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Capacity building needs to enable integration of mental health into general health policy and its inclusion in the essential healthcare services; expansion of economic research on resource use, costs, and effectiveness of essential mental health care services in different countries; better identification and use of levers and entry points for improved care delivery and policy development; greater participation in health sector reforms; strengthening of links between mental health and public health; and more effective resource mobilization. A sector-wide approach (SWAp) to reforms was adopted in many countries and often included a form of decentralization, along with development of a framework for policy and planning that emphasized a limited set of cost-effective prioritized health interventions and the integration of a number of vertical programs within mainstream health system functions. Mental disorders generally respond to psychological and social interventions and medications.
Dissociation may involve the protective activation of altered states of consciousness related to acute changes in a variety of brain systems in response to immediate danger. Dissociation can produce a variety of somatoform conditions such as pseudoneurological conversion symptoms, pain disorders and somatization disorder. Individuals with repeated early life trauma such as dissociative identity disorder (DID) or borderline personality disorder (BPD) may show all of these symptoms, leading to a particularly complex and variable clinical picture. Critical anatomical structures for the post-encounter defensive behavior described include the amygdala, the ventral periaqueductal gray and the hypothalamus. Failure of corticolimbic inhibition or excessive corticolimbic inhibition may be one underlying mechanism that leads to altered temporal lobe and limbic system functioning. Typically, dissociative symptoms in neurological disorders have been reported to result from lesions in the limbic system, specifically the temporal lobe or the temporoparietal junction.
This chapter summarizes available findings on the neuroendocrine effects of exposure to trauma during early development, with a focus on a role for such alterations in the increased risk of mood and anxiety disorders in adulthood. The principal components of the stress system are the hypothalamic-pituitary-adrenal (HPA) axis, the locus ceruleus-norepinephrine (LC-NE) system and the extrahypothalamic corticotropin-releasing factor (CRF) systems. In addition, increased rates of major depression, post-traumatic stress disorder (PTSD) and attention-deficit hyperactivity disorder (ADHD) have been reported in maltreated children. The relationship between early adverse experiences and the development of adult psychopathology is likely mediated by alterations in neurobiological systems involved in the regulation of stress. Findings from the research would have important implications for the development of optimized treatment strategies that directly target different neurobiological pathways involved in depression and anxiety disorders in victims of early child maltreatment.
This chapter examines the relationship between traumatic stress in childhood and the leading causes of morbidity, mortality and disability in the USA: cardiovascular disease, chronic lung disease, chronic liver disease, depression and other forms of mental illness, obesity, smoking and alcohol and drug abuse. The essence of the Adverse Childhood Experiences (ACE) Study has been to match retrospectively, approximately a half century after the fact, an individual's current state of health and well-being against adverse events in childhood. The chapter illustrates with a sampling from the findings in the ACE Study, the long-lasting, strongly proportionate and often profound relationship between adverse childhood experiences and important categories of emotional state, health risks, disease burden, sexual behavior, disability, and healthcare costs. Biomedical disease in adults had a significant relationship to adverse life experiences in childhood in the ACE Study.
There is now ample evidence from the preclinical and clinical fields that early life trauma has both dramatic and long-lasting effects on neurobiological systems and functions that are involved in different forms of psychopathology as well as on health in general. To date, a comprehensive review of the recent research on the effects of early and later life trauma is lacking. This book fills an obvious gap in academic and clinical literature by providing reviews which summarize and synthesize these findings. Topics considered and discussed include the possible biological and neuropsychological effects of trauma at different epochs and their effect on health. This book will be essential reading for psychiatrists, clinical psychologists, mental health professionals, social workers, pediatricians and specialists in child development.