Psychiatric Perspectives on Infertility: An Educational Quiz

The World Health Organization (WHO) is revising the ICD-10 classification of mental and behavioural disorders, under the leadership of the Department of Mental Health and Substance Abuse and within the framework of the overall revision framework as directed by the World Health Assembly. This article describes WHO's perspective and priorities for mental and behavioural disorders classification in ICD-11, based on the recommendations of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders. The WHO considers that the classification should be developed in consultation with stakeholders, which include WHO member countries, multidisciplinary health professionals, and users of mental health services and their families. Attention to the cultural framework must be a key element in defining future classification concepts. Uses of the ICD that must be considered include clinical applications, research, teaching and training, health statistics, and public health. The Advisory Group has determined that the current revision represents a particular opportunity to improve the classification's clinical utility, particularly in global primary care settings where there is the greatest opportunity to identify people who need mental health treatment. Based on WHO's mission and constitution, the usefulness of the classification in helping WHO member countries, particularly low- and middle-income countries, to reduce the disease burden associated with mental disorders is among the highest priorities for the revision. This article describes the foundation provided by the recommendations of the Advisory Group for the current phase of work.

Mental health knowledge and awareness among university students in Bangladesh

A new cycle is starting in the development of international classification and diagnostic systems. The World Health Organization (WHO) Department of Mental Health organized in January 2007 the first meeting of an Advisory Committee for the preparation of the Mental Disorders Chapter of the Eleventh Revision of the International Classification of Diseases (ICD-11), to be consistent with the overall ICD-11 plan coordinated by the WHO Classification Office. Of relevance, there has been an active process of collaboration between the World Psychiatric Association (WPA) and WHO since 2001 to explore new classification and diagnostic paths. Also presently, the American Psychiatric Association (APA) is preparing the bases for its Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V). Furthermore, other active national and regional psychiatric bodies such as the Chinese Society of Psychiatrists and the Latin American Psychiatric Association are researching and refining, respectively, their Chinese Classification of Mental Disorders, 3rd Edition (CCMD-3) and Latin American Guide for Psychiatric Diagnosis (GLADP), which represent ICD adaptations to local realities and needs. As health professionals and institutions consider and undertake these important activities on central topics for clinical care and public health, it may be wise to reflect carefully on their fundamental purposes so that their conceptualization can be optimized. A full international revision of classification and diagnostic systems takes place only every 10–20 years, and therefore this represents an opportunity as well as a responsibility not to be missed to advance our field. The term diagnosis has a widely accepted central position in the process of medical care. Feinstein (1) has noted that diagnostic categories provide the locations where clinicians store the observations of clinical experience and the diagnostic taxonomy establishes the patterns according to which clinicians observe, think, remember and act. But, what is diagnosis? The eminent historian and philosopher of medicine, Laín–Entralgo (2), has pointed out that ‘diagnosis is more than identifying a disorder (nosological diagnosis) or distinguishing one disorder from another (differential diagnosis); diagnosis is really understanding what is going on in the mind and body of the person who presents for care’. In an attempt to delineate the nature and scope of that ‘understanding’ required to achieve a proper diagnosis, we may find the following reflections helpful. As health professionals, our natural area of concern is health. In Sanskrit, the mother of all Indo-European languages, the term for health is hal, meaning ‘wholeness’. Ancient Greek philosophers pointed out that if the whole is not well, it is impossible for the part to be well (3). Furthermore, WHO (4) has enshrined in its Constitution that ‘health is a state of complete physical, emotional, and social well being and not merely the absence of disease’. As we know, medicine at large and psychiatry in particular are professions committed to helping people restore and promote their health. In fact, health promotion, in addition to health restoration (disease cure, alleviation or management), is increasingly recognized as a proper and important task of clinical care (5, 6). From the above reflections, it should be possible to accept that diagnosis would fulfill better its fundamental role as informational basis for clinical care if it were to have a scope broad enough to describe the overall health status of the person presenting for care. And this means covering both ill health (or disease) and positive health, the latter involving domains such as functioning, personal and social values and resources, and quality of life (7). This also means bringing up to the front the humanistic purpose of clinical care (8). Its target and focus is the health of people who are not simply carriers of disease, but human beings with history and aspirations, whose dignity is to be respected and promoted. In connection to this, it should be recognized that diagnosis is not only a formulation, but an interactive process as concluded by trialog forums of patients, families and health professionals (9). It is encouraging to note an array of recent national and international developments and policies in mental health that are quite consistent with the above perspectives. A US Presidential Commission on Mental Health (10) has recommended to place consumers and families as well as integration of services at the center of an urgently needed transformation of the health systems. Also relevant here are recent policy statement on value-based practice from the National Institute of Mental Health of England, and the French Etats Generaux de la Psychiatrie in June 2003 demanding attention to ‘complex clinical situations’ through contextualized diagnosis and care. The WHO European Ministerial Conference on Mental Health (11) has spoken on the cruciality of mental health and the need to empower people and to obtain patient- and carer-centered integration of services. In connection to the historical aspirations noted earlier and the above policy developments in the international health field, the WPA prepared and published in 2003 a set of International Guidelines for Diagnostic Assessment (IGDA) that pointed out that a patient is more than a carrier of disease and proposed a comprehensive diagnostic model with standardized and idiographic components that reflect person-centered integrative perspectives. More recently, WPA approved at its 2005 General Assembly an Institutional Program on Psychiatry for the Person: from Clinical Care to Public Health (IPPP). It represents an initiative affirming the whole person of the patient in context as the center and goal of clinical care and health promotion, at both individual and community levels. It involves an articulation of science and humanism to optimize attention to the ill and positive health aspects of the person. It includes four operational components: Conceptual Bases, Clinical Diagnosis, Clinical Care, and Public Health. The IPPP initiative finds stimulating consistency on many points with such significant conceptual developments in the field as the European Medicine de laPersone (12), the Value-based Practice Approach promoted by the National Institute of Mental Health of England (8), and the Recovery Movement originating in the United States and now extending internationally (13, 14). In April 2006, WPA updated its formal position concerning the development of ICD-11 and related diagnostic systems. This statement recognized that WPA over the past several years, particularly through its Classification Section and in collaboration with WHO and national and regional psychiatric associations, has contributed significantly to setting the foundations of future international classification and diagnostic systems. Key activities have included a large International Survey on the Use of ICD-10, DSM-IV and Related Diagnostic Systems, a number of WPA-WHO Symposia on International Classification and Diagnosis at WPA Congresses and Conferences, which have led to three published monographs and crucial advances in the field, and work commissioned by WHO on the bases for the development of the ICD-11 mental health component presented at WHO meetings from 2003 to 2005. It also noted that the process of ICD revision has recently entered a new phase with the WHO Classification Office directing the overall developmental process and the WHO Mental Health Department directing the development of the Mental Disorders Chapter. The position statement declared that WPA will offer its full collaboration to the World Health Organization for the preparation of ICD-11 and related diagnostic systems, and that it will cooperate with its Member Societies, including the American Psychiatric Association and other national and regional associations, concerning their own classification projects with the expectation that they be as consistent as possible with WHO's ICD-11 and Family of International Classifications. To ensure this, effective interactive mechanisms for coordination and harmonization should be implemented. The position statement further indicated that WPA will continue exploring through its various components, particularly its Section on Classification and Diagnostic Assessment and pertinent Institutional Programs, and in collaboration with WHO and national and regional associations, the most promising approaches to fulfill etiopathogenic and clinical diagnostic validities and the accomplishment of the following principal developmental tasks: striving for the best possible core international classification of mental disorders, attending to the elucidation of optimal definitions and thresholds for the ascertainment of mental disorders, utilizing complementary dimensional approaches, and taking into consideration the most appropriate cultural framework for classification and diagnosis, and working for the development of the most useful comprehensive and integrative diagnostic models to enhance clinical care and health promotion. This is widely regarded as an important task. Obtaining an improved nosology of mental disorders would respond to the well-established expectations of clinicians, researchers, educators and public health planners for a tool long considered as crucial for their work. The assignment rules related to the definitions of the classified disorders would allow health professionals to identify them in the clinic and the community in a reasonably reliable manner for their pertinent professional purposes. In the Laín-Entralgo (2) terminology outlined earlier, this disorder identification process corresponds to nosological diagnosis. Of relevance to this critical task, WHO following its constitutional responsibilities is launching the development of the 11th Revision of the International Classification of Diseases. This work is coordinated at the whole system level by the WHO Classification Office and at the mental disorders chapter level by the WHO Mental Health Department. At this more specific level, the work is expected to include discussions on how this chapter will fit within the whole system, the particular uses of the classification in the mental health field, the definition of mental disorders, the conceptualization of broad and narrow categories, the use of dimensionality, the presentation of the classification for research and for clinical care in specialized and primary care settings, the organization of workgroups for major disorder categories and cross-cutting themes, the harmonization of the ICD classification with those developed by national and regional associations, and the engagement of world-wide scientific and stake holder contributions. It is hoped that the development of the mental disorders chapter, through alpha and beta versions, be completed around 2012, with a possible approval of the whole ICD-11 in 2014. WPA, which has a substantial record of collaboration with WHO on the matter (15, 16), will participate actively throughout this developmental process, at the various levels of work and through the engagement of national psychiatric societies and classification groups. The American Psychiatric Association, which has contributed richly to the field through the preparation and publication of path-opening editions of its Diagnostic and Statistical Manual of Mental Disorders, particularly DSM-III and DSM-IV, is working intensively towards the preparation of a DSM-V (17). It is presently holding a series of research conferences on psychopathological and methodological aspects of the classification. It has included WHO and WPA representatives in their advisory committees for DSM-V. There are also other national and regional psychiatric associations which have developed substantial adaptations of the International Classification of Mental Disorders to their particular circumstances and purposes. Specially notable are the Chinese Classification of Mental Disorders, 3rd Edition (CCMD-3) published by the Chinese Society of Psychiatry (18), the French Classification of Child and Adolescent Mental Disorders prepared by the French Federation of Psychiatry (19), the Third Cuban Glossary of Psychiatry (GC-3) (20), and the Latin American Guide of Psychiatric Diagnosis produced by the Latin American Psychiatric Association (21). All these associations, among others, are expected to contribute to the development of ICD-11 in coordination with the World Psychiatric Association. Along with all this activity, a consensus is emerging towards ICD-11 as a single international reference for the classification of mental disorders, with national and regional versions representing adaptations, annotations or extensions of the ICD core classification. The plan for the development of a Person-centered Integrative Diagnosis (PID) as a theoretical model as well as a practical guide is an initiative of the World Psychiatric Association through its Institutional Program on Psychiatry for the Person (IPPP). Collaboration for this development is being arranged with WPA's scientific sections and member societies and their national diagnosis and classification groups as well as with WHO. The growth of the World Psychiatric Association in recent years, in terms of the enlargement and strengthening of the WPA family of national psychiatric societies, its wide array of scientific sections, and active publications program is bolstering the position of WPA to undertake major global initiatives such as PID. A key starting point for the development of PID would be the schema combining standardized multiaxial and personalized idiographic formulations at the core of the WPA International Guidelines for Diagnostic Assessment (IGDA) (22). Also informative to this process would be the recent Evaluation of the DSM Multiaxial System, which has documented the value of such a system and offered recommendations for its further development and implementation (23). At the heart of Person-centered Integrative Diagnosis (PID) is a concept of diagnosis different from the more conventional notion of just identifying and differentiating disorders. In PID, diagnosis is tentatively defined as the description of the positive and negative aspects of health, interactively, within the person's life context. PID would include the best possible classification of mental and general health disorders (expectedly the ICD-11 classification of diseases and its national and regional adaptations) as well as the description of other health-related problems, and positive aspects of health (adaptive functioning, protective factors, quality of life, etc.), attending to the totality of the person (including his/her dignity, values, and aspirations). The approach would employ categorical, dimensional, and narrative descriptive approaches as needed, to be formulated and applied interactively by clinicians, patients, and families. It appears that PID comes close to Laín-Entralgo's (2) concept of real diagnosis. The proposed phases for the development of Person-centered Integrative Diagnosis, including its theoretical model and its practical guide or manual, in terms of main activities and outcomes, follow. Design of the Person-centered Integrative Diagnostic (PID) Model. This would encompass a review of the pertinent background (including the monographs listed above) aimed at evaluating critically the status of the diagnostic field, its fundamental limitations to provide an adequate basis for clinical care and public health actions, and the most suitable and promising domains and structures for the diagnosis of a person's health. Possible domains include illnesses, disabilities/functioning, risk and protective factors (resilience, resources, supports) and quality of life. Possible structures may include multilevel schemas encompassing standardized (categories and dimensions) and idiographic/narrative information. This work would include literature research conducted and discussed by members of the IPPP Clinical Diagnosis Component through the internet and face to face meetings, with input from WPA components and pertinent health stakeholders. The timeline for this phase would be calendar year 2007. Development of the Person-centered Integrative Diagnostic (PID) Guide. The sub-phases of the PID Guide development would include the following: Preparation of the PID Guide draft. This would include the schemas, instruments and procedures to evaluate real persons according to each of the domains of the PID. This work would include literature research and intense interactive discussions conducted by members of the IPPP Clinical Diagnosis Component through the internet and face to face meetings, with input from WPA components and pertinent health stakeholders. This draft is hoped to be ready by the end of 2008. Evaluation of the PID Guide draft. This evaluation would be conducted by the IPPP Clinical Diagnosis Workgroup in collaboration with the WPA Global Consortium of Classification and Diagnosis Sections through clinical and epidemiological studies using reliability, validity, and feasibility criteria. This work is hoped to be completed by the end of 2009. Preparation and publication of the final version of the PID Guide. This work will be based on the results of the evaluative phase outlined above, expert discussions and health stakeholders input. This is hoped to be accomplished by the end of 2010. Person-centered Integrative Diagnosis Guide translations, implementation, and training. This work would include, first, the translation of the PID Guide to prominent world languages; second, the promotion and facilitation of the implementation of the PID Guide across the world; and third, the development of training curricula and programs at graduate, post-graduate and continuing professional education levels both for specialty and primary care arenas. The work would be conducted by the IPPP Clinical Diagnosis Workgroup in collaboration with partner organizations in the year 2011 and thereafter. The upcoming work on the development of the best possible classification of mental disorders (through WHO's ICD-11 and related versions from the APA and other national and regional psychiatric associations) as well as that of a Person-centered Integrative Diagnosis brings a sense of excitement and historical responsibility to the many institutions and individuals involved. It will be certainly a world-wide effort. In contemplating this scenario from the pages of Acta Psychiatrica Scandinavica it is necessary to reflect on the enormous contributions from Nordic European colleagues to the foundations of these developments. We are celebrating this year the 300th birthday of Carolus Linnaeus, who as professor of biology and medicine at Uppsala University set key principles for systematization in the life sciences. We must also recognize the contributions of Stengel (24) to the international classification of mental disorders and of Essen-Moeller and Wohlfahrt (25) to the original conceptualization of multiaxial diagnosis. Last, but not least, we would like to thank Otto Steenfeldt-Foss (26), who has argued cogently that psychiatry and medicine being based on science and humanism must be personalized in diagnosis and care.

Anticonvulsant Treatment for Psychiatric and Seizure Indications Among Youths

Provision of fertility services for women at increased risk of complications during fertility treatment or pregnancy: an Ethics Committee opinion.

Purpose: The general objective of the study was to explore mental health awareness and stigma in rural vs. urban communities. Methodology: The study adopted a desktop research methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library. Findings: The findings reveal that there exists a contextual and methodological gap relating to mental health awareness and stigma in rural vs. urban communities. Preliminary empirical review found significant differences in mental health perceptions and access to care between these areas. In rural communities, stigma was deeply ingrained, leading to reluctance in seeking help, exacerbated by limited access to services. Urban residents, while having better access to mental health resources and higher awareness, faced different stressors such as social isolation and pollution, contributing to high rates of mental health disorders. The study recommended tailored interventions, such as telehealth for rural areas and addressing environmental factors in urban settings, to effectively combat stigma and improve mental health outcomes. that Unique Contribution to Theory, Practice and Policy: The Social Cognitive Theory, Labeling Theory and Theory of Planned Behaviour may be used to anchor future studies on mental health awareness and stigma in rural vs. urban communities. The study highlighted the need to refine theoretical models to account for geographical and cultural variables. It emphasized the importance of tailoring mental health interventions to the unique challenges of rural and urban settings, suggesting practical solutions like telehealth and community-based support groups. Policymakers were urged to prioritize funding and public education campaigns to reduce stigma and improve service accessibility. The study recommended integrating these findings into existing theoretical frameworks and called for future longitudinal and comparative research to further explore the relationship between community type and mental health stigma.

As in many other countries, child psychiatry in China has gradually developed from general psychiatry. In the early days of the profession, child psychiatry was considered as psychiatry for "little adults". Child psychiatry in China has gradually developed and expanded since the implementation of Professor Guotai Tao's child psychiatric services in Nanjing in the 1930s. In particular, the profession has developed rapidly since its affiliation with the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP) in 1998. Child psychiatry has been one of the fastest developing advanced international disciplines over the past 10 years. Pediatric psychiatry mainly focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families. In 1899, the term ''child psychiatry'' (in French) was used as a subtitle in Manheimer 's monograph Les Troubles Mentaux de l'Enfance. The Swiss psychiatrist Moritz Tramer (1882–1963) was probably the first to define child psychiatry, in 1933, in terms of diagnosis, treatment, and prognosis within the medical discipline. In 1934, he founded the Journal of Child Psychiatry (1934–1952), which later became Acta Paedopsychiatrica (1953–1994). The first academic pediatric psychiatry department was established in 1930 at the Johns Hopkins Hospital in Baltimore by Leo Kanner (1894–1981). Since then, the clinical practice, research, and teaching of child psychiatry have gradually developed around the world.1 There have been three stages to the development of children's psychiatry in China. The first is the exploration and development period, which occurred mainly during the 1930s to the 1950s. This period was characterized by the introduction of Western models by experts and the exploratory development of child psychiatric services. Professor Yulin Cheng, Guotai Tao, and Yonghe Ling other professors are the pioneers. The second stage is the initial development period, which occurred from the 1950s to the late 1970s. Child psychiatric clinics and/or wards were established in Nanjing, Shanghai, Beijing, Guangzhou, Sichuan, Hunan and other places and child psychiatric teams were formed. Although there was a pause in the early 1970s, child psychiatric service models continued to be developed. The third period, from the late 1970s to the present, was characterized by rapid progress. The development of child psychiatry has been promoted mainly since the economic reform and opening-up in China, with the transformation of the medical model from a pure biomedical model to a biopsychosocial medical model. Psychiatrists, pediatricians, and psychologists have begun to focus on child mental health and have conducted some interdisciplinary research and practice. Following the establishment of the Nanjing Child Mental Health Research Center, many provinces and cities have established child mental health centers. Psychiatric hospitals or mental health institutes affiliated to major medical universities in Nanjing, Beijing, Hunan, Sichuan, Shanghai and other places have successively established Master's and doctoral training sites for child psychiatry and applied psychology. Relevant disciplines and research institutions such as child health care, behavioral pediatrics, special education schools, and autism training centers have successively joined the ranks of child mental health services. In particular, Professor Guotai Tao founded the Nanjing Child Mental Health Research Center in 1984. In August 1987, the center was appointed by the World Health Organization (WHO) as a scientific research and training cooperation center, and was appointed by the Chinese Ministry of Health (now the National Health Commission) as a child mental health guidance center. Many child psychiatrists and mental health workers have been trained, and academic exchanges have been promoted in China and abroad.2 With the rapid development of disciplines, Chinese child psychiatry has reached an internationally renowned and advanced level. Multidisciplinary participation in child psychiatry is good. For example, the psychology of child development, developmental behavior pediatrics, child neurology, child health care, education, and sociology have begun to attach importance to clinical practice and research on mental health. A growing number of universities and colleges offer degrees for social workers in clinical psychology and childcare. In addition, with more primary care centers in the community, primary care physicians can implement screening and follow-up for children with mental health disorders. However, the primary care providers still need more education and training. To address this problem, the National Health Commission has been advocating multilevel collaboration. Pediatricians and primary care physicians across the country are now being trained in early diagnosis and basic treatment for common mental disorders in children. They are taught to screen patients for signs of developmental disorders by checking, for example, whether a 3-month-old baby's eyes can follow moving objects or whether an 18-month-old child can make eye contact. The problem of the shortage of child psychiatrists has been partially solved.3 Children and adolescent mental health problems are related to a country's development and to global changes. About 20% of children and adolescents worldwide experience mental health disorders. The major challenges for children and adolescents with mental disorders are stigma, isolation, discrimination, and the lack of access to health care and education facilities. Obviously, children and adolescents are vulnerable groups; they have no political power and their mental health problems are complicated. The mental health of children and adolescents requires multisectoral cooperation and the attention of the whole society. In particular, the protection afforded by government actions and policies is crucial. Policies must be designed to ensure that children and adolescents can access even the most basic mental healthcare. However, there are few countries worldwide that provide specific policies for the mental health needs of children and adolescents.4 China has a large population of children. Rapid economic development and social reforms in recent years have had a substantial impact on the mental health of children and adolescents. Increasing social pressures and workers migration, and changes in family planning, have changed traditional family structures and social support systems.3 As part of development and progress within China, the Chinese government has initiated a series of policies and regulations to promote mental health. Some of these policies are aimed at promoting mental health in children and adolescents; for example, "The Law of the People's Republic of China on the Protection of Minors", "The Law of the People's Republic of China on the Protection of the Rights and Interests of Women and Children", "The Law of the People's Republic of China on the Protection of Disabled Persons", "Mental Health Law of the People's Republic of China", and programmatic documents such as the "Healthy China 2030 Planning Outline", "National Program of Outline for Action for Child Development in China (2011–2020)", "Guidelines for the Prevention and Treatment of Attention-Deficit/Hyperactivity Disorder'', ''Guidelines for the Diagnosis, Treatment and Rehabilitation of Children with Autism'', and ''Technical Specifications for Children's Mental Health Care''.5-10 These reflect how the support of national policies has driven the development of child psychiatry. Major national basic and clinical research projects have invested in child psychiatry research, such as the National Natural Science Foundation of China, which has supported national research and development plans in key health areas. Research by a team led by Professor Zhang Dai has demonstrated that FMR1, DISC1, EN2, and SHANK3 genes are related to autism. Studies by a team led by Professor Kun Xia and Jingping Zhao have shown that XRXN1, GRIN2B, RELN, and DAB1 genes may be antecedents of autism. Such research has been published in several high quality academic journals in recent years.11, 12 Some research of the National "12th and 13th Five-Year Plan" scientific and technological support projects led by Professor Yi Zheng, on "The Epidemiological Study of Child Mental Disorders in China" and "Comprehensive Intervention Strategies for Chronic Non-communicable Diseases with Attention Deficit-Hyperactivity Disorder". These show that Chinese child psychiatry has become a discipline supported by the national key research project. Traditional research group in child psychiatry include the team led by Professor Guotai Tao, Jie Lin and Xiaoyan Ke about autism, mental retardation and childhood schizophrenia; team led by Professor Yufeng Wang on attention deficit hyperactivity disorder; team led by Professor Xiaoling Yang and Jing Liu about autism spectrum disorders; team led by Professor Xuerong Li, Linyan Su and Xuerong Luo on epidemiological surveys and tool scales for child mental disorders; team led by Professor Rene Xin, Yasong Du and Wenhong Chen on epidemiological investigation of children's behavior problems and related research on child psychology and family therapy; team led by Professor Shiji Zhang, Yi Zheng, Yonghua Cui and Fan He on tics and related disorders; and team led by Professor Youhe Shan, Lanting Guo and Yi Huang on behavioral scales and tic disorders. The above studies have published valuable articles in academic journals and won many awards. Child psychiatrists need to be dedicated. The treatment of patients with mental illness is difficult and often daunting, and children's mental health disorders are particularly difficult to treat. Treatment of children with autism or mania requires tackling difficult problems and good practice in basic clinical skills. In China, child psychiatrists experience low returns and low income. The number of child psychiatric inpatients and outpatients is constantly increasing, and their treatment often relies on the dedication of child psychiatrists. To treat such patients, there are now more than 10 centers, nearly 1000 beds, and dozens of special education centers, such as autism rehabilitation centers. To care for left-behind children, children infected with AIDS, children affected by natural disasters such as earthquakes, and children with substance abuse and internet addiction, many child mental health workers and full-time child psychiatrists have formed competent national and local emergency response teams. Child psychiatrists are now available to help children to cope with a variety of social disasters, such as the Wenchuan earthquake or the "3.01" terrorist incident in Kunming. The development of modern child psychiatry in China is interlinked with foreign exchange. Since Professor Guotai Tao's studies in the United States in 1940, Chinese child psychiatry has been continuously introducing and incorporating foreign advanced diagnosis and treatment and research concepts. At present, Professor Tao has discussed diagnostic issues with international authoritative experts in foreign journals and participated in the preparation of the 11th revision of the International Classification of Diseases (ICD-11). Professor Tao was the first international participant in efforts to promote the integration of child and adult psychiatry and the popularization of the notion of the lifelong effects of mental illness, such as the Cross-Strait Summit Forum, and domestic and foreign academic institutions and academic exchanges, such as the Asian Society for Child and Adolescent Psychiatry and Allied Professions (ASCAPAP) and the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP). Chinese child psychiatrists have attended and contributed to both of the latter societies. Since the 1930s, older generations of individuals, such as Yulin Cheng, Guotai Tao, and Xueshi Chen, have made substantial contributions to the development of the discipline of child psychiatry. In 1989, Professor Jie Lin set up and led the Child Psychiatric Group of the Chinese Medical Association Psychiatry Branch. Professor Guotai Tao served as a consultant of the Group. Almost at the same time, the Chinese Mental Health Association established the Child and Adolescent Professional Committee, with Xuerong Li as director. Xueshi Chen serves as a consultant. Since then, two academic organizations have held annual meetings or training courses. In 1998, Professor Shiji Zhang, Yi Zheng, and Linyan Su participated in the IACAPAP congress and joined this organization, which is the most highly regarded academic organization in international child psychiatry. Chinese child psychiatry is fully in line with international developments in child psychiatry. In 2003, Professor Yi Zheng and Linyan Su attended the WHO Expert Headquarters "Concern for Children and Adolescents with Mental Disorders" meeting as Chinese representatives. In the same year, Professor Yi Zheng participated in the ASCAPAP congress and was elected as an executive member. In 2004, Professor Yi Zheng was appointed onto the IACAPAP executive committee. Professor Yi Zheng created the Cross-Strait Children's Psychiatry Summit Forum, which is held once every 2 years alternately in the mainland of China and Taiwan province, China. The Forum is now in its ninth session and has promoted the rapid development of the discipline. In 2010, the 19th IACAPAP International congress was successfully held in Beijing. This was the first time that this congress had been held in a developing country. Professor Yi Zheng served as Executive Chairman, and Professor Jing Liu served as Chairman of the organizing committee. Xiulian Gu, Zhu Chen, Wenkang Zhang and the country's main health care officials attended the opening ceremony and delivered speeches. More than 1300 foreign scholars and 500 domestic scholars attended the congress. Yi Zheng was elected onto the ASCAPAP executive committee and was elected Chairman, and Jing Liu was elected Vice-Chairman of ASCAPAP. At the 21st IACAPAP Conference held in South Africa in 2014, Professor Yi Zheng was elected Vice-President of IACAPAP and won the International Child Psychiatry Outstanding Contribution Award, indicating that Chinese child psychiatry has played a major role on the international stage.2 China has a population of more than 1.3 billion individuals, of which 238 million are children younger than 15 years of age.13 Though a nationwide prevalence study is lacking, some regional epidemiological studies show that the prevalence of mental health disorders in children is close to the worldwide prevalence of 20%,14-18 indicating that about 50 million children in China require treatment for mental health disorders. However, there is a scarcity of child and adolescent psychiatrists (CAPs) in China, and there are less than 500 full-time CAPs nationwide. Currently, only a national psychiatrist certification system exists, and there is no child psychiatrist certification system. Instead, students must obtain a postgraduate training certificate or a nationally approved Ph.D. or Master 's degree training certificate to become a child psychiatrist. A recent survey showed that training units for CAPs are mainly concentrated in large and medium-sized cities. Moreover, only a small number of medical personnel in China can diagnose and treat children and adolescents with mental health disorders, and these have insufficient training. Currently available training for child psychiatrists contains insufficient scientific, practical, and problem-solving content. Furthermore, current educational training poorly equips child psychiatrists for subsequent teaching and professional scientific research abilities. Therefore, a greater training focus is needed on more comprehensive qualities and abilities, such as dedication. Although CAPs undertake a long process of training, this mainly comprises postgraduate or doctoral Master's degree training; the national specialized certification system for CAPs has only been piloted in major cities. The CAP training system requires further improvements, and more CAPs are needed.19 China still has a shortage of child psychiatrists. To address this, a new type of multilevel collaboration is currently being implemented. Pediatricians and primary care physicians are also receiving training in child psychiatry. In addition, psychotherapists from other countries have been recruited to help train psychiatrists. China is currently exploring all possible ways to strengthen multilevel collaboration to promote the children's physical and mental health.3 The artificial boundary between children and adults with mental health disorders will be removed: more attention and value will be placed upon the treatment of adult attention deficit–hyperactivity disorder (ADHD), adult autism spectrum disorder (ASD), adult tic disorder, and other issues. Gene diagnosis and classification of child neurological and mental development disorders will become a reality: the detection of genes for susceptibility to ASD, ADHD, tic disorders, child schizophrenia, and child bipolar disorder will become possible. The concept of the supremacy of child mental health will gradually be accepted. More and more studies have confirmed that among the main factors for healthy and successful child developmental, child mental health is of paramount importance. As physical health and nutritional issues have been generally resolved in most parts of China, the impact of mental health on the future success of children will be a core health issue. Therefore, mental health should start with children. The multidisciplinary and multisector nature of child mental health will be further improved: medicine, economics, sociology, and other disciplines will pay close attention to child mental health. In particular, the only-child problem, the problems experienced by elderly parents in raising a second child, the problem of left-behind children, AIDS-infected children, Internet addiction problems, youth suicide, and crime prevention problems will become the focus of social attention. There will be new breakthroughs in early diagnosis and interventions for child mental health disorders: the ICD-11 (containing input from Chinese experts) will soon be released. Early warning indicators for child psychological problems and quantitative assessment techniques for child mental health care will be promoted from the national level to the whole country. Like child vaccination, assessments and interventions for child psychological conditions will benefit every child, which will set a global precedent. Treatment methods for child mental health disorders will be qualitatively improved. In addition to the further optimization of the structure and dosage of antipsychotics, research on functional food will make significant progress, and the use of alternative medicine and traditional Chinese medicine for child mental health disorders will be further clarified. In conclusion, the development of child psychiatry in China is still far behind developed countries, but a golden age of rapid development is approaching. Research on prevention and control of major chronic non-communicable diseases in the Ministry of Science and Technology (No: 2016YFC1306100) None.

Background: Lack of awareness and negative perceptions regarding mental well-being and mental diseases among high-risk population prevents them from seeking help. Purpose: The aim of the current study is to assess awareness of mental health, attitudes towards mental illness, and utilization barriers of mental health services among adults in Najran region, Kingdom of Saudi Arabia. Methods: To meet the study's objectives, a crosssectional design was employed, utilizing a convenience sample of 400 participants. The research involved a validated survey tool that featured structured questions covering demographic information, the Mental Health Knowledge Questionnaire (MHKQ), the Community Attitudes Toward Mental Illness Inventory (CAMI), which includes 40 Likertscale items, and the Barriers to Mental Health Services Questionnaire. Results: The results of the current study revealed that most of the participants had unsatisfactory knowledge: 245 (61.3%). A significant majority showed negative attitudes toward mental illness: 290 (72.5%). The main barriers to accessing mental health services were; stigma: 135 participants (33.7%), unwanted intervention concerns: 82 (20.5%), financial problems: 78 (19.5%), access difficulties: 45 (11.3%), and confidentiality concerns: 60 participants (15%). Furthermore, a significant positive connection existed between knowledge scores - 1 - Awareness of Mental Health and positive attitudes (r=0.598, p= 0.0001). Conclusion: The current study shed light on the concerning lack of knowledge and the prevalent negative attitudes among the studied sample. The main barriers to accessing mental health services were stigma, unwanted intervention concerns, and financial issues. Implications for Nursing: The findings underscore the urgent need for targeted interventions to address these issues, such as organizing workshops and seminars to educate the public about mental health, as well as about mental illness, and promote positive mental health practices. Keywords: Awareness of mental health, Attitudes regarding mental illness, Utilization barriers of mental health services, Najran region, Kingdom of Saudi Arabia.

Previous studies have suggested that firefighters, police officers and civil servants in the education sector, particularly in Western countries, are vulnerable to mental stress and disorders; however, evidence for this association in South Korea is lacking. This study aimed to identify whether firefighters, police officers and teachers are at a higher risk for occupational mental health disorders. We used workers' compensation claims from civil servants (2009-18). Our target population comprised 46 209 civil servants (9009 civil servants in administrative and technical positions, 23 107 police officers, 4417 firefighters and 8676 civil servants in the educational sector). Occupational and environmental medicine physicians and medical doctors defined and confirmed mental disorders. We conducted Cox proportional hazards regression analyses to evaluate civil servants' risk of occupational mental health disorders. Compared with the civil servants in administrative and technical positions, civil servants in the education sector (hazard ratio [HR] = 2.16; 95% confidence interval [CI]:1.65-2.84) showed a statistically significant increased risk of mental disorders; conversely, firefighters did not (HR = 0.80; 95% CI 0.51-1.27). Police officers had a significantly decreased mental disorder risk compared with civil servants in administrative and technical positions (HR = 0.17; 95% CI 0.11-0.25). The risk of occupational mental health disorders was higher in civil servants in the education sector but lower in police officers and firefighters than civil servants in administrative and technical positions. Further studies on civil servants' mental health awareness are required to confirm our results.

Millions of people suffer from mental illnesses in India with one of the highest suicide rates globally. Mental health is an important element of overall well-being, yet it remains an ignored aspect of healthcare in India. Despite increasing awareness around physical health, mental health continues to be overshadowed by stigma, misconceptions, and inadequate resources. The widespread lack of awareness, compounded by cultural taboos, poor mental health education, and the lack of mental health professionals has made mental health care inaccessible for Indians. The major challenges facing mental health awareness in India, including the stigma surrounding mental illness, widespread misconceptions, and insufficient mental health resources. Additionally, the role of cultural barriers and policy gaps that hinder effective mental health care. Some useful techniques to improve mental health awareness are educational initiatives, public campaigns, and the use of digital media platforms. Supporting mental health infrastructure, encouraging community help networks, and developing sustainable intersectoral collaborations are also important to improving access to mental health care. Promoting mental health education and awareness in India can break the cycle of stigma and ensure timely treatment and support for individuals suffering from mental health issues, ultimately leading to healthier individuals, communities, and a more resilient society.

Reporting adverse drug reactions (ADRs) has traditionally been the sole province of healthcare professionals. Since 2003 in Denmark, consumers have been able to report ADRs directly to the authorities. The objective of this study was to compare ADRs reported by consumers with ADRs reported from other sources, in terms of their type, seriousness and the suspected medicines involved. The number of ADRs reported to the Danish ADR database from 2004 to 2006 was analysed in terms of category of reporter, seriousness, category of ADRs by system organ class (SOC) and the suspected medicines on level 1 of the anatomical therapeutic chemical (ATC) classification system. ADR reports from consumers were compared with reports from other sources (physicians, pharmacists, lawyers, pharmaceutical companies and other healthcare professionals). Chi-square and odds ratios (ORs) were calculated to investigate the dependence between type of reporter and reported ADRs (classified by ATC or SOC). We analysed 6319 ADR reports corresponding to 15 531 ADRs. Consumers reported 11% of the ADRs. Consumers' share of 'serious' ADRs was comparable to that of physicians (approximately 45%) but lower than that of pharmacists and other healthcare professionals. When consumer reports were compared with reports from other sources, consumers were more likely to report ADRs from the following SOCs: 'nervous system disorders' (OR = 1.27; 95% CI 1.05, 1.53); 'psychiatric disorders' (OR = 1.70; 95% CI 1.31, 2.20) and 'reproductive system and breast disorders' (OR = 2.02; 95% CI 1.13, 3.61) than other sources. Compared with other sources, consumers reported fewer ADRs from the SOCs 'blood and lymphatic system disorders' (OR = 0.22; 95% CI 0.08, 0.59) and 'hepatobiliary system disorders' (OR = 0.14; 95% CI 0.04, 0.57). Consumers were more likely to report ADRs from the ATC group N (nervous system) [OR = 2.72; 95% CI 2.34, 3.17], ATC group P (antiparasitic products) [OR = 2.41; 95% CI 1.32, 4.52] and ATC group S (sensory organs) [OR = 4.79; 95% CI 2.04, 11.23] than other sources. Consumers reported fewer ADRs from the ATC group B (blood and blood-forming organs) [OR = 0.04; 95% CI 0.006, 0.32] and the ATC groups J (anti-infective for systemic use) [OR = 0.44; 95% CI 0.33, 0.58], L (antioneoplastic and immunomodulating agents) [OR = 0.19; 95% CI 0.12, 0.30] and V (various) [OR = 0.03; 95% CI 0.004, 0.21] than other sources. In the SOC 'nervous system disorders', consumers reported seven categories of ADRs that were not reported by the other sources. This study showed that compared with other sources, consumers reported different categories of ADRs for different types of medicines. Consumers should be actively included in systematic drug surveillance systems, including clinical settings, and their reports should be taken as seriously as reports from other sources.

Is maternal polycystic ovary syndrome (PCOS) associated with increased risks for a broad spectrum of psychiatric and mild neurodevelopmental disorders in offspring? Maternal PCOS and/or anovulatory infertility is independently, and jointly with maternal obesity, perinatal problems, cesarean delivery and gestational diabetes, associated with increased risks in offspring for almost all groups of psychiatric and mild neurodevelopmental disorders with onset in childhood or adolescence. Maternal PCOS was previously associated with autism spectrum disorder, attention-deficit/hyperactivity disorders and possibly developmental delay in offspring. Few studies have investigated the association between maternal PCOS and other psychiatric and neurodevelopmental disorders in offspring. This was a population-based cohort study in Finland including all live births between 1996 and 2014 (n = 1 105 997). After excluding births to mothers with symptoms similar to PCOS, a total of 1 097 753 births by 590 939 mothers remained. Children were followed up until 31 December 2018, i.e. up to the age of 22 years. National registries were used to link data of the included births and their mothers. Data from 24 682 (2.2%) children born to mothers with PCOS were compared with 1 073 071 (97.8%) children born to mothers without PCOS. Cox proportional hazards modeling was used to evaluate the hazard ratio (HR) and 95% CI for the risk of neuropsychiatric disorders in relation to maternal PCOS. Stratified analyses were performed to test the independent role of PCOS and the joint effects of PCOS with maternal obesity, perinatal problems, cesarean delivery, gestational diabetes and use of fertility treatment. The analysis was adjusted for maternal age, country of birth, marriage status at birth, smoking, parity, psychiatric disorders, prescription of psychotropic N05/N06 during pregnancy and systemic inflammatory diseases when applicable. A total of 105 409 (9.8%) children were diagnosed with a neurodevelopmental or psychiatric disorder. Firstly, maternal PCOS was associated with any psychiatric diagnosis (HR 1.32; 95% CI 1.27-1.38) in offspring. Particularly, the risk was increased for sleeping disorders (HR 1.46; 95% CI 1.27-1.67), attention-deficit/hyperactivity disorders and conduct disorders (HR 1.42; 95% CI 1.33-1.52), tic disorders (HR 1.42; 95% CI 1.21-1.68), intellectual disabilities (HR 1.41; 95% CI 1.24-1.60), autism spectrum disorder(HR 1.40; 95% CI 1.26-1.57), specific developmental disorders (HR 1.37; 95% CI 1.30-1.43), eating disorders (HR 1.36; 95% CI 1.15-1.61), anxiety disorders (HR 1.33; 95% CI 1.26-1.41), mood disorders (HR 1.27; 95% CI 1.18-1.35) and other behavioral and emotional disorders (ICD-10 F98, HR 1.49; 95% CI 1.39-1.59). In short, there was no significant difference between sexes. The results were robust when restricting the analyses to the first-born children or births to mothers without psychiatric diagnosis or purchase of psychotropic medication. Secondly, stratified analysis according to maternal BMI showed that the risk of any neuropsychiatric disorder was increased in offspring to normal-weight mothers with PCOS (HR 1.20; 95% CI 1.09-1.32), and markedly higher in those to severely obese mothers with PCOS (HR 2.11; 95% CI 1.76-2.53) compared to offspring to normal-weight mothers without PCOS. When excluding perinatal problems, mothers with PCOS were still associated with increased risks of any neuropsychiatric disorders in offspring (HR 1.28; 95% CI 1.22-1.34) compared to mothers without PCOS. However, an additional increase was observed for PCOS in combination with perinatal problems (HR 1.99; 95% CI 1.84-2.16). Likewise, excluding cases with maternal gestational diabetes (HR 1.30; 95% CI 1.25-1.36), cesarean delivery (HR 1.29; 95% CI 1.23-1.35) or fertility treatment (HR 1.31; 95% CI 1.25-1.36) did not eliminate the associations. The register-based prevalence of PCOS was lower than previously reported, suggesting that this study may capture the most severe cases. To combine anovulatory infertility with PCOS diagnosis as PCOS exposure might introduce diagnostic bias. It was not feasible to distinguish between subtypes of PCOS. Furthermore, familial factors might confound the association between maternal PCOS and neuropsychiatric disorders in offspring. Maternal BMI was available for birth cohort 2004-2014 only and there was no information on gestational weight gain. This study provides further evidence that maternal PCOS and/or anovulatory infertility, independently and jointly with maternal obesity, perinatal problems, gestational diabetes and cesarean delivery, implies a broad range of adverse effects on offspring neurodevelopment. These findings may potentially help in counseling and managing pregnancies. This study was supported by the joint research funding of Shandong University and Karolinska Institute (SDU-KI-2019-08 to X.C and C.L.), THL Finnish Institute for Health and Welfare: Drug and pregnancy project [M.G.], the Swedish Research Council [2014-10171 to C.L.], the regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institute Stockholm County Council [SLL20170292 to C.L.], the Swedish Brain Foundation [FO2018-0141 and FO2019-0201 to C.L.]. X.C. was supported by the China Scholarship Council during her training in Karolinska Institute. L.K. was supported by the China Scholarship Council for his PhD study in Karolinska Institute. The authors have no competing interests to disclose. N/A.

Information about safety issues from use of asthma medications in children is limited. Spontaneous adverse drug reaction (ADR) reports can provide information about serious and rarely occurring ADRs in children. To characterize paediatric ADRs reported for asthma medications licensed for paediatric use. Spontaneous ADR reports located in the European ADR database, EudraVigilance. ADRs reported for asthma medications licensed for paediatric use from 2007 to 2011 were analysed. The included substances were beclometasone, budesonide, fenoterol, fluticasone, formoterol, mometasone, montelukast, salbutamol and terbutaline and the combinations of budesonide/formoterol, fenoterol/ipratropium and fluticasone/salmeterol. Reported ADRs were categorized with respect to distribution on age, sex, type and seriousness of reported ADRs, medications and type of reporter. The unit of analysis was one ADR. We located 326 spontaneous reports corresponding to 774 ADRs for the included asthma medications. Approximately 85% of reported ADRs were serious including six fatal cases. In total, 57% of ADRs were reported for boys. One quarter of all ADRs occurred in children up to 1 year of age. Physicians reported the majority of ADRs. Across medicines, the majority of reported ADRs were of the type "psychiatric disorders" (13% of total ADRs), followed by "respiratory, thoracic and mediastinal disorders" (10% of total ADRs) and "skin and subcutaneous disorders" (9% of total ADRs). The largest number of ADRs was reported for budesonide (21% of total ADRs), followed by salbutamol (20% of total ADRs) and fluticasone (19% of total ADRs). For salbutamol, the largest numbers of serious ADRs were "tachycardia", "accidental exposure/incorrect dose administered" and "respiratory failure". Only a few ADRs from use of asthma medications in children were identified in the EudraVigilance ADR database, but a large majority of these were serious including fatal cases.

This study aimed to assess the awareness of mental health risk factors among pregnant women seeking care at Plateau State Specialist Hospital, Jos. A descriptive cross-sectional design was employed, with data collected from 104 respondents using a self-structured questionnaire. Key findings revealed a moderate level of awareness regarding mental health among the respondents, with 61.64% having heard about mental health and 46.58% believing it is somewhat important during pregnancy. However, 52.05% were unaware of risk factors that could increase mental health problems. The most prevalent risk factor experienced was financial difficulty (42.47%), followed by stressful life events (32.88%). Regarding preventive measures, 58.90% of respondents were unaware of ways to prevent mental health problems during pregnancy. The strategy most endorsed was "talking to someone about your feelings" (38.36%), but 52.05% felt they were only somewhat likely to implement preventive strategies. Additionally, 32.87% of respondents felt somewhat comfortable seeking help from a mental health professional, while stigma (31.51%) and cost (15.07%) were identified as major barriers to seeking support. The study concludes that while there is some awareness of mental health among pregnant women in the hospital, significant knowledge gaps exist regarding risk factors and preventive measures. The findings underscore the need for targeted interventions to educate both healthcare providers and expectant mothers about mental health during pregnancy, as well as efforts to address socioeconomic and cultural barriers to accessing mental health services.

The development of headucate in mental health awareness