Ethnic differences in first clinical presentation of bipolar disorder: results from an epidemiological study.
BACKGROUND
Although high incidence rates of mania have been described in some ethnic minority populations, little is known about any ethnic differences in the early clinical presentation of bipolar disorder.


METHODS
All cases of operationalised DSM-IV bipolar I disorder (BPI), first manic episode, within a defined epidemiological catchment area over a 35-year period, were identified; sociodemographic data, including ethnicity, and clinical information were then extracted. The proportion of African-Caribbean (n=52), African (n=33) and white European (n=149) cases who experienced a depressive episode before onset of mania and psychotic symptoms at first mania were compared.


RESULTS
African-Caribbean and African groups were significantly less likely to have experienced a depressive episode before onset of first mania, at 13.5% and 6.1%, respectively, compared with 28.1% in the white European group. African-Caribbean and African groups also experienced more severe psychotic symptoms at first mania, but there were no differences in mood incongruent or first rank symptoms between ethnic groups.


CONCLUSIONS
Data pertaining to diagnosis and clinical symptoms were extracted by retrospective case note review.


CONCLUSIONS
Ethnic differences in clinical presentation of bipolar disorder may have implications for assessment and treatment of ethnic minority patients.
Kennedy
N
N
Box 63, Section of General Psychiatry, Division of Psychological Medicine, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. nkennedy@stpatsmail.com
Boydell
J
J
van Os
J
J
Murray
R M
RM
D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000208:ethnology*; D044383:Black People / Q000523:psychology* / Q000706:statistics & numerical data; D015897:Comorbidity; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000208:ethnology; D005260:Female; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000208:ethnology; D012189:Retrospective Studies; D044465:White People / Q000523:psychology* / Q000706:statistics & numerical data