wellness in psychiatry the dawn of a new era focus on definitions neurobiology interventions n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Wellness in Psychiatry-The Dawn of a New Era Focus on Definitions. Neurobiology & Interventions PowerPoint Presentation
Download Presentation
Wellness in Psychiatry-The Dawn of a New Era Focus on Definitions. Neurobiology & Interventions

Loading in 2 Seconds...

play fullscreen
1 / 37

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


  • 55 Views
  • Uploaded on

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.”.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Wellness in Psychiatry-The Dawn of a New Era Focus on Definitions. Neurobiology & Interventions' - gusty


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
wellness in psychiatry the dawn of a new era focus on definitions neurobiology interventions

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

Rakesh Jain, MD, MPH

the world health organization defines health as
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.

definitions
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.

warwick edinburgh mental well being scale wemwbs
Warwick-Edinburgh Mental Well-Being Scale (WEMWBS)

Tennant R et al. Health Qual Life Outcomes. 2007:5:63.

wemwbs population sample
WEMWBS – Population Sample

Tennant R et al. Health Qual Life Outcomes. 2007:5:63.

maternal well being and developmental difficulties in children
Maternal Well-Being and Developmental Difficulties in Children

P=0.004

Tough SC et al. BMC Pediatrics. 2010;10:19.

money appears to not be able to buy mental health mental health before and after a win
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.

physician heal thyself
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.

concepts in this emerging field
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.

mental well being is much more than absence of symptoms
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.

mental wellness a huge payoff for everyone including those with psychiatric disorders
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.

imaging happiness
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.

psychological well being is connected to limbic system functioning
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.

pessimism accelerates telomere shortening and increases il 6
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.

optimism mitigates biological impact of stress
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.

positive affect may diminish the risk of cardiovascular events
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.

health behavior is affected by quality of mental health
Health Behavior is Affected by Quality of Mental Health

Steptoe A et al. J Pers. 2009;77(6):1747-1776.

happiness influences inflammation
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.

how does positive mental well being affect our health
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.

so what should we tell our family
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
complete state model of mental health
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.

neurobiological driven rationale combination may be the gold standard therapy in depression
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

slide23

How Are You Feeling Right Now?

0 = very bad - - - - - - - - - - - - - - - - - - - - - - - - - - -100 = very good

Kittingsworth MA, Gilbert DT. Science 2010. vol 330:932

no inherit conflict between negative positive mental health
No Inherit Conflict BetweenNegative & Positive Mental Health

Yesterday’s Remission

Today’s Remission

the interacting spheres of a health promoting whole school environment
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.

seligman s theory of authentic happiness
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.

happiness the seligman model
Happiness – The Seligman Model

Seligman M et al. Am Psychol. 2006;61(8):774-788.

positive psychotherapy
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.

ppt is it effective in patients with depression
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.

mindfulness based cognitive therapy mbct promising new therapy
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

who 5
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).

models are changing are we ready disease model vs disease to wellness model
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

difference between treating depression and offering positive mental health
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

in conclusion paradigm shift aiming toward wellness
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