Understanding the excess of psychosis among the African-Caribbean population in England. Review of current hypotheses.
BACKGROUND
Increased rates of schizophrenia continue to be reported among the African-Caribbean population in England.


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


METHODS
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.
Sharpley
M
M
Department of Psychiatry, Institute of Psychiatry, King's College London, UK.
Hutchinson
G
G
McKenzie
K
K
Murray
R M
RM
D001294:Attitude to Health; D001714:Bipolar Disorder / Q000208:ethnology; D003937:Diagnosis, Differential; D004641:Emigration and Immigration; D004739:England / Q000453:epidemiology; D005190:Family; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008016:Life Change Events; D002189:Marijuana Abuse / Q000208:ethnology; D011247:Pregnancy; D011287:Prejudice; D011297:Prenatal Exposure Delayed Effects; D012307:Risk Factors; D012559:Schizophrenia / Q000453:epidemiology / Q000208:ethnology* / Q000235:genetics; D012931:Social Environment; D014504:Urban Health; D014900:West Indies / Q000208:ethnology