The Mount Sinai journal of medicine, New York
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Modern psychopharmacology provides us with several effective antidepressants. We are increasingly recognizing the importance of interindividual differences in plasma concentration with these drugs. ⋯ The importance of studies in this area has been underscored by anecdotal reports as well as cross-cultural surveys of prescribing patterns which indicate that antidepressant dosage requirements may differ among racial groups. This review will focus on the relatively young field of cross-cultural psychopharmacology and the efforts being made to determine the importance of society, culture, environment, genetics, and biophysiology in the prescribing and metabolism of and response to antidepressant drugs.
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Recent research and clinical experience has shown that African Americans may be at greater risk for inappropriate treatment. Such experiences can interact negatively with an existing distrust of the mental health system. Providers may show different prescribing patterns with racial and ethnic minorities: they may overuse antipsychotics, dispense higher dosages, and more commonly give involuntary treatment, which results in more side effects and a poorer outcome. ⋯ Newer pharmacological agents may be potentially more helpful for minorities because they are better tolerated, have better side effect profiles, and demonstrate better efficacy. However, African Americans have limited access to these agents. Education of providers and patients, policy changes in the public sector, wider implementation of research policies concerning inclusion of minorities, and different marketing strategies by pharmaceutical concerns are probably necessary to maximize pharmacotherapy of minorities.
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This study is the second in a series examining the prescribing of antipsychotic medication to patients with schizophrenia in cross-cultural clinical programs. A computer search identified all patients with the diagnosis of "schizophrenia" treated during a 1-year period in an inpatient Hispanic and Asian psychiatric unit(s); second computer search identified a matched (admission date) sample of Anglo patients from the general inpatient psychiatry services. The medication variables included type of neuroleptic drug used, the maximum dose, the stabilized dose (i.e., neuroleptic dose at discharged and the dose associated with first report of extrapyramidal symptoms. ⋯ The analysis with maximum dose revealed a significant main effect for both actual (p < 0.05) and standardized CPZ (p < 0.05). Similar results were also found for stabilized dose with both actual (p < 0.05) and standardized CPZ (p < 0.05). Examination of the direction of mean differences for both medication dosing variables using both CPZ comparisons revealed that the patients in general sample received significantly larger doses of antipsychotic medication than either Asian or Hispanic patients.
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Recent studies suggest that minorities may have higher plasma levels caused by ethnic variations in pharmacokinetics under standard neuroleptic treatment; they would be at increased risk for extrapyramidal side effects and more likely to be treatment noncompliant. This study examined the prescribing pattern of antipsychotic medication to minority schizophrenics in outpatient psychiatric programs developed to meet their treatment needs. A computer search was conducted of registered clients in a Hispanic and Asian outpatient clinic(s). ⋯ With regard to the former secondary analysis yielded significant differences between the clinic sample and the Hispanic (p < 0.05) and Asian (p < 0.05) samples, which did not differ significantly from each other but which received significantly less drugs than the other patient population. These results were similar to the standardized dose comparison. The findings replicate previous inpatient reports and have implications for cross-cultural treatment programs.
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International Medical Graduates (IMGs) have played an integral role in provision of medical services in the United States, representing 25% of physicians nationwide and up to 43% in some states. Because of the concern with the future physician surplus, several proposals have been advanced specifically targeting IMGs. Although the need to downsize our residency training programs is apparent, focusing specifically on the IMG who has met all requirements for entry into residency training is neither morally acceptable nor pragmatically effective. Downsizing can be accomplished independent of the need to single out a specific group without jeopardizing either quality of training or quality of care if all groups responsible for residency training work together.