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Racial categories in psychiatric clinical practice: an issue to be taken seriously

Posted by plosmedicine on 31 Mar 2009 at 00:16 GMT

Author: Thomas Paparrigopoulos
Position: MD
Institution: University of Athens, Psychiatry Dpt., Eginition Hospital, Greece
Additional Authors: Christos Theleritis
Submitted Date: November 07, 2007
Published Date: November 7, 2007
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

In view of a recent article by Lundy Braun and colleagues [1] we would like to comment on the significance of race in psychiatric clinical practice. First, for mental health professionals it is hard to conceive that assessment of patients of different origins and social backgrounds can be made within a few minutes time. As a rule, these patients need more time to confide their complaints. Immigrants are an underprivileged population with a higher prevalence of mental disorders. However, it has been reported that immigrants with low acculturation status have a lower psychiatric morbidity, although social class and education might be the decisive factors for the development of psychopathology [2]. Whatever the case, we can attest that immigrants in Greece are more vulnerable to the development of psychopathology when exposed to adverse events; moreover, these people are usually of lower income, less educated than Greek citizens and often without insurance, and are often reluctant to make use of mental health services [3].

Second, a physician should bear in mind that people with different cultural backgrounds tend to react differently when experiencing a mental health problem and may present with a variety of somatization and dissociative symptoms. This is acknowledged in the major classification systems of mental disorders (DSM-IV and ICD-10) wherein culture-bound psychiatric syndromes are described. Regional adaptations such as the Chinese ICD-10 version may be of help [4].

Globalization and growing migration has made more compelling the need for culturally competent services. Transcultural psychiatric units affiliated to psychiatric clinics may ensure the continuity of care and patients' reintegration in the community [2]. Moreover, an interdisciplinary approach encompassing the behavioral neurosciences, sociology and behavioral anthropology would secure the provision of the best of care to all psychiatric patients regardless of nationality [5].

Thus, individualized treatment in our 'creolized' society is of great importance. This implies more time with the patient and informants, learning more about his cultural background, family history, and social support systems. In patient-focused psychiatry, psychosocial interventions and pharmacotherapy might be used alone or in combination. Also, cognitive behavioral therapy might address the patients' specific pathogenic cultural beliefs [2]. Regarding pharmacotherapy, a culturally-competent clinician should be informed about the differential pharmacogenetics and pharmacodynamics in ethnic groups, should be aware of the personal expectations of using medications and the possibility of parallel use of traditional medicines.

Unfortunately, we have to ponder on the fact that despite the advances in the field of neuropsychiatric genetics we may be far from any significant contribution to individualized medicine as yet; as Burke and Psatty mention, even in the era of genomics individualized health care based on a good patient-physician relationship may have an advantage over any kind of technology [6].


1. Braun L, Fausto-Sterling A, Fullwiley D, Hammonds EM, Nelson A, et al. (2007) Racial categories in medical practice: How useful are they? PLoS Med 4: e271. doi:10.1371/journal.pmed.0040271

2. Trujillo M (2001) Culture and the organization of psychiatric care. Psych Clin North Am 24:539-552.

3. Anagnostopoulos DC, Vlassopoulou M, Rotsika V, Pehlivanidou H, Legaki L, et al., (2004) Psychopathology and mental health service utilization by immigrants' children and their families. Transcult Psychiatry 41:465-486.

4. Mezzich JE, Berganza CE, Ruiperez MA (2001) Culture in DSM-IV, ICD-10 and evolving diagnostic systems. Psych Clin North Am 24:407-419,

5. Fàbrega Jr H (2001) Epilogue. Psych Clin North Am 24:595-608.

6. Burke W, Psatty BM (2007) Personalized medicine in the era of genomics. JAMA 298: 1682-1684.

No competing interests declared.