Mental Health

Mental disorders on the rise in Europe

Mental disorders, the core health challenge of the 21st century

• Mental Disorders¹

  

  Every year, almost 4 people of 10 (38.2%) of the total EU population suffer from at least one of mental disorders.
  
  This corresponds to an estimated
  164.7 million persons.

• Distribution

  

  Mental health problems cut across age, gender and countries¹.

  • Relatively high frequencies of common mental disorders, mostly non-psychotic depression and anxiety, are associated with poor education, material disadvantage and unemployment.²
  • People of lower socio-economic status experience more common mental disorders.²

• Impact on individuals affected and on society¹

  

  Mental disorders have a large impact on individuals affected and on society and the burden can be subdivided in 4 major areas:

  • Loss of quality of life QoL
  • Associated stigma
  • Unemployment
  • Direct and indirect costs

The burden of mental disorders in the European Union

• Most common types of mental disorders⁴

  

  • Anxiety disorders (14%)
  • Mood disorders (7.8%), dominated by major depression (6.9%)
  • Somatoform disorders (6.3%)
  • Alcohol dependence (3.4%) and opioid and cannabis dependence
  • Psychotic (1.2%) and eating disorders

• Gender differences^1,4

  

  • There are clear gender differences in the type of mental disorders affecting females versus males.
  • Women were disproportionately affected by depression, twice as prevalent than in men.
  • For men alcohol use disorders are the biggest relative contributor to the disease burden in Europe.

• Distribution by age^2,3,4

  

  • Mental disorders often start at a relatively young age
  • Mental health problems are common among older people
  • Generalized Anxiety Disorder has the highest prevalence among those aged ≥65
  • Dementia affects 5% of people over 65 on average, and 20% of those over 80

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Depression

• Definition²

  

  • Depression (major depressive disorder) is a common but serious mood disorder.
  • It causes severe symptoms that affect how a person feels, thinks, and handles daily activities, such as sleeping, eating, or working.

• Epidemiology in Europe

  

  • Depression is the most important contributor to the burden of mental diseases in Europe, both in terms of years of life lost due to premature mortality and years of life lost due to living with disability.³
  • Depression is more prevalent among females and persons aged 40–59.^1,3

• Risk factors

  

  • The specific cause of major depressive disorder is not known.
  • Major depressive disorder appears to be a multifactorial and heterogeneous group of disorders involving genetic and environmental factors.¹

• Signs and symptoms¹

  

  • Most patients with major depressive disorder present with a normal appearance.
  • In patients with more severe symptoms, a decline in grooming and hygiene may be observed, as well as a change in weight.
  • Among the criteria for a major depressive disorder, at least 5 out of the 9 symptoms listed in the Diagnostic and Statistical Manual of Mental Disorder 5th Edition (DSM-5) must have been present during the same 2-week period (and at least one of the symptoms is either depressed mood or loss of interest or pleasure)

  Main signs and symptoms of major depression

  Depressed mood Diminished interest or loss of pleasure in almost all activities (anhedonia) Sleep disturbance (insomnia or hypersomnia)

  Fatigue or loss of energy Psychomotor agitation or retardation Feelings of worthlessness Diminished ability to think or concentrate, indecisiveness Significant weight change or appetite disturbance Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan for committing suicide

• Diagnosis

  

  • Depression screening tests can be valuable, the most widely used being the Patient Health Questionnaire-9¹.
    • The results obtained from the use of any depression screening or rating scales do not diagnose depression and may be imperfect in any population, especially in elderly patients.
  • Depression is a clinical diagnosis, based on the history and physical findings.
    • No diagnostic laboratory tests are available to diagnose major depressive disorder, but focused laboratory studies may be useful to exclude potential medical illnesses that may present as major depressive disorder.¹
  • Neuroimaging can help clarify the nature of the neurologic illness that may produce psychiatric symptoms.¹

• Management

  

  • In all patient populations, the combination of medications and psychotherapy generally provides the quickest and most sustained response.¹
  • 70-80% of individuals with major depressive disorder can achieve a significant reduction in symptoms with appropriate treatment.¹

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Schizophrenia

• Definition^1,3

  

  • Schizophrenia is a chronic and severe mental disorder that affects how people think, feel, and perceive.
  • The hallmark symptom of schizophrenia is psychosis, such as experiencing:
    • auditory hallucinations (voices)
    • delusions (fixed false beliefs)
    • disorganized speech
    • Negative symptoms (diminished emotional expression)

• Epidemiology in Europe

  

  • The lifetime prevalence of schizophrenia has generally been estimated to be approximately 1% worldwide.
  • The prevalence of schizophrenia is about the same in men and women.
  • The onset of schizophrenia usually occurs between the late teens and the mid-30s.
  • The first 5–10 years of the illness can be stormy, but this initial period is usually followed by decades of relative stability.

• Risk factors

  

  • The causes of schizophrenia are not known.¹
  • Genetic and perinatal are the most likely sets of risk factors.
    • Many different genes may increase the risk of schizophrenia, but no single gene causes the disorder by itself
    • Interactions between genes and aspects of the individual’s environment are necessary for schizophrenia to develop. Environmental factors may involve: exposure to viruses, malnutrition before birth, problems during birth and psychosocial factors³

• Signs and symptoms^1,3

  

  • The symptoms of schizophrenia may be divided into the following 4 domains:
    • Positive symptoms –Psychotic symptoms not generally seen in healthy people (i.e. hallucinations, delusions, disorganized speech and behavior)
    • Negative symptoms – Associated with disruptions to normal emotions and behaviors (i.e. decrease in emotional range, poverty of speech, and loss of interests and drive)
    • Cognitive symptoms –Subtle for some patient, more severe for others. Patients may notice changes in their memory or other aspects of thinking. They also find it difficult to understand nuances and subtleties of interpersonal cues and relationships
    • Mood symptoms - Patients often seem cheerful or sad in a way that is difficult to understand; they often are depressed.

• Diagnosis

  

  • The diagnosis of schizophrenia is made according to the criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5) and the patient must have experienced at least 2 of the following symptoms:¹
    • Delusions
    • Hallucinations
    • Disorganized speech
    • Disorganized or catatonic behavior
    • Negative symptoms
  • At least 1 of the symptoms must be the presence of delusions, hallucinations, or disorganized speech.
  • Schizophrenia is not associated with any characteristic laboratory results.¹

• Management

  

  • Treatment of schizophrenia requires an integration of medical, psychological, and psychosocial inputs.¹
    • The medical management of schizophrenia often requires a combination of medications, which may include antipsychotic, antidepressant, and anti-anxiety medication.²
    • Traditional or typical antipsychotics diminish the positive symptoms such as hallucinations and delusions, and prevent relapses.^1,2
    • Newer antipsychotic medications, also known as atypical antipsychotics, are useful to treat both the positive and negative symptoms. They can also have positive effects on cognitive and mood symptoms.²
    • Psychosocial treatment is essential, as individuals who participate in regular psychosocial treatment are less likely to have relapses or be hospitalized.^1,3

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