Racial influence on diagnosis in psychotic mania

In a sample of 100 patients with psychotic mania, we examined whether African-Americans were more likely than Caucasians to present with Schneiderian first-rank symptoms, potentially contributing to a misdiagnosis of schizophrenia. In this sample, African-American patients were significantly more likely than Caucasian patients to have received a clinical diagnosis other than bipolar or schizoaffective disorder. There were no racial differences in affective symptoms, but there were differences in psychotic symptom profiles, primarily due to increased hallucinations in African-Americans and increased persecutory delusions in Caucasians. Racial differences in the clinical diagnosis of patients with mania were not due to differences in symptomatic expression, however.