L'Entrevue pour la vue d'ensemble culturelle (DSM-5) et Cultural Formulation de deux cas cliniques : Interférence de la spiritualité et de la religion au début du processus psychopathologique

Objectives. – In our experience in the Department of Psychiatry in Varese, admissions of patients of African origin have increased significantly (from 1.8% in 1999 to 4.2% in 2013). In clinical practice, we have observed that spiritual factors are recurrent elements at the onset of an illness, and in our study we set out to explore these factors, using the analysis and comparison of the two cases. Method. – We used the new DSM-5 version of the Cultural Formulation Interview, which provides a cultural overview and is structured into 16 questions. Results. – In our first case, Tariq was a young man of Moroccan origin, who was reunited with his family in Italy after many years. He experienced cultural trauma from the move from Morocco to Italy. Arab culture is clearly expressed in this case: the feeling of a Djinn can in itself explain the symptoms of malaise and apathy that appeared, and that clinicians observed at the start of the psychopathology. The second case concerns Jamal, who fled from Sierra Leone following a series of traumatic events. These led to a psychopathological evolution towards a delusional disorder with a culturally-determined mystical content. In this case report, we can see that contact with the spirit is here linked to the beat of the drum and sound vibrations. Discussion. –Religious and spiritual issues are recognized as being important factors, especially in the early stages of an illness: this can be seen as a strong call for help and a key element in the restructuring of cultural identity. The patient uses his cognitive resources to defend himself against symptoms and reduce anxiety and this process is a positive element in the relationship (known as rapporto bipersonale). Conclusions. – The new Cultural Formulation Interview has proved to be a good method for diagnosis and the therapeutic relationship with the patient: the Interview enables patients to exhibit greater communicability and adherence to treatment and care is facilitated.