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Brain fag syndrome: a culture-bound syndrome that may be approaching extinction

  • Oyedeji A. Ayonrinde (a1), Chiedu Obuaya (a2) and Solomon Olusola Adeyemi (a3)
Abstract
Aims and method

To explore the current salience of ‘brain fag’ as a nosological, diagnostic and clinical construct in modern West African psychiatry. A semi-structured questionnaire and vignette based on classical symptoms of brain fag syndrome were used to explore current knowledge, explanatory models and practice among Nigerian psychiatrists.

Results

Of 102 psychiatrists who responded, 98% recognised the term ‘brain fag syndrome’ and most recognised the scenario presented. However, only 22% made a diagnosis of brain fag syndrome in their practice preferring diagnoses of anxiety, affective and somatic disorders.

Clinical implications

A decreasing number of Nigerian psychiatrists are making a diagnosis of ‘brain fag syndrome’. We found strong evidence of nosological and diagnostic decline in the syndrome in its place of birth. This may signal the early extinction of this disorder or nosological metamorphosis from a ‘culture-bound’ syndrome in West African psychiatric practice.

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Copyright
This is an open-access article published by the Royal College of Psychiatrists and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Correspondence to Oyedeji A. Ayonrinde (deji.ayonrinde@slam.nhs.uk)
Footnotes
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Declaration of interest

None.

Footnotes
References
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2 Harris, B. A case of brain fag in East Africa. Br J Psychiatry 1981; 139: 162–3.
3 Peltzer, K, Cherian, VI, Cherian, L. Brain fag symptoms in rural South African secondary school pupils. Psychol Rep 1998; 83 (3 Pt 2): 1187–96.
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5 Ola, BA, Morakinyo, O, Adewuya, AO. Brain fag syndrome a myth or Reality. Afr J Psychiatry 2009; 12: 135–43.
6 Aina, OF, Morakinyo, O. Culture-bound syndromes and the neglect of cultural factors in psychopathologies among Africans. Afr J Psychiatry 2011; 14: 278–85.
7 World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders. WHO, 1992.
8 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revised (DSM-IV-TR). APA, 2000.
9 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). APA, 2013.
10 Okulate, GT, Olayinka, MO, Jones, OBE. Somatic symptoms in depression: evaluation of their diagnostic weight in an African setting. Br J Psychiatry 2004; 184: 422–7.
11 Ola, BA, Igbokwe, DO. Factorial validation and reliability analysis of the brain fag syndrome scale. Afr Health Sci 2011; 11: 334–40.
12 World Health Organization. WHO-AIMS Report on Mental Health System in Nigeria. WHO, 2006.
13 Reed, GM, Mendonça Correia, J, Esparza, P, Saxena, S, Maj, M. The WPAWHO Global Survey of Psychiatrists' Attitudes Towards Mental Disorders Classification. World Psychiatry 2011; 10: 118–31.
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16 Anumonye, A. Lorazepam in the treatment of ‘brain fag syndrome’. Afr J Psychiatry 1978; 3: 121–3.
17 Ayonrinde, OA, Bhugra, D. Culture bound syndromes. In Troublesome Disguises: Managing Challenging Disorders in Psychiatry (2nd edn) (eds Bhugra, D, Malhi, GSA). Wiley–Blackwell, 2015.
18 Ayonrinde, OA. Brain fag syndrome: new wine in old bottles or old wine in new bottles? Niger J Psychiatry 2008; 6: 4750.
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BJPsych Bulletin
  • ISSN: 2056-4694
  • EISSN: 2056-4708
  • URL: /core/journals/bjpsych-bulletin
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Brain fag syndrome: a culture-bound syndrome that may be approaching extinction

  • Oyedeji A. Ayonrinde (a1), Chiedu Obuaya (a2) and Solomon Olusola Adeyemi (a3)
Submit a response

eLetters

Extinction of brain fag syndrome: too early to conclude

Foluke T Odeyale, Specialist Registrar, Community General Adult Psychiatry, St Mary's Hospital Campus, Solent NHS Trust
Adetokunbo B Shangobiyi, Associate Specialist in Addiction services,, Tees Esk and Wear Valley NHS Foundation Trust
Itoro I Udo, Locum Consultant Psychiatrist, Broadoak Unit, Merseycare Trust,
29 July 2015

I had a case of brain fag syndrome for my long case, in medical school. Hence, the article by Ayonrinde et al caught and held my attention (1). Ayorinde et al’s paper is of medical anthropological significance. It signifies how the evolution of cultural, social and educational development may have impacted psychiatric diagnoses, philosophy and treatments. They have presented a paper that anticipates the possible future demise of a once well recognised culture bound syndrome. Indeed, psychiatry is often in dialogue with global, historical, political and sociocultural forces in the environment.

Ayonrinde et al set out to “explore awareness of brain fag, its aetiology, diagnosis, explanatory models and management” amongst psychiatrists in Nigeria (1). However, they may have prematurely concluded that their findings “signal the early extinction of this disorder or nosological metamorphosis from a ‘culture-bound’ syndrome in West African psychiatric practice” (1). Given that brain fag syndrome would be expected to occur more commonly among students, one wonders whether the questionnaires should have been aimed at medical practitioners based in Universities, Polytechnics, Colleges of Education and other tertiary institutions. This would have reduced selection bias as students would be expected to present at these institutions in the first instance. Most mental illness and disorders, even in low and middle income countries, are treated in primary care (2). Being acquainted with the culture, we opine that most students, due to stigma, may not want to consult a psychiatrist and may rather present to a private nurse/doctor or university health centre to get treatment. This may be one of the reasons why psychiatrists see less of this syndrome.

On discussing this paper with a general practice colleague who works in a University Health Centre in Nigeria, she reported that they do get presentations like these, around one or two in a year. They do not always refer on to psychiatrists, and manage them with antidepressants, anxiolytics or low dose antipsychotics. Patients generally get better and symptoms resolve within days to a week. After which they tend to go home on a break from academia. They rarely return with the same symptoms. They generally do not get followed up and tend to resume their studies successfully.

References:

1.Ayonrinde OA, Obuaya C, Adeyemi SO. Brain Fag Syndrome: A Culture-bound Syndrome that May be Approaching Extinction. BJPsych Bulletin. 2015: 1-6.

2.Gureje O, Abdulmalik J, Kola L, Yasamy TM, Adebayo K. Integrating Mental Health into Primary Care in Nigeria: Report of a Demonstration Project Using the Mental Health Gap Action Programme Intervention Guide. BMC Health Services Research 2015; 15:242.



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