Τετάρτη, 1 Μαΐου 2019

Mental Health

Evaluation and Management of Mental Health Disability in Post-secondary Students

Abstract

Purpose of Review

Due to the interdisciplinary nature of mental health disability in post-secondary educational settings, there is limited information available in the general psychiatric literature. This paper aims to familiarize psychiatrists with issues surrounding mental health disability in post-secondary educational settings. In this manuscript, we review critical aspects of the evaluation and management of post-secondary students who may be entitled to academic accommodations as a result of impairment from psychiatric diagnoses. We discuss common misconceptions about mental health impairment and best practices to mitigate its burden. We review relevant legislation and literature from psychiatric, psychological, and higher education journals and include multidisciplinary expert opinions.

Recent Findings

Mental illness is increasingly common in the post-secondary student population. When symptoms are severe, they can lead to academic impairment or disability. Nationwide data suggests an increase in post-secondary students requesting accommodations for mental health–related impairments. Recent guidelines from the American Psychiatric Association and The Jed Foundation aim to familiarize mental health providers, evaluators, administrators, students, and their families with best practices related to evaluating and managing mental health disability in post-secondary educational settings.

Summary

Evaluating, accommodating, and managing mental health disability during the post-secondary years are complicated processes. Legislation and nuanced evaluations can guide evaluating psychiatrists and administrators in recommending appropriate accommodations. By being knowledgeable about relevant legislation, best practices for evaluations, and available student resources, psychiatrists will be able to collaborate effectively with all stakeholders.



Innovative Models in Mental Health Delivery Systems: Task Sharing Care with Non-specialist Providers to Close the Mental Health Treatment Gap

Abstract

Purpose of Review

Most people do not have access to adequate mental health care, and lack of skilled human resources is a major factor. We provide a narrative review of approaches to implementing task sharing—engaging non-specialist providers—to deliver mental health care.

Recent Findings

There is strong evidence both for the effectiveness of task sharing as a means of delivering care for a range of conditions across settings and for the effectiveness of non-specialist providers and health workers in delivering elements of culturally adapted psychosocial and psychological interventions for common and severe mental disorders. Key approaches to facilitate task sharing of care include balanced care, collaborative care, sustained training and supervision, use of trans-diagnostic interventions based on a dimensional approach to wellness and illness, and the use of emerging digital technologies.

Summary

Non-specialist providers and health workers are well positioned to deliver evidence-based interventions for mental disorders, and a variety of delivery approaches can support, facilitate, and sustain this innovation. These approaches should be used, and evaluated, to increase access to mental health services.



Attention Deficit Hyperactivity Disorder (ADHD) in the Prison System

Abstract

Purpose of Review

To examine recent advances in the understanding of attention deficit hyperactivity disorder (ADHD) among the prison population.

Recent Findings

Efforts have been made to develop useful tools for assessing ADHD among prisoners. Prisoners with ADHD demonstrate incremental vulnerability due to comorbid psychiatric disorders, neurodevelopmental disorders and traumatic brain injury. Compared with prisoners without ADHD, prisoners with ADHD become involved in the criminal justice system at a younger age and have higher rates of recidivism in adulthood. Recent studies demonstrate the effectiveness of extended release stimulant medication and psychological interventions. Early identification and treatment of prisoners with ADHD have the potential to demonstrate health economic benefits.

Summary

Our understanding of ADHD among prisoners continues to develop. However, further research is needed, particularly among neglected groups such as females. Much more attention is needed by the prison service to engender better outcomes for this at-risk population.



Predictors of Transition to Psychosis in Individuals at Clinical High Risk

Abstract

Purpose of Review

Current research is examining predictors of the transition to psychosis in youth who are at clinical high risk based on attenuated psychotic symptoms (APS). Determining predictors of the development of psychosis is important for an improved understanding of mechanisms as well as the development of preventative strategies. The purpose is to review the most recent literature identifying predictors of the transition to psychosis in those who are already assessed as being at risk.

Recent Findings

Multidomain models, in particular, integrated models of symptoms, social functioning, and cognition variables, achieve better predictive performance than individual factors. There are many methodological issues; however, several solutions have now been described in the literature.

Summary

For youth who already have APS, predicting who may go on to later develop psychosis is possible. Several studies are underway in large consortiums that may overcome some of the methodological concerns and develop improved means of prediction.



The Relationship Between Epilepsy and Anxiety Disorders

Abstract

Purpose of Review

The current review aims at providing an overview of relevant aspects of anxiety symptoms and anxiety disorders (AD) in adults patients with epilepsy (PWE).

Recent Findings

Firstly, the appropriate diagnosis of type of anxiety symptoms and AD in PWE will be presented. Anxiety symptoms are often peri-ictal and classified in relation to their temporal occurrence to seizures. Anxiety symptoms are of three types: preictal (preceding a seizure), ictal (presenting as part of the seizure symptoms and signs), and postictal (occurring within 72 h of a seizure). AD are diagnosed in the interictal period and occur independently of seizures. Four specific AD in PWE can be objectified: anticipatory anxiety of epileptic seizures (AAS), seizure phobia, epileptic social phobia, and epileptic panic disorder. Secondly, the bidirectional pathophysiological relationship between anxiety and epilepsy will be described. Anxiety is a trigger for seizures in some patients, and the notion of stress and arousal is essential to understand the relationship between anxiety and seizure. Moreover, seizures arising from the limbic network especially involving amygdala, which may express fear-related semiology, provide insight into the pathophysiology of AD comorbidities. Thirdly, the methods of screening for AD and anxiety symptoms will be detailed. Fourthly, the pharmacological and psychobehavioral management of anxiety symptoms and AD in PWE will be presented. Arousal-based approaches for preictal and ictal symptoms and anxiety-based approaches for postictal and interictal symptoms will be presented.

Summary

Despite lack of evidence-based approaches, it is recognized that management of epilepsy is not only about controlling seizures, but also depends heavily on detecting, correctly diagnosing, and appropriately managing anxiety symptoms and AD comorbidities, in order to maximize quality of life. Improving self-control and self-efficacy is of fundamental importance in the management of PWE. Further rigorously designed studies focusing on anxiety symptoms and AD are essential to improve the overall care of PWE.



Behavioral Responses in Youth Exposed to Natural Disasters and Political Conflict

Abstract

Purpose of Review

The aim of this review was to focus solely on youths' behavioral responses to natural disasters and political conflicts in order to fully understand their impact and scope.

Recent Findings

Recent studies in the field of trauma have shown that theoretical conceptions have moved away from a narrow focus on the individual and towards wider ecological perspectives and from a narrow focus on negative responses to trauma exposure towards positive prosocial responses. Although there is a distinction between youths' behavioral responses towards natural disasters vs. towards political conflicts, in both of these adverse situations, behavioral responses exist alongside emotional responses.

Summary

Adolescents exposed to either type of adverse scenario are often able to turn their negative experiences into positive ones, take greater responsibility for themselves and others, contribute to recovery processes, and engage in prosocial behaviors. These responses must be investigated in the context of the trauma field's recent understandings regarding psychological, biological, environmental, and cultural factors.



The NIMH Research Domain Criteria (RDoC) Initiative and Its Implications for Research on Personality Disorder

Abstract

Purpose of Review

We discuss the implications of the Research Domain Criteria (RDoC) initiative for neuroscience research on personality disorder (PD). To organize our review, we construct a preliminary conceptual mapping of PD symptom criteria onto RDoC constructs. We then highlight recent neuroscience research, often built around concepts that correspond to RDoC elements, and discuss the findings in reference to the constructs we consider most pertinent to PD.

Recent Findings

PD symptoms were strongly conceptually tied to RDoC constructs within the Social Processes domain, implicating brain systems involved in interpersonal rejection, facial emotion perception, and self-referential processes. Negative and Positive Valence Systems were conceptually associated with many PD symptoms, with particular relevance ascribed to the latter's Reward Valuation construct, which could reflect a more widespread disruption of computational processes involved in estimating the probability and benefits of a future outcome. Within the Cognitive Systems domain, the Cognitive Control construct mainly related to PD symptoms associated with impulse control, suggesting a connection to neural circuits that underlie goal selection and behavioral control. Arousal and Regulatory Systems could only be conceptually mapped onto PD symptoms through the Arousal construct, with different symptoms reflecting either a higher or lower biological sensitivity to internal and external stimuli.

Summary

The RDoC framework has promise to advance neuroscience research on PD. The Social Processes domain is especially relevant to PD, although constructs falling within the other RDoC domains could also yield important insights into the neurobiology of PD and its connections with other forms of psychopathology. Identifying RDoC constructs (e.g., habit formation) that subserve more fundamental processes relevant to personality functioning warrants further investigation.



Cannabinoid Regulation of Fear and Anxiety: an Update

Abstract

Purpose of Review

Anxiety- and trauma-related disorders are prevalent and debilitating mental illnesses associated with a significant socioeconomic burden. Current treatment approaches often have inadequate therapeutic responses, leading to symptom relapse. Here we review recent preclinical and clinical findings on the potential of cannabinoids as novel therapeutics for regulating fear and anxiety.

Recent Findings

Evidence from preclinical studies has shown that the non-psychotropic phytocannabinoid cannabidiol and the endocannabinoid anandamide have acute anxiolytic effects and also regulate learned fear by dampening its expression, enhancing its extinction and disrupting its reconsolidation. The findings from the relevant clinical literature are still very preliminary but are nonetheless encouraging.

Summary

Based on this preclinical evidence, larger-scale placebo-controlled clinical studies are warranted to investigate the effects of cannabidiol in particular as an adjunct to psychological therapy or medication to determine its potential utility for treating anxiety-related disorders in the future.



Epidemiological and Clinical Gender Differences in OCD

Abstract

Purpose of Review

This review highlights recent research regarding gender differences in OCD, with a focus on prevalence, course of illness, symptom presentation, comorbidity, and treatment response.

Recent Findings

Overall, findings remain mixed. OCD may be more common among males in childhood, but is more common among females in adolescence and adulthood. Males tend to report an earlier age of onset and present with symptoms related to blasphemous thoughts. Females often describe symptom onset as occurring during or after puberty or pregnancy and present with symptoms related to contamination and/or aggressive obsessions. Females also tend to report significantly higher depression and anxiety. There are no reported gender differences in treatment outcome.

Summary

Gender may play a role in the onset, presentation, and impact of OCD symptoms. However, more work is needed to account for differences across studies, with one promising future direction being the study of reproductive hormones.



Community Interventions to Promote Mental Health and Social Equity

Abstract

Purpose of Review

We review recent community interventions to promote mental health and social equity. We define community interventions as those that involve multi-sector partnerships, emphasize community members as integral to the intervention, and/or deliver services in community settings. We examine literature in seven topic areas: collaborative care, early psychosis, school-based interventions, homelessness, criminal justice, global mental health, and mental health promotion/prevention. We adapt the social-ecological model for health promotion and provide a framework for understanding the actions of community interventions.

Recent Findings

There are recent examples of effective interventions in each topic area. The majority of interventions focus on individual, family/interpersonal, and program/institutional social-ecological levels, with few intervening on whole communities or involving multiple non-healthcare sectors. Findings from many studies reinforce the interplay among mental health, interpersonal relationships, and social determinants of health.

Summary

There is evidence for the effectiveness of community interventions for improving mental health and some social outcomes across social-ecological levels. Studies indicate the importance of ongoing resources and training to maintain long-term outcomes, explicit attention to ethics and processes to foster equitable partnerships, and policy reform to support sustainable healthcare-community collaborations.




Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480

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