk/
2. – 5. oktober 2003, Montreal
The Society for the Study of Psychiatry and Culture : annual meeting
Hjemmeside : http://www.psychiatryandculture.org/
16. – 18. oktober 2003, Uppsala
Culture,Migration and Mental Health : 30 Years of Latin American Exile and Migration
Unit for Transcultural Psychiatry and Refugee Trauma at the University Hospital in Uppsala
Plenary speakers
Dr Inge Genefke
Professor Pedro Ruiz, Texas, USA : Impact of Migration/Acculturation on MentalHealth and Mental Illness : The Hispanic
Americans Example in the USA
Professor Renato Alarcon. Rochester
Professor Juan Mezzich,New York
Ass. professor Solvig Ekblad : The relationship between trauma, postmigrationstress and perceived mental health: voices
from refugees and staff in the introduction programme
and many others.
The Conference will have four sections
Integration of migrants and refugees in the society
Refugee Trauma (War trauma and Torture
Transcultural Psychiatry
30 years of Latin American Exileand Migration.
It is my sincere hope that, come October, We will be able to welcome you personally to our conference.
Manuel Fernandez
Director Unit for Transcultural Psychiatry and Refugee Trauma
University Hospital and Uppsala University
Uppsala Sweden
telephone: 46-18-6113754
Fax: 46-18-6113755
manuel.fernandez@uas
20. – 24 oktober 2003, Stockholm
En fördjupningskurs i transkulturell psykiatri
Transkulturellt Centrum
Kursen syftar till att ge en fördjupad kunskap om bedömning och behandling av psykisk ohälsa i en mångkulturell
befolkning. Aktuell kunskap, forskning och metodutveckling i transkulturell psykiatri kommer att förmedlas. Teori kommer
att förankras till kliniska erfarenheter. Delar av kursen sker på engelska.
Föreläsare
Laurence Kirmayer, McGill University, Montreal Canada; Valerie DeMarinis, Uppsala Universitet; Solvig Ekblad, KI; Sofie
Bäärnhielm, Victoria Corbo & Batja Håkansson, TC.
Föreläsningsteman
The Cultural Context of Clinical Assessment/Interkulturell kommunikation/Working with Cultural Brokers/Diagnostik, kultur,
DSM IV/Understanding Cultural Idioms of Distress/ Behandling/Vad behöver vårdpersonal för kompetens för att möta en
mångkulturell befolkning/Etnofarmakologi/Religion, kultur och hälsa - den existentiella utmaningen.
Begränsat plastantal 25, plats ges i turordning
Kontakt : Sofie Bäärnhielm tel 6722905 : [email protected]
Victoria Corbo tel 6722906, Batja Håkansson tel 6722908
se hele programmet her : http://www.sll.se/docs/w_tkc/utbildning/Kal_host_03.pdf
Marianne Østerskov, projektsygeplejerske på Videnscentret deltog i et tilsvarende kursus for et år siden. I er
velkomne til at kontakte Marianne Østerskov :
35 45 71 42
[email protected]
27. – 29. oktober 2003, Sydney
Innovation – creativity – harmony
Multicultural Mental Health Australia
Conference themes :
Innovation in service design, development & delivery
including cultural appropriateness, representation of diversity, cultural competence of providers, acknowledging diversity in
accreditation processes
Creative technical solutions in health information & service delivery
including telemedicine, Internet and web based initiatives, innovative communication models
Creating healthy public policy
including community participation and partnership, diversity in the policy development process, political agendas and
public policy, short term versus long term policy vision
Building capacity in communities & systems
including promoting advocacy and participation, building resilience, the role of public policy in healthy lifestyle, competency
skills, understanding and reflecting the communities we serve
Dealing with diversity in consumers & carer participation
including models to promote NESB participation
Spirituality, health & well-being
including cultural understanding of illness and health, beliefs and healing, traditional medicine, cultural practices in healing
Diversity & creativity in health & well-being
including arts based interventions (music, visual and performance art) across the spectrum, art and creativity in promoting
health and well-being
Health & well-being of refugees
including torture and trauma, physical health, socio-economic factors, settlement, coordination of service delivery, the role
of policy
Creativity & innovation in clinical practice
including cultural appropriate models, diagnostic tools, outcome measures, skills building and maintenance
Innovation in discovery, research & evaluation
including culturally inclusive evaluation and outcome measurement, culture and genetics, culture and pharmacology.
læs mere her :
http://www.tmhc.nsw.gov.au/diversity.htm
9. – 13. november 2003, Malta
For better mental health through deeper understanding and more adaptive dissemination
The Transcultural Psychiatry Section of the World Psychiatric Association, Caretranslate International
Network and University of Malta
Invite interested persons to participate in Psychiatric Care Across Cultures
Venue: Golden Tulip Vivaldi Hotel – St Julians, Malta.
9-10 November: CONFERENCE 1Conference 1 will be dedicated to two themes:
Theme 1A : Psychiatry across cultures
As is the custom, members of WP ATP Section will update participants about the progress of their work in cross-cultural
psychiatry. Non-members will join the members of the Transcultural Psychiatry Section in discussing papers about this
vigorously growing subject. One session will be dedicated to papers written by non-members.
One must keep in mind that this was the branch of psychiatry that attracted the largest number of participants in the XII
WORLD CONGRESS OF PSYCHIATRY IN YOKOHAMA, 2002. Here an opportunity is offered to reopen and extend this
lively debate, as a stepping stone to XII WORLD CONGRESS OF PSYCHIATRY, to be held in Cairo in 2005.
Theme 1B : Migration and acculturative stress
Migrants face challenges to their mental health throughout the various stages of their experience, from well before they
depart to long after they have arrived at their destination. Many issues call for discussion and dialogue: issues of
theoretical understanding, service adaptation and treatment response; personal, family and community issues of
acceptance and engagement in treatment and care; problems of adjustment to culture that are faced by of both sides. This
important international topic has been widely requested
.
11. –12. November: CONFERENCE 2: First Pan Mediterranean Conference on Psychiatry and Cultures, incorporating
‘Caretranslate’
Conference 2 will be dedicated to three themes:
Theme 2A : Mental health in the light of Islam and related cultures
This theme addresses the religious and other core components of culture that impinge on mental health and on illness and
its care within the vast parts of the world and among the scattered minorities that follow the call of Islam. It is hoped that
better mutual understanding will promote not only better mutual learning and cooperation, but also better self
understanding and more appropriate care within whichever culture and service system one operates.
Theme 2B : Adapting service to culture, capability and need
The dissemination of good policy, service design and practice calls for adaptations to the realities of the receiving country
or ethnic group. Papers are sought that communicate experiences and improve the collected know how of such adaptation
so as to make the service congruent with the culture, the resource and organisational capability, as well as the need, that
characterise the receiving context. (See ‘Note About Theme 2B’, below).
Theme 2C : Migration and acculturative stress (covered in both Conference 1 and Conference 2 – description
above)
13 November: To be mainly dedicated to cultural events. The morning may be used for further paper presentations if
required.
Further Notes
Notes about the Conference, Accommodation and Social Activities
Conference Organisers
Papers collected in the form of a CD-ROM and hard copies of the abstracts will be distributed to participants at the
conference, and covered by registration fees.
Note: A paper will not be published in the CD ROM or in the Abstracts unless at least one author registers for the
conference.
Please take note of the following important dates:
15 June 2003: Deadline for submission of abstracts (250-300 words).
1 August 2003: last date for hotel booking
31 August 2003: Deadline for papers, in ‘camera ready’ state to be submitted by e-mail (or fax, number +(356) 2134 4879,
where e-mail is unavailable). See note below re submission and format requirements.
Early submission of abstracts (250-300 words) is encouraged.
English will be the language of the proceedings of the conference.
A social program will be organised for participants and accompanying persons both during and outside conference hours.
The conference secretariat e-mail is [email protected]
hjemmeside : http://www.confluence.com.mt/
januar 2004
Tibetansk medicin – en introduktion
Dansk Etnomedicinsk Selskab
Flere oplysninger ved at maile til : mailto:[email protected]
hjemmeside : http://www.etnomed.dk/
22. maj – 5 juni 2004, Ladakh
Tibetansk medicin
Dansk Etnomedicinsk Selskab
Kurset retter sig mod alle tre søjler og har til sigte at udbygge praktiserende lægers viden om ikke naturvidenskabeligt
baserede helbredelsessystemer. Samtidig har der været et stort ønske om at arbejde med den antropologiske vinkel på
etniske grupper og deres selvforståelse, således at lægerne bliver bedre rustet til at arbejde med mennesker med en
anden etnisk baggrund end dansk.
Kurset foregår delvis i New Delhi og delvis i Ladakh. Når disse to steder er valgt skyldes det, at man her finder en levende
tradition for brug af ikke naturvidenskabeligt baserede helbredelsessystemer. Den tibetanske medicin, der med
pulsmålinger og brug af naturmedicin vinder større og større indpas både herhjemme og i Østen, er et levende eksempel
på hvordan vestlig medicin udfordres af traditionelle systemer. Samtidig er der en fantastisk orakeltradition, hvor veje til
helbredelse vises gennem trance og tungetalere. Få steder som i Ladakh lever buddhisme så godt og spiller så stor en rolle
i folks verdensopfattelse. Buddhisme eller religion indgår som en vigtig del af al handling.
Det spændende er, at der i Ladakh eksistere et jævnbyrdigt samspil mellem vestlig og traditionel medicin. Man vælger, så
at sige, sin helbreder ud fra sygdommes karakter. Om det skal være en vestligt uddannet læge, en tibetansk læge, en
amchi, en lokal uddannet traditionel læge, en lamo, som er et orakel, eller et besøg i klosteret for at gennemføre eller få
gennemført rituelle handlinger.
Vi vil i Ladakh benytte lejligheden til at søge ud i bjergene for at prøve højde på egen krop og samtidig komme helt tæt på
en række små landsbysamfund, der lever ganske isoleret. Her vil der blive rig lejlighed til at diskutere sygdom og
helbredelse.
Kursusafgift: ca. kr. 22.000,-
Flere oplysninger ved at maile til : mailto:[email protected]
hjemmeside : http://www.etnomed.dk/
29. september – 9. oktober 2004, Tyrkiet
Islam og lægekunst
Dansk Etnomedicinsk Selskab
Flere oplysninger ved at maile til : mailto:[email protected]
hjemmeside : http://www.etnomed.dk/