Early Psychosis in India and Canada: Investigating outcomes and family factors

描述（由申请人提供）：在文化精神病学和精神分裂症结局研究中，人们一致发现，发展中国家精神分裂症治疗的结局优于发达国家。然而，很少有人知道为什么会这样。目前尚不清楚这种差异是否延伸到所有的结果域或仅限于选择和狭义定义的临床和功能的结果，现有的研究已经focuson. Given这些显着的知识差距，拟议的项目的长期目标是一个持续的研究计划，将揭示精神病的结果跨文化差异的性质和机制。具体而言，该项目涉及两个团队之间的合作，这两个团队在印度的文化相关精神分裂症研究和加拿大的首次精神病发作研究方面具有互补优势。以前的跨文化不同的精神病结果的调查往往受到混杂因素的限制，如未经治疗的精神病和接受的治疗的持续时间的差异。为了避免这个陷阱，拟议的研究将集中在印度钦奈和加拿大蒙特利尔的既往未经治疗的首发精神病患者身上，他们将接受明确定义的类似治疗两年。主要目的是调查一系列结果领域和家庭因素的研究中心间差异，以及家庭因素的差异是否有助于结果的变化。我们的前提是，在印度精神病的更好的结果可以在很大程度上解释为相对较高的水平，提供给印度精神病患者的家庭支持相比，在发达国家，如加拿大。本研究的具体假设是：（1）治疗后两年内，印度患者的功能、主观和临床结局均优于加拿大患者。他们将更有可能工作或上学，报告更好的生活质量，症状改善更快，更持久。他们也更有可能继续参与治疗，而不是退出治疗。(2)印度患者将更有可能有家庭成员参与其治疗，并享受更高水平的特定类型的家庭支持和参与，包括一般心理支持和促进治疗依从性和康复的特定支持。此外，家庭因素将介导临床结局的中心间差异。将采用定量和定性相结合的研究方法。在这两个地点，定性方法将特别有助于了解患者如何看待康复以及家庭成员和患者如何看待家庭在精神病患者生活中的作用。该项目的研究结果将促进我们对印度早期精神病过程的理解;精神分裂症结果的跨文化差异;以及家庭如何为印度更好的结果做出贡献。这种理解将塑造印度文化上适当的家庭和早期干预服务的发展，并提出改善西方精神分裂症预后的策略，从而减轻（即使部分）精神分裂症造成的严重负担，无论文化背景如何。 公共卫生相关性：这项研究涉及发达国家加拿大和发展中国家印度之间的研究合作，目的是了解精神分裂症是否以及为什么在不同的文化背景下有不同的结果。这项计划将增加我们对家庭在促进治疗方面的作用的认识，从而有助于发展早期干预和家庭服务。我们的研究结果还将揭示年轻的精神分裂症患者如何看待和理解康复，以及家庭如何看待他们在精神分裂症治疗中的作用。

DESCRIPTION (provided by applicant): In cultural psychiatry and schizophrenia outcome research, it is consistently found that the outcomes of treated schizophrenia are better in developing countries than in developed ones. Yet, little is known about why this is so. It is not known whether this difference extends to all outcome domains or is limited to the select and narrowly defined clinical and functional outcomes that existing research has focused on. Given these significant knowledge gaps, the long-term goal of the proposed project is a sustained research program that will reveal the nature of and the mechanisms underlying cross-cultural variation in psychosis outcomes. Specifically, the project involves collaboration between two teams with complementary strengths in culturally relevant schizophrenia research in India and pioneering first-episode psychosis research in Canada. Previous investigations of cross-culturally varied psychosis outcomes have often been limited by confounding factors such as differences in the duration of untreated psychosis and treatments received. To avoid this pitfall, the proposed study will focus on patients with previously untreated first-episode psychosis in Chennai, India and Montreal, Canada who will receive clearly defined and similar treatment for two years. Key objectives are to investigate inter-site differences in a range of outcome domains and family factors and whether the differences in family factors contribute to variation in outcomes. Our premise is that the better outcomes of psychosis in India can be largely explained by the comparatively higher levels of family support available to persons with psychosis in India as compared to in developed countries such as Canada. The specific hypotheses of this study are: (1) Two years after treatment, the Indian patients will have better functional, subjective, and clinical outcomes than the Canadian ones. They will be likelier to be working or in school, report a better quality of life, and have higher and more sustained improvement in symptoms. They will also be likelier to stay engaged in and not drop out from treatment. (2) The Indian patients will be more likely to have family members involved in their treatment and enjoy higher levels of specific types of family support and involvement, both general psychological support and support specific to promoting treatment adherence and recovery. Further, family factors will mediate the inter-site variation in clinical outcomes. A combination of quantitative and qualitative research methods will be deployed. At both sites, qualitative methods will especially help understand how patients regard recovery and how family members and patients perceive the family's role in the lives of young people with psychosis. The project's findings will advance our understanding of the course of early psychosis in India; of cross-cultural variation in schizophrenia outcomes; and of how families contribute to better outcomes in India. This understanding will shape the development of culturally appropriate family and early intervention services in India and suggest strategies for improving schizophrenia outcomes in the West, thus alleviating (even if partially) the severe burden that schizophrenia imposes irrespective of cultural setting. PUBLIC HEALTH RELEVANCE: This study involves research collaboration between a developed country, Canada and a developing country, India for the purpose of understanding whether and why schizophrenia has different outcomes in different cultural settings. This project will increase our knowledge of the role of families in facilitating treatment, and thus help the development of early intervention and family services. Our findings will also shed light on how young persons with schizophrenia view and understand recovery and how families view their role in the treatment of schizophrenia.