Book: Mental Health Disorders: A Social Problem That Needs Help From Society, How To Provide Treatment, Mental Health Audiobook

Book Title:

Mental Health Disorders: A Social Problem That Needs Help From Society, How To Provide Treatment, Mental Health Audiobook.

Author(s): Scott Langanke.

Year: 2021.

Edition: First (1ed).

Publisher: Independently Published.

Type(s): Paperback.

Synopsis:

There are many different mental disorders, with different presentations. They are generally characterised by a combination of abnormal thoughts, perceptions, emotions, behaviour, and relationships with others. Mental disorders include depression, bipolar disorder, schizophrenia, and other psychoses, dementia, and developmental disorders including autism.

It is becoming an imperative social problem that needs our joined hands to tackle.

This audiobook is designed for mental health professionals who do not have much time to study and also for ordinary people who want to understand more about mental disorders in order to help themselves or others overcome difficulties. It comes in text & audio format so that you can listen to it while at the gym or stuck in traffic! Sections include:

  1. Introduction.
  2. Cautionary Statement for Forensic Use of DSM-5.
  3. Personality Disorders.
  4. Brief Psychotic Disorder.
  5. Schizotypal Disorder.
  6. Narcissistic Personality Disorder.
  7. Diagnostic Criteria For Autism And Autism Spectrum Disorder (ASD).
  8. Neurodevelopmental Disorders.
  9. Communication Disorders.
  10. Specific Learning Disorder.

And SO MUCH MORE!

What is Biological Pyschitry?

Introduction

Biological psychiatry or biopsychiatry is an approach to psychiatry that aims to understand mental disorder in terms of the biological function of the nervous system. It is interdisciplinary in its approach and draws on sciences such as neuroscience, psychopharmacology, biochemistry, genetics, epigenetics and physiology to investigate the biological bases of behaviour and psychopathology. Biopsychiatry is the branch of medicine which deals with the study of the biological function of the nervous system in mental disorders.

There is some overlap with neurology, which focuses on disorders where gross or visible pathology of the nervous system is apparent, such as epilepsy, cerebral palsy, encephalitis, neuritis, Parkinson’s disease and multiple sclerosis. There is also some overlap with neuropsychiatry, which typically deals with behavioral disturbances in the context of apparent brain disorder. In contrast biological psychiatry describes the basic principles and then delves deeper into various disorders. It is structured to follow the organisation of the DSM-IV, psychiatry’s primary diagnostic and classification guide. The contributions of this field explore functional neuroanatomy, imaging, and neuropsychology and pharmacotherapeutic possibilities for depression, anxiety and mood disorders, substance abuse and eating disorders, schizophrenia and psychotic disorders, and cognitive and personality disorders.

Biological psychiatry and other approaches to mental illness are not mutually exclusive, but may simply attempt to deal with the phenomena at different levels of explanation. Because of the focus on the biological function of the nervous system, however, biological psychiatry has been particularly important in developing and prescribing drug-based treatments for mental disorders.

In practice, however, psychiatrists may advocate both medication and psychological therapies when treating mental illness. The therapy is more likely to be conducted by clinical psychologists, psychotherapists, occupational therapists or other mental health workers who are more specialised and trained in non-drug approaches.

The history of the field extends back to the ancient Greek physician Hippocrates, but the phrase biological psychiatry was first used in peer-reviewed scientific literature in 1953. The phrase is more commonly used in the United States than in some other countries such as the UK. However the term “biological psychiatry” is sometimes used as a phrase of disparagement in controversial dispute.

Brief History

Early 20th Century

Sigmund Freud was originally focused on the biological causes of mental illness. Freud’s professor and mentor, Ernst Wilhelm von Brücke, strongly believed that thought and behaviour were determined by purely biological factors. Freud initially accepted this and was convinced that certain drugs (particularly cocaine) functioned as antidepressants. He spent many years trying to “reduce” personality to neurology, a cause he later gave up on before developing his now well-known psychoanalytic theories.

Nearly 100 years ago, Harvey Cushing, the father of neurosurgery, noted that pituitary gland problems often cause mental health disorders. He wondered whether the depression and anxiety he observed in patients with pituitary disorders were caused by hormonal abnormalities, the physical tumour itself, or both.

Mid 20th Century

An important point in modern history of biological psychiatry was the discovery of modern antipsychotic and antidepressant drugs. Chlorpromazine (also known as Thorazine), an antipsychotic, was first synthesized in 1950. In 1952, iproniazid, a drug being trialled against tuberculosis, was serendipitously discovered to have anti-depressant effects, leading to the development of monoamine oxidase inhibitors (MAOIs) as the first class of antidepressants. In 1959 imipramine, the first tricyclic antidepressant, was developed. Research into the action of these drugs led to the first modern biological theory of mental health disorders called the catecholamine theory, later broadened to the monoamine theory, which included serotonin. These were popularly called the “chemical imbalance” theory of mental health disorders.

Late 20th Century

Starting with fluoxetine (marketed as Prozac) in 1988, a series of monoamine-based antidepressant medications belonging to the class of selective serotonin reuptake inhibitors were approved. These were no more effective than earlier antidepressants, but generally had fewer side effects. Most operate on the same principle, which is modulation of monoamines (neurotransmitters) in the neuronal synapse. Some drugs modulate a single neurotransmitter (typically serotonin). Others affect multiple neurotransmitters, called dual action or multiple action drugs. They are no more effective clinically than single action versions. That most antidepressants invoke the same biochemical method of action may explain why they are each similarly effective in rough terms. Recent research indicates antidepressants often work but are less effective than previously thought.

Problems with Catecholamine/Monoamine Hypotheses

The monoamine hypothesis was compelling, especially based on apparently successful clinical results with early antidepressant drugs, but even at the time there were discrepant findings. Only a minority of patients given the serotonin-depleting drug reserpine became depressed; in fact reserpine even acted as an antidepressant in many cases. This was inconsistent with the initial monoamine theory which said depression was caused by neurotransmitter deficiency.

Another problem was the time lag between antidepressant biological action and therapeutic benefit. Studies showed the neurotransmitter changes occurred within hours, yet therapeutic benefit took weeks.

To explain these behaviours, more recent modifications of the monoamine theory describe a synaptic adaptation process which takes place over several weeks. Yet this alone does not appear to explain all of the therapeutic effects.

Scope and Detailed Definition

Biological psychiatry is a branch of psychiatry where the focus is chiefly on researching and understanding the biological basis of major mental disorders such as unipolar and bipolar affective (mood) disorders, schizophrenia and organic mental disorders such as Alzheimer’s disease. This knowledge has been gained using imaging techniques, psychopharmacology, neuroimmunochemistry and so on. Discovering the detailed interplay between neurotransmitters and the understanding of the neurotransmitter fingerprint of psychiatric drugs such as clozapine has been a helpful result of the research.

On a research level, it includes all possible biological bases of behaviour – biochemical, genetic, physiological, neurological and anatomical. On a clinical level, it includes various therapies, such as drugs, diet, avoidance of environmental contaminants, exercise, and alleviation of the adverse effects of life stress, all of which can cause measurable biochemical changes. The biological psychiatrist views all of these as possible aetiologies of or remedies for mental health disorders.

However, the biological psychiatrist typically does not discount talk therapies. Medical psychiatric training generally includes psychotherapy and biological approaches. Accordingly, psychiatrists are usually comfortable with a dual approach: “psychotherapeutic methods […] are as indispensable as psychopharmacotherapy in a modern psychiatric clinic”.

Basis for Biological Psychiatry

Sigmund Freud developed psychotherapy in the early 1900s, and through the 1950s this technique was prominent in treating mental health disorders.

However, in the late 1950s, the first modern antipsychotic and antidepressant drugs were developed: chlorpromazine (also known as Thorazine), the first widely used antipsychotic, was synthesized in 1950, and iproniazid, one of the first antidepressants, was first synthesized in 1957. In 1959 imipramine, the first tricyclic antidepressant, was developed.

Based significantly on clinical observations of the above drug results, in 1965 the seminal paper “The catecholamine hypothesis of affective disorders” was published. It articulated the “chemical imbalance” hypothesis of mental health disorders, especially depression. It formed much of the conceptual basis for the modern era in biological psychiatry.

The hypothesis has been extensively revised since its advent in 1965. More recent research points to deeper underlying biological mechanisms as the possible basis for several mental health disorders.

Modern brain imaging techniques allow non-invasive examination of neural function in patients with mental health disorders, however this is currently experimental. With some disorders it appears the proper imaging equipment can reliably detect certain neurobiological problems associated with a specific disorder. If further studies corroborate these experimental results, future diagnosis of certain mental health disorders could be expedited using such methods.

Another source of data indicating a significant biological aspect of some mental health disorders is twin studies. Identical twins have the same nuclear DNA, so carefully constructed studies may indicate the relative importance of environmental and genetic factors on the development of a particular mental health disorder.

The results from this research and the associated hypotheses form the basis for biological psychiatry and the treatment approaches in a clinical setting.

Scope of Clinical Biological Psychiatric Treatment

Since various biological factors can affect mood and behaviour, psychiatrists often evaluate these before initiating further treatment. For example, dysfunction of the thyroid gland may mimic a major depressive episode, or hypoglycaemia (low blood sugar) may mimic psychosis.

While pharmacological treatments are used to treat many mental disorders, other non-drug biological treatments are used as well, ranging from changes in diet and exercise to transcranial magnetic stimulation and electroconvulsive therapy. Types of non-biological treatments such as cognitive therapy, behavioural therapy, and psychodynamic psychotherapy are often used in conjunction with biological therapies. Biopsychosocial models of mental illness are widely in use, and psychological and social factors play a large role in mental disorders, even those with an organic basis such as schizophrenia.

Diagnostic Process

Correct diagnosis is important for mental health disorders, otherwise the condition could worsen, resulting in a negative impact on both the patient and the healthcare system. Another problem with misdiagnosis is that a treatment for one condition might exacerbate other conditions. In other cases apparent mental health disorders could be a side effect of a serious biological problem such as concussion, brain tumour, or hormonal abnormality, which could require medical or surgical intervention.

Examples of Biologic Treatments

  • Seasonal affective disorder: light therapy, SSRIs (Like fluoxetine and paroxetine).
  • Clinical depression: SSRIs, serotonin-norepinephrine reuptake inhibitors (venlafaxine), dopamine reuptake inhibitors: (bupropion), tricyclic antidepressants, monoamine oxidase inhibitors, electroconvulsive therapy, transcranial magnetic stimulation, fish oil, St. John’s wort.
  • Bipolar disorder: lithium carbonate, antipsychotics (like olanzapine or quetiapine), anticonvulsants (like valproic acid, lamotrigine and topiramate).
  • Schizophrenia: antipsychotics such as haloperidol, clozapine, olanzapine, risperidone and quetiapine.
  • Generalized anxiety disorder: SSRIs, benzodiazepines, buspirone.
  • Obsessive-compulsive disorder: tricyclic antidepressants, SSRIs.
  • ADHD: clonidine, D-amphetamine, methamphetamine, and methylphenidate.

Latest Biological Hypotheses of Mental Health Disorders

New research indicates different biological mechanisms may underlie some mental health disorders, only indirectly related to neurotransmitters and the monoamine chemical imbalance hypothesis.

Recent research indicates a biological “final common pathway” may exist which both electroconvulsive therapy and most current antidepressant drugs have in common. These investigations show recurrent depression may be a neurodegenerative disorder, disrupting the structure and function of brain cells, destroying nerve cell connections, even killing certain brain cells, and precipitating a decline in overall cognitive function.

In this new biological psychiatry viewpoint, neuronal plasticity is a key element. Increasing evidence points to various mental health disorders as a neurophysiological problem which inhibits neuronal plasticity.

This is called the neurogenic hypothesis of depression. It promises to explain pharmacological antidepressant action, including the time lag from taking the drug to therapeutic onset, why downregulation (not just upregulation) of neurotransmitters can help depression, why stress often precipitates mood disorders, and why selective modulation of different neurotransmitters can help depression. It may also explain the neurobiological mechanism of other non-drug effects on mood, including exercise, diet and metabolism. By identifying the neurobiological “final common pathway” into which most antidepressants funnel, it may allow rational design of new medications which target only that pathway. This could yield drugs which have fewer side effects, are more effective and have quicker therapeutic onset.

There is significant evidence that oxidative stress plays a role in schizophrenia.

Criticism

A number of patients, activists, and psychiatrists dispute biological psychiatry as a scientific concept or as having a proper empirical basis, for example arguing that there are no known biomarkers for recognized psychiatric conditions. This position has been represented in academic journals such as The Journal of Mind and Behaviour and Ethical Human Psychology and Psychiatry, which publishes material specifically countering “the idea that emotional distress is due to an underlying organic disease.” Alternative theories and models instead view mental disorders as non-biomedical and might explain it in terms of, for example, emotional reactions to negative life circumstances or to acute trauma.

Fields such as social psychiatry, clinical psychology, and sociology may offer non-biomedical accounts of mental distress and disorder for certain ailments and are sometimes critical of biopsychiatry. Social critics believe biopsychiatry fails to satisfy the scientific method because they believe there is no testable biological evidence of mental disorders. Thus, these critics view biological psychiatry as a pseudoscience attempting to portray psychiatry as a biological science.

R.D. Laing argued that attributing mental disorders to biophysical factors was often flawed due to the diagnostic procedure. The “complaint” is often made by a family member, not the patient, the “history” provided by someone other than patient, and the “examination” consists of observing strange, incomprehensible behaviour. Ancillary tests (EEG, PET) are often done after diagnosis, when treatment has begun, which makes the tests non-blind and incurs possible confirmation bias. The psychiatrist Thomas Szasz commented frequently on the limitations of the medical approach to psychiatry and argued that mental illnesses are medicalised problems in living.

Silvano Arieti, while approving of the use of medication in some cases of schizophrenia, preferred intensive psychotherapy without medication if possible. He was also known for approving the use of electroconvulsive therapy on those with disorganised schizophrenia in order to make them reachable by psychotherapy. The views he expressed in Interpretation of Schizophrenia are nowadays known as the trauma model of mental disorders, an alternative to the biopsychiatric model.

Book: The Origins and Course of Common Mental Disorders

Book Title:

The Origins and Course of Common Mental Disorders.

Author(s): David Goldberg and Ian Goodyer.

Year: 2005.

Edition: First (1st).

Publisher: Routledge.

Type(s): Hardcover, Paperback, and Kindle.

Synopsis:

Why are some people more vulnerable to common mental disorders than others?

What effects do genes and environments exert on the development of mental disorders?

The Origins and Course of Common Mental Disorders describes the nature, characteristics and causes of common emotional and behavioural disorders as they develop across the lifespan, providing a clear and concise account of recent advances in our knowledge of the origins and history of anxious, depressive, anti-social, and substance related disorders.

Combining a lifespan approach with developments in neurobiology, this book describes the epidemiology of emotional and behavioural disorders in childhood, adolescence and adult life. David Goldberg and Ian Goodyer demonstrate how both genes and environments exert different but key effects on the development of these disorders and suggest a developmental model as the most appropriate for determining vulnerabilities for psychopathology. Divided into four sections, the book covers the:

  • Nature and distribution of common mental disorders.
  • Biological basis of common disorders.
  • Human life cycle relevant to common disorders.
  • Developmental model.

This highly readable account of the origins of emotional and behavioural disorders will be of interest to behavioural science students and all mental health professionals including psychiatrists, psychologists, social workers, nurses, and counsellors.

Book: Models for Mental Disorder: Conceptual Models in Psychiatry

Book Title:

Models for Mental Disorder: Conceptual Models in Psychiatry.

Author(s): Peter Tyrer.

Year: 2013.

Edition: Fifth (5th).

Publisher: Wiley-Blackwell.

Type(s): Paperback and Kindle.

Synopsis:

Models for Mental Disorder, first published in 1987, anticipated the
move towards integration of psychiatric services into multidisciplinary teams (doctor, psychologist, nurse, social worker, etc) and the need to bring together the different philosophies of mental illness.

Peter Tyrer has identified four different models of mental disorder that are relevant to clinical practice: the disease, psychodynamic, cognitive-behavioural and social models.

Each model is described and reviewed, with reference to case studies and
illustrations, to show how it relates to mental health disorders and can be
used to interpret and manage these disorders.

The book has been widely read and is often used for training purposes so that
each professional can understand and appreciate that differences in viewpoint
are often a consequence of one or more models being used in a different way
rather than a fundamental schism in approach.

Since the fourth edition was published in 2005, the disciplines of mental health
have moved even closer together with the growth of assertive outreach and
more integrated community teams. This, combined with the greater awareness
of mental health among users of services, which leads to more penetrating and
informed questions at interviews with professionals, has emphasized the need
for a wider understanding of these models.

  • The only book to describe the models framing mental health diagnosis and management.
  • A great review for those wanting a better grasp of psychiatric disorders and for integration of concepts for treatment planning.
  • New information on formal classifications of mental disorder.
  • New information on mindfulness and mentalisation regarding the dynamic model.
  • Clearly written in a style which includes some humour and a conversational presentation – a joy to read for the beginner and more experienced practitioner alike.
  • Features a teaching exercise for use when training students in the various models.

Book: Mental Disorders Audio And Text Book: Complete Understanding, Ways To Treat And Easy To Follow

Book Title:

Mental Disorders Audio And Text Book: Complete Understanding, Ways To Treat And Easy To Follow.

Author(s): Garfield Chrismom.

Year: 2021.

Edition: First (1st).

Publisher: Independently Published.

Type(s): Paperback and Kindle.

Synopsis:

There are many different mental disorders, with different presentations. They are generally characterised by a combination of abnormal thoughts, perceptions, emotions, behaviour, and relationships with others. Mental disorders include depression, bipolar disorder, schizophrenia, and other psychoses, dementia, and developmental disorders including autism.

It is becoming an imperative social problem that needs our joined hands to tackle.

This audiobook is designed for mental health professionals who do not have much time to study and also for ordinary people who want to understand more about mental disorders in order to help themselves or others overcome difficulties. It comes in text & audio format so that you can listen to it while at the gym or stuck in traffic! Sections include:

  1. Introduction.
  2. Cautionary Statement for Forensic Use of DSM-5.
  3. Personality Disorders.
  4. Brief Psychotic Disorder.
  5. Schizotypal Disorder.
  6. Narcissistic Personality Disorder.
  7. Diagnostic Criteria For Autism And Autism Spectrum Disorder (ASD).
  8. Neurodevelopmental Disorders.
  9. Communication Disorders.
  10. Specific Learning Disorder.

And SO MUCH MORE!

Book: Management of Mental Disorders

Book Title:

Management of Mental Disorders.

Author(s): Dr. Gavin Andrews, Dr. Kimberlie Dean, Dr. Margo Genderson, Dr. Caroline Hunt, Dr. Philip Mitchell, Dr. Perminder Sachdev, and Dr. Julian Trollor.

Year: 2014.

Edition: Fifth (5th).

Publisher: Createspace Independent Publishing Platform.

Type(s): Paperback.

Synopsis:

Management of Mental Disorders, 5th Edition (MMD5) is an innovative book that provides practical guidance in recognizing and treating mental disorders. The fifth edition has been revised by experts and is a compilation of the best practices in mental health circa 2013. MMD5 outlines the steps required for proper assessment and focuses on how to implement the many effective treatments that are now available. This book also includes resource materials, such as outcome measures, worksheets, and information pamphlets for individuals with mental disorders and their families. MMD5 is designed to complement the skills of busy clinicians and for use as a textbook for undergraduate and graduate students.

The design of the fifth edition – core assessment and clinical skills and sections on the internalising, externalising, psychotic, neurodevelopmental, and neurocognitive clusters of disorders – is based on papers prepared for the discussions of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the International Classification of Diseases, 11th Edition (ICD-11) working groups. These papers presume that disorders within each of these five clusters share genetic risk factors, familiarity, specific environmental risk factors, neural substrates, biomarkers, temperamental antecedents, abnormalities of cognitive or emotional processing, symptom similarity, high rates of comorbidity, course of illness, and treatment response that differ in important ways from disorders within the other four clusters. The clusters are not intended to replace existing diagnostic criteria but rather are used to facilitate the identification of possible relationships between disorders in terms of the risk and clinical factors.

The present edition is the first to make the five-cluster structure of mental disorders explicit. Management of Mental Disorders is a publication of the Clinical Research Unit for Anxiety and Depression (CRUfAD), University of New South Wales (UNSW) School of Psychiatry at St Vincent’s Hospital, Sydney, Australia.

CRUfAD has produced treatment protocols for 30 years, first for the Royal Australian and New Zealand College of Psychiatrists and then with the Division of Mental Health, World Health Organisation, Geneva. Country specific versions of previous editions of the Management of Mental Disorders were produced for New Zealand, Canada, the United Kingdom, China, and Italy.

What is Open Dialogue?

Introduction

Open Dialogue is an alternative approach for treating psychosis as well as other mental health disorders developed in the 1980s in Finland by Yrjö Alanen and his collaborators.

Background

Open dialogue interventions are currently being trialed in several other countries including Australia, Austria, Denmark, Germany, Italy, Norway, Poland, the United Kingdom, and the United States.

Key principles of the open dialogue method include: the participation of friends and family, responding to the client’s utterances (which may seem nonsensical in the case of pyschosis), trying to make meaning of what a client has to say, and “tolerating uncertainty”.

Theoretical Basis

In a paper illustrating the Open dialogue method Seikkula, Alakar and Aaltonen postulate that “from the social constructionist point of view, psychosis can be seen as one way of dealing with terrifying experience in one’s life that do not have language other than the one of hallucinations and delusions” and that “psychotic reactions should be seen [as] attempts to make sense of one’s experiences that are so heavy that they have made it impossible to construct a rational spoken narrative” arguing that people may talk about such experiences in metaphor.

They offer a model that “psychotic reactions greatly resemble traumatic experiences” with experiences of victimisation “not being stored in the part of the memory system that promotes sense-making”. Postulating that “an open dialogue, without any pre-planned themes or forms seems to be important in enabling the construction of a new language in which to express difficult events in one’s life.”

This understanding differs radically from common psychiatric models of psychosis that view it as being caused by a biological process in the brain, such as the dopamine hypothesis of schizophrenia.

Effectiveness

A systematic review of academic publications on the topic in 2018 concluded that: “most studies were highly biased and of low quality” and that “further studies are needed in a real-world setting to explore how and why [open dialogue] works.”

What is the Incidence of Mental Health in New York?

Research Paper Title

Rising Mental Health Incidence Among Adolescents in Westchester, NY.

Background

Many governments have publicly released healthcare data, which can be mined for insights about disease conditions, and their impact on society.

Methods

The researchers present a big-data analytics approach to investigate data in the New York Statewide Planning and Research Cooperative System (SPARCS) consisting of 20 million patient records.

Results

Whereas the age group 30-48 years exhibited an 18% decline in mental health (MH) disorders from 2009 to 2016, the age group 0-17 years showed a 5.4% increase. MH issues amongst the age group 0-17 years comprise a significant expenditure in New York State. Within this age group, we find a higher prevalence of MH disorders in females and minority populations. Westchester County has seen a 32% increase in incidences and a 41% increase in costs.

Conclusions

The approach is scalable to data from multiple government agencies and provides an independent perspective on health care issues, which can prove valuable to policy and decision-makers.

Reference

Rao, A.R., Rao, S. & Chhabra, R. (2021) Rising Mental Health Incidence Among Adolescents in Westchester, NY. Community Mental health Journal. doi: 10.1007/s10597-021-00788-8. Online ahead of print.

Interventions for Preventing Type 2 Diabetes in Adults with Mental Disorders in Low- & Middle-Income Countries

Research Paper Title

Interventions for preventing type 2 diabetes in adults with mental disorders in low- and middle-income countries.

Background

The prevalence of type 2 diabetes is increased in individuals with mental disorders. Much of the burden of disease falls on the populations of low- and middle-income countries (LMICs).

Therefore the aim of this study was to assess the effects of pharmacological, behaviour change, and organisational interventions versus active and non-active comparators in the prevention or delay of type 2 diabetes among people with mental illness in LMICs.

Methods

The researchers searched the Cochrane Common Mental Disorders Controlled Trials Register, CENTRAL, MEDLINE, Embase and six other databases, as well as three international trials registries. They also searched conference proceedings and checked the reference lists of relevant systematic reviews. Searches are current up to 20 February 2020.

A randomised controlled trials (RCTs) of pharmacological, behavioural or organisational interventions targeting the prevention or delay of type 2 diabetes in adults with mental disorders in LMICs.

Pairs of review authors working independently performed data extraction and risk of bias assessments. They conducted meta-analyses using random-effects models.

Results

One hospital-based RCT with 150 participants (99 participants with schizophrenia) addressed our review’s primary outcome of prevention or delay of type 2 diabetes onset. Low-certainty evidence from this study did not show a difference between atypical and typical antipsychotics in the development of diabetes at six weeks (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.03 to 7.05) (among a total 99 participants with schizophrenia, 68 were in atypical and 31 were in typical antipsychotic groups; 55 participants without mental illness were not considered in the analysis). An additional 29 RCTs with 2481 participants assessed one or more of the review’s secondary outcomes. All studies were conducted in hospital settings and reported on pharmacological interventions.

One study, which the researchers could not include in our meta-analysis, included an intervention with pharmacological and behaviour change components. They identified no studies of organisational interventions. Low- to moderate-certainty evidence suggests there may be no difference between the use of atypical and typical antipsychotics for the outcomes of drop-outs from care (RR 1.31, 95% CI 0.63 to 2.69; two studies with 144 participants), and fasting blood glucose levels (mean difference (MD) 0.05 lower, 95% CI 0.10 to 0.00; two studies with 211 participants). Participants who receive typical antipsychotics may have a lower body mass index (BMI) at follow-up than participants who receive atypical antipsychotics (MD 0.57, 95% CI 0.33 to 0.81; two studies with 141 participants; moderate certainty of evidence), and may have lower total cholesterol levels eight weeks after starting treatment (MD 0.35, 95% CI 0.27 to 0.43; one study with 112 participants). There was moderate certainty evidence suggesting no difference between the use of metformin and placebo for the outcomes of drop-outs from care (RR 1.22, 95% CI 0.09 to 16.35; three studies with 158 participants).

There was moderate-to-high certainty evidence of no difference between metformin and placebo for fasting blood glucose levels (endpoint data: MD -0.35, 95% CI -0.60 to -0.11; change from baseline data: MD 0.01, 95% CI -0.21 to 0.22; five studies with 264 participants). There was high certainty evidence that BMI was lower for participants receiving metformin compared with those receiving a placebo (MD -1.37, 95% CI -2.04 to -0.70; five studies with 264 participants; high certainty of evidence). There was no difference between metformin and placebo for the outcomes of waist circumference, blood pressure and cholesterol levels. Low-certainty evidence from one study (48 participants) suggests there may be no difference between the use of melatonin and placebo for the outcome of drop-outs from care (RR 1.00, 95% CI 0.38 to 2.66). Fasting blood glucose is probably reduced more in participants treated with melatonin compared with placebo (endpoint data: MD -0.17, 95% CI -0.35 to 0.01; change from baseline data: MD -0.24, 95% CI -0.39 to -0.09; three studies with 202 participants, moderate-certainty evidence).

There was no difference between melatonin and placebo for the outcomes of waist circumference, blood pressure and cholesterol levels. Very low-certainty evidence from one study (25 participants) suggests that drop-outs may be higher in participants treated with a tricyclic antidepressant (TCA) compared with those receiving a selective serotonin reuptake inhibitor (SSRI) (RR 0.34, 95% CI 0.11 to 1.01). It is uncertain if there is no difference in fasting blood glucose levels between these groups (MD -0.39, 95% CI -0.88 to 0.10; three studies with 141 participants, moderate-certainty evidence). It is uncertain if there is no difference in BMI and depression between the TCA and SSRI antidepressant groups.

Conclusions

Only one study reported data on the primary outcome of interest, providing low-certainty evidence that there may be no difference in risk between atypical and typical antipsychotics for the outcome of developing type 2 diabetes. The researchers are therefore not able to draw conclusions on the prevention of type 2 diabetes in people with mental disorders in LMICs. For studies reporting on secondary outcomes, there was evidence of risk of bias in the results. There is a need for further studies with participants from LMICs with mental disorders, particularly on behaviour change and on organisational interventions targeting prevention of type 2 diabetes in these populations.

Reference

Mishu, M.P., Uphoff, E., Aslam, F., Philip, S., Wright, J., Tirbhowan, N., Ajjan, R.A., Azdi, Z.A., Stubbs, B., Chhurchill, R. & Siddiqi, N. (2021) Interventions for preventing type 2 diabetes in adults with mental disorders in low- and middle-income countries. The Cochrane Database of Systematic Reviews. doi: 10.1002/14651858.CD013281.pub2.

Barriers & Facilitators who Impact Veterans’ Engagement with Mental Health Support

Research Paper Title

The journey to professional mental health support: a qualitative exploration of the barriers and facilitators impacting military veterans’ engagement with mental health treatment.

Background

It is often claimed that military veterans are reticent to seek help for mental disorders, even though delayed treatment may impair recovery and impact the wellbeing of those close to the veteran.

This paper aims to explore the barriers and facilitators to accessing professional mental health support for three groups of veterans who met criteria for a probable mental health disorder and:

  1. Do not recognise a probable mental disorder;
  2. Recognise they are affected by a mental disorder but are not seeking professional support; or
  3. Are currently seeking professional mental health support.

Methods

Qualitative telephone interviews were conducted with 62 UK military veterans. Thematic analysis identified core themes along an illustrative journey towards professional mental health support.

Results

Distinct barriers and facilitators to care were discussed by each group of veterans depicting changes as veterans moved towards accessing professional mental health support. In contrast to much of the literature, stigma was not a commonly reported barrier to care; instead care-seeking decisions centred on a perceived need for treatment, waiting until a crisis event occurred. Whilst the recognition of treatment need represented a pivotal moment, the data identified numerous key steps which had to be surmounted prior to care-seeking.

Conclusions

As care-seeking decisions within this sample appeared to centre on a perceived need for treatment future efforts designed to encourage help-seeking in UK military veterans may be best spent targeting the early identification and management of mental health disorders to encourage veterans to seek support before reaching a crisis event.

Reference

Rafferty, L.A., Wessely, S., Stevelink, S.A.M. & Greenberg, N. (2021) The journey to professional mental health support: a qualitative exploration of the barriers and facilitators impacting military veterans’ engagement with mental health treatment. European Journal of Pscyhotraumatology. 10(1).1700613. doi: 10.1080/20008198.2019.1700613.