Neurobiology of Consciousness 1 Running Head: NEUROBIOLOGY ...
Wellness in Psychiatry-The Dawn of a New Era Focus on Definitions. Neurobiology & Interventions...
-
Upload
daisy-lucas -
Category
Documents
-
view
217 -
download
0
Transcript of 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.”
World Health Organization. Promoting Mental Health. Concepts, Emerging Evidence, Practice. 2004.
Definitions
World Health Organization. Promoting Mental Health. Concepts, Emerging Evidence, Practice. 2004; Slade M. BMC Health Serv Res. 2010;10:26.
“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.”
Warwick-Edinburgh Mental Well-Being Scale (WEMWBS)
Tennant R et al. Health Qual Life Outcomes. 2007:5:63.
WEMWBS – Population Sample
Tennant R et al. Health Qual Life Outcomes. 2007:5:63.
All the time
Often
Some of the time
Rarely
None of the time
Maternal Well-Being and Developmental Difficulties in Children
Tough SC et al. BMC Pediatrics. 2010;10:19.
Low Risk
Elevated Risk
Moderate Risk
High Risk
0%
10%
20%
30%
40%
17%
23%
30%
37%
SF-8 Health Survey(Poor Mental Health)
% E
leva
ted
Dev
elo
pm
enta
l D
iffi
cult
ies
in C
hil
dre
n
P=0.004
Money Appears to Not be Able to Buy Mental Health!
Mental Health Before and After a Win
GHQ, General Health Questionnaire. Higher score means worsening
Gardner J, Oswald AJ. J Health Econ. 2007;26(1):46-60.
x
0.61x
0.06x0.05x
Physician Heal Thyself…!
Murfett A, Charman D. Aust Fam Physician. 2006;35(9):748-750.
Pattern of well-being in GP respondents
Frequency Percent
Excellent 51 10.6
Very good 130 27.1
Good 221 46.0
Poor 67 14.0
Total 469 97.7
Missing 11 2.3
Total 480 100.0No difference between men and women
No difference by ethnic groupsNo difference between self-employed, associates, or salaried
Concepts in this Emerging Field
Positive
Mental
Health
Mental
Well-bein
g
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
Burgdorf J, Panksepp J. Neurosci Biobehan Rev. 2006;30(2):173-187.
Presence of fitness
decrements
Presence of fitness
increments
Absence of fitness
decrements
Absence of fitness
increments
Valence
ArousalPANA
−PA −NA
NA, Negative Affect PA, Positive Affect
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. Neurosci Biobehan Rev. 2006;30(2):173-187; Slade M. BMC Health Serv Res. 2010;10:26.
Imaging HappinessSignificantly increased BOLD signal during happiness scripts compared to emotionally neutral scripts are seen on the left dorsomedial prefrontal cortex, dorsal anterior cingulate gyrus, 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, subgenual cingulate gyrus, 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
van Reekum CM et al. J Cogn Neurosci. 2007;19(2):237-248.
PWB, Psychological Well-Being ScaleActivity in the ventral Anterior Cingulate Cortex in response to negative vs. neutral image
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).
Pessimism Accelerates Telomere Shortening and Increases IL-6
O’Donovan A et al. Brain Behav Immun. 2009;23(4):446-449.
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
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
Steptoe A et al. J Pers. 2009;77(6):1747-1776.
65
70
75
80
85
90
95USAEastern and Central EuropeansAsians
Life satisfaction
% n
on
-sm
okers
Happiness Influences Inflammation
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.
Fib
rin
og
en g
/L
How Does Positive Mental Well-Being Affect Our Health?
Steptoe A et al. J Pers. 2009;77(6):1747-1776.
Shared Neuroendocrine, Inflammatory, Autonomic, &
Immune Pathways
Positive Health
Behaviors
Shared Genetics
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
Slade M. BMC Health Serv Res. 2010;10:26.
INCOMPLETE MENTAL ILLNESS
COMPLETE MENTAL HEALTH
INCOMPLETE MENTAL HEALTH
COMPLETE MENTAL ILLNESS
High subjective well-being symptoms
Low subjective well-being symptoms
Low mental illness
symptoms
High mental illness
symptoms
Struggling Flourishing
LanguishingFloundering
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.
Limbic Hyperactivity
Dorsal Cortex Emotional/Cognitive
Dysregulation
Pleasure Circuit
Dampening
Pharmacotherapy Cognitive-Behavioral Therapy
Positive Activity Interventions
Pharmacotherapy +Cognitive-Behavioral Therapy +Positive Activity Interventions
35 45 55 65 75 85 95
rest/sleep
working
home computer
grooming, self care
other
watching television
relaxing, nothing special
shopping, errandspreparing food
eatingwalking, taking a walk
playing
exercising
not mind wandering
pleasant mind wandering
unpleasant mind wandering
neutral mind wandering
making love
talking, conversation
listening to music
praying/worshipping/meditating
taking care of your children
reading
doing housework
listening to radio, news
commuting, traveling
Kittingsworth MA, Gilbert DT. Science 2010. vol 330:932
How
Are
You
Fee
ling
Rig
ht
Now
?
0 = very bad - - - - - - - - - - - - - - - - - - - - - - - - - - -100 = very good
No Inherit Conflict BetweenNegative & Positive Mental Health
Yesterday’s Remission
Today’s Remission
The Interacting Spheres of a Health-Promoting Whole-School Environment
Wyn J et al. Aust N Z J Psychiatry. 2000;34(4):594-601.
Curriculum:teaching and
learning
Partnerships and services
Organization: ethos and
environment
Seligman - Creator of the Field of Positive Psychology and Positive Psychotherapy (PPT)
Seligman’s Theory of Authentic Happiness
Seligman ME. Authentic Happiness: Using the New Positive Psychology to Realize Your Potential for Lasting Fulfillment. 2002.
1. The Pleasant Life, which consists in having as much positive emotion as possible and learning the skills to prolong and intensify pleasures
2. 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
3. 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
4. The Achieving Life, which is a life dedicated to achieving for the sake of achievement
Happiness – The Seligman Model
Seligman M et al. Am Psychol. 2006;61(8):774-788.
Positive Emotion (the pleasant
life)
Meaning (the
meaningful life)
Engagement
(the engaged
life)
Positive Psychotherapy
Seligman M et al. Am Psychol. 2006;61(8):774-788.
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.
6-Week Group Therapy
Week 1 Using your Strengths
Week 2 Three Good Things/Blessings
Week 3 Obituary/Biography
Week 4 Gratitude Visit
Week 5 Active/Constructive Responding
Week 6 Savoring
PPT – Is It Effective in Patients With Depression?
Seligman M et al. Am Psychol. 2006;61(8):774-788.
P<0.04 at 6 months and 1 year
6 weekly group sessions with homework assignments
0
4
8
12
16
20 PPT, n = 19Control, n = 20
BD
I S
co
res
Mindfulness Based Cognitive Therapy (MBCT) – Promising New Therapy
M-ADM = Medication (anti-depressant continuation)MBCT= Mindfulness based CTPla+Clin = Placebo plus clinical management
Segal Z, et al. Arch Gen Psychiatry 2010. 67(12):1256-1264
Bringing Happiness to the Masses
Clinical Practice and Wellness Measurement - 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).
Wellness(Positive
Psychology, Resilience, etc.)
Models are Changing: Are We Ready? Disease Model vs. Disease to Wellness Model
Absence of Symptoms
Absence of Symptoms
Disease
Disease
Difference between Treating Depression and Offering Positive Mental Health
Depressive SymptomsDepressive SymptomsDepressive SymptomsDepressive Symptoms
Goal achieved ??
Time for a round of congratulations???
P o s i t i v e M e n t a l H e a l t hPositive Mental HealthPositive Mental HealthPos i t i ve Menta l Hea l th
In Conclusion – Paradigm Shift Aiming toward Wellness
Depressive SymptomsDepressive Symptoms
Depressive Symptoms
Depressive Symptoms