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First-episode psychosis at the West Bologna Community Mental Health Centre: results of an 8-year prospective study

Published online by Cambridge University Press:  07 March 2012

I. Tarricone*
Affiliation:
Institute of Psychiatry, Bologna University, Italy West Bologna Mental Health Department, AUSL Bologna, Italy
S. Mimmi
Affiliation:
Public Health Department, Bologna University, Italy
A. Paparelli
Affiliation:
Institute of Psychiatry, King's College London, UK
E. Rossi
Affiliation:
Institute of Psychiatry, Bologna University, Italy
E. Mori
Affiliation:
Institute of Psychiatry, Bologna University, Italy
S. Panigada
Affiliation:
Institute of Psychiatry, Bologna University, Italy
G. Carchia
Affiliation:
Institute of Psychiatry, Bologna University, Italy
V. Bandieri
Affiliation:
Institute of Psychiatry, Bologna University, Italy
R. Michetti
Affiliation:
West Bologna Mental Health Department, AUSL Bologna, Italy
G. Minenna
Affiliation:
West Bologna Mental Health Department, AUSL Bologna, Italy
J. Boydell
Affiliation:
Institute of Psychiatry, King's College London, UK
C. Morgan
Affiliation:
Institute of Psychiatry, King's College London, UK
D. Berardi
Affiliation:
Institute of Psychiatry, Bologna University, Italy West Bologna Mental Health Department, AUSL Bologna, Italy
*
*Address for correspondence: Dr I. Tarricone, Institute of Psychiatry, Bologna University, Viale Pepoli 5, 40123 Bologna, Italy. (Email: [email protected])

Abstract

Background

Research mostly conducted in the UK and northern Europe has established that there are high rates of first-episode psychosis (FEP) in large cities and immigrant populations; moreover, psychosis has been found to be associated with cannabis use and early trauma. The present study aimed to evaluate the incidence rate of FEP and the distribution of several risk factors (e.g. age, ethnicity, substance abuse) in Bologna, Italy.

Method

The Bologna FEP (BoFEP) study is an 8-year prospective study. All FEP patients, 18–64 years old, consecutively referred to the West Bologna Community Mental Health Centre (CMHC) from 2002 to 2009 were evaluated. Sociodemographic information, migration history and clinical data were collected through an ad-hoc schedule. Psychiatric diagnoses were recorded using the Schedule for Clinical Assessment of Neuropsychiatry (SCAN).

Results

The overall incidence rate (IR) in the BoFEP study was 16.4 per 100 000 person-years [95% confidence interval (CI) 13.9–18.9]. The incidence was higher in young people, men and migrants (MI).

Conclusions

The IR of FEP found by the Bologna study is lower than that found by other European studies. However, as in other studies, the incidence was higher in certain groups. This heterogeneity has implications for policy and mental health service development, and for understanding the aetiology of psychosis.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2012

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References

Aleman, A, Kahn, RS, Selten, JP (2003). Sex differences in the risk of schizophrenia: evidence from meta-analysis. Archives of General Psychiatry 60, 565571.CrossRefGoogle ScholarPubMed
Arsenault, L, Cannon, M, Poulton, R, Murray, R, Caspi, A (2002). Cannabis use in adolescence and risk for adult psychosis: longitudinal prospective study. British Medical Journal 325, 12121213.CrossRefGoogle Scholar
Berardi, D, Leggieri, G, Menchetti, M, Ferrari, G (1999). Collaboration between mental health services and primary care: the Bologna Project. Primary Care Companion to the Journal of Clinical Psychiatry 1, 180183.Google ScholarPubMed
Bourque, F, van der Ven, E, Malla, A (2011). A meta-analysis of the risk for psychotic disorders among first- and second-generation immigrants. Psychological Medicine 4, 897910.CrossRefGoogle Scholar
Boydell, J, van Os, J, Lambri, M, Castle, D, Allardyce, J, Murray, RM (2003). Incidence of schizophrenia in south-east London between 1965 and 1997. British Journal of Psychiatry 182, 4549.CrossRefGoogle ScholarPubMed
Broome, MR, Woolley, JB, Tabraham, P, Johns, LC, Bramon, E, Murray, GK, Pariante, C, McGuire, PK, Murray, RM (2005). What causes the onset of psychosis? Schizophrenia Research 79, 2334.CrossRefGoogle ScholarPubMed
Brown, AS, Begg, MD, Gravenstein, S, Schaefer, CA, Wyatt, RJ, Bresnahan, M, Babulas, VP, Susser, ES (2004). Serologic evidence of prenatal influenza in the etiology of schizophrenia. Archives of General Psychiatry 61, 774780.CrossRefGoogle ScholarPubMed
Cantor-Graae, E, Selten, JP (2005). Schizophrenia and migration: a meta-analysis and review. American Journal of Psychiatry 162, 1224.CrossRefGoogle ScholarPubMed
Cheng, F, Kirkbride, JB, Lennox, BR, Perez, J, Masson, K, Lawrence, K, Hill, K, Feeley, L, Painter, M, Murray, GK, Gallagher, O, Bullmore, ET, Jones, PB (2011). Administrative incidence of psychosis assessed in an early intervention service in England: first epidemiological evidence from a diverse, rural and urban setting. Psychological Medicine 41, 949958.CrossRefGoogle Scholar
Coid, JW, Kirkbride, JB, Barker, D, Cowden, F, Stamps, R, Yang, M, Jones, PB (2008). Raised incidence rates of all psychoses among migrant groups: findings from the East London first episode psychosis study. Archives of General Psychiatry 65, 12501258.CrossRefGoogle ScholarPubMed
Cooper, JE, Goodhead, D, Craig, T, Harris, M, Howat, J, Korer, J (1987). The incidence of schizophrenia in Nottingham. British Journal of Psychiatry 151, 619626.CrossRefGoogle ScholarPubMed
Di Forti, M, Morgan, C, Dazzan, P, Pariante, C, Mondelli, V, Marques, TR, Handley, R, Luzi, S, Russo, M, Paparelli, A, Butt, A, Stilo, SA, Wiffen, B, Powell, J, Murray, RM (2009). High-potency cannabis and the risk of psychosis. British Journal of Psychiatry 195, 488491.CrossRefGoogle ScholarPubMed
Department of Anti-drug Policy (2010). Yearly report to Parliament on the use of drugs and the status of drug addictions in Italy. Report 2010. Data for the year 2009–2010.Google Scholar
Fearon, P, Kirkbride, JB, Morgan, C, Dazzan, P, Morgan, K, Lloyd, T, Hutchinson, G, Tarrant, J, Fung, WL, Holloway, J, Mallett, R, Harrison, G, Leff, J, Jones, PB, Murray, RM; AESOP Study Group (2006). Incidence of schizophrenia and other psychoses in ethnic minority groups: results from the MRC AESOP Study. Psychological Medicine 36, 15411550.CrossRefGoogle ScholarPubMed
Häfner, H, Riecher-Rössler, A, an der Heiden, W, Maurer, K, Fätkenheuer, B, Löffler, W (1993). Generating and testing a causal explanation of the gender difference in age at first onset of schizophrenia. Psychological Medicine 23, 925940.CrossRefGoogle ScholarPubMed
Jablensky, A, Sartorius, N, Ernberg, G, Anker, M, Korten, A, Cooper, JE, Day, R, Bertelsen, A (1992). Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study. Psychological Medicine. Monograph Supplement 20, 197.CrossRefGoogle ScholarPubMed
Kirkbride, JB, Boydell, J, Ploubidis, GB, Morgan, C, Dazzan, P, McKenzie, K, Murray, RM, Jones, PB (2008). Testing the association between the incidence of schizophrenia and social capital in an urban area. Psychological Medicine 38, 10831094.CrossRefGoogle Scholar
Kirkbride, JB, Fearon, P, Morgan, C, Tarrant, J, Lloyd, T, Holloway, J, Hutchinson, G, Leff, JP, Mallet, RM, Harrison, GL, Murray, RM, Jones, PB (2006). Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3-center AESOP Study. Archives of General Psychiatry 63, 250258.CrossRefGoogle ScholarPubMed
Kirkbride, JB, Scoriels, L (2009). Review of the 6th symposium for the search for the causes of schizophrenia, Sao Paulo, Brazil, 3-6 February 2009. European Archives of Psychiatry and Clinical Neuroscience 259, 505509.CrossRefGoogle Scholar
Lao, TS, Sundquist, J, Frank, G, Johansson, LM, Johansson, SE, Sundquist, K (2006). Incidence of schizophrenia or other psychoses in first- and second-generation immigrants: a National Cohort Study. Journal of Nervous and Mental Disease 194, 2733.CrossRefGoogle Scholar
Large, M, Sharma, S, Compton, MT, Slade, T, Nielssen, O (2011). Cannabis use and earlier onset of psychosis: a systematic meta-analysis. Archives of General Psychiatry 68, 555561.CrossRefGoogle ScholarPubMed
McGorry, PD, Purcell, R, Goldstone, S, Amminger, GP (2011). Age of onset and timing of treatment for mental and substance use disorders: implications for preventive intervention strategies and models of care. Current Opinion in Psychiatry 24, 301306.CrossRefGoogle ScholarPubMed
McGrath, J, Saari, K, Hakko, H, Jokelainen, J, Jones, P, Järvelin, MR, Chant, D, Isohanni, M (2004 b). Vitamin D supplementation during the first year of life and risk of schizophrenia: a Finnish birth cohort study. Schizophrenia Research 67, 237245.CrossRefGoogle ScholarPubMed
McGrath, J, Saha, S, Welham, J, El Saadi, O, MacCauley, C, Chant, D (2004 a). A systematic review of the incidence of schizophrenia: the distribution of rates and the influence of sex, urbanicity, migrant status and methodology. BMC Medicine 2, 13.CrossRefGoogle ScholarPubMed
Menezes, PR, Scazufca, M, Busatto, G, Coutinho, LM, McGuire, PK, Murray, RM (2007). Incidence of first-contact psychosis in São Paulo, Brazil. British Journal of Psychiatry 191 (Suppl. 51), s102s106.CrossRefGoogle Scholar
Morgan, C, Burns, T, Fitzpatrick, R, Pinfold, V, Priebe, S (2007). Social exclusion and mental health (conceptual and methodological review). British Journal of Psychiatry 191, 477483.CrossRefGoogle ScholarPubMed
Morgan, C, Charalambides, M, Hutchinson, G, Murray, RM (2010). Migration, ethnicity, and psychosis: toward a sociodevelopmental model. Schizophrenia Bulletin 36, 655664.CrossRefGoogle Scholar
Morgan, C, Dazzan, P, Morgan, K, Jones, P, Harrison, G, Leff, J, Murray, R, Fearon, P; AESOP study group (2006). First episode psychosis and ethnicity: initial findings from the AESOP study. World Psychiatry 5, 4046.Google ScholarPubMed
Morgan, C, Fisher, H (2007). Environment and schizophrenia: environmental factors in schizophrenia: childhood trauma – a critical review. Schizophrenia Bulletin 33, 3–10.CrossRefGoogle ScholarPubMed
Mortensen, PB, Pedersen, CB, Westergaard, T, Wohlfahrt, J, Ewald, H, Mors, O, Andersen, PK, Melbye, M (1999). Effects of family history and place and season of birth on the risk of schizophrenia. New England Journal of Medicine 340, 603608.CrossRefGoogle ScholarPubMed
Pedersen, CB, Mortensen, PB (2001). Evidence of a dose-response relationship between urbanicity during upbringing and schizophrenia risk. Archives of General Psychiatry 58, 10391046.CrossRefGoogle ScholarPubMed
Preti, A, Miotto, P (2000). Increase in first admissions for schizophrenia and other major psychoses in Italy. Psychiatry Research 94, 139152.CrossRefGoogle ScholarPubMed
Province of Bologna (2007). Report on the labour market, 1st Semester, 2007 (www.provincia.bologna.it/probo/Engine/RAServePG.php). Accessed 5 August 2011.Google Scholar
Thornicroft, G, Bisoffi, G, De Salvia, D, Tansella, M (1993). Urban-rural differences in the associations between social deprivation and psychiatric service utilization in schizophrenia and all diagnoses: a case-register study in Northern Italy. Psychological Medicine 23, 487496.CrossRefGoogle ScholarPubMed
UN (1980). Social and Demographic Statistics: Classifications of Size and Type of Locality and Urban/Rural Areas. E/CN.3/551. United Nations: New York.Google Scholar
van Os, J, Bak, M, Hanssen, M, Bijl, RV, De Graaf, R, Verdoux, H (2002). Cannabis use and psychosis: a longitudinal population-based study. American Journal of Epidemiology 156, 319327.CrossRefGoogle ScholarPubMed
van Os, J, Kenis, G, Rutten, BP (2010). The environment and schizophrenia. Nature 468, 203212.CrossRefGoogle ScholarPubMed
van Os, J, Rutten, BP, Poulton, R (2008). Gene-environment interactions in schizophrenia: review of epidemiological findings and future directions. Schizophrenia Bulletin 34, 10661082.CrossRefGoogle ScholarPubMed
Veling, W, Selten, JP, Veen, N, Laan, W, Blom, JD, Hoek, HW (2006). Incidence of schizophrenia among ethnic minorities in the Netherlands: a four-year first-contact study. Schizophrenia Research 86, 189193.CrossRefGoogle ScholarPubMed
WHO (1998). Schedules for Clinical Assessment in Neuropsychiatry Version 2.1 (SCAN-2.1). Division of Mental Health, World Health Organization: Geneva, Switzerland.Google Scholar