Packages of Care for Schizophrenia in Low- and Middle-Income Countries 英文参考文献.docVIP

NeglectedDiseases 1 PackagesofCareforSchizophreniainLow-andMiddle- IncomeCountries JairdeJesusMari1,2*,DeniseRazzouk1,RangaswamyThara3,JulianEaton4,GrahamThornicroft2 1DepartmentofPsychiatry,UniversidadeFederaldeSa?o Paulo,Sa?o Paulo,Brazil,2HealthServicesandPopulationResearchDepartment,InstituteofPsychiatry,King’s CollegeLondon,UnitedKingdom,3SchizophreniaResearchFoundation,Chennai,India,4CBMInternational,WestAfricaRegion,Abuja,Nigeria This is the third in a series of articles highlighting the delivery of ‘‘packages of care’’ for mental health disorders in low- and middle- incomecountries.Packagesofcarearecombinationsoftreatmentsaimed at improving the recognition and management of conditions to achieve optimaloutcomes. ofAfrica,Melanesia,andPolynesiathereisinadequatepersonnel to treat mental disorders. In particular, there is a scarcity of psychiatric nurses [12]. This lack of human resources is a major contributor to a worldwide treatment gap for schizophrenia [13,14]. It is estimated that around 41.7 million people with schizophreniaareinneedofcareinLMICs(TableS1),aworrying statisticgiven thatadelay intreatment ofpsychosisinLMICsis highly associated with poor outcomes and increasing levels of disabilities[15,16]. Introduction Theschizophreniasyndrome,arelativelyrarementaldisorder, comprises thought disorder, unusual beliefs (delusions), misper- ceptions (mainly auditory hallucinations), cognitive and affective symptoms,andnegativesymptomssuchasbluntedaffect,lackof motivation, and an experience of emptiness. The first episode of schizophrenia, which usually occurs when patients are in their earlytwenties,mayhaveanabruptorinsidiousonset.Introspec- tion,defensiveness,andeccentricitycanbepartofthepremorbid personality. Before the onset of psychotic symptoms, social performance and interpersonal relationships can be altered or near to normal. Box 1 shows the International Classification of Disease(ICD)10diagnosticcriteriaforschizophrenia[1]. In this article, w