Subject(s)
Black or African American/psychology , Physician-Patient Relations , Psychiatry/education , Psychotherapy/methods , Cultural Diversity , Dysthymic Disorder/diagnosis , Dysthymic Disorder/therapy , Female , Hepatitis C/complications , Hepatitis C/drug therapy , Hepatitis C/psychology , Humans , Liver Cirrhosis/psychology , Liver Cirrhosis/virology , Middle Aged , Psychotherapeutic Processes , Psychotherapy/education , Self Concept , Social Identification , TexasABSTRACT
OBJECTIVE: Recent studies in primary care settings indicate that African Americans face health disparities in the treatment of major depression. We reviewed the literature to find evidence of specific patient, physician, and practice-setting factors related to such barriers. DATA SOURCES: We searched for and retrieved articles in Medline (1966-2004) and hand-checked bibliographies to find additional articles that were relevant to the evaluation and treatment of African Americans with depression. STUDY SELECTION AND DATA EXTRACTION: Two investigators (AKD, MO) independently examined the abstracts retrieved from the literature search, and excluded articles that did not match a predefined search strategy. Two other investigators (HLC, MMW) identified potential articles through bibliographic review. In the extracted set articles, we examined cited barriers to diagnosis and effective management. RESULTS: We found 24 articles that fulfilled our criteria. These studies indicate that African Americans face a number of barriers in the recognition and treatment of major depression including clinical presentation with somatization, stigma about diagnosis, competing clinical demands of comorbid general medical problems, problems with the physician-patient relationship, and lack of comprehensive primary care services. CONCLUSIONS: Research indicates that African Americans who have depression may be frequently under diagnosed and inadequately managed in primary care as a result of patient, physician, and treatment-setting factors. Our systematic review can assist family physicians in understanding how to overcome such barriers to the diagnosis and treatment of depressive disorders in African American patients.
Subject(s)
Black or African American , Depressive Disorder, Major/diagnosis , Family Practice , Mental Health Services/organization & administration , Primary Health Care , Adult , Depressive Disorder, Major/therapy , Female , Humans , Male , Middle Aged , Physician-Patient RelationsABSTRACT
Individuals who use cocaine report a variety of neuropsychiatric symptoms that are yet to be adequately targeted with treatment modalities. To address this problem requires an understanding of these symptoms and their neurobiological origins. Our paper reviewed the existing data on the neuropsychiatic implications of cocaine. We conducted a Medline search from 1984-2004 using terms, such as "cocaine", "cocaine addiction", "cocaine abuse", "cocaine neuropsychiatry" and "dual diagnosis". The search produced additional reference materials that were used in this review, although we focused on data that have likely clinical implications. The literature evidence suggested that, whereas acute cocaine overdose is potentially fatal, the ingestion of mild-to-moderate doses could result in fatal or nonfatal neuropsychiatric events. Also, chronic cocaine use may be associated with deficits in neurocognition, brain perfusion and brain activation patterns. Some of these deficits were unresolved with periods of abstinence ranging from 3-200 days. Taken together, these studies suggest the need for further investigations to fully characterize the neurobiological substrates of cocaine use disorders (CUDs) with the future possibility of more efficient treatment modalities.
