Race, racism, and epidemiological surveys.

Many studies of clinical populations have reported significant differences between whites and blacks in prevalence rates of mental disorders. However, data from the Epidemiologic Catchment Area study indicate only modest differences. The author describes factors in the treatment experiences of black and white patients that may lead researchers to find questionable disparities in prevalence rates. These factors include racial differences in treatment-seeking behavior, likelihood of involuntary commitment, representation in research samples, presentation of psychiatric symptoms and resulting diagnoses, and accuracy of psychological tests as well as disparities in treatment. The author suggests guidelines for improving research methods and designs, including documenting the ethnic composition of samples and using structured diagnostic assessments, so that unintended inequalities can be identified, addressed, and monitored and the accuracy of prevalence data among blacks can be improved.

Schizophrenia and affective disorder in black and white patients: a methodologic note.

Contrary to many published reports of higher rates of schizophrenia and lower rates of affective disorder among blacks, this analysis of data collected over a ten-year period in a psychiatric clinic that serves a predominantly black population found minimal differences between the two ethnic groups. Methodologic considerations that reduce spurious black-white differences are discussed. The authors urge proper caution in evaluating such reported differences and propose screening measures to identify biased diagnostic procedures.

Racial and geographic differences in the psychopathology of schizophrenia.

The authors compared the psychopathology of black and white and of rural and urban schizophrenic patients. Using a structured interview, psychiatrists rated 273 schizophrenic patients consecutively admitted to seven hospitals and mental health centers over 3 1/2 years. Results indicate that important symptoms were more severe in black than in white schizophrenic patients: black patients were more angry, impulsive, hallucinating, dysphoric, and asocial. A greater number of important symptoms were found to be more intense in rural than in urban schizophrenic patients: rural patients were more angry, aggressive, silly, negativistic, and uncooperative, but urban patients were more anxious, rigid, ambivalent, and asocial.

Symptomatology of depression in black and white patients.

This study compares the symptoms of public mental health patients diagnosed as having a depressive disorder, and then relates its findings to the previous literature concerning black-white differences in mental illness. Results of this study corroborate previous observations that a somewhat smaller proportion of black admissions than white admissions are diagnosed with a depressive disorder and that a higher proportion of black admissions are diagnosed with a schizophrenic disorder. Some black-white differences in depressive symptoms were corroborated-notably, slightly higher percentages of hostility, dangerousness, and somatic complaints in blacks-and these appeared to be independent of socio-economic status.

Hallucinations and delusions in black psychiatric patients.

A higher incidence of hallucinations has been previously reported among blacks, as compared to whites, in both psychiatric and nonpsychiatric populations. In contrast to these reports, which relied on hospital records, the present study utilized standardized research rating scales, and confirmed the above observation among schizophrenic patients. Some blacks, irrespective of diagnosis, probably experience a variety of non-schizophrenic hallucinations, may lead to erroneous diagnoses of schizophrenia. Current ignorance regarding the content of hallucinations in normal and non-schizophrenic, and in schizophrenic blacks is a source of diagnostic confusion which may have dire consequences for many individuals.

Overview: white norms and psychiatric diagnosis of black patients.

Allegations of psychiatric misdiagnosis of black patients are supported by only a few examples of such errors, but there is a modest body of circumstantial evidence suggesting that black patients run a higher risk of being misdiagnosed than white patients. The author reviews the studies providing such evidence and concludes that greater awareness among clinicians and research into more appropriate diagnostic criteria for black patients are desirable.

MMPI diagnosis of black psychiatric patients.

Black-white differences in MMPI norms may lead to significant misclassification of black psychiatric patients, which can compound diagnostic errors from other sources. The authors suggest that clinicians who use MMPI results in evaluations of black patients interpret test reports carefully, keeping in mind the possibility of spuriously elevated scores and paying careful attention to areas of potential "false positives."

Complex partial seizures simulating schizophrenia .

The clinical features that distinguish schizophrenia from the symptomatic psychoses were seen in a patient whose complex partial seizures remained undiagnosed for five years, resulting in 30 psychiatric hospitalizations.