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Resolving acute bipolar mood episodes is only one part of an overall strategy for treating bipolar disorder. Successful prevention of mood episode relapse, particularly bipolar depressive episodes, through effective continuation and maintenance therapies can greatly improve patient functioning and outcomes. Little evidence is available to guide decisions on the treatment of bipolar depression, especially in the maintenance phase, and additional research into effective options is urgently needed. General strategies for treating patients with bipolar disorder include continuing the acute pharmacotherapeutic regimen into the maintenance phase and considering tolerability.
From our regular book review column.
Interviewing Clients Across Cultures: A Practitioner's Guide
Letter to the Editor
The Impact of Ethnicity on Metabolic Outcomes During Treatment With Antipsychotics: Complexities Abound
Because this piece has no abstract, we have provided for your benefit the first 3 sentences of the full text.
Kate Loewenthal, Professor of Psychology at RoyalHolloway, University of London, is the author of numerous articlesdealing with religion and mental health. In the presentwork, she brings credibility, balance, and clarity to the subject,anchored in genuine scholarship. The book's brevity (141 pagesof text) belies the richness of the source material, much of it recent,that she taps for her discussion.' ‹
A Clinical Manual of Cultural Psychiatry
Objective: Published results from a U.S. study of depressed suicide attempters and a Madrid, Spain, study including all consecutively admitted suicide attempters suggested that aggression scores were higher in U.S. attempters. This observation led us to compare depressed attempters and controls from both suicide research centers and explore whether New York City (NYC) patients carry out suicidal acts of greater lethality than patients in Madrid. The study goals were (1) to compare aggression scores in attempters and healthy volunteers between the 2 cities and (2) to determine whether higher aggression scores are associated with greater medical lethality of suicide attempts.
Method: The respective samples from NYC and Madrid included attempters with a DSM-IV diagnosis of major depressive disorder (N = 117 and N = 133) and healthy controls (N = 90 and N = 317). Aggression scores, measured by the Brown-Goodwin Scale, in attempters and healthy volunteers from both sites were compared using an analysis of variance model. The relationship between lethality of suicidal acts and aggression scores in attempters was assessed using logistic regression analyses. NYC subjects were recruited from 1998 to 2001, and Madrid subjects were selected from consecutive admissions in 1999.
Results: Depressed suicide attempters from NYC made attempts of greater lethality and reported more lifetime aggressive behavior than depressed attempters in Madrid. NYC healthy volunteers also reported more aggression than their Madrid counterparts.
Conclusions: This pilot study suggests that the greater lethality of suicidal behavior in NYC compared to Madrid is related to higher aggression levels, although the data have limitations. Cross-cultural studies are needed to verify whether aggression and higher lethality suicide attempts share a common diathesis explaining the higher suicide rates in NYC.
The Asian tsunami on December 26, 2004, has had a profound impact on the mental health of largenumbers of people in several South Asian nations. Many psychological interventions with relevanceto this disaster have been shown to be effective in a Western context. For these psychological interventionsto prove effective in the tsunami-affected regions, they must be understood and accepted byhealth-care practitioners and patients in their individual cultural settings and must be adapted to thesesettings on the basis of careful dialogue between health-care professionals, community and religiousleaders, and patients. Religious, socioeconomic, and other cultural influences all affect the acceptabilityand success of various psychological assessment and treatment tools. The cultural specificityof these tools needs careful validation in the tsunami-affected countries. The challenge in each localsituation is to find the optimal means of adapting tools such as cognitive-behavioral therapy into appropriatestrategies for local communities. We advocate a culturally sensitive approach to ensure thatthe impact of interventions is optimized to benefit the communities recovering from such a traumaticdisaster.
Objective: This study examined the risk of lifetime substance use disorders and mood and anxiety disorders between Island-born Puerto Ricans, foreign-born Cuban Americans, and foreign-born non-Latino whites and their U.S.-born counterparts.
Method: Data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N = 43,093) were used to derive lifetime prevalence rates of specific DSM-IV psychiatric disorders by subethnicity and nativity group. Logistic regression models were constructed to detect variation in the odds of each psychiatric disorder across groups.
Results: A protective effect of foreign-born nativity in risk for psychiatric disorders was present for all groups but varied according to the assessed disorder. For non-Latino whites, the effect was observed for most specific psychiatric disorders, whereas, for Puerto Ricans and Cuban Americans, the effect was only evident for specific substance use disorders.
Conclusion: The protective effect of nativity against psychiatric morbidity found in other studies among Mexican Americans and non-Latino whites does not entirely generalize to Puerto Ricans and Cuban Americans and may not generalize to individuals of other origins. The results of this study are discussed in terms of potential mechanisms involved in variations in the risk of specific psychiatric disorders among groups defined by nativity and race-ethnicity and the importance of identifying specific cultural components that may serve as risk and protective factors of psychiatric morbidity.
Objective: We assessed clinical, demographic, and cognitive predictors of everyday functioning in Mexican American and Anglo-American outpatients with schizophrenia.
Method: Three groups of participants aged 40 years and over with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder were compared: 79 Anglo-Americans, 24 Mexican American patients who chose to be tested in English, and 33 Mexican American patients who preferred Spanish. The study was conducted from October 2001 to July 2004.
Results: On demographic, clinical, cognitive, and functional measures, Anglo-American participants were generally similar to Mexican American participants who opted for being tested in English. Mexican American participants who preferred Spanish were significantly different from the other 2 groups on several measures, including everyday functioning performance. To determine the predictors of everyday functioning, separate regression analyses were conducted for each of the 3 groups. Cognitive ability consistently accounted for the greatest proportion of variance in performance regardless of ethnicity, language preference, or education. Among the Mexican American participants, level of acculturation was the second strongest predictor of everyday functioning when the group was examined as a whole; however, acculturation was not a significant predictor when controlling for language preference.
Conclusion: Cognitive performance and language preference (a proxy for acculturation) may play a particularly important role in predicting ability to perform everyday tasks. Further studies to better understand the potential impact of ethnicity, culture, education, and language on everyday functioning may help develop more specific and culture-sensitive intervention strategies for different ethnic groups.
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