Dr Stephen Strakowski urges psychiatrists to actively avoid racial bias when prescribing antipsychotics and carefully consider their medication choices in patients of color.
Joyce and Iver Small Professor of Psychiatry; Vice Chair, Research, Department of Psychiatry, Indiana University School of Medicine; Professor, Department of Community and Global Health, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana; Professor of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin
To give you background on this manuscript, like I said, this is from a very good Mount Sinai health system in New York City. As I'll talk about, it's not unique to them, so it shouldn't be perceived that way. The investigators extracted over 200,000 records from their electronic health record with about 19,000 people with bipolar disorder, which is our focus today. These are people who were all given a clinical diagnosis of bipolar disorder in the record.
As I mentioned already, unfortunately this is nothing new. This inequity in medication choice in people with mood disorders, generally, and bipolar disorder, specifically, if you are Black, has for 30 years had excessive rates of antipsychotic prescribing. . They found virtually the same thing as this Mount Sinai sample in two large datasets — one national dataset and one local at University of Mississippi.
, 6th ed], recommended against using these first-generation antipsychotics generally, because of the problem that even if haloperidol is used in a narrow way for acute mania, there's unfortunately a tendency to continue to prescribe the drug long past any utility it might provide. Accompanying that as the antipsychotics came to market, because they were new back in those times, was a use of these then-called major tranquilizers to manage what was perceived asand hostility in Black people, which was almost certainly, and has been discussed by Metzl and others, to be a misperception based on stigma and bias.
Despite our good intentions, we still are vulnerable to the same biases as the rest of society. Again, since the Civil Rights Act, and certainly in healthcare, there really has not been a good national strategy to correct these inequities. As far as I'm concerned, it's really up to us. It's up to us to try to change how we think about how we care for people and keep these inequities in mind.
Antipsychotics Neuroleptics Neuroleptic Drugs Racial Disparity Ethnic Disparity Racial-Ethnic Disparity Racial-Ethnic Disparities Atypical Antipsychotics Second Generation Antipsychotics Bipolar Disorder Bipolar Mania Manic Depression Bipolar Affective Disorder Depression Fellowship Fellows Residency Residents Mood Disorder Adverse Effects Side Effects Racism
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