Racial discrimination is associated with distressing subthreshold positive psychotic symptoms among US urban ethnic minority young adults.

BACKGROUND: Racial discrimination is related to depression, anxiety, and severe psychological distress, and evidence drawn from studies emanating from the United Kingdom and The Netherlands suggest racial discrimination is also related to clinical psychosis and subthreshold psychotic symptoms in racial and ethnic minority (REM) populations. The present study sought to determine the association between racial discrimination experiences and attenuated positive psychotic symptoms (APPS) in a United States (US) urban, predominantly immigrant and REM young adult population. METHODS: A cohort of 650 young adults was administered a self-report inventory for psychosis risk [i.e., Prodromal Questionnaire (PQ)], and the Experiences of Discrimination Questionnaire. The PQ allowed the dimensional assessment of APPS, as well as the categorical assessment of a potentially "high risk" group (i.e., 8 or more APPS endorsed as distressing), the latter of which was based on previous validation studies using the structured interview for prodromal syndromes. The relations between self-reported racial discrimination and APPS, and racial discrimination and "high" distressing positive PQ endorsement were determined, while accounting for anxiety and depression symptoms. RESULTS: Racial discrimination was significantly associated with APPS and with significantly higher odds of endorsing eight or more distressing APPS, even after adjusting for anxiety and depression symptoms. CONCLUSION: The present study provides preliminary evidence that racial discrimination among US ethnic minorities may be associated with APPS, as well as potentially higher risk for psychosis.

Isolating cognitive and neurologic HIV effects in substance-dependent, confounded cohorts: a pilot study.

Controversy exists as to whether effects of HIV infection can be detected in the cognitive profiles of substance users, with methodological differences in degree of control for confounding factors a major contributor to empirical discrepancies. To address this shortcoming, we conducted a small but well-controlled study aimed at isolating HIV neurocognitive (NC) effects in a group of chronic substance users. Thirty HIV-negative substance users were individually matched to 30 HIV-positive substance users on relevant medical and demographic factors, including reading level and methadone therapy status. Results revealed that reading level, methadone maintenance therapy, and positive urine toxicology each exerted significant influence on NC function, and that HIV status was a significant predictor of learning and speeded processing after these control factors were considered. The HIV-positive group also displayed significantly more neurologically assessed motor impairment (p < .05), which was specifically related to impaired cognition in this group and independent of degree of immunocompromise. These data demonstrate the need for increased attention to clinical/demographic characteristics of groups under study. They also show that with applied methodological rigor, the deleterious effects of HIV on cognition can be parsed from substance use, even in small samples with chronic and active use histories.

Race-based rejection sensitivity partially accounts for the relationship between racial discrimination and distressing attenuated positive psychotic symptoms.

AIM: Self-reported experiences of racial discrimination have been associated with a continuum of psychotic experiences in racial and ethnic minority populations; however, the underlying mechanisms of this relationship are not yet clear. Race-based rejection sensitivity (RS-race) has been associated with thought intrusions about being the target of racial discrimination; therefore, the present study aimed to determine whether RS-race accounts for the relationship between racial discrimination and psychotic-like experiences in racial and ethnic minority populations. METHODS: A sample of 644 young adults from a US urban, predominantly immigrant, and racial and ethnic minority population was administered a self-report inventory of psychosis risk (i.e. Prodromal Questionnaire (PQ) ), providing a dimensional assessment of the total number of attenuated positive psychotic symptoms experienced as distressing (APPS-distress). Participants also completed the Experiences of Discrimination Questionnaire and the Rejection Sensitivity Questionnaire-Race. RESULTS: Hierarchical linear regression analyses revealed that RS-race and racial discrimination were both significantly related to higher levels of APPS-distress. Bootstrapping analyses of indirect effects indicated that RS-race partially accounted for the relationship between racial discrimination and APPS-distress. CONCLUSION: Although the cross-sectional nature of the data limits conclusions about causal inference, our findings do suggest that racial discrimination and RS-race may both be important for understanding risk for distress in the psychotic spectrum among racial and ethnic minority young adults. Some individuals who report racial discrimination may be more vulnerable to APPS-distress in part because they are anxiously anticipating being racially slighted, and this should be explored further in prospective clinical high-risk studies.

Spontaneous labelling and stigma associated with clinical characteristics of peers 'at-risk' for psychosis.

AIM: The public health benefits of utilizing an 'at-risk for psychosis' designation are tempered by concerns about stigma. It is therefore of interest to examine whether symptoms associated with this designation might spontaneously induce labels associated with a psychotic disorder, other non-psychotic disorders or non-psychiatric labels. This pilot study explored the labels associated with characteristics of 'high risk for psychosis' and the corresponding stigma level. METHODS: A vignette describing an identical character, followed by a series of questions about stigmatizing attitudes towards the vignette character, was administered in the present investigation. RESULTS: The results indicated that even though most young people (59%) did not spontaneously label the vignette character with psychotic-like diagnostic labels, the single most frequent label provided was 'paranoid/a'. When such labelling, that is, strongly tied to psychosis, occurred, respondents exhibited stronger stigmatizing attributions of fear compared to those indicating non-psychiatric labels (e.g. 'weird'). CONCLUSIONS: These results suggest that the majority of respondents did not endorse diagnostic labels spontaneously, thus signaling that stigma in the majority of cases would not naturalistically be elicited. However, a segment of respondents evidenced stigma simply from behavioural changes manifested by individuals exhibiting signs of psychosis, independent of diagnosis. Implications for reducing any stigma associated with an 'at-risk for psychosis' designation are discussed.

Discrimination, arrest history, and major depressive disorder in the U.S. Black population.

Everyday discrimination contributes negatively to depressive symptomatology among Blacks in the US and being arrested could add to this depression. Using data from the National Survey on American Life, the present study determined the association between an arrest history and major depressive disorder (MDD), while accounting for discrimination among African Americans, US-born Afro-Caribbeans and first-generation Black immigrants. Findings from logistic regression analyses adjusted for discrimination suggested an arrest history is associated with 12-month MDD (Adjusted OR=1.47; 95% CI=1.02-2.10) and lifetime MDD (Adjusted OR=1.56 CI=1.17-2.09). Accounting for drug and alcohol dependence attenuated the association between arrest history and 12-month MDD, but not lifetime MDD. The associations between arrest history and both 12-month and lifetime MDD, and discrimination and lifetime MDD varied by ethnic/immigrant group. Specifically, while the association between arrest history and MDD (both 12-month and lifetime) was strongest among US-born Afro-Caribbeans, evidence consistent with the immigrant paradox, the association between discrimination and lifetime MDD was particularly relevant for first-generation Black immigrants, suggesting discrimination may hinder the protection of first-generation status. Mental health prevention and treatment programs should target the stress associated with being arrested and experiencing discrimination among US Blacks.

Early cannabis use and schizotypal personality disorder symptoms from adolescence to middle adulthood.

BACKGROUND: While increasing evidence suggests that cannabis use may play a role in the development of schizophrenia in some young people, less is known about the strength and specificity of its relationship to latent schizophrenia liability, i.e., schizotypal personality disorder traits. AIMS: Determine the predictive value of cannabis use during childhood and early adolescence on schizotypal personality disorder (SPD) symptoms projecting into adulthood, using a community-based longitudinal cohort from upstate New York. METHOD: Prospective data from 804 participants was used to determine associations between early cannabis use and later schizotypal symptoms, accounting for important potential confounds (e.g., adolescent schizotypal symptoms). RESULTS: Cannabis use with onset prior to age 14 strongly predicted SPD symptoms in adulthood, independent of early adolescent SPD symptoms, major depression, anxiety disorder, other drug use, and cigarette use. There was no interaction effect of early cannabis use and early adolescent SPD symptoms on SPD symptoms into adulthood. CONCLUSIONS: Our data provide further support for a strong association of early cannabis use with the development of symptoms characteristic of schizophrenia spectrum disorders. As with studies in schizophrenia, early SPD symptoms could not fully explain the association of early cannabis use with later schizotypal symptoms. The mechanisms that underlie the association of cannabis use and schizotypal symptoms in a developmental context deserve further exploration.