Culture-Specific Psychiatric Syndromes: A Review (part 2)

Kufungisisa (Thinking Too Much)
Also new to DSM-5 is kufungisisa, or “thinking too much,” a disorder of distress reported by the Shona people of Zimbabwe. The term represents both a cause of conditions akin to anxiety and depression (eg, “my heart is painful because I think too much”) as well as an idiom of psychosocial stressors, such as financial or marital problems. Symptoms can overlap with several DSM diagnoses, including anxiety, panic disorders, and depression. Ruminations and somatic symptoms may be addressed with cognitive-behavioral psychotherapeutic approaches; otherwise, standard treatments for anxiety or depression can be tried.[2]
Recent research of kufungisisa has been primarily centered around patients with HIV. It has been observed that patients living with HIV are at a high risk of developing depression. In Zimbabwe, the diagnosis of depression among adolescents with HIV was characterized as a manifestation of kufungisisa, which included stress, pain, a lack of hope, and suicidal thoughts.[5]

Piblokto/Pibloktoq
Piblokto, also known as “arctic hysteria,” describes a dissociative episode in which patients experience prolonged, extreme excitement sometimes followed by seizures and coma. This diagnosis is found in Arctic and Subarctic Inuit. A prodrome of irritability can occur, and during the episode, patients frequently exhibit dangerous, irrational behavior (eg, property destruction, stripping naked). It has been hypothesized by at least one researcher that the condition could result from vitamin A toxicity; organ meat from Arctic food sources, such as polar bears, seals, and walruses, contains extremely high levels of the vitamin.[1,6,7] Other potential causes of this syndrome include forms of malnutrition (eg, vitamin D or calcium deficiency) and the conditions associated with amok, including delirium and severe psychotic, mood, or personality disorders.

Clinical Lycanthropy
Lycanthropy is a rare condition in which sufferers experience the delusion of transforming into an animal. Affected people may also behave like the animal they believe they have turned into. “Lycanthropy” derives from the Greek myth in which King Lycaon is transformed into a wolf as punishment for serving human flesh to Zeus at dinner,[8] and perhaps the folk belief in werewolves has its origin in the condition. Wolf and dog transformations are most commonly described, but transformations into other animals, including birds and insects, have also been reported. In that sense, the syndrome may be shaped by personal, cultural, and regional influences. Effectively a specific form of a delusional misidentification syndrome, it is not surprising that lycanthropy typically occurs in the context of schizophrenia, psychotic mood disorders, or substance-induced psychoses.

Wendigo Psychosis
The term “wendigo psychosis” describes an insatiable craving for human flesh even when other food is available. It was first described in Algonquin Indians who felt that tribe members engaging in cannibalism then turned into, or were occupied by, a feared, flesh-eating creature or spirit called the wendigo. If attempts at a cure by traditional native healers or Western doctors failed and the person went on to threaten others or act violently, execution of the sufferer often followed. Although some have denied the validity of this disorder, there have been several credible eyewitness accounts by both aboriginal and nonaboriginal peoples. A psychotic origin of these behaviors cannot be excluded.[9]

Maladi Moun (Humanly Caused Illness)
Maladi moun (“humanly caused illness”), found in Haitian communities, is seen as an explanation for many medical and psychiatric symptoms. It is thought that illness is literally “sent” by others out of envy and hatred and can describe psychosis, depressive symptoms, and even academic or social problems. The condition often overlaps with delusional disorder and schizophrenia with paranoid features. In approaching this condition, it is important to differentiate extreme forms of rationalization mixed with magical beliefs, overvalued ideas, and explanations shared by a cultural subgroup from emerging or manifest psychotic symptoms. Potentially emerging psychosis may require close observation and treatment of frequently present comorbid conditions, including depression and substance use disorders, whereas manifest psychotic disorders probably require antipsychotic treatment [2].
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