Cultural mistrust and the clinical diagnosis of paranoid schizophrenia in African American patients

This study examined agreement between clinical diagnoses and research diagnoses of schizophrenia for a sample of African American patients recently admitted to a psychiatric hospital. It also examined the association of cultural mistrust with disagreement between clinical diagnoses and research diagnoses of the paranoid subtype of schizophrenia. Complete data was available for 118 (77%) of the 154 cases from the original sample. Agreement among the different sources of diagnoses was poor in 5 out of 6 comparisons. The lack of agreement can be attributed, in part, to the fact there were significantly more cases of schizophrenia using clinical diagnoses than those using SCID or best estimate methods. Contrary to the hypothesis, however, level of cultural mistrust did not predict the excess in clinical diagnoses of paranoid schizophrenia. Cultural mistrust was positively associated with the odds of a diagnosis of paranoid schizophrenia by the best estimate method. The implications of the results for the diagnosis and treatment of African American patients are discussed.