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Background: Cognitive reserve (CR) is a protective factor against cognitive and functional impairment in first-episode psychosis (FEP). The aim of this study was to evaluate the differences in clinical presentation accord-ing to the use of cannabis (cannabis users vs non-users) among patients presenting a FEP (non-affective vs af-fective psychosis), to investigate the impact of CR and cannabis use on several outcomes and to explore the potentially mediatory role played by CR in the relationship between cognitive domains or clinical status and functionality, depending on the use of cannabis. Methods: Linear regression analysis models were carried out to assess the predictive value of CR on clinical, functional and cognitive variables at baseline and at two-year follow-up. The mediation analyzes were performed according to the principles of Baron and Kenny. Results: CR was associated with better cognitive performance, regardless of cannabis consumption or diagnosis. In both diagnoses, CR was associated with better clinical and functional outcomes in those patients who did not use cannabis. In terms of mediation procedure, CR mediates the relationship between some cognitive domains and functioning at follow-up only in patients without cannabis use. Limitations: The small sample size of the affective group. Conclusions: CR plays a differential role in the outcome of psychoses according to whether patients are cannabis users or not. Both in affective and non-affective groups CR exerted a greater effect in patients without cannabis use. Our results suggest that the deleterious effect of cannabis use on functioning in FEP surpasses the protective effect of CR.

Abstract thinking is a cognitive process that involves the assimilation of concepts reduced from diffuse sensory input, organized, and interpreted in a manner beyond the obvious. There are multiple facets by which abstraction is measured that include semantic, visual-spatial and social comprehension. This study examined the prevalence and course of abstract and concrete responses to semantic proverbs and aberrant abstraction (composite score of semantic, visual-spatial, and social comprehension) over 20 years in 352 participants diagnosed with schizophrenia, affective psychosis, and unipolar non-psychotic depression. We utilized linear models, two-way ANOVA and contrasts to compare groups and change over time. Linear models with Generalized Estimation Equation (GEE) to determine association. Our findings show that regardless of diagnosis, semantic proverb interpretation improves over time. Participants with schizophrenia give more concrete responses to proverbs when compared to affective psychosis and unipolar depressed without psychosis. We also show that the underlying structure of concretism encompasses increased conceptual overinclusion at index hospitalization and idiosyncratic associations at follow-up; whereas, abstract thinking overtime encompasses increased visual-spatial abstraction at index and rich associations with increased social comprehension scores at follow-up. Regardless of diagnosis, premorbid functioning, descriptive characteristics, and IQ were not associated with aberrant abstraction. Delusions are highly and positively related to aberrant abstraction scores, while hallucinations are mildly and positively related to this score. Lastly, our data point to the importance of examining the underlying interconnected structures of ‘established’ constructs vis-a-vis mixed methods to provide a description of the rich interior world that may not always map onto current quantitative measures.

Treatment resistance (TR) in patients with first-episode psychosis (FEP) is a major cause of disability and functional impairment, yet mechanisms underlying this severe disorder are poorly understood. As one view is that TR has neurodevelopmental roots, we investigated whether its emergence relates to disruptions in synchronized cortical maturation quantified using gyrification-based connectomes. Seventy patients with FEP evaluated at their first presentation to psychiatric services were followed up using clinical records for 4 years; of these, 17 (24.3%) met the definition of TR and 53 (75.7%) remained non-TR at 4 years. Structural MRI images were obtained within 5 weeks from first exposure to antipsychotics. Local gyrification indices were computed for 148 contiguous cortical regions using FreeSurfer; each subject’s contribution to group-based structural covariance was quantified using a jack-knife procedure, providing a single deviation matrix for each subject. The latter was used to derive topological properties that were compared between TR and non-TR patients using a Functional Data Analysis approach. Compared to the non-TR patients, TR patients showed a significant reduction in small-worldness (Hedges’s g = 2.09, P < .001) and a reduced clustering coefficient (Hedges’s g = 1.07, P < .001) with increased length (Hedges’s g = −2.17, P < .001), indicating a disruption in the organizing principles of cortical folding. The positive symptom burden was higher in patients with more pronounced small-worldness (r = .41, P = .001) across the entire sample. The trajectory of synchronized cortical development inferred from baseline MRI-based structural covariance highlights the possibility of identifying patients at high-risk of TR prospectively, based on individualized gyrification-based connectomes.

Background The dimensional symptom structure of classes of affective psychoses, and more specifically the relationships between affective and mood symptoms, has been poorly researched. Here, we examined these questions from a network analysis perspective. Methods Using Exploratory Graph Analysis (EGA) and network centrality parameters, we examined the dimensionality and network structure of 28 mood and psychotic symptoms in subjects diagnosed with schizoaffective disorder (n=124), psychotic bipolar disorder (n=345) or psychotic depression (n=245), such as in the global sample of affective psychoses. Results EGA identified four dimensions in subjects with schizoaffective or bipolar disorders (depression, mania, positive and negative) and three dimensions in subjects with psychotic depression (depression, psychosis and activation). The item composition of dimensions and the most central symptoms varied substantially across diagnoses. The most central (i.e., interconnected) symptoms in schizoaffective disorder, psychotic bipolar disorder and psychotic depression were hallucinations, delusions and depressive mood, respectively. Classes of affective psychoses significantly differed in terms of network structure but not in network global strength. Limitations The cross-sectional nature of this study precludes conclusions about the causal dynamics between affective and psychotic symptoms. Conclusion EGA is a powerful tool for examining the dimensionality and network structure of symptoms in affective psychoses showing that both the interconnectivity pattern between affective and psychotic symptoms and the most central symptoms vary across classes of affective psychoses. The findings outline the value of specific diagnoses in explaining the relationships between mood and affective symptoms.

The concept of affective psychosis regroups psychotic disorders with mood syndrome. Previous studies provided evidence to support a dichotomy between affective and non-affective psychoses although questions remain regarding the utility and validity of such a category to develop clinical guidelines. The aim of this study is to explore similarities and differences within affective psychoses to question whether strategies would apply to all the diagnoses falling under this umbrella term. Using Bayesian model comparison methods, we explored the homogeneity of the characteristics of first-episode affective patients (N = 77) treated in a specialized 3-year early intervention in psychosis programme. Our analysis revealed affective psychoses display many similarities regarding socio-demographic variables, the course of positive and manic symptoms over three years, and outcome at discharge. Our results did not support the heterogeneous model. However, despite no significant differences in the course of symptoms with the major depressive disorder group, the schizoaffective disorder group displayed a more severe clinical picture at the beginning of the programme and a poorer functional outcome than the two other groups. Absence of clear boundaries and the several similarities within affective psychoses suggest they can usefully be grouped to define treatment strategies that are easily legible by clinicians.

Background The importance of cerebrospinal fluid (CSF) diagnostics for psychiatry is growing. The CSF/blood albumin quotient (QAlb) is considered to be a measure of the blood–CSF barrier function. Recently, systematically higher QAlb in males than in females was described in neurological patients. The aim of this study was to investigate whether a sex difference could also be detected in a well-characterized psychiatric cohort. Methods The patient cohort comprised 989 patients, including 545 females and 444 males with schizophreniform and affective syndromes who underwent CSF diagnostics, including QAlb measurement. The basic CSF findings and antineuronal autoantibody data of this cohort have already been published. This re-analysis employed analysis of covariance with age correction for QAlb mean values and chi2-testing for the number of increased age-corrected QAlb levels to investigate sex differences in QAlb. Results The QAlb levels were elevated above reference levels by 18% across all patients, and a comparison between male and female patients revealed a statistically significant sex difference, with increased values in 26% of male patients and a corresponding rate of only 10% in female patients (chi 2 = 42.625, p

Background Functional connectivity abnormalities between Broca’s and Wernicke’s areas and the putamen revealed by functional magnetic resonance imaging (fMRI) are related to auditory hallucinations (AH). In long-term schizophrenia, reduced white matter structural integrity revealed by diffusion imaging in left arcuate fasciculus (connecting Broca’s and Wernicke’s areas) is likely related to AH. The structural integrity of connections with putamen and their relation to AH are unknown. Little is known about this relationship in first-episode psychosis (FEP), although auditory transcallosal connections were reported to play a role. White matter in the Broca’s-Wernicke’s-putamen language-related circuit and auditory transcallosal fibers was examined to investigate associations with AH in FEP. Methods White matter connectivity was measured in 40 FEP and 32 matched HC using generalized fractional anisotropy (gFA) derived from diffusion spectrum imaging (DSI). Results FEP and HC did not differ in gFA in any fiber bundle. In FEP, AH severity was significantly inversely related to gFA in auditory transcallosal fibers and left arcuate fasciculus. Although the right hemisphere arcuate fasciculus-AH association did not attain significance, the left and right arcuate fasciculus associations were not significantly different. Conclusions Despite overall normal gFA in FEP, AH severity was significantly related to gFA in transcallosal auditory fibers and the left hemisphere connection between Broca’s and Wernicke’s areas. Other bilateral tracts’ gFA were weakly associated with AH. At the first psychotic episode, AH are more robustly associated with left hemisphere arcuate fasciculus and interhemispheric auditory fibers microstructural deficits, likely reflecting mistiming of information flow between language-related cortical centers.

Objective:The aim of the study was to assess whether the auditory brainstem response (ABR) profiling test for schizophrenia (SZ) would recognise schizoaffective disorder (SZA) patients as SZ or not.Method:Male and female SZA patients (n = 16) from the psychosis unit at Uppsala University Hospital were investigated. Coded sets of randomised ABR recordings intermingled with patients with SZ, adult attention-deficit hyperactivity disorder (ADHD) and healthy controls were analysed by an independent party blinded to clinical diagnoses.Results:The ABR profiling test for SZ was positive in 5/16 patients (31%) and negative in 11/16 patients (69%) with SZA. A surprising finding was that 4/16 (25%) SZA patients were positive for the ABR profiling test for ADHD.Conclusion:With the ABR profiling test, a minority of patients with SZA tested positive for SZ. In contrast, a majority (85%) of patients with SZ in a previous study tested positive. These preliminary results leave us ignorant whether SZA should be regarded as a SZ-like disorder or a psychotic mood disorder and add to the questions regarding the validity of this diagnostic entity. However, the ABR profiling method is still in its infancy and its exploration in a range of psychiatric disorders is warranted.

Background: Psychotic experiences (PE) refer to the subclinical expressions of psychotic symptoms and are prevalent in the general population, particularly during childhood, adolescence and early adulthood. Young people with PE are at increased risk of comorbid mental disorders and poorer functioning. Subtle variances in neuropsychological abilities and cognitive performance are also associated with PE. The overall aim of this thesis was to study how these risk markers and correlates change across the lifespan and improve our understanding of factors influencing the onset and recurrence of PE and their consequences. Firstly, early infant cognitive and motor development and its association with later PE in childhood and adolescence was investigated (Study I). Secondly, neurocognitive and motor performance was investigated longitudinally from mid- to late-adolescence in young people who had a lifetime report of PE compared to those who did not report PE (Study II). Thirdly, mental health, functional and neuropsychological outcomes in early adulthood were investigated in young people who had reported PE, predominantly in childhood and adolescence (Study III). Finally, social cognition and self-reported Autism-Spectrum Disorder (ASD) in early adulthood were investigated in young people who had reported PE, predominantly in childhood and adolescence (Study IV).Method: Analyses were conducted on two longitudinal datasets: the Western Australia Pregnancy Cohort (Raine) Study and the Adolescent Brain Development (ABD) Study. During the course of this thesis, a 10-year follow-up study was conducted in early adulthood as part of the ABD Study. Data on mental health, functional, neuropsychological and social cognitive outcomes were collected. The Raine Study (ages 1-17 years) included parent- and self-report measures. The ABD Study (ages 11-21 years) included clinical interview, neuropsychological assessments and self-report measures. Statistical analyses included logistic regressions, multivariate analysis of variances and traditional mediation models. Results: Developmental delays in multiple areas were noted from ages 1, 2 and 3 years among youth who reported PE in childhood and adolescence. This association was particularly marked in the recurrent PE group, with over 40% having developmental delays in multiple domains (Study 1). During late adolescence, poorer fine motor skills and slower processing speed were noted in young people who had reported PE at any time in their lives (Study II). During early adulthood, those who had ever reported PE were at a higher risk of meeting DSM-5 criteria for a current and lifetime psychiatric disorder and multimorbidity. They also had poorer social and global functioning and lower scores on attentional and fine motor skill tasks, when compared to controls who had never reported PE. Young adults with PE had poorer theory of mind scores, specifically for neutral and negative stimuli, and an external locus of control compared to controls. They also reported a greater number of self-reported ASD traits, and the association between PE and social cognition deficits was not mediated by ASD traits.Conclusion: Cognitive and motor abilities appear to be important risk markers for PE in young people, with deviances from normal development detectable from as early as the first year of life. Early delays, and lags in cognitive and motor performance, are evident during childhood, adolescence and early adulthood. Based on the findings from early adulthood, PE themselves are important signals for poorer mental health, including multi-morbid disorders, and worse social and global functioning. PE are also associated with higher numbers of ASD traits in early adulthood. The results provide new insights into the trajectory and lifetime course PE and inform important windows for early intervention.

[Background and hypothesis] Evidence suggests that childhood maltreatment (ie, childhood abuse and childhood neglect) affects educational attainment and cognition. However, the association between childhood maltreatment and Intelligence Quotient (IQ) seems stronger among controls compared to people with psychosis. We hypothesised that: the association between childhood maltreatment and poor cognition would be stronger among community controls than among people with first-episode of psychosis (FEP); compared to abuse, neglect would show stronger associations with educational attainment and cognition; the association between childhood maltreatment and IQ would be partially accounted for by other risk factors; and the association between childhood maltreatment, educational attainment, and IQ would be stronger among patients with affective psychoses compared to those with nonaffective psychoses., [Study Design] 829 patients with FEP and 1283 community controls from 16 EU-GEI sites were assessed for child maltreatment, education attainment, and IQ., [Study Results] In both the FEP and control group, childhood maltreatment was associated with lower educational attainment. The association between childhood maltreatment and lower IQ was robust to adjustment for confounders only among controls. Whereas childhood neglect was consistently associated with lower attainment and IQ in both groups, childhood abuse was associated with IQ only in controls. Among both patients with affective and nonaffective psychoses, negative associations between childhood maltreatment and educational attainment were observed, but the crude association with IQ was only evident in affective psychoses., [Conclusions] Our findings underscore the role of childhood maltreatment in shaping academic outcomes and cognition of people with FEP as well as controls., The EU-GEI Study is funded by grant agreement HEALTH-F2-2010-241909 (Project EU-GEI) from the European Community’s Seventh Framework Programme, and Grant 2012/0417-0 from the São Paulo Research Foundation. B.P.F. Rutten is funded by a VIDI award (no. 91.718.336) from the Netherlands Scientific Organization. H. L. Fisher, C. Gayer-Anderson, and C. Morgan are supported by the Economic and Social Research Council (ESRC) Centre for Society and Mental Health at King’s College London [ES/S012567/1]. C. Arango has received support by the Spanish Ministry of Science and Innovation. Instituto de Salud Carlos III (SAM16PE07CP1, PI16/02012, PI19/024), co-financed by ERDF Funds from the European Commission, “A way of making Europe”, CIBERSAM. Madrid Regional Government (B2017/BMD-3740 AGES-CM-2), European Union Structural Funds. European Union Seventh Framework Program under grant agreements, FP7- HEALTH-2013-2.2.1-2-603196 (Project PSYSCAN) and FP7- HEALTH-2013-2.2.1-2-602478 (Project METSY); and European Union H2020 Program under the Innovative Medicines Initiative 2 Joint Undertaking (grant agreement No 115916, Project PRISM, and grant agreement No 777394, Project AIMS-2-TRIALS), Fundación Familia Alonso and Fundación Alicia Koplowitz. J.B. Kirkbride is supported by the NIHR University College London Hospital Biomedical Research Centre.

To investigate which factors individuals with a psychotic depression experience as preventive of suicide while beeing hospitalized. Semi-structured qualitative interviews with nine inpatients, all hospitalized for a unipolar or bipolar depressive episode with psychosis, were conducted at time of discharge. For analysis we used systematic text condensation. Main outcomes were accounts of participants' experiences of suicide prevention measures and treatment, and how these affected suicidal ideation, plans, and attempts. Participants experienced (1) suicide attempts being physically interrupted or prevented; (2) receiving medical treatment to alleviate unbearable suffering; (3) finding refuge behind locked doors; (4) receiving guidance to redefine their identity and situation. They reported being protected from suicidal impulses and imagined persecutors in a secure environment with staff present. They described their autonomy as compromised by intense suffering and chaos. They retrospectively appreciated staff interventions, if these were performed compassionately and with empathy. Participants described that suicidal thoughts and actions were triggered by terrifying psychotic experiences, anxiety and sleeplessness, and felt that medication - and in one instance electroconvulsive therapy- alleviated suffering. At time of discharge, participants reported no psychotically motivated suicidal thoughts. They described a new, insightful self-view and acknowledged having been severely mentally ill. To prevent impulsive suicidal behavior, findings highlight the need for both security measures and a treatment approach focusing on modifying psychotic experiences and intense anxiety. Gaining anxious and paranoid patients' trust is essential to build motivation for medical treatment. Patients emphasize that having time to talk is crucial to this process.

Aims Patients with brief psychotic episodes (BPE) have variable and fluctuating clinical outcomes which challenge psychiatric care. Our meta-analysis aims at providing a comprehensive summary of several clinical outcomes in this patient group. Methods A multistep systematic PRISMA/MOOSE-compliant literature search was performed for articles published from inception until 1st March 2021. Web of Science database was searched, complemented by manual search of original articles reporting relevant outcomes (psychotic recurrence, prospective diagnostic change or stability, remission, quality of life, functional status, mortality and their predictors) for patients diagnosed with acute and transient psychotic disorders (ATPD), brief psychotic disorders (BPD), brief intermittent psychotic symptoms (BIPS) and brief limited intermittent psychotic symptoms (BLIPS). Random-effects methods and Q-statistics were employed, quality assessment with Newcastle-Ottawa Scale, assessment of heterogeneity with I2 index, sensitivity analyses (acute polymorphic psychotic disorders, APPD) and multiple meta-regressions, assessment of publication bias with funnel plot, Egger's test and meta-regression (psychotic recurrence and sample size). Results A total of 91 independent articles (n = 94 samples) encompassed 37 ATPD, 24 BPD, 19 BLIPS and 14 BIPS samples, totalling 15 729 individuals (mean age: 30.89 ± 7.33 years, mean female ratio: 60%, 59% conducted in Europe). Meta-analytical risk of psychotic recurrence for all BPE increased from 15% (95% confidence interval (CI) 12–18) at 6 months, 25% (95% CI 22–30) at 12 months, 30% (95% CI 27–33) at 24 months and 33% (95% CI 30–37) at ⩾36 months follow-up, with no differences between ATPD, BPD, BLIPS and BIPS after 2 years of follow-up. Across all BPE, meta-analytical proportion of prospective diagnostic stability (average follow-up 47 months) was 49% (95% CI 42–56); meta-analytical proportion of diagnostic change (average follow-up 47 months) to schizophrenia spectrum psychoses was 19% (95% CI 16–23), affective spectrum psychoses 5% (95% CI 3–7), other psychotic disorders 7% (95% CI 5–9) and other (non-psychotic) mental disorders 14% (95% CI 11–17). Prospective diagnostic change within APPD without symptoms of schizophrenia was 34% (95% CI 24–46) at a mean follow-up of 51 months: 18% (95% CI 11–30) for schizophrenia spectrum psychoses and 17% (95% CI 10–26) for other (non-psychotic) mental disorders. Meta-analytical proportion of baseline employment was 48% (95% CI 38–58), whereas there were not enough data to explore the other outcomes. Heterogeneity was high; female ratio and study quality were negatively and positively associated with risk of psychotic recurrence, respectively. There were no consistent factor predicting clinical outcomes. Conclusions Short-lived psychotic episodes are associated with a high risk of psychotic recurrences, in particular schizophrenia spectrum disorders. Other clinical outcomes remain relatively underinvestigated. There are no consistent prognostic/predictive factors.

There is controversy about the status of schizoaffective disorder depressive-type (SA-D), particularly whether it should be considered a form of schizophrenia or a distinct disorder. We aimed to determine whether individuals with SA-D differ from individuals with schizophrenia in terms of demographic, premorbid and lifetime clinical characteristics, and genetic liability to schizophrenia, depression and bipolar disorder. Participants were from the CardiffCOGS sample and met ICD-10 criteria for schizophrenia (n=713) or SA-D (n=151). Two samples, Cardiff Affected-sib (n=354) and Cardiff F-series (n=524), were used for replication. For all samples, phenotypic data were ascertained through structured interview, review of medical records, and an ICD-10 diagnosis made by trained researchers. Univariable and multivariable logistic regression models were used to compare individuals with schizophrenia and SA-D for demographic and clinical characteristics, and polygenic risk scores (PRS). In the CardiffCOGS, SA-D, compared to schizophrenia, was associated with female sex, childhood abuse, history of alcohol dependence, higher functioning Global Assessment Scale (GAS) score in worst episode of psychosis, lower functioning GAS score in worst episode of depression, and reduced lifetime severity of disorganised symptoms. Individuals with SA-D had higher depression PRS compared to those with schizophrenia. PRS for schizophrenia and bipolar disorder did not significantly differ between SA-D and schizophrenia. Compared to individuals with schizophrenia, individuals with SA-D had higher rates of environmental and genetic risk factors for depression and a similar genetic liability to schizophrenia. These findings are consistent with SA-D being a sub-type of schizophrenia resulting from elevated liability to both schizophrenia and depression.Key words: Polygenic risk score; depression; psychosis; diagnosis; phenotypes

Background Earlier studies suggested that perceptions of voice intents (benevolence, malevolence) are associated with different psychological and behavioral responses including compliance with command hallucinations (CH). However, to our knowledge, no studies have examined the clinical differences between subgroups of clients with different perceptions of the intents of their CH. In order to better understand the risk for compliance with CH, our objectives were 1) to compare sociodemographic and clinical profiles of subgroups of clients (based on perceptions of CH intents); and 2) to investigate their specific associated risk factors for compliance with CH. Method We analyzed the MacArthur Violence Risk Assessment Study, focusing on 181 participants with psychosis reporting CH. Group comparisons and within-group ordinal logistic regression analyses were performed using sociodemographic and clinical measures such as the BPRS, BIS-11 and NAS-PI. Results Of the 181 participants, 102 (56.4%) reported having only malevolent voices, 14 (7.7%) rated them as benevolent only, 58 (32.03%) as benevolent and malevolent, and only 7 (3.86%) as neutral only. Results showed that individuals with malevolent voices had more emotional disturbance while those with benevolent CH had more severe positive psychotic symptoms and were more certain that they would comply in the future. Moreover, childhood physical abuse, belief about having to obey as well as psychotic symptoms significantly predict compliance with malevolent CH in a multivariate model. Conclusions Our results suggest that researchers and clinicians should consider perceptions of voice intents when both assessing risk of compliance with CH and developing relevant intervention targets.

Background Recovery is the ultimate goal of psychosis treatment . Basic self-disturbances (BSDs) are non-psychotic phenomena associated with clinical outcome, present in prodromal, psychotic and residual phases of psychotic disorders. Aim To investigate the relationship between BSDs and recovery seven years after first treatment in patients with psychotic disorders. Method Prospective longitudinal study of 56 patients recruited during first adequate treatment for schizophrenia (n = 35) and other psychotic disorders (n = 21) (psychotic bipolar disorder, delusional disorder, psychotic disorder NOS). At baseline and follow-up BSDs were assessed using the Examination of Anomalous Self-Experience (EASE) manual, while standard clinical instruments were used to ascertained diagnosis, clinical symptom severity, and functioning. Recovery was defined as absence of psychotic symptoms and regaining of functioning that persisted the last two years before follow-up. Results At follow up, 34% achieved recovery (5 (14%) with schizophrenia and 14 (67%) with other psychoses at baseline). Recovery was predicted by an absence of a schizophrenia diagnosis, low baseline level of BSDs and further reductions in BSDs from baseline to follow-up. Change in BSDs was the strongest predictor, also after adjusting for premorbid adjustment and duration of untreated psychosis, and was not confounded by diagnosis. Conclusion Low baseline levels of basic self-disturbances and further reductions over time independently predict recovery seven years later in first treated psychosis patients. This work was supported by Innlandet Hospital Trust, Norway (Grant Nos. 150281 and 150338), and Eastern Norway Health Authority (Grants no. 2006258-2011085-2014102). BN was supported by an NHMRC Senior Research Fellowship (Grant no. 1137687).

Purpose Although excess risks particularly for a diagnosis of schizophrenia have been identified for ethnic minority people in England and other contexts, we sought to identify and synthesise up-to-date evidence (2018) for affective in addition to non-affective psychoses by specific ethnic groups in England. Methods Systematic review and meta-analysis of ethnic differences in diagnosed incidence of psychoses in England, searching nine databases for reviews (citing relevant studies up to 2009) and an updated search in three databases for studies between 2010 and 2018. Studies from both searches were combined in meta-analyses allowing coverage of more specific ethnic groups than previously. Results We included 28 primary studies. Relative to the majority population, significantly higher risks of diagnosed schizophrenia were found in Black African (Relative risk, RR 5.72, 95% CI 3.87–8.46, n = 9); Black Caribbean (RR 5.20, 95% CI 4.33–6.24, n = 21); South Asian (RR 2.27, 95% CI 1.63–3.16, n = 14); White Other (RR 2.24, 95% CI 1.59–3.14, n = 9); and Mixed Ethnicity people (RR 2.24, 95% CI 1.32–3.80, n = 4). Significantly higher risks for diagnosed affective psychoses were also revealed: Black African (RR 4.07, 95% CI 2.27–7.28, n = 5); Black Caribbean (RR 2.91, 95% CI 1.78–4.74, n = 16); South Asian (RR 1.71, 95% CI 1.07–2.72, n = 8); White Other (RR 1.55, 95% CI 1.32–1.83, n = 5); Mixed Ethnicity (RR 6.16, 95% CI 3.99–9.52, n = 4). Conclusions The risk for a diagnosis of non-affective and affective psychoses is particularly elevated for Black ethnic groups, but is higher for all ethnic minority groups including those previously not assessed through meta-analyses (White Other, Mixed Ethnicity). This calls for further research on broader disadvantages affecting ethnic minority people.