Module 3: Priority Mental Health Conditions

The World Health Organization (WHO) identified several priority mental health conditions that “represented a high burden (in terms of mortality, morbidity, and disability); caused large economic costs; or were associated with violations of human rights”. The priority conditions are depression, schizophrenia and other psychotic disorders, suicide, epilepsy, dementia, substance use disorders, and mental disorders in children. The causes, symptoms, etiologies, and treatments of several of these priority disorders will be briefly discussed below.(1)

Please note that the information provided below is not an exhaustive list of the symptoms or treatments for each disorder and is not intended for use as a diagnostic tool.

Depression

Major depression is one of the most common mental illnesses, with a worldwide lifetime prevalence of approximately 12%.(2) Symptoms of depression include sad mood, loss of interest in activities that used to be pleasurable, weight gain or loss , fatigue, inappropriate feelings of guilt, difficulty concentrating, and thoughts of suicide.(3) Depression can cause problems at work, in personal relationships, and can lead to suicide . Depression rates are twice as high in women as in men.(4) Depression has also been correlated with adverse health behaviors including smoking, alcohol abuse, physical inactivity, and sleep disturbances.(5) Antidepressants are typically used to treat depression, as are psychotherapy and lifestyle changes. In treatment-resistant cases, some people turn to electroconvulsive therapy (ECT), in which the brain is electrically stimulated to reduce depressive symptoms. Psychotherapy or psychological counseling is often an important part of treatment, and includes improving problem-solving capabilities, setting goals, and changing depressive cycles of thinking.(6) Lifestyle changes like regular exercise, avoidance of alcohol and drugs, and adequate sleep may lessen the effects of depression.(7)

Schizophrenia(8)

Although the lifetime risk for schizophrenia is only 0.08-0.44 %, the symptoms that characterize the disorder can severely impair daily functioning. Schizophrenia is a psychotic disorder categorized by a variety of symptoms. Positive symptoms (behaviors that are induced by the illness) include hallucinations ( perceiving stimuli that are not there), delusions (strongly held false beliefs ), thought disorders ), and movement disorders . Negative symptoms (the feelings or behaviors that are reduced or not present in those with the illness) include flat affect, loss of pleasure in daily life, and not speaking. Cognitive symptoms include a decreased ability to use information and make decisions, and problems with attention, focus, and working memory. Although schizophrenia is rarely cured, it can often be managed with antipsychotic medications and psychosocial interventions such as  cognitive behavioral therapy . However, the nature of the disease, as well as the unpleasant side effects of the medications, often decrease patient adherence to treatment regimens.

Epilepsy(9)

Epilepsy is characterized by repeated seizures caused by abnormal electrical signaling in the brain . Epilepsy is estimated to affect approximately 50 million people worldwide, or approximately 5-8 people per 1,000, of whom 80% live in developing countries.(10) Epilepsy can be caused by stroke, dementia, congenital brain defects, brain injuries, some metabolism disorders, and tumors. Seizures can present differently depending on which areas of the brain are affected . Doctors in developed nations often diagnose epilepsy by monitoring the brain’s electrical activity using use EEGs (electroencephalograms) . Epilepsy treatment typically includes anticonvulsant medications or surgery, depending on the cause and severity of the seizures.

Dementia(11)

Dementia is characterized by a loss of brain function that impairs memory, language, thoughts, judgment, and behavior. Dementia can be caused by stroke, brain tumors and other brain injuries, chronic alcohol abuse, and diseases such as multiple sclerosis, Parkinson’s disease, and Alzheimer’s disease (the most common type of dementia). Treatments for some forms of dementia include antipsychotics, mood stabilizers, and stimulants, though degenerative forms of dementia (such as Alzheimer’s disease) do not yet have a cure. As life expectancies increase worldwide, dementia is becoming an increasingly important global health issue. Currently, an estimated 24.3 million people worldwide have dementia, 60% of whom live in developing countries.(12) By 2040, it is estimated that 71% of the projected 81.1 million dementia cases will be in the developing world.

Alcohol and Drug Abuse(13)

The World Health Organization reports that 4.4% of the worldwide disease burden is attributable to alcohol consumption, and an estimated 200 million people worldwide used illicit drugs between 2005 and 2006.(14) Studies suggest that alcohol and drug abuse in developing countries is rising due to urbanization, poverty, migration, changes in technology, lack of education, and the high profit potential associated with drug sales. Alcohol and tobacco each contribute 0.5 to 16% of the disease burden (DALYs) in developing counties. Excessive alcohol consumption can lead to injury, disease, and birth defects, while tobacco use increases the risk of a variety of cancers, and intravenous drug use contributes to the spread of HIV/AIDS. Substance abuse disorders are often addressed via prevention programs, psychological counseling, medication, and support groups.

Mental Disorders in Children(15)

Common childhood mental disorders include autism, Down syndrome, fetal alcohol syndrome, and attention deficit disorder . Although the specific symptom set depends on the disorder, many developmental disorders are characterized by delayed achievement of (or failure to achieve) developmental milestones, limited cognitive functioning, impaired language or motor abilities, and behavioral problems. Childhood mental disorders are particularly challenging to address in low-income countries due to a lack of nutritional foods that aid in mental development, lower levels of parental education , and limited or no social services for developmentally-challenged children.

Go To Module 4: Causes of Psychological Disorders >>

Footnotes

(1) World Health Organization (WHO). Mental Health Gap Action Programme (mhGAP): Scaling up care for mental, neurological, and substance use disorders. Retrieved 28 June 2012.

(2) Ibid.

(3) Centers for Disease Control and Prevention. “Depression”. Retrieved 28 June 2012.

(4) Mayo Clinic. “Depression (Major Depression). Retrieved 28 June 2012.

(5) Centers for Disease Control and Prevention. “Depression”. Retrieved 28 June 2012.

(6) BMJ. “Learning from low-income countries: mental health”. Retrieved 28 June 2012.

(7) Mayo Clinic. “Depression (Major Depression). Retrieved 28 June 2012.

(8) National Institute of Mental Health. “Schizophrenia”. Retrieved 28 June 2012.

(9) National Institutes of Health. “Epilepsy”. Retrieved 28 June 2012.

(10) World Health Organization (WHO). Mental Health Gap Action Programme (mhGAP): Scaling up care for mental, neurological, and substance use disorders. Retrieved 28 June 2012.

(11) National Institutes of Health. “Dementia”. Retrieved 28 June 2012.

(12) World Health Organization (WHO). Mental Health Gap Action Programme (mhGAP): Scaling up care for mental, neurological, and substance use disorders. Retrieved 28 June 2012.

(13) World Health Organization. “Substance Use Problems in Developing Countries”. Retrieved 28 June 2012.

(14) World Health Organization (WHO). Mental Health Gap Action Programme (mhGAP): Scaling up care for mental, neurological, and substance use disorders. Retrieved 28 June 2012.

(15) World Health Organization (WHO). “Need to address mental disorders in children”. Retrieved 28 June 2012.