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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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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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.