Confluence of law enforcement, mental health, and race.

Disparities in victimization by law enforcement for both people of color and individuals with mental health disorders is gaining national attention following the deaths of George Floyd, Sandra Bland, TAmir Rice, and many others. Despite this, the discussion around the intersectionality of race, psychiatric illness, and law enforcement is still in its infancy, the purpose of this article is to discuss the confluence of race and psychiatric illness as vulnerabilities in various contacts with law enforcement in order to further highlight this issue and to ignite further needed research on this topic. Possible solutions such as police-hiring practices, bias training, and trauma-informed policing will be discussed.

The Report of the W. Montague Cobb /NMA Health Institute Consensus Panel on the Plight of Underrepresented Minorities in Medical Education.

Many programs have been designed to increase the number of minorities participating in medical education. Despite these programs, the number of underrepresented minorities (URMs) has never reached the level of representation as is noted in the general census reporting of 12-13%.Using a focused literature review methodology, the Cobb Institute W. Montague Cobb Institute/NMA Health Institute (The Cobb Institute)1 reviewed articles from medical and social science publications to elucidate the causes for the dearth of URMs. Multiple articles have been written to examine this phenomenon and they have identified many challenges. Factors identified include stigmata and stereotyping, growing up in under resourced communities, sub-standard public education opportunities, lack of role models and mentors, lower standardized test scores, and admissions committee practices; all negatively impact URMs on the path to graduate medical education. The W. Montague Cobb Institute/NMA Health Institute (The Cobb Institute) has identified many common impediments along the path to matriculation and offer recommendations and strategies to address the URM matriculation issue. The Cobb Institute concluded there is a substantial need to invest more in 'working' programs with proven outcomes aimed at increasing admittance into medical schools for black males in particular and URMs in general. PURPOSE: The purpose of this paper is to discuss and identify effective programs and strategies used to increase admissions of underrepresented minorities (URM) in general, and black males in particular, into medical school. We will examine best practices and make recommendations regarding successful actions which can lead to increasing black males in the admissions process.

Lactose intolerance and health disparities among African Americans and Hispanic Americans: an updated consensus statement.

Dairy foods contribute nine essential nutrients to the diet including calcium, potassium and vitamin D; nutrients identified by the 2010 Dietary Guidelines for Americans as being "of public health concern" within the U.S. population. Milk and milk product intake is associated with better diet quality and has been associated with a reduced risk of chronic diseases or conditions including hypertension, cardiovascular disease, metabolic syndrome, Type 2 Diabetes and osteoporosis. Some research also indicates dairy food intake may be linked to reduced body fat, when accompanied by energy-restriction. On average, both African Americans and Hispanic Americans consume less than the recommended levels of dairy foods, and perceived or actual lactose intolerance can be a primary reason for limiting or avoiding dairy intake. True lactose intolerance prevalence is not known because healthcare providers do not routinely measure for it, and no standardized assessment method exists. Avoiding dairy may lead to shortfalls of essential nutrients and increased susceptibility to chronic disease. This updated Consensus Statement aims to provide the most current information about lactose intolerance and health, with specific relevance to the African American and Hispanic American communities. Topics covered include diagnostic considerations, actual and recommended dairy food intake and levels of consumption of key dairy nutrients among African Americans and Hispanic Americans; prevalence of self-reported lactose intolerance among various racial/ethnic groups; the association between dairy food intake, lactose intolerance and chronic disease; and research-based management recommendations for those with lactose intolerance.

Major depressive disorder in the African American population.

Depression is a common mental disorder that presents with depressed mood. It can become chronic or recurrent and lead to substantial impairment in an individual's ability to function. At this level, it is identified as major depressive disorder (MDD). Depression and MDD occur across all racial and ethnic groups. Although many depressed patients are treated in primary care, depression in these settings has been underdetected and undertreated. African Americans, especially, who suffer from depression are frequently underdiagnosed and inadequately managed in primary care due to patient, physician, and treatment setting factors. Patient factors include being poor, uninsured, restrictive insurance policies, biological-genetic vulnerability, nonresponsiveness to traditional pharmacological interventions, and stigma (i.e., attitudes and perceptions of mental illness). Physician factors include diagnosis and assessment, physician characteristics, physician bias, and culture; and treatment setting factors include systemic variables such as lack of or poor access to health care, racism, environment, and patient management. African Americans are less likely to receive proper diagnosis and treatment, more likely to have depression for long periods of time, and more likely to suffer greater disability from depression. Understanding patient, physician, and treatment setting factors as contributing barriers that impede effective diagnosis and treatment of depression and MDD in African Americans is critical to effective patient management and discovery. Greater African American participation in clinical research trials also is needed to effectively improve, diagnose, and treat depression in African Americans. This article examines depression among African Americans in the context of gender, culture, and psychosocial determinants, and their engagement in clinical trials.

Suicide: current trends.

Suicide is the act of a human being intentionally causing his or her own death. More than 1 million people commit suicide every year. It is the 13th leading cause of death worldwide, with China, India, and Japan accounting for almost half of all suicides. In less than 50 years, the rate of suicide among Sri Lankans has risen from a modest level to one of the highest in the world (118 per 100,000). Suicide is a major preventable cause of premature death. It is influenced by psychosocial, cultural, and environmental risk factors. The impact of suicide can be devastating for all concerned. It is common in people who are living with chronic mental illness. Individuals with severe clinical depression and alcohol use disorders are at highest risk if untreated. On an interpersonal level, friends and families of suicide victims require social support. On a national level, governments need to recognize the causes of suicide and protect those most vulnerable. If governments commit to defining national responses to prevent suicide, significant progress can be made. On a global scale, research and health organizations can identify global trends and encourage the sharing of information in effective prevention activities. In September 2010, World Suicide Prevention Day, with a theme of "Many faces, many places: suicide prevention across the world," encouraged public awareness worldwide to unite in commitment and action to promote understanding about suicide and removal of stigmatization'. There is compelling evidence that adequate prevention and awareness can reduce suicide rates.

Richard Allen Williams, M.D.: a Career Fighting Disparities and Fostering Equity.

This is a literature review where we acknowledge Richard Allen Williams, the first African American physician to win the John P. McGovern Compleat Physician Award, and recognize his achievements in race and ethnicity in healthcare. There have been significant advances in the diagnosis and treatment of cardiovascular disease; however, racial disparities continue to create inequity in the medical community especially for African Americans. Dr. Williams founded the Association of Black Cardiologists (ABC) in 1974 to address the misperception about, and the misdiagnosis and maltreatment of African American patients. He emphasized the importance of diversity and the non-biased approach to the treatment of all communities. This literary review further explores current racial disparities African Americans face during the COVID-19 pandemic. Granted that Dr. Williams' win is a step towards progress and change, there is much to be done to conquer the cultural divide in healthcare.

Attention-deficit/hyperactivity disorder in African American youth.

This article examines attention-deficit/hyperactivity disorder (ADHD) in African American youth. Tackling the myths and misinformation surrounding ADHD in the African American community can be one of the most difficult issues in mental illness circles. There is a lot of conflicting information about how African Americans are diagnosed, examined, and treated. This article clarifies some of the misconceptions and offers some comprehensibility to the issue of ADHD in African American youth. The incidence of ADHD is probably similar in African Americans and Caucasians. However, fewer African Americans are diagnosed with and treated for ADHD. That reality flies in the face of some perceptions in many African American communities. Reasons for this disparity have not been fully clarified and are most likely complex and numerous. Some barriers to treatment are driven by the beliefs of patients and their families, while others are the result of limitations in the health care system. Patient-driven obstacles to care include inadequate knowledge of symptoms, treatment, and consequences of untreated ADHD and fear of overdiagnosis and misdiagnosis. System-driven limitations include a lack of culturally competent health care providers, stereotyping or biases, and failure of clinicians to evaluate the child in multiple settings before diagnosis.

Understanding forensic psychiatry in healthcare practices and collaboration between legal nurse consultants and physicians.

In 2000, the Institute of Medicine stunned many professionals with their published report that noted the vast number of deaths that occur each year in hospitals across the United States which reach as many as 98,000. Therefore, it comes as no surprise that the healthcare arena faces litigious issues regularly, with some specialties budgets being significantly impacted by the cost of maintaining liability insurance. Legal Nurse Consultants and forensic physicians working in tandem but who work independently from treating clinicians can carry out forensic independent medical examinations (IME). This can help to assess the validity of malpractice claims, including issues of causation and degree of injuries claimed due to the incident(s) and recommend treatment strategies where appropriate. Reviews can cover a wide range of issues such as a person's past or current testamentary capacity, a prisoner or an accused person's mental health and/or mental impairment where necessary sending them for more assessment or treatment outside prison. This article argues that independent medical reviews are a useful tool that can assist the civil and criminal courts processes.

Duloxetine in the treatment of major depressive disorder: comparisons of safety and efficacy.

BACKGROUND: Pooled data from double-blind, placebo-controlled studies were utilized to compare the safety and efficacy of duloxetine in the treatment of major depressive disorder (MDD) in African-American and Caucasian patients. METHODS: Efficacy and safety data were pooled from seven double-blind, placebo-controlled clinical trials of duloxetine. Patients (aged > or =18 years) meeting DSM-IV criteria for MDD received duloxetine (40-120 mg/day; African Americans, N=69; Caucasians, N=748) or placebo (African Americans, N=59; Caucasians, N=594) for up to nine weeks. Efficacy measures included the 17-item Hamilton Rating Scale for Depression (HAMD17) total score, the Clinical Global Impression of Severity (CGI-S) and Patient Global Impression of Improvement (PGI-I) scales, and Visual Analog Scales (VAS) for pain. Safety was assessed using discontinuation rates, spontaneously reported treatment-emergent adverse events, vital signs and laboratory analyses, RESULTS: Based upon mean changes in HAMD17, CGI-S and PGI-I scales, the magnitude of duloxetine's treatment effects did not differ significantly between African-American and Caucasian patients. Discontinuation rates due to adverse events among duloxetine-treated patients were 13.0% for African Americans and 17.0% for Caucasians. No adverse event led to discontinuation in more than one African-American patient. The most common treatment-emergent adverse events in both ethnic groups included nausea, headache, constipation, dizziness and insomnia. The rate of occurrence of these events did not differ significantly between African-American and Caucasian patients. Mean changes from baseline for pulse, blood pressure, weight and laboratory analytes were small and showed no significant differences between African-American and Caucasian patients. CONCLUSION: In this analysis of data from seven clinical trials, no convincing evidence was found to suggest that the overall safety and tolerability profile or the efficacy profile for duloxetine in this cohort of African-American patients differed from that observed in a comparator group of Caucasian patients. The results from these analyses provide supportive evidence for the efficacy and safety of duloxetine in the treatment of MDD in African-American patients.

Overcoming challenges in the diagnosis and treatment of attention-deficit/hyperactivity disorder in African Americans.

The incidence of ADHD appears to be similar in African Americans and white populations. However, fewer African-American than white children are diagnosed and treated for ADHD. Reasons for this disparity have not been fully elucidated; causes are most likely complex. Whereas certain barriers to treatment are driven by patients and their families, others are due to limitations in the healthcare system. Patient-driven obstacles to care include inadequate knowledge regarding the symptoms, treatment and consequences of untreated ADHD and fear of overdiagnosis and misdiagnosis. A survey conducted to explore cultural differences between African-American and white respondents found that African Americans were more likely than whites to be unfamiliar with ADHD. In addition, African Americans felt that they were diagnosed with ADHD more often than whites and that teachers blamed ADHD for learning or behavior problems more often in African Americans. Health system barriers include a lack of culturally competent healthcare providers, stereotyping/biases and failure of the clinician to evaluate the child in multiple settings before diagnosis. Strategies to overcome these challenges include increased dissemination of ADHD information through community events; improved training of clinicians in cultural competence; and open communication among parents, clinicians and school personnel.

Treatment disparities among African American men with depression: implications for clinical practice.

A decade has passed since the National Institute of Mental Health initiated its landmark Real Men Real Depression public education campaign. Despite increased awareness, depressed African American men continue to underutilize mental health treatment and have the highest all-cause mortality rates of any racial/ethnic group in the United States. We review a complex array of socio-cultural factors, including racism and discrimination, cultural mistrust, misdiagnosis and clinician bias, and informal support networks that contribute to treatment disparities. We identify clinical and community entry points to engage African American men. We provide specific recommendations for frontline mental health workers to increase depression treatment utilization for African American men. Providers who present treatment options within a frame of holistic health promotion may enhance treatment adherence. We encourage the use of multidisciplinary, community-based participatory research approaches to test our hypotheses and engage African American men in clinical research.

Remaking the American health care system: a positive reflection on the Affordable Care Act with emphasis on mental health care.

Health care reform under the Patient Protection and Affordable Care Act (PPACA, ACA) of 2010 may be the most significant health care-related legislation enacted since the establishment of Medicare and Medicaid several decades ago. Over two years ago the U.S. Supreme Court upheld the constitutionality of the individual mandate of the Patient Protection and Affordable Care Act. This legislation has emerged as a significant and ambitious undertaking for all levels of the U.S. government. With the need to accommodate the estimated 30 million people projected over time to become newly insured it is increasingly important to understand the necessity of reform, how the legislation has been interpreted and implemented to fit the goals of the federal, state, and local governments, and what the potential benefits and consequences of changing the system are, in particular, as it relates to mental health care.

Sociocultural issues in african american and Hispanic minorities seeking care for attention-deficit/hyperactivity disorder.

OBJECTIVE: To review the sociocultural factors that may affect the diagnosis and management of attention-deficit/hyperactivity disorder (ADHD) in African American and Hispanic minorities seen in the primary care setting in the United States. DATA SOURCES: Searches on MEDLINE and PubMed were conducted in April and September 2012 on ADHD and its related problems and disabilities. A general search was conducted using the terms (attention deficit hyperactivity disorder OR attention deficit/hyperactivity disorder OR ADHD OR AD/HD) AND (ethnicity OR cultural OR culture). Issues of particular relevance to racial and ethnic minorities utilizing health care services were researched using the string (black OR African OR Hispanic OR Latino OR minority OR racial) combined with terms relating to access, insurance, comorbidity, high-risk behavior, treatment compliance, and nonpharmacologic modalities. Searches were limited to English-language citations, and no date parameters were used. References identified as pertinent to this review were selected for citation. STUDY SELECTION/DATA EXTRACTION: Information revealing contrasts between minorities and the US non-Hispanic white population was organized in distinct categories, such as access to medical care and insurance, cultural attitudes, and the effects of stigmatization. The authors also provide perspectives for the primary care physician from their own clinical experience. DATA SYNTHESIS: Rates of diagnosis of in the United States are higher for non-Hispanic whites than for minorities, yet true prevalence is probably similar across racial-ethnic groups. When the stigma of mental illness is added to the challenges faced by racial/ethnic minorities or immigrant status, patients may be especially sensitive. Underuse of clinical services may reflect economic limitations on access to care, cultural attitudes toward mental illness, and the effects of real or perceived prejudice and stigmatization. CONCLUSIONS: Primary care clinicians in the United States should seek to become more aware of cultural factors that could interfere with the recognition and management of ADHD.

The potential of neural stem cell transplantation for the treatment of fetal alcohol spectrum disorder.

Fetal alcohol spectrum disorder (FASD) is caused by intrauterine exposure to alcohol and can cause a full range of abnormalities to brain development, as well as long-term sequelae of cognitive, sensory and motor impairments. The incidence is estimated to be as high as 2% to 5% in children born within the US, however the prevalence is even higher in low socioeconomic populations. Despite the various mechanisms thought to explain the etiology of FASD, molecular targets of ethanol toxicity during development are not completely understood. More recent findings explore the role of GABA-A and GABA-B mechanisms, as well as cell death, cell signaling and gene expression malfunctions. Stem cell based therapies have grown exponentially over the last decade, which have lead to novel clinical interventions across many disciplines. Thus, early detailed understanding of the therapeutic potential of stem cell research has provided promising applications across a wide range of illnesses. Consequently, these potential benefits may ultimately lead to a reduced incidence and severity of this highly preventable and prevalent birth defect. It is recognized that stem cell derivations provide unique difficulties and limitations of therapeutic applications. This review will outline the current knowledge, along with the benefits and challenges of stem cell therapy for FASD.

Depression and chronic diseases: it is time for a synergistic mental health and primary care approach.

OBJECTIVE: To identify the growing significance of depression as a global leading cause of years lost to disability and its role as a major independent risk factor in many chronic illnesses. The distinct effects of depression on morbidity and mortality in cancer, diabetes, heart disease, and stroke are investigated, including behavioral factors and plausible biological mechanisms (psychoneuroimmunology of depression). DATA SOURCES: PubMed articles in English were searched from 1992 to 2012 (20-year span) using the following search criteria: psychoneuroimmunology of depression, immune-mediated inflammation, depression treatment recommendations, depression screening, years lost to disability, underserved populations and depression, chronic illnesses and depression, and selective serotonin reuptake inhibitors and immune system. DATA SYNTHESIS: Evidence of the robust bidirectional relationship between depression and individual chronic diseases is presented and discussed. A brief overview of currently recommended psychotherapeutic and psychopharmacologic treatment approaches in regard to depression in chronic diseases is provided. RESULTS: Discordance between mental health and primary care within the US public health system is a systematic problem that must be addressed. This situation leads to a potentially high hidden prevalence of underdiagnosed and undertreated depression, especially in the underserved populations. CONCLUSION: Measures must be implemented across the communities of mental health and primary care practitioners in order to achieve a synergistic approach to depression.

Thiamine deficiency and delirium.

Thiamine is an essential vitamin that plays an important role in cellular production of energy from ingested food and enhances normal neuronal actives. Deficiency of this vitamin leads to a very serious clinical condition known as delirium. Studies performed in the United States and other parts of the world have established the link between thiamine deficiency and delirium. This literature review examines the physiology, pathophysiology, predisposing factors, clinical manifestations (e.g., Wernicke's encephalopathy, Wernicke-Korsakoff syndrome, structural and functional brain injuries) and diagnosis of thiamine deficiency and delirium. Current treatment practices are also discussed that may improve patient outcome, which ultimately may result in a reduction in healthcare costs.

Alcohol: the lubricant to suicidality.

Suicide is a major public health problem in the United States as well as around the world. The significant role that alcohol plays in suicidality is well known and accepted in the scientific community. The use of alcohol does not necessarily lead to suicide, but through its action and effects, alcohol is an important proximal risk factor for suicidal behavior. There is very little data showing how and why alcohol exerts such tremendous influence and "lubricates the gears" to propel the act of committing suicide. This article will elucidate the complex relationship between alcohol and suicide and how alcohol use can lead to suicide. The article also describes how alcohol affects brain neurophysiology in regards to suicidal behavior.

Textmania: text messaging during the manic phase of bipolar I disorder.

Advancements in modern technology have brought tremendous changes in human behavior. One such change is in modes of communication such as text messaging, or texting. This form of communication has emerged as one of the dominant modes of communication in the world. This report presents a differential pattern of texting seen during the manic episode of a young adult with bipolar I disorder. We observed all the DSM IV manic symptoms; interestingly the patient's predominant medium for communication was texting. The patient reported a dramatic increase in the quantity of both texting and sex-texting (or sexting) in addition to a decrease in quality of the message content. In addition, there was a substantial increase in the number of people with whom the patient engaged in simultaneous texting conversations. This case provides evidence for the need to consider non-traditional forms of communication when evaluating a patient's communication pattern during mania.