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PSYCHIATRIC DIAGNOSIS IN DEVELOPING COUNTRIES 273 dependency on only one cultural tradition, i.e. European, will make it possible for mental health professionals of other cultures to contribute more effectively to psychiatric research. The overall goal should be the one summarized by Mezzich et al. [86]: The developments of comprehensive diagnostic modes and regional adaptations of ICD-10 reveal the ebullience of the diagnostic field, especially when appraised from a broad international perspective. It seems likely that the ongoing tension between universality and diversity in diagnostic systems will continue to yield innovative solutions. Emerging proposals are increasingly involving integrated assessments of health status and according pointed attention to the ethical requirements of psychological diagnosis. These proposals must be carefully formulated and thoughtfully and widely evaluated if they are to contribute effectively to the fulfilment of diagnosis as a conceptual and practical tool for clinical care, health promotion and epidemiology. These are the challenges and opportunities for the future development of psychiatric classification in developing countries. REFERENCES 1. Martinez C., Marlin H.W. 1966) Folk diseases among urban Mexican-Americans. JAMA, 196: 147±150. 2. Barlett P., Low S. 1980) Nervios in rural Costa Rica. Med. Anthropology, 4: 523±529. 3. Rubel A.J., O'Nell C.W., Collado-Ardon R. 1984) Susto, a Folk Illness. University of California Press, Berkeley. 4. Saeed K., Gater R., Hussain A., Mubbashar M. 2000) The prevalence, classification and treatment of mental disorders among attenders of native faith healers in rural Pakistan. Soc. Psychiatry Psychiatr. Epidemiol., 35: 480±485. 5. Wig N.N. 1990) Indian concepts of mental health and their impact on care of the mentally ill. Int. J. Ment. Health, 18: 71±80. 6. Mora G. 1980) Historical and theoretical trends in psychiatry. In Comprehensive Textbook of Psychiatry, 3rd edn Eds H.I. Kaplan, A.M. Freedman, B.J. Sadock), pp. 4±98. Williams and Wilkins. Philadelphia. 7. Weiss M.G., Desai A., Jadhav S., Gupta L., Channabasavanna S.M., Doongaji D.R., Behere P.B. 1988) Humoral concepts of mental illness in India. Soc. Sci. Med., 27: 471±477. 8. Dube K.C. 1978) Nosology and therapy of mental illness in Ayurveda. Comp. Med. East West, 6: 209±228. 9. Deb Sikdar B.M. 1961) Glimpses of medico-psychological practices in ancient India. Ind. J. Psychiatry, 11: 250±259. 10. Varma L.P. 1965) Psychiatry in Ayurveda. Ind. J. Psychiatry, 7: 292±312. 11. Narayana Reddy G.N., Ramu M.G., Venkataram B.S. 1987) Concept of manas psyche) in Ayurveda. NIMHANS J., 5: 125±131. 12. Balodhi J.P. 1987) Constituting the outlines of a philosophy of AyurvedaÐ mainly on mental health import. Ind. J. Psychiatry, 29: 127±130. 13. Graziani J.S. 1980) Arabic Medicine in the Eleventh Century as Represented in the Works of Ibn Jazlah. Hamdard Academy, Karachi.
274 PSYCHIATRIC DIAGNOSIS AND CLASSIFICATION 14. Lambo T.A. 1965) Psychiatry in the tropics. Lancet, ii: 1119±1121. 15. Lambo T.A. 1971) The African mind in contemporary conflict. WHO Chron., 25: 343±353. 16. Ko S.M., Tsoi W.F. 1991) New admissions to psychiatric wards in a general hospital. Ann. Acad. Med. Singapore, 20: 204±207. 17. Tsoi W.F. 1993) First admission schizophrenia: clinical manifestation and subtypes. Singapore Med. J., 34: 399±402. 18. Erinosho O.A. 1977) Mental health delivery-systems and post treatment performance in Nigeria. Acta Psychiatr. Scand., 55: 1±9. 19. Binite A. 1981) Psychiatric disorders in a rural practice in the Bendel State of Nigeria. Acta Psychiatr. Scand., 64: 273±280. 20. Ebigbo P.O. 1982) Development of a culture specific Nigeria) screening scale of somatic complaints indicating psychiatric disturbances. Cult. Med. Psychiatry, 6: 29±43. 21. Oyarebu K. 1980) Diagnostic and demographic classification of psychiatric patients admission in Bendel state of Nigeria. A review of the University of Benin Teaching Hospital UBTH) psychiatric inpatients' record of 1980. Acta Psychiatr. Belg., 83: 501±508. 22. Gureje O., Bamidele R. 1999) Thirteen year outcome among Nigerian outpatients with schizophrenia. Soc. Psychiatry Psychiatr. Epidemiol., 34: 147±151. 23. Hartog J. 1973) Ninety-sixMalay psychiatric patientsÐcharacteristics and preliminary epidemiology. Int. J. Soc. Psychiatry, 19: 49±59. 24. Matuja W.P., Ndosi N.K., Collins M. 1995) Nature of referrals to the psychiatric unit at Muhibili Medical Centre, Dar es Salaam. East Afr. Med. J., 72: 761±765. 25. Avasthi A., Khan M.K.R., Elroey A.M. 1991) Inpatient sociodemographic and diagnostic study from a psychiatric hospital in Libya. Int. J. Soc. Psychiatry, 37: 267±279. 26. Turkson S.N. 1998) Psychiatric diagnosis among referred patients in Ghana. East Afr. Med. J., 75: 336±338. 27. Johnson F.Y. 1997) Ward SixPsychiatric Unit at the Port Moresby General Hospital: a historical review and admission statistics from 1980 to 1989. P.N.G. Med. J., 40: 79±88. 28. Saxena S., Nepal M.K., Mohan D. 1988) DSM-III Axis I diagnosis of Indian psychiatric patients with somatic complaints. Am. J. Psychiatry, 145: 1023±1024. 29. Saxena S., Wig N.N. 1983) Psychiatric problems of Afghan refugees in Delhi: a study of 152 outpatients. Ind. J. Psychiatry, 25: 40±45. 30. Saxena S. 1989) Diagnosis of refugees. Am. J. Psychiatry, 146: 410±411. 31. Saxena S., Prasad K.V. 1989) DSM-III sub-classification of dissociative disorders applied to psychiatric outpatients in India. Am. J. Psychiatry, 146: 261±262. 32. Sethi S., Khanna S. 1993) Phenomenology of mania in eastern India. Psychopathology, 26: 274±278. 33. Patel V., Musara T., Butau T., Maramba P., Fuyane S. 1995) Concepts of mental illness and medical pluralism in Harare. Psychol. Med., 25: 485±493. 34. Keegstra H.J. 1986) Depressive disorders in Ethiopia. A standardised assessment using the SADD schedule. Acta Psychiatr. Scand., 73: 658±664. 35. Kortmann F. 1988) DSM-III in Ethiopia: a feasibility study. Eur. Arch. Psychiatry Clin. Neurosci., 237: 101±105. 36. Skodol A.E., Schwartz S., Dohrenwend B.P., Levav I., Shrout P.E. 1994) Minor depression in a cohort of young adults in Israel. Arch. Gen. Psychiatry, 51: 542±551.
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PREFACE xi world who are interested
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2 PSYCHIATRIC DIAGNOSIS AND CLASSIF
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10 PSYCHIATRIC DIAGNOSIS AND CLASSI
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IMPLICATIONS OF COMORBIDITY 81 Fina
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IMPLICATIONS OF COMORBIDITY 85 leve
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IMPLICATIONS OF COMORBIDITY 87 ledg
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Table 4.2 Matrix of levels and subl
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IMPLICATIONS OF COMORBIDITY 91 unde
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IMPLICATIONS OF COMORBIDITY 93 Tabl
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IMPLICATIONS OF COMORBIDITY 99 Tabl
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IMPLICATIONS OF COMORBIDITY 105 52.
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108 PSYCHIATRIC DIAGNOSIS AND CLASS
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THE ROLE OF PHENOMENOLOGY IN PSYCHI
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MULTIAXIAL DIAGNOSIS IN PSYCHIATRY
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CLINICAL ASSESSMENT INSTRUMENTS IN
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