Comparing the Clinical Presentation of First-Episode Psychosis across Different Migrant and Ethnic Minority Groups in Montreal, Quebec

By van der Ven, Elsje; Bourque, François et al. | Canadian Journal of Psychiatry, May 2012 | Go to article overview

Comparing the Clinical Presentation of First-Episode Psychosis across Different Migrant and Ethnic Minority Groups in Montreal, Quebec


van der Ven, Elsje, Bourque, François, Joober, Ridha, Selten, Jean-Paul, Malla, Ashok K., Canadian Journal of Psychiatry


Objective: To explore differences in severity and nature of symptoms of first-episode psychosis (FEP) according to ethnic group and migrant status.

Method: We administered rating scales to assess positive and negative symptoms, as well as general psychopathology, to 301 consecutive patients presenting with an FEP within a defined catchment area in Montreal, Quebec, classified according to ethnicity and migrant status. Symptom scores of Euro-Canadian patients without a recent history of migration, that is, the reference group (n = 145), were compared with those of African and Afro-Caribbean (n = 39), Asian (n = 27), Central and South American (n = 15), Middle Eastern and North African (n = 24), and European and North American (n = 39) patients.

Results: Except for referral source, there were no significant differences between ethnic groups on any demographic variables. The African and Afro-Caribbean group had a higher level of negative symptoms (especially alogia) and general psychopathology scores on the Positive and Negative Syndrome Scale (especially, uncooperativeness, preoccupation, and poor attention), compared with the reference group. Ethnic groups did not differ on the Scale for the Assessment of Positive Symptoms scores.

Conclusions: A comparison of FEP patients from different ethnic groups and native-born Euro-Canadians revealed no significant differences in the nature of positive symptoms at first presentation or in age at onset, suggesting that there was no evidence for the hypothesis that ethnic minorities are misdiagnosed as psychotic. Increased severity of negative symptoms and general psychopathology, specifically among the black ethnic minority group, may have implications for the role of ethnicity for the treatment and outcome of the initial episode of psychotic disorders.

Objectif : Explorer les différences de gravité et de nature des symptômes du premier épisode psychotique (PEP) selon le groupe ethnique et le statut d'immigrant.

Méthode : Nous avons administré des échelles de cotation, pour évaluer les symptômes positifs et négatifs ainsi que la psychopathologie générale, à 301 patients consécutifs présentant un PEP dans un secteur psychiatrique défini de Montréal, Québec, classés selon l'ethnicité et le statut d'immigrant. Les scores de symptômes des patients euro-canathens sans antécédents récents de migration, c'est-à-dire, le groupe de référence (n = 145), ont été comparés avec ceux des patients africains et afro-caribéens (n = 39), asiatiques (n = 27), centraméricains et sud-américains (n = 15), du Moyen-Orient et nord-africains (n = 24), et européens et nord-américains (n = 39).

Résultats : À l'exception de la source d'aiguillage, il n'y avait pas de différences significatives entre les groupes ethniques à aucune variable démographique. Le groupe africain et afro-caribéen avait un niveau plus élevé de symptômes négatifs (spécialement alogie) et de scores de psychopathologie générale à l'échelle du syndrome positif et négatif (spécialement manque de coopération, préoccupation, et attention médiocre), comparé avec le groupe de référence. Les scores des groupes ethniques ne différaient pas à l'échelle d'évaluation des symptômes positifs.

Conclusions : Une comparaison de patients de PEP de différents groupes ethniques et d'Euro-Canathens nés au pays n'a révélé aucune différence significative de la nature des symptômes positifs lors de la première présentation ou de l'âge à l'apparition de la maladie, ce qui suggère qu'il n'y avait pas de données probantes à l'appui de l'hypothèse selon laquelle les minorités ethniques sont mal diagnostiquées comme psychotiques. La gravité accrue des symptômes négatifs et de la psychopathologie générale, spécifiquement chez le groupe de minorité ethnique noire, peut avoir des implications pour le rôle de l'ethnicité dans le traitement et le résultat du premier épisode de troubles psychotiques.

Key Words: ethnicity, psychosis, symptoms, schizophrenia, first episode, age at onset

Abbreviations

CORS Circumstances of Onset and Relapse Schedule

DSM Diagnostic and Statistical Manual of Mental Disorders

DUP duration of untreated psychosis

FEP first-episode psychosis

ICC intraclass correlation

PANSS Positive and Negative Syndrome Scale

SANS Scale for the Assessment of Negative Symptoms

SAPS Scale for the Assessment of Positive Symptoms

There is now consistent evidence for an increased incidence of psychotic disorders in many migrant and ethnic minority groups across various countries.

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