Global mental health and schizophrenia

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Asher, Laura ; Fekadu, Abebaw ; Hanlon, Charlotte (2018)

Purpose of review\ud The aim was to synthesise recent evidence on schizophrenia illness experience and outcomes and models of care in low and middle-income countries (LMIC).\ud \ud Recent findings\ud There is a plurality of explanatory models for psychosis and increasing evidence that context influences experiences of stigma. People with schizophrenia in LMIC are vulnerable to food insecurity, violence and physical health problems, in addition to unmet needs for mental healthcare. Family support may help to improve outcomes if present, but caregivers may be overwhelmed by the challenges faced. Despite efforts to increase availability, evidence-based care remains inaccessible to many people with schizophrenia. Non-randomised evaluations in South Africa and Mexico indicate that psychosocial support groups for people with schizophrenia and caregivers may be acceptable and useful. Randomised controlled trials in Pakistan and China show that culturally-adapted cognitive-behavioural therapy can reduce symptom severity. There is emerging evidence that traditional and alternative medicine, such as Tai Chi, may be beneficial, but to date most research is of low quality. The challenges of biomedical-traditional provider collaborations have been highlighted. Evaluations of integrated mental health care in primary care are underway and promise to provide vital information about how to scale-up quality care.\ud \ud Summary\ud Acceptable and effective responses to schizophrenia in LMIC should be cognisant of both cultural context and universal concerns. Efforts to enhance the quality of family support should be central to models of care.
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