Psychiatry (Abingdon, England)最新文献

Cultures influence individual identities and cognitive schema that influence the way help is sought and how the inner world of the individual is explored. Help-seeking and sources for help are identified through cultural explanations and expectations. Traditional ego-based psychotherapy may not work with various ethnic and cultural groups. Here, we highlight some of the factors that clinicians must be aware of when providing therapies related to relationships.

Here, we provide an overview of the cultural aspects of epidemiological findings and provision of mental health care to people with intellectual disability (ID). The prevalence of intellectual disability may vary between cultural and ethnic groups, but this depends to a large extent on the definition and assessment methods used. Although human-rights-based policies have led to de-institutionalization and community care, stigmatization and discrimination of individuals with ID and health inequalities are common across cultures, which may be associated with the high rates of mental illness in this population. Negative attitudes of mental-health professionals towards those with ID or minority groups may lead to double discrimination and diagnostic overshadowing, and communication issues and complex caregiver networks further complicates the recognition and management of mental illness in individuals with ID. There are several ways in which clinicians could improve practice, including awareness of culturally associated explanatory models, providing person-centred care while also building a working relationship with caregivers, and addressing communication barriers, which may improve the care of individuals with ID and reduce discrimination and health inequalities in all cultural groups.

Cultural factors play an important role not only at a biological level: the pharmacodynamics and pharmacokinetics of drugs but non-biological factors also play a role. These factors include religious factors, taboos, diet, smoking and expectations from the medication. Some of these factors are described in this paper so that clinicians are aware of response to drugs.

All individuals have cultural identity, but this aspect may be more relevant in patients from black and ethnic minority backgrounds. In this paper, some of the key issues are highlighted and suggestions are made for assessment.

Culture plays an important role in precipitating, perpetuating and preventative factors in relation to any illness. Cultures also determine how individuals seek help and how resources are allocated. Clinicians must be aware of idioms that patients use and explanatory models used by them and their carers to describe their symptoms. Culture influences pathways that patients choose in looking for help. Culturally appropriate interventions are more likely to be accepted.

The common mental disorders, predominantly anxiety and depression, constitute a significant public health problem and are associated with significant morbidity. When detected, these disorders are managed almost exclusively in primary care. Research into common mental disorders and ethnicity to date raises important questions about the understanding, nature and course of common mental disorders, access to services, treatment received and the perceived value of consulting for emotional problems across cultural groups. It also emphasizes the complex interactions between ethnicity, socioeconomic status, social inclusion, age and sex. Ethnicity is thus one of several important explanatory variables. Much has been written about the development of culturally sensitive services and the development of core competencies for culturally aware psychiatrists. Such training is now a core requirement for mental health professionals working with culturally diverse patient groups. However, there is as yet limited evidence as to the impact of cultural competency training on service delivery. Further work is also needed to achieve services that are informed by users' views.

Pathways into psychiatric care are determined by a number of factors. These include cultural explanations of illness, systems of healthcare and resources available. Of these, explanatory models of illness are perhaps the most significant. Patients from ethnic minorities may also feel that they are prejudiced against. Clinicians, therefore, must be aware of potential obstacles into healthcare.

Military veterans present with complex difficulties which are challenging to work with therapeutically. They experience a range of co-morbidities, and social, health, and relationship difficulties. In addition they present with significant barriers to help-seeking and often find their own ways of coping. Alcohol and substance misuse-related problems are common and, combined with hyper-arousal, can lead to aggression and the potential for contact with the criminal system. This article attempts to outline the issues that military veterans commonly present with and describes a model of working with traumatized veterans. The model is a phase-oriented approach to trauma which views stabilization as an essential part of the treatment, moving on to processing the trauma and then reintegration from military to civilian life.

Our understanding of the neurobiology of post-traumatic stress disorder (PTSD) has improved significantly in recent years. Previous work on the development of fear and memory has underpinned subsequent research that has focused on PTSD. It is now well established that specific areas of the brain are key to the development and maintenance of PTSD. These include the amygdala, hippocampus and medial prefrontal cortex, a popular current hypothesis being that the former is overactive in PTSD due to failure of the other areas to regulate its activity sufficiently. In addition to specific areas of the brain, it is now known that hormones and neurotransmitters such as cortisol and noradrenaline appear to play major roles in PTSD. This article provides an overview of current knowledge in this area.