Understanding the excess of psychosis among the African-Caribbean population in England. Review of current hypotheses

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.