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Lost in Translation; A Life in a New Language
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DOUGLASS, ALAN B.; HAYS, PETER ; PAZDERKA, F ; RUSSELL, JAMES M.
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Narcolepsy in which the hallucinatory component is unusually prominent may lead to the development of an illness indistinguishable from the schizophrenic syndrome. Psychotic symptoms dominate the symptomatology, so that the primary illness is obscured. Five patients are described for whom conventional antipsychotic drugs were ineffectual, but for whom treatment with stimulants produced substantial improvement. The diagnosis of narcolepsy was confirmed by Human Leukocyte Antigen typing and sleep laboratory testing. These results support the “REM intrusion” hypothesis of the causation of schizophrenia in as many as 7% of a series of schizophrenic patients. Implications for diagnosis and treatment are discussed.
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The place of culture in psychiatric nosology is explored through the example of taijin kyofusho (TKS), a common Japanese psychiatric disorder characterized by a fear of offending or hurting others through one's awkward social behavior or an imagined physical defect. Although variants of this disorder have been described in other cultures (e.g., dysmorphophobia), the full spectrum appears to be confined to Japan. TKS can be understood as a pathological amplification of culture-specific concerns about the social presentation of self and the impact of improper conduct on the well-being of others. Both social interaction and constitutional vulnerability may contribute to the cognitive processes that underlie TKS. The salience of cultural differences for psychiatric nosology then depends on whether the clinical focus is on disordered biology, individual psychology and experience, or the social context of behavior. Any attempt to include cultural variation in psychiatric diagnoses must begin by making explicit the intended use of the classification because different social contexts and clinical goals demand alternative diagnostic schemes.
BONNER, RONALD L.; RICH, ALEXANDER R.
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The role of loneliness, irrational beliefs, and deficient reasons for living in predicting vulnerability to hopelessness under conditions of negative life stress was examined. Subjects (N = 178) completed the UCLA Loneliness Scale, Rational Beliefs Inventory, and the Reasons for Living Inventory at the beginning of the semester. Then, at midterm, measures of negative life stress, depression, and hopelessness were obtained from the same subjects. It was hypothesized that the vulnerability factors would interact with negative life stress to predict hopelessness, independent of depressed mood. The results of multiple regression analyses supported this hypothesis. Implications for research, prevention, and treatment are noted.
PFOHL, BRUCE ; REDERER, MARTINA ; CORYELL, WILLIAM ; STANGL, DALENE
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We examined the clinical data for 230 depressed inpatients who had completed a dexamethasone suppression test (DST) to determine whether those with an elevated post-DST serum cortisol level exhibited any of the classic physiological stigmata of Cushing's syndrome. Hypertension was significantly more frequent among DST nonsuppressors (21.2%) than among normal suppressors (11.3%). Percent blood lymphocyte count was significantly lower among nonsuppressors. Confounders such as gender, age, body weight, and use of antihypertensives did not account for the findings. Implications for morbidity and mortality rates among patients with affective disorder are discussed.
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