IDENTIFICATION OF PSYCHOSIS-RISK TRAITS IN AFRICA

描述（由申请人提供）：本提案是长期国际合作的一部分，旨在发展纵向研究项目，研究撒哈拉以南非洲精神病风险特征的发展和进展。目前项目的重点是评估肯尼亚内罗毕周边地区的青少年和青年。这些地区在文化上基本上是同质的，居民讲斯瓦希里语和英语两种语言。我们在肯尼亚开展了这项工作，开展了青年焦点小组，评估了用于评估发展为精神病的“超高风险”症状的结构化访谈的可用性。我们招募并培训了当地研究人员使用结构化仪器识别UHR症状，并已开始在肯尼亚基贝拉使用这些仪器开展社区青年评估。R21提案的重点是能力建设和培训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。作为这项工作的一部分，我们的具体目标是：1)表征UHR青年（14-25岁）的神经认知、神经学和人体测量特征，并将其与匹配的对照组进行比较；2)每隔18个月评估UHR青年的症状进展，确定向精神病过渡的比率，并确定表明精神病进展的特征。我们假设，与对照组相比，UHR的异常率会增加，这些异常会增加UHR青年过渡到精神病的可能性。精神分裂症和相关精神障碍是世界上致残性最强的疾病之一，给社会造成巨大的经济成本，给患者和受影响的家庭造成痛苦。在发展中国家，精神分裂症患者和有发展为精神病风险的患者经常注意到认知和运动异常。在精神分裂症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可测量风险。我们的建议将开始对临床特征进展进行纵向研究，这将首次在非洲确定UHR青年的发展特征。该提案将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、职业发展和指导加强当地研究。预计这些努力将对促进肯尼亚独立和协作的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.