AETC-NMC | Curricula

Summary

The most common mental disorders among African Americans include:

Depression
Bipolar disorder
Post-traumatic stress disorder (PTSD)
Generalized anxiety disorder
Panic disorder
Schizophrenia

Depression

Major depression differs from normal sadness or grief; symptoms last longer and are more pervasive and can include: anhedonia, hopelessness, flattened mood, sleep disturbances, appetite changes, reduced concentration, and feelings of sadness. Among African Americans, depression is often under-diagnosed or misdiagnosed, resulting in less than optimal treatment and outcomes. Even severe cases of depression can be treated successfully, especially if treatment is started earlier. Treatment typically consists of psychotherapy, pharmacotherapy, or a combination of both.

Bipolar Disorder

A patient with bipolar disorder, previously known as manic-depression, can experience changes in mood from feeling very high (mania) to feeling very low (depression). When appropriately diagnosed and treated, patients’ mood swings can be controlled so that they can lead fulfilling lives. Although rates of bipolar disorder among African Americans are comparable to those among other Americans, African Americans are less likely to be diagnosed and, therefore, less likely to receive effective treatment. Bipolar disorder typically requires lifelong treatment, often involving a team of a psychiatrist, psychologists, social workers, and psychiatric nurses. The primary treatments for bipolar disorder include medications; individual, group, or family psychotherapy; or education and support groups.

Anxiety Disorders

Anxiety disorders are the most common type of emotional disorder. Some common symptoms include:

Overwhelming feelings of panic and fear
Uncontrollable, obsessive thoughts
Painful, intrusive memories
Recurrent nightmares
Physical symptoms (gastrointestinal distress, heart pounding, being easily startled, and muscle tension)

The main types are:

Generalized anxiety disorder
Posttraumatic stress disorder (PTSD)
Panic disorder
Other anxiety disorders (phobias, obsessive compulsive disorder)

Treatment typically consists of medication, psychotherapy, or a combination of the 2. Although the prevalence of anxiety disorders is generally comparable across racial groups, particular types appear to be more prevalent among African Americans, including social anxiety disorder and PTSD.

Schizophrenia

Schizophrenia is a chronic, disabling brain disorder that can manifest as a wide range of symptoms, including:

Hallucinations (typically, voices that others cannot hear) and delusions
Disorganized thinking
Movement disorders
Needing help with everyday tasks

Treatment of schizophrenia generally focuses on controlling the symptoms and primarily consists of antipsychotic medications and psychosocial treatments.

African American vs white patients are more likely to receive a diagnosis of schizophrenia, and this is more likely if:

The patient has another mental disorder that may manifest with psychotic features.
The diagnosing clinician has misinterpreted cultural idioms of emotional distress as schizophrenic symptoms.
The patient’s symptoms are actually those of a systemic medical condition that may involve psychotic symptoms, such as substance abuse or a neurologic disorder.

To limit the risk of misdiagnosing schizophrenia, practitioners need to understand both the clinician-related and patient-related factors that can contribute to such a misdiagnosis—largely a matter of developing a culturally competent approach to diagnosis of the disorder.

African Americans’ Mental Health–Seeking Habits

Clear and up-to-date data on the types of mental healthcare services that African Americans tend to seek are not readily available. However, earlier studies indicated that many African Americans either fail to seek help or delay seeking it when experiencing mental or emotional problems. In many African American communities, religious institutions play a critical role not only in spiritual life but also as a source of assistance during mental and emotional difficulties. In addition, many African Americans tend to rely on personal connections; primary care providers or other nonspecialists; emergency departments; or faith healers, herbalists, and other nonstandard practitioners.

Ethnopsychopharmacology

Along with misdiagnosis of mental disorders, inappropriate use of psychotropic medications, and skepticism about mental healthcare among African Americans, there are potential concerns regarding genetic variations that influence patients’ responses to medications. Several studies have reported that certain polymorphisms in the hepatic enzymes responsible for metabolizing psychotropic medications—such as antidepressants, anxiolytics, and antipsychotic medications—are more common in African Americans and therefore may be associated with greater risk of adverse effects and toxicities.

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	2. Triple Whammy—HIV, Mental Disorders, African Americans Curricula 1 2 3 4 AETC-NMC Home Curricula Home Glossary Feedback

	About Curriculum 2 Introduction Module 1: Context: African Americans, Mental Disorders, and HIV Disease Learning Objectives & Pretraining Assessment The Complex Knot—Being HIV-Positive, African American, With a Mental Disorder African Americans’ Vulnerability to Mental Disorders Evolving Demographics of US Society Patterns of Access to Healthcare Services Substance Abuse and Mental Health Issues HIV, Vulnerable Populations, and African Americans Summary References Assessment Questions Module 2: What Is a Mental Disorder? Learning Objectives & Pretraining Assessment Depression Depression Among African Americans Treatment of Depression Bipolar Disorder DSM Criteria for Bipolar Disorder Treatment Anxiety Disorders Posttraumatic Stress Disorder Panic Disorder Other Anxiety Disorders Treating Anxiety Disorders Anxiety Disorders Among African Americans Schizophrenia How Is Schizophrenia Treated? Psychosocial Treatments Schizophrenia Among African Americans Mental Health–Seeking Habits of African Americans References Ethnopsychopharmacology Considerations References Summary Assessment Questions Module 3: HIV Infection and Mental Disorders Learning Objectives & Pretraining Assessment Incidence of Mental Disorders in the United States Associations Between HIV Disease and Mental Disorders Treatment of Mental Disorders in HIV-Infected Patients Summary References Assessment Questions Module 4: Untying the Knot Learning Objectives & Pretraining Assessment Barriers to Obtaining Appropriate Diagnosis and Care Mental Health Services Sector Role of Multicultural Organizations Employing Nonstandard Therapeutic Tools Role of Spirituality Music Therapy Review and Further Resources Summary References Assessment Questions Case Studies Suggested Activities	Summary The most common mental disorders among African Americans include: Depression Bipolar disorder Post-traumatic stress disorder (PTSD) Generalized anxiety disorder Panic disorder Schizophrenia Depression Major depression differs from normal sadness or grief; symptoms last longer and are more pervasive and can include: anhedonia, hopelessness, flattened mood, sleep disturbances, appetite changes, reduced concentration, and feelings of sadness. Among African Americans, depression is often under-diagnosed or misdiagnosed, resulting in less than optimal treatment and outcomes. Even severe cases of depression can be treated successfully, especially if treatment is started earlier. Treatment typically consists of psychotherapy, pharmacotherapy, or a combination of both. Bipolar Disorder A patient with bipolar disorder, previously known as manic-depression, can experience changes in mood from feeling very high (mania) to feeling very low (depression). When appropriately diagnosed and treated, patients’ mood swings can be controlled so that they can lead fulfilling lives. Although rates of bipolar disorder among African Americans are comparable to those among other Americans, African Americans are less likely to be diagnosed and, therefore, less likely to receive effective treatment. Bipolar disorder typically requires lifelong treatment, often involving a team of a psychiatrist, psychologists, social workers, and psychiatric nurses. The primary treatments for bipolar disorder include medications; individual, group, or family psychotherapy; or education and support groups. Anxiety Disorders Anxiety disorders are the most common type of emotional disorder. Some common symptoms include: Overwhelming feelings of panic and fear Uncontrollable, obsessive thoughts Painful, intrusive memories Recurrent nightmares Physical symptoms (gastrointestinal distress, heart pounding, being easily startled, and muscle tension) The main types are: Generalized anxiety disorder Posttraumatic stress disorder (PTSD) Panic disorder Other anxiety disorders (phobias, obsessive compulsive disorder) Treatment typically consists of medication, psychotherapy, or a combination of the 2. Although the prevalence of anxiety disorders is generally comparable across racial groups, particular types appear to be more prevalent among African Americans, including social anxiety disorder and PTSD. Schizophrenia Schizophrenia is a chronic, disabling brain disorder that can manifest as a wide range of symptoms, including: Hallucinations (typically, voices that others cannot hear) and delusions Disorganized thinking Movement disorders Needing help with everyday tasks Treatment of schizophrenia generally focuses on controlling the symptoms and primarily consists of antipsychotic medications and psychosocial treatments. African American vs white patients are more likely to receive a diagnosis of schizophrenia, and this is more likely if: The patient has another mental disorder that may manifest with psychotic features. The diagnosing clinician has misinterpreted cultural idioms of emotional distress as schizophrenic symptoms. The patient’s symptoms are actually those of a systemic medical condition that may involve psychotic symptoms, such as substance abuse or a neurologic disorder. To limit the risk of misdiagnosing schizophrenia, practitioners need to understand both the clinician-related and patient-related factors that can contribute to such a misdiagnosis—largely a matter of developing a culturally competent approach to diagnosis of the disorder. African Americans’ Mental Health–Seeking Habits Clear and up-to-date data on the types of mental healthcare services that African Americans tend to seek are not readily available. However, earlier studies indicated that many African Americans either fail to seek help or delay seeking it when experiencing mental or emotional problems. In many African American communities, religious institutions play a critical role not only in spiritual life but also as a source of assistance during mental and emotional difficulties. In addition, many African Americans tend to rely on personal connections; primary care providers or other nonspecialists; emergency departments; or faith healers, herbalists, and other nonstandard practitioners. Ethnopsychopharmacology Along with misdiagnosis of mental disorders, inappropriate use of psychotropic medications, and skepticism about mental healthcare among African Americans, there are potential concerns regarding genetic variations that influence patients’ responses to medications. Several studies have reported that certain polymorphisms in the hepatic enzymes responsible for metabolizing psychotropic medications—such as antidepressants, anxiolytics, and antipsychotic medications—are more common in African Americans and therefore may be associated with greater risk of adverse effects and toxicities. « BACK NEXT »
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2. Triple Whammy—HIV, Mental Disorders, African Americans

Summary