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Week5 - Psych&129C& Week&5&...

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Unformatted text preview: Psych&129C& Week&5& Spring&2015& Depression&cont.&&& Anxiety&& Soma?c&symptoms&& •  In&the&presence&of&soma?c&symptoms,& depression&less&likely&to&be&diagnosed& –  Some&cultures&may&focus&on&soma?c&symptoms& when&they&are&distressed&rather&than&mood& features&or&cogni?ve&features& Ethnic&differences&in&soma?c& symptoms?& •  Research&supports&some&differences& –  Chinese&people&have&lower&rates&of&depression;& deny&depression&or&express&it&soma?cally& –  In&Korea&also&lower&rates& •  Same&soma?c&emphasis&when&describing& depression&in&Arab&and& Soma?c&Symptoms&cont.& •  La?nos&& –  Greater&endorsement&of&soma?c&symptoms& –  more&likely&to&report&pain&symptoms&together& with&their&depression&& –  Consider&case&of&nervios& Nervios;&cultural&idiom&that&includes& soma?c&presenta?on&& •  A&generalized&state&of&distress,&found&in&numerous&cultures& •  Both&physical&and&emo?onal&distress&that&emerges&from&conflicts&in& life&(family,&paren?ng,&marriage);&oWen&in&context&of&social& disadvantage& •  Can&represent&an&acceptable&mode&of&distress& •  Symptoms&include&headaches,&backaches,&trembling,&lack&of& appe?te&and&sleep,&fa?gue,&physical&agita?on,&menstrual& irregularity,&vomi?ng&during&en?re&pregnancy,&lump&in&the&throat,& difficulty&breathing,&chest&pain,&stomach&ache,&nausea,&diarrhea,& flatulence,&dizziness,&blurred&vision,&fevers&and&swea?ng&among& others&&& •  Psychological&symptoms&include&irritability,&anger,&sadness,& obsessive&idea?on,&overwhelming&concerns,&lack&of&concentra?on,& confusion,&crying&spells,&fears,&anxiety&and&erra?c&behavior&& •  Usually&have&higher&scores&on&measures&of&anxiety&and&depression& Why&soma?cize?& •  S?gma& •  Findings&from&Asian&and&East&Indian&samples& –  Disorders&like&anxiety&and&depression&are&treated& as&most&socially&disrup?ve&but&somatoform& disorders&are&least&social&disrup?ve&& –  Pa?ents&diagnosed&with&“only&somatoform& disorders”&compared&to&“depression&only”&had& lower&s?gma&scores&& Why&soma?cize?& •  Not&the&same&dis?nc?on&in&“mind”&and&“body”&across& cultures& –  In&Korean&medicine&vital&organs&are&associated&with&feelings&(lungs&are&related&to& worry,&liver&to&anger,&kidneys&to&fear)& –  Chinese&medicine]Disharmony&of&vital&organs&and&imbalance&of&qi& –  Indian&medicine&(Ayurvedic&system)]unique&pa_ern&of&living&force&and&energy&that& controls&various&ac?vi?es&of&the&body]disease&emerges&when&these&are&not&in& balance& »  vata&(related&to&breathing,&heartrate,&bowel/bladder&func?on)]anxiety,& aching&confusion;&pi_a&(diges?on&and&hormones)]&anger;&agita?on,& inflamma?on,&uclers;&kapha&(involves&strength&and&immunity)]lethargic,&sinus& conges?on,&upper&respiratory&problems& •  Relates&to&changes&in&self]a_en?on&with&increased& accultura?on& –  Focus&switches&from&soma?c&to&affec?ve&& Kirmayer&et&al.,&2001& styles&of&clinical&presenta/on&& Who&is&least&likely&to&get&services?& faculta?ve& soma?zer& 26%& Ini?al&soma?zer& 34%& persistent& soma?zer& 25%& psychologizer& 15%& N&=700&Canadian&pa?ents& Ini?al&soma?c&complaint]what&caused&and&half&say&psychological&reason& Faculta?ve&–when&prompted&again,&“do&you&think&it&could&be&stress,&worries&etc.& Solu?ons&to&mismanaging&soma?c& symptoms?&& Limita?ons&of&research& –  Methodological&issues& •  Self&report& •  Instrumenta?on&–&psychometric&proper?es& •  Need&more&mixed&methods&research& & Depression&Measurement& •  Construct&validity?& •  Are&the&same&words&being&used&to&describe& depression& –  Structured&interview&say&“depressed,&sad,&down&in& dumps,&blue”& •  In&study&with&Na?ve&Americans,&they&preferred&phrased& such&as&lonely,&empty,&and&feeling&like&crying&& •  Reliability&& •  Is&factor&structure&equivalent&across&groups& Mixed&Methods&Research& •  Qualita?ve&studies&combined&with& quan?ta?ve&studies&& •  Provides&in]depth,&contextualized,&and&natural& but&more&?me]consuming&insights&of& qualita?ve&research&coupled&with&the&more] efficient&but&less&rich&or&compelling&predic?ve& power&of&quan?ta?ve&research.& What&about&anxiety?&& •  •  •  •  Panic&A_acks/Disorder& Social&Anxiety&Disorder& Generalized&Anxiety&Disorder& Post]trauma?c&Stress&Disorder& scientific skepticism must be at play with the Choy article, and assumptions cannot be made Panic&A_acks&& •  No&consistent&differences&in&life?me&prevalence&rates& across&epi&studies&& –  Differen?al&rates&appear&in&response&to&a&stressor&such&as& 9/11& •  African&Americans&(13.4%),&Puerto&Ricans&(16.8%)&and&non]La?no& Whites&(5.5%);&significant&aWer&controlling&for&covariates&& –  Some&differences&in&symptoms& •  More&numbness&and&?ngling&in&AA,&dizziness&in&Asian&groups,&fear& of&dying&in&Arab&and&AA,&depersonaliza?on&among&Puerto&Ricans&& •  Context&may&influence&varia?on&& –  African&americans&have&high&rates&of&diabetes,&more&a_en?on&focused&on& feared&symptoms&& more stressful life events might explain how you react to stressful stimuli Cultural&explana?ons&& Culture may affect how we conceptualize, interpret, and explain panic attacks •  Ethnophysiology& –  E.g.&wind&a_acks,&khyal,&Cambodians& •  Dysregula?on&in&the&flow&of&wind&like&substance&in&the& body,&resul?ng&in&dizziness,&?nnitus,&and&neck&soreness& •  Connected&to&view&that&surge&of&khyal&during&anxiety& may&rupture&neck&vessels,&cause&ear&damage,&and& misdiagnosis can occur if you do not have this fain?ng& knowledge of ethnophysiology b/c you have to understand how people perceive their own body –  E.g.&neck&soreness&& neck soreness/ sore neck syndrome - Khmer refugees - sore neck and person fears that wind and BP may burst vessels in this area - Headachce, blurry vision, buzzing in the ear, dizziness, palpitations, trembling Ataques&de&nervios& •  Ataque&de&Nervios6Uncontrollable&shou?ng,&crying,&trembling,& depersonaliza?on,&suicidal&behavior,&and&verbal&or&physical&aggression.&& •  Prevalent&among&La?n&American&women;&puerto&ricans&rates&range&7]15%.& •  &Most&common&in&those&with&significant&marital&problems&and&those&more& acculturated&to&the&US.&&& •  Usually&precipitated&by&stressor&such&as&rela?onship&loss&or&death&of&a& loved&one&& •  Higher&rates&of&anxiety,&depression&and&substance&use&(Guarnaccia&et&al.,& 2010).& –  33%&of&ataques&fulfill&DSM&criteria&for&panic&a_acks;&17%&fulfill&panic&disorder&criteria& Patterning of behavior that, to a certain extent, can be normalized within the culture. Can be an okay reaction to stress in this culture, but more severe forms of the behavior can overlap with mire clinical disorders, like panic attacks DSM&5&considera?ons& •  Add&culture&specific&symptoms&to&list&and&see& if&it&improves&detec?on&cross&culturally& –  Tinnitus,&neck&soreness,&headache,&uncontrollable& screaming&of&crying& –  Encourage&use&of&specified&symptoms&as& illustra?ve&instead&of&required/cons?tu?ve&of&PA& –  Unexpected&criteria&for&panic&disorder&may&not&be& culturally&appropriate&(e.g.,&standing&up,&going&out& this type of criteria, you will miss on&a&windy&day,&& with culturally-expressive symptoms Social&Anxiety&Disorder& •  US&rates&are&higher&than&non]European& countries&& –  US&rates&range&from&2.8]6.8%& –  Asian&countries&range&from&.2].8%& –  European&countries&range&from&1.1]4.8%& •  In&US,&being&American&Indian,&and&low&income& increases&risk&& •  Immigrant&status&is&associated&with&lower& rates&in&La?no&and&non]La?no&whites& fear of embarrassment, being the center of attention, participating in class, being in groups, going to parties Taijin]kyofu]sho& •  What&is&TKS?& –  Fear&that&others&will&no?ces&some&perceived&physical& defects&such&as&blushing&or&trembling,&unpleasant& body&odor,&too&much&direct&eye&to&eye&contact,&staring& at&others&body&parts&etc.&& –  Person&will&embarrass,&offend&or&harm&others&& •  Hypothesized&mechanism;&Allocentric& interpersonal&focus&of&fear/&interdependent&self] construal& • Data&also&suggest&that&this&disorder&is&found&in& western&cultures&& being concerned about doing something that makes other people feel other people feel embarrassed or uncomfortable mechanism makes sense because many eastern cultures emphasize interpersonal harmony where others should be felt comfortable or okay, rather than one’s self TKS&ques?onnaire& Fear&of&offending&others& •  Endorsement&fear&of&offending&other&due&to& 10&sxs&(Choy&et&al.,&2008)& –  15.5]39.2%&in&US& –  6.3]25%&in&Korean&sample& •  Study&found&surprisingly&high&level&of&TKS&fear& of&offending&symptoms&in&US&pa?ents& & Choy&et&al.&2008& Fear&of&embarrassment&is&greater&than&fear&of&offense&for&each&symptom&& Social&Anxiety&and&self]construals& •  Social&anxiety&symptoms&are&endorsed&by& individuals&collec?vist&countries&(Japan&and&South& Korean)&more&frequently&than&individualis?c& countries& –  Greater&acceptance&of&socially&re?cent&and&withdrawn& behaviors&& •  Social&anxiety&may&also&be&associated&with& mismatch&between&person’s&own&self]construal& and&cultural&defined&social&role& –  In&Us&born&white&men&and&women& •  Men&with&interdependent&self&construal&and&women&with& independent&self]construal&had&higher&social&anxiety&& DSM&5&recommenda?ons& •  Consider&the&inclusion&of&allocentric&fear&as&an& alterna?ve&way&of&expressing&fear&of&nega?ve& evalua?on&& •  DSM&and&clinicians&should&consider& excessiveness&in&context&of&cultural&values&& Generalized&Anxiety&Disorder& •  Life?me&rates&are&higher&for&non]La?no& Whites&than&for&Asian&American,&African& Americans,&Caribbean&Blacks&and&La?nos.&&& –  Non]La?no&whites&had&2x&the&prevalence&than&US& born&Mexican&Americans&and&over&4x&prevalence& compared&to&Mexican&immigrants&& •  Non]western&samples&(Asia,&Africa,&etc)&tend& to&show&much&lower&rates&of&GAD&than& individuals&from&European&backgrounds& Why?& ...
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  • Winter '16
  • The Culture, •  Research&supports&some&differences, •  Can&represent&an&acceptable&mode&of&distress, •  Usually&have&higher&scores&on&measures&of&anxiety&and&depression

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