Psychiatric symptoms and attribution to jinn.

There is often a discrepancy between the explanation of psychiatric symptoms by
the non-western patient (and/or his/her family/traditional healer) and by the
western-trained practitioner. This can create difficulties in diagnosis and
treatment.
Islamic patients often attribute psychiatric symptoms to a specific concept
called jinn (Colaço Belmonte, 1976; Blom et al., 2010). Other well known
concepts are evil eye and black magic. Next to the symptoms of hallucinations,
in Islamic patients jinn attributions are common for symptoms of mood
disorders, obsessive-compulsive disorder, but also in the case of grief, family
disputes, marriages problems and infertility. Although this is described in
several ethnic groups around the world (Ryan, 2007; Studer, 2010) and well
known in Islamic countries, systematic research in Islamic patients in the
western world is still pending (Lim et al., accepted).
In many cases jinn are described in a manner that psychiatrists would classify
as multimodal hallucinations. Multimodal hallucinations can be part of a
schizophrenia spectrum disorder, but are also reported in mood disorders, PTSD
and other psychiatric disorders (Lim et al., accepted).
It is suspected that patients who attribute their symptoms to jinn have a
reduced response to treatment and worse prognosis and as a consequence, worse
adherence to treatment. Therefore, gaining knowledge about attribution to, and
meaning of jinn in relation to psychiatric symptoms is indispensable for the
treatment of Islamic patients in the western world. Such knowledge may
contribute to innovation/ improvement in health care programs for Islamic
patients. A connection and better understanding between patients who hold a
religious/ cultural explanatory model on one side, and health care workers who
hold a medical explanatory model on the other side, may result in a more
integrated care system.
Quantitative research about attribution of psychiatric symptoms to jinn has not
been undertaken yet. The extent of the occurrence of attribution to jinn is
unknown, as are the existence and size of differences between ethnic groups.
Possibly, attribution is associated with demographic parameters such as age,
gender, level of education and time since migration.

Primary Objective: To determine the prevalence of attribution to jinn in
Islamic patients with psychiatric symptoms attending an outpatient clinic in an
urban area of Utrecht in the Netherlands, in particular in relation to symptoms
classified as hallucinations. Distribution of modalities of hallucinations is
expected to vary according to jinn attribution. Hallucinations will be
described in detail, also to determine if there is a association between the
modalities of hallucinations and jinn attribution.

Secondary Objective(s): To determine if there is an association between
demographic parameters and the attribution of psychiatric symptoms to jinn, and
to explore the meaning of jinn to the patient in more detail.

This is a cross-sectional study. All new patients of 18 years and older that
are signed up for treatment at the outpatient clinic of i-Psy Utrecht will be
asked to participate in the study.
The duration of the inclusion period is 12 months.
All new patients who give informed consent will be asked basic demographic
features as indicated in the appendix. They will be interviewed to determine
the presence of hallucinations and attribution of these symptoms to jinn.
Phenomenology of hallucinations will be systematically questioned with a
semi-structured interview. In case of absence of hallucinations the patient
will be interviewed about their explanatory model.

Not applicable.