WPCG ^>SQG,/Pp4Ʊc˛gG"JeE!n{ڪ,ȭ)v&4GEzn.xнFEKAqyLtja.nsBEx4Ԭ2KO1"qFQf1<_:5;6ڈoG$|1?<q4C)Ȩ6xW _BG~ʡ@*M?4(]swZ?k:"bvI+<|Σ=?D%r}ӳ0i?;DL=Dg 3;|F}̰ wmYM6s5*dxcԤ*Ja6Vʹ6Kw <`c &󠯆/\pzcNJr"^(`@0:5`eFsmR4$a=ASZ#!UN  %[ 0(aw@4 m N ^  ) 0l 0D' k M  U<f a -!!NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN Ba 0sHP LaserJet III (2nd Floor),,,,,,0x9 Z6Times New Roman RegularX($ EDD{X-esktop3|x U ethnicitiesmisdiagnosed1920sCaminahBacotedystonicClozapineRisperidonemisdiagnosisToland"Campinah-Bacote^-c  $    1    _Forexample,thereisevidencethatmetabolicabsorptionratesandsideeffectsvaryin  ethnicminorities.Thiscouldcontribute?+ 4 <DL!X?to treatmentresistancebysomeindividuals,raisingthechanceforforcedtreatment.((3$ !      1  (%$  1   $    2    _ԀThisstudywasofpatientsfromPuertoRicoandtheDominicanRepublic.  $    3    _ԀInformedconsentlawsvaryfromstatetostateandmostjurisdictionshaveexceptionsfor  peoplewithmentaldisabilitiesincertaincircumstances.AfulldescriptionofthelawofinformedconsentandtherighttorefusetreatmentisbeyondthescopeofthisQ&A.However,pertinentmaterialsareavailableontheNAPASwebsite.ForaveryrecentdiscussionabouttherequirementforinformedconsentinthecontextofexperimentalmedicaltherapiesseeHeinrichv ` Sweet,___F.3d___2002WL1941483(1stCir2002).Ahelpfuldiscussionofinformedconsent, L  againinthemedicalcontext,canbefoundat_Harnish_ԀvChildrensHospitalMedicalCenter,439 8  N.E.2d240(Mass.Sup._Jud_.Ct.1982)\  `$Times NewRoman[TABLE C ##LXd#  $    3    _ԀInformedconsentlawsvaryfromstatetostateandmostjurisdictionshaveexceptionsfor  peoplewithmentaldisabilitiesincertaincircumstances.AfulldescriptionofthelawofinformedconsentandtherighttorefusetreatmentisbeyondthescopeofthisQ&A.However,pertinentmaterialsareavailableontheNAPASwebsite.ForaveryrecentdiscussionofinformedconsentinthecontextofexperimentalmedicaltherapiesseeHeinrichvSweet,___F.3d___2002WL ` 1941483(1stCir2002).Ahelpfuldiscussionofinformedconsent,againinthemedicalcontext, L  canbefoundat_Harnish_ԀvChildrensHospitalMedicalCenter,439N.E.2d240(Mass.Sup._Jud_. 8  Ct.1982) d1, 2, 3,Level 1Level 2Level 3Level 4Level 5B#?>21, 2, 3,NumbersX  .0 X !  _  e8IXXdd8Q&AonEthnic_Psychopharmacology_PreparedbyCenterforPublicRepresentationOctober2002    Q.Whenaskedbyclientsofcolorabouttheirlegalrightsregardingpsychiatric__medication,arethereanyspecialissuesorconcernsofwhichIshouldmakethem___aware?_  A.Yes.Thereisagrowingbodyofresearchthatsuggeststhatpeopleresponddifferentlytopsychotropicmedicationbasedontheirethnicbackground.ThisareaofstudyiscalledEthnicPsychopharmacology.AfricanAmericans,Asians,Hispanics,andCaucasianshavedifferentresponsestothesamedosagesofcommonlyprescribedpsychotropicmedication.Furthermore,recentimmigrantsfromAsia,Africa,and_fromLatin_ԀAmericancountrieshavedifferentresponsestosuchthandopersonsofthesameracialbackgroundwhohavelivedinthiscountryformanyyears(Mendozaetal1991,MendozaandSmith2000).Researchershavefoundthatbothbiologicalandenvironmentaldifferencesamongethnicitiesplaymajorrolesinanindividualsresponsetopsychotropicmedications.Despitetheamountofresearch,itsclearconclusions,anditsimportantimplications,manyclinicians,advocatesandclientsremainuninformed.  %  1      ׀P&A  advocatesshouldbepreparedtoalerttheirminorityclientstotheseissuesandtoadvocatefortheplanning,design,andimplementationofculturallyresponsiveandethnicspecifictreatmentmodalitiesineveryelementoftheservicesystem.  Researchdatingbackasfarasthe1920sdocumentsfindingsofdifferencesinresponsesto $D # medicationsbasedonethnicity.Theinitialresearchwasdonewithcocaine,ephedrine,atropineandscopolamine(_Hu_Ԁetal1991).Sincethen,alargebodyofbiologicaldatahassupportedtheearlyfindings.Althoughthebulkofthisresearchhastraceddifferencesintheeffectsofmedications_betweenandamong__African_ԀAmerican,Asians,andCaucasians,researchregardingotherethnicgroups,primarilyNativeAmericansandHispanics,isgrowing(Mendozaetal1991).  MultiplestudieshaveconcludedthatAfricanAmericansaremorelikelythanotherethnicgroupstobemisdiagnosedandovermedicated(Lawson2000,_Adebimpe_,CaminahBacote2002,Bakeretal1999,Linetal1995).BecauseAfricanAmericansarerepeatedlymisdiagnosedwithschizophrenia,depressivedisordersareoftennotdiagnosed(Lawson2000).Consequently,AfricanAmericansreceivemoreantipsychotic_medication,__________are_ԀmorelikelythanCaucasianstodeveloptardive_dyskinesia,_Ԁand_mayhaveaninc__reasedlikelihood________ofincidents_Ԁofneuroleptictoxicity(Lawson2000).Likewise,AfricanAmericanshavemoresideeffectsthanCaucasianswithtreatedwiththestandarddosageoflithium(Caminah_ԄBacote_Ԁ2002,Lin,Poland1996,Lawson2000).However,researchhasnotyetconclusivelyestablishedtheadvisabilityofusinglowerdosesofpsychotropics_acrosstheboard_with__ԀAfricanAmericanclients.  Asusedintherelevantresearch,theterm_ Hispanic_ԀreferstoMexicans,CentralAmericans,Cubans,PuertoRicans,SouthAmericans,andindividualsofSpanishdescentlivingintheUnitedStates.WhilesomeresearchhasfoundsimilaritiesinresponsestopsychiatrictreatmentforHispanicsasawhole,therearealsodifferenceswithinthesubgroups.HispanicstendtorespondbettertolowerdosesofRisperidone,forexample,andtheyhaveahigherrateofadversesideeffects(Lawson2000). %  2      ׀DoctorsinLatinAmericatypicallyprescribelowerdoses_of )$( psychiatricmedicationsthantheircounterpartsintheUnitedStates._Interestingly,_ԀtherateofimprovementisfasterinLatinAmericancountries(CampinahBacote2002,Adams1984,Mendoza1991).Forexample,inArgentinaand_Chile,_ԀpatientsaretypicallytreatedwithClozapineat300mg/daywhichislessthantheamounttypicallyusedintheUnitedStates_to__treat__successfully_ԀtreatCaucasians(MendozaandSmith2000).  Theterm AsianreferstoChinese,Filipino,Indian,Korean,Vietnamese,Japaneseandothergroupsofpeoplefromthecontinentof_Asia.Asiansmakeupalargepercentageoftheworldspopulation(Pi2000)._ԀManyoftheethnicpsychopharmacologystudieshaveconcludedthatAsianpatientsrequirelowerdosesofantipsychoticmedicationsthanCaucasianpatients(CampinahBacote2002,Linetal1999,Linetal1995Pi2000).ResearchinthisareahashadanimpactonrecommendeddosagelevelsforAsians.Researchershavesuggestedthatdosagelevelstartathalfofthestandarddosageforallpsychiatricmedication(CampinahBacote2002,Linetal1999,Linetal1995,Pi2000).ThereisalsosomedatatosuggestthatAsiansmaybeatanincreasedriskofdevelopingacutedystonicreactionsfromantipsychotics(Pi2000).  Thereareyetveryfewconclusionsaboutthelongtermeffectsofmedicationbasedonethnicity. Forexample,therelationshipisbetweenethnicityandneurolepticmalignantsyndrome X  isunknown(Pi2000).Asnotedearlier,AfricanAmericanshaveahigherrateoftardivedyskinesia(Lawson2000).Althoughthereasonsareunknown,itmaybeduetoabiologicalfactororbecausehighernumbersofAfricanAmericansaregivenantipsychoticmedications.  Overall,thisresearchprovidessignificantinformationthatP&Aclientsneedtoknowwhenmakingdecisionsaboutpsychiatricmedication.Inmostcircumstances,individualshavearighttodeterminethenatureandextentoftheirmedicalcare.Thelegaldoctrineofinformed p+&* consentrequiresdoctorstoexplainthetreatmentoptionstotheirpatientsandtoobtainconsentpriortoadministeringtreatment.Thedoctrineisusuallydescribedashavingthreeparts:(1)thedoctorsdutytodiscloseinareasonablemannerallsignificantmedicalinformationthatthephysicianpossessesorreasonablyshouldpossessthatismaterialtoanintelligentdecisionbythepatient(information):(2)_theat_Ԁabilityoftheindividualtounderstandtheinformationprovided(competenceorcapacity);and,(3)thattheconsentisgivenfreeofcoercion(voluntariness)._ %  3      _Ԁ  8  Usingthisstandard,anargumentcanbemadethatareasonablepersonwould_consider,_ofr_   _example,__Ԁknowledgeofanincreasedriskofadversesideeffectssignificantinmakinghisorherdecisiontoconsenttotreatment.Therefore,itcanbearguedthatthedoctorhasadutytodiscloseinformationaboutthepotentialdiffering_impact_Ԁofpsychiatricmedicationstoapersonofcolor. H   Asadvocates,isitalsoimportantforustoletourclientsknowabouttheexistenceofthisinformationandtourgethemtodiscussitwiththeirdoctors.TheCenterforPublicRepresentationhasdevelopedatrainingmodulewhichithaspresented,oftenwiththeassistanceofaclinician,toprofessional,familyandclientgroups.P&AstaffmaycontactReginaHillinCPRsNewton,Massachusettsofficeformoreinformation(6179650776).  AbibliographyofarticlesonEthnicPsychopharmacologyfollowsachartlistingimportantresearch_findingsbyethnicbackground._____________________ #l! e 8IXXdXXd8   XIXXX N!XXI  EthnicPsychopharmacology  ResearchFindingsChart#XIX! N&#'  (Numbersarereferencestothearticleslistedbelowthechart)#XIXXXI&#*Vddd Xdd Xdd X(#(#,A dd ,A dd ,A dd +    < AfricanAmericans 'P  'Asians 'P  'Hispanics P  Ahigherrateofmisdiagnosisandovermedication (2,3,6,7,16,18,38)     Betterresultshavebeenfoundwithlowerdosesof_clozaril_ (7,18,33)    TendtorespondbettertolowerdosesofRisperidone    (1 , 7,28)    Havemoresideeffectswiththestandarddosesoflithium (2,3,7,8,16,18,31,39)  T  FormanyTaiwanesethetherapeuticleveloflithiumislowerthanthestandardrange (7,33,39,38)  @  InLatinAmerica,lowerdosesofmedicationsareoftenused,thanintheUnitedStatesandtherateofimprovementisfaster (1,7,28)  , Higherrisksofsideeffectsfrom_Tricyclic_Antidepressantssuchas_Elavil_and_Vivactil_Ԁ (3,7)  $t! Itisbesttostartathalfofthestandarddosageofallpsychiatricmedication (5,7,18,19,20,21,33)  $t% _Tricyclic_Ԁantidepressantsideeffectslikedrymouth,impairedvision,andweightgain,areseenathalfthedosesgiventoEuropeanAmericans (1,7,28)  L+ Tendtohaveabetterandmorerapidresponsewith_tricyclic_Ԁantidepressantswhengiventheproperdosage. (2,3,16)  ,|0 Tendtousealternativetreatmentmethods,suchasherbalremedies,whichmayeffectresponsestopsychotropicmedication (19,23,33)  h6   !,9   |: _AremorelikelytobenonresponderstoFluoxetine(Prozac) (2,3,)  <       <  TendtometabolizeTricyclicAntidepressantsmoreslowlythanCaucasians (_18,19,33)  <   d AfricanAmericans    Asians    Hispanics    TendtohavesignificantlyfasterresponsesthanotherracialgroupsfrombenzodiazepinessuchasAtivanandHalcion (2,3,18)  (   (x   d Higherrateoftardivedyskinesia (16,34,45)  H   \   \  Morelikelytoreceivedepotmedication (16)  "   #   $ Zyprexatypicallyworksbetterasanantipsychotic (3,10,12,26)  d'   <(  <)  N!XXISources !l*   #XIX! 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