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

描述(申请人提供)：在文化精神病学和精神分裂症结局研究中，一直发现发展中国家的精神分裂症治疗结果好于发达国家。然而，人们对为什么会出现这种情况知之甚少。目前尚不清楚这种差异是延伸到所有结果领域，还是仅限于现有研究所关注的精选和狭义的临床和功能结果。鉴于这些重大的知识差距，拟议项目的长期目标是一个持续的研究计划，将揭示精神病结果中跨文化差异的本质和潜在机制。具体地说，该项目涉及两个团队之间的合作，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发精神病研究方面具有互补优势。以前对跨文化差异精神病结果的调查往往受到混杂因素的限制，如未治疗精神病的持续时间和接受的治疗的差异。为了避免这一陷阱，拟议的研究将专注于印度金奈和加拿大蒙特利尔的首次发作精神病患者，这些患者将在两年内接受明确定义的类似治疗。主要目标是调查不同地点在一系列结果领域和家庭因素上的差异，以及家庭因素的差异是否会导致结果的差异。我们的前提是，与加拿大等发达国家相比，印度精神病患者可获得的家庭支持水平相对较高，这在很大程度上可以解释印度精神病患者的较好结果。本研究的具体假设是：(1)治疗两年后，印度患者的功能、主观和临床结果将好于加拿大患者。他们将更有可能在工作或在学校，报告更好的生活质量，并有更高和更持续的症状改善。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他们的治疗，并享有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专门促进治疗坚持和康复的支持。此外，家庭因素将在临床结果的不同部位之间起中介作用。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年轻人生活中的作用。该项目的发现将促进我们对印度早期精神病的过程、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的理解。这一理解将塑造印度适合文化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结果的战略，从而减轻(即使是部分)精神分裂症施加的严重负担，而不考虑文化背景。

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.