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Book Forum: Cultural and Ethnic Issues   |    
Ethnicity and Psychopharmacology
SANJAY GUPTA, M.D.
Am J Psychiatry 2001;158:1544-1544. doi:10.1176/appi.ajp.158.9.1544
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Olean, N.Y.

Edited by Pedro Ruiz, M.D. Washington, D.C., American Psychiatric Press, 2000, 192 pp., $28.50 (paper).

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The field of psychiatry has advanced a great deal in the last decade, with greater insights into brain function as well as psychopharmacology, largely because of modern imaging techniques as well as strong psychopharmacological research. In conjunction with these developments, we have learned that ethnicity and cross-cultural issues play an important role in successfully treating individuals of diverse cultural groups. This book, part of volume 19 in the Review of Psychiatry series edited by John M. Oldham, M.D., and Michelle B. Riba, M.D., does an excellent job of bringing together information pertaining to several aspects of psychopharmacological treatment of diverse cultural groups and making it available to the clinician in a user-friendly format. The chapter contributors have backgrounds of having worked in the field, which adds considerable credibility.

The second chapter focuses on the social, cultural, and biological issues pertaining to psychopharmacology in the African American population. This chapter also brings to the forefront some of the diagnostic biases among psychiatrists in the cross-cultural setting and provides important insights into the limitations of psychiatric care in the African American community. Chapter 3 deals with the Hispanic community, which is growing substantially in size in the United States. Psychiatrists will be facing increasing numbers of Hispanic patients, and it would only help them to know about the cultural issues and genetic variations among the different Hispanic groups. One such aspect listed in this chapter is polymorphic variability. I learned from this chapter that Mexican Americans have a faster rate of metabolism. This chapter discusses the cytochrome 450 system and the variations in catalytic activity across ethnic groups with divergent dietary habits. A high-protein diet, for example, has been shown to enhance drug metabolism through increased oxidation and conjugation. Animal studies have shown that changes in dietary fat content have resulted in substantial changes in the metabolic efficiency of the P450 system. This book also brings to light the fact that herbal supplement use may vary across cultures and has an effect on drug metabolism by way of the P450 system. In addition to providing information on African American and Hispanic ethnic groups, the book also has a substantial focus on Chinese and East Asians, a large proportion of whom have fast acetylation.

Another important feature of this book is information on the attitudes of different ethnic groups toward mental illness as well as psychotropic medication. It also provides insight into the important family members who could play a substantial role in maintaining medication compliance.

This handbook is easy to read and understand. Typographical errors and misspellings are rare, and the editing is of high quality. Overall the information in this book is well organized, covering issues involving neuropsychopharmacology in different ethnic groups. It is suggested reading for psychiatrists and clinicians working in behavioral health. Family physicians, internists, and other physicians prescribing psychotropic agents would also benefit.

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