Skip to main content

First-episode psychosis at the West Bologna Community Mental Health Centre: results of an 8-year prospective study

  • I. Tarricone (a1) (a2), S. Mimmi (a3), A. Paparelli (a4), E. Rossi (a1), E. Mori (a1), S. Panigada (a1), G. Carchia (a1), V. Bandieri (a1), R. Michetti (a2), G. Minenna (a2), J. Boydell (a4), C. Morgan (a4) and D. Berardi (a1) (a2)...

Research mostly conducted in the UK and northern Europe has established that there are high rates of first-episode psychosis (FEP) in large cities and immigrant populations; moreover, psychosis has been found to be associated with cannabis use and early trauma. The present study aimed to evaluate the incidence rate of FEP and the distribution of several risk factors (e.g. age, ethnicity, substance abuse) in Bologna, Italy.


The Bologna FEP (BoFEP) study is an 8-year prospective study. All FEP patients, 18–64 years old, consecutively referred to the West Bologna Community Mental Health Centre (CMHC) from 2002 to 2009 were evaluated. Sociodemographic information, migration history and clinical data were collected through an ad-hoc schedule. Psychiatric diagnoses were recorded using the Schedule for Clinical Assessment of Neuropsychiatry (SCAN).


The overall incidence rate (IR) in the BoFEP study was 16.4 per 100 000 person-years [95% confidence interval (CI) 13.9–18.9]. The incidence was higher in young people, men and migrants (MI).


The IR of FEP found by the Bologna study is lower than that found by other European studies. However, as in other studies, the incidence was higher in certain groups. This heterogeneity has implications for policy and mental health service development, and for understanding the aetiology of psychosis.

Corresponding author
*Address for correspondence: Dr I. Tarricone, Institute of Psychiatry, Bologna University, Viale Pepoli 5, 40123 Bologna, Italy. (Email:
Hide All
Aleman A, Kahn RS, Selten JP (2003). Sex differences in the risk of schizophrenia: evidence from meta-analysis. Archives of General Psychiatry 60, 565571.
Arsenault L, Cannon M, Poulton R, Murray R, Caspi A (2002). Cannabis use in adolescence and risk for adult psychosis: longitudinal prospective study. British Medical Journal 325, 12121213.
Berardi D, Leggieri G, Menchetti M, Ferrari G (1999). Collaboration between mental health services and primary care: the Bologna Project. Primary Care Companion to the Journal of Clinical Psychiatry 1, 180183.
Bourque F, van der Ven E, Malla A (2011). A meta-analysis of the risk for psychotic disorders among first- and second-generation immigrants. Psychological Medicine 4, 897910.
Boydell J, van Os J, Lambri M, Castle D, Allardyce J, Murray RM (2003). Incidence of schizophrenia in south-east London between 1965 and 1997. British Journal of Psychiatry 182, 4549.
Broome MR, Woolley JB, Tabraham P, Johns LC, Bramon E, Murray GK, Pariante C, McGuire PK, Murray RM (2005). What causes the onset of psychosis? Schizophrenia Research 79, 2334.
Brown AS, Begg MD, Gravenstein S, Schaefer CA, Wyatt RJ, Bresnahan M, Babulas VP, Susser ES (2004). Serologic evidence of prenatal influenza in the etiology of schizophrenia. Archives of General Psychiatry 61, 774780.
Cantor-Graae E, Selten JP (2005). Schizophrenia and migration: a meta-analysis and review. American Journal of Psychiatry 162, 1224.
Cheng F, Kirkbride JB, Lennox BR, Perez J, Masson K, Lawrence K, Hill K, Feeley L, Painter M, Murray GK, Gallagher O, Bullmore ET, Jones PB (2011). Administrative incidence of psychosis assessed in an early intervention service in England: first epidemiological evidence from a diverse, rural and urban setting. Psychological Medicine 41, 949958.
Coid JW, Kirkbride JB, Barker D, Cowden F, Stamps R, Yang M, Jones PB (2008). Raised incidence rates of all psychoses among migrant groups: findings from the East London first episode psychosis study. Archives of General Psychiatry 65, 12501258.
Cooper JE, Goodhead D, Craig T, Harris M, Howat J, Korer J (1987). The incidence of schizophrenia in Nottingham. British Journal of Psychiatry 151, 619626.
Di Forti M, Morgan C, Dazzan P, Pariante C, Mondelli V, Marques TR, Handley R, Luzi S, Russo M, Paparelli A, Butt A, Stilo SA, Wiffen B, Powell J, Murray RM (2009). High-potency cannabis and the risk of psychosis. British Journal of Psychiatry 195, 488491.
Department of Anti-drug Policy (2010). Yearly report to Parliament on the use of drugs and the status of drug addictions in Italy. Report 2010. Data for the year 2009–2010.
Fearon P, Kirkbride JB, Morgan C, Dazzan P, Morgan K, Lloyd T, Hutchinson G, Tarrant J, Fung WL, Holloway J, Mallett R, Harrison G, Leff J, Jones PB, Murray RM; AESOP Study Group (2006). Incidence of schizophrenia and other psychoses in ethnic minority groups: results from the MRC AESOP Study. Psychological Medicine 36, 15411550.
Häfner H, Riecher-Rössler A, an der Heiden W, Maurer K, Fätkenheuer B, Löffler W (1993). Generating and testing a causal explanation of the gender difference in age at first onset of schizophrenia. Psychological Medicine 23, 925940.
Jablensky A, Sartorius N, Ernberg G, Anker M, Korten A, Cooper JE, Day R, Bertelsen A (1992). Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study. Psychological Medicine. Monograph Supplement 20, 197.
Kirkbride JB, Boydell J, Ploubidis GB, Morgan C, Dazzan P, McKenzie K, Murray RM, Jones PB (2008). Testing the association between the incidence of schizophrenia and social capital in an urban area. Psychological Medicine 38, 10831094.
Kirkbride JB, Fearon P, Morgan C, Tarrant J, Lloyd T, Holloway J, Hutchinson G, Leff JP, Mallet RM, Harrison GL, Murray RM, Jones PB (2006). Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3-center AESOP Study. Archives of General Psychiatry 63, 250258.
Kirkbride JB, Scoriels L (2009). Review of the 6th symposium for the search for the causes of schizophrenia, Sao Paulo, Brazil, 3-6 February 2009. European Archives of Psychiatry and Clinical Neuroscience 259, 505509.
Lao TS, Sundquist J, Frank G, Johansson LM, Johansson SE, Sundquist K (2006). Incidence of schizophrenia or other psychoses in first- and second-generation immigrants: a National Cohort Study. Journal of Nervous and Mental Disease 194, 2733.
Large M, Sharma S, Compton MT, Slade T, Nielssen O (2011). Cannabis use and earlier onset of psychosis: a systematic meta-analysis. Archives of General Psychiatry 68, 555561.
McGorry PD, Purcell R, Goldstone S, Amminger GP (2011). Age of onset and timing of treatment for mental and substance use disorders: implications for preventive intervention strategies and models of care. Current Opinion in Psychiatry 24, 301306.
McGrath J, Saari K, Hakko H, Jokelainen J, Jones P, Järvelin MR, Chant D, Isohanni M (2004 b). Vitamin D supplementation during the first year of life and risk of schizophrenia: a Finnish birth cohort study. Schizophrenia Research 67, 237245.
McGrath J, Saha S, Welham J, El Saadi O, MacCauley C, Chant D (2004 a). A systematic review of the incidence of schizophrenia: the distribution of rates and the influence of sex, urbanicity, migrant status and methodology. BMC Medicine 2, 13.
Menezes PR, Scazufca M, Busatto G, Coutinho LM, McGuire PK, Murray RM (2007). Incidence of first-contact psychosis in São Paulo, Brazil. British Journal of Psychiatry 191 (Suppl. 51), s102s106.
Morgan C, Burns T, Fitzpatrick R, Pinfold V, Priebe S (2007). Social exclusion and mental health (conceptual and methodological review). British Journal of Psychiatry 191, 477483.
Morgan C, Charalambides M, Hutchinson G, Murray RM (2010). Migration, ethnicity, and psychosis: toward a sociodevelopmental model. Schizophrenia Bulletin 36, 655664.
Morgan C, Dazzan P, Morgan K, Jones P, Harrison G, Leff J, Murray R, Fearon P; AESOP study group (2006). First episode psychosis and ethnicity: initial findings from the AESOP study. World Psychiatry 5, 4046.
Morgan C, Fisher H (2007). Environment and schizophrenia: environmental factors in schizophrenia: childhood trauma – a critical review. Schizophrenia Bulletin 33, 3–10.
Mortensen PB, Pedersen CB, Westergaard T, Wohlfahrt J, Ewald H, Mors O, Andersen PK, Melbye M (1999). Effects of family history and place and season of birth on the risk of schizophrenia. New England Journal of Medicine 340, 603608.
Pedersen CB, Mortensen PB (2001). Evidence of a dose-response relationship between urbanicity during upbringing and schizophrenia risk. Archives of General Psychiatry 58, 10391046.
Preti A, Miotto P (2000). Increase in first admissions for schizophrenia and other major psychoses in Italy. Psychiatry Research 94, 139152.
Province of Bologna (2007). Report on the labour market, 1st Semester, 2007 ( Accessed 5 August 2011.
Thornicroft G, Bisoffi G, De Salvia D, Tansella M (1993). Urban-rural differences in the associations between social deprivation and psychiatric service utilization in schizophrenia and all diagnoses: a case-register study in Northern Italy. Psychological Medicine 23, 487496.
UN (1980). Social and Demographic Statistics: Classifications of Size and Type of Locality and Urban/Rural Areas. E/CN.3/551. United Nations: New York.
van Os J, Bak M, Hanssen M, Bijl RV, De Graaf R, Verdoux H (2002). Cannabis use and psychosis: a longitudinal population-based study. American Journal of Epidemiology 156, 319327.
van Os J, Kenis G, Rutten BP (2010). The environment and schizophrenia. Nature 468, 203212.
van Os J, Rutten BP, Poulton R (2008). Gene-environment interactions in schizophrenia: review of epidemiological findings and future directions. Schizophrenia Bulletin 34, 10661082.
Veling W, Selten JP, Veen N, Laan W, Blom JD, Hoek HW (2006). Incidence of schizophrenia among ethnic minorities in the Netherlands: a four-year first-contact study. Schizophrenia Research 86, 189193.
WHO (1998). Schedules for Clinical Assessment in Neuropsychiatry Version 2.1 (SCAN-2.1). Division of Mental Health, World Health Organization: Geneva, Switzerland.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 6
Total number of PDF views: 54 *
Loading metrics...

Abstract views

Total abstract views: 263 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 18th November 2017. This data will be updated every 24 hours.