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。我们建议试点并建立一项研究的能力，该研究将调查南非夸祖鲁-纳塔尔Vulindlela首发精神病障碍(FEP)的发病率、早期病程和治疗路径(INCET)：以下简称FEP-INCET研究。以前在非洲的大多数研究都依赖于入院，而FEP-INCET将包括那些向非正式和正式的社区从业者寻求帮助的人。这将是在非洲环境下进行的第一项研究，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路径；并确定在该路径的每个点上影响求助的因素。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。我们认为，通过将非洲直接纳入专注于精神障碍的调查人员的范围，它将对全球心理健康产生革命性影响。首席调查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是一个贫困的农村社区，人口45万，主要是祖鲁人。这是非洲为数不多的几个这样的研究可行的地点之一。其中一个原因是，我们从事艾滋病毒研究的同事研究了瓦林德拉的人口统计学、社会文化环境和卫生保健资源。该社区有一个强大的传统议会，有五个传统区，每个区由一名部落首领领导。部落首领在社区生活中发挥着关键作用，与正式的政府当局并驾齐驱。失业率约为45%。15-34岁的人口中有三分之一以上是艾滋病毒阳性者。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性的特点将是在传统的治疗实践中识别患者。FEP-INCET的这项预备研究将在Vulindlela的五个病房之一进行。在这个病房里有5名传统治疗师，两家卫生所，没有全科医生，也没有医院。我们将在五名传统治疗师和两名诊所试行FEP筛查；翻译和改编评估，以用于IsiZulu语言和当地文化；并在夸祖鲁-纳塔尔大学建立实施研究所需的能力。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.