Symptoms of psychosis in schizophrenia, schizoaffective disorder, and bipolar disorder

A comparison of African Americans and Caucasians in the Genomic Psychiatry Cohort

Genomic Psychiatry Cohort Consortium

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Several studies have reported differences between African Americans and Caucasians in relative proportion of psychotic symptoms and disorders, but whether this reflects racial bias in the assessment of psychosis is unclear. The purpose of this study was to examine the distribution of psychotic symptoms and potential bias in symptoms assessed via semi-structured interview using a cohort of 3,389 African American and 5,692 Caucasian participants who were diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder. In this cohort, the diagnosis of schizophrenia was relatively more common, and the diagnosis of bipolar disorder and schizoaffective disorder-bipolar type was less relatively common, among African Americans than Caucasians. With regard to symptoms, relatively more African Americans than Caucasians endorsed hallucinations and delusions symptoms, and this pattern was striking among cases diagnosed with bipolar disorder and schizoaffective-bipolar disorder. In contrast, the relative endorsement of psychotic symptoms was more similar among cases diagnosed with schizophrenia and schizoaffective disorder-depressed type. Differential item function analysis revealed that African Americans with mild psychosis over-endorsed "hallucinations in any modality" and under-endorsed "widespread delusions" relative to Caucasians. Other symptoms did not show evidence of racial bias. Thus, racial bias in assessment of psychotic symptoms does not appear to explain differences in the proportion of symptoms between Caucasians and African Americans. Rather, this may reflect ascertainment bias, perhaps indicative of a disparity in access to services, or differential exposure to risk factors for psychosis by race.

Original languageEnglish (US)
Pages (from-to)546-555
Number of pages10
JournalAmerican Journal of Medical Genetics, Part B: Neuropsychiatric Genetics
Volume171
Issue number4
DOIs
StatePublished - Jun 1 2016

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Bipolar Disorder
African Americans
Psychotic Disorders
Psychiatry
Schizophrenia
Racism
Delusions
Hallucinations
Symptom Assessment
Interviews

Keywords

  • Psychosis
  • Race
  • Schizophrenia

ASJC Scopus subject areas

  • Genetics(clinical)
  • Psychiatry and Mental health
  • Cellular and Molecular Neuroscience

Cite this

@article{283e422fa7cf436ab92f94f702d7f966,
title = "Symptoms of psychosis in schizophrenia, schizoaffective disorder, and bipolar disorder: A comparison of African Americans and Caucasians in the Genomic Psychiatry Cohort",
abstract = "Several studies have reported differences between African Americans and Caucasians in relative proportion of psychotic symptoms and disorders, but whether this reflects racial bias in the assessment of psychosis is unclear. The purpose of this study was to examine the distribution of psychotic symptoms and potential bias in symptoms assessed via semi-structured interview using a cohort of 3,389 African American and 5,692 Caucasian participants who were diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder. In this cohort, the diagnosis of schizophrenia was relatively more common, and the diagnosis of bipolar disorder and schizoaffective disorder-bipolar type was less relatively common, among African Americans than Caucasians. With regard to symptoms, relatively more African Americans than Caucasians endorsed hallucinations and delusions symptoms, and this pattern was striking among cases diagnosed with bipolar disorder and schizoaffective-bipolar disorder. In contrast, the relative endorsement of psychotic symptoms was more similar among cases diagnosed with schizophrenia and schizoaffective disorder-depressed type. Differential item function analysis revealed that African Americans with mild psychosis over-endorsed {"}hallucinations in any modality{"} and under-endorsed {"}widespread delusions{"} relative to Caucasians. Other symptoms did not show evidence of racial bias. Thus, racial bias in assessment of psychotic symptoms does not appear to explain differences in the proportion of symptoms between Caucasians and African Americans. Rather, this may reflect ascertainment bias, perhaps indicative of a disparity in access to services, or differential exposure to risk factors for psychosis by race.",
keywords = "Psychosis, Race, Schizophrenia",
author = "{Genomic Psychiatry Cohort Consortium} and Greg Perlman and Roman Kotov and Jinmiao Fu and Bromet, {Evelyn J.} and Fochtmann, {Laura J.} and Helena Medeiros and Pato, {Michele T.} and Pato, {Carlos N.} and Colony Abbott and Azevedo, {Maria Helena} and Buckley, {Peter F.} and Escamilla, {Michael A.} and Fanous, {Ayman H.} and Buckley, {Peter F} and Lehrer, {D. S.} and Fabio Macciardi and Antonio Macedo and Dolores Malaspina and Marder, {Stephen R.} and McCarroll, {Steven A.} and Morley, {C. P.} and Humberto Nicolini and Perkins, {Diana O.} and Rakofsky, {Jeffrey J.} and Rapaport, {M. H.} and Pamela Sklar and Smoller, {Jordan W.} and Sobell, {Janet L.}",
year = "2016",
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doi = "10.1002/ajmg.b.32409",
language = "English (US)",
volume = "171",
pages = "546--555",
journal = "American Journal of Medical Genetics, Part B: Neuropsychiatric Genetics",
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T1 - Symptoms of psychosis in schizophrenia, schizoaffective disorder, and bipolar disorder

T2 - A comparison of African Americans and Caucasians in the Genomic Psychiatry Cohort

AU - Genomic Psychiatry Cohort Consortium

AU - Perlman, Greg

AU - Kotov, Roman

AU - Fu, Jinmiao

AU - Bromet, Evelyn J.

AU - Fochtmann, Laura J.

AU - Medeiros, Helena

AU - Pato, Michele T.

AU - Pato, Carlos N.

AU - Abbott, Colony

AU - Azevedo, Maria Helena

AU - Buckley, Peter F.

AU - Escamilla, Michael A.

AU - Fanous, Ayman H.

AU - Buckley, Peter F

AU - Lehrer, D. S.

AU - Macciardi, Fabio

AU - Macedo, Antonio

AU - Malaspina, Dolores

AU - Marder, Stephen R.

AU - McCarroll, Steven A.

AU - Morley, C. P.

AU - Nicolini, Humberto

AU - Perkins, Diana O.

AU - Rakofsky, Jeffrey J.

AU - Rapaport, M. H.

AU - Sklar, Pamela

AU - Smoller, Jordan W.

AU - Sobell, Janet L.

PY - 2016/6/1

Y1 - 2016/6/1

N2 - Several studies have reported differences between African Americans and Caucasians in relative proportion of psychotic symptoms and disorders, but whether this reflects racial bias in the assessment of psychosis is unclear. The purpose of this study was to examine the distribution of psychotic symptoms and potential bias in symptoms assessed via semi-structured interview using a cohort of 3,389 African American and 5,692 Caucasian participants who were diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder. In this cohort, the diagnosis of schizophrenia was relatively more common, and the diagnosis of bipolar disorder and schizoaffective disorder-bipolar type was less relatively common, among African Americans than Caucasians. With regard to symptoms, relatively more African Americans than Caucasians endorsed hallucinations and delusions symptoms, and this pattern was striking among cases diagnosed with bipolar disorder and schizoaffective-bipolar disorder. In contrast, the relative endorsement of psychotic symptoms was more similar among cases diagnosed with schizophrenia and schizoaffective disorder-depressed type. Differential item function analysis revealed that African Americans with mild psychosis over-endorsed "hallucinations in any modality" and under-endorsed "widespread delusions" relative to Caucasians. Other symptoms did not show evidence of racial bias. Thus, racial bias in assessment of psychotic symptoms does not appear to explain differences in the proportion of symptoms between Caucasians and African Americans. Rather, this may reflect ascertainment bias, perhaps indicative of a disparity in access to services, or differential exposure to risk factors for psychosis by race.

AB - Several studies have reported differences between African Americans and Caucasians in relative proportion of psychotic symptoms and disorders, but whether this reflects racial bias in the assessment of psychosis is unclear. The purpose of this study was to examine the distribution of psychotic symptoms and potential bias in symptoms assessed via semi-structured interview using a cohort of 3,389 African American and 5,692 Caucasian participants who were diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder. In this cohort, the diagnosis of schizophrenia was relatively more common, and the diagnosis of bipolar disorder and schizoaffective disorder-bipolar type was less relatively common, among African Americans than Caucasians. With regard to symptoms, relatively more African Americans than Caucasians endorsed hallucinations and delusions symptoms, and this pattern was striking among cases diagnosed with bipolar disorder and schizoaffective-bipolar disorder. In contrast, the relative endorsement of psychotic symptoms was more similar among cases diagnosed with schizophrenia and schizoaffective disorder-depressed type. Differential item function analysis revealed that African Americans with mild psychosis over-endorsed "hallucinations in any modality" and under-endorsed "widespread delusions" relative to Caucasians. Other symptoms did not show evidence of racial bias. Thus, racial bias in assessment of psychotic symptoms does not appear to explain differences in the proportion of symptoms between Caucasians and African Americans. Rather, this may reflect ascertainment bias, perhaps indicative of a disparity in access to services, or differential exposure to risk factors for psychosis by race.

KW - Psychosis

KW - Race

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DO - 10.1002/ajmg.b.32409

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SN - 1552-4841

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