Schizophrenia & Culture_ A Cross cultural perspective.pptx

a presentation on Schizophrenia disorder and culture

1. Schizophrenia & Culture: A Cross-Cultural Perspective By Group 4

2. Group Members Names IDs Iqra Sagheer F2020381003 Jawereya Shabbir F2020381037 Hafsa Shahzada F2020381002 Javeria Shahid F2020381006 Kinza Eeman F2020381054 Zunaira Qaisar F2020381057 Illsa Iqbal Katariwala F2020381032

3. Table of Contents Introduction to Schizophrenia & Culture Prevalence & Perception of Schizophrenia Risk & Protective Factors Treatment Approaches & Challenges Cultural Variations in Schizophrenia Symptoms Strategies for Culturally Competent Care 01 02 03 04 05 06 Conclusion: Strategies for caregivers of schizophrenic clients 07

4. What is Schizophrenia? 01 By Iqra Sagheer

5. Psychotic symptoms: hallucinations, delusions, disorganized speech. Impact on daily functioning . Schizophrenia Mental illness characterized by distorted perception, disorganized thinking, and impaired emotional responses.

6. Importance of Cultural Context Cultural beliefs shape perception and interpretation of symptoms. Influence on help-seeking behaviours and treatment preferences. Cultural factors impact expression and course of illness. Example within Pakistani Culture Family centrality: Mental health viewed as a family concern. Role of collectivism in caregiving and decision-making. Impact on treatment adherence and outcomes.

7. Overview of Individualistic & Collectivistic (Pakistani) Culture Individualistic Culture Traits: Autonomy : Prioritizes personal freedom. Individual Needs : Decision-making favors individual desires. Personal Impact : Mental health is seen as affecting the individual primarily. Professional Help : Preference for seeking professional support. Collectivistic Culture Traits (Pakistani): Interconnectedness : Values family unity. Collective Concern : Mental health affects family reputation. Elder Input : Treatment decisions involve elder family members. Family Honor : Help-seeking influenced by family beliefs and honour .

8. Prevalence & Perception of Schizophrenia 02 By Jawereya Shabbir

9. Statistics on Schizophrenia Prevalence According to Journal of Pakistan Medical Association, Approximate Global prevalence of schizophrenia. Prevalence in urban and rural communities of Pakistan The significant variation in prevalence rates across different countries and regions. 1.05% 1% 0.48% 0.3% - 0.7%

10. Gender Differences in Schizophrenia P K : schizophrenia affects both genders, with being more prevalent among males compared to females. S tudies : males with schizophrenia exhibit more severe symptoms . Y ounger age of onset compared to females Globally : schizophrenia affect males and females equally in terms of prevalence. Females with schizophrenia have better treatment adherence and outcomes

11. Cultural Beliefs and Stigmas Individualistic Seen as a curable disorder as increasing awareness is reducing stigma. Individuals face social isolation but there are growing movements for inclusion and support. Misunderstandings exist but are being actively addressed through education and advocacy. Stigmatization Social Isolation, Discrimination, & Rejection Collectivistic Viewed as shameful, personal weakness or moral failing, influenced by lack of awareness. High levels of social isolation, discrimination, and rejection within families and communities Fear, misunderstanding, or misconceptions about their condition, leading to profound psychological distress and impaired social functioning. Fear, & Misconceptions

12. Cultural Beliefs and Stigmas Individualistic Barriers are mitigated by anti-stigma campaigns, better insurance coverage, and support services. Better availability of mental health resources. Financial assistance programs are present. Barriers to Accessing Mental Healthcare Collectivistic Barriers to accessing mental healthcare services due to fear of judgment or discrimination. Limited availability of mental health resources, lack of awareness about available services, and financial constraints Availability of Mental Health Resources

13. Common Verbatims in Pakistani Culture "Isay ghar mein hi rakho, bahar mat le jao." “Bas iski shadi krwa do, apni jaan churwao” "Kisi ko mat batao, logon ka chakkar lag jayega." "Tum chup hi rehna, shor mat machana." "Is se shadi kaun karega?” "Iski wajah se hamara naam badnaam ho jayega." Log kiya kahen g? "Nafsiyati doctor ke paas kyun lekar jayein, yeh sab sirf paise ka chakkar hai." "Pagal hai, isko pagal khane mein dal do." "Yeh sab imagination hai, kuch nahi hota, bas attention chahiye." "Logon ki nazron mein gir jayega agar isay asal haqeeqat pata chali." "Inka koi ilaaj nahi, sirf dua se theek ho jayega." "Isay samajh nahi aata, bewakoof hai."

14. Impact of Religion, Superstitions, & Tradition Attribution to Supernatural Causes: such as possession by evil spirits or punishment from a higher power. Reliance on Spiritual Healers: as seeking help from spiritual healers, religious leaders, or traditional healers rather than consulting medical professionals. Impact on Treatment and Recovery: as delayed diagnosis and intervention can worsen symptoms, impair functioning, and result in poorer long-term outcomes.

15. Cultural Variations 03 By Hafsa Shahzada

16. Cultural Content Hallucinations: Spirits or ancestors. Delusions: Witchcraft Expression Somatic, social, cognitive manifestations. Ex: heaviness of the body Cultural Differences in Hallucinations & Delusions Interpretation Pathology=mysticism Ex: Pir Murid social evil Gender & Power Delusions of persecution: oppression & social identity

17. Thought Disorders & Cognitive Impairment Language & Communication Styles Structure & nuances of language. Ex: thought blocking Diagnosis & Treatment Client backgrounds and symptoms Belief Systems & Explanatory Models Shape what’s normal and abnormal mental functioning Access to Resources SE factors, quality healthcare for minorities

18. The 70-year old Grandfather shot for Blasphemy Case Study

19. Case Summary An aged British citizen, M. Asghar suffers from debilitating paranoid schizophrenia Paranoid delusions and auditory hallucinations. Last 4 years: imprisoned under dire conditions after being sentenced to death for blasphemy.

20. Background A father of 5 and a grandfather of 4 1993 Edinburgh, Scotland : Medical records indicated he was first treated for MDD 2000 : Suffered a stroke. Psychiatrist diagnosed seizures, grandiosity, paranoia

21. Diagnostic Symptoms February 2010: Legal detention in Royal Victoria hospital Symptoms : Psychosis. Convinced he was being persecuted by British and Pakistani governments, and that his house was “bugged” Released as an outpatient, but lacked insight. Family failed to comprehend his diagnosis

22. Flight to Pakistan Escape to Pakistan Outpatient :Closely followed. Persecutory & grandiose delusions Deterioration Ran Away Fled with his wife to escape “unjust restrictions” Non-Compliance Never fully took his medications. Lack of family support

23. Disgruntled tenant reported him for blasphemy Incarcerated CRIME Attack Locked in a cell,a prison guard barged in & shot him TRIAL Disorder not acknowledged. Medical records rejected Death Row Held against his will in a max security jail with minimum medical care

24. Cultural Factors Influencing Schizophrenia Expression: Risk & Protective Factors By Javeria Shahid 04

25. Cultural Factors Influencing Schizophrenia Expression Understanding schizophrenia within the cultural context of Pakistan involves examining how cultural factors shape the expression, perception, and management of the illness. Cultural dynamics , such as family support systems, societal values , and gender norms , significantly influence the risk and protective factors associated with schizophrenia.

26. Collectivistic Culture Protective Factors Strong Support Networks: Family and community support can provide emotional and practical help. Shared Responsibility: The collective approach can alleviate individual burdens and promote adherence to treatment. Risk Factors Stigma and Shame: Mental illness may bring shame to the family, leading to denial or delayed treatment. High Expectations: Pressure to conform to social norms can exacerbate stress and symptoms.

27. Individualistic Culture Protective Factors Access to Resources: Greater emphasis on personal rights can lead to better access to mental health services. Focus on Self-Advocacy: Encouragement of self-care and seeking professional help can enhance recovery prospects. Risk Factors Isolation: Higher rates of social isolation can worsen symptoms. Emphasis on Independence: There may be less willingness to seek help, fostering untreated progression of the disorder.

28. Influence of Collectivist Culture on Symptom Manifestation Social isolation Stigma & Exclusion Cultural Interpretation Within religious or cultural frameworks Underreporting Group well-being over individual expression Poverty & Socioeconomic Stress Economic hardships and poor living conditions Somatic Symptoms Psychological distress through physical symptoms Exposure to domestic or communal violence triggers symptoms Trauma and Violence

29. Influence of Individualistic Culture on Symptom Manifestation I solation Emotional expression Emphasis on Autonomy Personal stress Cognitive symptoms Personal experience Stigma and Self-blame Internalized stigma Symptom reporting Self awareness & introspection Emphasis on self reliance Delay in Help-seeking Behavior

30. Gender roles affect symptom recognition, help-seeking behavior, and treatment accessibility Male Gender Norms: Societal norms may lead to delayed diagnosis or misattribution of symptoms in men to character flaws rather than mental illness. Female Gender Norms: Women may be more likely to internalize stress due to societal expectations, potentially leading to underdiagnosis. Role of Gender Norms and Schizophrenia Diagnosis

31. Treatment Approaches and Challenges in Pakistani Culture By Kinza Eeman 05

32. Treatment Approaches and Challenges Cultural beliefs that attribute mental illness to supernatural forces, leading to a reliance on rituals, prayers, and natural remedies. Mental health services face significant challenges: scarcity, unaffordability, and social stigma Discourages individuals from seeking help. Gender roles and expectations also impact treatment, with women facing restrictions on seeking help outside the home.

33. 1. Traditional Healing Practices of Pakistan vs. Western Medicine PK : traditional healing practices with roots in cultural and religious beliefs. Spiritual healers (pirs) and herbalists (hakeems) who use rituals, prayers, and natural remedies to treat mental illnesses Western medicine : biological disorder requiring evidence-based treatments like medication and psychotherapy. Pakistanis prefer traditional healing practices : cultural beliefs, accessibility, and affordability. Collectivistic Culture Individualistic Culture

34. Schizophrenia cannot be understood without understanding despair وہ خود سے باتیں کرتا ہ ے ۔ یہ لوگ میرے بارے میں باتیں کر رہے ہیں ۔ Voices Wehem They are not pagal , nor is it Jinn or Asar, or Drama It may be symptoms of Schizophrenia.

35. Assessment and Intervention - Assessment Consideration of family and social networks. Use of culturally adapted assessment tools, like the KPRS (in Pakistan) , Urdu version of the PANSS (UPANSS). - Intervention Family therapy, involving relatives and caregivers. Community-based interventions, like group therapy or support groups. - Assessment Emphasis on personal responsibility and autonomy. Use of standardized assessment tools, like PANSS or BPRS or DSM-V. - Intervention Individual therapy, such as (CBT). Medication management, with a focus on personal medication adherence. Encouraging independence and self-reliance. Collectivistic Culture Individualistic Culture

36. 2. Accessibility and Affordability of Mental Health Services Accessibility and affordability of mental health services in Pakistan are significant challenges. Mental health infrastructure is underdeveloped, with a limited number of psychiatric hospitals and professionals. Mental health services in Pakistan face significant challenges, including: Limited availability: Mental health facilities and professionals are scarce, especially in rural areas. High costs: Treatment, including medication and therapy sessions, can be unaffordable for many Pakistanis. Social stigma: Seeking mental health services can be stigmatized, discouraging people from seeking help.

37. Do not abandon them. Understand and help them https://www.behance.net/gallery/22955453/Understand-Schizophrenia-Thesis-Project What’s Wrong With You “Pagal ho kia “

38. 3. Cultural Competence in Mental Health Care Providers Cultural competence is crucial in mental health care, as it affects patient trust, understanding, and treatment outcomes. However, many healthcare providers in Pakistan lack cultural competence, leading to: Misdiagnosis or misunderstanding of symptoms Inappropriate treatment plans Poor patient engagement and adherence 01 03 02

39. Strategies for Culturally Competent Care 06 . By Zunaira Qaiser

40. Culturally Tailored Interventions and Psychoeducation Programs Designing Interventions that Respect Cultural Norms Understanding Cultural Norms: Align interventions with cultural beliefs and practices. Use culturally relevant metaphors and examples, incorporate traditional practices, and ensure culturally sensitive communication. Family and Community Involvement: Engage family and community support in treatment processes. Program Features: Community health workers, religious perspectives, addressing stigma.

41. Collaboration with Community Leaders and Religious Figures Engaging Religious Leaders in Mental Health Advocacy Role of Religious Leaders: Trusted, influential figures in Pakistani society. Strategies for Engagement: Workshops and seminars, advocacy encouragement. Community-Based Support Initiatives Importance of Community Support: Creating a supportive environment. Types of Initiatives: Support groups, awareness campaigns, education programs.

42. Training Programs for Mental Health Professionals on Cultural Sensitivity Training Objectives: Awareness of cultural differences, understanding impacts, developing communication skills. Curriculum Components: Local cultural practices, role-playing, expert lectures. Implementation Strategies: Integration into training programs, continuing education, online accessibility. Measured Improvements: Enhanced outcomes, patient engagement, reduced dropout rates. Feedback from Professionals: Positive changes in care approaches and relationships.

43. 07 Caregiver Perspective By Illsa Iqbal Katariwala

44. Role of Caregiver Managing Social Pressure Awareness of Consequences Intense responsibilities

45. Challenges Faced By Caregivers Collectivistic The need to meet the high expectations set by the family and society Lack of open discussion about mental health issues. Manifests somatically Expectation to prioritize family needs and the shame associated with seeking external help. Stress & Anxiety Depression & Hopelessness Individualistic Result from the dual pressures of caregiving and maintaining a career. Isolating nature of caregiving and the perceived lack of adequate support or resources. Cognitive manifestation. Perceived failure to manage caregiving duties independently, as emphasis on self-sufficiency. Guilt & Self blame

46. Challenges Faced By Caregivers Collectivistic Isolate themselves from family and friends to avoid criticism and shame. High expectations and the pressure to conform to familial duty, often without sufficient rest or external resources. The burden of keeping the patient's condition hidden, leading to internalized stress. Social Isolation Frustration & Burnout Individualistic Due to the emphasis on independence, prefer limited involvement of extended family. Juggling caregiving with work and personal life. Suffering from loss of identity other than caregiving and watching loved one is distressing state Trauma

47. Culturally Relevant Strategies for Caregivers Other family members rotate responsibilities Division of Responsibility Mental health check-up for caregivers Professional Help Neighbors can help out families with daily chores Social Support Support groups, Psychoeducation and advocacy Community Resources

48. “Sometimes a caregiver also needs someones care.”- Tia

49. Aslam, N., Baki, A. A., & Zaidi, S. M. H. (2018). Cultural beliefs and practices in psychosis: A cross-cultural study. Psychiatric Bulletin, 42(5), 213-218. https://www.researchgate.net/publication/372477050_Gender_role_beliefs_and_wellbeing_among_young_adults_in_Pakistan_and_the_United_Kingdom Brown, J. (2014, January 28). Mohammed Asghar case: Mentally ill Briton sentenced to death in Pakistan for blasphemy continues to deteriorate | The Independent. The Independent . https://www.independent.co.uk/news/world/asia/mohammed-asghar-case-mentally-ill-briton-sentenced-to-death-in-pakistan-for-blasphemy-continues-to-deteriorate-9091663.html Gurak, K. (2016). Risk and Protective Factors, Perceptions of Family Environment, Ethnicity, and Schizophrenia Symptoms. The Journal of Nervous and Mental Disease, 204(8), 570. https://doi.org/10.1097/NMD.0000000000000558 Healthdirect Australia. (n.d.). Schizophrenia . Healthdirect. https://www.healthdirect.gov.au/schizophrenia Hussain, S., Irfan, M., & Anwar, M. (2019). Prevalence of Schizophrenia in a Tertiary Care Hospital of Pakistan. Journal of Pakistan Medical Association, 69(1), 80-84. References

50. Khaleeli, H. (2017, November 30). Family of Mohammad Asghar: ‘We just want our father home.’ The Guardian . https://www.theguardian.com/world/2014/oct/04/family-mohammad-asghar-pakistan-blasphemy-laws Mahmood, A. (2016, October 21). Sentencing a schizophrenic to death ─ and other Pakistan stories. DAWN.COM . https://www.dawn.com/news/1135767 Saha, S., Chant, D., Welham, J., & McGrath, J. (2005). A systematic review of the prevalence of schizophrenia. PLoS Medicine, 2(5), e141. Schizophrenia . (n.d.). National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/topics/schizophrenia World Health Organization: WHO. (2022, January 10). Schizophrenia https://www.who.int/news-room/fact-sheets/detail/schizophrenia Schizophrenia | Healthline . (n.d.). https://www.healthline.com/mental-health/schizophrenia References

51. If you have any questions please feel free to ask Thank You