Establishing a clinical high-risk program in Tunisia, North Africa: A pilot study in early detection and...

Area of Science:

• Psychiatry
• Mental Health Research
• Global Health

Background:

• Significant advancements in early identification and prevention strategies for young people at clinical high-risk (CHR) have been achieved.
• However, most established procedures originate from high-income nations, limiting their accessibility in middle-income countries.
• North African nations like Tunisia can greatly benefit from these empirically-based assessment approaches.

Purpose of the Study:

• To establish the first clinical high-risk program (CHiRP) in Tunisia, a middle-income country.
• To adapt and implement structured assessment tools (CAARMS, BPRS, SCID) with high interrater reliability.
• To evaluate the feasibility of screening, assessing, and managing CHR youth in a North African context.

Main Methods:

• Nine Tunisian psychiatric raters received comprehensive training on structured assessments (CAARMS, BPRS, SCID).
• High standards of interrater reliability were achieved (ICC ≥ .80 for CAARMS/BPRS, Kappa ≥ .75 for SCID).
• Ten pilot patients exhibiting potential CHR signs were recruited and evaluated for Attenuated Psychosis Syndrome.

Main Results:

• Trained raters met rigorous interrater reliability criteria for all assessment tools.
• Six out of ten pilot patients were classified as CHR with Attenuated Psychosis.
• One patient converted to psychosis within 3 months, yielding a 17% conversion rate comparable to global benchmarks.

Conclusions:

• The first CHR program has been successfully established in Tunisia, demonstrating the adaptability of high-income country methods.
• Key efforts included assembling a dedicated team, securing administrative support, and achieving high rater reliability.
• The study confirms the feasibility of screening, assessing, treating, and following CHR patients in Tunisia, with outcomes mirroring those in Western and European countries.