1. Prevention of Psychiatric Disorders Dr Alex Pavlovic ST6 Psychotherapy and Psychiatry

2. Learning objectives Understand key concept in health promotion and illness prevention Be able to apply them in a practical example Be able to answer Paper 1 MCQs and EMQs on this topic

3. Structure Total time – 1 hour Clarification of concepts - 30 min Example - 10 min Practice Paper 1 – 20 min

4. Introduction to topic This is a small topic but there are about 6 questions (according to RCPsych website) Relatively easy to grasp Public health topic and deals with general concepts Details of individual preventive methods will be covered in respective topics

5. Defining mental health promotion ‘…creation of individual, social and environmen- tal conditions that enable optimal psychological and psychophysiological development...’ Hosman & Jané-Llopis, 1999

6. Prevention of mental disorder ‘…reducing incidence, prevalence, recurrence of mental disorders, the time spent with symptoms, or the risk condition for a mental illness, preventing or delaying recurrences and also decreasing the impact of illness in the affected person, their families and the society…’ Mrazek & Haggerty, 1994

7. Prevention Primary – Universal – Selective – Indicated Secondary Tertiary

8. Universal prevention Interventions that are targeted at the general public or to a whole population group that has not been identified on the basis of increased risk.

9. Selective prevention Interventions that are targeted at individuals or subgroups of the population whose risk of developing a mental disorder is significantly higher than average, as evidenced by biological, psychological or social risk factors.

10. Indicated prevention Interventions that are targeted at high-risk people who are identified as having minimal but detectable signs or symptoms foreshadowing mental disorder or biological markers indicating predisposition for mental disorder but who do not meet diagnostic criteria for disorder at that time.

11. Secondary prevention Early diagnosing and treatment of existent disease (before it causes significant morbidity). This is a bulk of medical activity and it aims to avoid chronicity and the establishment of significant sequelae.

12. Tertiary prevention Reducing negative impact of existent disease by restoring function and reducing disease-related complications. This largely corresponds to rehabilitation.

13. Risk and Protective factors Risk factors are associated with an increased probability of onset, greater severity and longer duration of major health problems. Protective factors refer to conditions that improve people’s resistance to risk factors and disorders.

14. Risk and protective factors Generic - those that are common to several mental health problems and disorders. (Example: poverty and child abuse are common to depression, anxiety and substance abuse) Disease-specific -those that are mainly related to the development of a particular disorder. (Example: negative thinking is specifically related to depression, and major depression is specifically related to suicide)

15. Risk and protective factors individual family-related social economic environmental

16. Specific prevention of mental health disorders Mental disorders with known aetiology Mental disorders with uncertain aetiology but predictable course and prognosis Psychosocial problems connected with mental disorders

17. Mental disorders with known aetiology Infectious diseases (Syphilis, HIV- prevention of STDs, early treatment) Vascular dementia (Modification of cardiovascular risk factors) Iodine deficiency (addition of iodine to salt, water, flour, milk) Phenylketonuria (early detection and phenylalanine free food) Foetal alcohol syndrome (avoiding alcohol consumption in pregnancy)

18. Mental disorders with uncertain aetiology but predictable course and prognosis Mood disorders – use of lithium in prevention of further episodes of depression (psychoprophylactics) Schizophrenia – Early intervention services, reducing ‘high expressed emotions’ in the family Alcoholism – reduction and abstinence

19. Psychosocial problems connected with mental disorders Violence –public health action on alcoholism as a contributing factor, ‘safe houses’ for females who are victims of domestic violence, education, social inclusion and cohesion Suicide – control of guns and toxic substances, treating the mental health disorder, treating chronic pain, responsible media reporting Staff burnout – health at the work place – appropriate workload, supervision, mentoring

20. Who is responsible for promotion and prevention? Other health professionals Police and probation officers Educational system Politicians Journalists Trade unions Managers / supervisors in any profession General public etc.

21. Protective and risk factors for depression

22. Primary prevention

23. Group work Imagine you are the Secretary for Health and have a large budget to tackle anorexia nervosa. What would you do? Construct the table of protective and risk factors Promotional and preventive strategies – Primary (Universal, Selective, Indicated) – Secondary – Tertiary

24. Practice for Paper 1 MCQs and EMQs

25. My contact Alex dralex@doctors.org.uk