The Effects of Race and Information Variance on Disagreement Between Psychiatric Emergency Service and Research Diagnoses in First-Episode Psychosis

Strakowski, Stephen M.; Hawkins, John; Keck, Paul E.; McElroy, Susan L.; West, Scott A.; Bourne, Michelle L.; Sax, Kenji W.; Tugrul, Karen C.

doi:10.4088/jcp.v58n1010a

Cited by 94 publications

(90 citation statements)

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“…Clinical uncertainty in diagnosis and treatment of ethnic minorities is a major concern addressed by these reports. The literature also identifies some diagnostic uncertainty with African Americans and Latinos (Minsky et al, 2003;Strakowski et al, 1997). Psychiatric assessment has received increasing attention in this context because of its apparent subjectivity and vulnerability to bias (Lewczyk, Garland, Hurlburt, Gearity, & Hough, 2003).…”

Section: Introductionmentioning

confidence: 99%

Ethnicity and Clinical Psychiatric Diagnosis in Childhood

Minsky

Petti

Gara

et al. 2006

Adm Policy Ment Health

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This paper focuses on whether a consistent difference by ethnicity existed in the clinical diagnosis of children and adolescents in two behavioral health service environments and reviews plausible explanations for such a difference. Key measures were clinical diagnosis and ethnicity, abstracted from the administrative dataset of a New Jersey behavioral health care organization during 2000-2002, and a data collection conducted for the State of Indiana during 1991-1992. Sample sizes were 5,394 and 10,437, respectively. Only primary diagnoses were used in this study, classified into externalizing versus internalizing disorders. Logistic regression was performed for the dependent variable of presence/absence of an externalizing disorder or internalizing disorder. A main effect for ethnicity was found; African American youth received more externalizing diagnoses than did European American youth (odds ratio 2.01 (CI: 1.73-2.33) in one sample and 1.67 (CI: 1.44-1.94) in the other); African American youth also received fewer internalizing diagnoses than European American youth (odds ratio 0.55 (CI: .48-.63) in one sample and 0.75 (CI:.64-.88) in the other. Potential explanations for these findings include: 1. Biopsychosocial origin; 2. Clinician bias; 3. Discordant normative behavioral expectations between parents and service providers; and 4. Interaction between differential expression of underlying pathology and tolerance for such expressions.

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Section: Introductionmentioning

confidence: 99%

Ethnicity and Clinical Psychiatric Diagnosis in Childhood

Minsky

Petti

Gara

et al. 2006

Adm Policy Ment Health

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“…The reasons underlying this disagreement were information variability (58%) and variations in diagnostic criteria (42%). 21 The systematic use of diagnostic taxonomies and of guidelines, scales, and structured interviews for the evaluation of patients has been proposed as a possible solution to improve diagnoses performed in emergency settings. 20 Along these lines, we have observed that the use of operational diagnostic criteria and the training in the application of the SCID have increased the reliability of diagnoses performed in psychiatric emergency assessments.…”

Section: Accuracy Of the Diagnosis Of First-episode Psychosismentioning

confidence: 99%

Diagnóstico diferencial de primeiro episódio psicótico: importância da abordagem otimizada nas emergências psiquiátricas

Del-Ben

Rufino

Marques

et al. 2010

Rev. Bras. Psiquiatr.

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Objective: To review the literature regarding the diagnosis of first-episode psychosis in the context of psychiatric emergency. Method: Review of empirical and review articles selected by electronic search in the PubMed database. Results: Specific features of emergency care -single, brief, and cross-sectional assessments with little information -may jeopardize the diagnostic process. These limitations can be circumvented by the application of operational diagnostic criteria, by the use of scales and structured interviews, and by short observation periods (24-72 hours). Diagnoses of bipolar disorder, schizophrenia, psychotic depression, and delusional disorder performed in the context of emergency have good stability, but the same does not apply to the diagnoses of brief psychotic disorder, schizophreniform disorder, and schizoaffective disorder. Firstepisode psychosis can occur in the course of the use of psychoactive substances and the persistence of psychotic symptoms even after cessation of the use of the substance is relatively frequent. The rational use of subsidiary tests may be of help in establishing the differential diagnosis of psychotic episodes due to general medical conditions. Conclusion: The diagnosis of first-episode psychosis can be adequately performed by psychiatric emergency services if evidence-based routines are implemented. Descriptors

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“…[68][69][70][71][72][73][74] In other words, the high rates of psychosis in African Americans that had been observed for many years came to be seen as artifacts of pervasive diagnostic error. Strakowski et al 75 initially suggested that African…”

Section: Clinician Biasmentioning

confidence: 99%

The Social Causes of Psychosis in North American Psychiatry: A Review of a Disappearing Literature

Jarvis

2007

Can J Psychiatry

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Objective: To review the North American literature with respect to the role of social factors in the etiology of psychosis, including schizophrenia. Method: Relevant publications were identified through a search of MEDLINE from 1966 to 2006. Identified studies and articles had to originate in Canada or the United States to be included in the review. Articles written prior to 1966 were identified by cross-referencing bibliographies and reference lists. Articles were considered relevant if they discussed ethnoracial or other social factors as being causal or contributing to the development of psychosis or schizophrenia. Results: The relation between the etiology of psychosis and such social factors as poverty, migration, and racial discrimination has been neglected in the North American psychiatric literature for the last 40 years. In Canada and the United States, there is a dearth of research on these issues: the study of social causes of psychosis has been replaced by a focus on the clinical encounter, in which clinician bias is presumed to be responsible for widespread misdiagnosis of psychosis in minority (mainly African-American) populations. The reasons for neglecting social causes of psychosis in the North American psychiatric literature are obscure but may have to do with the rise of genetic-biological paradigms in recent decades. Conclusions: The neglect of social causes of psychosis in the North American psychiatric literature has been coincident with an increase in scholarly concern among European clinicians and researchers. Careful reading of the European literature may reveal helpful avenues for future investigation in the North American context. In addition, drawing on social science literature and methods may help to clarify mechanisms underlying poverty, migration, and racial discrimination that contribute to psychosis in vulnerable individuals and groups.

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The Effects of Race and Information Variance on Disagreement Between Psychiatric Emergency Service and Research Diagnoses in First-Episode Psychosis

Cited by 94 publications

References 0 publications

Ethnicity and Clinical Psychiatric Diagnosis in Childhood

Ethnicity and Clinical Psychiatric Diagnosis in Childhood

Diagnóstico diferencial de primeiro episódio psicótico: importância da abordagem otimizada nas emergências psiquiátricas

The Social Causes of Psychosis in North American Psychiatry: A Review of a Disappearing Literature

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