IDENTIFICATION OF PSYCHOSIS-RISK TRAITS IN AFRICA

描述(由申请人提供)：这项建议是开发纵向研究项目的努力和长期国际合作的一部分，以研究撒哈拉以南非洲精神疾病风险特征的发展和进展。目前的项目重点是评估肯尼亚内罗毕周围地区的青少年和青壮年。这些地区的文化基本相同，居民使用斯瓦希里语和英语两种语言。我们在肯尼亚开始了这项工作，通过领导青年焦点小组，评估结构化访谈的可用性，以评估发展中的精神病的“超高风险”(UHR)症状。我们招募和培训了当地研究人员，以管理用于识别UHR症状的结构化工具，并已开始在肯尼亚基贝拉使用这些工具进行社区青年评估。这项R21提案侧重于肯尼亚当地精神卫生人员使用标准化诊断、神经认知、神经学和人类学评估的能力建设和培训。作为这项工作的一部分，我们的具体目标是1)描述UHR青年(14-25岁)的神经认知、神经学和人体测量学特征，并将这些特征与匹配的对照组进行比较；2)评估UHR青年症状的进展，最长可达18个月，确定过渡到精神障碍的比率，并确定指示进展为精神病的特征。我们假设，与对照组相比，UHR的异常率将会增加，这些异常将增加UHR青年转变为精神病的可能性。精神分裂症和相关的精神障碍是世界上致残率最高的疾病之一，给社会带来了巨大的经济成本，并给受影响的患者和家庭带来了痛苦。在发展中国家，认知和运动异常经常出现在精神分裂症患者和那些有发展成精神病风险的患者身上。在精神分裂症患者中也发现了特定的头部和面部尺寸，这可能表明患这种疾病的风险是可测量的。我们的计划将开始对临床特征进展的纵向研究，这将首次成为非洲UHR青年发展的特征。该提案旨在确定和解决非洲大陆纵向研究面临的潜在挑战，评估研究能力，并通过培训、职业发展和辅导加强当地研究。这些努力预计将对促进肯尼亚的独立和协作精神卫生研究以及临床护理产生长期影响。

DESCRIPTION (provided by applicant): This proposal is part of an effort and long-range international collaboration to develop longitudinal research projects to study the development and progression of psychosis-risk traits in sub-Saharan Africa. The current project focuses on evaluating adolescents and young adults in regions around Nairobi, Kenya. These areas are culturally largely homogenous, and residents are bilingual in Swahili and English. We began this effort in Kenya, by conducting youth focus groups, assessing the usability of a structured interview for evaluating "ultra-high-risk" (UHR) symptoms for developing psychosis. We have recruited and trained local research workers in administering structured instruments for identification of UHR symptoms, and have begun conducting community youth assessments using these instruments in Kibera, Kenya. This R21 proposal focuses on capacity building and training of local mental health personnel on the use of standardized diagnostic, neurocognitive, neurological and anthropological assessment in Kenya. As part of this effort, our specific aims are to 1) Characterize the neurocognitive, neurologic, and anthropometric profiles of UHR youth (14-25 yrs) and compared these to matched controls, and 2) Evaluate the progression of symptoms in UHR youth at intervals up to 18 months, identify the rate of transition to psychotic disorders and identify traits indicating progression towards psychosis. We hypothesize that there will be increased rates of abnormality in UHR compared to controls, and these abnormalities will increase the probability of transition to psychosis in UHR youth. Schizophrenia and related psychotic disorders are among the most disabling illnesses worldwide, and cause enormous economic costs to society and distress to patients and families affected. Cognitive and movement abnormalities are often noted in patients with schizophrenia and those at risk for developing psychosis in developing countries. Specific head and face dimensions have also been found in schizophrenia, and may indicate a measureable risk of developing the illness. Our proposal will begin longitudinal studies on progression of clinical traits, which would characteriz the development of UHR youth for the first time in Africa. The proposal will aim to identify and address potential challenges to longitudinal studies in the continent, assess research capacity and strengthen local research through training, career development and mentoring. These efforts are expected to have a long-term impact in advancing independent and collaborative mental health research, as well as clinical care in Kenya.