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S48 F. Napo et al. / European Psychiatry 27 (2012) / supplement n°2 / S44-S49 isolation, stigmatisation and social exclusion of psychiatric patients. In fact, social isolation may further augment mental disorders: Makanjoula and Olaifa (1987) reported in their study on negative mood states among Nigerians that “depression in particular, may be then considered both as a reaction to the loss of the position of the subject in the group to which the person belongs and as a reaction to the threat of a catastrophe” [27]. Prof. Baba Koumaré, the head of the department, explained that the existence of beliefs in external evil agents enables patients e.g. suffering from major depression to externalize their feelings of guilt and shame and thus to blame evil outside agents for their suffering, which then may be misdiagnosed by psychiatrists as paranoia or a psychotic rather than an affective disorder. On the other hand, a salutogenetic perspective emphasizes mechanisms that facilitate “resistance to psychotic symptoms”: external agents can evoke “self resistance” and power of the patient. It appears that the attribution of misery and pain to external agents also mobilizes group and family support. Explanatory models and concepts that are supported by a common belief may thus facilitate that the patient and accompanying family work together against the perceived threat. The interviewed experts also suggested that the apparent resistance of their patients against a perceived “external source causing illness” can reduce suicidal tendencies. A common enemy which often appears in the role of an “outsider” to the family clan may thus strengthen or reunite the family bond. The Malian experts emphasized that professionals should not deny the cultural influence on illness concepts and rather integrate traditional and local explanatory models of suffering as an important resource for the therapeutic treatment for the patients. This includes respect for traditional ways to heal mental illness, which were explicitely named by all patients as a necessary step for recovery. Altogether, our study underlines the importance of a culturally sensitive diagnostic process and of strengthening family bonds and social inclusion. Regularly involving relatives in a communal psychiatric setting offers an important perspective of integrating and transforming the subjective conceptions of patients suffering from psychotic symptoms. This African treatment perspective includes systematic approaches as well as transculturally relevant aspects and focuses on the resilience of patients and their families within a practical, salutogenetic approach. Confl ict of interest statement None. References [1] Antonovsky A. Gesundheitsforschung versus Krankheitsforschung. In A. Franke & M. Broda (Editors), Psychosomatische Gesundheit. Versuch einer Abkehr von Pathogenese- Konzept Tübingen: DGVT- Verlag, 1993;3- 14 [2] Bleuler E. Dementia praecox oder die Gruppe der Schizophrenien. Berlin: Springer; 1911 [3] Blumhagen D. On the nature of explanatory models. In Reidel R.(Editors) Culture, Medecine and Psychiatry Dordrecht,Holland, and Boston,U.S.A:R Publishing, 1981;5. 337- 37. [4] Bhui K, Bhugra D. Explanatory models for mental distress:implications for clinical practice and research. Brit J Psychiatry 2002;181:6- 7. [5] Callan A, Littlewood R. Patient satisfaction: ethnic origin or explanatory model? International Journal of Social Psychiatry 1998:44. [6] Carothers JC. Frontal lobe function and the African. J MentSci 1951;97:122- 48. [7] Cochrane R, Bal S. Mental hospital admission of 1971 and 1981. Soc Psychiatry 1989;24:2- 11. 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Berlin: Springer Verlag, 2004;45- 153. [13] Hardon A, Hodgkin C, Fresle D. How to investigate the use of medicines by consumers.World Health Organization and University of Amsterdam 2004;1- 69. [14] Hardon et al. Analysis of qualitative data.in. Applied health research manual: Antropology of health care. Amsterdam, Het Spinhuis. 2001 [15] Heinz A. Colonial practices in the construction of the schizophrenic patient as primitive man. Critique of Anthropology, 1998;18:421- 44. [16] Heinz A. Die Konzeptionen des „Selbst“ im kulturellen Vergleich. In Wohlfahrt E, Zaumseil M. (Editors), Transkulturelle Psychiatrie- Interkulturelle Psychotherapi.e. Interdisziplinäre Theorie und Praxis. Berlin: Springer Verlag, 2006;387- 90. [17] Inem VA, Ayankogbe OO, Obazee EM, Ladipo MMA, Udonwa NE, Odusote K. Conceptual and contextual paradigm of the family as a unit of care. Nig Med Pract 2004;45(1):9- 12. [18] Kahraman B. Die kultursensible Therapiebeziehung: Störungen und Lösungsansätze am Beispiel türkischer Klienten. Gießen: Psychosozialverlag, 2000;45- 6. [19] Kleinman A, Eisenberg L, Good B. Culture, illness, and care: clinical lessons from anthropological and cross- cultural research. Ann Intern Med 1978;88:251–88. [20] Kleinman A. Rethinking Psychiatry: from Cultural Category to Personal Experience. New York: Free Press, 1988:256. [21] Kleinman A. Patient and healers in the context of culture.An Exploration of the borderland between Anthropology, Medicine, and Psychiatry. Berkeley, Los Angeles, London: University of California press; 1980. [22] Kora K, Özek M, Baral I. Ein Beitrag zum Thema der wahnhaften Depressionen (mit Fallbeispielen aus der Türkei ). In Koch E, Özek M, Pfeiffer WM, Schepker R. Chancen und Risiken von Migration- Deutschtürkische Perspektiven. Freiburg: Lambertus; 1998. [23] Koumare B, Coudray J P& Miguel- Garcia E. Der psychiatrische Dienst in Mali. 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[31] Mayring P. Qualitative Inhaltsanalyse. In Flick, U., Kardorff, E.v. & Steinke, I. (Editors), Qualitative Forschung: Ein Handbuch Reinbek: Rohwohlt; 2000;468- 75. [32] Napo F. Eine afrikanische Perspektive der Psychologi.e. Saarbrücken: Vdm Verlag, 2008. [33] Ohaeri JU, Oedjide A. Somatization symptoms among Patients using primary health facilities in a rural community in Nigeria.Am J Psychiatry 1994;151:728- 31. [34] Patel V. Explanatory models of mental illness in sub- Saharan Africa. Social Science Medicine1995;40:1291- 8. [35] Ritter R, Chaudhry HR, Aigner M, Zitterl W, Stompe T. Subjektive Krankheitsmodelle zwischen spezifi scher Krankheitserfahrung und Kultur. Neuropsychiatr 2010;24:33- 41. [36] Sartorins N, Jablensky A, Korten A, et al. Early manifestation and fi rst- contact incidence of schizophrenia in different cultures. A preliminary report on the initial evaluation phase of the WHO Collaboration study on determinates of the outcome of severe mental disorders. Psychol Med 1986;16(4):909-28. F. Napo et al. / European Psychiatry 27 (2012) / supplement n°2 / S44-S49 S49 [37] Schneider K. Klinische Psychopathologie Stuttgart New York: Thieme 1992:471- 80. [38] Stehphen M, Adebimpe MD. et al. Ethnicity and Diagnosis in Patients with Affective Disorders. J Clin Psychiatry 2003; 64:747- 57. [39] Weiss MG, Sarna SD, Gaur RK, Sharma JS, Desai A, Doongaji DR. Traditional concepts of mental disorder among Indian psychiatric patients: Preliminary report of work in progress. Soc Sci Med 1986;23:379- 86. [40] Weiss M. Explanatory Model Interview Catalogue(Emic):framework for comparative study of illness. Transcultural Psychiatry 1997;34:235- 63. [41] Williams B, Healy D. Perceptions of illness causation among new refeerrals to a communtity mental health team:explanatory model or explanatory map? Social Science and Medecine 2001;53:465- 76. [42] Witzel A. Das Problemzentrierte Interview. In G. H. Jüttemann (Editors), Qualitative Forschung in der Psychologie Weinheim: Beltz 1985;227- 52. [43] Wohlfart E, Kluge U & Napo F. Ethnopsychiatrische Differentialdiagnostik psychotischer Phänomene. Zeitschrift für Medizinische Soziologie 2009;(18):140- 50. Proofs 08_Napo.indd S49 14/06/2012 14:44:50
Page 1 and 2: 68767 EUROPEAN PSYCHIATRY THE JOURN
Page 3 and 4: Vol. 27, Supplement n°2, June 2012
Page 5 and 6: Editorial © 2012 Elsevier Masson S
Page 7 and 8: health of Turkish woman in Germany:
Page 9 and 10: studies [8,6,27]. Commonly suggeste
Page 11 and 12: lack of desire to obtain an educati
Page 13 and 14: the study should be emphasised [4,1
Page 15 and 16: clear is the picture regarding depr
Page 17 and 18: SD=15.9; t(183)= - 2.575; p=.011).
Page 19 and 20: as caring for children and taking c
Page 21 and 22: © 2012 Elsevier Masson SAS. All ri
Page 23 and 24: were then scrutinized independently
Page 25 and 26: [6] Berry J, Kim U. Acculturation a
Page 27 and 28: A. Heredia Montesinos et al. / Euro
Page 29 and 30: 3.2. Interrelations of stigma, depr
Page 33 and 34: F. Mammadova et al. / European Psyc
Page 35 and 36: [17] Su KP, Chiu TH, Huang CL, et a
Page 37 and 38: society, history (slavery and colon
Page 39 and 40: That the model is false suggests th
Page 41 and 42: 6. Ego disorders in psychosis - tra
Page 43 and 44: In this state, socially unaccepted
Page 45 and 46: generating a model of the self with
Page 47 and 48: Acknowledgements This work was supp
Page 49 and 50: to Kleinman, explanatory models con
Page 51: categories was performed very caref
Page 55 and 56: patients (often with lower social s
Page 57 and 58: are listed by Turkish immigrants in
Page 59 and 60: [19] Schnegg M, Lang H. Die Analyse
Page 61 and 62: 1. Introduction The number of immig
Page 63 and 64: on the availability of service usag
Page 65 and 66: Studies in some European countries
Page 69 and 70: our study, we composed an assessmen
Page 71 and 72: With regard to content, the pilot a
Page 73 and 74: Acknowledgments We are very gratefu
Page 75 and 76: cross- cultural mental health train
Page 77 and 78: 3.3.2. German experiences Despite t
Page 79 and 80: [31] Mösko M, Gil- Martinez F, Sch
Page 81 and 82: 2. Psychosocial care as a necessary
Page 83 and 84: * First Rank Symptoms according to
Page 85 and 86: Epilogue A. Kleinman Esther and Syd
Page 87 and 88: Proofs

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