Descriptive Psychopathology: The Signs and Symptoms of ...

136 Section 3: Examination domainslikely to have abused drugs or to be catatonic than to have Parkinson’s disease.A mother is many times more likely than the father to experience severe depressiveillness after the birth of their child. 10 Traumatic brain injury, alcoholism, andillicit drug use are more commonly seen in males; while depressive illness, andeating disorders are more often seen in females. Men are at higher risk for suicidebecause of their greater access to guns and their greater use of alcohol.Although the diagnostic conclusions of some clinicians are influenced by thepatient’s race and ethnicity, these decisions are typically spurious. For example,139 representative British psychiatrists completed a questionnaire about a clinicalvignette of a patient with psychosis. Forms of the vignette were identical exceptthat the gender and race of the patient varied. The psychiatrists deemed theAfro-Caribbean version to be potentially more violent and warranting criminalproceedings. They also judged this version to have a shorter illness duration andneeding less antipsychotic agents. The female version was perceived as lessviolent, less criminal, and also less likely to need an antipsychotic agent. TheAfro-Caribbian version was more often said to have a cannabis-induced or anacute reactive psychosis and less often to be schizophrenic, contrary to the claimthat schizophrenia is over-diagnosed in this demographic group. 11Racial and gender bias in diagnosis, however, is not always found. Psychiatristsin the USA were recruited and randomly assigned to assess one of four videovignettes depicting an elderly simulated patient with a depression. 12 The vignetteswere identical except for race (Euro- or African-American) and gender of thepatient. Eighty-one percent of the psychiatrists correctly recognized the depression.The patient’s race and gender were not associated with diagnosis, otherpatient characteristics, or treatment recommendations.The modest effect of race and ethnicity upon diagnostic considerations primarilyrelates to co-occurring general medical and neurologic conditions associatedwith a particular racial or ethnic group. For example, sickle cell disease, morecommon in African- than Euro-Americans, can lead to vascular brain disease andbehavior change. Being African-American per se, however, does not increase therisk for severe mood disorder, but being African-American does alter access tohealth care. 13Social behaviorsEvery culture fosters culture-specific normative behaviors. In diverse societies,knowing the dominant cultural norms and the typical social behaviors of ethnicgroups in populations being served is necessary to provide good care. Socialbehaviors can enrich or muddy the big picture.A common ideal in many societies is “good manners” and “common courtesy”.These social graces include saying please and thank you, appropriate turn-taking,