Psychosocial Etiology Research Articles

How lay is lay? Chinese students' perceptions of anorexia nervosa in Hong Kong

Using a locally devised self-report questionnaire that encompassed both professional and lay explanatory models, this study explored the perceptions of anorexia nervosa (AN) in a large sample of 842 Chinese undergraduates who had little biomedical exposure to this rare condition in Hong Kong. Anorexia nervosa, or yan shi zheng, was conceived as a chronic psychiatric condition of severe weight loss (34%) that arose from mixed psychosocial etiologies. Unlike the more exact professional categorizations but consonant with the lexical meanings of yan shi and Chinese anorectic patients' illness reality, appetitive complaints, sadness and fat phobia were believed to be the main expressions of AN. The illness was seen to affect young women of affluent societies, and to call for help from mental health professionals as well as family members. Although it was not stigmatizing, it would nearly never be admired. Factor analysis revealed a discernible resemblance between lay and professional epistemologies, particularly in the configuration of anorexic symptomatology into “specific” (fat phobic) and “general” types. This implies that in psychiatric disease categories with an uncertain etiology and a substantial cultural component, lay people may package and construct knowledge in a fashion similar to that of professionals. The findings of this study question biomedicine's positivistic claim to psychopathology, and suggest that lay and professional ethnopsychiatric theories and lived anorectic experience are interdependent facets of a socially constructed world.

Management of recurring vesi-covaginal fistulas by vaginal flap technique

— Since 1990 9 patients with vesi-covaginal fistulae located in the trigonal area of the bladder have been treated using the Leach, Raz transvaginal approach (1983). 6 women had been operated previously (4 women once / 2 women twice). Although it is customary to recommend the transabdominal route when operative repair fails, we preferred the transvaginal technique. When the urethral catheter was removed on the tenth to fifteenth postoperative day, all patients were dry. The outpatient voiding diary documented urgency/frequency syndrome in 2 cases and urinary retention in 1 due to psychosocial causes and neurogenic etiology (previous abdominoperineal resection). This technique is certainly interesting and we recommend it before attempting any abdominal surgical repair in particularly unsuccessful cases because it offers several advantages: excellent exposure, no opening of the bladder, minimal dissection, multilayer closure, reduced postoperative discomfort and shorter hospital stay.

‘Psyche’ – Spirit as well as Mind?

Much has been written about the dangers of Cartesian dichotomy for psychiatry, with its equally perilous errors of ‘mindless’ or ‘brainless’ psychiatry (Eisenberg, 1986), as well as the nonsense of talking about disease as either ‘mental’ or ‘physical’, or with ‘somatic’ or ‘psychological’ symptoms. Kendell (1993) has made this point eloquently; this paper further extends the theme. We psychiatrists complain when our medical colleagues cannot get beyond the physical, even when evidence for psychosocial aetiology is quite blatant, but we may be guilty of an equivalent error in almost totally excluding spiritual considerations from the way we understand our patients. This was alluded to in the address to the Royal College of Psychiatrists by our patron (HRH the Prince of Wales, 1991). We ask patients to which religion they ascribe, but we neglect the much more important question of “what does your religion and your faith mean to you?”

Postnatal mental illness: a transcultural perspective.

The three main conditions that are associated with childbirth are the maternity blues, postnatal depression and post-partum psychosis. The prevalence of the blues, which are mild, transient and very common disturbances of postnatal mood, does not appear in a major way to be related to environmental, social or cultural factors. Postnatal depression, which has a predominantly psychosocial etiology, surprisingly does not appear to vary in incidence across different cultures in the few studies reported that permit direct comparisons. There is also no good evidence for or against the theory that postnatal depression is partly the consequence of the customs and rituals that traditionally mark the transition to parenthood being stripped away in developed Western societies. However, the lack of relevant research and limitations of method severely restrict any conclusions that can be drawn. There is much firmer evidence for a consistent incidence of post-partum psychosis across cultural and ethnic divides; this observation, together with clinical data and historical evidence of an unchanging incidence rate during the past 150 years, points to a primarily endogenous etiology for the psychoses, which may be triggered by the physiology of childbirth. The transcultural approach to postnatal psychiatric disorders provides a unique opportunity not only to test hypotheses about social and cultural contributions to the etiology of psychotic and non-psychotic reactions to childbirth, but also an opportunity to study the ways in which social factors can influence the evolution of psychopathology. It is also possible that in some cultures the family and social milieu may play a major part in buffering infants from the adverse effects of maternal postnatal illness, but the evidence is anecdotal. Systematic research across cultures will lead to better recognition of maternal illness as well as to better prevention and management.

Self-injurious behavior in Alzheimer's disease

Self-injurious behaviors in psychiatric disorders are not uncommon, particularly among developmentally disabled children and psychotic patients. However; this phenomenon is rarely discussed in Alzheimer's disease. In this paper we cite a case of self-injurious behavior in a patient with probable Alzheimer's disease and speculate about psychologic, neurochemical, as well as potential environmental and psychosocial etiologies.

Fabriquer le sens : le réseau sémantique du cancer

Francine Saillant: Constructing meaning: the semantic network of cancer. This paper presents the findings of a clinical anthropology study about the cancer experience of a population of francophone patients of Quebec (Canada). The general theme of popular knowledge about cancer is speciflcally investigated. The cancer phenomenon is analysed as a representation and a symbol. Cancer knowledge among patients is regarded as a production of meaning. The data showed that the popular knowledge of cancer is constructed during the course of illness, this knowledge is produced in a dedramatization perspective (cancer is not only a reality mediated by death) and in the connexion with the life story of the ill subject. Psychosocial etiology explains the personal situation of the patient, environmental etiology explains the cancer prevalence in modem society.

Attitudes towards mental illness: the influence of education and experience.

Female nursing students who had completed an instructional and experiential training program were compared on their perception, beliefs and opinions about mental illness with students who had just entered the same program. The results showed that students who had completed their training were better able to perceive the presence and severity of mental illness. Both groups favoured psychosocial etiology and psychosocial forms of treatment. There was no difference in their attitudes towards the mentally ill and both groups shared an overall optimism about prognosis. The implications of the lack of sophisticated knowledge about psychiatric disorders among mental health professionals are discussed.

Suicide in the Young

In the United States, suicide is the third leading cause of death among young people, 15 to 24 years. This new volume provides ample data about the epidemiology of suicide, the complexities of our fully understanding the psychosocial etiology of suicide, and the challenge of treating suicidal young people and their families. This volume has many strengths. The introduction and three summary chapters by the editors (chapters 10, 18, and 25) are outstanding and clearly written. Readers might start with these four sections before proceeding through the remainder of the book. The abstracts for each chapter are concise and well written. The scope of the volume, including epidemiology and etiology, diagnosis, and prevention and intervention, is broad. The layout of the book is excellent: the graphics are outstanding and the text readable. There are some outstanding chapters, namely, "Cohort Studies of Suicide," "Toward the Prediction of Violent Deaths Among the

Psychotherapeutic intervention in angina: II. Implications for research and practice

The second of a two-part series, this article draws on the clinical and research literature reviewed in the first article to formulate guidelines for research and clinical practice. In future research, the complex heterogeneity of coronary artery disease (CAD) must be recognized in more rigorous descriptive, comparative, and physiologic correlative studies of psychosocial etiology. Pseudoangina is largely unexamined by systematic study and therefore warrants research on several of its aspects. Similarly, systematic research on intervention in angionoid pain is virtually nonexistent and obviously warranted. Clinical guidelines include the emphasis of didactic, supportive approaches, detailed focus on several aspects of the pain, early and extended psychotherapeutic availability, recognition and treatment of underlying specific psychopathology, and somatic interventions aimed at presumed pathophysiologic mechanisms.

Adolescents' attitudes towards mental illness: relationship between components and sex differences.

Using a vignette format, components of attitudes towards mental illness were assessed in 413 high school students. The results suggest that while attitude components are generally not highly related, perceived severity of mental illness is positively related to attribution to physical causes, and negatively related to social acceptability. Beliefs in psychosocial etiology and psychosocial treatment correlate positively with optimistic beliefs about prognosis. Belief in the appropriateness of psychosocial treatment is also related to greater social acceptance of the mentally ill, whereas belief in medical treatment is negatively related to social acceptance. Additional data suggest that differences between males and females in their social acceptance of the mentally ill may be related to differences in beliefs about psychosocial etiology and perceived appropriateness of psychosocial treatment.