Atypical psychotic symptoms in a Hispanic population: diagnostic dilemmas and implications for treatment.

OBJECTIVE

To better characterize psychotic symptoms and their treatment in Hispanic populations.

DESIGN

Chart review.

SETTING

Chelsea MGH Health Center and Chelsea Counseling Center (both affiliates of the Massachusetts General Hospital).

PARTICIPANTS

Forty-four Hispanic patients presenting with psychotic symptoms in the context of mood and anxiety disorders.

MEASUREMENTS: Chart review focussed on diagnosis, description, and cataloguing of psychotic symptoms and review of treatment efficacy.

RESULTS

All but two patients described some atypical psychotic symptoms (e.g., doorbells or telephones ringing, voices of children, and visual hallucinations of animals or relatives). Treatment varied; 34 percent received monotherapy (either neuroleptic, antidepressant, or anxiolytic); 61 percent received polypharmacy; of these, 48 percent received a combination of antidepressant and anxiolytic; 19 percent received antidepressant with neuroleptic; 14 percent received antidepressant with neuroleptic and anxiolytic. No regimen was significantly better than any other.

CONCLUSIONS

Psychotic symptoms in Hispanic patients have been noted anecdotally to present differently from those described in other populations. Our review appears to support this observation. Clinicians who work with Hispanic patients should ask about these atypical psychotic symptoms. We provide speculation on the nature of these symptoms, review approaches to treatment, and make recommendations for further investigation.