>Research by Strakowski et al. (66, 67) has shown there to be a clinician overemphasis on the relevance of psychotic symptoms and an underemphasis on mood-related symptoms in the diagnosis of schizophrenia-spectrum disorders in African Americans. This pattern was also found in a more recent study conducted by Gara et al. (39), which showed that, when compared with Non-Latino Whites, African Americans who screened positive for major depression (moderately severe to severe depression) were significantly more likely to receive a misdiagnosis of schizophrenia. Gara et al. (68) found no significant difference between blind ratings for the severity of depressive and manic symptoms between African American and White individuals; however, African American patients were assigned higher ratings of psychosis. This suggests that in Black patients, clinicians tend to overemphasize psychotic symptoms, and diagnoses may be “skewed” toward schizophrenia-spectrum disorders, even though they exhibit similar levels of depressive and manic symptoms as White individuals (68). Misdiagnosing patients through the influence of bias and stereotypes can harm patients psychologically or socially (14), as per Figure 2.

I've seen this a lot on treatment teams working at short term hospitals. Symptoms more congruent with severe mood disorders being determined to be from psychosis and being given treatment as such. Then just confusion by psychiatrists when the medication isn't working and they need to switch it up.