Strakowski Stephen M, Keck Paul E, Arnold Lesley M, Collins Jacqueline, Wilson Rodgers M, Fleck David E, Corey Kimberly B, Amicone Jennifer, Adebimpe Victor R
Bipolar and Psychotic Disorders Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
J Clin Psychiatry. 2003 Jul;64(7):747-54. doi: 10.4088/jcp.v64n0702.
Clinically, African American psychiatric patients are disproportionately diagnosed with schizophrenia compared with white patients. Why this occurs is unknown. Extending prior work, the authors hypothesized that first-rank symptoms distract clinicians so that they fail to identify affective disorders in African Americans.
195 African American and white patients with at least 1 psychotic symptom (delusions, hallucinations, or prominent thought disorder) at admission were recruited from January 1, 1998, through May 31, 2001. Each patient received 3 independent DSM-IV diagnoses: a clinical diagnosis, a structured-interview diagnosis, and an expert-consensus diagnosis. The expert-consensus diagnoses were derived from the structured interviews, which were audiotaped and transcribed, and medical records. After reviewing edited transcripts and medical records from which ethnic cues had been eliminated, 2 psychiatrists assigned expert-consensus diagnoses and first-rank symptom ratings. For the 79 patients who received an expert-consensus diagnosis of an affective disorder, clinical variables, diagnoses, and first-rank symptoms were compared between African American (N = 39) and white (N = 40) patients.
Seventy-nine (41%) of 195 patients were diagnosed with an affective disorder by expert consensus. African American men with an expert-consensus affective disorder were significantly (p <.03) more likely than other patients to be diagnosed with a schizophrenia spectrum disorder by clinical assessment and structured interview. Although first-rank symptoms were more commonly identified in African American men, this finding did not explain the difference in diagnoses. Post hoc analyses suggested that African American men diagnosed with a schizophrenia spectrum disorder were more likely than other patients to have been identified during structured interview as having psychotic symptoms in the absence of affective symptoms.
The apparent misdiagnosis of schizophrenia in African-Americans with mood disorders cannot be ascribed to differences in first-rank symptoms. However, it may be due to a perception that psychotic symptoms are more chronic or persistent than affective symptoms in these patients.
临床上，与白人患者相比，非裔美国精神病患者被诊断为精神分裂症的比例过高。其原因尚不清楚。在先前研究的基础上，作者推测一级症状会分散临床医生的注意力，导致他们无法识别非裔美国人的情感障碍。
从1998年1月1日至2001年5月31日，招募了195名入院时至少有1种精神病性症状（妄想、幻觉或明显的思维障碍）的非裔美国人和白人患者。每位患者接受3种独立的DSM-IV诊断：临床诊断、结构化访谈诊断和专家共识诊断。专家共识诊断源自结构化访谈（访谈进行了录音和转录）以及病历。在审查了已编辑的、去除了种族线索的转录文本和病历后，2名精神科医生给出了专家共识诊断和一级症状评分。对于79名经专家共识诊断为情感障碍的患者，比较了非裔美国人（N = 39）和白人（N = 40）患者之间的临床变量、诊断和一级症状。
195名患者中有79名（41%）经专家共识诊断为情感障碍。经专家共识诊断为情感障碍的非裔美国男性在临床评估和结构化访谈中被诊断为精神分裂症谱系障碍的可能性显著高于其他患者（p <.03）。虽然一级症状在非裔美国男性中更常见，但这一发现并不能解释诊断上的差异。事后分析表明，被诊断为精神分裂症谱系障碍的非裔美国男性在结构化访谈中比其他患者更有可能在没有情感症状的情况下被识别出有精神病性症状。
患有情绪障碍的非裔美国人中明显的精神分裂症误诊不能归因于一级症状的差异。然而，这可能是由于人们认为这些患者的精神病性症状比情感症状更具慢性或持续性。
