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少数族裔患者的精神病误诊:基于案例的伦理、公平性与教育探索

Psychotic Misdiagnosis of Racially Minoritized Patients: A Case-Based Ethics, Equity, and Educational Exploration.

作者信息

Jegarl Anita M, Jegede Oluwole, Isom Jessica, Ciarleglio Nicole, Black Carmen

机构信息

From: Yale School of Medicine (Ms. Jegarl; Drs. Jegede, Isom, and Black); Connecticut Mental Health Center, New Haven, CT (Ms. Ciarleglio).

出版信息

Harv Rev Psychiatry. 2023;31(1):28-36. doi: 10.1097/HRP.0000000000000353.

Abstract

The overdiagnosis and misdiagnosis of racially minoritized groups as having a primary psychotic disorder is one of psychiatry's longest-standing inequities born of real-time clinician racial bias. Evidence suggests that providers assign a diagnosis of schizophrenia and/or schizoaffective disorder according to race more than any other demographic variable, and this inequity persists even in the absence of differences in clinician symptom ratings. This case report describes the journey of one young Black woman through her racialized misdiagnosis of schizophrenia and the process by which interdisciplinary, health equity-minded providers across the spectrum of medical education and practice joined together to provide a culturally informed, systematic rediagnosis of major depressive disorder and post-traumatic stress disorder. Expert discussion is provided by three Black academic psychiatrists with expertise in social justice and health equity. We provide an evidence-based exploration of mechanisms of clinician racial bias and detail how the psychosis misdiagnosis of racially minoritized groups fails medical ethics and perpetuates iatrogenic harm to patients who truly need help with primary mood, trauma, and substance use disorders.

摘要

将少数族裔群体过度诊断和误诊为原发性精神障碍,是精神病学中长期存在的不公平现象之一,源于临床医生实时的种族偏见。有证据表明,医疗人员根据种族而非其他人口统计学变量来诊断精神分裂症和/或分裂情感性障碍,即使临床医生对症状的评分没有差异,这种不公平现象依然存在。本病例报告描述了一位年轻黑人女性被误诊为精神分裂症的经历,以及跨医学教育和实践领域、关注健康公平的多学科医疗人员共同为其重新诊断为重度抑郁症和创伤后应激障碍的过程。三位在社会正义和健康公平方面具有专业知识的黑人学术精神病医生提供了专业讨论。我们基于证据探讨了临床医生种族偏见的机制,并详细说明了对少数族裔群体的精神病误诊如何违背医学伦理,以及如何持续对真正需要治疗原发性情绪、创伤和物质使用障碍的患者造成医源性伤害。

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