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MENTAL HEALTH

MENTAL HEALTH. Ahmed Mandil , Prof of Epidemiology Dr. Mohammad Afzal Mahmood College of Medicine, King Saud University. Headlines. General reflections Magnitude of the problem Classifications Disorders Etiology Prevention and control Integration into PHC. Teaching and Learning Aims.

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MENTAL HEALTH

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  1. MENTAL HEALTH Ahmed Mandil, Prof of Epidemiology Dr. Mohammad Afzal Mahmood College of Medicine, King Saud University

  2. Headlines General reflections Magnitude of the problem Classifications Disorders Etiology Prevention and control Integration into PHC

  3. Teaching and Learning Aims • There is ignorance, superstition, stigma and fear around Mental Illness • Etiology, pathogenesis diagnosis and treatment are imperfect. • There is a different paradigm and a less rigorous epidemiology Mental Health

  4. Often sad,sometimes mad,occasionally bad • The medical model is: • Insufficient • Diagnosis is largely clinical and experiential Mental Health

  5. More of an art than a science • Treatment is pragmatic • Prevention is about the politics of health • “populations, people pressures, poverty” Mental Health

  6. Mental Health is a worldwide problem Mental Health

  7. We are all vulnerable Mental Health

  8. Global Burden Mental & Substance Use disorders StudyHarvey A Whiteford, et al: Global burden of disease attributable to mental andsubstance use disorders: findings from the Global Burden ofDisease Study 2010. Lancet: August 29, 2013 http://dx.doi.org/10.1016/S0140-6736(13)61611-6 183·9 million DALYs (disability adjusted life years) 7·4% of all DALYs worldwide. 8·6 million YLLs (Years of life lost) 175∙3 million YLDs (22·9% of all YLDs) (Year of life lost to disability) Leading cause of YLDs worldwide. Depressive disorders 40·5% of DALYs caused by mental and substance use disorders Anxiety disorders 14·6% Mental Health

  9. Global Burden Mental & Substance Use disorders StudyHarvey A Whiteford et al,: Global burden of disease attributable to mental andsubstance use disorders: findings from the Global Burden ofDisease Study 2010. Lancet: August 29, 2013 http://dx.doi.org/10.1016/S0140-6736(13)61611-6 Mental Health

  10. Global Burden Mental & Substance Use disorders StudyHarvey A Whiteford et al: Global burden of disease attributable to mental andsubstance use disorders: findings from the Global Burden ofDisease Study 2010. Lancet: August 29, 2013 http://dx.doi.org/10.1016/S0140-6736(13)61611-6 Mental Health

  11. KSA Estimates • Riyadh: 30 – 40 % of PHC patients had mental disorders (mostly undiagnosed) • Al-Khobar: 22 % of health clinics patients had mental health disorders (8 % diagnosed) • Central province: 18 % of adults with minor disorder, with rates higher among: • Young: 15-29 years (23 %) • Divorced and widows (40 %) • Suicidal rates: 1.1 per 100,000 mostly among: • Men • Age: 30-39 years • Immigrants Mental Health

  12. Classification of Mental Illness (I)The Neuroses: e.g. depression, anxiety, mania, obsessions and compulsions (usually the patient retains insight and orientation; they experience deep distress and may commit suicide)The Psychoses: e.g.schizophrenia, puerperal psychosis (the patient is disorientated, deluded, and lacking in insight)The Dementias: e.g. progressive deterioration with loss of recent memory and deterioration of a normal personality. They may be primary or more commonly secondary to another condition e.g. alcohol, cerebro-vacular stroke Mental Health

  13. Affective Disorders Anxiety, depression, mania, obsessional disorders Schizophrenia e.g. paranoid type, disorganized type Organic states e.g. dementia Personality Disorder Abnormal personality Classification of Mental Illness (II) • Substance abuse • Drugs, alcohol • Learning disorders • Subnormality Mental Health

  14. Classification of Mental Illness (III) Drug Problems Addictive drugs, (Heroin, Cocaine, Amphetamines,) alcohol nd drug related illness-psychosis, delirium and dementia Personality Disorders A personality and behaviour that is damaging to the individual and/or to society and which is not tolerated by the dominant culture Mental subnormality / learning disorders: Problems around intelligence and ability to learn on the basis of teaching and experience Mental Health

  15. Mental Handicap/learning disability The mind of a young child in the body of an adult Mental Health

  16. Etiology of Mental Illness (I) • Multiple factors (individual, family and community) • Genetic factors • Social / environmental factors (e.g. stress, deprivation) • Physical factors (e.g. trauma, disease as: syphilis and pellagra) Mental Health

  17. Etiology of Mental Illness (II) Inheritance-Genetics/Intra-uterine environment Schizophrenia,Huntington’s Drug Abuse Alcohol,Heroin etc Upbringing Mothering,education,parenting Neurological diseases MS,Brain tumour Trauma/head injury Biochemistry/metabolic Porphyria,Diabetes Infections-HIV,Syphilis,CJD Vascular-CVA Nutrition/PCM Mental Health

  18. Prevention and control Mental Health

  19. Preventive Networks Mosque, Family, Home, Friends, Work Mental Health

  20. Primary Prevention(Ref: WHO, Prevention & Promotion 2002WHO, Prevention of Mental Disorders 2004) Universal prevention: targeting the general public or a whole population group. Selective prevention: targeting individuals or subgroups of the population whose risk of developing a mental disorder is significantly higher than that of the rest of the population. Indicated prevention: targeting persons at high-risk for mental disorders. Mental Health

  21. Primary PreventionReducing/Eliminating Risk & Facilitating Protective Factors(Ref: WHO, Prevention & Promotion 2002WHO, Prevention of Mental Disorders 2004) Mental Health

  22. Prevention of Mental Illness • Protection of the very young (promotion of family life) • Prevention of social stress and insecurity • Protection of the aged who may suffer from cerebral degeneration, depression and/or psychopathic states • Prevention of brain damage • Public education in mental health • Premarital consultations and medical examination • Provision of suitable institutions • Legislation as regards drug abuse, compulsory admission to residential hospitals and guardianship • Rehabilitation Mental Health

  23. Treatment and Care Hospital Care Community Care Mental Health

  24. Integration of Mental Health into PHC • The morbidity burden in great • Mental and physical health problems are interwoven • Treatment gap is enormous • PHC care for mental health • Enhances success • Promotes respect for human rights • Is affordable and cost-effective • Generates good health outcomes Mental Health

  25. KSA Mental Healthcare Facilities Mental Health

  26. References (I) • WHO. Integrating mental health into primary care: A global perspective. Geneva: WHO, 2008 • WHO. Saudi Arabia: Integrated primary care for mental health in the Eastern Province. In: Integrating mental health into primary care: A global perspective. Geneva: WHO, 2008 • Sims P. Mental health and illness: An epidemiological perspective. University of Papua New Guinea • Al-Fares E, Al-Shammari S, Al-Hamed A. Prevalence of psychiatric disorders in an academic primary care department in Riyadh. Saudi Medical Journal 1992; 13: 49-53 Mental Health

  27. References (II) • Al-Khathmi A, Ogbeide D. Prevalence of mental illness among Saudi adult primary care patients in central Saudi Arabia. Saudi Medical Journal 2002; 23: 721-724 • Elfawal M. Cultural influence on the incidence and choice of method of suicide in Saudi Arabia. American Journal of Forensic Medicine & Pathology 1999; 20: 163-168 • Al-Khathami A. The implementation and evaluation of an educational program for PHC physicians to improve their recognition of mental illness in the Eastern Province of Saudi Arabia [dissertation]. Al-Khobar: King Faisal University, 2001 Mental Health

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