Neurological, Psychiatric, and Developmental Disorders

Meeting the Challenge in the Developing World

Publisher: National Academies Press
ISBN: 9780309071925
eISBN Pdf: 9780309570084
eISBN Epub: 9780309170932
Place of publication: United States
Year of digital publication: 2001
Month: January
Pages: 459
DDC: 616
Language: English

Caption

Brain disorders—neurological, psychiatric, and developmental—now affect at least 250 million people in the developing world, and this number is expected to rise as life expectancy increases. Yet public and private health systems in developing countries have paid relatively little attention to brain disorders. The negative attitudes, prejudice, and stigma that often surround many of these disorders have contributed to this neglect.

Lacking proper diagnosis and treatment, millions of individual lives are lost to disability and death. Such conditions exact both personal and economic costs on families, communities, and nations. The report describes the causes and risk factors associated with brain disorders. It focuses on six representative brain disorders that are prevalent in developing countries: developmental disabilities, epilepsy, schizophrenia, bipolar disorder, depression, and stroke.

The report makes detailed recommendations of ways to reduce the toll exacted by these six disorders. In broader strokes, the report also proposes six major strategies toward reducing the overall burden of brain disorders in the developing world.

Neurological, Psychiatric, and Developmental Disorders
Copyright
REVIEWERS
Preface
Acknowledgments
Contents
Part I
- Executive Summary
  - BACKGROUND
  - SCOPE
  - MAGNITUDE OF THE PROBLEM
  - FINDINGS AND FUTURE STRATEGIES
    - To Reduce the Burden of Brain Disorders Now
    - To Create Options for the Future
  - CONCLUSION
- 1 Introduction
  - NEUROLOGICAL, PSYCHIATRIC, AND DEVELOPMENTAL DISORDERS
  - CHALLENGES FOR THE CARE OF BRAIN DISORDERS
  - GOALS OF THE STUDY
  - STUDY APPROACH
  - ORGANIZATION OF THE REPORT
- REFERENCES
- 2 The Magnitude of the Problem
  - EFFECTS ON COMMUNITIES AND NATIONS
    - The Disease Burden
  - EFFECTS ON INDIVIDUALS AND FAMILIES
    - Lost Productivity
    - Stigma and Discrimination
  - THE ROLES OF POVERTY AND GENDER INEQUALITY
    - The Role of Poverty
    - Poverty-Associated Risk Factors for Brain Disorders
      - Unsafe and Unhygienic Living Conditions
      - Hunger and Malnutrition
      - Inadequate Access to Health Care
      - Lack of Educational and Employment Opportunities
    - The Role of Gender Inequality
      - Postnatal Depression
      - Rape and Sexual Violence
      - HIV/AIDS
      - Domestic Violence
  - CAPACITY TO ADDRESS BRAIN DISORDERS
- REFERENCES
- 3 Integrating Care of Brain Disorders into Health Care Systems
  - THE ROLE OF PRIMARY CARE IN ADDRESSING BRAIN DISORDERS
  - DEVELOPING A SYSTEM OF CARE
    - Primary Care
    - The Role of Secondary and Tertiary Care
  - BUILDING CAPACITY THROUGH TRAINING
  - COLLABORATION WITH OTHER HEALTH AND NONHEALTH SECTORS
    - Private Physicians
    - Schools and Educators
    - Community-Based Rehabilitation Programs
    - Community Organizations
    - Traditional Healers
  - THE COST OF INTEGRATING SERVICES
  - BUILDING RESEARCH CAPACITY THROUGH COLLABORATION
  - POLICY IMPLICATIONS
    - National Policy
    - Local Policy
  - INTERNATIONAL SUPPORT FOR SYSTEMS OF PRIMARY CARE
    - The Role of Professional Societies and International Organizations
    - Provision of Essential Drugs
  - NATIONAL CENTERS FOR TRAINING AND RESEARCH
  - CONCLUSION
  - REFERENCES
- 4 Findings and Future Strategies
  - REDUCING THE DISEASE BURDEN NOW
    - Increasing Awareness
    - Utilizing Existing Health Systems
    - Expanding Use of Cost-Effective Interventions
  - CREATING OPTIONS FOR THE FUTURE
    - Applied Research
    - Capacity Strengthening
    - The Role of International Aid
  - CONCLUSION
Part II
- INTRODUCTION
- 5 Developmental Disabilities
  - DEFINITION
    - Cognitive Disabilities
    - Motor Disabilities
    - Vision, Hearing and Speech Disabilities
    - Behavioral Disorders
  - SCOPE OF THE PROBLEM
  - PREVALENCE AND INCIDENCE
    - Prevalence of Cognitive Disabilities
    - Prevalence of Motor Disabilities
    - Prevalence of Vision Disabilities
    - Prevalence of Hearing and Speech Disabilities
    - Prevalence of Behavioral Disabilities
  - RISK FACTORS
    - Genetic
    - Nutritional Deficiencies
      - Micronutrient Deficiencies
      - Protein-Energy Malnutrition
    - Infection
    - Environmental Toxins
    - Perinatal and Neonatal
    - Poverty and Trauma
  - INTERVENTIONS
    - Primary and Secondary Prevention
      - Genetic Factors
      - Nutritional Deficiencies
      - Infections
      - Environmental Toxins
      - Prenatal Care and Perinatal Services
      - Trauma
      - Secondary Prevention
    - Rehabilitation
      - Models for Rehabilitation
      - Barriers to Implementation
    - Cost Analysis
  - CAPACITY
    - Research training programs
      - Regional rehabilitation training programs
      - Clinical training programs
      - Special education training programs
  - CONCLUSION
  - REFERENCES
- 6 Epilepsy
  - DEFINITION
  - SCOPE OF THE PROBLEM
    - Stigma and Discrimination
    - Treatment Gap
    - Infectious Diseases
  - PREVALENCE AND INCIDENCE
    - Mortality Rates
  - RISK FACTORS
    - Genetic
    - Pre-, Peri- and Post-Natal
    - Parasitic Infections
    - Bacterial Infections
    - Viral Infections
    - Head Injuries
    - Febrile Seizures
  - INTERVENTIONS
    - Prevention
    - Treatment
  - CAPACITY
    - Training
    - Research
  - ANNEX 6-1
    - BIOLOGICAL CYCLE
    - EPIDEMIOLOGY
    - PREVENTION
    - TREATMENT
  - REFERENCES
- 7 Schizophrenia
  - DEFINITION
  - SCOPE OF THE PROBLEM
    - Mortality
    - Social and Economic Costs
  - PREVALENCE AND INCIDENCE
    - Prevalence
    - Incidence
  - RISK FACTORS
    - Genetic
    - Environmental
    - Brain Pathology
    - Neurochemistry
    - Functional Neuroimaging and Cognitive Deficits
    - Neurodevelopmental
    - Associations with Age and Gender
    - Substance Abuse Comorbidity
    - Factors Affecting Course and Outcome
  - INTERVENTIONS
    - Prevention
    - Treatment
      - Early Treatment
      - Pharmacotherapy
      - The Primary Health Care Model
      - Family Interventions
      - Group Interventions Focused on the Patient
      - Therapeutic Communities
      - Role of the Hospital
  - CAPACITY
  - REFERENCES
- 8 Bipolar Disorder
  - DEFINITION
  - SCOPE OF THE PROBLEM
    - Mortality
    - Social and Economic Costs
  - PREVALENCE AND INCIDENCE
  - RISK FACTORS
    - Genetic
    - Substance Abuse
    - Environmental
    - Associations with Age and Gender
    - Factors Affecting Course and Outcome
  - INTERVENTIONS
    - Prevention
    - Treatment
      - Pharmacotherapy
      - Mood Stabilizers
      - Other Mood Stabilizers
      - Psychosocial Treatment
  - CAPACITY
  - REFERENCES
- 9 Depression
  - DEFINITION
  - SCOPE OF THE PROBLEM
    - Mortality
      - Suicide
      - Physical Illness
    - Social and Economic Costs
  - PREVALENCE AND INCIDENCE
  - RISK FACTORS
    - Environmental
    - Genetic
    - Gender and Reproductive Health
    - Neuroendocrine
    - Comorbidity
    - Associations with Age
    - Factors Affecting Course and Outcome
  - INTERVENTIONS
    - Prevention
      - Social and Public Health Models
    - Preventing Suicide
    - Treatment
      - Medical interventions
      - Psychosocial interventions
      - Traditional healers
    - Cost Analysis
  - CAPACITY
    - Training
    - Research
  - REFERENCES
- 10 Stroke
  - DEFINITION
  - SCOPE OF THE PROBLEM
    - Mortality
    - Social and Economic Costs
  - PREVALENCE AND INCIDENCE
    - Prevalence
  - INCIDENCE
  - RISK FACTORS
    - Physiological
      - Hypertension
      - Diabetes
      - Cardiac Disease
      - Elevated Serum Cholesterol
      - Elevated Serum Homocysteine
      - HIV/AIDS
      - Postpartum Cerebral Venous Thrombosis
    - Risk Factors for Stroke in Children
    - Behavioral
      - Cigarette Smoking
      - Diet
      - Alcohol Abuse
      - Physical Inactivity
    - Factors Affecting Course and Outcome
  - INTERVENTIONS
    - Prevention
    - Treatment
    - Rehabilitation
    - Cost Analysis
  - CAPACITY
  - REFERENCES
Epilogue
- ESTABLISHING NATIONAL AND LOCAL PRIORITIES FOR ADDRESSING BRAIN DISORDERS
- THE POTENTIAL FOR PREVENTION
- INCREASING THE CLINICAL AND RESEARCH PROFESSIONAL CAPACITY IN DEVELOPING COUNTRIES
- COLLABORATIVE RESEARCH INTO GLOBAL HEALTH PROBLEMS
- ACCESS TO AND AFFORDABILITY OF ESSENTIAL PHARMACEUTICAL PRODUCTS
- AN INVESTMENT IN FUTURE OPPORTUNITIES
APPENDIX A The Study Approach
- BRAIN DISORDERS AND SELECTION OF SPECIFIC DISORDERS FOR SECTION II
- DEVELOPING COUNTRIES
- EARLY HISTORY OF THE STUDY
- CHARGE TO THE COMMITTEE
- COMMISSIONED PAPERS AND TECHNICAL INPUT TO THE STUDY
- WORKSHOP AND COMMITTEE MEETINGS
- OTHER IOM REPORTS ON GLOBAL HEALTH
APPENDIX B Measurement Issues in Calculating the Global Burden of Disease
APPENDIX C Workshop Agenda
APPENDIX D Economic Analysis
- GUIDELINES FOR ECONOMIC ANALYSIS OF COMMUNITY MENTAL HEALTH CARE PROGRAMS IN LOW-INCOME COUNTRIES
- THE RATIONALE FOR AN ECONOMIC PERSPECTIVE
- PRINCIPLES OF ECONOMIC ANALYSIS
- PLANNING AND DESIGNING AN ECONOMIC STUDY
- DATA COLLECTION
  - Resource Utilization
    - Resource Costs
  - Outcomes
  - Local Service Structures
- DATA ANALYSIS AND PRESENTATION
- CONTACT POINT
- FURTHER READING
- MONEY MATTERS IN EPILEPSY
- INTRODUCTION
- COST
  - Direct cost
    - Indirect cost
    - Intangible cost
- CONSEQUENCE (BENEFIT)
- PERSPECTIVE
- COST OF ILLNESS STUDIES (COI)
- SPECIAL PROBLEMS IN EVALUATING COST OF EPILEPSY
- GENERAL TOOLS OF ECONOMIC EVALUATION
  - Cost Benefit Analysis
    - Cost Effectiveness Analysis
    - Cost Utility Analysis (CUA)
    - Cost Minimization Analysis (CMA)
- PHARMACO-ECONOMIC EVALUATION OF EPILEPSY
- COMPARISON OF NEWER AEDS AGAINST CONVENTIONAL AEDS
- ACQUISITION COST MAY NOT REFLECT THE OVERALL COST
- ECONOMIC ASPECTS OF EPILEPSY: SCENARIO IN DEVELOPING COUNTRIES
- COST OF EPILEPSY CARE IN INDIA
- REFERENCES
APPENDIX E Committee and Staff Biographies
- STUDY STAFF
Glossary
- EPIDEMIOLOGICAL TERMS
Acronyms