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.

中文翻译：

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低收入和中低收入国家精神病的早期干预和首发精神病的管理：系统评价

背景和假设 低收入和中低收入国家 (LMIC) 的首发精神病 (FEP) 患者接受治疗会出现延误，导致预后较差和死亡率较高。有强有力的证据表明 FEP 的精神病早期干预 (EIP) 服务有效且具有成本效益，但中低收入国家 EIP 的证据尚未得到审查。我们的目的是回顾中低收入国家 FEP 管理早期干预的证据。研究设计 我们检索了 4 个电子数据库（Medline、Embase、PsycINFO 和 CINAHL），以识别 1980 年以来发表的描述 EIP 服务和治疗中低收入国家 FEP 的干预措施的研究。相关文章的参考书目是手工检索的。遵循系统评价和荟萃分析 (PRISMA) 指南的首选报告项目。研究结果 搜索策略产生了 5074 条记录；我们纳入了 18 项研究，涉及来自 6 个中低收入国家的 2294 名参与者。十三项研究（1553 名参与者）描述了不同的 EIP 方法。药理学干预研究（n = 4；433 名参与者）发现，接受抗精神病药物的 FEP 中代谢综合征的患病率较高 (P ≤ .005)。一项研究发现，与口服抗精神病药物相比，使用注射药物的患者生活质量更好 (P = .023)。在非药物干预措施中（n = 3；308 名参与者），短信提醒提高了治疗参与度（OR = 1.80，CI = 1.02–3.19）。研究证据的方法学质量相对较低。结论 有限的证据表明，EIP 可以在中低收入国家提供，但需要适应文化因素和有限的资源。适应措施包括与传统治疗师合作、让非专业医疗保健专业人员参与、使用移动技术、考虑长效抗精神病药物的最佳使用以及监测抗精神病药物的副作用。