Ethnic minority position and migrant status as risk factors for psychotic symptoms in the general population: a meta-analysis.

Psychotic symptoms (PS) are experienced by a substantial proportion of the general population. When not reaching a threshold of clinical relevance, these symptoms are defined as psychotic experiences (PEs) and may exist on a continuum with psychotic disorders. Unfavorable socio-environmental conditions, such as ethnic minority position (EMP) and migrant status (MS), may increase the risk of developing PS and PEs. We conducted an electronic systematic review and a meta-analysis assessing the role of EMP and MS for the development and persistence of PS in the general population. Sub-group analyses were performed investigating the influence of ethnic groups, host countries, age, types of PS, and scales. Twenty-four studies met our inclusion criteria. EMP was a relevant risk factor for reporting PS [odds ratio (OR) 1.44, 95% confidence interval (CI) 1.22-1.70) and PEs (OR 1.36, 95% CI 1.16-1.60). The greatest risk was observed in people from the Maghreb and the Middle East ethnic groups in Europe (OR 3.30, 95% CI 2.09-5.21), in Hispanic in the USA (OR 1.98, 95% CI 1.43-2.73), and in the Black populations (OR 1.85, 95% CI 1.39-2.47). We found a significant association between MS and delusional symptoms (OR 1.47, 95% CI 1.33-1.62). We found no association between EMP and persistence of PEs.EMP was associated with increased risk of reporting PS and PEs, and the risk was higher in ethnic groups facing deprivation and discrimination. We found an association between MS and delusional symptoms. These results raise questions about the precise role of socio-environmental factors along the psychosis continuum.

Dreaming without REM sleep.

To test whether mental activities collected from non-REM sleep are influenced by REM sleep, we suppressed REM sleep using clomipramine 50mg (an antidepressant) or placebo in the evening, in a double blind cross-over design, in 11 healthy young men. Subjects were awakened every hour and asked about their mental activity. The marked (81%, range 39-98%) REM-sleep suppression induced by clomipramine did not substantially affect any aspects of dream recall (report length, complexity, bizarreness, pleasantness and self-perception of dream or thought-like mentation). Since long, complex and bizarre dreams persist even after suppressing REM sleep either partially or totally, it suggests that the generation of mental activity during sleep is independent of sleep stage.

Valproate-induced hyperammonaemic encephalopathy: review of 14 cases in the psychiatric setting.

OBJECTIVES: To review signs and symptoms of valproate-induced hyperammonaemic encephalopathy without hepatotoxicity in the psychiatric setting, explore its mechanisms, and give recommendations for prevention and treatment. METHODS: Medline search with keywords valproate, ammonia, hyperammonaemia, encephalopathy, and then cross-references to articles obtained through this search. Only cases with indication of valproate for psychiatric condition were included. RESULTS: Fourteen cases published in the psychiatric setting are reviewed. Valproate-induced hyperammonaemic encephalopathy is a rare adverse event, occurring almost equally in men and women, with a large age range, and reported in two patients with mental retardation. Symptoms appeared either a few days after initiation of valproate therapy, or after several months or years. The main symptoms were fluctuations in consciousness and disorientation. Clinical severity was not related to blood ammonia levels. All patients recovered after valproate-induced hyperammonaemic encephalopathy diagnosis and treatment, usually involving discontinuation of valproate. CONCLUSIONS: Valproate-induced hyperammonaemic encephalopathy is rare and usually reversible in patients without urea cycle disorders when valproate is discontinued. Therapy with carnitine is recommended. Special caution should be used in patients with mental retardation. Psychiatrists should suspect valproate-induced hyperammonaemic encephalopathy when consciousness deteriorates.

Are the rates of schizophrenia unusually high in Canada? A comparison of Canadian and international data.

Two major risk factors for schizophrenia are present in Canada, high latitude and a large and growing immigrant population. Consequently, one would expect unusually high rates of schizophrenia and an increase in these rates over time. This systematic review tests these two hypotheses. Searches of electronic databases were performed through 2011. Out of 45 studies 12 fulfilled all the inclusion criteria. The means of Canadian and international rates were compared by one-tailed unequal variance t-test. Trends with time in Canadian rates were tested by the Spearman rank correlation coefficient. Prevalence and incidence rates in Canada were significantly higher than those in international studies. Rates increased over time, with a significant increase for prevalence and a trend for incidence. This rise was supported by historical data, recent hospital admission data, and the only Canadian cohort study. The findings of elevated rates in Canada and their increase over time give concern due to the serious personal, social, and financial burden of schizophrenia. These results, based on a small number of studies, warrant confirmation by specially designed studies. They could explain the discrepant results of the risk associated with immigration in Canadian studies.

Symptoms of schizophrenia and psychosis according to foreign birth in a Canadian sample of homeless persons.

OBJECTIVE: The objective of the study was to examine the relationship between foreign birth and symptoms of schizophrenia and psychosis in a clinical sample of homeless persons. METHODS: All the charts documented between 2002 and 2007 by a psychiatric outreach team in Ottawa, Canada, were retrospectively reviewed regarding country of birth and psychiatric symptoms identified in a clinical assessment. Data were analyzed by univariate and multivariate logistic regressions. RESULTS: The sample included 552 men and 333 women with data on psychiatric symptoms and country of birth. A total of 106 individuals (12%) were born outside of Canada. This proportion was lower than that observed in the general population of Ottawa or in Canada. Foreign-born individuals were older and had a higher level of education than Canadian-born individuals. Sixteen percent of the sample presented symptoms of schizophrenia, and 15% presented symptoms of psychosis other than schizophrenia. In univariate analyses persons presenting symptoms of schizophrenia or psychosis were more likely to be foreign-born than native-born (odds ratio [OR]=2.92, 95% confidence interval [CI]=1.74-4.90, and OR=4.79, CI=2.92-7.86, respectively). Multivariate analyses gave very similar results (OR=2.62, CI=1.50-4.58, and OR=4.14, CI=2.44-7.03, respectively). A positive trend or significant association was observed for all regions of origin other than the non-Caribbean Americas. CONCLUSIONS: This is the first study to report an association between foreign birth and symptoms of schizophrenia and psychosis among homeless persons. These findings are consistent with the increased risk of schizophrenia and psychosis observed among immigrants to European countries.

Catatonia is frequent in black immigrants admitted to Psychiatry in Canada.

Objective. To assess the prevalence of catatonia in a sample of patients of African ancestry admitted to Psychiatry in Canada. Methods. Retrospective chart review of 20 consecutive black francophone inpatients assessed by the same psychiatrist. Results. The sample consisted of 12 men and eight women aged 17-59 years. Catatonic symptoms were prominent in 30% of this small sample (n=6), more frequent than the 9% reported in a Canadian general psychiatry population of 140 inpatients (P=0.0126). Conclusions. This finding is limited by the small sample size and the provenance from troubled countries for most of the patients. It is consistent with earlier reports of a higher prevalence of catatonia in nonwhite subjects and among immigrants coming from developing countries, and stresses the importance of systematically assessing catatonia in clinical settings. Further research is warranted to distinguish between the effects of ethnic origin and immigrant status and to determine if the increased prevalence of catatonia is related to neurobiological causes such as maternal gestational infections or to socio-cultural factors.

Homicidal ideation with intent during a manic episode triggered by antidepressant medication in a man with brain injury.

BACKGROUND: Mood disorders are more frequent after brain injury and both depressive and manic episodes are associated in these patients with an increased risk of aggression. Antidepressant medications are associated with a risk of manic induction. CASE REPORT: We describe a case of homicidal ideation with intent during the onset of a manic episode in a patient with prior brain injury on antidepressant medication at low dosage. The manic episode could have been secondary to brain injury and/or triggered by antidepressant medications. This case raises the possibility of the sensitizing role of brain injury for antidepressant-induced mania. CONCLUSIONS: Further studies are needed to assess the role of brain injury as a risk factor for antidepressant-induced mania. Physicians should be cautious when prescribing antidepressants to patients with prior brain injury and inform them and their relatives of the possibility of a switch into mania.