To document if prescription opioid medications used for pain enhanced or worsened pain syndromes from medical conditions in patients who received a diagnosis of prescription opioid dependence as determined by a diagnosis by DSM-IV criteria. Further, whether detoxification improved or worsened pain perceptions and self reports in patients who chronically administered prescription opioid medications.

Our study consisted of a retrospective sample of patients taken from the Addiction Treatment Unit at St. Lawrence Hospital in Lansing, Michigan. Patients were selected from those who voluntarily sought detoxification from opioid medications in an inpatient setting. Selection criteria for the study consisted of a DSM-IV diagnosis of opioid prescription medication dependence, willingness to undergo medical detoxification, cooperation with self-report scales and abstinence from opioid medications. Study patients were randomly selected from discharges in patient census for the years 2001-2003.

The significant findings were that self reported pain scores improved during the detoxification from admission to discharge, from a mean of 5.5 at admission to mean of 3.4 at discharge (0 is no pain, and 10 is the most pain). The detoxification period extended to an average of 5 days. While oxycodone CR (OxyContin) produced higher levels of self-reported pain at admission and discharge, these patients experienced significant levels of pain reduction as with other opioid medications.

Patients with a DSM-IV diagnosis of prescription opioid dependence reported (self) less pain with detoxification and abstinence from the opioid medications.

Transcultural psychiatry is a branch of psychiatry where cultural context for psychiatric symptoms is studied. It emerged as a consequence of migration of diverse ethnic groups and questions whether international diagnosis classifications fit in different cultures.

The aim of this review is to make professionals aware of the importance of cultural context for the way mental disorders present themselves depending on the patient's origin.

We report the detailed case of a 23-year-old Moroccan woman, attended for the first time by the mental health services when she was 8. Since that moment, she felt herself possessed by a strange being. Auditory hallucinations appeared. It was only when her father or her husband were at home that she felt the “being” was gone. Her husband, as formerly his father, represented a symbol of protection against that evil being and indeed against her mental disorder, which was directly related to her cultural beliefs.

Every country has a different culture and every migration brings with it a new environment. The way people adapt to it may result in mental illness. We want to discuss if symptoms fit international diagnosis classifications.

Psychiatrists should become aware of the limitations of the international classifications when used on different ethnic groups. We should have a cultural approach in order to treat the diverse populations from all around the world.

The authors have not supplied their declaration of competing interest.

Gli Autori affrontano alcuni aspetti concettuali e metodologici legati allo studio della morbilità psichiatrica nella medicina di base. Vengono discussi i concetti di «malattia» in generale e di «caso psichiatrico» in particolare, con le ripercussioni che tali definizioni possono avere sull'attività di ricerca. Sono presentati i risultati di alcuni studi che hanno utilizzato i modelli statistici basati sulla latent trait theory per indagare i disturbi emotivi di comune riscontro tra i pazienti del medico di base. È stato cosi possibile evidenziare che tali disturbi tendono a distribuirsi lungo un continuum in assenza di punti di interruzione o di rarità. I problemi diagnostici tuttora presenti nella medicina di base sono considerati alia luce delle difficoltà nell'applicazione delle tradizionali categorie diagnostiche e delle prospettive aperte dai recenti sistemi multiassiali di classificazione.

medicina di base, disturbi emotivi, diagnosi.

The Authors examine some conceptual and methodological issues involved in the study of psychiatric morbidity in primary care settings. The concept of «disease» in general and that of «psychiatric case» in particular are discussed together with the implications that such definitions may have in research activity. Some studies are reviewed which have employed statistical models based on latent trait theoryto investigate the emotional disorders commonly found among subjects who consult the general practitioner. It becomes apparent that these disorders tend to distribute along a continuum with no rarity points or interruptions. Diagnostic problems still present in primary care settings are considered paying attention to the difficulties in the application of traditional diagnostic categories and to the new perspectives disclosed by recent multiaxial systems of classification.