Advancing study of cognitive impairments for antipsychotic-naïve psychosis comparing high-income versus low- and middle-income countries with a focus on urban China: Systematic review of cognition and study methodology.

BACKGROUND: Comparing the course of antipsychotic-naïve psychosis in low- and middle-income countries (LMIC) may help to illuminate core pathophysiologies associated with this condition. Previous reviews-primarily from high-income countries (HIC)-identified cognitive deficits in antipsychotic-naïve, first-episode psychosis, but did not examine whether individuals with psychosis with longer duration of untreated psychosis (DUP > 5 years) were included, nor whether LMIC were broadly represented. METHOD: A comprehensive search of PUBMED from January 2002-August 2018 identified 36 studies that compared cognitive functioning in antipsychotic-naïve individuals with psychosis (IWP) and healthy controls, 20 from HIC and 16 from LMIC. RESULTS: A key gap was identified in that LMIC study samples were primarily shorter DUP (<5 years) and were primarily conducted in urban China. Most studies matched cases and controls for age and gender but only 9 (24%) had sufficient statistical power for cognitive comparisons. Compared with healthy controls, performance of antipsychotic-naïve IWP was significantly worse in 81.3% (230/283) of different tests of cognitive domains assessed (90.1% in LMIC [118/131] and 73.7% [112/152] in HIC). CONCLUSIONS: Most LMIC studies of cognition in antipsychotic-naïve IWP adopted standardized procedures and, like HIC studies, found broad-based impairments in cognitive functioning. However, these LMIC studies were often underpowered and primarily included samples typical of HIC: primarily male, young-adult, high-school educated IWP, in their first episode of illness with relatively short DUP (<5 years). To enhance understanding of the long-term natural course of cognitive impairments in untreated psychosis, future studies from LMIC should recruit community-dwelling IWP from rural areas where DUP may be longer.

Stigma and substance use disorders: an international phenomenon.

PURPOSE OF REVIEW: To collect and update published information on the stigma associated with substance abuse in nonclinical samples, which has not been recently reviewed. RECENT FINDINGS: Searching large databases, a total of only 17 articles were published since 1999, with the majority of studies conducted outside the United States. Using major stigma concepts from a sociological framework (stereotyping, devaluation in terms of status loss, discrimination, and negative emotional reactions), the studies reviewed predominantly indicated that the public holds very stigmatized views toward individuals with substance use disorders (SUDs), and that the level of stigma was higher toward individuals with SUDs than toward those with other psychiatric disorders. SUMMARY: The prevalence of SUDs is increasing in the US general population, but these disorders remain seriously undertreated. Stigma can reduce willingness of policymakers to allocate resources, reduce willingness of providers in nonspecialty settings to screen for and address substance abuse problems, and may limit willingness of individuals with such problems to seek treatment. All of these factors may help explain why so few individuals with SUDs receive treatment. Public education that reduces stigma and provides information about treatment is needed.