Psychotic disorders are diagnosed and managed almost entirely based on studies of people in Europe, North America, and Australia. This programme will identify and track 240 newly diagnosed individuals in India, Nigeria, and Trinidad, alongside 240 controls at each site, to see whether the disorders look the same—in frequency, symptoms, outcomes, and family impact—across these radically different settings. The problem is stark: around 20 million people worldwide experience a psychotic disorder, yet treatment guidelines are built on evidence from a handful of wealthy regions. Without knowing whether the disorders differ in developing countries, clinicians cannot know whether existing interventions will work or what local needs are being missed. If this research succeeds, it could reshape how mental health services are designed in low- and middle-income countries. Better understanding of symptom profiles, help-seeking behaviour, and physical health complications could lead to culturally appropriate care pathways, earlier intervention, and reduced long-term disability. The findings may also challenge or refine fundamental models of psychosis itself, revealing whether the condition is truly universal or shaped by social and environmental context.
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What is the programme about? Psychotic disorders are frequently distressing conditions in which people experience symptoms such as hallucinations (seeing or hearing things that are not there) and false thoughts or beliefs (delusions). These disorders usually begin at a young age (in the 20s) and often (but not always) lead to long term distress and suffering. Around 20 million people world wide experience a psychotic disorder. However, what we know about these disorders is based on research done mainly in Europe, North America, and Australia. We do not know much about these disorders in other places, especially in developing countries. This is a problem because it means we do not know how best to treat those with a psychotic disorder in developing countries. This programme, then, is about finding out more about psychotic disorders in other places. What we want to know is: are psychotic disorders the same? That is, are they as frequent, are the symptoms the same, is the outcome the same, and are the effects and needs the same in developing countries? What will we do? We will carry out research on psychotic disorders in areas (sites) in three countries: India, Nigeria, and Trinidad. We have chosen these places because they are very different from each other. Using the same methods, in each site, we will identify 240 individuals with a psychotic disorder that has not been previously treated and 240 individuals without a psychotic disorder. We will collect information from them at the point we identify them and 2 years later. This is so that we can look at what happens, at outcomes, over time. The information we gather will be about: symptoms and how they initially developed, possible causes (risk factors), social circumstances and disability, symptoms over time, the impact on individuals and families, and about any physical health problems. We will use this information to compare psychotic disorders between the sites. We will compare how frequent they are and the typical symptoms; outcomes over 2 years; what help is sought and the impact on individuals and families over time; and the occurrence of physical health problems. What will the programme tell us? This programme will tell us more about how psychotic disorders differ between different countries and about how to intervene more effectively. Because we have so little information at the moment about these questions, our programme promises to have a big impact, both on our understanding of psychotic disorders and on how to intervene in more diverse settings.
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