Culture-Specific Psychiatric Syndromes: A Review (part 1)

MELAPUS.COM
Sep 4, 2018 · 3 min read

Part 1 of Medscape’s Rare and Unusual Psychiatric Conditions series looked at rare psychiatric syndromes that, although seldom encountered in practice, should be identifiable and treatable by clinicians. Similarly, Part 2 looks at syndromes that have been described or tend to manifest in certain cultures or regions of the world.

In the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV),[1] these conditions were termed “culture-bound syndromes”; the fifth edition of the DSM (DSM-5)[2] includes them under “Cultural Concepts of Distress.” This updated approach is intended to more accurately characterize cultural influences on the expression and experience of mental disorders that can manifest in anybody, increasing relevance to clinical practice. Some previously included conditions have been removed in the new manual, whereas others have been added or maintained as examples of culturally colored conditions. Although DSM-5 deemphasizes specific conditions in favor of a broader approach to cultural concepts, both those examples included and not included in the manual remain relevant to practice, given that they’re still reported in many cultures around the world.

Amok (‘Running Amok’)/Berserker

Loosely translated as “rampage” in Malay, amok is a dissociative condition characterized by an unpremeditated violent, disorderly, or homicidal rage directed against other objects or persons. This diagnosis is found in Southeast Asia and Scandinavia. The condition, which is often accompanied by amnesia and exhaustion, is typically incited by a perceived or actual insult and can occur as part of a brief psychotic episode or as an exacerbation of a chronic psychotic illness. A similar term, “berserker,” is used in Old Norse literature to describe a frenzied rage in Viking warriors.[1,3,4] Such conditions as intermittent explosive disorder; catatonic excitement; agitation and aggression under the influence of substances; and aggression associated with psychotic, mood, or personality disorders share features with amok.

All images from Thinkstock.

Khyâl Cap (Wind Attacks)

Found in Cambodians and Cambodian immigrants, and new to DSM-5, is khyâl cap, or “wind attacks” — characterized by dizziness, shortness of breath, palpitations, and other symptoms of anxiety and autonomic arousal. The episodes often meet the criteria for panic attacks and can be related to other anxiety or trauma-related disorders. The name comes from the theory that symptoms are due to a wind-like substance rising up in the body. Clinicians should rule out physical causes of anxiety symptoms and explore potential trauma etiology. Treatment approaches should focus on anxiety symptoms and, if present, trauma.[2]

Latah/Jumping Frenchmen of Maine

Latah describes an exaggerated startle response to frightening stimuli, diagnosed in Southeast Asia and Japan. Patients can experience a trance-like dissociation as well as echolalia and echopraxia. A similar condition, termed “jumping Frenchmen of Maine” syndrome, has been described in Franco-Canadian lumberjack communities.[1,4] This condition has features of dissociative or conversion disorders or catatonia, and it could also be a severe form of shock in response to a sudden or severe traumatic event.

Medscape

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