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Management of the mental health patient is a concept that has gradually evolved in many countries and cultures. Traditional mental health care is critical in providing support to societies and communities that would otherwise have no one to attend to the coexisting physical and mental illnesses. Over the past few years there have been moves to facilitate collaboration between traditional practitioners and Western practitioners. The collaboration has taken place in countries such as South Africa and India, where national health policies have been amended to try and recognize the role of traditional practitioners. The complexity of mental health systems in some countries may be increased by the parallel operation of traditional healers and Western-style practitioners. One of the main obstacles hindering collaboration between Western-style practitioners and traditional practitioners concerns human rights abuses that can occur in prayer camps and traditional shrines.
This chapter reviews how functions of genetic susceptibility factors can be validated, specifically using disrupted in schizophrenia 1 (DISC1) as an example. Studies at multiple levels, from protein chemistry, cell biology, animal study, to clinical work provide comprehensive understanding of the functions of susceptibility factors. Once genetic studies identify candidate susceptibility factors for the diseases, functions of such proteins can be tested in cells by modulating expression of the target molecules or by expressing their genetic variants. The chapter describes rodent models with manipulations for genetic susceptibility factors of mental illnesses in greater detail. A series of studies by Weinberger and associates has pioneered the possible correlation of brain dysfunction with genetic variations in susceptibility factors associated with mental illnesses. To identify mechanistic links from genetic factors to the phenotypes, especially those observed during brain development and maturation, a combination of human studies with animal experiments is expected.
Mindfulness meditation (MM) practices constitute an important group of meditative practices that have received growing attention. The aim of the present paper was to systematically review current evidence on the neurobiological changes and clinical benefits related to MM practice in psychiatric disorders, in physical illnesses and in healthy subjects.
Method
A literature search was undertaken using Medline, ISI Web of Knowledge, the Cochrane collaboration database and references of retrieved articles. Controlled and cross-sectional studies with controls published in English up to November 2008 were included.
Results
Electroencephalographic (EEG) studies have revealed a significant increase in alpha and theta activity during meditation. Neuroimaging studies showed that MM practice activates the prefrontal cortex (PFC) and the anterior cingulate cortex (ACC) and that long-term meditation practice is associated with an enhancement of cerebral areas related to attention. From a clinical viewpoint, Mindfulness-Based Stress Reduction (MBSR) has shown efficacy for many psychiatric and physical conditions and also for healthy subjects, Mindfulness-Based Cognitive Therapy (MBCT) is mainly efficacious in reducing relapses of depression in patients with three or more episodes, Zen meditation significantly reduces blood pressure and Vipassana meditation shows efficacy in reducing alcohol and substance abuse in prisoners. However, given the low-quality designs of current studies it is difficult to establish whether clinical outcomes are due to specific or non-specific effects of MM.
Discussion
Despite encouraging findings, several limitations affect current studies. Suggestions are given for future research based on better designed methodology and for future directions of investigation.
Sociological approaches to psychological well-being are fundamentally different. The distinctive emphasis of sociological approaches is on how processes such as life events, social conditions, social roles, social structures, and cultural systems of meaning affect states of mind. Many sociologists study how social conditions affect levels of mental health. Most research that takes place in clinical settings examines particular types of mental illnesses, such as schizophrenia, bipolar disorder, major depression, and obsessive-compulsive disorder. Emile Durkheim's study, Suicide, is generally regarded as the first explicitly sociological study of mental health. Contemporary studies in the sociology of mental health confirm the importance of social integration as a fundamental cause of well-being. Social inequality relates not only to economic and work conditions but is also an aspect of all social institutions. Birth cohorts are another social influence that shapes mental health. Generational factors also affect general levels of well-being and distress.
from
Part III
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Social factors and the outcome of psychosis
By
Graham Thornicroft, Health Service and Population Research Department, Box 29, Institute of Psychiatry De Crespigny Park, London, UK,
Aliya Kassam, Health Service and Population Research Department, Box 29, Institute of Psychiatry De Crespigny Park, London, UK
This chapter focuses on people who have diagnoses of mental illnesses. The stigma concept has been used extensively for some particular physical conditions. The focus on the core concept of stigma has also separated the field of mental illness from the mainstream of disability-related policy and, in particular, the stigma idea has offered policymakers and politicians few recommendations for action. 'Stigma' can be seen as an overarching term that contains three important elements: problems of knowledge (ignorance); problems of attitudes (prejudice); and problems of behaviour (discrimination). Most of the published work on mental health and stigma consists of attitude surveys, but very few have been repeated over time to see if attitudes are becoming more or less favourable. A series of common beliefs about mental illnesses have developed, which are firmly held but not based firmly on evidence. These are often described by experts as 'myths'.
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