CLINICAL HANDBOOK OF SCHIZOPHRENIA

618 VIII. SPECIAL TOPICSTABLE 60.1. Reports Comparing Rates of Schizophrenia by RaceReference Results SettingDelbello et al. (2001) African Americans are more likely to bediagnosed with schizophrenia thanEuropean Americans.Inpatient adolescent facilityBlow et al. (2004)Barnes (2004)Neighbors et al. (2003)Strakowski et al. (2003)Minsky et al. (2003)African Americans are four times morelikely to be diagnosed with schizophreniathan European Americans.African Americans are four times morelikely to be diagnosed with schizophreniathan European Americans.African Americans are more likely to bediagnosed with schizophrenia thanEuropean Americans when semistructuredinterviews are used.African Americans are more likely to bediagnosed with schizophrenia thanEuropean Americans despite use ofstructured interviews.African Americans are more likely thanLatinos or European Americans to bediagnosed with schizophrenia.Veterans AdministrationdatabaseState psychiatric hospitalsPrivate and public inpatientfacilitiesInpatient, outpatient countymental health systemBehavioral health servicesystem in New JerseySeveral studies have reported putative gene associations for African Americans whenfindings in other ethnic groups have been negative. Polymorphisms of the synapsin IIIand NOTCH 4 genes were associated with schizophrenia in African Americans but notEuropean Americans. One possibility is that schizophrenia may have a different geneticetiology in African Americans. A more likely explanation is that individuals of Africanancestry have older genetic variations, since they have ancestry genes and greaterhaplotype diversity. As a result, genetic differences that may exist are easily identified.The Caspi Study reminded us that for psychiatric disorders, genes should only beconsidered in the context of environmental factors. In that study, major depression wasassociated with the number of lifetime episodes of childhood abuse, but only in the presenceof a certain allele of the serotonin receptor. Family members often ask about theirrisk for schizophrenia. A simple statement of known risk could be misinterpreted. It isalso important to inform families that ethnicity probably does not increase risk, and thatfamily environment does not cause schizophrenia. Nevertheless, risk is not conferred bygenetic factors alone. Environment, in a broad sense, is also important.SOCIOCULTURAL FACTORSAfrican American families face the challenge of having limited resources. The direct costsof schizophrenia often exceed the median family income of African Americans. Moreover,African Americans are more likely to believe that mentally ill individuals are violent.Yet African American families are more likely to retain schizophrenic members in theirmidst despite limited resources. Part of the reason is that African Americans are more tolerantof the often unconventional and unpredictable behavior of a family member withschizophrenia. African Americans are less likely than European Americans to believe that