Panic Disorder Among American Indians: A Descriptive Study

Competencies for direct service staff members who work with adults with severe mental illnesses: Specific knowledge, attitudes, skills, and bibliography.

“…Competency #11: Conduct activities in a culturally competent manner Understand and value cultural and ethnic differences, their alternative perspectives on mental illness, on help-seeking, and on alternative healing practices, as well as lifestyles, goals, family and community life (Four National Panels on Cultural Competence, 1997): A.1 Demonstrate basic cultural competency, especially with those minority groups that live within the catchment area.A.2 Provide culturally competent interventions and models of care that take into account the individual's values (e. g., spirituality, community, family) and critical life experiences (e. g. racism, discrimination).A.3 Work collaboratively with culturally appropriate allies such as traditional healers, priests, local ethnic community based organizations, and other members of the cultural community in all aspects of service deliveryDemonstrate ability to clearly understand and communicate effectively with the client: B.1 Use language and communication style that is understandable.B.2 Be fluent in common foreign languages.B.3 Seek out culturally competent linguistic support for treatment and interventions, orB.4 Refer to providers who have relevant language skillsMake diagnoses that are culturally informed (Flaskerud & Hu, 1992): C.1 Pay particular attention to different levels of physical and medical co-morbitities among cultural groups.C.2 Separate cultural aspects from the person's psychopathology.C.3 Integrate culturally relevant information into assessment and treatment records.Make assessments that are culturally informed (American Psychological Association, 1996): D.1 Provide evaluations that are culturally and linguistically competent.D.2 When needed, seek input from a qualified practitioner trained in ethnic-specific biological, cultural, socioeconomic, and psychological variables.D.3 Show specific knowledge concerning norms, biases, and limitations of each assessment instrument used.Develop treatment plans that are culturally informed (American Psychological Association, 1996; Munoz & Sanchez, 1997): E.1 Write treatment plans and records that include culturally relevant issues that impact on treatment responsiveness, and take into account cultural beliefs about health, mental health, and interventions.E.2 If not sufficiently knowledgeable about the clients' culture and life experiences, seek the guidance of a culturally competent provider in conjunction with the consumer and family, where appropriate.Provide culturally competent treatment (National Latino Behavioral Health Workgroup, 1996; Neligh, 1990): F.1 Tailor treatment modalities (e. g. psycho-education, psychotherapy, rehabilitation, family therapy, specialized group therapy, behavioral approaches, use of traditional healers, and outreach), so that they are culturally acceptable and effective.F.2 Conduct psychosocial interventions within the context of the value system of consumers and family members (e. g., egalitarian, family-focused, spiritually-oriented) and address issues specific to their life experiences (e. g., discrimination, violence, gender role conflicts, life transitions).F.3 Provide psychotherapeutic interventions that address psychological issues specific to a consumer's cultural background (e. g., current and historical trauma, acculturat...…”

“…Provide culturally competent treatment (National Latino Behavioral Health Workgroup, 1996; Neligh, 1990): F.1 Tailor treatment modalities (e. g. psycho-education, psychotherapy, rehabilitation, family therapy, specialized group therapy, behavioral approaches, use of traditional healers, and outreach), so that they are culturally acceptable and effective.F.2 Conduct psychosocial interventions within the context of the value system of consumers and family members (e. g., egalitarian, family-focused, spiritually-oriented) and address issues specific to their life experiences (e. g., discrimination, violence, gender role conflicts, life transitions).F.3 Provide psychotherapeutic interventions that address psychological issues specific to a consumer's cultural background (e. g., current and historical trauma, acculturation, intergenerational and gender role distinctions, and life transitions).F.4 Know the different effects of psychotropic medication on racial groups and the problems of literacy in labeling medication.…”

Substance Abuse in Patients With Comorbid Anxiety Disorder

“… use of lifetime prevalence rather than 1‐month‐during‐abstinence prevalence; 1,22 use of patient‐rated scales that require patients to make etiologic assessments regarding their symptoms, despite the complexity of making such assessments; 6,22 use of interview schedules poorly designed to differentiate SRD and AD, such as the Schedule for Affective Disorders and Schizophrenia (SADS); 1 failure to delay assessment until patients have gone through detoxification, which can mimic AD; 10 selection of subgroups of alcoholic patients in whom anxiety may be over‐represented, such as women, 4 American Indians, 23 and combat veterans; 13 and use of small sample sizes of subjects or patients with SRD 1,23 …”

“…selection of subgroups of alcoholic patients in whom anxiety may be over‐represented, such as women, 4 American Indians, 23 and combat veterans; 13 and…”

Panic attacks and panic disorder in the American Indian community

“…Furthermore, a national survey of over 43,000 participants found that Native American was the only racial category associated with increased risk for 12-month and lifetime panic disorder relative to Asians, Hispanics, African-Americans, and Caucasians (Grant et al, 2006). Yet, only a single publication has described the clinical features of panic attacks and panic disorder in AIs (Neligh, Baron, Braun, & Czamecki, 1990). Findings from this study are seriously limited, however, due to a small sample size (n = 7), presence of comorbid psychiatric conditions, outdated diagnostic criteria, and absence of panic symptom information.…”