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Social Psychiatry and Psychiatric Epidemiology
Published in: Social Psychiatry and Psychiatric Epidemiology 3/2008

01-03-2008 | ORIGINAL PAPER

The need for culture sensitive diagnostic procedures

A study among psychotic patients in Morocco

Authors: Tekleh Zandi, Johan M. Havenaar, Annechien G. Limburg-Okken, Hans van Es, Salah Sidali, Nadia Kadri, Wim van den Brink, Rene S. Kahn

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 3/2008

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Abstract

Objective

We examine the procedural validity of a standardized instrument for the diagnosis of psychotic disorders in Morocco.

Method

Twenty-nine patients from Casablanca, Morocco, with a psychotic or mood disorder were examined using the Comprehensive Assessment of Symptoms and History (CASH) an adapted version using cultural formulation to make the instrument more culturally sensitive (CASH-CS). Chance corrected agreement was calculated between diagnoses based on these two versions of CASH and independent clinical diagnoses according to local psychiatrists.

Results

Agreement for traditional CASH versus clinical diagnosis and for CASH versus CASH-CS was low (kappa = −0.19; SD 0.16 and kappa = 0.21; SD 0.16, respectively). De CASH-CS, showed good agreement with clinical diagnosis (kappa = 0.79; SD 0.11).

Conclusion

Standardized instruments for the assessment of psychosis such as the CASH may be liable to cultural misinterpretations. This may be relevant to the interpretation of the high incidence rates of schizophrenia among immigrants.

Significant outcomes

Agreement between a culturally naïve version of a standardized diagnostic instrument for the assessment of psychosis and clinical diagnosis by Moroccan psychiatrists is poor. Adding additional probes and decision rules based on cultural formulation improves agreement with clinical diagnosis significantly.

Limitations

The study was conducted in a small sample. Both versions of CASH were administered by the same interviewer in a single interview session.
Appendix
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Metadata
Title
The need for culture sensitive diagnostic procedures
A study among psychotic patients in Morocco
Authors
Tekleh Zandi
Johan M. Havenaar
Annechien G. Limburg-Okken
Hans van Es
Salah Sidali
Nadia Kadri
Wim van den Brink
Rene S. Kahn
Publication date
01-03-2008
Publisher
D. Steinkopff-Verlag
Published in
Social Psychiatry and Psychiatric Epidemiology / Issue 3/2008
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-007-0290-0

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