Elevated Rates of Psychosis Among Treatment-Seeking Hispanic Patients With Major Depression

Brown University, Providence, Rhode Island, United States
Journal of Nervous & Mental Disease (Impact Factor: 1.69). 02/2005; 193(1):66-9. DOI: 10.1097/
Source: PubMed


It is unknown whether rates of psychosis differ among depressed patients of various races and ethnic groups. In the present study, we sought to determine whether Hispanic patients with major depression who present for treatment are more likely to report psychotic symptoms than whites, even after controlling for multiple potential confounding factors. Fifteen hundred patients presenting to the Rhode Island Hospital Department of Psychiatry's outpatient practice underwent standardized diagnostic evaluations. Rates of psychosis were compared among Hispanic patients diagnosed with a current major depressive disorder and a white control group closely matched on several key demographic and clinical variables. Comparison rates of psychosis were also made with other ethnic groups. Rates of psychosis were significantly higher in 22 Hispanic patients diagnosed with depression (27.3%) compared with a closely matched white control group (N = 44; 6.8%; chi = 5.2; df = 1; p = .02). Rates of psychosis were also significantly higher in Hispanics than in Portuguese patients, but not blacks, although the former cohort differed in several key demographic and clinical variables. The study suggests that Hispanic patients with major depression who present for treatment may be more likely than whites to report psychotic symptoms. It remains unclear whether these reports represent true psychosis or culturally influenced idioms of distress.

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    • "The present study was designed to assess the clinical significance of psychosislike symptoms among Latinos with MDD (Lewis-Fernandez et al., 2009; Lewis-Fernandez et al., 2010; Mischoulon et al., 2005; Olfson et al., 2002; Posternak and Zimmerman, 2005; Vega et al., 2006). "
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    ABSTRACT: We compared treatment response (≥50 decrease in Nine-Item Patient Health Questionnaire total score) among 24 Latinos with major depressive disorder, presenting with and without specific psychosislike symptoms: A, hearing noises or house sounds, B, hearing voices calling one's name, C, seeing fleeting visions such as shadows, and D, symptoms more likely to be truly psychotic (e.g., poorly defined and short-lasting voices [other than B], fleeting paranoid ideation, or fleeting ideas of reference). 18 subjects (75%) endorsed symptoms of cluster A, 12 (50%) of cluster B, 10 (31%) of cluster C, and 12 (50%) of cluster D. Only subjects who reported symptoms from the D cluster exhibited significantly unfavorable depressive outcomes (compared to those with absence of D symptoms). The authors propose a phenomenological differentiation between benign psychosislike symptoms (clusters A-C) and the expression of the psychotic continuum (cluster D) in depressed Latinos.
    The Journal of nervous and mental disease 09/2015; 203(10). DOI:10.1097/NMD.0000000000000365 · 1.69 Impact Factor
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    • "Blacks were the group that most often reported isolated psychotic symptoms. This was in contrast with our hypothesis that Latinos would endorse these symptoms the most (David et al., 1999; Olfson et al., 2002; Posternak and Zimmerman, 2005). "
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    ABSTRACT: OBJECTIVE: To determine whether isolated psychotic symptoms are more likely to be endorsed by depressed Latinos as opposed to other ethnic-racial groups; whether these symptoms affect Latinos similarly to other ethnic-racial groups in terms of treatment response; and whether they are more likely to be associated with anxiety disorders in depressed Latinos. METHODS: We analyzed data from STAR⁎D subjects who self identified as White, Black, or Latino. Rates of isolated psychotic symptoms were assessed by the self-rated Psychiatric Diagnostic Screening Questionnaire (PDSQ) and compared between ethnic-racial groups. Depressive remission outcomes were compared within each ethnic-racial group between subjects who endorsed psychotic symptoms versus no psychotic symptoms. Associations between isolated psychotic symptoms and anxiety disorders were also examined. RESULTS: Among 2597 eligible subjects with at least one post-baseline assessment and available PDSQ data excluding first-rank symptoms, the prevalence of auditory-visual hallucination was 2.5% in Whites (n=49/1928), 11.3% in Blacks (n=45/398) 6.3% in Latinos (n=17/270) (χ(2)=64.9; df=2; p<0.001). Prevalence of paranoid ideation was 15.5% in Whites (n=299/1927), 31.5% in Blacks (n=126/400), and 21.1% in Latinos (n=57/270) (χ(2)=57.3; df=2; p<0.001). Among Whites and Blacks but not Latinos, depressive remission rates were worse in subjects with auditory-visual hallucinations compared to those without them. Paranoid ideation had a significant negative impact on remission in Whites only. In all ethnic-racial groups, a significant association was found between auditory-visual hallucinations and PTSD and panic disorder. LIMITATIONS: The STAR*D study did not include any structured clinician-based assessment of psychotic symptoms. CONCLUSION: Latinos do not appear to have worse outcomes when treated for MDD with auditory-visual hallucinations, differently from Whites and Blacks.
    Journal of Affective Disorders 03/2013; 150(2). DOI:10.1016/j.jad.2013.02.012 · 3.38 Impact Factor
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    • "Otros/as han encontrado que los/as adultos/as hispanos/as con el TDM que buscan servicios tienen más probabilidades de reportar experiencias consideradas psicóticas por quienes los/as diagnostican que los/ as portugueses y los/as norteamericanos/as blancos/as. Curiosamente, los/as hispanos/as no difirieron de los/ as afroamericanos/as en este aspecto (Posternak & Zimmerman, 2005). De todos modos, se postula que si el reporte de ciertas experiencias que pudieran parecer psicóticas sin serlo es muy común en ciertas etapas (p. "
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    ABSTRACT: The present study examined the role of dissociation as a mediator in the relationship between self-reported childhood abusive experiences and adult posttraumatic symptomatology in a nonclinical, Spanish-speaking Latino sample. Participants were 208 (144 female, 64 male) students at the University of Puerto Rico. It was hypothesized that dissociation would mediate the relationship between childhood abusive experiences and adult posttraumatic symptomatology. Dissociation was measured using the Dissociative Experiences Scale, and posttraumatic distress was measured using 9 of the 10 clinical scales of the Trauma Symptom Inventory (TSI). Results indicated that dissociation fully mediated the relationship between childhood abusive experiences and the Anxious Arousal and Dysfunctional Sexual Behavior scales of the TSI. Dissociation also partially mediated the relationship between childhood exposure and the other TSI clinical scales used in the analyses. Implications for clinicians working with Puerto Rican survivors of childhood abuse are discussed.
    Journal of Trauma & Dissociation 07/2011; 12(4):358-74. DOI:10.1080/15299732.2011.573759 · 1.72 Impact Factor
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