About this Research Topic

Background

Current knowledge about psychosis originates almost entirely from high-income countries, and more generally from the Western world, while little data is derived from low- and middle-income countries (LMICs). This restricts our understanding of the aetiology, course, and treatment of the illness across different contexts, cultures, and healthcare systems. For instance, notions such as that incidence and risk factors of schizophrenia and other psychotic disorders are similar worldwide and that a better prognosis for psychosis is found in LMICs have been challenged by data coming from developing countries.

A large treatment gap for psychosis exists in LMICs, with evidence suggesting that only about one-third of patients suffering with psychosis have access to specialized mental healthcare, leaving most patients without appropriate treatment. This has a detrimental effect on prognosis, which is further affected by unfavourable contextual factors often occurring in developing countries, such as poor physical healthcare, food insecurity, stigma, poor mental health literacy, and violence, among others.

International clinical guidelines recommend a holistic approach to the treatment of psychosis, consisting of a combined pharmacological and psychological intervention in community-based care, and in acute services during crisis. While this approach is embraced in well-structured, organized, and adequately funded healthcare systems, it is not, or only poorly, implemented in low-resourced settings. In fact, treatment of psychosis in LMICs is mainly hospital-based and it almost exclusively relies on antipsychotic medications. This is due to different challenges, including limited financial resources and a lack of non-medically trained professionals (e.g. psychologists, psychotherapists) to deliver evidence-based interventions. Yet, it has to be noted that when evidence-based interventions are used they may often lack cultural adaptation. Also, data suggest that in some regions traditional or alternative health practitioners are the first point of contact for most people suffering with psychosis, thus increasing the lag between the onset of symptoms and the delivery of evidence-based mental healthcare.

Taken together, this information suggests that the understanding and effective context-tailored care of psychosis in LMICs deserves more attention and work. The overall aim of this Research Topic is to improve our understanding of psychosis and its treatment in LMICs, to benefit the lives of people suffering with psychosis, and their families.

In this Research Topic, we welcome articles using any study design (e.g. reviews, meta-analyses, cohort/case-control studies, and clinical trials) that would:
• contribute to a better understanding of the aetiology of psychosis in LMICs
• examine possible explanatory models (e.g. culturally specific risk factors)
• analyse pathways of care and existing mental health policies
• explore the involvement of caregivers in treatment
• examine whether/how psychosocial interventions are implemented and/or delivered in clinical settings within LMICs.

Keywords: psychosis, LMICs, schizophrenia, psychotic disorder

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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