Racial and ethnic effects on psychotic psychiatric diagnostic changes from admission to discharge: a retrospective chart review

Different cultural norms for paranoia that exist among African Americans may be misconstrued and fuel the overdiagnosis of schizophrenia. The present study examined whether the frequency of psychotic psychiatric diagnoses differs by race/ethnicity, particularly with regard to paranoid schizophrenia. We examined the frequency upon admission and at discharge and further explored the pattern of diagnostic changes that occurred by racial/ethnic group.

The present study is a secondary analysis of diagnostic data obtained on inpatients admitted to a research unit from 1990 to 2003 with a typical length of stay from 3 to 6 months. Admission and discharge diagnoses were obtained from each chart on the sample of 238 patients, 55% (N = 130) of whom were white; 24% (N = 58), African American; and 21% (N = 50), Latino. Inpatients were grouped into 4 diagnostic categories: schizoaffective disorder, paranoid schizophrenia, schizophrenia-undifferentiated or -disorganized type, and other psychotic disorder.

Upon admission, African American patients were more likely to receive a less-defined diagnosis, such as psychosis not otherwise specified, in part because they tended on average to be younger. Over the course of hospitalization, diagnoses for white patients were more likely to move toward schizoaffective at discharge (OR = 6.85, 95% CI = 1.53 to 30.66). African American patients were more likely to experience a diagnostic change to paranoid schizophrenia (OR = 4.58, 95% CI = 1.70 to 13.36). Interestingly, Latino patients were the least likely group to experience diagnostic changes during their hospitalization stay.

The present preliminary findings reveal an interesting pattern of diagnostic changes that occurred over the course of hospitalization that should be followed up in a comprehensive study.