A comparisaon of the incidence and characteristics of psychosis in Palermo and South London

Student thesis: Doctoral ThesisDoctor of Philosophy


There is consistent evidence that incidence rates of psychotic disorders
vary in different geographical areas. The variation of the distribution of a
disease can give clues to the role played by different risk factors.
In Italy there are only a few epidemiological studies on psychosis. In this
thesis I aimed to contribute by a) widening Italian epidemiological research
on the incidence of psychoses and b) investigating the role of some of the
putative risk factors associated with this group of disorders.
Results in this thesis are presented in two parts. The first part reports
incidence rates of psychoses in Palermo. I collected data on 204 first
episode psychosis patients, presenting to the mental health services, over
a period of 3 years in a well-defined catchment area of Palermo, Italy. I
carried out an incidence study and I calculated crude and adjusted
incidence rates of affective and non-affective psychoses. I compared the
Palermo incidence data I acquired with the existing UK data from the
AESOP study.
My findings were consistent with the literature indicating that there is an
increased risk for all psychotic disorders in males and in migrants.
Incidence rates of all psychoses in Palermo were lower than in UK except
for schizophrenia and the most striking difference was in the likelihood to
develop affective psychoses which was significantly greater in UK.
The second chapter of results describes the prevalence of some putative
risk factors associated with the development of psychotic disorders, such
as cannabis and other illicit drug consumption, family history of psychiatric
disorders and psychosis, childhood traumatic experiences, adult adverse
life events. I carried out a case control study on a subsample of 68 first
episode psychotic patients and a sample of 74 healthy controls
representative of the local population.
Family history for psychiatric disorders was more common among patients
than controls; cannabis consumption was higher among cases at the time
of assessment. Patients were more likely than healthy controls to have
started to smoke cannabis before 15 years of age, and to report a higher
frequency of use.
Some experiences (having been injured or assaulted, having experienced
having been expelled from school, running away from home, having been
forced into authority care) and physical and sexual abuse in childhood
were more common among cases than in controls.
Date of Award2015
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorRobin Murray (Supervisor)

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