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Bridging Bedside and Bench Translational Neuropsychiatry Research in Africa<br />DrLailaAsmal<br />University of Stellenbo...
Schizophrenia Research Overview<br />120 FEP participants (matched controls)<br />Treated with Flupenthixoldecanoate, 2 ye...
Translational Neuropsychiatry Research in Africa<br />
Bedside to bench and back<br />1.  Woolf SH, 2009<br />
Translational Neuropsychiatry Research in Africa<br />
Africa is not a country!<br />
But what do we have in common?<br />Wide-based age pyramid <br />Rural populations with recent but rapid urban migration<b...
Quadruple burden of disease<br />Pre-transitional diseases and poverty related conditions<br />childhood undernutrition an...
World Land Area<br />www.worldmapper.com<br />
Urban slums<br />www.worldmapper.com<br />
Undernourishment<br />www.worldmapper.com<br />
HIV Prevalence<br />www.worldmapper.com<br />
Syphilis deaths<br />www.worldmapper.com<br />
Epilepsy deaths<br />www.worldmapper.com<br />
Stroke deaths<br />www.worldmapper.com<br />
Translational NeuropsychiatryResearch in Africa<br />
What is Neuropsychiatry?<br />Mental disorders caused by:<br />Structural brain dysfunction<br />Electrical malfunction<br...
Challenges facing Neuropsychiatry Research in Africa<br />Studies in SSH are not easily accessible<br />Methodological con...
Dementia: a Developed World problem?<br />71% of dementia in developing countries by 20406<br />Prevalence is increasing i...
Dementia Developing Countries<br />6.  Kalaria J, 2008<br />
Case vignettes <br />
Alternate pathophysiology?<br />Poverty<br /><ul><li>Economic deprivation
Low education
Unemployment
Inadequate housing
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Asmal translational neuropsychiatry research

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Asmal translational neuropsychiatry research

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

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