Schizophrenia remains an enigma even today, centuries after it was initially described in Europe having been referred to much earlier in ancient Indian texts such as the Charaka Samhita. Its aetiology is still undetermined despite the millions of dollars invested in genetic and other forms of research. Although the nosological quandary over whether or not schizophrenia is part of a spectrum of disorders along with bipolar disorders is widely discussed, there are still more reasons to consider it as a distinctive diagnostic entity as it has fairly clear cut symptom patterns in most cases. It is highly likely to retain this stature for many more years. Diagnosis and management are still entirely clinical and we are yet to find the elusive genetic or other biological marker that will advance day-to-day practice.
We therefore considered it appropriate at this time to assemble a broad range of articles addressing several aspects of schizophrenia with a focus on low and middle income countries (LAMIC). With over 60% of the world's population living in these countries, this is very much a ‘happening’ place. Globalization and the economic upsurge in countries such as China and India have greatly enhanced the extent and depth of scientific research in LAMIC. Thus, the last decade or so has witnessed a growing number of publications from these countries, albeit still much fewer than from more developed nations. This volume is an attempt to provide an overview of research on schizophrenia in the LAMIC. It includes chapters on topics such as genetics and neuroimaging, pharmacological and psychosocial interventions, as well as issues related to gender, culture, course and outcome.
The first paper on epidemiology sets the tone by reviewing current understanding of the prevalence and incidence of schizophrenia as well as on issues having a bearing on the occurrence of the disorder especially as they relate to LAMIC. Acute and transient psychotic disorders, as a group, differ from schizophrenia. Over 400 people with this diagnosis have been well studied and issues such as stability of diagnosis or change in diagnosis are addressed in this paper.
Interventions for schizophrenia are discussed in three papers, and include drug treatment, psychosocial treatments, and community mental health approaches. A thorough search of the literature and review of meta-analyses led the authors of the paper on pharmacological treatment to conclude that in most LAMIC first generation anti-psychotics are widely used and found to be equally efficacious as second generation anti-psychotic drugs.
Research in the area of psychosocial rehabilitation is sparse from these countries and the more recent ones have been confined to post-disaster interventions. Community-based interventions are gaining momentum and the author underscores the need to be aware of ethical practices in such cases.
The field of culture and schizophrenia is more familiar to anthropologists and sociologists than to psychiatrists or other mental health professionals. The paper on culture draws attention to sociocultural factors that impact behaviour and symptomatology and the importance of considering psychiatric disorders in their context, including in ethnic minorities and migrants.
Work on genetics and radioimaging in LAMIC, often done despite great odds against such research, is well captured in the next two papers respectively. The recent spate of studies on course and outcome of schizophrenia is summarized while alluding to recent and varied points of view regarding the observed better clinical outcomes in these regions of the south.
The paper on explanatory models draws heavily from cultural beliefs in populations which impact greatly on help-seeking behaviours. Disability and stigma are of great significance in these countries, many of which do not have a well-knit welfare policy in place. Stigma affects all facets of life and behaviour, especially marriages, many of which are still arranged by families. This issue is closely linked to the account on women and children which eloquently refers to the myriad social problems they have to face, not just as service seekers, but in their social and family roles as well. Victimization, abuse and the health consequences such as sexually transmitted infections including HIV are genuine concerns for this group.
It is hoped that the chapters which deal with fairly distinctive aspects of schizophrenia research will provide readers a good sense of recent research in LAMIC as well as a flavour of interesting variability. Hopefully these will provide further impetus for more research into various aspects of schizophrenia in LAMIC.
We acknowledge the contributions of all authors and reviewers to make this a comprehensive volume. We also thank the editors of the International Review of Psychiatry for inviting us to edit this special issue.