Mamah Daniel, Musau Abednego, Mutiso Victoria N, Owoso Akinkunle, Abdallah Arbi Ben, Cottler Linda B, Striley Catherine W, Walker Elaine F, Ndetei David M
Department of Psychiatry, Washington University Medical School, St. Louis, MO, United States.
Africa Mental Health Foundation, Nairobi, Kenya.
Schizophr Res. 2016 Oct;176(2-3):340-348. doi: 10.1016/j.schres.2016.08.004. Epub 2016 Aug 11.
The schizophrenia prodrome has not been extensively studied in Africa. Identification of prodromal behavioral symptoms holds promise for early intervention and prevention of disorder onset. Our goal was to investigate schizophrenia risk traits in Kenyan adolescents and identify predictors of psychosis progression. 135 high-risk (HR) and 142 low-risk (LR) adolescents were identified from among secondary school students in Machakos, Kenya, using the structured interview of psychosis-risk syndromes (SIPS) and the Washington early recognition center affectivity and psychosis (WERCAP) screen. Clinical characteristics were compared across groups, and participants followed longitudinally over 0-, 4-, 7-, 14- and 20-months. Potential predictors of psychosis conversion and severity change were studied using multiple regression analyses. More psychiatric comorbidities and increased psychosocial stress were observed in HR compared to LR participants. HR participants also had worse attention and better abstraction. The psychosis conversion rate was 3.8%, with only disorganized communication severity at baseline predicting conversion (p=0.007). Decreasing psychotic symptom severity over the study period was observed in both HR and LR participants. ADHD, bipolar disorder, and major depression diagnoses, as well as poor occupational functioning and avolition were factors relating to lesser improvement in psychosis severity. Our results indicate that psychopathology and disability occur at relatively high rates in Kenyan HR adolescents. Few psychosis conversions may reflect an inadequate time to conversion, warranting longer follow-up studies to clarify risk predictors. Identifying disorganized communication and other risk factors could be useful for developing preventive strategies for HR youth in Kenya.
精神分裂症前驱期在非洲尚未得到广泛研究。识别前驱期行为症状有望实现早期干预和预防疾病发作。我们的目标是调查肯尼亚青少年的精神分裂症风险特征，并确定精神病进展的预测因素。使用精神病风险综合征结构化访谈（SIPS）和华盛顿早期识别中心情感与精神病（WERCAP）筛查，从肯尼亚马查科斯的中学生中识别出135名高危（HR）青少年和142名低危（LR）青少年。对各组的临床特征进行比较，并对参与者进行为期0、4、7、14和20个月的纵向随访。使用多元回归分析研究精神病转化和严重程度变化的潜在预测因素。与LR参与者相比，HR参与者中观察到更多的精神疾病共病和心理社会压力增加。HR参与者的注意力也较差，但抽象能力较好。精神病转化率为3.8%，只有基线时的言语紊乱严重程度可预测转化（p=0.007）。在研究期间，HR和LR参与者的精神病症状严重程度均有所下降。注意力缺陷多动障碍、双相情感障碍和重度抑郁症诊断，以及职业功能差和意志缺乏是与精神病严重程度改善较小相关的因素。我们的结果表明，肯尼亚HR青少年的精神病理学和残疾发生率相对较高。很少有精神病转化可能反映出转化时间不足，需要进行更长时间的随访研究以明确风险预测因素。识别言语紊乱和其他风险因素可能有助于为肯尼亚的HR青少年制定预防策略。
