Disease Knowledge Centres

  • Psychiatry/Mental Health - Disease Topic Overview

    Psychiatry is the medical specialty dealing with mental illnesses, including prevention, diagnosis and treatment of these disorders.

    Psychiatric disorders include a large number of very different diseases that affect thinking, emotion and/or behaviour.1 These disorders are caused by complex interactions between physical, psychological, social, cultural and hereditary influences.1

    About 20% of adults will experience a mental illness at some point in their lives.1 The prevalence of psychiatric disorders in Europe and the United States is high, and the most common are; somatoform disorders, mood disorders and anxiety.2 Schizophrenia and bipolar disorder are also very common, affecting 1-2% of world population.1

    The high prevalence of psychiatric disorders is important in health spending in Europe and the United States.2 All studies of depressive disorders have stressed the importance of the mortality and morbidity associated with depression.3 The mortality risk for suicide in depressed patients is more than 20-fold higher than in the general population.3 Other studies have also shown the importance of depression as a risk factor for cardiovascular death.3

    Currently studies are underway to determine the genetic factors involved in different psychiatric disorders.4-6 It has recently been shown that abnormal levels of neurotrophins (brain-derived neurotrophic factor [BDNF]), which are involved in the process of neuroplasticity, can increase the risk of developing bipolar disorders4 and schizophrenia.5,6 BDNF represents an interesting therapeutic target, but is not the only genetic factor involved in mental disorders. Research must be continued in order to understand the complex interactions behind psychiatric disorders, and to develop prevention strategies and effective treatments.6

    1. Beers M.H. et al. The Merck manual of medical information. Merck research laboratories. Second home edition. 2003, 597-659.
    2. Sansone R.A. et al. Psychiatric disorders: a global look at facts and figures. Psychiatry (Edgmont). December 2010 ; 7 (12) : 16-9.
    3. Lépine J.P. et al. The increasing burden of depression. Journal of Neuropsychiatric Disease and Treatment. May 2011 ; 7 (1) : 3-7.
    4. Neves F.S. et al. The role of BDNF genetic polymorphisms in bipolar disorder with psychiatric comorbidities. Journal of Affective Disorders. June 2011 ; 131 (1-3) : 307-311.
    5. Neves-Pereira M. et al. BDNF gene is a risk factor for schizophrenia in a Scottish population. Molecular Psychiatry. January 2005 ; 10 : 208–212.
    6. Rizos E.N. et al. Reduced serum BDNF levels in patients with chronic schizophrenic disorder in relapse, who were treated with typical or atypical antipsychotics. World Journal of Biological Psychiatry. March 2010 ; 11 (2-2) ; 251-255.

  • ADHD

    Attention-deficit hyperactivity disorder (ADHD) is a heterogeneous neurobehavioural disorder characterised by inattention, hyperactivity and impulsivity.1 ADHD is one of the most common neurobehavioural disorders of childhood,1,2 but can continue to cause impairment throughout adolescence and into adulthood.3

    Learn more about ADHD… by visiting the ADHD Institute

    Diagnosis of ADHD often occurs based on the history of ADHD symptoms, which usually develop before the age of 7 years4 and are often first noticed in the school setting. This is because the characteristic symptoms of inattention, impulsivity and hyperactivity are problematic in social and school environments.5 Teachers in particular may be very well placed to identify ADHD symptoms when children start school.6 Symptoms can persist through adolescence and into adulthood.7

    Learn more about the diagnosis of ADHD…

    The aim of treatment is to manage the symptoms of ADHD and improve psychological, social, educational and occupational functioning.8 In this respect, treatment should encompass pharmacological and behavioural approaches. Due to the chronic nature of ADHD, a management programme should be put in place that takes into account the need for treatment and monitoring over time.9 A guide to managing ADHD may involve setting out desired improvements following discussions with the patient, the treating clinician and, if appropriate, parents, carers and school teachers. It may also be appropriate to set goals for treatment.9

    Learn more about the treatment options for patients with ADHD…

    A range of additional resources are also available. These include; a discussion forum , ADHD Institute meetings, congress reports, a congress calendar and useful links.

    References:
    1. Remschmidt H. Global consensus on ADHD/HKD. Eur Child Adolesc Psychiatry 2005; 14: 127-137.
    2. Brown RT, Freeman WS, Perrin JM, et al. Prevalence and assessment of attention-deficit/hyperactivity disorder in primary care settings. Pediatrics 2001; 107: e43.
    3. Pliszka S, AACAP Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2007; 46: 894-921.
    4. American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (Text Revision): DMS-IV-TR.
    5. Faraone SV, Doyle AE. The nature and heritability of attention-deficit/hyperactivity disorder. Child Adolesc Psychiatr Clin N Am 2001; 10: 299-316, viii-ix.
    6. National Institute for Health and Clinical Excellence (NICE). Attention deficit hyperactivity disorder: diagnosis and management of ADHD in children, young people and adults, 2008. Available from http://www.nice.org.uk/nicemedia/pdf/CG072NiceGuidelinev4.pdf. Accessed 1 October 2010.
    7. Faraone SV, Biederman J, Mick E. The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychol Med 2006; 36: 159-165.
    8. American Academy of Pediatrics. Subcommittee on Attention-Deficit/Hyperactivity Disorder and Committee on Quality Improvement. Clinical practice guideline: treatment of the school-aged child with attention-deficit/hyperactivity disorder. Pediatrics 2001; 108: 1033-1044.
    9. Quinlan DM. Assessment of attention deficit/hyperactivity disorder and comorbidities. In: Brown TE (Ed). Attention-deficit Disorders and Comorbidities in Children, Adolescents, and Adults (1st ed). Washington, DC: American Psychiatric Press Inc, 2000.

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Latest Drug News

NICE rejects Botox (Allergan) for Migraine prevention - 16-02-2012
NICE,the National Institute for Health and Clinical Excellence has published draft guidance rejecting the use of Botox (botulinum toxin type A)from Allergan, to prevent headaches in adult patients experiencing chronic Migraines. The Institute's committee of experts has concluded that there is not enough evidence to recommend the drug, and so has asked that its manufacturer Allergan provide additional information in support of its use on the NHS. The Scottish Medicines Consortium refused to recommend the drug for Migraine prevention last year. The clinical benefit was seen as modest and confused by the placebo effect.
Sycrest(Lundbeck) is launched for Bipolar Disorder in UK - 16-01-2012
Sycrest(asenapine)from Lundbeck is launched in the UK for treatment of moderate to severe manic eposodes associated with Bipolar Disorder in adults. EU approval was given in 2010. Sycrest is licensed by Lundbeck from Merck Inc. which markets the drug in the USA as Saphris for Schizophrenia and Bipolar Disorder. The advantages of the new antipsychotic are a less weight gain than with traditional antipsychotics and rapid efficacy as early as day two.

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Latest Clinical Trials

Mindfulness-Based Approaches to Insomnia
The overall goal of this project is to evaluate the evidence for the efficacy of two mindfulness-based interventions, mindfulness-based therapy for insomnia (MBT-I) and mindfulness-based stress reduction (MBSR), for reducing arousal and improving sleep among individuals with psychophysiological insomnia. Specific Aim 1: To obtain evidence for the relative effects of MBT-I and MBSR compared to a delayed-treatment control condition followed by behavior therapy for insomnia (BT-I) on arousal levels. It is hypothesized that MBSR and MBT-I will be superior to the control condition at reducing arousal levels. Specific Aim 2: To obtain evidence for the relative effects of MBT-I, MBSR, and the delayed-treatment control on sleep. It is hypothesized that MBT-I will be superior to the MBSR and control conditions at improving sleep parameters. Specific Aim 3: To investigate the relationship between measures of arousal (self-report and objective measures) and sleep (self-report and objective measures) to enhance the understanding of the role of arousal in psychophysiological insomnia.
Acupuncture for the Treatment of Insomnia
Insomnia is a common and disabling condition associated with psychiatric and medical comorbidities and often persists despite currently available treatments. Acupuncture has been reported to benefit individuals with insomnia and can decrease hyperarousal. This blinded RCT will investigate the impact of a standardized acupuncture protocol on insomnia, daytime symptoms, and hyperarousal.

Latest Journal Publications

Journal of Behavior Therapy and Experimental Psychiatry
US-born Latinos report significantly more depression than foreign-born Latinos in the US, and Latinas have twice the rate of depression than Latino men. The purpose of this pilot study was to test the feasibility of an innovative, short-term program of Schema Therapy (ST) combined with Motivational Interviewing (MI) techniques to reduce depression and increase resilience among second generation Latinas of low income in the US. In addition to blending ST and MI strategies with a focus on resilience, a novel technique called collaborative-mapping was a crucial strategy within treatment. Scheduling for sessions was flexible and patients had unlimited cell phone access to the therapist outside of sessions, although few used it. A mixed linear regression model for BDI-II scores of 8 women who completed all eight 2-h sessions demonstrated that the treatment significantly decreased BDI-II scores during the course of treatment (p = .0003); the average decreasing rate in BDI-II scores was 2.8 points per visit. Depression scores remained sub-threshold for 12 months after treatment completion. Resilience scores significantly increased after treatment completion and remained high at all follow-up visits through 1 year (p < .01). Thus, this short term, customized intervention was both feasible and effective in significantly decreasing depression and enhancing resilience for this sample with effects enduring one year after treatment. This study is the first to combine ST and MI in therapy, which resulted in an appealing, desirable, and accessible depression treatment for this severely understudied, underserved sample of low income, second generation Latinas in the US.
The Journal of Affective Disorders
Background: There has been a marked increase in antidepressant medication prescription and use over the past three decades with unclear effects on the mental health status of the population. This study examined the impact of expansion of antidepressant use on prevalence and characteristics of depression and suicidal ideations in the community. Method: Instrumental variable models were used to assess the impact of antidepressant treatments on the prevalence of depressive episodes, mixed anxiety and depression states and suicidal ideations in 22,845 participants of the 1993, 2000 and 2007 National surveys of psychiatric morbidity of Great Britain who were between 16 and 64 years of age. Results: Increased prevalence of antidepressant treatment did not impact the prevalence of depressive episodes or mixed anxiety and depression states. However, antidepressant treatment was associated with decreased prevalence of severe and, to a lesser extent, mild depressive episodes and suicidal ideations and a corresponding increase in prevalence of moderate depressive episodes. Limitations: The data were cross-sectional and based on self-report of symptoms in the past month and current medication use with no information on dose and duration of medication treatment. Conclusions: Expansion of antidepressant treatments in recent years has not changed the community prevalence of depression overall, but it has reduced the prevalence of more severe depression and suicidal ideations. The findings call for better targeting and more judicious use of antidepressants in cases of more severe depressive episodes which are more likely to respond to such treatments.

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Psychiatry/Mental Health