Background: The National Health Service (NHS) was established in 1948 as a publicly funded healthcare system in the UK providing universal health coverage that is comprehensive, equitable and free at the point of delivery. The British experience of person centered medicine (PCM) is enshrined in the NHS constitution. Objectives: The objective of this study was to highlight important developments in and evolution of PCM within the NHS in person-centered care (PCC), research and innovations in undergraduate and graduate health education. Methods: This is a narrative overview of the British experience of PCM. Results: It is evident that the British experience and practice of PCM have evolved naturistically over seven decades since the establishment of the NHS. Academic research groups in collaboration with the NHS have introduced person-centered models of care supported by pivotal research in practice. Importantly, person-centered nursing has been widely adopted following the early development of a framework for person-centered nursing and its extensive evaluation. There emerged many initiatives on PCM by National Voices, the Health Foundation, British medical schools and the Royal Medical Colleges. The landmark development was the production by the Royal College of Psychiatrists in the UK of the first blueprint for a postgraduate psychiatric curriculum that is in tune with person-centered psychiatry. Conclusions: It is envisaged that the NHS will evolve and increasingly promote, adopt, codesign and implement PCC approaches adapted to the local, regional and national contexts including services redesign, health education and applied health research. These innovations contribute to the universal development of person-centered healthcare and health education.

This chapter focuses on illicit psychoactive substances, while issues related to alcohol use. The development of services for substance misusers in developing countries has been slow or non-existent. National mental health programmes promoted by WHO have often referred to the growth of substance misuse in developing countries and the need for developing addiction services. Alcohol services are often provided by mainstream mental health services. Drug treatment has been confined to detoxification for people with opiate addiction, but not maintenance treatment. High mental health morbidity has a particularly adverse effect on general health and social well-being in the population of low- and middle-income countries. Training costs can be reduced by joint funding between organizations and areas or by "skill sharing", where staff from drugs projects train mental health teams and vice versa. This has the added benefit of eroding some of the barriers and misunderstandings between services.

Conflict | Epidemiology | Intervention | Mental Health | Policy | Psychosocial Support | Syrian Refugees | Treatment | النزاع | علم الوبائيات | التدخلات | الصحة النفسية | السياسات | الممارسات | الدعم النفسي الاجتماعي | اللاجئون السوريون | العلاج

BACKGROUND The aim of this study was to explore the co-morbidity between Major Depressive Disorder (MDD) and Schizophrenia (SZ) among a large number of patients describing their clinical characteristics and rate of prevalence. SUBJECTS AND METHODS A cohort-study was carried out on 396 patients affected by MDD and SZ who consecutively attended the Department of Psychiatry, Rumeilah Hospital in Qatar. We employed the World Health Organization - Composite International Diagnostic Interview (WHO-CIDI) and the Structured Clinical Interview for DSM-5 (SCID-5) for diagnoses. Patients were also grouped in MDD patients with and without co-morbid SZ (MDD vs MDD/SZ) for comparisons. RESULTS A total of 396 subjects were interviewed. MDD patients with comorbid SZ (146(36.8%)) were 42.69±14.33 years old whereas MDD without SZ patients (250 (63.2%)) aged 41.59±13.59. Statistically significant differences between MDD with SZ patients and MDD without SZ patients were: higher BMI (Body Mass Index) (p=0.025), lower family income (p=0.004), higher rate of cigarette smoking (p<0.001), and higher level of consanguinity (p=0.023). Also, statistically significant differences were found in General Health Score (p=0.017), Clinical Global Impression-BD Score (p=0.042), duration of illnesses (p=0.003), and Global Assessment of Functioning (p=0.012). Rates of anxiety dimensions (e.g.: general anxiety, agoraphobia, somatisation, etc.), mood dimensions (e.g.: major depression, mania, oppositional defiant behaviour, Bipolar disorder), Attention Deficit Hyperactivity Disorder, psychotic and personality dimensions were higher among MDD with SZ patients than MDD without SZ. CONCLUSION This study confirms that MDD with SZ is a common comorbidity especially among patients reporting higher level of consanguinity. MDD/SZ comorbidity presents unfavourable clinical characteristics and higher levels of morbidity at rating scales.

Pioneering psychiatrist who discovered the pivotal role of serotonin in the pathogenesis of depression

Background: Psychiatric co-morbidity is a common condition, partly due to the overlap of symptoms in the categorical diagnosis of mental disorders. The co-occurrence of schizophrenia (SZ) and obsessive compulsive disorder (OCD) is a common and challenging co-morbid condition. Also, the relationship between SZ and OCD remains unclear. Aim: The aim of this study was to describe the co-morbidity of obsessive-compulsive disorder (OCD) among schizophrenia (SZ) patients and compare clinical characteristics of schizophrenia patients with versus without comorbid OCD. Subjects and Methods: A cohort-study was carried out on 396 patients enrolled between November 2011 to June 2014 at the Department of Psychiatry, Rumeilah Hospital in Qatar. We employed the WHO Composite International Diagnostic Interview (WHO-CIDI), and Structured clinical interview for DSM-5 (SCID-5) for diagnoses, the Yale-Brown Obsessive Compulsive Scale Symptom Checklist for scoring OCD. Patients were grouped in SZ patients with and without comorbid OCD (SZ-OCD vs SZ). Results: 396 subjects were interviewed. Age of SZ-OCD patients was 42.69 +/- 14.33 (years old) whereas SZ patients without OCD ranged 41.59 +/- 13.59 years old. There were statistically significant differences in clinical characteristics between SZ with and without OCD: age (p = 0.010), BMI (body mass index; p = 0.011), education (p = 0.033), employment (p = 0.019), cigarette smoking (p = 0.039), sheesha smoking (p = 0.008), and prevalence of consanguinity (p = 0.043). In particular, the rate of consanguinity in the current generation was 31.8% [95% CI = 29.1-34.7]. Also, there were statistically significant differences at Hamilton Depression score, General Health Score, Clinical Global Impression- Score, duration of illnesses, and Global Assessment of Functioning (p < 0.001). The results show that anxious, mood and psychotic dimensions rated higher among SZ - OCD ones than SZ only patients. Conclusion: This study confirms that SZ-OCD is a common co-morbidity and prevalence of SZ OCD is higher among patients reporting a degree of consanguinity. Even if this condition is under-recognized in clinical practice, it may significantly change SZ presentation and outcome since psychopathological dimensions report higher scores in the co-morbidity sample.

Background Depressive disorders are a leading cause of the global burden of disease and are associated with high recurrent often continuing morbidity and high excess mortality by suicide and cardiovascular disease. Whilst there are established, effective and cost-effective treatments for depression, their long-term management is often neglected: there is continuing controversy over the case of need for long-term treatment including lifelong treatment and safety issues. Objective and methods In this narrative review, we critically examine the evidence for the effectiveness and safety of lithium salts in the long-term management of unipolar depression. We refer to existing recent international guidelines as well as the scientific literature selectively and against the background of our longstanding experience with patients suffering from unipolar depression who are often under treated or inappropriately treated. Results and discussion According to many studies mostly dating back to the 1970/1980s, lithium is efficacious in the prophylaxis of unipolar depression particularly depression with melancholia and delusional depression and showing a clearly episodic course. Also the efficacy of lithium maintenance treatment following recovery by ECT has been clearly shown. Moreover, convincing evidence exists that lithium has added value and benefit for its unique anti-suicidal effects as well as reducing mortality by other causes. The anti-suicidal effect has been convincingly demonstrated in bipolar as well as in unipolar patients. Nevertheless its use in the management of patients with unipolar depression has not been properly recognized by a majority of textbooks and guidelines. Whilst it has been well considered as an effective treatment for depression that has not responded to antidepressants as an adjunct treatment, also called augmentation, it has been much less recommended for the prevention of recurrent episodes of unipolar depression. One of the reasons for this neglect is the blurring of the diagnosis “unipolar depression” by modern diagnostic tools. Lithium will hardly work in a patient with “unipolar depression spectrum disease”. Conclusions We conclude that lithium is an effective prophylactic treatment for carefully selected patients with unipolar depression and is safe when prescribed in recommended doses/plasma lithium levels and with regular, careful monitoring. We propose that lithium prophylaxis can be indicated in patients with unipolar depression and that the occurrence of 2 episodes of depression within 5 years is a practical criterion for starting lithium prophylaxis particularly in severe depression with psychotic features and high suicidal risk. Furthermore, an indication might be considered especially in unipolar patients in whom a bipolar background is suspected. In some cases, lithium prophylaxis may be recommended after a single episode of depression that is severe with high suicidal risk and continued life-long.

Refugees have high rates of mental health morbidity as a result of conflict. However, their needs for mental healthcare and psychosocial support are often unmet, despite the efforts of professional and humanitarian organisations. The war refugee crisis is a global challenge that needs a global solution. We call on all governments, regional and international organisations to take responsible humanitarian actions to intervene and support people affected by these disasters and for all humanity to unite against the forces of injustice and degradation. The thematic papers in this issue report on the Syrian crisis from a variety of perspectives.

The recent influx of refugees and immigrants to Greece has coincided with the ongoing and deteriorating financial crisis. This situation does not allow the Greek authorities to provide help to the desired extent. Yet, the church, local communities, medical societies and non-governmental organisations are offering good psychosocial support. In parallel with support for refugees it is important to provide support for the citizens of the host country. The rich countries of northern Europe should help the poorer countries of southern Europe cope with the refugees. A number of important declarations on refugee mental health and related issues have been produced recently, including the Anti-war Declaration of Athens.

The authors provided good guidance on the complexities of managing hypertension with associated chronic comorbid physical conditions, such as kidney disease, diabetes, chronic obstructive pulmonary disease (COPD), and heart failure.1 However, they did not mention the mental health problems that are often seen in these people …