evaluates diagnosis at a London psychiatric hospital. Br J Psychiatry.
1999;175:283–285
http://www.ncbi.nlm.nih.gov/pubmed/10645332
"
Of 29 African and African-Caribbean patients diagnosed with
schizophrenia, the diagnoses of the British and the Jamaican
psychiatrists agreed in 16 instances (55%) and disagreed in 13 (45%).
Hence, interrater reliability was poor (kappa = 0.45). PSE CATEGO
diagnosed a higher proportion of subjects as having schizophrenia than
the Jamaican psychiatrist did (chi 2 = 3.74, P = 0.052).
"
The sample size is small but it backs up the noting that UK
psychiatrists are diagnosing schizophrenia differently. This may be the
reason why black people are overdiagnosed with schizophrenia in the UK
and not the problem of the change in the diagnosis over the last half
century though perhaps this is still relevant.
It doesn't account for all the 9x overdiagnosis rate but it's probably
the most controllable factor...well...that and cannabis misuse. The
recommendation I'd make is for training practising psychiatrists as well
as all psychiatry students. I recvkon it'd work better than recommending
diagnosis be checked by a UK-trained black psychiatrist.
The overdiagnosis problem wouldn't be a problem if black people had good
experiences in mental healthcare or the treatments didn't often harm the
patient. The sad thing is treatment for schizophrenia is traumatic,
harmful, unethical and inhumane. I would guess a significant part of the
prognosis is caused by treatment and the diagnosis itself.
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