We propose to take advantage of a unique opportunity to study cognition and its relation to other domains in a large untreated sample of individuals with psychosis (IWP), within an ethically appropriate context that is unlikely to continue to be available. After the onset of psychosis, studies of cognition in treated IWP suggest persisting deficits in many SCZ patients; these are present in bipolar affective psychoses to a somewhat lesser extent, indicating a continuum of severity in psychosis. To address this, we propose to study cognition among a large sample (n=500) of completely untreated IWP, assessed prior to AP treatment, within Ningxia Province who span a wide age range (21 to 65) and are community sampled. Ningxia is among the most poor and remote provinces in China, where the 686 Program has not fully penetrated but where identification of untreated cases is increasing. A community sampled comparison group of treated IWP's (n=500) (matched on locale, gender, age, and duration of illness) will also be recruited. Our goal is to illuminate the natural course of cognition and its relation to symptoms and functioning, in the absence of medication effects. We possess an unprecedented opportunity to do so within the 686 national treatment program. Our multidisciplinary research team is comprised of world-recognized experts from the fields of epidemiology, clinical psychology, and psychiatry. Building upon a history of successful collaborations, each investigator brings extensive capacity-building experience to execute this challenging project. A major goal is also to train a new cohort of investigators in Ningxia Province to increase capacity to intervene with untreated psychosis, thus serving as a model for scale-up for the 686 program.
The national `686 Project' is a historic transformation of China's mental health services and is the largest national program to offer free treatment to persons with psychosis in history. This project provides an unprecedented opportunity to study the `natural state' of cognition in a large untreated sample of individuals with psychosis, in the absence of the effect of medications. The proposed research training program, which takes place in one of the most remote provinces of China, increases capacity to intervene with untreated psychosis and may serve as a model for scale-up for first intervention in China and worldwide.
