W Veling1, J K Burns2,3, E M Makhathini3, S Mtshemla3, S Nene3,4, S Shabalala3, N Mbatha3, A Tomita5,6, J Baumgartner7, I Susser8,9, H W Hoek10,11,12, E Susser11,13. 1. Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. w.veling@umcg.nl. 2. University of Exeter, Exeter, UK. 3. Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa. 4. Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa. 5. Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa. 6. KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa. 7. Duke Global Health Institute, Duke University, Durham, USA. 8. Department of Anthropology, Hunter College and Graduate Center, City University of New York, New York, USA. 9. Department of Socio-Medical Sciences, Mailman School of Public Health, Columbia University, New York, USA. 10. Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 11. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA. 12. Parnassia Psychiatric Institute, The Hague, The Netherlands. 13. New York State Psychiatric Institute, New York, USA.
Abstract
PURPOSE: There is considerable variation in epidemiology and clinical course of psychotic disorders across social and geographical contexts. To date, very little data are available from low- and middle-income countries. In sub-Saharan Africa, most people with psychoses remain undetected and untreated, partly due to lack of formal health care services. This study in rural South Africa aimed to investigate if it is possible to identify individuals with recent-onset psychosis in collaboration with traditional health practitioners (THPs). METHODS: We developed a strategy to engage with THPs. Fifty THPs agreed to collaborate and were asked to refer help-seeking clients with recent-onset psychosis to the study. At referral, the THPs rated probability of psychosis ("maybe disturbed" or "disturbed"). A two-step diagnostic procedure was conducted, including the self-report Community Assessment of Psychic Experiences (CAPE) as screening instrument, and a semi-structured interview using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Accuracy of THP referrals, and test characteristics of the THP rating and the CAPE were calculated. RESULTS: 149 help-seeking clients were referred by THPs, of which 44 (29.5%) received a SCAN DSM-IV diagnosis of psychotic disorder. The positive predictive value of a THP "disturbed" rating was 53.8%. Test characteristics of the CAPE were poor. CONCLUSION: THPs were open to identifying and referring individuals with possible psychosis. They recognized "being disturbed" as a condition for which collaboration with formal psychiatric services might be beneficial. By contrast, the CAPE performed poorly as a screening instrument. Collaboration with THPs is a promising approach to improve detection of individuals with recent-onset psychosis in rural South Africa.
PURPOSE: There is considerable variation in epidemiology and clinical course of psychotic disorders across social and geographical contexts. To date, very little data are available from low- and middle-income countries. In sub-Saharan Africa, most people with psychoses remain undetected and untreated, partly due to lack of formal health care services. This study in rural South Africa aimed to investigate if it is possible to identify individuals with recent-onset psychosis in collaboration with traditional health practitioners (THPs). METHODS: We developed a strategy to engage with THPs. Fifty THPs agreed to collaborate and were asked to refer help-seeking clients with recent-onset psychosis to the study. At referral, the THPs rated probability of psychosis ("maybe disturbed" or "disturbed"). A two-step diagnostic procedure was conducted, including the self-report Community Assessment of Psychic Experiences (CAPE) as screening instrument, and a semi-structured interview using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Accuracy of THP referrals, and test characteristics of the THP rating and the CAPE were calculated. RESULTS: 149 help-seeking clients were referred by THPs, of which 44 (29.5%) received a SCAN DSM-IV diagnosis of psychotic disorder. The positive predictive value of a THP "disturbed" rating was 53.8%. Test characteristics of the CAPE were poor. CONCLUSION:THPs were open to identifying and referring individuals with possible psychosis. They recognized "being disturbed" as a condition for which collaboration with formal psychiatric services might be beneficial. By contrast, the CAPE performed poorly as a screening instrument. Collaboration with THPs is a promising approach to improve detection of individuals with recent-onset psychosis in rural South Africa.
Entities:
Keywords:
Case finding; Psychosis; Screening; South Africa; Traditional health practitioners
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