title: Characterizing psychosis risk traits in Africa: A longitudinal study of Kenyan adolescents.
abstract: The schizophrenia prodrome has not been extensively studied in Africa. Identification of prodromal behavioral symptoms holds promise for early intervention and prevention of disorder onset. Our goal was to investigate schizophrenia risk traits in Kenyan adolescents and identify predictors of psychosis progression. 135 high-risk (HR) and 142 low-risk (LR) adolescents were identified from among secondary school students in Machakos, Kenya, using the structured interview of psychosis-risk syndromes (SIPS) and the Washington early recognition center affectivity and psychosis (WERCAP) screen. Clinical characteristics were compared across groups, and participants followed longitudinally over 0-, 4-, 7-, 14- and 20-months. Potential predictors of psychosis conversion and severity change were studied using multiple regression analyses. More psychiatric comorbidities and increased psychosocial stress were observed in HR compared to LR participants. HR participants also had worse attention and better abstraction. The psychosis conversion rate was 3.8%, with only disorganized communication severity at baseline predicting conversion (p=0.007). Decreasing psychotic symptom severity over the study period was observed in both HR and LR participants. ADHD, bipolar disorder, and major depression diagnoses, as well as poor occupational functioning and avolition were factors relating to lesser improvement in psychosis severity. Our results indicate that psychopathology and disability occur at relatively high rates in Kenyan HR adolescents. Few psychosis conversions may reflect an inadequate time to conversion, warranting longer follow-up studies to clarify risk predictors. Identifying disorganized communication and other risk factors could be useful for developing preventive strategies for HR youth in Kenya.
authors: Department of Psychiatry, Washington University Medical School, St. Louis, MO, United States. Electronic address: mamahd@psychiatry.wustl.edu.
authors: Daniel
authors: D
authors: Mamah
authors: Africa Mental Health Foundation, Nairobi, Kenya.
authors: Abednego
authors: A
authors: Musau
authors: Africa Mental Health Foundation, Nairobi, Kenya.
authors: Victoria N
authors: VN
authors: Mutiso
authors: Department of Psychiatry, Washington University Medical School, St. Louis, MO, United States.
authors: Akinkunle
authors: A
authors: Owoso
authors: Department of Anesthesiology, Washington University Medical School, St. Louis, MO, United States.
authors: Arbi Ben
authors: AB
authors: Abdallah
authors: Department of Epidemiology, University of Florida, Gainesville, United States.
authors: Linda B
authors: LB
authors: Cottler
authors: Department of Epidemiology, University of Florida, Gainesville, United States.
authors: Catherine W
authors: CW
authors: Striley
authors: Department of Psychology, Emory University, Atlanta, United States.
authors: Elaine F
authors: EF
authors: Walker
authors: Africa Mental Health Foundation, Nairobi, Kenya; Department of Psychiatry, University of Nairobi, Kenya.
authors: David M
authors: DM
authors: Ndetei
mesh_terms: D000293:Adolescent; D015897:Comorbidity; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D062706:Prodromal Symptoms; D011379:Prognosis; D011618:Psychotic Disorders / Q000453:epidemiology*; D012307:Risk Factors; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000453:epidemiology; D013334:Students
keywords: Africa; Kenya; Prodrome; Psychosis; Risk; Schizophrenia