Nowadays, with the increasing social pressure, the incidence of mental illness is becoming more and more serious. The following mental illness has become the second largest health problem in the Asia-Pacific region, and I want to share it with you. Welcome to browse.
Mental illness has become the second biggest health problem in the Asia-Pacific region.
? In developed and developing countries in the Asia-Pacific region, people have begun to realize the importance of mental illness. Atsuro Tsutsumi, an associate professor of global affairs at Kanazawa University in Japan, said in the report. But the attention paid to it is still lower than other major diseases. ?
In fact, mental illness has become the second largest loss factor caused by disability /YLD in Asia-Pacific region.
The years of life lost due to disability is a disease measurement method introduced by the World Health Organization in the 1990s, which combines the general situation of the disease with the degree of weakness caused by the disease in the development process. Because the onset time of mental illness is relatively early, the total number of years lost is very high. According to this standard, in the 15 countries and regions involved in the report, mental illness accounts for more than 20% of the total declared losses caused by disability every year on average.
What's more, Ma Xin said that when depression is severe, there will be pessimism and despair, and even suicide. 15% to 20% of depressed patients will choose to commit suicide.
China is classified as a backward group.
The research * * * involves 15 countries and regions in the Asia-Pacific region, including Chinese mainland, China, Taiwan Province Province, China and Hongkong, China. This study evaluates the achievements of different countries in mental health.
According to the four categories of environment, accessibility, opportunities and governance 18 indicators, five countries in the Asia-Pacific region 15 were evaluated and ranked. These 15 countries can be clearly divided into four groups. New Zealand and Australia scored more than 90 points, ranking first and second, belonging to the first group. China Taiwan Province Province, China Hongkong and Singapore, South Korea and Japan, as high-income countries in Asia, rank in the second group; Chinese mainland scored 45.5 points, ranking ninth, belonging to the third echelon with Malaysia and Thailand; India, Philippines, Vietnam, Indonesia and Pakistan are in the last group.
The report also said that countries in the same group are facing similar challenges in the process of assisting the mentally ill to integrate into society, but the degree varies greatly among different groups.
? Treatment gap? huge
The report points out that there is a huge mental illness in China? Treatment gap? The proportion of patients who need treatment but do not seek or fail to get treatment is extremely high. In China, 92% of patients with severe mental illness did not receive treatment, which even surpassed the Indian in the fourth group (90%). At present, the total number of patients with mental illness who have not received treatment is estimated to be 654.38+58 million.
One reason is that psychiatrists are too scarce. According to official figures, China currently has only 1.7 doctors per 65,438+10,000 people, with a global average of 3.96. Although this data has increased significantly in recent years. But the chief physician of Peking University Sixth Hospital and the Health Planning Commission? Office of the National Mental Health Program? Consultant Professor Mahone still pointed out:? We don't have enough psychiatrists. ?
Southern Weekend reporter once found that there are almost no psychiatrists in Tibet, and there are no drugs to treat mental illness.
At the same time, the report shows that 14% of registered psychiatrists in China have no training, and another 29% have only a three-year college diploma. Generally speaking, there is a serious shortage of trained mental health personnel.
China plans to increase the number of psychiatrists to 40,000 by 2020. Mahone said,? I have some concerns about how to achieve this goal. ?
Practice of 686 Project Community Therapy in China
The report mentioned that there are many suggestions on the transition from mental health services to primary health care, but there are few successful cases in low-and middle-income countries. China? The central government subsidizes local health funds for the management and treatment of severe mental illness? , referred to as the 686 project, has greatly changed this situation.
This is called a mental patient? Unlock? This project. So-called? Unlock? It is a complete process, including a series of intervention measures, such as psychiatrists, nurses and other professional teams unlocking the patient at the lock-up site, taking the patient to the designated psychiatric hospital for diagnosis and hospitalization (systematic drug therapy, combined with psychotherapy, work and entertainment therapy or improved electroconvulsive therapy), leaving the hospital after the patient's condition improves or stabilizes, and returning to the community for follow-up, medication, rehabilitation, health education and so on.
Peking University Institute of Mental Health is the lead unit of the 686 Project. Ma Hong said that from 60 pilot projects in 2005 to 2012,686? The project has unlocked more than 2,000 mental patients nationwide, and 286 cases were unlocked on 20 12. By the end of 2065, 438+04 has covered 87% of the country's administrative regions and will eventually cover the whole country.
? 686? The greatest significance of the project is to promote the development of mental health in the country, establish a service network and information platform, introduce work norms and operating procedures, and train a large number of grassroots personnel and patients' families, which will be used in the past. Lock? Mental patients living in hospitals return to their families and communities.
She added that during this period, the * * * project registered 4.3 million patients with severe mental illness. By the end of 20 14, community-centered management and services had been provided for 3150,000 patients.
? The comprehensive community team should continue to expand, and the potential professional resources can not be ignored. For example, family members can become case managers through training. ? Mahone concluded.
In addition to practice, countries in the Asia-Pacific region have also begun substantive legislation and policy formulation. According to the report, the most striking thing is the first landmark mental health law in China. After 27 years' discussion, on June 20 12, 10, China passed the first mental health law, the Mental Health Law of People's Republic of China (PRC). The Act came into effect in 20 13.
The new mental health law officially stipulates that part of the treatment is free, but the report believes that the practical benefits of this law are limited and the treatment is still limited. Ma Hong said that unpublished research in her institution found that 93% of families with two mental patients would fall into poverty.
Attachment: About Depression
definition
Depression is a common emotional disorder, which can be caused by many reasons. The main clinical feature is obvious and persistent depression, and depression is not commensurate with its situation. Clinical manifestations can range from depression to sadness and even coma. Some cases have obvious anxiety and restlessness; In severe cases, mental symptoms such as hallucinations and delusions may occur. Most cases have a tendency of recurrent attacks, most of which can be relieved every time, and some of them can have residual symptoms or become chronic.
Depression mainly includes: depression, dysthymia, psychogenic depression, depression with brain or body diseases, depression with mental disorders caused by psychoactive substances or non-addictive substances, and post-psychotic depression.
At least 10% of patients with depression can have manic episodes, at which time they should be diagnosed as bipolar disorder. Depression is characterized by recurrent episodes, and its episodes are often related to stress events. Most of the acute episodes can be obviously or completely relieved. The prognosis is generally good, without leaving personality defects, but some may have residual symptoms or become chronic.
In 2003, an epidemiological survey of depressive disorder among people over 0/5 years old in Beijing/Kloc showed that the lifetime prevalence rate of depressive disorder patients was 6.87%, which was higher in women than in men.
The occurrence of depression is related to biological, psychological and social factors. In the investigation of patients with depression, it is found that about 40% ~ 70% patients have genetic tendency. In addition, biochemical factors, neuroendocrine dysfunction, psychosocial environment factors, personality factors, childhood experiences, physical diseases, abuse and dependence of psychoactive substances, and drug factors can all become risk factors for depression. Evidence shows that positive family history, life events, personality defects and other factors will significantly increase the risk of individual depression.
Disease burden
Depression has the characteristics of high incidence, high recurrence rate and high disability rate. Research shows that its recurrence rate is as high as 80%, which brings heavy economic burden and huge economic losses to society.
WHO research shows that depression ranks fifth in the global disease burden, from 65438 to 0990. Among the pre-10 diseases in the age group of 15 ~ 44, five are neuropsychiatric diseases (depression, suicide, bipolar disorder, schizophrenia and alcohol/drug dependence). Depression and suicide/self-injury are the biggest problems that lead to the loss of mental disorders.
By 2020, depression will become the second largest source of disease burden after coronary heart disease. Mental disorder and suicide will rank 1 and 2 (20.2%), while malignant tumor, cardiovascular and cerebrovascular diseases and respiratory diseases will rank 3 ~ 5. The disease burden of depression, suicide, self-injury and Alzheimer's Harmo's disease has obviously increased, and depression is still the most important problem in the burden of mental illness (44% in 1990 and 47% in 2020).
Influence of depression on patients and society
Depression will significantly affect individuals' physical and mental health, social interaction, professional ability and physical activity. Psychosocial function damage related to depression includes: inability to go to work, decreased working ability, marital disharmony and parent-child relationship problems. Most importantly, people with depression have an increased risk of suicide, self-injury and even killing their loved ones. Two-thirds of depressed patients have suicidal thoughts and behaviors, and 15% ~ 25% of depressed patients finally commit suicide. The high suicide rate among young people and the elderly may be related to the increase in alcohol and drug abuse.
Suicide is one of the common symptoms of depression and the main cause of death of patients with depression. At present, the suicide rate in China is 22.2/65438+ 10,000, and the suicide rate in rural areas is 3-4 times higher than that in cities. People related to depression account for about 40% ~ 70% of suicides.
The main symptoms of the disease
The typical symptoms of depression include depression, slow thinking, decreased will and behavior, among which depression is the most important. Typical symptoms can be seen in the morning and evening, and the change of twilight in the morning. Mental examination should pay attention to the following aspects:
Emotion: Depression is the core symptom of depression. Many times, patients will have sadness, depression and self-evaluation, and feel that life is meaningless. Some patients feel deeply guilty, even guilty.
Interest: Most patients will lose interest and lack happiness.
Fatigue, loss of vitality or loss: patients need to be urged or pushed by others to do anything (including self-care), otherwise they don't want to move at all. Have different degrees of fatigue, can not effectively restore energy through rest or sleep. Feel difficult about work and often can't finish the task. Some patients will feel helpless.
Thinking and speech: Patients tend to slow down their thinking activities and reduce their speech activities. The thinking process is difficult, and some simple problems take a long time to complete. The decision-making ability is obviously reduced and becomes indecisive.
Anxiety or agitation symptoms: patients have symptoms such as anxiety and nervousness, which are often more prominent in elderly patients with depression.
Physical symptoms (appetite, weight, sleep and sexual desire): most patients show anorexia, weight loss, some form of sleep disorder, etc. Low libido is quite common in patients with depression.
Suicide: Because of depression and low self-evaluation, patients are prone to inferiority, self-blame and despair, so patients with depression are prone to suicidal thoughts.
Chronic pain: Chronic functional pain is closely related to depression. Chronic functional pain can be an important symptom of depression or the chief complaint of medical treatment, and depressive symptoms can obviously aggravate the pain symptoms caused by various reasons.
Therapeutic strategy
The treatment of depression patients mainly includes drug therapy, psychotherapy and electroconvulsive therapy. Antidepressants can effectively relieve depression and its accompanying anxiety, tension and physical symptoms, and the effective rate is about 60% ~ 80%. According to the foreign drug treatment rules for depression, it is suggested to use new antidepressants in acute stage, such as SSRIs, SNRIs, NaSSAs and so on.
The treatment of depression should be targeted, improve or eliminate the core symptoms of depression from beginning to end, restore patients' social functions (work, study and life), and minimize recurrence. At the same time, it is necessary to improve people's mental health awareness and correct understanding of mental illness, correct incorrect views, eliminate the sense of shame of patients and their families, and urge patients to take the initiative to seek medical treatment. The whole society should strive to continuously improve the level of prevention and treatment of depression, improve the cure rate of patients, improve the quality of life of patients and reduce the burden of disease.
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