Ethnicity and the Diagnosis of Affective Illness

种族与情感疾病的诊断

• 批准号: 6917356
• 负责人: Michael A Escamilla
• 金额: $ 29.2万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-07-15 至 2009-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6917356
• 关键词: African American; Hispanic Americans; antipsychotic agents; caucasian American; clinical research; diagnosis design /evaluation; diagnosis quality /standard; human subject; mental disorder diagnosis; mood disorders; patient safety /medical error; racial /ethnic difference; schizophrenia

DESCRIPTION (provided by applicant): Mood disorders are among the most common and debilitating conditions affecting humanity. Correctly identifying and treating mood disorders is critical in order to address this serious public health problem. However, African-Americans with mood disorders are significantly more likely than white patients to be misdiagnosed with schizophrenia. Consequently, African-Americans are at increased risk for receiving inadequate treatment. Failure to correctly identify African-Americans with these conditions contributes to disparities in medical care delivery between ethnic minority and majority patients. However, it is not known why African-Americans with mood disorders are more likely than whites to be misdiagnosed with schizophrenia. Previous investigators suggested that misdiagnoses of schizophrenic disorders appeared to occur because clinicians failed to elicit affective symptoms from African-Americans with mood disorders. Moreover, when mood and psychotic symptoms were both identified, clinicians appeared to minimize the affective symptoms in African-American men. These findings suggest the hypothesis that African-Americans with severe mood disorders are more likely than whites to be misdiagnosed with schizophrenia because clinicians over-emphasize psychotic symptoms at the expense of mood symptoms in the former. Consistent with this hypothesis, African- Americans are more likely to receive excess antipsychotics. Previous studies typically contrasted only African- American and white patients, so it is unknown whether this problem of misdiagnosis is unique to African-Americans or also occurs in other U.S. minorities. Although some studies reported that mood disorders were also commonly misdiagnosed as schizophrenia in Latinos, other work disagreed. Because there are few studies of these issues in Latinos, it is difficult to identify associations among diagnosis, treatment and ethnicity in this patient group. With these considerations in mind, we propose a large, regionally diverse, six-site collaborative R01 study to examine the effects of ethnicity on clinical diagnosis and treatment assignment in African-American, Latino and white patients with mood disorders. The primary objective is to test the hypothesis that clinicians over-emphasize psychotic symptoms at the expense of affective symptoms in African-Americans, leading to an excess of clinical diagnoses of schizophrenia relative to other ethnic groups. A second objective is to test the hypothesis that over-emphasis of psychotic symptoms also contributes to increased antipsychotic use in African-Americans. The final objective is to determine whether Latinos are at risk for similar problems in diagnostic assessments and treatment assignment.

描述（由申请人提供）：情绪障碍是影响人类的最常见和令人衰弱的条件。正确识别和治疗情绪障碍对于解决这个严重的公共卫生问题至关重要。但是，患有情绪障碍的非裔美国人比白人患者更有可能被精神分裂症诊断。因此，非裔美国人接受治疗不足的风险增加。未能正确识别具有这些条件的非裔美国人，会导致少数民族和多数患者之间的医疗服务差异。但是，尚不清楚为什么患有情绪障碍的非裔美国人比白人更有可能被精神分裂症误诊。先前的研究人员建议，由于临床医生未能引起患有情绪障碍的非裔美国人的情感症状，因此似乎发生了精神分裂症疾病的误诊。此外，当识别出情绪和精神病症状时，临床医生似乎可以最大程度地减少非裔美国人的情感症状。这些发现表明，患有严重情绪障碍的非裔美国人比白人更有可能被精神分裂症误诊，因为临床医生过分强调精神病症状，以牺牲前者的情绪症状为代价。与这一假设一致，非裔美国人更有可能接受过多的抗精神病药。先前的研究通常仅与非裔美国人和白人患者形成鲜明对比，因此尚不清楚这种误诊问题是非裔美国人独有的还是在其他美国少数民族中发生的。尽管一些研究报告说，情绪障碍通常也被误诊为拉丁美洲人的精神分裂症，但其他工作不同意。 因为在拉丁美洲人中对这些问题的研究很少，所以很难确定该患者组中诊断，治疗和种族之间的关联。考虑到这些考虑，我们提出了一项大型，区域多样的，六个站点的协作R01研究，以研究种族对具有情绪障碍的非裔美国人，拉丁裔和白人患者临床诊断和治疗分配的影响。主要目的是检验以下假设：临床医生过度强调精神病症状，但以非裔美国人的情感症状为代价，导致相对于其他种族群体的精神分裂症的临床诊断过多。第二个目标是检验以下假设：精神病症状的过度强调也有助于增加非裔美国人的抗精神病药物。最终目标是确定拉丁美洲人是否有诊断评估和治疗分配中类似问题的风险。