Fearon P, Kirkbride JB, Morgan C, et al. Incidence of schizophrenia and other psychoses in ethnic minority groups: results from the MRC AESOP Study

University of Cambridge, Cambridge, England, United Kingdom
Psychological Medicine (Impact Factor: 5.94). 12/2006; 36(11):1541-50. DOI: 10.1017/S0033291706008774
Source: PubMed

ABSTRACT The incidence of schizophrenia in the African-Caribbean population in England is reported to be raised. We sought to clarify whether (a) the rates of other psychotic disorders are increased, (b) whether psychosis is increased in other ethnic minority groups, and (c) whether particular age or gender groups are especially at risk.
We identified all people (n=568) aged 16-64 years presenting to secondary services with their first psychotic symptoms in three well-defined English areas (over a 2-year period in Southeast London and Nottingham and a 9-month period in Bristol). Standardized incidence rates and incidence rate ratios (IRR) for all major psychosis syndromes for all main ethnic groups were calculated.
We found remarkably high IRRs for both schizophrenia and manic psychosis in both African-Caribbeans (schizophrenia 9.1, manic psychosis 8.0) and Black Africans (schizophrenia 5.8, manic psychosis 6.2) in men and women. IRRs in other ethnic minority groups were modestly increased as were rates for depressive psychosis and other psychoses in all minority groups. These raised rates were evident in all age groups in our study.
Ethnic minority groups are at increased risk for all psychotic illnesses but African-Caribbeans and Black Africans appear to be at especially high risk for both schizophrenia and mania. These findings suggest that (a) either additional risk factors are operating in African-Caribbeans and Black Africans or that these factors are particularly prevalent in these groups, and that (b) such factors increase risk for schizophrenia and mania in these groups.

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    • "Sample AESOP-10 is a 10-year follow-up study of a cohort of 557 individuals with a first episode of psychosis who were initially identified in two centers (i.e. southeast London, and Nottinghamshire, UK) contributing to the AESOP study (Fearon et al., 2006; Kirkbride et al., 2006). At baseline the researchers screened all inpatient and outpatient mental health services (MHS) in defined catchment areas of Southeast London and Nottingham (September 1997–August 1999), and the first 9 months of this period in Bristol, to identify eligible cases of firstepisode psychosis between the ages of 16 and 64 years (Kirkbride et al., 2006). "
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    ABSTRACT: It has long been held that schizophrenia and other psychotic disorders have a predominately poor course and outcome. We have synthesized information on mortality, clinical and social outcomes from the ÆSOP-10 multicenter study, a 10-year follow-up of a large epidemiologically characterized cohort of 557 people with first-episode psychosis. Symptomatic remission and recovery were more common than previously believed. Distinguishing between symptom and social recovery is important given the disparity between these; even when symptomatic recovery occurs social inclusion may remain elusive. Multiple factors were associated with an increased risk of mortality, but unnatural death was reduced by 90% when there was full family involvement at first contact compared with those without family involvement. These results suggest that researchers, clinicians and those affected by psychosis should countenance a much more optimistic view of symptomatic outcome than was assumed when these conditions were first described.This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
    The Journal of nervous and mental disease 04/2015; 203(5). DOI:10.1097/NMD.0000000000000295 · 1.69 Impact Factor
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    • "patients' medical notes) was used to establish characteristics of illness presentation and contact with psychiatric services, including: mode of onset, mode of contact (voluntary or compulsory), and duration of untreated psychosis (DUP, defined as the period from the first clear description of psychotic phenomena, from any source, to first contact with statutory mental health services). The ethnicity of the participants was based on subject self-ascription; participants were asked to assign themselves to an ethnic group according to the categories devised for the 1991 UK census (Fearon et al., 2006). Black African and Black Caribbean are the largest ethnic minority groups in the areas in which the study was conducted. "
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    ABSTRACT: The impact of self esteem and Locus of Control (LoC) on clinical presentation across different ethnic groups of patients at their first psychotic episode (FEP) remains unknown. We explored these constructs in 257 FEP patients (Black n=95; White British n=119) and 341 controls (Black n=70; White British n=226), and examined their relationship with symptom dimensions and pathways to care. FEP patients presented lower self-esteem and a more external LoC than controls. Lower self esteem was associated with a specific symptoms profile (more manic and less negative symptoms), and with factors predictive of poorer outcome (longer duration of untreated psychosis (DUP) and compulsory mode of admission). A more external LoC was associated with more negative symptoms and an insidious onset. When we explored these constructs across different ethnic groups, we found that Black patients had significantly higher self esteem than White British. This was again associated with specific symptom profiles. While British patients with lower self esteem were more likely to report delusions, hallucinations and negative symptoms, Black patients with a lower self esteem showed less disorganization symptoms. These findings suggest that self esteem and LoC may represent one way in which social experiences and contexts differentially influence vulnerable individuals along the pathway to psychosis. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    03/2015; 227(2-3). DOI:10.1016/j.psychres.2015.03.030
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    • "Importantly, a lack of recognition by significant others or one's larger social environment may aggravate these risks. According to recent epidemiological studies, social marginalization, minority status , migration, and other facets that define individuals as being different from their social surroundings, are potential risk factors for schizophrenia, leading to significantly increased incidences in the affected population (Fearon et al., 2006; Cantor-Graae and Selten, 2005; Zammit et al., 2010; Bourque et al., 2011). Although a disturbance or loss of the excentric position has to be distinguished from psychological problems of self-assertiveness or self-worth, the challenge to one's ipseity in social encounters may nevertheless be increased by experiences of social exclusion, discrimination, or deprivation. "
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    ABSTRACT: Most mental disorders include more or less profound disturbances of intersubjectivity, that means, a restricted capacity to respond to the social environment in a flexible way and to reach a shared understanding through adequate interaction with others. Current concepts of intersubjectivity are mainly based on a mentalistic approach, assuming that the hidden mental states of others may only be inferred from their external bodily behaviour through 'mentalizing' or 'mindreading'. On this basis, disorders of intersubjectivity for example in autism or schizophrenia are attributed to a dysfunction of Theory of Mind modules. From a phenomenological point of view, however, intersubjectivity is primarily based on a pre-reflective embodied relationship of self and other in an emergent bipersonal field. Instead of a theory deficit, autistic and schizophrenic patients rather suffer from a basic disturbance of being-with-others which they try to compensate by explicit inferences and hypothetical assumptions about others. The paper consequently distinguishes three levels of intersubjectivity: (a) primary intersubjectivity or intercorporeality, (b) secondary intersubjectivity or perspective-taking, and (c) tertiary intersubjectivity, implying a self-other metaperspective. On this basis, disturbances on these different levels in autism and schizophrenia are described.
    Journal of Consciousness Studies 01/2015; 22(1-2). · 0.77 Impact Factor
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