Current Psychiatry Reviews - Volume 13, Issue 4, 2017

Background: Health is influenced by numerous factors that affect the health service system and health status of the people in every country. This article aims to compare the determinants of the health service system and the health status of the people in Thailand, the Lao PDR, Vietnam, and Cambodia; and to recommend policies that impact the population's health and the country's development. Methods: A comprehensive search of the literature from a variety of online search and academic databases, and synthesis of previous study was used in this paper. Data on country indicators were taken from published online databases of the Ministry of Public Health of Cambodia, Lao PDR, Thailand,and Vietnam; the World Health Organization, and the World Bank. Results: In Thailand, the determinants of the health service system and health status of the people are medical information and technology because of the government initiatives to improve the quality of healthcare services through the use of modern technology. In Vietnam, the society and culture, and the strengths and weaknesses of the hospital significantly affect the health status and health service system there because of the religious beliefs of the people. However, in Cambodia, the strengths and weaknesses of the hospital are the primary determinant of the health service system and health status of the people due to the condition of the hospitals, the availability of new medical devices, and the number of healthcare professionals. In the Lao PDR, trade and investment, and medical information and technology, significantly influence the health service system and health status of the people because of the government efforts to outsource capital expenditures and medical technology. Conclusion: The strengths and weaknesses of the hospital are the key determinants of the health service system and health status of the people in all GMS countries. Understanding the determinants of health is essential in order to develop policies and programs that impact the population's health and the country's development.

Background: ASEAN integration aims to transform the GMS into a single market with free flows of products, services, and skilled labor, as well as investment openness, which will ultimately force regional economic growth. Therefore, this integration is likely to bring about a big change to this area in the new era; it can subsequently cause many problems as well, including mental health issues of the people in this region. The characteristic differences among the GMS member countries in terms of trade and investment, social and cultural values, medical information and technology, and the living and working environment have become major problems affecting mental health disorders, which are usually identified as depression, stress, and substance abuse. Methods: This review paper is a literature review of the relationship of the determinants affecting GMS mental disorders conducted using the following strategies: 1) collecting data from previous qualitative and quantitative research studies, comparatively analyzing the literature, articles, published papers, and reports relevant to the existing policies on economic, environmental, and healthcare issues obtained from the GMS; and 2) exchanging information from the institutions involved, including reports and papers regarding the determinants affecting mental health disorders of the people in the GMS, which were used to generate the synthesis of the existing knowledge of the mental health and to provide recommendation programs for the GMS people. Results: Based on the reviewed literature there are four key factors affecting mental health, especially mental health in GMS populations: 1) the living and work environments; 2) trade and investment; 3) technology and medical information; and 4) social and cultural values. The study found that the increasing number of mental health disorders is a big burden for national healthcare spending. Financial issues have become a major key to the wide prevalence of mental disorders in the GMS. Health issues related to mental health disorders are also caused by the environment and other related factors and therefore a stable and a well-balanced environment is an indicator of healthy mental status. In addition, the environment is a way to pursue both physical and mental health because green spaces serve as a mood freshener and can alleviate anxiety, stress, and depression. Conclusion: Globalization and urbanization should follow sustainable development instructions and concerns about the population's health, especially regarding mental health. These key determinants affect the people's life, especially in terms of mental health thus leading to mental health disorders.

Background: Mental health disorders can affect physical and psychological behaviors. The people of the Greater Mekong Subregion (GMS) have a high risk of mental health disorders, such as depression, stress, and substance abuse because the people in this region are trafficked for forced sex work and various forms of forced labor. In these situations, victims often endure violence and abuse from trafficking recruiters, employers, and other individuals. The purposes of this study were to identify the elements characterizing mental health disorders, especially in terms of depression, stress, and substance abuse, and to identify the treatment modalities for mental health disorders in the GMS. Methods: The researcher undertook a comparative analysis of the literature, reviews of epidemiological studies and mental disorder therapies, and overviews of previous research studies, were used to generate a synthesis of the existing knowledge of the mental disorder therapeutic modalities. Regarding the search methods, the data from the electronic databases PubMed, PsycINFO, Dynamed and ScienceDirect were supplemented with a manual reference search covering relevant studies from 2005 to 2016. Results: Thirty-one papers were included in the review of elements characterizing mental health disorders, especially in terms of depression, stress, and substance abuse, and to identify the treatment modalities for mental health disorders in the GMS. Nine papers defined characterizing mental health disorders, in terms of depression, stress, and substance abuse. Twenty-two papers showed the treatment modalities for mental health disorders that the treatment was effective, these included pharmacological treatments and psychological treatments, such as mindfulness-based cognitive therapy, biofeedback, and music therapy. Useful guidance can be provided for the prevention and treatment of mental health disorders, and for the care of people in the Greater Mekong Subregion. Conclusion: The finding of this review confirms the therapeutic modalities can provide useful guidance for the prevention and treatment of mental health disorders and the care of the people in the Greater Mekong Subregion. In addition, the effective interventions should be tested regarding their suitability for the socio-cultural context in the Greater Mekong Subregion.

Background: The characteristic differences among the Greater Mekong Subregion (GMS) countries in terms of trade and investment, society and cultural values, medical information and technology, and the living and working environment have become major health problems in terms of mental disorders. The purpose of this article is to identify the gaps in those aspects, to propose mental health and mental disorder recommendation programs, and to recommend policies for policy makers and research investors. Methods: A comparative analysis and literature review of existing policy, including overviews of previous research were used to generate a synthesis of the existing knowledge of the mental health and mental disorder recommendation programs. Results: The review results recommend mental health and mental disorder programs for policy makers, research investors, and stakeholders in order to strengthen the directions for implementing these programs in the future. Conclusion: The healthcare provision in each country will not be limited only to its citizens; the healthcare markets and target groups are likely to expand to the neighboring countries in the context of changes in domestic and international factors, which have both positive and negative impacts according to the political, economic, and social situations of the influencing countries.

Background: The diagnosis of depression is not only highly prevalent but also remarkable heterogeneous symptomatically. Only a few symptoms are considered common to most presentations of depression, while others form various combinations to define subtypes of depressive disorder. Most antemortem neuroimaging studies and postmortem neurochemical and cellular research have demonstrated significant structural, functional and cellular alterations shared by a majority of subjects with depression. However, it seems very likely that identifying relevant etiological factors and cellular mechanisms associated with the specific neuropathology of depression subtypes may help to focus or individualize depression treatments. Objective: The main aim of this review article is to point to the need of studying those differential cellular mechanisms characterizing different subtypes of depression as they relate to relevant neural circuits. Method: The review is based on a literature search using mainly PubMed and Google Scholar databases. Articles were considered relevant if they contained studies relating depression subtypes (or distinct symptom clusters) to neuroimaging or neuropathological parameters. Results and Conclusions: Antemortem quantification in psychiatric diagnostic scales and neuroimaging studies, with their larger number of subjects, have started to identify functional differences that discriminate depression subtypes. However, characterization of cellular and neurochemical pathology in neurons and glial cells has yet to be directed to uncover molecular and cellular mechanisms in relevant brain centers and circuits differentially affected in depression subtypes. Identifying these mechanisms will depend on our ability to first sort out cellular alterations by combining postmortem and animal model studies of depression subtypes.

Background: The aspects of cultural identity and its impact on obsessive-compulsive disorder (OCD) have been understudied. There are different opinions, ranging from the idea that culture does not affect the symptoms of this condition to the idea that cultures with high religiosity may have more severity of OCD. Also, the concept of OCD has considerably varied across history and cultures, from being considered an issue related to lack of control of blasphemous ideas, and a part of anxious issues, to the description of complex neurobiological systems in its causation. Objective: The aim of this review was to address OCD as a well-characterized disorder with a proposed neurobiological basis which may or may not have variations depending on cultural diversity. The question that was asked in this review is whether or not there are cultural differences in the manifestations of the OCD symptomatology and which factors of cultural diversity have a major influence on such manifestations along with the differences among some cultures regarding OCD issues, where the difference among countries has also been highlighted. Methods: A review of the literature was conducted that includes the following words: obsessivecompulsive disorder, culture, cultural identity and religion in a period of 10 years. Conclusion: Cultural variations do not seem to differ from symptomatic clusters of OCD, which may be indicating that a series of adaptive behaviors is evolutionarily evolving to be constantly altered, perhaps by well-determined pathophysiological mechanisms. Some aspects that have been related to some dimensions of OCD symptomatology are religion and religiosity, affecting the content of obsessions and the severity of manifestations. Properly evaluating the education background, access to health services, food, and the genetic structure of populations, using investigational instruments sensitive to these cultural elements, will increase our understanding of the importance of culture on OCD and its treatment.

Background: Neuropsychiatry is now witnessing a consistently increasing number of reports in peer reviewed literature suggesting that internet use may have addictive potential, conglomerated and mediated through reward pathway and akin to substance abuse. Methods: We searched for papers indexed in PubMed/Medline with various combinations of the following terms; Internet use, Internet overuse, Internet Addiction, Social Networking Site, Gaming Disorder, Dopamine, Hippocampus, Limbic system, Neural mechanisms, Nucleus accumbens, Prefrontal cortex, Reward system, and Stress. Literature obtained from this search was subjected to certain inclusion/exclusion defining a focused review question of the neuropsychiatric effects of internet use/overuse. The papers included were subjected to deductive analysis and results were then obtained as per the conceptual outlook of current neuropsychiatry. Results: Various neuroimaging studies performed on heavy internet users have demonstrated extensive gray and white matter changes and other organizational variations in the brain. Extensive internet use can also precipitate stress propensity in users manifesting as easy fatigue, sleep disturbances, headache, reduced work efficiency, psychological disturbances and neurological problems including, but not limited to, irritation, anxiety, obsessive-compulsion, indecisiveness, impulsivity, loss of working memory, and similar neurocognitive ailments. Exhaustive use of internet may also reflect on the changing food preferences in the form of meeting instant energy needs, higher intake of stimulant beverages, and presumably novel liking for smoking or use of addictive substances to relieve the accumulated mental strain. Conclusions: The present analysis explains the implied neural mechanisms of compulsive internet overuse, and also suggests the possible means to deal with the health problems arising from this phenomenon which is emerging as a serious public health concern.

Background: Major depression is a serious mental disorder and an important social problem in which cognitive functions of the patients are substantially deteriorated. Depression is also commonly associated with suicides. Stress induced hyperactivity of the hypothalamic-pituitaryadrenal axis is thought to be an important contributory factor for the development of this psychiatric disease. Objective: The aim of the article is to address the possible mechanisms by which chronic stresses stimulate the hypothalamic-pituitary-adrenal axis that in turn affect the other systems underpinning the pathogenesis of depression. Method: A total of 126 research and review articles were surveyed to elucidate the mechanisms by which stress induced elevated glucocorticoid level causes widespread damages in the brain that predispose to depression. Results: It is evident that chronic stresses induce hyperactivity of the hypothalamic-pituitary-adrenal axis that in turn increases the glucocorticoid level in circulation. Increased glucocorticoid level may activate glutamate-induced excitotoxicity that in turn makes damages to the monoamine neurotransmitter systems. Excessive glucocorticoid also induces the release of inflammatory cytokines in the brain. Furthermore, the steroid can also dysregulate the microRNA expressions in the brain. All these effects together may aggravate the state of depression. Conclusion: Hyperactivity of hypothalamic-pituitary-adrenal axis causes elevation of glucocorticoid in the circulation that imparts deleterious influences on various systems, leading to brain damage and depression.

Background: Over a number of decades, Cognitive Behavior Therapy has evolved and been modified by various theorists and researchers. Concerns regarding the integrity of cognitive and behavioral treatment in research studies, including fidelity, competence, and treatment differentiation, have been raised. Ensuring adequate treatment fidelity and competency is a prerequisite to have a reliable measure of the independent variable and having confidence in the corresponding statistical conclusions. Objective: To review the extant literature on the topic of treatment fidelity and consolidate recommendations that would be relevant to researchers and practitioners of Cognitive Behavior Therapy. Results: Adequate fidelity data is not typically reported in psychotherapy outcome studies. This decreases confidence in the conclusions of these studies, and in the conclusions of meta-analytic analyses that involve these studies. Several studies have consistently demonstrated that assuming treatment fidelity or competence is problematic. Conclusion: Previous recommendations are compiled and reemphasized. Individual psychotherapists are encouraged to seek competency-based certifications (e.g., through the Academy of Cognitive Therapy) to verify competency and fidelity of Cognitive Behavior Therapy practice. Researchers are encouraged to utilize direct-observational methods to ensure fidelity of practice and reliability of the independent variable. Due to concerns about demand characteristics and possible inflation of fidelity estimates, it is strongly recommended that expertly trained, blind raters who are not dependent on the project or organization be used to assess the fidelity and competency of clinical practice. Additionally, it is recommended that journal editors require inclusion of fidelity data from manuscripts that are seeking publication.