Ethnicity and Clinical Psychiatric Diagnosis in Childhood

This paper focuses on whether a consistent difference by ethnicity existed in the clinical diagnosis of children and adolescents in two behavioral health service environments and reviews plausible explanations for such a difference. Key measures were clinical diagnosis and ethnicity, abstracted from the administrative dataset of a New Jersey behavioral health care organization during 2000–2002, and a data collection conducted for the State of Indiana during 1991–1992. Sample sizes were 5,394 and 10,437, respectively. Only primary diagnoses were used in this study, classified into externalizing versus internalizing disorders. Logistic regression was performed for the dependent variable of presence/absence of an externalizing disorder or internalizing disorder. A main effect for ethnicity was found; African American youth received more externalizing diagnoses than did European American youth (odds ratio 2.01 (CI: 1.73–2.33) in one sample and 1.67 (CI: 1.44–1.94) in the other); African American youth also received fewer internalizing diagnoses than European American youth (odds ratio 0.55 (CI: .48–.63) in one sample and 0.75 (CI:.64–.88) in the other. Potential explanations for these findings include: 1. Biopsychosocial origin; 2. Clinician bias; 3. Discordant normative behavioral expectations between parents and service providers; and 4. Interaction between differential expression of underlying pathology and tolerance for such expressions.     

Differential Diagnosis of Chorea

Chorea is a common movement disorder that can be caused by a large variety of structural, neurochemical (including pharmacologic), or metabolic disturbances to basal ganglia function, indicating the vulnerability of this brain region. The diagnosis is rarely indicated by the simple phenotypic appearance of chorea, and can be challenging, with many patients remaining undiagnosed. Clues to diagnosis may be found in the patient’s family or medical history, on neurologic examination, or upon laboratory testing and neuroimaging. Increasingly, advances in genetic medicine are identifying new disorders and expanding the phenotype of recognized conditions. Although most therapies at present are supportive, correct diagnosis is essential for appropriate genetic counseling, and ultimately, for future molecular therapies.     

The Effects of Sociodemographic Factors on Psychiatric Diagnosis

Objective

Several studies have reported that ethnic differences influence psychiatric diagnoses. Some previous studies reported that African Americans and Hispanics are diagnosed with schizophrenia spectrum disorders more frequently than Caucasians, and that Caucasians are more likely to be diagnosed with affective disorders than other ethnic groups. We sought to identify associations between sociodemographic factors and psychiatric diagnosis.

Methods

We retrospectively examined the medical records of all psychiatric inpatients (ages over 18 years) treated at Kern county mental hospital (n=2,051) between July 2003 and March 2007 for demographic, clinical information, and discharge diagnoses.

Results

African American and Hispanic males were more frequently diagnosed with schizophrenia spectrum disorders than Caucasians, whereas Caucasian females were more frequently diagnosed with affective disorders than females in the other ethnic groups, suggesting that patient ethnicity and gender may influence clinical diagnoses. Demographic variables, that is, a lower education, failure of marriage, homelessness, and low quality insurance, were found to be significantly associated with a diagnosis of schizophrenia spectrum disorders after adjusting for clinical variables. And, the presence of a family psychiatric history, failure of marriage, not-homelessness, and quality insurance were found to be associated with a diagnosis of affective disorders.

Conclusion

Our results show that these demographic factors, including ethnicity, have effects on diagnoses in psychiatric inpatients. Furthermore, these variables may help prediction of psychiatric diagnoses.     

Differential Diagnosis in Pseudoepileptic Seizures

Summary: With increasing use of intensive video-EEG monitoring, publications concerning pseudoepileptic seizures have burgeoned, but without clarification concerning differing psychopathologic mechanisms and without distinction of different syndromic varieties. The frequent concurrence of pseudoepileptic and epileptic seizures has not been sufficiently recognized, and an undue reliance on clinical experience on the one hand and individual tests such as EEG on the other has proven equally misleading in this group of cases.     

Differential Diagnosis of Episodic Symptoms

Summary: Because nonepileptic disorders may cause episodic and paroxysmal symptoms that resemble epilepsy, these conditions and syndromes must be considered in the differential diagnosis or when antiepileptic drugs are ineffective. Gastroesophageal reflux usually presents as recurrent vomiting in infants and young children. A small subgroup of infants develop apnea and cyanosis accompanied by posturing of the limbs, deviation of the eyes, or opisthotonos, which leads to the incorrect diagnosis of epilepsy. Breath-holding spells and pallid infantile syncope, common in infants and young children, may also be mistaken for epileptic attacks. The parasomnias, including pavor nocturnus and somnambulism, are frequently mistaken for epilepsy, since these nocturnal episodes are paroxysmal in nature, may be associated with automatic behavioral mannerisms, and tend to be recurrent. Migraine is especially difficult to differentiate from epilepsy because its manifestations, particularly in children, are so diverse. Other disorders that may superficially mimic epilepsy include transient ischemic attacks, syncope, and transient global amnesia.     

Latin American Guide for Psychiatric Diagnosis (GLDP)

Culturally competent diagnostic systems are necessary for an effective and ethical clinical practice, as cultural diversity of patients increase around the world. Latin American psychiatrists hold a long-standing commitment to this enterprise. Recently, two main Latin American adaptations to the international psychiatric classification have emerged: the Cuban Glossary of Psychiatry, and the project of the Latin American Guide for Psychiatric Diagnosis (GLADP). Keeping ICD-10 as the basis for nosological organization, GLADP is being developed with contributions by mental health professionals from Latin American countries. GLADP comprises 4 parts: (1) historical and cultural framework, (2) comprehensive diagnosis and formulation, (3) psychiatric nosology and (4) appendixes.     

Clinical Approach to Diagnosis of Comorbid Addictive and Psychiatric Disorders

Abstract

The outcome of severe mental illness is greatly diminished when persons also abuse alcohol and other drugs. This paper debunks any notion that substance abuse is acquired, rather portraying drug use and abuse to be an addiction and disease. The author then summarizes relevant factors related to diagnosing this disease including the need for a period of abstinence and the consideration of personality factors. Implications of an addiction diagnosis are discussed.