Witch doctors and mental illness in mainland China: a preliminary study

Article Abstract:

It is believed that witch doctors play a significant role in health care in mainland China. Located primarily in the countryside, witch doctors perform shamanistic ritual healing and intervene in the spirit world on behalf of their patients. Illnesses are explained by the actions and influences of ghosts and spirits. Although this practice is officially illegal, the authorities often tolerate this method of healing unless it results in physical injury to the patient. Few witch doctors agreed to be interviewed or would admit to their activities, which has made the gathering of any accurate data difficult. Through the patients that where seen at an outpatient psychiatric clinic over a period of about one year, the activities of local witch doctors were assessed. Three case histories of patients treated at the clinic who also had sought help from a witch doctor are reported. More than 70 percent of the patients from a rural area who were interviewed during this period had previously consulted a witch doctor. The witch doctors were primarily poorly educated peasants who practiced ritual healing on a part-time basis. Researchers noted that these results are only representative of individuals who admitted seeing a witch doctor; the actual figures are probably much higher. There is currently a serious shortage of trained mental health professionals and facilities in these rural areas. It may be concluded that most rural Chinese consult with witch doctors, which has significant public health implications. More extensive systematic studies are needed to assess to effects of this practice upon the health of the Chinese people. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, China, Psychiatric services, Mental health services, Shamans

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Neuroleptic malignant syndrome in 12 of 9,792 Chinese inpatients exposed to neuroleptics: a prospective study

Article Abstract:

Neuroleptic malignant syndrome (NMS) is a serious reaction to antipsychotic drugs (neuroleptics). The patient becomes catatonic, rigid, feverish, and experiences stupor, difficulty breathing, an unstable blood pressure, and incontinence; death occurs in 20 percent of the cases. The reaction is rare, and little is known regarding the predisposing risk factors. This report evaluated 12 cases of NMS which occurred in one psychiatric hospital in China during a seven-year period. It was estimated that over 97 percent (9,792 out of 10,080) of the patients treated in this hospital during this time period received neuroleptics. All of the 12 NMS patients were under age 40, and all but one were diagnosed as schizophrenic. The patients were on high doses of neuroleptics at the time, and eight of them were taking more than one type. None of the 2,784 patients receiving the most common high-potency oral neuroleptic, trifluoperazine, developed NMS, but patients exposed to depot fluphenazine decanoate were more than three times as likely to develop NMS. If the patients received depot fluphenazine decanoate along with an antiparkinsonian drug, the rate was 10 times as high as the overall rate. Because of the rarity of NMS, risk factors are hard to establish, and more data from multiple psychiatric centers will have to be gathered. The increased risk noted when depot fluphenazine decanoate was used may be a result of a high dose, and further study is needed. All of the patients in this study group eventually recovered completely. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drugs, Risk factors, Adverse drug reactions, Neuroleptic malignant syndrome

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Extrapyramidal symptoms due to dopamine-blocking agents in patients with AIDS encephalopathy

Article Abstract:

Brain disease (encephalopathy) with resulting psychiatric symptoms is commonly seen in AIDS patients. The psychiatric symptoms are usually treated with neuroleptic (antipsychotic) drugs. These drugs can cause serious side effects, including the tremors associated with parkinsonism. There are some indications that AIDS patients are more susceptible to the side effects of neuroleptic drugs than are other patients. To examine this issue further, the medical charts of 31 AIDS patients and 32 non-AIDS patients who had taken neuroleptic drugs for less than one month were reviewed. The mean drug dose (in chlorpromazine equivalents) given to AIDS patients was 301.1 mg per day and to non-AIDS patients was 679.4 mg per day. When doses were adjusted for weight, the means were 4.6 and 9.1 mg per kg of body weight per day, respectively. Each group was then divided into subgroups by those who received doses of less than 4 mg/kg/d and those who received more. There were 22 AIDS patients and seven non-AIDS patients in the group receiving less than 4 mg/kg/d. Extrapyramidal symptoms such as parkinsonism were noted for 11 of the 22 AIDS patients and for two of the seven non-AIDS patients. In the groups taking more than 4 mg/kg/d, seven of nine AIDS patients and 15 of 25 non-AIDS patients were seen to have extrapyramidal symptoms. Overall, AIDS patients were 2.4 times more likely to have such symptoms than non-AIDS patients. These results indicated that neuroleptic drugs should be used cautiously in the treatment of AIDS patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Drug therapy, AIDS (Disease), Encephalopathy, Extrapyramidal disorders

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