asmal translational neuropsychiatry research
TRANSCRIPT
Bridging Bedside and Bench Translational Neuropsychiatry Research in Africa
Dr Laila AsmalUniversity of Stellenbosch, Cape Town, South Africa
Schizophrenia Research Overview
• 120 FEP participants (matched controls)– Treated with Flupenthixol decanoate, 2 year follow-up
– Predictors of outcome, course of illness, ethnic differences, structural brain changes
• Confluence subsample– RCT, risperidone or flupenthixol imi
– Structural and functional MRI changes
• Stanley discontinuation study– Omega 3 and ALA
• Other – cochrane, genetics, family therapy study, metabolic disease, early childhood trauma, criminality
Translational Neuropsychiatry Research in Africa
Bedside to bench and back
1. Woolf SH, 2009
Translational Neuropsychiatry Research in Africa
Africa is not a country!
But what do we have in common?
• Wide-based age pyramid • Rural populations with recent but rapid urban
migration• Social and political instability• Widespread poverty and unevenly distributed
health resources• Absence of sound strategies for data collection• Quadruple burden of disease
Preux PM, 2005
Quadruple burden of disease
• Pre-transitional diseases and poverty related conditions– childhood undernutrition and infections, maternal
mortality• Emerging chronic diseases – obesity, heart disease, diabetes
• Injuries– including interpersonal violence
• HIV/AIDS, TB, malaria
MRC Burden of Disease Unit, 2004
Translational Neuropsychiatry Research in Africa
What is Neuropsychiatry?
• Mental disorders caused by:– Structural brain dysfunction– Electrical malfunction– Extrinsic toxic-metabolic derangements
• Emphasises neurological basis of mental illness
• Utilises modern neurodiagnostic investigations in evaluation and treatment
Hurwitz M, 2009
Challenges facing Neuropsychiatry Research in Africa
• Studies in SSH are not easily accessible• Methodological constraints make epidemiological
studies difficult to compare. • Clear endpoints difficult to measure• Questionnaires not suitable for diverse populations• Medical records are commonly incomplete• Lack of specialised personnel, diagnostic equipment • Use of different terminologies to classify disorders.
Preux, 2005
Dementia: a Developed World problem?
• 71% of dementia in developing countries by 20406
• Prevalence is increasing in developing countries5
• Confounders5: – shorter survival, lack of awareness, inadequate
diagnostic assessments, variability of costs of care – under-reporting
• Research focus on elderly population• Some work on HIV
5. Kalaria R, 20086. Prince M, 2009
Dementia Developing Countries
6. Kalaria J, 2008
Case vignettes
Alternate pathophysiology?
Poverty
• Economic deprivation
• Low education• Unemployment• Inadequate
housing• Lack of basic
eminities• Overcrowding
• Infectious diseases• High stressors• Inadequately
treated depression• Reduced access to
social capital• Malnutrition• Obstetric risks• Epilepsy• Violence and trauma
Dementia
• Higher prevalence
• Earlier onset
• Poor/lack of care
• More severe course
Layering of risk factors
Perinatal insults
Infectious diseases
Nutritional deficiencies
Head injuries
Vascular risk factors
Epilepsy
Poor education
Genetic risk
Dementia
What do we need?
• Multi-centric prevalence survey across Africa– Sufficient participants encompassing diversity – Common protocol– Focus on co-morbidity– Carer, need for care, disability, health care use
• Biological samples (DNA, haematology, fasting glucose and lipids and frozen serum)
• Longitudinal studies to better estimate incidence, morbidity, and mortality.
• Dissemination of knowledge
References
1. Woolf SH. JAMA, Jan 2008; 299(2) The Meaning of Translational Research and why it matters: 211-213
2. Preux PM, Druet-Cabanac M. Epidemiology and aetiology of epilepsy in sub-Saharan Africa. Lancet Neurol 2005; 4: 21–31
3. MRC Burden of Disease Unit, 20044. www.worldmapper.com5. Hurwitz, Fundamentals of Neuropsychiatry, UBC, 20096. Kalaria et al. Alzheimer's disease and vascular dementia in
developing countries: prevalence, management, and risk factors. Lancet Neurol. 2008 Sep; 7(9): 812–826.
7. Prince MJ, The 10/66 dementia research group - 10 years on. Indian J Psychiatry. 2009 January; 51(Suppl1): S8–S15.