Identification of patients with recent-onset psychosis in KwaZulu Natal, South Africa: a pilot study with traditional health practitioners and diagnostic instruments

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 helpseeking 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.

Ancestral calling, traditional health practitioner training and mental illness: An ethnographic study from rural KwaZulu-Natal, South Africa

“…The current study complements an epidemiological pilot study, entitled Psychotic Disorders in an African Setting: Incidence, Early Course and Treatment Pathways (FEP-INCET), designed to develop a method for screening, identification, and follow-up of individuals with incident psychosis within a rural, low-income South African setting (Veling et al, 2019). The ethnography was built on previous fieldwork conducted intermittently in the region since 1992 (Susser, 2009).…”

“…To explore today's concepts and pathways to care in South Africa in relation to mental disturbances, including unusual perceptual experiences, we conducted an exploratory ethnographic study at sites of traditional health practices and at a local clinic in KwaZulu-Natal (KZN), South Africa. This qualitative study complements an epidemiological study of first episode psychosis in Vulindlela, a rural area in KZN (Psychotic Disorders in an African Setting: Incidence, Early Course and Treatment Pathways; FEP-INCET study; Veling et al, 2019). During fieldwork, one of the explanations that was given by the participants for unusual perceptual experiences and other mental disturbances, was the ''calling of the ancestors to become a traditional health practitioner (THP) 1 .''…”

Psychopathology among apprentice traditional health practitioners: A quantitative study from rural KwaZulu-Natal, South Africa

“…The present research was conducted as an add-on study to a mixed-methods preparatory study for the investigation of the incidence, early course, and treatment pathways of psychotic disorders in a rural South African setting (FEP-INCET study; Veling et al, 2019). The study was approved by the regional chairperson Zulu Inkosi and his Traditional Council.…”

“…The present paper is an add-on to an epidemiological study of first episode psychosis in a rural area in KwaZulu-Natal (KZN), South Africa (Psychotic Disorders in an African Setting: Incidence, Early Course and Treatment Pathways; FEP-INCET study; Veling et al, 2019). The current research is part of a multidisciplinary, multimethod study (see also Van der Zeijst et al, 2020) on psychopathology, including experiences that psychiatric nosology might characterize as psychotic phenomena, among a sample of (apprentice) traditional health practitioners (THPs).…”

Patient patronage and perspectives of traditional bone setting at an outpatient orthopaedic clinic in Northern Tanzania

“…The idea that patients who utilize traditional bone setters are not reaching large tertiary hospitals indicates need for a system of referral between traditional practitioners and allopathic providers. Like previous successes training traditional healers to triage patients, bone setters could be trained to recognize cases that require additional expertise and materials and help coordinate their referral to allopathic hospitals with the resources to treat complex musculoskeletal injuries 30 , 31 . Interestingly, over half of the patients in the prior-TBS group reported use of allopathic techniques in traditional practice, demonstrating that since bone setters in northern Tanzania are already using allopathic techniques, they may be amenable to training in these areas.…”