Framework to prioritise action on global mental health

For mental health to gain significant attention, and funding from policymakers globally, it is not enough to convince people that it has a high disease burden but also that there are deliverable and cost-effective interventions - according to South African researchers writing in PLoS Medicine.

Worldwide, the lifetime prevalence of mental disorders is between 12% and 49%, with over 70% of this burden in low- and middle-income countries. Despite this, mental illness has not received appropriate visibility, policy attention, or funding. Furthermore, 44% of African countries do not even have a mental health policy, and 33% do not have a mental health plan. Yet even in rich countries, when health budgets are cut, quite often the first area to be cut is mental health. In the United States, US$ 2,100,000,000 has been cut from mental health budgets over the past three years, and further cuts are expected for 2012.

Mark Tomlinson and Crick Lund from the Department of Psychiatry and Mental Health argue that global mental health must demonstrate its social and economic impact.

The authors argue: "a coherent evidence base for scalable interventions that can be shown to have an impact at the structural level - on economic development and human well-being - is central. This is the language of most policy makers." Tomlinson and Lund discuss a framework to help understand why some global health initiatives are more successful in generating funding and political priority than others and argue that a health issue gains political priority when three conditions are met: country political leaders and international leaders publicly and privately express support for the issue, and do so in a sustained fashion; policies are enacted to address the problem; and resources appropriate to the disease burden are allocated to the issue.

However, the authors say: "In the case of mental health, none of these conditions is currently being met in a substantial way."

"Greater community cohesion and international governance structures need to be developed to contribute to a more unified voice regarding global mental health.

International organisations such as the World Health Organisation, the World Federation for Mental Health, and the Movement for Global Mental Health, as well as national organisations, need to become a united force, for example, through a unified organisational network that delivers clear, consistent, and well-timed messages for policy and public consumption. "

Medicalxpress

Oxygen and light in synthesis of anti-malaria drug

The most effective anti-malaria drug can now be produced inexpensively and in large quantities. This means that it will be possible to provide medication for the 225 million malaria patients in developing countries at an affordable price. Researchers have developed a very simple process for the synthesis of artemisinin, the active ingredient that pharmaceutical companies could only obtain from plants up to now.

The chemists use a waste product from current artemisinin production as their starting substance. This substance can also be produced biotechnologically in yeast, which the scientists convert into the active ingredient using a simple yet very ingenious method.

There is an effective treatment against malaria, but it is not accessible to all of the more than 200 million people worldwide who are affected by the disease. Millions, especially in the developing world, cannot afford the combination drug preparation, which consists mainly of artemisinin.

Moreover, the price for the medication varies, as this substance is isolated from sweet wormwood (Artemisia annua) which grows mainly in China and Vietnam, and varies seasonally in its availability.

To make the drug affordable for at least some patients in developing countries, the Clinton Foundation, for example, subsidises its cost to the tune of several million dollars per year. Nevertheless, over one million people die of malaria each year because they do not have access to effective drugs.

This may be about to change. Peter H. Seeberger, Professor of Chemistry at the Freie Universität Berlin and his colleague François Lévesque have discovered a very simple way of synthesising the artemisinin molecule, which is known as an anti-malaria drug from traditional Chinese medicine and has an extremely complex chemical structure. "The production of the drug is therefore no longer dependent on obtaining the active ingredient from plants," says Peter Seeberger.

Synthesis

As a starting point, the chemists use artemisinic acid - a substance produced as a hitherto unused by-product from the isolation of artemisinin from sweet wormwood, which is produced in volumes ten times greater than the active ingredient itself.

Moreover, artemisinic acid can easily be produced in genetically modified yeast as it has a much simpler structure. "We convert the artemisinic acid into artemisinin in a single step," says Peter Seeberger. "And we have developed a simple apparatus for this process, which enables the production of large volumes of the substance under very controlled conditions."

The only reaction sequence known up to now required several steps, following each of which the intermediate products had to be isolated laboriously - a method that was far too expensive to offer as a viable alternative to the production of the drug from plants.

The striking simplification of artemisinin synthesis required not only a keen sense for an elegant combination of the correct partial reactions to enable the process to take place in a single step; it also took a degree of courage, as the chemists departed from the paths typically taken by industry up to now.

Molecule

The effect of the molecule, which not only targets malaria but possibly also other infections and even breast cancer, is due to, among other things, a very reactive chemical group formed by two neighbouring oxygen atoms - which chemists refer to as an endoperoxide. Peter Seeberger and François Lévesque use photochemistry to incorporate this structural element into the artemisinic acid. Ultraviolet light converts oxygen into a form that can react with molecules to form peroxides.

"Photochemistry is a simple and cost-effective method. However, the pharmaceutical industry has not used it to date because it was so difficult to control and implement on a large scale," explains Peter Seeberger. In the large reaction vessels with which industrial manufacturers work, flashes of light do not penetrate deeply enough from outside and the reactive form of oxygen is not produced in sufficient volumes.

The Potsdam-based scientists have succeeded in resolving this problem using an ingenious trick: They channel the reaction mixture containing all of the required ingredients through a thin tube that they have wrapped around a UV lamp.

In this structure, the light penetrates the entire reaction medium and triggers the chemical conversion process with optimum efficiency. "The fact that we do not carry out the synthesis as a one-pot reaction in a single vessel, but in a continuous-flow reactor enables us to define the reaction conditions down to the last detail," explains Peter Seeberger.

After just four-and-a- half minutes a solution flows out of the tube, in which 40 percent of the artemisinic acid has become artemisinin.

Photoreactors

"We assume that 800 of our simple photoreactors would suffice to cover the global requirement for artemisinin," said Peter Seeberger. And it could all happen very quickly. Peter Seeberger estimates that the innovative synthesis process could be ready for technical use in a matter of six months. This would alleviate the global shortage of artemisinin and exert considerable downward pressure on the price of the associated drugs.

- MNT

Even mild dehydration affects our moods

Most people only think about drinking water when they are thirsty; but by then it may already be too late.

Even mild dehydration can alter a person's mood, energy level, and ability to think clearly, according to two studies recently conducted at the University of Connecticut's Human Performance Laboratory.

Drink 2 litres of water a day

The tests showed that it didn't matter if a person had just walked for 40 minutes on a treadmill or was sitting at rest - the adverse effects from mild dehydration were the same. Mild dehydration is defined as an approximately 1.5 percent loss in normal water volume in the body.

The test results affirm the importance of staying properly hydrated at all times and not just during exercise, extreme heat, or exertion, said Lawrence E. Armstrong, one of the studies' lead scientists and a professor of physiology in UConn's Department of Kinesiology in the Neag School of Education.

"Our thirst sensation doesn't really appear until we are 1 percent or 2 percent dehydrated. By then dehydration is already setting in and starting to impact how our mind and body perform," said Armstrong, an international expert on hydration who has conducted research in the field for more than 20 years.

"Dehydration affects all people, and staying properly hydrated is just as important for those who work all day at a computer as it is for marathon runners, who can lose up to 8 percent of their body weight as water when they compete."

Separate groups of young women and men were tested. Twenty-five women took part in one study. Their average age was 23.

The men's group consisted of 26 men with an average age of 20.

All of the participants were healthy, active individuals, who were neither high-performance athletes nor sedentary - typically exercising for 30 to 60 minutes per day.

Each participant took part in three evaluations that were separated by 28 days. All participants walked on a treadmill to induce dehydration, and all of the subjects were hydrated the evening before the evaluations commenced. As part of the evaluation, the subjects were put through a battery of cognitive tests that measured vigilance, concentration, reaction time, learning, memory, and reasoning. The results were compared against a separate series of tests when the individuals were not dehydrated.

In the tests involving the young women, mild dehydration caused headaches, fatigue, and difficulty concentrating, according to one of the studies, which appeared in the February issue of The Journal of Nutrition. The female subjects also perceived tasks as more difficult when slightly dehydrated, although there was no substantive reduction in their cognitive abilities.

In the tests involving the young men, mild dehydration caused some difficulty with mental tasks, particularly in the areas of vigilance and working memory, according to the results of the second UConn study.

While the young men also experienced fatigue, tension, and anxiety when mildly dehydrated, adverse changes in mood and symptoms were "substantially greater in females than in males, both at rest and during exercise," according to the study. The men's study was published in the British Journal of Nutrition in November 2011.

"Even mild dehydration that can occur during the course of our ordinary daily activities can degrade how we are feeling - especially for women, who appear to be more susceptible to the adverse effects of low levels of dehydration than men," said Harris Lieberman, one of the studies' co-authors and a research psychologist with the Military Nutrition Division, US Army Research Institute of Environmental Medicine in Natick, Mass.

"In both sexes these adverse mood changes may limit the motivation required to engage in even moderate aerobic exercise. Mild dehydration may also interfere with other daily activities, even when there is no physical demand component present."

Why women and men are so adversely affected by mild dehydration is unclear, and more research is necessary.

But other research has shown that neurons in the brain detect dehydration and may signal other parts of the brain regulating mood when dehydration occurs. This process could be part of an ancient warning system protecting humans from more dire consequences, and alerting them to the need for water to survive.

To stay properly hydrated, experts like Armstrong recommend that individuals drink eight, 8-ounce glasses of water a day, which is approximately equivalent to about 2 litres of water.

People can check their hydration status by monitoring the colour of their urine. Urine should be a very pale yellow in individuals who are properly hydrated.

Urine that is dark yellow or tan in colour indicates greater dehydration. Proper hydration is particularly important for high-risk groups, such as the elderly, people with diabetes, and children.

- medicalreplies.com
 

Recognition of problem personalities

by Dr R. A. R. Perera

About ten percent of psychological references are labelled as 'personality and behavioural disorders'. Negative attitudes of the society to such patients are common. The immediate family and his or her acquaintances may dislike or disapprove of the person who is disruptive, uncooperative and rejects authority, and thus unstable relationship results. The World Health Organisation defines personality disorder as a person with 'deeply engrained, maladaptive patterns of behaviour generally recognisable by the time of adolescence or earlier and continuing through most of adult life'.

What is normality?

What is considered a personality disorder by one observer may be considered normal by another.

It may be difficult to distinguish stress-related reactions and unacceptable behaviour from personality disorder. In patients with problem personalities, evidence of serious, repeated or long-standing problems will be found for example;Problem at school work, with the police of in marriage

Rage of fighting

Prostitution/Vagrancy

Running away from home

Persistent lying

Such people also show irresponsibility, lack of concern for others, inability to profit from past experience and an inability to form and maintain close warm relationships. The individual naturally 'plays down' this history but inconsistencies at the interview, followed up by direct questioning and tactful confrontation, will usually reveal the problem.

A family history of personality disorder, absence of or rejection by parental figures in early life, and limited opportunities for early close relationships and for identification with satisfactory models are common associations. Violent problem personalities report punitive rejecting alcoholic or persistent anti social parents, excessive physical punishment and problem-solving by violence.

Childhood fire setting and cruelty to animals is significant and repeated violence as an adult and associated jealousy makes future violence more likely. Such persons may be brought in to a psychologist because of:

* A chance association of physical and mental illness

* Consequences of their behaviour, such as injury

or intoxication

* Psychological complains, tension, boredom, depression, feelings of rejection and loneliness. These may be complicated by maladaptive impulsive behaviour, for example self-poisoning and self-mutilation

Acute stress reactions and short-lived conduct disorders may resemble as a personality disorder, especially when the patient is emotional.

Organic brain disease mental handicap or alcohol intoxication can present as behaviour difficulties when compounded by lack of satisfactory history and difficulties in communication.

Sometimes a psychosis or a neurosis may present as a personality disorder. The individual who comes to the psychologist may hope for an immediate answer to his life problems, and an unstable relationship may be all that can be achieved. Lack of close, deep relationships does not mean relationships never occur. In fact there are many fleeting, demanding contacts with one or two individuals.

Priorities set by patient, such as finance, housing, police or marital problems, may need to be dealt with as a first step. Triggers to outbursts of disturbed behaviour should be sought at an early stage. Overwhelmed by a strong emotional reaction, the patient takes refuge in problem behaviour.

The patient must be made aware of the link between the trigger and the impulse for maladaptive behaviour. Avoidance or control of triggering situations should be promoted. Repeated detailed 'thinking through' of the consequences of actions should approach impulsiveness.

Reminders of past and present achievements and respect shown by others in words and actions can reduce depressive feelings. Self-mutilation, such as repeated wrist slashing, requires exclusion of psychosis and attempted suicide. Self-mutilation is reinforced by effective reduction of tension following cutting and the inevitable medical and personal attention shown by the family. Loyal, sometimes battered, wives may be the mainstay for years until the spouse eventually settles down'.Such partners may need help with their reactive distress, ambivalence and unrealistic hope. Dealing with these problems due to choice or impossible behaviour requires services of volunteer or state social services participation on long term basis.