DESCRIPTION (provided by applicant): This proposal is part of an effort and long-range international collaboration to develop longitudinal research projects to study the development and progression of psychosis-risk traits in sub-Saharan Africa. The current project focuses on evaluating adolescents and young adults in regions around Nairobi, Kenya. These areas are culturally largely homogenous, and residents are bilingual in Swahili and English. We began this effort in Kenya, by conducting youth focus groups, assessing the usability of a structured interview for evaluating "ultra-high-risk" (UHR) symptoms for developing psychosis. We have recruited and trained local research workers in administering structured instruments for identification of UHR symptoms, and have begun conducting community youth assessments using these instruments in Kibera, Kenya. This R21 proposal focuses on capacity building and training of local mental health personnel on the use of standardized diagnostic, neurocognitive, neurological and anthropological assessment in Kenya. As part of this effort, our specific aims are to 1) Characterize the neurocognitive, neurologic, and anthropometric profiles of UHR youth (14-25 yrs) and compared these to matched controls, and 2) Evaluate the progression of symptoms in UHR youth at intervals up to 18 months, identify the rate of transition to psychotic disorders and identify traits indicating progression towards psychosis. We hypothesize that there will be increased rates of abnormality in UHR compared to controls, and these abnormalities will increase the probability of transition to psychosis in UHR youth. Schizophrenia and related psychotic disorders are among the most disabling illnesses worldwide, and cause enormous economic costs to society and distress to patients and families affected. Cognitive and movement abnormalities are often noted in patients with schizophrenia and those at risk for developing psychosis in developing countries. Specific head and face dimensions have also been found in schizophrenia, and may indicate a measureable risk of developing the illness. Our proposal will begin longitudinal studies on progression of clinical traits, which would characteriz the development of UHR youth for the first time in Africa. The proposal will aim to identify and address potential challenges to longitudinal studies in the continent, assess research capacity and strengthen local research through training, career development and mentoring. These efforts are expected to have a long-term impact in advancing independent and collaborative mental health research, as well as clinical care in Kenya.

This project has significant potential implications. 1) It would improve the identification of individuals who would progress to schizophrenia or related psychotic disorders, by characterizing specific abnormalities in clinically high-risk populations. Early detection (i.e. before disorder onset) would potentially lead to prevention of psychosis in subjects at risk through early intervention strategies. This has particular relevance in sub-Saharan Africa, where financial and health care resources for managing psychotic disorders are extremely limited. 2) It would provide essential training to local research staff in the use and validation of standardized psychiatric assessment tools and related methods, culturally adapted to the local population. These have long-term implications in fostering mental health research in Africa. 3) It will help build a system of mental health education by the local population, by creating a working network of culturally adept mental health researchers. This is expected to facilitate identification of mental health symptoms and help seeking. 4) Data available about the prevalence and risk factors for developing schizophrenia, will inform mental health policy formulation strategies in Kenya.