Misdiagnosis of African-Americans with Psychiatric Issues - Part I.

PURPOSE: This article highlights issues of misdiagnosis in an African-American, adult clinical population by doing point prevalence, record review study within a comprehensive community mental health center. METHOD: Psychiatric evaluations of 330 patients were reviewed and clinically identifiable variables of: a) childhood Intellectual Disability (ID), special education, Attention Deficit Hyperactive Disorder (ADHD), or Autism/Pervasive Developmental Disorder (PDD); b) head injury causing Organic Brain Syndrome (OBS) or Temporal Lobe Epilepsy (TLE); c) a history of chronic substance abuse prior to the development of psychiatric symptoms; or d) childhood trauma causing Anxiety, Depression, and Panic Disorders were tabulated. RESULTS: Two hundred and twenty patients, who were free of the four variables, had a single psychiatric diagnosis and 18 had multiple co-morbid diagnoses. More than 25% (92/330) of the patients had the four variables in their histories. Four of the 92 patients had more than one variable in their history. Of the remaining 88 cases, 42 had psychiatric issues beginning in childhood (28 had history of ID, 4 had history of learning disabilities, 3 had history of ADHD, 7 had histories of Autism/PDD); 9 had histories of OBS or TLE; 20 had histories of substance abuse; and 18 had histories of extensive childhood trauma). CONCLUSIONS: Careful attention to common issues in African-Americans can inform the psychiatric diagnostic process pointing to prevention or treatment considerations that would benefit the African-American community at large.

Misdiagnosis of African-Americans with Psychiatric Issues - Part II.

PURPOSE: The second "Misdiagnosis of African-Americans with Psychiatric Issues" article focuses on traumatic life experiences that meet a proposed criteria for Developmental Trauma Disorder (DTD).l METHOD: Psychiatric evaluations of 330 patients were reviewed and clinically identifiable variables of: a) childhood mental retardation (MR), special education, Attention Deficit Hyperactive Disorder (ADHD), or Autism/Pervasive Developmental Disorder (PDD); b) head injury causing Organic Brain Syndrome (OBS) or Temporal Lobe Epilepsy (TLE); c) a history of chronic substance abuse prior to the development of psychiatric symptoms; or d) childhood trauma causing Anxiety, Depression, and Panic Disorders were tabulated. RESULTS: In Part I,2-Reference Part I we learn that the above four variables did not influence two-thirds of the African-American patient's psychiatric diagnoses; however, excluding patients with multiple diagnoses, 26.7% of the patient's diagnoses were shaped by these variables. Of these, 20% (18 of 88 patients), or 5.5% of the total 330 patients, had diagnoses that were strongly influenced by childhood traumatic experiences. Accordingly, we present two case histories that explicate the psychopathology seen in African-Americans traumatized as children. CONCLUSIONS: This study helps to stress and confirm the importance of how understanding childhood traumatic experiences shape adult African-American psychopathology and the potential for misdiagnosis - an important factor for prevention and appropriate treatment of African-American patients with psychiatric issues.