Disorders and mental illness
Schizophrenia
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- Schizophrenia
Key facts
- Schizophrenia causes psychosis and is associated with considerable disability and may affect all areas of life including personal, family, social, educational, and occupational functioning.
- Stigma, discrimination, and violation of human rights of people with schizophrenia are common.
- More than two out of three people with psychosis in the world do not receive specialist mental health care.
- A range of effective care options for people with schizophrenia exist and at least one in three people with schizophrenia will be able to fully recover.
Schizophrenia is characterised by significant impairments in the way reality is perceived and changes in behaviour related to:
- persistent delusions: the person has fixed beliefs that something is true, despite evidence to the contrary;
- persistent hallucinations: the person may hear, smell, see, touch, or feel things that are not there;
- experiences of influence, control or passivity: the experience that one’s feelings, impulses, actions, or thoughts are not generated by oneself, are being placed in one’s mind or withdrawn from one’s mind by others, or that one’s thoughts are being broadcast to others;
- disorganized thinking, which is often observed as jumbled or irrelevant speech;
- highly disorganised behaviour e.
g. the person does things that appear bizarre or purposeless, or the person has unpredictable or inappropriate emotional responses that interfere with their ability to organise their behaviour; - “negative symptoms” such as very limited speech, restricted experience and expression of emotions, inability to experience interest or pleasure, and social withdrawal; and/or
- extreme agitation or slowing of movements, maintenance of unusual postures.
People with schizophrenia often also experience persistent difficulties with their cognitive or thinking skills, such as memory, attention, and problem-solving.
At least one third of people with schizophrenia experiences complete remission of symptoms (1). Some people with schizophrenia experience worsening and remission of symptoms periodically throughout their lives, others a gradual worsening of symptoms over time.
Magnitude and impact
Schizophrenia affects approximately 24 million people or 1 in 300 people (0.
32%) worldwide. This rate is 1 in 222 people (0.45%) among adults (2). It is not as common as many other mental disorders. Onset is most often during late adolescence and the twenties, and onset tends to happen earlier among men than among women.
Schizophrenia is frequently associated with significant distress and impairment in personal, family, social, educational, occupational, and other important areas of life.
People with schizophrenia are 2 to 3 times more likely to die early than the general population (3). This is often due to physical illnesses, such as cardiovascular, metabolic, and infectious diseases.
People with schizophrenia often experience human rights violations both inside mental health institutions and in community settings. Stigma against people with this condition is intense and widespread, causing social exclusion, and impacting their relationships with others, including family and friends. This contributes to discrimination, which in turn can limit access to general health care, education, housing, and employment.
During humanitarian and public health emergencies, extreme stress and fear, breakdown of social supports, isolation and disruption of health-care services and supply of medication can occur. These changes can have an impact on the lives of people with schizophrenia, such as exacerbation of existing symptoms. During emergencies, people with schizophrenia are more vulnerable than others to various human rights violations, including neglect, abandonment, homelessness, abuse and exclusion.
Causes of schizophreniaResearch has not identified one single cause of schizophrenia. It is thought that an interaction between genes and a range of environmental factors may cause schizophrenia. Psychosocial factors may also affect the onset and course of schizophrenia. Heavy use of cannabis is associated with an elevated risk of the disorder.
ServicesCurrently, the vast majority of people with schizophrenia around the world are not receiving mental health care.
Approximately 50% of people in mental hospitals have a schizophrenia diagnosis (4). Only 31.3% of people with psychosis receive specialist mental health care (5). Most resources for mental health services are inefficiently spent on care within mental hospitals.
There is clear evidence that mental hospitals are not effective in providing the care that people with mental health conditions need and, regularly, violate the basic human rights of persons with schizophrenia. Efforts to transfer care from mental health institutions to the community need to be expanded and accelerated. Such efforts start with the development of a range of quality community-based mental health services. Options for community-based mental health care include integration in primary health and general hospital care, community mental health centres, day centres, supported housing, and outreach services for home-based support. The engagement of the person with schizophrenia, family members and the wider community in providing support is important.
A range of effective care options for people with schizophrenia exist, and these include medication, psychoeducation, family interventions, cognitive-behavioural therapy and psychosocial rehabilitation (e.g., life skills training). Facilitated assisted living, supported housing and supported employment are essential care options that should be available for people with schizophrenia. A recovery-oriented approach – giving people agency in treatment decisions – is essential for people with schizophrenia and for their families and/or caregivers as well.
WHO responseWHO’s Comprehensive Mental Health Action Plan 2013-2030 highlights the steps required to provide appropriate services for people with mental disorders including schizophrenia. A key recommendation of the Action Plan is to shift services from institutions to the community. The WHO Special Initiative for Mental Health aims to further progress towards objectives of the Comprehensive Mental Health Action Plan 2013-2030 by ensuring 100 million more people have access to quality and affordable care for mental health conditions.
WHO's Mental Health Gap Action Programme (mhGAP) uses evidence-based technical guidance, tools and training packages to expand service in countries, especially in resource-poor settings. It focuses on a prioritized set of conditions, including psychosis, directing capacity building towards non-specialized health-care providers in an integrated approach that promotes mental health at all levels of care. Currently mhGAP is being implemented in more than 100 WHO Member States.
The WHO QualityRights Project involves improving the quality of care and human rights conditions in mental health and social care facilities and to empower organizations to advocate for the health of people with mental health conditions and psychosocial disabilities.
The WHO guidance on community mental health services and person-centred and rights-based approaches provides information and support to all stakeholders who wish to develop or transform their mental health system and services to align with international human rights standards including the UN Convention on the Rights of Persons with Disabilities.
(1) Harrison G, Hopper K, Craig T, Laska E, Siegel C, Wanderling J. Recovery from psychotic illness: a 15- and 25-year international follow-up study. Br J Psychiatry 2001;178:506-17.
(2) Institute of health Metrics and Evaluation (IHME). Global Health Data Exchange (GHDx). http://ghdx.healthdata.org/gbd-results-tool?params=gbd-api-2019-permalink/27a7644e8ad28e739382d31e77589dd7 (Accessed 25 September 2021)
(3) Laursen TM, Nordentoft M, Mortensen PB. Excess early mortality in schizophrenia. Annual Review of Clinical Psychology, 2014;10, 425-438.
(4) WHO. Mental health systems in selected low- and middle-income countries: a WHO-AIMS cross-national analysis. WHO: Geneva, 2009
(5) Jaeschke K et al. Global estimates of service coverage for severe mental disorders: findings from the WHO Mental Health Atlas 2017 Glob Ment Health 2021;8:e27.
WHO’s Comprehensive Mental Health Action Plan 2013-2030
WHO Special Initiative for Mental Health
WHO's Mental Health Gap Action Programme (mhGAP)
WHO QualityRights Project
WHO guidance on community mental health services and person-centred and rights-based approaches
More on mental health
Autism
It is estimated that worldwide about one in 100 children has autism(1).
This estimate represents an average figure, and reported prevalence varies substantially across studies. Some well-controlled studies have, however, reported figures that are substantially\r\n higher. The prevalence of autism in many low- and middle-income countries is unknown.
Causes
Available scientific evidence suggests that there are probably many factors that make a child more likely to have autism, including environmental and genetic factors.
Available epidemiological data conclude that there is no evidence of a causal association between measles, mumps and rubella vaccine, and autism. Previous studies suggesting a causal link were found to be filled with methodological flaws(2)(3).
There is also no evidence to suggest that any other childhood vaccine may increase the risk of autism. Evidence reviews of the potential association between the preservative thiomersal and aluminium adjuvants contained in inactivated vaccines and the\r\n risk of autism strongly concluded that vaccines do not increase the risk of autism.
Assessment and care
A broad range of interventions, from early childhood and across the life span, can optimize the development, health, well-being and quality of life of autistic people. Timely access to early evidence-based psychosocial interventions can improve the ability\r\n of autistic children to communicate effectively and interact socially. The monitoring of child development as part of routine maternal and child health care is recommended.
It is important that, once autism has been diagnosed, children, adolescents and adults with autism and their carers are offered relevant information, services, referrals, and practical support, in accordance with their individual and evolving needs and\r\n preferences.
The health-care needs of people with autism are complex and require a range of integrated services, that include health promotion, care and rehabilitation. Collaboration between the health sector and other sectors, particularly education, employment and\r\n social care, is important.
Interventions for people with autism and other developmental disabilities need to be designed and delivered with the participation of people living with these conditions. Care needs to be accompanied by actions at community and societal levels for greater accessibility, inclusivity and support.
Human rights
All people, including people with autism, have the right to the enjoyment of the highest attainable standard of physical and mental health.
And yet, autistic people are often subject to stigma and discrimination, including unjust deprivation of health care, education and opportunities to engage and participate in their communities.
People with autism have the same health problems as the general population. However, they may, in addition, have specific health-care needs related to autism or other co-occurring conditions. They may be more vulnerable to developing chronic noncommunicable\r\n conditions because of behavioural risk factors such as physical inactivity and poor dietary preferences, and are at greater risk of violence, injury and abuse.
People with autism require accessible health services for general health-care needs like the rest of the population, including promotive and preventive services and treatment of acute and chronic illness. Nevertheless, autistic people have higher rates\r\n of unmet health-care needs compared with the general population. They are also more vulnerable during humanitarian emergencies. A common barrier is created by health-care providers’ inadequate knowledge and understanding of autism.
WHO resolution on autism spectrum disorders
In May 2014, the Sixty-seventh World Health Assembly adopted a resolution entitled Comprehensive and coordinated efforts for the management of autism spectrum disorders,\r\n which was supported by more than 60 countries.
The resolution urges WHO to collaborate with Member States and partner agencies to strengthen national capacities to address ASD and other developmental disabilities.
WHO response
WHO and partners recognize the need to strengthen countries' abilities to promote the optimal health and well-being of all people with autism.
WHO's efforts focus on:
- increasing the commitment of governments to taking action to improve the quality of life of people with autism;
- providing guidance on policies and action plans that address autism within the broader framework of health, mental and brain health and disabilities;
- contributing to strengthening the ability of the health workforce to provide appropriate and effective care and promote optimal standards of health and well-being for people with autism; and
- promoting inclusive and enabling environments for people with autism and other developmental disabilities and providing support to their caregivers.
WHO Comprehensive mental health action plan 2013–2030 and World Health Assembly Resolution WHA73.10 for “global actions on epilepsy and other neurological disorders” calls on countries to address the current significant\r\n gaps in early detection, care, treatment and rehabilitation for mental and neurodevelopmental conditions, which include autism.
It also calls for counties to address the social, economic, educational and inclusion needs of people living with mental\r\n and neurological disorders, and their families, and to improve surveillance and relevant research.
References
(1) Global prevalence of autism: A systematic review update. Zeidan J et al. Autism Research 2022 March.
(2) Wakefield's affair: 12 years of uncertainty whereas no link between autism and MMR vaccine has been proved. Maisonneuve H, Floret D. Presse Med. 2012 Sep; French (https://www.ncbi.nlm.nih.gov/pubmed/22748860).\r\n
(3) Lancet retracts Wakefield’s MMR paper. Dyer C. BMJ 2010;340:c696. 2 February 2010 (https://pubmed.ncbi.nlm.nih.gov/20124366/)\r\n
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Schizophrenia
Schizophrenia- Healthcare issues »
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- Read more/ nine0004 Schizophrenia
Key Facts
- Schizophrenia is a severe mental disorder that affects approximately 24 million people, or 1 in 300 people worldwide.
- Schizophrenia causes psychosis, is associated with severe disability, and can negatively affect all areas of life, including personal, family, social, academic and work life.
- People with schizophrenia are often subject to stigma, discrimination and human rights violations. nine0286
- Worldwide, more than two thirds of people with psychosis do not receive specialized mental health care.
- There are a number of effective care options for patients with schizophrenia that can lead to a complete recovery of at least one in three patients.
Symptoms
Schizophrenia is characterized by significant disturbances in perception of reality and behavioral changes such as:
- persistent delusions: the patient has a persistent belief in the truth of certain things, despite evidence to the contrary;
- persistent hallucinations: the patient hears, sees, touches non-existent things and smells non-existent smells;
- feeling of external influence, control or passivity: the presence in the patient of the feeling that his feelings, impulses, actions or thoughts are dictated from outside, put in or disappear from consciousness at the will of others, or that his thoughts are broadcast to others; nine0005
- disorganized thinking, often expressed in incoherent or pointless speech;
- Significant disorganization of behavior, which is manifested, for example, by the patient performing actions that may seem strange or meaningless, or in an unpredictable or inappropriate emotional reaction that does not give the patient the opportunity to organization of their behavior;
- "negative symptoms" such as extreme poverty of speech, smoothness of emotional reactions, inability to feel interest or pleasure, social autism; and/or
- Extreme agitation or, on the contrary, slowness of movements, freezing in unusual postures.
People with schizophrenia often also experience persistent cognitive or thinking problems that affect memory, attention, or problem-solving skills.
At least one third of patients with schizophrenia experience complete remission of symptoms (1). In some, periods of remission and exacerbation of symptoms follow each other throughout life, in others there is a gradual increase in symptoms. nine0322
Scope and impact
Schizophrenia affects approximately 24 million people, or 1 in 300 people (0.32%) worldwide. Among adults, the rate is 1 in 222 (0.45%) (2). Schizophrenia is less common than many other mental disorders. Onset is most common in late adolescence and between the ages of 20 and 30; while women tend to have a later onset of the disease. nine0322
Schizophrenia is often accompanied by significant stress and difficulties in personal relationships, family life, social contacts, studies, work or other important areas of life.
Individuals with schizophrenia are 2-3 times more likely to die early than the population average (2).
It is often associated with physical illnesses such as cardiovascular disease, metabolic disease, and infectious disease.
Patients with schizophrenia often become the object of human rights violations both within the walls of psychiatric institutions and in everyday life. Significant stigmatization of people with this disease is a widespread phenomenon that leads to their social isolation and has a negative impact on their relationships with others, including family and friends. This creates grounds for discrimination, which in turn limits access to health services in general, education, housing and employment. nine0322
Humanitarian emergencies and health crises can cause intense stress and fear, disrupt social support mechanisms, lead to isolation and disruption of health services and supply of medicines. All these shocks can have a negative impact on the lives of people with schizophrenia, in particular by exacerbating existing symptoms of the disease. People with schizophrenia are more vulnerable during emergencies to various human rights violations and, in particular, face neglect, abandonment, homelessness, abuse and social exclusion.
nine0322
Causes of schizophrenia
Science has not established any one cause of the disease. It is believed that schizophrenia may be the result of the interaction of a number of genetic and environmental factors. Psychosocial factors may also influence the onset and course of schizophrenia. In particular, heavy marijuana abuse is associated with an increased risk of this mental disorder.
Assistance services
At present, the vast majority of people with schizophrenia do not receive mental health care worldwide. Approximately 50% of patients in psychiatric hospitals are diagnosed with schizophrenia (4). Only 31.3% of people with psychosis get specialized mental health care (5). Much of the resources allocated to mental health services are inefficiently spent on the care of patients admitted to psychiatric hospitals.
Available scientific evidence clearly indicates that hospitalization in psychiatric hospitals is not an effective treatment for mental disorders and is regularly associated with the violation of the basic rights of patients with schizophrenia.
Therefore, it is necessary to ensure the expansion and acceleration of work on the transfer of functions in the field of mental health care from psychiatric institutions to the level of local communities. Such work should begin with the organization of the provision a wide range of quality community-based mental health services. Options for community-based mental health care include integrating this type of care into primary health care and hospital care. general care, setting up community mental health centres, outpatient care centres, social housing with nursing care and social home care services. Involvement in the care process is essential the patient with schizophrenia, his family members and members of local communities. nine0322
Schizophrenia management and care
There are a number of effective approaches to treating people with schizophrenia, including medication, psychoeducation, family therapy, cognitive behavioral therapy, and psychosocial rehabilitation (eg, life skills education).
The most important interventions for helping people with schizophrenia are assisted living, special housing and employment assistance. It is extremely important for people with schizophrenia and their families and/or caregivers to a recovery-centered approach that empowers people to participate in decisions about their care. nine0322
WHO action
steps are in place to ensure that appropriate services are provided to people with mental disorders, including schizophrenia. One of the key recommendations The action plan is to transfer the function of providing assistance from institutions to local communities. WHO Special Mental Health Initiative aims to further progress towards the goals of the Comprehensive Plan mental health action 2013–2030 by ensuring that 100 million more people have access to quality and affordable mental health care. nine0322
The WHO Mental Health Gap Action Program (mhGAP) is working to develop evidence-based technical guidelines, tools and training packages to scale up services in countries, especially in low-resource settings.
The program focuses on a priority list of mental health disorders, including psychosis, and aims to strengthen the capacity of non-specialized health workers in as part of an integrated approach to mental health care at all levels of care. To date, the mhGAP Program has been implemented in more than 100 WHO Member States. nine0322
The WHO QualityRights project aims to improve the quality of care and better protect human rights in mental health and social care settings and to expand opportunities of various organizations and associations to defend the rights of persons with mental disorders and psychosocial disabilities.
The WHO guidelines on community mental health services and human rights-based approaches provide information for all stakeholders who intend to develop or transform mental health systems and services. health in accordance with international human rights standards, including the UN Convention on the Rights of Persons with Disabilities. nine0322
Bibliography
(1) Harrison G, Hopper K, Craig T, Laska E, Siegel C, Wanderling J.
Recovery from psychotic illness: a 15- and 25-year international follow-up study. Br J Psychiatry 2001;178:506-17.
(2) Institute of Health Metrics and Evaluation (IHME). Global Health Data Exchange (GHDx). http://ghdx.healthdata.org/gbd-results-tool?params=gbd-api-2019-permalink/27a7644e8ad28e739382d31e77589dd7 (accessed 25 September 2021)
(3) LaursenTM, Nordentoft M, Mortensen PB. Excess early mortality in schizophrenia. Annual Review of Clinical Psychology , 2014;10, 425-438.
(4) WHO. Mental health systems in selected low- and middle-income countries: a WHO-AIMS cross-national analysis. WHO: Geneva, 2009
(5) Jaeschke K et al. Global estimates of service coverage for severe mental disorders: findings from the WHO Mental Health Atlas 2017 Glob Ment Health 2021;8:e27.
Autism
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Key Facts
- Autism, also called autism spectrum disorder, is a diverse group of pathological conditions caused by the development of the brain.
- Signs of autism can be detected in early childhood, but often it is not diagnosed until later in life.
- Approximately 1 in 100 children have autism.
- The abilities and needs of people with autism can vary and change over time. Some people with autism are able to lead independent and productive lives, while others become severely disabled and require lifelong care and support.
- Evidence-based psychosocial interventions can improve communication skills and social behavior that positively impact the well-being and quality of life of people with autism and their caregivers. nine0286
- Care for people with autism must be accompanied by local and community action to make physical and social environments and relationships more accessible, inclusive and supportive.
Introduction
Autism Spectrum Disorders (ASD) are a group of different conditions.
All of them are characterized by certain difficulties with social interaction and communication. Other features include atypical patterns of action and behaviors, such as difficulty moving from one activity to another, focus on details, and unusual responses to external stimuli. nine0322
The abilities and needs of people with autism can vary and change over time. Some people with autism are able to live independent and productive lives, while others become severely disabled and require lifelong care and support. Autism often negatively affects educational or employment opportunities. In addition, for family members of people with autism, care and support responsibilities can often be a source of significant stress. Community attitudes and the level of support from local and national governments are important determinants of the quality of life of people with autism. nine0322
Signs of autism can be identified in early childhood, but the condition is often diagnosed at much later stages.
People with autism often have comorbid conditions and illnesses, including epilepsy, depression, anxiety, and attention deficit hyperactivity disorder, as well as behavioral problems such as sleep disturbances or self-harm. The level of intellectual abilities of people with autism varies in a wide range from severe cognitive impairment to a high level of intelligence. nine0322
Epidemiology
Worldwide, autism is estimated to affect about 1 in 100 children (1). At the same time, we are talking about an average indicator, and the prevalence rates of autism recorded according to different studies vary widely. However, according to some reputable controlled studies, the real numbers are much higher. The prevalence of autism in many low- and middle-income countries is unknown.
Causes
Available scientific evidence indicates many factors that may increase the likelihood of children developing autism, including environmental and genetic factors.
Available epidemiological data do not establish a causal relationship between autism and measles, mumps and rubella vaccination. Past studies suggesting such a causal relationship have been many methodological problems were found (2), (3). nine0322
Similarly, there is no evidence that any childhood vaccine can increase the risk of developing autism. Evidence reviews on a potential association between the preservative thiomersal and aluminum adjuvants contained in inactivated vaccines and the risk of developing autism strongly suggest that vaccines do not lead to an increase in this risk.
Needs Assessment and Care Management
A range of interventions, from early childhood and throughout life, can contribute to the optimal development, well-being and quality of life of people with autism. Timely evidence-based psychosocial interventions at an early age can improve the ability of children with autism to communicate and interact effectively with others.
It is recommended to monitor the development of children as part of the planned provision of medical care to mothers and children. nine0322
It is important that immediately after diagnosis, children, adolescents and adults diagnosed with autism and their caregivers have access to relevant information, referrals and practical support tailored to their individual needs. constantly changing needs and preferences.
The health care needs of people with autism are complex and therefore they require comprehensive services, including health promotion, care and rehabilitation services. Therefore, it is important to ensure cooperation with other sectors, in particular with the education system, employment and the social sector. nine0322
Interventions to help people with autism and other developmental disabilities should be planned and implemented with the participation of people with these conditions themselves. Caring for people with autism should be accompanied by local action.
and at the level of society as a whole, in order to make the physical and social environment and relationships more accessible, inclusive and supportive.
Human rights
All people, including those with autism, have the right to the highest attainable standard of physical and mental health. nine0322
Yet people with autism often face stigma and discrimination: their health care and education rights are unfairly denied, and their opportunities to participate in society are limited.
People with autism may experience the same health problems as the rest of the population. In addition, they may have special health care needs related to autism and other related conditions. They can be are more vulnerable to chronic noncommunicable diseases associated with behavioral risk factors such as physical inactivity and poor diet, and are at greater risk of violence, injury and abuse. nine0322
People with autism, like the rest of the population, need affordable health services to meet general health needs, including health promotion and prevention services, as well as acute and chronic care.
However less than in the general population, the level of satisfaction of the medical needs of people with autism is at a lower level. These people are also more vulnerable in humanitarian emergencies. One of the common barriers is the insufficient level of knowledge and understanding of the specifics of autism by medical professionals. nine0322
WHO Resolution on Autism Spectrum Disorders
In May 2014, the Sixty-seventh World Health Assembly adopted a resolution on "Comprehensive and concerted efforts for the management of autism spectrum disorders", supported by over 60 countries.
The resolution calls on WHO to work with Member States and partner agencies to strengthen national capacity to address ASD and other developmental disabilities. nine0322
WHO activities
WHO and partners recognize the need to strengthen countries' capacity to promote the optimal health and well-being of all people with autism.
The main activities of WHO in this regard are:
- promoting the adoption of targeted measures by national governments to improve the quality of life of people with autism;
- develop recommendations for policies and action plans to address autism in the broader context of physical, mental, brain health and care for people with disabilities; nine0005
- help to empower healthcare professionals to provide appropriate and effective care for people with autism and achieve optimal health and well-being; and
- promote and support an inclusive and supportive environment for people with autism and other developmental disabilities.
WHO comprehensive mental health action plan 2013–2030 and World Health Assembly Resolution WHA73.10 "Global action against epilepsy and other neurological disorders" contain calling on countries to address significant gaps in the early detection, care, treatment and rehabilitation of people with mental and neurodevelopmental disorders, including and autism. The resolution also calls on countries to take action to meet the social, economic, educational and other needs of people living with mental and neurological disorders and their families, and to develop surveillance and related research activities. nine0322
References
(1) Global prevalence of autism: A systematic review update. Zeidan J et al. Autism Research 2022 March.
(2) Wakefield's affair: 12 years of uncertainty whereas no link between autism and MMR vaccine has been proven. Maisonneuve H, Floret D. Presse Med. 2012 Sep; French https://pubmed.
