Maurice Lipsedge

Some social and phenomenological characteristics of psychotic immigrants

Various studies have shown: (i) increased rates of psychoses in immigrants to Britain, and a particularly high rate of schizophrenia in the West Indian- and West African-born; and (ii) a greater proportion of atypical psychoses in immigrants. A retrospective study of psychotic inpatients from a London psychiatric unit demonstrated increased rates of schizophrenia in patients from the Caribbean and West Africa. These patients included a high proportion of those with paranoid and religious phenomenology, those with frequent changes of diagnosis, formal admissions, and married women. The West Indian-born had been in Britain for nearly 10 years before first seeing a psychiatrist and, if they had an illness with religious symptomatology, were likely to have been in hospital for only 3 weeks. Rates of schizophrenia without paranoid phenomenology were similar in each ethnic group. It is suggested that the increase in the diagnosis of schizophrenia in the West Indian-born, and possibly in the West African-born, may be due in part to the occurrence of acute psychotic reactions which are diagnosed as schizophrenia.

School phobia and agoraphobia.

The incidence of past school phobia was surveyed by questionnaire in 786 women under 60 years of age who were members of an agoraphobia correspondence club. Twenty-two per cent admitted to previous school phobia, a proportion similar to that found in 57 non-agoraphobic neurotic controls. Past school phobia predicted an earlier onset of subsequent agoraphobia and a more severe psychiatric state as far as symptoms not specifically agoraphobic were concerned. Adolescent agoraphobic difficulties were more associated with school phobia than with agoraphobia in adult life. It was concluded that school phobia leads to agoraphobia in only a small proportion of cases. Although school phobia may predispose to later agoraphobia, it seems more likely that both conditions reflect a lasting tendency to neurotic illness.

The butterfly and the serpent: Culture, psychopathology and biomedicine

Cultural explanations of psychopathology in the West have rarely employed models derived by anthropologists for small-scale non-literate communities. Some general features of those ritual patterns usually classed as ‘culture-bound syndromes’ are applicable to Western neurosis. Such reactions articulate both personal predicament and public concerns. usually core structural oppositions between age groups or the sexes. They gain their power. by relying on certain unquestionable assumptions which. although beyond everyday jural relationships, articulate such relationships. In the case of Western reactions, such ‘mystical sanction’ is provided by biomedicine. Theoretical paradigms emphasize either the individual pragmatic or expressive aspects, or social homeostasis.

A Comparison of Communication Modes in Adult Psychiatry

The process and outcome of clinical tasks in an acute psychiatric unit were compared using four different communication modes: face to face, telephone, hands-free telephone, and a low-cost videoconferencing system. Six doctors and six patients took part in the study. Four assessment measures were used. The videoconferencing system was positively received by both patients and doctors. Both doctors and patients preferred communication modes with visual cues. However, there were few significant differences between communication modes when using single measures; only multiple levels of analysis can adequately assess the differences between such modes of communication.

Psychiatric illness among British Afro-Caribbeans.

1 Wadsworth MEJ, Cripps HA, Midwinter RE, Colley JRT. Blood pressure in a national birth cohort at the age of 36 related to social and familial factors, smoking, and body mass. BrMedJ 1985;291: 1534-8. 2 Barker DJP, Osmond C. Death rates from stroke in England and Wales predicted from past maternal mortality. BrMedJ 1987; 295:83-6. 3 Ounsted MK, Cockburn JM, Moar VA, Redman CWG. Factors associated with the blood pressures of children born to women who were hypertensive during pregnancy. Arch Dis Child 1985;60:631-5.

An Evaluation of the Use of Interactive Television in an Acute Psychiatric Service

This study reports the results of the use of a low-cost videoconferencing system (LCVC) for communication in an acute psychiatric service. Qualitative research methodology was used to examine the use of the LCVC in interactions between psychiatrists, patients and nursing staff, including information on refusals. One hundred and five clinical interactions were studied over four months. The LCVC proved technically reliable and compatible with the performance of a wide range of clinical tasks. However, the results suggest the need for better understanding of the nature and origins of the attitudes that users bring to the use of such communications technology. A framework is presented for the classification of user responses in terms of preexisting attitudes of the users, technological limitations of the system and the mental state of the users. The study demonstrated the potential for interactive television to support many of the communication tasks necessary in a dispersed psychiatric service and for telepsychiatry to become a major method of service provision.

Preliminary evaluation of a low cost videoconferencing system for teaching in clinical psychiatry.

The use of a digitized low cost videoconferencing system (LCVC) for the teaching of clinical medical students on clinical attachment to a psychiatric ward is described. This work was performed as part of the Telemed project which is evaluating the use of the LCVC in a range of tasks in clinical psychiatry. Any move towards greater reliance on communications technology in psychiatry should take account of the requirements of clinical teaching. The case presentation was used as a teaching paradigm in a controlled study comparing teaching face-to-face with teaching mediated via the LCVC. A questionnaire was developed for student evaluation of the case presentation. General user responses to the LCVC are reported. No significant differences were found between the conditions. User responses were favourable, suggesting that remote interactive teaching via the LCVC warrants further investigation.

Migration, ethnicity and diagnosis.

Various studies have demonstrated an increase in mental illness in black immigrans in Britain. A retrospective study of hospital records suggests that if the culturally atypical features of paranoid and religious flavour are taken into consideration, rates are then similar to those of the British-born. An interim report from an ongoing prospective study, using the Present State Examination and a Religious Interest Questionnaire, suggests that some of the black patients with diagnoses of schizophrenia might be more reasonably considered to have acute psychotic reactions or bouffées délirantes. The relative significance of culturally significant features as consitituting an entity or merely being pathoplastic is briefly discussed.

Psychopathology and its public sources: From a provisional typology to a dramaturgy of domestic sieges

Abstract ‘Psychopathology’ without a discrete biological aetiology deploys available cultural models and may on occasion be epidemic. British media reports of a relatively new social phenomenon, hostage‐taking followed by sieges, were examined. The protagonists were generally young men, and the majority of the sieges occurred in an urban setting. Sieges with a domestic motivation were more likely than those occurring in the course of a crime to result in death or other violence to the principal and hostage. In contrast both with other western ‘culture‐specific’ patterns and with criminal sieges, domestic sieges may thus be understood as primarily expressive rather than instrumental. Yet, subjective agency engages with shared idioms of retribution, sacrifice and redemption in what may not inappropriately be considered as ritual performances.

A Religious Interest Questionnaire for use with psychiatric patients

Abstract The renewed research on religious experience and psychiatric Ulness requires a short and accessible measure of religious background, experience, belief and practice among patients and their families. The fourth edition of an unpublished questionnaire, previously used in clinical practice and research, is presented along with its scoring notes and its limitations.