https://psychiatry-training.wiki.otago.ac.nz/images/a/ae/Wuttchen1994.pdf

Reliability and validity studies of the WHO-Composite International Diagnostic Interview (CIDI): A critical review

The National Healthcare Disparities Report summarizes health care quality and access among various racial, ethnic, and income groups and other priority populations, such as residents of rural areas and people with disabilities.

National Healthcare Disparities Report

• We studied DSM-III diagnoses made by the lay Diagnostic Interview Schedule (DIS) method in relation to a standardized DSM-III diagnosis by psychiatrists in the two-stage Baltimore Epidemiologic Catchment Area mental morbidity survey. Generally, prevalence estimates based on the DIS one-month diagnoses were significantly different from those based on the psychiatric diagnoses. Subjects identified as cases by each method were often different subjects. Measured in terms of K, the chance-corrected degree of agreement between the DIS and psychiatrists' one-month diagnoses was moderate for DSM-III alcohol-use disorder (abuse and dependence combined), and lower for other mental disorder categories. The unreliability of either the DIS or psychiatric diagnoses is one potential explanation for the observed disagreements. Others include the following: (1) insufficient or inadequate information (on which to base a diagnosis); (2) recency of disorder; (3) incomplete criterion coverage; (4) overinclusive DIS questions; and (5) degree of reliance on subject symptom reports. Further study of the nature and sources of these discrepancies is underway. This work should produce a more complete understanding of obstacles to mental disorder case ascertainment by lay interview and clinical examination methods in the context of a field survey.

Comparison of the lay Diagnostic Interview Schedule and a standardized psychiatric diagnosis. Experience in eastern Baltimore.

Although clinicians are encouraged to be more sensitive to cultural factors in the diagnosis and treatment of mental disorders, as evidenced by the significant changes in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994), little information is provided to help them determine which aspects of culture are important to the mental health of African Americans. This article discusses the importance of cultural mistrust as a psychological construct in the lives of African Americans. The origins of the construct, the research it has generated over the past 2 decades, and implications for improving interventions with Black clients seeking mental health care are discussed. The need for greater cultural sensitivity in psychological interventions with African Americans often places mental health clinicians in a double bind. On the one hand, they are told to acknowledge and respect cultural differences. On the other hand, they are warned about relying on stereotypes and generalizations in working with people of African descent who are in need of psychological services. One way to avoid this apparent contradiction is to review the literature and identify cultural themes or issues that have been shown to have direct relevance to the mental health treatment of African Americans. Psychologists interested in cultural variables often fail to identify the specific aspects of culture that are thought to influence behavior (Betancourt & Lopez, 1993). Prevalence studies indicate that paranoid schizophrenia is the most frequent diagnosis given to African Americans (Collins, Rickman, & Mathura, 1980; Mukherjee, Shukla, Woodle, Rosen, & Olarte, 1983; Toch, Adams, & Greene, 1987). This finding has been explained by some in terms of clinicians' insensitivity to different cultural norms for paranoid ideations in the Black population (Adebimpe, 1981; Grier & Cobbs, 1968; Jones & Gray, 1986; Ridley, 1984). However, this explanation remains an unARTHUR L. WHALEY received his PhD in clinical psychology from Rutgers

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Cultural Mistrust: An Important Psychological Construct for Diagnosis and Treatment of African Americans

Research on race and diagnosis initially focused on black-white differences in depression and schizophrenia. Statistics showing a higher treated prevalence of schizophrenia and a lower prevalence of depression for blacks seemed to support the claim that blacks did not suffer from depression. Others argued, however, that clinicians were misdiagnosing depression in blacks. This article reviews empirical studies of racial differences in individual symptoms and summarizes the evidence on misdiagnosis. It argues that more attention must be paid to resolving two contradictory assumptions made by researchers working in the area of race and diagnostic inference: (1) blacks and whites exhibit symptomatology similarly but diagnosticians mistakenly assume that they are different; (2) blacks and whites display psychopathology in different ways but diagnosticians are unaware of or insensitive to such cultural differences. The article concludes with suggested research directions and a discussion of critical research issues.

/pdf/the-influence-of-racial-factors-on-psychiatric-diagnosis-a-1ufy7k5h1b.pdf

The influence of racial factors on psychiatric diagnosis: a review and suggestions for research.

This article examines the validity of the National Institute of Mental Health Diagnostic Interview Schedule (DIS) relative to three of its measures: alcoholism, depression, and schizophrenia when compared with the clinical interview. Preliminary results indicate that greater diagnostic agreement was observed for alcoholism and depression than for schizophrenia. Much of the disagreement between the DIS interview and the clinician's ratings regarding schizophrenia seems to have occurred in cases with a mixture of schizophrenic and depressive symptoms.

The NIMH Diagnostic Interview Schedule: A test of its validity in a population of Black adults.

A retrospective study covering the period 1974-1978 was conducted on the inpatient population at the Department of Psychiatry, Howard University Hospital, for the two major diagnostic categories, major affective disorders (MAD) and the schizophrenias. Among the schizophrenias, the diagnoses of schizophrenia, paranoid type, and schizophrenia, not otherwise specified, account for approximately 73 percent of all schizophrenic diagnoses. The distribution of diagnoses among the MAD category demonstrated that approximately 74 percent of all diagnoses were accounted for by the subcategory depressive neurosis. Further analyses according to age at admission and annual trends were also conducted. The implications of these analyses, conducted on all black patient populations who were diagnosed by nonwhite diagnosticians, are discussed.

Frequency of schizophrenia and depression in a black inpatient population.

This retrospective study was conducted in response to a need to evaluate the overall utilization rates of the psychiatric consultation liaison service by nonpsychiatric units within Howard University Hospital, which deals almost exclusively with a black, inner-city population. The study covers a three-year period (July 1982 to July 1985). During this time only 815 patients (2 percent) were referred for psychiatric evaluation out of the total number of hospital admissions (40,000 patients).Patient characteristics and general attitudes appear to have had a major role in this low ratio of referrals, particularly a lack of awareness and bias against psychiatry. This latter finding is in disparity with other published reports. Diagnostically, depression, organic mental disorders (acute), and substance abuse (mainly PCP) constituted the greater bulk of the patients seen by the consultation liaison psychiatry service. The review of a random sample of psychiatric inpatients (n = 100) revealed that in 50 percent of the cases there was a coexisting physical illness or abnormality.The role of mental health education and the liaison function needs to be emphasized. It is suggested that efforts should be directed toward a wider acceptance and utilization of consultation liaison psychiatry by primary care physicians in general hospitals. The factors listed by physicians and patients that may account for the observed underutilization of consultation liaison services are discussed. The results of 20 interviews and the reasons given by referring physicians as to whether or not they will seek consultation from the consultation liaison services are also reviewed.

Utilization of a consultation liaison psychiatry service in a general hospital.

Cultural and linguistic barriers have long been problems in establisbing an effective therapeutic alliance between patients and therapists from different cultural, ethnic, and racial backgrounds. The current emphasis on cultural psychiatry has stimulated the inclusion of culturally relevant material in the curricuia of American psychiatric residency programs, such as the program at Howard University Hospital in Washington, D.C. After a preliminary study of foreign patients treated on the psychiatry service, the department of psychiatry established a program of seminars and didactic sessions intended to familiarize staff and trainees with cultural patterns of the largest groups of foreign students attending the university. The department also participated in a transcultural fellowship program for medical students sponsored by the American Psychiatric Association and the National Institute of Mental Health. After describing the programs, the authors briefly discuss such culturally related issues as foreign ...

Training psychiatric staff to treat a multicultural patient population.

Clay eating, a form of geophagia, is often observed in the human population, particularly during pregnancy. The intent of this study was to determine the effects of maternal geophagia on developmental and behavioral characteristics of the offspring. Twelve Sprague-Dawley female rats and their 88 progeny were divided into three groups: control, 20 percent clay, and 35 percent clay. The experimental diets were fed to adult rats during the period of gestation and for 14 days following parturition. Righting reflex, homing response, and activity level tests were administered and hemoglobin concentrations and red blood cell counts were determined. Data suggest that the higher level of maternal clay ingestion during the perinatal period decreased growth and development of motor skills in the infant pups. Homing skills, however, were enhanced.

Clyde B. Mathura

Papers

The NIMH Diagnostic Interview Schedule: A test of its validity in a population of Black adults.

Frequency of schizophrenia and depression in a black inpatient population.

Utilization of a consultation liaison psychiatry service in a general hospital.

Training psychiatric staff to treat a multicultural patient population.

Effects of maternal geophagia on infant and juvenile rats.