Monday, October 10, 2011, is World Mental Health Day, a global effort by the United Nation’s World Health Organization (WHO) to promote education and awareness about mental illnesses.
The theme of this year’s event is “Investing in Mental Health,” with UN Secretary General Ban Ki-moon urging international leaders and organizations to increase resources and services for mental health treatments.
In an international message, the Secretary stated that worldwide financial recessions, unemployment, wars and poverty have contributed to an ongoing global mental-health crisis. Despite mental disorders accounting for 13 percent of diseases throughout the world, a majority of poor to moderate-income nations spend less than 2 percent of their budgets on mental health services. And many do not have nearly enough healthcare providers to serve the needs of their citizens with mental illnesses, with less than one specialist per one million people available in many parts of the world. Furthermore, whatever funds are allocated tend to be utilized by mental hospitals, which reach only seven percent of patients in developing nations, rather than for local, community-based services and as part of primary care efforts. In fact, in poor countries, four out of five people suffering from psychiatric conditions do not receive treatment.
Those with mental disabilities and their families suffer from undue hardships due to the stigma associated with their illnesses which consequently limits their participation in public and social life within their communities, Ki-moon added. The Mental Health Gap Action Programme of WHO, he states, is an example of a new and innovative approach in cost-effective prevention and treatment of mental disorders. He stressed the need for renewed leadership and global collaboration to begin to address the problem, calling for providers, policy makers, donors and individuals to take action and invest in improving mental health throughout the world.
Mental disorders refer to a host of illnesses including schizophrenia, depression, anxiety, bipolar disorder, mental retardation and drug and alcohol abuse. Many of these conditions are present simultaneously, with several others arising from AIDS and other non-communicable diseases that are disproportionately high in underdeveloped nations.
The World Federation for Mental Health, a global grassroots organization representing over 150 countries and a partner agency involved in the World Mental Health Day, provides informational packets for health care providers on schizophrenia, caregivers support, depression, Generalized Anxiety Disorder (GAD) and suicide, among others.
The GAD document provides facts about the psychiatric condition, which is marked by excessive worry that interferes with daily life. The illness often triggers physical symptoms including headaches, muscle tensions, nervousness, sleep problems, and difficulty concentrating and breathing. In the United States alone, about 6.8 million adults are affected, with stress and genetics playing a role. While in advanced countries, women suffer at far greater rates than men, in developing nations, the condition is equally split among men and women.
GAD and many other mental illnesses are highly treatable with psychotherapy and medications. Cognitive behavioral therapy, a form of talk therapy, for example, has been shown to be effective in training patients to connect feelings, emotions and behaviors. Medications for psychiatric disorders include benzodiazepines, such as valium, and serotonin reuptake inhibitors, which increase brain chemicals that regulate emotions and mood. Research is continually finding new ways to prevent, treat and understand the causes of mental illnesses.
Elevated or low levels of the stress hormone cortisol are associated with depression and lower quality of life in bipolar patients, a new study from Umeå University in Sweden announced. The study found that depression is almost twice as common and poor quality of life is five times as common in people with bipolar disorder.
Bipolar disorder affects approximately 5.7 million adults in the US every year. People with bipolar disorder experience unusual shifts in mood, energy, activity levels, and ability to carry out day-to-day tasks. Previous studies confirmed that stress triggers bipolar episodes in patients. Mania and depression further contribute to the stress load experienced by people with bipolar disorder. The relationship between the stress system, depression, and quality of life, however, had not been examined until this study.
“In bipolar depression the stress system is often activated, which means that the affected individuals have elevated cortisol levels in the blood. We have now been able to show that both over- and underactivity in the stress system, with corresponding elevated or reduced cortisol levels, can impair mental health in terms of depression and poor quality of life in these patients,” said Umeå University PhD student Martin Maripuu.
The study examined the cortisol levels in 145 type one and two bipolar patients and matched them with 145 controls. Researchers used the Dexamethasone Suppression Test (DST) to measure cortisol levels in patients, the Beck Depression Inventory (BDI) and the Montgomery-Åsberg Depression Rating Scale (MADRS-S) to measure self-reported depression, and the World Health Organization Quality of Life Assessment–100 and the Global Assessment of Functioning to measure self-reported quality of life.
Depression was twice as common in bipolar patients with high and low cortisol levels, as compared to people with normal cortisol levels in their blood. Low quality of life was six times more common in patients with bipolar and low cortisol levels. It was five times more common in patients with bipolar and high cortisol levels. Additionally, patients with low cortisol have, on average, had their disorder for a longer period of time. This could mean that people with bipolar disorder experience chronic stress, which causes an “exhaustion” of the stress system, resulting in reduced cortisol levels.
Though these new breakthroughs need additional research, this information could lead to a better understanding and better treatment of bipolar disorder. These researchers have shifted the focus of bipolar disorder treatment by suggesting that effective treatment of bipolar disorder should involve regulating and researching the stress system.
“The results may also ultimately lead to the development of new drugs that work by normalizing the stress system and cortisol levels,” said Maripuu.
New research shows that people with bipolar disorder who also suffer from an anxiety disorder are more likely to consider and attempt suicide, experience psycho-social problems and abuse drugs.
Published in the Journal of Psychiatric Research, the study also revealed that bipolar patients who experienced comorbid anxiety disorders had double the rate of emergency room admissions for depression related to their primary condition than their counterparts.
Bipolar disorder is characterized by a fluctuation between periods of mania and episodes of depression. The severity ranges, with the unpredictable mood swings varying in duration and triggered by different factors. The cause is unknown, though the condition tends to occur more frequently in families with histories of the disease.
Examining the relationship between the two psychological disorders, bipolar disorder and anxiety, lead researcher Regina Sala, MD of the New York State Psychiatric Institute at Columbia University, and her colleagues evaluated the symptoms and treatments of 1600 bipolar adults registered with the National Epidemiologic Survey on Alcohol and Related Conditions. Of the total 1600 patients, 1172 met the criteria for bipolar disorder type I and 428 for bipolar disorder type II, with the first type indicating a greater severity of the disorder than the second.
The scientists found that roughly 60% of individuals with a primary diagnosis of either bipolar disorder type I or type II also experienced an anxiety disorder once in their lifetime, and 40% suffered from two or more throughout their lives. Bipolar patients who suffered from an anxiety disorder had a much higher likelihood of suffering from psychosocial problems, such as work-related issues and interpersonal relationships, and substance-abuse problems.
This group also experienced a higher lifetime risk factor for more severe bipolar symptoms, such as more depressive and manic episodes and more suicidal thoughts and attempts. They also were more likely to seek treatment and mental health services that those with bipolar disorder alone.
Anxiety disorders account for a host of conditions marked by excessive stress that interferes with daily life. While certain traumatic events may trigger the emergence of an anxiety disorder, sometimes the onset is not clearly definable. Research is ongoing to determine biological and environmental factors that make some individuals more prone to developing the condition than others.
Given the results of this study, the authors recommend early detection and treatment of anxiety disorders in patients with bipolar disorder to improve the overall outcomes for these patients.
It is well established that people suffering from social anxiety fear being negatively evaluated by others. More recently, however, researchers have shown that even positiverecognition can set off triggers for those who suffer from social anxiety. In our recent paper, we looked into how different facial expressions affect social anxiety and found some insight on the mechanisms behind the act of avoidance.
Social anxiety disorder is a debilitating psychological condition. People with this disorder suffer from persistent and excessive fears of one or more social or performance situations, where there is potential for evaluation by others. Those who suffer from social anxiety also exhibit something we call ‘attentional bias,’ which includes behaviors such as avoidance. Attentional bias can happen when someone is faced with social situations that increase their anxiety. Because of these fears and consequential behaviors, the disorder can be severely incapacitating causing significant impairment in daily functioning and is one of the most prevalent lifetime disorders. Given the nature of the disorder concerning fear and avoidance of social situations, most sufferers fail to seek treatment unless they develop an additional disorder, which is associated with further impairment. That’s why identifying the causes and maintenance of social anxiety is so important.
Considering that the fear of being evaluated and judged by others is often at the core of social anxiety disorder, we were interested in finding out if this core fear could explain the relationship between social anxiety and attentional biases, such as avoidance. In our recent study, we simulated an anxiety-provoking social situation and used a computer task in order to assess how attention is distributed to differing facial expressions (e.g., angry, happy and neutral facial expressions). We found that higher levels of social anxiety symptoms were associated with a greater avoidance of angry facial expressions. Furthermore, the relationship between social anxiety and an avoidance of angry faces was explained by increased levels of fear of positive evaluation.
Currently, the most common and effective therapy for social anxiety disorder is Cognitive Behavior Therapy (CBT). Present CBT interventions, which emphasize fear of negative evaluation, cognitive restructuring, and exposure work, typically do so with regards to situations involving apprehension of negative appraisal. As a result, fear of positive evaluation may not be specifically addressed during treatment. The information we collected from our study on facial expressions, attentional biases, and social anxiety can help change these limitations in treatment.
By expanding upon current diagnostic and therapy techniques that identify and address not only the social anxiety fears that involve negative attention from others, but also incorporating strategies that address fears of being positively evaluated by others, our findings are exceptionally useful for clinicians who work with people suffering from social anxiety. This fear of positive judgement may be one potential explanation as to why such individuals tend to use avoidance strategies in social situations. As such, treatment strategies for individuals with social anxiety disorder that are more disorder specific may prove more successful for improving cognitive-behavioral symptoms associated with this debilitating disorder. Given that research on fear of positive evaluation is still in its infancy, future research is warranted to assess the inclusion of fear of positive evaluation in CBT in order to examine whether this does indeed diminish attentional avoidance often seen in those with social anxiety disorder.
