Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, Sixth Floor, Boston, MA 02114, USA.
Psychiatr Serv. 2012;63(5):482-7. doi: 10.1176/appi.ps.201100271.
The lifetime prevalence of psychosis-like symptoms among Latinos living in the United States is 9.5%, and up to 27% of Latinos with major depressive disorder also experience psychosis-like symptoms. Yet clinicians remain uncertain about the nature and clinical implications of these putative psychotic symptoms, and there is no consensus about treatment strategies. The authors conducted a review of the literature to examine the epidemiology, clinical features, and significance of psychosis-like symptoms among Latinos, particularly when such symptoms present with major depressive disorder, and the strategies to treat them.
A search of the National Library of Medicine was conducted for all articles published through February 2011 by using the keywords "Hispanic" and "Latino" with "depression and psychotic," with "idiom of distress," and with "psychotic."
A total of 37 articles were reviewed. In clinical settings, the prevalence of psychosis-like symptoms among cross-sections of Latino patients ranged from 22% to 46% and was even higher among Latino veterans. Psychosis-like symptoms were associated with higher medical and psychiatric comorbidity and greater suicidality, functional impairment, and utilization of services. The authors describe the types of psychosis-like symptoms experienced by Latinos and propose criteria for the differential diagnosis of such symptoms and typical psychotic features.
Clinicians treating depressed Latinos are often confronted with the clinical dilemma of whether to augment antidepressants with an antipsychotic. The authors argue that atypical psychotic symptoms experienced by Latinos with major depressive disorder are nonpsychotic manifestations and that antipsychotic medication should be delayed unless treatment of depression fails to address the psychosis-like symptoms.
居住在美国的拉丁裔人群中，精神病样症状的终身患病率为 9.5%，而有 27%的重性抑郁障碍患者也经历过类似精神病的症状。然而，临床医生对于这些潜在的精神病症状的性质和临床意义仍不确定，也没有关于治疗策略的共识。作者对文献进行了回顾，以检查拉丁裔人群中精神病样症状的流行病学、临床特征和意义，尤其是当这些症状与重性抑郁障碍同时出现时，以及治疗这些症状的策略。
作者使用了“西班牙裔”和“拉丁裔”与“抑郁和精神病”、“痛苦的习语”和“精神病”的关键词，对美国国立医学图书馆在 2011 年 2 月之前发表的所有文章进行了搜索。
共审查了 37 篇文章。在临床环境中，跨拉丁裔患者群体的精神病样症状的患病率从 22%到 46%不等，而拉丁裔退伍军人的患病率更高。精神病样症状与更高的躯体和精神共病率以及更高的自杀率、功能障碍和服务利用率有关。作者描述了拉丁裔患者经历的精神病样症状的类型，并提出了这些症状和典型精神病特征的鉴别诊断标准。
治疗抑郁的拉丁裔患者的临床医生经常面临是否在抗抑郁药中加入抗精神病药的临床困境。作者认为，重性抑郁障碍的拉丁裔患者经历的非典型精神病样症状是非精神病表现，只有在抗抑郁治疗未能解决这些类似精神病的症状时，才应延迟使用抗精神病药物。
