THE LATIN AMERICAN GUIDE FOR PSYCHIATRIC DIAGNOSIS : A Cultural Overview - 17/08/11
Résumé |
After making important advances in diagnostic reliability, the field of psychiatry seems to be turning its attention back to diagnostic validity. In psychiatric nosology two parallel efforts seem to be taking place: one, addressed at the development of a truly international system for classifying psychiatric disorders, and a second one, concerned with the incorporation of cultural variables in the formulation of the psychiatric diagnosis in order to make it more useful for treatment planning and health promotion. These efforts are not merely academic, they are necessary for clinical practice, as ethnic and cultural diversity of those seeking mental health services increase around the world, especially in developed societies, such as the United States.11
Among recent efforts to update diagnostic validity, existing universalistic diagnostic systems are being examined critically in order to pay closer attention to local realities and the uniqueness of the individual patient. The first type of these developments involves adaptations of the international classification system to regional or national clinical patterns and needs.21 A second one is the recognition of the practical importance of making contextual factors an important part of the diagnostic formulation, including the perspectives of the patient and his or her family, as recently proposed by the World Psychiatric Association.40
The ICD-10 Classification of Mental and Behavioral Disorders37 is being accepted currently by most countries and by the World Psychiatric Association as the international standard in the field for statistical reporting and for clinical care and research. Emerging now is the need to harmonize international communication with recognition of cultural diversity and specific local requirements. Developers of the United States classification system in psychiatry have admitted that “specific and consistent attention to the role of culture in presentation and diagnosis is an innovation of DSM-IV.”10 They go on to recognize that this reflects their concern on the misapplication in different countries and ethnic populations of a diagnostic system that, like any other, is a product of the specific cultural and socioeconomic forces of the specific setting in which it has been developed. A consequence of this recognition of culture by North American nosologists is the inclusion, in the description of disorders in DSM-IV, of information on “the ways in which varied cultural backgrounds affect the content and form of the symptom presentation.”6 Another is the inclusion of a Cultural Formulation Outline in DSM-IV.19
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Vol 24 - N° 3
P. 433-446 - septembre 2001 Retour au numéro
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- Sing Lee
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- Parmanand Kulhara, Subho Chakrabarti
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