This document discusses the global burden of mental illness and the role that psychosomatic medicine can play in addressing it, particularly in Africa. It notes that mental disorders account for 13% of the global burden of disease and reviews strategies like integrating mental health treatment into primary care. Psychosomatic medicine is well-suited to contribute through its expertise in managing co-morbid medical and psychiatric conditions and working at the interface of different medical fields. The document argues that training consultation-liaison psychiatrists could help address Africa's lack of psychiatric resources and lack of treatment for co-occurring conditions.
Rethinking, rebuilding psychosocial care for cancer patientsJames Coyne
Presented as the 8th Trevor Anderson Psycho-Oncology Lecture, September 8, 2014, Melbourne, Australia.
Discusses how psychosocial care for cancer patients needs to be reorganized so that a broader range of cancer patients are served. Routine screening for distress is unlikely to be an efficient means of countering tendencies of cancer care more generally becoming more organized around time efficiency and billable procedures. Psychosocial care for many cancer patients involves discussions, negotiations, and care coordination they cannot be well fit into the idea of a counseling session. The unsung heroes of providing such care are underappreciated social workers and oncology nurses.
Rethinking, rebuilding psychosocial care for cancer patientsJames Coyne
Presented as the 8th Trevor Anderson Psycho-Oncology Lecture, September 8, 2014, Melbourne, Australia.
Discusses how psychosocial care for cancer patients needs to be reorganized so that a broader range of cancer patients are served. Routine screening for distress is unlikely to be an efficient means of countering tendencies of cancer care more generally becoming more organized around time efficiency and billable procedures. Psychosocial care for many cancer patients involves discussions, negotiations, and care coordination they cannot be well fit into the idea of a counseling session. The unsung heroes of providing such care are underappreciated social workers and oncology nurses.
Dr. Eugene Ahn of Sylvester Comprehensive Cancer Center discussed mind-body approaches to cancer healing at the 2011 WellBeingWell Conference in Miami.
Presentation on palliative care given at the Caregiver's Conference for the Cystic Fibrosis Affiliate and Satellite Sites at Riley Children's Hospital.
Dying Matters: Feel the fear, and have the conversation anywayNHSRobBenson
Presentation on a short training project and supporting materials for GPs and other health professionals proven to boost confidence and improved end of life care. From Hilary Fisher and Lorna Potter from England's Dying Matters coalition as part of the Department of Health's QIPP end of life care workstream seminar series at Healthcare Innovation Expo 2011.
Road map for social psychiatry in 21 st centrury role of industry -Devashish Konar
Psychiatry has to move in tandem with industry for its next level of development. Closer association with Pharmaceutical, Biomedical and Digital industries will be important in the road map of Social Psychiatry in 21st century.
Dr. Eugene Ahn of Sylvester Comprehensive Cancer Center discussed mind-body approaches to cancer healing at the 2011 WellBeingWell Conference in Miami.
Presentation on palliative care given at the Caregiver's Conference for the Cystic Fibrosis Affiliate and Satellite Sites at Riley Children's Hospital.
Dying Matters: Feel the fear, and have the conversation anywayNHSRobBenson
Presentation on a short training project and supporting materials for GPs and other health professionals proven to boost confidence and improved end of life care. From Hilary Fisher and Lorna Potter from England's Dying Matters coalition as part of the Department of Health's QIPP end of life care workstream seminar series at Healthcare Innovation Expo 2011.
Road map for social psychiatry in 21 st centrury role of industry -Devashish Konar
Psychiatry has to move in tandem with industry for its next level of development. Closer association with Pharmaceutical, Biomedical and Digital industries will be important in the road map of Social Psychiatry in 21st century.
Most Common Skin Disorders - Causes and Treatment | Sehat.comSehat.com
Almost everyone might have experienced at one time or the other the horror of dealing with a skin disorder/disease. Irrespective of the age, one can be affected by various skin ailments and if not treated properly the condition may get aggravated.
Please I need a response to this case study.1 pagezero plagi.docxcherry686017
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The Case:
The sleepy woman with anxiety
This week’s discussion presents a case study involving a 44-year old woman with a chief complaint of anxiety beginning at age 15 years old. She has a long history of mental illness and continued therapies. The purpose of this discussion is to analyze her case history to determine medication and treatment effectiveness.
Client Questions
Question 1. Are you having feelings of harming yourself or harming someone else?
Rationale: This is a possibly uncomfortable yet important set of questions to ask each client. Primary care providers may be in a unique position to prevent suicide due to their frequent interactions with suicidal patients. Reviews suggest that among patients who committed suicide, 80 percent had contact with primary care clinicians within one year of their death, whereas only 25 to 30 percent of decedents had contact with psychiatric clinicians within the year of their death (Stene-Lars & Reneflot, 2017).
Question 2. What was happening in your life as a teenager when the anxiety started and you began to self-medicate?
Rationale: Per our report, this patient began suffering signs and symptoms of anxiety at 15-years old. Asking these types of questions we may gain insight into an underlying cause or triggering event. Anxiety disorders are the most common psychiatric disorders with onset in childhood, with prevalence estimates ranging from 10 to 30 percent. Nearly 37 percent of behaviorally inhibited preschool-age children had social anxiety disorder at age 15, compared with 15 percent of non- behaviorally inhibited children
.
Children with anxiety disorders are more likely to have persistent anxiety disorders into adulthood. (Rapee, 2014).
Question 3. What was happening in your life a year ago when these symptoms returned and became debilitating? Let’s discuss what the triggering events may have been.
Rationale: Self-discovery of triggering events may help the client to come to terms with the determinants of her anxiety and depression. Studies have shown that specific types of stressors were found to differentially predict increases in specific facets of anxiety sensitivity; health-related stressors predicted increases in disease-related concerns and fear of mental incapacitation, whereas stressors related to family discord predicted increases in fear of feeling unsteady, fear of mental incapacitation, and fear of having publicly observable symptoms of anxiety (McLaughlin & Hatzenbuehler, 2009).
Support System
The support system as reported by our client is her husband. She states he is supportive and has little to no contact with the family of origin. She has a few friends and a few outside interests. As PMHNP, discussing relationships with the client is one avenue to gain insight into anxiety patterns and coping mechanisms as seen by outside support. With the client’s permissio.
Original ArticleDesign and implementation of a randomized.docxgerardkortney
Original Article
Design and implementation of a randomized
trial evaluating systematic care for bipolar
disorder
Abundant evidence demonstrates that treatments
for bipolar disorder can reduce the severity of
mood symptoms and improve daily functioning.
Specific pharmacotherapies have been proven effi-
cacious in the acute management of mania and
depression (1, 2) as well as in the prevention of
recurrence (1). For lithium, more intensive treat-
ment has been shown to improve both long-term
clinical outcomes and psychosocial functioning.
Promising evidence also supports the efficacy of
several disease-specific psychosocial interventions
for bipolar disorder (3, 4).
Unfortunately, treatments provided in everyday
practice fall far short of those proven in clinical
Simon GE, Ludman E, Unützer J, Bauer MS. Design and implementation
of a randomized trial evaluating systematic care for bipolar disorder.
Bipolar Disord 2002: 4: 226–236. ª Blackwell Munksgaard, 2002
Objectives: Everyday care of bipolar disorder typically falls short of
evidence-based practice. This report describes the design and
implementation of a randomized trial evaluating a systematic program to
improve quality and continuity of care for bipolar disorder.
Methods: Computerized records of a large health plan were used to
identify all patients treated for bipolar disorder. Following a baseline
diagnostic assessment, eligible and consenting patients were randomly
assigned to either continued usual care or a multifaceted intervention
program including: development of a collaborative treatment plan,
monthly telephone monitoring by a dedicated nurse care manager,
feedback of monitoring results and algorithm-based medication
recommendations to treating mental health providers, as-needed outreach
and care coordination, and a structured psychoeducational group
program (the Life Goals Program by Bauer and McBride) delivered by the
nurse care manager. Blinded assessments of clinical outcomes, functional
outcomes, and treatment process were conducted every 3 months for
24 months.
Results: A total of 441 patients (64% of those eligible) consented to
participate and 43% of enrolled patients met criteria for current major
depressive episode, manic episode, or hypomanic episode. An additional
39% reported significant subthreshold symptoms, and 18% reported
minimal or no current mood symptoms. Of patients assigned to the
intervention program, 94% participated in telephone monitoring and 70%
attended at least one group session.
Conclusions: In a population-based sample of patients treated for bipolar
disorder, approximately two-thirds agreed to participate in a randomized
trial comparing alternative treatment strategies. Nearly all patients
accepted regular telephone monitoring and over two-thirds joined a
structured group program. Future reports will describe clinical
effectiveness and cost-effectiveness of the intervention program compared
with usual care.
Gregory E Simona, Evette
Lud.
Discussion QuestionWhat you do think will be the market impact.docxelinoraudley582231
Discussion Question
What you do think will be the market impact(s) of the proposed increase in the federal minimum wage to $10 per hour?
a) Will the proposed increase help workers? And if so which part(s) of the labor market will be helped.
b) Which part(s) of the labor market will hurt by the proposed increase? How will they be hurt?
c) What will happen to the prices of goods and services produced with minimum wage labor?
3) What is your conclusion? Is this proposal a good idea or not? Explain why.
POST MUST BE BETWEEN 200-250 WORDS, APA FORMAT
Journal of Counseling & Development ■ Winter 2005 ■ Volume 83116
Trends
One of the most common disorders facing people today is
depression. By some estimates, roughly 10% to 25% of the
population experiences some form of depression. Accord-
ing to Murray and Lopez (1997), depression is the number
one cause of disability worldwide. It is clearly the most com-
mon disorder experienced by people who see mental health
practitioners (Gilroy, Carroll, & Murra, 2002). Also, it may be
the most common disorder of mental health workers them-
selves (Mahoney, 1997; Pope & Tabachnik, 1994), with re-
search suggesting that from one third to more than 60% of
mental health professionals had reported a significant epi-
sode of depression within the previous year. Depressing? Yes,
but there is hope and good news. Depression, by and large, is
a problem readily amenable to treatment, and there are many
successful approaches, many of which have empirical evi-
dence to support their efficacy. The bad news, however, is that
depression has been increasing in epidemic proportions. Data
reflect that depression is 10 times as prevalent now as it was in
1960! Seligman (2002) provided a provocative paradox on
depression. He stated that while every objective indicator of
well-being in the U.S. has been increasing, every indicator of
subjective well-being is decreasing.
Clearly, the importance of the current knowledge base on
depression is obvious. Counselors, from pre-K to adult men-
tal health workers, need to be well-versed on the current
state of treatment for depression. For counselors, it is quite
likely that for many of their clients, whether they present
with problems of mood disturbance or not, depression may
be involved. For professionals, who are at high risk for mood
disorders by the very nature of their work, the importance of
treatment and prevention in self-care is critical. Thus, this
topic has considerable value because it is quite likely that
counselors will work with clients with depression, and it is
quite likely, given the empirical evidence, that counselors
are experiencing or will be experiencing some form of de-
pression/mood disturbance themselves.
The article “Treatment and Prevention of Depression”
(Hollon, Thase, & Markowitz, 2002) reviews the current state
of research on various treatment modalities, comparing the
effectiveness of the more widely used approaches—psycho-
dynamic therapy.
Case # 29- The depressed man who thought he was out of options. .docxannandleola
Case # 29- The depressed man who thought he was out of options.
Depression has become a common mental disorder in our elderly population. This has caused a global concern for occur, geriatric patients, as depression often results in a significant burden for families as well as communities. Elderly people who suffer from depression may have an inferior baseline and record for medical assessments than those individuals without depression. Despite consistent evidence of the effectiveness of antidepressants for many with depression,
3
particularly those with more severe depression, remission rates are disappointingly low. An AHRQ-sponsored report found that only 46% of patients experienced remission from depression during 6 to 12 weeks of treatment with second-generation antidepressants. One major reason for this issue is non-adherence to medications and treatment plans. Studies have shown that patients' age, race and ethnicity are consistently associated with predictions of outcomes. (Rossom et al., 2016).
This case study involves a 69-year old man whose chief complaint is unremitting, chronic depression. After several years of medications and treatments, he feels hopeless for a recovery from his chronic depression. This assignments seeks to explore his family and social support systems, diagnostic testing, differential diagnosis and pharmacologic treatment options for this patient.
Questions for the client
How have you been sleeping lately?
How many times in the last week have you had feelings of hopelessness?
Are you having thoughts of harming yourself? Do you have a plan?
These questions are an important yet simple place to start when treating patients. Sleep disturbances plague much of the world's population and have shown to be a major indicator for mental health issues. Changes in sleep neurophysiology are often observed in depressive patients, and impaired sleep is, in many cases, the chief complaint of depression (Armitage, 2007). Depressed patients with sleep disturbance are likely to present more severe symptoms and difficulties in treatment. In addition, persistent insomnia is the most common residual symptom in depressed patients and is considered a vital predictor of depression relapse and may contribute to unpleasant clinical outcomes (Hinkelmann et al., 20120. Questions involving feelings of hopelessness and suicidal ideations with or without a plan relate to issues of patient safety. Across psychiatric disorders, hopelessness is associated with suicidal ideation and behavior. A meta-analysis of 166 longitudinal studies (sample size not reported) found that hopelessness was associated with an increased risk of ideation (Ribeiro, Huang, Fox, & Franklin, 2018).
Family and social support system
Family and social support systems are imperative for any patient in recovery. If the patient is agreeable to discussions with family members, then a discussion with his wife would be helpful. Researc.
Efficacy of individualized homeopathic treatment and fluoxetine for moderate ...home
his study is the first trial of classical homeopathy that will evaluate the efficacy of homeopathic
individualized treatment using C-potencies versus placebo or fluoxetine in peri- and postmenopausal women with
moderate to severe depression. It is an attempt to deal with the obstacles of homeopathic research due to the
need for individual prescriptions in one of the most common psychiatric diseases.
A CROSS-SECTIONAL STUDY ANALYSING THE LEVEL OF DEPRESSION AND ITS CAUSATIVE F...amsjournal
Depression is a pathological state of the mind characterised lack of self-confidence and self-esteem. The
cause of depression is multi factorial and various physical, psychological, environmental and genetic
factors have been implicated in the causation of depression. Despite being a serious condition in all age
groups, depression is more common and significant in the geriatric population as it is associated with
significant morbidity and mortality. Various scales have been developed to assess depression of which the
Geriatric Depression Scale is most suited for elderly population. It has a long form and short form, the
latter being more appropriate for elderly patients with dementia. In our study, we aim to analyse the
prevalence of depression among elderly patients visiting the outpatient departments of a tertiary care
hospital and determine the factors influencing depression in them. The study was an Observational cross sectional
study carried out on 51 elderly patients over the age of 60 years attending the various outpatient
departments of PSG Hospital. The Geriatric Depression Scale Short form was used to determine the
prevalence of depression. A self-designed questionnaire considering various factors causing depression
was administered to determine the factors influencing depression. It was found that among 51 elders in the
age group of 60 to 80 years, 58.8% were depressed of which 54% were males and 68% were females.
Financial fears regarding future and income insufficiency were the most important factors contributing to
depression. This shows that monetary fear is a major factor resulting in depression. The most effective
strategy to combat depression is to ensure appropriate self-report. The government and other organizations
must ensure that better support, both financial and other services like healthcare are provided to the
elderly in order to prevent depressive illnesses.
Homeopathy for Depression - DEP-HOM: study protocol for a randomized, partial...home
Homeopathy is often sought by patients with depression. In classical homeopathy, the treatment
consists of two main elements: the case history and the prescription of an individually selected homeopathic
remedy. Previous data suggest that individualized homeopathic Q-potencies were not inferior to the antidepressant
fluoxetine in a sample of patients with moderate to severe depression. However, the question remains whether
individualized homeopathic Q-potencies and/or the type of the homeopathic case history have a specific
therapeutical effect in acute depression as this has not yet been investigated. The study aims to assess the two
components of individualized homeopathic treatment for acute depression, i.e., to investigate the specific effect of
individualized Q-potencies versus placebo and to investigate the effect of different approaches to the homeopathic
case history.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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Fricchione psychosomatic medicine in mental health
1. Psychosomatic Medicine and its Relevance to Mental Health in Africa Gregory Fricchione, MD Associate Chief of Psychiatry Director, Division of Psychiatry and Medicine Director, Benson Henry Institute Senior Scientist, Pierce Division of Global Psychiatry Massachusetts General Hospital Professor of Psychiatry Harvard Medical School
3. Objectives To Review: Scope of the global mental health crisis The Importance of Psychosomatic Medicine in helping to address it Implications for modern medicine and the quest to improve mental health in Africa.
4. International Psychiatry 1972-73 British J Psychiatry : prevalence of mental illnesses ~ equal in developed and developing worlds; services very unequal 1993 HSPH, HDSM, World Bank, WHO: --GBD=gap between current health status and ideal of life into old age free of disease/disability --DALYs= sum of yrs of life lost due to premature death (YLL) + yrs lost due to disability (YLD) for incident cases of the health condition.
6. Background Murray CJL and Lopez AD, eds.1996; The GBD: A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. HSPH on behalf of WHO and World Bank, Cambridge, MA. WHO GBD: 2004 Update (WHO, 2008): --Depression, schizophrenia, epilepsy, dementia, alcohol dependence and other neuropsychiatric and substance use disorders constitute 13% of GBD surpassing CV disease and cancer. --Depression alone is the 3rd leading cause of GBD. By 2020, suicide is estimated to result in 1.5 million deaths a year and up to 30 million will attempt it.
7. Background WHO Solutions: 1. Treat in Primary Care, 2. Make psychotropics available, 3. Community care, 4. Educate the public, 5. Involve communities, families and consumers, 6. National policies, programs and legislation, 7. Develop human resources, 8. Link with other sectors, 9. Monitor community health, 10. More research. Recent Lancet Series: “mental health is essential for general health”; psychiatric disorders can predispose to physical illnesses and exacerbate them and vice versa. This is a Psychosomatic Medicine argument.
8. Chester M. Pierce Division of Global Psychiatry at MGH 2002 African Diaspora Meeting at MGH 2003 Global Division Established 2009 Named for Prof Pierce and David Henderson takes over from Greg Fricchione as Director. Bauer AM, Fielke K, Brayley J, Araya M, Alem A, Frankel BL, Fricchione GL. Tackling the global mental health challenge: a psychosomatic medicine/consultation-liaison psychiatry perspective. Psychosomatics. 2010 May;51(3):185-93. --depression in primary care --neuropsychiatry --consultant/supervisory model
9.
10. Prevalence of Depression Med Illness % Prev Rate Cardiac Disease 17-27 Cerebrovascular 14-19 DAT 30-50 PD 4-75 Epilepsy (controlled) 3-9 Epilepsy (intractable) 20-55 DM 9(interview)-26 (self-report) Cancer 22-29 Pain 30-54 Obesity 20-30 General Pop 10.3 [Evans et al, Biol Psychiatry 2005; 58: 175-189]
11. Depression Primary prevention or early detection of depression should be a major focus of primary care practice Only ~ half of those patients who present to their primary care physician with major depression are accurately diagnosed (Eisenberg, 1992.) A diagnosis of major depression is often missed in patients who present with unexplained somatic symptoms or a symptomatic worsening of a chronic medical illness (Kirmayer, 1993).
17. Improving Outcomes in Primary Care Psychiatry 5) Stepped Care: Comparison of “stepped-care” with usual care in Santiago, Chile ( Araya et al, 2003, Lancet): 3 primary care clinics, n= 240 female adults Stepped care: 3-month multicomponent intervention by health worker (group psychoeducation; structured, systematic f/u; meds by PCP for severe depression) Stepped care: 78% improved (HDRS< 50% baseline), 73% recovered (HDRS < 8) at 6 mos Usual care: 32% improved; 30% recovered at 6 mos.
18. Depression Research Chisholm et al, 2004: --Estimated the population-level cost-effectiveness of evidence-based primary-care-based depression interventions in 14 epidemiological subregions of the world and their contribution towards reducing current burden. -- Total population-level costs and effectiveness (DALYs averted) were combined to form average and incremental cost-effectiveness ratios. -- Interventions can reduce the burden of depression by 10-30%. -- So conclusion was more intervention is needed if burden to be reduced.
19. The Role of Psychosomatic Medicine Psychosomatic medicine is a discipline dedicated to 1) Advancing understanding of connections between psychological and social forces and human physiology, including health and disease; and 2) Advocating the application of holistic integrative principles to patient care The field of psychosomatic medicine with its practical arm consultation–liaison (C–L) psychiatry is well-positioned to contribute to global mental health through expertise in: Understanding and managing co-morbid conditions and Working in systems at the interface of psychiatry and medicine.
20. The Role of Psychosomatic Medicine Disease burden attributable to mental illness is likely underestimated, given the interrelationship between psychiatric and both communicable (e.g., acquired immune deficiency syndrome [AIDS]) and noncommunicable diseases (e.g., cardiac disease, diabetes). Worldwide, depression is associated with poorer health among those with chronic medical conditions. Patients with mental disorders have increased mortality from common conditions, including cancer, stroke, cardiovascular disease, respiratory diseases, and accidents. These patients receive fewer guideline based interventions, which may account for some of their excess mortality.
21. The Role of Psychosomatic Medicine Similarly, psychiatric disorders predispose to health-risk behaviors, including use of tobacco, alcohol, and other substances; inactivity; overeating; and high-risk sexual behaviors, all of which are common among individuals with mental disorders. Taken together, the direct and indirect effects of psychiatric disorders on GBD are substantial. The nature of the interrelationship of mental and physical bodily events is such that there can truly be no health without mental health. High disease burden, together with lack of resources for specialty treatment and a substantial treatment gap, provide the basis for a link between primary care and mental health care C–L psychiatrists are well-equipped to provide consultations and assist primary care physicians in treating patients with mental disorders.
22. The Role of Psychosomatic Medicine One of the best-studied C–L models is the collaborative-care model for primary-care depression management, developed out of the outpatient C–L service at the University of Washington Drawing on the insights of those leaders who envisioned C–L psychiatry as central to the development of primary-care treatment of mental disorders, the extension of C–L psychiatry to global mental health is a logical one because the field fosters development of a skill-set well suited to advancing the global mental health agenda.
23. The Role of Psychosomatic Medicine By efficiently using specialist resources, a primary care model may improve access to care in underserved areas. Moreover, such a model is consistent with important principles of high-quality care, specifically, that services should be community-based and patient-centered with an emphasis on improving daily functioning. Treatment of mental disorders in the primary-care setting may lead to higher acceptance by patients and may reduce the stigma of seeking help. By modeling professional behavior toward patients with mental illness, C–L psychiatrists may help allay fears of primary-care providers and other allied healthcare workers and thus contribute to reducing stigma.
24. The Role of Psychosomatic Medicine Two notable features include the specialized knowledge at the interface of medicine, neurology, and psychiatry; and the ability to function primarily in the role of a consultant-educator and supervisor, rather than as a primary service provider. These skills are of critical importance in the international arena and can result in psychiatrists diagnosing a range of disorders with neuropsychiatric presentations, including: -- infectious diseases (such as TB, malaria, and AIDS-related neuropsychiatric conditions) --neurological disorders (epilepsy, stroke, dementias) --endocrinological conditions (thyroid disease), --nutritional deficiencies (B12 and folate deficiencies, Wernicke’s encephalopathy), -- autoimmune disorders (multiple sclerosis and lupus), and -- a host of other conditions, including other causes of delirium and dementia, and substance intoxication and withdrawal. Bidirectionality: HIC psychiatrists can learn a great deal about neuropsychiatry of infectious diseases from collaborations in Africa.
29. Example: South Australia RRMHS has successfully used a C–L approach in primary care to facilitate a seamless, integrated mental health system with an economy of scale (fewer than 10 full-time-equivalent psychiatrists) across a vast state. The service has tailored the strengths of the C–L approach to provide subspecialist support to local, community-based primary providers and has expanded the capacity of local primary-care services to provide high-quality mental health care.
30. Example: Ethiopia The Ethiopian model represents a prototypical solution opportunity that promises to address the country’s basic mental health needs by concurrently training a primary-care workforce (EPHTI) and a specialized workforce (TAAPP) that can serve consultant and supervisory functions. Training C–L psychiatrists is a next logical step, given both the high comorbidity of infectious and nutritional diseases and the plan to distribute the psychiatrists around the country. There is a Consultation Service with training opportunities now at St Paul’s Hospital.
31. Implications for Mental Health in Africa Problem: Lack of psychiatric resources to manage direct burden of the neuropsychiatric illnesses and indirect burden from complications of co-morbidities with physical illnesses. Needs 1) Resource development and capacity building through psychosomatic medicine and consultation psychiatry education of native psychiatrists, primary care doctors, psychiatry residents, nurses, health workers. 2) Need for research into cultural diagnosis and treatment of psychiatric illnesses in primary care settings; 3) Need for research in the new molecular psychosomatic medicine and the neuropsychiatry of disease; 5) Need for research in the use of resiliency enhancing strategies to see if goals in primary, secondary and tertiary prevention can be advanced.
32. Summary Are mental health problems too big to be tackled? William Foege, MD, MPH: Conqueror of Smallpox -Never let the perfect be the enemy of the good. -“Of the many visions of global mental health, some are optimistic, some are realistic, and some are pessimistic. I urge you to remember James Reston’s advice: ‘Stick with the optimists. It will be tough enough even if they are right!’ ” - Global health is a field fueled by “unwarranted optimism” that allows us to go beyond what seems to be possible. And Psychosomatic Medicine can help!