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Understanding the excess of psychosis among the African—Caribbean population in England

Review of current hypotheses

GERARD HUTCHINSON, MD and ROBIN M. MURRAY, MD

Department of Psychiatry, Institute of Psychiatry, King's College London, UK

KWAME McKENZIE, MRCPsych

Department of Psychiatry, Royal Free Hospital, London, UK

Correspondence: Dr Mandy Sharpley, Section of Social Psychiatry, Institute of Psychiatry, DeCrespigny Park, London SE5 8AF, UK

Declaration of interest None.

ABSTRACT

Background Increased rates of schizophrenia continue to be reported among the African—Caribbean population in England.

Aims To evaluate the competing biological, psychological and social explanations that have been proposed.

Method Literature review.

Results The African—Caribbean population in England is at increased risk of both schizophrenia and mania; the higher rates remain when operational diagnostic criteria are used. The excess of the two psychotic disorders are probably linked: African—Caribbean patients with schizophrenia show more affective symptoms, and a more relapsing course with greater social disruption but fewer chronic negative symptoms, than White patients. No simple hypothesis explains these findings.

Conclusions More complex hypotheses are needed. One such links cultural variation in symptom reporting, the use of phenomenological constructs by psychiatrists and social disadvantage.

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