Ethnopsychopharmacology

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A growing body of research has begun to highlight differences in the way racial and ethnic groups respond to psychiatric medication. [1] [2]

Contents

It has been noted that there are "dramatic cross-ethnic and cross-national variations in the dosing practices and side-effect profiles in response to practically all classes of psychotropics." [3]

Differences in drug metabolism

Drug metabolism is controlled by a number of specific enzymes, and the action of these enzymes varies among individuals. For example, most individuals show normal activity of the IID6 isoenzyme that is responsible for the metabolism of many tricyclic antidepressant medications and most antipsychotic drugs. However, studies have found that one-third of Asian Americans and one-third of African Americans have a genetic alteration that decreases the metabolic rate of the IID6 isoenzyme, leading to a greater risk of side effects and toxicity. [4] The CYP2D6 enzyme, important for the way in which the liver clears many drugs from the body, varies greatly between individuals in ways that can be ethnically specific. [2] Though enzyme activity is genetically influenced, it can also be altered by cultural and environmental factors such as diet, the use of other medications, alcohol and disease states.

Differences in pharmacodynamics

If two individuals have the same blood level of a medication there may still be differences in the way that the body responds due to pharmacodynamic differences; pharmacodynamic responses may also be influenced by racial and cultural factors. [5]

In addition to biology and environment, culturally determined attitudes toward illness may affect how an individual responds to psychiatric medication.

Cultural factors

In addition to biology and environment, culturally determined attitudes toward illness and its treatment may affect how an individual responds to psychiatric medication. Some cultures see suffering and illness as unavoidable and not amenable to medication, [6] while others treat symptoms with polypharmacy, often mixing medications with herbal drugs. [7] Cultural differences may have an effect on adherence to medication regimes as well as influence the placebo effect. [8]

Further, the way an individual expresses and reacts to the symptoms of psychiatric illness, and the cultural expectations of the physician, may affect the diagnosis a patient receives. For example, bipolar disorder often is misdiagnosed as schizophrenia in people of color.

Recommendations for research and practice

The differential response of many ethnic minorities to certain psychiatric medications raises important concerns for both research and practice.

Include Ethnic Groups. Most studies of psychiatric medications have white male subjects. [5] Because there is often a greater difference within racial and ethnic groups than between them, researchers must be certain they choose prototypical representatives of these groups, or use a larger random sample. [9]

Further, because broad racial and ethnic groups have many different subgroups. For example, in North American research it may not be enough to characterize individuals as Asian, Hispanic, Native American, or African American. [9] Even within the same ethnic group, there are no reliable measures to determine important cultural differences. [10]

"Start Low and Go Slow." Individuals who receive a higher dose of psychiatric medication than needed may discontinue treatment because of side effects, or they may develop toxic levels that lead to serious complications. A reasonable approach to prescribing medication to any psychiatric patient, regardless of race or culture, is to "start low and go slow". [5]

Someday there may be a simple blood test to predict how an individual will respond to a specific class of drugs; research in these fields fall in the domain of pharmacogenomics and pharmacometabolomics.

See also

Related Research Articles

Mental disorder Distressing thought or behavior pattern

A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitting, or occur as a single episode. Many disorders have been described, with signs and symptoms that vary widely between specific disorders. Such disorders may be diagnosed by a mental health professional.

Pharmacology branch of biology concerning drugs

Pharmacology is a branch of medicine and pharmaceutical sciences which is concerned with the study of drug or medication action, where a drug can be broadly or narrowly defined as any man-made, natural, or endogenous molecule which exerts a biochemical or physiological effect on the cell, tissue, organ, or organism. More specifically, it is the study of the interactions that occur between a living organism and chemicals that affect normal or abnormal biochemical function. If substances have medicinal properties, they are considered pharmaceuticals.

Causes of mental disorders etiology of psychopathology

A mental disorder is an impairment of the mind causing disruption in normal thinking, feeling, mood, behavior, or social interactions, and accompanied by significant distress or dysfunction.

Psychiatric medication

A psychiatric or psychotropic medication is a psychoactive drug taken to exert an effect on the chemical makeup of the brain and nervous system. Thus, these medications are used to treat mental illnesses. Usually prescribed in psychiatric settings, these medications are typically made of synthetic chemical compounds. Since the mid-20th century, such medications have been leading treatments for a broad range of mental disorders and have decreased the need for long-term hospitalization, therefore lowering the cost of mental health care. The recidivism or rehospitalization of the mentally ill is at a high rate in many countries and the reasons for the relapses are under research.

Substance abuse Harmful use of a drug including alcohol

Substance abuse, also known as drug abuse, is use of a drug in amounts or by methods which are harmful to the individual or others. It is a form of substance-related disorder. Differing definitions of drug abuse are used in public health, medical and criminal justice contexts. In some cases criminal or anti-social behaviour occurs when the person is under the influence of a drug, and long term personality changes in individuals may occur as well. In addition to possible physical, social, and psychological harm, use of some drugs may also lead to criminal penalties, although these vary widely depending on the local jurisdiction.

Self-medication is a human behavior in which an individual uses a substance or any exogenous influence to self-administer treatment for physical or psychological ailments.

Pharmacogenomics Branch of science

Pharmacogenomics is the study of the role of the genome in drug response. Its name reflects its combining of pharmacology and genomics. Pharmacogenomics analyzes how the genetic makeup of an individual affects his/her response to drugs. It deals with the influence of acquired and inherited genetic variation on drug response in patients by correlating gene expression or single-nucleotide polymorphisms with pharmacokinetics and pharmacodynamics. The term pharmacogenomics is often used interchangeably with pharmacogenetics. Although both terms relate to drug response based on genetic influences, pharmacogenetics focuses on single drug-gene interactions, while pharmacogenomics encompasses a more genome-wide association approach, incorporating genomics and epigenetics while dealing with the effects of multiple genes on drug response.

Emergency psychiatry Clinical application of psychiatry in emergency settings

Emergency psychiatry is the clinical application of psychiatry in emergency settings. Conditions requiring psychiatric interventions may include attempted suicide, substance abuse, depression, psychosis, violence or other rapid changes in behavior. Psychiatric emergency services are rendered by professionals in the fields of medicine, nursing, psychology and social work. The demand for emergency psychiatric services has rapidly increased throughout the world since the 1960s, especially in urban areas. Care for patients in situations involving emergency psychiatry is complex.

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This article is about depression and culture.

The mental health of Filipino Americans is emotional and cognitive status of Americans of Filipino descent. Filipino Americans are more likely to suffer from mental illness than other Asian Americans due to a variety of social and economic factors. Filipino-Americans utilize mental health services less than some Asian-American groups.

References

  1. ↑ Silva, H. (2013). "Ethnopsychopharmacology and pharmacogenomics". Adv. Psychosom. Med. 33: 88–96. doi:10.1159/000348741. PMID   23816866.
  2. 1 2 Chen, C.H.; Chen, C.Y.; Lin, K.M. (2008). "Ethnopsychopharmacology". Int Rev Psychiatry. 20 (5): 452–9. doi:10.1080/09540260802515997. PMID   19012131.
  3. ↑ Lin, K.; Anderson, D.; Poland, R. (1995). "Ethnicity and Psychopharmacology: Bridging the Gap". The Psychiatric Clinics of North America . 18 (3): 635–647. PMID   8545272.
  4. ↑ Risby, E. (1996). "Ethnic Considerations in the Pharmacotherapy of Mood Disorders". Psychopharmacology Bulletin. 32 (2): 231–234. PMID   8783892.
  5. 1 2 3 Wells, S. M. Research shows ethnicity is a factor in medication response. in Psychopharmacology across cultures: The science and practice of ethnopsychopharmacology. the Evaluation Center@HSRI 23 Oct. 1998; 1(3).
  6. ↑ Keitel, M., Kopala, M., and Georgiades, I. (1995). "Factors Influencing Multicultural Health". In J. Ponterotto, et al. (eds.), Handbook of Multicultural Counseling. Thousand Oaks, CA: SAGE Publications.
  7. ↑ Chien, C. (1993). "Ethnopsychopharmacology". In A. Gaw (ed.), Culture, Ethnicity, and Mental Illness. Washington, DC: American Psychiatric Press.
  8. ↑ The United States Department of Health and Human Services. Mental Health: A Report of the Surgeon General. "Chapter 2: The Fundamentals of Mental Health and Mental Illness." pp 88 Retrieved May 21, 2012
  9. 1 2 Turner, S.; Cooley-Quille, M. (1996). "Socioecological and Sociocultural Variables" in Psychopharmacological Research: Methodological Considerations". Psychopharmacology Bulletin. 32 (2): 183–192. PMID   8783887.
  10. ↑ Phinney, J. (1996). "When We Talk About American Ethnic Groups, What Do We Mean?". American Psychologist. 51 (9): 918–927. doi:10.1037/0003-066X.51.9.918.
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