Background: Causal belief systems and help-seeking practices may impact on pathway to care and features of first-episode psychosis (FEP) that have prognostic value. This is particularly relevant in South Africa where many people subscribe to traditional belief systems and consult traditional healers. Aim: To evaluate the relationship between causal attributions and pathway to care and features of FEP that have prognostic value. Method: We tested associations between causal attributions and pathway to care and duration of untreated psychosis (DUP), age of onset, PANSS-rated positive, negative and general symptoms and depressive symptoms (Calgary Depression Scale) in a sample of 54 FEP patients. Results: Spiritual attribution of cause (49% of patients) was associated with long DUP, while consultation with a traditional healer (39% of patients) was associated with long DUP and high negative symptoms. Only 19% had consulted a psychiatrist. Seventy nine per cent (79%) were referred to hospital by family, police were involved in 44% of admissions, and 81% were admitted involuntarily. Conclusions: Spiritual attributions of cause and previous consultation with traditional healers may delay entry to psychiatric care and thereby negatively impact on prognosis of FEP. This highlights the importance of mental health education and developing a positive collaborative relationship with traditional healers, especially in low- and middle-income countries.
Background: Family interventional programmes are effective adjuncts to pharmacotherapy in patients with schizophrenia. Modification in content of such programmes in response to local challenges is considered important, but has not been fully explored in Africa. Aims: To assess the feasibility and acceptability of an interventional family study for people with schizophrenia and their families in a socially deprived urban community in South Africa and to explore the contextual factors that could influence implementation of the intervention. Method: A psychiatric nurse facilitated semi-structured interviews with four multi-family groups, each comprising adult outpatients with schizophrenia and their caregivers. Six sessions were held per group. Thematic analysis was applied. Results: Three themes emerged: stigma and abuse; substance abuse comorbidity and caregiver burden of multiple stressors. Many of these stressors relate to the challenges of an impoverished urban environment. Conclusions: Multi-family groups with a psycho-educational and behaviour modification frame are acceptable. Negative symptoms are seen as protective in areas of community violence. Modification of traditional models of family therapy to include factors related to poverty, violence, caregiver burden, stigma and limited health care access should be considered in this setting.
Information about patterns of expression of neurological soft signs (NSS) in schizophrenia among individuals belonging to the same genetic ancestry may provide new insight for the understanding of the disease's genetic functions. This study aimed to investigate whether patterns of NSS expression in first episode schizophrenia are comparable in populations with dissimilar genetic ancestry. A sample of 207 patients with first episode schizophrenia were examined using the Neurological Evaluation Scale before they were exposed to anti-psychotics. They were allocated to two African ancestry groups: Black (81 Yoruba Nigerians, and 18 Xhosa South Africans), and non-Black (98 Coloured, and 10 White South Africans). Assessments were carried out using validated measures of clinical characteristics of schizophrenia. We determined the frequency, severity, factor structure, and association of NSS with clinical characteristics. Factor derived categories were compared using the Pearson's ( r) and Tucker's congruence methods. The associations between factor derived categories and clinical characteristics of schizophrenia were determined using Pearson's correlations and multiple regression analyses. Neurological soft signs were more frequent and more severe in the Black African ancestry group. Also, the factor structure and presentation of NSS in the two ancestry groups were significantly different. Neurological soft signs, especially motor sequencing and cognitive-perceptual abnormalities, were independently associated with disorganization psychopathologies in all the participant groups. Differences in the profile of NSS in Black compared with non-Black African ancestry patients with first episode schizophrenia may suggest differing patterns of expression of NSS in schizophrenia according to genetic ancestry.
Although traditional initiation forms a pivotal part of Xhosa culture, it may be a stressful life event for the individual. In this study, 75 Xhosa males diagnosed with schizophrenia were interviewed to examine their perceptions of the role of initiation in the onset and course of their illness. In all, eight patients (10.7%) perceived the initiation rites as a stressful event that had triggered the onset of a psychotic episode, and six (8%) felt it precipitated a relapse. Our findings suggest that initiation rituals may be perceived as a stressful life event influencing the onset and course of schizophrenia. This underlines the importance of understanding the cultural background of patients.
The 10Kin1day workshop was generously sponsored by the Neuroscience and Cognition program Utrecht (NCU) of the Utrecht University (https://www.uu.nl/en/research/neuroscience-and-cognition-utrecht), the ENIGMA consortium (http://enigma.ini.usc.edu), and personal grants: MvdH: NWO-VIDI (452-16-015), MQ Fellowship; SB-C: the Wellcome Trust; Medical Research Council UK; NIHR CLAHRC for Cambridgeshire and Peterborough Foundation National Health Services Trust; Autism Research Trust; LB: New Investigator Award, Canadian Institutes of Health Research; Dara Cannon: Health Research Board (HRB), Ireland (grant code HRA-POR-2013-324); SC: Research Grant Council (Hong Kong)-GRF 14101714; Eveline Crone: ERC-2010-StG-263234; UD: DFG, grant FOR2107 DA1151/5-1, DA1151/5-2, SFB-TRR58, Project C09, IZKF, grant Dan3/012/17; SD: MRC-RFA-UFSP-01-2013 (Shared Roots MRC Flagship grant); TF: Marie Curie Programme, International Training Programme, r'Birth; DG: National Science Centre (UMO-2011/02/A/NZ5/00329); BG: National Science Centre (UMO-2011/02/A/NZ5/00329); JH: Western Sydney University Postgraduate Research Award; LH: Science Foundation Ireland, ERC; HH: Research Grant Council (Hong Kong)-GRF 14101714; LJ: Velux Stiftung, grant 369 & UZH University Research Priority Program Dynamics of Healthy Aging; AJ: DFG, grant FOR2107 JA 1890/7-1; KJ: National Science Centre (UMO-2013/09/N/HS6/02634); VK: The Russian Foundation for Basic Research (grant code 15-06-05758 A); TK: DFG, grant FOR2107 KI 588/14-1, DFG, grant FOR2107 KI 588/15-1; AK: DFG, grant FOR2107 KO 4291/4-1, DFG, grant FOR2107 KO 4291/3-1; IL: The Russian Foundation for Basic Research (grant code 15-06-05758 A); EL: Health and Medical Research Fund - 11121271; SiL: NHMRC-ARC Dementia Fellowship 1110414, NHMRC Dementia Research Team Grant 1095127, NHMRC Project Grant 1062319; CL-J: 537-2011, 2014-849; AM: Wellcome Trust Strategic Award (104036/Z/14/Z), MRC Grant MC_PC_17209; CM: Heisenberg-Grant, German Research Foundation, DFG MO 2363/3-2; PM: Foundation for Science and Technology, Portugal - PDE/BDE/113601/2015; KN: National Science Centre (UMO-2011/02/A/NZ5/00329); PN: National Science Centre (UMO-2013/09/N/HS6/02634); JiP: NWO-Veni 451-10-007; PaR: PER and US would like to thank the Schizophrenia Research Institute and the Chief-Investigators of the Australian Schizophrenia Research Bank V. Carr, U. Schall, R. Scott, A. Jablensky, B. Mowry, P. Michie, S. Catts, F. Henskens, and C. Pantelis; AS: National Science Centre (UMO-2011/02/A/NZ5/00329); SS: European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 707730; CS-M: Carlos III Health Institute (PI13/01958), Carlos III Health Institute (PI16/00889), Carlos III Health Institute (CPII16/00048); ES: National Science Centre (UMO-2011/02/A/NZ5/00329); AT: The Russian Foundation for Basic Research (grant code 15-06-05758 A); DT-G: PI14/00918, PI14/00639; Leonardo Tozzi: Marie Curie Programme, International Training Programme, r'Birth; SV: IMPRS Neurocom stipend; TvE: National Center for Research Resources at the National Institutes of Health (grant numbers: NIH 1 U24 RR021992 (Function Biomedical Informatics Research Network), NIH 1 U24 RR025736-01 (Biomedical Informatics Research Network Coordinating Center; http://www.birncommunity.org) and the NIH Big Data to Knowledge (BD2K) award (U54 EB020403 to Paul Thompson). NvH: NWO-VIDI (452-11-014); MW: National Science Centre (UMO-2011/02/A/NZ5/00329); Veronica O'Keane: Meath Foundation; AV and AW: CRC Obesity Mechanism (SFB 1052) Project A1 funded by DFG. The funding sources had no role in the study design, data collection, analysis, and interpretation of the data ; We organized 10Kin1day, a pop-up scientific event with the goal to bring together neuroimaging groups from around the world to jointly analyze 10,000+ existing MRI connectivity datasets during a 3-day workshop. In this report, we describe the motivation and principles of 10Kin1day, together with a public release of 8,000+ MRI connectome maps of the human brain. Ongoing grand-scale projects like the European Human Brain Project (1), the US Brain Initiative (2), the Human Connectome Project (3), the Chinese Brainnetome (4) and exciting world-wide neuroimaging collaborations such as ENIGMA (5) herald the new era of big neuroscience. In conjunction with these major undertakings, there is an emerging trend for bottom-up initiatives, starting with small-scale projects built upon existing collaborations and infrastructures. As described by Mainen et al. (6), these initiatives are centralized around self-organized groups of researchers working on the same challenges and sharing interests and specialized expertise. These projects could scale and open up to a larger audience and other disciplines over time, eventually lining up and merging their findings with other programs to make the bigger picture.