AESOP-10 - The causes of ethnic differences in the course and outcome of psychosis

我们将解决英国精神卫生服务面临的两个最重要的问题。首先，在任何种族的人中，哪些因素会影响精神病发作后的康复？英国国民健康保险制度在早期治疗精神病患者方面投入了巨大的资金。然而，关于哪些因素促进或损害长期康复，以及哪些患者和哪些特征应该成为强化治疗的重点，人们知之甚少。其次，为什么居住在英国的非洲裔加勒比人和非洲黑人的精神病结果更差，法医单位的强制入院和拘留比白人更多？这一问题一直是许多争议的主题，并一再进行法定调查。不幸的是，由此产生的报告几乎没有什么改善，可能是因为缺乏确凿的证据来作为其建议的基础。我们希望在MRC的支持下，重新检查我们广泛调查的人，当时他们在10年前遭受了第一次精神病发作。我们将调查生物因素(如大脑、神经和神经心理异常)、社会因素(如童年逆境、成人社会排斥和歧视)以及持续使用大麻在决定精神病结果方面的作用，以及这些因素是否因种族而不同。通过这种方式，我们将阐明A)症状的严重性、神经心理障碍、社会逆境和大麻使用及其与基因构成的交互作用等因素是否可以预测样本中作为一个整体谁将康复；B)为什么黑人患者在法医单位强制入院和拘留的情况下预后更差。我们的发现将提高对精神病的理解，并将指出为一般精神病患者，特别是黑人患者开发更合适的服务的方法。

We will address two of the most important issues facing the UK mental health services. Firstly, what factors impair recovery following onset of psychosis in people of any ethnicity? The NHS has made a huge investment in units for the early treatment of individuals with their first episode of psychosis. However, little is known about which factors facilitate or impair long-term recovery, and therefore which patients and which characteristics should be the focus of intensive treatment. Secondly, why do African-Caribbean and Black African people living in the UK have a poorer outcome of psychosis with more compulsory admissions and detention in forensic units than White people? This issue has been the subject of much controversy and repeated statutory inquiries. Unfortunately the resultant reports have produced little improvement, probably because of the lack of hard evidence on which to base their recommendations.We wish to re-examine the 535 people whom we extensively investigated, with the support of the MRC, when they suffered their first episode of psychosis 10 years previously. We will investigate the role of biological factors (such as brain, neurological and neuropsychological abnormalities), social factors (such as childhood adversity, and adult social exclusion and discrimination), and continued cannabis use in determining the outcome of psychosis, and whether these factors differ by ethnicity. In this way, we will shed light on A) whether factors such as severity of symptoms, neuropsychological impairments, social adversity, and cannabis use and its interaction with genetic make-up, can predict who will recover in the sample as a whole; B) why Black patients have a worse outcome with more compulsory admissions and detentions in forensic units. Our findings will improve understanding of psychosis, and will point to ways of developing more appropriate services for psychotic patients in general and Black patients in particular.