bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health psychology
Authors: Weinman John , Petrie Keith J. 
Published: January 2013

AbstractHealth psychology is concerned with understanding human behaviour in the context of health, illness, and health care. It is the study of the psychological factors, which determine how people stay healthy, why they become ill, and how they respond to illness and health care. Health psychology has emerged as a separate discipline in the past 30 years and there are many reasons for its rapid development. An important background factor is the major change in the nature of health problems in industrialized societies during the twentieth century. Chronic illnesses such as heart disease and cancer have become the leading causes of death, and behavioural factors such as smoking, diet, and stress are now recognized as playing a major role in the aetiology and progression of these diseases. The provision of health care has grown enormously and there is an increased awareness of good communication as a central ingredient of medical care and of the importance of such factors as patient satisfaction and quality of life as key outcomes in evaluating the efficacy of medical interventions. Although health psychology has developed over a similar time period to general hospital/liaison psychiatry and shares some common areas of interest, there are some clear differences between these two fields. Liaison psychiatry has a primary focus on hospital patients, particularly those experiencing psychological difficulties in the face of a physical health problem. In contrast, health psychology has a much broader focus on both healthy and ill populations and on the psychological processes that influence their level of health or their degree of adaptation to disease. Whereas health psychology has been mainly concerned with developing explanations based on theory, for health-related and illness-related behaviour, liaison psychiatry has concentrated on the diagnosis and treatment of either unexplained symptoms or psychiatric disorders occurring in people with medical conditions (see the other chapters in Part 5 of this volume). In this chapter we provide an overview of the main themes and areas in health psychology. Four broad areas of behaviour will be reviewed, namely behavioural factors influencing health, symptom and illness behaviour, health care behaviour, and treatment behaviour. Inevitably such an overview is selective and the interested reader should seek out a more comprehensive introductory text or more in-depth accounts of specific areas.
Anxiolytics and hypnotics
Authors: Lader Malcolm 
Published: January 2013

AbstractIn many countries the drug treatment of both anxiety and insomnia still largely revolves around the use of the benzodiazepines. Nevertheless, controversy and disagreement still rage about the risk–benefit ratio of compounds in this area. Short-term use in both indications is well established, with a favourable database as a rationale for this approach. However, long-term use is still only researched in a limited way. While both the efficacy and safety of long-term use remain unclear, acceptance of current guidelines limiting the use of benzodiazepines seems wise. The advent of the SSRIs as anxiolytics has driven a wedge between the treatment methods for anxiety and insomnia. Anxiety can be treated just as effectively with an SSRI (and probably, pregabalin) as with a benzodiazepine, and more safely. The treatment of insomnia still relies on the benzodiazepines until the risk–benefit ratio of newer drugs such as the melatonin-related compounds becomes clear. Nevertheless, in the author's opinion the most important outstanding issue is the relationship between drug and non-drug treatments. The management of anxiety disorders and of insomnia is complex and is hampered by a dearth of information concerning the relative merits of various treatment modalities. Much research is also needed on the optimum strategies for combining all the therapies available to us, and on identifying predictors of response. Developments in the neuropharmacology of insomnia hold out the promise of new compounds with novel and perhaps more effective modes of action. With respect to anxiety disorders, a major shift of emphasis has followed the demonstration of the efficacy of the SSRIs.
Antipsychotic and anticholinergic drugs
Authors: Meltzer Herbert Y. , Bobo William V. 
Published: January 2013

AbstractThe discovery by Delay and Denicker in 1953 that chlorpromazine was highly effective in alleviating delusions, hallucinations, and disorganized thinking, was the seminal breakthrough in the treatment of schizophrenia, the first agent to produce sufficient relief of core psychotic symptoms to permit life outside of institutions for many patients with schizophrenia, and even a return to a semblance of function within normal limits. Chlorpromazine and the other related typical antipsychotic drugs which were introduced over the next 30 years have proven to be of immense benefit to vast numbers of people who experience psychotic symptoms as a component of a diverse group of neuropsychiatric and medical disorders, as well as drug-induced psychoses. These drugs have been invaluable in providing clues to the aetiology of schizophrenia and other forms of mental illness with psychotic features and as tools in understanding fundamental neural processes, especially those involving dopamine, a key neurotransmitter involved in psychosis. This class of drugs has now been supplanted by the so-called atypical antipsychotic drugs, of which clozapine is the prototype. This chapter will describe the various classes of antipsychotic agents, with emphasis on the atypical antipsychotic drugs, their benefits and adverse effects, recommendations for use in clinical practice, and mechanism of action. The drugs used to treat the extrapyramidal side-effects (EPS) produced mainly by the typical antipsychotic drugs are also considered.
Drugs for cognitive disorders
Authors: Iversen Leslie 
Published: January 2013

AbstractCognitive disorders are among the most difficult of all nervous system illnesses to treat as they affect the most complex and least clearly understood aspects of brain function. Animal studies cannot accurately mirror the complexities of human cognition, and there are few, if any, animal models of human cognitive illnesses. As so few drugs have been found to exert clinically significant effects, animal models for testing novel cognition-enhancing agents have unknown predictive value. However, progress has been made in recent years with improved international agreement on the criteria used to approve new cognition-enhancing drugs, and the introduction of new drugs for the treatment of dementia.
Drugs used in the treatment of the addictions
Authors: Law Fergus D. , Nutt David J. 
Published: January 2013

AbstractMedical treatment of the addictions remains controversial, with addiction itself viewed as a lifestyle problem, a hijacking of brain systems by drugs, or as a medical illness. Many of these controversies may be avoided by taking a goal-oriented approach to treatment, in which clinical objectives are defined, and both medications and psychological interventions are used to facilitate progress towards these. The effectiveness of medications is maximized when they are used as one component of a comprehensive treatment plan. There are no ‘magic bullets’ in addiction treatment—the same pharmacological principles apply to these drug treatments as to any other. Drugs need to be given in effective doses, at appropriate intervals, allowed time to reach steady state, and also to dissipate when terminated on the basis of their half-life. Some drugs also have an abuse potential of their own (e.g. opiates, sedative-hypnotics) especially those with a rapid onset of action, and such drugs need to be particularly closely monitored and controlled, to minimize their diversion and misuse.
Complementary medicines
Authors: Werneke Ursula 
Published: January 2013

AbstractComplementary medicines pose a particular challenge to medical practitioners who may feel that their patients need conventional treatment but often find themselves out of their depth when patients ask about complementary therapies. Pharmacological options include herbal medicines, certain foods, and nutritional supplements such as vitamins and minerals. Physical treatments include acupuncture, massage, and osteopathy to name a few. Treatments, which purport to achieve their effects through changes in internal ‘energy flow’ include reiki, reflexology, healing, and therapeutic touch, and also homeopathy and traditional Chinese acupuncture. All these treatments are either used alternatively, i.e. instead of, or complementary, i.e. in addition to, conventional medicine. In patients with mental health problems, depending on the definition and inclusion criteria, estimates of the prevalence of complementary medicine use range from 8 per cent to 57 per cent. Depression and anxiety seem to be the most common indications.
Transcranial magnetic stimulation
Authors: McLoughlin Declan , Mogg Andrew 
Published: January 2013

AbstractrTMS has an increasing role as a useful investigational tool for probing neuronal circuitry in a variety of neuropsychiatric disorders. However its therapeutic value is at present less certain. The anti-depressant efficacy of rTMS has now been investigated for over 15 years and despite initial early enthusiasm there is still not clear evidence for its usefulness as a treatment in depression, reflected in the recent FDA and NICE decisions. Further research is required to identify specific brain regions in specific conditions that may be appropriate targets for treatment with rTMS, allowing tailoring of treatments for individual patients. The recent development of neuronavigational techniques using MRI imaging should aid treatment site localization. Other future research should be directed at establishing optimal rTMS parameters, e.g. the intensity, frequency and number of treatments.
Neurosurgery for psychiatric disorders
Authors: Matthews Keith , Christmas David 
Published: January 2013

AbstractDespite its chequered past, modern NMD bears little similarity to historical freehand procedures. Advances in neuroimaging mean that anatomical substrates for depression and OCD are being elucidated. Ablative procedures such as ACAPS and ACING are unlikely to undergo randomized controlled trials but prospective clinical audit suggests that such procedures may offer improvement to selected patients with treatment-refractory depression and OCD. Interventions such as VNS and DBS offer the possibility of double-blind testing but as yet there is insufficient evidence to suggest that such procedures offer greater effectiveness.
Brief individual psychodynamic psychotherapy
Authors: Ursano Amy M. , Ursano Robert J. 
Published: January 2013

AbstractBrief dynamic psychotherapy is an important treatment for numerous disorders, primarily the adjustment, anxiety, and mood disorders. Both alone and in combination with medication brief dynamic psychotherapy is an effective part of the treatment armamentarium. Clinicians should be trained in the brief as well as the longer term treatments and their use as brief, intermittent, and maintenance treatments. Skill in the longer term psychotherapies is important to developing skill in the brief dynamic psychotherapy where the needs for rapid establishment of the therapeutic alliance and the accurate assessment of transference and defence patterns are important. Empirical studies comparing well-defined brief dynamic psychotherapy with cognitive and interpersonal psychotherapies are limited. Future research must address which form of brief psychotherapy may be most helpful for which patient. An individual's preferred learning path-what he or she may see and observe most easily such as thoughts or feelings or interpersonal relations-may be an important variable in determining which brief psychotherapy for which patient. State, trait, and contextual variables will influence this learning modality. The process of change in brief individual psychodynamic psychotherapy, a process of altering neuronal organization through verbal means, is influenced by the patient's diagnosis, medications, past history, cognitive style, developmental stage, and affective availability, as well as the doctor–patient match.
Public policy and mental health
Authors: Muijen Matt , McCulloch Andrew 
Published: January 2013

Abstract
Public policy, and specifically national public policy, is one of the key factors that affects the practice of psychiatry, the shape of mental health services, and the environment within which mental health services work. The specific content of public policy varies greatly across the world and often even across neighbouring countries. It is therefore impossible within the space of this chapter to undertake systematic international comparisons. This chapter gives an overview of: (a) what policy is and why it might be important; (b) types of policy and policy development internationally; (c) international structures and organizations that are relevant to the scope and content of policy, especially in the field of human rights which is often the starting point for policy; (d) the breadth of policy activity that is relevant to mental health—stretching beyond the health ministry and health policy—and the partnerships that are necessary to tackle the mental health of individuals and populations.
Cultural differences care pathways, service use, and outcome
Authors: van Os Jim , McKenzie Kwame 
Published: January 2013

AbstractThis chapter discusses the influence of culture on the route an individual takes to access treatment for psychological distress and the treatment received. Culture is difficult to measure. All categories of cultural variables have different meanings and measure different things. Research into them leads to different hypotheses. Given this reality, there is no need to join the cul-de-sac argument of whether one or the other is the most important. In the discussion below, the roles of ethnicity and of socio-economic, political, community, national, and other factors that help to define the culture of an individual or a group are acknowledged. Associations with pathways to care, service use, and outcome will be presented.
Planning and providing mental health services for a community
Authors: Burns Tom 
Published: January 2013

AbstractThe aim of this chapter is to assist clinicians and managers review and plan services effectively for their local population. Severe psychiatric disorders manifest themselves in social relations and often disrupt social structures; they have wide-ranging consequences and services need to be comprehensive. Health and social care have been intertwined in psychiatry from its origins—it is neither feasible nor sensible to ignore the wider context of their management. The last 30 years have seen an explosion of Mental Health Services Research alongside the shrinking and closure of mental hospitals (see Chapter 7.6). Policy considerations, particularly cost containment and public safety, have influenced the research agenda which is disproportionately Anglophone (from the United States, United Kingdom, and Australasia) and focused on new services developed as alternatives to institutional care with staffing and motivation that are not easily generalizable. More routine practices, crucial for safe and effective care, have been relatively neglected by researchers. This chapter is mainly devoted to describing the essential components of a mental health service—its ‘building blocks’. It will then consider how they relate to one another, how they can be prioritized, and how integrated into an effective local service linking into other essential services. Lastly it will stress how their inevitable evolution should be monitored. Services for adults (increasingly referred to as ‘adults of working age’ indicating 18–65 years) will be used as the template. In many settings these may be the only services, stretching to accommodate all comers. In better resourced health care systems a range of specialized services have evolved from this basic model and are described elsewhere in this section (refugees 7.10.1, homeless 7.10.2, and ethnic minorities 7.10.3).
Evaluation of mental health services
Authors: Tansella Michele , Thornicroft Graham 
Published: January 2013

AbstractEvaluation is the basis for improving care to people with mental illness. It is vital to know whether interventions are beneficial or harmful, and whether they offer value for money. Mental health interventions need to be understood both in terms of their active ingredients and how they fit within their context. Such combined interventions, often including pharmacological, psychological, and social elements, are the epitome of ‘complex interventions’ and their evaluation poses considerable challenges. In this chapter we shall discuss definitions of evaluation, and go on to discuss why evaluate, what to evaluate, and how to evaluate mental health services. In our conclusion we shall offer an indication of the most important trends in this field in the coming years. The overall approach that we take is centred upon the idea that ongoing evaluative research is of fundamental importance in discovering which interventions are effective, neutral, or harmful, and that such information is essential to deliver better mental health care.
Economic analysis of mental health services
Authors: Knapp Martin , Chisholm Dan 
Published: January 2013

AbstractEconomics is concerned with the use and distribution of resources within a society, and how different ways of allocating resources impact on the well-being of individuals. Economics enters the health sphere because resources available to meet societal needs or demands are finite, meaning that choices have to be made regarding how best to allocate them (typically to generate the greatest possible level of population health). Economics provides an explicit framework for thinking through ways of allocating resources. Resource allocation decisions in mental health are complicated by the fact that disorders are common, debilitating, and often long-lasting. Epidemiological research has demonstrated the considerable burden that mental disorders impose because of their prevalence, chronicity, and severity: globally, more than 10 per cent of lost years of healthy life and over 30 per cent of all years lived with disability are attributable to mental disorders. Low rates of recognition and effective treatment compound the problem, particularly in poor countries. However, disease burden is not in itself sufficient as a justification or mechanism for resource allocation or priority-setting. A disorder can place considerable burden on a population but if appropriate strategies to reduce this burden are absent or extremely expensive in relation to the health gains achieved, large-scale investment would be considered misplaced. The reason is that scarce resources could be more efficiently channelled to other burdensome conditions for which cost-effective responses were available. For priority-setting and resource allocation, it is necessary to ask what amount of burden from a disorder can be avoided by using evidence-based interventions, and at what relative cost of implementation in the target population. Cost and cost-effectiveness considerations enter into health care reform processes, priority-setting exercises within and across health programmes, and regulatory decisions concerning drug approval or pricing. Two broad levels of economic analysis can be distinguished: macro and micro.
Mental health services for homeless mentally ill people
Authors: Craig Tom K. J. 
Published: January 2013

Abstract
Specialist multidisciplinary teams for homeless mentally ill people provide an essential safety net for those who have fallen out of the wider mental health care system. They offer distinct advantages in terms of their capacity to work across traditional geographical and bureaucratic barriers, to take the longer-term view of the task of engagement, and to bring together the multiple strands of care across different provider agencies. Introduced as a temporary measure over a decade ago, they are still with us and likely to remain a permanent fixture of urban mental health care.
The biology of ageing
Authors: Bittles Alan H. 
Published: January 2013

AbstractAlthough old age is readily recognizable, methods to define and measure the underlying biological processes are much less amenable to study. For this reason, life expectancy has been widely used as a surrogate measure of ageing, as well as to monitor economic progress at national and regional levels. It is generally acknowledged that lifespan is a constitutional feature of the human phenotype, and twin studies have indicated that 25–33 per cent of the variance in human longevity is genetic in origin. External factors including lifestyle can also exert a major influence, as illustrated by the current mean life expectancies of 79 and 86 years for males and females in Japan, whereas the comparable figures for Botswana are 35 and 33 years, respectively. The importance of genetic inheritance as a determinant of extended survival has been illustrated by population level studies in Okinawa, an island prefecture of southern Japan with a very high prevalence of long-lived individuals. On the island, the mortality rates of the male and female siblings of centenarians were approximately half those of birth cohort-matched, non-centenarian siblings. These findings parallel an earlier study of the family of Jeanne Calment, who died in France in 1997 aged 122 years. Of her 55 relatives, 24 per cent had lived to &gt;80 years compared to just 2 per cent of a matched control group. However, it remains unclear whether the enhanced lifespan of individuals who exhibit above average longevity is due to a slowing of the overall ageing process or is primarily associated with resistance to major life-threatening pathologies. The concept of an ‘allostatic load’, potentially involving the neuroendocrine, sympathetic nervous, immune and cardiovascular systems, and metabolic pathways, has been advanced to describe the lifetime costs of adapting to physical and psychological stresses. According to this hypothesis, while the actions of biological mediators of stress can be initially beneficial to health, chronic stimulation results in regulatory imbalance and subsequent pathophysiological changes. Empirical studies have indicated increased physiological dysregulation and functional decline at &gt;70 years of age, which would imply that predicted global increases in the numbers of older persons will be accompanied by disproportionately larger groups of individuals with major age-related pathologies.