WPA guidance on the protection and promotion of mental health in children of persons with severe mental disorders

This guidance details the needs of children, and the qualities of parenting that meet those needs. Parental mental disorders can damage the foetus during pregnancy through the action of drugs, prescribed or abused. Pregnancy and the puerperium can exacerbate or initiate mental illness in susceptible women. After their birth, the children may suffer from the social disadvantage associated with severe mental illness. The parents (depending on the disorder, its severity and its persistence) may have intermittent or prolonged difficulties with parenting, which may sometimes result in childhood psychological disturbance or child maltreatment. This guidance considers ways of preventing, minimizing and remedying these effects. Our recommendations include: education of psychiatrists and related professions about the effect of parental mental illness on children; revision of psychiatric training to increase awareness of patients as caregivers, and to incorporate relevant assessment and intervention into their treatment and rehabilitation; the optimum use of pharmacological treatment during pregnancy; pre-birth planning when women with severe mental illness become pregnant; development of specialist services for pregnant and puerperal women, with assessment of their efficacy; community support for parenting by mothers and fathers with severe mental disorders; standards of good practice for the management of child maltreatment when parents suffer from mental illness; the importance of multi-disciplinary teamwork when helping these families, supporting their children and ensuring child protection; the development of child and adolescent mental health services worldwide.     

Cholinergic involvement in mental disorders.

A recent resurgence of interest in possible cholinergic mechanisms in schizophrenia, mania and depression represents a further extension of the attempt to explain these disorders on the basis of an abnormality in neurotransmission. New emphasis is less on individual neurotransmitters than it is upon their interdependent relationships. The latter is best exemplified by the treatment of Parkinson's disease, which has moved from a cholinergic approach to one that makes important use of dopaminergic mechanisms. Whether or not a reverse shift, from dopaminergic towards cholinergic approaches is justified for treating schizophrenia remains doubtful. Persuasive evidence can be adduced for new approachess to treatments of mania and depression through cholinergic mechanisms. The development of centrally active cholinemimetic agents will permit the clinical testing of some of the hypotheses engendered by this revival of inquiry into the role of acetylcholine in emotional disorders.     

Use of mechanical ventilation in adults with severe asthma.

Asthma severe enough to require intubation and mechanical ventilation is associated with a mortality rate of about 10%. Therapeutic modalities are ever-changing and at times controversial. This paper provides an update on such modalities and presents, in a step-wise fashion, those most appropriate for practical patient care. The timing of intubation and the methods used to control airway patency, arterial pH and gas levels, and hemodynamic status are crucial to the success of therapy. Finally, conventional and disputed methods of bronchodilation are outlined.     

Recognition of organic mental disorders by physicians.

To test the ability of nonpsychiatrist physicians to correctly diagnose organic mental disorders in patients who present with psychiatric symptoms a multiple-choice questionnaire was distributed. Given six brief case histories, little more than half (55%) of the respondents made the right choice even half of the time. The results strongly suggest a need among physicians for increased familiarity with the psychiatric manifestations of medical-surgical conditions.     

Gastro-oesophageal reflux complicating highly selective vagotomy.

An unacceptably high incidence of gastro-oesophageal reflux was observed in a small series of patients with duodenal ulcer who had been treated by highly selective vagotomy. Possibly this is due to an altered angle of entry of the oesophagus into the stomach, and we now routinely narrow this angle at operation.     

Hearing impairment and mental state in the elderly living at home.

Altogether 153 (60%) out of a sample of 253 people aged 70 years and over living in their own homes were found to have impaired hearing when tested by pure-tone audiometry. This is almost twice the prevalence found in all other studies, in which deafness was assessed clinically or by self-reporting. The prevalence of deafness increased with age. Evidence of organic brain syndrome (dementia), as determined by questionnaire, was present in 39 (16%) out of 245 respondents, and of depression in 82 (35%). Dementia and depression were both age related. An apparent association between deafness and dementia was shown to be due to age alone. A significant relation between deafness and depression was independent of age and socioeconomic state. The use of audiometric techniques of assessment established that an association exists between deafness and depression that is not simply a function of differential reporting reflecting the emotional state of the respondent.