Since mental illness has been posing a threat to the health of families and society all over the world in several developing and developed countries, in achieving health for all people, WHO’s Comprehensive Mental Health Action Plan 2013-2030 was formulated for the essential role of mental health. The strategies include to strengthen effective leadership and governance for mental health; to provide comprehensive integrated and responsive mental health and social care services in community-based settings; to implement action plan for promotion and prevention of mental health while strengthening the information systems, evidence, and research for mental health in the current scenario of emerging different problems due to software technology, social media illusions, cybercrimes and artificial intelligence etc.,
The WHO mhGAP Intervention Guide 2.0 provides guidance for doctors, nurses, and other health workers in non-specialist health settings on the assessment and management of mental disorders. WHO’s Mental Health Gap Action Programme (mhGAP) uses evidence-based technical guidance, tools, and training packages to expand services in countries, especially in resource-poor settings in an integrated approach that promotes mental health at all levels of care. Some of the prominent mental illness disorders such as anxiety disorders, depression, bipolar disorder, Post-Traumatic Stress Disorder (PTSD), Schizophrenia, eating disorders, disruptive behaviour and dissocial disorders, neurodevelopmental disorders, types of risk for developing a mental disorder and application of health systems and social support will be discussed in a limited range.
Anxiety Disorders
We get in day-to-day practice many men and women with a complaint of excessive fear and worry and related behavioral disturbances. For every small thing for example if the husband fails to come to the house on time and delayed due to some office work some wives book a cab and go to the office of the husband with a great fear of imagining some accident took place or husband hospitalized etc., this is an example of anxiety disorder. In 2019, 301 million people were living with an anxiety disorder, including 58 million children and adolescents. Anxiety disorders are characterized by excessive fear and worry and related behavioral disturbances. Symptoms are severe enough to result in significant distress or significant impairment in functioning. There are several different kinds of anxiety disorders, such as: generalized anxiety disorder characterized by excessive worry, panic disorder characterized by panic attacks, social anxiety disorder characterized by excessive fear and worry in social situations, for example some persons when the see a mob get unexplained fear to go that side, separation anxiety disorder characterized by excessive fear or anxiety about separation from those individuals to whom the person has a deep emotional bond, and others. Effective psychological treatment exists, and depending on the age and severity, medication may also be considered. In modern management, apart from drugs, counselling techniques would treat this person satisfactorily.
Depression
During the last two decades, several young people have been suffering from depression when they don’t get proper employment or a low salary, have problems in family conflicts with a wife or husband, and love failure. From 2000 to 2005, extramarital sex unnecessary doubt on wife character and hence landing in depression. In 2019, 280 million people were living with depression, including 23 million children and adolescents. Depression is different from usual mood fluctuations and short-lived emotional responses to challenges in everyday life. During a depressive episode, the person experiences feeling sad, irritable, and empty or a loss of pleasure or interest in activities, for most of the day, poor concentration, feelings of excessive guilt or low self-worth, hopelessness about the future, thoughts about dying or suicide, disrupted sleep, changes in appetite or weight, and feeling especially tired or low in energy. People with depression are at an increased risk of suicide. Yet, effective psychological treatment exists, and depending on the age and severity, medication has to be started under an expert.
Bipolar Disorder
This is an interesting case of a 23-year-old female who first came with moderate depressive symptoms, lacking energy and reporting difficulty in paying attention; notably, these symptoms started abruptly. She reported two brief episodes of depression over the past 2 years. Each lasts about 2 months. She came to know significant psychosocial stress stemming from the loss of her job and the deaths of 2 uncles, both of which were related to the COVID-19 pandemic. The patient reported that she still finds enjoyment in talking to friends and socializing and she has hope of finding a new job and is constantly looking.
She was diagnosed with ADHD (Attention-deficit/hyperactivity disorder) in middle school, during which time she responded well to treatment. She continued to do well until her college years, at which time she began experiencing difficulty falling asleep as well as irritability. She found that practicing mindfulness and yoga daily helped her residual ADHD symptoms. Of note, she had no history of suicidal thoughts or behavior, self-injurious behaviors, psychiatric hospitalization, or problems with substance abuse. Upon further querying of her family history, her maternal grandmother was diagnosed with a nervous breakdown and spent 2 months in a psychiatric hospital in her 30s. She was treated successfully. This sort of case is called suffering from bipolar disorder.
In 2019, 40 million people experienced bipolar disorder. People with bipolar disorder experience alternating depressive episodes with periods of manic symptoms, which may include euphoria or irritability, increased activity or energy, and other symptoms such as increased talkativeness, racing thoughts, increased self-esteem, decreased need for sleep, distractibility, and impulsive, reckless behaviour. People with bipolar disorder are at an increased risk of suicide. Yet effective treatment options exist forthe reduction of stress and strengthening of social functioning, and medication. The other psychiatric disorders and their management will be discussed in the coming issue. (To be concluded).