Race may play role in Dx of schizophrenia, bipolar disorder.

WASHINGTON -- Clinicians appear to be more likely to diagnose black patients with schizophrenia than white patients, even after controlling for symptom presentation, according to a study of more than 200 patients.

"The findings suggest that a racial bias exists in clinical settings, with clinicians being more likely to give a diagnosis of schizophrenia to black patients than to white patients," Sherif Abdelmessih, a psychology researcher at Fordham University in New York, said in a poster presented at the annual meeting of the American Psychiatric Association.

Study participants originally were recruited for a study on the genetics of psychiatric disorders from inpatient units and outpatient treatment programs at Zucker Hillside Hospital and at other affiliates of the North Shore Long Island Jewish Health System in New York.

Patients were included whether they had a primary diagnosis of schizophrenia or bipolar disorder with psychosis--based on the Structured Clinical Interview for DSM-IV Disorders (SCID)--or a clinical diagnosis of schizophrenia, schizoaffective disorder, or bipolar I disorder. Participants with a clinical diagnosis of schizophrenia or schizoaffective disorder were combined into one group.

Logistic regression analysis included the symptoms of auditory hallucinations, Schneiderian first-rank symptoms, and negative symptoms, based on the SCID and coded as present or absent.

In all, 206 patients were included--83 black and 123 white. More patients were male (61%). In terms of research diagnoses, 68% of the patients had schizophrenia, and 32% had bipolar disorder with psychosis. In terms of clinical diagnoses, 45% had schizophrenia, 32% had bipolar disorder, and 23% had schizoaffective disorder, Mr. Abdelmessih wrote.

He and his associates found that 28% of black patients with a research diagnosis of bipolar disorder received clinical diagnoses of schizophrenia, compared with 13% of white patients. In contrast, 95% of black patients with a research diagnosis of schizophrenia received a clinical diagnosis of schizophrenia, compared with 90% of white patients.

Neither race nor presentation of classic symptoms predicted a discrepancy between clinical and research diagnoses.

BY KERRI WACHTER

Senior Writer