A CLINICAL CASE OF AFFECTIVE SPECTRUM DISORDER IN AN INTERNATIONAL MEDICAL STUDENT: CULTURAL ASPECTS

Abstract

Most studies of depression in international students focus on the prevalence and factors of acculturative stress. However, cultural analysis of the clinical presentation of mental disorders, particularly among Indian medical students studying in Russia, remains insufficient. This case demonstrates how cultural factors (membership of a religious minority, somatization of depression, stigma, and family expectations) modulate the course of recurrent depressive disorder in an international medical student and influence help-seeking behavior. Patient A., 24, a Muslim medical student from India, presented with complaints of depressed mood, psychomotor retardation, early awakening, decreased libido, and episodic anti-vital thoughts. Since the age of 16, he had noted prolonged depressive episodes with somatovegetative symptoms (diarrhea, back pain). He was diagnosed with recurrent depressive disorder, current episode mild with somatic symptoms. He was treated with fluoxetine, then mirtazapine, supplemented by psychotherapy and psychoeducation. Clinical remission was achieved, and the patient returned to full academic and social activities. This case highlights the need to move beyond a nosocentric approach. Considering such culturally determined factors that are significant in this case, such as the somatization of depressive manifestations, cultural anonymity when seeking help, as well as the religious prohibition on suicide as a defense mechanism, contributed to a more complete understanding of the mechanisms of development of affective disorder in the patient and the prospects for its treatment. Cultural competence among mental health professionals is essential for effective care of international students studying at Russian universities.