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Wellness in Psychiatry-The Dawn of a New Era Focus on Definitions. Neurobiology & Interventions

Wellness in Psychiatry-The Dawn of a New Era Focus on Definitions. Neurobiology & Interventions. Rakesh Jain, MD, MPH. The World Health Organization Defines Health as:. “…a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”.

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Wellness in Psychiatry-The Dawn of a New Era Focus on Definitions. Neurobiology & Interventions

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  1. Wellness in Psychiatry-The Dawn of a New EraFocus on Definitions. Neurobiology & Interventions Rakesh Jain, MD, MPH

  2. The World Health Organization Defines Health as: “…a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” World Health Organization. Promoting Mental Health. Concepts, Emerging Evidence, Practice. 2004.

  3. Definitions “recovery is not about ‘getting rid’ of problems. It is about seeing people beyond their problems – their abilities, possibilities, interests and dreams – and recovering the social roles and relationships that give life value and meaning.” World Health Organization. Promoting Mental Health. Concepts, Emerging Evidence, Practice. 2004; Slade M. BMC Health Serv Res. 2010;10:26.

  4. Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) Tennant R et al. Health Qual Life Outcomes. 2007:5:63.

  5. WEMWBS – Population Sample Tennant R et al. Health Qual Life Outcomes. 2007:5:63.

  6. Maternal Well-Being and Developmental Difficulties in Children P=0.004 Tough SC et al. BMC Pediatrics. 2010;10:19.

  7. Money Appears to Not be Able to Buy Mental Health!Mental Health Before and After a Win x 0.61 x x 0.06 0.05 x GHQ, General Health Questionnaire. Higher score means worsening Gardner J, Oswald AJ. J Health Econ. 2007;26(1):46-60.

  8. Physician Heal Thyself…! No difference between men and women No difference by ethnic groups No difference between self-employed, associates, or salaried Murfett A, Charman D. AustFam Physician. 2006;35(9):748-750.

  9. Concepts in this Emerging Field Cover both affect and psychological functioning Covers the overlapping concepts of hedonic and eudemonic well-being Has consequences for both health and social outcomes Stewart-Brown S et al. Health Qual Life Outcomes. 2009;7:15.

  10. Mental Well-Being is Much More than Absence of Symptoms NA, Negative Affect PA, Positive Affect Arousal NA PA Presence of fitness decrements Presence of fitness increments Valence Absence of fitness increments Absence of fitness decrements −PA −NA Burgdorf J, Panksepp J. NeurosciBiobehan Rev. 2006;30(2):173-187.

  11. Mental Wellness: A Huge Payoff for Everyone, Including Those With Psychiatric Disorders • Mental Wellness lowers risk of mental illness • Mental illness episode length/depth reduced by Mental Wellness Burgdorf J, Panksepp J. NeurosciBiobehan Rev. 2006;30(2):173-187; Slade M. BMC Health Serv Res. 2010;10:26.

  12. Imaging Happiness Significantly increased BOLD signal during happiness scripts compared to emotionally neutral scripts are seen on the left dorsomedial prefrontal cortex, dorsal anterior cingulategyrus, insula, and dorsal postero-lateral prefrontal cortex, as well as on the thalami, left hypothalamus, and left middle temporal gyrus. In the bottom row, foci of significantly increased BOLD signals during happiness scripts compared to irritability scripts are shown on the left anterior insula, left hypothalamus, thalamus bilaterally, inferior and middle temporal gyri bilaterally, and right posterior insula, while areas of decreased BOLD effect are seen on the left dorsomedial prefrontal and dorsal anterolateral prefrontal cortices, subgenualcingulategyrus, and left lingual gyrus. Cerequeira CT et al. Braz J Med Biol Res. 2008;41(12):1076-1085.

  13. Psychological Well-Being is Connected to Limbic System Functioning PWB, Psychological Well-Being Scale Activity in the ventral Anterior Cingulate Cortex in response to negative vs. neutral image van Reekum CM et al. J CognNeurosci. 2007;19(2):237-248.

  14. Pessimism Accelerates Telomere Shortening and Increases IL-6 Scatterplot of dispositional pessimism and telomere length (TL) (r=−0.55, P=0.001). Study investigated whether dispositional tendencies towards optimism and pessimism were associated with TL and IL-6 in a sample of 36 healthy postmenopausal women. Pessimism was independently associated with shorter TL (β=−0.68, P=0.001) and higher IL-6 concentrations (β=0.50, P=0.02). O’Donovan A et al. Brain Behav Immun. 2009;23(4):446-449.

  15. Optimism Mitigates Biological Impact of Stress Double-blind, placebo-controlled study showed that acute psychological stress increased serum levels of interleukin-6 (IL-6) and negative mood in 59 healthy men. Further analysis of this sample investigated the relationship between dispositional optimism and stress-induced changes in immunity and mood. Brydon L et al. Brain Behav Immun. 2009;23(6):810-816.

  16. Positive Affect May Diminish the Risk of Cardiovascular Events Cubic spline analysis of the incidence rate ratio comparing each level of positive affect to a score of 1. Solid line indicates point estimate and dashed lines indicate 95% confidence interval. Dotted line indicates no association. Study examined the association between positive affect and cardiovascular events in 1,739 adults. There were 145 (8.3%) acute non-fatal or fatal ischaemic heart disease events during the14 916 person-years of observation. In a proportional hazards model controlling for age, sex, and cardiovascular risk factors, positive affect predicted coronary heart disease (adjusted HR, 0.78; 95% CI 0.63–0.96 per point; P<0.02). Davidson KW et al. Eur Heart J. 2010;31(9):1065-1070.

  17. Health Behavior is Affected by Quality of Mental Health Steptoe A et al. J Pers. 2009;77(6):1747-1776.

  18. Happiness Influences Inflammation Fibrinogen g/L Happiness and fibrinogen stress responses. Shown is the mean increase in plasma fibrinogen after acute mental stress in the 5 happiness quintiles, adjusted for gender, age, grade of employment, BMI, smoking, baseline fibrinogen, and GHQ. Error bars are SEM. Differences in fibrinogen stress responses across happiness quintiles were significant (P=0.011). Steptoe A et al. Proc Natl Acad Sci U S A. 2005;102(18):6508-6512.

  19. How Does Positive Mental Well-Being Affect Our Health? • Shared • Genetics • Positive Health Behaviors • Shared • Neuroendocrine, • Inflammatory, • Autonomic, & Immune Pathways Steptoe A et al. J Pers. 2009;77(6):1747-1776.

  20. So, what should we tell our Family? • The ‘new’ standard of recovery is NOT just a mere absence of symptoms, but presence of Positive Affect and Mental Wellness • All, even those with mental illness, can and should aim for this new standard of full recovery and optimum mental functioning

  21. Complete State Model of Mental Health High subjective well-being symptoms INCOMPLETE MENTAL ILLNESS COMPLETE MENTAL HEALTH Struggling Flourishing High mental illness symptoms Low mental illness symptoms Floundering Languishing COMPLETE MENTAL ILLNESS INCOMPLETE MENTAL HEALTH Low subjective well-being symptoms Slade M. BMC Health Serv Res. 2010;10:26.

  22. Layous K et al. J Altern Complement Med. 2011;17(8):675-683. Neurobiological Driven Rationale: Combination May Be the Gold Standard Therapy in Depression Pharmacotherapy Cognitive-Behavioral Therapy Limbic Hyperactivity Dorsal Cortex Emotional/ Cognitive Dysregulation Pleasure Circuit Dampening Pharmacotherapy + Cognitive-Behavioral Therapy + Positive Activity Interventions Positive Activity Interventions

  23. How Are You Feeling Right Now? 0 = very bad - - - - - - - - - - - - - - - - - - - - - - - - - - -100 = very good Kittingsworth MA, Gilbert DT. Science 2010. vol 330:932

  24. No Inherit Conflict BetweenNegative & Positive Mental Health Yesterday’s Remission Today’s Remission

  25. The Interacting Spheres of a Health-Promoting Whole-School Environment Organization: ethos and environment Curriculum: teaching and learning Partnerships and services Wyn J et al. Aust N Z J Psychiatry. 2000;34(4):594-601.

  26. Seligman - Creator of the Field of Positive Psychology and Positive Psychotherapy (PPT)

  27. Seligman’s Theory of Authentic Happiness The Pleasant Life, which consists in having as much positive emotion as possible and learning the skills to prolong and intensify pleasures The Engaged Life, which consists in knowing your character (highest) strengths and re-crafting your work, love, friendship, play, and parenting to use them as much as possible The Meaningful Life, which consists in using your character strengths to belong to and serve something that you believe is larger than just your self The Achieving Life, which is a life dedicated to achieving for the sake of achievement Seligman ME. Authentic Happiness: Using the New Positive Psychology to Realize Your Potential for Lasting Fulfillment. 2002.

  28. Happiness – The Seligman Model Seligman M et al. Am Psychol. 2006;61(8):774-788.

  29. Positive Psychotherapy Randomized controlled trials of PPT show efficacy in mild, moderately, and severely depressed individuals, with moderate to large effect sizes and sustained at 1 year follow-up. Seligman M et al. Am Psychol. 2006;61(8):774-788.

  30. PPT – Is It Effective in Patients With Depression? 6 weekly group sessions with homework assignments P<0.04 at 6 months and 1 year Seligman M et al. Am Psychol. 2006;61(8):774-788.

  31. Mindfulness Based Cognitive Therapy (MBCT) – Promising New Therapy M-ADM = Medication (anti-depressant continuation) MBCT= Mindfulness based CT Pla+Clin = Placebo plus clinical management Segal Z, et al. Arch Gen Psychiatry 2010. 67(12):1256-1264

  32. Bringing Happiness to the Masses

  33. Clinical Practice and Wellness Measurement - WHO-5

  34. WHO-5 Scoring: The raw score is calculated by totaling the figures of the five answers. The raw score ranges from 0 to 25, 0 representing worst possible and 25 representing best possible quality of life. To obtain a percentage score ranging from 0 to 100, the raw score is multiplied by 4. A percentage score of 0 represents worst possible, whereas a score of 100 represents best possible quality of life. Interpretation: It is recommended to administer the Major Depression (ICD-10) Inventory if the raw score is below 13 or if the patient has answered 0 to 1 to any of the five items. A score below 13 indicates poor wellbeing and is an indication for testing for depression under ICD-10. Monitoring change: In order to monitor possible changes in wellbeing, the percentage score is used. A 10% difference indicates a significant change (ref. John Ware, 1995).

  35. Models are Changing: Are We Ready? Disease Model vs. Disease to Wellness Model Absence of Symptoms Disease Wellness (Positive Psychology, Resilience, etc.) Absence of Symptoms Disease

  36. Difference between Treating Depression and Offering Positive Mental Health Goal achieved ?? Time for a round of congratulations??? Depressive Symptoms Depressive Symptoms Depressive Symptoms Depressive Symptoms

  37. In Conclusion – Paradigm Shift Aiming toward Wellness Positive Mental Health Positive Mental Health Positive Mental Health Positive Mental Health Depressive Symptoms Depressive Symptoms Depressive Symptoms Depressive Symptoms

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