{"title":"No service is an island: towards an ecosystem approach to mental health service evaluation","authors":"A. Rosen, L. Salvador-Carulla","doi":"10.1002/wps.20963","DOIUrl":"https://doi.org/10.1002/wps.20963","url":null,"abstract":"","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2022-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44531394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
regarding the efficacy of various treatments. But this study also shows an important role for psychiatrists in managing, and supervising, the long-term neuropsychiatric effects of COVID-19.
{"title":"Repurposing fluvoxamine, and other psychiatric medications, for COVID‐19 and other conditions","authors":"E. Lenze, A. Reiersen, P. Santosh","doi":"10.1002/wps.20983","DOIUrl":"https://doi.org/10.1002/wps.20983","url":null,"abstract":"regarding the efficacy of various treatments. But this study also shows an important role for psychiatrists in managing, and supervising, the long-term neuropsychiatric effects of COVID-19.","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":"21 1","pages":"314 - 315"},"PeriodicalIF":73.3,"publicationDate":"2022-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43415290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Kessler, A. Kazdin, S. Aguilar-Gaxiola, A. Al-Hamzawi, J. Alonso, Y. Altwaijri, L. Andrade, C. Benjet, C. Bharat, G. Borges, R. Bruffaerts, B. Bunting, J. C. Almeida, G. Cardoso, W. Chiu, A. Cía, M. Ciutan, L. Degenhardt, G. Girolamo, P. Jonge, Ymkje Anna de Vries, S. Florescu, O. Gureje, J. Haro, M. Harris, Chi‐yi Hu, A. Karam, E. Karam, G. Karam, N. Kawakami, A. Kiejna, V. Kovess-Masfety, Sing Lee, V. Makanjuola, J. Mcgrath, M. Medina-Mora, J. Moskalewicz, F. Navarro-Mateu, A. Nierenberg, D. Nishi, A. Ojagbemi, B. Oladeji, Siobhan O'Neill, J. Posada-Villa, V. Puac-Polanco, C. Rapsey, A. M. Ruscio, N. Sampson, K. Scott, T. Slade, J. C. Stagnaro, Dan J Stein, H. Tachimori, M. Have, Y. Torres, M. Viana, D. Vigo, David R. Williams, B. Wojtyniak, M. Xavier, Z. Zarkov, H. Ziobrowski
Patient‐reported helpfulness of treatment is an important indicator of quality in patient‐centered care. We examined its pathways and predictors among respondents to household surveys who reported ever receiving treatment for major depression, generalized anxiety disorder, social phobia, specific phobia, post‐traumatic stress disorder, bipolar disorder, or alcohol use disorder. Data came from 30 community epidemiological surveys – 17 in high‐income countries (HICs) and 13 in low‐ and middle‐income countries (LMICs) – carried out as part of the World Health Organization (WHO)’s World Mental Health (WMH) Surveys. Respondents were asked whether treatment of each disorder was ever helpful and, if so, the number of professionals seen before receiving helpful treatment. Across all surveys and diagnostic categories, 26.1% of patients (N=10,035) reported being helped by the very first professional they saw. Persisting to a second professional after a first unhelpful treatment brought the cumulative probability of receiving helpful treatment to 51.2%. If patients persisted with up through eight professionals, the cumulative probability rose to 90.6%. However, only an estimated 22.8% of patients would have persisted in seeing these many professionals after repeatedly receiving treatments they considered not helpful. Although the proportion of individuals with disorders who sought treatment was higher and they were more persistent in HICs than LMICs, proportional helpfulness among treated cases was no different between HICs and LMICs. A wide range of predictors of perceived treatment helpfulness were found, some of them consistent across diagnostic categories and others unique to specific disorders. These results provide novel information about patient evaluations of treatment across diagnoses and countries varying in income level, and suggest that a critical issue in improving the quality of care for mental disorders should be fostering persistence in professional help‐seeking if earlier treatments are not helpful.
{"title":"Patterns and correlates of patient‐reported helpfulness of treatment for common mental and substance use disorders in the WHO World Mental Health Surveys","authors":"R. Kessler, A. Kazdin, S. Aguilar-Gaxiola, A. Al-Hamzawi, J. Alonso, Y. Altwaijri, L. Andrade, C. Benjet, C. Bharat, G. Borges, R. Bruffaerts, B. Bunting, J. C. Almeida, G. Cardoso, W. Chiu, A. Cía, M. Ciutan, L. Degenhardt, G. Girolamo, P. Jonge, Ymkje Anna de Vries, S. Florescu, O. Gureje, J. Haro, M. Harris, Chi‐yi Hu, A. Karam, E. Karam, G. Karam, N. Kawakami, A. Kiejna, V. Kovess-Masfety, Sing Lee, V. Makanjuola, J. Mcgrath, M. Medina-Mora, J. Moskalewicz, F. Navarro-Mateu, A. Nierenberg, D. Nishi, A. Ojagbemi, B. Oladeji, Siobhan O'Neill, J. Posada-Villa, V. Puac-Polanco, C. Rapsey, A. M. Ruscio, N. Sampson, K. Scott, T. Slade, J. C. Stagnaro, Dan J Stein, H. Tachimori, M. Have, Y. Torres, M. Viana, D. Vigo, David R. Williams, B. Wojtyniak, M. Xavier, Z. Zarkov, H. Ziobrowski","doi":"10.1002/wps.20971","DOIUrl":"https://doi.org/10.1002/wps.20971","url":null,"abstract":"Patient‐reported helpfulness of treatment is an important indicator of quality in patient‐centered care. We examined its pathways and predictors among respondents to household surveys who reported ever receiving treatment for major depression, generalized anxiety disorder, social phobia, specific phobia, post‐traumatic stress disorder, bipolar disorder, or alcohol use disorder. Data came from 30 community epidemiological surveys – 17 in high‐income countries (HICs) and 13 in low‐ and middle‐income countries (LMICs) – carried out as part of the World Health Organization (WHO)’s World Mental Health (WMH) Surveys. Respondents were asked whether treatment of each disorder was ever helpful and, if so, the number of professionals seen before receiving helpful treatment. Across all surveys and diagnostic categories, 26.1% of patients (N=10,035) reported being helped by the very first professional they saw. Persisting to a second professional after a first unhelpful treatment brought the cumulative probability of receiving helpful treatment to 51.2%. If patients persisted with up through eight professionals, the cumulative probability rose to 90.6%. However, only an estimated 22.8% of patients would have persisted in seeing these many professionals after repeatedly receiving treatments they considered not helpful. Although the proportion of individuals with disorders who sought treatment was higher and they were more persistent in HICs than LMICs, proportional helpfulness among treated cases was no different between HICs and LMICs. A wide range of predictors of perceived treatment helpfulness were found, some of them consistent across diagnostic categories and others unique to specific disorders. These results provide novel information about patient evaluations of treatment across diagnoses and countries varying in income level, and suggest that a critical issue in improving the quality of care for mental disorders should be fostering persistence in professional help‐seeking if earlier treatments are not helpful.","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2022-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45958830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
World Psychiatry 21:2 June 2022 care system has been used to estimate the optimal workforce in full time equivalents in acute wards and acute day care in the Basque Country (Spain), and the relative technical efficiency of service provision in catchment areas, including both acute and nonacute services. Impact analysis is another key compo nent of the evaluation in mental health care. This should not be limited to endpoint re sults on individuals. Major attention should be paid to the process of implementation and the analysis of the readiness, usability, adoption and penetration of a new service in real world environments. The empha sis on fidelity should be balanced with the need for adaptation to local con texts. Additional mention should be made of the role of international networks in pro moting new models of care and imple mentation. Relevant examples are the Crisis Now/Recovery International glob ally growing network of facilities, which provides welcoming, peerpartnership and firmly communitybased service fa cilities, not backed as yet by published rigorous research; the ICIRCLE consor tium, that promotes community models in urban environments; and the EUCOM model of community care in Eu rope. The broader biopsychosociocultural innovations have evolved with an empha sis on complexity science, codesign with lived experience and family expertise, hu man rights facilitation and community based recovery approaches. Attempts to fragment and undo costeffective commu nitybased reforms are often accompanied by demands for evermore hospital beds. These hospitalcentric views should no long er prevail over responsive, wholistic ecosys tems, integrating community and hospital components. Transforming acute mental health care towards community models exceeds men tal health systems, heralding broader reform of general acute health care and support systems towards community care. To keep ontrack with previous advances, the eval uation of the mental health sector acute care should adopt a health care ecosystem perspective, including systematic assess ment of the service delivery systems, their impact on processes, outcomes, workforce, and especially service users and families, val orizing lived experiences.
{"title":"Acute psychiatric care: the need for contextual understanding and tailored solutions","authors":"Kuruthukulangara S. Jacob","doi":"10.1002/wps.20964","DOIUrl":"https://doi.org/10.1002/wps.20964","url":null,"abstract":"World Psychiatry 21:2 June 2022 care system has been used to estimate the optimal workforce in full time equivalents in acute wards and acute day care in the Basque Country (Spain), and the relative technical efficiency of service provision in catchment areas, including both acute and nonacute services. Impact analysis is another key compo nent of the evaluation in mental health care. This should not be limited to endpoint re sults on individuals. Major attention should be paid to the process of implementation and the analysis of the readiness, usability, adoption and penetration of a new service in real world environments. The empha sis on fidelity should be balanced with the need for adaptation to local con texts. Additional mention should be made of the role of international networks in pro moting new models of care and imple mentation. Relevant examples are the Crisis Now/Recovery International glob ally growing network of facilities, which provides welcoming, peerpartnership and firmly communitybased service fa cilities, not backed as yet by published rigorous research; the ICIRCLE consor tium, that promotes community models in urban environments; and the EUCOM model of community care in Eu rope. The broader biopsychosociocultural innovations have evolved with an empha sis on complexity science, codesign with lived experience and family expertise, hu man rights facilitation and community based recovery approaches. Attempts to fragment and undo costeffective commu nitybased reforms are often accompanied by demands for evermore hospital beds. These hospitalcentric views should no long er prevail over responsive, wholistic ecosys tems, integrating community and hospital components. Transforming acute mental health care towards community models exceeds men tal health systems, heralding broader reform of general acute health care and support systems towards community care. To keep ontrack with previous advances, the eval uation of the mental health sector acute care should adopt a health care ecosystem perspective, including systematic assess ment of the service delivery systems, their impact on processes, outcomes, workforce, and especially service users and families, val orizing lived experiences.","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2022-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46270311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mental disorder is reported to account for almost a third of global disease burden as measured by years lived with disability (YLDs). On the other hand, mental wellbeing results in broad positive impacts. Effective public mental health interventions exist to treat mental disorder, prevent associated impacts, prevent mental disorder from arising, and promote mental wellbeing and resilience. However, only a minority of those with mental disorder receive treatment, with far lower coverage in lowand middle-income countries (LMICs). There is even less coverage of interventions to prevent associated impacts of mental disorder, and negligible coverage of interventions to prevent mental disorder, or promote mental well-being and resilience. This implementation gap represents a breach of the right to health, and results in population-scale suffering and associated economic costs. The gap has further widened during the COVID-19 pandemic. The United Nations (UN) Sustainable Developmental Goals have set a target of universal coverage by 2030 which includes treatment and prevention of mental disorder and promotion of mental well-being. The most recent World Health Organization (WHO) Mental Health Atlas highlighted that “global targets can be reached in 2030 only if there is a collective global commitment over the next 10 years across Member States to make massive investments and expanded efforts at the country level relating to mental health policies, laws, programmes and services”. Public mental health involves a population approach to improve coverage, outcomes and coordination of interventions to treat mental disorder, prevent associated impacts, prevent mental disorder from arising, and promote mental well-being and resilience. This aims to support efficient, equitable and sustainable reduction in mental disorder, promotion of population mental well-being, and achievement of the UN Sustainable Developmental Goals target of universal coverage by 2030. The WPA Action Plan 2020-2023 promotes public mental health as a guiding principle. A Working Group on Public Mental Health has been then established, including experts such as J. Allan, F.K. Baingana, J. Campion, Y. Huang, A. Javed, N. Lamb, S. Levin, C. Lund, M. Marmot, S. Saxena, T. Schulze, E. Sorel, H. Tu, P. Udomratn, and M. van Ommeren (observer). The Working Group highlighted that public mental health is not well defined or understood, with some languages having no terms for it. This contributes to lack of action on relevant issues. The Group agreed upon the definition outlined above, which is reported on the Group webpage of the WPA website (www.wpanet.org/publicmental-health) and in a recent publication. The main objective of the Working Group is to improve implementation of public mental health interventions in four ways. The first is to raise awareness, value, acceptance and prioritization of this area in national health policies. The second is to promote national assessments of public mental heal
据报道，以残疾生活年数(YLDs)衡量，精神障碍几乎占全球疾病负担的三分之一。另一方面，心理健康会产生广泛的积极影响。目前存在有效的公共精神卫生干预措施，以治疗精神障碍，预防相关影响，预防精神障碍的产生，并促进精神健康和复原力。然而，只有少数精神障碍患者得到治疗，低收入和中等收入国家的覆盖率要低得多。预防精神障碍相关影响的干预措施覆盖面更少，而预防精神障碍或促进精神健康和复原力的干预措施覆盖面则可以忽略不计。这一执行差距是对健康权的侵犯，并造成全民痛苦和相关的经济代价。在2019冠状病毒病大流行期间，这一差距进一步扩大。联合国可持续发展目标设定了到2030年实现全民覆盖的目标，其中包括治疗和预防精神障碍以及促进精神健康。世界卫生组织(世卫组织)最新的《精神卫生地图集》强调，"只有会员国在今后10年作出全球集体承诺，在国家一级就精神卫生政策、法律、规划和服务进行大规模投资并扩大努力，才能在2030年实现全球目标"。公共精神卫生涉及一种人口方法，以改善治疗精神障碍的干预措施的覆盖面、结果和协调，预防相关影响，预防精神障碍的产生，并促进精神健康和复原力。其目的是支持有效、公平和可持续地减少精神障碍，促进人口精神健康，并实现联合国可持续发展目标中到2030年实现全民覆盖的具体目标。《2020-2023年行动计划》将促进公共精神卫生作为一项指导原则。随后成立了一个公共精神卫生工作组，成员包括J. Allan、F.K. Baingana、J. Campion、Y. Huang、A. Javed、N. Lamb、S. Levin、C. Lund、M. Marmot、S. Saxena、T. Schulze、E. Sorel、H. Tu、P. Udomratn和M. van Ommeren(观察员)等专家。工作组强调指出，公众心理健康没有得到很好的定义或理解，有些语言没有这方面的术语。这导致在有关问题上缺乏行动。该集团同意上述定义，该定义已在世界环境署网站(www.wpanet.org/publicmental-health)的集团网页和最近的一份出版物中公布。工作组的主要目标是通过四种方式改进公共精神卫生干预措施的实施。首先是在国家卫生政策中提高对这一领域的认识、重视、接受和优先次序。第二是促进国家对公共精神卫生未满足需求和所需行动的评估，然后为政策制定和执行提供信息。第三是促进公共精神卫生培训，包括通过数字平台，通过确定不同部门需要采取的行动以及澄清核心课程、培训目标和里程碑，支持精神科医生和其他专业人员解决公共精神卫生实施方面的差距，特别是在中低收入国家。公共心理健康培训的例子在上述小组网页上有重点介绍。第四，支持制定综合公共精神卫生方法，包括通过与初级卫生系统和一般卫生系统合作，进行疾病管理和预防。进一步的目标包括:a)与感兴趣的国家合作，以确定的资金促进这些方法;(b)在公共精神卫生议程上与其他组织合作——迄今为止，这些组织包括经济合作与发展组织(经合组织)、联合国国际儿童紧急基金会(儿童基金会)和世卫组织;(C)通过出版物、演讲和培训(也在网上提供)传播与公共精神卫生有关的工作;(d)支持在《2020-2023年世界行动计划》的其他领域采取公共精神卫生办法，包括儿童、青少年和青年精神卫生、合并症管理以及与其他组织建立伙伴关系。工作组已经出版的出版物包括一篇关于整个领域的社论，涉及2019冠状病毒病大流行的公共精神卫生方法的文章，以及关于解决公共精神卫生实施失败所需行动的论文。工作组成员已经并将在2021年和2022年世界精神病学大会上发言，并将在英国皇家精神科医学院2022年国际大会的公共精神卫生专题讨论会上发言。 为了就解决公共精神卫生执行差距所需采取的行动达成共识，工作组成员被邀请撰写一篇卫生政策文章，其中建议采取以下六项行动:a)通过评估未满足的需求、估计扩大覆盖面带来的影响和相关经济效益，以及开展合作，来说明公共精神卫生的必要性7。Karim Z, Javed A, Azeem MW。[J]中华医学杂志2022;38:320-2。8. Imran N, Haider II, Mustafa AB等。中东当代精神病学2021;28:45。9. Arora R, Mukherjee SD。[J]中华医学杂志，2011;31(2):357 - 357。10. 汉基尔A，汤姆A，易卜拉欣H等。中华精神病杂志2020;32:135-8。11. Ibrahim H, Tom A, Youssef A等。中华精神病学杂志[J]; 2009; 33(2): 391 - 391。
{"title":"WPA Working Group on Public Mental Health: objectives and recommended actions","authors":"J. Campion, A. Javed","doi":"10.1002/wps.20981","DOIUrl":"https://doi.org/10.1002/wps.20981","url":null,"abstract":"Mental disorder is reported to account for almost a third of global disease burden as measured by years lived with disability (YLDs). On the other hand, mental wellbeing results in broad positive impacts. Effective public mental health interventions exist to treat mental disorder, prevent associated impacts, prevent mental disorder from arising, and promote mental wellbeing and resilience. However, only a minority of those with mental disorder receive treatment, with far lower coverage in lowand middle-income countries (LMICs). There is even less coverage of interventions to prevent associated impacts of mental disorder, and negligible coverage of interventions to prevent mental disorder, or promote mental well-being and resilience. This implementation gap represents a breach of the right to health, and results in population-scale suffering and associated economic costs. The gap has further widened during the COVID-19 pandemic. The United Nations (UN) Sustainable Developmental Goals have set a target of universal coverage by 2030 which includes treatment and prevention of mental disorder and promotion of mental well-being. The most recent World Health Organization (WHO) Mental Health Atlas highlighted that “global targets can be reached in 2030 only if there is a collective global commitment over the next 10 years across Member States to make massive investments and expanded efforts at the country level relating to mental health policies, laws, programmes and services”. Public mental health involves a population approach to improve coverage, outcomes and coordination of interventions to treat mental disorder, prevent associated impacts, prevent mental disorder from arising, and promote mental well-being and resilience. This aims to support efficient, equitable and sustainable reduction in mental disorder, promotion of population mental well-being, and achievement of the UN Sustainable Developmental Goals target of universal coverage by 2030. The WPA Action Plan 2020-2023 promotes public mental health as a guiding principle. A Working Group on Public Mental Health has been then established, including experts such as J. Allan, F.K. Baingana, J. Campion, Y. Huang, A. Javed, N. Lamb, S. Levin, C. Lund, M. Marmot, S. Saxena, T. Schulze, E. Sorel, H. Tu, P. Udomratn, and M. van Ommeren (observer). The Working Group highlighted that public mental health is not well defined or understood, with some languages having no terms for it. This contributes to lack of action on relevant issues. The Group agreed upon the definition outlined above, which is reported on the Group webpage of the WPA website (www.wpanet.org/publicmental-health) and in a recent publication. The main objective of the Working Group is to improve implementation of public mental health interventions in four ways. The first is to raise awareness, value, acceptance and prioritization of this area in national health policies. The second is to promote national assessments of public mental heal","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2022-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41996450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
331 rative advocacy and leadership; b) public mental health practice; c) public mental health train ing and improving population knowledge; d) improving coverage of public mental health interventions through settings-based approaches, integrated approaches, digital technology, maximizing existing resources, and focus on highreturn interventions; e) a rights approach, legislation and regulation; f) public mental health research, including that focused on implementation.
{"title":"The ICD‐11 is now officially in effect","authors":"P. Pezzella","doi":"10.1002/wps.20982","DOIUrl":"https://doi.org/10.1002/wps.20982","url":null,"abstract":"331 rative advocacy and leadership; b) public mental health practice; c) public mental health train ing and improving population knowledge; d) improving coverage of public mental health interventions through settings-based approaches, integrated approaches, digital technology, maximizing existing resources, and focus on highreturn interventions; e) a rights approach, legislation and regulation; f) public mental health research, including that focused on implementation.","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2022-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41953066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
311 ship between trauma exposure and onset of other psychiatric disorders, there are several mechanisms that can be considered, and these arguably function in an interactive manner. One key potential mechanism is the impact of PTSD on the capacity to down-regulate emotional distress. It is well documented that PTSD involves impaired emotion regulation, and it is possible that this impairment predisposes people to develop new psychiatric disorders or worsens others. The capacity to regulate emotions in PTSD can be related to the well-documented deficits in executive functioning. Deficient working memory and attentional capacity can limit the extent to which one can regulate emotions, which can result in greater risk for mental health problems. Moreover, avoidance is a key symptom of PTSD, and this can trigger a cascade of strategies that can be maladaptive. Avoidance can involve situations or thoughts and memories related to the traumatic experience. This tendency can generalize to more pervasive avoidance of social networks, emotional states, and activities that promote good mental health. This can lead to a worsening of depression, anxiety and other psychiatric conditions. Another common form of avoidance for people with PTSD is self-medicating with prescription or non-prescription substances to numb the distress that is experienced along with traumatic memories. This behaviour can not only lead to substance abuse, which has been documented in longitudinal studies of PTSD, but also facilitate other psychiatric problems, because issues may not be addressed in a constructive manner. Avoidance tendencies can also result in not seeking help from mental health services, which can impede early intervention or adequate treatment for other psychiatric disorders. The DSM-5 explicitly recognizes the presence of harmful behaviors in PTSD, including such risk-taking behaviors as dangerous driving, severe alcohol use, and self-harm. These reactions are conceptualized as a result of the extreme arousal and the difficulties in impulse control that can be experienced by people with PTSD. These behaviors can lead to a range of events and habits triggering repetitive cycles of exposure to trauma. This can compound the sensitization that has been reported in PTSD, in which the condition results in neural sensitivity to threats and stressors in one’s environment, such that the person is more reactive to these events. One of the strongest transdiagnostic predictors of risk for mental health problems is represented by maladaptive or catastrophic appraisals about oneself or the environment. A key feature of PTSD is the tendency to engage in catastrophic appraisals after the traumatic experience, and these appraisals can generalize to many aspects of a person’s life, such as one’s selfesteem, trust in others, fears of negative evaluations, germs, or self-blame. These cognitive tendencies are major risk factors for an array of psychiatric conditions, including anxiety,
{"title":"Intimate partner violence and mental health: lessons from the COVID‐19 pandemic","authors":"L. Howard, Claire A. Wilson, P. Chandra","doi":"10.1002/wps.20976","DOIUrl":"https://doi.org/10.1002/wps.20976","url":null,"abstract":"311 ship between trauma exposure and onset of other psychiatric disorders, there are several mechanisms that can be considered, and these arguably function in an interactive manner. One key potential mechanism is the impact of PTSD on the capacity to down-regulate emotional distress. It is well documented that PTSD involves impaired emotion regulation, and it is possible that this impairment predisposes people to develop new psychiatric disorders or worsens others. The capacity to regulate emotions in PTSD can be related to the well-documented deficits in executive functioning. Deficient working memory and attentional capacity can limit the extent to which one can regulate emotions, which can result in greater risk for mental health problems. Moreover, avoidance is a key symptom of PTSD, and this can trigger a cascade of strategies that can be maladaptive. Avoidance can involve situations or thoughts and memories related to the traumatic experience. This tendency can generalize to more pervasive avoidance of social networks, emotional states, and activities that promote good mental health. This can lead to a worsening of depression, anxiety and other psychiatric conditions. Another common form of avoidance for people with PTSD is self-medicating with prescription or non-prescription substances to numb the distress that is experienced along with traumatic memories. This behaviour can not only lead to substance abuse, which has been documented in longitudinal studies of PTSD, but also facilitate other psychiatric problems, because issues may not be addressed in a constructive manner. Avoidance tendencies can also result in not seeking help from mental health services, which can impede early intervention or adequate treatment for other psychiatric disorders. The DSM-5 explicitly recognizes the presence of harmful behaviors in PTSD, including such risk-taking behaviors as dangerous driving, severe alcohol use, and self-harm. These reactions are conceptualized as a result of the extreme arousal and the difficulties in impulse control that can be experienced by people with PTSD. These behaviors can lead to a range of events and habits triggering repetitive cycles of exposure to trauma. This can compound the sensitization that has been reported in PTSD, in which the condition results in neural sensitivity to threats and stressors in one’s environment, such that the person is more reactive to these events. One of the strongest transdiagnostic predictors of risk for mental health problems is represented by maladaptive or catastrophic appraisals about oneself or the environment. A key feature of PTSD is the tendency to engage in catastrophic appraisals after the traumatic experience, and these appraisals can generalize to many aspects of a person’s life, such as one’s selfesteem, trust in others, fears of negative evaluations, germs, or self-blame. These cognitive tendencies are major risk factors for an array of psychiatric conditions, including anxiety, ","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":"31 10","pages":"311 - 313"},"PeriodicalIF":73.3,"publicationDate":"2022-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41331499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The year 2021 has been another tough one for us all. Uncertainty about the COVID situation, restrictions about travel, and difficulties in getting connected have been the major issues that have affected our professional work and personal lives during that year. The WPA has also struggled coping with these limitations. However, that period has given us some motivation and new insight to work under difficult circumstances and to continue with the implementation of our Action Plan 20202023. The WPA Executive Committee and Standing Committees, along with the Secretariat staff, remained committed to fulfil their responsibilities. The WPA’s drive to encourage and inspire learning among colleagues and trainees around the world led to offering more online educational activities during 2021. We were delighted to organize, support and promote several new educational modules, courses, teaching sessions and online programmes. The accelerated development of the WPA education portal and learning management system (LMS) has promoted the launch of new education and training modules to support our young professionals, especially for the emergency response measures during the pandemic period. The first of these modules supports psychiatrists in using e-mental health tools. The portal also gives ready access to WPA’s existing training materials available in several languages. Available programmes also include ICD-11 and Yoga courses, free webinars on Early Intervention in Psychosis, updates in Psychopharmacology and courses on Telepsychiatry, Psychotherapy and Child and Adolescent Psychiatry. We continued with our projects outlined in the Action Plan. Various Working Groups offered a number of activities in ar eas of training, research and clinical updates. The Working Groups on Co-morbidity in Mental Illnesses, Early Intervention in Psychosis, Public Mental Health, and Promotion of Psychiatry among Medical Students highlighted their contributions in various activities. I am pleased that we also completed some unfinished projects started in the previous triennium. The WPA Scientific Sections likewise supported the scientific work of the Association in an inspiring way. Since the start of the network of WPA Collaborating Centres in 2016, these centres are providing practical advice on teaching, policy, research and clinical activities in psychiatry worldwide. During 2021, the network, now including eight sites, supported the implementation of the WPA’s strategic plan to build a global alliance for better mental health. In addition to the pandemic, unfortunately, we saw many adversities in 2021 in several parts of the world. Following WPA’s mission to help and support our membership during disasters, we established an Advisory Committee for Responses to Emergencies (ACRE), that brought together the leaders of the larger Member Societies to facilitate practical and concrete aid to Member Societies in need. This work continued mobilizing and fostering education, in for
{"title":"Implementation of the WPA Action Plan 2020‐2023: an update","authors":"A. Javed","doi":"10.1002/wps.20978","DOIUrl":"https://doi.org/10.1002/wps.20978","url":null,"abstract":"The year 2021 has been another tough one for us all. Uncertainty about the COVID situation, restrictions about travel, and difficulties in getting connected have been the major issues that have affected our professional work and personal lives during that year. The WPA has also struggled coping with these limitations. However, that period has given us some motivation and new insight to work under difficult circumstances and to continue with the implementation of our Action Plan 20202023. The WPA Executive Committee and Standing Committees, along with the Secretariat staff, remained committed to fulfil their responsibilities. The WPA’s drive to encourage and inspire learning among colleagues and trainees around the world led to offering more online educational activities during 2021. We were delighted to organize, support and promote several new educational modules, courses, teaching sessions and online programmes. The accelerated development of the WPA education portal and learning management system (LMS) has promoted the launch of new education and training modules to support our young professionals, especially for the emergency response measures during the pandemic period. The first of these modules supports psychiatrists in using e-mental health tools. The portal also gives ready access to WPA’s existing training materials available in several languages. Available programmes also include ICD-11 and Yoga courses, free webinars on Early Intervention in Psychosis, updates in Psychopharmacology and courses on Telepsychiatry, Psychotherapy and Child and Adolescent Psychiatry. We continued with our projects outlined in the Action Plan. Various Working Groups offered a number of activities in ar eas of training, research and clinical updates. The Working Groups on Co-morbidity in Mental Illnesses, Early Intervention in Psychosis, Public Mental Health, and Promotion of Psychiatry among Medical Students highlighted their contributions in various activities. I am pleased that we also completed some unfinished projects started in the previous triennium. The WPA Scientific Sections likewise supported the scientific work of the Association in an inspiring way. Since the start of the network of WPA Collaborating Centres in 2016, these centres are providing practical advice on teaching, policy, research and clinical activities in psychiatry worldwide. During 2021, the network, now including eight sites, supported the implementation of the WPA’s strategic plan to build a global alliance for better mental health. In addition to the pandemic, unfortunately, we saw many adversities in 2021 in several parts of the world. Following WPA’s mission to help and support our membership during disasters, we established an Advisory Committee for Responses to Emergencies (ACRE), that brought together the leaders of the larger Member Societies to facilitate practical and concrete aid to Member Societies in need. This work continued mobilizing and fostering education, in for","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":"21 1","pages":""},"PeriodicalIF":73.3,"publicationDate":"2022-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41392342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
truths – truths perhaps accessible only to forms of self-conscious or hyperreflexive awareness unavailable to most of us. In closing, one must acknowledge some gaps in our grasp of subjectivity and its significance for psychiatry. It may be obvious to common sense that the exercise of free will, together with a person’s experience of meaning or significance, do play a role in human behavior and thereby affect the material plane of brain functioning (if I choose to close my eyes, in prayer, patterns in visual cortex are altered). But it is also true that we have difficulty incorporating the domains of conscious life and its physical substrate within a single explanatory account (the mind/body problem). In particular, we have difficulty integrating “act” with “affliction” aspects of psychological existence – that is, appreciating the subtle but decisive ways in which defensive or other goal-directed forms of thought or behavior can interact with aspects of mental life over which the person has little or no control. Even more basic is the challenge of observing and describing consciousness itself, whose ever-changing, all-encompassing flow we, as human beings and language speakers, are constantly tempted to misperceive or misdescribe. We succumb to this temptation by using words that stress the substantive over the transitory aspects of experience, or by focusing on particular objects of awareness while ignoring subtle alterations in, for example, the experience of space, time, or the overall atmosphere of reality. In fact, no approach can be fully “bottom-up” in the sense of being purely empirical or a-theoretical: when it comes to describing experience, patients as well as professionals are burdened (though also blessed) with the objectifying prejudices of their language and their worldview. The study of “lived experience” may then be impossible as a foolproof, quasi-empiricist venture. It is, however, also indispensable – and to both the ethical and the scientific enterprise of psychiatry.
{"title":"What is good acute psychiatric care (and how would you know)?","authors":"D. Tracy, Dina M. Phillips","doi":"10.1002/wps.20958","DOIUrl":"https://doi.org/10.1002/wps.20958","url":null,"abstract":"truths – truths perhaps accessible only to forms of self-conscious or hyperreflexive awareness unavailable to most of us. In closing, one must acknowledge some gaps in our grasp of subjectivity and its significance for psychiatry. It may be obvious to common sense that the exercise of free will, together with a person’s experience of meaning or significance, do play a role in human behavior and thereby affect the material plane of brain functioning (if I choose to close my eyes, in prayer, patterns in visual cortex are altered). But it is also true that we have difficulty incorporating the domains of conscious life and its physical substrate within a single explanatory account (the mind/body problem). In particular, we have difficulty integrating “act” with “affliction” aspects of psychological existence – that is, appreciating the subtle but decisive ways in which defensive or other goal-directed forms of thought or behavior can interact with aspects of mental life over which the person has little or no control. Even more basic is the challenge of observing and describing consciousness itself, whose ever-changing, all-encompassing flow we, as human beings and language speakers, are constantly tempted to misperceive or misdescribe. We succumb to this temptation by using words that stress the substantive over the transitory aspects of experience, or by focusing on particular objects of awareness while ignoring subtle alterations in, for example, the experience of space, time, or the overall atmosphere of reality. In fact, no approach can be fully “bottom-up” in the sense of being purely empirical or a-theoretical: when it comes to describing experience, patients as well as professionals are burdened (though also blessed) with the objectifying prejudices of their language and their worldview. The study of “lived experience” may then be impossible as a foolproof, quasi-empiricist venture. It is, however, also indispensable – and to both the ethical and the scientific enterprise of psychiatry.","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2022-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44024230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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