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African Americans More Likely to Be Misdiagnosed with
Schizophrenia, Rutgers Study Finds
The study suggests a bias
in misdiagnosing blacks with major depression
and schizophrenia
African-Americans with
severe depression are more likely to be misdiagnosed
as having schizophrenia,
according to a new Rutgers study.
The study, which appears in
a recent issue of the journal Psychiatric
Services, examined the
medical records of 1,657 people at a community
behavioral health clinic
that included screening for major depression as
part of its assessment for
schizophrenia in new patients.
“By definition,
schizophrenia is a diagnosis of exclusion: Clinicians
must rule out other
potential causes of symptoms, including mood disorders,
before the diagnosis of
schizophrenia is given,” said Michael Gara, a
professor of psychiatry at
Rutgers Robert Wood Johnson Medical School
and a faculty member at
Rutgers University Behavioral Health Care.
“However, there has been a
tendency for clinicians to overemphasize the
relevance of psychotic
symptoms and overlook symptoms of major depression
in African Americans
compared with other racial or ethnic groups. No studies
show that African- Americans
with schizophrenia are more likely to also have
major depression.”
The study, which looked at
599 blacks and 1,058 non-Latino whites, found
that clinicians failed to
effectively weigh mood symptoms when diagnosing
schizophrenia among African
Americans, suggesting that racial bias, whether
conscious or subconscious,
is one factor in the diagnosis of schizophrenia
in this population.
Other factors include
genetics, poverty and discrimination, as well as
symptoms caused by
infections and malnutrition early in life.
“Individuals from a racial
minority group also might feel hopelessness or
mistrust when being assessed
by someone from a racial majority group, which
could affect how they act
and how the clinician interprets symptoms,”
Gara said.
The findings suggest that
clinicians put more emphasis on psychotic than
depressive symptoms in
African- Americans, which skews diagnoses toward
schizophrenia even when
these patients show similar depressive and manic
symptoms as white patients.
“Inaccurate diagnosis can
have serious consequences,” Gara said.
“Mood disorder treatments
differ from those for schizophrenia, and the
prognosis for these
conditions is typically more positive than for
schizophrenia. These
patients who may have major depression with psychotic
features or bipolar disorder
and who are misdiagnosed with schizophrenia do
not receive the optimal
treatment, putting them at risk for the worsening
of the underlying disease
process or for suicide. Also, the side effects of
medication taken for
schizophrenia, such as diabetes and weight gain, can
be serious.”
The researchers recommend
that screening for major depression be required
when assessing black
patients for schizophrenia.
The study supports extensive
previous research done by co-author Stephen
Strakowski of Dell Medical
School on how overemphasis of psychotic symptoms
in African Americans can
contribute to misdiagnosis of schizophrenia
spectrum disorders.
Additional Rutgers authors
included Shula Minsky, Steven Silverstein and
Theresa Miskimen.
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