Ethnicity and the Diagnosis of Affective Illness

种族与情感疾病的诊断

• 批准号: 7094250
• 负责人: IRA Marc LESSER
• 金额: $ 24.44万
• 依托单位: LUNDQUIST INSTITUTE FOR BIOMEDICAL INNOVATION AT HARBOR-UCLA MEDICAL 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/7094250
• 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最令人衰弱的疾病之一。为了解决这一严重的公共卫生问题，正确识别和治疗情绪障碍至关重要。然而，患有情绪障碍的非裔美国人比白人患者更有可能被误诊为精神分裂症。因此，非洲裔美国人接受治疗不足的风险增加。未能正确识别患有这些疾病的非裔美国人，导致少数族裔患者和多数族裔患者在提供医疗服务方面存在差异。然而，目前尚不清楚为什么患有情绪障碍的非洲裔美国人比白人更容易被误诊为精神分裂症。之前的研究人员表示，精神分裂症障碍的误诊似乎是因为临床医生未能从患有情绪障碍的非裔美国人身上引发情感症状。此外，当情绪和精神病症状都被识别时，临床医生似乎会将非裔美国人男性的情感症状降至最低。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误诊为精神分裂症，因为临床医生过度强调精神病症状，而忽视了前者的情绪症状。与这一假设一致，非裔美国人更有可能接受过量的抗精神病药物。之前的研究通常只对比非裔美国人和白人患者，因此目前尚不清楚这种误诊问题是非洲裔美国人独有的，还是美国其他少数民族也存在的。尽管一些研究报告称，在拉丁裔中，情绪障碍也经常被误诊为精神分裂症，但其他研究并不同意这一点。由于在拉丁裔中对这些问题的研究很少，因此很难在这一患者群体中确定诊断、治疗和种族之间的联系。考虑到这些因素，我们提出了一项大型的、地区多样化的、六个地点合作的R01研究，以考察种族对非裔美国人、拉丁裔和白人心境障碍患者临床诊断和治疗分配的影响。主要目标是检验这样一个假设，即临床医生过度强调精神症状，而忽视非裔美国人的情感症状，导致相对于其他种族群体而言，精神分裂症的临床诊断过多。第二个目标是测试这一假设，即过度强调精神病症状也有助于增加非裔美国人的抗精神病药物的使用。最终目标是确定拉美裔人在诊断评估和治疗分配方面是否存在类似问题的风险。