Treatment Of Severe Mental Disorders Research Articles

The incidence, psychiatric co-morbidity and pharmacological treatment of severe mental disorders in children and adolescents

BackgroundAntipsychotic drug use among children and adolescents is increasing, and there is growing concern about off-label use and adverse effects. The present study aims to investigate the incidence, psychiatric co-morbidity and pharmacological treatment of severe mental disorder in Norwegian children and adolescents. MethodsWe obtained data on mental disorders from the Norwegian Patient Registry on 0–18 year olds who during 2009–2011 were diagnosed for the first time with schizophrenia-like disorder (International Classification of Diseases, 10th revision codes F20-F29), bipolar disorder (F30-F31), or severe depressive episode with psychotic symptoms (F32.3 or F33.3). Data on filled prescriptions for psychotropic drugs were obtained from the Norwegian Prescription Database. ResultsA total of 884 children and adolescents (25.1 per 100 000 person years) were first time diagnosed with schizophrenia-like disorder (12.6 per 100 000 person years), bipolar disorder (9.2 per 100 000 person years), or severe depressive episode with psychotic symptoms (3.3 per 100 000 person years) during 2009–2011. The most common co-morbid mental disorders were depressive (38.1%) and anxiety disorders (31.2%). Antipsychotic drugs were prescribed to 62.4% of the patients, 72.0% of the schizophrenia-like disorder patients, 51.7% of the bipolar disorder patients, and 55.4% of the patients with psychotic depression. The most commonly prescribed drugs were quetiapine (29.5%), aripiprazole (19.6%), olanzapine (17.3%), and risperidone (16.6%). ConclusionsWhen a severe mental disorder was diagnosed in children and adolescents, the patient was usually also prescribed antipsychotic medication. Clinicians must be aware of the high prevalence of depressive and anxiety disorders among early psychosis patients.

Sirukumab: A Potential Treatment for Mood Disorders?

Convergent evidence indicates that abnormalities in the innate immune system may be pertinent to the pathogenesis, phenomenology, and possible treatment of several mental disorders. In keeping with this view, the targeting of interleukin-6 with the human monoclonal antibody sirukumab may represent a possible treatment and disease modification approach, for adults with brain-based disorders (e.g., major depressive disorder). A PubMed/Medline database search was performed using the following search terms: sirukumab; anti-IL-6; IL-6; major depressive disorder; inflammation. A systematic review was conducted of both preclinical and clinical trials reporting on the pharmacology of sirukumab or investigating the efficacy of targeting IL-6 signaling. Overall, sirukumab has been reported to be a safe and well-tolerated agent, capable of modulating the immune response in healthy populations as well as in subjects with inflammatory disorders (e.g., rheumatoid arthritis). Sirukumab’s effects on cytokine networks as part of the innate immune system provide a coherent rationale for possible application in neuropsychiatric disorders with possible benefits across several domains of the biobehavioral Research Domain Criteria matrix (e.g., general cognitive processes, positive valence systems). Amongst individuals with complex brain-based disorders (e.g., mood disorders), the dimensions/domains most likely to benefit with sirukumab are negative valence disturbances (e.g., anxiety, depression, rumination), positive valence disturbances (e.g., anhedonia) as well as general cognitive processes. We suggest that sirukumab represents a prototype and possibly a proof-of-concept that agents that engage IL-6 targets have salutary effects in psychiatry.

Supplementation with Omega-3 Fatty Acids in Psychiatric Disorders: A Review of Literature Data.

A new application for omega-3 fatty acids has recently emerged, concerning the treatment of several mental disorders. This indication is supported by data of neurobiological research, as highly unsaturated fatty acids (HUFAs) are highly concentrated in neural phospholipids and are important components of the neuronal cell membrane. They modulate the mechanisms of brain cell signaling, including the dopaminergic and serotonergic pathways. The aim of this review is to provide a complete and updated account of the empirical evidence of the efficacy and safety that are currently available for omega-3 fatty acids in the treatment of psychiatric disorders. The main evidence for the effectiveness of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) has been obtained in mood disorders, in particular in the treatment of depressive symptoms in unipolar and bipolar depression. There is some evidence to support the use of omega-3 fatty acids in the treatment of conditions characterized by a high level of impulsivity and aggression and borderline personality disorders. In patients with attention deficit hyperactivity disorder, small-to-modest effects of omega-3 HUFAs have been found. The most promising results have been reported by studies using high doses of EPA or the association of omega-3 and omega-6 fatty acids. In schizophrenia, current data are not conclusive and do not allow us either to refuse or support the indication of omega-3 fatty acids. For the remaining psychiatric disturbances, including autism spectrum disorders, anxiety disorders, obsessive-compulsive disorder, eating disorders and substance use disorder, the data are too scarce to draw any conclusion. Concerning tolerability, several studies concluded that omega-3 can be considered safe and well tolerated at doses up to 5 g/day.

Persistence of racial disparities in prescription of first-generation antipsychotics in the USA.

The aim of this study was to estimate the prevalence of first-generation antipsychotics (FGA) prescribed for treatment of psychiatric and neurological conditions and use of benztropine to reduce extrapyramidal side effects (EPS) by patient race/ethnicity in a nationally representative sample of adult outpatient visits. The study sample included all outpatient visits (N = 8154) among patients aged 18-69 years where a prescription for one or more antipsychotics was recorded across 6 years of the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (2005-2010). Use of FGA was compared by race/ethnicity using multiple logistic regression models accounting for patient and clinical characteristics stratified by neighborhood poverty rate. Frequency of EPS was determined by use of benztropine to reduce or prevent EPS. Black patients were significantly more likely than White patients to use FGA (odds ratio = 1.48, p = 0.040) accounting for psychiatric and neurological diagnoses, treatment setting, metabolic factors, neighborhood poverty, and payer source. Black patients were more than twice as likely as White patients to receive higher-potency FGA (haloperidol or fluphenazine), particularly in higher-poverty areas (odds ratio = 2.50, p < 0.001). Use of FGA, higher among Black than White patients, was positively associated with use of benztropine to reduce EPS. Racial disparities in the pharmacological treatment of severe mental disorders persist 30 years after the introduction of second-generation antipsychotics. The relatively high frequency of FGA of use among Black patients compared with White patients despite more Food and Drug Administration-approved indications and lower EPS risk for second-generation antipsychotics requires additional research.

The quest for tailored treatments: a meta-discussion of six social cognitive therapies.

In this commentary on the 6 articles comprising this In Session issue on metacognition and mentalizing in the psychotherapeutic treatment of severe mental disorders, we strive to contextualize and bring together salient issues reflected in these articles. In the foreground of our discussion is the point that the commonalities of these and related social cognitive treatments far outweigh their differences. We attempt to pinpoint some of the more specific tailored treatment elements described by the authors and relate these to empirical findings and theoretical and practical problems. Among the key issues addressed in this commentary are conceptual fallacies, therapist transparency, personality disorder and self-harm in adolescence, therapeutic alliance, and a metacognitive-informed group psychotherapy practice for patients with avoidant personality disorder or alexithymia.

Body psychotherapy for the treatment of severe mental disorders – an overview

The evidence base for the effectiveness of body psychotherapy (BPT) in the treatment of severe mental disorders has improved much over the last decade; both methodologically robust randomised controlled trials and also qualitative studies demonstrated how BPT can contribute substantially to the treatment portfolio and help address chronic conditions and disorder-specific psychopathology. This paper summarises how BPT is utilised for the treating a range of severe mental disorders including mania and schizophreniform psychosis, personality disorder and severe anxiety as well as depressive disorders. The intervention strategies are related to specific body-oriented phenomena, i.e. disturbances of body experience and body-mind regulation disorders; the approaches are described in the context of a new theoretical paradigm of BPT as embodied and embedded relational psychotherapy, aiming to facilitate improved self/affect regulation. For each specific illness, a short sketch of the cardinal symptoms and body image phenomenology is followed by a summary of disorder-specific intervention strategies of BPT for severe mental illness.

The usefulness for indicated prevention of severe mental disorders should play a central part in the further development of CBT.

Schizophrenic, severe major depressive and bipolar disorders often do not respond sufficiently to the usual pharmacotherapy and therefore constitute the world's greatest public health problem (1). Thus, we have every reason to be happy that we can offer cognitive behavior therapy (CBT) as an effective non-pharmacological adjunct to the millions of people who are treated for those conditions worldwide. Obviously there are methodological problems as well as discrepant and negative results in numerous studies and meta-analyses on the effectiveness of complementary CBT in the above disease groups. Overall, however, the evidence speaks much more for than against the assumption that CBT or CBT-oriented strategies may improve the outcome of pharmacological treatment and prophylaxis, especially for treatment-resistant or chronic patients. On the other hand, the “promise of CBT” should not be overestimated in this important area of therapeutics. Taken as a whole, the hitherto achieved effects are only moderate, and data concerning bipolar disorders are not sufficient. Also, the evidence of efficacy for CBT should not mean that other approaches are now excluded from the search for useful psychotherapies for severe mental disorders. The traditional vulnerability-stress-coping models and also the newer salience theory of psychoses (2) offer a good framework for the development and use of psychological treatment strategies. They show, in fact, that different environmental stressors as well as personal and environmental protective factors may be involved in each individual case. CBT programs can target various but obviously not all of these psychosocial factors. Furthermore, important psychosocial influences such as trauma or migration interact with genetic-epigenetic and other biological factors (3). Therefore, even enthusiastic psychotherapists should not ignore that treatment and prophylaxis of severe mental disorders primarily deal with the current correction and future prevention of disorder-specific neuronal network pathologies in the human brain. The more we understand these pathologies, the more it will be possible to correct the network alterations by means of targeted neuromodulation. Research is currently testing new psychotropic drugs, neuroprotective substances and various brain stimulation methods to achieve this goal. The debate on “promise and limitations of CBT” reflects the presently unsatisfactory state of development. To date there are still no really causally effective psychotropic drugs available for the treatment of severe mental disorders, due to the lack of knowledge about etiology. That is why we try to combine substances which only influence the final pathogenetic pathways, and therefore are only partially effective, with complementary psychological interventions. Here, CBT has proven particularly useful, as it has a favorable impact on some of the psychosocial factors which are important for the release of and coping with the clinical symptoms. Nevertheless, the therapeutic problems are far from being solved, and the search for causal treatment approaches must go on. The directions for future research should include further testing of CBT in the initial high-risk states of psychosis or bipolar disorders (4). In persons who have already suffered from long courses of these diseases, with relapses or chronicity, CBT can only be an adjunct and at best produce the effects described in Thase et al's paper (5). Often the primary therapeutic goal of recovery is not at all achievable and what can be obtained is only coping with symptoms or loss of functions in order to reduce the burden of the disease and improve the quality of life. On the contrary, in the high-risk states, which can nowadays be characterized very well for psychoses (6) and increasingly better for severe mood disorders (7), we just observe initial changes of experience which, depending on the individual constellation of stressors and protective factors, can progress or not to the actual disease. The prevention of the outbreak of severe mental disorders is what is meant by the concept of indicated prevention (8). Right from the beginning, CBT was involved in the studies of indicated prevention of schizophrenia and has repeatedly been shown to be effective as the sole therapy without concurrent use of medication (9). It seems to be able to even prevent the transition of early cognitive disorders into attenuated psychotic symptoms and their transition into full schizophrenic symptoms (10). If this approach of indicated prevention is successfully transferred also to severe mood disorders, it promises to be much more useful in the fight against the world's greatest public health problem than the late adjunctive strategy (11).

The promise of cognitive behavior therapy for treatment of severe mental disorders: a review of recent developments.

Cognitive behavior therapy (CBT), as exemplified by the model of psychotherapy developed and refined over the past 40 years by A.T. Beck and colleagues, is one of the treatments of first choice for ambulatory depressive and anxiety disorders. Over the past several decades, there have been vigorous efforts to adapt CBT for treatment of more severe mental disorders, including schizophrenia and the more chronic and/or treatment refractory mood disorders. These efforts have primarily studied CBT as an adjunctive therapy, i.e., in combination with pharmacotherapy. Given the several limitations of state-of-the-art pharmacotherapies for these severe mental disorders, demonstration of clinically meaningful additive effects for CBT would have important implications for improving public health. This paper reviews the key developments in this important area of therapeutics, providing a summary of the current state of the art and suggesting directions for future research.

Patients With First-Episode Psychosis are Not a Homogeneous Population: Implications for Treatment

Objective: This study aimed at defining the characteristics of a population of patients diagnosed with first-episode psychosis (FEP), and accessing for the first time a center for early intervention in psychosis in the health district of Milan and its surroundings. Methods: Patients were included in the study from January 2007 to December 2008; criteria: first contact with any public mental health service of the catchment area for a first episode of schizophrenia or related syndromes according to the ICD-10 criteria. Cluster analysis was used to divide patients into groups based on the main socio-demographic and clinical characteristics at presentation. Results: Overall, 91 FEP patients were enrolled in the study. Two clusters were identified, which differed principally by symptom profile. Patients in cluster 1 (n=36) had severe agitation, and a history of alcohol and/or substance abuse at presentation more often than those in cluster 2 (n=55), who were more likely to suffer at presentation from severe depression or apathy, anxiety, poor self-care, functional or work impairment and severe social withdrawal. After six months of treatment patients improved on almost all symptomatic dimensions on the Health of the Nation Outcome Scale and the Brief Psychiatric Rating Scale, with greater improvement in cluster 1 than in cluster 2. Conclusions: The findings of this study need replication in larger samples and on a wider severity scale. Nevertheless, the heterogeneity of patients with FEP might impact on treatment. Policymakers should recognize the importance of the diagnostic and outcome assessment in the treatment of severe mental disorders.

Clinical Roundup: Selected Treatment Options for Anxiety

Alternative and Complementary TherapiesVol. 19, No. 6 Clinical Roundup: Selected Treatment Options for AnxietyPublished Online:23 Dec 2013https://doi.org/10.1089/act.2013.19603AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byBody psychotherapy for the treatment of severe mental disorders – an overview27 October 2014 | Body, Movement and Dance in Psychotherapy, Vol. 10, No. 1 Volume 19Issue 6Dec 2013 Information© 2013, Mary Ann Liebert, Inc.To cite this article:Clinical Roundup: Selected Treatment Options for Anxiety.Alternative and Complementary Therapies.Dec 2013.337-343.http://doi.org/10.1089/act.2013.19603Published in Volume: 19 Issue 6: December 23, 2013PDF download

1713 – Early recognition and treatment of youth and young adults at-risk for the development of severe mental disorders

Despite improvements in treatment for patients with severe mental disorders, such as bipolar disorder and schizophrenia, there is still a long delay from first symptoms to correct diagnosis and treatment. Since these illnesses usually manifest themselves within adolescence and young adulthood, this time lag impacts chances for an adequate individual development. With rather unspecific symptomatology in early stages of the development of the disorders and the still existing stigmatisation, a broad and low-threshold strategy is needed. In November 2008 an early recognition and prevention centre for mental disorders was opened at the University Hospital in Dresden. The aim of this service is to shorten the delay to correct diagnosis and treatment in severe mental disorders. In parallel, early detection instruments are developed and early intervention strategies studied in research projects. In this specialized centre diagnostics, counselling and treatment are provided for subjects aged 12 to 40 by a multidisciplinary team in a low-threshold setting. 250 youth and young adults were offered diagnostics and, if appropriate, treatment. In about 2/3 of clients, mental disorders had already manifested themselves, in some cases an additional risk for even more severe developments was ascertained. Counselling and transfer to appropriate treatment is offered to all clients, all are followed up on a regular basis to validate the process and assess the prognostic value of our service. A broad, low-threshold and multidisciplinary approach for early recognition and treatment of severe mental disorders holds the chance of earlier appropriate care.

Mental illness recognition and beliefs about adequate treatment of a patient with schizophrenia: Association with gender and perception of aggressiveness-dangerousness in a community sample of Mexico City

In developing countries, little is known about public recognition and beliefs about treatment of severe mental disorders, both emergent key elements in reducing stigma and the gap of treatment of such patients. It has been proposed that they may be related to gender and perception of patient's aggressiveness and/or dangerousness. To assess mental illness recognition and beliefs about treatment of schizophrenia, and to determine their relationship with perception of patient's aggressiveness/dangerousness and gender of the perceiver in a community sample of Mexico City. A convenience sample of 1038 subjects responded to a questionnaire that assesses all variables after reading a vignette of a patient with paranoid schizophrenia. Women were 1.88 times more likely to recognize the presence of mental illness and considered psychiatric interventions as the most adequate treatment of symptoms. In contrast, non-psychiatric interventions were more often considered by men (64.7%). Responders who recognize mental illness were more likely to perceive the patient as dangerous, which was related to the suggestion of more restrictive interventions. It is necessary to direct special efforts to increase mental health literacy among men. The general public needs objective information about aggression and dangerousness in anti-stigma campaigns among developing countries similar to Mexico.

Interview: The future of psychiatric medicine: clinical trials and beyond

Leslie Citrome is currently Clinical Professor of Psychiatry and Behavioral Sciences at New York Medical College in Valhalla (NY, USA) and has a private practice in Pomona (NY, USA). Citrome was the founding Director of the Clinical Research and Evaluation Facility at the Nathan S Kline Institute for Psychiatric Research in Orangeburg (NY, USA). After spending nearly two decades as a researcher in the psychopharmacological treatment of severe mental disorders, Citrome is now engaged as a consultant in clinical trial design and interpretation. Citrome has authored or coauthored over 400 scientific research reports, reviews, chapters and abstracts. He is on the editorial board of nine different medical journals and reviews for over 50 other journals. He has lectured extensively around the world on the quantitative assessment of clinical trial results using the evidence-based medicine metrics of number needed to treat and number needed to harm. Leslie Citrome speaks to Laura McGuinness, Managing Commissionin...

S55-04 Promoting appropriate health care in Europe - the case of psychiatry

Nowadays different professions are involved in mental heath care in Europe, e.g. general practitioners, psychiatrists, psychologists, psychotherapists, social-workers, case-managers, prevention specialists, health ministry bureaucrats etc. As mental health represents a weak concept with vague and ambiguous definitions and delimitations it remains quite unclear who should be responsible for mental health today and in the future. In the last decades psychiatrists gained high expertise in treating mental disorders (e.g. psychopharmacological, psychotherapeutic and social measures) but lost terrain in mental health matters because of a lack of interest in such questions leading to the hardly acceptable contemporary situation that professionals without any psychopathological knowledge and without clinical experiences in mental illnesses as well as in the various transitional states between mental health and disordered health have taken the leading positions in the field of mental health care. Of course, the main tasks of psychiatry are to diagnose and to treat mental disorders, but as the prognosis of mental disorders and the treatment efficacy highly depend on the time of recognizing the disorder (the earlier the recognition of a mental disorders and the earlier the start of therapy the better the treatment out-come and prognosis) early recognition of mental disorders and prevention measures (esp. secondary and tertiary prevention) have to become core fields of psychiatry. Therefore psychiatry cannot any longer restrict itself to the treatment of severe mental disorders but has to take again a crucial role in future mental health care system in cooperation with other mental health stake-holders. This implies that future training programs for psychiatrists have to take into account such considerations and have to include beside usual fields of interests (e.g. psychopathology, neurosciences, psychopharmacology, psychotherapy, medical humanities, etc.) also topics like early recognition, transitional states and prevention of mental disorders as regular parts.

Neurosurgical Approaches to Therapeutic Brain Stimulation For Treatment-Resistant Depression

During the 1940s and 1950s, psychosurgery was used for the treatment of severe mental disorders but was associated with significant complications. These problems and the advent of psychotropic drugs led to a decline in the use of psychosurgery. Neuroanatomical and brain imaging studies have revealed distinct brain regions and the pathways that connect them, which may underlie depression and other mental disorders. On the basis of this knowledge, modern stereotactic neurosurgical methods have been used to implant electrodes in the brain to provide therapeutic stimulation. Electrical stimulation by these electrodes with pacemaker-like devices can be used to modulate brain function by stimulating or inhibiting the activity of specific brain regions, without causing permanent or destructive lesions that cannot be reversed. Deep brain stimulation and cortical brain stimulation are two such neurosurgical approaches to therapeutic brain stimulation for treatment-resistant depression.

L'éthique au secours de la psychochirurgie ?

Recent successes of deep brain stimulation in intractable Parkinson's disease are reviving interest in a neurosurgical approach for the treatment of severe mental disorders. In April 2002, the French National Committee on Medical Ethics (NCME) gave very positive encouragement to such an approach, by arguing in favour of the progress of the techniques that have been developed, their efficacy and general safety. Is this judgement scientifically justified? Scrutinizing the argumentation exposed by the NCME reveals a quite different situation : the efficacy of “functional” neurosurgery of mental illnesses has yet to be proven ; the undesirable side-effects remain as frequent as disabling ; there has been no real major conceptual change. Psychosurgical reductionism remains attractive. Psychiatrists should worry that a national agency for medical ethics could settle such a difficult question as psychosurgery without acknowledging their experience in the matter nor showing the most elementary impartiality this requires. A question with quite serious consequences, as the history of their specialty unfortunately demonstrates.

O tema do duplo pode esclarecer sobre o autismo e a linguagem?

A origem deste artigo foi o interesse pelo tema do duplo, no contexto do tratamento dos distúrbios psíquicos severos da criança. Surgiram então questões tão distintas que podem apenas ser indicadas aqui, embora tenham esta origem comum. Se forem pertinentes, elas exigirão um desenvolvimento próprio posterior, na confrontação com a clínica: Como as crianças, e as crianças autistas, começam a falar? Qual o papel do "duplo idênticodo "duplo diferente", e da duplicação na subjetivação, assim como na aquisição da linguagem? Quais os significados da inversão especular? Quais os diferentes "níveis de reconhecimento da imagem especular" ? O que há de êxito e de tropeço na ecolalia? Ε possível articular literalidade e lateralidade? Ε comparar a repetição na psicose e no luto? Mesmo a partir de um ponto de vista lacaniano, referimo-nos, sobre a duplicação, a textos kleinianos esclarecedores. Parece necessária uma maior articulação entre a predominância da palavra e do olhar no investimento da criança, e seus eventuais desdobramentos. As crianças citadas foram observadas por terapeutas no CEM PI, ou em atividades do cotidiano, ou numa psicoterapia na instituição (dois últimos casos).

Review of Canadian mental health law and policy.

JOHN E. GRAY, MARGARET A. SHONE, and PETER F. LIDDLE Canadian Mental Health Law and Policy Markham, ON: Butterworths, 2000, 400 pages (ISBN -0433-43052-4, C$110, Softcover) Reviewed by JOHN HUNSLEY The approach of most psychologists and other mental health professionals towards the realm of public policy and law is perhaps best characterized as one of benign neglect. Most of us concentrate our efforts on conducting research and/or providing services and professional training. Far too infrequently do we attempt to contribute to the shaping of broader policy issues that affect both those who receive our services and our professions themselves. Fortunately, the authors of this book - a policy advisor, a lawyer, and a professor of psychiatry - take their responsibility to inform and guide public debate very seriously. They have produced a multidisciplinary text that succinctly summarizes the main points of Canadian mental health laws and the variability across provinces and territories in these laws and in their typical interpretation and application. By their estimates, there are 800,000 Canadians with severe mental disorders (especially schizophrenia and bipolar disorder) whose lives may be touched and, indeed, altered by these laws. For these individuals, their family members, and the health and legal professionals who work with them, this book offers a concise guide to the laws dealing with key issues such as involuntary hospital admission, authorization of psychiatric treatment, and treatment refusal. Although not always an easy read for those unfamiliar with legal terms and writing, the book is geared to a wide audience that includes legal and policy specialists, mental health professionals, and advocates for the mentally ill. The first quarter of the book focuses on setting the stage for later presentations on Canadian law and policy. To this end, early chapters are focused on providing an overview of Canadian mental health law, historical considerations affecting legal interpretations, and the nature, causes, and treatment of severe mental disorders. This last chapter is rather dated and limited in scope, providing little information on either (i) the important treatment implications (including therapeutic enhancements and reduced side-effects) of the second generation of antipsychotic medication or (ii) the role of psychosocial interventions in reducing relapse and rehospitalization. In contrast, the chapter on historical matters will undoubtedly be of value to those who teach courses on professional standards and ethics. The authors' presentation of how the legal requirement of physical dangerousness supplanted the standard of the need for treatment is particularly compelling, as are their discussions of how the Canadian Charter of Rights and Freedoms might affect mental health law policy and law reform. Most of the remaining chapters, comprising the majority of the text, focus on specific mental health laws dealing with (i) involuntary hospitalization, admission procedures, and treatment requirements, (ii) conditions for refusing treatment, (iii) assisted community treatment, (iv) legal safeguards for patients, (v) mandated services, and (vi) psychiatric issues in the Canadian criminal justice system. Taken together, these chapters provide information on the Mental health acts of each province and territory, the mental disorders provisions of the Criminal Code of Canada, and the numerous adult guardianship, substitute decision-making, and consent to health care laws. …

Differences in quality of life domains and psychopathologic and psychosocial factors in psychiatric patients.

Although treatment of severe mental disorders should strive to optimize quality of life (QOL) for the individual patient, little is known about variations in QOL domains and related psychopathologic and psychosocial factors in patients suffering from schizophrenia, schizoaffective disorder, and/or mood disorders. We hypothesized that QOL in severe mental disorder patients would have a more substantial relationship with psychosocial factors than with illness-associated factors. A case-control, cross-sectional design was used to examine QOL of 210 inpatients who met DSM-IV criteria for a severe mental disorder and who were consecutively admitted to closed, open, and rehabilitation wards. Following psychiatric examination, 210 inpatients were assessed using standardized self-report measures of QOL, insight, medication side effects, psychological distress, self-esteem, self-efficacy, coping, expressed emotion, and social support. QOL ratings for patients and a matched control group (175 nonpatients) were compared. Regression and factor analyses were used to compare multidimensional variables between patients with schizophrenia and schizoaffective and mood disorders. In all QOL domains, patients were less satisfied than nonpatient controls. Patients with schizophrenia reported less satisfaction with social relationships and medication when compared with patients with schizoaffective and/or mood disorders. Regression analysis established differential clusters of predictors for each group of patients and for various domains of QOL. On the basis of the results of factor analysis, we propose a distress protection model to enhance life satisfaction for severe mental disorder patients. Psychosocial factors rather than psychopathologic symptoms affect subjective QOL of hospitalized patients with severe mental disorders. The findings enable better understanding of the combining effects of psychopathology and psychosocial factors on subjective life satisfaction and highlight targets for more effective intervention and rehabilitation.

Health care reform for Americans with severe mental illnesses: report of the National Advisory Mental Health Council.

This report was produced in response to a request by the Senate Committee on Appropriations that the National Advisory Mental Health Council prepare and submit a report on the cost of insurance coverage of medical treatment for severe mental illness commensurate with the coverage of other illnesses and an assessment of the efficacy of treatment of severe mental disorders. About 5 million Americans (2.8% of the adult population) experience severe mental disorders in a 1-year period. Treating these disorders now costs the nation an estimated $20 billion a year (with an additional $7 billion a year in nursing home costs). These costs represent 4% of total U.S. direct health care costs. When the social costs are also included, severe mental disorders exact an annual financial toll of $74 billion. This total accounts for the dollar costs of shortened lives and lost productivity, as well as the costs incurred in the criminal justice and social service systems. However, it cannot begin to account in human terms for the enormous emotional cost and pain borne by Americans with severe mental illness and by their families. Many myths and misunderstandings contribute to the stigmatization of persons with mental illness and to their often limited access to needed services. For example, millions of Americans and many policy makers are unaware that the efficacy of an extensive array of treatments for specific mental disorders has been systematically tested in controlled clinical trials; these studies demonstrate that mental disorders can now be diagnosed and treated as precisely and effectively as are other disorders in medicine. The existence of effective treatments is only relevant to those who can obtain them. Far too many Americans with severe mental illness and their families find that appropriate treatment is inaccessible because they lack any insurance coverage or the coverage they have for mental illness is inequitable and inadequate. For example, private health insurance coverage for mental disorders is often limited to 30-60 inpatient days per year, compared with 120 days or unlimited days for physical illnesses. Similarly, the Medicare program requires 50% copayment for outpatient care of mental disorders, compared with 20% copayment for other medical outpatient treatment. These inequities in both the public and private sectors can and should be overcome.(ABSTRACT TRUNCATED AT 400 WORDS)