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Psychosis with good prognosis in Afro-Caribbean people now living in the United Kingdom

^a Department of Psychological Medicine, Kings College Hospital London and the Institute of Psychiatry, London SE5 8AF, ^b Maudsley Hospital, London SE5 8AZ, ^c Towers Hospital, Leicester LE5 0TD

Correspondence to: Dr K McKenzie, Brixton Community Care Project, Maudsley Hospital, 103 Denmark Hill, London SE5 8AZ.

Abstract

Objectives: To compare the course and outcome of psychotic illness in a group of Afro-Caribbean patients resident in the United Kingdom and a group of white British patients.
Design: Cohort study of consecutive admissions followed up for four years.
Subjects: 113 patients with psychotic illness of recent onset admitted to two south London hospitals.
Main outcome measures: Course of illness, history of self harm, social disability, treatment received, and hospital use adjusted for socioeconomic origin.
Results: The Afro-Caribbean group spent more time in a recovered state during the follow up period (adjusted odds ratio 5.0; 95% confidence interval 1.7 to 14.5), were less likely to have had a continuous illness (0.3; 0.1 to 0.8), were less at risk of self harm (0.2; 0.1 to 0.8), and were less likely to have been prescribed antidepressant treatment (0.3; 0.1 to 0.9). There were no differences in hospital use, but the Afro-Caribbean group had more involuntary admissions (8.9; 2.1 to 35.6) and more imprisonments over the follow up period (9.2; 1.6 to 52.3).
Conclusions: Afro-Caribbean patients in the United Kingdom have a better outcome after psychiatric illness than do white people. The combination of high incidence and more benign course of illness of psychotic illness in this group may be due, at least in part, to a greater exposure to precipitants in the social environment.

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