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Hanlon C, Roberts T, Misganaw E, Malla A, Cohen A, Shibre T, Fekadu W, Teferra S, Kebede D, Mulushoa A, Girma Z, Tsehay M, Kiross D, Lund C, Fekadu A, Morgan C, Alem A. Studying the context of psychoses to improve outcomes in Ethiopia (SCOPE): Protocol paper. PLoS One 2024; 19:e0293232. [PMID: 38722946 PMCID: PMC11081395 DOI: 10.1371/journal.pone.0293232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/08/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Global evidence on psychosis is dominated by studies conducted in Western, high-income countries. The objectives of the Study of Context Of Psychoses to improve outcomes in Ethiopia (SCOPE) are (1) to generate rigorous evidence of psychosis experience, epidemiology and impacts in Ethiopia that will illuminate aetiological understanding and (2) inform development and testing of interventions for earlier identification and improved first contact care that are scalable, inclusive of difficult-to-reach populations and optimise recovery. METHODS The setting is sub-cities of Addis Ababa and rural districts in south-central Ethiopia covering 1.1 million people and including rural, urban and homeless populations. SCOPE comprises (1) formative work to understand care pathways and community resources (resource mapping); examine family context and communication (ethnography); develop valid measures of family communication and personal recovery; and establish platforms for community engagement and involvement of people with lived experience; (2a) a population-based incidence study, (2b) a case-control study and (2c) a cohort study with 12 months follow-up involving 440 people with psychosis (390 rural/Addis Ababa; 50 who are homeless), 390 relatives and 390 controls. We will test hypotheses about incidence rates in rural vs. urban populations and men vs. women; potential aetiological role of khat (a commonly chewed plant with amphetamine-like properties) and traumatic exposures in psychosis; determine profiles of needs at first contact and predictors of outcome; (3) participatory workshops to develop programme theory and inform co-development of interventions, and (4) evaluation of the impact of early identification strategies on engagement with care (interrupted time series study). Findings will inform development of (5) a protocol for (5a) a feasibility cluster randomised controlled trial of interventions for people with recent-onset psychosis in rural settings and (5b) two uncontrolled pilot studies to test acceptability, feasibility of co-developed interventions in urban and homeless populations.
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Affiliation(s)
- Charlotte Hanlon
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, King’s College London, London, United Kingdom
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tessa Roberts
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, King’s College London, London, United Kingdom
- ESRC Centre for Society & Mental Health, King’s College London, London, United Kingdom
| | - Eleni Misganaw
- Mental Health Service User Association, Addis Ababa, Ethiopia
| | - Ashok Malla
- Department of Psychiatry and Douglas Mental Health Institute, McGill University, Montreal, Canada
| | - Alex Cohen
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Wubalem Fekadu
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Teferra
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Derege Kebede
- Department of Preventive Medicine, School of Public Health, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adiyam Mulushoa
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zerihun Girma
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mekonnen Tsehay
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dessalegn Kiross
- Victoria University of Wellington, School of Nursing, Midwifery and Health Practice, Wellington, New Zealand
| | - Crick Lund
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, King’s College London, London, United Kingdom
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Abebaw Fekadu
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Craig Morgan
- ESRC Centre for Society & Mental Health, King’s College London, London, United Kingdom
| | - Atalay Alem
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Lee Pow J, Donald C, di Forti M, Roberts T, Weiss HA, Ayinde O, John S, Olley B, Ojagbemi A, Esponda GM, Lam J, Poornachandrika P, Dazzan P, Gaughran F, Kannan PP, Sudhakar S, Burns J, Chiliza B, Cohen A, Gureje O, Thara R, Murray RM, Morgan C, Hutchinson G. Cannabis use and psychotic disorders in diverse settings in the Global South: findings from INTREPID II. Psychol Med 2023; 53:7062-7069. [PMID: 36951137 PMCID: PMC10719629 DOI: 10.1017/s0033291723000399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/26/2023] [Accepted: 02/06/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Cannabis use has been linked to psychotic disorders but this association has been primarily observed in the Global North. This study investigates patterns of cannabis use and associations with psychoses in three Global South (regions within Latin America, Asia, Africa and Oceania) settings. METHODS Case-control study within the International Programme of Research on Psychotic Disorders (INTREPID) II conducted between May 2018 and September 2020. In each setting, we recruited over 200 individuals with an untreated psychosis and individually-matched controls (Kancheepuram India; Ibadan, Nigeria; northern Trinidad). Controls, with no past or current psychotic disorder, were individually-matched to cases by 5-year age group, sex and neighbourhood. Presence of psychotic disorder assessed using the Schedules for Clinical Assessment in Neuropsychiatry and cannabis exposure measured by the World Health Organisation Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). RESULTS Cases reported higher lifetime and frequent cannabis use than controls in each setting. In Trinidad, cannabis use was associated with increased odds of psychotic disorder: lifetime cannabis use (adj. OR 1.58, 95% CI 0.99-2.53); frequent cannabis use (adj. OR 1.99, 95% CI 1.10-3.60); cannabis dependency (as measured by high ASSIST score) (adj. OR 4.70, 95% CI 1.77-12.47), early age of first use (adj. OR 1.83, 95% CI 1.03-3.27). Cannabis use in the other two settings was too rare to examine associations. CONCLUSIONS In line with previous studies, we found associations between cannabis use and the occurrence and age of onset of psychoses in Trinidad. These findings have implications for strategies for prevention of psychosis.
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Affiliation(s)
- Joni Lee Pow
- Department of Psychiatry, University of the West Indies, Saint Augustine, Trinidad
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Casswina Donald
- Department of Psychiatry, University of the West Indies, Saint Augustine, Trinidad
| | - Marta di Forti
- Social, Genetic and Developmental Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Tessa Roberts
- Social, Genetic and Developmental Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Helen A. Weiss
- Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Olatunde Ayinde
- Department of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse, University of Ibadan, Ibadan, Nigeria
| | - Sujit John
- Department of Psychiatry, Schizophrenia Research Foundation, Chennai, India
| | - Bola Olley
- Department of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse, University of Ibadan, Ibadan, Nigeria
| | - Akin Ojagbemi
- Department of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse, University of Ibadan, Ibadan, Nigeria
| | - Georgina Miguel Esponda
- Social, Genetic and Developmental Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Joseph Lam
- Social, Genetic and Developmental Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | | | - Paola Dazzan
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Fiona Gaughran
- Psychosis Studies Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Selvaraju Sudhakar
- Department of Psychiatry, Chengelpet Medical College, Chengelpet, Tamil Nadu, India
| | - Jonathan Burns
- Mental Health Research Group, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Bonginkosi Chiliza
- Department of Psychiatry, University of KwaZulu Natal, Durban, South Africa
| | - INTREPID Group
- Department of Psychiatry, University of the West Indies, Saint Augustine, Trinidad
| | - Alex Cohen
- Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Oye Gureje
- Department of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse, University of Ibadan, Ibadan, Nigeria
| | - Rangaswamy Thara
- Department of Psychiatry, Schizophrenia Research Foundation, Chennai, India
| | - Robin M. Murray
- Psychosis Studies Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Craig Morgan
- Social, Genetic and Developmental Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Gerard Hutchinson
- Department of Psychiatry, University of the West Indies, Saint Augustine, Trinidad
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Roberts T, Susser E, Lee Pow J, Donald C, John S, Raghavan V, Ayinde O, Olley B, Miguel Esponda G, Lam J, Murray RM, Cohen A, Weiss HA, Hutchinson G, Thara R, Gureje O, Burns J, Morgan C. Urbanicity and rates of untreated psychotic disorders in three diverse settings in the Global South. Psychol Med 2023; 53:1-9. [PMID: 36645027 PMCID: PMC10600928 DOI: 10.1017/s0033291722003749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/28/2022] [Accepted: 11/23/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Extensive evidence indicates that rates of psychotic disorder are elevated in more urban compared with less urban areas, but this evidence largely originates from Northern Europe. It is unclear whether the same association holds globally. This study examined the association between urban residence and rates of psychotic disorder in catchment areas in India (Kancheepuram, Tamil Nadu), Nigeria (Ibadan, Oyo), and Northern Trinidad. METHODS Comprehensive case detection systems were developed based on extensive pilot work to identify individuals aged 18-64 with previously untreated psychotic disorders residing in each catchment area (May 2018-April/May/July 2020). Area of residence and basic demographic details were collected for eligible cases. We compared rates of psychotic disorder in the more v. less urban administrative areas within each catchment area, based on all cases detected, and repeated these analyses while restricting to recent onset cases (<2 years/<5 years). RESULTS We found evidence of higher overall rates of psychosis in more urban areas within the Trinidadian catchment area (IRR: 3.24, 95% CI 2.68-3.91), an inverse association in the Nigerian catchment area (IRR: 0.68, 95% CI 0.51-0.91) and no association in the Indian catchment area (IRR: 1.18, 95% CI 0.93-1.52). When restricting to recent onset cases, we found a modest positive association in the Indian catchment area. CONCLUSIONS This study suggests that urbanicity is associated with higher rates of psychotic disorder in some but not all contexts outside of Northern Europe. Future studies should test candidate mechanisms that may underlie the associations observed, such as exposure to violence.
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Affiliation(s)
- Tessa Roberts
- ESRC Centre for Society & Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ezra Susser
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
- New York State Psychiatric Institute, New York, USA
| | - Joni Lee Pow
- Department of Psychiatry, University of the West Indies, St Augustine Campus, Trinidad & Tobago
| | - Casswina Donald
- Department of Psychiatry, University of the West Indies, St Augustine Campus, Trinidad & Tobago
| | - Sujit John
- Schizophrenia Research Foundation, Chennai, India
| | | | - Olatunde Ayinde
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bola Olley
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Georgina Miguel Esponda
- ESRC Centre for Society & Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joseph Lam
- Department of Population, Practice and Policy, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Robin M. Murray
- Division of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alex Cohen
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen A. Weiss
- MRC International Statistics & Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Gerard Hutchinson
- Department of Psychiatry, University of the West Indies, St Augustine Campus, Trinidad & Tobago
| | | | - Oye Gureje
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Jonathan Burns
- Mental Health Research Group, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Craig Morgan
- ESRC Centre for Society & Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research, Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
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Morgan C, Cohen A, Esponda GM, Roberts T, John S, Pow JL, Donald C, Olley B, Ayinde O, Lam J, Poornachandrika P, Dazzan P, Gaughran F, Kannan PP, Sudhakar S, Burns J, Chiliza B, Susser E, Weiss HA, Murray RM, Rangaswamy T, Gureje O, Hutchinson G. Epidemiology of Untreated Psychoses in 3 Diverse Settings in the Global South: The International Research Program on Psychotic Disorders in Diverse Settings (INTREPID II). JAMA Psychiatry 2023; 80:40-48. [PMID: 36383387 PMCID: PMC9669922 DOI: 10.1001/jamapsychiatry.2022.3781] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/11/2022] [Indexed: 11/17/2022]
Abstract
Importance Less than 10% of research on psychotic disorders has been conducted in settings in the Global South, which refers broadly to the regions of Latin America, Asia, Africa, and Oceania. There is a lack of basic epidemiological data on the distribution of and risks for psychoses that can inform the development of services in many parts of the world. Objective To compare demographic and clinical profiles of cohorts of cases and rates of untreated psychoses (proxy for incidence) across and within 3 economically and socially diverse settings in the Global South. Two hypotheses were tested: (1) demographic and clinical profiles of cases with an untreated psychotic disorder vary across setting and (2) rates of untreated psychotic disorders vary across and within setting by clinical and demographic group. Design, Setting, and Participants The International Research Program on Psychotic Disorders in Diverse Settings (INTREPID II) comprises incidence, case-control, and cohort studies of untreated psychoses in catchment areas in 3 countries in the Global South: Kancheepuram District, India; Ibadan, Nigeria; and northern Trinidad. Participants were individuals with an untreated psychotic disorder. This incidence study was conducted from May 1, 2018, to July 31, 2020. In each setting, comprehensive systems were implemented to identify and assess all individuals with an untreated psychosis during a 2-year period. Data were analyzed from January 1 to May 1, 2022. Main Outcomes and Measures The presence of an untreated psychotic disorder, assessed using the Schedules for Clinical Assessment in Neuropsychiatry, which incorporate the Present State Examination. Results Identified were a total of 1038 cases, including 64 through leakage studies (Kancheepuram: 268; median [IQR] age, 42 [33-50] years; 154 women [57.5%]; 114 men [42.5%]; Ibadan: 196; median [IQR] age, 34 [26-41] years; 93 women [47.4%]; 103 men [52.6%]; Trinidad: 574; median [IQR] age, 30 [23-40] years; 235 women [40.9%]; 339 men [59.1%]). Marked variations were found across and within settings in the sex, age, and clinical profiles of cases (eg, lower percentage of men, older age at onset, longer duration of psychosis, and lower percentage of affective psychosis in Kancheepuram compared with Ibadan and Trinidad) and in rates of untreated psychosis. Age- and sex-standardized rates of untreated psychoses were approximately 3 times higher in Trinidad (59.1/100 000 person-years; 95% CI, 54.2-64.0) compared with Kancheepuram (20.7/100 000 person-years; 95% CI, 18.2-23.2) and Ibadan (14.4/100 000 person-years; 95% CI, 12.3-16.5). In Trinidad, rates were approximately 2 times higher in the African Trinidadian population (85.4/100 000 person-years; 95% CI, 76.0-94.9) compared with the Indian Trinidadian (43.9/100 000 person-years; 95% CI, 35.7-52.2) and mixed populations (50.7/100 000 person-years; 95% CI, 42.0-59.5). Conclusions and Relevance This analysis adds to research that suggests that core aspects of psychosis vary by historic, economic, and social context, with far-reaching implications for understanding and treatment of psychoses globally.
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Affiliation(s)
- Craig Morgan
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- ESRC Centre for Society and Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, King’s College London, London, United Kingdom
- National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, United Kingdom
| | - Alex Cohen
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Georgina Miguel Esponda
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- ESRC Centre for Society and Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, King’s College London, London, United Kingdom
| | - Tessa Roberts
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- ESRC Centre for Society and Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, King’s College London, London, United Kingdom
| | - Sujit John
- Schizophrenia Research Foundation, Chennai, India
| | - Joni Lee Pow
- Department of Psychiatry, University of the West Indies, Saint Augustine, Trinidad
| | - Casswina Donald
- Department of Psychiatry, University of the West Indies, Saint Augustine, Trinidad
| | - Bola Olley
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Olatunde Ayinde
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Joseph Lam
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- ESRC Centre for Society and Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, King’s College London, London, United Kingdom
| | | | - Paola Dazzan
- National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, United Kingdom
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Fiona Gaughran
- National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, United Kingdom
- Psychosis Studies Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | | | | | - Jonathan Burns
- Mental Health Research Group, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Bonginkosi Chiliza
- Department of Psychiatry, University of KwaZulu Natal, Durban, South Africa
| | - Ezra Susser
- Columbia Mailman School of Public Health, Columbia University, New York, New York
- New York Psychiatric Institute, New York
| | - Helen A. Weiss
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robin M. Murray
- National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, United Kingdom
- Psychosis Studies Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | | | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Gerard Hutchinson
- Department of Psychiatry, University of the West Indies, Saint Augustine, Trinidad
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Farhang S, Shirzadi M, Alikhani R, Alizadeh BZ, Bruggeman R, Veling W. ARAS recent onset acute phase psychosis survey, a prospective observational cohort of first episode psychosis in Iran-the cohort profile. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:101. [PMID: 36402780 PMCID: PMC9675807 DOI: 10.1038/s41537-022-00295-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
The Middle East is underrepresented in psychosis research. The ARAS recent onset acute phase psychosis survey (ARAS) is a longitudinal cohort across multiple centers in Iran, established to investigate characteristics, determinants and early course of psychosis in a non-Western, Middle East context. Here, baseline characteristics of the ARAS cohort are reported. The ARAS cohort enrolled patients with recent onset psychosis from September 2018 to September 2021 in East Azerbaijan, Kermanshah and Tehran, including Iranian patients from different sociocultural contexts. The baseline assessment included demographics, socioeconomic status, clinical (positive, negative, depressive symptoms) and psychosocial (religiosity, social support, self-stigma) characteristics, cognitive functioning, metabolic profile, substance use and medication use measured by validated questionnaires. These assessments will be followed up after one and five years. A total of 500 patients with a first episode of psychosis were enrolled from three provinces in Iran. With 74.1% being male, the mean age (SD) of patients was 32.3 (9.7) years. Nearly a quarter of patients was diagnosed with schizophrenia and 36.8% with substance induced psychotic disorder. Amphetamine (24%) and opium (12%) use were common, cannabis use was not (5%). Only 6.1% of patients lived alone while 29% of patients was married and had children. The majority of them had achieved secondary educational level and 34% had a paid job. The most common antipsychotic treatment was risperidone. There was a wide range for scores of PANSS, with 9.4% having dominant negative symptoms. The most common prescribed medication was risperidone. Near to 40% of patients had noticeable signs of depression and prevalence of metabolic syndrome was 13.4%. The majority of patients (57.2%) had moderate and 5.4% reported to have severe disability. More than 30% reported to be highly religious. Patients had the highest satisfaction with people living with, and the lowest for finance and job.
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Affiliation(s)
- Sara Farhang
- Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Maryam Shirzadi
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Rosa Alikhani
- Department of Psychiatry, Psychosis Research Center, University of Social Welfare and Rehabilitation, Tehran, Iran
| | - Behrooz Z Alizadeh
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Richard Bruggeman
- Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wim Veling
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Oloniniyi IO, Weiss HA, John S, Esan O, Hibben M, Patel V, Murray RM, Cohen A, Hutchinson G, Gureje O, Thara R, Morgan C, Roberts T. Life events and psychosis: case-control study from India, Nigeria, and Trinidad and Tobago. BJPsych Open 2022; 8:e168. [PMID: 36111619 PMCID: PMC9534879 DOI: 10.1192/bjo.2022.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is evidence of an association between life events and psychosis in Europe, North America and Australasia, but few studies have examined this association in the rest of the world. AIMS To test the association between exposure to life events and psychosis in catchment areas in India, Nigeria, and Trinidad and Tobago. METHOD We conducted a population-based, matched case-control study of 194 participants in India, Nigeria, and Trinidad and Tobago. Cases were recruited through comprehensive population-based, case-finding strategies. The Harvard Trauma Questionnaire was used to measure life events. The Screening Schedule for Psychosis was used to screen for psychotic symptoms. The association between psychosis and having experienced life events (experienced or witnessed) was estimated by conditional logistic regression. RESULTS There was no overall evidence of an association between psychosis and having experienced or witnessed life events (adjusted odds ratio 1.19, 95% CI 0.62-2.28). We found evidence of effect modification by site (P = 0.002), with stronger evidence of an association in India (adjusted odds ratio 1.56, 95% CI 1.03-2.34), inconclusive evidence in Nigeria (adjusted odds ratio 1.17, 95% CI 0.95-1.45) and evidence of an inverse association in Trinidad and Tobago (adjusted odds ratio 0.66, 95% CI 0.44-0.97). CONCLUSIONS This study found no overall evidence of an association between witnessing or experiencing life events and psychotic disorder across three culturally and economically diverse countries. There was preliminary evidence that the association varies between settings.
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Affiliation(s)
- Ibidunni O. Oloniniyi
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- Correspondence: Ibidunni O. Oloniniyi.
| | - Helen A. Weiss
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, UK
| | - Sujit John
- Department of Psychiatry, Schizophrenia Research Foundation, India
| | - Oluyomi Esan
- Department of Psychiatry, University of Ibadan, Nigeria
| | - Maia Hibben
- Department of Psychiatry, Faculty of Medical Sciences, University of the West Indies, Trinidad and Tobago
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Massachusetts, USA; and Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Massachusetts, USA
| | - Robin M. Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Alex Cohen
- Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, UK
| | - Gerard Hutchinson
- Department of Psychiatry, Faculty of Medical Sciences, University of the West Indies, Trinidad and Tobago
| | - Oye Gureje
- WHO Collaborating Centre for Research and Training in Mental Health, Neuroscience and Substance Abuse, Department of Psychiatry, University of Ibadan, Nigeria
| | - Rangaswamy Thara
- Department of Psychiatry, Schizophrenia Research Foundation, India
| | - Craig Morgan
- ESRC Centre for Society and Mental Health, King's College London, UK
| | - Tessa Roberts
- ESRC Centre for Society and Mental Health, King's College London, UK
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7
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Khattak MI, Dikomitis L, Khan MF, Haq MU, Saeed U, Awan NR, Haq ZU, Shepherd T, Mallen CD, Farooq S. Patients’ and healthcare professionals’ perspectives on a community-based intervention for schizophrenia in Pakistan: A focus group study. PLoS One 2022; 17:e0273286. [PMID: 36037187 PMCID: PMC9423632 DOI: 10.1371/journal.pone.0273286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 08/05/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To explore the perceptions and experiences of schizophrenia from patients, their care givers, health care providers, spiritual and traditional healers to develop a community-based intervention for improving treatment adherence for people with schizophrenia in Pakistan. Methods This qualitative study involved four focus group discussions (FGD) with a total of 26 participants: patients and carers (n = 5), primary care staff (n = 7), medical technicians (n = 8) and traditional and spiritual healers (n = 6). The participants were selected using purposive sampling method. FGDs were audio-recorded and transcribed. A thematic analysis was applied to the data set. Results The themes identified were (i) Schizophrenia is not merely a biomedical problem: participants believed that poverty and an inferiority complex resulting from social disparity caused schizophrenia and contributed to non-adherence to medications; (ii) Spiritual healing goes hand in hand with the medical treatment: participants regarded spiritual and traditional treatment methods as an inherent part of schizophrenia patients’ well-being and rehabilitation; (iii) Services for mental illness: mental health is not covered under primary health in a basic health unit: participants believed that the lack of services, training and necessary medication in primary care are major issues for treating schizophrenia in community; (iv) Barriers to community-based interventions: primary care staff believed that multiple pressures on staff, lack of incentives, non-availability of medication and lack of formal referral pathways resulted in disintegration of dealing with schizophrenia patients in primary care facilities. Conclusion The study has identified a number of barriers and facilitators to developing and delivering a psychosocial intervention to support people living with schizophrenia in Pakistan. In particular, the importance of involving spiritual and traditional healers was highlighted by our diverse group of stakeholders.
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Affiliation(s)
- Maria Ishaq Khattak
- Institute of Public Health & Social Sciences, Khyber Medical University, Pakistan Khyber Medical University Peshawar, Peshawar, Pakistan
| | - Lisa Dikomitis
- Kent and Medway Medical School, University of Kent and Canterbury Christ Church University, Canterbury, United Kingdom
| | | | - Mukhtar Ul Haq
- Postgraduate Medical Institute, Lady Reading Hospital, Peshawar, Pakistan
| | - Umaima Saeed
- Institute of Public Health & Social Sciences, Khyber Medical University, Pakistan Khyber Medical University Peshawar, Peshawar, Pakistan
| | - Naila Riaz Awan
- Postgraduate Medical Institute, Lady Reading Hospital, Peshawar, Pakistan
| | - Zia Ul Haq
- Institute of Public Health & Social Sciences, Khyber Medical University, Pakistan Khyber Medical University Peshawar, Peshawar, Pakistan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Thomas Shepherd
- School of Medicine, Keele University, Staffordshire, United Kingdom
| | | | - Saeed Farooq
- School of Medicine, Keele University, Staffordshire, United Kingdom
- Midlands Partnership Foundation Trust, St. George’s Hospital, Stafford, United Kingdom
- * E-mail:
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8
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Akena D, Semeere A, Kadama P, Mwesiga EK, Nakku J, Nakasujja N. Feasibility of conducting a pilot randomized control trial of a psycho-education intervention in patients with a first episode psychosis in Uganda—A study protocol. PLoS One 2022; 17:e0268493. [PMID: 35905117 PMCID: PMC9337703 DOI: 10.1371/journal.pone.0268493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 04/13/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Psychotic disorders contribute to significant morbidity and mortality partly due to the chronicity of the illness and high relapse rates. Delivering psycho-education messages about disease etiology, their signs and symptoms and the benefits of treatment adherence have been shown to improve clinical outcomes among individuals with psychoses. However, little has been done to examine the feasibility and efficacy of this intervention in low resourced settings.
Objective
Our primary objective will be to determine the feasibility of recruiting and retaining patients with a first episode psychosis (FEP) and for the secondary objective, we will determine the preliminary efficacy of psycho-education on illness self-management, stigma, adherence to medications and symptom severity.
Hypothesis
We hypothesize that (i) we will recruit 70% of eligible participants and accrue a sample size of 80 over 20-weeks, retaining 80% of the sample size for 24 weeks, (ii) the intervention will lead to improvement in clinical outcomes (described above).
Methods
We will recruit 80 adult patients who have been diagnosed with a FEP, received antipsychotic medication at Butabika Hospital and reside within 21km from the Hospital. Trained village health team (VHTs) members will deliver 6 psycho-education sessions to 40 participants and their family members (intervention arm). Participants in the control arm (n = 40) will receive routine care. We will document how feasible it will be to recruit and retain participants over 24 weeks and document the preliminary efficacy of the intervention on illness self-management, stigma, adherence to medications and severity of symptoms.
Data analysis
We will document the proportion of participants who consent and get recruited, the proportion of those who will get retained and reasons for drop out. We will conduct an intention to treat analysis comparing the groups at weeks 4, 12, 24 and assess the effect of the intervention on the clinical outcomes (described above). We will use the Bonferroni approach to correct for multiple comparisons.
Trial registration
Clinical trials.gov registration number: NCT 04602585.
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Affiliation(s)
- Dickens Akena
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
- * E-mail:
| | - Aggrey Semeere
- Infectious Disease Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Philippa Kadama
- Infectious Disease Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Emmanuel K. Mwesiga
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Juliet Nakku
- Butabika National Mental referral Hospital, Kampala, Uganda
| | - Noeline Nakasujja
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
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9
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Gureje O, Ojagbemi A. Applicability and future status of schizophrenia as a construct in Africa. Schizophr Res 2022; 242:52-55. [PMID: 35151534 DOI: 10.1016/j.schres.2022.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Oye Gureje
- Department of Psychiatry, University of Ibadan, Nigeria; Department of Psychiatry, Stellenbosch University, South Africa.
| | - Akin Ojagbemi
- Department of Psychiatry, University of Ibadan, Nigeria
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10
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van der Zeijst MCE, Veling W, Makhathini EM, Mbatha ND, Shabalala SS, van Hoeken D, Susser E, Burns JK, Hoek HW. Course of psychotic experiences and disorders among apprentice traditional health practitioners in rural South Africa: 3-year follow-up study. Front Psychiatry 2022; 13:956003. [PMID: 36245859 PMCID: PMC9558832 DOI: 10.3389/fpsyt.2022.956003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Culture is inevitably linked with the experience, interpretation and course of what modern biomedicine understands to be psychotic symptoms. However, data on psychoses in low- and middle-income countries are sparse. Our previous study showed that psychotic and mood-related experiences, symptoms and disorders are common among individuals who had received the ancestral calling to become a traditional health practitioner (THP) in rural KwaZulu-Natal, South Africa. Our related ethnographic study suggested that ukuthwasa (the training to become a THP) may positively moderate these calling-related symptoms. As far as we know, no research has been conducted into the course of psychiatric symptoms among apprentice THPs. OBJECTIVE We studied the course of psychotic experiences, symptoms and disorders among apprentice THPs. We also assessed their level of functioning and expanded our knowledge on ukuthwasa. MATERIALS AND METHODS We performed a 3-year follow-up of a baseline sample of apprentice THPs (n = 48). Psychiatric assessments (CAPE, SCAN), assessment of functioning (WHODAS) and a semi-structured qualitative questionnaire were completed for 42 individuals. RESULTS At 3-year follow-up, psychotic experiences were associated with significantly less distress and there was a reduction in frequency of psychotic symptoms compared to baseline. The number of participants with psychotic disorders had decreased from 7 (17%) to 4 (10%). Six out of seven participants (86%) with a psychotic disorder at baseline no longer had a psychiatric diagnosis at follow-up. Although the mean level of disability among the (apprentice) THPs corresponded with the 78th percentile found in the general population, 37 participants (88%) reported no or mild disability. Forty-one participants (98%) reported that ukuthwasa had positively influenced their psychiatric symptoms. CONCLUSION In rural KwaZulu-Natal, psychotic experiences, symptoms and disorders have a benign course in most individuals who are undergoing the process of becoming a THP. Ukuthwasa may be an effective, culturally sanctioned, healing intervention for some selected individuals, potentially because it reframes distressing experiences into positive and highly valued experiences, reduces stigma, and enhances social empowerment and identity construction. This implies that cultural and spiritual interventions can have a positive influence on the course of psychosis.
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Affiliation(s)
| | - Wim Veling
- Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - Elliot M Makhathini
- Department of Nursing, Durban University of Technology, Pietermaritzburg, South Africa.,Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Ndukuzakhe D Mbatha
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Sinethemba S Shabalala
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | | | - Ezra Susser
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States.,New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States
| | - Jonathan K Burns
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.,Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Hans W Hoek
- Parnassia Psychiatric Institute, The Hague, Netherlands.,Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
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11
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Asher L, Birhanu R, Baheretibeb Y, Fekadu A. "Medical treatments are also part of God's gift": Holy water attendants' perspectives on a collaboration between spiritual and psychiatric treatment for mental illness in Ethiopia. Transcult Psychiatry 2021; 58:585-599. [PMID: 34034571 DOI: 10.1177/13634615211015082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In Ethiopia, traditional and spiritual treatments, such as holy water, are used by people with mental disorders instead of, or alongside, psychiatric services. Collaborations between traditional and psychiatric providers may increase access to evidence-based treatments and address human rights abuses. This study aimed to explore the perspectives of holy water attendants on a novel collaboration between holy water and psychiatric care, at St Mary's Clinic, Entoto, Ethiopia, and to characterize the users of this service. Semi-structured interviews were conducted with 14 holy water attendants, who run group houses for holy water residents and are paid by family members. A thematic analysis was conducted. Socio-demographic and clinical data were extracted from the records of all service users who had attended the clinic. A total of 174 individuals have attended the clinic in the three years since it opened. The majority were diagnosed with schizophrenia. Holy water attendants provide a partial gatekeeping role to psychiatric care, selecting which of their clients they think will benefit and, for these individuals, facilitating attendance to the clinic and antipsychotic medication adherence. Psychiatric care was felt to be compatible with holy water by some, but not all, attendants. However, family members often had the "final say" in individuals attending the clinic, in some cases putting up strong resistance to using psychiatric care. A novel collaboration is acceptable to some holy water attendants and may increase access to psychiatric care amongst people with mental illness living at a holy water site in Ethiopia.
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Affiliation(s)
- Laura Asher
- University of Nottingham, School of Medicine, Academic Unit of Population and Lifespan Sciences, Nottingham, UK
| | - Ribka Birhanu
- Addis Ababa University, College of Health Sciences, Department of Psychiatry, Addis Ababa, Ethiopia
| | - Yonas Baheretibeb
- Addis Ababa University, College of Health Sciences, Department of Psychiatry, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Addis Ababa University, College of Health Sciences, Department of Psychiatry, Addis Ababa, Ethiopia
- Addis Ababa University, College of Health Sciences, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
- Brighton and Sussex Medical School, Global Health & Infection Department, Brighton, UK
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12
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van der Zeijst MCE, Veling W, Makhathini EM, Mtshemla S, Mbatha ND, Shabalala SS, Susser I, Burns JK, Susser E, Hoek HW. Psychopathology among apprentice traditional health practitioners: A quantitative study from rural KwaZulu-Natal, South Africa. Transcult Psychiatry 2021; 58:486-498. [PMID: 33021152 DOI: 10.1177/1363461520949672] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Sociocultural context seems to influence the epidemiology, phenotype, treatment, and course of psychosis. However, data from low- and middle-income countries is sparse. This research is part of a multidisciplinary and multimethod study on possible mental disturbances, including hallucinations, among (apprentice) traditional health practitioners (THPs) who have experienced the "ancestral calling to become a THP" in rural KwaZulu-Natal, South Africa. The aim of the current article is to examine whether the calling-related experiences can be assessed according to a psychiatric taxonomy. We included individuals who were identified with the calling and who were undergoing training to become a THP (ukuthwasa). IsiZulu-speaking formal mental health practitioners conducted thorough psychiatric interviews that measured psychological experiences with and without distress using the Community Assessment of Psychic Experiences, and psychiatric symptoms and disorders using the Schedule for Clinical Assessment in Neuropsychiatry. Of the 48 individuals who participated, 92% had psychotic experiences (PE), causing distress in 75%; and 23% met DSM-5 criteria for an unspecified psychotic disorder (15%) or mood disorder (8%). In conclusion, in rural KwaZulu-Natal, the ancestral calling may resemble phenomena that psychiatry would understand in the context of psychosis, ranging from subclinical PE to clinical psychotic disorder. Ukuthwasa might have a beneficial influence on the course of psychotic symptoms in some individuals, potentially because it reduces stigma and promotes recovery. Further multidisciplinary research is needed to investigate the psychopathology of the apprentice THPs and the underlying processes of ukuthwasa.
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Affiliation(s)
| | - Wim Veling
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elliot Mqansa Makhathini
- Durban University of Technology, Durban, South Africa.,University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | | | | | | | - Ida Susser
- City University of New York, New York, NY, USA.,Columbia University, New York, NY, USA
| | - Jonathan K Burns
- University of KwaZulu-Natal, KwaZulu-Natal, South Africa.,University of Exeter, Exeter, UK
| | - Ezra Susser
- New York State Psychiatric Institute, New York, NY, USA
| | - Hans W Hoek
- Parnassia Psychiatric Institute, The Hague, The Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Columbia University, New York, NY, USA
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13
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Pham TV, Koirala R, Wainberg ML, Kohrt BA. Reassessing the Mental Health Treatment Gap: What Happens if We Include the Impact of Traditional Healing on Mental Illness? Community Ment Health J 2021; 57:777-791. [PMID: 32894398 PMCID: PMC7936992 DOI: 10.1007/s10597-020-00705-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
In this Fresh Focus, we reassess what the mental health treatment gap may mean if we consider the role of traditional healing. Based on systematic reviews, patients can use traditional healers and qualitatively report improvement from general psychological distress and symptom reduction for common mental disorders. Given these clinical implications, some high-income countries have scaled up research into traditional healing practices, while at the same time in low-and middle-income countries, where the use of traditional healers is nearly ubiquitous, considerably less research funding has studied or capitalized on this phenomena. The World Health Organization 2003-2020 Mental Health Action Plan called for government health programs to include traditional and faith healers as treatment resources to combat the low- and middle-income country treatment gap. Reflection on the work which emerged during the course of this Mental Health Action Plan revealed areas for improvement. As we embark on the next Mental Health Action Plan, we offer lessons-learned for exploring potential relationships and collaborations between traditional healing and biomedicine.
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Affiliation(s)
- Tony V Pham
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2213 Elba Street, Durham, NC, 27705, USA.
- Duke Global Health Institute, 310 Trent Drive, Durham, NC, 27710, USA.
- Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, 44616, Nepal.
| | - Rishav Koirala
- University of Oslo, Problemveien 7, 0315, Oslo, Norway
- Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, 44616, Nepal
- Brain and Neuroscience Center Nepal, Krishna Dhara Marg, Kathmandu, 44600, Nepal
| | - Milton L Wainberg
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, 10032, USA
| | - Brandon A Kohrt
- Duke Global Health Institute, 310 Trent Drive, Durham, NC, 27710, USA
- Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, 44616, Nepal
- George Washington University School of Medicine and Health Sciences, 2120 L Street, NW, Suite 600, Washington, DC, 20037, USA
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14
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Smartt C, Ketema K, Frissa S, Tekola B, Birhane R, Eshetu T, Selamu M, Prince M, Fekadu A, Hanlon C. Pathways into and out of homelessness among people with severe mental illness in rural Ethiopia: a qualitative study. BMC Public Health 2021; 21:568. [PMID: 33752638 PMCID: PMC7986271 DOI: 10.1186/s12889-021-10629-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/15/2021] [Indexed: 11/23/2022] Open
Abstract
Background Little is known about the pathways followed into and out of homelessness among people with experience of severe mental illness (SMI) living in rural, low-income country settings. Understanding these pathways is essential for the development of effective interventions to address homelessness and promote recovery. The aim of this study was to explore pathways into and out of homelessness in people with SMI in rural Ethiopia. Methods In-depth interviews were conducted with 15 people with SMI who had experienced homelessness and 11 caregivers. Study participants were identified through their participation in the PRIME project, which implemented a multi-component district level plan to improve access to mental health care in primary care in Sodo district, Ethiopia. People enrolled in PRIME who were diagnosed with SMI (schizophrenia, schizoaffective disorder or bipolar disorder) and who had reported experiencing homelessness at recruitment formed the sampling frame for this qualitative study. We used OpenCode 4.0 and Microsoft Excel for data management. Thematic analysis was conducted using an inductive approach. Results Study participants reported different patterns of homelessness, with some having experienced chronic and others an intermittent course. Periods of homelessness occurred when family resources were overwhelmed or not meeting the needs of the person with SMI. The most important pathways into homelessness were reported to result from family conflict and the worsening of mental ill health, interplaying with substance use in many cases. Participants also mentioned escape and/or wanting a change in environment, financial problems, and discrimination from the community as contributing to them leaving the home. Pathways out of homelessness included contact with (mental and physical) health care as a catalyst to the mobilization of other supports, family and community intervention, and self-initiated return. Conclusions Homelessness in people with SMI in this rural setting reflected complex health and social needs that were not matched by adequate care and support. Our study findings indicate that interventions to prevent and tackle homelessness in this and similar settings ought to focus on increasing family support, and ensuring access to acceptable and suitable housing, mental health care and social support. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10629-8.
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Affiliation(s)
- Caroline Smartt
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, London, UK.,King's College London, King's Global Health Institute, London, UK
| | | | - Souci Frissa
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, London, UK.,King's College London, King's Global Health Institute, London, UK
| | - Bethlehem Tekola
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, London, UK.,King's College London, King's Global Health Institute, London, UK
| | - Rahel Birhane
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, Addis Ababa, Ethiopia.,Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa, Ethiopia
| | - Tigist Eshetu
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, Addis Ababa, Ethiopia
| | - Medhin Selamu
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, Addis Ababa, Ethiopia.,Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa, Ethiopia
| | - Martin Prince
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, London, UK.,King's College London, King's Global Health Institute, London, UK
| | - Abebaw Fekadu
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, Addis Ababa, Ethiopia.,Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa, Ethiopia.,Department of Global Health & Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Charlotte Hanlon
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, London, UK. .,King's College London, King's Global Health Institute, London, UK. .,Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, Addis Ababa, Ethiopia. .,Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa, Ethiopia.
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15
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Cohen A, Morgan C. Estimating the incidence of psychosis in diverse settings. Psychol Med 2021; 51:527-528. [PMID: 31843029 DOI: 10.1017/s0033291719003702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Craig Morgan
- Social Epidemiology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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16
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Stigma of Treatment Stages for First-Episode Psychosis: A Conceptual Framework for Early Intervention Services. Harv Rev Psychiatry 2021; 29:131-141. [PMID: 33666396 PMCID: PMC9931450 DOI: 10.1097/hrp.0000000000000288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Early intervention services (EIS; in the United States, Coordinated Specialty Care) can lead to substantial improvements in psychiatric symptoms and social functioning for individuals with first-episode psychosis who engage in treatment. Nevertheless, stigma associated with early intervention services can limit their full potential benefits by preventing or reducing participation. Drawing from Corrigan's "why try" model positing relationships between public and self-stigma, engagement in treatment services, and the EIS treatment model, this article proposes a framework that delineates how distinct forms of stigma are linked to given stages of treatment engagement in first-episode psychosis. We identify three phases of engagement: (1) community outreach, which has associations with public stigma; (2) the referral and evaluation process, which primarily has associations with self-stigma; and (3) EIS, which have associations with self-stigma and its psychosocial consequences. For each phase, we describe evidence-based strategies typically provided by EIS programs, using OnTrackNY as an exemplary model, to illustrate potential linkages in our conceptual framework. By specifying how distinct forms of stigma are associated with EIS treatment stages, this framework is intended to guide EIS programs in explicitly addressing stigma to optimize recovery of individuals with first-episode psychosis.
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17
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Govindan R, Rangaswamy T, John S, Kandasamy S. Methodology for Development of a Community Level Intervention Module for Physical Illness in Persons with Mental Illness (CLIPMI). Indian J Psychol Med 2020; 42:S94-S98. [PMID: 33487810 PMCID: PMC7802035 DOI: 10.1177/0253717620973381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Medical illnesses seen in persons with psychiatric disorders are important but often ignored causes of increased morbidity and mortality. Hence, a community level intervention program addressing the issue is proposed. MATERIALS AND METHODS Patients with severe mental illnesses will be identified by a door-to-door survey and assessed for comorbid physical illnesses like anemia, hypertension, diabetes, and so on. They will then be randomized into two groups. The treatment as usual (TAU) group will not receive intervention from the trained community level workers, while the Intervention group will receive it. RESULTS The two groups will be compared for the prevalence and severity of comorbid physical illnesses. The expected outcome is compared to the TAU group, the intervention group will have a greater reduction in the morbidity due to physical illnesses and improved mental health. CONCLUSION If successful, the module can be incorporated into the community level mental health delivery system of the District Mental Health Program (DMHP).
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Affiliation(s)
| | | | - Sujit John
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India
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18
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Mayston R, Kebede D, Fekadu A, Medhin G, Hanlon C, Alem A, Shibre T. The effect of gender on the long-term course and outcome of schizophrenia in rural Ethiopia: a population-based cohort. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1581-1591. [PMID: 32239264 DOI: 10.1007/s00127-020-01865-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/25/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Although some studies have suggested that women with schizophrenia are more likely to achieve positive outcomes, the evidence-base is fraught with inconsistencies. In this study we compare the long-term course and outcomes for men and women living with schizophrenia in rural Ethiopia. METHODS The Butajira course and outcome study for severe mental disorders is a population-based cohort study. Community ascertainment of cases was undertaken between 1998 and 2001, with diagnostic confirmation by clinicians using the Schedules for Clinical Assessment in Neuropsychiatry. Findings from annual outcome assessments were combined with clinical records, patient and caregiver report, and psychiatric assessments at 10-13 years using the Longitudinal Interval Follow-up Evaluation- LIFE chart. For the sub-group of people with schizophrenia (n = 358), we compared course of illness and treatment, co-morbidity, recovery, social outcomes and mortality between men and women. Multivariable analyses were conducted for modelling associations identified in bivariate analyses according to blocks shaped by our a priori conceptual framework of the biological and social pathways through which gender might influence the course and outcome of schizophrenia. RESULTS Looking into over 10-13 years of follow-up data, there was no difference in the functioning or recovery in women compared to men (AOR = 1.79, 95% CI = 0.91, 3.57). Women were less likely to report overall life satisfaction (AOR = 0.22, 95% CI = 0.09, 0.53) or good quality of spousal relationships (AOR = 0.09, 95% CI = 0.01-1.04). Men were more likely to have co-morbid substance use and there was a trend towards women being more likely to be prescribed an antidepressant (AOR = 2.38, 95% CI = 0.94, 5.88). There were no gender differences in the course of illness, number of psychotic episodes or adherence to medications. CONCLUSION In this rural African setting, we found little evidence to support the global evidence indicating better course and outcome of schizophrenia in women. Our findings are suggestive of a gendered experience of schizophrenia which varies across contexts. Further investigation is needed due to the important implications for the development of new mental health services in low and middle-income country settings.
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Affiliation(s)
- Rosie Mayston
- Centre for Global Mental Health, Health Service, and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Derege Kebede
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Global Health & Infection, Brighton & Sussex Medical School, Brighton, UK
| | - Girmay Medhin
- Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service, and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Atalay Alem
- Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Teshome Shibre
- Department of Psychiatry, Horizon Health Network, Fredericton, NB, Canada.
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Roberts T, Gureje O, Thara R, Hutchinson G, Cohen A, Weiss HA, John S, Lee Pow J, Donald C, Olley B, Miguel Esponda G, Murray RM, Morgan C. INTREPID II: protocol for a multistudy programme of research on untreated psychosis in India, Nigeria and Trinidad. BMJ Open 2020; 10:e039004. [PMID: 32565481 PMCID: PMC7311008 DOI: 10.1136/bmjopen-2020-039004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION There are few robust and directly comparable studies of the epidemiology of psychotic disorders in the Global South. INTREPID II is designed to investigate variations in untreated psychotic disorders in the Global South in (1) incidence and presentation (2) 2-year course and outcome, (3) help-seeking and impact, and (4) physical health. METHODS INTREPID II is a programme of research incorporating incidence, case-control and cohort studies of psychoses in contiguous urban and rural areas in India, Nigeria and Trinidad. In each country, the target samples are 240 untreated cases with a psychotic disorder, 240 age-matched, sex-matched and neighbourhood-matched controls, and 240 relatives or caregivers. Participants will be followed, in the first instance, for 2 years. In each setting, we have developed and are employing comprehensive case-finding methods to ensure cohorts are representative of the target populations. Using methods developed during pilot work, extensive data are being collected at baseline and 2-year follow-up across several domains: clinical, social, help-seeking and impact, and biological. ETHICS AND DISSEMINATION Informed consent is sought, and participants are free to withdraw from the study at any time. Participants are referred to mental health services if not already in contact with these and emergency treatment arranged where necessary. All data collected are confidential, except when a participant presents a serious risk to either themselves or others. This programme has been approved by ethical review boards at all participating centres. Findings will be disseminated through international conferences, publications in international journals, and through local events for key stakeholders.
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Affiliation(s)
- Tessa Roberts
- Health Service & Population Research department, Institute of Psychiatry Psychology and Neuroscience, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Oye Gureje
- WHO Collaborating Centre for Research and Training in Mental Health, Neuroscience and Substance Abuse, Department of Psychiatry, University of Ibadan, Ibadan, Oyo, Nigeria
| | | | - Gerard Hutchinson
- Department of Psychiatry, The University of the West Indies at Saint Augustine Faculty of Medical Sciences, Saint Augustine, Tunapuna-Piarco, Trinidad and Tobago
| | - Alex Cohen
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Helen Anne Weiss
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Sujit John
- Schizophrenia Research Foundation, Chennai, India
| | - Joni Lee Pow
- Department of Psychiatry, The University of the West Indies at Saint Augustine Faculty of Medical Sciences, Saint Augustine, Tunapuna-Piarco, Trinidad and Tobago
| | - Casswina Donald
- Department of Psychiatry, The University of the West Indies at Saint Augustine Faculty of Medical Sciences, Saint Augustine, Tunapuna-Piarco, Trinidad and Tobago
| | - Bola Olley
- Department of Psychiatry, University of Ibadan College of Medicine, Ibadan, Oyo, Nigeria
| | - Georgina Miguel Esponda
- Health Service & Population Research department, Institute of Psychiatry Psychology and Neuroscience, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Craig Morgan
- Health Service & Population Research department, Institute of Psychiatry Psychology and Neuroscience, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
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20
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Akena D, Semeere A, Kadama P, Mwesiga E, Basangwa D, Nakku J, Nakasujja N. Clinical outcomes among individuals with a first episode psychosis attending Butabika National Mental Referral Hospital in Uganda: a longitudinal cohort study. A study protocol for a longitudinal cohort study. BMJ Open 2020; 10:e034367. [PMID: 32513876 PMCID: PMC7282297 DOI: 10.1136/bmjopen-2019-034367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 05/04/2020] [Accepted: 05/15/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Psychotic disorders significantly contribute to high morbidity and mortality. In high-income countries, the predictors of mortality, relapse and barriers to care among patients with first episode psychoses (FEP) have been studied as a means of tailoring interventions to improve patient outcomes. However, little has been done to document relapse rates and their predictors in patients with FEP in low resourced, high disease burdened sub-Saharan Africa. OBJECTIVE We shall estimate the rates of relapse of psychotic symptoms and the factors that predict them in patients with FEP over 4 years. METHODS AND ANALYSIS We will assemble a cohort of patients with an FEP seen at the Butabika National Mental Referral Hospital in Kampala over a 4-year period. Participants will be adults (≥18 years old), who have received a diagnosis of a psychosis according to the Mini International Neuropsychiatric Instrument (M.I.N.I.), with a demonstrable resolution of active symptoms following the use of antipsychotic medications, and deemed clinically stable for a discharge by the healthcare practitioner. All participants will be required to provide written informed consent. Trained research assistants will collect Demographic and clinical parameters, age of onset of symptoms, diagnostic data using the M.I.N.I., physical examination data, symptom severity, level of social and occupational functioning and household income, during the 4-year study period. We will conduct a verbal audit in the event of loss of life. We shall perform survival analysis using the Aalen-Johansen estimator, and describe the population characteristics by demographics, social and economic strata using simple proportions. ETHICS AND DISSEMINATION All participants will provide written informed consent. Ethical approvals for the study have been obtained from the Makerere University School of Medicine Research and Ethics Committee and the Uganda National Council for Science and Technology. Findings will be published in peer reviewed journals.
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Affiliation(s)
| | - Aggrey Semeere
- Research Department of the Infectious Disease Institute, Infectious Diseases Institute Makerere University, Kampala, Uganda
| | - Philippa Kadama
- Research Department of the Infectious Disease Institute, Infectious Diseases Institute Makerere University, Kampala, Uganda
| | - Emanuel Mwesiga
- Department of Psychiatry, Makerere University College of Sciences, Kampala, Uganda
| | - David Basangwa
- Research Department of Butabika Hospital, Butabika National Referral Hospital, Kampala, Uganda
| | - Juliet Nakku
- Psychiatry, Butabika National Referral and Teaching Mental Hospital, Kampala, Uganda
| | - Noeline Nakasujja
- Department of Psychiatry, Makerere University College of Sciences, Kampala, Uganda
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21
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Chen TQ, Hu N, Huo B, Masau JF, Yi X, Zhong XX, Chen YJ, Guo X, Zhu XH, Wei X, Jiang DS. EHMT2/G9a Inhibits Aortic Smooth Muscle Cell Death by Suppressing Autophagy Activation. Int J Biol Sci 2020; 16:1252-1263. [PMID: 32174799 PMCID: PMC7053323 DOI: 10.7150/ijbs.38835] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/05/2020] [Indexed: 02/06/2023] Open
Abstract
Although EHMT2 (also known as G9a) plays a critical role in several kinds of cancers and cardiac remodeling, its function in vascular smooth muscle cells (VSMCs) remains unknown. In the present study, we revealed a novel function of EHMT2 in regulating autophagic cell death (ACD) of VSMC. Inhibition of EHMT2 by BIX01294 or knockdown of EHMT2 resulted in reduced VSMC numbers which were independent of proliferation and apoptosis. Interestingly, EHMT2 protein levels were significantly decreased in VSMCs treated with autophagic inducers. Moreover, more autophagic vacuoles and accumulated LC3II were detected in VSMCs treated with BIX01294 or lenti-shEHMT2 than their counterparts. Furthermore, we found that EHMT2 inhibited the ACD of VSMCs by suppressing autophagosome formation. Mechanistically, the pro-autophagic effect elicited by EHMT2 inhibition was associated with SQSTM1 and BECN1 overexpression. Moreover, these detrimental effects were largely nullified by SQSTM1 or BECN1 knockdown. More importantly, similar results were observed in primary human aortic VSMCs. Overall, these findings suggest that EHMT2 functions as a crucial negative regulator of ACD via decreasing SQSTM1 or BECN1 expression and that EHMT2 could be a potent therapeutic target for cardiovascular diseases (e.g., aortic dissection).
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Affiliation(s)
- Tai-Qiang Chen
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Nan Hu
- Department of Cardiothoracic Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
| | - Bo Huo
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jackson Ferdinand Masau
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xin Yi
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Xiao-Xuan Zhong
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yong-Jie Chen
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xian Guo
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xue-Hai Zhu
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Key Laboratory of Organ Transplantation, Ministry of Education.,NHC Key Laboratory of Organ Transplantation.,Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences
| | - Xiang Wei
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Key Laboratory of Organ Transplantation, Ministry of Education.,NHC Key Laboratory of Organ Transplantation.,Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences
| | - Ding-Sheng Jiang
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Key Laboratory of Organ Transplantation, Ministry of Education.,NHC Key Laboratory of Organ Transplantation.,Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences
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22
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Li R, Wei X, Jiang DS. Protein methylation functions as the posttranslational modification switch to regulate autophagy. Cell Mol Life Sci 2019; 76:3711-3722. [PMID: 31222372 PMCID: PMC11105718 DOI: 10.1007/s00018-019-03161-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 05/10/2019] [Accepted: 05/28/2019] [Indexed: 02/07/2023]
Abstract
Studies over the past decades have elucidated the critical role of autophagy in human health and diseases. Although the processes of autophagy in the cytoplasm have been well studied, the posttranscriptional and epigenetic regulation mechanisms of autophagy are still poorly understood. Protein methylation, including histone methylation and non-histone protein methylation, is the most important type of posttranscriptional and epigenetic modification. Recent studies have shown that protein methylation is associated with effects on autophagosome formation, autophagy-related protein expression, and signaling pathway activation, but the details are still unclear. Thus, it is important to summarize the current status and discuss the future directions of research on protein methylation in the context of autophagy.
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Affiliation(s)
- Rui Li
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan, 430030, China
| | - Xiang Wei
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan, 430030, China
- Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, China
- NHC Key Laboratory of Organ Transplantation, Ministry of Health, Wuhan, China
- Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China
| | - Ding-Sheng Jiang
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan, 430030, China.
- Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, China.
- NHC Key Laboratory of Organ Transplantation, Ministry of Health, Wuhan, China.
- Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China.
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23
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Berry C, Othman E, Tan JC, Gee B, Byrne RE, Hodgekins J, Michelson D, Ng ALO, Marsh NV, Coker S, Fowler D. Assessing social recovery of vulnerable youth in global mental health settings: a pilot study of clinical research tools in Malaysia. BMC Psychiatry 2019; 19:188. [PMID: 31221136 PMCID: PMC6585120 DOI: 10.1186/s12888-019-2164-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 05/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A social recovery approach to youth mental health focuses on increasing the time spent in valuable and meaningful structured activities, with a view to preventing enduring mental health problems and social disability. In Malaysia, access to mental health care is particularly limited and little research has focused on identifying young people at risk of serious socially disabling mental health problems such as psychosis. We provide preliminary evidence for the feasibility and acceptability of core social recovery assessment tools in a Malaysian context, comparing the experiential process of engaging young Malaysian participants in social recovery assessments with prior accounts from a UK sample. METHODS Nine vulnerable young people from low-income backgrounds were recruited from a non-government social enterprise and partner organisations in Peninsular Malaysia. Participants completed a battery of social recovery assessment tools (including time use, unusual experiences, self-schematic beliefs and values). Time for completion and completion rates were used as indices of feasibility. Acceptability was examined using qualitative interviews in which participants were asked to reflect on the experience of completing the assessment tools. Following a deductive approach, the themes were examined for fit with previous UK qualitative accounts of social recovery assessments. RESULTS Feasibility was indicated by relatively efficient completion time and high completion rates. Qualitative interviews highlighted the perceived benefits of social recovery assessments, such as providing psychoeducation, aiding in self-reflection and stimulating goal setting, in line with findings from UK youth samples. CONCLUSIONS We provide preliminary evidence for the feasibility and acceptability of social recovery assessment tools in a low-resource context, comparing the experiential process of engaging young Malaysian participants in social recovery assessments with prior accounts from a UK sample. We also suggest that respondents may derive some personal and psychoeducational benefits from participating in assessments (e.g. of their time use and mental health) within a social recovery framework.
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Affiliation(s)
- Clio Berry
- School of Psychology, Pevensey I, University of Sussex, Falmer, Brighton, East Sussex, BN1 9QH, UK. .,Research & Development, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Millview Hospital, Nevill Avenue, Hove, BN3 7HY, UK.
| | - Ellisha Othman
- SOLS HEALTH, SOLS 24/7, 1Petaling Commerz and Residential Condos, #G-8, Jalan, 1C/149, Off Jalan Sungai Besi, Sungai Besi, 57100 Kuala Lumpur, Malaysia
| | - Jun Chuen Tan
- SOLS HEALTH, SOLS 24/7, 1Petaling Commerz and Residential Condos, #G-8, Jalan, 1C/149, Off Jalan Sungai Besi, Sungai Besi, 57100 Kuala Lumpur, Malaysia
| | - Brioney Gee
- 0000 0001 1092 7967grid.8273.eClinical Psychology, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk NR4 7TJ UK ,grid.451148.dResearch & Development, Norfolk & Suffolk NHS Foundation Trust, 80 St Stephens Road, Norwich, NR1 3RE UK
| | - Rory Edward Byrne
- 0000 0004 0430 6955grid.450837.dPsychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Psychosis Research UnitHarrop House, Prestwich Hospital, Bury New Road, Manchester, M25 3BL UK
| | - Joanne Hodgekins
- 0000 0001 1092 7967grid.8273.eClinical Psychology, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk NR4 7TJ UK ,grid.451148.dResearch & Development, Norfolk & Suffolk NHS Foundation Trust, 80 St Stephens Road, Norwich, NR1 3RE UK
| | - Daniel Michelson
- 0000 0004 1936 7590grid.12082.39School of Psychology, Pevensey I, University of Sussex, Falmer, Brighton, East Sussex BN1 9QH UK
| | - Alvin Lai Oon Ng
- SOLS HEALTH, SOLS 24/7, 1Petaling Commerz and Residential Condos, #G-8, Jalan, 1C/149, Off Jalan Sungai Besi, Sungai Besi, 57100 Kuala Lumpur, Malaysia ,grid.430718.9Department of Psychology, Faculty of Science and Technology, Sunway University, No. 5, Jalan Universiti, Bandar Sunway, Petaling Jaya, Selangor Malaysia
| | - Nigel V. Marsh
- grid.456586.cDepartment of Psychology, James Cook University, 149 Sims Drive, Singapore, 387380 Singapore
| | - Sian Coker
- SOLS HEALTH, SOLS 24/7, 1Petaling Commerz and Residential Condos, #G-8, Jalan, 1C/149, Off Jalan Sungai Besi, Sungai Besi, 57100 Kuala Lumpur, Malaysia ,0000 0001 1092 7967grid.8273.eClinical Psychology, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk NR4 7TJ UK ,grid.430718.9Department of Psychology, Faculty of Science and Technology, Sunway University, No. 5, Jalan Universiti, Bandar Sunway, Petaling Jaya, Selangor Malaysia
| | - David Fowler
- 0000 0004 1936 7590grid.12082.39School of Psychology, Pevensey I, University of Sussex, Falmer, Brighton, East Sussex BN1 9QH UK
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Veling W, Burns JK, Makhathini EM, Mtshemla S, Nene S, Shabalala S, Mbatha N, Tomita A, Baumgartner J, Susser I, Hoek HW, Susser E. Identification of patients with recent-onset psychosis in KwaZulu Natal, South Africa: a pilot study with traditional health practitioners and diagnostic instruments. Soc Psychiatry Psychiatr Epidemiol 2019; 54:303-312. [PMID: 30413848 PMCID: PMC6440845 DOI: 10.1007/s00127-018-1623-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 10/30/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE There is considerable variation in epidemiology and clinical course of psychotic disorders across social and geographical contexts. To date, very little data are available from low- and middle-income countries. In sub-Saharan Africa, most people with psychoses remain undetected and untreated, partly due to lack of formal health care services. This study in rural South Africa aimed to investigate if it is possible to identify individuals with recent-onset psychosis in collaboration with traditional health practitioners (THPs). METHODS We developed a strategy to engage with THPs. Fifty THPs agreed to collaborate and were asked to refer help-seeking clients with recent-onset psychosis to the study. At referral, the THPs rated probability of psychosis ("maybe disturbed" or "disturbed"). A two-step diagnostic procedure was conducted, including the self-report Community Assessment of Psychic Experiences (CAPE) as screening instrument, and a semi-structured interview using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Accuracy of THP referrals, and test characteristics of the THP rating and the CAPE were calculated. RESULTS 149 help-seeking clients were referred by THPs, of which 44 (29.5%) received a SCAN DSM-IV diagnosis of psychotic disorder. The positive predictive value of a THP "disturbed" rating was 53.8%. Test characteristics of the CAPE were poor. CONCLUSION THPs were open to identifying and referring individuals with possible psychosis. They recognized "being disturbed" as a condition for which collaboration with formal psychiatric services might be beneficial. By contrast, the CAPE performed poorly as a screening instrument. Collaboration with THPs is a promising approach to improve detection of individuals with recent-onset psychosis in rural South Africa.
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Affiliation(s)
- W Veling
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - J K Burns
- University of Exeter, Exeter, UK
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - E M Makhathini
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - S Mtshemla
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - S Nene
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - S Shabalala
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - N Mbatha
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - A Tomita
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - J Baumgartner
- Duke Global Health Institute, Duke University, Durham, USA
| | - I Susser
- Department of Anthropology, Hunter College and Graduate Center, City University of New York, New York, USA
- Department of Socio-Medical Sciences, Mailman School of Public Health, Columbia University, New York, USA
| | - H W Hoek
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
- Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - E Susser
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
- New York State Psychiatric Institute, New York, USA
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Christianson L. Improving functional outcomes in college and university students with schizophrenia in the Western world. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2018; 66:61-68. [PMID: 28777705 DOI: 10.1080/07448481.2017.1360306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Retrospective research from patients with schizophrenia suggests that remission becomes increasingly less likely the longer psychosis goes untreated. Yet symptoms of schizophrenia are insidious and disease evolution varies between patients, requiring an ongoing diagnostic process. One way of justifying early treatment is by focusing on functionality rather than symptomatology. Most patients are diagnosed with schizophrenia between the ages of 17 and 25-when many young adults are undergraduates or pursuing post-graduate education. The extent to which schools partner with mental health services has implications for the short-term success of students' recovery and their future employability. Translating study findings on schizophrenia to the college setting remains an important area of investigation.
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Affiliation(s)
- Laura Christianson
- a Pritzker School of Medicine , University of Chicago , Chicago , Illinois , USA
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26
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Humphries S, King R, Dunne MP, Nguyen CH. Early psychosis in central Vietnam: A longitudinal study of short-term functional outcomes and their predictors. Int J Soc Psychiatry 2017; 63:602-613. [PMID: 28817993 DOI: 10.1177/0020764017724589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Few longitudinal studies have investigated the functional outcomes of individuals with recent-onset psychotic illness in low- and middle-income countries. AIMS To investigate short-term functional remission and its predictors in a central Vietnamese sample. METHODS A naturalistic 6-month prospective cohort study recruited 79 patients of public health facilities who had experienced a first episode of schizophrenia or related illness in the past 18 months. Individuals and their family members were interviewed using standardised assessments of community functioning, symptoms, treatment, demographics and various psychosocial variables. Rates of functional remission (i.e. no or minimal impairment) were calculated based on rigorous, culturally appropriate criteria. Generalised estimating equations were used to explore predictors of remission. RESULTS Rates of global functional remission were 28% at baseline and 53% at follow-up. In individual functional domains, remission was least common for occupational activities, intermediate for relationships and relatively common for daily living activities. Global functional remission was significantly associated with absence of negative and cognitive symptoms, average or better household economic status and unimpaired premorbid functioning. CONCLUSION Remission rates appeared similar to those seen in many international intervention studies. However, individuals from poor households had markedly unfavourable outcomes, suggesting the need for community-based interventions targeting low-socioeconomic status (SES) groups.
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Affiliation(s)
- Seiji Humphries
- 1 School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia.,2 Institute for Community Health Research, Hue University of Medicine and Pharmacy, Hue City, Vietnam
| | - Robert King
- 1 School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia
| | - Michael P Dunne
- 2 Institute for Community Health Research, Hue University of Medicine and Pharmacy, Hue City, Vietnam.,3 School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Cat Huu Nguyen
- 4 Department of Psychiatry, Hue University of Medicine and Pharmacy, Hue City, Vietnam
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Gureje O, Makanjuola V, Kola L, Yusuf B, Price L, Esan O, Oladeji BD, Appiah-Poku J, Haris B, Othieno C, Seedat S. COllaborative Shared care to IMprove Psychosis Outcome (COSIMPO): study protocol for a randomized controlled trial. Trials 2017; 18:462. [PMID: 29017605 PMCID: PMC5634898 DOI: 10.1186/s13063-017-2187-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 09/06/2017] [Indexed: 12/19/2022] Open
Abstract
Background Psychotic disorders are a group of severe mental disorders that cause considerable disability to sufferers and a high level of burden to families. In many low- and middle-income countries (LMIC), traditional and faith healers are the main providers of care to affected persons. Even though frequently canvassed as desirable for improved care delivery, collaboration between these complementary alternative health providers (CAPs) and conventional health providers has yet to be rigorously tested for feasibility and effectiveness on patient outcomes. Methods/design COSIMPO is a single-blind, cluster randomized controlled trial (RCT) being conducted in Nigeria and Ghana to compare the effectiveness of a collaborative shared care (CSC) intervention program implemented by CAPs and primary health care providers (PHCPs) with care as usual (CAU) at improving the outcome of patients with psychosis. The study is designed to test the hypotheses that patients receiving CSC will have a better clinical outcome and experience fewer harmful treatment practices from the CAPs than patients receiving CAU at 6 months after study entry. An estimated sample of 296 participants will be recruited from across 51 clusters, with a cluster consisting of a primary care clinic and its neighboring CAP facilities. CSC is a manualized intervention package consisting of regular and scheduled visits of PHCPs to CAP facilities to assist with the management of trial participants. Assistance includes the administration of antipsychotic medications, management of comorbid physical condition, assisting the CAP to avoid harmful treatment practices, and engaging with CAPs, caregivers and participants in planning discharge and rehabilitation. The primary outcome, assessed at 6 months following trial entry, is improvement on the Positive and Negative Symptom Scale (PANSS). Secondary outcomes, assessed at 3 and 6 months, consist of levels of disability, experience of harmful treatment practices and of victimization, and levels of perceived stigma and of caregivers’ burden. Discussion Information about whether collaboration between orthodox and complementary health providers is feasible and can lead to improved outcome for patients is important to formulating policies designed to formally engage the services of traditional and faith healers within the public health system. Trial registration National Institutes of Health Clinical Trial registry, ID: NCT02895269. Registered on 30 July 2016 Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2187-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria.
| | | | - Lola Kola
- World Health Organization Collaborating Centre, Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Bidemi Yusuf
- Department of Epidemiology, Medical Statistics and Environmental Health, University of Ibadan, Ibadan, Nigeria
| | | | - Oluyomi Esan
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | | | - John Appiah-Poku
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | - Soraya Seedat
- Stellenbosch University, Stellenbosch Central, Stellenbosch, South Africa
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28
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From delivery science to discovery science: realising the full potential of global mental health. Epidemiol Psychiatr Sci 2016; 25:499-502. [PMID: 27086899 PMCID: PMC7137659 DOI: 10.1017/s2045796016000263] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The discipline of global mental health has been singularly associated with the generation of knowledge which seeks to reduce the treatment gap for mental disorders. Its priority research agenda has focused on delivery science, i.e. the science of implementing evidence-based interventions. Considerable new resources have furthered this agenda, leading to a flowering of innovations to address barriers to the delivery of interventions while also contributing to the growth and consolidation of research capacity in low and middle income countries. A significant, but as yet under-recognised, opportunity of this global mental health initiative is its potential contribution to discovery science, notably research aimed at identifying the aetiology of mental disorders and the development of novel interventions. This editorial considers a range of potential themes for such discovery science and its guiding principles. Given the limited knowledge that we currently possess about the nature of mental disorders or their effective prevention and treatment, this may well be the most important ultimate contribution of global mental health, i.e. generating knowledge which not only reduces the treatment gap but the actual global burden of mental disorders, and will finally do justice to the 'global' of this discipline.
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Cohen A, Padmavati R, Hibben M, Oyewusi S, John S, Esan O, Patel V, Weiss H, Murray R, Hutchinson G, Gureje O, Thara R, Morgan C. Concepts of madness in diverse settings: a qualitative study from the INTREPID project. BMC Psychiatry 2016; 16:388. [PMID: 27829384 PMCID: PMC5103598 DOI: 10.1186/s12888-016-1090-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 10/25/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In order to facilitate case identification of incident (untreated and recent onset) cases of psychosis and controls in three sites in India, Nigeria and Trinidad, we sought to understand how psychoses (or madness) were conceptualized locally. The evidence we gathered also contributes to a long history of research on concepts of madness in diverse settings. METHODS We conducted focus group discussions and individual interviews to collect information about how informants in each site make sense of and respond to madness. A coding framework was developed and analyses of transcripts from the FGDs and interviews were conducted. RESULTS Analyses suggest the following: a) disturbed behaviors are the primary sign of madness; b) madness is attributed to a wide range of causes; and, c) responses to madness are dictated by cultural and pragmatic factors. These findings are congruent with similar research that has been conducted over the past 50 years. CONCLUSIONS The INTREPID research suggests that concepts about madness share similar features across diverse settings: a) terms for madness are often derived from a common understanding that involves disruptions in mental processes and capacities; b) madness is recognized mostly by disruptive behaviours or marked declines in functioning; c) causal attributions are varied; and, d) help-seeking is a complex process.
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Affiliation(s)
- Alex Cohen
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Maia Hibben
- Department of Psychiatry, University of the West Indies, St Augustine, Trinidad
| | - Samuel Oyewusi
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Sujit John
- Schizophrenia Research Foundation, Chennai, India
| | - Oluyomi Esan
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Vikram Patel
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Weiss
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Robin Murray
- Psychosis Studies Department, Institute of Psychiatry, King’s College London, London, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
| | - Gerard Hutchinson
- Department of Psychiatry, University of the West Indies, St Augustine, Trinidad
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | | | - Craig Morgan
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College London, London, UK
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Morgan C, John S, Esan O, Hibben M, Patel V, Weiss H, Murray RM, Hutchinson G, Gureje O, Thara R, Cohen A. The incidence of psychoses in diverse settings, INTREPID (2): a feasibility study in India, Nigeria, and Trinidad. Psychol Med 2016; 46:1923-1933. [PMID: 27019301 DOI: 10.1017/s0033291716000441] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There are striking global inequities in our knowledge of the incidence, aetiology, and outcome of psychotic disorders. For example, only around 10% of research on incidence of psychotic disorders originates in low- and middle-income countries. We established INTREPID I to develop, implement, and evaluate, in sites in India (Chengalpet), Nigeria (Ibadan), and Trinidad (Tunapuna-Piarco), methods for identifying and recruiting untreated cases of psychosis, as a basis for investigating incidence and, subsequently, risk factors, phenomenology, and outcome. In this paper, we compare case characteristics and incidence rates across the sites. METHOD In each site, to identify untreated cases of psychoses in defined catchment areas, we established case detection systems comprising mental health services, traditional and spiritual healers, and key informants. RESULTS Rates of all untreated psychoses were 45.9 (per 1 00 000 person-years) in Chengalpet, 31.2 in Ibadan, and 36.9 in Tunapuna-Piarco. Duration of psychosis prior to detection was substantially longer in Chengalpet (median 232 weeks) than in Ibadan (median 13 weeks) and Tunapuna-Piarco (median 38 weeks). When analyses were restricted to cases with a short duration (i.e. onset within preceding 2 years) only, rates were 15.5 in Chengalpet, 29.1 in Ibadan, and 26.5 in Tunapuna-Piarco. Further, there was evidence of age and sex differences across sites, with an older average age of onset in Chengalpet and higher rates among women in Ibadan. CONCLUSION Our findings suggest there may be differences in rates of psychoses and in the clinical and demographic profiles of cases across economically and socially distinct settings.
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Affiliation(s)
- C Morgan
- Health Service and Population Research Department,Society and Mental Health Research Group,Centre for Epidemiology and Public Health,Institute of Psychiatry, King's College London,UK
| | - S John
- Schizophrenia Research Foundation,Chennai,India
| | - O Esan
- Department of Psychiatry,University of Ibadan,Nigeria
| | - M Hibben
- Department of Psychiatry,University of the West Indies,Trinidad
| | - V Patel
- Department of Population Health,London School of Hygiene and Tropical Medicine,London,UK
| | - H Weiss
- Department of Population Health,London School of Hygiene and Tropical Medicine,London,UK
| | - R M Murray
- Health Service and Population Research Department,Society and Mental Health Research Group,Centre for Epidemiology and Public Health,Institute of Psychiatry, King's College London,UK
| | - G Hutchinson
- Department of Psychiatry,University of the West Indies,Trinidad
| | - O Gureje
- Department of Psychiatry,University of Ibadan,Nigeria
| | - R Thara
- Schizophrenia Research Foundation,Chennai,India
| | - A Cohen
- Department of Population Health,London School of Hygiene and Tropical Medicine,London,UK
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Abstract
The growing momentum towards a global consensus on universal health coverage, alongside an acknowledgment of the urgency and importance of a comprehensive mental health action plan, offers a unique opportunity for a substantial scale-up of evidence-based interventions and packages of care for a range of mental disorders in all countries. There is a robust evidence base testifying to the effectiveness of drug and psychosocial interventions for people with schizophrenia and to the feasibility, acceptability and cost-effectiveness of the delivery of these interventions through a collaborative care model in low resource settings. While there are a number of barriers to scaling up this evidence, for eg, the finances needed to train and deploy community based workers and the lack of agency for people with schizophrenia, the experiences of some upper middle income countries show that sustained political commitment, allocation of transitional financial resources to develop community services, a commitment to an integrated approach with a strong role for community based institutions and providers, and a progressive realization of coverage are the key ingredients for scale up of services for schizophrenia.
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Affiliation(s)
- Vikram Patel
- London School of Hygiene & Tropical Medicine, the Public Health Foundation of India and Sangath, Goa, India
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A focus on adolescence to reduce neurological, mental health and substance-use disability. Nature 2015; 527:S161-6. [DOI: 10.1038/nature16030] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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