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。我们建议进行一项研究的试点和能力建设，该研究将调查南非夸祖鲁-纳塔尔的Vulindlela的首发精神病性障碍（FEP）的发病率、早期病程和治疗途径（INCET）：此后称为FEP-INCET研究。鉴于非洲以前的大多数研究都依赖于住院治疗，FEP-INCET将包括那些寻求非正式和正式社区从业人员帮助的人。这将是第一项在非洲开展的研究，以得出FEP的发病率;前瞻性地调查FEP的早期表现和早期病程的范围;追踪进入和离开非正式和正式医疗保健的途径;并确定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、生物学研究和遗传学研究。我们相信，通过将非洲直接纳入专注于精神障碍的调查人员的范围，这将对全球精神卫生产生变革性影响。主要研究人员是哥伦比亚大学的Ezra Susser和夸祖鲁-纳塔尔大学的Jonathan Burns。Vulindlela是一个贫穷的农村社区，人口45万，主要是祖鲁人。这是非洲少数几个可行的研究地点之一。原因之一是我们的艾滋病研究同事研究了人口统计学，社会文化环境和Vulindlela的医疗资源。该社区有一个强大的传统理事会，下设五个传统选区，每个选区由一名部落酋长领导。部落酋长在社区生活中与正式的政府当局一道发挥关键作用。失业率约为45%。15 - 34岁人口中有三分之一以上艾滋病毒呈阳性。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（往往是唯一的）呼叫端口。FEP-INCET的一个具有挑战性和新颖性的特点是在传统的治疗实践中识别患者。FEP-INCET的预备研究将在Vulindlela的五个病房之一进行。在这个病房里，有5名传统治疗师，两个诊所，没有全科医生，也没有医院。我们将在五个传统治疗师和两个诊所试点筛查氟氯乙烷;翻译和调整评估结果，以便在祖鲁语和当地文化中使用;并在夸祖鲁-纳塔尔大学建立开展研究所需的能力。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.