The need for culture sensitive diagnostic procedures: a study among psychotic patients in Morocco.
OBJECTIVE
We examine the procedural validity of a standardized instrument for the diagnosis of psychotic disorders in Morocco.


METHODS
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).


CONCLUSIONS
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.


CONCLUSIONS
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.


CONCLUSIONS
The study was conducted in a small sample. Both versions of CASH were administered by the same interviewer in a single interview session.
Zandi
Tekleh
T
Altrecht, Institute for Mental Health Care, Utrecht, The Netherlands. hijma-zandi@planet.nl
Havenaar
Johan M
JM
Limburg-Okken
Annechien G
AG
van Es
Hans
H
Sidali
Salah
S
Kadri
Nadia
N
van den Brink
Wim
W
Kahn
Rene S
RS
D018864:Cultural Diversity; D003469:Culture; D003937:Diagnosis, Differential; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D015994:Incidence; D008297:Male; D009018:Morocco / Q000208:ethnology; D009426:Netherlands / Q000453:epidemiology; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000208:ethnology*; D012680:Sensitivity and Specificity