Putative Psychotic Symptoms in the Mexican American Population

Behavioral Research and Training Institute, University Behavioral HealthCare, UMDNJ, Piscataway, New Jersey, USA.
Journal of Nervous & Mental Disease (Impact Factor: 1.69). 08/2006; 194(7):471-7. DOI: 10.1097/
Source: PubMed


It is reported that Latin Americans describe culturally normative experiences or express putative psychotic symptoms in medical and mental health treatment settings that complicate the diagnostic process. Previous research reported that Latinos were more likely than European Americans and African Americans to have their diagnoses changed from schizophrenia to other disorders. This study describes the prevalence and likelihood of putative psychotic symptoms being expressed independent of any psychiatric disorder or co-occurring with common disorders such as depression or anxiety within a Mexican American population sample. Epidemiologic data of the Mexican American Prevalence and Services Survey (N = 3012) were used to contrast rates and patterns of putatively psychotic features among adults by demographic variables and diagnostic status using DSM-III-R criteria and receipt of treatment. Putative psychotic symptoms were reported by 17% of US-born and 7% of immigrants without disorders, and by 38% of US-born and 28% of immigrants with lifetime disorders, totaling 18% lifetime prevalence for the entire study population of Mexican Americans. First-rank Schneiderian symptoms were higher in those with a disorder compared with those without a disorder for both sexes. The results of this study indicate that putative psychotic symptoms are common among Mexican Americans, and their presence is a strong precautionary signal for evaluating clinicians to correctly distinguish whether putative psychotic symptoms are indicators of nonorganic psychoses or other psychiatric disorders, or are simply cultural expressions. Research is needed to identify the determinants of misdiagnosis in clinical practice, and guidelines are needed to assist clinicians.

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    • "In fact, several population studies have shown that 10–25% of the general (non-psychiatric) population has had hallucinatory experiences including visions or voices with no psychiatric basis (Menezes and Moreira-Almeida 2010). There is a growing body of research that suggests that elevated rates of hallucinations by Latinos are deeply embedded within a culture-bound phenomenon (Geltman and Chang 2004; Olfson et al. 2002; Vega et al. 2006). Yet, little is known about whether it truly reflects or indicates mental illness (Pierre 2001). "
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    ABSTRACT: Objective: . To examine racial-ethnic differences in the endorsement and attribution of psychotic-like symptoms in a nationally representative sample of African-Americans, Asians, Caribbean Blacks, and Latinos living in the USA. Design: Data were drawn from a total of 979 respondents who endorsed psychotic-like symptoms as part of the National Latino and Asian American Study (NLAAS) and the National Survey of American Life (NSAL). We use a mixed qualitative and quantitative analytical approach to examine sociodemographic and ethnic variations in the prevalence and attributions of hallucinations and other psychotic-like symptoms in the NLAAS and NSAL. The lifetime presence of psychotic-like symptoms was assessed using the World Health Organization Composite International Diagnostic Interview (WMH-CIDI) psychotic symptom screener. We used logistic regression models to examine the probability of endorsing the four most frequently occurring thematic categories for psychotic-like experiences by race/ethnicity (n > 100). We used qualitative methods to explore common themes from participant responses to open ended questions on their attributions for psychotic-like symptoms. Results: African-Americans were significantly less likely to endorse visual hallucinations compared to Caribbean Blacks (73.7% and 89.3%, p < .001), but they endorsed auditory hallucinations symptoms more than Caribbean Blacks (43.1% and 25.7, p < .05). Endorsing delusions of reference and thought insertion/withdrawal were more prevalent for Latinos than for African-Americans (11% and 4.7%, p < .05; 6.3% and 2.7%, p < .05, respectively). Attribution themes included: supernatural, ghosts/unidentified beings, death and dying, spirituality or religiosity, premonitions, familial and other. Respondents differed by race/ethnicity in the attributions given to psychotic like symptoms. Conclusion: Findings suggest that variations exist by race/ethnicity in both psychotic-like symptom endorsement and in self-reported attributions/understandings for these symptoms on a psychosis screening instrument. Ethnic/racial differences could result from culturally sanctioned beliefs and idioms of distress that deserve more attention in conducting culturally informed and responsive screening, assessment and treatment.
    Full-text · Article · Jun 2014 · Ethnicity and Health
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    • "Published cut-offs with high specificity (89–91%) were used for case definition (Zimmerman and Chelminski, 2006).We chose to test for PTSD because there is a high index of suspicion for a preferential association of auditory–visual hallucinations and PTSD in Latinos (Lewis-Fernandez et al., 2010). We included other common anxiety disorders such as panic disorder and agoraphobia because they are frequently associated with psychosis-like symptoms in Latinos (Olfson et al., 2002; Vega et al., 2006; Lewis- Fernandez et al., 2009). We intentionally excluded generalized anxiety disorder due to its high overlap with MDD. "
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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.
    Full-text · Article · Mar 2013 · Journal of Affective Disorders
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    • "In contrast to traditional immigrant studies (Harrison et al., 1997; Selten et al., 2001; Fearon et al., 2006; Veling et al., 2006), we considered information about the cultural context of the presented symptoms of the participants as vital for the accurate formulation of DSM-IV diagnoses. (Littlewood and Lipsedge, 1981a, 1981b; Karno et al., 1983; Arnold et al., 2004; Vega et al., 2006; Zandi et al., 2010). Another strength of the current study is the use of the same interviewers and at baseline and follow-up thus minimizing inter-rater variability. "
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    ABSTRACT: Previous research has shown discrepancies between a standard diagnostic interview for schizophrenia (CASH) and a culture sensitive version of this instrument (CASH-CS) in Moroccan patients. More specifically we showed that among Moroccan immigrants the CASH-CS resulted in fewer patients with a diagnosis of schizophrenia compared with diagnoses based on the CASH, whereas for Native Dutch patients there was no difference between the CASH and the CASH-CS. The aim of the current study was to compare the predictive validity of a diagnosis of schizophrenia according to the CASH and CASH-CS. Thirty months after referral, 26 Moroccan and 26 native Dutch patients with a suspected first psychotic episode were compared with regard to 30-month diagnostic stability, symptom development, psychosocial functioning, medication use and hospitalization using baseline diagnoses based on the two versions of the CASH. Moroccan patients who were diagnosed with schizophrenia using the standard CASH at baseline had a significantly better 30-month prognosis than native Dutch patients with the same CASH diagnosis. Prognosis of schizophrenia according to the CASH-CS was similar for Moroccans and native Dutch patients. Diagnostic stability according to the CASH was high for native Dutch (92%), but low for Moroccan patients (27%), whereas diagnostic stability according to the CASH-CS was high for both groups (85% and 81%, respectively). These data raise questions regarding the validity of the standard CASH in Moroccan immigrants in The Netherlands and support the validity of the CASH-CS. As a consequence, there are serious doubts about the validity of previous studies showing an increased incidence of schizophrenia in immigrants using standard diagnostic procedures.
    Full-text · Article · Dec 2011 · Schizophrenia Research
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