Decreased core symptoms of mania and utilization of lithium/mood stabilizing anticonvulsants in U.S. bipolar I patients of African vs European ancestry

• Published in: Journal of affective disorders 2020-01, Vol.260, p.361-365
• Main Authors: Akinhanmi, Margaret, El-Amin, Suliman, Balls-Berry, Joyce E., Vallender, Eric J., Ladner, Mark, Geske, Jennifer, Coombes, Brandon, Biernacka, Joanna, Kelsoe, John, Frye, Mark A.
• Format: Article
• Language: English
• Subjects: Adult; Anticonvulsants - therapeutic use; Antimanic Agents - therapeutic use; Bipolar; Bipolar Disorder - drug therapy; Bipolar Disorder - ethnology; Bipolar Disorder - psychology; Black or African American; Black People - psychology; Databases, Factual; Female; Health disparity; Humans; Lithium; Lithium Compounds - therapeutic use; Male; Middle Aged; Patient Acceptance of Health Care - ethnology; Pilot Projects; Psychosis; United States; White People - psychology
• ISSN: 0165-0327; 1573-2517; 1573-2517
• DOI: 10.1016/j.jad.2019.09.022

•Bipolar persons of African ancestry (AA), compared to persons of European ancestry (EA), presented with less core mania symptoms and more psychotic symptoms.•Compared to EA patients, AA patients reported less use of lithium and mood stabilizers and more use of atypical antipsychotics and select typical antipsychotics.•Differential symptom presentation may contribute to the diagnostic disparity in the AA patient group, and increased minority recruitment is necessary to comprehensively understand the contributions to misdiagnosis. Misdiagnosis is common in bipolar disorder and disproportionally affects racial and ethnic minorities. There is interest in better understanding the contribution of differential symptomatic illness presentation to misdiagnosis. Utilizing the Genetic Association Information Network (GAIN) public database, this study compared clinical phenomenology between bipolar patients of African vs European ancestry (AA = 415 vs EA = 480). The Diagnostic Interview for Genetic Studies (DIGS) was utilized to evaluate symptom endorsement contributing to diagnostic confirmation of bipolar I disorder (BPI) and lifetime medication use. Elevated/euphoric mood was less endorsed in AA vs EA participants (p = 0.03). During the most severe episode of mania, AA participants, in comparison to EA participants, had a lower sum of manic symptoms (p = 0.006) and a higher rate of hallucinations (p = 0.01). During lifetime psychosis, AA participants, in comparison to EA participants, had a higher lifetime sum of delusions (p = 0.01) and hallucinations (p