A 39-year-old Cambodian man presents to the PMHNP for an evaluation following an event that he refers to as "Khayal." Which culture-bound syndrome should the PMHNP include in the differential diagnosis?

Choice A reason: Fright-related syndromes occur in some cultures but are generally associated with depressive or anxious reactions following trauma rather than the somatic and panic-like symptoms described in this case. Choice B reason: The concept of a weak nervous system with associated mood and somatic symptoms describes neurasthenia, a diagnosis used historically in East Asia, but it is not the same as Khayal attacks. Choice C reason: “Khayal” or “wind attack” is a culture-bound syndrome seen primarily among Cambodians and other Southeast Asian populations. It resembles a panic attack and is believed to result from disturbances in the wind-like substance (“khyal”) flowing through the body. Symptoms include dizziness, tinnitus, neck soreness, shortness of breath, and palpitations. It is often triggered by anxiety or worry and involves intense fear that a wind-like substance is rising in the body, causing physical distress and even death. Choice D reason: “Thinking too much,” or “khyal cap,” is a different cultural concept, associated with excessive rumination and social or interpersonal problems, not the acute somatic symptoms described here.