Global estimates of service coverage for severe mental disorders: findings from the WHO Mental Health Atlas 2017

Translation from Preclinical Research to Clinical Trials: Transdermal Drug Delivery for Neurodegenerative and Mental Disorders

Neurodegenerative diseases (NDs), particularly dementia, provide significant problems to worldwide healthcare systems. The development of therapeutic materials for various diseases has a severe challenge in the form of the blood-brain barrier (BBB). Transdermal treatment has recently garnered widespread favor as an alternative method of delivering active chemicals to the brain. This approach has several advantages, including low invasiveness, self-administration, avoidance of first-pass metabolism, preservation of steady plasma concentrations, regulated release, safety, efficacy, and better patient compliance. Topics include the transdermal method for therapeutic NDs, their classification, and the mechanisms that allow the medicine to enter the bloodstream through the skin. The paper also discusses the obstacles and potential outcomes of transdermal therapy, emphasizing the benefits and drawbacks of different approaches.

Do metacognitive therapies for schizophrenia-spectrum disorders work? A meta-analytic investigation

Recent reviews and meta-analyses of metacognitive therapy for schizophrenia-spectrum disorder (SSD) have included uncontrolled studies, single-session interventions, and/or analyses limited to a single form of metacognitive therapy. We sought to evaluate the efficacy of metacognitive therapies more broadly based on controlled trials (CT) of sustained treatments. We conducted a pre-registered meta-analysis of controlled trials that investigated the effects of meta-cognitive therapies on primary positive symptom outcomes, and secondary symptom, function and/or insight measures. Electronic databases were searched up to March 2022 using variants of the keywords, 'metacognitive therapy', 'schizophrenia', and 'controlled trial'. Studies were identified and screened according to PRISMA guidelines. Outcomes were assessed with random effects models and sample, intervention, and study quality indices were investigated as potential moderators. Our search identified 44 unique CTs with usable data from 2423 participants. Data were extracted by four investigators with reliability >98%. Results revealed that metacognitive therapies produced significant small-to-moderate effects on delusions (g = 0.32), positive symptoms (g = 0.30) and psychosocial function (g = 0.31), and significant, small effects on cognitive bias (g = 0.25), negative symptoms (g = 0.24), clinical insight (g = 0.29), and social cognition (g = 0.27). Findings were robust in the face of sample differences in age, education, gender, antipsychotic dosage, and duration of illness. Except for social cognition and negative symptoms, effects were evident even in the most rigorous study designs. Thus, results suggest that metacognitive therapies for SSD benefit people, and these benefits transfer to function and illness insight. Future research should modify existing treatments to increase the magnitude of treatment benefits.

Relationships of depression and antidepressant use with epigenetic age acceleration and all-cause mortality among postmenopausal women

We investigated relations of depressive symptoms, antidepressant use, and epigenetic age acceleration with all-cause mortality risk among postmenopausal women. Data were analyzed from ≤1,900 participants in the Women's Health Initiative study testing four-way decomposition models. After a median 20.4y follow-up, 1,161 deaths occurred. Approximately 11% had elevated depressive symptoms (EDS+), 7% were taking antidepressant medication at baseline (ANTIDEP+), while 16.5% fell into either category (EDS_ANTIDEP+). Baseline ANTIDEP+, longitudinal transition into ANTIDEP+ and accelerated epigenetic aging directly predicted increased mortality risk. GrimAge DNA methylation age acceleration (AgeAccelGrim) partially mediated total effects of baseline ANTIDEP+ and EDS_ANTIDEP+ on all-cause mortality risk in socio-demographic factors-adjusted models (Pure Indirect Effect >0, P < 0.05; Total Effect >0, P < 0.05). Thus, higher AgeAccelGrim partially explained the relationship between antidepressant use and increased all-cause mortality risk, though only prior to controlling for lifestyle and health-related factors. Antidepressant use and epigenetic age acceleration independently predicted increased all-cause mortality risk. Further studies are needed in varying populations.

Caregiving experiences of family caregivers of patients with schizophrenia in a community: a qualitative study in Beijing

OBJECTIVES

This study aims to understand the caregiving experiences of family caregivers of people with schizophrenia in a community.

DESIGN

A qualitative study based on phenomenological analysis was conducted through in-depth interviews.

SETTING

This study was carried out from May to June 2023 in two community health service centres in urban Beijing, China.

PARTICIPANTS

We selected 16 family caregivers for interviews using purposive sampling method.

RESULTS

Four themes and 10 subthemes were identified: (1) psychosocial distress of family caregivers (feeling unprepared and helpless at the beginning, confronting negative emotions in long-term care and straying away from social life); (2) adverse impacts on the whole family (poor cooperation within the family, insufficient family involvement in professional care); (3) coping with family caregiving (accepting the reality of the patients' illness, struggling with family life balance and having realistic expectations); (4) concerns about future care (daily living support, physical health management).

CONCLUSION

Family caregivers experienced psychosocial distress and family stress in the process of caregiving. They had to cope with caregiving stress and were concerned about the long-term care of people with schizophrenia. These findings provide implications for intervention programmes to strengthen social support, family involvement, and active coping for caregivers and develop long-term care mechanisms for people with schizophrenia.

Depressive symptoms and antidepressant use in relation to white blood cell count among postmenopausal women from the Women's Health Initiative

Inflammation can play a role in the pathophysiology of depression, and specific types of antidepressants may have inflammatory or anti-inflammatory properties. Furthermore, depression and antidepressant use has been linked to white blood cell (WBC) count, a routinely measured inflammatory marker. We examined the cross-sectional and longitudinal relationships of depressive symptoms and/or antidepressant use with WBC count among postmenopausal women. Analyses of cross-sectional data at enrollment were performed on 125,307 participants, 50-79 years of age, from the Women's Health Initiative Clinical Trials and Observational Studies who met eligibility criteria, and a subset of those with 3-year follow-up data were examined for longitudinal relationships. Depressive symptoms were defined using the Burnam Algorithm whereas antidepressant use was defined using therapeutic class codes. WBC count (Kcell/ml) was obtained through laboratory evaluations of fasting blood samples. Multivariable regression modeling was performed taking sociodemographic, lifestyle and health characteristics into consideration. At enrollment, nearly 85% were non-users of antidepressants with no depressive symptoms, 5% were antidepressant users with no depressive symptoms, 9% were non-users of antidepressants with depressive symptoms, and 2% were users of antidepressants with depressive symptoms. In fully-adjusted models, cross-sectional relationships were observed whereby women in the 2nd (OR = 1.06, 95% CI: 1.01, 1.13), 3rd (OR = 1.06, 95% CI: 1.00, 1.12) or 4th (OR = 1.10, 95% CI: 1.05, 1.17) quartiles of WBC count were more likely to exhibit depressive symptoms, and women in the 4th quartile were more likely to be users of antidepressants (OR = 1.07, 95% CI: 1.00, 1.15), compared to women in the 1st quartile. Compared to women who exhibited no depressive symptoms at either visit, those with consistent depressive symptoms at enrollment and at 3-year follow-up had faster decline in WBC count (β = -0.73, 95% CI: -1.33, -0.14) over time. No significant bidirectional relationships were observed between changes in depressive symptoms score and WBC count over time. In conclusion, depressive symptoms and/or antidepressant use were cross-sectionally related to higher WBC counts among postmenopausal women. Further evaluation of observed relationships is needed in the context of prospective cohort studies involving older adult men and women, with repeated measures of depression, antidepressant use, and WBC count.

Mental health literacy and its associated factors among traditional healers toward mental illness in Northeast, Ethiopia: A mixed approach study

BACKGROUND

Currently, the biggest issue facing the entire world is mental health. According to the Ethiopian Ministry of Health, nearly one-fourth of the community is experiencing any of the mental illness categories. Most of the cases were treated in religious and traditional institutions, which the community most liked to be treated. However, there were very limited studies conducted to show the level of mental health literacy among traditional healers.

AIMS

The study aimed to assess the level of mental health literacy and its associated factors among traditional healers toward mental illness found in Northeast, Ethiopia from September 1-30/2022.

METHOD

A mixed approach cross-sectional study design was carried out on September 130, 2022, using simple random sampling with a total sample of 343. Pretested, structured questionnaires and face-to-face interviews were utilized for data collection. The level of Mental Health Literacy (MHL) was assessed using the 35 mental health literacy (35-MHLQ) scale. The semi-structured checklist was used for the in-depth interview and the FGD for the qualitative part. Data was entered using Epi-data version 4.6 and, then exported to SPSS version 26 for analysis. The association between outcome and independent variables was analyzed with bivariate and multivariable linear regression. P-values < 0.05 were considered statistically significant. Thematic analysis was used to analyze the qualitative data, and the findings were then referenced with the findings of the quantitative data.

RESULTS

The findings of this study showed that the sample of traditional healers found in Dessie City scored a total mean of mental health literacy of 91.81 ± 10:53. Age (β = -0.215, 95% CI (-0.233, -0.05), p = 0.003, informal educational status (β = -5.378, 95% CI (-6.505, -0.350), p = 0.029, presence of relative with a mental disorder (β = 6.030, 95% CI (0.073, 7.428),p = 0.046, getting information on mental illness (β = 6.565, 95% CI (3.432, 8.680), p = <0.001, and mental health training (β = 4.889, 95% CI (0.379, 6.455), p = 0.028 were variables significantly associated with mental health literacy. Traditional healers provide a variety of explanations for the causes of mental illness, including biological, psychological, and supernatural ones.

CONCLUSION

The mean score of the Mental Health Literacy Scale (MHLS) is lower among traditional healers compared with other studies. Age, informal educational status, family history of mental illness, getting information on mental illness, and mental health training were significantly associated with mental health literacy. Therefore, different works to improve the levels of mental health literacy among traditional healers are essential.

Safety, tolerability, and pharmacokinetics of JX11502MA in Chinese healthy subjects: a first-in-human, randomized, double-blind, placebo-controlled study following single-dose administration

BACKGROUND

JX11502MA is a potent partial agonist of dopamine D2 and D3 receptors, with a preferential binding profile for D3 receptors in vitro, potentially for treating schizophrenia.

METHODS

A first-in-human, randomized, double-blind, placebo-controlled, single ascending dose clinical trial was designed. The subjects were randomly assigned to receive JX11502MA and placebo capsules with seven ascending dose groups: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 6 mg, and 8 mg. The PK profiles of JX11502MA and its metabolites were evaluated, along with a safety and tolerability assessment.

RESULTS

Considering the safety of participants, the dose escalation was halted at 3 mg. Following single-dose administration, JX11502MA exhibited rapid absorption with a median Tmax ranging from 1 to 1.75 h. The terminal half-life of JX11502MA ranged from 73.62 to 276.85 h. The most common treatment-emergent adverse events (TEAEs) for subjects receiving JX11502MA were somnolence (56.3%), dizziness (18.8%), nausea (21.9%), vomiting (18.8%), and hiccups (18.8%).

CONCLUSIONS

JX11502MA was generally well tolerated at a single dose of 0.25 to 3 mg. The PK profiles and safety characteristics in this study indicated that JX11502MA has the potential to be a favorable treatment option for patients with schizophrenia.

TRIAL REGISTRATION

https://clinicaltrials.gov (identifier: NCT05233657).

Exploring the efficacy of traditional Chinese medicine exercise in alleviating anxiety and depression in older adults: a comprehensive study with randomized controlled trial and network meta-analysis

Background

Anxiety and depression pose a significant global health challenge for elderly individuals. Research has demonstrated the potential of traditional Chinese medicine (TCM) exercise therapies in alleviating these conditions. However, ongoing debate and uncertainty persist regarding the optimal therapy and its impact on anxiety and depression. This study aims to evaluate and prioritize TCM exercise therapies for anxiety and depression in older adults, to identify the most effective intervention, and to provide a basis for informed decision-making in clinical practice.

Methods

We conducted a comprehensive search of electronic databases including The Web of Science, PubMed, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wang Fang, and Wei Pu database up to July 2022. Two researchers independently reviewed all included studies and extracted relevant data. Traditional meta-analysis was performed using Review Manager version 5.4, while network meta-analysis was conducted using STATA software version 15.1 to generate network evidence plots and funnel plots.

Result

A total of 30 trials, involving 2,806 participants, met the eligibility criteria. The traditional meta-analysis revealed that TCM exercise significantly improved anxiety (SMD = -0.82, 95% CI = -1.39, -0.26, p = 0.004) and depression (SMD = -0.63, 95% CI = -0.85, -0.41, p < 0.01) compared to the control group. In the network meta-analysis, Tai Chi exercise was ranked as the most effective intervention for anxiety (68.3%), followed by Yi Jin Jing (63.6%). For depression, the Tai Chi exercise was ranked as the most effective (87.8%), followed by the Ba Duan Jin exercise (74.1%).

Conclusion

TCE exercise can improve anxiety and depression in older adults, Among the four TCE exercise therapies included, Tai Chi exercise showed better efficacy than other types of treatment. Nevertheless, further research is required to validate the effectiveness of this exercise therapy through larger and more rigorous clinical trials.

Systematic review registration

http://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023438697.

Incidence, prevalence, and global burden of schizophrenia - data, with critical appraisal, from the Global Burden of Disease (GBD) 2019

Schizophrenia substantially contributes to the burden of mental disorders. Schizophrenia's burden and epidemiological estimates in some countries have been published, but updated estimates of prevalence, incidence, and schizophrenia-related disability at the global level are lacking. Here, we present the data from and critically discuss the Global Burden of Diseases, Injuries, and Risk Factors Study data, focusing on temporal changes in schizophrenia's prevalence, incidence, and disability-adjusted life years (DALYs) globally. From 1990 to 2019, schizophrenia raw prevalence (14.2 to 23.6 million), incidence (941,000 to 1.3 million), and DALYs (9.1 to 15.1 million) increased by over 65%, 37%, and 65% respectively, while age-standardized estimates remained stable globally. In countries with high socio-demographic index (SDI), both prevalence and DALYs increased, while in those with low SDI, the age-standardized incidence decreased and DALYs remained stable. The male/female ratio of burden of schizophrenia has remained stable in the overall population over the past 30 years (i.e., M/F = 1.1), yet decreasing from younger to older age groups (raw prevalence in females higher than males after age 65, with males having earlier age of onset, and females longer life expectancy). Results of this work suggest that schizophrenia's raw prevalence, incidence, and burden have been increasing since 1990. Age-adjusted estimates did not reduce. Schizophrenia detection in low SDI countries is suboptimal, and its prevention/treatment in high SDI countries should be improved, considering its increasing prevalence. Schizophrenia sex ratio inverts throughout the lifespan, suggesting different age of onset and survival by sex. However, prevalence and burden estimates for schizophrenia are probably underestimated. GBD does not account for mortality from schizophrenia (and other mental disorders, apart from anorexia nervosa).

Psychological Help-Seeking Status for Living with Mental Health Conditions in Türkiye: Using a Multivariate Probit Model

BACKGROUND/AIM

Mental disorders constitute a significant public health concern, contributing significantly to the overall disease burden. Individuals experiencing mental distress often delay or avoid seeking psychological help or do not seek help due to varying factors. This study examines the factors affecting individuals' preferences, particularly young people, in seeking psychological help in Türkiye.

METHODS

This study utilized microdata from the Türkiye Health Survey conducted by TURKSTAT in 2016 and 2019. The factors influencing decisions to consult with a psychologist, psychotherapist, or psychiatrist were determined by multivariate probit regression analysis. The Türkiye Health Survey employed a stratified two-stage cluster sampling method, surveying 17,242 individuals over the age of 15 in 9470 households in 2016 and 17,084 individuals over the age of 15 in 9470 households in 2019.

RESULTS

The analysis findings indicated that, in the entire sample, women are more likely to seek psychological help, while younger women are less likely to do so. In the entire sample, as the education level increased, the probability of individuals receiving psychological help increased, while it decreased for young people. It was determined that people who use tobacco and alcohol are more likely to receive psychological help than others. It was also determined that individuals who perceive their health status as good, especially those who are both young and perceive their health status as good, are less likely to seek psychological help.

CONCLUSIONS

The significance and impact of the variables on the probability of individuals seeking psychological help vary for both the entire sample and young people. There may be various restrictions in getting psychological help, and people may resort to informal methods instead of professionals to cope with their existing problems. In developing preventive strategies to safeguard mental health, factors related to young people's and individuals' psychological help-seeking status should be prioritized, and more attention should be paid to them.

International monitoring of capacity of treatment systems for alcohol and drug use disorders: Methodology of the Service Capacity Index for Substance Use Disorders

OBJECTIVES

We aimed to develop a Service Capacity Index for Substance Use Disorders (SCI-SUD) that would reflect the capacity of national health systems to provide treatment for alcohol and drug use disorders, in terms of the proportion of available service elements in a given country from a theoretical maximum.

METHODS

Data were collected through the WHO Global Survey on Progress with Sustainable Development Goals (SDG) Health Target 3.5, conducted between December 2019 and July 2020 to produce the SCI-SUD, based on 378 variables overall.

RESULTS

The SCI-SUD was directly derived for 145 countries. We used multiple imputation to produce comparable SCI-SUD estimates for countries that did not submit data (40 countries) or had very high level of missingness (9 countries). The final SCI-SUD demonstrates considerable consistency and internal stability and is strongly associated with the macro-level economic, healthcare-related and epidemiologic (such as prevalence rates) variables.

CONCLUSION

The presented methodology represents a step forward in monitoring the global situation in regard to the development of treatment systems for SU disorders, however, further work is warranted to improve the external validity of the measure (e.g., in-depth data generation in countries) and ensure its feasibility for regular reporting (e.g., reducing the number of variables).

Reimagining global mental health in Africa

In 2001, the WHO launched The World Health Report most specifically addressing low-income and middle-income countries (LAMICs). It highlighted the importance of mental health (MH), identifying the severe public health impacts of mental ill health and made 10 recommendations. In 2022, the WHO launched another world MH report and reaffirmed the 10 recommendations, while concluding that 'business as usual for MH will simply not do' without higher infusions of money. This paper suggests the reason for so little change over the last 20 years is due to the importation and imposition of Western MH models and frameworks of training, service development and research on the assumption they are relevant and acceptable to Africans in LAMICs. This ignores the fact that most mental and physical primary care occurs within local non-Western traditions of healthcare that are dismissed and assumed irrelevant by Western frameworks. These trusted local institutions of healthcare that operate in homes and spiritual spaces are in tune with the lives and culture of local people. We propose that Western foundations of MH knowledge are not universal nor are their assumptions of society globally applicable. Real change in the MH of LAMICs requires reimagining. Local idioms of distress and healing, and explanatory models of suffering within particular populations, are needed to guide the development of training curricula, research and services. An integration of Western frameworks into these more successful approaches are more likely to contribute to the betterment of MH for peoples in LAMICs.

Efficacy of Psychosocial and Psychological Interventions in Addition to Drug Therapy to Improve Global Functioning of Inpatients with Schizophrenia Spectrum and Mood Disorders: A Real-World Observational Study

Introduction and Aim

Psychotic and mood disorders are associated with significant functional impairment, premature mortality, physical morbidity, and great social and economic burden. The aim of this study is to evaluate the effectiveness of psychosocial, psychological, and rehabilitative interventions implemented in an Italian psychiatric inpatient facility, with a focus on patients with schizophrenia spectrum versus those with mood disorders.

Methods

A retrospective observational study was conducted in the psychiatric hospital Villa Maria Pia in Rome, Italy, during 2022. Patients with an established diagnosis of schizophrenia spectrum and mood disorder (ICD-9-CM) were assessed on admission (T0) and at the end of treatment (T1), using the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF). Interventions involved a multidisciplinary team and included individual and group activities. The t-test for independent samples was used to compare continuous variables between groups and Spearman correlation coefficient to calculate correlations between variables.

Results

The study sample consisted of 141 patients, the majority of them being adults (51.3 years ± 12.4) men (F/M= 68/73). Among them, 85 patients (60.3%) actively engaged in psychosocial and rehabilitative interventions and, compared to non-participating individuals, they showed lower functioning and symptoms at discharge (delta GAF was significantly higher among patients who had taken part in the psychosocial activities, t = -2.095; p = 0.038). Considering the index computed (n of interventions/days of hospitalization), the number of psychosocial activities was positively correlated with the improvement in patients' functioning in the sample taking part in activities (r = 0.272, p = 0.012), especially with psychotherapy and support groups (r = 0.202, p = 0.017 and r = 0.188, p = 0.025, respectively). Splitting the total sample into schizophrenia-spectrum disorder (N = 37) and mood disorder (N = 48) groups, the positive correlations between GAF improvement and participation in psychosocial activities were confirmed only in the schizophrenia-spectrum group. These correlations were not significant for symptomatology (BPRS) either in the total or the individual group.

Conclusion

Evidence from our study suggests that inpatient rehabilitation can be effective and useful for people with severe mental disorders. Further investigations are needed to better understand its effectiveness on improving quality of life and social functioning in the long term.

Girl's and women's experiences of seeking mental health support for symptoms associated with psychosis. A narrative review

BACKGROUND

Women are more likely than men to experience symptoms associated with psychosis, such as voice hearing, and more likely to seek mental health support. However, little is known about the emotional experiences of girls and young women who seek help for symptoms of psychosis to inform gender sensitive services and access routes. The current review offers the first focused insights into barriers and facilitators relating to help seeking for girls and women experiencing symptoms of psychosis.

METHODS

OneSearch, PubMed, and PsychINFO databases were searched for suitable papers in relation to the research question between November 2021 and February 2022; 139 papers were found, of which eight met the inclusion criteria for review.

RESULTS

Across the eight papers reviewed, participants were aged 15- to 71-years-old. From the participant numbers available, data from a total of 54,907 participants from a range of demographic groups were included in the review. Results and findings sections from the eight papers were reviewed for themes, and four overarching themes emerged: (1) The emotional cost of seeking help, (2) voice hearing for girls and women, (3) side effects of treatment, and (4) facilitators to accessing support.

DISCUSSION

Engagement in talking therapies can be difficult when services minimize the experience of psychosis-related symptoms. Women may be more likely to have their symptom-related distress diagnosed as a mood disorder, rather than symptoms of psychosis being identified, preventing timely tailored intervention. Normalization, psychoeducation, social support, and validation were recommended as helpful interventions.

How to measure barriers in accessing mental healthcare? Psychometric evaluation of a screening tool in parents of children with intellectual and developmental disabilities

Caring for children with intellectual and developmental disabilities (IDD) can cause an enormous physical and emotional burden, and therefore these parents have an elevated risk to experience mental health problems. The characteristics of current healthcare systems and parents' responsibilities to care for their children seem to impede their access to mental healthcare. There is so far a lack of instruments to screen for such obstacles. The aim of this study was to develop and validate a scale for measuring barriers to accessing mental healthcare. The Parental Healthcare Barriers Scale (PHBS) was developed on the basis of an extensive literature research, input and discussion from experts and parents with lived experience. A cross-sectional survey was used to collect data from 456 parents of children with IDD. Physical health, mental health, social support, and parenting were measured for concurrent and discriminant validity of the PHBS. The PHBS scale revealed acceptable to good reliability and validity. It consists of four subscales (i.e., support accessibility, personal belief, emotional readiness, and resource availability). The PHBS found parents prioritized their children's treatments over their own mental health challenges (93.4%), did not have enough time (90.4%), and had financial concerns (85.8%). Parents in rural and remote areas had more limited resources. Findings from our study suggest increasing financial support for the parents seeking mental health services, introducing evidence-based treatments, increasing the availability of healthcare services for parents, and adjusting current services to their needs.

Specialised psychiatric beds and 24-hour residential care in Australia 2018-2019 - Comparative analysis and commentary according to international benchmarking

OBJECTIVE

A commentary on Australian specialised private and public psychiatric acute and non-acute inpatient care, and 24-hour-staffed community residential care with regard to international benchmarks.

METHOD

Descriptive analysis of specialised psychiatric beds from the Australian Institute of Health and Welfare (AIHW) with the WHO Mental Health Atlas 2020, and an international Delphi consensus on optimal and minimal psychiatric beds per capita.

RESULTS

Australian private sector beds have shown a 3.8% annual growth rate from 2014-15 to 2018-19, in contrast to relatively static public sector bed numbers. Australia's national combined public and private psychiatric bed number (hospital acute and non-acute, and 24-hour-staffed community residential) of 48.8 per 100,000 population is lower than the WHO European (100.6) and World Bank High Income (69.2) medians, due to fewer community residential and non-acute beds. Australia's 40.9 general and stand-alone psychiatric beds per 100,000 are below the Delphi consensus optimal level of 60 beds per 100,000, but above the bed shortage threshold (30 per 100,000).

CONCLUSIONS

Rising bed numbers in private hospitals have contributed to Australian psychiatric inpatient capacity, although the level remains below comparable international medians. Recent initiatives to increase psychiatric bed numbers may signal a policy shift in the public sector, complementary to private and community care.

Anti-stigma initiatives for mental health professionals-A systematic literature review

WHAT IS KNOWN ON THE SUBJECT?: Negative attitudes towards mental illness lead to the formation of stigma. Stigma prevents the recovery of people diagnosed with mental illness. There is evidence of stigmatic attitudes towards mental ill health among mental health professionals. Anti-stigma initiatives, such as education and training, may be effective in enhancing or maintaining positive attitudes towards mental illness among mental health professionals. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Education and training that is designed and delivered around a specific mental health diagnosis or condition appears an appropriate strategy that could benefit mental health professionals to develop a deeper appreciation and understanding of mental ill health and its impacts on individuals. Consumer involvement in the education and training of mental health professionals regarding the stigma of mental illness is recommended; however, this is an under-explored area of investigation. There is a weak evidence base regarding the long-term sustainability of effects from anti-stigma education and training. This should be addressed via further research in future. WHAT ARE THE IMPLICATIONS FOR PRACTICES?: Anti-stigma initiatives can support mental health professionals to develop stigma-free, recovery-oriented practices in their work. Further, such initiatives can improve the provision of evidence-based quality care for the consumers, facilitating their recovery. ABSTRACT: Introduction Despite an increasing focus on stigma, evidence shows prejudicial attitudes towards mental illness among mental health professionals still exist. It is suggested that anti-stigma initiatives can aid in enhancing the attitudes of mental health professionals. However, research on initiatives targeting stigma of mental illness among mental health professionals is limited. Aim To identify and analyse scientific literature pertaining to the effectiveness of anti-stigma initiatives regarding mental ill health among mental health professionals. Method A systematic literature review was performed using the databases MEDLINE, CINAHL, PsycINFO, PubMed, Scopus, Google Search engine and Google Scholar. The papers were limited to English language, published in peer-reviewed journals with full-text articles available and published between the years 2008 and 2020 to understand the most recent trends in the attitudes of mental health professionals including nurses. The Population, Intervention, Comparison and Outcome (PICO) strategy was used to identify papers meeting the inclusion criteria. Results A total of 439 papers were identified. However, papers not meeting the inclusion criteria were excluded from selection. Three appraisers reviewed the selected papers individually using the Joanna Briggs Institute [JBI] critical appraisal tool. Finally, eight unanimously accepted papers were included in the systematic review. Several effective anti-stigma initiatives were identified through the review, and these had positive impacts on mental health professionals' attitudes towards mental illness, for at least a short period. It was identified that contact-based interventions are relevant and effective although the involvement of consumers and caregivers in the design and delivery of interventions was not explicitly addressed in detail in studies included in the review. Education strategies tailored for specific mental illness may be more appropriate, rather than approaches that refer to mental illness in general. Conclusions This review shows the evidence of pessimistic attitudes towards mental illness persists among mental health professionals. Anti-stigma initiatives identified in the selected papers were effective in changing these attitudes. Future research should be focused on the effectiveness of contact-based interventions and understanding the longer-term effects of the interventions among homogeneous groups. Full consideration of the varying level of clinical experience and expertise in mental health should guide the development and implementation of anti-stigma initiatives in this context. Implications for practice Anti-stigma interventions can have a positive impact on mental health professionals' knowledge, attitudes and supportive caring for people diagnosed with mental illness. Such anti-stigma interventions may meaningfully support stakeholders to address the impact of negative attitudes on the physical and mental health status of people diagnosed with mental illness. With sustained leadership, effort and reinforcement, it is possible to create workplace cultures that prioritize stigma-free and recovery-oriented behaviours and practices within mental health services.

Diagnosis of Schizophrenia Based on the Data of Various Modalities: Biomarkers and Machine Learning Techniques (Review)

Schizophrenia is a socially significant mental disorder resulting frequently in severe forms of disability. Diagnosis, choice of treatment tactics, and rehabilitation in clinical psychiatry are mainly based on the assessment of behavioral patterns, socio-demographic data, and other investigations such as clinical observations and neuropsychological testing including examination of patients by the psychiatrist, self-reports, and questionnaires. In many respects, these data are subjective and therefore a large number of works have appeared in recent years devoted to the search for objective characteristics (indices, biomarkers) of the processes going on in the human body and reflected in the behavioral and psychoneurological patterns of patients. Such biomarkers are based on the results of instrumental and laboratory studies (neuroimaging, electro-physiological, biochemical, immunological, genetic, and others) and are successfully being used in neurosciences for understanding the mechanisms of the emergence and development of nervous system pathologies. Presently, with the advent of new effective neuroimaging, laboratory, and other methods of investigation and also with the development of modern methods of data analysis, machine learning, and artificial intelligence, a great number of scientific and clinical studies is being conducted devoted to the search for the markers which have diagnostic and prognostic value and may be used in clinical practice to objectivize the processes of establishing and clarifying the diagnosis, choosing and optimizing treatment and rehabilitation tactics, predicting the course and outcome of the disease. This review presents the analysis of the works which describe the correlates between the diagnosis of schizophrenia, established by health professionals, various manifestations of the psychiatric disorder (its subtype, variant of the course, severity degree, observed symptoms, etc.), and objectively measured characteristics/quantitative indicators (anatomical, functional, immunological, genetic, and others) obtained during instrumental and laboratory examinations of patients. A considerable part of these works has been devoted to correlates/biomarkers of schizophrenia based on the data of structural and functional (at rest and under cognitive load) MRI, EEG, tractography, and immunological data. The found correlates/biomarkers reflect anatomic disorders in the specific brain regions, impairment of functional activity of brain regions and their interconnections, specific microstructure of the brain white matter and the levels of connectivity between the tracts of various structures, alterations of electrical activity in various parts of the brain in different EEG spectral ranges, as well as changes in the innate and adaptive links of immunity. Current methods of data analysis and machine learning to search for schizophrenia biomarkers using the data of diverse modalities and their application during building and interpretation of predictive diagnostic models of schizophrenia have been considered in the present review.