First-episode psychosis in the ultra-Orthodox Jewish population

Few if any methodologically robust studies of first-episode psychosis have been carried out in the ultra-Orthodox Jewish population. The opening of an inpatient psychiatry department within an ultra-Orthodox neighborhood in Israel offered the unique opportunity to study the specifics of first -episode psychosis in this subpopulation. Medical records of 60 ultra-Orthodox male Jewish patients with first-episode psychosis were examined over the first 18 months of the new department's operation. Data regarding the patients' demographical status, anamnestic information, clinical presentation, and psychiatric care were analyzed. Participants were 18-30 years old; 15 (25%) were already engaged or married. Most patients (37, 61.7%) had not been employed in any formal activity prior to their hospitalization, with 21 patients (35%) studying in a Talmudical school. Religion-related delusions were noted in 20 patients (33.3%), and community/rabbi-related delusions in 18 patients (30%). Only three patients (5%) reported suicidal attempts. Duration of untreated psychosis (DUP) ranged between 1-48 months (mean 10.4, SD 9.5). In contrast to other first-episode psychosis studies, this study highlights specific features of first-episode psychosis in the ultra-Orthodox Jewish population, which is characterized by a high marriage rate, short DUP, low rates of substance use and suicidal attempts, expression of religious- and community-related themes in delusion content, and limited cooperation with health care providers. A better understanding of the cultural specifics of first-episode psychosis in this subpopulation may enable earlier treatment, improve prognosis, and facilitate compliance with medications and rehabilitation programs.