INTREPID (International Research Programme on Psychoses in Diverse Settings) III: Deepening and Broadening Knowledge of Psychoses Globally

这个节目讲的是什么？精神障碍通常是令人痛苦的状况，其中人们经历诸如幻觉（看到或听到不存在的东西）和错误的想法或信念（妄想）等症状。这些疾病通常开始在年轻的时候（在20多岁），并经常（但不总是）导致长期的痛苦和折磨。然而，我们对这些疾病的了解主要是基于欧洲，北美和澳大利亚的研究。我们对其他地方的这些疾病了解不多，特别是在全球南部。这是一个问题，因为这意味着我们不知道如何最好地治疗那些在大多数地方的精神障碍。大约5年前，我们开始了一项研究计划，以了解更多关于其他地方的精神障碍，特别是印度，尼日利亚和特立尼达-选择他们是因为他们彼此非常不同。在这一过程中，我们确定并跟踪了大约200名患有精神障碍的人和200名没有精神障碍的人。这项工作已经告诉了我们很多我们不知道的东西，可以总结为：不同地区的精神病有多常见，哪些群体受影响最大，典型的发病年龄，哪些因素会增加风险，身体健康需求，以及短期结果（2年）。然而，还有很多我们不知道的：结果的差异是否会持续，在中期和长期？研究中通常不包括的群体，例如，那些无家可归的精神病患者为什么会有如此大的差异？那么其他地方呢--我们看到的是同样的东西吗？目前拟议的方案是建立在已经为回答这些问题而开展的工作的基础上，并将其扩展。首先，我们将继续并扩大我们在印度、尼日利亚和特立尼达的研究。我们将以两种方式做到这一点。(1)我们将在第一次参与后6年跟踪我们以前工作中包括的所有个人。我们将从他们那里收集有关他们的症状和生活的其他方面如何随着时间的推移而变化的信息（包括他们认为最重要的生活方面）。我们将按地点和群体比较这些信息，看看是否有类似的和其他差异，我们以前观察到的。(2)我们将确定另外60名以前没有接受过治疗的精神障碍患者和60名没有精神障碍的患者。这将使我们能够更详细地了解存在差异的一些可能原因，例如，也许是因为对压力的反应不同，或者认知的不同，或者生物年龄的不同（与实际年龄）-这可能解释了身体健康和死亡率的差异。第二，我们将创建一个基于网络的目录，列出世界各地使用与我们相似方法进行的所有精神病研究，并在可能的情况下，联合收割机将他们的数据集结合起来，使研究人员能够在更广泛的地方进行比较。第三，我们将在印度、尼日利亚和特立尼达的每一个环境中与有精神病生活经历的人、照顾者、以及其他方面，如服务提供者，制定新的一揽子干预措施，以适应每个地方环境的需要。在今后的工作中，我们将测试和实施这些干预措施。该计划将告诉我们更多关于精神障碍如何以及为什么在不同国家之间存在差异，以及如何更有效地进行干预。由于我们目前对这些问题的信息非常少，我们的计划有望产生巨大的影响，无论是对我们对精神障碍的理解，还是对如何在更多样化的环境中进行干预。

What is the programme about?Psychotic disorders are frequently distressing conditions in which people experience symptoms such as hallucinations (seeing or hearing things that are not there) and false thoughts or beliefs (delusions). These disorders usually begin at a young age (in the 20s) and often (but not always) lead to long term distress and suffering.Around 20 million people worldwide experience a psychotic disorder. However, what we know about these disorders is based on research done mainly in Europe, North America, and Australia. We do not know much about these disorders in other places, especially in the Global South. This is a problem because it means we do not know how best to treat those with a psychotic disorder in most places.Around 5 years ago, we started a programme of research to find out more about psychotic disorders in other places, specifically India, Nigeria, and Trinidad - chosen because they are very different from each other. In this, we identified and followed over time around 200 people with a psychotic disorder and 200 people without in each place. This work has already told us much we didn't know, which can be summarised as: there are differences across places in how common psychoses are, which groups are most affected, the typical age of onset, what factors increase risk, in physical health needs, and in short term outcomes (at 2 years).There is, however, much we still don't know: Do differences in outcome continue, over the medium and long term? What about groups typically not included in research, e.g., those who are homeless with a psychosis? Why are there such wide variations? And what about other places - do we see the same things?This current proposed programme builds on and extends the work already to answer these questions.What will we do?First, we will continue and expand our research India, Nigeria, and Trinidad. We will do this in two ways. (1) We will follow all individuals included in our previous work at 6 years after their first participation. We will collect information from them about how their symptoms and other aspects of their lives have changed over time (including those aspects of their lives they feel are most important). We will compare this information by place and by group, to see if there are similar and other differences to what we have observed before.(2) We will identify 60 more individuals with a psychotic disorder that have not been previously treated and 60 individuals without a psychotic disorder. This will allow us to look in more detail at some possible reasons why there are differences, e.g., perhaps because of differences in responses to stress, or differences in cognition, or differences in biological age (vs. actual age) - which may explain differences in physical health and mortality.Second, we will create a web-based catalogue of all studies of psychoses using similar approaches to ours around the world and, where possible, combine their data sets to enable researchers to conduct comparisons across a wider range of places.Third, we will work - in each setting in India, Nigeria, and Trinidad - with people with lived experience of psychosis, carers, and others such as service providers to develop new packages of interventions, tailored to the needs of each local setting. In future work, we will test and implement these interventions.What will the programme tell us?This programme will tell us more about how and why psychotic disorders differ between different countries and about how to intervene more effectively. Because we have so little information at the moment about these questions, our programme promises to have a big impact, both on our understanding of psychotic disorders and on how to intervene in more diverse settings.