First Episode Psychosis in South India

印度南部第一集精神病

• 批准号: 7427068
• 负责人: Ashok Malla
• 金额: $ 2.5万
• 依托单位: MCGILL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-07-15 至 2010-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7427068
• 关键词: Accounting; Acute; Address; Adolescence; Aftercare; Age; Behavior Disorders; Boxing; Buffers; Canada; Classification; Clinical; Clinical Services; Collaborations; Data; Detection; Developed Countries; Developing Countries; Development; Disease; Early Intervention; Extended Family; Face; Family; Foundations; Funding; Future; Goals; Health Services Accessibility; Illness impact; Incidence; India; Individual; Institutes; Intervention; Investigation; Knowledge; Lead; Measures; Mediating; Mental Health; Mental disorders; NIH Program Announcements; Nuclear; Occupational; Operative Surgical Procedures; Outcome; Outcomes Research; PEPP; Patients; Pilot Projects; Policy Developments; Population; Prevalence; Prevention; Protocols documentation; Psyche structure; Psychiatry; Psychotic Disorders; Public Health; Purpose; Research; Resources; Role; Sampling; Schizophrenia; Services; Site; Testing; Toxic effect; Training; Universities; Variant; clinical epidemiology; design; development policy; experience; family structure; first episode psychosis; improved; innovation; intervention program; novel; programs; response; therapy development; treatment effect

DESCRIPTION (provided by applicant): One of the most consistent findings in both cultural psychiatry and outcome research in schizophrenia is that outcomes of schizophrenia are better in developing countries than in developed ones. Yet, little is known about why this is the case. The proposed project is a first step towards building a sustained research program that will reveal the mechanisms underlying the cross-cultural variation in psychosis outcomes. Specifically, the project involves collaboration between leading schizophrenia research teams, with complementary strengths in culturally relevant schizophrenia research in India and pioneering first-episode psychosis research in Canada. Previous investigations of cross-cultural variation in outcomes of psychosis have often been limited by confounding factors such as differences in duration of untreated psychosis and treatments received. The proposed study avoids this pitfall by focusing on first-episode patients who have not been treated before. Over the proposed two-year funding period, a well characterized sample of patients with previously untreated first- episode psychosis will be followed in India and Canada and treatment interventions will be clearly defined. The premise of the pilot studies to be undertaken is that family factors positively impact the course of schizophrenia in India, buffering the toxic effects of untreated psychosis prior to detection and reinforcing the effects of treatment after detection. The specific hypotheses to be tested are (1) Duration of untreated psychosis will have a less detrimental effect on clinical outcomes in India than in Canada. Differences between family support available to patients in India and Canada will account for the less pernicious effect of delay in treatment. (2) Duration of untreated psychosis in India itself will be predicted by family factors such as previous family experience with mental illness and the type of family structure (nuclear versus extended). Individuals in extended families and in families with lower levels of prior experience with mental illness will have longer duration of untreated psychosis. (3) Family factors will significantly predict six-month and one-year clinical and occupational outcomes in India. Results will increase our understanding of what it is that families do that contributes to better outcomes in India. Such an understanding will lead to the development of culturally appropriate family interventions and strategies to reduce treatment delay in India. In the course of collaborating to conduct these pilot studies, the Indian site will also build its capacity to conduct long-term research in early psychosis. Such research can inform the development of policies and clinical services that can address the severe burden of schizophrenia on people in developing countries who face acute shortage of resources. PUBLIC HEALTH RELEVANCE: This study seeks to strengthen the research collaboration between a developed country, Canada and a developing country, India for the purpose of understanding why schizophrenia has different outcomes in different cultural settings. This project will increase the understanding of the role of families in seeking and facilitating treatment, and thus help the development of early intervention and family services. An important outcome of this project will be the building of culturally appropriate and sustainable research capacity in a developing country and thereby the improvement of services for people with schizophrenia across the world.

描述（由申请人提供）：文化精神病学和精神分裂症结果研究中最一致的发现之一是，发展中国家的精神分裂症结果比发达国家更好。然而，人们对为什么会出现这种情况却知之甚少。拟议的项目是建立持续研究计划的第一步，该计划将揭示精神病结果跨文化差异的机制。具体来说，该项目涉及领先的精神分裂症研究团队之间的合作，在印度文化相关的精神分裂症研究和加拿大开创性的首发精神病研究方面具有互补优势。先前对精神病结果的跨文化差异的研究常常受到混杂因素的限制，例如未治疗的精神病的持续时间和接受的治疗的差异。拟议的研究通过关注之前未接受过治疗的首发患者来避免这一陷阱。在拟议的两年资助期内，将在印度和加拿大对先前未经治疗的首发精神病患者的特征明确的样本进行跟踪，并明确规定治疗干预措施。即将进行的试点研究的前提是，家庭因素对印度精神分裂症的病程产生积极影响，在检测前缓冲未经治疗的精神病的毒性作用，并在检测后加强治疗的效果。要检验的具体假设是 (1) 在印度，未经治疗的精神病持续时间对临床结果的不利影响小于加拿大。印度和加拿大患者可获得的家庭支持之间的差异将解释延迟治疗的危害较小的原因。 (2) 在印度，未经治疗的精神病的持续时间将由家庭因素预测，例如家庭以前患有精神疾病的经历和家庭结构的类型（核心家庭与大家庭）。大家庭中的个人以及先前患有精神疾病的经历较低的家庭中的个人，未经治疗的精神病持续时间会更长。 (3) 家庭因素将显着预测印度六个月和一年的临床和职业结果。结果将加深我们对家庭所做的事情有助于印度取得更好结果的理解。这种理解将有助于制定适合印度文化的家庭干预措施和战略，以减少印度的治疗延误。在合作进行这些试点研究的过程中，印度站点还将建设其对早期精神病进行长期研究的能力。此类研究可以为政策和临床服务的制定提供信息，从而解决资源严重短缺的发展中国家人民面临的精神分裂症的严重负担。公共卫生相关性：本研究旨在加强发达国家（加拿大）和发展中国家（印度）之间的研究合作，以了解为什么精神分裂症在不同的文化背景下有不同的结果。该项目将增进人们对家庭在寻求和促进治疗方面的作用的了解，从而有助于早期干预和家庭服务的发展。该项目的一个重要成果将是在发展中国家建立适合文化的可持续研究能力，从而改善为全世界精神分裂症患者提供的服务。