Effective Treatments in Psychiatry (Cambridge Pocket Clinicians)

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A common theme across models of cultural competence, however, is that they make treatment effectiveness for a culturally diverse clientele the responsibility of the system, not of the people seeking treatment. Later chapters of this Supplement describe the findings to date in relation to each ethnic or racial group. The main point is that cultural competence is more than the sum of its parts: It is a broad-based approach to transform the organization and delivery of all mental health services to meet the diverse needs of all patients.

The introductory chapter of this Supplement emphasized the overall genetic similarities across ethnic groups and noted that while there may be some genetic polymorphisms that show mean differences between groups, these variations cannot be used to distinguish one population from another. Observed group differences are outweighed by shared genetic variation and may be correlates of lifestyle rather than genetic factors Paabo, For example, researchers are finding some racial and ethnic differences in response to a heart medication Exner et al.

It is nevertheless reasonable to assume that medications for mental disorders, in the absence of data to the contrary, are as effective for racial and ethnic minority groups as they are for whites. Therefore, this Supplement encourages people with mental illness, regardless of race or ethnicity, to take advantage of scientific advances and seek effective pharmacological treatments for mental illness. As part of the standard practice of delivering medicine, clinicians always need to individualize therapies according to the age, gender, culture, ethnicity, and other life circumstances of the patient.

There is a growing body of research on subtle genetic differences in how medications are metabolized across certain ethnic populations. Similarly, this body of research also focuses on how lifestyles that are more common to a given ethnic group affect drug metabolism. Lifestyle factors include diet, rates of smoking, alcohol consumption, and use of alternative or complementary treatments. These factors can interact with drugs to alter their safety or effectiveness. The relatively new field known as ethnopsychopharmacology investigates ethnic variations that affect medication dosing and other aspects of pharmacology.

Most research in this field has focused on gene polymorphisms DNA variations affecting drug metabolizing enzymes. After drugs are taken by mouth, they enter the blood and are circulated to the liver, where they are metabolized by enzymes proteins encoded by genes. Certain genetic variations affecting the functions of these enzymes are more common to particular racial or ethnic groups. The variations can affect the pace of drug metabolism: A faster rate of metabolism leaves less drug in the circulation, whereas a slower rate allows more drug to be recirculated to other parts of the body.

For example, African Americans and Asians are, on average, more likely than whites to be slow metabolizers of several medications for psychosis and depression Lin et al. Clinicians who are unaware of these differences may inadvertently prescribe doses that are too high for minority patients by giving them the dose normally prescribed for whites. This would lead to more medication side effects, patient nonadherence, and possibly greater risk of long-term, severe side effects such as tardive dyskinesia Lin et al.

A key point is that this area of research looks for frequency differences across populations, rather than between individuals. For example, one research study reported on population frequencies for a polymorphism linked to the breakdown of neurotransmitters. It found the particular polymorphism in 15 to 31 percent of East Asians, compared with 7 to 40 percent of Africans, and 33 to 62 percent of Europeans and Southwest Asians Palmatier et al.

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It is important to note that these differences become apparent across populations, but do not apply to an individual seeking treatment unless the clinician has specific knowledge about that person's genetic makeup, or genotype, or their medication blood levels. The concern about applying research regarding ethnically based differences in population frequencies of gene polymorphisms is that it will lead to stereotyping and racial profiling of individuals based on their physical appearance Schwartz, For any individual, genetic variation in response to medications cannot be inferred from racial or ethnic group membership alone.

Since its inception, America has struggled with its handling of matters related to race, ethnicity, and immigration. The histories of each racial and ethnic minority group attest to long periods of legalized discrimination - and more subtle forms of discrimination - within U. Ancestors of many of today's African Americans were forcibly brought to the United States as slaves. The Indian Removal Act of forced American Indians off their land and onto reservations in remote areas of the country that lacked natural resources and economic opportunities. Over , Japanese Americans were unconstitutionally incarcerated during World War II, yet none was ever shown to be disloyal.

Although racial and ethnic minorities cannot lay claim to being the sole recipients of maltreatment in the United States, legally sanctioned discrimination and exclusion of racial and ethnic minorities have been the rule, rather than the exception, for much of the history of this country. Each of the later chapters of this Supplement describes some of the key historical events that helped shape the contemporary mental health status of each group.

Racism and discrimination are umbrella terms referring to beliefs, attitudes, and practices that denigrate individuals or groups because of phenotypic characteristics e. Racism and discrimination also have been documented in the administration of medical care. They are manifest, for example, in fewer diagnostic and treatment procedures for African Americans versus whites Giles et al.

More generally, racism and discrimination take forms from demeaning daily insults to more severe events, such as hate crimes and other violence Krieger et al. Racism and discrimination can be perpetrated by institutions or individuals, acting intentionally or unintentionally. Public attitudes underlying discriminatory practices have been studied in several national surveys conducted over many decades. One of the most respected and nationally representative surveys is the General Social Survey, which in found that a significant percentage of whites held disparaging stereotypes of African Americans, Hispanics, and Asians.

Minority groups commonly report experiences with racism and discrimination, and they consider these experiences to be stressful Clark et al. In a national probability sample of minority groups and whites, African Americans and Hispanic Americans reported experiencing higher overall levels of global stress than did whites Williams, The differences were greatest for two specific types: financial stress and stress from racial bias.

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Asian Americans also reported higher overall levels of stress and higher levels of stress from racial bias, but sampling methods did not permit statistical comparisons with other groups. American Indians and Alaska Natives were not studied Williams, Recent studies link the experience of racism to poorer mental and physical health. A study of African Americans found perceived 6 discrimination to be associated with psychological distress, lower well-being, self-reported ill health, and number of days confined to bed Williams et al.

A recent, nationally representative telephone survey looked more closely at two overall types of racism, their prevalence, and how they may differentially affect mental health Kessler et al. One type of racism was termed "major discrimination" in reference to dramatic events like being "hassled by police" or "fired from a job.

Major discrimination was associated with psychological distress and major depression in both groups. The other form of discrimination, termed "day-to-day perceived discrimination," was reported to be experienced "often" by almost 25 percent of African Americans and only 3 percent of whites. This form of discrimination was related to the development of distress and diagnoses of generalized anxiety and depression in African Americans and whites. The magnitude of the association between these two forms of discrimination and poorer mental health was similar to other commonly studied stressful life events, such as death of a loved one, divorce, or job loss.

While this line of research is largely focused on African Americans, there are a few studies of racism's impact on other racial and ethnic minorities. Perceived discrimination was linked to symptoms of depression in a large sample of 5, children of Asian, Latin American, and Caribbean immigrants Rumbaut, Two recent studies found that perceived discrimination was highly related to depressive symptoms among adults of Mexican origin Finch et al.

In summary, the findings indicate that racism and discrimination are clearly stressful events see also Clark et al. Racism and discrimination adversely affect health and mental health, and they place minorities at risk for mental disorders such as depression and anxiety. Whether racism and discrimination can by themselves cause these disorders is less clear, yet deserves research attention. These and related findings have prompted researchers to ask how racism may jeopardize the mental health of minorities.

Poverty disproportionately affects racial and ethnic minorities. The overall rate of poverty in the United States, 12 percent in , masks great variation. While 8 percent of whites are poor, rates are much higher among racial and ethnic minorities: 11 percent of Asian Americans and Pacific Islanders, 23 percent of Hispanic Americans, 24 percent of African Americans, and 26 percent of American Indians and Alaska Natives U.

Census Bureau, Measured another way, the per capita income for racial and ethnic minority groups is much lower than that for whites Table Table gives Per Capita Income averages by ethnicity in For centuries, it has been known that people living in poverty, whatever their race or ethnicity, have the poorest overall health see reviews by Krieger, ; Adler et al. It comes as no surprise then that poverty is also linked to poorer mental health Adler et al. Studies have consistently shown that people in the lowest strata of income, education, and occupation known as socioeconomic status, or SES are about two to three times more likely than those in the highest strata to have a mental disorder Holzer et al.

Poverty in the United States has become concentrated in urban areas Herbers, Poor neighborhoods have few resources and suffer from considerable distress and disadvantage in terms of high unemployment rates, homelessness, substance abuse, and crime. A disadvantaged community marked by economic and social flux, high turnover of residents, and low levels of supervision of teenagers and young adults creates an environment conducive to violence. Young racial and ethnic minority men from such environments are often perceived as being especially prone to violent behavior, and indeed they are disproportionately arrested for violent crimes.

However, the recent Surgeon General's Report on Youth Violence cites self-reports of youth from both majority and minority populations that indicate that differences in violent acts committed may not be as large as arrest records suggest. The Report on Youth Violence concludes that race and ethnicity, considered in isolation from other life circumstances, shed little light on a given child's or adolescent's propensity for engaging in violence DHHS, Regardless of who is perpetrating violence, it disproportionately affects the lives of racial and ethnic minorities.

More than 40 percent of inner city young people have seen someone shot or stabbed Schwab-Stone et al. How is poverty so clearly related to poorer mental health? This question can be answered in two ways. People who are poor are more likely to be exposed to stressful social environments e. In this way, poverty among whites and nonwhites is a risk factor for poor mental health. Also, having a mental disorder, such as schizophrenia, takes such a toll on individual functioning and productivity that it can lead to poverty. In this way, poverty is a consequence of mental illness Dohrenwend et al.

Both are plausible explanations for the robust relationship between poverty and mental illness DHHS, Scholars have debated whether low SES alone can explain cultural differences in health or health care utilization e. Lillie-Blanton et al. Most scholars agree that poverty and socioeconomic status do play a strong role, but the question is whether they play an exclusive role.

The answer to this question is "no. An excellent example is presented in Chapter 6. Mexican American immigrants to the United States, although quite impoverished, enjoy excellent mental health Vega et al. In this study, immigrants' culture was interpreted as protecting them against the impact of poverty. In other studies of African Americans and Hispanics cited in Chapters 3 and 6 , more generous mental health coverage for minorities did not eliminate disparities in their utilization of mental health services.

Minorities of the same SES as whites still used fewer mental health services, despite good access. The debate separates poverty from other factors that might influence the outcome - such as experiences with racism, help-seeking behavior, or attitudes - as if they were isolated or independent from one another. In fact, poverty is caused in part by a historical legacy of racism and discrimination against minorities.

And minority groups have developed coping skills to help them endure generations of poverty. In other words, poverty and other factors are overlapping and interdependent for different ethnic groups and different individuals. As but one example, the experience of poverty for immigrants who previously had been wealthy in their homeland cannot be equated with the experience of poverty for immigrants coming from economically disadvantaged backgrounds.

An important caveat in reviewing this evidence is that while most researchers measure and control for SES they do not carefully define and measure aspects of culture. Many studies report the ethnic or racial backgrounds of study participants as a shorthand for their culture, without systematically examining more specific information about their living circumstances, social class, attitudes, beliefs, and behavior.

In the future, defining and measuring different aspects of culture will strengthen our understanding ethnic differences that occur, beyond those explained by poverty and socioeconomic status. The United States is undergoing a major demographic transformation in racial and ethnic composition of its population. In , 23 percent of U. In 25 years, it is projected that about 40 percent of adults and 48 percent of children will be from racial and ethnic minority groups U.

While these changes bring with them the enormous richness of diverse cultures, significant changes are needed in the mental health system to meet the associated challenges, a topic addressed in Chapter 7. The four most recognized racial and ethnic minority groups are themselves quite diverse. For instance, Asian Americans and Pacific Islanders include at least 43 separate subgroups who speak over languages.

Even among African Americans, diversity has recently increased as black immigrants arrive from the Caribbean, South America, and Africa. Some members of these subgroups have largely acculturated or assimilated into mainstream U. African Americans had long been the country's largest ethnic minority group.

However, over the past decade, they have grown by just 13 percent to In contrast, higher birth and immigration rates led Hispanics to grow by 56 percent, to According to census figures, Hispanics have replaced African Americans as the second largest ethnic group after whites U.

Hispanics grew faster than any other ethnic minority group in terms of the actual number of individuals and the rate of population growth. The group with the second highest rate of population growth was Asian Americans, who in the census were counted separately from Native Hawaiians and Other Pacific Islanders. Because of immigration, the Asian American population grew American Indians and Alaska Natives surged between 38 and 50 percent over each of the decades from the s through the s. Even so, the rate is still greater than that for the general population. One factor accounting for this higher-than-average growth rate is an increase in the number of people who now identify themselves as American Indian or Alaska Native.

The current size of the American Indian and Alaska Native population is just under 1 percent of the total U. This number nearly doubles, however, when including individuals who identify as being American Indian and Alaska Native as well as one or more other races U. The numbers of ethnic minority children and youth are increasing most rapidly. Between and , the numbers of black youth are expected to increase by 19 percent, American Indian and Alaska Native youth by 17 percent, Hispanic youth by 59 percent, and Asian and Pacific Islander youth by 74 percent. Before then, American Indians lived primarily on reservations to which the government assigned them.

Today, although they are not evenly distributed, members of each of the four major racial and ethnic minority groups reside throughout the United States. In the Midwest, which is less ethnically diverse, over 85 percent of the population is white, and most of the remainder is black. This proportion has remained relatively unchanged since the s. Although the Nation as a whole is becoming more ethnically diverse, this diversity remains relatively concentrated in a few States and large metropolitan areas. In general, minorities are more likely than whites to live in urban areas.

In , 88 percent of minorities lived in cities and their surrounding areas, compared to 77 percent of whites. During the last century, U. For example, the Immigration Act established the National Origins System, which restricted annual immigration from any foreign country to 2 percent of that country's population living in the United States, as counted in the census of Since most of the foreign-born counted in the census were from northern and western European countries, the Immigration Act reinforced patterns of white immigration and staved off immigration from other areas, including Asia, Latin America, and Africa.

Until the s, approximately two-thirds of all legal immigrants to the United States were from Europe and Canada. The Immigration Act of replaced the National Origins System and allowed an annual immigration quota of 20, individuals from each country in the Eastern Hemisphere. The Act also gave preference to individuals in certain occupations. The effect was striking: Immigration from Asia skyrocketed from 6 percent of all immigrants in the s to 37 percent by the s. Yet another provision of the Act supported family reunification and gave preference to people with relatives in the United States, one factor behind the growth in immigration from Mexico and other Latin American countries U.

Over this same period of time, the percentage of immigrants from Europe and Canada fell from 68 percent to 12 percent U. Immigration and Naturalization Service, In the past 20 years, immigration has led to a shift in the racial and ethnic composition of the United States not witnessed since the late 17th century, when black slaves became part of the labor force in the South Muller, Though this wave of immigration is similar to the surge of immigration that occurred in the early part of this century, a critical difference is in the countries of origin.

In the early s, immigrants primarily came from Europe and Canada, while recent immigration is primarily from Asian and Latin American countries. Overall, the racial and ethnic makeup of the United States has changed more rapidly since than during any other period in history. The reform in immigration policy in , the increase in self-identification by ethnic minorities, and the slowing of the country's birth rates, especially among non-Hispanic white Americans, have all led to an increasing, and increasingly diverse, racial and ethnic minority population in the United States.

In medicine, each disease or disorder is considered mutally exclusive from another WHO, Each disorder is presumed, but rarely proven, to have unique pathophysiology Scadding, In very general terms, most other healing systems throughout history conceived of sickness and health in the context of understanding relations of human beings to the cosmos, including planets, stars, mountains, rivers, deities, spirits, and ancestors Porter Defined in the next section of this chapter as "beliefs, attitudes, and practices that denigrate individuals or groups because of phenotypic characteristics or ethnic group affilliation Researchers may have collected this information but did not report it in their published studies.

Perceived discrimination" is the term used by researchers in reference to the self-reports of individuals about being the target of discrimination or racism. The term is not meant to imply that racism did not take place. Turn recording back on. National Center for Biotechnology Information , U.

Search term. Introduction To better understand what happens inside the clinical setting, this chapter looks outside. Culture of the Patient The culture of the patient, also known as the consumer of mental health services, influences many aspects of mental health, mental illness, and patterns of health care utilization. Symptoms, Presentation, and Meaning The symptoms of mental disorders are found worldwide. Causation and Prevalence Cultural and social factors contribute to the causation of mental illness, yet that contribution varies by disorder. Family Factors Many features of family life have a bearing on mental health and mental illness.

Coping Styles Culture relates to how people cope with everyday problems and more extreme types of adversity. Treatment Seeking It is well documented that racial and ethnic minorities in the United States are less likely than whites to seek mental health treatment, which largely accounts for their under-representation in most mental health services Sussman et al. Immigration Migration, a stressful life event, can influence mental health.

Overall Health Status The burden of illness in the United States is higher in racial and ethnic minorities than whites. Culture of the Clinician As noted earlier, a group of professionals can be said to have a "culture" in the sense that they have a shared set of beliefs, norms, and values. Communication The emphasis on verbal communication is a distinguishing feature of the mental health field. Primary Care Primary care is a critical portal to mental health treatment for ethnic and racial minorities.

Clinician Bias and Stereotyping Misdiagnosis also can arise from clinician bias and stereotyping of ethnic and racial minorities. Culture, Society, and Mental Health Services Every society influences mental health treatment by how it organizes, delivers, and pays for mental health services.

Service Settings and Sectors Mental health services are provided by numerous types of practitioners in a diverse array of environments, variously called settings and sectors. Within these settings, services are furnished by specialized mental health professionals, such as psychologists, psychiatric nurses, psychiatrists, and psychiatric social workers;. The general medical and primary care sector offers a comprehensive range of health care services including, but not limited to, mental health services.

Primary care physicians, nurse practitioners, internists, and pediatricians are the general types of professionals who practice in a range of settings that include clinics, offices, community health centers, and hospitals;. The human services sector is made up of social welfare housing, transportation, and employment , criminal justice, educational, religious, and charitable services. These services are delivered in a full range of settings - home, community, and institutions;.

The voluntary support network refers to self-help groups and organizations devoted to education, communication, and support. Financing of Mental Health Services and Managed Care Mental health services are financed from many funding streams that originate in the public and private sectors. Table Table Culturally Competent Services The last four decades have witnessed tremendous changes in mental health service delivery.

Medications and Minorities The introductory chapter of this Supplement emphasized the overall genetic similarities across ethnic groups and noted that while there may be some genetic polymorphisms that show mean differences between groups, these variations cannot be used to distinguish one population from another. Racism, Discrimination, and Mental Health Since its inception, America has struggled with its handling of matters related to race, ethnicity, and immigration.

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Three general ways are proposed: Racial stereotypes and negative images can be internalized, denigrating individuals' self-worth and adversely affecting their social and psychological functioning;. Racism and discrimination by societal institutions have resulted in minorities' lower socioeconomic status and poorer living conditions in which poverty, crime, and violence are persistent stressors that can affect mental health see next section ; and.

Poverty, Marginal Neighborhoods, and Community Violence Poverty disproportionately affects racial and ethnic minorities. Demographic Trends The United States is undergoing a major demographic transformation in racial and ethnic composition of its population. Diversity within Racial and Ethnic Groups The four most recognized racial and ethnic minority groups are themselves quite diverse. Growth Rates African Americans had long been the country's largest ethnic minority group.

Impact of Immigration Laws During the last century, U. Conclusions Culture influences many aspects of mental illness, including how patients from a given culture express and manifest their symptoms, their style of coping, their family and community supports, and their willingness to seek treatment. Likewise, the cultures of the clinician and the service system influence diagnosis, treatment, and service delivery. Cultural and social influences are not the only determinants of mental illness and patterns of service utilization for racial and ethnic minorities, but they do play important roles.

Mental disorders are highly prevalent across all populations, regardless of race or ethnicity. The role of any one of these major factors can be stronger or weaker depending on the specific disorder. Within the United States, overall rates of mental disorders for most minority groups are largely similar to those for whites.

This general conclusion does not apply to vulnerable, high-need sub-groups, who have higher rates and are often not captured in community surveys. The overall rates of mental disorder for many smaller racial and ethnic groups, most notably American Indians, Alaska Natives, Asian Americans and Pacific Islanders are not sufficiently studied to permit definitive conclusions. Ethnic and racial minorities in the United States face a social and economic environment of inequality that includes greater exposure to racism and discrimination, violence, and poverty, all of which take a toll on mental health.

Living in poverty has the most measurable impact on rates of mental illness. People in the lowest stratum of income, education, and occupation are about two to three times more likely than those in the highest stratum to have a mental disorder. Racism and discrimination are stressful events that adversely affect health and mental health.

They place minorities at risk for mental disorders such as depression and anxiety. Stigma discourages major segments of the population, majority and minority alike, from seeking help. Attitudes toward mental illness held by minorities are as unfavorable, or even more unfavorable, than attitudes held by whites. Mistrust of mental health services is an important reason deterring minorities from seeking treatment. Their concerns are reinforced by evidence, both direct and indirect, of clinician bias and stereotyping.

The extent to which clinician bias and stereotyping explain disparities in mental health services is not known. The cultures of ethnic and racial minorities alter the types of mental health services they use. Cultural misunderstandings or communication problems between patients and clinicians may prevent minorities from using services and receiving appropriate care. References Adler, N. Socioeconomic status and health: The challenge of the gradient.

American Psychiatric Association. Baker, F. Issues in the psychiatric treatment of African Americans. Bebbington, P. The predictive utility of expressed emotion in schizophrenia: An aggregate analysis. Bell, C. Pimping the African-American community. Community violence and children on Chicago's southside. The misdiagnosis of black patients with manic depressive illness. The misdiagnosis of black patients with manic depressive illness: Second in a series. Berry, J. Comparative studies of acculturative stress. Bhugra, D.

Attitudes towards mental illness: A review of the literature. Blazer, D. Bond, C. Responses to violence in a psychiatric setting: The role of patient's race. Borowsky, S. Who is at risk of nondetection of mental health problems in primary care? Brockington, I. Levings, J. Broman, C. Brown, E. Kaiser Family Foundation. Brown, J. Childhood abuse and neglect: Specificity of effects on adolescent and young adult depression and suicidality.

Burkett, G. Culture, illness, and the biopsychosocial model. Chambless, D. An update on empirically validated therapies. Chen, J. Racial differences in the use of cardiac catheterization after acute myocardial infarction.


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Chun, C. Clancy, C. Utilization of specialty and primary care: The impact of HMO insurance and patient-related factors. Clark, R. Racism as a stressor for African Americans. A biopsychosocial model. Cooper-Patrick, L.


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Race, gender, and partnership in the patient-physician relationship. Identification of patient attitudes and preferences regarding treatment of depression. Corrigan, P. Lessons from social psychology on discrediting psychiatric stigma. Cross, T. Davis, J. Dinwiddie, S. Early sexual abuse and life-time psychopathology: A co-twin-control study. Dohrenwend, B. Social status and stressful life events. Socioeconomic status and psychiatric disorders: The causation-selection issue. Drake, R. Implementing evidence-based practices in routine mental health service settings. Druss, B.

Understanding disability in mental and general medical conditions. Dwight-Johnson, M. Treatment preferences among primary care patients. Eaton, W. Scheid Eds. Epstein, A. Racial disparities in medical care. Exner, D. Ronald S. Manuel Pardo. Mary E. Norman Levine. Sab Will. May C. Howard Bauchner. Robert N. Home Contact us Help Free delivery worldwide. Free delivery worldwide.

Bespalov, Germany. Thomas Steckler, Belgium. Sunday 07 Oct TP. Chairs: Louk Vanderschuren, The Netherlands. Chairs: Anne Eckert, Switzerland. Sunday 07 Oct PA Poster award ceremony. Chairs: Joop van Gerven, The Netherlands. Sunday 07 Oct TA Travel award ceremony. Presentations: This can lead to long cycles of prescribing, before an effective medication can be found. In this symposium, the speakers propose to bridge the interlinked problems of non-response to the treatment, staying well, and detection of imminent recurrence in patients with depression.

They will lay out the need for improvement of research endeavours by pointing out the potential health economics and social impact of better optimised treatment of depression, for example by guided antidepressant prescribing or specific recurrence prevention therapies.

They will also explore innovative new approaches, including those drawing on cognitive psychology and neuroimaging, that aim to better predict outcomes in depression and take steps towards personalized treatments. Chairs: Catherine Harmer, United Kingdom. Aggression, defined as the overt and covert behaviour with the intention of inflicting physical and psychological damage, is a physiological trait with important roles throughout evolution, both in defence and predation.

When expressed in humans in the wrong context, aggression leads to social maladjustment and crime. The aetiology and mechanisms underlying aggression are still largely elusive. In order to develop more effective treatment strategies, it is impelling to understand how genetic factors and environment can change cell function, neural organisation and function, that together lead to aggressive behavioural outcomes. In studying the mechanistic underpinnings of aggression, the consortia study multiple levels of complexity, and integrate across those. Studying genes, gene-networks and biochemical metabolites and mapping their mode of action from the molecular-, via the cellular-, to the brain-circuit level the consortia aim to identify biomarkers for maladaptive aggressive behaviour, taking into account important and so far less investigated factors, such as gender and age of the studied subjects and the timeline of development of aggression.

In this symposium, the speakers will present innovative research designs and results of highly powered studies from all four of the international aggression consortia. Chairs: Barbara Franke, The Netherlands. Simone Macri, Italy. It has been hypothesized that the thalamic reticular nucleus TRN , due to its role as gatekeeper of thalamo-cortical information flow, is affected in the disorder and contributes to the disruption of functions relevant to SZ sensory gating, selected attention, arousal state regulation and memory consolidation. This symposium will present converging evidence from animal models and patients, which points out to TRN dysfunction in SZ.

The speakers will first show that the TRN in rodent models of SZ has a key role in disrupting thalamo-cortical functional connectivity and may drive cortical events. Moreover, evidence that reduced spindle activity which relies on TRN neurons in SZ is an endophenotype that impairs sleep-dependent memory consolidation and may be a novel treatment biomarker will be presented.

Next, the speakers will show state-of-the-art in-vivo physiology experiments coupled with optogenetic tools, which demonstrate that TRN cells, via modulation by hypothalamic inputs, control arousal and consciousness. Finally, the symposium will focus on the susceptibility of parvalbumin-expressing TRN inhibitory neurons to oxidative stress in a mouse model of redox dysregulation and in SZ patients , suggesting that TRN might be affected by such mechanism in SZ.

Together, these new results highlight that TRN anomalies may greatly contribute to cognitive and sleep deficits in SZ. Chairs: Pascal Steullet, Switzerland. Judith Pratt, United Kingdom. Digital technology is the means to store and transmit data in binary form. The speed, accuracy and miniature scale on which this now occurs has already transformed how we work. It is widely assumed that a comparable transformation will take place in how we provide healthcare. However, how this can and should happen has not yet become obvious.

Indeed, some of the problems that marked the early development of medicines are apparent in the early applications of technology to health care. Are appliances effective, are they safe and who should pay for them? These questions clearly resonate with the same issues for analogue devices and for medicines themselves. This session will concentrate on the current application of digital technology to the simple measurement of patient experience. Major joint initiatives with industry are ongoing in mental health.

We will provide a forum for updating on current progress and discussion of future directions. In the tradition of ECNP, it will bring together clinical scientists from academia, industry and the regulatory authorities. Chairs: Guy Goodwin, United Kingdom. Chairs: Jonathan Bisson, United Kingdom. Sunday 07 Oct CE. Relapse can result in a host of serious problems for both patients and society, including recurrent hospitalizations, loss of a job, involvement with the criminal justice system, and ultimately failure to integrate into society.

To remedy this vexing clinical situation, the past decade has seen a re-evaluation of the use of long-acting antipsychotics LAIs routinely over oral antipsychotics, with a wide variety of LAI choices now being available. However, long-acting antipsychotics remain underused, and clinicians need to be better prepared to propose LAIs as first-line treatments for relapse prevention and to answer questions about LAIs that patients and their families might have.

At the same time, innovative strategies to better detect non-adherence or partial non-adherence including point-of-care therapeutic drug monitoring TDM are becoming available and should lead to a re-evaluation of the value of antipsychotic blood level monitoring. Educational financial support provided by Saladax Biomedical. Research on the etiology of mood disorders have implicated dysfunction in glutamatergic receptors, along with impairments in synaptic structure and function. Thus, the focus of novel medication development is directed to how central glutamate systems can be effectively and safely modulated to improve outcomes in patients living with MDD and deserving of relief.

Educational financial support provided by Allergan plc. The use of long-acting injectable antipsychotics LAIs in severe mental disorders is usually restricted to patients in long-term treatment, who prefer them to oral antipsychotics, and to patients with multiple relapses who have a history of non-adherence. However, preliminary evidence from patients in the early phases of this disorders suggest that second generation LAIs may be superior to second generation oral medications with regard to relapse and rehospitalisation prevention, control of symptoms and psychosocial functioning.

Several studies have found that psychiatrists are generally reluctant to prescribe LAI antipsychotics and under-estimate their acceptability by patients. The speakers Drs. Emborg and Grande will review the data supporting the early use of LAI in this disorders and discuss the benefits of this medications with the audience. Sunday 07 Oct C. Although treatment options are available, relapse is common; the disease can also be difficult to control, with progression in some patients leading to more serious consequences.

New treatment options are urgently needed, and novel therapies are currently being investigated. During this symposium, our faculty will update physicians on the current treatment options for MDD, focusing on patients who exhibit treatment resistance. They will discuss the latest data from clinical studies, as well as discussing current challenges and the future prospects for the management of MDD.

Chairs: Ana Gonzalez-Pinto, Spain. Eduard Vieta, Spain. They wish the doctor to be more aware of their needs and how they can be fulfilled. Koen Demyttenaere, Belgium. It will help them recognize the prevalence of ADHD in patients with different psychiatric disorders, describe clinical features, differential diagnosis and treatment strategies.

At the end of this symposia the attendees will have knowledge of the landmark clinical trials have an understanding how it interpret their results with respect to the topics listed above. Presentations and discussion at the symposia will be focused on application of scientific data to real world clinical cases and related decision making.

It is important to be fully aware of the evidence demonstrated by clinical trials while making clinical decisions for the individual patients. Educational financial support provided by Sunovion, Angelini and Sumitomo Dainippon. Chairs: Sofia Brissos, Portugal. Monday 08 Oct BS. It has been estimated that 76 million people worldwide are addicted to alcohol, 29 million people are addicted to illicit drugs such as opiates, psychostimulants and cannabis and 1. Remarkably, only 1 in 6 addicts are estimated to be in treatment, and the available treatment options are modest in terms of number and efficacy.

Despite decades of research, that have yielded a wealth of knowledge on brain function and the effects of substances of abuse thereon, not many candidate treatments have emerged that have resulted in effective therapies for addiction. It is particularly disappointing that, unlike many other areas of psychiatry, animal models of drug-seeking and taking are expected to have high levels of construct validity and, therefore, should more readily support development and validation of clinically effective medications. This brainstorming session aims to identify reasons for this translation failure, and — more importantly- improved research strategies for the forthcoming era.

This includes improved animal models, preclinical drug testing regimens, and ways to move data from the preclinic to the clinic. The topic will be discussed from both an academic and industrial perspective. Both animal and human addiction scientists are warmly invited to participate. Chairs: Jaanus Harro, Estonia. Louk Vanderschuren, The Netherlands. Anton Y. The identification of biomarkers clinically useful to psychiatric disorders is one of the most challenging tasks in psychiatric research and of major concern in modern medicine: World Health Organization data show that psychiatric disorders are responsible for almost 30 disability-adjusted life years DALYs, a measure of disease burden.

In this brainstorming session, biomarkers for schizophrenia SZ will be discussed. The psychopharmacological treatment with antipsychotics for SZ often is not effective in all symptom dimensions and side effects are common, indicating that treatment biomarkers are urgently needed. Data also show that SZ is an umbrella of disorders that result in complex dysfunctions at the molecular level and distinct biochemical pathways.

Some patients might develop the disease because of metabolic or neurotransmitter disturbances, others because of inflammatory processes or neurodevelopmental abnormalities. Whatever the root cause of the disorder, most patients show changes in neurophysiological parameters or in brain structure and function. The stratification of patients, aimed to develop personalized treatments, is a challenge that can be tackled with biomarkers. In addition to diagnostic biomarkers, there is also a need for biomarkers to identify whether a medication will be successful for specific symptoms in specific patients.

Moreover, biomarkers are also needed for risk assessment and early detection of SZ, both of which are even more challenging than the areas of application described above.

yziwoxugep.tk: Cambridge Pocket Clinicians series

However, regardless of the category of biomarkers—diagnosis, treatment, or early detection—we need a deeper understanding of the molecular basis and dysregulated signaling pathways in SZ. Chairs: Michael Davidson, Israel. Dan Rujescu, Germany. Florence Thibaut, France.

Cognition is a new key treatment target across depression and bipolar disorder, but there has been a lack of consensus on how cognitive impairment should be assessed and managed. Within the International Society for Bipolar Disorders ISBD , the Cognition Task Force, chaired by Professor Miskowiak, has recently developed some consensus-based recommendations for clinicians on why, when and how to assess and address cognition in their patients.

This brainstorming session will start with a brief overview of the ISBD task force recommendations. This will lead to a discussion with the audience of the rationale and practical applicability of these recommendations and next steps in terms of their implementation in clinical settings. Learning objectives for the audience are to gain insight into the reasons why assessment of cognition is important, when this should be conducted in the course of illness, which screening tools are available and what the next steps are if impairment is detected.

Learning objectives for the chairs of the symposium involve the delineation of the potential obstacles and ways of tackling them, in order to aid the implementation of the consensus-based ISBD task force recommendations in the clinic. Chairs: Kerstin Jessica von Plessen, Switzerland. Monday 08 Oct S. However, recent findings are expanding our view and underlie the need of a conceptual shift from a brain-centred to a body-environment inclusive approach in the neuroscience and psychiatry fields.

Indeed, preclinical and clinical findings implicate the entire body and the living environment as key determinants in the onset of psychiatric disorders -- from major depressive disorder to schizophrenia -- and in treatment strategies. Moreover, tackling the complexity of behaviour in a comprehensive mind-body perspective is opening new venues for a deeper comprehension of the biological processes defining brain function per se.

The role of stress and changes in metabolism and the influence of the lifestyle, including diet and physical activity, in the vulnerability and course of psychiatric disorders will be presented. In addition, antidepressant treatment as strategy for an enhanced brain plasticity to be harnessed by positive environmental stimuli will be illustrated.

Finally, a description of the neural mechanisms underlying the action of the environment in triggering psychopathology will be provided. Overall, the symposium has been built to provide a comprehensive picture through the description of both experimental and clinical data collected with multidisciplinary approaches, ranging from molecular and cellular methods to environmental interventions.

Chairs: Igor Branchi, Italy. Andreas Meyer-Lindenberg, Germany. Important research efforts have been made to identify predictors of response to lithium or suicidality in BD patients. This symposium will first focus on studies that aim to address the existing gap between research efficacy and clinical effectiveness of lithium treatment in BD. New findings on the reliability and validity of the most commonly used scales for the measurement of lithium response will be discussed, highlighting potential ways to enhance their clinical utility and to fill the gap efficacy-effectiveness.

Moreover, data from the R-LINk initiative, which aims to optimize the lithium response through the personalized evaluation of individuals with BD, will be presented. Next, the speakers will focus on suicidal behaviour, a severe complication associated with BD, and will show studies concerning the impact of genetics and early adverse environmental factors e. Finally, genomic, transcriptomic, proteomic and epigenomic data from a large cohort of patients affected by BD and related disorders e. Chairs: Jose Manuel Goikolea, Spain. Frank Bellivier, France. The state of evidence for shared etiologies across psychiatric disorders.

Chairs: Mark Weiser, Israel. Hilleke Hulshoff Pol, The Netherlands. Monday 08 Oct E. Chairs: Stefano Pallanti, Italy. Monday 08 Oct CA. The PRISM project aims to define a set of quantifiable biological parameters for social withdrawal and cognitive deficits to cluster and differentiate patients with these disorders.

During this campfire, participants will have the unique opportunity for high quality engagement and interactions by questions and discussion with key experts from the PRISM project. Experts: Martien Kas, The Netherlands. Hugh M. Marston, United Kingdom. Moreover, effective interventions in this area should not only prevent mental illness, but also promote a good mental health. Whilst there is an undoubtable degree of overlap between prevention of mental disorders and mental health promotion, the latter has remained on the margins.

Cambridge Pocket Clinicians: Dermatology: Diseases and Therapy

This campfire will offer an opportunity of debate on this intriguing topic with a key expert in the field. Experts: Stefan Borgwardt, Switzerland. Monday 08 Oct CB Coffee break. Monday 08 Oct PV Poster viewing Posters that are on display can already be viewed during this time. Monday 08 Oct J. Chairs: Iria Grande, Spain. Age at first episode modulates progressive cortical thinning in individuals with psychosis. Phenomenology and neurobiology of inner speech in healthy subjects and its implication in understanding of auditory verbal hallucinations.

Pregabalin reduces smoking and drinking in alcohol dependent subjects. Effects of a novel G protein-biased opioid, PZM21, on nociceptive and addiction-like behavior in mice. Responsivity of the brain reward network to the taste of beer in light, at-risk, and dependent alcohol users. Chairs: Sue Wilson, United Kingdom. Ketamine reduces alcohol consumption in hazardous drinkers by interfering with the reconsolidation of drinking memories: Preliminary findings.

Norepinephrine transporter occupancy of venlafaxine in patients with major depressive disorder using positron emission tomography and [18F]FMeNER-D2. Monday 08 Oct PL. Chairs: Elisabeth Binder, Germany. Monday 08 Oct L Lunch. Monday 08 Oct CD. This means that scientists are often reluctant to step forward to inform the public — with the resultant information vacuum often being filled by non-experts.

Cambridge Pocket Clinicians: Maternal-Fetal Medicine

Psychiatric and neurodegenerative disorders represent a significant challenge for communication to the general public, given their intrinsic complexity and the difficult advance in understanding the brain and its diseases. Starting from such premises, the speaker of this session will give attendees some basic tools to help understand how to fill the gap between the scientific community and the general public and what type of research material might interest the press.

An understanding of these principles may also open other career opportunities for scientists and clinicians with a neuroscience background. Chairs: Emma Robinson, United Kingdom. Monday 08 Oct TP. Chairs: Kim Q. Do, Switzerland. Chairs: Carmen Moreno, Spain. Chairs: Michelle Roche, Ireland. Monday 08 Oct TA Travel award ceremony. In many states and countries, cannabis now stands poised to join alcohol and tobacco as a legal drug. Whereas newspaper headlines have focused on the links between cannabis and psychosis, less attention has been paid to the much more common problem of cannabis addiction.

Certain cognitive changes have been attributed to cannabis use, although their causality and longevity are fiercely debated. Identifying why some individuals are more vulnerable than others to the adverse effects of cannabis is now of paramount important to public health. This symposium will provide a state-of-the-art review of the factors which influence the mental health effects of cannabis.