Racial influence on diagnosis in psychotic mania

Racial Differences in DSM Diagnosis Using a Semi-Structured Instrument: The Importance of Clinical Judgment in the Diagnosis of African Americans

“…The differentiation of bipolar disorder and schizophrenia has been identified as a particularly difficult problem (Blacker and Tsuang 1992;Fein and McGrath 1990;Pope and Lipinski 1978;Strakowski et al 1995;Strakowski et al 1996;Strakowski, Shelton and Kolbrener 1993). Symptoms of both bipolar disorder and schizophrenia can present in the same episode, and such comorbidity adds to the complexity of making an accurate diagnosis (Chen, Swann and Johnson 1998).…”

“…First, the concern is grounded in a particular line of reasoning in interpreting existing diagnostic evidence. Many studies that look at diagnosis within a hospital setting have found that schizophrenia is diagnosed more frequently among African Americans and that mood disorders are diagnosed more often among whites (Lipton and Simon 1985;Liss et al 1973;Mukherjee et al 1983;Neighbors et al 1999;Raskin, Crook and Herman 1975;Simon et al 1973;Snowden and Cheung 1990;Strakowski et al 1996;Tonks, Paykel and Klerman 1970;Welner, Liss and Robins 1973;Welner et al 1972). The term "over-diagnosis" has been used to refer to the findings related to schizophrenia while "under-diagnosis" has been used to describe the findings on mood disorders.…”

“…1 Studies showing that schizophrenia more often is diagnosed among African Americans and that mood disorders more often are diagnosed among whites have raised serious questions about the accuracy of clinical judgment across race (Lawson, 1986;Neighbors, et al 1989;Simon et al 1973;Strakowski et al 1996;Worthington, 1992). Studies of clinicians using semi-structured instruments along with the careful application of criteria published in the most recent Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association (American Psychiatric Association) typically find no race differences in diagnosis.…”

“…From this standpoint, making modifications to the diagnostic criteria of DSM-III on the basis of patient race meant opening the door to stereotypes, bias, and ultimately misdiagnosis. DSM-III's attempt to limit clinical discretion was seen as a positive step because the diagnostic habits of clinicians working with African Americans had been suspect for quite some time (Fischer 1969;Garb 1997;Griffith 1996;Jones and Gray 1986;Kramer, Rosen, and Willis 1973;Raskin, Crook, and Herman 1975;Simon et al 1973;Strakowski et al 1996; Thomas and Sillen 1972;Welner et al 1972).…”

The role of race in diagnostic and disposition decision making in a pediatric psychiatric emergency service

“…This delay in seeking treatment may result in more severe diagnoses and more restrictive dispositions at the point of contact. Another possibility is that diagnostic discrepancies may be due to diagnostic errors, and misdiagnosis which may result from clinician bias, social and cultural distance between patient and clinician [29], cultural variations in the clinical presentation of psychiatric illness [24,51], different experiences with stress, stereotypes of psychopathology [29], and "cultural paranoia" and mistrust [52][53][54](p.453).…”