What is Culture-Bound Syndrome?


In medicine and medical anthropology, a culture-bound syndrome, culture-specific syndrome, or folk illness is a combination of psychiatric and somatic symptoms that are considered to be a recognisable disease only within a specific society or culture.

There are no objective biochemical or structural alterations of body organs or functions, and the disease is not recognized in other cultures. The term culture-bound syndrome was included in the fourth version of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) which also includes a list of the most common culture-bound conditions (DSM-IV: Appendix I). Counterpart within the framework of ICD-10 (Chapter V) are the culture-specific disorders defined in Annex 2 of the Diagnostic criteria for research.

More broadly, an endemic that can be attributed to certain behaviour patterns within a specific culture by suggestion may be referred to as a potential behavioural epidemic. As in the cases of drug use, or alcohol and smoking abuses, transmission can be determined by communal reinforcement and person-to-person interactions. On etiological grounds, it can be difficult to distinguish the causal contribution of culture upon disease from other environmental factors such as toxicity.


A culture-specific syndrome is characterised by:

  • Categorisation as a disease in the culture (i.e. not a voluntary behaviour or false claim);
  • Widespread familiarity in the culture;
  • Complete lack of familiarity or misunderstanding of the condition to people in other cultures;
  • No objectively demonstrable biochemical or tissue abnormalities (signs); and
  • The condition is usually recognised and treated by the folk medicine of the culture.

Some culture-specific syndromes involve somatic symptoms (pain or disturbed function of a body part), while others are purely behavioural. Some culture-bound syndromes appear with similar features in several cultures, but with locally specific traits, such as penis panics.

A culture-specific syndrome is not the same as a geographically localised disease with specific, identifiable, causal tissue abnormalities, such as kuru or sleeping sickness, or genetic conditions limited to certain populations. It is possible that a condition originally assumed to be a culture-bound behavioural syndrome is found to have a biological cause; from a medical perspective it would then be redefined into another nosological category.

Medical Perspectives

The American Psychiatric Association states the following:

The term culture-bound syndrome denotes recurrent, locality-specific patterns of aberrant behavior and troubling experience that may or may not be linked to a particular DSM-IV diagnostic category. Many of these patterns are indigenously considered to be “illnesses,” or at least afflictions, and most have local names. Although presentations conforming to the major DSM-IV categories can be found throughout the world, the particular symptoms, course, and social response are very often influenced by local cultural factors. In contrast, culture-bound syndromes are generally limited to specific societies or culture areas and are localized, folk, diagnostic categories that frame coherent meanings for certain repetitive, patterned, and troubling sets of experiences and observations.

The term culture-bound syndrome is controversial since it reflects the different opinions of anthropologists and psychiatrists. Anthropologists have a tendency to emphasize the relativistic and culture-specific dimensions of the syndromes, while physicians tend to emphasize the universal and neuropsychological dimensions. Guarnaccia & Rogler (1999) have argued in favour of investigating culture-bound syndromes on their own terms, and believe that the syndromes have enough cultural integrity to be treated as independent objects of research.

Guarnaccia and Rogler demonstrate the issues that occur when diagnosing cultural bound disorders using the DSM-IV. One of the key problems that arise is the “subsumption of culture bound syndromes into psychiatric categories”, which ultimately creates a medical hegemony and places the western perspective above that of other cultural and epistemological explanations of disease. The urgency for further investigation or reconsideration of the DSM-IV’s authoritative power is emphasized, as the DSM becomes an international document for research and medical systems abroad. Guarnaccia and Rogler provide two research questions that must be considered, “firstly, how much do we know about the culture-bound syndromes for us to be able to fit them into standard classification; and secondly, whether such a standard and exhaustive classification in fact exists”.

It is suggested that the problematic nature of the DSM becomes evident when we view it as definitively conclusive. Questions are raised to whether culture-bound syndromes can be treated as discrete entities, or whether their symptoms are generalised and perceived as an amalgamation of previously diagnosed illnesses. If this is the case, then the DSM may be what Bruno Latour would defined as “particular universalism”. In that the Western medical system views itself to have a privileged insight into the true intelligence of nature, in contrast to the model provided by other cultural perspectives.

Some studies suggest that culture-bound syndromes represent an acceptable way within a specific culture (and cultural context) among certain vulnerable individuals (i.e. an ataque de nervios at a funeral in Puerto Rico) to express distress in the wake of a traumatic experience. A similar manifestation of distress when displaced into a North American medical culture may lead to a very different, even adverse outcome for a given individual and his or her family. The history and etymology of some syndromes such as Brain-Fog Syndrome, have also been reattributed to 19th century Victorian Britain rather than West Africa.

In 2013, the DSM 5, dropped the term culture-bound syndrome, preferring the new name “Cultural Concepts of Distress”.

Cultural Collusion Between Medical Perspectives

Within the traditional Hmong culture, epilepsy (qaug dab peg) directly translates to “the spirit catches you and you fall down” which is said to be an evil spirit called a dab that captures your soul and makes you ill. In this culture, individuals with seizures are seen to be blessed with a gift; an access point into the spiritual realm which no one else has been given. In westernised society, epilepsy is considered a serious long-term brain condition, that can have a major impairment on an individual’s life. The way the illness is dealt with in Hmong culture is vastly different due to the high-status epilepsy has amongst the culture, compared to individuals who have the condition in westernised societies. Individuals with epilepsy within the Hmong culture are a source of pride for their family.

Another culture bound illness is neurasthenia which is a vaguely described medical ailment in Chinese culture that presents as lassitude, weariness, headaches, and irritability and is mostly linked to emotional disturbance. A report done in 1942 showed that 87% of patients diagnosed by Chinese psychiatrists as having neurasthenia could be reclassified as having major depression according to the DSM-3 criteria. Another study conducted in Hong Kong showed that most patients selectively presented their symptoms according to what they perceived as appropriate and tended to only focus on somatic suffering, rather than the emotional problems they were facing.


Globalisation is a process whereby information, cultures, jobs, goods, and services are spread across national borders. This has had a powerful impact on the 21st century in many ways including through enriching cultural awareness across the globe. Greater level of cultural integration is occurring due to rapid industrialisation and globalisation, with cultures absorbing more influences from each other. As cultural awareness begins to increase between countries, there is a consideration into whether cultural bound syndromes will slowly lose their geographically bound nature and become commonly known syndromes that will then become internationally recognised. Anthropologist and psychiatrist Roland Littlewood makes the observation that these diseases are likely to vanish in an increasingly homogenous global culture in the face of globalisation (and industrialisation). Depression for example, was once only accepted in western societies, however it is now recognised as a mental disorder in all parts of the world. In contrast to Eastern civilisations such as Taiwan, depression is still much more common in Western cultures like the United States. This could indicate that globalisation may have an impact on allowing disorders to be spread across borders, however these disorders may remain predominant in certain cultures.


The fourth edition of Diagnostic and Statistical Manual of Mental Disorders classifies the below syndromes as culture-bound syndromes.

NameGeographical Localisation/Population(s)
Running AmokBrunei, Singapore, Malaysia, Indonesia, Philippines, Timor-Leste
Ataque de NerviosHispanophone, as well as in the Philippines where it is known as “nervous breakdown”
Bilis, CóleraLatinos
Bouffée DéliranteFrance and French-speaking countries
Brain Fag SyndromeWest African students
Dhat SyndromeIndia
Falling-Out, Blacking OutSouthern United States and Caribbean
Ghost SicknessNative American (Navajo, Muscogee/Creek)
KoroChinese, Malaysian and Indonesian populations in Southeast Asia; Assam; occasionally in the West
LatahMalaysia and Indonesia, as well as the Philippines (as mali-mali, particularly among Tagalogs)
LocuraLatinos in the United States and Latin America
Mal de PeleaPuerto Rico
NerviosLatin America, Latinos in the United States, Philippines
Evil EyeMediterranean; Hispanic populations and Ethiopia
PibloktoArctic and subarctic Inuit populations
Zou huo ru mo
(Qigong Psychotic Reaction)
Han Chinese
RootworkSouthern United States, Caribbean nations
Sangue DormidoPortuguese populations in Cape Verde
Shenjing ShuairuoHan Chinese
Shenkui, shen-kʼueiHan Chinese
SpellAfrican American, White populations in the southern United States and Ethiopia
SustoLatinos in the United States; Mexico, Central America and South America
Taijin KyofushoJapanese
ZārEthiopia, Somalia, Egypt, Sudan, Iran, and other North African and Middle Eastern societies

DSM-5 List

The fifth edition of Diagnostic and Statistical Manual of Mental Disorders classifies the below syndromes as cultural concepts of distress, a closely related concept.

NameGeographical Localisation/Population(s)
Ataque de NerviosHispanophone, as well as in the Philippines
Dhat SyndromeIndia
Khyâl CapCambodian
Ghost SicknessNative American
Maladi MounHaiti
NerviosLatin America, Latinos in the US
Shenjing ShuairuoHan Chinese
SustoLatinos in the US, Mexico, Central America and South America
Taijin KyofushoJapanese

ICD-10 List

NameGeographical Localisation/Population(s)
AmokSoutheast Asian Austronesians
Dhat Syndrome (Dhātu), Shen-kʼuei, JiryanIndia and Taiwan
Koro, Suk Yeong, Jinjin BemarSoutheast Asia, India, and China
LatahMalaysia and Indonesia
Nervios, Nerfiza, Nerves, NevraEgypt; Greece; northern Europe; Mexico, Central and South America
Pa-leng (Frigophobia)Taiwan and Southeast Asia
Pibloktoq (Arctic Hysteria)Inuit living within the Arctic Circle
Susto, EspantoMexico, Central and South America
Taijin Kyofusho, Shinkeishitsu (Anthropophobia)Japan
Ufufuyane, SakaKenya, Southern Africa (among Bantu, Zulu, and affiliated groups)
UqamairineqInuit living within the Arctic Circle
Fear of WindigoIndigenous people of Northeast America

Other Examples

Though “the ethnocentric bias of Euro-American psychiatrists has led to the idea that culture-bound syndromes are confined to non-Western cultures”, a prominent example of a Western culture-bound syndrome is anorexia nervosa.

Within the contiguous US, the consumption of kaolin, a type of clay, has been proposed as a culture-bound syndrome observed in African Americans in the rural south, particularly in areas in which the mining of kaolin is common.

In South Africa, among the Xhosa people, the syndrome of amafufunyana is commonly used to describe those believed to be possessed by demons or other malevolent spirits. Traditional healers in the culture usually perform exorcisms in order to drive off these spirits. Upon investigating the phenomenon, researchers found that many of the people claimed to be affected by the syndrome exhibited the traits and characteristics of schizophrenia.

Some researchers have suggested that both premenstrual syndrome (PMS) and the more severe premenstrual dysphoric disorder (PMDD), which have currently unknown physical mechanisms, are Western culture-bound syndromes. However, this is controversial.

Tarantism is an expression of mass psychogenic illness documented in Southern Italy since the 11th century.

Morgellons is a rare self-diagnosed skin condition reported primarily in white populations in the US. It has been described by a journalist as “a socially transmitted disease over the Internet”.

Vegetative-vascular dystonia can be considered an example of somatic condition formally recognised by local medical communities in former Soviet Union countries, but not in Western classification systems. Its umbrella term nature as neurological condition also results in diagnosing neurotic patients as neurological ones, in effect substituting possible psychiatric stigma with culture-bound syndrome disguised as a neurological condition.

Refugee children in Sweden have been known to fall into coma-like states on learning their families will be deported. The condition, known in Swedish as uppgivenhetssyndrom, or resignation syndrome, is believed to only exist among the refugee population in Sweden, where it has been prevalent since the early part of the 21st century. In a 130-page report on the condition commissioned by the government and published in 2006, a team of psychologists, political scientists, and sociologists hypothesized that it was a culture-bound syndrome.

A startle disorder similar to latah, called imu (sometimes spelled imu:), is found among Ainu people, both Sakhalin Ainu and Hokkaido Ainu.

A condition similar to piblokto, called menerik (sometimes meryachenie), is found among Yakuts, Yukaghirs, and Evenks living in Siberia.

The trance-like violent behaviour of the Viking age berserkers – behaviour that disappeared with the arrival of Christianity – has been described as a culture-bound syndrome.

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What is the Biopsychiatry Controversy?


The biopsychiatry controversy is a dispute over which viewpoint should predominate and form a basis of psychiatric theory and practice.

The debate is a criticism of a claimed strict biological view of psychiatric thinking. Its critics include disparate groups such as the antipsychiatry movement and some academics.

Overview of Opposition to Biopsychiatry

Biological psychiatry or biopsychiatry aims to investigate determinants of mental disorders devising remedial measures of a primarily somatic nature.

This has been criticised by Alvin Pam for being a “stilted, unidimensional, and mechanistic world-view”, so that subsequent “research in psychiatry has been geared toward discovering which aberrant genetic or neurophysiological factors underlie and cause social deviance”. According to Pam the “blame the body” approach, which typically offers medication for mental distress, shifts the focus from disturbed behaviour in the family to putative biochemical imbalances.

Research Issues

2003 Status in Biopsychiatric Research

Biopsychiatric research has produced reproducible abnormalities of brain structure and function, and a strong genetic component for a number of psychiatric disorders (although the latter has never been shown to be causative, merely correlative). It has also elucidated some of the mechanisms of action of medications that are effective in treating some of these disorders. Still, by their own admission, this research has not progressed to the stage that they can identify clear biomarkers of these disorders.

Research has shown that serious neurobiological disorders such as schizophrenia reveal reproducible abnormalities of brain structure (such as ventricular enlargement) and function. Compelling evidence exists that disorders including schizophrenia, bipolar disorder, and autism to name a few have a strong genetic component. Still, brain science has not advanced to the point where scientists or clinicians can point to readily discernible pathologic lesions or genetic abnormalities that in and of themselves serve as reliable or predictive biomarkers of a given mental disorder or mental disorders as a group. Ultimately, no gross anatomical lesion such as a tumour may ever be found; rather, mental disorders will likely be proven to represent disorders of intercellular communication; or of disrupted neural circuitry. Research already has elucidated some of the mechanisms of action of medications that are effective for depression, schizophrenia, anxiety, attention deficit, and cognitive disorders such as Alzheimer’s disease. These medications clearly exert influence on specific neurotransmitters, naturally occurring brain chemicals that effect, or regulate, communication between neurons in regions of the brain that control mood, complex reasoning, anxiety, and cognition. In 1970, The Nobel Prize was awarded to Julius Axelrod, Ph.D., of the National Institute of Mental Health, for his discovery of how anti-depressant medications regulate the availability of neurotransmitters such as norepinephrine in the synapses, or gaps, between nerve cells. (American Psychiatric Association, Statement on Diagnosis and Treatment of Mental Disorders, 26 September 2003).

Focus on Genetic Factors

Researchers have proposed that most common psychiatric and drug abuse disorders can be traced to a small number of dimensions of genetic risk and reports show significant associations between specific genomic regions and psychiatric disorders. Though, to date only a few genetic lesions have been demonstrated to be mechanistically responsible for psychiatric conditions. For example, one reported finding suggests that in persons diagnosed as schizophrenic as well as in their relatives with chronic psychiatric illnesses, the gene that encodes phosphodiesterase 4B (PDE4B) is disrupted by a balanced translocation.

The reasons for the relative lack of genetic understanding is because the links between genes and mental states defined as abnormal appear highly complex, involve extensive environmental influences and can be mediated in numerous different ways, for example by personality, temperament or life events. Therefore, while twin studies and other research suggests that personality is heritable to some extent, finding the genetic basis for particular personality or temperament traits, and their links to mental health problems, is “at least as hard as the search for genes involved in other complex disorders.” Theodore Lidz and The Gene Illusion argue that biopsychiatrists use genetic terminology in an unscientific way to reinforce their approach. Joseph maintains that biopsychiatrists disproportionately focus on understanding the genetics of those individuals with mental health problems at the expense of addressing the problems of the living in the environments of some extremely abusive families or societies.

Focus on Biochemical Factors

The chemical imbalance hypothesis states that a chemical imbalance within the brain is the main cause of psychiatric conditions and that these conditions can be improved with medication which corrects this imbalance. In that, emotions within a “normal” spectrum reflect a proper balance of neurotransmitter function, but abnormally extreme emotions which are severe enough to impact the daily functioning of patients (as seen in schizophrenia) reflect a profound imbalance. It is the goal of psychiatric intervention, therefore, to regain the homeostasis (via psychopharmacological approaches) that existed prior to the onset of disease.

This conceptual framework has been debated within the scientific community, although no other demonstrably superior hypothesis has emerged. Recently, the biopsychosocial approach to mental illness has been shown to be the most comprehensive and applicable theory in understanding psychiatric disorders. However, there is still much to be discovered in this area of inquiry. As a prime example – while great strides have been made in the field of understanding certain psychiatric disorders (such as schizophrenia) others (such as major depressive disorder) operate via multiple different neurotransmitters and interact in a complex array of systems which are (as yet) not completely understood.


Niall McLaren emphasizes in his books Humanizing Madness and Humanizing Psychiatry that the major problem with psychiatry is that it lacks a unified model of the mind and has become entrapped in a biological reductionist paradigm. The reasons for this biological shift are intuitive as reductionism has been very effective in other fields of science and medicine. However, despite reductionism’s efficacy in explaining the smallest parts of the brain this does not explain the mind, which is where he contends the majority of psychopathology stems from. An example would be that every aspect of a computer can be understood scientifically down to the last atom; however, this does not reveal the program that drives this hardware. He also argues that the widespread acceptance of the reductionist paradigm leads to a lack of openness to self-criticism and therefore halts the very engine of scientific progress. He has proposed his own natural dualist model of the mind, the biocognitive model, which is rooted in the theories of David Chalmers and Alan Turing and does not fall into the dualist’s trap of spiritualism.

Economic Influences on Psychiatric Practice

American Psychiatric Association president Steven S. Sharfstein, M.D. has stated that when the profit motive of pharmaceutical companies and human good are aligned, the results are mutually beneficial for all. In that, “Pharmaceutical companies have developed and brought to market medications that have transformed the lives of millions of psychiatric patients. The proven effectiveness of antidepressant, mood-stabilising, and antipsychotic medications has helped sensitize the public to the reality of mental illness and taught them that treatment works[citation needed]. In this way, Big Pharma has helped reduce stigma associated with psychiatric treatment and with psychiatrists.” However, Sharfstein acknowledged that the goals of individual physicians who deliver direct patient care can be different from the pharmaceutical and medical device industry. Conflicts arising from this disparity raise natural concerns in this regard including:

  • A “broken health care system” that allows “many patients [to be] prescribed the wrong drugs or drugs they don’t need”;
  • “medical education opportunities sponsored by pharmaceutical companies [that] are often biased toward one product or another”;
  • “[d]irect marketing to consumers [that] also leads to increased demand for medications and inflates expectations about the benefits of medications”;
  • “drug companies [paying] physicians to allow company reps to sit in on patient sessions to learn more about care for patients.”

Nevertheless, Sharfstein acknowledged that without pharmaceutical companies developing and producing modern medicines – virtually every medical specialty would have few (if any) treatments for the patients that they care for.

Pharmaceutical Industry Influences in Psychiatry

Studies have shown that promotional marketing by pharmaceutical and other companies has the potential to influence physician decision making. Pharmaceutical manufacturers (and other advocates) would argue that in today’s modern world – physicians simply do not have the time to continually update their knowledge base on the status of the latest research and that by providing educational materials for both physicians and patients, they are providing an educational perspective and that it is up to the individual physician to decide what treatment is best for their patients. The idea of pure promotion (e.g. lavish dinners) is a remnant of bygone era. It has been replaced by educationally-based activities that became the basis for the legal and industry reforms involving physician gifts, influence in graduate medical education, physician disclosure of conflicts of interest, and other promotional activities.

In an essay on the effect of advertisements for marketed anti-depressants there is some evidence that both patients and physicians can be influenced by media advertisements and this has the possibility of increasing the frequency of certain medicines being prescribed over others.

Book: Mental Health Workbook: 6 Books in 1

Book Title:

Mental Health Workbook: 6 Books in 1: The Attachment Theory, Abandonment Anxiety, Depression in Relationships, Addiction Recovery, Complex PTSD, Trauma, CBT Therapy, EMDR and Somatic Psychotherapy.

Author(s): Emily Attached, Marzia Fernandez, and Gino Mackesy.

Year: 2020.

Edition: First (1st).

Publisher: Independently Published.

Type(s): Hardcover, Paperback, Audiobook, and Kindle.


This Book includes: 6 Manuscripts

  1. Attachment Theory Workbook.
  2. Abandonment Recovery Workbook.
  3. The Addiction Recovery Workbook.
  4. Complex PTSD, Trauma and Recovery.
  5. EMDR and Somatic Psychotherapy.
  6. Somatic Psychotherapy.

Book 1: Attachment Theory Workbook

You can start to redress the balance to build stronger relationships with those close to you, with chapters that cover:

  • How anxiety disorder develops.
  • How to become self-disciplined with your emotions.
  • Learning to communicate effectively.
  • How positive reinforcement works.
  • How your physical health affects your mental state.
  • Dealing with conflict.
  • Empathetic listening and its link to happiness.
  • And more…

Book 2: Abandonment Recovery Workbook

You will learn how to cope with the feelings of abandonment through chapters that examine:

  • What affecting abandonment.
  • Abandonment anxiety.
  • How abandonment can change a life.
  • Depression in Relationships.
  • Building healthier relationships.
  • The power of forgiveness.

Book 3: The Addiction Recovery Workbook

In this book, you will find the necessary help to get you on the road to recovery, with chapters that cover:

  • How to replace your addiction and find the peace you crave.
  • Educating yourself about your addiction.
  • What to avoid when you are developing new habits.
  • Exercise, hydration and a non-toxic lifestyle.
  • Getting creative to life healthier.

Book 4: Complex PTSD, Trauma and Recovery

In this book, you will finally find new ways to tackle your trauma, with chapters that focus on:

  • How depression is defined.
  • How you can avoid exacerbating the problem.
  • A range of trauma treatment exercises.
  • Trauma and the link to mental health.
  • Understanding anxiety.
  • Complex PTSD.

Books 5 and 6: EMDR and Somatic Psychotherapy

You’ll discover how it could help you, with chapters that cover:

  • The principles of EMDR and Somatic Psychotherapy.
  • The basic concepts of Somatic Psychotherapy and EMDR Therapy.
  • Examining the neurobiology of stress and trauma.
  • How the brain works and how it is affected by trauma.
  • Somatic Psychotherapy explained.

Mental Health & COVID-19: Psychological Impacts that Merit Consideration now Rather than Later

Research Paper Title

Mental health in the COVID-19 pandemic.


During any outbreak of an infectious disease, the population’s psychological reactions play a critical role in shaping both spread of the disease and the occurrence of emotional distress and social disorder during and after the outbreak. Despite this fact, sufficient resources are typically not provided to manage or attenuate pandemics’ effects on mental health and well-being. While this might be understandable in the acute phase of an outbreak, when health systems prioritise testing, reducing transmission and critical patient care, psychological and psychiatric needs should not be overlooked during any phase of pandemic management.

There are many reasons for this. It is known that psychological factors play an important role in adherence to public health measures (such as vaccination) and in how people cope with the threat of infection and consequent losses. These are clearly crucial issues to consider in the management of any infectious disease, including COVID-19. Psychological reactions to pandemics include maladaptive behaviours, emotional distress and defensive responses. People who are prone to psychological problems are especially vulnerable.

All of these features are in clear evidence during the current COVID-19 pandemic. One study of 1,210 respondents from 194 cities in China in January and February 2020 found that:

  • 54% of respondents rated the psychological impact of the COVID-19 outbreak as moderate or severe;
  • 29% reported moderate to severe anxiety symptoms; and
  • 17% reported moderate to severe depressive symptoms.

Notwithstanding possible response bias, these are very high proportions – and it is likely that some people are at even greater risk. During the 2009 H1N1 influenza outbreak (‘swine flu’), a study of mental health patients found that children and patients with neurotic and somatoform disorders were significantly over-represented among those expressing moderate or severe concerns.

Against this background, and as the COVID-19 pandemic continues to spread around the world, the authors hypothesise a number of psychological impacts that merit consideration now rather than later.

In the first instance, it should be recognised that, even in the normal course of events, people with established mental illness have a lower life expectancy and poorer physical health outcomes than the general population. As a result, people with pre-existing mental health and substance use disorders will be at increased risk of infection with COVID-19, increased risk of having problems accessing testing and treatment and increased risk of negative physical and psychological effects stemming from the pandemic.

Second, we anticipate a considerable increase in anxiety and depressive symptoms among people who do not have pre-existing mental health conditions, with some experiencing post-traumatic stress disorder in due course. There is already evidence that this possibility has been under-recognised in China during the current pandemic.

Third, it can be anticipated that health and social care professionals will be at particular risk of psychological symptoms, especially if they work in public health, primary care, emergency services, emergency departments and intensive or critical care. The World Health Organisation has formally recognised this risk to healthcare workers, so more needs to be done to manage anxiety and stress in this group and, in the longer term, help prevent burnout, depression and post-traumatic stress disorder.

There are several steps that can and should be taken now to minimise the psychological and psychiatric effects of the COVID-19 pandemic.

First, while it might be ostensibly attractive to re-deploy mental health professionals to work in other areas of healthcare, this should be avoided. Such a move would almost certainly worsen outcomes overall and place people with mental illness at disproportionate risk of deterioration in physical and mental health. If anything, this group needs enhanced care at this time.

Second, the authors recommend the provision of targeted psychological interventions for communities affected by COVID-19, particular supports for people at high risk of psychological morbidity, enhanced awareness and diagnosis of mental disorders (especially in primary care and emergency departments) and improved access to psychological interventions (especially those delivered online and through smartphone technologies). These measures can help diminish or prevent future psychiatric morbidity.

Finally, there is a need for particular focus on frontline workers including, but not limited to, healthcare staff. In the USA, the Centres for Disease Control and Prevention offer valuable advice for healthcare workers in order to reduce secondary traumatic stress reactions, including increased awareness of symptoms, taking breaks from work, engaging in self-care, taking breaks from media coverage and asking for help. This kind of advice needs to be underpinned by awareness of this risk among employers, enhanced peer-support and practical assistance for healthcare workers who find themselves exhausted, stressed and feeling excessive personal responsibility for clinical outcomes during what appears to be the largest pandemic of our times.

Even in this emergency circumstance, or especially in this emergency circumstance, we neglect mental health at our peril and to our long-term detriment.


Cullen, W., Gulati, G. & Kelly, B.D. (2020) Mental Health in the COVID-19 Pandemic. QJM: An International Journal of Medicine. 113(5), pp.311-312.

Should We Target Inflammation, The Gut Microbiome, and Mitochondrial Dysfunction in Combat PTSD-Metabolism?

Research Paper Title

Novel Pharmacological Targets for Combat PTSD-Metabolism, Inflammation, The Gut Microbiome, and Mitochondrial Dysfunction


Current pharmacological treatments of post-traumatic stress disorder (PTSD) have limited efficacy.

Although the diagnosis is based on psychopathological criteria, it is frequently accompanied by somatic comorbidities and perhaps “accelerated biological ageing,” suggesting widespread physical concomitants.

Such physiological comorbidities may affect core PTSD symptoms but are rarely the focus of therapeutic trials.


To elucidate the potential involvement of metabolism, inflammation, and mitochondrial function in PTSD, the researchers integrate findings and mechanistic models from the DOD-sponsored “Systems Biology of PTSD Study” with previous data on these topics.


Data implicate inter-linked dysregulations in metabolism, inflammation, mitochondrial function, and perhaps the gut microbiome in PTSD.

Several inadequately tested targets of pharmacological intervention are proposed, including insulin sensitisers, lipid regulators, anti-inflammatories, and mitochondrial biogenesis modulators.


Systemic pathologies that are intricately involved in brain functioning and behaviour may not only contribute to somatic comorbidities in PTSD, but may represent novel targets for treating core psychiatric symptoms.


Bersani, F.S., Mellon, S.H., Lindqvist, D., Kang, J.I., Rampersaud, R., Somvanshi, P.R., Doyle, F.J., Hammamieh, R., Jett, M., Yehuda, R., Marmar, C.R. & Wolkowitz, O.M. (2020) Novel Pharmacological Targets for Combat PTSD-Metabolism, Inflammation, The Gut Microbiome, and Mitochondrial Dysfunction

Mental Stress Tasks & the Prefrontal Cortex

Research Paper Title

Relationship Between Cerebral Blood Oxygenation and Electrical Activity During Mental Stress Tasks: Simultaneous Measurements of NIRS and EEG.


The incidence of stress-induced psychological and somatic diseases has been increasing rapidly, and it is important to clarify the neurophysiological mechanisms of stress response in order to establish effective stress management methods.

The researchers previously reported that the prefrontal cortex (PFC) plays an important role in stress response.


In the present study, the researchers employed near-infrared spectroscopy (NIRS) and electroencephalography (EEG) to investigate the characteristics of PFC activity during mental arithmetic tasks.

A two-channel NIRS device was used to measure haemoglobin (Hb) concentration changes in the bilateral PFC during a mental arithmetic task (2 min) in normal adults.

Simultaneously, EEG was used to also measure bilateral PFC activity during the same task.

They evaluated concentration changes of oxy-Hb induced by the task while analysing α wave changes using power spectrum analysis.


It was observed that oxy-Hb in the bilateral PFC increased significantly during the task (p < 0.05), while α wave power in the PFC decreased significantly (p < 0.01).


The present results indicate that mental stress tasks caused the activation of the bilateral PFC.

Simultaneous measurements of NIRS and EEG are useful for evaluating the neurophysiological mechanism of stress responses in the brain.


Nagasawa, Y., Ishida, M., Komuro, Y., Ushioda, S., Hu, L. & Sakatani, K. (2020) Relationship Between Cerebral Blood Oxygenation and Electrical Activity During Mental Stress Tasks: Simultaneous Measurements of NIRS and EEG. Advances in Experimental Medicine and Biology. 1232:99-104. doi: 10.1007/978-3-030-34461-0_14.

Somatic Symptom Disorder & Social Stigma

Research Paper Title

Social Stigma Towards People with Medically Unexplained Symptoms: the Somatic Symptom Disorder.


The majority of previous studies on mental health stigma have focused on medically explained symptoms and the studies on medically unexplained symptoms (MUS) have only assessed the consequences of internalised stigma.

A new category in DSM 5, named as somatic symptom disorder (SSD), includes multiple somatic disorders with medically-explained or -unexplained somatic symptoms.

This study aimed to test the effects of social stigma on people with SSD with MUS depending on the attribution model.


In a class environment, 348 college students from different regions in Turkey were presented with a vignette on a person with SSD with MUS and asked to complete a survey including demographics and attitudes towards that person.


Along the same lines with previous findings for other mental disorders, the path analysis using AMOS revealed that stigma-related cognitions (i.e., dependency, dangerousness and responsibility) shaped people’s affective (i.e., anger and pity) and behavioural responses (i.e., social distance) to these people.

The most important predictor of social distance was pity and the level of contact was not related to social distance.


In conclusion, anti-stigma interventions towards SSD with MUS should involve building empathy towards these patients and educating people about this disorder contrary to the recommended interventions for other mental health disorders stressing the importance of contact.


Eger Aydogmus, M. (2020) Social Stigma Towards People with Medically Unexplained Symptoms: the Somatic Symptom Disorder.

Development and Implementation of a Hospital-Based Clinical Practice Guideline to Address Paediatric Somatic Symptom and Related Disorders

Research Paper Title

Taking the Pain out of Somatisation: Development and Implementation of a Hospital-Based Clinical Practice Guideline to Address Paediatric Somatic Symptom and Related Disorders.


The diagnostic category of somatic symptom and related disorders (SSRDs), although common, is often poorly recognized and suboptimally managed in inpatient pediatric care.

Little literature exists to address SSRDs in the inpatient paediatric setting.

The purpose of the study was to characterise current SSRD practice, identify problem areas in workflow, and develop a standardised approach to inpatient evaluation and management at a tertiary care academic children’s hospital.


A multidisciplinary group identified patients with SSRD admitted between May 2012 and October 2014.

A retrospective chart review on a convenience sample was performed to identify population characteristics and current practice.

Lean methodology was used to define current state practice and future state intervention.

These methods were used to guide identification of problem areas, which informed protocol, a clinical practice guideline, and resource development.


Thirty-six patients aged 8 to 17 years met inclusion criteria for chart review.

Most patients presented with either neurological or pain-related complaints.

The mean length of stay was 5.44 days (SD = 6.3), with few patients receiving a mental health consultation within 24 hours of hospitalisation.

Patients averaged 5.8 medical and/or psychiatric diagnoses on discharge (SD = 5.2), and two-thirds did not have an SSRD diagnosis.

Half of patients had co-morbid psychiatric diagnoses, whereas one-quarter were discharged with no mental health follow-up.


In this study, the researchers describe the process and content development of a single-site institutional protocol, clinical practice guideline, and resources for the evaluation and management of paediatric SSRDs.

This study may serve as a model for similar standardisation of SSRD care in other inpatient paediatric medical settings.


Kullgren, K.A., Shefler, A., Malas, N., Monroe, K., Leber, S.M., Sroufe, N., El Sakr, A., Pomeranz, E., O’Brien, E. & Mychaliska, K.P. (2020) Taking the Pain out of Somatization: Development and Implementation of a Hospital-Based Clinical Practice Guideline to Address Pediatric Somatic Symptom and Related Disorders. Hospital Paediatrics. 10(2), pp.105-113. doi: 10.1542/hpeds.2019-0141. Epub 2020 Jan 2.