The lifetime prevalence of schizophrenia and related psychotic disorders exceeds 3% and these are among the most disabling illnesses worldwide. Treatment of schizophrenia early in the course of the illness is linked to better outcomes, and accurately identifying individuals before the onset of psychotic illness holds promise for developing preventative interventions and minimizing the burden of schizophrenia. This has particular relevance in sub-Saharan Africa, where financial and health care resources for managing psychotic disorders are extremely limited.

The introduction of the ultra-high risk (UHR) criteria has significantly advanced the possibility of indicated prevention of a full-blown psychotic disorder. UHR criteria include 3 different syndromes: attenuated positive symptoms, brief limited intermittent psychotic symptoms, or a combination of genetic risk indicators and recent functional deterioration. Supporting their conceptualization as criteria of an imminent risk of psychosis, studies report transition rates to psychosis of 16% to 54% within 1-2.5 years. There have, however, not been prior published references investigating the prevalence of ultra-high-risk symptomatology in Africa.

To evaluate factors influencing the development of psychotic disorders, without the influence of psychotropic medication, which is a limitation in doing similar studies in developed countries.

1. To Assess Cognitive, Athropometric and Dyskinesia traits in Kenyan Youth. - Rates of abnormalities will be compared in 120 UHR+ and 60 matched-control youth aged 14-25 years, in Machakos, Kenya.
2. To Longitudinally Evaluate Symptom Change and Identify Psychosis Predictors. - 120 UHR+ youth will be assessed at baseline (month 0), and months 1, 6, 12 and 18.

A team of AMHF staff and 12 nurses will be trained on the use of the assessment tools. Then,120 UHR and 60 control participants will be recruited through house-to-house visits. 3,000 youths will be screened to pick suitable study participants in Machakos District. For initial screening, the Prime-Screen and WERCAP screen will be given to willing participants within the age range (14 to 25 yrs). The text in the Prime-Screen had been slightly culturally modified following extensive discussions between PI and AMHF research staff in March 2010. Written consent will be obtained from all participants and in the case of minors (aged less than 18 yrs) from parents.
Inclusion criteria for UHR+ participants will be initially made using the Prime-Screen and WERCAP screen, and requiring a score of 5 or more on at least three items. Participants that screen positive will be assessed for UHR criteria by the Structured Interview of Psychosis-Risk Syndromes (SIPS) version 5.0. Control participants will be randomly selected among those that screen negative (i.e. 0-1 in all 12 questions on the Prime-Screen, then validated by the SIPS). UHR participants will be matched as close as possible with controls (2:1) based on gender, age (+ or – 2 years) and town of recruitment. The SIPS had been slightly modified following feedback obtained through six targeted focus groups involving youth and mental health professionals, conducted by Dr. Linda Cottler (consultant), the PI, and other key AMHF and Washington University staff (July, 2010). The rationale for the minor alterations in the SIPS text was to ensure that the questions are in context with Kenyan culture.

a. Neurocognition will be measured using specific modules from the Penn Computerized Neurocognitive Battery (P-CNP)
b. Trained research assistants will assess six quantitative head/face measures
c. Trained research assistants will assess facial and upper body movement abnormality
d. Psychosis-risk symptoms will be assessed using the SIPS at all time points. Neurocognitive symptoms assessed using the P-CNP will be assessed at months 0 and 18. Motor abnormalities will be assessed at months 0 and 18.
e. DSM-IV-TR criteria for non-affective (schizophrenia, schizoaffective disorder, schizophreniform disorder, brief psychotic disorder) and affective (bipolar disorder, major depressive disorder) psychosis will be assessed using the Computerized Diagnostic Interview Schedule (C-DIS) at months 0 and 18, or if psychotic disorder is suggested by the SIPS at any time point.
f. Baseline SIPS, cognitive, anthropometric and neurologic profiles will be compared in UHR+ that transition to psychotic disorders (and/or progress in symptoms) and those that do not transition (or that do not progress in symptoms).
End date: December 2014