THE ART AND SCIENCE OF THE PSYCHOPHARMACOTHERAPY OF AFRICAN-AMERICANS

Recent research and clinical experience has shown that African America ns may be at greater risk for inappropriate treatment. Such experience s can interact negatively with an existing distrust of the mental heal th system. Providers may show different prescribing patterns with raci al and ethnic minorities: they may overuse antipsychotics, dispense hi gher dosages, and more commonly give involuntary treatment, which resu lts in more side effects and a poorer outcome. Conversely, they may un deruse other psychotropic medications, especially for anxiety and affe ctive disorders, which are underdiagnosed in minorities. Recent resear ch suggests that ethnic differences may exist in pharmacokinetics, and so different dosing strategies may be necessary. Not surprisingly Afr ican Americans in distress are more likely to seek initial treatment o utside of the mental health system, seek treatment later in the course of the illness, complain more about side effects, and terminate treat ment earlier. Cultural as well as socioeconomic factors must be consid ered. Newer pharmacological agents may be potentially more helpful for minorities because they are better tolerated, have better side effect profiles, and demonstrate better efficacy. However, African Americans have limited access to these agents. Education of providers and patie nts, policy changes in the public sector, wider implementation of rese arch policies concerning inclusion of minorities, and different market ing strategies by pharmaceutical concerns are probably necessary to ma ximize pharmacotherapy of minorities.