Improved compliance with pharmacotherapy was achieved in treating Hispanic outpatients with psychotic disorders when recognition of culturally based differences between patients and psychiatrists led to modifications in prescribing practices. Unacculturated Hispanic outpatients experienced akathisia as an increase in “nerviosismo.” Addressing this issue, as well as using anxiolytics and low doses of antipsychotics when beginning treatment, led to an improvement in compliance. Increased discussion of other antipsychotic side effects, which forced us to confront our false assumption that unacculturated Hispanics would be prone to suggestibility and, therefore, that discussions of side effects would lead to an increase in somatization, similarly improved medication compliance and therapeutic alliance. Practicing psychiatrists need to become aware of cultural factors to better treat patients with different backgrounds.
OPLER: New York University School of Medicine, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, and New York State Office of Mental Health; RAMIREZ: Long Island University; DOMINGUEZ: Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital; FOX: Bronx Psychiatric Center; JOHNSON: Dowling College, Oakdale, NY.
Please send correspondence and reprint requests to: Lewis A. Opler, MD, PhD, 765 Gramatan Ave., Mt. Vernon, NY 10552.
This article is dedicated to Rafael Tavares, MD, founder and first Director of the Hispanic Mental Health Clinic at Columbia-Presbyterian Medical Center, whose pioneering work and vision has led to improved psychiatric services for the Hispanic community.