Objective: To investigate whether schizophrenia manifests itself differently in Xhosa-speaking South Africans, compared with English-speaking white South Africans.
Design: A comparative study of the presentation of schizophrenia in two groups of patients.
Settings and subjects: A sample of 63 patients (43 Xhosa-speaking and 20 English-speaking) admitted to a large psychiatric hospital for the first time with a diagnosis of schizophrenia.
Outcome measures: The Present State Examination (PSE) was used to confirm the clinical diagnosis of schizophrenia. The Relatives' Rating of Symptoms and Social Behaviour (KAS-R) was used to obtain information on the behavioural and emotional expression of schizophrenia.
Results: A significantly higher prevalence of aggressive and disruptive behaviour was reported by relatives of Xhosa-speaking patients with schizophrenia of recent onset compared with English-speaking patients. The PSE elicited significantly more delusions of persecution, sexual and fantastic delusions, self-neglect and irritability in the Xhosa-speaking patients.
Conclusion: Significant differences in the presentation of schizophrenia, but not its core symptoms, were identified in Xhosa-speaking blacks and English-speaking whites.