Long-term clinical course and outcome of schizophrenia in rural Ethiopia: 10-year follow-up of a population-based cohort

Shibre, Teshome; Medhin, Girmay; Alem, Atalay; Kebede, Derege; Teferra, Solomon; Jacobsson, Lars; Kullgren, Gunnar; Hanlon, Charlotte; Fekadu, Abebaw

doi:10.1016/j.schres.2014.10.053

Cited by 33 publications

(35 citation statements)

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“…In addition, previous studies not included in this review have reported that females had better clinical and functional recovery outcomes (Albert et al, ; Chang et al, ; Shibre et al, ; Verma, Subramaniam, Abdin, Poon, & Chong, ). However, studies included in this review did not reveal such gender difference in subjective recovery status.…”

Section: Discussionmentioning

confidence: 87%

Conceptualizations of subjective recovery from recent onset psychosis and its associated factors: A systematic review

Temesgen

Chien

Bressington

2018

Early Intervention Psych

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Studies in subjective recovery from recent onset psychosis are limited to developed countries. Acquiring hope and self-confidence, overcoming symptoms and stigma through mobilizing all resources available were accentuated in conceptualizing subjective recovery and related factors. Recovery-oriented health care services should acknowledge individual differences and involve service users in their care decisions.

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Section: Discussionmentioning

confidence: 87%

Conceptualizations of subjective recovery from recent onset psychosis and its associated factors: A systematic review

Temesgen

Chien

Bressington

2018

Early Intervention Psych

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“…Studies that measured the spectra directly found that psychoticism and detachment are impressively stable over time, with 10‐year stability correlations of .66 and .82, respectively 272 . Moreover, psychoticism, trait detachment, and especially negative symptoms are associated with poor functioning and predict worse global outcomes even ten years later 41,273‐275 . Positive symptoms appear to predict worse functioning in the general population 260 , but not in patients with psychotic disorders, where negative symptoms account for impairment 276 .…”

Section: Validity Evidencementioning

confidence: 99%

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): I. Psychosis superspectrum

et al. 2020

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The Hierarchical Taxonomy of Psychopathology (HiTOP) is a scientific effort to address shortcomings of traditional mental disorder diagnoses, which suffer from arbitrary boundaries between psychopathology and normality, frequent disorder co‐occurrence, heterogeneity within disorders, and diagnostic instability. This paper synthesizes evidence on the validity and utility of the thought disorder and detachment spectra of HiTOP. These spectra are composed of symptoms and maladaptive traits currently subsumed within schizophrenia, other psychotic disorders, and schizotypal, paranoid and schizoid personality disorders. Thought disorder ranges from normal reality testing, to maladaptive trait psychoticism, to hallucinations and delusions. Detachment ranges from introversion, to maladaptive detachment, to blunted affect and avolition. Extensive evidence supports the validity of thought disorder and detachment spectra, as each spectrum reflects common genetics, environmental risk factors, childhood antecedents, cognitive abnormalities, neural alterations, biomarkers, and treatment response. Some of these characteristics are specific to one spectrum and others are shared, suggesting the existence of an overarching psychosis superspectrum. Further research is needed to extend this model, such as clarifying whether mania and dissociation belong to thought disorder, and explicating processes that drive development of the spectra and their subdimensions. Compared to traditional diagnoses, the thought disorder and detachment spectra demonstrated substantially improved utility: greater reliability, larger explanatory and predictive power, and higher acceptability to clinicians. Validated measures are available to implement the system in practice. The more informative, reliable and valid characterization of psychosis‐related psychopathology offered by HiTOP can make diagnosis more useful for research and clinical care.

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“…Lack of good quality care is associated with a high level of physical, emotional, economic and social suffering and disability [15, 16], excess mortality [17] and experience of physical restraint or other forms of deprivations of liberty, discrimination and abuse [18]. There is no mental health legislation to protect the rights of people with mental health problems [19] and there is limited representation for service users at the national level, with just one active advocacy group led by caregivers of people with mental health problems [20].…”

Section: Introductionmentioning

confidence: 99%

Service user involvement in mental health system strengthening in a rural African setting: qualitative study

Abayneh¹,

Lempp

Alem³

et al. 2017

BMC Psychiatry

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BackgroundIt is essential to involve service users in efforts to expand access to mental health care in integrated primary care settings in low- and middle-income countries (LMICs). However, there is little evidence from LMICs to guide this process. The aim of this study was to explore barriers to, and facilitators of, service user/caregiver involvement in rural Ethiopia to inform the development of a scalable approach.MethodsThirty nine semi-structured interviews were carried out with purposively selected mental health service users (n = 13), caregivers (n = 10), heads of primary care facilities (n = 8) and policy makers/planners/service developers (n = 8). The interviews were audio-recorded and transcribed in Amharic, and translated into English. Thematic analysis was applied.ResultsAll groups of participants supported service user and caregiver involvement in mental health system strengthening. Potential benefits were identified as (i) improved appropriateness and quality of services, and (ii) greater protection against mistreatment and promotion of respect for service users. However, hardly any respondents had prior experience of service user involvement. Stigma was considered to be a pervasive barrier, operating within the health system, the local community and individuals. Competing priorities of service users included the need to obtain adequate individual care and to work for survival. Low recognition of the potential contribution of service users seemed linked to limited empowerment and mobilization of service users. Potential health system facilitators included a culture of community oversight of primary care services. All groups of respondents identified a need for awareness-raising and training to equip service users, caregivers, service providers and local community for involvement. Empowerment at the level of individual service users (information about mental health conditions, care and rights) and the group level (for advocacy and representation) were considered essential, alongside improved, accessible mental health care and livelihood interventions.ConclusionAs Ethiopia increases access to mental health care, a fundamental barrier to service user involvement is beginning to be addressed. Our study identified further barriers that need to be tackled, including a supportive political climate, and receptiveness amongst stakeholders. The findings will inform the development of a model of service user involvement, which will be piloted and evaluated.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-017-1352-9) contains supplementary material, which is available to authorized users.

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Long-term clinical course and outcome of schizophrenia in rural Ethiopia: 10-year follow-up of a population-based cohort

Cited by 33 publications

References 50 publications

Conceptualizations of subjective recovery from recent onset psychosis and its associated factors: A systematic review

Conceptualizations of subjective recovery from recent onset psychosis and its associated factors: A systematic review

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): I. Psychosis superspectrum

Service user involvement in mental health system strengthening in a rural African setting: qualitative study

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