Unemployment,ethnicity and psychosis

Boydell J, Bebbington P, Bhavsar V, Kravariti E, van Os J, Murray RM, Dutta R. Unemployment, ethnicity and psychosis. Objective: This study describes the incidence of psychosis in unemployed people and determines whether unemployment has a greater impact on the development of psychosis amongst Black minority groups than White groups. Method: Patients with a first diagnosis of Research Diagnostic Criteria psychosis, in a defined area of London from 1998 to 2004, were identified. Crude and standardised incidence rates of psychosis amongst unemployed people for each ethnic group were calculated. Poisson regression modelling tested for interactions between unemployment and ethnicity. Results: Hundred cases occurred amongst employed people and 78 cases occurred amongst the unemployed people. When standardised to the employed White population of the area, White unemployed people had a standardised incidence ratio (SIR) of 11.7 (95% CI 6.4–19.7), Black Caribbean people had a SIR of 60.1(95% CI 39.3–88) and Black African people had a SIR of 40.7 (95% CI 25.8–61.1). There was no interaction however between ethnicity and unemployment (Likelihood ratio test P = 0.54). Conclusion: Rates of psychosis are high amongst unemployed people in south London and extremely high amongst Black Caribbean and Black African unemployed people. There was no evidence however that the minority groups were particularly sensitive to the stresses, limitations or meaning of unemployment.     

Psychoses, ethnicity and socio-economic status

BACKGROUND: Consistent observation of raised rates of psychoses among Black and minority ethnic (BME) groups may possibly be explained by their lower socio-economic status. AIMS: To test whether risk for psychoses remained elevated in BME populations compared with the White British, after adjustment for age, gender and current socio-economic status. METHOD: Population-based study of first-episode DSM-IV psychotic disorders, in individuals aged 18-64 years, in East London over 2 years. RESULTS: All BME groups had elevated rates of a psychotic disorder after adjustment for age, gender and socio-economic status. For schizophrenia, risk was elevated for people of Black Caribbean (incidence rate ratios (IRR)=3.1, 95% CI 2.1-4.5) and Black African (IRR=2.6, 95% CI 1.8-3.8) origin, and for Pakistani (IRR=3.1, 95% CI 1.2-8.1) and Bangladeshi (IRR=2.3, 95% CI 1.1-4.7) women. Mixed White and Black Caribbean (IRR=7.7, 95% CI 3.2-18.8) and White Other (IRR=2.1, 95% CI 1.2-3.8) groups had elevated rates of affective psychoses (and other non-affective psychoses). CONCLUSIONS: Elevated rates of psychoses in BME groups could not be explained by socio-economic status, even though current socio-economic status may have overestimated the effect of this confounder given potential misclassification as a result of downward social drift in the prodromal phase of psychosis. Our findings extended to all BME groups and psychotic disorders, though heterogeneity remains.     

Psychosis incidence through the prism of early intervention services

We know little about first-episode psychosis epidemiology beyond cities or when measured through early intervention in psychosis services. We present results from 18 months of the 3-year Social Epidemiology of Psychoses in East Anglia (SEPEA) study of incepted incidence observed through five early intervention services. We identified 378 eligible individuals (incidence: 45.1/100 000 person-years, 95% CI 40.8-49.9). Rates varied across these services, but were 2-3 times higher than those on which services were commissioned. Risk decreased with age, was nearly doubled among men and differed by ethnic group; doubled in people of mixed ethnicity but lower for those of Asian origin, compared with White British people. Psychosis risk among ethnic minorities was lower than reported in urban settings, which has potential implications for aetiology. Our data suggest considerable psychosis morbidity in diverse, rural communities.     

Rates and risk factors by ethnic group for suicides within a year of contact with mental health services in England and Wales

OBJECTIVE: This study compared suicide rates, clinical symptoms, and perceived preventability of suicide among persons in four ethnic groups who completed suicide within 12 months of contact with mental health services. METHODS: The rates and standardized mortality ratios (SMRs) of suicide following contact with mental health services were calculated by using national suicide data from 1996 to 2001 for the four largest ethnic groups in England and Wales: black Caribbean, black African, South Asian (Indian, Pakistani, and Bangladeshi), and white. The study also investigated whether clinical indices of risk show ethnic variations. RESULTS: A total of 8,029 suicides in the four ethnic groups were investigated. Overall, compared with the SMRs for their white counterparts, low SMRs were found for South-Asian men and women (SMR=.5, 95% confidence interval [CI]=.4-.6 for South-Asian men and SMR=.7, CI=.5-.9 for South-Asian women). High SMRs were found for black Caribbean and black African men aged 13-24 (SMR=2.9, CI=1.4-5.3 for black Caribbean men and SMR=2.5, CI=1.1-4.8 for black African men). High SMRs were found for young women aged 25-39 of South-Asian origin (SMR=2.8, CI=1.9-3.9), black Caribbean origin (SMR=2.7, CI=1.3-4.8), and black African origin (SMR=3.2, CI=1.6-5.7). Some widely accepted suicide risk indicators were less common in the ethnic minority groups than in the white group. There were more symptoms of active psychosis for people from ethnic minority groups who later committed suicide, and perceived preventability was highest among black Caribbean people. CONCLUSIONS: Rates and SMRs varied across ethnic groups. Specific preventive actions must take account of the ethnic variations of clinical indices of risk and include more effective treatment of psychosis.     

Ethnic differences in achievement of developmental milestones by 9 months of age: The Millennium Cohort Study

This paper examines ethnic differences in the attainment of developmental milestones during infancy and possible explanations for observed differences are investigated. Data from the first survey of the Millennium Cohort Study (n = 15,994; 8212 males, 7782 females; mean age 9.2 mo [SD 0.5]) were examined. We found that Black Caribbean (odds ratio [OR] = 0.23, 95% confidence interval [CI] = 0.11-0.48), Black African (OR 0.31, 95% CI 0.18-0.55), and Indian (OR 0.55, 95% CI 0.33-0.93) infants were less likely to show delay in the attainment of gross motor milestones compared with White infants after adjustment for a range of explanatory variables. Pakistani and Bangladeshi infants were more likely to have delays in fine motor development (OR 1.69, 95% CI 1.21-2.35 and OR 2.17, 95% CI 1.17-4.02 respectively) and communicative gestures (OR 4.19, 95% CI 1.47-11.94 and OR 7.64, 95% CI 3.96-14.76 respectively), but these differences were explained by socioeconomic factors and markers of cultural tradition. In conclusion, unexplained ethnic differences were seen in the attainment of gross motor milestones, with Indian, Black Caribbean, and Black African children less likely to be delayed (in adjusted models). Increased likelihood of fine motor and communicative gesture delays among Pakistani and Bangladeshi infants, that disappear when socioeconomic factors are taken into account, point to the need to address deprivation among these groups to reduce the likelihood of developmental delay and possible longer term behavioural and cognitive problems and consequent opportunities throughout life.     

Risk factors and the prevalence of neurosis and psychosis in ethnic groups in Great Britain

Abstract Background Our aim was to examine whether variations in the prevalence of neurosis and psychosis between ethnic minorities throughout Great Britain are explained by social disadvantage. Method A total of 10,108 adult householders throughout Great Britain were assessed in a two-stage survey with the Revised Clinical Interview Schedule (CIS-R) and Psychosis Screening Questionnaire (PSQ). Respondents with a positive PSQ or who received a diagnosis of, or treatment for, psychosis were examined by a psychiatrist using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Data on respondents preferred ethnic group were collapsed into four groups: Whites, African-Caribbean or Africans, south Asians and other. Results Ethnic grouping was strongly associated with: unemployment; lone parent status; lower social class; low perceived social support; poverty (indicated by lack of car ownership) and having a primary social support group of less than three close others. All these associations applied to the group Africans and Afro-Caribbeans, but only some applied to the other groups. No ethnic group had significantly increased rates of neurosis. Only the African-Caribbean group were at significantly increased risk of a psychotic disorder (odds ratio 4.55; 95% CI: 1.13, 18.30). After adjustment for risk factors, the odds of psychosis were lower (odds ratio 2.97; 95% CI: 0.66, 13.36). Conclusions The excess of psychosis in Africans and Afro-Caribbeans in Great Britain appears to be partly explained by socio-economic disadvantage, but larger studies are needed to confirm this.     

Compulsory admission at first presentation to services for psychosis: does ethnicity still matter? Findings from two population-based studies of first episode psychosis

Objectives

Compared with the majority population, those from minority ethnic groups in the UK are more likely to be admitted compulsorily during a first episode of psychosis (FEP). We investigated whether these disparities in pathways in to care continue.

Methods

We analysed data from two first episode psychosis studies, conducted in the same geographical area in south London 15 years apart: the Aetiology and Ethnicity in Schizophrenia and Other Psychosis (AESOP) and the Clinical Record Interactive Search-First Episode Psychosis (CRIS-FEP) studies. The inclusion/exclusion criteria for case ascertainment for first episode psychosis were identical across the two studies. We performed multivariable logistic regression to estimate odds of compulsory admission by ethnic group, controlling for confounders.

Participants

Two hundred sixty-six patients with first episode psychosis, aged 18–64 years, who presented to mental health services in south London in 1997–1999 and 446 with FEP who presented in 2010–2012.

Results

When the two samples  were compared, ethnic differences in compulsory admission appear to have remained the same for black African patients, i.e. three times higher than white British in both samples: AESOP (adj. OR = 3.96; 95% CI = 1.80–8.71) vs. CRIS-FEP (adj. OR = 3.12; 95% CI = 1.52–6.35). Black Caribbean patients were three times more likely to be compulsorily admitted in AESOP (adj. OR = 3.20; 95% CI = 1.56–6.54). This was lower in the CRIS-FEP sample (adj. OR = 1.68; 95% CI = 0.71–3.98) and did not meet conventional levels for statistical significance.

Conclusion

Ethnicity is strongly associated with compulsory admissions at first presentation for psychosis with evidence of heterogeneity across groups, which deserves further research.

     

Adverse pregnancy outcomes in mothers with affective psychosis

OBJECTIVES: Affective psychosis has its peak incidence during the childbearing years, but little is known about the effects of the illness on pregnancy. We investigated risks of preterm delivery (PTD), low birthweight (LBW), births of infants small for their gestational age (SGA), stillbirth and infant death in births to mothers with affective psychosis using a nested case-control design within a cohort of 1,558,071 singleton births in Sweden during 1983-1997. METHODS: Using prospectively collected data from population registers, we compared the pregnancy outcomes of 5,618 births to women with affective psychosis with the outcomes of 46,246 births to unaffected mothers. RESULTS: Mothers with affective psychosis had elevated risk for giving birth to preterm, small or growth-retarded babies. The risk for stillbirth and infant death during the first year of life was not significantly higher. The risks were greatest in mothers receiving hospital treatment for affective disorder during pregnancy: (i) preterm delivery: odds ratio (OR) = 2.67, 95% confidence interval (CI) = 1.71-4.17; (ii) SGA: OR = 2.36; 95% CI = 1.34-4.16; (iii) low birthweight: OR = 2.22; 95% CI = 1.31-3.76; and (iv) stillbirth: OR = 2.19; 95% CI = 0.55-8.76. After adjustment for covariates, particularly smoking, the risks were attenuated but remained significant. CONCLUSIONS: Clinicians should be aware of the increased risk of adverse pregnancy outcomes in women with affective psychosis, some of which may be preventable.     

Racial and ethnic differences in sleep-disordered breathing and sleep duration among stroke patients

ObjectiveWe sought to characterize racial and ethnic differences in pre- and post-stroke sleep-disordered breathing (SDB) and pre-stroke sleep duration.MethodsWithin the Brain Attack Surveillance in Corpus Christi cohort of patients with ischemic stroke (8/26/2010-1/31/2020), pre-stroke SDB risk was assessed retrospectively using the Berlin Questionnaire. Post-stroke SDB was defined by prospective collection of the respiratory event index (REI) using the ApneaLink Plus performed shortly after stroke. Pre-stroke sleep duration was self-reported. We used separate regression models to evaluate the association between race/ethnicity and each outcome (pre-stroke SDB, post-stroke SDB, and pre-stroke sleep duration), without and with adjustment for potential confounders.ResultsThere was no difference in pre-stroke risk of SDB between Black and non-Hispanic white (NHW) participants (odds ratio (OR) 1.07, 95% CI 0.77-1.49), whereas MA (Mexican American), compared to NHW, participants had a higher risk of SDB before adjusting for demographic and clinical variables (OR 1.26, 95% CI 1.08-1.47). Post-stroke SDB risk was higher in MA (estimate 1.16, 95% CI 1.06-1.28) but lower in Black (estimate 0.79, 95% CI 0.65-0.96) compared to NHW participants; although, only the ethnic difference remained after adjustment. MA and Black participants had shorter sleep duration than NHW participants (OR 0.83, 95% CI 0.72-0.96 for MA; OR 0.67, 95% CI 0.49-0.91 for Black participants) before but not after adjustment.ConclusionsRacial/ethnic differences appear likely to exist in pre- and post-stroke SDB and pre-stroke sleep duration. Such differences might contribute to racial/ethnic disparities in stroke incidence and outcomes.     

Incidence and clinical correlates of aggression and violence at presentation in patients with first episode psychosis

This study aimed to identify the incidence and clinical correlates of aggression and violence in first episode psychosis. We prospectively recruited subjects with a first episode of DSM-psychosis presenting from a geographically defined catchment area to a secondary referral psychiatric service over a four-year period (n = 157). We used the Modified Overt Aggression Scale to retrospectively assess aggression (a hostile or destructive mental attitude, including verbal aggression, physical aggression and/or violence) and violence (the exercise of physical force), blind to diagnosis. One in three patients with psychosis was aggressive at the time of presentation. One patient in 14 engaged in violence that caused, or was likely to cause, injury to other people. Aggression was independently associated with drug misuse (odds ratio (OR) 2.80, 95% confidence interval 1.12-6.99) and involuntary admission status (OR = 3.62, 95% CI 1.45-9.01). Violence in the week prior to presentation was associated with drug misuse (OR = 2.75, CI 1.04-7.24) and involuntary admission status (OR = 3.21, CI 1.21-8.50). Violence in the week following presentation was associated with poor insight (OR 2.97, CI 1.03-8.56) and pre-contact violence (OR 3,82, CI 1.34-10.88). In patients with schizophrenia, violence in the week following presentation was associated with drug misuse (OR = 7.81, CI 1.33-45.95) and high psychopathology scores (OR = 20.59, CI 1.66-254.96). Overall, despite a high rate of verbal aggression, physical violence towards other people is uncommon in individuals presenting with first episode psychosis.     

Psychotic symptoms in the general population of England

BACKGROUND: There is considerable evidence that incidence of schizophrenia and other psychoses varies across ethnic groups in the UK, with particularly high rates for people of African-Caribbean origin. AIMS: The aims of this shady were to estimate in a community-based sample of people from ethnic minorities: 1) the prevalence of psychotic symptoms; and 2) risk factors for reporting psychotic symptoms. METHOD: Face-to-face interviews were carried out with a probabilistic sample of 4281 adults from six ethnic groups living in the UK. Psychotic symptoms were measured using the psychosis screening questionnaire (PSQ). RESULTS: There was a twofold higher rate of reporting psychotic symptoms on the PSQ in Black Caribbean people compared with Whites. Adjustment for demographic factors had little effect on this association. CONCLUSION: Prevalence rates of psychotic symptoms were higher in people from ethnic minorities, but were not consistent with the much higher first contact rates for psychotic disorder reported previously, particularly in Black Caribbeans.     

The influence of the patients' ethnicity, socio-demographic conditions and strain on psychiatric diagnoses given at an outpatient clinic

Although psychiatric diagnoses are influenced by cultural and social conditions, with large global variations, the ICD and DSM systems are applied worldwide. The aims of this study were to describe the distribution of different ethnic patient groups in psychiatric outpatient services and the influence of ethnicity, demographic conditions and social strain on psychiatric diagnoses. An entire year's cohort of psychiatric outpatients (n = 839) in an outpatient register was divided into nine groups, according to country of birth. The proportion of each group in the outpatient population was compared with its corresponding proportion in the catchment area. In order to examine the relationship between socio-demographic variables and strain on the one hand, and DSM-III-R diagnoses on the other, stepwise logistic regression analyses were carried out. Swedes were the only group under-represented as outpatients (P < 0.001). Africans ran a higher risk (OR = 5.55, 95% CI = 2.56-12.04) than other ethnic groups of receiving a diagnosis of psychotic disorder--except schizophrenia--and Greek patients were more likely to receive a diagnosis of somatoform disorder (OR = 8.81, 95% CI = 4.41-17.59). Swedes were twice as likely to receive a diagnosis of personality disorder (OR = 2.16, 95% CI = 1.55-3.15). Schizophrenia was related to male gender (OR = 1.75, 95% CI = 1.04-2.94) and affective disorders to age >40 years (OR = 1.71, 95% CI = 1.22-2.40). Ethnicity has a strong impact on how diagnoses are given in cross-cultural settings. We could not confirm earlier findings of under-representation of ethnic minorities in outpatient services.     

Minor physical anomalies across ethnic groups in a first episode psychosis sample

Minor physical anomalies (MPAs) are more prevalent amongst individuals with psychosis, supporting a neurodevelopmental model for psychotic disorders. The aim of this study was to investigate the possibility that neurodevelopmental adversity contributes to the excess of psychosis found in some ethnic groups in the UK. Subjects with first onset psychosis and healthy neighbourhood controls were enrolled in the AESOP study in South East London and Nottingham between 1997 and 1999. MPA rates were estimated in four broad ethnic groupings (White, African Caribbean, Black African and Other). Patients (n=245) had a higher mean total MPA score than healthy controls (n=158). This held true across each of the four ethnic groupings. The results of this study suggest that neurodevelopmental factors play a role in the aetiology of psychosis across all ethnic groups.     

Ethnicity,social disadvantage and psychotic‐like experiences in a healthy population based sample

Objective:  We sought to investigate the prevalence and social correlates of psychotic‐like experiences in a general population sample of Black and White British subjects. Method:  Data were collected from randomly selected community control subjects, recruited as part of the ÆSOP study, a three‐centre population based study of first‐episode psychosis. Results:  The proportion of subjects reporting one or more psychotic‐like experience was 19% (n = 72/372). These were more common in Black Caribbean (OR 2.08) and Black African subjects (OR 4.59), compared with White British. In addition, a number of indicators of childhood and adult disadvantage were associated with psychotic‐like experiences. When these variables were simultaneously entered into a regression model, Black African ethnicity, concentrated adult disadvantage, and separation from parents retained a significant effect. Conclusion:  The higher prevalence of psychotic‐like experiences in the Black Caribbean, but not Black African, group was explained by high levels of social disadvantage over the life course.     

Racial/ethnic differences in 12-month prevalence and persistence of mood,anxiety, and substance use disorders: Variation by nativity and socioeconomic status

BackgroundDespite equivalent or lower lifetime and past-year prevalence of mental disorder among racial/ethnic minorities compared to non-Latino Whites in the United States, evidence suggests that mental disorders are more persistent among minorities than non-Latino Whites. But, it is unclear how nativity and socioeconomic status contribute to observed racial/ethnic differences in prevalence and persistence of mood, anxiety, and substance disorders.MethodData were examined from a coordinated series of four national surveys that together assessed 21,024 Asian, non-Latino Black, Latino, and non-Latino White adults between 2001 and 2003. Common DSM-IV mood, anxiety, and substance disorders were assessed using the Composite International Diagnostic Interview. Logistic regression analyses examined how several predictors (e.g., race/ethnicity, nativity, education, income) and the interactions between those predictors were associated with both 12-month disorder prevalence and 12-month prevalence among lifetime cases. For the second series of analyses, age of onset and time since onset were used as additional control variables to indirectly estimate disorder persistence.ResultsNon-Latino Whites demonstrated the highest unadjusted 12-month prevalence of all disorder types (p < 0.001), though differences were also observed across minority groups. In contrast, Asian, Latino, and Black adults demonstrated higher 12-month prevalence of mood disorders among lifetime cases than Whites (p < 0.001) prior to adjustments Once we introduced nativity and other relevant controls (e.g., age, sex, urbanicity), US-born Whites with at least one US-born parent demonstrated higher 12-month mood disorder prevalence than foreign-born Whites or US-born Whites with two foreign parents (OR = 0.51, 95% CI = [0.36, 0.73]); this group also demonstrated higher odds of past-year mood disorder than Asian (OR = 0.59, 95% CI = [0.42, 0.82]) and Black (OR = 0.70, 95% CI = [0.58, 0.83]) adults, but not Latino adults (OR = 0.89, 95% CI = [0.74, 1.06]). Racial/ethnic differences in 12-month mood and substance disorder prevalence were moderated by educational attainment, especially among adults without a college education. Additionally, racial/ethnic minority groups with no more than a high school education demonstrated more persistent mood and substance disorders than non-Latino Whites; these relationships reversed or disappeared at higher education levels.ConclusionNativity may be a particularly relevant consideration for diagnosing mood disorder among non-Latino Whites; additionally, lower education appears to be associated with increased relative risk of persistent mood and substance use disorders among racial/ethnic minorities compared to non-Latino Whites.     

Comorbidities amongst patients with multiple sclerosis: a population‐based controlled study

Background: Data regarding the wide spectrum of comorbidity amongst patients with multiple sclerosis (MS) are still scanty, especially in Asian populations. Our goal was to analyze comorbidity prevalences and risks amongst Chinese patients with MS, compared to matched controls. Methods: In total, 898 patients with MS and 4490 randomly matched individuals without MS were extracted from the National Health Insurance Research Dataset in Taiwan. We selected 30 comorbid medical conditions for analysis. Conditional logistic regression analyses were used to examine the risks of comorbidity between the two groups. Results: The regression analyses showed that patients with MS were more likely to have systemic lupus erythematosus (OR = 26.9, 95% CI = 10.3–70.3), depression (OR = 6.9, 95% CI = 5.3–8.9), peripheral vascular disorders (OR = 6.6, 95% CI = 4.0–11.0), deficiency anemias (OR = 4.9, 95% CI = 2.8–8.7), rheumatoid arthritis (OR = 4.8, 95% CI = 2.9–8.1) and fluid and electrolyte disorders (OR = 4.8, 95% CI = 2.8–8.3) than the matched controls. Conclusions: Patients with MS had higher risk of multiple medical comorbidities compared to a matched control group in an ethnic Chinese population.     

Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3-center AeSOP study

CONTEXT: Convention suggests uniformity of incidence of schizophrenia and other psychoses; variation would have implications for their causes and biological characteristics. OBJECTIVE: To investigate variability in the incidence of psychotic syndromes in terms of place, ethnicity, age, and sex. DESIGN: Three-center, prospective, comprehensive survey of clinically relevant first-onset psychotic syndromes over a 2-year period (1997-1999). Census data provided the denominator. SETTING: Southeast London, Nottingham, and Bristol, England. PARTICIPANTS: One million six hundred thousand person-years yielded 568 subjects aged 16 to 64 years with clinically relevant psychotic syndromes. MAIN OUTCOME MEASURES: The World Health Organization Psychosis Screen and the Schedules for Clinical Assessment in Neuropsychiatry to classify, blind to ethnicity, all DSM-IV psychotic syndromes and the subclasses of schizophrenia, other nonaffective disorders, affective disorders, and substance-induced psychosis. RESULTS: All syndromes showed a characteristic age distribution. Schizophrenia was significantly more common in men (incidence rate ratio [IRR], 2.3 [95% confidence interval (CI), 1.7-3.1]); affective disorders occurred equally in men and women (IRR, 1.0 [95% CI, 0.7-1.3]). All psychoses were more common in the black and minority ethnic group (crude IRR, 3.6 [95% CI, 3.0-4.2]). Differences in age, sex, and study center accounted for approximately a quarter of this effect (adjusted IRR, 2.9 [95% CI, 2.4-3.5]) in each psychosis outcome. The age-sex standardized incidence rate for all psychoses was higher in Southeast London (IRR, 49.4 [95% CI, 43.6-55.3]) than Nottingham (IRR, 23.9 [95% CI, 20.6-27.2]) or Bristol (IRR, 20.4 [95% CI, 15.1-25.7]). Rates of all outcomes except affective disorders remained significantly higher in Southeast London when the model was expanded to control for ethnicity. CONCLUSIONS: There is significant and independent variation of incidence of schizophrenia and other psychoses in terms of sex, age, ethnicity, and place. This confirms that environmental effects at the individual, and perhaps neighborhood level, may interact together and with genetic factors in the etiology of psychosis.     

Predictors of psychosis remission in psychotic disorders that co-occur with substance use

OBJECTIVE: To examine rates and predictors of psychosis remission at 1-year follow-up for emergency admissions diagnosed with primary psychotic disorders and substance-induced psychoses. METHOD: A total of 319 patients with comorbid psychosis and substance use, representing 83% of the original referred sample, were rediagnosed at 1 year postintake employing a research diagnostic assessment. Remission of psychosis was defined as the absence of positive and negative symptoms for at least 6 months. Likelihood ratio chi-square tests and multivariate logistic regression were the main means of analysis. RESULTS: Of those with a baseline diagnosis of primary psychotic disorder, 50% were in remission at 1 year postintake, while of those with a baseline diagnosis of substance-induced psychosis, 77% were in remission at this time point. Lower Positive and Negative Syndrome Scale (PANSS) symptom levels at baseline, better premorbid functioning, greater insight into psychosis, and a shorter duration of untreated psychosis predicted remission at 1 year in both diagnostic groups. No interaction effects of baseline predictors and diagnosis type were observed. A stepwise multivariate logistic regression holding baseline diagnosis constant revealed the duration of untreated psychosis (odds ratio [OR] = 0.97; 95% confidence interval [CI] = 0.95, 0.997), total PANSS score (OR = 0.98; 95% CI = 0.97, 0.987), Premorbid Adjustment Scale score (OR = 0.13; 95% CI = 0.02, 0.88), and Scale to Assess Unawareness of Mental Disorders unawareness score (OR = 0.84; 95% CI = 0.71, 0.993) as key predictors of psychosis remission. CONCLUSIONS: The association of better premorbid adjustment, a shorter duration of untreated psychosis, better insight into psychotic symptoms, and lower severity of psychotic symptoms with improved clinical outcome, reported previously in studies of schizophrenia, generalizes to psychosis remission in psychotic disorders that are substance induced.     

Ethnic disparities in incidence of stroke subtypes: Auckland Regional Community Stroke Study, 2002-2003

BACKGROUND: Limited population-based data exist on differences in the incidence of major pathological stroke types and ischaemic stroke subtypes across ethnic groups. We aimed to provide such data within the large multi-ethnic population of Auckland, New Zealand. METHODS: All first-ever cases of stroke (n=1423) in a population-based register in 940 000 residents (aged 15 years) in Auckland, New Zealand, for a 12-month period in 2002-2003, were classified into ischaemic stroke, primary intracerebral haemorrhage (PICH), subarachnoid haemorrhage, and undetermined stroke, according to standard definitions and results of neuroimaging/necropsy (in over 90% of cases). Ischaemic stroke was further classified into five subtypes. Ethnicity was self-identified and grouped as New Zealand (NZ)/European, Maori/Pacific, and Asian/other. Incidence rates were standardised to the WHO world population by the direct method, and differences in rates between ethnic groups expressed as rate ratios (RRs), with NZ/European as the reference group. FINDINGS: In NZ/European people, ischaemic stroke comprised 73%, PICH 11%, and subarachnoid haemorrhage 6%, but PICH was higher in Maori/Pacific people (17%) and in Asian/other people (22%). Compared with NZ/European people, age-adjusted RRs for PICH were 2.7 (95% CI 1.8-4.0) and 2.3 (95% CI 1.4-3.7) among Maori/Pacific and Asian/other people, respectively. The corresponding RR for ischaemic stroke was greater for Maori/Pacific people (1.7 [95% CI 1.4-2.0]), particularly embolic stroke, and for Asian/other people (1.3 [95% CI 1.0-1.7]). The onset of stroke in Maori/Pacific and Asian/other people began at significantly younger ages (62 years and 64 years, respectively) than in NZ/Europeans (75 years; p<0.0001). There were ethnic differences in the risk factor profiles (such as age, sex, hypertension, cardiac disease, diabetes, hypercholesterolaemia, smoking status, overweight) for the stroke types and subtypes. INTERPRETATION: Compared to NZ/Europeans, Maori/Pacific and Asian/other people are at higher risk of ischaemic stroke and PICH, whereas similar rates of subarachnoid haemorrhage were evident across ethnic groups. The ethnic disparities in the rates of stroke types could be due to substantial differences found in risk factor profiles between ethnic groups. This information should be considered when planning prevention and stroke-care services in multi-ethnic communities.     

Fewer neurological soft signs among first episode psychosis patients with heavy cannabis use

BACKGROUND: Although neurological soft signs (NSS) have been consistently associated with schizophrenia and a variety of risk factors, few studies have focused on the association between NSS and environmental factors such as cannabis use, particularly in patients with first episode psychosis. METHODS: We administered the Neurological Evaluation Scale (NES) to 92 patients during their first episode of functional psychosis. Psychopathology was assessed with the Positive And Negative Syndrome Scale (PANSS) and the family history of psychotic disorder was established on the basis of the Family Interview for Genetic Studies (FIGS). We also assessed lifetime cannabis and cocaine use utilizing that specific section of the Composite International Diagnostic Interview. The outcome variable was the presence of high NSS, defined by a score above the median split of the NES score (>21). RESULTS: Most patients (80/92, 87%) presented a non-affective psychosis. The presence of high NSS showed a significant independent association with not having been a heavy cannabis user (OR=8.3; 95% CI, 2.4-33.3), family history of psychosis (OR=4.3; 95% CI, 1.2-14.9), male sex (OR=4.0; 95% CI, 1.2-14.0), lower score in verbal fluency and higher score in negative symptoms (both p<0.01). CONCLUSION: Our cross-sectional results support the hypothesis that potentially different pathways associated with the emergence of first episode psychosis may exist, including neurological premorbid alteration and environmental cannabis abuse.