bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamic contrast-enhanced perfusion CMR
Authors: Nagel Eike , Schwitter Juerg , Arai Andrew
Published: October 2018

Dynamic contrast-enhanced perfusion cardiovascular magnetic resonance (CMR) visualizes the first passage of a peripherally injected contrast agent bolus through the left ventricle and myocardium. The presence and extent of myocardial ischaemia is assessed during vasodilation using adenosine or regadenoson and, in most cases, is repeated at rest. Contrast-enhanced perfusion CMR methods use electrocardiogram-gated fast T1-sensitive imaging to capture the signal changes during contrast agent passage with high temporal (every or every other heartbeat) and spatial (below 3 × 3 mm in-plane, up to submillimetre) resolution, allowing the detection of subendocardial ischaemia and microvascular disease. In clinical routine, perfusion CMR data are mostly visually interpreted but can also be analysed semi-quantitatively by describing or quantitatively. Perfusion CMR is highly accurate in detecting significant coronary artery stenoses. Combined with cine and late gadolinium enhancement imaging, it provides comprehensive assessment and risk stratification of patients with known or suspected coronary artery disease and is gaining an increasing role in international practice guidelines.
Early and late gadolinium enhancement
Authors: Selvanayagam Joseph , Nucifora Gaetano
Published: October 2018

The peculiar features of gadolinium-chelated contrast agents and the development of contrast-enhanced inversion recovery technique in the late 1990s formed the basis of early and late gadolinium enhancement imaging, revolutionizing the application of magnetic resonance imaging in patients with cardiac diseases. Several clinical studies have indeed demonstrated the clinical benefits of early and late gadolinium enhancement imaging, including the discrimination between scarred/fibrotic myocardium and normal myocardium and the identification of mural thrombi and areas of microvascular obstruction among patients with acute myocardial infarction. The technique currently plays a key role in the differential diagnosis between cardiac diseases with ischaemic and non-ischaemic aetiology and in the assessment of patients with acute myocardial infarction and its complications. Due to its invaluable ability to provide diagnostic and prognostic information, it is indeed more frequently implemented for patients’ clinical management and decision-making. This chapter discusses the technical aspects of early and late gadolinium enhancement imaging, reviews the initial studies that led to the validation of the technique, and focuses on its application according to the main clinical syndromes (i.e. acute and chronic myocardial infarction, heart failure, conduction diseases, and ventricular arrhythmias). Guidelines for correct image acquisition and interpretation will be also provided, in particular, how to deal with patients with cardiac arrhythmias or with patients unable to breath-hold properly, and how to discriminate true late gadolinium enhancement areas from artefacts is discussed.
Dilated cardiomyopathy
Authors: Masci Pier Giorgio , Maestrini Viviana , Kwon Deborah
Published: October 2018

Dilated cardiomyopathy (DCM) is a common cause of heart failure in the general population. In the past decade, the prognosis of DCM patients has improved significantly, thanks to advances in medical therapy and the introduction of device(s) treatment. Despite these advances, the 10-year survival remains <60%, with deaths often preceded by numerous heart failure exacerbations, reflecting the difficulty associated with individual risk stratification. The clinical course varies widely, ranging from progressive heart failure or sudden death to excellent recovery of left ventricular function and good prognosis. Cardiovascular magnetic resonance (CMR) has progressively gained acceptance in the workup of patients with DCM, allowing a precise and non-invasive quantification of left and right ventricular volumes, mass, and function, along with tissue characterization of the myocardium. CMR plays a crucial clinical role in DCM patients by helping to identify the potential aetiology and to assess for novel CMR prognostic markers improving risk stratification. Recent evidence also suggests that CMR has a role in the selection of candidates who likely benefit from device(s) therapy.
Takotsubo syndrome
Authors: Eitel Ingo , Rossum Albert van , Stiermaier Thomas , Thiele Holger
Published: October 2018

Takotsubo syndrome (TTS), a form of non-ischaemic cardiomyopathy characterized by a peculiar pattern of transient left ventricular (LV) systolic dysfunction, has drawn increasing research interest in the last decade. While clinical and epidemiological features have been well characterized, the main pathophysiological mechanism of TTS remains largely unknown. Cardiovascular magnetic resonance (CMR) imaging is uniquely suited for the evaluation of patients with TTS. In addition to identifying the typical regional wall motion abnormalities, it allows for precise quantification of right ventricular and LV function, the assessment of additional abnormalities/complications (e.g. pericardial and/or pleural effusion, LV thrombi), and most importantly myocardial tissue characterization (myocardial oedema, inflammation, necrosis/fibrosis). Thus, CMR enables a comprehensive assessment of the entire spectrum of functional and structural changes that occur in patients with TTS. This chapter outlines the role of CMR in TTS and demonstrates that CMR provides important diagnostic information and allows for verifying all relevant functional and tissue criteria to establish or rule out the diagnosis of TTS.
Non-compaction or excessive trabeculation cardiomyopathy
Authors: Petersen Steffen , Almeida Ana G , Angelini Annalisa , Han Yuchi
Published: October 2018

Cardiomyopathies with excessive trabeculations, often labelled as ‘left ventricular non-compaction’, can lead to complications, including heart failure, life-threatening heart rhythm disturbances, and cardiac emboli. The main patho-anatomical substrate is increased cardiac trabeculations. Cardiac imaging can depict the location and extent of trabeculations in the ventricle. Cardiovascular magnetic resonance is increasingly requested to confirm or exclude cardiomyopathy with excessive trabeculations when clinically suspected or in patients with a known family history. The ‘non-compaction-to-compaction ratio’ and the trabecular mass are the two most commonly used diagnostic approaches that have good diagnostic accuracy when used in patients with an intermediate pre-test probability. Increased trabeculations in the context of a low pre-test probability, and no other cardiac abnormalities considered associated with this cardiomyopathy, appear benign and may not represent disease.
Myocarditis
Authors: Ferreira Vanessa M , Fernandes Juliano L , Basso Cristina , Friedrich Matthias G
Published: October 2018

Myocarditis has a high prevalence, especially in young and middle-aged patients. It is the most important differential diagnosis in patients with acute cardiac disease and evidence for cellular injury (positive troponin). In clinical decision-making, it is important to rule in or rule out myocardial inflammation. While endomyocardial biopsy, which remains the gold standard to achieve an aetiopathogenetic diagnosis, can be helpful in patients with heart failure, it is less used in the majority of cases. Cardiovascular magnetic resonance (CMR) imaging has become the most efficient non-invasive diagnostic tool for patients with suspected myocarditis. Its unique value is based on the ability to identify inflammation and myocardial injury, in combination with an accurate assessment of ventricular volumes, as well as regional and global function. In many centres, myocarditis is the most frequent indication for CMR. The diagnostic criteria include markers for myocardial oedema, hyperaemia, and necrosis, while regional or global dysfunction and pericardial effusion serve as supportive criteria. Novel markers, such as quantitative mapping techniques, may allow for even better identification and classification of myocarditis.
Infiltrative cardiomyopathy
Authors: Moon James , Desai Milind Y , Fontana Marianna
Published: October 2018

Abnormal substances can deposit in the myocardium either in the extracellular space (infiltration) or in cells (storage). Infiltration may be cells (inflammatory, histiocytosis, or tumour) or amyloid fibrils [in ventricular myocardium light chain-related (AL) or transthyretin-related (TTR), wild-type or mutant]. Storage may be glycogen (glycogen storage diseases, Danon), lipid (Fabry, Gaucher), mucopolysaccharidoses, or iron. Iron, malignancy, and inflammation (myocarditis) are covered elsewhere. Amyloid and storage diseases are typically systemic multi-organ disease, with ‘red flag’ clinical features often present. They mainly cause heart muscle disease, with hypertrophy mimicking hypertrophic cardiomyopathy. All are relatively rare and often diagnosed late when therapies are less effective. Imaging structural and functional changes provide pointers to the underlying aetiology and additional features may be present (perfusion defects, valve disease, atrial thickening), but it is in myocardial tissue characterization where CMR adds real value. In amyloid, deposition appears to proceed stepwise, with initial subendocardial, and later transmural, late gadolinium enhancement (LGE). Myocardial nulling may be difficult, requiring the phase-sensitive inversion recovery (PSIR) technique. In Fabry disease, a characteristic initial basal inferolateral LGE pattern occurs, later with extensive LGE, leading to dilatation and impairment. Mapping adds value. In amyloid, both native T1 and the ECV are very high. Both are prognostic and candidates for surrogate endpoints in drug development studies. In Fabry disease, native T1 is low, reflecting lipid storage, and may occur early before hypertrophy. The LGE area usually has T2 elevation correlating with blood troponin, which suggests inflammation as part of disease development.
Cardiovascular magnetic resonance in cardiac resynchronization therapy
Authors: Leyva Francisco , Manisty Charlotte
Published: October 2018

Cardiovascular magnetic resonance (CMR) can inform on the aetiology of heart failure, global cardiac function, and myocardial viability, all of which are essential in cardiac resynchronization therapy (CRT). Late gadolinium enhancement (LGE)-CMR allows quantification of myocardial scarring and characterization of the pattern of scar, both of which may be useful in risk stratification. In addition, the ability of CMR to localize myocardial scar and provide reliable measures of segmental motion and deformation is being applied to targeting left ventricular lead deployment. The development of CMR-compatible devices may permit the use of CMR in the optimization of CRT after implantation.
Athlete’s heart and prevention of sudden cardiac death in athletes
Authors: Scharhag Jürgen , Wu Katherine C , Bohm Philipp , Basso Cristina
Published: October 2018

Athlete’s heart is a physiological adaptation to regular exercise. It is characterized by harmonic, eccentric dilatation of all cardiac chambers, typically seen in endurance athletes and athletes who engage in disciplines with high volumes of endurance exercise. In contrast to eccentric hypertrophy of the heart in endurance athletes, which has been demonstrated in echocardiographic and cardiovascular magnetic resonance (CMR) studies, the early hypothesis of concentric hypertrophy in strength athletes has not been confirmed by most of the newer echocardiographic and CMR studies. Because CMR offers high sensitivity and specificity to differentiate between physiological and pathological cardiac adaptations, CMR has become an important tool to examine athlete’s heart and to evaluate athletes’ sports eligibility. Therefore, modern CMR plays an important role in the scientific and clinical assessment of exercise-induced cardiac adaptations and the prevention of sudden cardiac death in athletes.
CMR of vascular disease
Authors: Alpendurada Francisco , Nienaber Christoph A , Mohiaddin Raad H
Published: October 2018

Vascular disease comprises a heterogeneous group of conditions which are increasing in prevalence, due to an ageing population, and also in complexity as new treatment options emerge. Imaging is pivotal not only for diagnosis, but also for determining optimal management, including timing and type of intervention when appropriate. Several imaging modalities are routinely used in the assessment of vascular disease, including invasive angiography, ultrasound, computed tomography (CT), and cardiovascular magnetic resonance (CMR), each with its own advantages and limitations. The indications for CMR include the initial evaluation of vascular disease, and in particular serial monitoring. Multi-planar acquisition by CMR allows for the complete coverage of the vessels, and cine imaging enables the coupling of anatomical with functional information which can be extended to the heart for an integrated perspective. Tissue characterization infers different components of the vessel wall, but calcification is not well appreciated by CMR as it is by CT. Despite these advantages, the requirement for breath-holds in most acquisitions, relatively long study times, and incompatibility with some medical equipment in a magnetic environment limit its use in the unstable patient.
Benign cardiac tumours
Authors: Basso Cristina , Buser Peter T , Rizzo Stefania , Lombardi Massimo , Thiene Gaetano
Published: October 2018

Benign primary cardiac tumours are categorized, depending on their cellular differentiation. Benign tumours of myocyte differentiation are rhabdomyomas; those of pluripotent mesenchymal differentiation include myxomas, fibroelastomas, and haemangiomas, and those of myofibroblastic differentiation include fibromas. Lipomas and cystic tumour of the atrioventricular node form an additional group of miscellaneous masses. For each of these tumours, histopathology and CMR findings are presented.
Malignant tumours
Authors: Basso Cristina , Buser Peter T , Rizzo Stefania , Lombardi Massimo , Thiene Gaetano
Published: October 2018

In adult patients, sarcomas are the most frequently encountered primary cardiac malignant tumours, followed by lymphomas. Primary sarcomas of the heart form a group of tumours with variable differentiation and cell pleomorphism. According to histopathology, they are categorized as angiosarcomas, leiomyosarcomas, undifferentiated pleomorphic sarcoma, and myxofibrosarcomas. On cardiovascular magnetic resonance (CMR), most sarcomas appear extremely heterogeneous and usually cannot be differentiated from each other. Some cases with angiosarcomas can be identified by their specific appearance with early- and late-enhancement CMR. Some features of early- and late-enhancement CMR may argue for lymphoma, when discussing the differential diagnosis of a malignant primary cardiac mass.
Pericardial tumours
Authors: Basso Cristina , Buser Peter T , Rizzo Stefania , Lombardi Massimo , Thiene Gaetano
Published: October 2018

Primary malignant tumours of the pericardium include the solitary fibrous tumour and pericardial mesothelioma, which is the most common primary malignant pericardial tumour. Finally, intrapericardial germ cell tumours are neoplasms of germ cell origin that arise within the pericardium and mostly occur in infancy or childhood.
Introduction
Authors: Buechel Emanuela R Valsangiacomo , Muthurangu Vivek
Published: October 2018

This section provides an overview of the most specific aspects of imaging coronary heart disease and the most frequent lesions, in which cardiovascular magnetic resonance has an important clinical diagnostic role.
Segmental approach to congenital heart disease
Authors: Frescura Carla , Thiene Gaetano
Published: October 2018

The knowledge of cardiac anatomy is a prerequisite to the application of the segmental classification. Atria, ventricles, and vessels present anatomical markers that allow their precise identification. The segmental–sequential classification, that considers the heart as formed by three segments—atria, ventricles, and great arteries, connected at the atrioventricular and ventriculo-arterial junctions, permits an easy classification of complex congenital heart disease, useful for clinicians, surgeons, and pathologists.
Adapting CMR sequences for CHD and imaging small patients
Authors: Muthurangu Vivek
Published: October 2018

In this chapter, the necessary modifications to common cardiovascular magnetic resonance sequences will be discussed. Specific areas that will be covered are: optimization of steady-state free precession cine imaging for the assessment of function, whole heart imaging in infants and children, velocity-encoded phase contrast magnetic resonance for the assessment of flow in paediatrics, and modification of contrast-enhanced magnetic resonance angiographic sequences in childhood. In addition, various methods of dealing with respiratory motion in children will be discussed.
Novel CMR techniques for advanced surgical planning
Authors: Fogel Mark A
Published: October 2018

Medical and surgical care for the patient with congenital heart disease (CHD) has advanced greatly over the past 40 years; along with improved surgical and catheter-based techniques, intensive unit care, and overall medical advances, improved outcomes have accrued across a whole host of cardiac defects. This is owed, in no small part, to advances in imaging and cardiovascular magnetic resonance (CMR) which has played an important and growing role in this evolution. Novel CMR techniques 25 years ago, such as gadolinium-based imaging and two-dimensional velocity mapping, are now commonplace. At the cutting edge of novel CMR techniques, in the current era, are computational fluid dynamic modelling, three-dimensional printing, four-dimensional flow imaging, and X-ray magnetic resonance/interventional CMR, which will be the focus of this chapter. The hope is that one day these techniques will be the commonplace ones, aiding in the care of a broad spectrum of CHD.
Ebstein’s malformation of the tricuspid valve
Authors: Babu-Narayan Sonya V
Published: October 2018

Ebstein’s anomaly of the tricuspid valve is a rare congenital anomaly (1 in 200 000 live births) and is defined by the septal insertion of the tricuspid valve leaflet being >8 mm/m2 apically displaced from the septal insertion of the mitral valve leaflet. This is due to adherence of the septal leaflet to the ventricular septum secondary to failure of delamination. The inferior–posterior, and occasionally anterior, leaflet may also be displaced and rotated. The anterior leaflet is frequently part-redundant and may be fenestrated. Leaflets may be dysplastic or tethered, altering the surgical options. Ebstein’s anomaly may result in enlargement of the native and functional right atrium, enlargement of the functional right ventricle, left ventricular compression, arrhythmia, sudden death, and heart failure. Cardiovascular magnetic resonance (CMR) enables accurate quantification of right and left ventricular volumes and function, cardiac output, and cardiac shunt from measurement of Qp:Qs. CMR is highly informative regarding the anatomy and function of the tricuspid valve, in particular when the degree of displacement and/or rotation of the tricuspid valve is more than mild to moderate.
Tetralogy of Fallot
Authors: Powell Andrew J
Published: October 2018

Tetralogy of Fallot is the most common cyanotic congenital heart defect. Outcomes with surgical repair have improved over the years, leading to a growing number of adults with surgically repaired Tetralogy of Fallot. Nevertheless, residual cardiac abnormalities are common in these patients and thus they require life-long imaging surveillance. Cardiovascular magnetic resonance (CMR) is well suited for this task because of its ability to accurately measure biventricular size and function, quantify valve regurgitation, image the thoracic vasculature, and identify myocardial fibrosis. Information from CMR now guides decisions regarding pulmonary valve replacement and contributes to risk stratification for adverse cardiac events.
Double-outlet right ventricle
Authors: Yoo Shi-Joon , Helbing Willem A
Published: October 2018

Double-outlet right ventricle (DORV) encompasses a wide variety of abnormalities and requires precise demonstration of the cardiovascular abnormalities using a segmental approach for surgical decision and planning. The most important is whether the left ventricle can be directed surgically to the aorta without obstruction of the pulmonary outflow tract of the right ventricle. Echocardiography is the baseline imaging modality in preoperative assessment of DORV. In complex cases, cardiovascular magnetic resonance (CMR) provides comprehensive information regarding important surgical anatomy, blood flow, and ventricular volumes. Three-dimensional (3D) angiograms and 3D print models may provide undisputable information regarding surgical anatomy and allows practice surgery on the models prior to actual surgery. DORV is frequently associated with post-operative residual findings that require reintervention. CMR is particularly useful in post-operative assessment, as it provides accurate quantitative information regarding ventricular volumes and blood flow for decision and timing of surgical or interventional procedures.
A History of Women in British Medicine
Authors: Rimmer Abi
Published: October 2018

This chapter, A history of women in British medicine, discusses the pioneering women who first trained and practised in medicine in the United Kingdom. It looks at the women who challenged and changed the medical establishment and those who helped to found the first medical school for women. It also looks at the role that a number of courageous women doctors played in both the First and Second World Wars at great risk to themselves, often without the support of their governments. Finally it explores the ongoing struggle that women doctors face in trying to achieve equality with their male colleagues.
The Role of Women in Intellectual Disabilities: Clinicians, Scientists, Parents
Authors: Dave Rupal , Hassiotis Angela
Published: October 2018

The role of women in intellectual disabilities: clinicians, scientists, parents describes the personal experience of choosing to specialize in Psychiatry and furthermore to work with people with intellectual disability. This chapter provides factual information about current trends in gender ratios in the training grades and in the profession as a whole. It defines the meaning of intellectual disabilities (ID) and explores the challenges persons with ID face in society today. The latter point is exemplified through personal narratives. We highlight the Psychiatry of Intellectual Disability as a rewarding field of psychiatry that offers many opportunities for both professional advancement and personal growth.
Jail Birds: Challenges for Prisoners and Professionals
Authors: Bartlett Annie
Published: October 2018

This chapter considers the merits of different conceptual frameworks applied to women who offend and break the law, over time and between academic disciplines. It charts the increasing dominance of psychological and psychiatric models of disorder in the care of individual criminal women who, as a group, are widely recognized as socially and economically marginalized from birth. It analyses the relevance of this confused terrain for professionals currently working in women’s prisons, whether the patient in question has committed major or minor crimes. It argues that holistic thinking and the use of competing therapeutic discourses can be challenging but ultimately beneficial.
The Maternal Lap and the Mental Health Trust
Authors: O’Reilly Jo
Published: October 2018

This chapter describes how patients requiring care from psychiatric teams need a receptive and containing response in order to feel understood and as a basis for recovery. This mirrors the sensitive attunement that the infant depends upon when held on the maternal lap. It introduces the idea of the Mental Health Trust as having the potential to act as a concave receptacle, able to absorb and process all that is communicated by those in a disturbed state of mind. In this concave or receptive state of mind clinical management can be based upon a deeper understanding of the patient’s difficulties and needs. In contrast, if clinical teams behave in what is described as a more convex state of mind they are unable to absorb or think about their patients’ disturbance, which can lead to harmful re-enactments of inadequate nurture or rejection. Clinical examples are used to illustrate these ideas and the importance of teams being able to reflect about their work is emphasized.
Historical Child Sexual Abuse
Authors: Stubley Joanne , Barker Victoria , Eyres Maria
Published: October 2018

The chapter covers three areas in relation to historical child sexual abuse (HCSA). It reviews the historical perspective in terms of the response of psychiatry and psychotherapy and its relation to HCSA. It also examines the role of the mother in HCSA and it addresses a particular clinical issue which is the request for a gender-specific therapist made by those with a history of HCSA who are seeking help from services. Using a psychoanalytic understanding of this form of developmental trauma elucidates the underlying dynamics that are brought into the therapeutic encounter, the family dynamics, and within society.
Old Age, Women, and Dynamic Psychotherapy
Authors: Evans Sandra , Garner Jane
Published: October 2018

Old age can be a challenging time for people. It brings with it changes which include losses as well as opportunities for shifting one’s focus. Societal perceptions of ageing and projections of negative values associated with being old can act as a further blow to peoples’ general resilience. This chapter explores some of these societal projections over the centuries, in public and political life and in the arts. It examines how these influences may impact on women personally as we get older, including how we become ill psychologically and how we react to illness. What the authors consider to be important is that in late life, opportunities for restoration of the self still exist. People can and do recover from mental illness and older women can and do contribute to the wider social world in ways other than as mothers and carers.
A Woman who Made a Difference: An Interview with Nori Graham
Authors: Thompsell Amanda
Published: October 2018

This chapter describes an interview with Dr Nori Graham, a key figure in older people’s mental health, former Chairman of the Alzheimer’s Society and of Alzheimer’s Disease International, and an inspiration to generations of doctors. This reflective interview provides a first-person account of the development of mental health services for older people over the last 40 years, paying tribute to some of the pioneers and architects of the astonishing growth of old age psychiatry services during this period, and comparing the challenges then and now. Nori Graham also provides insights and advice on how to develop a successful career, and on dealing with the challenges for women doctors with children. Finally, she describes her work in helping to build up the Alzheimer’s Society and Alzheimer’s Disease International, both of which expanded considerably during her period as Chairman.
Change and Continuity in Psychiatry: One Woman’s Reflections
Authors: Murdoch Claire
Published: October 2018

This chapter offers a recollection of training and working as a nurse in Friern Barnet Hospital during the 1980s. As the era of the Victorian asylum drew to a close, the possibility of new and improved approaches to mental health provision loomed. Murdoch offers a personal account of working within and challenging the status quo. She describes prevailing policy and practice and a sense of the struggle to usher in the new while respecting and learning from the old. She offers insights into the contradictory permissiveness of the day, and the tolerance and celebration of eccentric and endearing aspects of life in the asylum. Murdoch conveys how much has changed and points to constant features in the search for effective, humane treatments over the three decades. Stigma, funding, freedom, responsibility, and structures to support care in the community all remain constants.
Treatment of depression in type 2 diabetes
Authors: Petrak Frank , Röhrig Bonnie
Published: October 2018

This chapter provides a brief overview of the current scientific evidence for the treatment of depression in type 2 diabetes. Considering the multiple adverse interactions between both conditions, treatment targets should always focus on diabetes-related medical outcome and improvement or remission of depression at the same time in people with diabetes. Depression can be treated with moderate to good results in depressed patients with type 2 diabetes by a variety of psychological and pharmacological interventions, with comparable results to the treatment of depressive patients without diabetes. Results regarding glycaemic control are inconsistent and indicate a low effectiveness of psychological interventions. Antidepressants demonstrated mild to moderate effect regarding better glycaemic control, but the results are still inconclusive and long-term effects are widely unknown. The chapter ends with a critical summary of methodological limitations of the research in that area and concludes with evidence-based recommendations for clinical practice.
Novel pharmacological targets
Authors: Moulton Calum D.
Published: October 2018

There is a bidirectional relationship between depression and type 2 diabetes (T2D). Patients with comorbid depression and T2D are at high risk of complications and premature mortality. Conventional treatments for depression do not consistently improve diabetes outcomes, despite improving depressive symptoms. Shared mechanisms may underpin both depression and T2D, providing novel pharmacological targets to treat both conditions simultaneously. There are several candidate pathways. For inflammation and vitamin D deficiency, there is good cross-sectional evidence to support an association with depression in T2D. Prospective epidemiological studies are needed to test biological pathways as predictive biomarkers of depression and T2D. Intervention studies are needed to test the modifiability of these pathways. Repurposing of established diabetes treatments may provide a ‘multiple hit’ strategy. The identification and modification of novel biological targets has the potential to treat both depression and T2D, as well as reducing longer term morbidity and mortality.
Novel technologies: What does gastric electrical stimulation offer to the patient with type 2 diabetes and depression?
Authors: Lebovitz Harold E. , Ben-Haim Shlomo
Published: October 2018

Owing to the epidemiologic dimensions of type 2 diabetes, obesity, and depression, the development of novel and effective treatment options for these conditions is of great importance. One of the major challenges in this field is that many antidiabetic and antidepressive drugs may have disadvantageous metabolic effects by increasing weight and worsening insulin resistance. Novel technologies more effectively considering the pathophysiological changes related to this entity are needed. The DIAMOND electrical stimulation device improves glycaemic control, causes weight loss and decreases systolic blood pressure in overweight and obese patients with type 2 diabetes. The DIAMOND device detects food ingestion and automatically activates its postprandial metabolic effects. It does so with minimal side effects, no hypoglycaemia, modest weight loss, minimal requirement for self-blood glucose monitoring, and improvement in eating behaviour. The properties of DIAMOND treatment suggest that it may have merit for treating patients with comorbid diabetes and depression.
Social capital and mental health
Authors: McKenzie Kwame
Published: October 2018

fSocial capital is a theory that attempts to describe features of the fabric of society. It identifies factors in populations such as the level of civic participation, social networks, and levels of trust because such forces shape the quality and quantity of social interactions and institutions that underpin society. Two questions have dominated the literature: can social capital prevent or cause mental illness, and does the level or type of social capital have an impact on the rate of mental illness? Though the quality and strength of the literature is at best patchy, the general conclusion is that there is an association between higher levels of some types of social capital and a lower risk of mental health problems. This chapter discusses the possible mechanisms at multiple levels through which social capital may change the risk and rates of mental illness.
Mental and physical health
Authors: McHugh Mike
Published: October 2018

Until recently the biomedical model dominated thinking about both physical health and mental health in Western society. It is now more useful to frame health as an integrated totality—one that includes physiological functioning, psychological and spiritual processes, and behaviour. This chapter explores this emerging agenda and focuses on well-being and prevention, particularly where well-being and prevention impact on both physical and mental illness. Evidence tells us that by strengthening mental health and well-being we not only reduce the risk of mental illness, but we also enhance physical health and population health more widely. Equally, improving physical health has a significantly positive influence on population mental health. We can increasingly exploit our understanding of these interconnections and release their potential to tackle some of the pressing health and well-being challenges we face. We have an opportunity to meaningfully draw physical and mental health together as a mutually dependent, integrated whole.
LGBTI and mental health
Authors: Plöderl Martin , Mahler Lieselotte , Nieder Timo O. , Mundle Götz
Published: October 2018

Lesbian, gay, bisexual, transgender, and intersex (LGBTI) individuals face specific mental health challenges, as will be described in this chapter. Many studies reported elevated mental health problems for LGB individuals compared with their heterosexual counterparts. Fewer studies are available for trans(-gender) and inter(-sex) individuals, but the majority reported increased levels of mental health problems compared with their cisgendered or non-inter counterparts. Current explanatory models centre on the pathogenic effect of homonegativity, transnegativity, and internegativity, as well as the underlying rigid gender roles, resulting in minority stressors that LGBTI individuals and those who are perceived as LGBTI are faced with. Such experienced or internalized minority stress can explain mental health disparities well. This contrasts with the long-standing medical view that LGBTI conditions are inherently pathological. Evidence-based LGBTI-specific prevention and intervention programmes are emerging.
Mental health in intellectual disability
Authors: Bhaumik Sabyasachi , Michael Dasari Mohan , Kiani Reza , Hiremath Avinash , Gangavati Shweta , Jesu Amala
Published: October 2018

This chapter focuses on the current knowledge in public health for people with intellectual disability and recognizes the extent of health inequalities these individuals experience. The prevalence of intellectual disability worldwide is discussed with special emphasis on the prevalence of mental health problems. Also highlighted are the population health characteristics, including physical and mental health problems. The issue of barriers to accessibility and the possible reasons are discussed. There is a section on premature mortality of people with intellectual disability and measures to improve the health status for this marginalized population. Recent initiatives, including prevention strategies and health promotional aspects, are discussed and solutions suggested, including those for low-and-middle income countries (LAMICs)emphasized. Training aspects to improve quality of health care in LAMICs is highlighted with the recognition of limitations in creating a sustainable transformation of services unless they are backed by authorities.
Physical and psychiatric co-morbidity
Authors: Okkels Niels , Kristiansen Christina Blanner , Munk-Jørgensen Povl
Published: October 2018

This chapter explains the concept of co-morbidity and why it is important. The high prevalence of physical illness in psychiatric patients contributes to an increased mortality compared with the general population, particularly from diabetes and cardiovascular diseases. The management of patients with co-morbidities is a great challenge to modern medicine: our healthcare systems are fragmented by specialization, clinical trials exclude patients with co-morbidities, and health professionals lack training in common issues related to co-morbidity, such as polypharmacy. To overcome the mortality gap between psychiatric patients and the general population we must rethink our healthcare systems, medical education, and public mental health interventions. To help patients with co-morbid illnesses, we must have a holistic approach that includes the patients’ needs and goals in a collaborative effort across health professions.
Globalization, migration, and mental health
Authors: Bhavsar Vishal , Zhang Shuo , Bhugra Dinesh
Published: October 2018

Globalization not only affects mental health, but also our conceptualizations and measurements of it. The last three decades have seen global efforts to determine the prevalence of human illness and to universalize the provision of mental health treatment for everyone. At the same time, theorization of the effect of global social, economic, and social transitions on mental health and the factors that influence it have been relatively lacking, limiting the effectiveness and take-up of interventions, and the development of policies. This chapter reviews previous theoretical models of the effects globalization on health, and develops a model for mental health. In particular, the measurement of mental health, well-being, and adversity is located under the influence of macrosocial processes. Influences on mental health across the many levels in which the individual is situated are emphasized. Questions and implications for further empirical work are drawn out, including in the ‘global mental health’ field.
Treatment of mental health problems in refugees and asylum seekers
Authors: Cossu Giulia , Preti Antonio , Carta Mauro Giovanni
Published: October 2018

Refugees from war zones and asylum seekers are exposed to a wide range of traumas, including persecution, humiliation, gender-based violence, human rights violations, and significant family losses. This results in a statistically higher risk of trauma-related mental disorders. However, refugees and asylum seekers are a heterogeneous population, as far as their gender, age, ethnic, cultural, educational and socio-economic background are concerned. There is no certainty that the Western-centred therapies will be effective in the treatment of the trauma-related mental disorders of refugees and asylum seekers. This chapter summarizes the currently available evidence on the mental health of refugees from war zones and asylum seekers, focusing in particular on the results of randomized controlled trials of psychosocial and other non-conventional interventions applied to refugees and asylum seekers. Culturally sensitive approaches, which activate same-cultural community network support, are more likely to contribute to the effectiveness of the care process.
Prevention of drug addiction
Authors: Mukamana Olive , Conrod Patricia
Published: October 2018

Drug addiction adversely affects individual and public health, and generates societal costs that are considerable worldwide. The current chapter reviews the risk factors for drug addiction both at the individual and environmental level, and it briefly describes the burden of disease associated with problematic drug use, particularly among young people. Prevention strategies are reviewed in three categories: universal interventions in which drug supply control policies, psychosocial and educational interventions are directed at the general population; interventions targeting high-risk populations; and brief interventions for those already experiencing problematic drug use. We also provide examples of effective interventions in each category and make recommendations for research and practice based on the available evidence. Finally, a comprehensive and developmentally appropriate approach to prevention is proposed as a promising strategy to integrate effective interventions that target the multiple factors implicated in the development of drug addiction.
Suicide and the prevention of suicidal behaviours
Authors: Vijayakumar Lakshmi , Silverman Morton
Published: October 2018

This chapter describes the public mental health approach to suicide and provides an overview of the prevalence and epidemiology of suicide worldwide. The chapter also reviews risk and protective factors, and critically examines the evidence of the various suicide prevention strategies. The challenges in implementing and evaluating suicide prevention strategies are discussed. A multi-sectoral public health model for implementing and evaluating suicide prevention programmes is described. Public health interventions, like restricting access to lethal means of suicide and reducing the availability and use of alcohol, should be a core strategy in all countries. Identifying and providing interventions to suicidal persons can be a skill that can be taught in a variety of settings. One of the indicators in the Sustainable Development Goals is suicide moratality rate. Hence, every country has a responsibility to improve data and reduce suicides in their country.
Suicidal behaviour among adolescents
Authors: Wasserman Danuta , Iosue Miriam , Carli Vladimir
Published: October 2018

Suicide is the second leading cause of death among adolescents and young adults, accounting for 8.5% of all deaths globally among 15–29 year olds. Several genetic, psychological, and environmental risk factors have been identified, including youth psychiatric disorders and self-harm, family history of suicide and mental health problems, stressful life events, impulsivity, aggressiveness, and access to lethal means. Individual protective factors play an important role in reducing the risk of suicide and suicidal behaviours, including sleep, physical activity, resilience, good self-esteem, pro-social behaviours, connectedness within and support from the family, trustful relationships with peers and school staff, and safe school and community environments,. Prevention of suicidal behaviour among adolescents is possible by counteracting risk factors, strengthening protective factors, and utilizing evidence-based universal school-based suicide prevention programmes for adolescents and adequate treatment when applicable.
Parenting skills and promotion of mental health over the lifespan
Authors: Scott Stephen
Published: October 2018

Improving parenting skills can improve a range of mental health outcomes in infancy, childhood, and adolescence, and can improve both physical and mental health in adulthood. High-quality, evidence-based parenting programmes are especially effective for reducing children’s antisocial behaviour and promoting attachment security. This form of early intervention confers lasting benefits well into adulthood, on intelligence and academic functioning, as well as a range of mental health outcomes, such as antisocial personality disorder, crime, drug addiction, and early death. The skill of the mental health practitioner has a substantial effect on outcomes, as well as choosing a high-quality parenting programmeme, it is important to train the practitioner well and subsequently to ensure there is ongoing supervision. To widen access, more online programmes need to be developed.
Pregnancy
Authors: Boyce Philip , Galbally Megan , Gregoire Alain
Published: October 2018

The application of public health approaches, including universal and targeted interventions during pregnancy, can have long-term mental health benefits for women and the next generation. Access to good antenatal care, ensuring women have adequate nutrition and micronutrients, a healthy lifestyle (in particular avoiding smoking), and being immunized against flu may reduce the risk of the fetus developing disorders with a neurodevelopmental origin, in particular schizophrenia and, to a lesser extent, bipolar disorder. The identification of and early intervention in common mental health problems among pregnant women and identifying potentially modifiable risk factors during pregnancy will reduce morbidity in women and may help prevent postpartum mental disorders. Such strategies will also optimize fetal development and reduce the risk of subsequent mental disorders in infants. Finally, pregnancy is also a time when interventions can be applied to minimize the risk of disorders, such as bipolar disorder, relapsing following childbirth.
Psychological intervention as a measure for promoting public mental health
Authors: Ng Roger M. K. , Lee Che Kin
Published: October 2018

The chapter reviews the evidence base of brief psychological interventions for the treatment of common mental disorders and substance misuse delivered by primary care sector and lay health counsellors. The efficacy and acceptability of different modalities of delivery of such brief psychological interventions are also examined. The chapter also reviews the controversy of psychological interventions for primary prevention of common mental disorders and substance misuse when applied universally. Finally, the chapter examines the efficacy and acceptability of brief psychological interventions to target people with subclinical symptoms and specific population groups vulnerable to developing mental disorders. The chapter concludes with suggestions on the future direction of the content and mode of delivery of psychological interventions so as to enhance their accessibility and acceptability by potential users.
Mental health and its social determinants
Authors: Chatterjee Mirai
Published: October 2018

Women show higher rates of many psychiatric disorders. They also look after ill family members, adding to their distress and stress. They are more likely to face poor social conditions such as overcrowding poverty and insecure employment. The Self Employed Women’s’ Association was established nearly 50 years ago. It supports and empowers women and this chapters draws some observations that may help others in low- and middle-income countries. The chapter illustrates a need for major changes in mental health policy and implementation, especially in relation to health care in primary care settings with appropriate access to referral services. Integration of public health and primary care is a possible option. Policymakers and legislators in India and other emerging countries need to work with civil society and localpeople to develop and deliver ways in which social determinants of mental health can be addressed, and with peopleat the centre of all efforts.
Non-governmental organizations and mental health
Authors: Regan Marguerite , Edwards Jenny , Elliott Iris
Published: October 2018

This chapter examines to contribution of non-governmental organizations (NGOs) to meeting the mental health needs of individuals, families, and communities. After providing an overview of the history of mental health NGOs, and the current policy frameworks within which they work, it then examines the scope of mental health NGOs, and maps the main international networks and within the UK context. It examines the contribution of NGOs, the key challenges they face working within mental health, and concludes with the steps NGOs can take when striving for parity for mental health. It includes examples of international mental health NGOs throughout.