Abstract
AbstractWe present the case of a 29-year-old single Bulgarian woman, Alice, who lived and worked alone in Germany at the time she presented with signs of acute psychosis, more specifically work-related paranoid ideation. She was diagnosed with Brief Psychotic Disorder and treated successfully with Perphenazine. A return to her home town in Bulgaria with concurrent discontinuation of antipsychotic treatment brought about a change in delusional content. She was now excessively preoccupied with religious themes, ancient rituals, and local traditions, and responded well to treatment with Olanzapine. Alice reluctantly returned to Germany but every time she started a new job she experienced depressive and paranoid exacerbations in spite of strict medication adherence. In the last 3 years, she has lived in Bulgaria and has been medication and episode free. We discuss the complex interaction between the experiences of expatriation, premorbid personality, and cultural values (of the patient and her family) in the etiology, course and outcome of brief psychotic disorder. We raise the possibility that contemporary Bulgarian cultural values (as described in a recent comparative international study) were important in Alice’s recovery and, as such, may have wider significance as protective factors for those at risk of mental disorder.
Highlights
After the collapse of communist rule in 1989, democratic changes occurred in Bulgaria
Alice was brought up in a family with a dominant, authoritarian father and a passive, submissive mother. She went to a German language school in Bulgaria from which she graduated with top marks
Expatriation, insufficient support from friends and family, occupational dissatisfaction, and lack of prospects for professional development escalated into a brief psychotic disorder in a young woman whose preoccupation with her job led her to work for more than 12 h a day hardly getting any sleep at all
Summary
After the collapse of communist rule in 1989, democratic changes occurred in Bulgaria. Over one million people left the country either permanently or as temporary workforce resulting in the greatest demographic collapse in Bulgarian history. Those who left the country were proud to taste freedom and live the western dream. We report the case of a young Bulgarian woman, who lived and worked in Germany for 10 years before she presented with symptoms of brief psychotic disorder. Her story is based on that of a real person but with her name and other biographical details changed to protect confidentiality. It illustrates the possible contribution of cultural values interacting with her premorbid personality and experiences of expatriation as risk factors in the etiology of the condition
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