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DSM-IV “Criterion A” Schizophrenia Symptoms Across Ethnically Different Populations: Evidence for Differing Psychotic Symptom Content or Structural Organization?

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Abstract

There is significant variation in the expression of schizophrenia across ethnically different populations, and the optimal structural and diagnostic representation of schizophrenia are contested. We contrasted both lifetime frequencies of DSM-IV criterion A (the core symptom criterion of the internationally recognized DSM classification system) symptoms and types/content of delusions and hallucinations in transethnic schizophrenia populations from Australia (n = 776), India (n = 504) and Sarawak, Malaysia (n = 259), to elucidate clinical heterogeneity. Differences in both criterion A symptom composition and symptom content were apparent. Indian individuals with schizophrenia reported negative symptoms more frequently than other sites, whereas individuals from Sarawak reported disorganized symptoms more frequently. Delusions of control and thought broadcast, insertion, or withdrawal were less frequent in Sarawak than Australia. Curiously, a subgroup of 20 Indian individuals with schizophrenia reported no lifetime delusions or hallucinations. These findings potentially challenge the long-held view in psychiatry that schizophrenia is fundamentally similar across cultural groups, with differences in only the content of psychotic symptoms, but equivalence in structural form.

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Acknowledgments

This work was supported by the Australian National Health and Medical Research Council (Grant numbers 339454, 143027, 9937625, 496698) and the United States National Institute of Mental Health (Grant number RO1 MH59588). We thank all participants and their families. We also acknowledge the contributions of: Deborah Nertney; Edward Jerah; SCARF, India; Sarawak Department of Health; University of Malaysia, Sarawak; the hospital and clinic staff in Kuching and Sri Aman; Queensland Health and the MGS Consortium.

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No conflicts declared.

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Authors and Affiliations

  1. Queensland Centre for Mental Health Research (Queensland Health), University of Queensland, Brisbane, QLD, Australia

    Duncan McLean

  2. Schizophrenia Research Foundation, Chennai, Tamil Nadu, India

    Rangaswamy Thara & Sujit John

  3. Department of Psychiatry, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia

    Robert Barrett

  4. Canberra Hospital, Canberra, ACT, Australia

    Peter Loa

  5. Queensland Brain Institute and Queensland Centre for Mental Health Research (Queensland Health), University of Queensland, Brisbane, QLD, Australia

    John McGrath & Bryan Mowry

  6. Queensland Centre for Mental Health Research, The Park – Centre for Mental Health, Locked Bag 500, Sumner Park BC, QLD, 4074, Australia

    Duncan McLean

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  1. Duncan McLean
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Correspondence to Duncan McLean.

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Robert Barrett is deceased.

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McLean, D., Thara, R., John, S. et al. DSM-IV “Criterion A” Schizophrenia Symptoms Across Ethnically Different Populations: Evidence for Differing Psychotic Symptom Content or Structural Organization?. Cult Med Psychiatry 38, 408–426 (2014). https://doi.org/10.1007/s11013-014-9385-8

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