Psychotic disorders in an African setting: Incidence, early course, and treatment

描述（由申请人提供）：非洲环境中的精神障碍：发病率、早期病程和治疗途径。我们建议在南非夸祖鲁-纳塔尔省Vulindlela开展一项调查首次发作性精神障碍（FEP）的发病率、早期病程和治疗途径（INCET）的研究，并为此进行试点和能力建设：以下简称为FEP-INCET研究。以往在非洲进行的大多数研究都依赖于住院情况，而该项目将包括那些向非正式和正式社区从业人员寻求帮助的人。这将是第一个在非洲环境下得出FEP发病率的研究；前瞻性探讨FEP的早期表现范围和早期病程；追踪进入和退出非正规和正规保健的途径；并确定在路径的每个点影响寻求帮助的因素。它将为未来的研究建立一个平台，包括早期干预研究、生物学研究和基因研究。我们相信，通过将非洲直接纳入专注于精神疾病的研究人员的范围，这将对全球精神卫生产生变革。主要研究者是哥伦比亚大学的Ezra Susser和夸祖鲁-纳塔尔省大学的Jonathan Burns。Vulindlela是一个贫穷的农村社区，人口45万，主要是祖鲁人。它是非洲少数几个可以进行这种研究的地点之一。其中一个原因是我们的HIV研究同事研究了Vulindlela的人口统计、社会文化环境和卫生保健资源。这个社区有一个强大的传统委员会，由五个传统的区组成，每个区由一名部落酋长领导。部落首领在社区生活中发挥着与正式政府当局并行的关键作用。失业率约为45%。超过三分之一的15-34岁人口是艾滋病毒阳性。传统治疗师在医疗保健中占主导地位，通常是FEP患者的第一个（通常也是唯一的）求助对象。FEP-INCET的一个具有挑战性和新颖的特征将是在传统治疗实践中识别患者。该计划的筹备性研究将在乌林德拉五个病房中的一个进行。这个病房里有5个传统治疗师，2个健康诊所，没有全科医生，也没有医院。我们将在五家传统治疗师和两家诊所试行FEP筛查；翻译和调整评估，以便在isiZulu语言和当地文化中使用；并在夸祖鲁-纳塔尔省大学建立实施这项研究所需的能力。完成这项工作后，我们将为FEP-INCET研究准备R01申请。

DESCRIPTION (provided by applicant): Psychotic disorders in an African setting: Incidence, early course, and treatment pathways. We propose to pilot and build capacity for a study that will investigate the incidence rate, early course, and treatment pathways (INCET) of first episode psychotic disorders (FEP) in Vulindlela, Kwazulu-Natal, South Africa: henceforth referred to as the FEP-INCET study. Whereas most previous studies in Africa have relied upon hospital admissions, the FEP-INCET will encompass those who seek help from informal and formal community practitioners. It will be the first study in an African setting to derive incidence rates for FEP; prospectively investigate the range of early manifestations and early course of FEP; trace the pathways into and out of informal as well as formal health care; and identify factors that influence help-seeking at each point in the pathway. It will establish a platform for future studies, including early intervention studies, biological studies, and genetic studies. We believe that it will be transformative for global mental health, by bringing Africa squarely into the purview of investigators who focus on psychotic disorders. The Principal Investigators are Ezra Susser at Columbia University and Jonathan Burns at the University of KwaZulu-Natal. Vulindlela is a poor rural community of population 450,000, mainly Zulu. It is one of the few sites in Africa where such a study is feasible. One reason is that our colleagues in HIV research have studied the population demography, the sociocultural environment, and the health care resources of Vulindlela. The community has a strong traditional council with five traditional wards, each headed by a tribal chief. The tribal chiefs play a key role in community life in parallel with formal government authorities. The unemployment rate is about 45%. More than one third of the population age 15-34 years is HIV positive. Traditional healers predominate in health care, and are usually the first (and often the only) port of call for patients with FEP. A challenging- and novel- feature of FEP-INCET will be the identification of patients at the traditional healer practices. This preparatory study for FEP-INCET will be done in one of the five wards of Vulindlela. In this ward there are 5 traditional healers, two health clinics, no general practitioners, and no hospitals. We will pilot screening for FEP at the five traditional healer and two clinic practices; translate and adapt assessments for use in the isiZulu language and the local culture; and build the capacity at the University of KwaZulu-Natal needed to implement the study. After completing this work, we will prepare an R01 application for the FEP-INCET study. PUBLIC HEALTH RELEVANCE: This study will do the preparatory work required to launch the first ever study of the incidence, course and treatment of first-episode psychoses in an African setting. Whereas most previous studies in Africa have relied upon hospital admissions, this study will include those who seek help from informal and formal community practitioners. We believe that it will be transformative for global mental health, by opening pathways to research and treatment in Africa, and broadening our understanding of the range and frequency of psychotic disorders across the globe.