1. WPA Medical Conditions That May Present with Psychosis Temporal lobe epilepsyTemporal lobe epilepsy TumorTumor StrokeStroke TraumaTrauma Endocrine/metabolic abnormalitiesEndocrine/metabolic abnormalities InfectionsInfections Multiple SclerosisMultiple Sclerosis Autoimmune diseasesAutoimmune diseases

2. WPA Evaluating Psychosocial Function PremorbidPremorbid CurrentCurrent

3. WPA Aspects of Psychosocial Function Relationship to parentsRelationship to parents Relationship to siblingsRelationship to siblings Relationship to peersRelationship to peers Sexual adjustmentSexual adjustment Educational historyEducational history Work functionWork function Recreational activities and interestsRecreational activities and interests

4. WPA Laboratory Workup No standard set of laboratory testsNo standard set of laboratory tests Test selected on basis of clinical presentation, mode of onset, and past historyTest selected on basis of clinical presentation, mode of onset, and past history

5. WPA Some Common Laboratory Tests Complete blood countComplete blood count UrinalysisUrinalysis Endocrine testsEndocrine tests Liver function testsLiver function tests ElectroencephalogramElectroencephalogram Computerized TomographyComputerized Tomography Magnetic Resonance ImagingMagnetic Resonance Imaging Neuropsychological testsNeuropsychological tests Projective testsProjective tests

6. WPA Cross Cultural Issues: Similarities Across Cultures Schizophrenia is found throughout the worldSchizophrenia is found throughout the world Some symptoms tend to be identical worldwideSome symptoms tend to be identical worldwide Negative symptoms Thought Disorder Cognitive Impairment

7. WPA Differences Across Cultures Content of psychotic symptomsContent of psychotic symptoms OutcomeOutcome Frequency of acute psychotic episodesFrequency of acute psychotic episodes

8. WPA Reasons for Frequency of Acute Psychosis InfectionsInfections NutritionNutrition Delays in provision of medical careDelays in provision of medical care

9. WPA Social Outcome in First Episode Schizophrenia: Nagasaki Follow-up after 2 years 1981-1982 Follow-up after 5 years 1984- 1985 Follow-up after 10 years 1989- 1990 Number of cases at follow-up 646558 Good Outcome 34.444.636.2 Poor Outcome 24.435.435.5 Hospitalized31.320.029.3 DAS overall evaluation (includes cases in the hospital) With good outcome 39.150.844.8 With poor outcome 60.949.255.2

10. WPA Poor Outcome: Predictors Prominent negative symptomsProminent negative symptoms Early age of onsetEarly age of onset Insidious onsetInsidious onset Poor premorbid adjustmentPoor premorbid adjustment Low educational achievementLow educational achievement Low parental social classLow parental social class Male genderMale gender

11. WPA Comparison of Course in Developed and Developing Countries Pattern of Course * 123456789 Developed Countries (n-604) 15.717.46.25.314.712.117.12.3-- Developing Countries (n-474) 37.111.66.52.319.010.611.21.10.6 * 1. Single psychotic episode, complete remission 2. Single psychotic episode, incomplete remission 2. Single psychotic episode, incomplete remission 3. Single psychotic episode, non-psychotic episodes complete remission 3. Single psychotic episode, non-psychotic episodes complete remission 4. Single psychotic episode, non-psychotic episodes incomplete remission 4. Single psychotic episode, non-psychotic episodes incomplete remission 5. 2+ psychotic episodes, complete remission 5. 2+ psychotic episodes, complete remission 6. 2+ psychotic episodes, incomplete remission 6. 2+ psychotic episodes, incomplete remission 7. Continuous psychotic illness, no remission 7. Continuous psychotic illness, no remission 8. Continuous non-psychotic illness 8. Continuous non-psychotic illness 9. Not known 9. Not known

12. WPA Reasons for Better Outcome in Developing Countries Better social support from extended familiesBetter social support from extended families Less social pressure to achieve occupationallyLess social pressure to achieve occupationally Lower stress in rural environments and small villagesLower stress in rural environments and small villages Less stigma toward mental illnessLess stigma toward mental illness