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The evaluation of these individuals raises many issues that clinicians need to address to formulate an accurate diagnosis and treatment plan that will be acceptable to the patient.
The assessment of minority patients has additional layers of complexity when compared with assessment of nonminority patients, especially when the patient has a different cultural or ethnic background from the clinician.
Thus, clinicians need to develop culturally competent knowledge, attitudes, and skills.
Also, clinicians need to be aware of their own cultural identity and their attitudes and beliefs toward ethnic minorities, because these will affect their relationships with patients. Finally, clinicians need additional skills because traditional methods of interviewing the patient may not be effective and psychological tests may not be adequate or appropriate.
Clinicians may need to use an interpreter Westermeyer or may need to conduct family interviews, and psychological tests may need modification Marsella Many organizations have begun to address these issues in the assessment and diagnosis of culturally diverse individuals. These organizations have published similar guidelines for clinical competence with culturally diverse individuals.
The American Counseling Association guidelines stress the awareness of both patient and clinician beliefs, the attainment of background knowledge about the patient including his or her worldviewand the development of culturally competent skills Sue et al.
In addition, the ICD-b World Health Organization incorporated major methodological developments such as a phenomenological organization of nosology, use of more specific definitions for diagnostic categories, the employment of multiaxial framework, and the development of an international psychiatric lexicon containing a description of culture-bound syndromes as well as an international casebook.
Finally, the American Psychiatric Association acknowledged the impact of culture and ethnicity on diagnosis and treatment, as stated in the introduction to DSM-IV American Psychiatric Association a: Special efforts have been made in the preparation of DSM-IV to incorporate an awareness that the manual is used in culturally diverse populations in the United States and internationally.
Clinicians are called on to evaluate individuals from numerous different ethnic groups and cultural backgrounds including many who are recent immigrants.
Diagnostic assessment can be especially challenging when a clinician from one ethnic or cultural group uses the DSM-IV Classification to evaluate an individual from a different ethnic or cultural group. In summary, the consideration of cultural factors in the assessment, diagnosis, and treatment of culturally diverse individuals has gained recognition in a variety of disciplines in the last decade.
In this chapter, we present a brief history of psychiatric case formulation; define culture, ethnicity, and race; and focus on an explication and elaboration of the DSM-IV outline for cultural formulation. These models include the psychodynamic, the biological, the behavioral, and the biopsychosocial Sperry et al.
The biological model, which posits an organic basis for psychopathology, was more commonly associated with other medical specialties and has become more prominent since with the advent of psychotropic medications Ayd and Blackwellthe discoveries of sensitive receptor assays resulting in more specific drugs Snyderand the development of improved structural and functional brain-imaging techniques Andreason We believe that focusing on the cultural formulation enhances the usefulness of the biopsychosocial model, especially for culturally diverse individuals.
In the past, many authors have discussed the importance of considering the effect of culture on diagnosis and treatment. Cultural identity of the individual.
For immigrants and ethnic minorities, note separately the degree of involvement with both the culture of origin and the host culture where applicable. Also note language abilities, use, and preferences including multilingualism.
The following may be identified: Cultural factors related to psychosocial environment and levels of functioning. Note culturally relevant interpretations of social stressors, available social supports, and levels of functioning and disability.
This would include stresses in the local social environment and the role of religion and kin networks in providing emotional, instrumental, and informational support. Cultural elements of the relationship between the individual and the clinician. Indicate differences in culture and social status between the individual and the clinician and problems that these differences may cause in diagnosis and treatment e.
Overall cultural assessment for diagnosis and care. The formulation concludes with a discussion of how cultural considerations specifically influence comprehensive diagnosis and care. American Psychiatric Association a, pp.
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