https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)61729-2.pdf

Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010

Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010.

Summary Background Comparable data on the global and country-specific burden of neurological disorders and their trends are crucial for health-care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study provides such information but does not routinely aggregate results that are of interest to clinicians specialising in neurological conditions. In this systematic analysis, we quantified the global disease burden due to neurological disorders in 2015 and its relationship with country development level. Methods We estimated global and country-specific prevalence, mortality, disability-adjusted life-years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) for various neurological disorders that in the GBD classification have been previously spread across multiple disease groupings. The more inclusive grouping of neurological disorders included stroke, meningitis, encephalitis, tetanus, Alzheimer's disease and other dementias, Parkinson's disease, epilepsy, multiple sclerosis, motor neuron disease, migraine, tension-type headache, medication overuse headache, brain and nervous system cancers, and a residual category of other neurological disorders. We also analysed results based on the Socio-demographic Index (SDI), a compound measure of income per capita, education, and fertility, to identify patterns associated with development and how countries fare against expected outcomes relative to their level of development. Findings Neurological disorders ranked as the leading cause group of DALYs in 2015 (250·7 [95% uncertainty interval (UI) 229·1 to 274·7] million, comprising 10·2% of global DALYs) and the second-leading cause group of deaths (9·4 [9·1 to 9·7] million], comprising 16·8% of global deaths). The most prevalent neurological disorders were tension-type headache (1505·9 [UI 1337·3 to 1681·6 million cases]), migraine (958·8 [872·1 to 1055·6] million), medication overuse headache (58·5 [50·8 to 67·4 million]), and Alzheimer's disease and other dementias (46·0 [40·2 to 52·7 million]). Between 1990 and 2015, the number of deaths from neurological disorders increased by 36·7%, and the number of DALYs by 7·4%. These increases occurred despite decreases in age-standardised rates of death and DALYs of 26·1% and 29·7%, respectively; stroke and communicable neurological disorders were responsible for most of these decreases. Communicable neurological disorders were the largest cause of DALYs in countries with low SDI. Stroke rates were highest at middle levels of SDI and lowest at the highest SDI. Most of the changes in DALY rates of neurological disorders with development were driven by changes in YLLs. Interpretation Neurological disorders are an important cause of disability and death worldwide. Globally, the burden of neurological disorders has increased substantially over the past 25 years because of expanding population numbers and ageing, despite substantial decreases in mortality rates from stroke and communicable neurological disorders. The number of patients who will need care by clinicians with expertise in neurological conditions will continue to grow in coming decades. Policy makers and health-care providers should be aware of these trends to provide adequate services. Funding Bill & Melinda Gates Foundation.

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Global, regional, and national burden of neurological disorders, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(07)61238-0.pdf

No health without mental health.

Suicidal behavior is a leading cause of injury and death worldwide. Information about the epidemiology of such behavior is important for policy-making and prevention. The authors reviewed government data on suicide and suicidal behavior and conducted a systematic review of studies on the epidemiology of suicide published from 1997 to 2007. The authors' aims were to examine the prevalence of, trends in, and risk and protective factors for suicidal behavior in the United States and cross-nationally. The data revealed significant cross-national variability in the prevalence of suicidal behavior but consistency in age of onset, transition probabilities, and key risk factors. Suicide is more prevalent among men, whereas nonfatal suicidal behaviors are more prevalent among women and persons who are young, are unmarried, or have a psychiatric disorder. Despite an increase in the treatment of suicidal persons over the past decade, incidence rates of suicidal behavior have remained largely unchanged. Most epidemiologic research on suicidal behavior has focused on patterns and correlates of prevalence. The next generation of studies must examine synergistic effects among modifiable risk and protective factors. New studies must incorporate recent advances in survey methods and clinical assessment. Results should be used in ongoing efforts to decrease the significant loss of life caused by suicidal behavior.

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Suicide and Suicidal Behavior

The rising trend is damaging for patients, unsupported by evidence, and must be reversed

/pdf/is-psychiatry-becoming-more-coercive-2x37x4dnl6.pdf

Is psychiatry becoming more coercive

Research for Change: the role of scientific journals publishing mental health research.

RESUMO Objetivo Descrever a atuacao dos Centros de Atencao Psicossocial (CAPS) em quatro centros urbanos no Brasil. Metodos Realizou-se um estudo transversal (AcesSUS) com entrevista a 917 usuarios acompanhados nos CAPS de Campinas, Sao Paulo, Porto Alegre e Fortaleza. Foram incluidas apenas as modalidades de CAPS destinadas a transtorno mental grave em adultos, sendo excluidos os CAPS voltados para uso de substâncias e para criancas e adolescentes. Os usuarios responderam a questionario de multipla escolha sobre seu percurso entre os servicos de atencao primaria, CAPS e hospitais em relacao aos problemas de saude mental. Resultados Atendimento psiquiatrico e uso de medicacao foram relatados em 90% a 100% dos usuarios acompanhados nos CAPS, combinado com atendimento multiprofissional e grupos terapeuticos. O acesso a medicacao foi interrompido nos 6 meses que antecederam a entrevista, especialmente em Fortaleza (64%) e Porto Alegre (51%). Em todos os municipios, menos de 10% dos usuarios tiveram internacao psiquiatrica apos inicio do tratamento no CAPS. Conclusoes A transicao do modelo hospitalar para o comunitario continua em processo de efetivacao no Brasil, com avancos comprovados. A situacao, porem, e diversa nas diferentes redes de atencao, requerendo analise contextualizada de cada localidade, com identificacao de dificuldades que impedem o adequado funcionamento dessas redes no paradigma psicossocial.

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Atuação dos Centros de Atenção Psicossocial em quatro centros urbanos no Brasil

One of the main reasons why the Italian experience has been the object of much controversial attention in the international literature over the last decade lies in the ambiguity of the terms of reference used. Methodologically, it is of critical importance to re-establish the permanent dialectical relationship between the reality of the Italian experience, the prescription of the Law, and the administration of the reform. In this context, the evaluative variables are less the 'process' indicators of implementation of the reform, and more the qualitative 'outcome' assessment of the fate of the policy. The following concepts are discussed in detail, both in relation to Italy and to the broader status of psychiatry: de-Institutionalisation and de-hospitalisation; psychiatric hospital; rehabilitation-Home; Service-Services-Intervention; User; primary health care; evaluative research.

Methodological Lessons From the Italian Psychiatric Experience

School of Medicine,Sapienza University of Rome,Via Vitorchiano 81, I-00189 Rome, Italye-mail: paolo.martelletti@uniroma1.itTel.: +39-06-3327-4631Fax: +39-06-3327-4632T.J. SteinerDivision of Neuroscience and Mental Health,Imperial College London, London, UKJ.M. Bertolote • T. Dua • B. SaracenoDepartment of Mental Health and Substance Abuse,World Health Organization, Geneva,Switzerland

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Benedetto Saraceno

Papers

Is psychiatry becoming more coercive

Research for Change: the role of scientific journals publishing mental health research.

Atuação dos Centros de Atenção Psicossocial em quatro centros urbanos no Brasil

Methodological Lessons From the Italian Psychiatric Experience

The definitive position of headache among the major public health challenges. An end to the slippery slope of disregard