Clinical Psychiatric Case Presentation: Culturally Responsive Diagnostic Formulation and Treatment in an Hispanic Female

Abstract

The case is presented of Mrs. T., a 49-year-old, twice married, Mexican-American psychiatric patient on her second admission to the San Antonio State Hospital (SASH). Pertinent psychiatric and social history, and events leading to her hospitalization, are discussed. Cultural factors affecting or otherwise influencing differential diagnosis, psycho-dynamics and treatment are also discussed. An important feature was a change in diagnosis that occurred along with culturally responsive assessment. 'The patient's treatment and progress in SASH's Bicultural Unit, which is staffed by Mexican-American, Spanish-speaking personnel and emphasizes a Mexican-American milieu treatment program, is reported. The participation of the unit personnel and the patient's family in her treatment is discussed. An essential feature pervading this case is the multiple presentation of psychiatric, sociocultural, cognitive, and emotional problems and issues. Post hospital adjustment of the patient is also reported.

Get full access to this article

View all access options for this article.

References

American Psychiatric Association (APA) . Diagnostic and statistical manual of mental disorders, 3d edition. Washington, D.C.: APA, 1980.

Cancro, R. The genetic studies of the schizophrenic syndrome: A review of their clinical implications. In L. Bellack (Ed.), Disorders of the schizophrenic syndrome. New York: Basic Books, 1979.

Carpenter, W. T., Jr. , Srauss, J. S. , & Muleh, S. Are there pathognomonic symptoms in schizophrenia? An empirical investigation of Kurt Schneider's first rank symptoms. Archives of General Psychiatry, 1973, 28(6), 847-852.

Cooper, J. E. , Kendall, R. E. , Gurland, B. J. , Sharpe, L. , Copeland, J. R. M. , & Simon, R. Psychiatric diagnosis in New York and London. Maudsley Monograph Series, 20. London: Oxford University Press, 1972.

Cudlar, I. , Harris, L. C. , & Jasso, R. An acculturation scale for Mexican American normal and clinical populations. Hispanic Journal of Behavioral Sciences, 1980, 2(3), 199-218.

Cuellar, I. Service delivery and mental health services for Chicano elders. In M. Miranda & R. A. Ruiz (Eds.), Chicano Aging and Mental Health. (DHHS Publication No. (ADM) 81-952). Rockville, Maryland: National Institute of Mental Health, 1981.

Cuellar, I. The diagnosis and evaluation of Mexican American schizophrenics. In R. M. Becerra , M. Karno , & J. I. Escobar (Eds.), Mental health and Hispanic Americans: A clinical perspective. New York: Grune and Stratton, 1982.

Katz, M. M. , Sanborn, K. O. , & Gudeman, H. Characterizing differences in psychopathology among ethnic groups in Hawaii. Research publications of the Association for Research in Nervous and Mental Disease, 1939/1969, 47-47.

Kleinman, A. M. Explanatory models in health care relationships. In Health of the family. Washington, D.C.: National Council for International Health Symposium, 1975.

10.

Kleinman, A. M.

Depression, somatization, and the "new cross-cultural psychia-try."

Social Science & Medicine, 1977, 11(1), 3-10.

11.

Kleinman, A. M. , Eisenberg, L. , & good, B. Culture, illness, and cure: Clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine, 1978, 88(2), 251-258.

12.

Martinez, C., Jr. Curanderos: Clinical aspects . Journal of Operational Psyc-hiatry, 1977, 8(2), 35-38.

13.

Mosher, L. R. , & Gunderson, J. G. Group, family, milieu and community support systems treatment for schizophrenia. In L. Bellack (Ed.), Disorders of the schizophrenic syndrome. New York: Basic Books, 1979.

14.

Shepherd, M. , Brook, E. M. , Cooper, J. L. , & Lin, T. Y. An experimental approach to psychiatric diagnosis. Acta Psychiatrica Scandinavica, Supplement 20. Cophenhagen: Munksgoard, 1968.

15.

Wing, J. , Nixon, J. , Cranach, M. , & Strauss, A. Further developments of the Present State Examination (PSE) and Catego system. In J. J. Bartko & W. Gulbinat (Eds.), Multivariate statistical methodologies used in the International Pilot Study of Schizophrenia. (DHHS Publication No. (ADM) 80-630). Washington, D.C.: U.S. Government Printing Office, 1980.

16.

World Health Organization . Schizophrenia: A multi-nation study. Geneva: World Health Organization Press, 1975.