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Ethnic differences in the presentation of bipolar affective disorder

Published online by Cambridge University Press:  16 April 2020

G. Kirov  and
R.M. Murray
G. Kirov
Affiliation:
Neuropsychiatric Genetics Unit, Tenovus Building, University of Wales College of Medicine, Heath Park, CardiffCF4 4XN
R.M. Murray
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, de Crespigny Park, LondonSE5 8AF, United Kingdom
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Summary

There have been repeated reports that Afro-Caribbean people living in the UK are more prone than white people to be diagnosed as having schizophrenia and mania, along with some evidence that they are less likely to receive a diagnosis of depression. We attempted to replicate these findings in a population of patients on lithium prophylaxis. We therefore assessed the clinical characteristics of people under the age of 55 from three ethnic groups attending a lithium clinic in south London, those of (1) white British (n = 88); (2) Afro-Caribbean (n = 31); and, (3) African (n = 15) origin.

Nineteen of the white patients met DSM-IV criteria for unipolar depression (UP) and eight met the criteria for bipolar II disorder (BP II); in contrast, only two black patients met the criteria for unipolar depression and none met the criteria for BP II. Among patients diagnosed as BP I, Africans were significantly more likely than whites to show exclusively or mainly manic presentations while Afro-Caribbeans were more likely to have had mood-incongruent delusions. On the other hand, white patients were significantly more likely than Afro-Caribbeans to have had suicidal ideas or actions, and showed a similar but not significant excess when compared with Africans.

Our findings could reflect either genuine ethnic differences in the presentation of severe affective disorder or be produced by the failure of British doctors to detect depression and deliver appropriate treatment to their black patients. The frequency with which Afro-Caribbean patients with mania present mood-incongruent delusions probably contributes to the high rates of diagnosed schizophrenia in this population.

Keywords

Afro-Caribbeanbipolardepressionlithiummania
Type
Original article
Information
European Psychiatry , Volume 14 , Issue 4 , July 1999 , pp. 199 - 204
Copyright
Copyright © Elsevier, Paris 1999

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References

American Psychiatric Association. Diagnostic and statistical manual of mental disorders Fourth Edition.Washington, DC: American Psychiatric Association 1994.Google Scholar
Bebbington, P, Hurry, J, Tennant, V. Psychiatric disorders in selected immigrant groups in Camberwell Soc Psychiatry 1981; 16: 43–51.CrossRefGoogle Scholar
Boyd, J, Weissman, MM. Epidemiology of affective disorders Arch Gen Psychiatry 1981; 38: 1039–1046.CrossRefGoogle ScholarPubMed
Burke, A. Suicide in Jamaica West Indian Med J 1985; 34: 48–53.Google ScholarPubMed
Dilsaver, SD, Chen, YW, Swann, AC, Shoaib, AM, Krajewski, KJ. Suicidality in patients with pure and depressive mania. Am J Psychiatry 1994; 151: 1312–1315.Google ScholarPubMed
Griffith, EEH, Bell, CC. Recent trends in suicide and homicide among blacks. J Am Med Ass 1989; 262: 2265–2269.CrossRefGoogle ScholarPubMed
Harrison, G, Owens, D, Holton, A, Neilson, D, Boot, D. A prospective study of severe mental disorder in Afro-Caribbean patients. Psychol Mededed 1988; 18: 643–657.CrossRefGoogle ScholarPubMed
Leff, JP, Fisher, M, Bertelsen, A. A cross-national epidemiological study of mania. Br J Psychiatry 1976; 129: 428–442.CrossRefGoogle ScholarPubMed
Lloyd, K. Depression and anxiety among Afro-Caribbean general practice attenders in Britain. Int J Soc Psychiatry 1993; 39: 1–9.CrossRefGoogle ScholarPubMed
Mahy, G. Suicide behavior in the Caribbean. Int Rev Psychiatry 1993; 5: 261–269.CrossRefGoogle Scholar
Makanjuola, ROA. Recurrent unipolar manic disorder in the Yoruba Nigerian: further evidence. Br J Psychiatry 1985; 147: 434–437.CrossRefGoogle ScholarPubMed
Mc Kenzie, K, VanOs, J, Fahy, T, Jones, P, Harvey, I, Toone, B. Psychosis with good prognosis in Afro-Caribbean people now living in the United Kingdom. Br Med J 1995; 311: 1325–1327.CrossRefGoogle Scholar
Neeleman, J, Jones, P, Van Os, J, Murray, RM. Parasuicide in Camberwell — Ethnic differences. Soc Psychiatry Psychiatr Epidemiol 1996; 31: 284–287.CrossRefGoogle ScholarPubMed
Norusis, MJ. SPSSO for Windows™, Release 6. 0. Chicago; SPSS Inck; 1993.Google Scholar
Nurnberger, J, Roose, SP, Dunner, DL, Fieve, RR. Unipolar mania: a distinct clinical entity. Am J Psychiatry 1979; 136: 1420–1423.Google ScholarPubMed
Perris, C. A study of bipolar manic-depressive and unipolar recurrent depressive psychosis. Acta Psychiatr Scand 1969; 42 Suppl: 194Google Scholar
Rwegellera, GGC. Suicide rates in Lusaka, Zambia: preliminary observations. Psychol Med 1978; 8: 423–432.CrossRefGoogle ScholarPubMed
Soni Raleigh, V, Balarajan, R. Suicide levels and trends among immigrants in England and Wales. Health Trends 1992; 24: 91–94.Google Scholar
Soni Raleigh, V. Suicide patterns and trends in people of Indian subcontinent and Caribbean origin in England and Wales. Ethnicity Health 1996; 1: 55–63.CrossRefGoogle Scholar
Strakowski, SM, Flaum, M, Amador, X, Bracha, HS, Pandurangi, AK, Robinson, D. Racial differences in the diagnosis of psychosis. Schizophr Res 1996; 21: 117–124.CrossRefGoogle Scholar
Van Os, J, Castle, J, Takei, N, Der, G, Murray, R. Psychotic illness in ethnic minorities: clarification from the 1991 census. Psychol Med 1996; 26: 203–208.CrossRefGoogle ScholarPubMed
Van Os, J, Takei, N, Castle, DJ, Wessely, S, Der, G, Macdonald, A, Murray, RM. The incidence of mania: time trends in relation to gender and ethnicity. Soc Psychiatry Psychiatr Epidemiol 1996; 31: 129–136.CrossRefGoogle ScholarPubMed
Wessely, S, Castle, D, Der, G, Murray, R. Schizophrenia and Afro-Caribbeans. A case control study. Br J Psychiatry 1991; 159: 795–801.CrossRefGoogle ScholarPubMed
Winokur, G, Clayton, P, Reich, T. Manic Depressive Illness. St. Louis: Mossby; 1969.Google Scholar
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