Clinico-epidemiologic study of cutaneous leishmaniasis in Diyarbakir Turkey.

Cutaneous leishmaniasis (CL) is a zoonotic disease, endemic and notifiable in southeastern Turkey. We investigated clinical features, individual characteristics, and environmental factors of affected patients, and identified additional patients with CL in Diyarbakir. In 2002 we studied the epidemiology of CL in Dedeköy and Durabeyli towns in Diyarbakir Province. We evaluated patients with any skin lesions. A questionnaire including demographic details was completed by each patient. Clinical details of lesions and other dermatological findings were recorded. We walked around the town and surveyed it for environmental factors. CL was diagnosed in 78 individuals aged 1-85 years (mean age of 20). Although all age groups were affected, the majority of patients were under age 20. The lesions ranged from approximately 0.5 to 20 cm. They were located on the face (46.7 %), upper extremity (23.2 %), lower extremity (5.1 %), and other sites. Different types of lesions were observed such as nodule with crust, nodule with osseous crust, violaceous infiltrative plaque with vegetative nodule, erysipelas-like plaque verrucous annular plaque, and eczema-like plaques. The incidence of CL is increasing in Dicle and Durabeyli towns and the clinical appearance may vary greatly.

Negative outcome factors for addicted migrants.

Several risk factors as well as protective factors are discussed in the development of mental disorders among migrants. With respect to addiction there are reports of an increased prevalence despite a higher threshold for utilisation of the treatment system. A case report is presented that exemplifies psychosocial and legal factors affecting the development and treatment possibilities of addicted migrants. It calls for a closer co-ordination between institutions and authorities in favour of the addicted individual.

[Psychotic experiences in a transcultural context - case report analysis on the importance of the second language for the therapeutic process]. / Psychotisches Erleben im transkulturellen Spannungsfeld - Eine kasuistische Analyse der Bedeutung der Zweitsprache für den therapeutischen Prozess -

The use of the second language among migrants can lead to a separation of affect and content of speech, which can be used in therapy when touching upon emotionally strenuous events. On the basis of 3 case reports of migrants of Turkish origin with a psychotic disorder, the importance of the second language when used by a native speaking therapists is analyzed. This can lead to the establishment of a therapeutic alliance, even though emotionally central themes are avoided in the process.

Schizophrenic disorders among Turkish migrants in Germany. A controlled clinical study.

Several studies have implied cultural differences in the psychopathology of schizophrenia between migrants and natives. In a diagnostically strictly controlled study, including comparison of diagnosis with a Turkish-speaking psychiatrist, 74 patients of Turkish and 48 of German origin, all with a diagnosis of schizophrenic disorder, were compared using PANSS and HAM-D. The Turkish sample showed higher depression and hostile excitement, even in the subsample of those with paranoid schizophrenia, and no differences in positive, negative or cognitive symptoms. The similarities especially concerning core symptoms reflect evidence from cross-cultural studies on schizophrenia. In conclusion this study shows main differences in psychopathology between psychotic migrants and natives, as discussed in the literature, may be mainly due to diagnostic differences.

[Differences between psychopathological evaluation in German and Turkish language of Turkish immigrants]. / Differenzen zwischen der psychopathologischen Evaluation in deutscher und türkischer Sprache bei türkischen Migranten.

The elevated rate of schizophrenia among migrants has been explained, among others, with misdiagnosis due to symptoms' being misinterpreted as psychotic. Previous studies have shown both higher and lower rates of psychotic symptoms of these patients when interviewed in their mother tongues, compared to being interviewed in the second language. In this study, 91 patients of Turkish origin and 50 of German origin with a paranoid-hallucinatory syndrome at admission were examined by an one interviewer each of Turkish and German origins using a standardized psychopathological instrument. In spite of comparative samples, correlation of psychopathological evaluation as well as diagnostic agreement between the two interviewers was significantly higher in the German patient group. Within the Turkish patient group, correlation was higher for those with good German language knowledge than for those with poor knowledge, yet only on a few items and without an effect on diagnostic agreement. The greatest difficulties lie in the evaluation of delusions. In spite of higher disagreement on psychopathology, the potential misdiagnoses cannot sufficiently explain the higher rate of schizophrenia among migrants.

[Current German laws for foreigners as a contributory factor in the treatment of a first-time acute schizophrenic episode]. / Das geltende Ausländerrecht als krankheitsaufrechterhaltender Faktor in der Behandlung eines schizophrenen Ersterkrankten.

In a case report we describe an 18 year old Croat refugee with a first episode schizophrenia to discuss the current German laws for foreigners as a possible factor for the maintenance of the disease. Short residence permits, the release of the professional discretion to the authorities, deficient information about the laws and the unclear situation in the native country of the patients can lead to a worst course and prognosis of the disease.

Potential for misdiagnosis among Turkish migrants with psychotic disorders: a clinical controlled study in Germany.

OBJECTIVE: The elevated rate of schizophrenia among migrants has been explained in part by possible misdiagnosis. In this study an attempt is made to quantify the extent of potential misdiagnosis among migrants in comparison to non-migrants. METHOD: One hundred patients of Turkish origin (Tr-Pat) and a control group of 50 patients of German origin (G-Pat), all with a paranoid-hallucinatory syndrome upon admission, were examined by an interviewer of Turkish origin (Tr-Int), an interviewer of German origin (G-Int) and the clinician. The diagnostic evaluation was then compared. RESULTS: Nineteen per cent of Tr-Pat and 4% of G-Pat showed diagnostic disagreement between the three raters, while in 8% of Tr-Pat and 0% of G-Pat the two research diagnoses disagreed. In Tr-Pat with 'bad' German knowledge showed tendentially more (29%) diagnostic disagreement than Tr-Pat with 'good' German knowledge (17%). CONCLUSION: The rate of potential misdiagnosis is higher among migrants, yet not strongly correlated to poor second language proficiency.

Psychiatric disorders among migrants in Germany: prevalence in a psychiatric clinic and implications for services and research.

Past studies examining the prevalence of psychiatric disorders among migrants have described a higher rate of schizophrenia, whereas the only major German study found a lower rate. Considering the changed composition of migrants today, a new assessment has become necessary. All admission records of migrants to a psychiatric clinic in 1993 and 1994 were assessed for diagnosis, symptomatology and treatment. Two hundred sixty-three migrant admissions, 8.4% of total admissions, were assessed. Of these 41.4% received a diagnosis of a schizophrenic disorder, significantly more than other clinic patients. The mean age at admission was 33.8 years, at onset of illness 28.6 years and at time of migration 20.3 years. Only 7.9% were mentally ill at the time of migration. Of those with psychotic and depressive symptoms at admission, 70% received a diagnosis of a schizophrenic disorder and 78% were treated with antipsychotics. Antidepressants were prescribed only to 47% of those with a diagnosis of a depressive disorder and only 33% of those with depressive and no psychotic symptoms. An underrepresentation of migrants shows differences in the use of psychiatric services. The higher rate of schizophrenia may be due to misdiagnosis, an artifactual effect of underrepresentation of other disorders or an actual higher rate among migrants. The reluctance to use antidepressants underlines the necessity of training, so as not to withhold treatment options due to cultural barriers.