CULTURAL CONSIDERATIONS
Awareness of cultural differences is important when
assessing for symptoms of schizophrenia. Ideas that
are considered delusional in one culture, such as be-
liefs in sorcery or witchcraft, may be commonly ac-
cepted by other cultures. Also auditory or visual hal-
lucinations, such as seeing the Virgin Mary or hearing
God’s voice, may be a normal part of religious expe-
riences in some cultures. The assessment of affect
requires sensitivity to differences in eye contact, body
language, and acceptable emotional expression; these
vary across cultures (APA, 2000).
In a large study involving 26,400 psychiatric
clients, Flaskerud and Hu (1992) found significant dif-
ferences in the psychiatric diagnoses given to both in-
patients and outpatients. African American and Asian
clients were diagnosed with schizophrenia more often
than white clients were. Latino clients had fewer di-
agnoses of schizophrenia than did white clients. The
study found that these differences in diagnosis could
not be attributed to other variables such as sex, age,
socioeconomic status, primary language, or expression
of psychopathology.
Psychotic behavior observed in countries other
than the United States or among particular ethnic
groups has been identified as a “culture-bound” syn-
drome. Although these episodes exist primarily in
certain countries, they may be seen in other places as
people visit or immigrate to other countries or areas.
Mezzich, Lin, and Hughes (2000) summarized some
of these psychotic behaviors:
- Bouffée delirante,a syndrome found in
West Africa and Haiti, involves a sudden
outburst of agitated and aggressive behav-
ior, marked confusion, and psychomotor
excitement. It is sometimes accompanied
by visual and auditory hallucinations or
paranoid ideation. - Ghost sicknessis preoccupation with
death and the deceased frequently observed
among members of some Native American
tribes. Symptoms include bad dreams,
weakness, feelings of danger, loss of
appetite, fainting, dizziness, fear, anxiety,
hallucinations, loss of consciousness,
confusion, feelings of futility, and a sense
of suffocation. - Locurarefers to a chronic psychosis experi-
enced by Latinos in the United States and
Latin America. Symptoms include incoher-
ence, agitation, visual and auditory halluci-
nations, inability to follow social rules,
unpredictability, and possible violence. - Qi-gongpsychotic reaction is an acute, time-
limited episode characterized by dissocia-
tive, paranoid, or other psychotic symptoms
that occur after participating in the Chinese
folk health-enhancing practice of qi-gong.
Especially vulnerable are those who become
overly involved in the practice.- Zar,an experience of spirits possessing a
person, is seen in Ethiopia, Somalia, Egypt,
Sudan, Iran, and other North African and
Middle Eastern societies. The afflicted
person may laugh, shout, wail, bang her
or his head on a wall or be apathetic and
withdrawn, refusing to eat or carry out
daily tasks. Such behavior is not considered
pathologic locally.
Ethnicity also may be a factor in the way a person re-
sponds to psychotropic medications. This difference in
response is probably the result of the person’s genetic
makeup. Some people metabolize certaindrugs more
slowly, so the drug level in the bloodstream is
higher than desired. African Americans, Caucasian
Americans, and Hispanic Americans appear to re-
quire comparable therapeutic doses of antipsychotic
medications. Asian clients, however, need lower doses
of drugs such as haloperidol (Haldol) to obtain the
same effects (Kudzma, 1999); therefore, they would be
likely to experience more severe side effects if given
the traditional or usual doses.
TREATMENT
PsychopharmacologyThe primary medical treatment for schizophrenia is
psychopharmacology. In the past, electroconvulsive
therapy, insulin shock therapy, and psychosurgery
were used, but since the creation of chlorpromazine
(Thorazine) in 1952, other treatment modalities have
become all but obsolete. Antipsychotic medications,
also known as neuroleptics,are prescribed primar-
ily for their efficacy in decreasing psychotic symp-
toms. They do not cure schizophrenia; they are used
to manage the symptoms of the disease.
The older, or conventional, antipsychotic medica-
tions are dopamine antagonists. The newer, or atypi-
cal, antipsychotic medications are both dopamine and
serotonin antagonists (see Chap. 2). These medica-
tions, usual daily dosages, and common side effects
are listed in Table 14-1. The conventional antipsy-
chotics target the positive signs of schizophrenia,
such as delusions, hallucinations, disturbed think-
ing, and other psychotic symptoms, but have no ob-
servable effect on the negative signs. The atypical an-
tipsychotics not only diminish positive symptoms; for
many clients, they also lessen the negative signs of
lack of volition and motivation, social withdrawal,
and anhedonia (Littrell & Littrell, 1998).302 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS