bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing shunts
Authors: Grosse-Wortmann Lars
Published: October 2018

Appropriate care for patients with shunt lesions mandates an exact understanding of their anatomy and haemodynamics. While echocardiography remains the first-line imaging tool and is frequently sufficient in the evaluation of shunts, there are situations in which the anatomical delineation remains incomplete and the shunt magnitude is uncertain. Cardiovascular magnetic resonance (CMR) demonstrates the anatomy of intra- and extra-cardiac shunts and is the gold standard for the quantification of shunt magnitude and ventricular volume loading. Particularly in complex shunt lesions and patients with insufficient acoustic windows, CMR is a valuable diagnostic tool. Short-cut communications between the pulmonary and systemic circulation shunts occur in isolation or as part of complex congenital heart disease. This chapter explores how CMR aids in the diagnosis, workup, and interventional planning of shunt lesions.
CMR for transposition of the great arteries
Authors: Babu-Narayan Sonya V
Published: October 2018

In this chapter, a cardiovascular magnetic resonance (CMR) imaging approach to complete transposition of the great arteries after atrial redirection (Mustard or Senning operation) or arterial switch surgery is discussed, as well as the Rastelli procedure for transposition of the great arteries, ventricular septal defect, and pulmonary stenosis. Congenitally corrected transposition of the great arteries, either unoperated or following anatomical or physiological repair, is also described. In these conditions, CMR is acknowledged to have high utility, including for accurate quantification of right, as well as left, ventricular function, to enable imaging of the aorta and pulmonary arteries, baffles, and conduits, and for the identification of myocardial fibrosis. Information from CMR aids prognostication and planning of intervention.
The single ventricle and surgical palliation
Authors: Fogel Mark A , Helbing Willem A
Published: October 2018

About 10% of patients with congenital heart disease have a univentricular heart, which includes a wide variation of diagnoses. These may occur in the setting of anomalies of cardiac and visceral situs. When considering treatment options, a practical approach has been to define univentricular heart disease as the heart in which just one ventricle is present that can sustain the circulation, whether anatomically or functionally. Treatment consists of staged palliation, starting with an aortic-to-pulmonary anastomosis, if required, and of stepwise separation of the systemic and pulmonary circulation, culminating in a total cavopulmonary connection where caval return passively flows into the lungs, bypassing the heart (called the Fontan procedure). Detailed anatomic, haemodynamic, and functional imaging is required throughout the staged treatment and during long-term follow-up. Cardiovascular magnetic resonance (CMR) is a widely recommended tool for this purpose. CMR imaging should include assessment of the pulmonary artery, the aortic arch to assess for arch obstruction, the ventricular outflow tract, systemic-to-pulmonary collaterals (aortic–pulmonary, veno-veno), anomalous venous structures, pulmonary or systemic veins, systemic venous return, ventricular size/function and blood flow, and tissue characterization for myocardial scarring. The focus of imaging may shift, depending on the stage of treatment. During staged palliation, CMR can be used to detect residual findings requiring additional interstage interventions. CMR is recommended after Fontan completion for serial follow-up of ventricular function, haemodynamics, physiology, and anatomical assessment of the Fontan pathway.
CMR in the multi-modality environment: status and perspectives
Authors: Rademakers Frank , Lombardi Massimo , Kramer Christopher
Published: October 2018

Cardiovascular magnetic resonance (CMR) as an imaging technique in cardiology is fairly recent, compared to echocardiography and nuclear imaging, but has evolved enormously over the last 20 years, with respect to technical improvements, and achieved much in terms of indications, validation, and prognostic implications. Due to several factors, including cost, expertise, availability to cardiac indications, and installed base, CMR remains underused, but things are improving, as witnessed by the growing use and increased presence of CMR in multi-modality guidelines. This can be further advanced by using the strengths of CMR and the expertise of the CMR community in the development of diagnostic pathways where CMR can find its legitimate place among the different imaging modalities. To convince the payers of this position, cost-effectiveness studies showing the efficiency and efficacy of CMR in specific indications are clearly needed. And in a world where patients themselves appropriately participate in their own diagnostic and therapeutic paths, involving patients more directly in setting up research and writing guidelines might be a key factor to the appropriate use of CMR.
7 T cardiac imaging
Authors: Robson Matthew
Published: October 2018

By increasing the field strength of the magnet used for magnetic resonance imaging (MRI), the available signal from the patient is enhanced, and this basic physics principle has driven the clinical MRI market to ever higher field strengths. Seven Tesla (7 T) scanners yield 4-5 times more signal than 1.5 T scanners; this signal-to-noise ratio increase facilitates high-resolution imaging, faster imaging when using accelerated techniques such as SENSE and GRAPPA, and greater sensitivity to low-concentration metabolites. Magnetic resonance spectroscopy acquisitions also benefit, owing to the greater chemical shift dispersion at ultra-high field. A significant difficulty is due to the radiofrequency excitation required that oscillates at 300 MHz, which results in destructive interference of the excitation fields and heating of the patient, and hence requires expensive additional hardware. While 7 T presents a great opportunity to cardiovascular MRI research, it is not yet a routine clinical tool, owing to the compound challenges of high cost, limited availability, and the difficulties of radiofrequency excitation at 300 MHz.
Diffusion tensor magnetic resonance imaging
Authors: Sosnovik David
Published: October 2018

The microstructure of the heart has a major impact on its mechanical and electrical properties. Diffusion tensor magnetic resonance imaging (DTI) exploits the anisotropic restriction of water diffusion in the myocardium to resolve its microstructure. Recent advances in the field have included the development of acceleration-compensated diffusion-encoded sequences, the investigation of sheet dynamics, and the development of highly accelerated techniques to enable whole heart coverage. Translational studies have demonstrated the utility of DTI in heart failure and other cardiomyopathies. While DTI of the heart remains investigational, ongoing advances in the field will soon allow the technique to be performed reliably and quickly in appropriate clinical scenarios.
Four-dimensional flow CMR
Authors: Bissell Malenka
Published: October 2018

Four-dimensional flow cardiovascular magnetic resonance allows visualization and quantification of blood flow in three-dimensional images in the heart and main blood vessels. Image acquisition currently takes around 8–30 minutes, depending on the area of interest. While temporal resolution is reduced, compared to two-dimensional flow analysis, the main advantages include easy prescription of acquisition, three-dimensional visualization, calculation of Qp/Qs in the same dataset, retrospective plane placement, and quantification of novel advanced imaging biomarkers.
Summary
Authors: Neubauer Stefan , Ferrari Victor
Published: October 2018

Cardiovascular magnetic resonance imaging (CMR) has developed over the past 20 years at breath-taking speed, with a technical effort that has fully anchored this method in mainstream cardiology. However, there is no reason to believe that such technical development has plateaued.
History of the Royal College of Psychiatrists’ Women’s Mental Health Special Interest Group
Authors: Mounty Jane , Cremona Anne , Ramsay Rosalind
Published: October 2018

This chapter describes the evolution of the Women’s Mental Health Special Interest Group of the RCPsych since its inception in 1996. Themes discussed. include understanding the specific needs of women patients, developing women’s mental health services, and improving the work−life balance of psychiatrists. Support for single-sex accommodation on in-patient wards and supporting carers, ethnic minority groups, and those with gender-specific and non-specific mental health problems are covered. The early establishment of a job-share register, and support for flexible training and working was followed by commitment to the gender equality initiatives of the Royal College, and following the ten-year anniversary, action through mentoring and role-modelling to support women psychiatrists aiming for top positions in their field whether clinical, academic, or managerial. The recent re-emergence of the Group under Dr Nicola Byrne and its goals for the future are described but there is still much work to be done.
Psychiatry and Patienthood
Authors: Lethem Rosemary
Published: October 2018

This chapter describes some of the author’s experiences as a psychiatrist and, simultaneously, a patient with a diagnosis of bipolar affective disorder, and how each influenced the other. This personal story is used as a framework to inform on relevant topics: working in psychiatry; treatments for depression including electroconvulsive therapy, antidepressant medication, psychotherapies, and support groups; classification of affective disorders; doctors’ mental health; services for sick doctors; recovery; and retirement, at a level designed to inform those considering a possible career in the field of mental health. The current person-centred approach to formulation and management is compared favourably with the ‘medical model’ hitherto widely in use. The ‘recovery’ paradigm is outlined, including its application in the United Kingdom.
Perinatal Psychiatry: Motherhood in Mental Health Services
Authors: Humphreys Jacqueline
Published: October 2018

Mental illness in the post-partum period was first documented in the 1800s. Early analysis of the impact of separating women and their babies has made the United Kingdom a world leader in psychiatric mother and baby units. However, perinatal psychiatry has lagged behind other specialties for recognition and funding; many areas still do not have specialist perinatal psychiatry teams. This chapter discusses whether cultural narratives of pregnancy and motherhood as a joyful experience have combined with the stigmatizing of mental health to create this environment. The treatment of pregnant and postnatal women requires consideration of factors not commonly found in other psychiatric specialties. Undertreatment of maternal mental illness has profound consequences, sometimes including the tragic death of the mother and child. However, the lobbying of perinatal psychiatrists (many of whom are women) and women with lived experience has led to increased recognition, funding, and training in the National Health Service.
Are Women’s Mental Health Units Needed?
Authors: Singh Aoife Rajyaluxmi
Published: October 2018

This chapter describes the shift from mixed-sex to same-sex in-patient wards in the United Kingdom and the current challenges in providing in-patient psychiatric care. Two women’s-only mental health units (WMHUs) are described and the views of women patients and staff are highlighted with the use of case examples. The available evidence regarding the need for WMHUs is examined and demonstrates that women with mental illness have different preferences with regards to mixed- or same-sex in-patient care, that same-sex wards are not necessarily safer, and that quality of care can vary considerably. Given the differential life experiences of women as compared to men, a WMHU should be able to address issues such as the effects of trauma and violence. Further research is needed to improve the understanding of the core factors underlying women’s mental illnesses and the specific skills that staff need to provide effective treatment.
A Woman the Government Feared: Barbara Robb (1912–76)
Authors: Hilton Claire
Published: October 2018

This chapter considers Barbara Robb, who wrote the bestseller, Sans Everything, in 1967. The book described degrading and undignified care provided to elderly patients on the long-stay wards of psychiatric hospitals, such as teasing, hitting, lack of privacy, and stripping of personal possessions including hearing aids, dentures, and spectacles. Sans Everything also contained suggestions to improve care. Barbara mobilized the media in her campaign, which placed significant pressure on the government. Her book and reputation for dealing with complaints led to revelations of other scandals of care, and investigations. She had remarkable strength of character to keep fighting in the face of public humiliation by the Ministry of Health. Ultimately, she made significant contributions to health service policy and practice.
Reducing the Risk of Dementia
Authors: Rodda Joanne
Published: October 2018

This chapter looks at the impact of health and lifestyle factors on the risk of developing dementia in later life. It provides a brief overview of dementia and its most common causes, and an explanation of the degree to which genetics play a role. It reviews the available evidence regarding the extent to which potentially modifiable risk factors including smoking, obesity, physical activity, cognitive activity, diet, alcohol, depression, and diabetes may contribute to a likelihood of developing dementia in later life. Both general dietary patterns and the evidence related to vitamin B12, folate, antioxidants, and omega 3 fatty acids are reviewed. Possible approaches to the conversion of this knowledge into a reduction in the prevalence of dementia in the future are discussed. It is written for anyone with an interest in dementia and potential opportunities to mitigate the impact on individuals and society.
The road less travelled
Authors: Bailey Sue
Published: October 2018

This chapter follows one person’s journey into psychiatry and a clinical career as a child and adolescent forensic psychiatrist. It covers the importance of taking a developmental understanding of clinical dilemmas set in social context and the often paradoxical attitudes of society throughout history towards those who are mentally ill and whose behaviour they fear, whether via harm to self or to others. It also considers how research can inform and improve practice and how serendipity can take a career along interesting routes of working with and shaping the decisions of policy-makers to improve mental health of populations and individuals. It describes how skills in mental health can improve practice across the whole of medicine and the importance of using emotional intelligence to enable clinical teams to deliver best care with true shared decision-making with patients and their families.
Global burden of diabetes and depression
Authors: Licinio Julio , Birkenfeld Andreas L. , Bornstein Stefan R.
Published: October 2018

Diabetes and depression are two of the major global health concerns in the twenty-first century. One way of measuring the global impact of these illnesses are the disability-adjusted life-years or DALYs. The calculation takes into account the average life expectancy of a specific country, the years lost by premature death, and the years lived with disability/disease. Furthermore, ongoing research has shown that interactions exist between depression and diabetes. Diabetes and other chronic diseases can lead to depression, while depression can increase the risk for developing diabetes or worsen the course of diabetes. In this book, the current understanding of the interactions between depression and diabetes will be discussed, highlighting various pathways in which these morbidities are linked. In addition, the authors give outlooks on how diabetes and depression might be treated in the future.
MicroRNAs as novel biomarkers in depression, diabetes, and cardiovascular diseases
Authors: Almedawar Mohamad M. , Siow Richard C. , Morawietz Henning
Published: October 2018

Diabetic, depressive, and cardiovascular disorders are leading causes of morbidity. In diabetics, symptoms of depression are associated with increased clinical complications. Diabetes mellitus is a major risk factor of cardiovascular diseases (CVDs). The vascular depression hypothesis suggests that CVD can increase the risk of depression or exacerbate depression-related conditions. Several studies found a strong correlation between depression and pre-existing vascular disease and vice versa. Recent studies implicate microvascular dysfunction in the pathophysiology of depression and CVD. In addition, microRNAs are potent regulators of gene expression in physiological and pathophysiological processes affecting the microcirculation. We propose an interaction between diabetes mellitus, depression, and CVD involving changes in microcirculation and microRNA expression. Hence, studies are warranted to develop novel microRNA therapeutics and biomarkers to identify diabetic patients at increased risk of developing clinical complications of depression.
Genetics
Authors: Kan Carol , Wong Ma-Li
Published: October 2018

An association between type 2 diabetes mellitus (T2DM) and depression has been reported in epidemiological studies. Finding a genetic overlap between T2DM and depression will provide evidence to support a common biological pathway to both disorders. Genetic correlations observed from twin studies indicate that a small magnitude of the variance in liability can be attributed to genetic factors. However, no genetic overlap has been observed between T2DM and depression in genome-wide association studies using both the polygenic score and the linkage disequilibrium score regression approaches. Clarifying the shared heritability between these two complex traits is an important next step towards better therapy and treatment. Another area that needs to be explored is gene–environment interaction, since genotypes can affect an individual’s responses to the environment and environment can differentially affect genotypes expression.
Innate immunity and inflammation in type 2 diabetes-associated depression
Authors: Moulton Calum D. , Pickup John C.
Published: October 2018

Depression affects 10%–20% of patients with type 2 diabetes (T2D) and predicts twofold increased risk of complications and mortality. There is growing evidence that biological mechanisms such as innate inflammation may link the two conditions. In particular, recent epidemiological findings have reported elevated inflammation in patients with depression and T2D compared with those with T2D alone. Aetiologically, elevated inflammation is likely to result from multiple stressors across the life-course. Clinically, inflammation may lead to predominantly somatic symptoms. Therapeutically, there is tentative evidence that anti-inflammatory therapies could improve depressive symptoms and glycaemic control concurrently. There is now a need (1) for prospective epidemiological research to define the aetiology of elevated inflammation; (2) for mechanistic research to test how inflammation can lead to both conditions concurrently; and (3) for interventional research to define modifiable immune pathways to improve both psychological and biomedical outcomes in people with T2D.
Hypothalamic–pituitary–adrenal axis
Authors: Young Allan H. , Juruena Mario F.
Published: October 2018

Increased adrenocortical secretion of hormones, primarily cortisol in depression, is one of the most consistent findings in neuropsychiatry. The maintenance of the internal homeostatic state of an individual is facilitated by the ability to circulate glucocorticoids to exert negative feedback on the secretion of hypothalamic–pituitary–adrenal (HPA) hormones through binding to mineralocorticoid and glucocorticoid receptors, thus limiting the vulnerability to diseases related to psychological stress in genetically predisposed individuals. The HPA axis response to stress can be thought of as a crucial part of the organism’s response to stress: acute responses are generally adaptive, but excessive or prolonged responses can lead to deleterious effects. A spectrum of conditions may be associated with increased and prolonged activation of the HPA axis, including depression, poorly controlled diabetes mellitus, and metabolic syndrome. HPA axis dysregulation and hypercortisolaemia may further contribute to a hyperglycaemic or poorly controlled diabetic state.
Gut–brain axis: Physiology and pathology
Authors: Petrella Carla , Nisticò Giuseppe , Nisticò Robert
Published: October 2018

A large body of research has shown the presence of a complex pathway of communication between gut and brain. It is now recognized that, through this pathway, microbiota can influence intestinal homeostasis and modulate brain plasticity in normal and pathological conditions. This chapter provides an overview of preclinical and clinical evidence supporting the possible mechanisms whereby microbiota can influence gastrointestinal function and stress-related behaviour. Since normalization of gut flora can prevent changes in behaviour, the authors further postulate that the gut–brain axis might represent a possible target for pharmacological and dietary strategies aimed at improving intestinal and mental health.
The association between depression and cognitive impairment in type 2 diabetes
Authors: Moulton Calum D. , Ballard Clive
Published: October 2018

Type 2 diabetes (T2D) is an established risk factor for vascular dementia and Alzheimer’s disease, yet, the reasons are incompletely understood. To date, intervention studies targeting isolated risk factors, such as hypertension or hyperglycaemia, have proved unsuccessful. Several well-designed cohort studies have suggested that depression predicts cognitive decline in patients with T2D. However, these studies, all of later-life depression, have not fully excluded the potential for clinical overlap between depression and dementia. Mechanisms linking depression and cognitive decline may include increased vascular risk and activation of the innate inflammatory response. Future cohort studies are needed to test the effects of earlier life depression on cognitive outcomes in T2D. Mechanistic research is needed to define pathways by which depressive symptoms could lead to both vascular dementia and beta-amyloid accumulation. Finally, intervention studies should test whether depression is a potential target for the primary- or secondary prevention of cognitive decline in T2D.
Psychotropic drugs and metabolic risk
Authors: Barthel Andreas , Bauer Michael
Published: October 2018

Increased appetite and weight gain represent a significant problem related with particular antipsychotic drugs, antidepressants, mood stabilizers, and—to a lesser extent—anxiolytic drugs. Psychotropic drug-induced weight gain may contribute to obesity-related metabolic changes and pathological conditions such as dyslipidaemia, type-2-diabetes and hypertension—summarized as the metabolic syndrome—with an increased risk for cardiovascular morbidity and mortality. Interestingly, psychotropic drugs are also used for the treatment of diabetes-related complications. For example, antidepressants are effective for the treatment of neuropathic pain in patients with diabetic neuropathy. Therefore, it is essential to thoroughly balance potential benefits and risks in an individual patient to ensure drug safety and optimize the clinical outcome. In addition to diet and exercise, selection of psychotropic drugs and dose adjustment based on regular clinical follow-up visits is the key for the prevention and management of psychotropic drug induced weight gain in clinical practice.
Targeting the circadian system
Authors: Potter Gregory D. M. , Scott Eleanor M.
Published: October 2018

Circadian (approximately 24-hour) rhythms are generated by a hierarchical system responsible for coordinating behaviour and physiology throughout the 24-hour day. Increasing evidence supports roles for disruption of the circadian system in the development of type 2 diabetes (T2DM) and depression. We outline the key aspects of circadian system regulation, discuss the findings indicating that biological disruption of the circadian system produces various behavioural and metabolic abnormalities, and review human studies which show that environmental disruption of the circadian system contributes to T2DM and depression. Finally, we will summarize the therapeutic potential of restoring circadian system organization to manage these diseases.
Cultural and global perspectives
Authors: Winkley Kirsty , Al-Ozairi Ebaa , Chew Boon-How
Published: October 2018

Depression and disease-related psychological problems in type 2 diabetes (T2DM), termed diabetes distress (DD), is a global problem and negatively impacts quality of life, self-management, and cardiovascular mortality. However, risk factors for and consequences of emotional distress vary and have different cultural meaning. In the East and low- to middle-income countries (LMIC), contextual factors, socio-demographics, low socio-economic status, and sub-optimal health/medical services predispose DD more than in the West and high-income countries (HIC). People from non-Western and LMIC may hold a more stigmatizing view of depression leading to mislabelling depression due to somatization, underdiagnosis, and a lack of clinical care. The prevalence of depression and DD is generally double in LMIC compared with HIC. There is a lack of direct and good-quality evidence of depression and DD’s effects on clinical outcomes, therefore improving access to effective treatment for depression and DD remains a global challenge.
National and international policy initiatives on multimorbidity
Authors: Schwarz Peter E. H. , Timpel Patrick
Published: October 2018

This chapter presents a reflection on different policy initiatives targeting multimorbidity. Owing to its global impact on public health, type 2 diabetes is used as an example in this context. Challenges on different levels are illustrated, and the implementation and limitations of scaling-up processes in integrated care initiatives as well as national policies on the prevention of chronic diseases are discussed. Questions on the responsibilities of society, government, and insurance companies to jointly tackle the epidemiologic challenges are addressed and general conclusions on the different approaches are drawn. One important issue significantly hampering the development, implementation, and scaling up of effective policies is the lack of sufficient long-term evaluations. To accomplish sustained improvements of the current public health situation, a strategic shift from individual to shared responsibilities of the different parties is needed. The chapter concludes with proposals for prevention policies and general recommendations for policy development.
Social factors and mental health
Authors: Craig Tom K. J.
Published: October 2018

The social environment plays a significant role in the onset, course and outcome of mental disorders. The impact has been conceptualised in two broad ways. First, in terms of unspecified aspects of how society is structured, as for example the observation of much higher rates of mental illness in areas of high population density or among minority ethnic populations. Second, through an attempt to drill down to what it is about these environments that is toxic—typically exploring associations between illness and stressful experiences, especially those involving abusive and bullying interactions. Both models also suggest preventive and restorative social interventions that could modify how mental health care is delivered.
The epidemiological burden of major psychiatric disorders
Authors: Dykxhoorn Jennifer , Kirkbride James B.
Published: October 2018

Psychiatric disorders, including common mental disorders, schizophrenia, and suicide, contribute substantially to the global burden of disease in terms of both morbidity and premature mortality, making them an important issue for public mental health. Epidemiological tools quantifying the burden of psychiatric disorders are important in furthering our understanding of psychiatric disorders and informing decision-making. In this chapter, we review major epidemiological studies from the past 30 years of psychiatric epidemiology to provide an overview of the burden of common mental disorders (depression and anxiety), psychotic disorders (schizophrenia and other psychotic disorders), and suicide. We also describe how the incidence and prevalence of these disorder vary by person and place, with a particular focus on the patterns of psychiatric disorders by ethnicity. Finally, we discuss the challenge of applying epidemiological evidence to public health, highlighting key issues facing public health professionals, researchers, and policymakers working in public mental health.
Critical epidemiology
Authors: Rosenberg Felix J. , Miranda Daniel
Published: October 2018

Critical epidemiology is the science of understanding and describing the distribution of health as socially determined and of contributing to the achievement of the universal right to it. e many causes of meDirect and indirect causation, and distant, intermediate, or proximate levels of organization of the epidemiological interrelations are all part of an integrated totality built by the historically changing dialectic relationship of particular social classes with their lived spaces. Critical epidemiology is, at last, the means to understand this relationship and to select the ‘[T]erritories of social exclusion’ as the prioritized targets for a participative construction of new health models leading to the effective reduction of health inequities and, hence, to universalize the right to health in all its objective and subjective meanings.
Public mental health and occupational health
Authors: Barnes Katie Blissard , Henderson Max
Published: October 2018

This chapter describes the wide-ranging role of occupational health in optimizing the health of the workforce and the workplace. In doing so it highlights the importance of the workplace for improving public mental health. It examines the relationship between work and public mental health from a number of angles, and describes how in the context of health inequalities mental health can each be seen as both an exposure and an outcome. It explores the impact that work can have on mental health. The main models describing the psychosocial work environment are explained. The chapter also explores the effect poor mental health can have on the workplace at an individual, organizational, and wider economic perspective. The unique role of occupational health in supporting employees and employers and benefits at the population level are emphasized.
Health equity
Authors: Hashimoto Hideki , Kawakami Norito
Published: October 2018

Health equity examines the circumstances in which there are no unnecessary or unavoidable disparities in health consequences and/or access to resources and opportunities in order to achieve health in the context of an individual’s needs so that society can realize justice as a whole. What exactly should be achieved for equity depends on the ethical basis referred to. Mental ill health can be a consequence and a cause of health inequity. The chapter reviews how inequity in socio-economic conditions and capabilities, including—but not limited to—access to healthcare services, affects people’s risk of mental ill health from the life course perspective. It also reviews the social stigma and subsequent social exclusion of those with mental ill health, which further precludes health equity. Finally, the concept of ‘social determinants of health’ as a policy agenda to realize health equity in public mental health provision is reviewed.
Housing and mental health
Authors: Craig Tom K. J. , Boardman Jed
Published: October 2018

There are strong links between housing quality and ill health, in particular infections, chronic diseases, and injuries. Poor-quality housing is associated with mental illness, although the links are complex given the fact that decrepit housing is often also high rise, multiple occupancy, and located in neighbourhoods characterized by vandalism, graffiti, and crime. People suffering from severe conditions such as schizophrenia are particularly sensitive to these stressful environments and many struggle to manage day to day, running into difficulties maintaining their home and keeping up with rent or mortgage payments. Therefore, early approaches emphasized a step-wise approach through progressively more independent settings, from hospital to group home, despite the fact that the majority of people would prefer independent living. Today, such stepped resettlement is being challenged by ‘housing first’ approaches that bypass the traditional rehabilitation model placing people directly into permanent housing with the flexible support they need to maintain it.
Social class and mental health
Authors: Brenner M. Harvey
Published: October 2018

The Great Depression saw increasingly higher rates of mental disorder at successively lower social class levels. These findings have been repeated over the twentieth and twenty-first centuries. Dynamic interpretations of these relations have concentrated on vulnerability to economic crises, resulting in major increases in mental hospitalization and suicide. These studies have shown psychological morbidity and suicide to be strongly influenced by employment and income loss. Did the Great Recession re-enact the Great Depression’s mental health crisis for world societies? Recent literature shows substantially elevated psychological disorder in the Great Recession across industrialized societies. New multivariate analyses, using gross domestic product declines and unemployment increases as the main recessional indicators, find that world suicide and industrialized country overall mortality rates increased owing to the Great Recession and government austerity. A paradigm is presented of the circular relations linking economic crises, social class, and the interactive relations of mental and physical health.
Social determinants in low-income countries
Authors: Ahmed Syed Masud , Hossain Mohammad Didar
Published: October 2018

Mental health disorders are increasingly being recognized as an important public health problem in low-income countries of Asia and Africa. For people of low-income countries, poverty is all pervasive and affects physical, as well as mental, health in various ways. Common mental disorders (CMD), such as anxiety and depression, are quite common among these populations. Social determinants—such as poverty and exclusion; low level of education; violence against women, including intimate partner violence; unemployment; unhygienic living and work environment; and social capital—play a significant role in precipitating CMD at different stages of life. The association is not always straightforward as sometimes these determinants act in a vicious circle (e.g. poverty and mental illnesses), which, in turn, is exacerbated by other determinants such as low education and unemployment. To address this complex problem, tackling of these important social determinants is essential and should be prioritized.
Clinical outcome assessment in mental health
Authors: Barbic Skye P. , Cano Stefan J.
Published: October 2018

Clinical outcome assessment (COA) in mental health is essential to inform patient-centred care and clinical decision-making. In this chapter, the reader is introduced to COA as it is evolving in the field of mental health. Multiple approaches to COA are presented, but emphasis is placed on approaches that generate clinically meaningful data. Understanding COA can position clinicians and stakeholders to better evaluate their own practice and to contribute to the ongoing evolution of COA research and evidence-based medicine. This chapter begins with the definitions of assessment and measurement. Conceptual frameworks and models of COA development and testing are then presented. These are followed by a discussion of measurement in practice that reviews measurement issues related to clinical decision-making, programme evaluation, and clinical trials. Finally, this chapter highlights the contribution of metrology to improving health outcomes of individuals who experience mental health disorders.
Prisoners and mental health
Authors: Appelbaum Kenneth L.
Published: October 2018

This chapter examines how incarceration affects public mental health and safety. It describes the benefits of mental health treatment during and after incarceration for individual patients and for society. It also reviews how the conditions of confinement can make inmates either better or worse, including the detrimental effects that harsh prison environments can have on future criminal behaviour. The chapter examines the history and misconceptions about rehabilitative programmes and the effectiveness of evidence-based interventions in reducing recidivism. It describes how mass incarceration has had great fiscal and social costs but few beneficial effects on crime rates. Finally, it reviews the advantages of alternatives to incarceration for individual offenders, family members, and the broader community.
Sexual minority adolescents and mental health
Authors: Montoro Richard
Published: October 2018

Sexual minority youth is a broad term that includes adolescents from both sexual orientation and gender minorities. As a major task of adolescence is identity formation, sexual minority youth are particularly vulnerable during this period of self-definition (‘coming out’) both because of societal stigma and traditionally poor parental support. This chapter will start by defining the common terms used by the diverse identities in this population and outlining basic concepts in sexual orientation and gender identity. The literature demonstrating the central role of stigma in creating the mental health disparities of sexual minority youth will be reviewed. As stigma is present at individual, interpersonal, and structural levels, the chapter will conclude with a discussion of the multiple multi-level interventions necessary to have an impact on these disparities. Policymakers and clinicians are uniquely positioned to have a powerful impact on the mental health disparities of sexual minority youth.
Prevention approaches to reduce alcohol-related harm
Authors: Gilmore William , Brown Katherine , Gilmore Ian
Published: October 2018

The health, social, and economic effects of alcohol use are experienced by drinkers, families, communities, and society at large. Alcohol use is inextricably linked to a range of mental health problems. It may be the primary problem or part of the co-morbidities that accompany so much mental illness. Alcohol use is also associated with many other health conditions, including liver disease, cardiovascular disease and cancer, and is strongly linked to violence, accidents, self-harm, suicide, and fetal alcohol spectrum disorder. This chapter outlines both primary and secondary prevention approaches to reduce alcohol-related harm that are evidence-based. Primary prevention approaches include regulating alcohol affordability, availability, and promotion, and providing information and education. Secondary prevention approaches include early identification and brief advice.
Promoting mental health and well-being
Authors: Weare Katherine
Published: October 2018

Schools are increasingly concerned with the well-being and mental health of their students. Effective schools use a ‘whole-school approach’ based on universal work from which targeted approaches gain coherence and support. The ethos is supportive, connected, and safe, with active steps to tackle stigma. ‘Difficult’ behaviour is seen as meaningful, and as an opportunity for learning and growth. Both risk factors and the building of resilience are addressed. Students and families are involved, ‘heard’, and engaged. Programmes to cultivate social and emotional skills are taught effectively with clear aims, programme fidelity, starting early, and carrying on for the long term. There are robust and clear processes to identify early, refer, and treat those with greater levels of mental health difficulty, integrated into the whole-school approach, involving the young person and their family, liaising closely with specialist services, and with easy and transparent pathways to timely and effective interventions.
Early intervention in psychiatry
Authors: Castle David J. , Lusicic Ana , Petrakis Melissa
Published: October 2018

Early intervention in psychiatry has enormous appeal in the sense that it can reduce distress and disability and promote better long-term outcomes. However, extant research is patchy in terms of defining precisely what ‘early intervention’ should entail, as well as determining the elements of such interventions that might be helpful and not harmful. This chapter provides a brief overview of selected disorders, encompassing examples of disorders that have an onset in childhood (autism), teenage years/early adulthood (bipolar disorder), and in later life (dementia). The chapter then focuses on schizophrenia, as schizophrenia is a disorder ubiquitous across the globe in terms of prevalence, which carries substantial disability, and for which there has been a worldwide investment in early intervention.
Poverty and interpersonal violence
Authors: Supraja T. A. , Padmavathy D. , Chandra Prabha S.
Published: October 2018

The aim of this chapter is to provide a theoretical and conceptual understanding of poverty and interpersonal violence and to offer insights into strategies that be used in working with different groups of people facing these issues. The chapter discusses the definitions and classifications of interpersonal violence. It moves on to explain the relationship between poverty and interpersonal violence and to examine the same based on existing theoretical approaches. The impact of these factors on persons across the lifespan is outlined followed by a section describing specific interventions that have been implemented with various groups faced with challenges due to poverty and interpersonal violence. Recommendations for future work regarding these issues are given.
Resilience and the role of spirituality
Authors: Cook Christopher C. H. , White Nathan H.
Published: October 2018

This chapter addresses the importance of spirituality in positive adaptation to adversity, often called resilience. Recognition of the significance of spirituality for clinical and public mental health applications is growing, yet has often been under-recognized. Spirituality may provide both a valuable perspective on resilient adaption and resources for supporting that adaptation. As an environmental influence, spirituality exerts itself at personal and communal levels through a number of associated constructs, such as self-efficacy, meaning, and transcendence. On the whole, research indicates that spirituality is positively correlated with health and inversely correlated with psychopathology, although negative associations with spirituality may also occur. Owing to the significance of spirituality in resilient adaptation, clinicians and public mental health policymakers are encouraged to support existing personal and communal spiritual strengths in the promotion of well-being.
Working with traditional healers to reduce the mental health treatment gap in low- and middle-income countries
Authors: Ndetei David M. , Musyimi Christine W. , Nandoya Erick S. , Matoke Lydia , Mutiso Victoria N.
Published: October 2018

Traditional healers have a unique role to play, especially in resource-limited settings. Although more than half of the community members in Africa consult healers, the majority of them have no formal training and thus identify and treat mental illness through experience or apprenticeship. The duration of training can take from several weeks to years, depending on the ability of the apprentice or the individual’s motivation to learn. An informal certification or being given the mandate to treat patients is certified by the trainer who is mostly a fellow healer or an older relative. This chapter discusses the roles, knowledge, attitude, and practice of traditional healers in mental health care, as well as unwarranted practices that have been regulated through the Traditional Health Practitioners’ Bill and Act. Recommendations for future plans to encourage their participation in mental health care are also outlined at the end of the chapter.
Stapes surgery
Authors: Aldren Christopher
Published: October 2018

This chapter discusses Shea’s 1998 paper on otosclerosis including the design of the study (outcome measures, results, conclusions, and a critique).
Ossiculoplasty
Authors: Aldren Christopher
Published: October 2018

This chapter discusses Colletti, Fiorino, and Sittoni’s paper on ossiculoplasty including the design of the study (outcome measures, results, conclusions, and a critique).
Tympanic membrane perforations
Authors: Selvadurai David , Oikonomou Georgios
Published: October 2018

This chapter discusses Macfadyen, Acuin, and Gamble’s paper on systemic antibiotics versus topical treatments for chronically discharging ears with underlying eardrum perforations including the design of the study, (including outcome measures, results, conclusions, and a critique).
Eustachian tube function
Authors: Whiteside Olivia
Published: October 2018

This chapter discusses Smith and Tysome’s paper on Eustachian tube function including the design of the study (including outcome measures, results, conclusions, and a critique).
Malignant otitis externa
Authors: Selvadurai David , Oikonomou Georgios
Published: October 2018

This chapter discusses Chandler’s 1968 paper on Malignant external otitis including the design of the study (outcome measures, results, conclusions, and a critique).
Impedance audiometry
Authors: Keaton Casie
Published: October 2018

This chapter discusses Jerger’s 1970 paper on clinical experience with impedance audiometry including the design of the study (outcome measures, results, conclusions, and a critique).
A facial nerve grading system
Authors: Kutz Walter
Published: October 2018

This chapter discusses House’s 1983 and 1985 papers on the facial nerve grading system (the House–Brackmann Facial Nerve Grading Scale (HBGS)) including the design of the study (outcome measures, results, conclusions, and a critique).
Medical management of Bell’s palsy
Authors: Phillips John
Published: October 2018

This chapter discusses Sullivan, Swan, Donnan, Morrison, Smith, McKinstry, Davenport, Vale, Clarkson, Hammersley, Hayavi, McAteer, Stewart, and Daly’s 2007 paper on the medical management of Bell’s palsy including the design of the study (outcome measures, results, conclusions, and a critique).
Tinnitus in normal hearing individuals
Authors: McFerran Don
Published: October 2018

This chapter discusses Heller and Bergman’s 1953 paper on tinnitus in normal hearing individuals including the design of the study (outcome measures, results, conclusions, and a critique).
The head thrust test
Authors: Murdin Louisa
Published: October 2018

This chapter discusses Halmagyi and Curthoy’s 1988 paper on the head thrust test including the design of the study (outcome measures, results, conclusions, and a critique).
Ménière’s disease
Authors: Murdin Louisa
Published: October 2018

This chapter discusses Pearson and Brackmann’s 1985 paper on Ménière’s disease including the design of the study (outcome measures, results, conclusions, and a critique).
Vestibular migraine
Authors: Murdin Louisa
Published: October 2018

This chapter discusses Neuhauser, Leopold, von Brevern, Arnold, and Lempert’s 2001 paper on vestibular migraine including the design of the study (outcome measures, results, conclusions, and a critique).
Hearing preservation in vestibular schwannoma surgery
Authors: Rompaey Vincent Van
Published: October 2018

This chapter discusses Gardner and Robertson’s paper on hearing preservation in vestibular schwannoma surgery including the design of the study (outcome measures, results, conclusions, and a critique).