Dystonia - a potential psychiatric pitfall

Article Abstract:

Dystonia is a class of movement disorders with different manifestations and can result from various causes, some of which are not well defined. The disorders generally involve sustained muscle contractions and lead to deformed postures and twisting movements. In recent years, the condition has been reevaluated, and it is more commonly viewed as a neurological disorder rather than a psychological one. The definition of dystonia and the classification of dystonic syndromes are reviewed. Classification proceeds according to age of onset, cause, and clinical distribution (ranging from local complaints to dystonias involving half or all of the body). Clinical characteristics are manifold, and diagnosis depends upon the types of distortions, movements, and other clinical features involved. Many dystonias are the consequence of antidopaminergic medication (antipsychotic drugs), prescribed to treat psychotic and other psychiatric symptoms. There are also dystonias that have no known cause. Examples of focal dystonias include torticollis (distortions of head and neck posture), blepharospasm (involuntary closure of the eyes), and writers' cramp. Generalized dystonias tend to run in families. The author claims that psychogenic dystonia is rare and represents a form of conversion hysteria. Psychiatrists should be reluctant to quickly attribute dystonia to psychological causes, based on current knowledge of the disorder. Unfortunately, little is really known about this bizarre syndrome, and as a consequence, treatments are not very effective, although high-dose anticholinergic drugs have proven somewhat useful. Since psychiatrists probably see as many patients with movement disorders as neurologists, they should be aware of current changes in thinking regarding dystonia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Care and treatment, Causes of, Identification and classification, Dystonia

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The 'new cross-cultural psychiatry': a case of the baby and the bathwater

Article Abstract:

A recent development in the field of psychiatry is cross-cultural psychiatry, which, simply put, attempts to recognize that what constitutes mental illness in one culture may be considered healthy or normal in another. While it is certainly true that culture and environment play a profound role in mental health, nevertheless a problem arises with cross-cultural psychiatry because some concepts of mental disorders have been held to be universal (in much the same way that smallpox is the same disease whether it occurs in India or England). Without some universality to its disease categories, psychiatry runs the risk of not being able to define what constitutes mental health, and therefore what constitutes appropriate therapy. In the absence of criteria that can be used outside a given culture to classify and diagnose disease entities, mentally ill people, their care and treatment, and social attitudes toward them become subject to the vagaries of sociopolitical pressures. In the development of this burgeoning field, it is important to not 'throw the baby out with the bathwater.' Cross-cultural psychiatry should utilize categorization schemes from Western biomedicine in discussing disease entities, while at the same time recognizing folk beliefs about the nature of mental health. Collaborative studies between psychiatrists, local healers, anthropologists and others are necessary for the validation of the claims and cures of cross-cultural psychiatry. In the meantime, however, research into this area that is ongoing may have validity of its own, despite the lack of a comprehensive theoretical framework with which to interpret the results. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Practice, Study and teaching, Psychiatry, Behavioral health care, Behavioral medicine, editorial, Psychiatry, Transcultural, Transcultural psychiatry

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