RACIAL-DIFFERENCES IN THE DIAGNOSIS OF PSYCHOSIS

In clinical populations, it has been reported that African-American pa tients are more likely to receive a diagnosis of schizophrenia than si milar Caucasian patients. Factors contributing to this racial discrepa ncy are poorly defined. The authors examined the hypothesis that racia l differences in severity of first-rank symptoms of schizophrenia cont ribute to this diagnostic difference. Patients were recruited as part of the DSM-IV Field Trial for Schizophrenia and Other Psychotic Disord ers, and evaluated using a structured rating instrument. Symptom and d iagnostic comparisons were performed between black and white patients. Black patients were significantly more likely than white patients to be diagnosed with schizophrenia and less likely with psychotic depress ion. Racial differences in symptom profiles were observed with black p atients demonstrating more severe psychotic symptoms, in general, and first-rank symptoms, specifically. There were no racial differences in rates of affective syndromes or severity of affective symptoms. Racia l disparity in diagnosis of psychotic patients may be in part secondar y to more severe first-rank symptoms in black patients, causing clinic ians to stray from DSM-III-R criteria.