Gender incongruence: a comparative study using ICD-10 and DSM-5 diagnostic criteria

Objective: To compare the presence of criteria listed in the DSM-5 and ICD-10 diagnostic manuals in a Brazilian sample of transgender persons seeking health services specifically for physical transition. Methods: This multicenter cross-sectional study included a sample of 103 subjects who sought services for gender identity disorder in two main reference centers in Brazil. The method involved a structured interview encompassing the diagnostic criteria in the two manuals. Results: The results revealed that despite theoretical disagreement about the criteria, the manuals overlap regarding diagnosis confirmation; the DSM-5 was more inclusive (97.1%) than the ICD-10 (93.2%) in this population. Conclusions: Although there is no consensus on diagnostic criteria on transgenderism in the diversity of social and cultural contexts, more comprehensive diagnostic criteria are evolving due to society's increasing inclusivity.

Between Don Quixote and Hamlet: vicissitudes of contemporary Cultural Psychiatry / Entre Don Quijote y Hamlet: vicisitudes de la Psiquiatría Cultural contemporánea

Abstract: Background: Although Cultural Psychiatry (CP) has emerged as a significant discipline and body of knowledge in recent decades, it finds itself in a current intense debate about its identity, its contributions, and its future. Objective: To examine conflictive areas of historical, epistemological, clinical, educational, and research interest in the present and future development of CP. Method: A narrative review of outstanding sources, articles, and textbooks on CP that reflect its current vicissitudes; for each area, adequate quotations of Cervantes' Don Quixote and Shakespeare's Hamlet are used. Results: In addition to updating definitions and content, discussions about whether CP is a psychiatric subspecialty, the scope of its diagnostic, clinical and therapeutic applications, evaluation of criticisms and strengths, interactions with other disciplines, as well as reflective speculations about its future, are outlined. Discussion and conclusion: CP is considered the receptacle of many disciplines, the last bastion of humanistic medicine in a globalized world, although its development will always be marked by scholarly debates about contexts, meanings, identities, and competencies regarding its ontological and epistemological components.

Resumen: Antecedentes: La Psiquiatría Cultural (PC) es una disciplina y cuerpo de conocimiento de creciente significación en décadas recientes que, sin embargo, es actualmente materia de un debate intenso acerca de su identidad, sus contribuciones y su futuro. Objetivo: Se examinan áreas de conflicto en aspectos históricos, epistemológicos, clínicos, educacionales y de investigación. Método: Revisión narrativa de fuentes relevantes, artículos y textos que reflejan las actuales vicisitudes de la PC; se utilizan citas referenciales apropiadas de Don Quijote, de Cervantes, y Hamlet, de Shakespeare, en tanto que perspectivas opuestas y/o complementarias. Resultados: Además de actualizaciones de definición y contenidos, se discute si la PC es una subespecialidad psiquiátrica, y se revisan sus aplicaciones diagnósticas, clínicas y terapéuticas; sus críticas y méritos; su interacción con otras disciplinas y reflexiones en torno a su futuro. Discusión y conclusión: La PC es el receptáculo de muchas disciplinas, el último bastión de una medicina humanística en un mundo globalizado, pero su futuro estará marcado siempre por debates académicos acerca del contexto, los significados, las identidades y las competencias respecto a sus componentes ontológicos y epistemológicos.

Posttraumatic Embitterment Disorder and Hwa-byung in the General Korean Population

OBJECTIVE: Posttraumatic embitterment disorder (PTED) is characterized by states of “embitterment”, characteristically similar to “Hwa-byung”, which is a Korean culture-bound syndrome. The present study aimed to assess diagnostic relationships between PTED and Hwa-byung. METHODS: A total of 290 participants completed our survey. PTED and Hwa-byung were diagnosed using a diagnostic interview and scale. Scales for depression, suicide ideation, and anger were used for evaluation. Fisher's exact tests and Mann-Whitney U tests were performed to evaluate diagnostic overlap between PTED and Hwa-byung, and associations of scale scores for depression, suicide ideation, and anger between the PTED, Hwa-byung, and non-diagnosed groups. Associations of these scales between the depressive and non-depressive groups, and suicidal and non-suicidal groups were also evaluated. RESULTS: Among the participants, 1.7% of the sample fit the diagnostic criteria for PTED and 2.1% fit the criteria for Hwa-byung. No individual fit the criteria for both. Anger scores were significantly higher in the Hwa-byung group than in the non-diagnostic group. There were not any significant differences in anger scores between the PTED and non-diagnostic groups. Depression scores were significantly higher in the PTED than in the non-diagnostic groups. In contrast, no significant differences were observed between depression scores in the Hwa-byung and non-diagnostic groups. CONCLUSION: These results suggest that PTED may be a disorder category that is distinct from Hwa-byung.

Comparative Analysis of Emotional Symptoms in Elderly Koreans with Hwa-Byung and Depression

OBJECTIVE: This study compared the symptomatic emotional traits of elderly South Korean patients with hwa-byung and those with depression. METHODS: We enrolled 58 patients with hwa-byung, 180 patients with depression, and 181 healthy control subjects. All participants completed the Hwa-byung Scale, Hamilton Depression Rating Scale (HDRS), Beck Depression Inventory (BDI), Geriatric Depression Scale (GDS), State Trait Anger Expression Inventory (STAXI), Reaction Inventory (RI), and Aggression Questionnaire (AQ). Chi-square tests and a one-way analysis of variance with Games-Howell post-hoc tests were used to compare demographic variables and scores. RESULTS: A binary logistic regression analysis was used to examine risk factors for hwa-byung. Scores in the hwa-byung group were higher than those in the depression group for the HDRS; BDI; GDS; trait anger STAXI subscale (trait anger temperament and trait anger reaction); state anger and anger expression STAXI subscales (anger-in, anger-out, and anger control); physical and verbal aggression as well as anger and hostility AQ subscales; and disturbance, embarrassing circumstances, personal disrespect, and unpleasant encounters RI subscales. A binary logistic regression analysis demonstrated that the state anger STAXI subscale, verbal aggression and anger AQ subscales, and unpleasant encounters RI subscale were significantly associated with hwa-byung. CONCLUSION: Elderly patients with hwa-byung had more severe anger traits and states as well as higher depression severity compared to those diagnosed with clinical depression. Excessive anger and anger reactivity to unpleasant factors may be risk factors for hwa-byung, whereas the appropriate expression (rather than suppression) of anger may decrease the risk of hwa-byung.

Spatial-temporal trends and risk of suicide in Central Brazil: an ecological study contrasting indigenous and non-indigenous populations

Objective: To examine spatial-temporal distribution and risk of suicide, as well as trends in suicide mortality rates, in the indigenous and non-indigenous population of the state of Mato Grosso do Sul, Brazil. Methods: Data were obtained from the Information Department of the Brazilian Unified Health System. Deaths recorded as voluntary self-inflicted injuries (ICD-10 codes X60.0 to X84.9) were considered suicide. Suicide rates were estimated and adjusted by age in the population > 9 years of age. Kernel analysis was used to assess the spatial distribution of suicide cases, while trend analysis was carried out using a non-parametric test (Mann-Kendall). Results: The suicide risk among the indigenous population was 8.1 (95%CI 7.2-9.0) times higher than in the non-indigenous population. For indigenous residents in the 15-24 age group, the risk was 18.5 (95%CI 17.5-19.6) times higher than in the non-indigenous population. The majority of indigenous cases were concentrated in a few villages in reservation areas, mainly occupied by Guarani-Kaiowá and Guarani-Ñandeva groups. Rate patterns remained stable over time in both groups. Conclusion: Suicide is a serious public health problem in Mato Grosso do Sul, and has had an alarming and disproportionate impact on the indigenous population for more than a decade.

A cross-cultural study of gambling disorder: a comparison between women from Brazil and the United States

Objective: To perform a cross-cultural comparison of gambling disorder (GD) in women from Brazil and the United States, two countries with pronounced social and cultural differences. We hoped to produce insight into the impact of cultural influences on the presentation of GD in women, which may be useful for the development of culturally-sensitive interventions. Method: We assessed 681 women with GD: 406 from a Brazilian sample and 275 from a U.S. sample. We assessed demographic and gambling behavior variables in addition to co-occurring psychiatric disorders. Results: Fewer Brazilian participants were Caucasian (73.3 vs. 91.3%; p = 0.022). Also, Brazilian women had lower levels of education (59.9% with high school or less vs. 44.4%; p < 0.001), and were more likely to have a current partner (54.9 vs. 43.4%; p = 0.003). Brazilian gamblers also reported lower urge scores (6.6±4.3 vs. 11.6±2.4; p < 0.001) and higher chasing rates (89.1 vs. 80.0%; p = 0.002). Brazilian gamblers reported higher rates of bingo gambling (19.2 vs. 5.7%; p < 0.001), but lower rates of card game gambling (5.8 vs. 23.1%; p < 0.001). Finally, Brazilian gamblers were more likely to endorse a history of major depressive disorder (36.9 vs. 24.4%; p = 0.001). Conclusions: This study reinforces the need for further general cross-cultural research on GD and particularly for studies investigating how gender mediates these differences. Finally, the differences noted in this analysis suggest that the findings of predominantly Anglo-Saxon cultures may not be generalizable to other world populations.

Contexto histórico y cultural en el estudio de la enfermedad mental: perspectivas latinoamericanas / Historical and cultural context in the study of mental disorders: latin american perspectives

La historia de la psiquiatría latinoamericana incorpora realidades culturales y epistemológicas que, en buena medida, han contribuido a la forja de una identidad de nuestra disciplina, aun sujeta sin embargo, al influjo de factores diversos, más aún en esta etapa de globalización y gigantescos cambios tecnológicos. El artículo examina las características del entorno latinoamericano y expone una secuencia histórica en la conceptualización de enfermedad mental, su diagnóstico y manejo desde la era precolombina hasta los albores del presente siglo. Se analizan y discuten las características distintivas de la identidad actual de la psiquiatría latinoamericana, los factores en juego para su búsqueda y su enunciado pleno, proceso complejo al que sin embargo debe aspirarse con tenacidad, objetividad y realismo.

The history of Latin American psychiatry incorporates cultural and epistemological realities that, in a good measure, have contributed to the formation of an identity still subjected, however, to the influence of different factors, even more so in this period of globalization and overwhelming technological changes. This article examines the unique characteristics of the Latin American continent and presents a historical sequence in the conceptualization of mental illness, its diagnosis and management from Pre-Columbian times to the dawn of the current Century. Distinctive characteristics of the current identity of Latin American psychiatry, and factors at play in its search and total understanding, are discussed. This is a complex process to which, however, is important to aspire with tenacity, objectivity and realism.

Nature of Persecutors and Their Behaviors in the Delusions of Schizophrenia: Changes between the 1990s and the 2000s

OBJECTIVE: Research suggests that the contents of delusions in schizophrenia are influenced by culture and social environment. However, few studies have investigated the chronological change of such delusions within a society. To investigate specifically the changes in the persecutory delusions of schizophrenia that have occurred over time, we compared the nature of the persecutors and their persecutory behaviors among inpatients with schizophrenia. METHODS: All admissions to the psychiatric unit of Hanyang University Guri Hospital with discharge diagnoses of schizophrenia during two different five-year time frames (1996-2000 and 2006-2010) were reviewed. From their inpatient medical records, we investigated the descriptions of persecutors and their persecutory behaviors in the delusions of 124 patients (54 in the1990s and 72 in the 2000s). RESULTS: Overall, persecutory behaviors and nature of persecutors in the delusions of schizophrenia did not differ between the two time frames. However, subgroup analysis revealed that in women but not in men, rejection as a persecutory behavior was significantly higher in the 1990s (p<0.05). CONCLUSION: The ten-year time interval may be too short to find significant changes in delusional content in general. However, our additional finding in women may be a result of the tremendous change in status of Korean women during the last decade.

Biopolíticas da depressão nos imigrantes Africanos / Biopolitics of depression in African immigrants

Este artigo foca o tema controverso das biopolíticas da depressão em imigrantes, em particular nos originários da África sub-sahariana. Os sintomas depressivos, ligados à ansiedade, são identificados também pela nova e mais importante patologia mental dos imigrantes: a Síndroma de Ulisses, de stress múltiplo e crónico, já definido como "o mal do século vinte e um", e que atinge principalmente os africanos. Não só entre estes imigrantes mas também em África, segundo um estudo conduzido pela OMS, a depressão tornou-se uma das principais patologias mentais. O tratamento farmacológico do sofrimento, entendido como fenómeno orgânico, é considerado o único caminho possível, silenciando os processos históricos, políticos e socioeconómicos que lhe estão na base. A atenção é portanto focada na saúde mental do indivíduo, desviando-a de problemas sociais de difícil resolução, que necessitariam de respostas económicas e políticas.

The following article focuses on the controversial issue of the biopolitics of depression in immigrants, especially those originating from Sub-Saharan Africa. Depressive symptoms connected with anxiety are predicted by the new and major mental pathology of the immigrants: the Ulysses Syndrome, a condition of multiple and chronic stress, already defined as the "twenty-first century's affliction", which affects mainly Africans. Depression has become one of the predominant mental disorders not only among African immigrants but in Africa itself, according to research conducted by the WHO. Pharmaceutical treatment of suffering, understood as an organic phenomenon, is considered the only possible route, suppressing the historical, political and socio-economic processes which remain at its foundation. So, the attention placed on the subject's mental health is being diverted from complicated social problems which would require economic and political responses.

Psychiatry in Korea for 21 Century: Quo vadis? / 신경정신의학

In this review article, the author tried to predict the characteristic features of psychiatric population and mental health problems in a new century in Korea. Accordingly the desirable attitude of psychiatrists and the scope of psychiatry were suggested. As problem areas, problems of adolescence, senility, family, stragglers, quasireligion, community mental health and transcultural practice were predicted. As psychiatrists' scopes to be accomplished, subspecialty in practice, community-based approach, cooperation with parapsychiatric and religious personnels, transcultural approach in practice, accomplishment of desirable mental health delivery system were suggested. Finally, psychiatric education suitable for the future society was emphacized for the better contribution.