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Mounting evidence suggests that the Mediterranean diet has a beneficial effect on mental health. It has been hypothesised that this effect is mediated by a variety of foods, nutrients and constituents; however, there is a need for research elucidating which of these components contribute to the therapeutic effect. This scoping review sought to systematically search for and synthesise the research on olive oil and its constituents and their impact on mental health, including the presence or absence of a mental illness or the severity or progression of symptoms. PubMed and OVID MEDLINE databases were searched. The following article types were eligible for inclusion: human experimental and observational studies, animal and preclinical studies. Abstracts were screened in duplicate, and data were extracted using a piloted template. Data were analysed qualitatively to assess trends and gaps for further study. The PubMed and OVID MEDLINE search yielded 544 and 152 results, respectively. After full-text screening, forty-nine studies were eligible for inclusion, including seventeen human experimental, eighteen observational and fourteen animal studies. Of these, thirteen human and four animal studies used olive oil as a comparator. Observational studies reported inconsistent results, specifically five reporting higher rates of mental illness, eight reporting lower and five reporting no association with higher olive oil intake. All human experimental studies and nine of ten animal studies that assess olive oil as an intervention reported an improvement of anxiety or depression symptoms. Olive oil may benefit mental health outcomes. However, more experimental research is needed.
To outline the life and work of Greek physician Asclepiades of Bithynia (124–40 BC), especially his contributions to thinking about mental illness.
Methods:
Review and discussion of relevant fragments of Asclepiades’ work that survive and review of secondary literature, supplemented by relevant systematic literature searches (e.g. PubMed).
Results:
Asclepiades challenged the long-standing Hippocratic doctrine of the four humours and developed an approach to physical and mental illness that was humane, reasoned, and a forerunner of later developments in psychiatry. Asclepiades argued that the human body, like everything in the universe, comprised tiny, imperceptible particles, which he called önkoi, seamless masses in perpetual motion. In consequence, Yapijakis describes Asclepiades as ‘the father of molecular medicine’. Asclepiades held that good health was maintained by free, balanced motion of önkoi through theoretical pores, while disease resulted from blockage or impaction of önkoi passing through pores in various body parts (e.g. brain). Based on this idea, Asclepiades recommended releasing people with apparent mental illness from confinement and using judicious combinations of diet, exercise, massage, bathing, and music to treat ‘phrenitis’ (delirium) and melancholia. He suggested that the physician act ‘safely, swiftly and pleasantly’ (‘cito, tutu, jucunde’) for both physical and mental illness.
Conclusions:
Asclepiades belongs to the historical tradition of progressive medical approaches to mental illness, not least because he applied his principles for the treatment of physical illness to mental illness. His ideas about psychiatry set the scene for further evolution of attitudes to mental illness and its treatment over subsequent centuries.
College students disproportionately live with increased risk and burden of mental illness and suicide, yet most students do not access formal campus mental health services. One part of the solution to this problem has been the Bandana Project (BP), a peer-led mental health awareness and suicide prevention program. The program leverages the members’ vested interest in peer support, mental health promotion, and suicide prevention efforts to foster connectedness and offer alternative support to those who may be struggling. Education offered through the program orients members to relevant, evidence-based suicide prevention strategies and to various mental health resources. The program may contribute to reducing the burden of suicide and mental illness on campuses and help make college communities more supportive of students’ mental health. Further development, applications, and limitations of this program on the college campus setting – and beyond – are discussed.
In the context of climate change, the impacts of extreme weather events are increasingly recognised as a significant threat to mental health in the UK. As clinicians and researchers with an interest in mental health, we have a collective responsibility to help understand and mitigate these impacts. To achieve this, however, it is vital to have an appreciation of the relevant policy and regulatory frameworks. In this feature article, a collaboration amongst mental health and policy experts, we provide an overview of the integration of mental health within current climate policies and regulations in the UK, including gaps and opportunities. We argue that current policy and regulatory frameworks are lacking in coverage, ambition, detail and implementation, as increases in weather extremes and their negative impacts on mental health outpace action. For example, across current national and local climate policies, there is almost no reference to the impacts of extreme weather events on mental health. Whilst alarming, this provides scope for future research to fill evidence gaps and inform policy and regulatory change. We call for mental health and policy experts to work together to improve our understanding of underlying mechanisms and develop practical interventions, helping to bring mental health within climate policy and regulatory frameworks.
An introduction and overview of the mental health conditions relevant to people with intellectual disability. The chapter focuses on the evidence base to support or refute whether they suffer greater rates of mental health problems, Psychiatric classification and prescribing; Comparison tables of international classification of diseases (ICD) versions 10 and 11; and the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) 4 and 5 and DC-LD.
Autism Spectrum Disorders (ASDs) are a group of severe developmental and neuropsychiatric disorders usually apparent by the age of three. Autism, referred to as autism spectrum disorder in the 11th revision of the International Classification of Diseases (ICD-11), is a neurodevelopmental condition characterised by persistent deficits in social interaction and social communication, as well as a range of restricted, repetitive behaviours (World Health Organization 2018). The onset of autism is in the developmental period (0–18 years of age), though for some autistic persons the symptoms may manifest later in life, at a time of increased social demands (World Health Organization 2018). In addition to the aforementioned core autistic features, many autistic people have associated symptoms, including hypo- or hypersensitivities to sensory stimuli, difficulties describing their emotional state (alexithymia), and problems with gross motor co-ordination The chapter will discuss the interface between autism spectrum disorder and intellectual disability and the potential management of the disorder. It will also cover the gender variations in presentation.
Moderate-to-vigorous physical activity (MVPA) is beneficial for health, and reducing sedentary behavior (SB) is recommended in international guidelines. People with mental illnesses are at higher risk of preventable diseases than the general population, partly attributable to lower MVPA and higher SB. Self-determination theory provides a framework for understanding how motivation regulates behavior. This study aimed to evaluate the contribution of different forms of motivation for physical activity (amotivation, controlled, autonomous) to MVPA and SB in people with mental illnesses.
Methods
Cross-sectional self-reported and accelerometer-derived MVPA and SB in people with a range of mental illnesses across four countries were pooled for analysis (Australia, Belgium, England, Uganda). Motivation for physical activity was measured using the Behavioural Regulation in Exercise Questionnaire (BREQ). Regression analyses were used to investigate the association of MVPA and SB with amotivation, controlled, autonomous motivations, controlling for mental health and demographic variables.
Results
Autonomous motivation was associated with 31% higher self-reported MVPA, and amotivation and controlled motivation were associated with 18% and 11% lower self-reported MVPA, respectively (n = 654). In contrast, controlled motivation was positively associated with SB (n = 189). Having physical comorbidities or an alcohol use disorder was associated with lower MVPA (n = 318). Sub-analyses with accelerometer-derived MVPA and SB (n = 139 and n = 145) did not reveal any associations with motivational forms.
Conclusions
Findings with an international sample support the universal relevance of motivation in promoting health-related behavior. Strategies for facilitating autonomous motivation should be utilized by health professionals seeking to support people with mental illnesses to become physically active.
Objective: The study aims to build a comprehensive network structure of psychopathology based on patient narratives by combining the merits of both qualitative and quantitative research methodologies. Research methods: The study web-scraped data from 10,933 people who disclosed a prior DSM/ICD11 diagnosed mental illness when discussing their lived experiences of mental ill health. The study then used Python 3 and its associated libraries to run network analyses and generate a network graph. Key findings: The results of the study revealed 672 unique experiences or symptoms that generated 30023 links or connections. The study also identified that of all 672 reported experiences/symptoms, five were deemed the most influential; “anxiety,” “fear,” “auditory hallucinations,” “sadness,” and “depressed mood and loss of interest.” Additionally, the study uncovered some unusual connections between the reported experiences/symptoms. Discussion and recommendations: The study demonstrates that applying a quantitative analytical framework to qualitative data at scale is a useful approach for understanding the nuances of psychopathological experiences that may be missed in studies relying solely on either a qualitative or a quantitative survey-based approach. The study discusses the clinical implications of its results and makes recommendations for potential future directions.
People living with mental illness report a broad spectrum of nutrition risks, beyond malnutrition, but appropriate and adequately validated nutrition risk screening tools for mental health settings are lacking. This study aimed to develop a nutrition-risk screening tool, the NutriMental Screener, and to perform preliminary feasibility and validity testing. In an international, stakeholder engaging approach, a multifaceted nutrition-risk screening tool for mental health services was developed by means of workshops with international stakeholders and two online surveys. Feasibility of the NutriMental screener was tested as part of a research study in Switzerland with 196 participants, evenly distributed across the three study groups (sixty-seven outpatients and sixty-five inpatients with psychotic or depressive disorders as well as sixty-four controls without mental illness). The NutriMental screener consists of ten items covering different nutritional issues that indicate the need for referral to a dietitian or clinical nutritionist. Almost all patients (94·7 %) reported at least one nutrition risk by means of the NutriMental screener. Prevalence for nutrition risks via NutriMental screener was higher in patients than in controls. Almost every second patient expressed a desire for nutritional support (44·7 %). After further validity testing is completed, there is the potential for the NutriMental Screener to replace malnutrition screening tools as routine screening in various mental health settings aiming to organise nutritional therapy prescriptions in a more targeted and efficient manner.
Prospective university students experience substantial academic stressors and psychological vulnerabilities, yet their mental health literacy (MHL) remains inadequately explored. This study investigates four dimensions of MHL – help-seeking behaviors, stigma, knowledge about mental health and understanding of mental illnesses. Besides, Geographic Information System (GIS) techniques are employed to analyze spatial disparities in MHL, which is the first in the context of MHL research. A total of 1,485 students were assessed for sociodemographic characteristics, admission-related variables, health behaviors and family histories of mental health issues. Data were analyzed using SPSS and ArcGIS software. Multivariable linear regression analyses unveiled predictors of the MHL dimensions, with gender, family income, admission test performance, smoking, alcohol and drug use, physical and mental health history, current depression or anxiety and family history of mental health and suicide incidents emerging as common predictors. GIS analysis unraveled notable regional disparities in MHL, particularly in knowledge of mental health and mental illness, with northern and some southern districts displaying higher literacy levels. In conclusion, these findings accentuate significant gender and sociodemographic inequalities in MHL among prospective university students, highlighting the imperative for targeted interventions to enhance MHL and foster mental well-being in this cohort.
This paper describes the content and evolution of a fourth-year course for medical students on teaching pathographies of mental illness. (It is a follow-up to Nathan Carlin’s Pathographies of Mental Illness that appeared as an Element in the Bioethics and Neuroethics series published by Cambridge University Press.) The course originally centered on classic (and some contemporary) memoirs; however, responding to student evaluations, newer material now ensures more diversity, with material written by women and people of color, and describes the difference that can make.
To explore the duration of support, reach, effectiveness and equity in access to and outcome of individual placement and support (IPS) in routine clinical practice. A retrospective analysis of routine cross-sectional administrative data was performed for people using the IPS service (N = 539).
Results
A total of 46.2% gained or retained employment, or were supported in education. The median time to gaining employment was 132 days (4.3 months). Further, 84.7% did not require time-unlimited in-work support, and received in-work support for a median of 146 days (4.8 months). There was a significant overrepresentation of people from Black and minority ethnic communities accessing IPS, but no significant differences in outcomes by diagnosis, ethnicity, age or gender.
Clinical implications
Most people using IPS services do not appear to need time-unlimited in-work support. Community teams with integrated IPS employment specialists can be optimistic when addressing people's recovery goals of gaining and retaining employment.
For centuries so called 'difficult women' have been labelled as 'hysterical' and 'out of their minds'. Today they wait longer for health diagnoses, often being told it's 'all in their heads'. Although healthcare systems are overburdened, why are women the first to feel the effects of this? Why is it so hard for women to find the kind of help they need? Why is no one listening to them? And why have so many lost faith in mental healthcare? Drawing on the lived experiences of women, alongside expert commentators, recent history, current events, and her own personal and professional experience, Dr Linda Gask explores women's mental healthcare today. In doing so she confronts her role as a psychiatrist, recalling experiences treating women and as a woman who has received mental healthcare, illustrating the dire need for more change, faster. Women can't all be out of their minds.
Families have the potential for causing harm and can play a part in the onset of mental health problems. Women’s behaviour is judged by a different set of standards to that of men. Parents still socialise girls differently from boys. The pressures of family life chip away at our confidence and self-esteem and powerfully influencing our ability to make successful adult relationships. Girls and women may be told that they are ‘hysterical’ or ‘out of their mind’ when their emotional response is quite justified by what is happening to them. However, life pressures can also trigger mental illness, and family stress such as living in poverty and with domestic violence can make this worse. Girls and young women experience much more sexual abuse during childhood than boys – the sheer extent of which was not acknowledged in the past. Improving material and psychological support to families is a mammoth task, but what is within our power, among our own friends, families and communities, is to do something when we suspect that young women are experiencing trauma and abuse – believing, helping and supporting them to find someone to share their stories with who is trustworthy and skilled.
Poor mental health is a leading contributor to the global burden of disease but there is poor understanding of how it is influenced by people's interactions with ecological systems. In a theory-generating case study we asked how interactions with ecosystems were perceived to influence stressors associated with psychological distress in a rural setting in Uganda. We conducted and thematically analysed 45 semi-structured interviews with residents of Nyabyeya Parish. Poverty and food insecurity were the primary reported causes of ‘thinking too much’ and related idioms suggesting psychological distress. Households bordering a conservation area reported that crop losses from wildlife contributed to food insecurity. However, forest resources represented important safety nets for those facing poverty and food insecurity. Commercial agricultural expansion also emerged as a salient theme in the lives of residents, reportedly exacerbating poverty and food insecurity amongst poorer households but contributing incomes to wealthier ones. Our exploratory study suggests how two globally prevalent land uses, nature conservation and commercial agriculture, may influence social determinants of psychological distress in the study area. We highlight co-benefits and trade-offs between global sustainability goals that could be managed to improve mental health.
With assisted dying becoming increasingly available to people suffering from somatic diseases, the question arises whether those suffering from mental illnesses should also have access. At the heart of this difficult and complex matter are values such as equality and parity of esteem. These issues require humane deliberation.
Where the real basis for finding someone to lack capacity is that you consider the beliefs or values that motivate their decision to be distorted by a mental illness, such that the decision is not authentically desired and so is unworthy of respect, this entails a number of empirical and normative claims. This chapter will interrogate these claims by reference to the wide-ranging literature on the nature of mental disorder, and on differing conceptions of autonomy and authenticity (as a component of autonomous decision-making). It will be concluded that while an agent acting on the basis of disordered beliefs or values will often be acting inauthentically (and thus non-autonomously), this will not always be the case, and situations could arise in which there is reason to believe that the agent would endorse or sanction their belief, even knowing it is derived from illness. Moreover, once the shaky conceptual ground on which such judgements must be made is acknowledged, it becomes essential that these judgements are brought out into the open, where they can be subject to appropriate scrutiny.
Just 20 years ago, molecular biologists Leonie Ringrose and Renato Paro published an article provocatively entitled ‘Remembering Silence’. The article focused on how modified epigenetic elements could subsequently return to their silent state (i.e. their epigenetic status before experimental or environmentally induced modulation). Ringrose and Paro raised a question of considerable importance to expanding research in human neuroepigenetics, that of reversibility. For neuroepigeneticists interested in the molecular impact of environments on individuals’ biological profiles, including epigenetic modifications thought to be mediators between life trauma and risk of psychopathology, this question could be translated as: if you experience a traumatic event and thus acquire an epigenetic state considered pathological, can you free yourself of that state? In this chapter, we examine researchers’ ambitions to account for the indeterminacy of life and the speculative possibility of reversing acquired epigenetic states. Bringing together the perspectives of medical anthropology and molecular biology, we explore how reversibility – a return to silence – is envisioned, how therapeutic interventions purported to bring about that silence might function, and what this might mean for the mental health of people who live in the aftermath of trauma.
Social contact refers to the facilitation of connection and interactions between people with and without mental health conditions. It can be achieved, for example, through people sharing their lived experience of mental health conditions, which is an effective strategy for stigma reduction. Meaningful involvement of people with lived experience (PWLE) in leading and co-leading anti-stigma interventions can/may promote autonomy and resilience. Our paper aimed to explore how PWLE have been involved in research and anti-stigma interventions to improve effective means of involving PWLE in stigma reduction activities in LMICs. A qualitative collective case study design was adopted. Case studies from four LMICs (China, Ethiopia, India and Nepal) are summarized, briefly reflecting on the background of the work, alongside anticipated and experienced challenges, strategies to overcome these, and recommendations for future work. We found that the involvement of PWLEs in stigma reduction is commonly a new concept in LMIC. Experienced and anticipated challenges were similar, such as identifying suitable persons to engage in the work and sustaining their involvement. Such an approach can be difficult because PWLE might be apprehensive about the negative consequences of disclosure. In many case studies, we found that long-standing professional connectedness, continued encouragement, information sharing, debriefing and support helped the participants’ involvement. We recommend that confidentiality of the individual, cultural norms and family concerns be prioritized and respected during the implementation. Taking into account socio-cultural contextual factors, it is possible to directly involve PWLEs in social contact-based anti-stigma interventions.