First Episode Psychosis in South India

描述（由申请人提供）：精神分裂症的文化精神病学和结局研究中最一致的发现之一是，发展中国家的精神分裂症结局优于发达国家。然而，很少有人知道为什么会这样。拟议的项目是建立一个可持续的研究计划的第一步，该计划将揭示精神病结果跨文化差异的机制。具体而言，该项目涉及领先的精神分裂症研究团队之间的合作，在印度与文化相关的精神分裂症研究方面具有互补优势，并在加拿大开创了首发精神病研究。以前的调查结果的精神病的跨文化差异往往受到混杂因素的限制，如未经治疗的精神病和接受治疗的持续时间的差异。这项拟议中的研究通过关注以前没有接受过治疗的首次发作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既往未经治疗的首发精神病患者进行充分表征的样本进行随访，并明确定义治疗干预措施。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，在发现前缓冲未经治疗的精神病的毒性影响，并在发现后加强治疗的效果。待检验的具体假设是（1）在印度，未经治疗的精神病持续时间对临床结局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有害影响较小。(2)在印度，未经治疗的精神病的持续时间本身将由家庭因素预测，例如以前的精神疾病家庭经验和家庭结构类型（核心与扩展）。在大家庭和家庭中的个人与精神疾病的经验较低的水平将有更长的时间未经治疗的精神病。(3)在印度，家庭因素将显著预测6个月和1年的临床和职业结局。结果将使我们更好地了解家庭所做的有助于印度取得更好成果的事情。这种理解将导致文化上适当的家庭干预措施和战略的发展，以减少印度的治疗延误。在合作开展这些试点研究的过程中，印度研究中心还将建设其对早期精神病进行长期研究的能力。这种研究可以为制定政策和临床服务提供信息，以解决精神分裂症给面临严重资源短缺的发展中国家人民造成的严重负担。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。该项目将提高对家庭在寻求和促进治疗方面的作用的认识，从而有助于发展早期干预和家庭服务。该项目的一个重要成果将是在发展中国家建立文化上适当和可持续的研究能力，从而改善对全世界精神分裂症患者的服务。

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.