Hikikomori, a form of severe social isolation, once characterized as a Japanese cultural-bond behavior with social and economic consequences, it is now being described in other countries. Its presentation mimics some clinical features of various classified mental diseases, such as prodromal phase of schizophrenia, personality disorders, Internet dependence, social phobia or depression, without fulfilling their defining criteria.

This work aimed to do a brief review of this subject, describing one case that is probably the first ever reported in Portugal, comparing it with similar cases around the world.

The patient was a 22-year-old male, taken to psychiatry evaluation after 4 years of social withdrawal, avoiding or blocking any contact even with family members, which resulted in work and school impairment. He spent most of his days locked at his room, investing his time in particular interests and Internet use, only leaving to eat or do his basic hygiene. At that time, he presented no affective or psychotic symptoms and perceived his behavior as egosintonic. After six appointments with psychotherapeutic approach, he was able to get a job and improved his communication with the others, especially with family.

This case fits most of the reports found on literature, in its presentation and clinical management. Hikikomori is not considered yet a disorder and further documentation of these cases is still needed to define its place in psychiatric nosology.

The authors have not supplied their declaration of competing interest.

In Vietnam, as well as in other low and middle-income countries, stigmatization and discrimination of mentally ill patients is highly prevalent.

It is important to identify determinants of stigmatization in a socio-cultural context as they may reveal anchor points for anti-stigma efforts.

This population based study conducted in urban and rural Hanoi aims to explore whether public perception of prognosis and course of illness concerning people with symptoms indicating schizophrenia have an impact on the desire for social distance, an important factor of stigmatization.

Based on a population survey using unlabelled vignettes for schizophrenia carried out in the greater Hanoi area in 2013, a sum score of the Social Distance Scale was calculated. A regression analysis was carried out to examine the impact perception of prognostic factors on the desire for social distance. The stratification of the sample (n = 455) was representative in terms of gender, age, urbanity and household size to the Hanoi population according to the 2013 census.

Factor analysis revealed three independent factors of prognosis perception:

– 1. lifelong dependency on others;

– 2. loss of social integration and functioning;

– 3. positive expectations towards treatment outcome.

Both negative prognostic ideas (1,2) were significantly correlated with more desire for social distance in schizophrenia.

Stronger desire for social distance was observed among people with negative expectations about the prognosis of persons suffering from psychotic symptoms. Thus, our study indicates a link between social acceptance and ability to maintain a social role in the Vietnamese society.

The authors have not supplied their declaration of competing interest.

Indigenous communities exist within most countries. These communities often have their own informal and invisible (to their mainstream neighbors) systems of health care. We wondered what happened to people who approached traditional community healers for help with mental health problems.

We interviewed 100 people who had received mental health diagnoses from conventional practitioners and then sought traditional community healers for help. We compared them to a matched population from a computer database who did not seek traditional healers. Patients who visited the healers did statistically significantly better than the comparison group. Panels of naïve graduate students evaluated patient interviews and picked themes that consistently emerged. Scenarios were developed to rate patients along these dimensions from “1” to “5”. New panels did the ratings. Comparisons were made between these 2 groups of people, and those who improved with healers had more change from before to after treatment on the dimensions of Present-centeredness; Forgiveness of others; Release of blame, bitterness, and chronic anger; Orientation to process versus outcome; Sense of Humor; Sense of Meaning and Purpose; and Faith and Hope. The patients who worked with the healers had a new and plausible (to the patient, his or her family, and the healers) explanation for why he or she got well, including a story reflecting a belief about how he or she can stay well; supportive community who believes in the person's cure.

The treatment provided by conventional healers produces measurable changes in several parameters associated with improved mental health.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Arab/Islamic culture such as those in Oman has been prescribed to be part of “collective culture” where family is central to one's identity. It is not clear how mental illness is perceived among young doctors in Oman in the light of modernization and acculturation.

Explore the socio-cultural teaching impact on attitudes towards mental health problems among Omani physicians.

The consenting residents were asked to fill self-reported questionnaire Attitudes towards Mental Health Problems (ATMHP). It measure: external shame (beliefs that others will look down on themselves self if one have mental health problems); internal shame (related to negative self-evaluations); and reflected shame (believing that one can bring shame to their family/community). Socio-demographic information was also sought, including age, gender and previous contact with a person with mental illness.

One hundred and seventy residents filled the questionnaire. The response rate was > 80%. The majority were female. It showed elevated scores in indices of external shame and reflected shame. However, having a history of mental distress or having contact with a person with mental illness have moderate indices external shame and reflected shame.

This study suggests that medical education has little eroded societal teaching among physicians under training in Oman. Thus, their attitude toward mental disorder appears to be expressed in term of external shame and reflected shame, which, in turn, encapsulate cultural patterning of shame and the centrality of family identity in Oman. Such socio-cultural teaching could lay groundwork for further research to mitigate mental illness in Oman.

The authors have not supplied their declaration of competing interest.

There is a dearth of studies that have explored cognitive performance in different grades of spirit possession.

This study was undertaken to investigate two areas: the first was to explore whether there is a difference in demographic characteristics among presently defined grades of spirit possession in Oman: total possession (TP), partial possession (PP) and symbiotic possession (SP) seen in the Omani society. The second was to compare cognitive performance among the different grades of possession. Assessment criteria for these three groups included indices of current nonverbal reasoning ability, attention/concentration and recall, and those measures calling upon executive functioning.

In terms of socio-demographic characteristics, being female, having low education and being in a particular age group are strongly associated with participants classified as TP. In contrast, the SP group endorsed more history of trauma. The three groups showed performance variation in current nonverbal reasoning ability, attention/concentration and recall, and executive functioning, with TP appearing to have poorer performance on these measures compared to PP and SP.

Previous studies have investigated whether spirit possession is a pathological state or a culture-specific idiom of distress. To our knowledge, this is the first study that has examined performances in cognitive measures among different types of possession. The entrance of possession trance disorder and dissociative trance disorder into the psychiatric nomenclature warrants more studies of this nature.

The authors have not supplied their declaration of competing interest.

Cultural signs may be found among people that speak a local dialect or live in a specific region or historical period. These cultural signs could influence psychopathology. The aim of this study was to design and validate a questionnaire that could evaluate the cultural factors causing concurrent obsessions and major depressive disorders in Iran.

To design the questionnaire, 10 psychologists and psychiatrists who were members of academic boards were questioned by an open questionnaire. Then, the answers to the questions were classified and based on exploratory factor analysis the questionnaire containing 11 factors and 79 questions was confirmed. Internal homogeneity was analyzed by Cronbach's alpha.

The results of Cronbach's alpha for all factors showed that the highest reliability was 0.90 and the lowest was 0.42. In exploratory factor analysis using Varimax rotation 11 factors were extracted that predict 47.3% of the scale variance. 25 factors were extracted of which14 had less than three items, therefore they were omitted because of not being able to acquire reliability as sub factors. Accordingly, a questionnaire containing 11 factors and 79 questions was constructed.

The findings showed that the instrument could identify the cultural factors that cause concurrent obsession and major depressive disorders in Iran.

The authors have not supplied their declaration of competing interest.

Show with a case report how psychiatric pathology may face differential diagnosis problems when sociocultural aspects are involved.

Seventy-three year old man, born in Colombia. During the last two months, he had come many times to the emergency service due to behavioural changes. He does not have previous psychiatric history. His daughter refers that one of the patient's sisters has been diagnosed of “mystical madness”. The previous days he abandoned his medical treatment saying that he “gets in touch with his wife and that he wants to meet her”. Since his wife's dead, he had presented an excessively adapted behaviour, without grief symptoms. The first hospitalization day he said we wanted to get married with one of his daughters, with a sexual content speech, being able to get emotional when he spoke about his dead wife. Now the patient is under frequent reviews, and it is thought the differential diagnosis of depression with psychotic symptoms, due to the lack of symptoms remission.

Whenever we face different psychiatric diagnosis we don’t keep in mind some sociocultural factors, which could be masked and raise different doubts. It is important to keep in mind that each country or ethnical have their own cultural habits which are going to deeply influence patient's personality.

The authors have not supplied their declaration of competing interest.

The accompagnant model was set up at the Fann psychiatric hospital in Dakar in 1971 by prof. H. Collomb. It requires the patient to be hospitalized with a non-patient to accompany him/her at all time during the hospitalization. This model compensates for economic and human deficiencies, and also presents itself as a therapeutic tool in the treatment of mental illnesses.

The contemporary use of the accompagnant model will be presented and its advantages and disadvantages assessed.

We investigate how the accompagnant model may have a role in the therapeutic process, and to what extent this model (or part of it) could be exported.

A qualitative study of the practice at Fann Psychiatric Hospital has been carried out, based on interviews with patients, professionals and accompanying persons.

There is a striking consensus between patients, professionals and the accompanying persons about the advantages of this practice. It facilitates the encounter between professionals and patients, and reduces the risk of living hospitalization as a traumatic experience. The accompanying persons contribute to warrant the respect of human dignity, and to maintain a therapeutic dynamic through their participation in the development of a caring environment and their expectation of a recovery process. They help ensure continuity of care and medication after the hospital stay.

The accompagnant model emphasizes the role relatives may play during and after the hospitalization, in ways that could be compared with what is currently expected from family therapeutic education.

The authors have not supplied their declaration of competing interest.

The focus of Medical Anthropology is, among other things, the study of medicine as an expression of culture and involves the analysis of healing traditions, both “traditional” and biomedical.

Greek Gypsies who have their own habitus, language, and culture.

Aims The discussion of treatment options that gypsies have or seek in order to address critical life situations outside a biomedical context.

Field research with interviews and observation.

Using Geertz's analytic approach of symbolic interpretation, this paper focuses on the mobilization and transformation of religious symbols in the clinical setting: how these “converse” with biomedicine and how they participate in the process of healing. Painful life experiences drive subjects to seek recourse in remedies outside the biomedical system. At the center of these experiences are thought to be attacks from the “evil eye.” According to the subjects’ worldview, all people are potential victims of the evil eye. A person's glance can provoke the injury, illness, mental illness or even death of another. Consequently, there is a hierarchy of therapeutic choices in which first preference is given to their own means for addressing a situation—only in the case of failure do they turn to specialists.

The beliefs of the subjects are strongly influenced by their worldview, a historically inherited model of health and healing that, unlike the biomedical model, expresses a belief that ailments are successfully cured “wıth God”.

The authors have not supplied their declaration of competing interest.

Journeys have been considered life-changing experiences since the first chronicles of humanity. Interest towards the relationship between travels and mental illness started off with the publication, in 1897, of Les aliénés voyageurs.

We report the case of a 52-year-old gentleman, married and without children, who works as a couch driver and has no past medical records. During a holiday trip, at his arrival to Saint Petersburg, he first experienced haze and cognitive and memory failures, along with malaise and sweating. The day after, while visiting the Hermitage museum, he underwent forthright auditive hallucinations, diffusion of thought phenomena and harm delusions. After ruling out diagnosable organic causes through CT scan, MRI and blood analyses including immunologic studies, he was put on olanzapine 10 mg/day with total symptomatic remission within 2 weeks.

Stendhal syndrome, described back in 1989 by Dr. Magherini, refers to anxious, somatic and psychotic symptoms affecting tourists who visit Florence. The celebrated author, himself, experienced intense emotions due to an overdose of beauty at the Italian city. Further clinical pictures related to journeys include Jerusalem Syndrome and Way of Saint James Syndrome. Another entity, Paris Syndrome, differentially affects Japanese visitors, disappointed with the actual experience of visiting the French city.

During journeys, people often abandon everyday life in order to open up to unknown sights and feelings. These can eventually, lead to certain sorts of mental illness.

The authors have not supplied their declaration of competing interest.

Xenophobia has been referred to as a global phenomenon, linked to the globalization process and noted in countries undergoing transition. It comes from the perceived threat of foreigners’ impact on the citizens’ identity or individual rights. Although the Gulf countries host a large number of migrants from several different cultures and ethnicity, so far no study has examined the conceptualization and pervasiveness of Xenophobia and counter strategies to such phenomenon.

Exploring Xenophobia in the Gulf context. Exploring socio-demographic and cognitive factors affecting xenophobia.

Validating a measure of Xenophobia in the Gulf cultural context. Examining the gender differences in Xenophobia among the GCC individuals. Studying socio-demographic and cognitive predictors of Xenophobia.

A sample of 513 individuals from the GCC countries completed several measures of socio-demographic and cognitive variables. Likert-type scale of xenophobia was developed and validated on a large sample of Qatari citizens that showed trustworthy indications of validity and reliability and delivered via internet survey.

The findings showed that Xenophobia negatively correlated with age, parents’ level of education, and varied subject to the type of father's job. The females showed Xenophobia more indications than males. Participants from the six GCC countries showed different levels of Xenophobia indicators. Bad experience with expatriates fully mediated the relationship between the socio-demographic of subjects and the number of Xenophobia indicators. Cognitive factors were also good predictors of Xenophobia across all cultures and gender.

Xenophobia in the Gulf region is influenced by several cognitive and socio-demographic factors that is mediated by, but not limited to, negative personal experiences and their cultural backgrounds.

The authors have not supplied their declaration of competing interest.

Study of the predictors of ethno-cultural adaptation among male population with PTSD.

We examined 72 males (age: 18–52) with PTSD (F43.1), acquired in interethnic Kyrgyz-Uzbek conflict. In the process of CBT 3 psychotherapeutic groups were formed: 1st (2 homogenous subgroups) included 24 ethnic Kyrgyz, 2nd (2 homogenous subgroups): 24 ethnic Uzbeks, 3rd (2 heterogeneous subgroups): 12 Uzbeks, 12 Kyrgyz.

Semi-formalized interview, standardized scales for evaluating PTSD, anxiety, depression, aggression, loneliness.

High levels of aggressiveness among Kyrgyz: 52.4, among Uzbeks: 51.7 (P < 0.05), loneliness among Kyrgyz: 38.9, among Uzbeks: 46.2 (P < 0.05), anxiety among Kyrgyz: 48.8, among Uzbeks: 52.4 (P < 0.05), depression among Kyrgyz: 57.5, among Uzbeks: 61.1 (P < 0.05) are mutually conditioning factors. In the CBT process, the values decreased: in 1st group anxiety level to 44.4 (P < 0.05), depression: 54.2 (P < 0.05); aggressiveness: 48.2 (P < 0.05), loneliness: 38.4 (P < 0.05); in 2nd: anxiety: 49.4 (P < 0.05), depression: 59.8 (P < 0.05), aggressiveness: 47.3 (P < 0.05), loneliness: 42.4 (P < 0.05); in 3rd: anxiety: 41,1 (P < 0.05), depression: 52.2 (P < 0.05), aggressiveness: 46.5 (P < 0.05), loneliness: 35.5 (P < 0.05).

High levels of aggressiveness and loneliness among the respondents of both ethnic groups are the predictors of PTSD. Emphasized anxiety-phobic (group 1) and anxiety-depressive (group 2) disorders are the activating mechanisms of adaptation processes in micro-society (psychotherapeutic group). Dominating anxiety-phobic disorders (group 1), anxiety-depressive disorders (group 2), and their entanglement with values of aggressiveness and loneliness determine development and stability of clinical-psychopathologic manifestations as dysthymic disorders, which is an indicator for biological treatment. Heterogeneous group, as a result of CBT, has shown activation of psychological adaptation mechanism by the dissociative type, which is one of the mechanisms of ethno-cultural adaptation and requires subsequent research.

The authors have not supplied their declaration of competing interest.

Stigma effects on the process of mental disorders and many researchers consider it as the most serious risk factor and inhibitor in promoting mental health.

The aim of this study was to explore the strategies to reduce the stigma toward people with mental disorders in Iran.

This qualitative study, using content analysis method, was undertaken from 2013 to 2015. All participants were recruited by purposive sampling method. They were stakeholders of mental health in Iran. Data were collected through 16 individual interviews, 2 focus group interviews and 6 written narratives. The data were collected, coded and analyzed simultaneously.

The major themes were: “Emphasis on education and changing attitudes”, “Changing the culture”, “Promoting services and support coverage”, “Role of various organizations and institutions”, “Integrated reform of structures and policies to improve the performance of custodians”, and “Evidence-based actions”.

It seems crucial to adopt strategies that lead to reduce the stigma of mental illnesses and increase awareness among people, scholars and service providers in the field of mental health. Additional studies are needed to evaluate the effectiveness of the emerging strategies to reduce stigma.

The author has not supplied his declaration of competing interest.

Despites nursing holistic trends for caring, in psychiatric wards of general hospitals the spiritual dimension remains controversy. Evidence shows spirituality rule in recovering and also alerts about complications associated to mental disorders and spirituality.

To describe spirituality meanings attributed by a psychiatric nursing team and discuss how they apply them on professional cares.

Clinical-qualitative design is a particularization of generic qualitative strategies brought from humanities to approach symbolic research questions in clinical settings. A semi-directed interview with open-ended question, in-depth, was carried out with a team of 22 nursing professionals in the psychiatric ward of a general hospital in Southeast Brazil. Data analysis was driven under the Ricoeur understanding of Freudian symbolic meaning, which affirm that a statement revels multiple meanings overwritten.

Spirituality is developed from several sources of restlessness and living together. The function of spirituality is to help fulfill social roles, keep internal balance and to maintain sacred practice attitudes towards life that brings symbolic salvation: help or redemption to hard life times. Nature of mental illness remains as spiritual stigma and a suspicion contradictorily to spiritual approach caring to patients in inpatients services, which is described, as inappropriate or confusable.

Even spirituality meanings are covered by symbolism, which expresses human attitudes to help in life crises they are surrounded by contradictions that situate this dimension in the limit of reason, which approximates carriers and patients causing weirdness. Nursing staff still needs training to deliver holistic care, and spiritual counseling to gain clarity in this issue.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The presenting author was speaker for Bristol Myers Squibb and Servier, and participated in clinical research funded by Janssen Cilag, Astra Zeneca, Eli Lilly, Sanofi Aventis, Schering Plough, Organon, Bioline Rx, Forenap, Wyeth, Otsuka Pharmaceuticals, Dainippon Sumitomo.

The authors have not supplied their declaration of competing interest.

Previous studies have shown that cultural context has an influence on emotion and cognition. In this study the emotional response to international affective picture system (IAPS) was compared between Iranians and normative ratings of Americans young adults.

One hundred and thirty eight Iranian university students (85 women, 48 men) age 18 to 52 (average= 31, SD = 7.76) enrolled in the study. Participants’ emotional response to IAPS images were rated in three dimensions (valence, arousal, dominance) using self-assessment Manikin (SAM) system. Then, valence, arousal, dominance scores were compared to those of 100 American undergraduates (50 females, 50 males) of the same age group, enrolled at Florida university and surveyed by Prof. PJ Lang in 2008.

Our results indicate that there is complete correlation between the mean ratings of valence, arousal and dominance between Iranian and American participants. Also the results showed similarities in valence ratings, but arousal ratings especially in female participants were different. The relationship between arousal and valence showed a similar boomerang shaped distribution seen with the North American sample. Iranian sample showed positively offset and negative bias comparable to the American counterparts.

The results are promising in the sense that IAPS images can be used in studies within Iranian cultural context. However, arousal values require a modification for their proper application in Iranian cultural context.

The author has not supplied his/her declaration of competing interest.