title: Detection, Assessment, and Management of Schizophrenia in an Andean Population of South America: Parkinsonism Testing and Transcranial Ultrasound as Preventive Tools.
abstract: Schizophrenia is a debilitating psychiatric illness that is among the world's top 10 causes of long-term disability, affecting people who are just entering the peak of social, economic, and intellectual productivity. Such functional loss is particularly relevant in indigenous communities, which rely on change in functional status (rather than on the presence of symptoms) to identify mental illness. Particularly among the indigenous communities of Latin America, the gap between mental health need and availability of resources to reduce the burden has been judged "a case of outrageous exclusion." For more than a decade, as part of the Investigation of Movement Abnormalities and Genetic of Schizophrenia study, the authors have been studying vulnerability markers (genetic, motor, imaging, and neuropsychological differences) for schizophrenia in a remote, indigenous population in rural northern Argentina. In this article, the authors discuss the implementation of a task-shifting paradigm resulting in more proficient identification and referral of individuals with untreated psychosis and a severalfold reduction in the duration of untreated psychosis, with very high retention rates (70%) and treatment adherence during a decade in a rural environment. The authors also propose to use transcranial ultrasound screening and testing for parkinsonism at illness onset before introduction of neuroleptics as potentially useful markers in determining illness severity, negative symptomatology, and tolerance to antipsychotic treatment/refractoriness.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL, and Roskamp Laboratory for Brain Development, Modulation and Repair, Morsani College of Medicine, University of South Florida, Tampa.
authors.forename: Mara
authors.initials: M
authors.lastname: Balda
authors.affiliation: Fundación de Lucha contra los Trastornos Neurológicos y Psiquiátricos en Minorías (FULTRA), Buenos Aires, Argentina.
authors.forename: Maria
authors.initials: M
authors.lastname: Calvó
authors.affiliation: Ministerio de Salud, Hospital Neuropsiquiátrico Néstor Sequeiros, Provinicia de Jujuy, Argentina.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Padilla
authors.affiliation: FULTRA, Buenos Aires, Argentina; and Hospital Neuropsiquiátrico Néstor Sequeiros, Provinicia de Jujuy, Argentina.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Guerrero
authors.affiliation: Roskamp Laboratory for Brain Development, Modulation and Repair, Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa.
authors.forename: Juan
authors.initials: J
authors.lastname: Molina
authors.affiliation: Universidad de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Nestor V
authors.initials: NV
authors.lastname: Florenzano
authors.affiliation: Roskamp Laboratory for Brain Development, Modulation and Repair, Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa.
authors.forename: Danielle
authors.initials: D
authors.lastname: Kamis
authors.affiliation: Department of Global Health and Department of Psychiatry and Family Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ.
authors.forename: Javier I
authors.initials: JI
authors.lastname: Escobar
authors.affiliation: Sansone Family Center for Well-Being and Center for Psychobiology of Personality, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO.
authors.forename: C Robert
authors.initials: CR
authors.lastname: Cloninger
authors.affiliation: Roskamp Laboratory for Brain Development, Modulation and Repair, Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa.
authors.forename: Gabriel
authors.initials: G
authors.lastname: de Erausquin