The Mount Sinai journal of medicine, New York
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This article is a review of studies involving ethnicity and spontaneous as well as iatrogenic movement disorder. We have focused on Parkinson's disease and tardive dyskinesia. ⋯ Asians seem to have a lower or equal risk of developing tardive dyskinesis as compared with Caucasians. We discuss the possible contribution of ethnicity to the etiology of movement disorders and the implications thereof.
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Sarcoidosis continues to be shrouded by anecdotal misinformation which has gained credence by repetition. These myths have been developing for the past 50 years and continue to accumulate, despite remedial data. Among the most egregious myths are that sarcoidosis is a disease of Blacks, that the chest radiography is diagnostic of sarcoidosis, and has chronologic significance, that serum angiotensin converting enzyme and bronchoalveolar lavage are diagnostic of sarcoidosis and serve as guides to therapy, that the Kveim-Siltzbach test is not a reliable diagnostic test for sarcoidosis, that sarcoidosis is difficult to diagnose, and that sarcoidosis is tuberculosis. ⋯ Sarcoidosis occurs with varying frequency among all races. The chest radiograph typical of sarcoidosis can be mimicked by other granulomatous and neoplastic diseases. The classic radiographic stages, from 0 to 111, do not reflect the time course of sarcoidosis can be made relatively easily in most patients, but its etiology is still unknown.
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It has been reported anecdotically that patients from Latin America need less medication than Anglo patients for the treatment of psychiatric disorders. These clinical observations have been questioned because of the character of the reports. ⋯ After investigation, such effects have been found to be pronounced in Asians, but few studies have been conducted with Hispanics. Fortunately, several studies are underway in Latin America, as reviewed in this brief report.
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Certain individuals have a metabolic deficiency in the metabolism of debrisoquin, sparteine, dextromethorphan, and more than 80 other clinically important drugs. Examples of such drugs include tricyclic antidepressants, neuroleptics, selective serotonin reuptake inhibitors, beta-adrenoceptor blockers, and antiarrhythmics. ⋯ CYP2D6 deficiency has important therapeutic consequences, such as increased side effects when medications that are substrates of this enzyme are prescribed for such individuals. To optimize drug therapy, physicians should therefore determine the metabolic capacity of their patients.
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Ethnic differences in pharmacological response have been recognized for a long time. New research methodologies in the field of pharmacogenetics have begun to provide us with important insights concerning the biological mechanisms that underlie this differential response. The emerging data have highlighted the central role of genetic factors in the metabolism, and perhaps plasma protein binding, of many of the psychotropic agents used today. ⋯ However, it is clear that as for psychiatry in general, the role of the environment in these genetic factors must be understood when considering psychopharmacological response in particular. The utility and possible application of these research methodologies in the clinical setting is still undetermined; these data must be pursued. The information concerning the relative efficiency of the drug-metabolizing enzymes which is made available through genotyping and phenotyping methodologies could be used by clinicians who provide psychopharmacotherapeutic services to patients from diverse ethnic backgrounds.