Illness recognition and disruptiveness in psychotic illness

A case control investigation was performed to examine the relatively high rate of unrecognized psychotic illness within an extended family with a high-density of psychotic illness and identify factors related to nonrecognition. The study was conducted within the catchment area of a Regional Mental Health Center in central Israel. Subjects were recruited using clinic records indicating multiple family members with mental illness. Additional subjects were recruited in the homes of the subjects through family members. A total of 247 subjects were recruited, 111 of whom were determined to suffer from a psychotic disorder based on criteria in standard use. Sixty-six subjects were members of a single extended family (clan) and 181 subjects were members of nonrelated families residing in the same geographic area. While the rate of unrecognized psychotic illness was insignificant among the members of the families not related to the clan, among clan members the rate of unrecognized psychotic illness was 45%. Among this clan, recognition of psychotic illness appeared to be directly related to disruptive behavior. Additionally, it was found that, overall, subjects were more likely to recognized by the mental health system if they had fewer ill family members and more education. We conclude that although nonrecognition of mental illness does not appear to be a problem among the families in the area who are not related to the particular clan, within the clan a particular subculture appears to have developed in which perceived need for psychiatric services is related to disruptive behavior. A high density of psychotic illness within a family and less education may create a family environment that becomes tolerant of psychotic symptoms that are not disruptive to others, resulting in nonrecognition of nondisruptive illness by the mental health system.