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108 Cards in this Set

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schizophreniform disorder. The disorder is most common in ? age group and is (more or less) common as schizophrenia.
A lifetime prevalence rate of ? percent and a 1-year prevalence rate of ? percent have been reported.
schizophreniform disorder. The disorder is most common in adolescents and young adults and is less than half as common as schizophrenia. A lifetime prevalence rate of 0.2 percent and a 1-year prevalence rate of 0.1 percent have been reported.
Several studies have shown that the relatives of patients with schizophreniform disorder are at high risk of having other psychiatric disorders

the distribution of the disorders (is similar to or differs) from the distribution seen in the relatives of patients with schizophrenia and bipolar disorders
DIFFERs

The relatives of patients with schizophreniform disorders are more likely to have MOOD disorders than are the relatives of patients with schizophrenia
relatives of patients with schizophreniform disorder are more likely to have a diagnosis of a ? disorder than are the relatives of patients with ? disorders.
relatives of patients with schizophreniform disorder are more likely to have a diagnosis of a psychotic mood disorder than are the relatives of patients with bipolar disorders.
several studies have shown that patients with schizophreniform disorder, as a group, have more ? symptoms (especially ?) and a (worse, =, better) outcome than patients with schizophrenia
several studies have shown that patients with schizophreniform disorder, as a group, have more affective symptoms (especially mania) and a better outcome than patients with schizophrenia
Brain imaging in Szphren?
A relative activation deficit in the inferior prefrontal region of the brain while the patient is performing a region-specific psychological task (the Wisconsin Card Sorting Test), as reported for patients with schizophrenia, has been reported in patients with schizophreniform disorder
he data can be interpreted to indicate a physiological similarity between the psychosis of schizophrenia and the psychosis of schizophreniform disorder.
Ventricular enlargement in Szphreniform ... =, >, or < than Sz?
< than sz
(may have enlargement of ventricles but not as clear a pattern as Sz
Patients with (Sz or Szphren) who were born during the winter and spring months (a period of high risk for the birth of these patients) had hyporesponsive skin conductances, but this association was absent in patients with (Sz or Szphreni) disorder
Patients with schizophrenia who were born during the winter and spring months (a period of high risk for the birth of these patients) had hyporesponsive skin conductances, but this association was absent in patients with schizophreniform disorder
Szphren: onset?
rapid, no long prodromal phase
Szphreniform features that are uncommon in comparison to sz?
Neagtive sx (if they are, poor prognosis)
Most estimates of progression to schizophrenia range between?
60 and 80 percent
Which patients more likely to have quick response to antipsychotic rx? szphreni or sz?
In one study, about 75 percent of patients with schizophreniform disorder and only 20 percent of the patients with schizophrenia responded to antipsychotic medications within 8 days
Szaffective ds:
onset age?
onset speed?
premorbid fxn?
stressors?
sudden
often in teens
good premorbid fxn
stressors associated with onset
Sz affec family hx?
mood disorers
The lifetime prevalence of schizoaffective disorder is less than? percent, possibly in the range of ? percent
The lifetime prevalence of schizoaffective disorder is less than 1 percent, possibly in the range of 0.5 to 0.8 percent
The depressive type of schizoaffective disorder may be (less or more) common in older persons than in younger persons,

bipolar type may be (less or more) common in young adults than in older adults
MORE
Sz affective gender bias?
> in women (who also have later onset)
Men with schizoaffective disorder are likely to exhibit ?
antisocial behaviour
and flat or inappropriate affect
As a group, patients with schizoaffective disorder have a (better or worse) prognosis than patients with schizophrenia

and a (better or worse) prognosis than patients with mood disorders.

Also, as a group, patients with schizoaffective disorder tend to have a (deteriorating or non deterioting) course and respond (worse, better) to lithium than do patients with schizophrenia.
As a group, patients with schizoaffective disorder have a better prognosis than patients with schizophrenia and a worse prognosis than patients with mood disorders. Also, as a group, patients with schizoaffective disorder tend to have a nondeteriorating course and respond better to lithium than do patients with schizophrenia.
Patients had
one full manic episode lasting 2 months
symptoms of schizophrenia for 10 years

Dx?
mood episode superimposed on schizophrenia
In practice, most clinicians look for the mood component to be? percent of the total illness in sz affective ds.
15 to 20
After 1 year, patients with schizoaffective disorder had different outcomes, depending on whether their predominant symptoms were affective (better or worse prognosis) or schizophrenic (better or worse prognosis)
After 1 year, patients with schizoaffective disorder had different outcomes, depending on whether their predominant symptoms were affective (better prognosis) or schizophrenic (worse prognosis)
One study that compared lithium with carbamazepine (Tegretol) found
schizoaffective disorder, depressive type findings?
bipolar type findings?
One study that compared lithium with carbamazepine (Tegretol) found that carbamazepine was superior for schizoaffective disorder, depressive type, but found no difference in the two agents for the bipolar type
The prevalence of delusional disorder in the United States is currently estimated to be ? percent
0.025 to 0.03
he annual incidence of delusional disorder is 1 to 3 new cases per persons.
100,000
The mean age of onset is about ? years, but the range for age of onset runs from ? years of age to the ?.
The mean age of onset is about 40 years, but the range for age of onset runs from 18 years of age to the 90s.
Delusional ds gender bias?
> in women slightly
Difference between gender and types of delusions?
Females: erotomania
Malese: paranoid delusions
DelD
Many patients are married and employed, but some association is seen with ? and ? socioeconomic status.
recent immigration

low
The most convincing data come from family studies that report an increased prevalence of delusional disorder and related personality traits () in the relatives of delusional disorder probands.
e.g., suspiciousness,
jealousy, and
secretiveness
DD family hx?
NO > sz, mood nor > DD
Is DD a changing or stable diagnosis usually?
Long-term follow-up of patients with delusional disorder indicates that the diagnosis of delusional disorder is relatively stable, with less than one fourth of the patients eventually being reclassified as having schizophrenia and less than 10 percent of patients eventually being reclassified as having a mood disorder.
The neurological conditions most commonly associated with delusions affect the
limbic system and the
basal ganglia.
Patients whose delusions are caused by neurological diseases and who show no intellectual impairment tend to have (simple or complex) delusions (like or unlike) to those in patients with delusional disorder.

Conversely, patients with neurological disorder with intellectual impairments often have (simple or complex) delusions (like or unlike) those in patients with delusional disorder
Patients whose delusions are caused by neurological diseases and who show no intellectual impairment tend to have complex delusions similar to those in patients with delusional disorder. Conversely, patients with neurological disorder with intellectual impairments often have simple delusions unlike those in patients with delusional disorder
Specific psycho-dynamic theories about the cause and the evolution of delusional symptoms involve suppositions regarding hypersensitive persons and specific ego defense mechanisms: (list 3)
reaction formation,
projection, and
denial
Freud's major contribution was to demonstrate the role of ? in the formation of delusional thought.
projection
Norman Cameron described seven situations that favor the development of delusional disorders
an increased expectation of receiving sadistic treatment,

situations that increase distrust and suspicion,
social isolation,

situations that increase envy and jealousy,

situations that lower self-esteem,

situations that cause persons to see their own defects in others,

and situations that increase the potential for rumination over probable meanings and motivations.
Elaboration of the delusion to include imagined persons and attribution of malevolent motivations to both real and imagined persons result in the organization of the ?—a perceived community of plotters.

This delusional entity hypothetically binds together projected fears and wishes to justify the patient's aggression and to provide a tangible target for the patient's hostilities.
pseudocommunity
List 4 risk factors associated with DD
Advanced age
Sensory impairment or isolation
Family history
Social isolation
Personality features (e.g., unusual interpersonal sensitivity)
Recent immigration
Patients with delusional disorder use primarily the defense mechanisms of
reaction formation, denial, and projection
DD

They use ? as a defense against aggression, dependence needs, and feelings of affection and transform the need for dependence into staunch independence
reaction formation
DD
Patients use to avoid awareness of painful reality.
denial
Consumed with anger and hostility and unable to face responsibility for the rage, they ? their resentment and anger onto others and use ? to protect themselves from recognizing unacceptable impulses in themselves.
projection
Most common delusions?
persecutory-type and jealousy-type delusions are probably the forms seen most frequently by psychiatrists
In contrast to persecutory delusions in ?, the clarity, logic, and systematic elaboration of the persecutory theme in delusional disorder leave a remarkable stamp on this condition.

How else contrast this with sz
Sz

The absence of other psychopathology, of deterioration in personality, or of deterioration in most areas of functioning also contrasts with the typical manifestations of schizophrenia.
The eponym ? syndrome has been used to describe morbid jealousy that can arise from multiple concerns
Othello
In , which has also been referred to as de Clérambault syndrome or psychose passionelle, the patient has the delusional conviction that another person, usually of higher status, is in love with him or her
erotomania
People with erotomania
usually more social or withdrawn
Such patients also tend to be solitary, withdrawn, dependent, and sexually inhibited as well as to have poor levels of social or occupational functioning.
Three main types of somatic delusions?
(1) delusions of infestation (including parasitosis);

(2) delusions of dysmorphophobia, such as of misshapenness, personal ugliness, or exaggerated size of body parts (this category seems closest to that of body dysmorphic disorder); and

(3) delusions of foul body odors or halitosis
How is olfactory delusion different
other name for it
age of onset
details
This third category, sometimes referred to as olfactory reference syndrome, appears somewhat different from the category of delusions of infestation in that patients with the former have an earlier age of onset (mean 25 years), male predominance, single status, and absence of past psychiatric treatment.
The delusion in Capgras syndrome is the belief
that a familiar person has been replaced by an impostor
What is Fregoli's phenomenon?
the delusion that persecutors or familiar persons can assume the guise of strangers
What is intermetamorphosis
familiar persons can change themselves into other persons at will
Patients with the syndrome complain of having lost not only possessions, status, and strength, but also their heart, blood, and intestines. The world beyond them is reduced to nothingness. This relatively rare syndrome is usually considered a precursor to a
schizophrenic or depressive episode

Cotard syndrome
nihilistic delusional disorder
The most common relationships in folie á deux are
sister-sister,
husband-wife, and
mother-child
GMC's most associated with DD?
Toxic-metabolic conditions and disorders affecting the limbic system and basal ganglia are most often associated with the emergence of delusional beliefs.
Complex delusions occur more frequently in patients with ? pathology
subcortical
In Huntington's disease and in individuals with idiopathic basal ganglia ?, for example, more than ? percent of patients demonstrated delusions at some point in their illness
50 %

calcifications
After right cerebral infarction, types of delusions that are more prevalent include
anosognosia and reduplicative paramnesia (i.e., individuals believing they are in different places at the same time)
Capgras syndrome has been observed in a number of medical disorders, including
CNS lesions,
vitamin B12 deficiency,
hepatic encephalopathy,
diabetes, and
hypothyroidism.
Focal syndromes have more often involved the ? rather than the ? hemisphere
Focal syndromes have more often involved the right rather than the left hemisphere
Delusions of infestation, lycanthropy (i.e., the false belief that the patient is an animal, often a wolf or “werewolf”), heutoscopy (i.e., the false belief that one has a double), and erotomania have been reported in small numbers of patients with
epilepsy, CNS lesions, or toxic-metabolic disorders.
DDX of DD
Delirium
Dementia
Alcohol-induced psychotic disorder
Amphetamine intox
Cannabis
L-dopa
Delusional disorder can be differentiated from somatoform disorders by
the degree to which the somatic belief is held by the patient. Patients with somatoform disorders allow for the possibility that their disorder does not exist, whereas patients with delusional disorder do not doubt its reality.
As mentioned, delusional disorder is considered a fairly stable diagnosis. About ? percent of patients have recovered at long-term follow-up, ? percent show decreased symptoms, and ? percent exhibit no change
As mentioned, delusional disorder is considered a fairly stable diagnosis. About 50 percent of patients have recovered at long-term follow-up, 20 percent show decreased symptoms, and 30 percent exhibit no change
Factors associated with good prognosis in DD
Fxn:
Gender:
Age of onset?
Speed of onset?
Duration?
Prescence or absence of precips?
Type of delusions?
The following factors correlate with a good prognosis: high levels of occupational, social, and functional adjustments; female sex; onset before age 30; sudden onset; short duration of illness; and the presence of precipitating factors. Although reliable data are limited, patients with persecutory, somatic, and erotic delusions are thought to have a better prognosis than patients with grandiose and jealous delusions.
Type of delusions with worse prognosis?
grandiose
jealous
Tx of folie a deux
treat and seperate
initial approach in psychotherapy with DD
Initially, a therapist should neither agree with nor challenge a patient's delusions
How might stimulate tx?
motivational approach
i.e., patient may be more interested in reducing anxiety, irritability
Possible approaches to consider in DD
align with distress created by DD but not Delusion
resist challenging delusion until strong rapport and see signs of delusion crumbling
Some investigators have indicated that ? may be particularly effective in delusional disorder, especially in patients with ? delusions.
Some investigators have indicated that pimozide may be particularly effective in delusional disorder, especially in patients with somatic delusions.
Brief Psychotic Ds
Age
gender bias
SES?
The exact incidence and prevalence of brief psychotic disorder is not known, but it is generally considered uncommon. The disorder occurs more often among younger patients (20s and 30s) than among older patients. Reliable data on sex and sociocultural determinants are limited, although some findings suggest a higher incidence in women and persons in developing countries. Such epidemiological patterns are sharply distinct from those of schizophrenia. Some clinicians indicate that the disorder may be seen most frequently in patients from low socioeconomic classes and in those who have experienced disasters or major cultural changes (e.g., immigrants). The age of onset in industrialized settings may be higher than in developing countries. Persons who have gone through major psychosocial stressors may be at greater risk for subsequent brief psychotic disorder.
Brief Psychotic Ds subtypes?
The DSM-IV-TR describes three subtypes: (1) the presence of stressors, (2) the absence of stressors, and (3) a postpartum onset, each of which is discussed below.
Some clinicians have observed that ??? may be more common at the onset of brief psychotic disorder than at the onset of eventually chronic psychotic disorders
labile mood, confusion, and impaired attention
Good prognostic factors for Brief Psychotic Ds

Which one may be surprising
Good premorbid adjustment
Few premorbid schizoid traits
Severe precipitating stressor
Sudden onset of symptoms
Affective symptoms
Confusion and perplexity during psychosis
Little affective blunting
Short duration of symptoms
Absence of schizophrenic relatives


Confusion and perplexity (although makes sense)
The characteristic symptom of psychosis is a visual hallucination of all or part of the person's own body.
autoscopic
The cause of the autoscopic phenomenon is unknown. A biological hypothesis is that

Psychological theories
abnormal, episodic activity in areas of the temporoparietal lobes is involved with the sense of self, perhaps combined with abnormal activity in parts of the visual cortex

associated the syndrome with personalities characterized by imagination, visual sensitivity, and, possibly, narcissistic personality disorder traits
Psychoactive substances are common causes of psychotic syndromes. The most commonly involved substances are
alcohol, indole hallucinogens, such as lysergic acid diethylamide (LSD), amphetamine, cocaine, mescaline, PCP, and ketamine
Tactile hallucinations (e.g., a sensation of bugs crawling on the skin) are characteristic of use
cocaine
Auditory hallucinations are usually associated with substance abuse
psychoactive
Olfactory hallucinations can result from
temporal lobe epilepsy
amok A dissociative episode characterized by a period of brooding followed by an outburst of violent, aggressive, or homicidal behavior directed at persons and objects. The episode tends to be precipitated by a perceived slight or insult and seems to be prevalent only among men.

The original reports that used this term were from Malaysia
Amok
An idiom of distress principally reported among Latinos from the Caribbean, but recognized among many Latin American and Latin Mediterranean groups. Commonly reported symptoms include uncontrollable shouting, attacks of crying, trembling, heat in the chest rising into the head, and verbal or physical aggression. Dissociative experiences, seizurelike or fainting episodes, and suicidal gestures are prominent in some attacks but absent in others. A general feature is a sense of being out of control
Ataque de nervios
The underlying cause is thought to be strongly experienced anger or rage. Anger is viewed among many Latino groups as a particularly powerful emotion that can have direct effects on the body and exacerbate existing symptoms. The major effect of anger is to disturb core body balances (which are understood as a balance between hot and cold valences in the body and between the material and spiritual aspects of the body). Symptoms can include acute nervous tension, headache, trembling, screaming, stomach disturbances, and, in more severe cases, loss of consciousness. Chronic fatigue may result from an acute episode.
bilis and colera
A syndrome observed in West Africa and Haiti. refers to a sudden outburst of agitated and aggressive behavior, marked confusion, and psychomotor excitement. It may sometimes be accompanied by visual and auditory hallucinations or paranoid ideation. The episodes may resemble an episode of brief psychotic disorder.
amok A dissociative episode characterized by a period of brooding followed by an outburst of violent, aggressive, or homicidal behavior directed at persons and objects. The episode tends to be precipitated by a perceived slight or insult and seems to be prevalent only among men. The episode is often accompanied by persecutory idea; automatism, amnesia, exhaustion, and a return to premorbid state following the episode. Some instances of amok may occur during a brief psychotic episode or constitute the onset or an exacerbation of a chronic psychotic process. The original reports that used this term were from Malaysia. A similar behavior pattern is found in Laos, Philippines, Polynesia (cafard or cathard), Papua New Guinea, and Puerto Rico (mal de pelea), and among the Navajo (iich'aa).
ataque de nervios An idiom of distress principally reported among Latinos from the Caribbean, but recognized among many Latin American and Latin Mediterranean groups. Commonly reported symptoms include uncontrollable shouting, attacks of crying, trembling, heat in the chest rising into the head, and verbal or physical aggression. Dissociative experiences, seizurelike or fainting episodes, and suicidal gestures are prominent in some attacks but absent in others. A general feature of an ataque de nervios is a sense of being out of control. Ataques de nervios frequently occur as a direct result of a stressful event relating to the family (e.g., death of a close relative, separation or divorce from a spouse, conflicts with a spouse or children, or witnessing an accident involving a family member). Persons may experience amnesia for what occurred during the ataque de nervios, but they otherwise return rapidly to their usual level of functioning. Although descriptions of some ataques de nervios most closely fit the DSM description of panic attacks, the association of most ataques with a precipitating event and the frequent absence of the hallmark symptoms of acute fear or apprehension distinguish them from panic disorder. Ataques span the range from normal expressions of distress not associated with a mental disorder to symptom presentations associated with anxiety, mood, dissociative, or somatoform disorders.
bilis and colera (also referred to as muina) The underlying cause is thought to be strongly experienced anger or rage. Anger is viewed among many Latino groups as a particularly powerful emotion that can have direct effects on the body and exacerbate existing symptoms. The major effect of anger is to disturb core body balances (which are understood as a balance between hot and cold valences in the body and between the material and spiritual aspects of the body). Symptoms can include acute nervous tension, headache, trembling, screaming, stomach disturbances, and, in more severe cases, loss of consciousness. Chronic fatigue may result from an acute episode.
bouffée délirante A syndrome observed in West Africa and Haiti. The French term refers to a sudden outburst of agitated and aggressive behavior, marked confusion, and psychomotor excitement. It may sometimes be accompanied by visual and auditory hallucinations or paranoid ideation. The episodes may resemble an episode of brief psychotic disorder.
brain fag A term initially used in West Africa to refer to a condition experienced by high school or university students in response to the challenges of schooling. Symptoms include difficulties in concentrating, remembering, and thinking. Students often state that their brains are “fatigued.” Additional somatic symptoms are usually centered around the head and neck and include pain, pressure or tightness, blurring of vision, heat, or burning. “Brain tiredness” or fatigue from “too much thinking” is an idiom of distress in many cultures, and resulting syndromes can resemble certain anxiety, depressive, and somatoform disorders.
dhat A folk diagnostic term used in India to refer to severe anxiety and hypochondriacal concerns associated with the discharge of semen, whitish discoloration of the urine, and feelings of weakness and exhaustion. Similar to jiryan (India), sukra prameha (Sri Lanka), and shen-k'uei (China).
falling-out or blackout Episodes that occur primarily in southern United States and Caribbean groups. They are characterized by a sudden collapse, which sometimes occurs without warming but is sometimes preceded by feelings of dizziness or “swimming” in the head. The person's eyes are usually open, but the person claims an inability to see. Those affected usually hear and understand what is occurring around them but feel powerless to move. This may correspond to a diagnosis of conversion disorder or a dissociative disorder.
ghost sickness A preoccupation with death and the deceased (sometimes associated with witchcraft), frequently observed among members of many American Indian tribes. Various symptoms can be attributed to ghost sickness, including bad dreams, weakness, feeling of danger, loss of appetite, fainting, dizziness, fear, anxiety, hallucinations, loss of consciousness, confusion, feelings of futility, and a sense of suffocation.
hwa-byung (also known as wool-hwa-byung) A Korean folk syndrome literally translated into English as “anger syndrome” and attributed to the suppression of anger. The symptoms include insomnia, fatigue, panic, fear of impending death, dysphoric affect, indigestion, anorexia, dyspnea, palpitations, generalized aches and pains, and a feeling of a mass in the epigastrium.
koro A term probably of Malaysian origin, that refers to an episode of sudden and intense anxiety that the penis (or, in women, the vulva and nipples) will recede into the body and possibly cause death. The syndrome is reported in South and East Asia, where it is known by a variety of local terms, such as shuk yang, shook yong, and suo yang (Chinese); jinjinia bemar (Assam); or rok-joo (Thailand). It is occasionally found in the West. Koro at times occurs in localized epidemic form in East Asian areas. The diagnosis is included in the second edition of Chinese Classification of Mental Disorders (CCMD-2).
latah Hypersensitivity to sudden fright, often with echopraxia, echolalia, command obedience, and dissociative or trancelike behavior. The term latah is of Malaysian or Indonesian origin, but the syndrome has been found in many parts of the world. Other terms for the condition are amurakh, irkunil, ikota, olan, myriachit, and menkeiti (Siberian groups); bah tschi, bah-tsi, baah-ji (Thailand); imu (Ainu, Sakhalin, Japan); and mali-mali and silok (Philippines). In Malaysia it is more frequent in middle-aged women.
locura A term used by Latinos in the United States and Latin America to refer to a severe form of chronic psychosis. The condition is attributed to an inherited vulnerability, to the effect of multiple life difficulties, or to a combination of both factors. Symptoms exhibited by persons with locura include incoherence, agitation, auditory and visual hallucinations, inability to follow rules of social interaction, unpredictability, and possibly violence.
mal de ojo A concept widely found in Mediterranean cultures and elsewhere in the world. Mal de ojo is a Spanish phrase translated into English as “evil eye.” Children are especially at risk. Symptoms include fitful sleep, crying without apparent cause, diarrhea, vomiting and fever in a child or infant. Sometimes adults (especially women) have the condition.
nervios A common idiom of distress among Latinos in the United States and Latin America. A number of other ethnic groups have related, though often somewhat distinctive, ideas of nerves (such as nerva among Greeks in North America). Nervios refers both to a general state of vulnerability to stressful life experiences and to a syndrome brought on by difficult life circumstances. The term nervios includes a wide range of symptoms of emotional distress, somatic disturbance, and inability to function. Common symptoms include headaches and brain aches, irritability, stomach disturbances, sleep difficulties, nervousness, easy tearfulness, inability to concentrate, trembling, tingling sensations, and mareos (dizziness with occasional vertigolike exacerbations). Nervios tends to be an ongoing problem, although variable in the degree of disability that is manifest. Nervios is a very broad syndrome that spans the range from patients free of a mental disorder to presentations resembling adjustment, anxiety, depressive, dissociative, somatoform, or psychotic disorders. Differential diagnosis depends on the constellation of symptoms experienced, the kinds of social events that are associated with the onset and progress of nervios, and the level of disability experienced.
piblokto An abrupt dissociative episode accompanied by extreme excitement of up to 30 minutes' duration and frequently followed by convulsive seizures and coma lasting up to 12 hours. It is observed primarily in Arctic and subarctic Eskimo communities, although regional variations in name exist. The person may be withdrawn or mildly irritable for a period of hours or days before the attack and typically reports complete amnesia for the attack. During the attack persons may tear off their clothing, break furniture, shout obscenities, eat feces, flee from protective shelters, or perform other irrational or dangerous acts.
qi-gong psychotic reactions Acute, time-limited episodes characterized by dissociative, paranoid, or other psychotic or nonpsychotic symptoms that may occur after participation in the Chinese folk health-enhancing practice of qi-gong (exercise of vital energy). Especially vulnerable are persons who become overly involved in the practice. This diagnosis is included in CCMD-2.
rootwork A set of cultural interpretations that ascribe illness to hexing, witchcraft, sorcery, or evil influence of another person. Symptoms may include generalized anxiety and gastrointestinal complaints (e.g., nausea, vomiting, diarrhea), weakness, dizziness, the fear of being poisoned, and sometimes fear of being killed (voodoo death). Roots, spells, or hexes can be put or placed on other person, causing a variety of emotional and psychological problems. The hexed person may even fear death until the root has been taken off (eliminated), usually through the work of a root doctor (a healer in this tradition), who can also be called on to bewitched an enemy. Rootwork is found in the southern United States among both African-American and European-American populations and in Caribbean societies. It is also known as mal puesto or brujeria in Latino societies.
sangue dormido (“sleeping blood”) A syndrome found among Portuguese Cape Verde Islanders (and immigrants from there to the United States). It includes pain, numbness, tremor, paralysis, convulsions, stroke, blindness, heart attack, infection, and miscarriages.
Shenjing shuariuo (“neurasthenia”) In China a condition characterized by physical and mental fatigue, dizziness, headaches, other pains, concentration difficulties, sleep disturbance, and memory loss. Other symptoms include gastrointestinal problems, sexual dysfunction, irritability, excitability, and various signs suggesting disturbance of the autonomic nervous system. In many cases the symptoms would meet the criteria for a DSM mood or anxiety disorder. The diagnosis is included in CCMD-2.
shen-k'uei (Taiwan); shenkui (China) A Chinese folk label describing marked anxiety or panic symptoms with accompanying somatic complaints for which no physical cause can be demonstrated. Symptoms include dizziness, backache, fatigability, general weakness, insomnia, frequent dreams, and complaints of sexual dysfunction, such as premature ejaculation and impotence. Symptoms are attributed to excessive semen loss from frequent intercourse, masturbation, nocturnal emission, or passing of white turbid urine believed to contain semen. Excessive semen loss is feared because of the belief that it represents the loss of one's vital essence and can therefore be life threatening.
shin-byung A Korean folk label for a syndrome in which initial phases are characterized by anxiety and somatic complaints (general weakness, dizziness, fear, anorexia, insomnia, gastrointestinal problems), with subsequent dissociation and possession by ancestral spirits.
spell A trance state in which persons “communicate” with deceased relatives or spirits. At times the state is associated with brief periods of personality change. The culture-specific syndrome is seen among African-Americans and European-Americans from the southern United States. Spells are not considered to be medical events in the folk tradition but may be misconstrued as psychotic episodes in clinical settings.
susto (frigh or “soul loss”) A folk illness prevalent among some Latinos in the United States and among people in Mexico, Central America, and South America. Susto is also referred to as espanto, pasmo, tripa ida, perdida del alma, or chibih. Susto is an illness attributed to a frightening event that causes the soul to leave the body and results in unhappiness and sickness. Persons with susto also experience significant strains in key social roles. Symptoms may appear any time from days to years after the fright is experienced. It is believed that in extreme cases, susto may result in death. Typical symptoms include appetite disturbances, inadequate or excessive sleep, troubled sleep or dreams, feelings of sadness, lack of motivation to do anything, and feelings of low self-worth or dirtiness. Somatic symptoms accompanying susto include muscle aches and pains, headache, stomachache, and diarrhea. Ritual healings are focused on calling the soul back to the body and cleansing the person to restore bodily and spiritual balance. Different experience of susto may be related to major depressive disorder, posttraumatic stress disorders, and somatoform disorders. Similar etiological beliefs and symptom configurations are found in many parts of the world.
taijin kyofu sho A culturally distinctive phobia in Japan, in some ways resembling social phobia in DSM. The syndrome refers to an intense fear that one's body, its parts or its functions, displease, embarrass, or are offensive to other people in appearance, odor, facial expressions, or movements. The syndrome is included in the official Japanese diagnostic system for mental disorders.
zar A general term applied in Ethiopia, Somalia, Egypt, Sudan, Iran, and other North African and Middle Eastern societies to the experience of spirits possessing a person. Persons possessed by a spirit may experience dissociative episodes that may include shouting, laughing, hitting the head against a wall, singing, or weeping. They may show apathy and withdrawal, refusing to eat or carry out daily tasks or may develop a long-term relationship with the possessing spirit. Such behavior is not considered pathological locally.
A term initially used in West Africa to refer to a condition experienced by high school or university students in response to the challenges of schooling.
“too much thinking
brain fag
refer to severe anxiety and hypochondriacal concerns associated with the discharge of semen, whitish discoloration of the urine, and feelings of weakness and exhaustion.
dhat
They are characterized by a sudden collapse, which sometimes occurs without warming but is sometimes preceded by feelings of dizziness or “swimming” in the head. The person's eyes are usually open, but the person claims an inability to see. Those affected usually hear and understand what is occurring around them but feel powerless to move. This may correspond to a diagnosis of conversion disorder or a dissociative disorder
falling out or
black out
amok A dissociative episode characterized by a period of brooding followed by an outburst of violent, aggressive, or homicidal behavior directed at persons and objects. The episode tends to be precipitated by a perceived slight or insult and seems to be prevalent only among men. The episode is often accompanied by persecutory idea; automatism, amnesia, exhaustion, and a return to premorbid state following the episode. Some instances of amok may occur during a brief psychotic episode or constitute the onset or an exacerbation of a chronic psychotic process. The original reports that used this term were from Malaysia. A similar behavior pattern is found in Laos, Philippines, Polynesia (cafard or cathard), Papua New Guinea, and Puerto Rico (mal de pelea), and among the Navajo (iich'aa).
ataque de nervios An idiom of distress principally reported among Latinos from the Caribbean, but recognized among many Latin American and Latin Mediterranean groups. Commonly reported symptoms include uncontrollable shouting, attacks of crying, trembling, heat in the chest rising into the head, and verbal or physical aggression. Dissociative experiences, seizurelike or fainting episodes, and suicidal gestures are prominent in some attacks but absent in others. A general feature of an ataque de nervios is a sense of being out of control. Ataques de nervios frequently occur as a direct result of a stressful event relating to the family (e.g., death of a close relative, separation or divorce from a spouse, conflicts with a spouse or children, or witnessing an accident involving a family member). Persons may experience amnesia for what occurred during the ataque de nervios, but they otherwise return rapidly to their usual level of functioning. Although descriptions of some ataques de nervios most closely fit the DSM description of panic attacks, the association of most ataques with a precipitating event and the frequent absence of the hallmark symptoms of acute fear or apprehension distinguish them from panic disorder. Ataques span the range from normal expressions of distress not associated with a mental disorder to symptom presentations associated with anxiety, mood, dissociative, or somatoform disorders.
bilis and colera (also referred to as muina) The underlying cause is thought to be strongly experienced anger or rage. Anger is viewed among many Latino groups as a particularly powerful emotion that can have direct effects on the body and exacerbate existing symptoms. The major effect of anger is to disturb core body balances (which are understood as a balance between hot and cold valences in the body and between the material and spiritual aspects of the body). Symptoms can include acute nervous tension, headache, trembling, screaming, stomach disturbances, and, in more severe cases, loss of consciousness. Chronic fatigue may result from an acute episode.
bouffée délirante A syndrome observed in West Africa and Haiti. The French term refers to a sudden outburst of agitated and aggressive behavior, marked confusion, and psychomotor excitement. It may sometimes be accompanied by visual and auditory hallucinations or paranoid ideation. The episodes may resemble an episode of brief psychotic disorder.
brain fag A term initially used in West Africa to refer to a condition experienced by high school or university students in response to the challenges of schooling. Symptoms include difficulties in concentrating, remembering, and thinking. Students often state that their brains are “fatigued.” Additional somatic symptoms are usually centered around the head and neck and include pain, pressure or tightness, blurring of vision, heat, or burning. “Brain tiredness” or fatigue from “too much thinking” is an idiom of distress in many cultures, and resulting syndromes can resemble certain anxiety, depressive, and somatoform disorders.
dhat A folk diagnostic term used in India to refer to severe anxiety and hypochondriacal concerns associated with the discharge of semen, whitish discoloration of the urine, and feelings of weakness and exhaustion. Similar to jiryan (India), sukra prameha (Sri Lanka), and shen-k'uei (China).
falling-out or blackout Episodes that occur primarily in southern United States and Caribbean groups. They are characterized by a sudden collapse, which sometimes occurs without warming but is sometimes preceded by feelings of dizziness or “swimming” in the head. The person's eyes are usually open, but the person claims an inability to see. Those affected usually hear and understand what is occurring around them but feel powerless to move. This may correspond to a diagnosis of conversion disorder or a dissociative disorder.
ghost sickness A preoccupation with death and the deceased (sometimes associated with witchcraft), frequently observed among members of many American Indian tribes. Various symptoms can be attributed to ghost sickness, including bad dreams, weakness, feeling of danger, loss of appetite, fainting, dizziness, fear, anxiety, hallucinations, loss of consciousness, confusion, feelings of futility, and a sense of suffocation.
hwa-byung (also known as wool-hwa-byung) A Korean folk syndrome literally translated into English as “anger syndrome” and attributed to the suppression of anger. The symptoms include insomnia, fatigue, panic, fear of impending death, dysphoric affect, indigestion, anorexia, dyspnea, palpitations, generalized aches and pains, and a feeling of a mass in the epigastrium.
koro A term probably of Malaysian origin, that refers to an episode of sudden and intense anxiety that the penis (or, in women, the vulva and nipples) will recede into the body and possibly cause death. The syndrome is reported in South and East Asia, where it is known by a variety of local terms, such as shuk yang, shook yong, and suo yang (Chinese); jinjinia bemar (Assam); or rok-joo (Thailand). It is occasionally found in the West. Koro at times occurs in localized epidemic form in East Asian areas. The diagnosis is included in the second edition of Chinese Classification of Mental Disorders (CCMD-2).
latah Hypersensitivity to sudden fright, often with echopraxia, echolalia, command obedience, and dissociative or trancelike behavior. The term latah is of Malaysian or Indonesian origin, but the syndrome has been found in many parts of the world. Other terms for the condition are amurakh, irkunil, ikota, olan, myriachit, and menkeiti (Siberian groups); bah tschi, bah-tsi, baah-ji (Thailand); imu (Ainu, Sakhalin, Japan); and mali-mali and silok (Philippines). In Malaysia it is more frequent in middle-aged women.
locura A term used by Latinos in the United States and Latin America to refer to a severe form of chronic psychosis. The condition is attributed to an inherited vulnerability, to the effect of multiple life difficulties, or to a combination of both factors. Symptoms exhibited by persons with locura include incoherence, agitation, auditory and visual hallucinations, inability to follow rules of social interaction, unpredictability, and possibly violence.
mal de ojo A concept widely found in Mediterranean cultures and elsewhere in the world. Mal de ojo is a Spanish phrase translated into English as “evil eye.” Children are especially at risk. Symptoms include fitful sleep, crying without apparent cause, diarrhea, vomiting and fever in a child or infant. Sometimes adults (especially women) have the condition.
nervios A common idiom of distress among Latinos in the United States and Latin America. A number of other ethnic groups have related, though often somewhat distinctive, ideas of nerves (such as nerva among Greeks in North America). Nervios refers both to a general state of vulnerability to stressful life experiences and to a syndrome brought on by difficult life circumstances. The term nervios includes a wide range of symptoms of emotional distress, somatic disturbance, and inability to function. Common symptoms include headaches and brain aches, irritability, stomach disturbances, sleep difficulties, nervousness, easy tearfulness, inability to concentrate, trembling, tingling sensations, and mareos (dizziness with occasional vertigolike exacerbations). Nervios tends to be an ongoing problem, although variable in the degree of disability that is manifest. Nervios is a very broad syndrome that spans the range from patients free of a mental disorder to presentations resembling adjustment, anxiety, depressive, dissociative, somatoform, or psychotic disorders. Differential diagnosis depends on the constellation of symptoms experienced, the kinds of social events that are associated with the onset and progress of nervios, and the level of disability experienced.
piblokto An abrupt dissociative episode accompanied by extreme excitement of up to 30 minutes' duration and frequently followed by convulsive seizures and coma lasting up to 12 hours. It is observed primarily in Arctic and subarctic Eskimo communities, although regional variations in name exist. The person may be withdrawn or mildly irritable for a period of hours or days before the attack and typically reports complete amnesia for the attack. During the attack persons may tear off their clothing, break furniture, shout obscenities, eat feces, flee from protective shelters, or perform other irrational or dangerous acts.
qi-gong psychotic reactions Acute, time-limited episodes characterized by dissociative, paranoid, or other psychotic or nonpsychotic symptoms that may occur after participation in the Chinese folk health-enhancing practice of qi-gong (exercise of vital energy). Especially vulnerable are persons who become overly involved in the practice. This diagnosis is included in CCMD-2.
rootwork A set of cultural interpretations that ascribe illness to hexing, witchcraft, sorcery, or evil influence of another person. Symptoms may include generalized anxiety and gastrointestinal complaints (e.g., nausea, vomiting, diarrhea), weakness, dizziness, the fear of being poisoned, and sometimes fear of being killed (voodoo death). Roots, spells, or hexes can be put or placed on other person, causing a variety of emotional and psychological problems. The hexed person may even fear death until the root has been taken off (eliminated), usually through the work of a root doctor (a healer in this tradition), who can also be called on to bewitched an enemy. Rootwork is found in the southern United States among both African-American and European-American populations and in Caribbean societies. It is also known as mal puesto or brujeria in Latino societies.
sangue dormido (“sleeping blood”) A syndrome found among Portuguese Cape Verde Islanders (and immigrants from there to the United States). It includes pain, numbness, tremor, paralysis, convulsions, stroke, blindness, heart attack, infection, and miscarriages.
Shenjing shuariuo (“neurasthenia”) In China a condition characterized by physical and mental fatigue, dizziness, headaches, other pains, concentration difficulties, sleep disturbance, and memory loss. Other symptoms include gastrointestinal problems, sexual dysfunction, irritability, excitability, and various signs suggesting disturbance of the autonomic nervous system. In many cases the symptoms would meet the criteria for a DSM mood or anxiety disorder. The diagnosis is included in CCMD-2.
shen-k'uei (Taiwan); shenkui (China) A Chinese folk label describing marked anxiety or panic symptoms with accompanying somatic complaints for which no physical cause can be demonstrated. Symptoms include dizziness, backache, fatigability, general weakness, insomnia, frequent dreams, and complaints of sexual dysfunction, such as premature ejaculation and impotence. Symptoms are attributed to excessive semen loss from frequent intercourse, masturbation, nocturnal emission, or passing of white turbid urine believed to contain semen. Excessive semen loss is feared because of the belief that it represents the loss of one's vital essence and can therefore be life threatening.
shin-byung A Korean folk label for a syndrome in which initial phases are characterized by anxiety and somatic complaints (general weakness, dizziness, fear, anorexia, insomnia, gastrointestinal problems), with subsequent dissociation and possession by ancestral spirits.
spell A trance state in which persons “communicate” with deceased relatives or spirits. At times the state is associated with brief periods of personality change. The culture-specific syndrome is seen among African-Americans and European-Americans from the southern United States. Spells are not considered to be medical events in the folk tradition but may be misconstrued as psychotic episodes in clinical settings.
susto (frigh or “soul loss”) A folk illness prevalent among some Latinos in the United States and among people in Mexico, Central America, and South America. Susto is also referred to as espanto, pasmo, tripa ida, perdida del alma, or chibih. Susto is an illness attributed to a frightening event that causes the soul to leave the body and results in unhappiness and sickness. Persons with susto also experience significant strains in key social roles. Symptoms may appear any time from days to years after the fright is experienced. It is believed that in extreme cases, susto may result in death. Typical symptoms include appetite disturbances, inadequate or excessive sleep, troubled sleep or dreams, feelings of sadness, lack of motivation to do anything, and feelings of low self-worth or dirtiness. Somatic symptoms accompanying susto include muscle aches and pains, headache, stomachache, and diarrhea. Ritual healings are focused on calling the soul back to the body and cleansing the person to restore bodily and spiritual balance. Different experience of susto may be related to major depressive disorder, posttraumatic stress disorders, and somatoform disorders. Similar etiological beliefs and symptom configurations are found in many parts of the world.
taijin kyofu sho A culturally distinctive phobia in Japan, in some ways resembling social phobia in DSM. The syndrome refers to an intense fear that one's body, its parts or its functions, displease, embarrass, or are offensive to other people in appearance, odor, facial expressions, or movements. The syndrome is included in the official Japanese diagnostic system for mental disorders.
zar A general term applied in Ethiopia, Somalia, Egypt, Sudan, Iran, and other North African and Middle Eastern societies to the experience of spirits possessing a person. Persons possessed by a spirit may experience dissociative episodes that may include shouting, laughing, hitting the head against a wall, singing, or weeping. They may show apathy and withdrawal, refusing to eat or carry out daily tasks or may develop a long-term relationship with the possessing spirit. Such behavior is not considered pathological locally.
ghost sickness
A Korean folk syndrome literally translated into English as “anger syndrome” and attributed to the suppression of anger.

The symptoms include insomnia, fatigue, panic, fear of impending death, dysphoric affect, indigestion, anorexia, dyspnea, palpitations, generalized aches and pains, and a feeling of a mass in the epigastrium.
hwa-byung
A term probably of Malaysian origin, that refers to an episode of sudden and intense anxiety that the penis (or, in women, the vulva and nipples) will recede into the body and possibly cause death
koro
Hypersensitivity to sudden fright, often with echopraxia, echolalia, command obedience, and dissociative or trancelike behavior. The term latah is of Malaysian or Indonesian origin, but the syndrome has been found in many parts of the world.
latah
A term used by Latinos in the United States and Latin America to refer to a severe form of chronic psychosis. The condition is attributed to an inherited vulnerability, to the effect of multiple life difficulties, or to a combination of both factors
locura
concept widely found in Mediterranean cultures and elsewhere in the world.
evil eye
mal de ojo
A common idiom of distress among Latinos in the United States and Latin America. A number of other ethnic groups have related, though often somewhat distinctive, ideas of nerves (such as nerva among Greeks in North America). ? refers both to a general state of vulnerability to stressful life experiences and to a syndrome brought on by difficult life circumstances. The term ? includes a wide range of symptoms of emotional distress, somatic disturbance, and inability to function. Common symptoms include headaches and brain aches, irritability, stomach disturbances, sleep difficulties, nervousness, easy tearfulness, inability to concentrate, trembling, tingling sensations, and mareos (dizziness with occasional vertigolike exacerbations). ? tends to be an ongoing problem, although variable in the degree of disability that is manifest. ? is a very broad syndrome that spans the range from patients free of a mental disorder to presentations resembling adjustment, anxiety, depressive, dissociative, somatoform, or psychotic disorders. Differential diagnosis depends on the constellation of symptoms experienced, the kinds of social events that are associated with the onset and progress of nervios, and the level of disability experienced.
Nervios
An abrupt dissociative episode accompanied by extreme excitement of up to 30 minutes' duration and frequently followed by convulsive seizures and coma lasting up to 12 hours. It is observed primarily in Arctic and subarctic Eskimo communities, although regional variations in name exist. The person may be withdrawn or mildly irritable for a period of hours or days before the attack and typically reports complete amnesia for the attack. During the attack persons may tear off their clothing, break furniture, shout obscenities, eat feces, flee from protective shelters, or perform other irrational or dangerous acts.
piblokto
Acute, time-limited episodes characterized by dissociative, paranoid, or other psychotic or nonpsychotic symptoms that may occur after participation in the Chinese folk health-enhancing practice of qi-gong (exercise of vital energy). Especially vulnerable are persons who become overly involved in the practice. This diagnosis is included in CCMD-2.
qi-gong psychotic reactions
A set of cultural interpretations that ascribe illness to hexing, witchcraft, sorcery, or evil influence of another person. Symptoms may include generalized anxiety and gastrointestinal complaints (e.g., nausea, vomiting, diarrhea), weakness, dizziness, the fear of being poisoned, and sometimes fear of being killed (voodoo death).
rootwork
amok A dissociative episode characterized by a period of brooding followed by an outburst of violent, aggressive, or homicidal behavior directed at persons and objects. The episode tends to be precipitated by a perceived slight or insult and seems to be prevalent only among men. The episode is often accompanied by persecutory idea; automatism, amnesia, exhaustion, and a return to premorbid state following the episode. Some instances of amok may occur during a brief psychotic episode or constitute the onset or an exacerbation of a chronic psychotic process. The original reports that used this term were from Malaysia. A similar behavior pattern is found in Laos, Philippines, Polynesia (cafard or cathard), Papua New Guinea, and Puerto Rico (mal de pelea), and among the Navajo (iich'aa).
ataque de nervios An idiom of distress principally reported among Latinos from the Caribbean, but recognized among many Latin American and Latin Mediterranean groups. Commonly reported symptoms include uncontrollable shouting, attacks of crying, trembling, heat in the chest rising into the head, and verbal or physical aggression. Dissociative experiences, seizurelike or fainting episodes, and suicidal gestures are prominent in some attacks but absent in others. A general feature of an ataque de nervios is a sense of being out of control. Ataques de nervios frequently occur as a direct result of a stressful event relating to the family (e.g., death of a close relative, separation or divorce from a spouse, conflicts with a spouse or children, or witnessing an accident involving a family member). Persons may experience amnesia for what occurred during the ataque de nervios, but they otherwise return rapidly to their usual level of functioning. Although descriptions of some ataques de nervios most closely fit the DSM description of panic attacks, the association of most ataques with a precipitating event and the frequent absence of the hallmark symptoms of acute fear or apprehension distinguish them from panic disorder. Ataques span the range from normal expressions of distress not associated with a mental disorder to symptom presentations associated with anxiety, mood, dissociative, or somatoform disorders.
bilis and colera (also referred to as muina) The underlying cause is thought to be strongly experienced anger or rage. Anger is viewed among many Latino groups as a particularly powerful emotion that can have direct effects on the body and exacerbate existing symptoms. The major effect of anger is to disturb core body balances (which are understood as a balance between hot and cold valences in the body and between the material and spiritual aspects of the body). Symptoms can include acute nervous tension, headache, trembling, screaming, stomach disturbances, and, in more severe cases, loss of consciousness. Chronic fatigue may result from an acute episode.
bouffée délirante A syndrome observed in West Africa and Haiti. The French term refers to a sudden outburst of agitated and aggressive behavior, marked confusion, and psychomotor excitement. It may sometimes be accompanied by visual and auditory hallucinations or paranoid ideation. The episodes may resemble an episode of brief psychotic disorder.
brain fag A term initially used in West Africa to refer to a condition experienced by high school or university students in response to the challenges of schooling. Symptoms include difficulties in concentrating, remembering, and thinking. Students often state that their brains are “fatigued.” Additional somatic symptoms are usually centered around the head and neck and include pain, pressure or tightness, blurring of vision, heat, or burning. “Brain tiredness” or fatigue from “too much thinking” is an idiom of distress in many cultures, and resulting syndromes can resemble certain anxiety, depressive, and somatoform disorders.
dhat A folk diagnostic term used in India to refer to severe anxiety and hypochondriacal concerns associated with the discharge of semen, whitish discoloration of the urine, and feelings of weakness and exhaustion. Similar to jiryan (India), sukra prameha (Sri Lanka), and shen-k'uei (China).
falling-out or blackout Episodes that occur primarily in southern United States and Caribbean groups. They are characterized by a sudden collapse, which sometimes occurs without warming but is sometimes preceded by feelings of dizziness or “swimming” in the head. The person's eyes are usually open, but the person claims an inability to see. Those affected usually hear and understand what is occurring around them but feel powerless to move. This may correspond to a diagnosis of conversion disorder or a dissociative disorder.
ghost sickness A preoccupation with death and the deceased (sometimes associated with witchcraft), frequently observed among members of many American Indian tribes. Various symptoms can be attributed to ghost sickness, including bad dreams, weakness, feeling of danger, loss of appetite, fainting, dizziness, fear, anxiety, hallucinations, loss of consciousness, confusion, feelings of futility, and a sense of suffocation.
hwa-byung (also known as wool-hwa-byung) A Korean folk syndrome literally translated into English as “anger syndrome” and attributed to the suppression of anger. The symptoms include insomnia, fatigue, panic, fear of impending death, dysphoric affect, indigestion, anorexia, dyspnea, palpitations, generalized aches and pains, and a feeling of a mass in the epigastrium.
koro A term probably of Malaysian origin, that refers to an episode of sudden and intense anxiety that the penis (or, in women, the vulva and nipples) will recede into the body and possibly cause death. The syndrome is reported in South and East Asia, where it is known by a variety of local terms, such as shuk yang, shook yong, and suo yang (Chinese); jinjinia bemar (Assam); or rok-joo (Thailand). It is occasionally found in the West. Koro at times occurs in localized epidemic form in East Asian areas. The diagnosis is included in the second edition of Chinese Classification of Mental Disorders (CCMD-2).
latah Hypersensitivity to sudden fright, often with echopraxia, echolalia, command obedience, and dissociative or trancelike behavior. The term latah is of Malaysian or Indonesian origin, but the syndrome has been found in many parts of the world. Other terms for the condition are amurakh, irkunil, ikota, olan, myriachit, and menkeiti (Siberian groups); bah tschi, bah-tsi, baah-ji (Thailand); imu (Ainu, Sakhalin, Japan); and mali-mali and silok (Philippines). In Malaysia it is more frequent in middle-aged women.
locura A term used by Latinos in the United States and Latin America to refer to a severe form of chronic psychosis. The condition is attributed to an inherited vulnerability, to the effect of multiple life difficulties, or to a combination of both factors. Symptoms exhibited by persons with locura include incoherence, agitation, auditory and visual hallucinations, inability to follow rules of social interaction, unpredictability, and possibly violence.
mal de ojo A concept widely found in Mediterranean cultures and elsewhere in the world. Mal de ojo is a Spanish phrase translated into English as “evil eye.” Children are especially at risk. Symptoms include fitful sleep, crying without apparent cause, diarrhea, vomiting and fever in a child or infant. Sometimes adults (especially women) have the condition.
nervios A common idiom of distress among Latinos in the United States and Latin America. A number of other ethnic groups have related, though often somewhat distinctive, ideas of nerves (such as nerva among Greeks in North America). Nervios refers both to a general state of vulnerability to stressful life experiences and to a syndrome brought on by difficult life circumstances. The term nervios includes a wide range of symptoms of emotional distress, somatic disturbance, and inability to function. Common symptoms include headaches and brain aches, irritability, stomach disturbances, sleep difficulties, nervousness, easy tearfulness, inability to concentrate, trembling, tingling sensations, and mareos (dizziness with occasional vertigolike exacerbations). Nervios tends to be an ongoing problem, although variable in the degree of disability that is manifest. Nervios is a very broad syndrome that spans the range from patients free of a mental disorder to presentations resembling adjustment, anxiety, depressive, dissociative, somatoform, or psychotic disorders. Differential diagnosis depends on the constellation of symptoms experienced, the kinds of social events that are associated with the onset and progress of nervios, and the level of disability experienced.
piblokto An abrupt dissociative episode accompanied by extreme excitement of up to 30 minutes' duration and frequently followed by convulsive seizures and coma lasting up to 12 hours. It is observed primarily in Arctic and subarctic Eskimo communities, although regional variations in name exist. The person may be withdrawn or mildly irritable for a period of hours or days before the attack and typically reports complete amnesia for the attack. During the attack persons may tear off their clothing, break furniture, shout obscenities, eat feces, flee from protective shelters, or perform other irrational or dangerous acts.
qi-gong psychotic reactions Acute, time-limited episodes characterized by dissociative, paranoid, or other psychotic or nonpsychotic symptoms that may occur after participation in the Chinese folk health-enhancing practice of qi-gong (exercise of vital energy). Especially vulnerable are persons who become overly involved in the practice. This diagnosis is included in CCMD-2.
rootwork A set of cultural interpretations that ascribe illness to hexing, witchcraft, sorcery, or evil influence of another person. Symptoms may include generalized anxiety and gastrointestinal complaints (e.g., nausea, vomiting, diarrhea), weakness, dizziness, the fear of being poisoned, and sometimes fear of being killed (voodoo death). Roots, spells, or hexes can be put or placed on other person, causing a variety of emotional and psychological problems. The hexed person may even fear death until the root has been taken off (eliminated), usually through the work of a root doctor (a healer in this tradition), who can also be called on to bewitched an enemy. Rootwork is found in the southern United States among both African-American and European-American populations and in Caribbean societies. It is also known as mal puesto or brujeria in Latino societies.
sangue dormido (“sleeping blood”) A syndrome found among Portuguese Cape Verde Islanders (and immigrants from there to the United States). It includes pain, numbness, tremor, paralysis, convulsions, stroke, blindness, heart attack, infection, and miscarriages.
Shenjing shuariuo (“neurasthenia”) In China a condition characterized by physical and mental fatigue, dizziness, headaches, other pains, concentration difficulties, sleep disturbance, and memory loss. Other symptoms include gastrointestinal problems, sexual dysfunction, irritability, excitability, and various signs suggesting disturbance of the autonomic nervous system. In many cases the symptoms would meet the criteria for a DSM mood or anxiety disorder. The diagnosis is included in CCMD-2.
shen-k'uei (Taiwan); shenkui (China) A Chinese folk label describing marked anxiety or panic symptoms with accompanying somatic complaints for which no physical cause can be demonstrated. Symptoms include dizziness, backache, fatigability, general weakness, insomnia, frequent dreams, and complaints of sexual dysfunction, such as premature ejaculation and impotence. Symptoms are attributed to excessive semen loss from frequent intercourse, masturbation, nocturnal emission, or passing of white turbid urine believed to contain semen. Excessive semen loss is feared because of the belief that it represents the loss of one's vital essence and can therefore be life threatening.
shin-byung A Korean folk label for a syndrome in which initial phases are characterized by anxiety and somatic complaints (general weakness, dizziness, fear, anorexia, insomnia, gastrointestinal problems), with subsequent dissociation and possession by ancestral spirits.
spell A trance state in which persons “communicate” with deceased relatives or spirits. At times the state is associated with brief periods of personality change. The culture-specific syndrome is seen among African-Americans and European-Americans from the southern United States. Spells are not considered to be medical events in the folk tradition but may be misconstrued as psychotic episodes in clinical settings.
susto (frigh or “soul loss”) A folk illness prevalent among some Latinos in the United States and among people in Mexico, Central America, and South America. Susto is also referred to as espanto, pasmo, tripa ida, perdida del alma, or chibih. Susto is an illness attributed to a frightening event that causes the soul to leave the body and results in unhappiness and sickness. Persons with susto also experience significant strains in key social roles. Symptoms may appear any time from days to years after the fright is experienced. It is believed that in extreme cases, susto may result in death. Typical symptoms include appetite disturbances, inadequate or excessive sleep, troubled sleep or dreams, feelings of sadness, lack of motivation to do anything, and feelings of low self-worth or dirtiness. Somatic symptoms accompanying susto include muscle aches and pains, headache, stomachache, and diarrhea. Ritual healings are focused on calling the soul back to the body and cleansing the person to restore bodily and spiritual balance. Different experience of susto may be related to major depressive disorder, posttraumatic stress disorders, and somatoform disorders. Similar etiological beliefs and symptom configurations are found in many parts of the world.
taijin kyofu sho A culturally distinctive phobia in Japan, in some ways resembling social phobia in DSM. The syndrome refers to an intense fear that one's body, its parts or its functions, displease, embarrass, or are offensive to other people in appearance, odor, facial expressions, or movements. The syndrome is included in the official Japanese diagnostic system for mental disorders.
zar A general term applied in Ethiopia, Somalia, Egypt, Sudan, Iran, and other North African and Middle Eastern societies to the experience of spirits possessing a person. Persons possessed by a spirit may experience dissociative episodes that may include shouting, laughing, hitting the head against a wall, singing, or weeping. They may show apathy and withdrawal, refusing to eat or carry out daily tasks or may develop a long-term relationship with the possessing spirit. Such behavior is not considered pathological locally.
sangue dormido (“sleeping blood”)
In China a condition characterized by physical and mental fatigue, dizziness, headaches, other pains, concentration difficulties, sleep disturbance, and memory loss. Other symptoms include gastrointestinal problems, sexual dysfunction, irritability, excitability, and various signs suggesting disturbance of the autonomic nervous system. In many cases the symptoms would meet the criteria for a DSM mood or anxiety disorder. The diagnosis is included in CCMD-2.
Shenjing shuariuo (“neurasthenia”)
A Chinese folk label describing marked anxiety or panic symptoms with accompanying somatic complaints for which no physical cause can be demonstrated. Symptoms include dizziness, backache, fatigability, general weakness, insomnia, frequent dreams, and complaints of sexual dysfunction, such as premature ejaculation and impotence. Symptoms are attributed to excessive semen loss from frequent intercourse, masturbation, nocturnal emission, or passing of white turbid urine believed to contain semen. Excessive semen loss is feared because of the belief that it represents the loss of one's vital essence and can therefore be life threatening.
shen-k'uei (Taiwan); shenkui (China)
A Korean folk label for a syndrome in which initial phases are characterized by anxiety and somatic complaints (general weakness, dizziness, fear, anorexia, insomnia, gastrointestinal problems), with subsequent dissociation and possession by ancestral spirits.
shin-byung
A trance state in which persons “communicate” with deceased relatives or spirits. At times the state is associated with brief periods of personality change. The culture-specific syndrome is seen among African-Americans and European-Americans from the southern United States.
spell
A folk illness prevalent among some Latinos in the United States and among people in Mexico, Central America, and South America. ? is also referred to as espanto, pasmo, tripa ida, perdida del alma, or chibih. ? is an illness attributed to a frightening event that causes the soul to leave the body and results in unhappiness and sickness. Persons with ? also experience significant strains in key social roles. Symptoms may appear any time from days to years after the fright is experienced. It is believed that in extreme cases, ? may result in death. Typical symptoms include appetite disturbances, inadequate or excessive sleep, troubled sleep or dreams, feelings of sadness, lack of motivation to do anything, and feelings of low self-worth or dirtiness. Somatic symptoms accompanying ? include muscle aches and pains, headache, stomachache, and diarrhea. Ritual healings are focused on calling the soul back to the body and cleansing the person to restore bodily and spiritual balance. Different experience of susto may be related to major depressive disorder, posttraumatic stress disorders, and somatoform disorders. Similar etiological beliefs and symptom configurations are found in many parts of the world.
Susto
A culturally distinctive phobia in Japan, in some ways resembling social phobia in DSM. The syndrome refers to an intense fear that one's body, its parts or its functions, displease, embarrass, or are offensive to other people in appearance, odor, facial expressions, or movements. The syndrome is included in the official Japanese diagnostic system for mental disorders.
taijin kyofu sho
A general term applied in Ethiopia, Somalia, Egypt, Sudan, Iran, and other North African and Middle Eastern societies to the experience of spirits possessing a person. Persons possessed by a spirit may experience dissociative episodes that may include shouting, laughing, hitting the head against a wall, singing, or weeping. They may show apathy and withdrawal, refusing to eat or carry out daily tasks or may develop a long-term relationship with the possessing spirit. Such behavior is not considered pathological locally.
zar
The percentage of CYP 2D6-poor metabolizers is (lower or higher) for Asians (0.5 to 2.4 percent), and (lower or higher) for whites (2.9 to 10 percent).
The percentage of CYP 2D6-poor metabolizers is lower for Asians (0.5 to 2.4 percent), and higher for whites (2.9 to 10 percent).
frequency of poor metabolizers of CYP 2Cmp: (low or high or intermediate) among whites (3 percent), (low or high or intermediate for African-Americans (18 percent), and (low or high or intermediate) (up to 20 percent) in Asian and Japanese populations.
frequency of poor metabolizers of CYP 2Cmp: low among whites (3 percent), intermediate for African-Americans (18 percent), and higher (up to 20 percent) in Asian and Japanese populations.