Racial and Ethnic Effects on Psychotic Psychiatric Diagnostic Changes From Admission to Discharge: A Retrospective Chart Review
J Clin Psychiatry 2008;69(3):464-469
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: Different cultural norms for paranoia that exist
among African Americans may be misconstrued and fuel the overdiagnosis of
schizophrenia. The present study examined whether the frequency of psychotic
psychiatric diagnoses differs by race/ethnicity, particularly with regard to
paranoid schizophrenia. We examined the frequency upon admission and at
discharge and further explored the pattern of diagnostic changes that occurred
by racial/ethnic group.
Method: The present study is a secondary analysis of
diagnostic data obtained on inpatients admitted to a research unit from 1990 to
2003 with a typical length of stay from 3 to 6 months. Admission and discharge
diagnoses were obtained from each chart on the sample of 238 patients, 55% (N =
130) of whom were white; 24% (N = 58), African American; and 21% (N = 50),
Latino. Inpatients were grouped into 4 diagnostic categories: schizoaffective
disorder, paranoid schizophrenia, schizophrenia-undifferentiated or
-disorganized type, and other psychotic disorder.
Results: Upon admission, African American patients were more
likely to receive a less-defined diagnosis, such as psychosis not otherwise
specified, in part because they tended on average to be younger. Over the
course of hospitalization, diagnoses for white patients were more likely to
move toward schizoaffective at discharge (OR = 6.85, 95% CI = 1.53 to 30.66).
African American patients were more likely to experience a diagnostic change to
paranoid schizophrenia (OR = 4.58, 95% CI = 1.70 to 13.36). Interestingly,
Latino patients were the least likely group to experience diagnostic changes
during their hospitalization stay.
Conclusions: The present preliminary findings reveal an
interesting pattern of diagnostic changes that occurred over the course of
hospitalization that should be followed up in a comprehensive study.