Intro to Mental Health Stage 1 2024 - Tagged.pdf

Introduction to Mental health Dr Anna Battaglia Faculty of Life Sciences & Medicine Centre for Education https://www.rethink.org/campaigns-and-policy/awareness-days-and-events/ https://www.rethink.org/aboutus/what-we-do/  Emotional disorders Affective disorde...

Introduction to Mental health Dr Anna Battaglia Faculty of Life Sciences & Medicine Centre for Education https://www.rethink.org/campaigns-and-policy/awareness-days-and-events/ https://www.rethink.org/aboutus/what-we-do/  Emotional disorders Affective disorders Low mood, unhappiness, sadness Such as major depression (unipolar), manic-depressive illness, bipolar depression, post natal depression etc. Anxiety disorders: Fearfulness, apprehension or anxiety Such as generalized anxiety disorder (GAD), panic disorder, phobias, Obsessive-compulsive disorder etc. Together they are known as emotional disorders Affective Disorders Anxiety Disorders  Emotional disorders National statistics compiled by the Government show that in England in 2007, 16.2% (around 1 in 6) of 7325 adults between the ages of 16 and 64 years met the diagnostic criteria for at least one emotional disorder (or common mental disorder; McManus et al., 2009). NHS report 2018 Impact of Covid- 19 on Mental Health At it has been said, we are all in the same storm, but we are not all in the same boat https:// www.mentalhealth.org.uk /coronavirus/divergence- mental-health- https://digital.nhs.uk/data-and-information/publications/statistical/ mental-health-of-children-and-young-people-in-england/2023-wave-4- follow-up  What is depression? Depression is a low mood that lasts for a long time and affects your everyday life. In its mildest form, depression can mean just being in low spirits. It doesn’t stop you leading your normal life but makes everything harder to do and seem less worthwhile. At its most severe, depression can be life-threatening because it can make you feel suicidal or simply give up the will to live. ‘It feels like I'm stuck under a huge grey-black cloud. It's dark and isolating, smothering me at every opportunity.’ ‘It starts as sadness then I feel myself shutting down, becoming less capable of coping. Eventually, I just feel Taken from www.mind.org.uk (accessed 21/09/16)  What is anxiety? Fear, anxiety and worry are part of normal experience and can all be very useful. However, when they become exaggerated, or attached to inappropriate stimuli or situations, they can interfere with normal functioning and cause immense distress. Anxiety disorders are characterised by constant or intense feelings of apprehension, uncertainty and fear. These feelings are one extreme of a continuum from ‘normal’ fear to anxiety – the responses differ not in kind but in degree. Both involve the ‘fight or flight’ system that comes into play in situations of actual or perceived danger ‘Going out of the house is a challenge because I [have a] fear of panicking and feel that I'm being watched or judged. It's just horrible. I want to get help but I'm afraid of being judged.’ Quote taken from www.mind.org.uk (accessed 19/10/16) Biopsychosocial: Holistic view of mental  Biopsychosocial: Holistic view of mental health Drugs Talking therapies CBT Community Friend & Family Social workers Different approaches will work for different people.  Psychology Social Biology (mind/behavior) (other) (Brain) Psychology Social Biology (other) (mind/behavior) (Brain) Biological change/intervention eg. brain damage or drugs Psychology Social Biology (mind/behavior) (other) (Brain) Psychological change/intervention eg. therapy Psychology Social Biology (mind/behavior) (other) (Brain) Social change/intervention eg divorce/new friend  Objective vs. subjective  Objective: ‘can be observed and literally measured by another individual’  Subjective: ‘the perspective of the person reporting on the contents of his or her conscious mind’ Taking a biological approach to mental health How can we understand the experience of mental health conditions by focussing on the brain and its function? A scientific approach – what does this mean? An emphasis on evidence Mental illness results form abnormal brain biology Looking for evidence of hereditary vulnerability in our genes Looking for changes in brain structure that might explain the condition Looking for changes in brain function that might explain a condition Treatments for depression: biological, psychological or social? SCHIZOPHRENI A ….WHAT IS IT? Paintings by L Wain  Amber Osterhaut anti-mental health stigma poster  Symptoms  Positive symptoms represent hypersensitivity and hyperawareness of thoughts and cognitive functions  Some individuals may experience auditory or visual hallucinations  Others may experience paranoia or anxiety or delusional thoughts  Psychosis is at the root of all schizophrenia symptoms: an incapacity to distinguish between real and unreal perceptions  Negative symptoms  In one third of all patients  Loss of normal mental function  Lack of emotions and loss of motivation  Causes of schizophrenia  Genetic  Birth defects  Environmental triggers  Imbalances in dopamine levels  Communication and coordination failures (neural oscillations, i.e. rhythmic or repetitive neural activity in the CNS )  DEPRESSION Vincent van Gogh, 1890 "Grief and fear, when lingering, provoke melancholia." Hippocrates, 460–377 BC (melancholia, from the Greek, 'black bile')  Risk Factors  Personal/family psychiatric history (major depression might result from a polygenic disorder)  Loss of a parent in childhood  Abuse in childhood  Use of alcohol, nicotine and recreational drugs  Anxiety and panic syndrome  Stress in the workplace  Household type and composition  Recent threatening life events  Puberty, pregnancy and perimenopause in women  Features of Depression Core Otherfeatures features  Poor self-esteem, self-confidence,control  Negative  Pervasiveview lowof past, present and future mood   Fatigue Loss of interest and enjoyment (anhedonia)  Disturbed sleep  Reduced energy, diminished activity  Diminished (or increased) appetite  Poor concentration and attention  Ideas or acts of self harm or suicide  Feelings of helplessness  DIAGNOSIS  Dysthymia: a few mild but persistent symptoms leading to a persistent low grade condition  Depressive disorder: more numerous and more severe symptoms  Severe depression: psychotic symptoms (delusions, hallucinations) or depressive stupor (from ABC of Mental Health, Davies & Craig eds, BMJ books)  How life stressful events impact upon monoaminergic  systems? Stress activates HPA causing CRF release and production of glucocorticoids.  Glucorticoids regulate components of the monoaminergic systems (receptors, transporters) and contribute to the modification of limbyc system structural connessions.  Important to remember: not everyone with stress becomes depressed and someone with no stress can become depressed. Each individual reacts differently to the environment, with genetic and developmental factors contributing differentially to the onset or not of depression  Excessive activation of the HPA axis is seen in half of depressed patients. From Nestler et al., 2002 Stress and depression from a psychological perspective  Monoamine hypothesis of mood disorders Depressed: Blockade of re-uptake Normal brain decreased restores normal monoamine concentration oflevels thus ameliorating monoamines is mood thought to be the cause of From Castren, 2005 depression Antidepressants mechanisms of action The Network Hypothesis of Depression Problems in activity- dependent neuronal communication could underlie depression. Antidepressants might improve information processing in the affected neural networks, trough morphological and physiological reorganization of specific neural connection in the brain (Castren, 2005) Observations show that antidepressants increase neuronal  Treatments available  Mild depression: cognitive psychotherapy  More severe:  Psychotherapy supplemented with drug therapy  Drug therapy alone  Very severe or prolonged cases: electroconvulsive therapy (ECT) is effective  Treating depression with a multi-therapeutic approach From Castren, 2005  Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature Jeffrey R Lacasse, Jonathan Leo Published: November 8, 2005 http://journals.plos.org/plosmedicine/article?id=10.1371/ journal.pmed.0020392  Challenging Received Wisdom: Antidepressants and the Placebo Effect by I Kirsch  http://www.ncbi.nlm.nih.gov/pmc/articles/ Controversial ideas  How did antidepressant drugs gain their reputation as a magic bullet for depression? And why has it taken so long for the story to become public? Answering these questions takes us to the point where the lines between clinical research and marketing disappear altogether. Using the Freedom of Information Act, Kirsch accessed clinical trials that were withheld, by drug companies, from the public and from the doctors who prescribe antidepressants. What he found, and what he documents here, promises to bring revolutionary change to the way our society perceives, and consumes, antidepressants. The Emperor's New Drugs exposes what we have failed to see before: depression is not caused by a chemical imbalance in the brain; antidepressants are significantly more dangerous than other forms of treatment and are only marginally more effective than placebos; and, there are other ways to combat depression, treatments that don't only include the empty promise of the antidepressant prescription.  On February 26, 2008, PLoS Medicine published a meta-analysis that my colleagues and I had conducted on antidepressant medication. Most meta- analyses suffer from publication bias, which can happen when pharmaceutical companies withhold unsuccessful trials from publication. To circumvent this, we used the Freedom of Information act in the U.S. to obtain the data on all clinical trials submitted to the Food and Drug Administration (FDA) for the licensing of the four new-generation antidepressants.  The results of our meta-analysis showed that people got better on medication, but they also got better on placebo, and the difference between the two was small. In fact, it was below the criterion for clinical significance established by the NICE in the UK  Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, et al. Initial Severity and Antidepressant Benefits: A Meta- Analysis of Data Submitted to the Food and Drug Administration. PLoS Med. 2008;5(2):e45  The never-ending debate… 2019 https://www.thelancet.com/journals/ https://bmjopen.bmj.com/content/9/6/ lancet/article/PIIS0140- e024886  Depression research news: look here  https://www.sciencedaily.com/news/ mind_brain/depression/ Inside the brain: a mini Neuroscience  course Here is the link to download the Spring 2013 edition of Big Picture (Wellcome Trust) called Inside the brain:  https://bigpictureeducation.com/brain VERY USEFUL SCIENCE OF THE BRAIN RESOURCE  https://www.bna.org.uk/static/uploads/resou rces/BNA_English.pdf