UNASSIGNED:在全球南部地区进行的关于精神病的研究不到10%,泛指拉丁美洲地区,亚洲,非洲,和大洋洲。缺乏关于精神病分布和风险的基本流行病学数据,这些数据可以为世界许多地方的服务发展提供信息。
UNASSIGNED:比较全球南方3个经济和社会不同背景下的病例队列和未经治疗的精神病发生率(发病率代表)的人口统计学和临床概况。对两个假设进行了测试:(1)未经治疗的精神病患者的人口统计学和临床概况因环境而异,以及(2)未经治疗的精神病患者的发生率因临床和人口统计学群体而异。
UNASSIGNED:不同环境中的精神病性疾病国际研究计划(INTREPIDII)包括发病率,病例控制,以及全球南部3个国家集水区未经治疗的精神病的队列研究:Kancheepuram区,印度;伊巴丹,尼日利亚;和特立尼达北部。参与者是未经治疗的精神病患者。这项发病率研究于2018年5月1日至2020年7月31日进行。在每个设置中,我们实施了全面的系统来识别和评估2年期间所有未治疗精神病患者.数据从2022年1月1日至5月1日进行了分析。
未经证实:存在未经治疗的精神病,使用神经精神病学临床评估时间表进行评估,其中包括当前状态检查。
UNASISIGNED:确定的病例共1038例,包括64个通过渗漏研究(Kancheepuram:268;中位[IQR]年龄,42[33-50]岁;154名女性[57.5%];114名男性[42.5%];伊巴丹:196;中位[IQR]年龄,34[26-41]岁;93名女性[47.4%];103名男性[52.6%];特立尼达:574;中位[IQR]年龄,30[23-40]岁;235名女性[40.9%];339名男性[59.1%])。在性别范围内和范围内发现了明显的变化,年龄,和病例的临床概况(例如,男性比例较低,发病年龄较大,精神病持续时间较长,与伊巴丹和特立尼达相比,Kanchepuram的情感性精神病百分比较低)和未经治疗的精神病发生率较低。与Kancheepuram(20.7/100,000人年;95%CI,18.2-23.2)和Ibadan(14.4/100,000人年;95%CI,12.3-16.5)相比,特立尼达未治疗精神病的年龄和性别标准化率约高3倍(59.1/100,000人年;95%CI,12.3-16.5)。在特立尼达,与印度特立尼达人(43.9/100000人年;95%CI,35.7-52.2)和混合人群(50.7/100000人年;95%CI,42.0-59.5)相比,非洲特立尼达人人口(85.4/100000人年;95%CI,76.0-94.9)的发病率高约2倍.
未经评估:这项分析增加了研究,表明精神病的核心方面因历史而异,经济,和社会背景,对全球精神病的理解和治疗具有深远的影响。
Less than 10% of research on psychotic disorders has been conducted in settings in the Global South, which refers broadly to the regions of Latin America, Asia, Africa, and Oceania. There is a lack of basic epidemiological data on the distribution of and risks for psychoses that can inform the development of services in many parts of the world.
To compare demographic and clinical profiles of cohorts of cases and rates of untreated psychoses (proxy for incidence) across and within 3 economically and socially diverse settings in the Global South. Two hypotheses were tested: (1) demographic and clinical profiles of cases with an untreated psychotic disorder vary across setting and (2) rates of untreated psychotic disorders vary across and within setting by clinical and demographic group.
The International Research Program on Psychotic Disorders in Diverse Settings (INTREPID II) comprises incidence, case-control, and cohort studies of untreated psychoses in catchment areas in 3 countries in the Global South: Kancheepuram District, India; Ibadan, Nigeria; and northern Trinidad. Participants were individuals with an untreated psychotic disorder. This incidence study was conducted from May 1, 2018, to July 31, 2020. In each setting, comprehensive systems were implemented to identify and assess all individuals with an untreated psychosis during a 2-year period. Data were analyzed from January 1 to May 1, 2022.
The presence of an untreated psychotic disorder, assessed using the Schedules for Clinical Assessment in Neuropsychiatry, which incorporate the Present State Examination.
Identified were a total of 1038 cases, including 64 through leakage studies (Kancheepuram: 268; median [IQR] age, 42 [33-50] years; 154 women [57.5%]; 114 men [42.5%]; Ibadan: 196; median [IQR] age, 34 [26-41] years; 93 women [47.4%]; 103 men [52.6%]; Trinidad: 574; median [IQR] age, 30 [23-40] years; 235 women [40.9%]; 339 men [59.1%]). Marked variations were found across and within settings in the sex, age, and clinical profiles of cases (eg, lower percentage of men, older age at onset, longer duration of psychosis, and lower percentage of affective psychosis in Kancheepuram compared with Ibadan and Trinidad) and in rates of untreated psychosis. Age- and sex-standardized rates of untreated psychoses were approximately 3 times higher in Trinidad (59.1/100 000 person-years; 95% CI, 54.2-64.0) compared with Kancheepuram (20.7/100 000 person-years; 95% CI, 18.2-23.2) and Ibadan (14.4/100 000 person-years; 95% CI, 12.3-16.5). In Trinidad, rates were approximately 2 times higher in the African Trinidadian population (85.4/100 000 person-years; 95% CI, 76.0-94.9) compared with the Indian Trinidadian (43.9/100 000 person-years; 95% CI, 35.7-52.2) and mixed populations (50.7/100 000 person-years; 95% CI, 42.0-59.5).
This analysis adds to research that suggests that core aspects of psychosis vary by historic, economic, and social context, with far-reaching implications for understanding and treatment of psychoses globally.