Treatment of a biracial child with schizophreniform disorder: cultural formulation

Over the past several years, the field of psychiatry has shown a higher level of cultural sensitivity and an increasing interest in the role of cultural factors in mental health. This has been notably reflected in the incorporation of cultural considerations, such as an outline for cultural formulation and a glossary of culture-bound syndromes, in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV; American Psychiatric Association, 1994). This case report is illustrative of the significance of considering cultural elements in diagnosing and treating a psychiatric disorder. It is also the first-known detailed case report on fakamahaki, a culture-bound syndrome from the Kingdom of Tonga. The syndrome is described in a child from the perspective of a child psychiatry fellow. To serve as a teaching case for clinicians in training as well as those in practice, the DSM-IV outline for cultural formulation has been used. This case can be helpful in educating others in the mental health field about the utility of a more comprehensive approach to understanding clients in contrast to the growing trend of very focused approaches.