Affirmative Care Across Cultures: Broadening Application.

Affirmative practice is an approach to health and behavioral health care that validates and supports the identities stated or expressed by those served. Affirmative care requires the practitioner to actively honor and celebrate identity while at the same time validating the oppression felt by individuals seeking services. Validation and empathy fundamentally result from increased understanding of individuals' history, cultural context, and lived experiences. Origins of the approach honored the experience of those in LGBTQ+ communities; however, affirmative care should be valued across cultures, systems, and settings in which health and behavioral health care are offered. Affirmative care principles should be applied across cultures and communities while recognizing the worth of the individual and avoiding stereotyping. Along with delineating historical and demographic contexts, the authors offer recommendations for affirmative care in practice with African American, Asian, Indigenous, and Latinx individuals, as well as those living in rural communities.

Religious Belief at the Level of the Brain: Neural Correlates and Influence of Culture.

This article summarizes key functional magnetic resonance imaging studies that correlate the neural substrate of religious belief and the influence of culture. I searched and updated PubMed (http://www.ncbi.nlm.nih.gov/pubmed) publications until March 2018 on religious belief and related topics. Belief, whether religious or nonreligious, is associated with greater signal in the ventromedial prefrontal cortex (vMPFC), a brain region important for self-representation, emotional associations, reward, and goal-driven behavior. However, religious belief, compared with nonreligious belief, registers greater signal in the precuneus, anterior insula, ventral striatum, anterior cingulate cortex, and posterior medial cortex-areas associated with governance of emotion, self-representation, and cognitive conflict. In contrast, nonreligious belief registers more signal in the left hemisphere memory networks (Harris et al. PLoS One 2009;4:e0007272). Moreover, cultural studies revealed self-judgment tasks in nonbelievers involved more the vMPFC, whereas Christians had significantly increased activation in the dorsomedial prefrontal cortex (Han et al. Soc Neurosci 2008;3:1-15). Consequently, the Christian belief of "surrendering to Christ" seemed to weaken neural coding of stimulus self-relatedness but enhanced neural activity underlying evaluative processes of self-referential stimuli. The findings suggest a transformation of the semantic autobiographical self to Christ's conceptual self.

Unraveling the Enigma of Bangungut: Is Sudden Unexplained Nocturnal Death Syndrome (SUNDS) in the Philippines a Disease Allelic to the Brugada Syndrome?

BACKGROUND: Sudden unexplained nocturnal death syndrome (SUNDS) has been reported worldwide. SUNDS is endemic in Southeast Asia and is colloquially known as Bangungut in the Philippines, Lai Tai in Thailand, and Pokkuri in Japan. Although SUNDS in Thailand and Japan have been determined to be phenotypically, genetically and functionally identical to the Brugada syndrome, the relationship between Bangungut/SUNDS in the Philippines and the Brugada syndrome has not been clarified. This paper explores the concordance between Bangungut/SUNDS and the Brugada syndrome. METHODS: We summarized autopsy studies on Bangungut retrieved from PubMed since 1917 and current epidemiological data on Philippine SUNDS to clarify its diagnostic features. We also reviewed current hypotheses of the pathophysiological mechanism of the Brugada syndrome to explore its applicability to Bangungut/SUNDS. RESULTS: The use of the term Bangungut is confusing as it includes many diseases that may cause SUNDS. However, our review reveals a notable subset of Bangungut, identified as Bangungut/SUNDS with no gross cardiac pathology that conforms to the clinical picture of the folk-belief of Bangungut and of the Brugada syndrome, namely: predominance among male in the 20-40 age range; sudden death during sleep or at rest, usually following ingestion of a large meal at night; and victims were in apparent good health prior to their demise. Current pathophysiological mechanisms of Brugada syndrome seemed plausible explanations for a majority of this subset of Bangungut/SUNDS. CONCLUSION: Bangungut/SUNDS and the Brugada syndrome appear closely related. Pathophysiological mechanisms of the Brugada syndrome may explain the enigma of Bangungut/SUND. Whether Bangungut/SUNDS is phenotypically, genetically and functionally an allele of the Brugada syndrome remains inconclusive due to lack of research data. We therefore proposed a research agenda including genetic testing and pharmacological challenge of probands and their family members suspected of SUNDS to conclusively establish the relationship between these two syndromes.

Hikikomori, a Japanese culture-bound syndrome of social withdrawal?: A proposal for DSM-5.

A form of severe social withdrawal, called hikikomori, has been frequently described in Japan and is characterized by adolescents and young adults who become recluses in their parents' homes, unable to work or go to school for months or years. The aim of this study was to review the evidence for hikikomori as a new psychiatric disorder. Electronic and manual literature searches were used to gather information on social withdrawal and hikikomori, including studies examining case definitions, epidemiology, and diagnosis. A number of recent empirical studies have emerged from Japan. The majority of such cases of hikikomori are classifiable as a variety of existing Diagnostic and Statistical Manual (DSM) psychiatric disorders. However, a notable subset of cases with substantial psychopathology does not meet criteria for any existing psychiatric disorder. We suggest hikikomori may be considered a culture-bound syndrome and merits further international research into whether it meets accepted criteria as a new psychiatric disorder. Research diagnostic criteria for the condition are proposed.

Mental health care of Filipino Americans.

Filipino Americans are the second-fastest-growing Asian immigrant group in the United States, following the Chinese. Yet there exists a dearth of information on mental health issues concerning Filipino Americans, who represent a diverse mixture of culture, beliefs, and practices and vary widely from other minorities as well as from the larger population. This group has experienced emotional and behavioral challenges in acclimatizing to Western culture. Their historical underpinnings, native core values, and traditions exert a crucial influence on their mental well-being. Filipino Americans underutilize existing mental health care services that are culturally, socially, and linguistically incompatible with their needs. Along with stigma, the adherence of traditional practices and healing methods remains a formidable barrier to the appropriate provision of care. The authors review factors influencing perceptions of mental health and illness, including religion, family, support systems, coping styles, and indigenous culture-bound traits. Recommendations for treatment consist of a structured, culturally sensitive, comprehensive approach that addresses the individual as well as the cultural milieu.

A psychiatric residency curriculum about Asian-American issues.

Asian Americans constitute the third-largest and the fastest-growing minority group in the United States, with a population of 10.2 to 11.9 million in Census 2000. It is a heterogeneous group that includes at least 43 ethnic subgroups with different languages and dialects, immigration patterns, and religious beliefs; varying socioeconomic status; and different traditional patterns of seeking health care. These social and cultural variables affect Asian Americans' help-seeking behaviors, development of psychiatric disorders, manifestation of psychiatric symptoms, treatment strategies, compliance, and outcomes. This article reviews experiences of Asian Americans relevant to their mental health, including migration patterns to the United States, socioeconomic status, and cultural variables. It proposes educational objectives in the assessment and treatment of Asian-American patients that are essential for the training of psychiatric residents. In particular, it addresses special considerations in implementation of a psychiatric curriculum directed to the care of Asian-American psychiatric patients.