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Hubbard A, Harris S, Dick M, McGee D. Understanding African American help-seeking for romantic relationships: Advocacy, barriers, and considerations. JOURNAL OF MARITAL AND FAMILY THERAPY 2024; 50:348-367. [PMID: 38383948 DOI: 10.1111/jmft.12692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 11/19/2023] [Accepted: 01/30/2024] [Indexed: 02/23/2024]
Abstract
African American couples experience greater levels of relationship distress than other racial/ethnic groups, but they are less likely to seek formal couple counseling. Existing literature highlights the importance of community support in the form of church, family, and friends. While the literature suggests that African Americans encounter unique barriers, we do not know how racism and discrimination impact the couple help-seeking process. This study seeks to address this gap and better understand unique barriers in the African American couple help-seeking (AACHS) process via a grounded theory-informed qualitative study. Findings from interviews with 11 African American individuals in committed relationships highlighted mistrust as a significant barrier to AACHS, while community supports are frequently sought out. Our findings add to current understandings about AACHS and highlight important areas for future research. In the clinical implications section, the authors outline tangible steps that clinicians can take based on the findings from this study.
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Affiliation(s)
- Aimee Hubbard
- Kansas City Relationship Institute, Independence, Missouri, USA
- Family Social Science, University of Minnesota, St. Paul, Minnesota, USA
| | - Steven Harris
- Family Social Science, University of Minnesota, St. Paul, Minnesota, USA
| | - Mary Dick
- Human Development and Family Sciences, Texas Tech University, Lubbock, Texas, USA
| | - DasJohn McGee
- Build Wealth, Minnesota, Minneapolis, Minnesota, USA
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Gardea-Resendez M, Ortiz-Orendain J, Miola A, Fuentes Salgado M, Ercis M, Coombes BJ, Gruhlke PM, Bostwick JM, Michel I, Vande Voort JL, Ozerdem A, McKean A, Frye MA, Taylor-Desir M. Racial differences in pathways to care preceding first episode mania or psychosis: a historical cohort prodromal study. Front Psychiatry 2023; 14:1241071. [PMID: 37732076 PMCID: PMC10507622 DOI: 10.3389/fpsyt.2023.1241071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/16/2023] [Indexed: 09/22/2023] Open
Abstract
Background There is evidence suggesting racial disparities in diagnosis and treatment in bipolar disorder (BD) and schizophrenia (SZ). The purpose of this study is to compare psychiatric diagnoses and psychotropic use preceding a first episode of mania (FEM) or psychosis (FEP) in racially diverse patients. Methods Using a comprehensive medical records linkage system (Rochester Epidemiology Project, REP), we retrospectively identified individuals diagnosed with BD or SZ and a documented first episode of mania or psychosis. Illness trajectory before FEP/FEM were characterized as the time from first visit for a mental health complaint to incident case. Pathways to care and clinical events preceding FEP/FEM were compared based on subsequent incident case diagnosis (BD or SZ) and self-reported race (White vs. non-White). Results A total of 205 (FEM = 74; FEP = 131) incident cases were identified in the REP. Duration of psychiatric antecedents was significantly shorter in non-White patients, compared to White patients (2.2 ± 4.3 vs. 7.4 ± 6.6 years; p < 0.001) with an older age at time of first visit for a mental health complaint (15.7 ± 6.3 vs. 11.1 ± 6.0 years; p = 0.005). There were no significant differences by race in FEM pathway to care or age of first seeking mental health. Overall non-White patients had lower rates of psychotropic use. Conclusion These data are unable to ascertain reasons for shorter duration of psychiatric antecedents and later age of seeking care, and more broadly first age of initial symptom presentation. If symptoms are confirmed to be earlier than first time seeking care in both groups, it would be important to identify barriers that racial minorities face to access timely psychiatric care and optimize early intervention strategies.
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Affiliation(s)
- Manuel Gardea-Resendez
- Department of Psychiatry, Universidad Autónoma de Nuevo León, Monterrey, Mexico
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Javier Ortiz-Orendain
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Alessandro Miola
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
| | | | - Mete Ercis
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Brandon J. Coombes
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Peggy M. Gruhlke
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - J. Michael Bostwick
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Ian Michel
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, United States
| | | | - Aysegul Ozerdem
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Alastair McKean
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Mark A. Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Monica Taylor-Desir
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
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Chakrabarti S, Singh N. Psychotic symptoms in bipolar disorder and their impact on the illness: A systematic review. World J Psychiatry 2022; 12:1204-1232. [PMID: 36186500 PMCID: PMC9521535 DOI: 10.5498/wjp.v12.i9.1204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/02/2022] [Accepted: 08/26/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lifetime psychotic symptoms are present in over half of the patients with bipolar disorder (BD) and can have an adverse effect on its course, outcome, and treatment. However, despite a considerable amount of research, the impact of psychotic symptoms on BD remains unclear, and there are very few systematic reviews on the subject.
AIM To examine the extent of psychotic symptoms in BD and their impact on several aspects of the illness.
METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. An electronic literature search of six English-language databases and a manual search was undertaken to identify published articles on psychotic symptoms in BD from January 1940 to December 2021. Combinations of the relevant Medical Subject Headings terms were used to search for these studies. Articles were selected after a screening phase, followed by a review of the full texts of the articles. Assessment of the methodological quality of the studies and the risk of bias was conducted using standard tools.
RESULTS This systematic review included 339 studies of patients with BD. Lifetime psychosis was found in more than a half to two-thirds of the patients, while current psychosis was found in a little less than half of them. Delusions were more common than hallucinations in all phases of BD. About a third of the patients reported first-rank symptoms or mood-incongruent psychotic symptoms, particularly during manic episodes. Psychotic symptoms were more frequent in bipolar type I compared to bipolar type II disorder and in mania or mixed episodes compared to bipolar depression. Although psychotic symptoms were not more severe in BD, the severity of the illness in psychotic BD was consistently greater. Psychosis was usually associated with poor insight and a higher frequency of agitation, anxiety, and hostility but not with psychiatric comorbidity. Psychosis was consistently linked with increased rates and the duration of hospitalizations, switching among patients with depression, and poorer outcomes with mood-incongruent symptoms. In contrast, psychosis was less likely to be accompanied by a rapid-cycling course, longer illness duration, and heightened suicidal risk. There was no significant impact of psychosis on the other parameters of course and outcome.
CONCLUSION Though psychotic symptoms are very common in BD, they are not always associated with an adverse impact on BD and its course and outcome.
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Affiliation(s)
- Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, UT, India
| | - Navdeep Singh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, UT, India
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Bias Discovery in Machine Learning Models for Mental Health. INFORMATION 2022. [DOI: 10.3390/info13050237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Fairness and bias are crucial concepts in artificial intelligence, yet they are relatively ignored in machine learning applications in clinical psychiatry. We computed fairness metrics and present bias mitigation strategies using a model trained on clinical mental health data. We collected structured data related to the admission, diagnosis, and treatment of patients in the psychiatry department of the University Medical Center Utrecht. We trained a machine learning model to predict future administrations of benzodiazepines on the basis of past data. We found that gender plays an unexpected role in the predictions—this constitutes bias. Using the AI Fairness 360 package, we implemented reweighing and discrimination-aware regularization as bias mitigation strategies, and we explored their implications for model performance. This is the first application of bias exploration and mitigation in a machine learning model trained on real clinical psychiatry data.
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Black Parker C, McCall WV, Spearman-McCarthy EV, Rosenquist P, Cortese N. Clinicians' Racial Bias Contributing to Disparities in Electroconvulsive Therapy for Patients From Racial-Ethnic Minority Groups. Psychiatr Serv 2021; 72:684-690. [PMID: 33730880 DOI: 10.1176/appi.ps.202000142] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patients from racial-ethnic minority groups undergo disparate electroconvulsive therapy (ECT) treatment compared with Caucasian peers. One leading hypothesis is that clinicians may unknowingly display racial bias when considering ECT for patients of color. Studies have consistently shown that patients of color face numerous racially driven, provider-level interpersonal and perceptual biases that contribute to clinicians incorrectly overdiagnosing them as having a psychotic-spectrum illness rather than correctly diagnosing a severe affective disorder. A patient's diagnosis marks the entry to evidence-based service delivery, and ECT is best indicated for severe affective disorders rather than for psychotic disorders. As a consequence of racially influenced clinician misdiagnosis, patients from racial-ethnic minority groups are underrepresented among those given severe affective diagnoses, which are most indicated for ECT referral. Evidence also suggests that clinicians may use racially biased treatment rationales when considering ECT after they have given a diagnosis of a severe affective or psychotic disorder, thereby producing secondary inequities in ECT referral. Increasing the use of gold-standard treatment algorithms when considering ECT for patients of color is contingent on clinicians transcending the limitations posed by aversive racism to develop culturally unbiased, clinically indicated diagnostic and treatment rationales.
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Affiliation(s)
- Carmen Black Parker
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Parker); Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta (McCall, Spearman-McCarthy, Rosenquist, Cortese)
| | - William V McCall
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Parker); Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta (McCall, Spearman-McCarthy, Rosenquist, Cortese)
| | - E Vanessa Spearman-McCarthy
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Parker); Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta (McCall, Spearman-McCarthy, Rosenquist, Cortese)
| | - Peter Rosenquist
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Parker); Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta (McCall, Spearman-McCarthy, Rosenquist, Cortese)
| | - Niayesh Cortese
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Parker); Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta (McCall, Spearman-McCarthy, Rosenquist, Cortese)
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The influence of prescriber and patient gender on the prescription of benzodiazepines: evidence for stereotypes and biases? Soc Psychiatry Psychiatr Epidemiol 2021; 56:1083-1089. [PMID: 33258001 DOI: 10.1007/s00127-020-01989-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Benzodiazepines are commonly prescribed globally. We hypothesize that gender stereotypes influence benzodiazepine prescriptions insofar as male prescribers are more likely to prescribe benzodiazepines to female patients. METHODS Our nationwide cohort study included 2,127,441 patients with a psychiatric disorder (ICD-9 codes 290-319) and 38,932 prescribers as part of the Taiwan National Health Insurance Research Database (1997-2013). We evaluated the effects of patient and prescriber gender on the proportion of patients prescribed benzodiazepines and the cumulative dosage of benzodiazepine prescription (mg) using generalized estimating equation and general linear models. RESULTS The proportion of patients prescribed benzodiazepines was higher among male (vs. female) prescribers [odds ratio (OR) = 1.06, 95% confidence interval (CI) = 1.05-1.07] and among female (vs. male) patients (OR = 1.08, 95% CI = 1.08-1.09). Similarly, male prescriber gender (β = 10,292.2, SE = 1265.5, p < 0.001) and female patient gender (β = 7913.7, SE = 627.1, p < 0.001) predicted higher cumulative dosages of benzodiazepine prescription. Mean cumulative dosage was highest among female patients seen by male prescribers (β = 4283.7, SE = 717.6, p < 0.001). The results were consistent in sensitivity analyses of patients with anxiety disorder (n = 1,632,363), major depression (n = 1,122,796), or chronic administration (n = 1,981,819), and prescribers with psychiatrists (n = 1276), and non-psychiatrists (n = 33,268). CONCLUSIONS Male prescribers were more likely to prescribe benzodiazepines to female patients relative to male patients. This gender bias in prescription is significant and warrants careful attention at point of care. We hypothesize that internalized societal biases and stereotypes affect benzodiazepine prescribing behaviour.
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Novak P, Chu J, Ali MM, Chen J. Racial and Ethnic Disparities in Serious Psychological Distress Among Those With Alzheimer's Disease and Related Dementias. Am J Geriatr Psychiatry 2020; 28:478-490. [PMID: 31500897 PMCID: PMC7021571 DOI: 10.1016/j.jagp.2019.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/09/2019] [Accepted: 08/09/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Alzheimer's disease and related dementias (ADRD) is a growing public health challenge. Prior research suggests that non-Hispanic whites (whites), non-Hispanic African Americans (African Americans), and Hispanics have differing risks for ADRD. OBJECTIVE To examine the existence of serious psychological distress (SPD) among whites, African Americans, and Hispanics; to calculate the predicted probability of ADRD in whites, African Americans, and Hispanics, and to decompose the differences among ADRD populations, quantifying the burden of higher SPD among African Americans and Hispanics, compared to whites. DATA AND METHOD The authors use nationally representative data from the Medical Expenditure Panel Survey (2007-2015) to estimate the association between ADRD and race, ethnicity, and SPD. Using Blinder-Oaxaca decomposition analysis, the authors estimate to what extent higher SPD among Hispanics and African Americans was associated with higher ADRD rates compared to whites. RESULTS After controlling for individuals' demographic and socioeconomic characteristics and co-existing medical conditions, the presence of SPD was still significantly associated with a higher likelihood of having ADRD. The model predicted significantly higher likelihood of having ADRD among African Americans (7.1%) and Hispanics (5.7%) compared to whites (4.5%). Higher rates of having SPD among African Americans explained 15% of white-black difference and 40% of the white-Hispanic difference in ADRD rates, respectively. DISCUSSION AND CONCLUSION Our findings suggest a significant relationship between SPD and ADRD and that the burden of SPD was greater among African Americans and Hispanics with ADRD. Efficient screening using self-reported SPD, compared to simply using diagnoses codes of mental illness, may be more helpful to reduce racial and ethnic disparities in ADRD.
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Affiliation(s)
- Priscilla Novak
- Department of Health Policy and Management (PN), University of Maryland College Park, School of Public Health, College Park, MD.
| | - Jun Chu
- University of Maryland College Park
| | - Mir M. Ali
- University of Maryland College Park, AND U.S. Department of Health and Human Services, Assistant Secretary for Planning and Evaluation
| | - Jie Chen
- University of Maryland College Park
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Millman ZB, Rakhshan Rouhakhtar PJ, DeVylder JE, Smith ME, Phalen PL, Woods SW, Walsh BC, Parham B, Reeves GM, Schiffman J. Evidence for Differential Predictive Performance of the Prime Screen Between Black and White Help-Seeking Youths. Psychiatr Serv 2019; 70:907-914. [PMID: 31310187 PMCID: PMC6773467 DOI: 10.1176/appi.ps.201800536] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Self-report screening instruments for emerging psychosis have the potential to improve early detection efforts by increasing the number of true positives among persons deemed to be at "clinical high risk" of the disorder, but their practical utility depends on their validity across race. This study sought to examine whether a commonly used self-report screening tool for psychosis risk performed equally among black and white youths in its ability to predict clinical high-risk status. METHODS Black (N=58) and white (N=50) help-seeking individuals ages 12-25 (61% female) were assessed with the Prime Screen and the Structured Interview for Psychosis-Risk Syndromes (SIPS). A logistic regression model estimated race differences in the strength of the relation between Prime Screen scores and SIPS-defined risk status. RESULTS Higher Prime Screen scores significantly predicted clinical high-risk status among white (p<.01) but not black participants. Among black youths without clinical high risk, self-reported Prime Screen scores more closely resembled scores for youths (black or white) with clinical high risk than scores of white peers who were also without clinical high risk. CONCLUSIONS Results suggest that consideration of race or ethnicity and associated cultural factors is important when screening for clinical high-risk status. Findings support the need to develop culturally valid early psychosis screening tools to promote appropriately tailored early intervention efforts.
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Affiliation(s)
- Zachary B Millman
- Department of Psychology, University of Maryland, Baltimore County, Baltimore (Millman, Rakhshan Rouhakhtar, Schiffman); Graduate School of Social Service, Fordham University, New York (DeVylder); School of Social Work, University of Maryland, Baltimore (Smith); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Phalen, Parham, Reeves); Department of Psychiatry, Yale University, New Haven, Connecticut (Woods, Walsh)
| | - Pamela J Rakhshan Rouhakhtar
- Department of Psychology, University of Maryland, Baltimore County, Baltimore (Millman, Rakhshan Rouhakhtar, Schiffman); Graduate School of Social Service, Fordham University, New York (DeVylder); School of Social Work, University of Maryland, Baltimore (Smith); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Phalen, Parham, Reeves); Department of Psychiatry, Yale University, New Haven, Connecticut (Woods, Walsh)
| | - Jordan E DeVylder
- Department of Psychology, University of Maryland, Baltimore County, Baltimore (Millman, Rakhshan Rouhakhtar, Schiffman); Graduate School of Social Service, Fordham University, New York (DeVylder); School of Social Work, University of Maryland, Baltimore (Smith); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Phalen, Parham, Reeves); Department of Psychiatry, Yale University, New Haven, Connecticut (Woods, Walsh)
| | - Melissa E Smith
- Department of Psychology, University of Maryland, Baltimore County, Baltimore (Millman, Rakhshan Rouhakhtar, Schiffman); Graduate School of Social Service, Fordham University, New York (DeVylder); School of Social Work, University of Maryland, Baltimore (Smith); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Phalen, Parham, Reeves); Department of Psychiatry, Yale University, New Haven, Connecticut (Woods, Walsh)
| | - Peter L Phalen
- Department of Psychology, University of Maryland, Baltimore County, Baltimore (Millman, Rakhshan Rouhakhtar, Schiffman); Graduate School of Social Service, Fordham University, New York (DeVylder); School of Social Work, University of Maryland, Baltimore (Smith); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Phalen, Parham, Reeves); Department of Psychiatry, Yale University, New Haven, Connecticut (Woods, Walsh)
| | - Scott W Woods
- Department of Psychology, University of Maryland, Baltimore County, Baltimore (Millman, Rakhshan Rouhakhtar, Schiffman); Graduate School of Social Service, Fordham University, New York (DeVylder); School of Social Work, University of Maryland, Baltimore (Smith); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Phalen, Parham, Reeves); Department of Psychiatry, Yale University, New Haven, Connecticut (Woods, Walsh)
| | - Barbara C Walsh
- Department of Psychology, University of Maryland, Baltimore County, Baltimore (Millman, Rakhshan Rouhakhtar, Schiffman); Graduate School of Social Service, Fordham University, New York (DeVylder); School of Social Work, University of Maryland, Baltimore (Smith); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Phalen, Parham, Reeves); Department of Psychiatry, Yale University, New Haven, Connecticut (Woods, Walsh)
| | - Brittany Parham
- Department of Psychology, University of Maryland, Baltimore County, Baltimore (Millman, Rakhshan Rouhakhtar, Schiffman); Graduate School of Social Service, Fordham University, New York (DeVylder); School of Social Work, University of Maryland, Baltimore (Smith); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Phalen, Parham, Reeves); Department of Psychiatry, Yale University, New Haven, Connecticut (Woods, Walsh)
| | - Gloria M Reeves
- Department of Psychology, University of Maryland, Baltimore County, Baltimore (Millman, Rakhshan Rouhakhtar, Schiffman); Graduate School of Social Service, Fordham University, New York (DeVylder); School of Social Work, University of Maryland, Baltimore (Smith); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Phalen, Parham, Reeves); Department of Psychiatry, Yale University, New Haven, Connecticut (Woods, Walsh)
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County, Baltimore (Millman, Rakhshan Rouhakhtar, Schiffman); Graduate School of Social Service, Fordham University, New York (DeVylder); School of Social Work, University of Maryland, Baltimore (Smith); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Phalen, Parham, Reeves); Department of Psychiatry, Yale University, New Haven, Connecticut (Woods, Walsh)
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Hamilton JE, Heads AM, Meyer TD, Desai PV, Okusaga OO, Cho RY. Ethnic differences in the diagnosis of schizophrenia and mood disorders during admission to an academic safety-net psychiatric hospital. Psychiatry Res 2018; 267:160-167. [PMID: 29908484 DOI: 10.1016/j.psychres.2018.05.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 03/24/2018] [Accepted: 05/18/2018] [Indexed: 01/26/2023]
Abstract
U.S. Hispanics, now the single largest minority group in the country, face unique mental health disparities. The current study utilizes Andersen's Behavioral Model of Health Service Use to examine ethnic disparities in receiving a schizophrenia or mood disorder diagnosis at psychiatric hospital admission. Our retrospective cohort study examined electronic health record data at an academic safety-net psychiatric hospital for adult patients (n = 5571) admitted between 2010 and 2013. Logistic regression with block-wise entry of predisposing, enabling and need variables was used to examine ethnic disparities in receiving a schizophrenia diagnosis at admission. The block of need factors was the strongest predictor of receiving a schizophrenia diagnosis compared to predisposing and enabling factors. Compared to non-Hispanic whites, Hispanics and African Americans had a greater likelihood of receiving a schizophrenia diagnosis at admission. Additionally, patients diagnosed with schizophrenia had elevated positive and negative symptoms and were more likely to be male, single/unmarried, homeless, high inpatient service utilizers, involuntarily hospitalized, and to exhibit functional impairment at psychiatric hospital admission. To address elevated positive and negative symptoms of schizophrenia, functional impairment, social withdrawal, and high inpatient service utilization, promising psychosocial interventions should be adapted for racial and ethnic minority populations and utilized as an adjuvant to antipsychotic medication.
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Affiliation(s)
- Jane E Hamilton
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA; UTHealth Harris County Psychiatric Center, Houston, TX, USA.
| | - Angela M Heads
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Thomas D Meyer
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Pratikkumar V Desai
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Olaoluwa O Okusaga
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey VA Medical Center, Houston,TX, USA
| | - Raymond Y Cho
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey VA Medical Center, Houston,TX, USA
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Akinhanmi MO, Biernacka JM, Strakowski SM, McElroy SL, Balls Berry JE, Merikangas KR, Assari S, McInnis MG, Schulze TG, LeBoyer M, Tamminga C, Patten C, Frye MA. Racial disparities in bipolar disorder treatment and research: a call to action. Bipolar Disord 2018; 20. [PMID: 29527766 PMCID: PMC6175457 DOI: 10.1111/bdi.12638] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Health disparities between individuals of African and European ancestry are well documented. The disparities in bipolar disorder may be driven by racial bias superimposed on established factors contributing to misdiagnosis, including: evolving empirically based diagnostic criteria (International Classification of Diseases [ICD], Research Diagnostic Criteria [RDC] and Diagnostic and Statistical Manual [DSM]), multiple symptom domains (i.e. mania, depression and psychosis), and multimodal medical and additional psychiatric comorbidity. METHODS For this paper, we reviewed the phenomenological differences between bipolar individuals of African and European ancestry in the context of diagnostic criteria and clinical factors that may contribute to a potential racial bias. RESULTS Published data show that bipolar persons of African ancestry, compared with bipolar persons of non-African ancestry, are more often misdiagnosed with a disease other than bipolar disorder (i.e. schizophrenia). Additionally, studies show that there are disparities in recruiting patients of African ancestry to participate in important genomic studies. This gap in biological research in this underrepresented minority may represent a missed opportunity to address potential racial differences in the risk and course of bipolar illness. CONCLUSION A concerted effort by the research community to increase inclusion of diverse persons in studies of bipolar disorder through community engagement may facilitate fully addressing these diagnostic and treatment disparities in bipolar individuals of African ancestry.
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Affiliation(s)
- Margaret O Akinhanmi
- Clinical and Translational ScienceMayo Clinic Graduate School of Biomedical SciencesRochesterMNUSA
| | - Joanna M Biernacka
- Division of Biomedical Statistics and InformaticsMayo ClinicRochesterMNUSA,Department of Psychiatry & PsychologyMayo ClinicRochesterMNUSA
| | - Stephen M Strakowski
- Department of PsychiatryDell Medical SchoolThe University of Texas at AustinAustinTXUSA
| | - Susan L McElroy
- Lindner Center of HOPEMasonOHUSA,Department of Psychiatry and Behavioral NeuroscienceUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Joyce E Balls Berry
- Mayo Clinic Center for Clinical & Translational Science (CCaTS)RochesterMNUSA,Department of Health Sciences ResearchMayo ClinicRochesterMNUSA
| | | | - Shervin Assari
- Department of PsychiatryUniversity of MichiganAnn ArborMIUSA
| | | | - Thomas G Schulze
- Institute of Psychiatric Phenomics and Genomics (IPPG)University HospitalLMUMunichGermany
| | - Marion LeBoyer
- Department of PsychiatryMondor HospitalUniversité Paris Est, AP‐HPCréteil, ParisFrance,Inser U955Institute for Biomedical Research Faculté de MédecineCréteil, Paris France
| | - Carol Tamminga
- Southwestern Department of PsychiatryUniversity of TexasDallasTXUSA
| | - Christi Patten
- Department of Psychiatry & PsychologyMayo ClinicRochesterMNUSA,Mayo Clinic Center for Clinical & Translational Science (CCaTS)RochesterMNUSA
| | - Mark A Frye
- Department of Psychiatry & PsychologyMayo ClinicRochesterMNUSA
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Campinha-Bacote J. Cultural considerations in forensic psychiatry: The issue of forced medication. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2017; 50:1-8. [PMID: 27726891 DOI: 10.1016/j.ijlp.2016.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 08/31/2016] [Accepted: 09/06/2016] [Indexed: 06/06/2023]
Abstract
There has been an ongoing debate regarding the forced use of antipsychotic medications and both the psychiatric and legal professions have reacted strongly to the growing debate. Within the penological context, cases such as Washington v. Harper, Riggins v. Nevada, and Sell v. United States established the framework for determining when antipsychotic medication may be forcibly administered. Medication decisions under the Sell and Riggins cases are to be approved at judicial hearings; whereas, administrative hearings are sufficient for Harper cases. Forensic psychiatrists are also given responsibility in making the legal decision of whether or not to forcibly treat a patient with psychotropic medication against his will. In making this critical decision, a significant factor that is often minimized is the cultural background of the patient. The purpose of this paper is to present cultural factors to be considered in forced medication. Focusing on the culture defense argument, a review of how the legal system has dealt with cultural implications of a case will be presented. This paper will then discuss cultural issues embedded in the assessment, diagnosis, and treatment of psychiatric patients by forensic psychiatrists who are called upon to make the decision of whether or not to force medicate a patient against his will. Lastly, recommendations and a framework for providing a culturally sensitive assessment during the decision to forcibly medicate a patient with psychotropic medication will be offered.
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Affiliation(s)
- Josepha Campinha-Bacote
- Transcultural C.A.R.E. Associates, 11108 Huntwicke Place, Blue Ash, OH 45241, United States.
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Oedegaard CH, Berk L, Berk M, Youngstrom EA, Dilsaver SC, Belmaker RH, Oedegaard KJ, Fasmer OB, Engebretsen IM. An ISBD perspective on the sociocultural challenges of managing bipolar disorder: A content analysis. Aust N Z J Psychiatry 2016; 50:1096-1103. [PMID: 27742913 DOI: 10.1177/0004867416668790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Clinical management of bipolar disorder patients might be affected by culture and is further dependent on the context of healthcare delivery. There is a need to understand how healthcare best can be delivered in various systems and cultures. The objective of this qualitative study was to gain knowledge about culture-specific values, beliefs and practices in the medical care provided to patients with bipolar disorders from a provider perspective in various areas of the world. SAMPLING AND METHODS The International Society for Bipolar Disorders (ISBD) network provided the framework for this qualitative study. An electronic interview with open-ended questions was administered to 19 international experts on bipolar spectrum disorder representing the International Society for Bipolar Disorders chapter network in 16 countries and six continents. In addition, there were two in-depth interviews with bipolar spectrum disorder experts done prior to the survey. The data were analysed using content analysis, and the information was structured using the software NVivo by QSR International Pty Ltd. FINDINGS All participants described sociocultural factors as important in healthcare delivery to bipolar patients in their part of the world, both in accessing healthcare and in providing culturally appropriate care. Factors that affected the provider's ability to supply good clinical management of patients were access to treatment options and long-term follow-up, as well as general strategies to combat stigma. In some societies, the patients' use of alternative treatments, gender issues and religion were also important factors. Understanding the impact of such culturally specific factors was overall regarded as essential for proper treatment interventions. CONCLUSION Sociocultural factors clearly affect the nature and quality of medical services delivered to bipolar patients. Financial, social and cultural factors affect patients' health-seeking behaviour, and this highlights the need for knowledge about such factors in order to adequately identify and treat bipolar patients globally. Culturally adapted training and psychoeducation programmes are particularly warranted.
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Affiliation(s)
- Christine H Oedegaard
- Global Mental Health Research Group (GMHRG), Centre for International Health, Faculty of Medicine and Dentistry, University of Bergen, Norway
| | - Lesley Berk
- IMPACT Strategic Research Centre, School of Medicine, Faculty of Health, Deakin University, Geelong, VIC, Australia.,Melbourne School of Population and Global Health and Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Faculty of Health, Deakin University, Geelong, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Orygen, The National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, Parkville, VIC, Australia.,The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Eric A Youngstrom
- Department of Psychology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Robert H Belmaker
- Beersheva Mental Health Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ketil J Oedegaard
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Norway .,Division of Psychiatry, Haukeland University hospital, Bergen, Norway
| | - Ole B Fasmer
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Norway.,Division of Psychiatry, Haukeland University hospital, Bergen, Norway
| | - Ingunn M Engebretsen
- Global Mental Health Research Group (GMHRG), Centre for International Health, Faculty of Medicine and Dentistry, University of Bergen, Norway
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Racial disparities during admission to an academic psychiatric hospital in a large urban area. Compr Psychiatry 2015; 63:113-22. [PMID: 26555499 DOI: 10.1016/j.comppsych.2015.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 08/17/2015] [Accepted: 08/27/2015] [Indexed: 01/27/2023] Open
Abstract
Multiple studies confirm that African Americans are less likely than non-Hispanic whites to receive needed mental health services. Research has consistently shown that African Americans are under-represented in outpatient mental health treatment settings and are over-represented in inpatient psychiatric settings. Further, African Americans are more likely to receive a diagnosis of schizophrenia and are less likely receive an affective disorder diagnosis during inpatient psychiatric hospitalization compared to non-Hispanic white patients, pointing to a need for examining factors contributing to mental health disparities. Using Andersen's Behavioral Model of Health Service Use, this study examined predisposing, enabling and need factors differentially associated with health service utilization among African American and non-Hispanic white patients (n=5183) during psychiatric admission. We conducted univariate and multivariate logistic regression analyses to examine both main effects and interactions. In the multivariate model, African American race at admission was predicted by multiple factors including younger age, female gender, multiple psychiatric hospitalizations, elevated positive and negative symptoms of psychosis, a diagnosis of schizophrenia and substance use, as well as having housing and commercial insurance. Additionally, screening positive for cannabis use at intake was found to moderate the relationship between being female and African American. Our study findings highlight the importance of examining mental health disparities using a conceptual framework developed for vulnerable populations (such as racial minorities and patients with co-occurring substance use).
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Berg AO, Aas M, Larsson S, Nerhus M, Hauff E, Andreassen OA, Melle I. Childhood trauma mediates the association between ethnic minority status and more severe hallucinations in psychotic disorder. Psychol Med 2015; 45:133-142. [PMID: 25065296 DOI: 10.1017/s0033291714001135] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Ethnic minority status and childhood trauma are established risk factors for psychotic disorders. Both are found to be associated with increased level of positive symptoms, in particular auditory hallucinations. Our main aim was to investigate the experience and effect of childhood trauma in patients with psychosis from ethnic minorities, hypothesizing that they would report more childhood trauma than the majority and that this would be associated with more current and lifetime hallucinations. METHOD In this cross-sectional study we included 454 patients with a SCID-I DSM-IV diagnosis of non-affective or affective psychotic disorder. Current hallucinations were measured with the Positive and Negative Syndrome Scale (P3; Hallucinatory Behaviour). Lifetime hallucinations were assessed with the SCID-I items: auditory hallucinations, voices commenting and two or more voices conversing. Childhood trauma was assessed with the Childhood Trauma Questionnaire, self-report version. RESULTS Patients from ethnic minority groups (n = 69) reported significantly more childhood trauma, specifically physical abuse/neglect, and sexual abuse. They had significantly more current hallucinatory behaviour and lifetime symptoms of hearing two or more voices conversing. Regression analyses revealed that the presence of childhood trauma mediated the association between ethnic minorities and hallucinations. CONCLUSIONS More childhood trauma in ethnic minorities with psychosis may partially explain findings of more positive symptoms, especially hallucinations, in this group. The association between childhood trauma and these first-rank symptoms may in part explain this group's higher risk of being diagnosed with a schizophrenia-spectrum diagnosis. The findings show the importance of childhood trauma in symptom development in psychosis.
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Affiliation(s)
- A O Berg
- NORMENT; K. G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Institute of Clinical Medicine,University of Oslo,and Oslo University Hospital, Oslo,Norway
| | - M Aas
- NORMENT; K. G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Institute of Clinical Medicine,University of Oslo,and Oslo University Hospital, Oslo,Norway
| | - S Larsson
- Department of Research and Development, Division of Mental Health and Addiction,Oslo University Hospital,Oslo,Norway
| | - M Nerhus
- NORMENT; K. G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Institute of Clinical Medicine,University of Oslo,and Oslo University Hospital, Oslo,Norway
| | - E Hauff
- Department of Research and Development, Division of Mental Health and Addiction,Oslo University Hospital,Oslo,Norway
| | - O A Andreassen
- NORMENT; K. G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Institute of Clinical Medicine,University of Oslo,and Oslo University Hospital, Oslo,Norway
| | - I Melle
- NORMENT; K. G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Institute of Clinical Medicine,University of Oslo,and Oslo University Hospital, Oslo,Norway
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Hembram M, Simlai J, Chaudhury S, Biswas P. First rank symptoms and neurological soft signs in schizophrenia. PSYCHIATRY JOURNAL 2014; 2014:931014. [PMID: 24701561 PMCID: PMC3950954 DOI: 10.1155/2014/931014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 12/25/2013] [Indexed: 11/18/2022]
Abstract
The aim of the study was to compare the neurological soft signs (NSS) in schizophrenia patients with and without first rank symptoms (FRS), their first degree relatives (FDR), and normal controls. The study was conducted on 60 schizophrenia patients diagnosed according to ICD 10 DCR and categorized into groups with and without FRS using Schedules for Clinical Assessment in Neuropsychiatry, 30 FDRs of the study sample, and 30 normal controls matched for age, education, and handedness. All the subjects gave written informed consent. Scale for the Assessment of Positive Symptoms and Scale for the Assessment of Negative Symptoms were applied to have a comprehensive assessment of the symptoms. NSS were assessed using Extended Standard Neurological Assessment Instrument. The correlations between NSS and clinical symptoms were relatively modest but significant. There was a weak relation between NSS and positive symptom severity. The FDR of schizophrenia patients had significantly lower NSS scores than schizophrenia patients, but only FDR of schizophrenia patients without FRS had significantly higher scores than normal controls. Our results indicate that NSS are more prominent in schizophrenia patients with negative symptoms and support the theory of NSS being a trait marker of schizophrenia particularly in those without FRS.
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Affiliation(s)
- Mahesh Hembram
- Department of Psychiatry, Ranchi Institute of Neuropsychiatry and Allied Sciences, Ranchi, Jharkhand 834006, India
| | - Jayati Simlai
- Department of Psychiatry, Ranchi Institute of Neuropsychiatry and Allied Sciences, Ranchi, Jharkhand 834006, India
| | - Suprakash Chaudhury
- Department of Psychiatry, Rural Medical College & Hospital, Pravara Institute of Medical Sciences (Deemed University), District Ahmednagar, Loni, Maharashtra 413736, India
| | - Parthasarathi Biswas
- Department of Psychiatry, Ranchi Institute of Neuropsychiatry and Allied Sciences, Ranchi, Jharkhand 834006, India
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Dinwiddie GY, Gaskin DJ, Chan KS, Norrington J, McCleary R. Residential segregation, geographic proximity and type of services used: evidence for racial/ethnic disparities in mental health. Soc Sci Med 2012; 80:67-75. [PMID: 23312305 DOI: 10.1016/j.socscimed.2012.11.024] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 07/20/2012] [Accepted: 11/22/2012] [Indexed: 11/24/2022]
Abstract
Residential characteristics influence opportunities, life chances and access to health services in the United States but what role does residential segregation play in differential access and mental health service utilization? We explore this issue using secondary data from the 2006 Medical Expenditure Panel Survey, 2006 American Medical Association Area Research File and the 2000 Census. Our sample included 9737 whites, 3362 African Americans and 5053 Latinos living in Metropolitan Statistical Areas. Using logistic regression techniques, results show respondents high on Latino isolation and Latino centralization resided in psychiatrist shortage areas whereas respondents high on African American concentration had access to psychiatrists in their neighborhoods. Predominant race of neighborhood was associated with the type of mental health professional used where respondents in majority African American neighborhoods were treated by non-psychiatrists and general doctors whereas respondents in majority Latino neighborhoods saw general doctors. Respondents high on Latino Isolation and Latino Centralization were more likely to utilize non-psychiatrists. These findings suggest that living in segregated neighborhoods influence access and utilization of mental health services differently for race/ethnic groups which contradicts findings that suggest living in ethnic enclaves is beneficial to health.
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Affiliation(s)
- Gniesha Y Dinwiddie
- African American Studies Department, University of Maryland College Park, 1147 Taliaferro Hall, College Park, MD 20742, United States.
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Abstract
This article explored the origins and implications of the underdiagnosis of affective disorders in African-Americans. MEDLINE and old collections were searched using relevant key words. Reference lists from the articles that were gathered from this procedure were reviewed. The historical record indicated that the psychiatric perception of African-Americans with affective disorders changed significantly during the last 200 years. In the antebellum period, the mental disorders of slaves mostly went unnoticed. By the early 20th century, African-Americans were reported to have high rates of manic-depressive disorder compared with whites. By the mid-century, rates of manic-depressive disorder in African-Americans plummeted, whereas depression remained virtually nonexistent. In recent decades, diagnosed depression and bipolar disorder, whether in clinical or research settings, were inexplicably low in African-Americans compared with whites. Given these findings, American psychiatry needs to appraise the deep-seated effects of historical stereotypes on the diagnosis and treatment of African-Americans.
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Choi MR, Eun HJ, Yoo TP, Yun Y, Wood C, Kase M, Park JI, Yang JC. The effects of sociodemographic factors on psychiatric diagnosis. Psychiatry Investig 2012; 9:199-208. [PMID: 22993517 PMCID: PMC3440467 DOI: 10.4306/pi.2012.9.3.199] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Revised: 04/27/2012] [Accepted: 04/27/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Several studies have reported that ethnic differences influence psychiatric diagnoses. Some previous studies reported that African Americans and Hispanics are diagnosed with schizophrenia spectrum disorders more frequently than Caucasians, and that Caucasians are more likely to be diagnosed with affective disorders than other ethnic groups. We sought to identify associations between sociodemographic factors and psychiatric diagnosis. METHODS We retrospectively examined the medical records of all psychiatric inpatients (ages over 18 years) treated at Kern county mental hospital (n=2,051) between July 2003 and March 2007 for demographic, clinical information, and discharge diagnoses. RESULTS African American and Hispanic males were more frequently diagnosed with schizophrenia spectrum disorders than Caucasians, whereas Caucasian females were more frequently diagnosed with affective disorders than females in the other ethnic groups, suggesting that patient ethnicity and gender may influence clinical diagnoses. Demographic variables, that is, a lower education, failure of marriage, homelessness, and low quality insurance, were found to be significantly associated with a diagnosis of schizophrenia spectrum disorders after adjusting for clinical variables. And, the presence of a family psychiatric history, failure of marriage, not-homelessness, and quality insurance were found to be associated with a diagnosis of affective disorders. CONCLUSION Our results show that these demographic factors, including ethnicity, have effects on diagnoses in psychiatric inpatients. Furthermore, these variables may help prediction of psychiatric diagnoses.
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Affiliation(s)
- Mal Rye Choi
- Department of Neuropsychiatry, Presbyterian Medical Center, Jeonju, Republic of Korea
- Department of Psychiatry, Kern Medical Center, Bakersfield, CA, USA
| | - Hun-Jeong Eun
- Department of Neuropsychiatry, Presbyterian Medical Center, Jeonju, Republic of Korea
| | - Tai P. Yoo
- Department of Psychiatry, Kern Medical Center, Bakersfield, CA, USA
| | - Youngmi Yun
- California State University at Bakersfield, Bakersfield, CA, USA
| | - Christopher Wood
- Department of Psychiatry, Kern Medical Center, Bakersfield, CA, USA
| | - Michael Kase
- Department of Psychiatry, Kern Medical Center, Bakersfield, CA, USA
| | - Jong-Il Park
- Department of Psychiatry, Chonbuk National University Hospital and Research Institute of Clinical Medicine, Jeonju, Republic of Korea
| | - Jong-Chul Yang
- Department of Psychiatry, Chonbuk National University Hospital and Research Institute of Clinical Medicine, Jeonju, Republic of Korea
- Department of Psychiatry, Chonbuk National University Medical School and Institute for Medical Sciences, Jeonju, Republic of Korea
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Awad AG, Rajagopalan K, Bolge SC, McDonnell DD. Quality of life among bipolar disorder patients misdiagnosed with major depressive disorder. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2011; 9:195-202. [PMID: 17632652 PMCID: PMC1911165 DOI: 10.4088/pcc.v09n0305] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Accepted: 12/08/2006] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Bipolar disorder is frequently misdiagnosed as major depressive disorder (MDD). We aim to quantify the prevalence of misdiagnosed bipolar disorder among the depression population and evaluate the quality-of-life (QOL) impact of misdiagnoses. METHOD Data were collected from 2 self-administered, cross-sectional studies in 2003. Patients participating in The Bipolar Disorder Misdiagnosis Study (N = 1156) were previously diagnosed with depression, experienced a depressive episode within the past year, and had no previous diagnosis of bipolar disorder or schizophrenia. Patients who experienced a manic episode in the past year, based on DSM-IV criteria, were classified as misdiagnosed. Patients participating in The Bipolar Disorder Project (N = 1214) self-reported a diagnosis of bipolar disorder and were recruited through community mental health centers and support groups. Quality of life was assessed via the Psychological General Well-Being (PGWB) Index and Medical Outcomes Study 8-Item Short-Form Health Survey (SF-8). Demographic differences between groups were controlled using linear regression models. RESULTS Of the diagnosed MDD sample, 14.3% met criteria for misdiagnosed bipolar disorder. When controlling for demographic differences, the PGWB overall score for the misdiag-nosed averaged 12.77 (p < .001) points lower than that of MDD patients and 9.55 (p < .001) points lower than that of diagnosed bipolar disorder patients. The average SF-8 mental component summary score for the misdiagnosed was 5.85 (p < .001) points lower than that of MDD patients and 3.18 (p = .002) points lower than that of diagnosed bipolar disorder patients. CONCLUSION Misdiagnosis is associated with poorer QOL than MDD or diagnosed bipolar disorder, which are recognized as having a considerable impact on QOL.
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Affiliation(s)
- A George Awad
- Humber River Regional Hospital, Toronto, Ontario, Canada
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Abstract
BACKGROUND Over the past 3 decades, a wide range of studies in the United States and the United Kingdom has reported that white individuals are more likely to be diagnosed with bipolar and affective disorders, whereas black individuals appear to be at higher risk for schizophrenia spectrum diagnoses. Despite the pressing need for strategies aimed at eliminating racial and cultural disparities in diagnosis and treatment of bipolar disorder, no systematic review of the existing literature in this area has been done. This study draws together the disparate strands of information in a comprehensive overview of the research base in this area. METHODS An electronic literature search of the Medline and PsychINFO databases was conducted in October 2009, supplemented by a review of references in the identified articles, for a total of 51 articles included in this qualitative review. RESULTS Black patients have consistently been found to be more likely than white patients to be diagnosed with schizophrenia rather than bipolar disorder. Four factors were identified as potential contributors to racial disparities in diagnostic rates: clinical presentation and expression of symptoms, access to care, help-seeking behaviors, and clinician judgment. CONCLUSION Despite efforts to curtail the phenomenon, racial disparities in diagnosis of bipolar disorder persist. Racial and cultural elements may affect how patients manifest behaviors and symptoms and how these are interpreted and attributed by clinicians in the diagnostic process. As an appropriate diagnosis determines treatment options and is central to quality of care, incorrect diagnosis can potentially have a negative impact on treatment effectiveness and accuracy of prognosis.
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Durbin A, Lin E, Taylor L, Callaghan RC. First-generation immigrants and hospital admission rates for psychosis and affective disorders: an ecological study in Ontario. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2011; 56:418-26. [PMID: 21835105 DOI: 10.1177/070674371105600705] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The immigrant population in Canada, and particularly in Ontario, is increasing. Our ecological study first assessed if there was an association between areas with proportions of first-generation immigrations and admissions rates for psychotic and affective disorders. Second, this study examined if area-level risks would persist after controlling for area socioeconomic factors in census-derived geographical areas-Forward Sortation Areas (FSAs)-in Ontario. METHODS Ontario's inpatient admission records from 1996 to 2005 and census data from 2001 were analyzed to derive FSA rates of first admissions for psychotic disorders and affective disorders per 100 000 person-years. Negative binomial regression models were adjusted, first, for FSA age and sex and, second, also for FSA population density and average income. RESULTS Using age- and sex-adjusted models, admission rates for psychotic disorders were higher in areas with greater proportions of immigrants. These areas were associated with lower admission rates for affective disorders. When FSA average income and population density were added to the models, the influence of immigrants was attenuated to nonsignificant levels in models predicting psychotic disorders admission rates. However, greater proportions of immigrants remained significantly protective when predicting rates of affective disorders. DISCUSSION Our study provides insight about the influence of area-level variables on risk of admission for psychotic and affective disorders in high immigrant areas. There is a dearth of current Canadian research on immigrant admission for psychotic disorders at the individual or area level. Future area- and individual-level studies may better identify groups at risk and possible explanations.
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Affiliation(s)
- Anna Durbin
- Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.
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Berg AO, Melle I, Rossberg JI, Romm KL, Larsson S, Lagerberg TV, Andreassen OA, Hauff E. Perceived discrimination is associated with severity of positive and depression/anxiety symptoms in immigrants with psychosis: a cross-sectional study. BMC Psychiatry 2011; 11:77. [PMID: 21548949 PMCID: PMC3115847 DOI: 10.1186/1471-244x-11-77] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 05/06/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Immigration status is a significant risk factor for psychotic disorders, and a number of studies have reported more severe positive and affective symptoms among immigrant and ethnic minority groups. We investigated if perceived discrimination was associated with the severity of these symptoms among immigrants in Norway with psychotic disorders. METHODS Cross-sectional analyses of 90 immigrant patients (66% first-generation, 68% from Asia/Africa) in treatment for psychotic disorders were assessed for DSM-IV diagnoses with the Structured Clinical Interview for DSM Disorders (SCID-I, sections A-E) and for present symptom severity by The Structured Positive and Negative Syndrome Scale (SCI-PANSS). Perceived discrimination was assessed by a self-report questionnaire developed for the Immigrant Youth in Cultural Transition Study. RESULTS Perceived discrimination correlated with positive psychotic (r=0.264, p<0.05) and depression/anxiety symptoms (r=0.282, p<0.01), but not negative, cognitive, or excitement symptoms. Perceived discrimination also functioned as a partial mediator for symptom severity in African immigrants. Multiple linear regression analyses controlling for possible confounders revealed that perceived discrimination explained approximately 10% of the variance in positive and depression/anxiety symptoms in the statistical model. CONCLUSIONS Among immigrants with psychotic disorders, visible minority status was associated with perceived discrimination and with more severe positive and depression/anxiety symptoms. These results suggest that context-specific stressful environmental factors influence specific symptom patterns and severity. This has important implications for preventive strategies and treatment of this vulnerable patient group.
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Affiliation(s)
- Akiah O Berg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingrid Melle
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Jan Ivar Rossberg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Kristin Lie Romm
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Sara Larsson
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Trine V Lagerberg
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ole A Andreassen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Edvard Hauff
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Gonzalez JM, Bowden CL, Berman N, Frank E, Bauer MS, Kogan JN, Alegría M, Miklowitz DJ. One-year treatment outcomes of African-American and Hispanic patients with bipolar I or II disorder in STEP-BD. PSYCHIATRIC SERVICES (WASHINGTON, D.C.) 2010. [PMID: 20123822 DOI: 10.1176/appi.ps.61.2.164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Few studies have compared treatment outcomes of African-American, Hispanic, and non-Hispanic white patients with bipolar disorder. The U.S. Systematic Treatment Enhancement Program for Bipolar Disorder compared one-year outcomes for bipolar I or II disorder from each of these racial-ethnic groups. METHODS African Americans (N=155) were retrospectively compared with a matched group of non-Hispanic whites (N=729), and Hispanics (N=152) were compared with a separate matched group of non-Hispanic whites (N=822). Response and recovery outcomes were examined. Survival analysis was used to compare time to treatment response for depression (Montgomery-Asberg Depression Rating Scale) and mania (Young Mania Rating Scale) as well as global assessment of functioning (Global Assessment of Functioning). RESULTS For manic and depressive symptoms, time to response and proportion of responders were similar across groups. Over the study year the proportion of days well was similar across groups. A smaller proportion of African Americans met criteria for improved global functioning. Depression response among African Americans with psychotic symptoms was slower than the response among African Americans without psychotic symptoms and among non-Hispanic whites with or without psychotic symptoms. No differences between Hispanics and non-Hispanic whites in response times and recovery were observed. CONCLUSIONS Results are consistent with U.S. clinical trials for other psychiatric disorders, which have reported similar outcomes for ratings of primary symptoms. Baseline psychotic symptoms are likely a significant contributor when African Americans with bipolar disorder are slow to recover. These results may be less generalizable to uninsured patients.
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Affiliation(s)
- Jodi M Gonzalez
- Department of Psychiatry, University of Texas Health Science Center, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA.
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Racial and ethnic disparities in detection and treatment of depression and anxiety among psychiatric and primary health care visits, 1995-2005. Med Care 2008; 46:668-77. [PMID: 18580385 DOI: 10.1097/mlr.0b013e3181789496] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Recent evidence questions whether formerly documented disparities in care for common mental disorders among African Americans and Hispanics still remain. Also, whether disparities exist mainly in psychiatric settings or primary health care settings is unknown. OBJECTIVE To comprehensively examine time trends in outpatient diagnosis and treatment of depression and anxiety among ethnic groups in primary care and psychiatric settings. DESIGN AND SETTING Analyses of office-based outpatient visits from the National Ambulatory Medical Care Study from 1995-2005 (n = 96,075). PARTICIPANTS Visits to office-based primary care physicians and psychiatrists in the United States. MAIN OUTCOME MEASURES Diagnosed with depression or anxiety, received counseling or a referral for counseling, received an antidepressant prescription, and any counseling or antidepressant care. RESULTS In these analyses of 10-year trends in treatment of common mental disorders, disparities in counseling/referrals for counseling, antidepressant medications, and any care vastly improved or were eliminated over time in psychiatric visits. Continued disparities in diagnoses, counseling/referrals for counseling, antidepressant medication, and any care are found in primary care visits. CONCLUSIONS Disparities in care for depression and anxiety among African Americans and Hispanics remain in primary care. Quality improvement efforts are needed to address cultural and linguistic barriers to care.
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Whaley AL, Hall BN. The Cultural/Racial Dimension of Psychotic Disorders in African American Patients. JOURNAL OF BLACK PSYCHOLOGY 2008. [DOI: 10.1177/0095798408316362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Studies of race differences in psychotic disorders frequently show greater severity among African Americans. An intraracial or cultural analysis of psychotic symptoms was conducted to better understand the racial disparities. Specifically, cultural/racial themes in the delusions and hallucinations of a sample of 156 African American psychiatric patients were examined via content analysis. Cultural/racial themes focusing on general racial issues and racism were identified in the delusions and hallucinations of these patients. The current findings also indicated that delusions were more prevalent and contain more cultural content than hallucinations. Implications for racial differences in psychotic symptom expression are discussed.
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Anglin DM, Malaspina D. Ethnicity effects on clinical diagnoses compared to best-estimate research diagnoses in patients with psychosis: a retrospective medical chart review. J Clin Psychiatry 2008; 69:941-5. [PMID: 18494534 PMCID: PMC5336694 DOI: 10.4088/jcp.v69n0609] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Ethnicity effects on diagnoses are frequently reported and have variably been attributed to diagnostic biases versus ethnic differences in environmental exposures, and other factors. METHOD We compared best-estimate gold standard research diagnoses to clinical diagnoses (DSM-III-R and DSM-IV criteria) among 129 white, 57 African American, and 50 Hispanic patients with psychosis admitted to an inpatient research unit from 1990 to 2003. RESULTS Clinical and research diagnoses showed greater agreement in Hispanic than in African American patients (white patients were intermediate). Diagnostic agreement for paranoid schizophrenia was likewise the best in Hispanic patients. While paranoid schizophrenia tended to be overdiagnosed in African American patients, it was underdiagnosed in white patients. Patterns of diagnostic agreement for schizoaffective disorder and "other" diagnoses were similar among the 3 ethnic groups. CONCLUSIONS Diagnostic unreliability may explain the excess of paranoid schizophrenia reported for African Americans. Further research is needed to elucidate the influence of ethnicity on clinical diagnosis before other theories to explain group differences can be reasonably proposed and reliably tested.
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Affiliation(s)
- Deidre M. Anglin
- Columbia University, Department of Psychiatry, New York State Psychiatric Institute New York, NY
| | - Dolores Malaspina
- New York University School of Medicine, Department of Psychiatry, New York, NY
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McGuire TG, Miranda J. New evidence regarding racial and ethnic disparities in mental health: policy implications. Health Aff (Millwood) 2008; 27:393-403. [PMID: 18332495 PMCID: PMC3928067 DOI: 10.1377/hlthaff.27.2.393] [Citation(s) in RCA: 362] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Minorities have, in general, equal or better mental health than white Americans, yet they suffer from disparities in mental health care. This paper reviews the evidence for mental health and mental health care disparities, comparing them to patterns in health. Strategies for addressing disparities in health care, such as improving access to and quality of care, should also work to eliminate mental health care disparities. In addition, a diverse mental health workforce, as well as provider and patient education, are important to eliminating mental health care disparities.
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Affiliation(s)
- Thomas G McGuire
- Department of Health Care Policy, Harvard Medical School in Boston, Massachusetts, USA
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Muroff J, Edelsohn GA, Joe S, Ford BC. The role of race in diagnostic and disposition decision making in a pediatric psychiatric emergency service. Gen Hosp Psychiatry 2008; 30:269-76. [PMID: 18433660 PMCID: PMC2388247 DOI: 10.1016/j.genhosppsych.2008.01.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Revised: 01/11/2008] [Accepted: 01/15/2008] [Indexed: 12/20/2022]
Abstract
OBJECTIVE We investigated the influence of race/ethnicity in diagnostic and disposition decision-making for children and adolescents presenting to an urban psychiatric emergency service (PES). METHOD Medical records were reviewed for 2991 child and adolescent African-American, Hispanic/Latino and white patients, treated in an urban PES between October 2001 and September 2002. A series of bivariate and binomial logistic regression analyses were used to delineate the role of race in the patterns and correlates of psychiatric diagnostic and treatment disposition decisions. RESULTS Binomial logistic regression analyses reveal that African-American (OR=2.28, P<.001) and Hispanic/Latino (OR=2.35, P<.05) patients are more likely to receive psychotic disorders and behavioral disorders diagnoses (African American: OR=1.66, P<.001; Hispanic/Latino: OR=1.36, P<.05) than white children/adolescents presenting to PES. African-American youth compared to white youth are also less likely to receive depressive disorder (OR=0.78, P<.05), bipolar disorder (OR=.44, P<.001) and alcohol/substance abuse disorder (OR=.18, P<.01) diagnoses. African-American pediatric PES patients are also more likely to be hospitalized (OR=1.50, P<.05), controlling for other sociodemographic and clinical factors (e.g., Global Assessment of Functioning). CONCLUSIONS The results highlight that nonclinical factors such as race/ethnicity are associated with clinical diagnostic decisions as early as childhood suggesting the pervasiveness of such disparities.
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Affiliation(s)
- Jordana Muroff
- School of Social Work, Boston University, Boston, MA 02215, USA.
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Strakowski SM, Tsai SY, Delbello MP, Chen CC, Fleck DE, Adler CM, Arndt S, Amicone J. Outcome following a first manic episode: cross-national US and Taiwan comparison. Bipolar Disord 2007; 9:820-7. [PMID: 18076531 DOI: 10.1111/j.1399-5618.2007.00411.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Bipolar disorder (BD) is recognized as a significant psychiatric condition worldwide, yet little is known about cross-national differences in the course of illness. This information might clarify features of the disorder that are illness versus culturally specific. Therefore, the aim of this study was to identify differential and shared outcome predictors in first-episode manic bipolar patients in Cincinnati, OH, USA and Taipei, Taiwan. METHODS DSM-IV bipolar patients were identified at the time of their first manic or mixed episode and were prospectively followed in a naturalistic, longitudinal study for one year. Patients were recruited from a first psychiatric hospitalization at university-affiliated, urban hospitals in Taipei and Cincinnati. The primary outcome measures were remission, recovery, recurrence and percent of follow-up spent with affective symptoms and syndromes. Treatment adherence was also assessed, as were a number of possible mediator variables. RESULTS The two patient groups showed a number of significant differences in index clinical presentation on characteristics previously associated with outcome in other studies (e.g., substance abuse). The patients in Taipei showed significantly better outcome on virtually all measures. Some of these findings reflected differences in index (mediator) variables, whereas others persisted after controlling for potential baseline confounds. CONCLUSIONS The early course of BD varies between Chinese and American patients. Some of this variance results from demographic and clinical cross-national differences in premorbid variables. Other sources of variance remain to be identified.
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Affiliation(s)
- Stephen M Strakowski
- Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0559, USA.
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31
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DeCoux Hampton M. The role of treatment setting and high acuity in the overdiagnosis of schizophrenia in African Americans. Arch Psychiatr Nurs 2007; 21:327-35. [PMID: 18037443 DOI: 10.1016/j.apnu.2007.04.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Revised: 03/19/2007] [Accepted: 04/07/2007] [Indexed: 12/23/2022]
Abstract
Multiple studies have shown that significant disparities exist in the diagnosis of schizophrenia between African Americans (AAs) and Whites with severe mental illness. This phenomenon has been a topic in the literature for nearly three decades, yet it remains unclear what factors contribute most conclusively to the overdiagnosis of schizophrenia in AAs. The purpose of this article was to collectively examine the contributing factors identified in the literature and to discuss the role of acuity and treatment setting in overdiagnosis as well. A variety of client-level (higher rates of use of psychotomimetic substances in AAs) and care process-level (misinterpretation of cultural mistrust as paranoia, under detection of depression, similarities in diagnostic criteria between mood and psychotic disorders, provider bias, miscommunication between patient and provider, changes in diagnostic criteria, differences in diagnostic practice between providers, and a lack of sufficient data obtained) factors emerged as influential in overdiagnosis. However, in this review, it also emerged that AAs tendency to use emergency and acute care services, a systems level factor, could be related as well. It is possible that assessment at a time when symptom acuity is severe might increase the likelihood of a schizophrenia diagnosis in AAs.
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Abstract
People from minority backgrounds who have a mental illness experience double discrimination associated with both mental illness and race. In 2001, the Surgeon General's landmark report on race, culture, ethnicity, and mental health compellingly documented racial and ethnic disparities in mental heath care related to issues of misdiagnosis, underuse, overrepresentation, and improper treatment. The report called for sound research, including investigation into the area of psychopharmacology, to determine the extent to which the variability of an individual's response to medications is accounted for by factors related to race, ethnicity, age, gender, family history, or lifestyle. This article will focus on the realm of ethnic psychopharmacology and propose a practice model for nurses to become culturally competent in the area of ethnic psychopharmacology.
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Cunningham-Williams RM, Ostmann EL, Spitznagel EL, Books SJ. Racial/ethnic variation in the reliability of DSM-IV pathological gambling disorder. J Nerv Ment Dis 2007; 195:551-9. [PMID: 17632244 DOI: 10.1097/nmd.0b013e318093ed13] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Racial/ethnic disparities in mental disorders, including pathological gambling disorder (PGD), may be either real or artifacts of how they are conceptualized and measured. We aimed to assess racial/ethnic variation in the reliability of self-reported lifetime PGD determined by meeting > or = 5 criteria of the Diagnostic and Statistical Manual of Mental Disorders. Using community advertising, we recruited 15-85-year-old Caucasians (n = 225) and African (American/other minorities (n = 87), who had gambled more than 5 times lifetime), for 2 interviews, held 1 week apart, about gambling and associated behaviors. Results indicate substantial to almost-perfect DSM-IV PGD reliability for Caucasians (kappa = 0.82) and African Americans/other minorities (kappa = 0.68). Reliability for symptoms and for game-specific disorders was fair to almost perfect (kappa = 0.37-0.90). After adjusting results for confounding variables and multiple comparisons, racial/ethnic variation in PGD and game-specific reliability failed to persist. Implications exist for increased attention to screening and prevention efforts critical to reducing racial/ethnic disparities in PGD prevalence.
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Emilien G, Septien L, Brisard C, Corruble E, Bourin M. Bipolar disorder: how far are we from a rigorous definition and effective management? Prog Neuropsychopharmacol Biol Psychiatry 2007; 31:975-96. [PMID: 17459551 DOI: 10.1016/j.pnpbp.2007.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Revised: 03/08/2007] [Accepted: 03/08/2007] [Indexed: 10/23/2022]
Abstract
Bipolar disorder is a pathological disturbance of mood, characterized by waxing and waning manic, depressive and, sometimes distinctly mixed states. A diagnosis of bipolar disorder can only be made with certainty when the manic syndrome declares itself. Most individuals who are diagnosed with this disorder will experience both poles of the illness recurrently, but depressive episodes are the commonest cause of morbidity and, indeed, of death by suicide. Twin, adoption and epidemiological studies suggest a strongly genetic aetiology. It is a genetically and phenotypically complex disorder. Thus, the genes contributing are likely to be numerous and of small effect. Individuals with bipolar disorder also display deficits on a range of neuropsychological tasks in both the acute and euthymic phases of illness and correlations between number of affective episodes experienced and task performance are commonly reported. Current self-report and observer-rated scales are optimized for unipolar depression and hence limited in their ability to accurately assess bipolar depression. The development of a specific depression rating scale will improve the assessment of bipolar depression in both research and clinical settings. It will improve the development of better treatments and interventions. Guidelines support the use of antidepressants for bipolar depression. With regard to the adverse effects of antidepressants for bipolar depression, double-blind, placebo-controlled data suggest that antidepressant monotherapy or the addition of a tricyclic antidepressant may worsen the course of bipolar disorder. Importantly, adjunctive psychotherapies add significantly (both statistically and clinically) to the efficacy of pharmacological treatment regimens. The successful management of bipolar disorder clearly demands improved recognition of bipolar disorder and effective long-term treatment for bipolar depression as well as mania.
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Affiliation(s)
- Gérard Emilien
- Wyeth Research, Clinical Neuroscience Programs, Coeur Défense - Tour A - La Défense 4, 92931 Paris La Défense Cedex, France.
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35
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Luhrmann TM. Social defeat and the culture of chronicity: or, why schizophrenia does so well over there and so badly here. Cult Med Psychiatry 2007; 31:135-72. [PMID: 17534703 DOI: 10.1007/s11013-007-9049-z] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The history of the way schizophrenia has been conceptualized in American psychiatry has led us to be hesitant to explore the role of social causation in schizophrenia. But there is now good evidence for social impact on the course, outcome, and even origin of schizophrenia, most notably in the better prognosis for schizophrenia in developing countries and in the higher rates of schizophrenia for dark-skinned immigrants to England and the Netherlands. This article proposes that "social defeat" may be one of the social factors that may impact illness experience and uses original ethnographic research to argue that social defeat is a common feature of the social context in which many people diagnosed with schizophrenia in America live today.
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36
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Gordon KH, Brattole MM, Wingate LR, Joiner TE. The impact of client race on clinician detection of eating disorders. Behav Ther 2006; 37:319-25. [PMID: 17071210 DOI: 10.1016/j.beth.2005.12.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2005] [Accepted: 12/13/2005] [Indexed: 11/17/2022]
Abstract
Eating disorders are thought to occur less among African-American women than among women of other ethnic groups. Ninety-one clinicians read 1 of 3 passages (differing only with regards to the girl's race: African-American, Caucasian, or Hispanic) describing disturbed eating patterns of a fictional character named Mary. Participants were then asked to indicate if they thought Mary had a problem and to rate her anxiety, depression, and eating disorder symptoms based upon the passage they had read. The results suggest that clinicians may have race-based stereotypes about eating disorders that could impede their detection of symptoms in African-American girls.
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Sherazi R, McKeon P, McDonough M, Daly I, Kennedy N. What's new? The clinical epidemiology of bipolar I disorder. Harv Rev Psychiatry 2006; 14:273-84. [PMID: 17162652 DOI: 10.1080/10673220601070047] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The last few decades have seen a rapid change in our understanding of the epidemiology of bipolar disorder, which has only recently started to achieve major research attention. This article reviews recent developments. In addition to electronic searches using MEDLINE and PsycLIT, references from articles were identified, major journals hand searched, and major textbooks of psychiatry and epidemiology reviewed. Studies may have overestimated the prevalence of mania, and underestimated incidence. The incidence of mania may be increasing in recent generations, but the data remain inconclusive. Age at onset of mania is earlier than previously believed, and there are gender differences in epidemiology and clinical course. Ethnic differences in epidemiology and clinical course of bipolar disorder are highlighted. Comorbid alcohol and substance abuse are common in patients suffering from bipolar disorder and are associated with a more severe clinical course and a worse outcome. Urban living and lower socioeconomic and single marital status may be risk factors for developing bipolar disorder.
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Abstract
Cultural background may influence the perception of psychiatric symptoms. We examined the effects of cultural biases on the identification of manic symptoms using the Young Mania Rating Scale. Two video interviews, each with an American person with mania, were shown to psychiatrists from three countries (US, UK and India). Total scores on the scale differed significantly between the US and UK (P<0.001) and between India and UK (P<0.001) rater groups. Overall, differences between India and US rater groups were less marked (P=0.28). These differences suggest that cultural biases influence the interpretation of manic symptoms.
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Affiliation(s)
- Paul Mackin
- School of Neurology, Neurobiology and Psychiatry, University of Newcastle upon Tyne, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK.
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39
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Carlson GA. Trouble bipolaire à début précoce : considérations cliniques et de recherche. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.neurenf.2006.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
OBJECTIVE To compare symptom profiles of African-American and white adolescents with a diagnosis of bipolar disorder. METHOD Adolescents, aged 12-18 years at their first psychiatric hospitalization, with a DSM-IV diagnosis of bipolar disorder, manic or mixed, were evaluated on measures of manic, depressive, and positive symptoms of psychosis. Ethnic differences in symptom profiles were examined using multivariate analysis of covariance, and specific symptoms contributing to the difference were analyzed. RESULTS Ethnic differences existed in manic and positive symptom profiles, but not depressive symptoms. Compared with the white cohort, African-American youths were diagnosed more frequently as having psychotic features, and had higher ratings for auditory hallucinations. CONCLUSIONS Similar to adults, symptom expression in adolescent bipolar disorder may differ between ethnic groups. Future studies are needed to replicate these findings and explore possible explanations.
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Affiliation(s)
- Nick C Patel
- The College of Pharmacy, University of Cincinnati, OH 45267-0004, USA.
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41
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Affiliation(s)
- Jose Segal
- Division of Psychiatry, Department of Neurosciences, Tara Hospital, University of the Witwatersrand, South Africa.
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42
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Patel NC, DelBello MP, Keck PE, Strakowski SM. Ethnic differences in maintenance antipsychotic prescription among adolescents with bipolar disorder. J Child Adolesc Psychopharmacol 2005; 15:938-46. [PMID: 16379514 DOI: 10.1089/cap.2005.15.938] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE The aim of this study was to compare the longitudinal use of psychotropic medications in African-American and Caucasian adolescents with a diagnosis of bipolar disorder following their first psychiatric hospitalization. METHODS Age- and gender-matched African-American (n=16) and Caucasian (n=16) adolescents, between the ages of 12 and 18 years and meeting Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for bipolar I disorder, manic or mixed, were evaluated over a period of 1 year following their first psychiatric hospitalization for a mood episode. Medication prescription and adherence during follow-up were compared between ethnic groups. RESULTS African-American adolescents received antipsychotic prescription for a significantly greater percentage of time during follow-up than Caucasian adolescents, after adjusting for rate of psychotic features (79% versus 40%; p=0.05). African-American and Caucasian patients received mood stabilizer/anticonvulsant prescription for similar percentages of time during follow-up. African-American and Caucasian adolescents exhibited similar rates of full adherence to antipsychotics, mood stabilizers/anticonvulsants, and all psychotropic medications. CONCLUSIONS African-American adolescents were prescribed atypical antipsychotic medications for longer periods of time than Caucasian adolescents, but reasons for this finding were unclear. Additional research efforts in adolescent bipolar disorder are needed to explore factors associated with ethnic disparity in pharmacological treatment interventions.
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Affiliation(s)
- Nick C Patel
- Department of Psychiatry, University of Cincinnati, and the General Clinical Research Center and Mental Health Service Line, Cincinnati Veterans Affairs Medical Center, Ohio 45267-0004, USA.
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Ciliberto N, Bossie CA, Urioste R, Lasser RA. Lack of impact of race on the efficacy and safety of long-acting risperidone versus placebo in patients with schizophrenia or schizoaffective disorder. Int Clin Psychopharmacol 2005; 20:207-12. [PMID: 15933481 DOI: 10.1097/00004850-200507000-00003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This analysis aimed to assess the relationship between race and clinical response to long-acting, injectable risperidone treatment in patients with schizophrenia or schizoaffective disorder. In a 12-week, randomized, double-blind study, patients with schizophrenia or schizoaffective disorder received placebo or long-acting risperidone (25, 50 or 75 mg every 2 weeks). Data were stratified by race as identified by demographic information: Caucasian, African-American or Other. Psychotic symptoms were assessed by the Positive and Negative Syndrome Scale (PANSS); movement disorders by the Extrapyramidal Symptom Rating Scale (ESRS); adverse events (AEs) were reported spontaneously. Data were available for 439 patients: 193 Caucasian (44%), 174 (40%) African-American and 72 (16%) Other patients. Baseline characteristics were similar between racial groups, as were study completion rates (overall: 30% placebo; 48% long-acting risperidone). There was a significant effect of treatment (P<0.001), but not of race, on improvement in PANSS total scores from baseline to endpoint. ESRS scores were low throughout the study, and no significant impact of race was observed. Overall rates of AEs were similar among the racial groups. Race did not appear to impact the efficacy and tolerability of long-acting risperidone.
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Affiliation(s)
- Natalie Ciliberto
- Medical Services CNS, Medical Affairs Division, Janssen Pharmaceutica, Inc, Titusville, New Jersey 08560, USA.
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44
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Kupfer DJ, Frank E, Grochocinski VJ, Houck PR, Brown C. African-American participants in a bipolar disorder registry: clinical and treatment characteristics. Bipolar Disord 2005; 7:82-8. [PMID: 15654936 DOI: 10.1111/j.1399-5618.2004.00163.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The goal of this paper was to compare clinical characteristics and treatment history of African-American and Caucasian participants in a bipolar disorder registry. METHODS The Western Pennsylvania Bipolar Disorder Registry used several recruitment methods to reach individuals self-identified as having bipolar disorder. Individuals who contacted and joined the registry completed an interviewer-administered questionnaire on clinical characteristics and treatment history. A sample of 2,718 registry participants was analyzed in order to compare these characteristics and history by race. RESULTS African-Americans in the registry reported a greater number of inpatient hospitalizations (9.8 versus 4.4) than Caucasians, as well as a higher suicide attempt rate (64% versus 49%). African-American participants were more likely to report a family member with schizophrenia. With respect to psychotropic medication, African-Americans were less likely to report taking antimanic medication or benzodiazepines, but more likely to report taking antipsychotics than Caucasians. CONCLUSIONS The present findings reinforce previous reports regarding the chronicity and severity of bipolar disorder among African-Americans. They also support previous studies that found high rates of attempted suicide among African-Americans with bipolar disorder. These findings provide further impetus for specific community and mental health services delivery efforts to reduce barriers to early accurate diagnosis and to appropriate ambulatory treatment for bipolar disorder.
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Affiliation(s)
- David J Kupfer
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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Bromet EJ, Finch SJ, Carlson GA, Fochtmann L, Mojtabai R, Craig TJ, Kang S, Ye Q. Time to remission and relapse after the first hospital admission in severe bipolar disorder. Soc Psychiatry Psychiatr Epidemiol 2005; 40:106-13. [PMID: 15685401 DOI: 10.1007/s00127-005-0864-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Few studies of the time to remission and first relapse in severe bipolar disorder have been based on epidemiologically defined samples or have examined patient characteristics and time-varying indicators of medication use simultaneously. Using a cohort from the Suffolk County Mental Health Project, we describe these temporal patterns and their relationships with childhood, illness, and treatment characteristics. METHOD A multi-facility cohort of 123 first-admission inpatients with DSM-IV bipolar disorder with psychotic features was followed for 4 years. Dates of the first complete remission (lasting at least 2 months), subsequent relapses, and use of antimanic (AM),antipsychotic (AP), and antidepressant (AD) medications were recorded. Childhood and illness characteristics were ascertained at baseline using standard instruments. RESULTS By the 4-year point, 83.7% had achieved a full remission, with 42.3% remitting within 3 months, 63.4% within 6 months, and 74.8% within 1 year. Overall, younger age of onset, history of childhood psychopathology, and higher Brief Psychiatric Rating Scale (BPRS) anxiety/depression scores were significantly associated with longer time to remission. Discontinuing AM, AP and AD (compared to never using) and taking AP and AD (compared to never using) were significantly associated with remission in the multivariate analysis. Of the 103 participants with complete remission, 61.2% suffered a relapse; 24.3 % relapsed within 6 months of remission, and 35.9% within a year. Overall, 32.5% of the 123 participants had a single episode followed by full remission. Childhood internalizing-type problems, higher BPRS anxiety/depression and Hamilton depression scores, and an admission episode not involving mania, but not patterns of medication use, were associated with shorter time to relapse. CONCLUSION By 4-year follow-up, the majority of severely ill bipolar patients had remitted from their initial episode, but more than half subsequently relapsed. Illness characteristics, especially depressive symptoms, and medication treatment were associated with the early course, although medication use after remission was not associated with relapse.
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Affiliation(s)
- Evelyn J Bromet
- Dept. of Psychiatry, Putnam Hall-South Campus, SUNY at Stony Brook, Stony Brook, NY 11794-8790, USA.
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Sanches M, Jorge MR. [Transcultural aspects of bipolar disorder]. BRAZILIAN JOURNAL OF PSYCHIATRY 2004; 26 Suppl 3:54-6. [PMID: 15597142 DOI: 10.1590/s1516-44462004000700013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cultural variations in the expression of emotions have been described. Consequently, there are cross-cultural influences on the diagnosis and management of bipolar disorder. This article provides a review of the evidence regarding the main aspects of transcultural psychiatry and bipolar disorder.
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Affiliation(s)
- Marsal Sanches
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo.
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Arnold LM, Keck PE, Collins J, Wilson R, Fleck DE, Corey KB, Amicone J, Adebimpe VR, Strakowski SM. Ethnicity and first-rank symptoms in patients with psychosis. Schizophr Res 2004; 67:207-12. [PMID: 14984879 DOI: 10.1016/s0920-9964(02)00497-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2002] [Revised: 10/29/2002] [Accepted: 11/04/2002] [Indexed: 01/01/2023]
Abstract
Previous studies suggested that African-American patients with psychotic disorders present more commonly with first-rank symptoms. However, it was unclear whether these results reflected true differences among African- and Euro-Americans in symptom presentation or instead resulted from raters being more likely to assign first-rank symptoms to African-American patients. In this study, a total of 195 African- and Euro-American patients presenting for hospitalization with psychosis were evaluated using structured diagnostic and symptom rating instruments; this evaluation was audiotaped. The tapes were transcribed and all cues indicating the patient's ethnicity were edited from the transcript and from medical records. Two board-certified psychiatrists then evaluated the transcripts and medical records in order to make consensus expert diagnosis and rate first-rank symptoms. Ratings of first-rank symptoms in African- and Euro-American patients were compared between ethnicity-blinded expert consensus assessments and the unblinded structured interview. African-American men received higher first-rank symptom ratings than the remaining patient groups by both ethnicity-blinded expert consensus and unblinded structured interview. African-American men also had significantly more total psychotic symptoms than Euro-American men. However, the ethnically blinded expert consensus did not find an increased rate of schizophrenia in the African-American men. These findings indicate that psychotic symptom presentation should be evaluated in the context of other symptoms (e.g., affective symptoms) in diagnostic assessments in order to prevent misdiagnoses of schizophrenia.
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Affiliation(s)
- Lesley M Arnold
- Bipolar and Psychotic Disorders Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0559, USA.
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Arnold LM, Strakowski SM, Schwiers ML, Amicone J, Fleck DE, Corey KB, Farrow JE. Sex, ethnicity, and antipsychotic medication use in patients with psychosis. Schizophr Res 2004; 66:169-75. [PMID: 15061250 DOI: 10.1016/s0920-9964(03)00102-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2002] [Revised: 03/16/2003] [Accepted: 03/17/2003] [Indexed: 11/22/2022]
Abstract
Previous studies suggested that African American patients with psychotic disorders receive higher doses of antipsychotic medication than white patients, are more likely to receive depot antipsychotics, and are less likely to be prescribed second-generation antipsychotics. African-American men in particular may be most likely to receive excessive doses of antipsychotics and depot antipsychotics, although this is less clear. Few studies have examined how sex and ethnicity interactions affect treatment of psychotic disorders. In this study, we examined whether the interaction of sex and ethnicity predicted the use of depot antipsychotics and the dosing of antipsychotics in a sample of inpatients with psychotic disorders. The inpatient records of 167 patients with psychotic disorders were evaluated for type and dose of medication at discharge. African-American men received depot antipsychotic medication more frequently than African-American women and white patients. This difference persisted after controlling for sociodemographic and clinical variables. African-American men and women with psychotic mood disorders were also more likely to be discharged on high antipsychotic doses compared with white patients. There were no ethnic or sex differences in the dosing of antipsychotics for the treatment of schizophrenia spectrum disorders. There were also no ethnic or sex differences in the use of second-generation antipsychotics.
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Affiliation(s)
- Lesley M Arnold
- Bipolar and Psychotic Disorders Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267-0559, USA.
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Abstract
OBJECTIVE There is a consensus that genetic factors are important in the causation of bipolar disorder (BPD); however, little is known about other risk factors in the aetiology of BPD. Our aim was to review the literature on such risk factors - risk factors other than family history of affective disorders - as predictors for the initial onset of BPD. METHODS We conducted a literature search using the MEDLINE, PsycINFO and EMBASE databases. We selected factors of interest including demographic factors, factors related to birth, personal, social and family backgrounds, and history of medical conditions. The relevant studies were extracted systematically according to a search protocol. RESULTS We identified approximately 100 studies that addressed the associations between antecedent environmental factors and a later risk for BPD. Suggestive findings have been provided regarding pregnancy and obstetric complications, winter-spring birth, stressful life events, traumatic brain injuries and multiple sclerosis. However, evidence is still inconclusive. Childbirth is likely to be a risk factor. The inconsistency across studies and methodological issues inherent in the study designs are also discussed. CONCLUSION Owing to a paucity of studies and methodological issues, risk factors of BPD other than family history of affective disorders have generally been neither confirmed nor excluded. We call for further research.
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Affiliation(s)
- Kenji J Tsuchiya
- National Centre for Register-based Research, University of Aarhus, Denmark.
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Kales HC, Valenstein M. Complexity in late-life depression: impact of confounding factors on diagnosis, treatment, and outcomes. J Geriatr Psychiatry Neurol 2003; 15:147-55. [PMID: 12230085 DOI: 10.1177/089198870201500306] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Late-life depression is a heterogeneous syndrome. Although depression in elderly patients is highly treatable, a number of factors or confounds create complexity in its overall management. Patient factors, such as medical illness, neuropsychiatric comorbidity, and race, may interact with provider factors to make management more complex. Outcomes and services research indicate that these factors, particularly medical illness, affect whether late-life depression is appropriately detected, diagnosed, and treated. Attention to such factors must be included in an agenda for mental health services research, with emphasis on the delivery of effective treatment to elderly patients with depression and improved outcomes in clinical settings.
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Affiliation(s)
- Helen C Kales
- Department of Psychiatry, University of Michigan, Ann Arbor Veterans Affairs Medical Center 48105, USA
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