Reprioritising global mental health: psychoses in sub-Saharan Africa.

Arthur Kleinman's 2009 Lancet commentary described global mental health as a "moral failure of humanity", asserting that priorities should be based not on the epidemiological and utilitarian economic arguments that tend to favour common mental health conditions like mild to moderate depression and anxiety, but rather on the human rights of those in the most vulnerable situations and the suffering that they experience. Yet more than a decade later, people with severe mental health conditions like psychoses are still being left behind. Here, we add to Kleinman's appeal a critical review of the literature on psychoses in sub-Saharan Africa, highlighting contradictions between local evidence and global narratives surrounding the burden of disease, the outcomes of schizophrenia, and the economic costs of mental health conditions. We identify numerous instances where the lack of regionally representative data and other methodological shortcomings undermine the conclusions of international research carried out to inform decision-making. Our findings point to the need not only for more research on psychoses in sub-Saharan Africa, but also for more representation and leadership in the conduct of research and in international priority-setting more broadly-especially by people with lived experience from diverse backgrounds. This paper aims to encourage debate about how this chronically under-resourced field, as part of wider conversations in global mental health, can be reprioritised.

Blood tryptophan and ATPase in psychosis of epilepsy.

Serum tryptophan and erythrocyte Na+/K+ ATPase were determined in 14 epileptics with and without psychosis. The nature of the psychosis in four patients was non-specific. The amino acid and the enzyme levels were also estimated in 11 patients with a diagnosis of functional affective psychosis, 14 patients with schizophrenia, and 9 normal subjects. Comparison of data among the patients and the normal subjects were done using analysis of variance. There were no significant differences in tryptophan profiles and Na+/K+ ATPase levels in epileptics with or without psychosis. In addition, the data obtained for these parameters for the schizophrenics were homogenous to those of epileptics. Significant differences were, however, obtained between the epileptics and patients with affective illness. The data thus suggested that the non-specific psychosis presented by the epileptics may be schizophrenia-like and lend support to a specific psychosis associated with epilepsy.