INDEX (Volume 4 Num 2) 2009

A Randomised Control Trial (RCT) of Undergraduate Cross-Cultural Psychiatry Training - Original Paper A. Chakraborty, . McKenzie, . Bhui, D. Bhugra 65 - 73

Rationale of study: Ethnic diversity in the UK requires doctors to be aware of the impact of culture on the clinical assessment, diagnosis and treatment of mental health problems. One way of improving practice is to add specific teaching on the subject of cultural psychiatry to medical school teaching but there is no evidencebase to support this. Aim: To assess the impact of a teaching on cultural psychiatry to medical students’ assessment and treatment of two vignettes of ethnic minority patients with psychological difficulties. Methods: A single-blind, randomised trial of teaching cultural psychiatry to fourth year medical students during their final psychiatric attachment. Students were asked to write down their management plans on case studies. These were rated on 12 items of cultural competency. The outcome was the mean score for the intervention and control groups. Main findings: There was no significant difference between the intervention and control groups in the total scores for each vignette. However, compared with the control group, the intervention group was significantly more likely to consider social and psychological interventions especially for the female patient vignette. Conclusions: This study offers some evidence that additional teaching on cultural psychiatry can change medical students’ assessment and treatment of patients.

Clinicians’ view of experience of assessing and following up depression among women in I.R. Iran - Original Paper M. Dejman, A. Forouzan, S. Assari, M. Farahani, H. MalekAfzali, M. Rostami, A. Farnam, M. Akbari, M. Taghi Taraghi, S. Ekblad 74 - 88

Background: Depression is a common and disabling disorder. Women suffer more than men according to surveys in Iran and other countries. Delay, misdiagnosis, non-specific treatments and lack of follow up have constituted a typical care pathway for depressed people throughout the world. One reason may be that the explanatory models of clinicians differ from those of patients in their own culture. This study explores the experiences of clinicians with a view understanding the explanatory model of depressed women from the clinician’s point of view. Methods: A qualitative method, using data collection from individual interviews with psychiatrists, clinical psychologists and general physicians, was applied in three Iranian cities with different ethnic backgrounds. Totally 24 participants – 6 general physicians, 14 psychiatrists and 4 clinical psychologists – participated in the study. Two techniques were used: presentation of a case vignette of depression to general physicians, and an interview guide for psychologists and psychiatrists. A content analysis technique was used to develop categories and subcategories both manually and with the help of computer programs (NVivo 7 and Open Code 3 software). Results: Female patients visit clinicians in moderate to severe stages of the illness. Psychological symptoms usually overshadow somatic symptoms, when decide to visit psychiatrists or psychologists. The important barriers to seeking help from clinicians were stigma, beliefs that the problem will go away by itself, a desire to deal with the problem without outside help, and fear of side effects and dependency on medicine. Conclusions: Training and skills development for clinicians, and empowering women and alleviating the constraints on their economic and social participation at all levels, are recommended to reduce gender inequities in perceived health issues.

Migrants in Spain and Andorra. Some thoughts after the French events - Original Paper J. Obiols-Llandrich 89 - 94

The events that took place in France in the autumn of 2005 in the urban ghettos all over the country were followed with great interest both in Spain and Andorra as neighbor countries of France. In Spain the immigrant flow is seen as a growing and overwhelming phenomenon happening in a country not used to be a host destination. On the contrary, for a long time, Spanish people migrated to other european countries or South America. In Andorra, instead, the immigrant population is about 70% of the whole population and, for decades, the country has been accustomed to receive foreign people. The concern about the French events has been notable in both countries. Urban violence is not a new phenomenon and some examples of the U.S. events of the 60’s and 70’s will be useful to relate those facts to some concepts proposed by cultural psychiatrists like anomic depression or culture deprivation.

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