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

Understanding the relevance between mental health and cultural associations is key to attempting to understand more about how the brain works for people of different ethnic and cultural groups. Mental health can be attributed to both the brain function but it can also be associated with environmental factors which can have a physiological effect. [1]

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 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

A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is also characterized by a clinically significant disturbance in an individual's cognition, emotional regulation, or behavior, often in a social context. Such disturbances may occur as single episodes, may be persistent, or may be relapsing–remitting. There are many different types of mental disorders, with signs and symptoms that vary widely between specific disorders. A mental disorder is one aspect of mental health.

<span class="mw-page-title-main">Pharmacology</span> Branch of biology concerning drugs

Pharmacology is the science of drugs and medications, including a substance's origin, composition, pharmacokinetics, pharmacodynamics, therapeutic use, and toxicology. 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.

Psychosis is a condition of the mind or psyche that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior that is inappropriate for a given situation. There may also be sleep problems, social withdrawal, lack of motivation, and difficulties carrying out daily activities. Psychosis can have serious adverse outcomes.

<span class="mw-page-title-main">Psychopharmacology</span> Study of the effects of psychoactive drugs

Psychopharmacology is the scientific study of the effects drugs have on mood, sensation, thinking, behavior, judgment and evaluation, and memory. It is distinguished from neuropsychopharmacology, which emphasizes the correlation between drug-induced changes in the functioning of cells in the nervous system and changes in consciousness and behavior.

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. These medications are typically made of synthetic chemical compounds and are usually prescribed in psychiatric settings, potentially involuntarily during commitment. 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, thereby 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.

Edwin Fuller Torrey, is an American psychiatrist and schizophrenia researcher. He is associate director of research at the Stanley Medical Research Institute (SMRI) and founder of the Treatment Advocacy Center (TAC), a nonprofit organization whose principal activity is promoting the passage and implementation of outpatient commitment laws and civil commitment laws and standards in individual states that allow people diagnosed with severe mental illness to be involuntarily hospitalized and treated throughout the United States.

<span class="mw-page-title-main">Pharmacogenomics</span> Study of the role of the genome in drug response

Pharmacogenomics, often abbreviated "PGx," 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 a patient affects their response to drugs. It deals with the influence of acquired and inherited genetic variation on drug response, by correlating DNA mutations with pharmacokinetic, pharmacodynamic, and/or immunogenic endpoints.

<span class="mw-page-title-main">Adverse drug reaction</span> Harmful, unintended result of medication

An adverse drug reaction (ADR) is a harmful, unintended result caused by taking medication. ADRs may occur following a single dose or prolonged administration of a drug or may result from the combination of two or more drugs. The meaning of this term differs from the term "side effect" because side effects can be beneficial as well as detrimental. The study of ADRs is the concern of the field known as pharmacovigilance. An adverse event (AE) refers to any unexpected and inappropriate occurrence at the time a drug is used, whether or not the event is associated with the administration of the drug. An ADR is a special type of AE in which a causative relationship can be shown. ADRs are only one type of medication-related harm. Another type of medication-related harm type includes not taking prescribed medications, known as non-adherence. Non-adherence to medications can lead to death and other negative outcomes. Adverse drug reactions require the use of a medication.

<span class="mw-page-title-main">Emergency psychiatry</span> 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.

The clinical global impression (CGI) rating scales are measures of symptom severity, treatment response and the efficacy of treatments in treatment studies of patients with mental disorders. It is a brief 3-item observer-rated scale that can be used in clinical practice as well as in researches to track symptom changes. It was developed by Early Clinical Drug Evaluation Program (ECDEU) team of researchers for use in NIMH-led clinical trials that could provide clinical judgment based assessment for determining the severity of symptoms and the treatment progress. This was meant to assess the patient's functioning prior to and after initiating medication in trials which is an important part of study process. Its 3 items assess, 1) Severity of Illness (CGI-S), 2) Global Improvement (CGI-I), and 3) Efficacy Index. Many researchers, while recognizing the validity of the scale, consider it to be subjective as it requires the user of the scale to compare the subjects to typical patients in the clinician experience.

Mental disorders are classified as a psychological condition marked primarily by sufficient disorganization of personality, mind, and emotions to seriously impair the normal psychological and often social functioning of the individual. Individuals diagnosed with certain mental disorders can be unable to function normally in society. Mental disorders may consist of several affective, behavioral, cognitive and perceptual components. The acknowledgement and understanding of mental health conditions has changed over time and across cultures. There are still variations in the definition, classification, and treatment of mental disorders.

Race and health refers to how being identified with a specific race influences health. Race is a complex concept that has changed across chronological eras and depends on both self-identification and social recognition. In the study of race and health, scientists organize people in racial categories depending on different factors such as: phenotype, ancestry, social identity, genetic makeup and lived experience. "Race" and ethnicity often remain undifferentiated in health research.

Dual diagnosis is the condition of having a mental illness and a comorbid substance use disorder. There is considerable debate surrounding the appropriateness of using a single category for a heterogeneous group of individuals with complex needs and a varied range of problems. The concept can be used broadly, for example depression and alcohol use disorder, or it can be restricted to specify severe mental illness and substance use disorder, or a person who has a milder mental illness and a drug dependency, such as panic disorder or generalized anxiety disorder and is dependent on opioids. Diagnosing a primary psychiatric illness in people who use substances is challenging as substance use disorder itself often induces psychiatric symptoms, thus making it necessary to differentiate between substance induced and pre-existing mental illness.

A psychiatric assessment, or psychological screening, is the process of gathering information about a person within a psychiatric service, with the purpose of making a diagnosis. The assessment is usually the first stage of a treatment process, but psychiatric assessments may also be used for various legal purposes. The assessment includes social and biographical information, direct observations, and data from specific psychological tests. It is typically carried out by a psychiatrist, but it can be a multi-disciplinary process involving nurses, psychologists, occupational therapist, social workers, and licensed professional counselors.

<span class="mw-page-title-main">Psychiatry</span> Branch of medicine devoted to mental disorders

Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of deleterious mental conditions. These include various matters related to mood, behaviour, cognition, perceptions, and emotions.

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Mental health inequality refers to the differences in the quality, access, and health care different communities and populations receive for mental health services. Globally, the World Health Organization estimates that 350 million people are affected with depressive disorders. Mental health can be defined as an individual's well-being and/or the absence of clinically defined mental illness. Inequalities that can occur in mental healthcare may include mental health status, access to and quality of care, and mental health outcomes, which may differ across populations of different race, ethnicity, sexual orientation, sex, gender, socioeconomic statuses, education level, and geographic location. Social determinants of health, more specifically the social determinants of mental health, that can influence an individual's susceptibility to developing mental disorders and illnesses include, but are not limited to, economic status, education level, demographics, geographic location and genetics.

The social determinants of mental health (SDOMH) are societal problems that disrupt mental health, increase risk of mental illness among certain groups, and worsen outcomes for individuals with mental illnesses. Much like the social determinants of health (SDOH), SDOMH include the non-medical factors that play a role in the likelihood and severity of health outcomes, such as income levels, education attainment, access to housing, and social inclusion. Disparities in mental health outcomes are a result of a multitude of factors and social determinants, including fixed characteristics on an individual level – such as age, gender, race/ethnicity, and sexual orientation – and environmental factors that stem from social and economic inequalities – such as inadequate access to proper food, housing, and transportation, and exposure to pollution.

References

  1. 1 2 Silva, H. (2013). "Ethnopsychopharmacology and pharmacogenomics". Adv. Psychosom. Med. Advances in Psychosomatic Medicine. 33: 88–96. doi:10.1159/000348741. ISBN   978-3-318-02394-7. 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. S2CID   218990240.
  3. ↑ Lin, K.; Anderson, D.; Poland, R. (1995). "Ethnicity and Psychopharmacology: Bridging the Gap". The Psychiatric Clinics of North America . 18 (3): 635–647. doi:10.1016/S0193-953X(18)30045-5. 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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