Early Intervention in Psychosis and Management of First Episode Psychosis in Low- and Lower-Middle-Income Countries: A Systematic Review.

BACKGROUND AND HYPOTHESIS: People with first-episode psychosis (FEP) in low- and lower-middle-income countries (LMIC) experience delays in receiving treatment, resulting in poorer outcomes and higher mortality. There is robust evidence for effective and cost-effective early intervention in psychosis (EIP) services for FEP, but the evidence for EIP in LMIC has not been reviewed. We aim to review the evidence on early intervention for the management of FEP in LMIC. STUDY DESIGN: We searched 4 electronic databases (Medline, Embase, PsycINFO, and CINAHL) to identify studies describing EIP services and interventions to treat FEP in LMIC published from 1980 onward. The bibliography of relevant articles was hand-searched. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. STUDY RESULTS: The search strategy produced 5074 records; we included 18 studies with 2294 participants from 6 LMIC countries. Thirteen studies (1553 participants) described different approaches for EIP. Pharmacological intervention studies (n = 4; 433 participants) found a high prevalence of metabolic syndrome among FEP receiving antipsychotics (P ≤ .005). One study found a better quality of life in patients using injectables compared to oral antipsychotics (P = .023). Among the non-pharmacological interventions (n = 3; 308 participants), SMS reminders improved treatment engagement (OR = 1.80, CI = 1.02-3.19). The methodological quality of studies evidence was relatively low. CONCLUSIONS: The limited evidence showed that EIP can be provided in LMIC with adaptations for cultural factors and limited resources. Adaptations included collaboration with traditional healers, involving nonspecialist healthcare professionals, using mobile technology, considering the optimum use of long-acting antipsychotics, and monitoring antipsychotic side effects.

Mother's perceptions and concerns over sharing sexual and reproductive health information with their adolescent daughters- A qualitative study among mothers of adolescent girls aged 14-19 years in the developing world, Sri Lanka.

INTRODUCTION: Studies across the world have shown that parent-adolescent SRH communication can prevent unhealthy sexual and reproductive health (SRH) practices among adolescents and promote their sexual and reproductive health. Parents have the ability to provide individualized sex education to suit the needs of their children, their families, and societal values. The fact that children have more opportunities in the family, makes parent-based sexuality education of children a better approach to Sri Lankan context. OBJECTIVE: To explore mother's perceptions and concerns over sharing SRH information with their daughters among Sinhalese mothers of adolescent girls aged 14-19 years in Sri Lanka. METHODOLOGY: Six Focus group discussions (FGD) were carried out among mothers of adolescent girls aged 14-19 years. Each focus group discussion included 10-12 participants who were recruited using the purposive sampling method. A focus group discussion guide developed after an extensive literature search and expert opinion was used to retrieve information from mothers. Data management and analysis mainly followed an inductive approach to thematic analysis principles. The findings were presented in narrative form using respondents' quotes in their own words and were developed into codes and themes. RESULTS: The mean age of the participants was 43.5 years while 62.4% (n = 40) were educated above the Ordinary level. Analysis of data identified eight main themes from the FGDs. Many mothers thought that sexual and reproductive information is important to adolescent girls. They tried to keep their girl adolescents informed about Adolescent sexual and reproductive health (ASRH) issues. They preferred abstinence-only education over abstinence-plus education. Lack of skills and lack of knowledge on adolescent SRH issues was a major challenge identified by the mothers to communicate SRH matters with their children. CONCLUSIONS AND RECOMMENDATIONS: Although mothers perceived their role as primary sex educators to their children, they were not confident about their knowledge and skills in discussing SRH matters with children. Implementation of interventions to improve mothers' attitudes and skills in communicating SRH matters with children is recommended.

Educational intervention for the prevention of internet addiction disorder among 15-19-year-old adolescents in Colombo district, Sri Lanka.

Introduction: Internet addiction disorder is growing as a potentially problematic condition, especially among adolescents. Nonetheless, the condition is widespread and problematic, limited scientific evidence is available on the prevention, and efficacy of the treatment globally as well as locally. Objectives: The objective of this study was to determine the effectiveness of the developed educational package for the prevention of Internet addiction disorder among 15-19-year-old adolescents in Colombo district. Methods: The study was a quasi-experimental study to determine the effectiveness of an educational intervention for the prevention of Internet addiction disorder. The educational package was developed on Social Cognitive Theory. The contents were designed following a literature review, expertise from a multidisciplinary panel, and using the preliminary results of the descriptive cross-sectional study. Adolescents from two educational zones in Colombo district were purposefully selected for the Intervention group (n=280) and control group (n=290). A self-administered questionnaire including a validated Internet Addiction Test(IAT) Sinhala version was used for the data collection. Following the implementation of the educational package, primary and secondary outcomes were compared between study groups by chi-square test and paired t-test using the SPSS-21 version. Results: Following the intervention, the proportion of adolescents with Internet addiction disorder in the intervention group was less in comparison with the control group and the difference was statistically significant (χ2=9.026, df=1, p=0.003). There was a statistically significant difference between the mean differences of pretest and post-test IAT scores (t=-0.412, df=279, p=0.001) with the reduction of mean IAT scores among the intervention group. The proportion of study participants engaged in social media (χ2=10.6,df=1, p=0.001) and excessive engagement in internet gaming (χ2=5.514, df=1, p=0.019) among the intervention and the control groups revealed a statistically significant difference in favor of the intervention group. Conclusions: The developed educational package was found effective for the prevention of Internet Addiction Disorder and recommended to use in future prevention programs and to aid the policymakers and administrators in the prevention, diagnosis, and management of Internet addiction disorder among this age group.