Psychiatry Research EG

The cosmopolitan occurrence of schizophrenia has been taken as evidence of its biological origins and the variation in its prevalence from one community to another as evidence of the contribution of cultural and environmental factors. Cultural conflict and ambiguity are thought to play a pathogenic role in aetiology. The pathoplastic effect of culture on the symptomatology and outcome of schizophrenia is well documented. Symptoms are noted as abnormal against the cultural background where supernatural forces are believed to influence the life of all human beings. In ICD-10 the diagnosis of schizophrenia relies heavily on Schneider’s first rank symptoms and caution is necessary in detecting these symptoms in communities where socioculturally-shared beliefs bear a resemblance to first rank symptoms. International studies documented the better outcome of schizophrenia in developing traditional societies than in developed industrial societies. Reasons for this difference have been sought in a presumed preponderance of schizophreniform attacks, in the tendency to lower expressed emotion of family members and in the tolerant sociocultural attitudes to schizophrenic patients in traditional societies. The management and rehabilitation of schizophrenic patients are also influenced by cultural factors. Patients who develop behavioural symptoms are more likely to be taken to traditional healers than those with somatic symptoms. It has also been demonstrated that involution of delusions is more likely if they have supernatural than environmental contents as family members find the former more easy to contain in their repertoire of culturally-shared beliefs.